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NHS Barking and Dagenham Clinical Commissioning Group Governing Body
24 May 2018
1.00pm – 1.20pm
Boardrooms, Becketts House, Ilford, IG1 2QX
Item Time Lead Attached, verbal or to follow
1.0 1.1
Welcome, introductions and apologies Declaration of conflicts of interest
1.00 Chair Verbal Attached
2.0
2.1 2.2 2.3
CCG Annual Report and Annual Accounts 2017/18
CCG Annual Report CCG Annual Accounts External Auditor’s letter of representation
1.05 TT/MP Attached
3.0
External Auditor’s Report to those charged with Governance (ISA260)
1.15 TT/MP To be tabled
4.0 Close 1.20
Barking and Dagenham CCG Conflicts of interest register - Governing Body members and other decision makers
Conflics of interest will remain on the register for a minimum of 6 months following expiry
From To
Fina
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Non
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Prof
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In
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Non
-Fin
anci
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Pers
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Inte
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King Edwards Medical Group
X Direct GP partner and other GPs are family members
Jun-10 current No immediate action required. Declarations made at the beginning of meetings. Will not be involved in any decision making regarding the conflict.
King Edwards Medical Group
X Indirect Other GPs are family members
Jun-10 current No immediate action required. Declarations made at the beginning of meetings. Will not be involved in any decision making regarding the conflict.
Health 1000 X Direct Director. PMCF lead Dec-14 current No immediate action required. Declarations made at the beginning of meetings. Will not be involved in any decision making regarding the conflict.
Proactive Care, Healthy London Partnerships, NHS England
X Direct Clinical Lead Mar-17 current No immediate action required. Declarations made at the beginning of meetings. Will not be involved in any decision making regarding the conflict.
North East London Foundation trust
X Direct GPwSI - Cardiology service, Barking & Dagenham Community Cardiology Service
Aug-11 current No immediate action required. Declarations made at the beginning of meetings. Will not be involved in any decision making regarding the conflict.
Together First X Direct Shareholder May-14 current No immediate action required. Declarations made at the beginning of meetings. Will not be involved in any decision making regarding the conflict.
Harley Fitzrovia Health Ltd
X Direct Director and Shareholder Jan-18 current No immediate action required. Declarations made at the beginning of meetings. Will not be involved in any decision making regarding the conflict.
Action taken to mitigate risk
Is the interest direct or indirect?
Name
Current position (s) held- i.e. Governing
Body, Member practice, Employee or other
Declared Interest- (Name of the
organisation and nature of business)
Type of Interest
Nature of Interest
Date of Interest
Date - 11 May 2018
Dr Jagan John Governing Body Member - CCG Chair
From To
Fina
ncia
l Int
eres
ts
Non
-Fin
anci
al
Prof
essi
onal
In
tere
sts
Non
-Fin
anci
al
Pers
onal
Inte
rest
s
Action taken to mitigate risk
Is the interest direct or indirect?
Name
Current position (s) held- i.e. Governing
Body, Member practice, Employee or other
Declared Interest- (Name of the
organisation and nature of business)
Type of Interest
Nature of Interest
Date of Interest
Monifieth Limited X Direct Director and Shareholder Mar-18 current No immediate action required. Declarations made at the beginning of meetings. Will not be involved in any decision making regarding the conflict.
Historic - Barking, Dagenham and Havering LMC
X Direct Member Oct-13 Mar-18 Historic
Thames View Health Centre
X Direct GP principal Apr-17 current No immediate action required. Declarations made at the beginning of meetings. Will not be involved in any decision making regarding the conflict.
Primary Clinical Partnership Ltd
X Direct Director/Shareholder Apr-17 current No immediate action required. Declarations made at the beginning of meetings. Will not be involved in any decision making regarding the conflict.
Apex Healthcare Ltd (who own Knightswood Residential Care Home)
X Direct Director/Shareholder Apr-17 current No immediate action required. Declarations made at the beginning of meetings. Will not be involved in any decision making regarding the conflict.
Queen Mary Medical School-London
X Direct Honorary Lecturer Apr-17 current No immediate action required. Declarations made at the beginning of meetings. Will not be involved in any decision making regarding the conflict.
Together First X Direct Shareholder May-14 current No immediate action required. Declarations made at the beginning of meetings. Will not be involved in any decision making regarding the conflict.
BHR CCGs Area Prescribing Committee
X Direct Chair Mar-15 current No immediate action required. Declarations made at the beginning of meetings. Will not be involved in any decision making regarding the conflict.
Dr Gurkirit Kalkat Governing Body Member - Clinical Director
From To
Fina
ncia
l Int
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ts
Non
-Fin
anci
al
Prof
essi
onal
In
tere
sts
Non
-Fin
anci
al
Pers
onal
Inte
rest
s
Action taken to mitigate risk
Is the interest direct or indirect?
Name
Current position (s) held- i.e. Governing
Body, Member practice, Employee or other
Declared Interest- (Name of the
organisation and nature of business)
Type of Interest
Nature of Interest
Date of Interest
Ramneek Hara Governing Body Member - Clinical Director
Urswick Medical Centre
X Direct GP Principal Apr-17 current No immediate action required. Declarations made at the beginning of meetings. Will not be involved in any decision making regarding the conflict.
Together First Ltd X Direct Shareholder May-14 current No immediate action required. Declarations made at the beginning of meetings. Will not be involved in any decision making regarding the conflict.
London Deanery X Direct GP registrar and GP appraiser mainly in Havering
Apr-17 current No immediate action required. Declarations made at the beginning of meetings. Will not be involved in any decision making regarding the conflict.
Barts Hospital & Queen Mary's university
X Direct Under-graduate tutor Oct-16 current No immediate action required. Declarations made at the beginning of meetings. Will not be involved in any decision making regarding the conflict.
Medimmune (Astrazeneca)
X Indirect Spouse is medical director Apr-11 current No immediate action required. Declarations made at the beginning of meetings. Will not be involved in any decision making regarding the conflict.
Historic - Pharmaceutical companies
X Direct Speaker and chair at educational lectures and meetings
2016 Historic.
Anju Gupta Governing Body Member - Clinical Director
Abbey Medical Centre X Direct GP Principal. Apr-16 current No immediate action required. Declarations made at the beginning of meetings. Will not be involved in any decision making regarding the conflict.
BHR CCGs X Direct Diabetes lead Sep-15 current No immediate action required. Declarations made at the beginning of meetings. Will not be involved in any decision making regarding the conflict.
From To
Fina
ncia
l Int
eres
ts
Non
-Fin
anci
al
Prof
essi
onal
In
tere
sts
Non
-Fin
anci
al
Pers
onal
Inte
rest
s
Action taken to mitigate risk
Is the interest direct or indirect?
Name
Current position (s) held- i.e. Governing
Body, Member practice, Employee or other
Declared Interest- (Name of the
organisation and nature of business)
Type of Interest
Nature of Interest
Date of Interest
Together First Ltd X Direct Shareholder Apr-17 current No immediate action required. Declarations made at the beginning of meetings. Will not be involved in any decision making regarding the conflict.
NELFT X Direct GPwSI -Diabetes Mar-10 current No immediate action required. Declarations made at the beginning of meetings. Will not be involved in any decision making regarding the conflict.
NHSE X Direct GP Appriaser Sep-13 current No immediate action required. Declarations made at the beginning of meetings. Will not be involved in any decision making regarding the conflict.
London Deanery X Direct GP Trainer Nov-17 current No immediate action required. Declarations made at the beginning of meetings. Will not be involved in any decision making regarding the conflict.
Wilson Mason PLC(Architects)
X Indirect Spouse is a consultant 2015 current No immediate action required. Declarations made at the beginning of meetings. Will not be involved in any decision making regarding the conflict.
White House surgery, Barking
X
X
X
Direct
Indirect
Indirect
GP principal
Sister is a GP partner and GPwSI-dermatology
Brother is also a GP partner
Sep-06 current No immediate action required. Declarations made at the beginning of meetings. Will not be involved in any decision making regarding the conflict.
Castleton Road Health Centre, Redbridge
X Direct GP principal April 2018 current No immediate action required. Declarations made at the beginning of meetings. Will not be involved in any decision making regarding the conflict.
Kanika Rai Governing Body Member - Clinical Director
From To
Fina
ncia
l Int
eres
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Non
-Fin
anci
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Prof
essi
onal
In
tere
sts
Non
-Fin
anci
al
Pers
onal
Inte
rest
s
Action taken to mitigate risk
Is the interest direct or indirect?
Name
Current position (s) held- i.e. Governing
Body, Member practice, Employee or other
Declared Interest- (Name of the
organisation and nature of business)
Type of Interest
Nature of Interest
Date of Interest
B&D CCG X
X
Indirect
Indirect
Brother-in-law is a B&D Clinical director.
Husband is a B&D GP
April 2018 current No immediate action required. Declarations made at the beginning of meetings. Will not be involved in any decision making regarding the conflict.
Together First Ltd X Direct Shareholder. Brother is also a director
May-14 current No immediate action required. Declarations made at the beginning of meetings. Will not be involved in any decision making regarding the conflict.
MacMillan X Direct GP for Barking and Dagenham
Jun-15 current No immediate action required. Declarations made at the beginning of meetings. Will not be involved in any decision making regarding the conflict.
NEL Cancer X Direct Cancer Lead Dec-17 current No immediate action required. Declarations made at the beginning of meetings. Will not be involved in any decision making regarding the conflict.
London Deanery X Direct FY2 Superviser and GP trainer
2013 current No immediate action required. Declarations made at the beginning of meetings. Will not be involved in any decision making regarding the conflict.
Queen Mary University & Imperial College
X Direct Under-graduate tutor 2007 current No immediate action required. Declarations made at the beginning of meetings. Will not be involved in any decision making regarding the conflict.
Tulasi Medical Practice X Direct Salaried GP and medical director
Jul-13 current No immediate action required. Declarations made at the beginning of meetings. Will not be involved in any decision making regarding the conflict.
St Albans Surgery X Direct Salaried GP - one session May-17 current No immediate action required. Declarations made at the beginning of meetings. Will not be involved in any decision making regarding the conflict.
Dr Amit Sharma Governing Body Member-Clinical Director
From To
Fina
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Non
-Fin
anci
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Prof
essi
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In
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sts
Non
-Fin
anci
al
Pers
onal
Inte
rest
s
Action taken to mitigate risk
Is the interest direct or indirect?
Name
Current position (s) held- i.e. Governing
Body, Member practice, Employee or other
Declared Interest- (Name of the
organisation and nature of business)
Type of Interest
Nature of Interest
Date of Interest
B&D CCG X Direct Macmillan GP Apr-14 current No immediate action required. Declarations made at the beginning of meetings. Will not be involved in any decision making regarding the conflict.
X Indirect Sister-in-law is a B&D Clinical Director
Nov-11 current No immediate action required. Declarations made at the beginning of meetings. Will not be involved in any decision making regarding the conflict.
X Indirect Wife is a B&D GP Aug-13 current No immediate action required. Declarations made at the beginning of meetings. Will not be involved in any decision making regarding the conflict.
Barking, Dagenham & Havering LMC
X Direct Member Sep-14 current No immediate action required. Declarations made at the beginning of meetings. Will not be involved in any decision making regarding the conflict.
Care Quality Commission
X Direct GP specialist adviser Nov-14 current No immediate action required. Declarations made at the beginning of meetings. Will not be involved in any decision making regarding the conflict.
Veda Solutions X Direct Director Aug-13 current No immediate action required. Declarations made at the beginning of meetings. Will not be involved in any decision making regarding the conflict.
NEL Commissioning Support Unit
X Indirect Partner is employed substantively
2014 current No immediate action required. Declarations made at the beginning of meetings. Will not be involved in any decision making regarding the conflict.
NHSE X Indirect Partner on secondment to London Regional Director for primary care
Jan-18 current No immediate action required. Declarations made at the beginning of meetings. Will not be involved in any decision making regarding the conflict.
Jane Milligan Employee - Governing Body Executive Member - Accountable Officer, NEL CCGs
From To
Fina
ncia
l Int
eres
ts
Non
-Fin
anci
al
Prof
essi
onal
In
tere
sts
Non
-Fin
anci
al
Pers
onal
Inte
rest
s
Action taken to mitigate risk
Is the interest direct or indirect?
Name
Current position (s) held- i.e. Governing
Body, Member practice, Employee or other
Declared Interest- (Name of the
organisation and nature of business)
Type of Interest
Nature of Interest
Date of Interest
Action for stammering X Indirect partner is a Trustee Oct-13 current No immediate action required. Declarations made at the beginning of meetings. Will not be involved in any decision making regarding the conflict.
Family Mosaic Housing Association
X Direct Non-executive director May-14 current No immediate action required. Declarations made at the beginning of meetings. Will not be involved in any decision making regarding the conflict.
Stonewall X Direct Ambassador Oct-14 current No immediate action required. Declarations made at the beginning of meetings. Will not be involved in any decision making regarding the conflict.
Peabody Housing Association
X Direct Non-executive director Jan-17 current No immediate action required. Declarations made at the beginning of meetings. Will not be involved in any decision making regarding the conflict.
Chartered Physiotherapists
X Direct Member (non-practising) Sep-87 current No immediate action required. Declarations made at the beginning of meetings. Will not be involved in any decision making regarding the conflict.
Historic - University Schools Trust, East London
X Direct Trustee Dec-17 Historic.
Ceri Jacob Employee - Governing Body Member - Managing Director
Ruislip Primary School X Direct Chair of Governors Feb-18 Current No immediate action required. Declarations made at the beginning of meetings. Will not be involved in any decision making regarding the conflict.
Tom Travers Employee - Governing Body Excecutive Member - Chief Finance Officer
Royal Free Foundation Trust
X Indirect Wife employed in the Finance Department
Jul-14 current No immediate action required. Declarations made at the beginning of meetings. Will not be involved in any decision making regarding the conflict.
From To
Fina
ncia
l Int
eres
ts
Non
-Fin
anci
al
Prof
essi
onal
In
tere
sts
Non
-Fin
anci
al
Pers
onal
Inte
rest
s
Action taken to mitigate risk
Is the interest direct or indirect?
Name
Current position (s) held- i.e. Governing
Body, Member practice, Employee or other
Declared Interest- (Name of the
organisation and nature of business)
Type of Interest
Nature of Interest
Date of Interest
Steve Rubery Employee - Governing Body Executive Member - Director of Delivery & Performance
BHR CCGs X IndirectCo-habiting partner is Planned Care Programme Lead
Feb-18 current No immediate action required. Declarations made at the beginning of meetings. Will not be involved in any decision making regarding the conflict.
Jacqui Himbury Employee - Governing Body Executive Member - Nurse director
None
NHS Havering CCG X Direct Lay member, Governance and Audit Chair
2013 2019 No immediate action required. Declarations made at the beginning of meetings. Will not be involved in any decision making regarding the conflict.
NHS Redbridge CCG X Direct Lay member, Governance and Audit Chair
2013 2019 No immediate action required. Declarations made at the beginning of meetings. Will not be involved in any decision making regarding the conflict.
University of Essex X Direct Independent Audit Committee member
2013 2019 No immediate action required. Declarations made at the beginning of meetings. Will not be involved in any decision making regarding the conflict.
Southend-on-Sea Borough Council
X Direct Independent Audit Committee member
2016 2018 No immediate action required. Declarations made at the beginning of meetings. Will not be involved in any decision making regarding the conflict.
Brentwood Citizen's Advice Bureau
X Direct General Advisor 2009 current No immediate action required. Declarations made at the beginning of meetings. Will not be involved in any decision making regarding the conflict.
Essex Ministry of Justice Advisor Committee
X Direct Lay member, Governance and Audit Chair
2010 2018 No immediate action required. Declarations made at the beginning of meetings. Will not be involved in any decision making regarding the conflict.
Kash Pandya Governing Body Member - Lay member, Governance
From To
Fina
ncia
l Int
eres
ts
Non
-Fin
anci
al
Prof
essi
onal
In
tere
sts
Non
-Fin
anci
al
Pers
onal
Inte
rest
s
Action taken to mitigate risk
Is the interest direct or indirect?
Name
Current position (s) held- i.e. Governing
Body, Member practice, Employee or other
Declared Interest- (Name of the
organisation and nature of business)
Type of Interest
Nature of Interest
Date of Interest
PriceWaterhouseCooper
X Indirect Son is employeed as a management accountant
2013 current No immediate action required. Declarations made at the beginning of meetings. Will not be involved in any decision making regarding the conflict.
Accenture X Indirect Son is employeed as Legal Counsel
2015 current No immediate action required. Declarations made at the beginning of meetings. Will not be involved in any decision making regarding the conflict.
Historic - Her Majesty's Inspector of Constabulary
X Direct Associate Inspector 2011 Jan-18 Historic.
Newham Deanery CIO X Direct Trustee 01/06/2016 current No immediate action required. Declarations made at the beginning of meetings. Will not be involved in any decision making regarding the conflict.
Redbridge Healthwatch X Direct Member 01/04/2013 current No immediate action required. Declarations made at the beginning of meetings. Will not be involved in any decision making regarding the conflict.
London Borough of Redbridge
X Indirect Husband is a Councillor 01/05/2014 current No immediate action required. Declarations made at the beginning of meetings. Will not be involved in any decision making regarding the conflict.
Historic - Forum for Health & Wellbeing
X Direct Director (paid employee) 01/12/1994 01/04/2018 Historic.
BHR CCGs X Indirect Lay member PPI (Havering CCG) PPI is brother in law
01/10/2017 Current No immediate action required. Declarations made at the beginning of meetings. Will not be involved in any decision making regarding the conflict.
Arthur Rank Hospice Charity - Cambridge
X Direct Trustee 01/05/2017 current No immediate action required. Declarations made at the beginning of meetings. Will not be involved in any decision making regarding the conflict.
Governing Body member - Lay member, PPI
Sahdia Warraich
Dr Arnold Furtig Independent GP member of BHR CCGs Primary Care Commissioning Committee
From To
Fina
ncia
l Int
eres
ts
Non
-Fin
anci
al
Prof
essi
onal
In
tere
sts
Non
-Fin
anci
al
Pers
onal
Inte
rest
s
Action taken to mitigate risk
Is the interest direct or indirect?
Name
Current position (s) held- i.e. Governing
Body, Member practice, Employee or other
Declared Interest- (Name of the
organisation and nature of business)
Type of Interest
Nature of Interest
Date of Interest
PriceWaterhouseCooper
X Indirect Son is a partner (south Korea)
2015 current No immediate action required. Declarations made at the beginning of meetings. Will not be involved in any decision making regarding the conflict.
Mayor of London (Sadiq khan)
X Indirect Son is a speech writer 2016 current No immediate action required. Declarations made at the beginning of meetings. Will not be involved in any decision making regarding the conflict.
University Hospital, Birmingham
X Indirect Son is an employee in middle management
2015 current No immediate action required. Declarations made at the beginning of meetings. Will not be involved in any decision making regarding the conflict.
Charles Beaumont Independent Lay Member of BHR CCGs Audit & Governance Committee
None
Halbutt Street Surgery X Direct GP 2017 current No immediate action required. Declarations made at the beginning of meetings. Will not be involved in any decision making regarding the conflict.
PELC X Direct Council Member Dec-13 current No immediate action required. Declarations made at the beginning of meetings. Will not be involved in any decision making regarding the conflict.
Together First Ltd X Direct Board Member & shareholder
Apr-14 current No immediate action required. Declarations made at the beginning of meetings. Will not be involved in any decision making regarding the conflict.
Primary Care Clinical partnership Ltd
X Direct Shareholder 2017 current No immediate action required. Declarations made at the beginning of meetings. Will not be involved in any decision making regarding the conflict.
Dr Adedayo Adedeji GP member and member of BHR CCGs Primary Care Commissioning Committee
From To
Fina
ncia
l Int
eres
ts
Non
-Fin
anci
al
Prof
essi
onal
In
tere
sts
Non
-Fin
anci
al
Pers
onal
Inte
rest
s
Action taken to mitigate risk
Is the interest direct or indirect?
Name
Current position (s) held- i.e. Governing
Body, Member practice, Employee or other
Declared Interest- (Name of the
organisation and nature of business)
Type of Interest
Nature of Interest
Date of Interest
Jane Gateley Employee - Director, Strategy & Integration
PHP (Hurley Group) X Indirect Spouse is Prgramme Director
On-going on-going No immediate action required. Declarations made at the beginning of meetings. Will not be involved in any decision making regarding the conflict.
Greater London Authority (GLA)
X Indirect Husband is area regeneration manager for North East London
2017 on-going No immediate action required. Declarations made at the beginning of meetings. Will not be involved in any decision making regarding the conflict.
Lower Clapton GP practice
X Direct Registered as a patient where City & Hackney CCG Chair is based.
2008 current No immediate action required. Declarations made at the beginning of meetings. Will not be involved in any decision making regarding the conflict.
Vertergi Limited X Direct Holder of 100% of the company shares
Sep-14 current No immediate action required. Declarations made at the beginning of meetings. Will not be involved in any decision making regarding the conflict.
MCB Software X Direct Holder of 100% of the company shares
Jun-16 current No immediate action required. Declarations made at the beginning of meetings. Will not be involved in any decision making regarding the conflict.
Sarah See Employee - Primary Care Transformation Director
NELFT X Indirect Partner is an employee working within Redbridge CAMHS
Mar-14 on-going No immediate action required. Declarations made at the beginning of meetings. Will not be involved in any decision making regarding the conflict.
Care UK (surrey wide) X Direct Nurse Practitioner, Clinical Lead - bank work
2007 current No immediate action required. Declarations made at the beginning of meetings. Will not be involved in any decision making regarding the conflict.
Greenbrook Healthcare (Londond wide)
X Direct Nurse Practitioner, Clinical Lead - bank work
2016 current No immediate action required. Declarations made at the beginning of meetings. Will not be involved in any decision making regarding the conflict.
Robert Meaker Employee - Innovation & Information Technology Senior Responsible Officer
Lucy Botting Employee - Deputy Director, Primary Care Transformation
Marie Price Employee - Corporate Services Director
From To
Fina
ncia
l Int
eres
ts
Non
-Fin
anci
al
Prof
essi
onal
In
tere
sts
Non
-Fin
anci
al
Pers
onal
Inte
rest
s
Action taken to mitigate risk
Is the interest direct or indirect?
Name
Current position (s) held- i.e. Governing
Body, Member practice, Employee or other
Declared Interest- (Name of the
organisation and nature of business)
Type of Interest
Nature of Interest
Date of Interest
Mole Valley District Council
X Direct Local district councillor 2014 current No immediate action required. Declarations made at the beginning of meetings. Will not be involved in any decision making regarding the conflict.
Sharon Morrow Employee - Unplanned Care SRO
None
Alan Steward Employee- System OD and Transition SRO (currently on secondment)
Steward and Steward Ltd
X Direct Director. Partner is also a director.
2012 current No immediate action required. Declarations made at the beginning of meetings. Will not be involved in any decision making regarding the conflict.
Louise Mitchell Employee - Planned Care SRO
None
Mark Eaton Consultant - Director of Recovery
Amnis Ltd X Direct Shareholder. Apr-18 current Amnis Ltd will not provide any services within NEL.
Regina ShakespeareHistoric
Consultant - Interim Director, Delivey & Performance
Regina Shakespeare Consulting Limted
X Direct Managing Director Feb-17 01/12/2017 Historic
Conor Burke -Historic
Employee - Acting Managing Director
CPB Healthcare Consulting Ltd
X Direct Director & owner Jan-18 Mar-18 Historic.
Markyate Surgery X Direct GP Apr-17 Mar-18 Historic.Together First Ltd X Direct Shareholder May-15 Mar-18 Historic.London Wellbeing care Ltd
X Direct Director Apr-17 Mar-18 Historic.
Kensington & Chelsea CCG
X Direct GP Partner Apr-14 Mar-18 Historic.
Tulasi Medical Centre X Direct GP partner. Spouse is practice manager
19/09/2006 Mar-18 Historic.
Tulasi Properties Ltd X Direct Director/Shareholder 01/08/2016 Mar-18 Historic.
Health & Happiness Clinic Ltd
X Direct Director/Shareholder 01/08/2012 Mar-18 Historic.
Dr Ravali Goriparthi-Historic
Governing Body Member - Clinical Director
Dr Waseem Mohi -Historic
Governing Body Member - CCG Chair
From To
Fina
ncia
l Int
eres
ts
Non
-Fin
anci
al
Prof
essi
onal
In
tere
sts
Non
-Fin
anci
al
Pers
onal
Inte
rest
s
Action taken to mitigate risk
Is the interest direct or indirect?
Name
Current position (s) held- i.e. Governing
Body, Member practice, Employee or other
Declared Interest- (Name of the
organisation and nature of business)
Type of Interest
Nature of Interest
Date of Interest
Together First Ltd X Direct Shareholder 01/06/2017 Mar-18 Historic.
Barking, Dagenham and Havering LMC
X Direct Member 07/09/2009 Mar-18 Historic.
Royal College of GPs X Direct Member Apr-17 Mar-18 Historic.
To: Meeting of NHS Barking and Dagenham Clinical Commissioning Group Governing Body
From: Marie Price, Director of Corporate Services and Tom Travers, Chief Finance Officer
Date: 24 May 2018
Subject: CCG Annual Report and Annual Accounts 2017/18
Executive summary
As a statutory requirement, Clinical Commissioning Groups (CCGs) are required to publish, as a single
document, an Annual Report, Accountable Officer Statement and Annual Accounts. In completion of
these documents the CCG has followed national guidance. There is a common format for ease of
national collation.
The national timetable required submission of draft documents to NHS England (NHSE) and external
auditors by 24 April; this deadline was met. Having reviewed the documents the auditors and NHSE
provided feedback to the CCGs, which were reflected in the draft documents considered by the Audit
and Governance Committee on 22 May 2018. The Committee and officers reviewed the Annual Reports
and Annual Accounts in detail at the meeting and made some minor amendments and the following
comments:
The Committee had noted the Head of Internal Audit Opinion.
Noted an unqualified opinion on the accounts, with no unadjusted audit differences.
Noted the Value for Money opinion which outlines that the CCGs’ have adequate arrangements to secure economy, efficiency and effectiveness in its use of resources, except for in relation to the overspend against revenue resource limits.
Noted a qualified regularity opinion in relation to the overspend against resource limit.
Final documentation is required to be submitted no later than 29 May 2018 having been signed off by
the CCG Accountable Officer. CCGs are required to publish the documentation by 30 September. A
fully designed report and summary will be presented to the CCG’s annual general meeting during
September for wider member and public discussion.
Recommendations
The Audit and Governance Committee recommends that the Governing Body:
Adopts the Annual Accounts, Annual Reports and all supporting documentation
Agrees that the Accountable Officer sign the necessary documentation to complete the
submission to meet the national deadline of 29 May 2018.
1.0 Purpose of the report
1.1 To provide assurance to the Governing Body that the process to complete the annual accounts
and report has been carried out in line with national guidance, and the final products, which have
been reviewed by NHSE England, external auditors and the CCG’s Audit and Governance
Committee are suitable for sign-off and final submission.
2.0 Production process
2.1 Since the receipt of national guidance earlier in the year, production of the draft annual reports
and accounts has been underway.
2.2 The drafts were considered in detail by the Audit and Governance Committee on 23 April 2018,
where internal and external auditors participated in the discussion. Committee members provided
further feedback and the Chairs were provided with a copy of the reports for their consideration.
2.3 Since receiving the draft documentation in April, external auditors have undertaken detailed
scrutiny. They have provided feedback and raised questions that have been responded to.
2.4 NHS England also carried out a thorough review against set criteria and did not advise of any
adjustments required by the CCG.
2.5 The Audit and Governance Committee on 22 May considered the accounts and annual report in
detail and recommended that the Governing Body approve the accounts and report for final
submission by 29 May.
3.0 Resources/investment
3.1 The final section of the Annual Accounts clarifies the CCG’s financial position at 31 March 2018.
The Annual Accounts and Report will be available for public inspection and discussion at the
Annual General Meetings in September.
4.0 Equalities
4.1 An equalities report is included as part of the Annual Report.
5.0 Risk
5.1 The key risk to the CCG is that the Annual Report and Annual Accounts are not submitted to
meet national timelines. However all deadlines so far have been met and subject to agreement at
this meeting, the final deadline will also be met.
Attachments: 2017/18 Annual Report, Accountable Officer Statement and Annual Accounts.
Author: Marie Price, Director of Corporate Services and Rob Adcock, Deputy CFO. Date: 23 May 2018
Barking and Dagenham
Clinical Commissioning Group
Annual Report and Accounts 2017/18
Barking and Dagenham Clinical Commissioning Group
2
Abbreviations used in this report AGC Audit and Governance Committee
AGS Annual Governance Statement
BHR Barking and Dagenham, Havering and Redbridge
BHRUT Barking Havering and Redbridge University Hospitals NHS Trust
CCG Clinical Commissioning Group
CQRG Clinical Quality Review Group
CQRM Contract and Quality Review Meetings
EPPR emergency preparedness, resilience and response
F&D Finance and Delivery
FFT friends and family test
FRPB Financial Recovery Programme Board
GB Governing Body
HWB Health and Wellbeing Board
ICPB Integrated Care Partnership Board
JC Joint Committee
JCAF joint committee assurance framework
JCB Joint Commissioning Board
MRSA Methicillin-resistant Staphylococcus aureus (a type of bacteria that is widely
resistant to antibiotics)
MSA mixed-sex accommodation
NEL north east London
NELFT NELFT NHS Foundation Trust
NHSE NHS England
NHSI NHS Improvement
NICE National Institute for Health and Care Excellence
PEF Patient Engagement Forum
PPI patient and public involvement
QI quality improvement
QIPP quality, innovation, productivity and prevention (a large-scale transformation
programme which aims to deliver a better quality service for less money)
RTT referral to treatment time
SRO Senior Responsible Officer
UEC urgent and emergency care
Annual report and accounts: 2017/18
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Contents Section A. PERFORMANCE REPORT .................................................................... 4
A1. Performance overview ................................................................................................... 5
A1(1) Accountable Officer’s perspective on performance ............................................. 5
A1(2) The purpose, activities and objectives of the CCG .............................................. 8
A1(3) The key issues and risks of the CCG ................................................................ 15
A1(4) Going concern opinion ...................................................................................... 16
A1(5) Performance summary ...................................................................................... 16
A2. Performance analysis ................................................................................................... 19
A2(1) Financial performance....................................................................................... 19
A2(2) How the CCG measures and checks performance ............................................ 21
A2(3) Other performance matters ............................................................................... 28
Section B. ACCOUNTABILITY REPORT .............................................................. 37
B1. Corporate governance report ....................................................................................... 38
B1(1) Members’ report ................................................................................................ 38
B1(2) Statement of Accountable Officer’s Responsibilities .......................................... 41
B1(3) Governance Statement ..................................................................................... 42
B1(4) Head of Internal Audit Opinion .......................................................................... 70
B1(5) Review of the effectiveness of governance, risk management and
internal control .............................................................................................................. 73
B2. Remuneration and Staff Report .................................................................................... 74
B2(1) Remuneration report ......................................................................................... 74
B2(2) Staff report ........................................................................................................ 81
B3. Parliamentary Accountability and Audit Report ............................................................. 86
B3(1) Audit certificate and report ................................................................................ 87
Section C. ANNUAL ACCOUNTS ......................................................................... 91
Barking and Dagenham Clinical Commissioning Group
4
Section A. PERFORMANCE REPORT
Jane Milligan
Accountable Officer
24 May 2018
Annual report and accounts: 2017/18
5
A1. Performance overview
A1(1) Accountable Officer’s perspective on performance
Barking and Dagenham Clinical Commissioning Group (CCG) is responsible, along with other
health and social care professionals and patients, for spending most of the local NHS budget.
We commission most local health services, from cancer care to mental health, hospital
operations to prescriptions. We do this jointly with our neighbouring CCGs in Havering and
Redbridge, working together on strategic planning as well as commissioning, taking a joint
approach to issues like primary care commissioning and the development of the Barking and
Dagenham, Havering and Redbridge (BHR) integrated care system.
We also share a management structure and managing director across the three CCGs in BHR.
Conor Burke was the Accountable Officer for BHR CCGs to 30 November 2017 and then the
Acting Managing Director to 31 March 2018. Ceri Jacob was appointed as Managing Director
for the three CCGs from 1 April 2018.
Since September, the BHR CCGs have also been working at a strategic level with the other
four CCGs in north east London (NEL) as the NEL Commissioning Alliance to maximise health
outcomes for local people. There is now one accountable officer – Jane Milligan, from 1
December 2017 - for all seven CCGs in NEL.
This year saw the first achievement from these new arrangements, as the Alliance awarded
their first joint contract – a new integrated NHS 111 and clinical assessment service. This will
see our GPs, nurses, paramedics and pharmacists giving clinical and treatment advice over the
phone. They can also book appointments for people with the most appropriate NHS service
when they need them. The service aims to improve our urgent and emergency care (UEC)
services across NEL, providing a better service to local people when they need it most.
Working in partnership across BHR with local GPs, health and social care partners, with our
toughest ever financial challenge as background - and I say more about this below - we have
nonetheless continued to make progress this year. Our highlights include:
Contributing to BHR CCGs achieving £32.2m of savings this year.
Making sure that we make the best use of every public penny we spend. Two of our clinical
directors sat on the steering group developing proposals (including ideas for prescribing
savings) and agreeing final recommendations, as well as presenting them at a wide range
of public events.
Running two full public consultations to ask the public for their views on proposed changes
so that only those who benefit medically from certain treatments receive them. ‘Spending
NHS money wisely’ 1 and 2 received more than 1600 responses.
Successfully implementing a range of clinically-led funding changes as a result of ‘Spending
NHS money wisely’ decisions and supporting our GPs to explain the decisions and changes
to patients.
Implementing joint schemes in and outside of our local hospitals, which reduce the number
of people needing to go to hospital, improve patient flows, and help people to get home
quicker once they are well.
Successfully managing waiting times for elective care patients in our area. This continues to
be supported by our GPs redirecting patients to alternative community settings as
appropriate. Our joint referral to treatment (RTT) recovery programme – delivered with our
local hospitals trust, Barking Havering and Redbridge University Hospitals NHS Trust
(BHRUT), and a real testament to the success of partnership working – saw the Trust meet
Barking and Dagenham Clinical Commissioning Group
6
the national RTT standard in June 2017 (earlier than originally planned) although it has
marginally dipped again to just below the national standard.
Increasing investment in mental health services as part of our continuing commitment to
tackle mental ill-health and improve access to services.
Supporting GP practices to have a wider range of healthcare professionals seeing patients
– such as practice nurses and pharmacists – and reducing administration so GPs have
more time to see the patients who need to see them.
Providing urgent same day appointments seven days a week from our GP hubs which can
now view and update a patient’s medical history, making using an appointment at a hub as
seamless and consistent as visiting your own GP.
Rolling out GP online services which make it easier for people to book GP appointments
and order repeat prescriptions anywhere, anytime.
Identifying common themes from GP practice inspections and developing tailored training,
new processes, policies and templates for practices. Through this focused and dedicated
support we have supported practices to improve the care they provide patients.
Securing funding from NHS England (NHSE) to recruit GPs from overseas. The local
scheme will recruit around 35 GPs in BHR and a neighbouring borough where GP staffing
levels are below London and national averages. We hope the recruitment drive will help
improve patient access to primary care services in some of the most challenged parts of
NEL.
Health 1000, a unique GP practice covering four residential care homes across BHR
delivering targeted primary care to residents to help prevent acute admissions, was
featured in the Guardian following a Nuffield Trust report which found that emergency
admissions among the care homes’ residents were reduced by 36%.
Our GPs working with BHRUT to deliver dramatic improvements to cancer performance –
from just over 70% to 88.1% in a year (to November 2017), with all eight standards met.
Working in partnership with our providers to ensure patients continued to receive urgent
care and treatment and doing all we could together to reduce delays for patients during the
cyber-attack on the NHS in May 2017.
The Health Secretary writing to us in recognition of the improvements we made in the use
of diagnostic tests
After identifying diabetes as an area for improvement, more than doubling the uptake of all
National Institute for Health and Care Excellence (NICE) recommendations for diabetes
care.
Ensuring almost 90 per cent of people with type 2 diabetes and nearly 80 per cent of those
with type 1 diabetes received an annual foot check – both significantly above the England
average.
Establishing a register of pre-diabetic patients across our area and setting up successful
structured education programmes, so GPs can help people as early as possible and
prevent some of these complications developing – resulting in a 10 per cent increase in
newly diagnosed patients with type 2 diabetes attending the programmes.
These achievements came as BHR CCGs faced a challenging financial position throughout
2017/18, which is expected to continue into 2018/19. Other NHS organisations face similar
challenges, however in BHR some specific local factors contributed to our worsening financial
position, including:
RTT: we worked closely with our local hospital trust (BHRUT) to address their RTT
performance issues. This reduced the amount of time our patients were waiting for care but
came at a considerable financial cost to the CCGs
Annual report and accounts: 2017/18
7
Contract over-performance: our acute providers have treated more people than planned,
which has increased the amount we have paid them.
As a result, in 2017/18 we needed to deliver savings of £55m to break even, which is just over
5% of our total annual budgets for the three BHR CCGs. Given the scale of the challenge,
NHSE (our regulator) placed us under legal Directions in March 2017. This is a legally
enforceable mandate that compels CCGs not only to achieve financial balance, but also to
make a number of organisational changes to ensure we deliver.
In 2017/18 we took action in a number of areas to support our financial recovery, including:
Reviewing all our contracts to ensure they provide best clinical value for money
Reviewing our operating model, corporate processes and expenditure to ensure they are as
efficient as possible
Working with our continuing healthcare teams to ensure we are consistently and effectively
commissioning these services
Supporting our provider organisation to ensure they are as efficient as possible
Looking at the services we commission to ensure they are clinically effective procedures,
then consulting with our communities on proposed changes to ensure we only fund care
where it is clinically required
Implementing new ways to deliver care, including moving treatment outside of hospital,
where it is better for our patients and safe to do so
Ensuring our estates are fully and appropriately utilised.
Through the above interventions we have delivered £32.2m of savings. This is a significant
amount, but short of where we needed to be by the end of the year. We remain under the legal
Directions and will need to continue to make savings for the foreseeable future. For next year
(2018/19) the BHR CCGs will need to deliver at least £45m to achieve a break even financial
position. We are developing a savings programme to ensure we deliver these significant
changes and have so far identified £33m of opportunities.
We continue to operate in one of the most challenging health economies in England and face
many health and care challenges: a rapidly growing population, areas of high deprivation and
some of the youngest, oldest, most diverse and most transient populations in London. This all
has an impact on the health of local people and the health and care services they need.
The BHR CCGs, like BHRUT (our main acute hospitals trust) and Barts Health NHS Trust
(which provides services at Whipps Cross Hospital, used by many Redbridge residents), are
currently rated as ‘requires improvement’ by the CQC. BHRUT was placed in ‘financial special
measures’ in February 2018 due to challenges around their financial performance. Our local
councils also remain under significant financial pressure.
NELFT NHS Foundation Trust (NELFT) - the local foundation trust providing community and
mental health services - is now rated as ‘good’.
There is more detail on our performance last year later in this report. Our focus for next year
remains on key areas such as emergency access performance, cancer care, mental health,
primary care improvement and access, improving UEC and standards and the better
management of long term conditions.
We are continuing to work with our commissioning and provider partners in acute, community,
primary and social care - both in BHR as members of the Integrated Care Partnership Board
(ICPB) and in NEL through the Alliance and the East London Health and Care Partnership
(ELHCP) - to integrate care, improve health outcomes and address local health, quality and
efficiency challenges. We believe the only way to bring about real sustainable performance
Barking and Dagenham Clinical Commissioning Group
8
improvement is through working together, sharing resources where appropriate, with a common
vision.
A1(2) The purpose, activities and objectives of the CCG
Our history, background and structure
Barking and Dagenham CCG is made up of all the GP practices within the borough, who are
our members (see B1(1) - the Members’ report - for details of who they are). Our role is to
commission, or ‘buy’, safe, high quality health services – mainly hospital, community and
mental health services - for our local population and to work together with our partners to
improve the health of the people of Barking and Dagenham.
We work very closely with our colleagues in Havering and Redbridge CCGs as we share a
main acute hospital provider in BHRUT, and a mental health and community services provider
in NELFT. We also face many common issues and challenges which are outlined further in this
report.
Working together like this means we are also able to make better use of our resources across
the local health system, avoiding duplication and facilitating joint working with our health and
social care partners. It also means we are able to share a single management team, led by one
managing director (formerly the accountable officer, until the Alliance formation as described
below) across all three BHR CCGs.
During the year the seven CCGs in NEL (the three in BHR and also in City and Hackney,
Newham, Tower Hamlets and Waltham Forest) also came together under the leadership of a
single accountable officer. Each CCG retains its own governing body (GB) – and in BHR these
three generally meet together now as the Joint Committee (JC) - and the majority of decision-
making still takes place at a local level. However, the seven CCGs will work collaboratively as
the NEL Commissioning Alliance where it is in the best interests of patients to do so. It is
expected that the seven CCGs will work together to:
commission services jointly (such as the London Ambulance Service, integrated urgent
care and specialist commissioning)
align commissioning strategies (for example, for UEC, mental health, planned care)
provide assurance to our regulators.
A key part of the new alliance arrangements in 2017/18 was the development of the new NEL
Joint Commissioning Committee (JCC). This committee will consider items common to all
CCGs – for example, how the CCGs make sure that its urgent care works in a similar way or
their contracting with hospitals. For a limited number of areas, it will also take decisions on
services that are commissioned once for NEL. The JCC will start meeting formally, in public, in
May 2018. All CCGs and local authorities are represented on the committee.
Waltham Forest CCG chair Anwar Khan is chair of the Joint Commissioning Committee, while
Barking and Dagenham CCG vice chair, Kash Pandya, has been appointed as lay member and
vice chair of the JCC.
Our population
Since 2001, Barking and Dagenham has seen rapid population growth, linked to both to new
housing developments and increasing birth rates. The population structure has changed
significantly with particularly large increases in the numbers of younger people living in the
borough.
There has also been a rapid shift in the proportions of various ethnic groups, with a large
decrease in the white British ethnic group and a large increase in the black African ethnic
Annual report and accounts: 2017/18
9
group. Our population faces a range of major health challenges and health outcomes are poor
for many local people because of a combination of poverty, deprivation and lifestyle. We have
higher numbers of deaths from the major diseases (heart disease, stroke, cancer, diabetes and
chronic lung disease) compared with the London average. Our residents also experience more
ill health and disability during their lifetimes.
There is a strong correlation between poverty/deprivation and poor health, for many reasons
that include poor diet/nutrition and unhealthy living and working conditions. In general, those
who live in areas of high deprivation suffer the most from poor health and wellbeing.
Key population information is below, with information on the other BHR boroughs and London
and England for comparison purposes.
Barking
and
Dagenham
Havering Redbridge Greater
London England
Estimated population
(2017) 209,000 254,300 304,200 8,835,500 55,609,600
% of population aged 0-
15 (2015) 27.2% 19.3% 22.8% 13.9% 19%
% of population aged 65+
(2015) 9.7% 18.4% 12.2% 12.5% 17.7%
% of population from
BAME groups (2017) 49.5% 15.7% 62.7% 42.5% ---
Unemployment rate
(2015) 11% 5.3% 7.9% 6.1% 5.1%
Male life expectancy
(2012-14) 77.6 80.2 80.9 80.3 79.5
Female life expectancy
(2012-14) 82.1 83.9 84.6 84.2 83.2
Teenage conception, per
1,000 aged 15-17 (2014) 32.4 22.8 18.5 21.5 22.8
Childhood obesity
(2015-16) 28.5 21.8 23.3 23.2 19.8
Prevalence of diabetes,
age 17+ 7.3 5.9 7.9 6.0 6.2
Mortality from preventable
causes, per 100,000 218.5 162.5 141.2 171.8 183.9
A1: Key population information for BHR boroughs
In London, Barking and Dagenham has the:
Highest proportion of people aged 0-15
Highest rate of unemployment
Lowest male and female life expectancy
Second highest rate of teenage conception
Third highest rate of mortality from preventable causes.
Barking and Dagenham Council has developed a vision for the borough that seeks to maximise
the opportunities for growth and regeneration, linked to new housing developments and the
strategic location of the borough: “One borough; one community; London’s growth opportunity”.
The Joint Health and Wellbeing Strategy sets out how this will help make the borough a
healthier place and tackle the poor outcomes currently experienced.
Barking and Dagenham Clinical Commissioning Group
10
Our commissioning activity
We commission a range of services from a number of providers. Our main acute hospital
services provider is BHRUT, although we also commission some acute services from Barts
Health NHS Trust. Our community and mental health services provider is NELFT. We
commission primary care services from local GPs. The GP out-of-hours service is provided by
the Partnership of East London Cooperatives, a not-for-profit social enterprise. We commission
the local GP federation – Together First - to provide additional GP appointments in the
evenings and at weekends from conveniently-located 'hubs' in the borough.
Working as part of the East London Health and Care Partnership
Officially launched in July 2017, the ELHCP brings together the area’s eight councils and 12
NHS organisations - including the BHR CCGs - with a shared mission to protect vital services
and provide better treatment and care built around the needs of local people, safely and
conveniently, closer to home. The Partnership’s main priorities are:
to help local people live healthy and independent lives
to improve local health and care services and outcomes
to have the right staff in the right place with the right resources to meet the community’s
needs
to be a well-run, efficient and open partnership.
The Partnership is not seeking to take away local control of services. It recognises that while
east London as a whole faces some common problems – such as the high rate of preventable
illness and a shortage of clinicians and care staff – the make-up and characteristics of the area
vary considerably and services must continue to be tailored and managed accordingly at a local
level. This will ensure people get high quality standards of care designed around their particular
needs.
The Partnership will drive forward the things that can only be achieved by all of the councils
and NHS organisations across east London working together, including:
good quality urgent and emergency care for the area
the availability of specialist clinical treatments
a better use of buildings and facilities
the recruitment and retention of doctors, nurses and other health and care professionals
an increased use of digital technology to speed up the diagnosis and treatment of illness
ways of working that put a stop to duplication and unnecessary expense.
Significant improvements are already being made by joining services up and people are
starting to feel the benefit. East London now has some of the best care provision and facilities
in the country, and the involvement of councils is enabling services to be aligned with the
development of housing, employment and education, all of which can have a big influence on
people’s health and wellbeing. However, there is still much to do.
For more information visit www.eastlondonhcp.nhs.uk
Our corporate objectives and how we measure success
1. Financial recovery
Secure financial recovery, meeting our control target agreed with NHSE, so that we begin
2018/19 on a sound financial footing.
Annual report and accounts: 2017/18
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This will be achieved through:
Delivery of our system delivery plan and the initiatives within it, including making difficult
decisions
Identification of new savings and efficiency initiatives for this year and next
Adhering to strict financial discipline and sound financial governance
Implementation of all recommendations within the well-led review linked to our
Directions, including further integration of our governance across the CCGs.
Measuring our success:
Delivery of savings plan
A pipeline of clinically-led projects to deliver in-year and future savings
Revised and strengthened financial governance arrangements agreed by GBs and in
place
GBs and committees meeting together jointly to support collaboration and greater
efficiency.
What we have achieved by April 2018:
We have delivered £32.2m savings (91% of our active schemes)
We achieved our greatest level of QIPP (the quality, innovation, productivity and
prevention programme) delivery since inception and have received positive reviews of
our PMO process and progress to date, which continues our track record of QIPP
delivery (BHR CCGs have delivered £113m of QIPP over the last four years)
We have made difficult decisions about changes to service provision following extensive
clinician-led public consultations with high participation rates
We have strengthened our governance, with new processes in place, including in-depth
scrutiny by key teams and a dedicated financial recovery programme board (FRPB)
accounting directly to GBs
We have successfully implemented the majority of the recommendations in the well-led
review action plan and have reported on our progress to NHSE on a regular basis
We have further integrated our governance, with GBs now meeting jointly for the
majority of meetings and all committees (where appropriate) now joint and with revised
membership, reflecting a more collaborative approach across the three CCGs.
2. Development of our integrated care system
Development of our integrated care system (previously referred to as accountable care),
through a collaborative population-based solution to our system challenges of quality and
resources.
This will be achieved through:
Continued development of our joint commissioning approach with BHR local authorities,
with a fully functioning and active commissioning board
Further strengthening relationships with our main providers, acknowledging our
respective pressures and the incentives in the system that can currently mitigate against
a system rather than individual organisational approach
Playing an active part within the ELHCP, with functions released to the NEL level where
it makes sense from a quality and economic perspective to operate at that scale (e.g.
maternity)
Barking and Dagenham Clinical Commissioning Group
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Measuring our success:
Establishment of the Joint Commissioning Board (JCB)
JCB agreed priorities and strategy to deliver improved patient outcomes
JCB strategy implemented in line with integrated care system framework and contracts
with BHR Provider Alliance
Integrated care system strategy, framework and implementation plan agreed at
NEL/BHR level
BHR Provider Alliance in place
A new BHR/NEL operating model agreed and implemented.
What we have achieved by April 2018:
The JCB has been established, reporting to the ICPB
The JCB has agreed a set of priorities and a work programme for 2018/19
BHR Providers have come together as an informal alliance (again reporting to the ICPB)
to develop a new way of working that better serves local people
A single accountable officer for NEL and a managing director for BHR have been
appointed.
3. Ensuring that we deliver on the objectives within our CCG and system wide
transformation programmes
Ensuring that we deliver on the objectives within our CCG and system wide transformation
programmes to improve planned care, complex care, UEC services and mental health.
This will be achieved through:
Implementation of Improving Referrals Together (the BHRUT and CCGs’ referral
management programme), to cover a range of specialties in areas such as
gastroenterology
Continued focus on delivery of the national standards for A&E, meeting required
trajectories for improvement – supported by creation of a joint senior role with a
particular focus on the timely discharge of people from hospital
Improving care for patients with complex needs including pressure care, multiple long
term conditions and end of life support
Delivery of constitutional standards and QIPP requirements within each programme.
Measuring our success:
Planned care
Patients who need to be referred to hospital for specialist opinion as part of the planned
care programme will be seen by the right department at the right time.
Our GP referrals will help secondary care colleagues to make the best decisions on who
should see and assess their patient.
National cancer waiting time and treatment standards for our population will be
maintained
RTT national standards will be delivered and maintained by BHRUT
Health and care colleagues will work together to determine a joint strategy for the
commissioning of services for local children and young people.
Urgent and emergency care
Delivery of the four hour A&E standard, and standards for ambulance response times
The number of delayed transfers of care to be maintained within targets agreed with the
local Health and Wellbeing Board (HWB)
Annual report and accounts: 2017/18
13
Deliver a reduction in the proportion of ambulance 999 calls that result in avoidable
transportation to an A&E department.
Mental health
At least 67% of people over 65 years estimated to have dementia (based on
prevalence) receive a diagnosis
At least 15% of adults with common mental health problems will have timely access to
IAPT services and 50% of people entering service achieve recovery, 75% of adults
referred to IAPT will be treated within six weeks of referral and 95% will be treated
within 18 weeks of referral
At least 50% of people experiencing a first episode of psychosis will be treated with a
NICE-approved care package within 2 weeks of referral
At least 30% of children and young people aged 0-18 with a diagnosable mental health
condition receive treatment from a NHS-funded service
Commission community eating disorder teams so that 95% of children and young
people receive treatment within four weeks of referral for routine cases; and one week
for urgent cases
Transforming Care programme - reduce inpatient bed capacity by March 2019 to 10-15
in CCG-commissioned beds per million population, and 20-25 in NHSE-commissioned
beds per million population.
What we have achieved by April 2018:
Planned care
Recovery of the 62 day cancer standard at BHRUT for seven consecutive months and
meeting the standard at Barts Health for nine of the past 11 months
Established a system-owned model for improving referrals together as commissioners
and providers
Established a joint forum to work together across local authority and CCG boundaries to
develop a future joint commissioning strategy for children and young people.
Urgent and emergency care
Based on performance to date, it is expected that the standard for A&E 4 hour
performance will not be achieved by BHRUT in 2017/18. Year to date performance is
82.62% (February 2018) against a local standard of 92%
Whilst ambulance response times for less urgent calls (category 3 and 4) are being met,
response times for urgent and emergency calls (category 1 and 2) are not being
achieved
Ambulance referrals from healthcare professionals have reduced in all three boroughs
in 2017/18; referrals for care homes have fallen in B&D and Redbridge.
Mental health
More than two-thirds of people over 65 years in B&D and Redbridge estimated to have
dementia have received a diagnosis (with more work to be done in Havering)
We anticipate falling short of the IAPT access target and have actions in place to
improve performance; recovery rates are strong in Havering and more challenged in
B&D and Redbridge; waiting time standards are being met consistently
We are exceeding the target that at least 50% of people experiencing a first episode of
psychosis will be treated with a NICE-approved care package within two weeks of
referral
Havering is expecting to exceed the 30% target for children and young people’s access
to mental health services, with B&D forecast to achieve 27% and Redbridge 22%.
Investment has been made in the services to increase capacity in 2018/19
Barking and Dagenham Clinical Commissioning Group
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We have invested in community eating disorder services and are expecting that
standards will be achieved by April 2018
The Transforming Care Programme is on track to achieve the inpatient bed trajectory for
2018/19.
4. Continued implementation of our agreed Primary Care Transformation Strategy
Continued implementation of our agreed Primary Care Transformation Strategy,
recognising primary care as the foundation of our integrated care system.
This will be achieved through four key workstreams which underpin the delivery of the GP
Forward View, namely:
Provider Development: ongoing development of primary care networks and resilience of
individual GP practices, leading to a sustainable primary care model and improved CQC
ratings
Primary Care Workforce: developing new roles and implementing support packages to
address identified recruitment and retention issues
Quality Improvement (QI): developing skills and methods in QI, reducing variation
between GP practices and monitoring improvements in patient outcomes, through
investments in long-term conditions such as diabetes, latent TB and atrial fibrillation
Reviewing the clinical leadership arrangements to enable a better alignment of talent
and skills to deliver the required changes from a commissioner and provider
perspective.
Measuring our success:
An effective GP network and federation model, working to deliver better health
outcomes and safe, quality primary care at a practice-, network- and borough-level, as a
key partner in the emerging Provider Alliance
GP Practice teams enjoying their working day and their contribution to the local health
and care system
The number of GPs working across BHR stabilised and increasing
A supported practice nurse and practice manager workforce, with new roles working in
a primary care environment as part of new models of care
Improved health outcomes in relation to commissioned long term conditions local
incentive schemes and improved access supported through an embedded BHR-wide QI
programme, led by locally-trained primary care QI facilitators
Development of a new group of primary care leaders to support the ICP and take
forward the primary care transformation strategy.
What we have achieved by April 2018:
Borough-based GP networks and federations, with a joined-up, clear vision, operating
model and business planning, commissioned to deliver borough-level population-based
schemes
More robust data on primary care workforce numbers, and better satisfaction rates to
the primary care staff survey
Mobilisation of workforce initiatives such as International GP Recruitment Programme,
GP retention programme, Practice Nurse and Practice Manager development schemes
Mobilisation of second wave of the BHR QI programme, led by local QI facilitators,
maximised by improvements in data quality and utilisation of data, and incremental
improvements in achievement against the indicators incorporated within the NEL
primary care dashboard
Annual report and accounts: 2017/18
15
Thirteen participants from across BHR completed the RCGP-accredited, UCL
Partnership Clinical Leadership Programme and a second tranche mobilised with a
further 15 participants
Ongoing delivery of individual projects aligned to either ten high impact areas of GP
Forward View and BHR ICP.
5. High quality, compassionate and safe care
High quality, compassionate and safe care for all commissioned services - delivering better
outcomes.
This will be achieved through refreshing our Quality Strategy, confirming our quality
priorities for 2017/20:
Implementation of the system pressure care improvement plan
Comprehensive quality impact assessments on all proposals/business cases forming
part of the System Delivery Plan
Strengthening collaborative commissioning of care for people living in care homes
Addressing key quality concerns such as: reducing the number of people who die from
treatable conditions, and improved infection and prevention control
Implementation of the SEND recommendations for children and the ‘Wood Review’
requirements for safeguarding (working with local safeguarding children boards).
Measuring our success:
A 10% reduction in the number of patients admitted to BHRUT with community-acquired
pressure ulcers
All QIPP proposals or investment business cases will have a comprehensive quality
impact assessment
The mortality indicators for BHRUT will not increase any further and will decrease
There will be a decrease in the number of recorded MRSA (Methicillin-resistant
Staphylococcus aureus, a type of bacteria that is widely resistant to antibiotics) and C.
difficile infections across BHR
The Local Safeguarding Children Boards will be fully engaged with implementing the
Wood Review Recommendations and leading this process.
What we have achieved by April 2018:
The number of patients admitted to BHRUT from community settings with community-
acquired pressure ulcers has remained static
100% of QIPP proposals and business case have a completed Quality Impact
Assessment
The mortality indicators for BHRUT have decreased slightly (by less than 1%), however
this is a very positive position
A total of 2175 community-acquired pressure ulcers in 2016/17 and 2093 in 2017/18
year to date, which demonstrates a downward trend (compared to an upward curve in
2016/17).
A1(3) The key issues and risks of the CCG
The key issues and risks for the CCG are performance and quality at our local hospitals trusts
and the BHR CCGs’ financial recovery. The CCG monitors risks closely, as described within
the governance statement later in this report.
Barking and Dagenham Clinical Commissioning Group
16
We continue to work closely with the Trusts to support them to deliver performance and quality
improvements.
Our main risk, however, relates to our financial circumstances and ability to achieve financial
balance and meet agreed control totals. We have mitigating actions in place through our
financial recovery and system delivery framework/plan. We understand and are committed to
delivering our statutory obligations and ensuring safe and high quality services. All savings and
investment proposals are rigorously assured, including a quality impact assessment for all.
A1(4) Going concern opinion
As at 31 March 2018 the CCG had net liabilities of £28,427,000 (£22,562,000 as at 31 March
2017).
The ability of the CCG to continue as a going concern is dependent upon its ability to secure
future funding from NHSE.
The budget for 2018/19 has already been agreed with NHSE. On this basis, there is no reason
to believe that sufficient funding will not be made available to the CCG in the 12 months from
the date of approval of these Financial Statements.
As such the Financial Statements in Section C have been prepared on a going concern basis.
A1(5) Performance summary
CCGs are accountable for how they spend public money and achieve good value for money for
their patients. They have a wide range of statutory duties they are required to meet.
NHSE assesses CCGs against the national CCG Improvement and Assessment Framework.
CCGs measure and monitor performance against a range of national and local key
performance indicators (KPIs) that measure the quality of services offered to local people.
This section summarises key performance issues, with more detailed information later in this
report, particularly in the performance analysis section (A2).
Financial performance
In 2017/18 Barking and Dagenham CCG was given funding of £307,828m from NHSE. Within
this funding the CCG is allowed to spend £4.6m on the running costs of the organisation.
The majority of the CCG’s spend is used to purchase services from NHS Trusts and NHS
Foundation Trusts. In 2017/18 we spent £203.8m on this, which is 66% of our gross spend.
In 2017/18, spend related to delegated co-commissioning arrangements totalled £29.6m
(9.45% of gross spend).
The CCG delivered a deficit position of £5.7m in 2017/18. This was achieved after receiving
£0.523m of additional funding through a risk pool agreement with local commissioners. The
CCG has also remained within the running costs allocation.
The financial position continues to be very difficult and so in 2018/19 we have a very
challenging financial plan. The CCG is planning multiple saving schemes totalling £13.23m in
2018/19.
CCG Improvement and Assessment Framework
Through a number of measures, NHSE assessed the BHR CCGs’ performance in summer
2017 against the indicators in four domains: better health, better care, sustainability and
leadership.
Annual report and accounts: 2017/18
17
Our work in tackling RTT, helping BHRUT to exit special measures, improvements for those
accessing psychological therapy, good patient engagement and improvements in UEC were
some of the successes they listed. Our assessment letter also pointed out where we continue
be challenged in terms of CCG/system performance, not least our financial position.
All three CCGs in BHR were rated as 'requires improvement', an assessment in common with
that of our local providers BHRUT and Barts Health, but one we want to build on and improve.
Our leadership and approach to partnership working was also noted as a strength, and we
recognise this will be critical to creating the change that is needed locally.
Primary care performance
We work with primary care providers to improve quality and reduce unexpected variation
across local services. A key performance indicator of overall quality is the CQC ratings for each
practice.
There have been improvements in ratings across all three CCGs, with 101 of 123 practices in
BHR now rated ‘good’ (up by 16.3% to 82.1% from the previous year). Only one practice in
Barking and Dagenham (four in BHR) is rated ‘inadequate’, down from five (12 in BHR) at the
end of March 2017.
A key area of focus during 2017/18 has been to improve care provided within primary care for
patients with diabetes. The National Diabetes Audit measures what percentage of patients with
type 2 diabetes on a practice’s diabetic register have an annual diabetic care process check
(which includes a standard list of checks). A measure of our performance over the past year is
the improvement in the percentage of patients who have had these checks.
There has been a significant improvement across all three CCGs, bringing Havering and
Redbridge up by almost 20 percentage points each to just under the England average and
Barking and Dagenham by more than 30 percentage points to well over the England average.
KPI performance
We commission a range of services from a number of providers. Our main acute hospital
services provider is BHRUT, although we also commission some acute services from Barts
Health. Our community and mental health services provider is NELFT.
The performance analysis section below contains detailed information on the local trusts’
performance against the KPIs, which are also summarised here:
RTT
Patients have a right to start their non-emergency NHS consultant-led treatment within a
maximum of 18 weeks from referral, unless they choose to wait longer or it is clinically
appropriate that they wait longer. The national standard is that 92% of patients should start
their treatment within this time.
BHRUT’s recent data for February 2018 shows performance is 90.6% (below the national
standard of 92%). This data will be subject to validation prior to national reporting. The total
number of patients waiting more than18 weeks reduced to fewer than 4,500 at end of March
2018.
Barts Health is currently non-compliant with the national RTT waiting time standards at
specialty as well as Trust aggregate level. In light of large-scale data quality issues faced, the
Trust board took the decision to suspend the monthly mandatory reporting of RTT waiting times
data.
Barking and Dagenham Clinical Commissioning Group
18
Diagnostic waiting times
BHRUT has delivered the national standard for 99% of patients waiting no longer than six
weeks for diagnostic tests (between July 2017 and January 2018). Performance in February
was 99.32%.
Barts Health achieved the national standard in April 2017, then again in December 2017,
January and February 2018 (with 99.5% in February).
A&E total waiting times
The national standard relating to A&E is that 95% of people should be seen and treated or
discharged within four hours.
Neither BHRUT nor Barts Health have achieved the national standard during the year. CCGs
have agreed recovery action plans and performance improvement trajectories for both trusts.
Cancer waiting times
Cancer performance is one of the eight national priorities for delivery. There are eight national
cancer waiting times standards against which performance is monitored.
February 2018 data demonstrates BHRUT achieved all cancer standards. The Trust’s
performance against the 62 day urgent GP referral standard was 85.7% (against the standard
of 85%).
At Barts Health the cancer 2-week wait performance for February 2018 was 97.7% (against a
standard of 93%). This standard has been met every month so far in 2017/18. The Trust met
the 62 day urgent GP referral standard in nine out of the 11 months reported between April
2017 and February 2018.
Mixed-sex accommodation
The contractual monthly target is zero tolerance. BHRUT reported eleven mixed-sex
accommodation (MSA) breaches between April 2017and March 2018.
Friends and family test
The friends and family test (FFT) measures how likely a patient would be to recommend the
ward or department to their friends and family if they needed similar care or treatment.
BHRUT performance for A&E FFT showed steady improvement between Q1 and Q3. Currently
in Q4 there has been a decline in performance but it is still higher than April 2017.
The FFT performance for inpatients has been maintained consistently through 2017/18 at
above 92% of patients who would recommend the service.
Incidents of MRSA
The target set by NHSE for all trusts is zero tolerance of cases of MRSA. BHRUT breached the
target by three cases of MRSA as of February 2018 (two cases in June and one in July 2017).
Incidents of C. difficile
The BHRUT reported position year to date is 13 incidents of C. difficile as at February 2018.
The annual threshold is 30.
Incidents of venous thromboembolism
The validated performance is above 98% in each of the first three quarters (against a 95%
threshold)
Annual report and accounts: 2017/18
19
Mental health - Improving Access to Psychological Therapies (IAPT)
Access: The target is that 15% of those with a reported prevalence for depression should have
access to talking therapies. We translate this to a quarterly target of 3.75% per quarter.
Recovery: The target is for 50% of eligible people to enter recovery each quarter.
Cumulatively access performance at the end of Q3 2017/18 is 10.09% against a target of
11.25%. Access performance for Q1 is 3.48%, Q2 is 3.45% and Q3 is 3.16% against the 3.75%
target. We work closely with our providers to ensure that there are plans in place to deliver the
standard on an ongoing basis.
The IAPT recovery standard was not met in Q2 and Q3 of 2017/18. Performance forQ2 and Q3
was 44% and 42% respectively (against the 50% target).
Mental health - Early Intervention Psychosis
The standard is for 50% of people experiencing a first episode of psychosis to be treated with a
NICE-approved care package within two weeks of referral.
The standard has consistently been met since April 2016. Performance between November
2017 and February 2018 has been 100%.
The London Ambulance Service
The London Ambulance Service (LAS) is commissioned by Brent CCG on behalf of all London
CCGs. They monitor and manage performance on our behalf.
The LAS has consistently failed the Category A performance standard in 2017/18, which is that
75% of calls which are life-threatening should be responded to within eight minutes.
More detail is provided in the performance analysis section that follows.
A2. Performance analysis
A2(1) Financial performance
The financial statements contained with the report provide a summary of the CCG’s financial
position and performance for 2017/18. This section of the report talks about how we manage
our money and how our financial performance is measured.
We are accountable for how we spend public money and achieve good value for money for our
patients. This is the fifth year of the CCG, and good financial control and management is vital
for the development of the organisation.
Funding
In 2017/18 Barking and Dagenham CCG was given funding of £307,828m from NHSE. Within
this funding the CCG is allowed to spend £4.6m on the running costs of the organisation.
How we spent the money
The majority of the CCG’s spend is used to purchase services from NHS Trusts and NHS
Foundation Trusts. In 2017/18 we spent £203.8m (£200.5m in 2017/18) on this, which is 66%
(65% in 2016/17) of our gross spend.
In 2017/18, spend related to delegated co-commissioning arrangements totalled £29.6m
(£28.2m in 2016/17). This equates to 9.45% of gross spend (9.15% in 2016/17).
Barking and Dagenham Clinical Commissioning Group
20
In summary we spent the money as follows:
£000s
Services from other NHS trusts 133,395
Services from foundation trusts 70,366
Services from other CCGs and NHSE 2,975
Healthcare from non-NHS organisations 40,226
Prescribing 26,797
GP primary care services 29,873
Other costs 11,350
Total 314,982
A2: How we spent the money (table and pie chart)
How we did
The CCG faced a very challenging financial position throughout the year, so we continued to
develop a financial recovery plan to help meet some of these financial pressures. Because of
the challenging financial position, the CCG continued in legal directions in relation to its
finances.
The CCG delivered a deficit position of £5.7m in 2017/18. This was achieved after receiving
£0.523m of additional funding through a risk pool agreement with local commissioners. The
CCG has also remained within the running costs allocation.
Financial pressures
The CCG has faced a range of financial pressures across the year including: investing in
increased levels of activity with our local NHS Trust and other providers to assist in meeting a
range of targets, including the 18 week RTT target; and slippage on savings programmes. In
addition the CCG has continued to invest in mental health services and the continued
improvement to access and services in primary care.
42%
22%
1%
13%
9%
9%4%
Services from other NHS trusts
Services from foundation trusts
Services from other CCGs and NHSE
Healthcare from non-NHS organisations
Prescribing
GP primary care services
Other costs
Annual report and accounts: 2017/18
21
Future years
The financial position continues to be very difficult and so in 2018/19 we have a very
challenging financial plan. The CCG is planning multiple saving schemes totalling £13.23m in
2018/19.
A2(2) How the CCG measures and checks performance
The performance management framework
The CCG measures and monitors performance against a range of national and local key
performance indicators (KPIs) that measure the quality of services offered to local people.
The CCG reports on performance against the KPIs to the JC through regular performance
reports to provide assurance of good performance and, where required, of actions being taken
to address areas where the required standards are not being achieved. Where risk to the
delivery of high quality services is assessed to be high, these risks are included on the CCG
assurance framework. The reports received by the JC include the quality report, the finance
and activity report and the contract report.
Each provider of healthcare commissioned by the CCG operates under a contract agreement
which includes details of the KPIs and quality standards to be delivered. These agreements
are linked to the objectives of the CCG set out each year in its operating plan and include the
national and local priorities and KPIs.
Each contract is managed through monthly or quarterly strategic performance reviews which
receive information on the performance of the provider on the delivery of the KPIs. A provider
performance management framework, illustrated below, sets out the route of escalation and
action to be taken to address non-achievement of performance standards.
A3: Provider performance management framework
The KPIs are drawn from a range of frameworks including those contained within the CCG
Improvement and Assurance Framework.
CCG Improvement and Assessment Framework
In March 2016, NHSE published a new framework outlining how they will assess CCGs. The
new Improvement and Assessment Framework for CCGs replaced both the previous
assurance framework and the separate performance dashboard. In the Government’s Mandate
Barking and Dagenham Clinical Commissioning Group
22
to NHSE, the framework takes an enhanced and more central place in the overall
arrangements for public accountability of the NHS.
The Improvement and Assessment Framework was reviewed and revised in 2017/18 (albeit
remaining broadly similar to the previous year) enabling improvement in key areas to be
tracked over time. Updates have been made to reflect priorities identified in Next Steps on the
Five Year Forward View. There is a smaller number of indicators in the framework (51 in total),
reducing the burden of assessment.
The framework covers indicators located in four domains:
Better health: this section looks at how the CCG is contributing towards improving the
health and wellbeing of its population, and bending the demand curve
Better care: this principally focuses on care redesign, performance of constitutional
standards, and outcomes, including in important clinical areas
Sustainability: this section looks at how the CCG is remaining in financial balance, and is
securing good value for patients and the public from the money it spends
Leadership: this domain assesses the quality of the CCG’s leadership, the quality of its
plans, how the CCG works with its partners, and the governance arrangements that the
CCG has in place to ensure it acts with probity, for example in managing conflicts of
interest.
The Forward View and the planning guidance set out national ambitions for transformation in a
number of vital clinical priorities such as mental health, dementia, learning disabilities, cancer,
maternity and diabetes. NHSE will rate these clinical areas on a four point ‘Ofsted-style’ scale.
They form part of the ‘Better Health’ and ‘Better Care’ element as illustrated below.
A4: CCG improvement and assessment framework
NHSE assessed the BHR CCGs’ performance in summer 2017 against these domains through
a number of measures.
Our work in tackling RTT, helping BHRUT to exit special measures, improvements for those
accessing psychological therapy, good patient engagement and improvements in UEC were
some of the successes listed. Our assessment letter also pointed out where we continue be
challenged in terms of CCG/system performance, not least our financial position.
Annual report and accounts: 2017/18
23
All three CCGs in BHR were rated as 'requires improvement', an assessment in common with
that of our local providers BHRUT and Barts Health, but one we want to build on and improve.
Our leadership and approach to partnership working was also noted as a strength, and we
recognise this will be critical to creating the change that is needed locally.
Primary care performance
We work with primary care providers to improve quality and reduce unexpected variation
across local services. A key performance indicator of overall quality is the CQC ratings for each
practice. Information on the current rating of all practices across BHR is in the first table below,
with the position from the previous year in the following table.
There have been improvements in ratings across all three CCGs, with 101 of 123 practices in
BHR now rated ‘good’ (up by 16.3% to 82.1% from the previous year). Only one practice in
Barking and Dagenham (four in BHR) is rated ‘inadequate’, down from five (12 in BHR) at the
end of March 2017.
As at March 2018
Total practices (% with
published reports)
Number (%)
Inadequate Requires
improvement Good
Barking and Dagenham
36 1 (2.7%) 6 (16.6%) 29 (80.5%)
Havering 44 3 (6.8%) 6 (13.6%) 35 (79.5%)
Redbridge 43 0 (0%) 6 (13.9%) 37 (86%)
Total 123 4 (3.3%) 18 (14.6%) 101 (82.1%)
A5: CQC ratings of primary care practices, March 2018
As at March 2017
Total practices (% with
published reports)
Number (% of total practices)
Inadequate Requires
improvement Good
Barking and Dagenham
36 (97%) 5 (13.8%) 7 (19.4%) 24 (66.6%)
Havering 45 (97%) 4 (8.8%) 11 (24.4%) 30 (66.6%)
Redbridge 45 (100%) 3 (6.6%) 13 (28.8%) 29 (64.4%)
Total 126 (98.4%) 12 (9.5%) 31 (24.6%) 83 (65.8%)
A6: CQC ratings of primary care practices, March 2018
A key area of focus during 2017/18 has been to improve care provided within primary care for
patients with diabetes. The National Diabetes Audit measures what percentage of patients with
type 2 diabetes on a practice’s diabetic register have an annual diabetic care process check
(which includes a standard list of checks). A measure of our performance over the past year is
the improvement in the percentage of patients who have had these checks.
Barking and Dagenham Clinical Commissioning Group
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Barking and Dagenham
Havering Redbridge England
Baseline
(NDA 2015/16) 28% 26% 25% 47.6%
Performance at 31 March 2018
60.13% 44.9% 44.78% Not yet available
Change Up 32.13% Up 18.9% Up 19.78% --
A7: Performance on the annual diabetic care process check
There has been a significant improvement across all three CCGs, bringing Havering and
Redbridge up by almost 20 percentage points each to just under the England average and
Barking and Dagenham by more than 30 percentage points to well over the England average.
Trust performance against the KPIs
We commission a range of services from a number of providers. Our main acute hospital
services provider is BHRUT, although we also commission some acute services from Barts
Health. Our community and mental health services provider is NELFT.
Through the lead commissioning arrangements in place with our neighbouring CCG in Newham
we work closely with Barts Health as a significant provider of services for around a third of the
population in Redbridge (and much smaller numbers in Barking and Dagenham and Havering).
We have reported below on all standards relating to BHRUT and NELFT. As we are not the
lead commissioner, we have only reported on Barts Health performance against standards
relating to RTT to treatment, A&E and cancer waiting times.
RTT
Patients have a right to start their non-emergency NHS consultant-led treatment within a
maximum of 18 weeks from referral, unless they choose to wait longer or it is clinically
appropriate that they wait longer. The national standard is that 92% of patients should start
their treatment within this time.
BHRUT
Due to the high number of unacceptably long waits for some patients at our local hospitals, last
year BHR CCGs and the main local acute trust BHRUT implemented a joint RTT and
Improvement Programme in 2016/17 with the support and oversight of NHSE and NHS
Improvement (NHSI).
The additional services for redirects - put in place to provide capacity for BHRUT to address the
backlog - ceased as planned but GPs continue to make full use of the embedded pathways to
ensure a sustainable position moving forwards.
Recent data for February 2018 shows performance is 90.6% (below the national standard of
92%). This data will be subject to validation prior to national reporting.
The total number of patients waiting more than18 weeks reduced to fewer than 4,500 at end of
March 2018 as the RTT Programme continued to treat patients with long waits.
A joint RTT Recovery Board Programme is in operation across the BHR health economy. This
meets fortnightly to review progress and manage risk and is supported by the PMO which
reviews and manages the implementation of the agreed programme work streams.
Annual report and accounts: 2017/18
25
The CCG continues to support the RTT Recovery Programme through implementation of
demand management schemes – diverting patients to alternative appropriate providers in the
community and independent sector at the start of the patient pathway and introducing new
clinically appropriate pathways for patient care outside of the acute sector.
Barts Health
Barts Health is currently non-compliant with the national RTT waiting time standards at
specialty as well as Trust aggregate level. In light of large-scale data quality issues faced, the
Trust board took the d45ecision to suspend the monthly mandatory reporting of RTT waiting
times data.45
As agreed with NHSE and NHSI, the Trust is working to the timeline of April 2018 for the
resumption of national RTT reporting (of February 2018 data). The 18-week RTT incomplete
trajectory for 2018/19 takes the Trust to 88.5% achievement against the 92% standard in March
2019. This aligns with the requirement for the Trust to reach compliance by September 2019.
Barts Health is about to start a validation exercise in relation to a significant number of
pathways currently on the planned waiting list and so tripartite agreement (i.e. the Trust,
commissioners and NHSE/NHSI) has been reached for the RTT trajectories to be reviewed in
July 2018
Diagnostic waiting times
BHRUT
The Trust has delivered the national standard for 99% of patients waiting no longer than six
weeks for diagnostic tests (between July 2017 and January 2018). Performance in February
was 99.32%.
Barts Health
The national standard was achieved in April 2017 followed by seven months of non-compliance
at the Trust. Improvements in performance were seen in December 2017, January and
February 2018 with performances of 99.21% and 99.51% and 99.5% respectively. This
represents achievement of the standard for the third successive month.
A&E total waiting times
The national standard relating to A&E is that 95% of people should be seen and treated or
discharged within four hours.
Neither BHRUT nor Barts Health have achieved the national standard during the year. CCGs
have agreed recovery action plans and performance improvement trajectories for both trusts.
BHRUT
BHRUT has not achieved the standard since August 2015.
BHRUT reported validated performance of 73.85% for March 2018. This does not achieve the
improvement trajectory of 95.0%.
Overall attendances at BHRUT during 2017/18 (289,138) were 2.75% higher than 2016/17
(281,179) attendances. 3.81% fewer patients were seen within four hours in 2017/18 than in
the same period in 2016/17.
The work streams of the Patient Flow Programme that support the improvement trajectory
include: enhanced UCC (urgent care centre) and redirection; streamlining complex discharges
and discharge to assess; and early discharge planning and seven day services.
Barking and Dagenham Clinical Commissioning Group
26
BHRUT’s A&E performance is monitored through individual performance meetings and via the
A&E delivery board. Twice daily calls continue with system partners.
Barts Health
Barts Health failed to achieve the A&E standard in March 2018 with a performance of 85.41%.
There has been a 2.59% growth in attendances at Barts Health between 2016/17 (475,159)
and 2017/18 (487,794). There was a marginal improvement in terms of 0.41% more patients
seen within the four hours, when comparing 2017/18 to 2016/17.
CCGs have signed off the final Barts Health A&E activity and performance trajectory for
2017/19. The Trust is expected to achieve 90% by September 2018 and national compliance
against the 95% A&E Target by March 2019 and sustain compliance thereafter. Barts Health
A&E performance is monitored through individual performance meetings and via the A&E
delivery board.
Actions to improve performance at Barts Health also continue in line with the sustainability and
patient flow improvement plan. These include: strengthening front door streaming, senior
support in ED into the evening, fast tracking of frail elderly patients, increasing senior
availability and response to ED from other clinical specialties, short term use of higher cost
agencies, adverts out for substantive medical and nursing posts and working with UCC provider
to increase attendance volumes and reduce type III breaches.
Cancer waiting times
Cancer performance is one of the eight national priorities for delivery. There are eight national
cancer waiting times standards against which performance is monitored.
Two weeks from urgent GP referral for suspected cancer to first appointment (93%)
Two weeks from referral for breast symptoms (whether cancer is suspected or not) to first
appointment (93%)
62 days from urgent GP referral for suspected cancer to first treatment (85%)
62 days from urgent referral from NHS Cancer Screening Programmes to first treatment
(90%)
62 days from a consultant's decision to upgrade the urgency of a patient to first treatment
(no operational standard set)
31 days from diagnosis (decision to treat) to first treatment for all cancers (96%)
31 days from decision to treat/earliest clinically appropriate date to second/subsequent
treatment (surgery or radiotherapy) (94%)
31 days from decision to treat/earliest clinically appropriate date to second/subsequent
treatment (drug therapy) (96%)
A new addendum to the Cancer Waits Guidance was issued in April 2018. This provides
additional information on inter-provider transfers and the Faster Diagnosis Standard, but the
existing guidance (version 9) still holds. The National Cancer Programme will be undertaking a
full rewrite of the guidance later this year.
BHRUT
February 2018 data demonstrates the Trust achieved all cancer standards. The Trust’s
performance against the 62 day urgent GP referral standard was 85.7% (against the standard
of 85%), which means that the recovery trajectory for February (85%) was also achieved.
In support of the recovery trajectory for the 62 day standard, the Cancer Recovery Programme
monitors additional local measures to ensure patients are progressing appropriately along the
Annual report and accounts: 2017/18
27
pathway from referral to diagnosis and treatment. These measures include the number of
patients who have waited more than 62 days for a decision to treatment, the number of
treatments undertaken, and median waits for first appointment. An increased target number of
treatments per week has been agreed with the Trust to support the treatment of these patients
and achievement of the 62 day standard in March 2018.
The Cancer Performance Recovery Programme Board, consisting of the Trust and
commissioners, has been established with agreed terms of reference. It meets fortnightly, with
assurance via monthly meetings to NHSE and NHSI. Focus continues on the improvements to
the 38 day inter-trust transfers, reduction of median waits to day 7 and improvements to the
Urology and Lower GI Pathways.
Barts Health
At Barts Health the cancer 2-week wait performance for February 2018 was 97.7% (against a
standard of 93%). This standard has been met every month so far in 2017/18.
The 62 day urgent referral performance for February 2018 was 86.3% compared to the
standard of 85%. This standard has been met in nine out of the 11 months reported between
April 2017 and February 2018.
Mixed-sex accommodation
The contractual monthly target is zero tolerance. BHRUT reported eleven MSA breaches
between April 2017and March 2018, which is higher than the total number of MSA breaches in
2016-17 (seven).
Friends and family test
The FFT measures how likely a patient would be to recommend the ward or department to their
friends and family if they needed similar care or treatment.
BHRUT performance for A&E FFT showed steady improvement between Q1 and Q3. Currently
in Q4 there has been a decline in performance but it is still higher than April 2017.
The FFT performance for inpatients has been maintained consistently through 2017/18 at
above 92% of patients who would recommend the service.
Incidents of MRSA
The target set by NHSE for all trusts is zero tolerance of cases of MRSA. BHRUT breached the
target by three cases of MRSA as of February 2018 (two cases in June and one in July 2017).
All MRSA bacteraemia infections are subject to root cause analysis investigations to identify
lapses of care, and these cases are reviewed at the monthly Joint Infection Prevention
Committee (IPC) meeting and at the Clinical Quality Review Group meeting (CQRG).
Incidents of C. difficile
The BHRUT reported position year to date is 13 incidents of C. difficile as at February 2018.
The annual threshold is 30. All C. difficile infections are subject to root cause analysis
investigations to identify lapses of care and these cases are reviewed at the monthly Joint IPC
meeting and at the CQRG meeting.
Incidents of venous thromboembolism
The validated Q1, Q2 and Q3 performances in 2017/18 are 98.83%, 98.19% and 98.18%
respectively, against a 95% threshold. Performance is discussed at Contract and Quality
Review Meetings (CQRM) and is escalated to service performance review meetings.
Barking and Dagenham Clinical Commissioning Group
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Mental health - Improving Access to Psychological Therapies (IAPT)
The annual target is that 15% of those with a reported prevalence for depression should have
access to talking therapies. Performance against the quarterly access rate standard target of
3.75% was 3.48%, 3.45% and 3.16% in the first three quarters of 2017/18.
The IAPT recovery standard was not met in Q2 and Q3 of 2017/18. Performance for Q2 and
Q3 was 44% and 42% respectively against the target of 50% of eligible people to enter
recovery each quarter.
Mental health - Early Intervention Psychosis
The standard is for 50% of people experiencing a first episode of psychosis to be treated with a
NICE-approved care package within two weeks of referral. The standard has consistently been
met since April 2016. Performance between November 2017 and February 2018 has been
100%.
The London Ambulance Service
The London Ambulance Service (LAS) is commissioned by Brent CCG on behalf of all London
CCGs. They monitor and manage performance on our behalf.
The LAS has consistently failed the Category A performance standard in 2017/18. The national
standard is that 75% of calls which are life-threatening (Cat A) should be responded to within
eight minutes. Their performance was predominantly static throughout the year and
consistently below their recovery trajectory. Cat C performance – for more routine calls - was
also below the improvement trajectory that was built into the 2017/18 contract quality schedule.
The lead commissioner of LAS has requested that the collaborative approve additional funding
to help with demand management initiatives and activity above plan in year. An ELHCP-level
demand management approach has been adopted and commissioners are working with the
provider to progress this.
A2(3) Other performance matters
Sustainable development
The CCG is required to report its progress in delivering against sustainable development
indicators. We are committed to promoting environmental and social sustainability through our
actions as a corporate body as well as a commissioner. Our procurement strategy requires us
to consider our providers approaches to sustainability and carbon management.
As part of our responsibility to the Social Value Act, we will consider local providers of our
services and suppliers of goods, and associated benefits for low emissions, local job creation,
local business prosperity, retention of CCG spending within the borough/BHR economy, and
the wider local social and economic benefits.
We have focused this year on our estates and facilities functions. We reduced our office
space significantly and reconfigured the layout to better utilise the remaining office space.
This will reduce lease and utilities costs as well as helping to improve our carbon footprint.
We put in place a car parking policy to discourage the numbers of staff who drive to work and
to encourage alternative transport options. This included reducing the number of car parking
spaces available and introducing a payment scheme.
We have promoted national campaigns such as NHS Sustainability Day and pledged to reduce
the amount of printing we do across the organisations. We have installed a new system on our
machines which requires the individual to enter a code to the printer before their printing is only
Annual report and accounts: 2017/18
29
released. This has reduced unnecessary printing and saved on paper usage and printing
costs.
As part of our approach to waste minimisation and management we have systems in place in
our offices for the recycling of paper, plastic and glass. We continue to use ‘Boardpad’, a
software application that enables GB members to receive all agendas and papers electronically,
reducing the requirement to produce paper copies.
When new staff members join the CCG, the issue of sustainability across all areas of the CCG is
highlighted as part of their induction. Sustainable development is also referenced in staff job
descriptions.
As part of commitment to social sustainability a number of our staff spent a few hours volunteering
at a local food bank warehouse. Tasks included helping to organise and sort food donated by
local residents and allowed staff the opportunity to learn how the service provides vital support to
local families in need.
All GB reports must include a reference to sustainable development to ensure that any decisions
made take this into account.
We continue to work closely with local partners to align commissioning across health and social
care to provide integrated local, sustainable services. We are part of the NEL Commissioning
Alliance, working collaboratively with six other CCGs to commission services and we work with
providers and council colleagues as part of the ELHCP.
Our primary care strategy includes a sustainable development section and we aim to increase
sustainability awareness and initiatives at practice level.
We are also required to report on sustainability in a standard format, developed by the NHS
Sustainability Development Unit. This requires input from the building landlord. We publish this
report annually on our website when the data collection is complete.
Emergency preparedness, resilience and response
Under the Civil Contingencies Act (2004) NHS organisations must show that they can deal with
such incidents while maintaining services to patients. This work is referred to as ‘emergency
preparedness, resilience and response’ (EPRR).
CCGs have to meet a number of EPRR core standards and NHSE is responsible for ensuring
that the CCG meets these via an annual assurance process, where a rating of compliance is
issued. Following the 2017/18 process the CCG has been issued with a compliance rating of
‘substantial’.
Improving quality
Barking and Dagenham, Havering and Redbridge CCGs have their own commissioning
strategies and priorities that they have agreed with their HWBs but there are five shared
common goals.
1. Commissioning safe, sustainable, high quality services for the local population, improving
the quality and ensuring the safety of acute hospital, primary care, community, mental
health and specialist services
2. Integrate care to provide individuals with a better experience, improved outcomes and
productivity.
3. Increasing productivity – good quality services are also productive services; productivity
measures can improve outcomes and patient experiences.
4. Redesign UEC services, so that patients and the public have access to convenient, high
quality, timely and cost effective UEC services and know how they can be accessed.
Barking and Dagenham Clinical Commissioning Group
30
5. Staying healthy - taking action to reduce the need for healthcare and to optimise the health
of the local population.
It can be seen that quality – whether it is about patient experience, safety or clinical
effectiveness - is central to all that we do as commissioners and our aim is to keep quality at
the heart of all we do and is an integral part of our commissioning cycle, supported by patient
and public involvement (PPI) at every stage.
Our approach to quality is embedded in our whole approach to commissioning and is based on
the following commitments:
We do and will keep quality at the heart of all we do and will continue to work with our
stakeholders to implement the recommendations from the Francis and Berwick reports.
We will continue to work with Healthwatch and with voluntary and community organisations
as well as member practice patient participation groups and our patient engagement forums
to listen to and gather patient and public views.
We will encourage patients to provide feedback on their experiences which will be used to
both provide early warnings of deteriorations in care and evidence of good practice that
should be adopted and shared. We will strength our use of sharing patient and care stories.
We will pursue co-operative relationships between clinicians in primary, acute, mental
health and community services in the way services are designed, delivered and improved.
We will use commissioning levers and contract processes to secure the best possible care
and to ensure that the healthcare providers from whom we commission services have a
culture of continuing improvement and have the capacity and capability to meet all national
and local quality standards.
We will encourage providers to both innovate and spread examples of proven innovation in
order to address the current and future challenges of our growing and changing
populations.
We will collaborate with local authorities to improve the quality, effectiveness and efficiency
of care for local people so that they can experience integrated care that is joined up and
tailored to their specific needs and preferences.
We will collaborate with other NHS commissioners and providers to improve the quality of
care that would be best addressed across a larger geographical area than covered by the
CCG.
We will continue to collaborate with NHSE to support improvements in the quality of
services delivered by GP practices through co-commissioning of primary care service.
For information on CCGs’ performance against a number of indicators, please visit the My NHS
website which publishes data on NHS performance. All CCGs are assessed against a number
of metrics in the following groups: better care, better health, sustainability and well-led, and
each is then given an overall score. The overall score for Barking and Dagenham CCG is
‘requires improvement’.
Quality improvement in primary care
We have three key QI approaches in primary care:
1. Ongoing QI training for practice staff and QI facilitators
2. Development of data dashboards to support application of QI methods to clinical
priorities/staff satisfaction working in a general practice setting
3. Local commissioned services to support improved patient outcomes.
Annual report and accounts: 2017/18
31
The current position across BHR can be summarised as follows:
Barking and Dagenham recently completed a set of tailored learning modules to address
areas of improvement identified through practice level dashboard and tailored training tools
for the diabetes pathway
Havering and Redbridge practices recently completed a UCL Partnership QI programme
(focussing on diabetes and/or atrial fibrillation), with 14 QI facilitators being trained
A majority of practices are now undertaking in-house QI initiatives, recording projects of Life
QI and showcasing work at events such as Health Education England Recruitment Days
A task and finish group has been established to develop phase two of this programme of
work, looking to implement a consistent, sustainable QI model across BHR which focusses
on practice efficiencies and improved health outcomes, supported by the Clinical
Effectiveness Group.
At a NEL level, a primary care partnership for QI was established during 2017/18 to oversee
and enable the development of QI capability in primary care provision across the patch at all
levels. This is based on the Institute for Healthcare Improvement model for improvement.
The partnership - consisting of members of GP Federations, Networks, LMC, UCL Partners,
RCGP and commissioners - recognises that there are differing starting points across NEL in
terms of previous experience and current investment. It further recognises that QI work
represents a significant challenge in terms of the pace and extent of growth in QI capability and
practice that is affordable and sustainable, within the constraints of low discretionary primary
care time and highly limited budgets.
This challenge is compounded by the fact that primary care comprises a large number of
independent contractors – a total of 350 across NEL - each with a distinctive identity and
different ways of working. Over a third of NEL’s practices (36%) are in BHR.
The NEL Quality Improvement Programme Board has developed a draft primary care
transformation programme dashboard to provide headline indicators of delivery against the
programme objectives across NEL, which range from practice staff satisfaction, key health
outcomes and uptake of QI as an embedded model within general practices. Once agreed, this
will be a dashboard with a single set of indicators for the whole of NEL.
During the past six months we have seen increasing numbers of practices across BHR
receiving a CQC rating of ‘good’, with fewer practices rated as ‘requires improvement’. This
improvement has been achieved through the hard work of practice teams, supported by a
CCG-commissioned individual practice support programme. This offers access to rapid
diagnostic work, help to develop an action plan alongside support and help to implement the
necessary changes to achieve a rating of ‘Good’. Feedback from this programme is shaping
the workforce development programme, particularly around practice nursing and practice
management. The CCG has also commissioned a number of mandatory training courses,
including practice-level clinical system training and an information governance training
programme.
Engaging people and communities
The CCG remains committed to placing patients and the public at the heart of the work we do
to transform and sustain services locally through genuine and effective engagement. The
patient voice continues to help shape improvements in the planning and commissioning of high
quality, sustainable and safer care in our area.
We believe that those who use a service are best-placed to help design it, so we have adopted
a co-design approach. This means inviting participants (in our case, particularly carers, patients
Barking and Dagenham Clinical Commissioning Group
32
and service users) to work with us to understand the issues and help shape the future model of
care and local services.
This will typically begin at an early stage, helping us to design communications around any
major proposals before we even start on the necessary further level of engagement and/or
consultation, to ensure they are easily understood. We also provide ‘easy read’ versions of
documents as and when appropriate.
This year has seen the CCGs deliver two major public consultations asking people what they
thought about proposals to stop funding or restrict access to a number of treatments, medicines
and procedures as we looked to deliver necessary savings for the local NHS.
‘Spending NHS Money Wisely’ ran from March to May 2017, with phase two running from
September to November 2017, and resulted in more than 1400 formal questionnaire responses
from the public. The CCGs ran a series of public consultation ‘events’ including workshops,
drop-ins and more formal meetings, engaging widely with patients and the public, presenting to
a wide selection of local community and voluntary groups. These were led by our GP clinical
directors.
We worked in conjunction with local Healthwatch, alongside our well established Patient
Engagement Forum (PEF), to design our consultation document and other specific
engagement materials and to co-host engagement workshops and other events as appropriate.
BHR CCGs have delivered comprehensive, successful and multiple public consultations in-
year, delivering almost £7m of savings for the local NHS and with the majority support of our
local communities.
Our PEF has adopted a new approach and now meets jointly with its neighbours across BHR
for alternate meetings, reflecting the strategic shape of the wider system and ensuring the most
senior CCG presence at meetings. We are already looking at pushing this further across an
ELHCP footprint with a ‘citizens’ panel’ that better reflects the make-up of our diverse
communities. This will help us to engage with local people to a high standard at all times. We
want patients, carers and the public to become equal partners alongside clinicians and
managers.
We are delighted that our sustained efforts this year on PPI have seen us assessed and rated
as ‘Green’ by NHSE against the new Patient and Community Engagement Indicator.
Additionally, the CCG has engaged with a wide range of stakeholders on our commissioning
intentions for the next year.
Report by the lay member for PPI
The Barking and Dagenham PEF has enjoyed another successful year in 2017/18,
acknowledging the moves towards working more closely with our neighbouring CCG
counterparts by participating in our first ever Joint PEF meetings. At the same time we have
maintained our local focus and ensured the patient voice in Barking and Dagenham is heard
loud and clear by commissioners and partners alike. PEF members have been invited to, and
involved in, a range of local and pan-London training opportunities along with the opportunity to
join a range of service procurement and feedback panels.
Key areas considered by our PEF have included:
Primary Care Transformation
Development of integrated care
Barking and Dagenham Youth Forum updates
Barking and Dagenham Healthwatch reports on local services
Potential further savings ideas for ‘Spending NHS money wisely’
Annual report and accounts: 2017/18
33
With the CCG facing very real financial pressure and some tough decisions around funding of
services, we have seen an increase in engagement directly with the public and other
representative bodies with two major public consultations titled ‘Spending NHS money wisely’.
The PEF was engaged early on for patient feedback and helped shape the consultation
materials and approach to meetings with a wide range of community groups across the
borough.
Two of our GP clinical directors – Dr Anju Gupta and Dr Ravi Goriparthi – sat on the clinical
steering group for this work and also went out into the community to talk to local people about
the proposals.
We have continued developing our positive relationship with the Barking and Dagenham
Healthwatch and other local voluntary sector organisations.
Thanks are due to all of our PEF members who give their time on a voluntary basis, not least to
the Chair, Nicholas Hurst, and Vice Chair, Ron Wright.
Sahdia Warraich
Lay member for PPI
Reducing inequalities and the health and wellbeing strategy
People’s chances of enjoying good health and a longer life are not equal. They are determined
by the social and economic conditions into which they are born and live their lives (which also
make a difference to the way that people use health services and look after their own health).
These different conditions create avoidable health inequalities.
We know that reducing health inequalities improves life expectancy and reduces disability so
people live longer more healthy lives. Doing something about these avoidable inequalities
requires action in different areas, across the whole of society.
CCGs have to consider their population and identify and address inequalities within that group.
One of important ways in which we do this is by working closely with our local council and other
local partners on a health and wellbeing strategy. This considers the changing health and social
care needs of the population, as set out in the local joint strategic needs assessment (JSNA)
and identifies key priorities which then underpin service planning and commissioning. Locally
we also come together across the three boroughs in BHR to integrate health and care planning
and services where possible, using our finite resources most effectively to reduce variation and
address health inequalities.
Better Health for London and the NHS Five Year Forward View acknowledge that the future
sustainability of the local health and social care economy hinges on a different approach to
prevention that addresses the wider determinants of health such as income and housing.
Unless we take prevention and public health seriously, this will adversely affect the future health
and wellbeing of residents - particularly our young residents - and the sustainability of public
services.
In this section we summarise the key elements of the Health and Wellbeing Strategy 2015/18,
along with our contribution to developing and delivering it. We shared this section with our HWB
colleagues and have incorporated their feedback where received.
The Health and Wellbeing Strategy sets out a vision for improving the health and wellbeing of
residents and reducing inequalities at every stage of people’s lives. It aims to help residents
improve their health by identifying the key priorities based on the evidence in our Joint Strategic
Needs Assessment, and what can be done to address them and what outcomes are intended
to be achieved. We are particularly focused on the following three key challenges:
Barking and Dagenham Clinical Commissioning Group
34
1. To tackle the burden of ill health demonstrated by the significant number of our population
in poor health and the high premature mortality rates, especially from coronary heart
disease, stroke, cancers and respiratory disease.
2. To continue to explore closer alignment of health and care services in the community to
deliver the ‘better care outside the hospital’ agenda.
3. To take account of our rapidly changing population in our commissioning strategies and
delivery plans, so that services keep pace with changing needs and numbers. This is
particularly true when considering the new housing developments and the increasing child
population.
The direction given by the HWB is to deliver an innovative approach tailored to local needs that
tackles the diseases and consequences of modern living, as well as strives to raise standards
of care and address health inequalities. Growth and regeneration provide an opportunity by
developing and using our community assets, strengthening partnership between those who
deliver and those who benefit from our services, and looking beyond needs and treatments to a
healthy and prosperous community where residents and businesses have the opportunity to
contribute as well as gain.
In supporting the concept of wellness, the HWB has continued to advocate shifting care away
from traditional paternalistic approaches to the redesign of patient pathways focusing on
prevention, on keeping people out of hospital and encouraging residents to take personal
responsibility for managing their own and their family’s health, and social responsibility for the
health of their neighbours and communities. To achieve this, we want to explore innovation that
has the potential to fundamentally change the shape and scope of health and care services and
meet local needs in new ways within a tighter financial framework. This aligns with the
Council’s vision of improved access and self-sufficiency:
The Joint Strategic Needs Assessment (JSNA) was updated in 2015, with the CCG taking a full
role in helping to shape the content, and the HWB Strategy and related delivery plan were
updated as a result.
How we were involved in developing the HWB strategy
The CCG played a significant part in developing the current health and wellbeing strategy and
informing the current refresh. This involved:
review of JSNA recommendations and revised delivery plan and outcome measures
input to the strategy and delivery plan content
chairing and programme managing the delivery plan in respect of two of the HWB sub
groups – Integrated Care and Children and Maternity - and taking a central role in the
Mental Health sub-group.
alignment of commissioning intentions to HWB priorities, including contracting process and
review of service areas identified in JSNA.
We continue to work with the council, developers and providers to support the Barking
Riverside development. This is a significant re-development of around 11,000 new homes, with
an expected population increase of over 27,000 residents by 2030 in four phases. It provides
huge potential to impact on the health and wellbeing of the population by designing from the
outset a healthy infrastructure and purpose built environment from which to provide new
models of integrated, person-focused care.
The Healthcare Delivery Plan sets out the additional primary and community care infrastructure
requirements and demonstrates that healthcare needs have been adequately considered as
part of the master planning proposals for the development. It describes how residents will
access primary healthcare during the initial phases of the Riverside development and the
Annual report and accounts: 2017/18
35
anticipated location, size and specification of new healthcare facilities required to serve latter
phases of development.
This work links to the Healthy New Town work programme, of which the CCG is a core partner,
which is focused on ensuring that the new Barking Riverside neighbourhood is a healthy place
to live and work. It further seeks to share the benefits of the new development across Barking
and Dagenham. This work is also linked to the exploration of a new ‘locality’ way of working in
Barking and Dagenham - local community nursing services (led by NELFT) have been
reconfigured around three localities in Barking and Dagenham (north, east and west), and local
GPs are beginning to work in ‘networks’ based on these same footprints. We see this as a
major initiative to address health and care inequalities and build community resilience in
Barking and Dagenham. Our next step will be to test the principles of integrated working in a
locality. Co-design of services with staff and local people will be a key principle of any changes.
Equality disclosures
Since April 2013, CCGs have had legal responsibility for demonstrating compliance with the
Equality Act 2010, specifically the Public Sector Equality Duty. In so doing, we must have due
regard to three aims of the ‘general duty’ which states we must:
eliminate unlawful discrimination, harassment and victimisation and other conduct
prohibited by the Act
advance equality of opportunity between people who share a protected characteristic and
those who do not
foster good relations between people who share a protected characteristic and those who
do not.
We continue to embed equality and diversity in our policy development, commissioning,
engagement, current workforce and in the recruitment of staff from diverse backgrounds.
It is essential that not only do we comply with the Act, but that the make-up of our staff reflects
the diversity of the wider population here in our part of east London. This enables us to better
commission safe, high quality services that are designed around the diverse needs of our
patients and the public, as we represent those communities directly. We also work closely with
our providers to identify the needs of all communities.
The CCG has no legal duty to publish our workforce data because we employ fewer than 150
staff, but as we are committed to employing a diverse workforce we do monitor staff equality
data.
We are mindful of our legal responsibilities under the Equality Act 2010 and we review the
applicants for posts, the number shortlisted and those appointed, to determine if they might fall
under the relevant protected characteristic (which includes age, disability and race). This
enables us to review our recruitment and selection practices and assure ourselves that these
practices are robust and we do not directly or indirectly discriminate against anyone. The
turnover of staff is low so our level of recruitment is also quite low, but as a small local
employer we welcome applications from our local community and people with a diverse
background.
We aim to develop an inclusive working culture which values diversity and supports staff to feel
confident to challenge any harassment, bullying or perceived victimisation. All staff have direct
access to our accountable officer via a contact ‘button’ on our staff intranet and are encouraged
to use this to raise any concerns directly with him that they might have. Training on equality and
diversity is mandatory for all staff and managers closely monitor uptake of this.
Barking and Dagenham Clinical Commissioning Group
36
Our GB report cover sheet includes a section specifically about equality impact prompting
managers to carry out an equality analysis of the policy or the function they are reporting to the
GB. We maintain a log for all our equality analyses and ensure the actions arising from the
analyses are implemented and monitored.
Implementing the Equality Delivery System 2 (EDS2)
The CCG is fully committed to promoting equal opportunities within its workforce and within the
services it commissions for patients and the public.
In implementing the EDS2 from a workforce perspective we can report that we have a fair and
transparent recruitment process, as detailed above. We have flexible working policies and
support our staff through personal development planning and training.
Equality impact assessments (EIAs) are carried out when we procure new services or redesign
service models and when developing new policies for use both externally and internally. Our
equality strategy sets out the wider arrangements for equalities across the CCG.
The NHS Workforce Race Equality Standard
The CCG monitors staff diversity and a workforce report is presented to each meeting of our
Remuneration and Workforce committee. Although we do not have an obligation to report
publicly in the same way as larger NHS organisations (as mentioned above, due to the number
of staff employed), we recognise the benefits of this, given the introduction of the first NHS
Workforce Race Equality Standard (WRES) which started from 1 April 2015. We produce
annual workforce reports in relation to WRES.
Annual report and accounts: 2017/18
37
Section B. ACCOUNTABILITY REPORT
Jane Milligan
Accountable Officer
24 May 2018
Barking and Dagenham Clinical Commissioning Group
38
B1. Corporate governance report
B1(1) Members’ report
Leadership changes
During the year, the CCG had a change of Accountable Officer. The establishment of the NEL
Commissioning Alliance meant the appointment of Jane Milligan as Accountable Officer for all
seven CCGs from 1 December 2017. The previous Accountable Officer, Conor Burke, became
the Acting Managing Director for the remainder of the year until he left the BHR CCGs at the
end of the year. The new Managing Director is Ceri Jacob (from 1 April 2018).
Dr Waseem Mohi, Chair of the CCG since its establishment, stood down at the end of the year.
The newly-elected Chair of the CCG is Dr Jagan John (from 1 April 2018).
Member profiles
Our website gives more details about our GB, including profiles of members:
www.barkingdagenhamccg.nhs.uk/About-us/Our-governing-body/
Member practices
Abbey Medical Centre 1 Harpour Road IG11 7RJ
Barking Group Practice 130 Upney Lane IG11 9LT
Becontree Medical Centre 645 Becontree Avenue RM8 3HP
Broad Street Medical Centre Morland Road RM10 9HU
Child and Family Doctors' Surgery 79 Axe Street IG11 7LX
Church Elm Lane Medical Centre Church Elm Lane RM10 9RR
Dewey Road Surgery 36 Dewey Road RM10 8AR
Faircross Health Centre 51 Upney Lane IG11 9LP
First Avenue Surgery 2 First Avenue RM10 9AT
Five Elms Medical Practice Five Elms Road RM9 5TT
Gables Surgery 50 Markyate Road RM8 2LD
Green Lane Surgery 872 Green Lane RM8 1BX
Halbutt Street Surgery 2 Halbutt Street RM9 5AS
Heathway Medical Centre 585 Heathway RM9 5AZ
Hedgemans Surgery 92 Hedgemans Road RM9 6HT
Highgrove Surgery 113-115 Marlborough Road RM8 2ES
John Smith Medical Centre 145-207 Bevan Avenue IG11 9NS
Julia Engwell Clinic Woodward Road RM9 4SR
King Edwards Medical Centre 1 King Edward's Road IG11 7TB
Laburnum Health Centre 11 Althorne Way RM10 7DF
Longbridge Road Surgery 620 Longbridge Road RM8 2AJ
Annual report and accounts: 2017/18
39
Marks Gate Health Centre Lawn Farm Grove RM6 5BJ
Markyate Surgery 50 Markyate Road RM8 2LD
Oval Road Practice 69 Oval Road North RM10 9ET
Parkview Medical Centre 199 Reede Road RM10 8EJ
Porters Avenue Health Centre Porters Avenue RM8 2EQ
Ripple Road Surgery 364 -370 Ripple Road IG11 7RJ
Salisbury Avenue Medical Centre 7 Salisbury Avenue IG11 9XQ
Shifa Medical Practice Orchard Health Centre, Gasgoigne Road IG11 7RS
St Albans Surgery Urswick Road RM9 6EA
Thames View Health Centre Bastable Avenue IG11 0LG
Tulasi Medical Centre 10 Bennetts Castle Lane RM8 3XU
Urswick Medical Centre Urswick Road RM9 6EA
Valence Medical Centre 563 Valence Avenue RM8 3RH
Victoria Medical Centre 1 Queens Road IG11 8GD
VM Surgery 60 Victoria Road IG11 8PY
White House Surgery 12 Movers Lane IG11 7UN
B1: Member practices
Composition of Governing Body
Name Title and/or role
CL
INIC
AL
DIR
EC
TO
RS
Dr Ravali Goriparthi Clinical Director
Dr Anju Gupta Clinical Director
Dr Ramneek Hara Clinical Director
Dr Jagan John Clinical Director
Dr Gurkirit Kalkat Clinical Director
Dr Waseem Mohi Chair
Clinical Director
Dr Kanika Rai Clinical Director
LA
Y
ME
MB
ER
S
Kash Pandya Vice Chair
Lay member - Governance
Sahdia Warraich Lay member- Public and patient involvement
SE
NI
OR
M AN
AG
ER S
Conor Burke Chief Officer (to 30 November 2017)
Acting Managing Director (1 December 2017 to 31 March 2018)
Barking and Dagenham Clinical Commissioning Group
40
Name Title and/or role
Jacqui Himbury Nurse Director
Jane Milligan Accountable Officer (from 1 December 2017)
Sharon Morrow
Mental Health and Learning Disabilities Transformation
Programme Director (to 30 July 2017)
Unplanned Care Senior Responsible Officer (SRO) (from 31 July
2017)
Steve Rubery Director of Delivery and Performance (from 5 February 2018)
Gina Shakespeare Interim Director of Delivery and Performance (31 July to 21
December 2017)
Tom Travers Chief Finance Officer
GB members
Meetings are also attended regularly by Matthew Cole, Director of Public Health, and Chris
Bush, Director of Commissioning, both from the London Borough of Barking and Dagenham;
and Marie Kearns and Frances Carroll (until September 2017) and Manisha Modhvadia (from
November 2017) all from Healthwatch Barking and Dagenham
Committees, including Audit Committee
The CCG’s Audit and Governance Committee (AGC) meets as one committee ‘in common’ with
Havering and Redbridge CCGs. The members are detailed below and more information about
the committee and its work is contained in the Governance Statement (section B1(3) of this
report).
Name of member Role
Kash Pandya (Chair) Lay Member (Governance), BHR CCGs
Sahdia Warraich Lay Member (PPI), Barking and Dagenham CCG
Richard Coleman Lay Member (PPI), Havering CCG
Khalil Ali Lay Member (PPI), Redbridge CCG
Charles Beaumont Co-opted Member, BHR CCGs
B3: AGC members
Details of membership of other committees are also contained in the Governance Statement.
Register of Interests
We publish a register of members’ and senior managers’ interests on the CCG’s website. This
is updated as and when changes are notified to the CCG.
The register gives details of company directorships or other significant interests held by
members and senior managers where those companies are likely to do business, or are
possibly seeking to do business with the NHS, where this may conflict with their managerial
responsibilities.
Annual report and accounts: 2017/18
41
Personal data related incidents
The NHS Information Governance (IG) Framework sets the processes and procedures by
which the NHS handles information about patients and employees, in particular personal
identifiable information. The framework is supported by an IG toolkit and the annual submission
process provides assurances to the CCG, other organisations and to individuals that personal
information is dealt with legally, securely, efficiently and effectively.
We place high importance on ensuring there are robust IG systems and processes in place to
help protect patient and corporate information. We have established an IG management
framework and have implemented IG processes and procedures in line with the IG toolkit. We
ensure all staff undertake annual IG training and have provided staff with guidance on their IG
roles and responsibilities.
We use local clinical and corporate incident management and reporting tools to record and
report incidents and record all internal incidents. We notify the Department of Health and the
Information Commissioner’s Office (ICO) of serious incidents that require investigation via the
national IG incident reporting tool.
During the reporting period, the CCG has had no serious incidents involving data loss or
confidentiality breaches that require formal reporting to the ICO.
Statement of disclosure to auditors
Each individual who is a member of the GB at the time the Members’ Report is approved
confirms:
so far as the member is aware, there is no relevant audit information of which the CCG’s
auditor is unaware that would be relevant for the purposes of their audit report
the member has taken all the steps that they ought to have taken in order to make him or
herself aware of any relevant audit information and to establish that the CCG’s auditor is
aware of it.
Modern Slavery Act
Barking and Dagenham CCG fully supports the Government’s objectives to eradicate modern
slavery and human trafficking but does not meet the requirements for producing an annual
Slavery and Human Trafficking Statement as set out in the Modern Slavery Act 2015.
B1(2) Statement of Accountable Officer’s Responsibilities
The National Health Service Act 2006 (as amended) states that each Clinical Commissioning
Group shall have an Accountable Officer and that Officer shall be appointed by the NHS
Commissioning Board (NHSE). NHSE has appointed Jane Milligan to be the Accountable
Officer of Barking and Dagenham CCG.
The responsibilities of an Accountable Officer are set out under the National Health Service Act
2006 (as amended), Managing Public Money and in the Clinical Commissioning Group
Accountable Officer Appointment Letter. They include responsibilities for:
The propriety and regularity of the public finances for which the Accountable Officer is
answerable,
For keeping proper accounting records (which disclose with reasonable accuracy at any
time the financial position of the Clinical Commissioning Group and enable them to ensure
that the accounts comply with the requirements of the Accounts Direction),
For safeguarding the Clinical Commissioning Group’s assets (and hence for taking
reasonable steps for the prevention and detection of fraud and other irregularities).
Barking and Dagenham Clinical Commissioning Group
42
The relevant responsibilities of accounting officers under Managing Public Money,
Ensuring the CCG exercises its functions effectively, efficiently and economically (in
accordance with Section 14Q of the National Health Service Act 2006 (as amended)) and
with a view to securing continuous improvement in the quality of services (in accordance
with Section14R of the National Health Service Act 2006 (as amended)),
Ensuring that the CCG complies with its financial duties under Sections 223H to 223J of the
National Health Service Act 2006 (as amended).
Under the National Health Service Act 2006 (as amended), NHSE has directed each Clinical
Commissioning Group to prepare for each financial year financial statements in the form and on
the basis set out in the Accounts Direction. The financial statements are prepared on an
accruals basis and must give a true and fair view of the state of affairs of the Clinical
Commissioning Group and of its net expenditure, changes in taxpayers’ equity and cash flows
for the financial year.
In preparing the financial statements, the Accountable Officer is required to comply with the
requirements of the Group Accounting Manual issued by the Department of Health and in
particular to:
Observe the Accounts Direction issued by NHSE, including the relevant accounting and
disclosure requirements, and apply suitable accounting policies on a consistent basis;
Make judgements and estimates on a reasonable basis;
State whether applicable accounting standards as set out in the Group Accounting Manual
issued by the Department of Health have been followed, and disclose and explain any
material departures in the financial statements; and,
Prepare the financial statements on a going concern basis.
To the best of my knowledge and belief, and subject to the disclosures set out below, I have
properly discharged the responsibilities set out under the National Health Service Act 2006 (as
amended), Managing Public Money and in my Clinical Commissioning Group Accountable
Officer Appointment Letter.
Disclosures:
as at 1 April 2017, the CCG is subject to directions from NHSE issued under Section 14Z21
of The National Health Service Act 2006 in relation to the organisation’s financial position
the CCG deficit has been reported by the external auditors under Section 30(b) of The
Local Audit and Accountability Act 2014.
I also confirm that:
as far as I am aware, there is no relevant audit information of which the CCG’s auditors are
unaware, and that as Accountable Officer, I have taken all the steps that I ought to have
taken to make myself aware of any relevant audit information and to establish that the
CCG’s auditors are aware of that information.
that the annual report and accounts as a whole is fair, balanced and understandable and
that I take personal responsibility for the annual report and accounts and the judgments
required for determining that it is fair, balanced and understandable.
B1(3) Governance Statement
Introduction and context
Barking and Dagenham CCG is a body corporate established by NHSE on 1 April 2013 under
the National Health Service Act 2006 (as amended).
Annual report and accounts: 2017/18
43
The CCG’s statutory functions are set out under the National Health Service Act 2006 (as
amended). The CCG’s general function is arranging the provision of services for persons for
the purposes of the health service in England. The CCG is, in particular, required to arrange
for the provision of certain health services to such extent as it considers necessary to meet the
reasonable requirements of its local population.
As at 1 April 2017, the CCG is subject to directions from NHSE issued under Section 14Z21 of
the National Health Service Act 2006 in relation to the organisation’s financial position. The
details can be found on the NHSE website.
Scope of responsibility
As Accountable Officer, I have responsibility for maintaining a sound system of internal control
that supports the achievement of the Clinical Commissioning Group’s policies, aims and
objectives, whilst safeguarding the public funds and assets for which I am personally
responsible, in accordance with the responsibilities assigned to me in Managing Public Money.
I also acknowledge my responsibilities as set out under the National Health Service Act 2006
(as amended) and in my Clinical Commissioning Group Accountable Officer Appointment
Letter.
I am responsible for ensuring that the Clinical Commissioning Group is administered prudently
and economically and that resources are applied efficiently and effectively, safeguarding
financial propriety and regularity. I also have responsibility for reviewing the effectiveness of the
system of internal control within the Clinical Commissioning Group as set out in this
governance statement.
Governance arrangements and effectiveness
The main function of the GB is to ensure that the group has made appropriate arrangements for
ensuring that it exercises its functions effectively, efficiently and economically and complies
with such generally accepted principles of good governance as are relevant to it.
This has been achieved through the following means:
The Constitution
The Constitution, which was approved by NHSE as part of the authorisation process in March
2013 provides that it is the GB which undertakes any functions not reserved or otherwise
delegated.
The scheme of delegation included in the constitution sets out those specific decisions that are
reserved for the Members’ Committee. These are as follows:
1. Make recommendations to the NHS Commissioning Board (now called NHSE) for
changes to the Constitution of the Group
2. Amending the Standing Orders and/or the Scheme of Delegation
3. Change the nature of the business of the Group or do anything inconsistent with the
mission, values and aims of the Group
4. Use any other name than that specified in Clause 1.1 of the Constitution in relation to
the activities of the Group
5. Merge, amalgamate or federate the Group with any other CCG
6. Seek to remove any Member
7. Reorganise the boundaries of or change the organisational structure of the Group
8. Approve the arrangements for appointing and removing Clinical Directors to/from the
GB.
Barking and Dagenham Clinical Commissioning Group
44
CCG governance structure
The CCG governance structure was created to ensure that clinicians and patients were at the
heart of decision making whilst delivering on the strategic objectives agreed by the GB at the
start of the year. These are shared corporate objectives across the three BHR CCGs (see
section A1(2) of this report).
The governance structure reflects the fact that there is a shared management team and
operating model supporting the three CCGs whilst maintaining the functions of each CCG in its
own right as a statutory body with local accountability.
In 2017/18 a number of changes to the CCG’s governance were made:
Joint Executive Committee – the functions of this committee were transferred to a new
committee of the three BHR CCGs’ GBs, called the BHR CCGs’ Joint Committee.
A number of the CCG’s committees were made ‘joint’ rather than ‘in common’ with fellow
BHR CCGs, in response to the ‘Well-led review’ arising from the legal directions and to
reflect the new agreed way of increased collaborative working across the three CCGs. The
two committees now joint are: Finance and Delivery (F&D) and Quality and Safety.
The Governing Body
The CCG GB is comprised of clinical directors, appointed members and officers who have the
duty to ensure the CCG exercises its functions effectively, efficiently and economically. The GB
takes responsibility for ensuring that the CCG meets all its financial obligations, including
accounting and auditing and performs its functions in a way which provides good value for
money.
The GB met in public on four occasions and the newly-created JC of the BHR CCGs also met
in public on four occasions. There was an annual planner for business items and the agendas
were structured to deal with performance, operations, engagement, commissioning and
strategy.
The key areas of focus for the GB throughout 2017/18 were:
Oversight and delivery of the Operating Plan and transformation programmes, with a
particular focus on recovery of the RTT standard at BHRUT.
Reporting on finance and activity information from commissioned health providers
Reporting on and oversight of CCG finances and the financial recovery programme
Reporting on and oversight of performance and quality issues within commissioned health
providers
Reporting on patient and public engagement in the work of the CCG
Commissioning and strategy opportunities with local commissioners and providers
The management of strategic risk through scrutiny of the Joint Committee Assurance
Framework (JCAF), previously called the Governing Body Assurance Framework
Primary care transformation
Compliance with CCG statutory duties
Minutes and reports from the committees of the GB and working groups where appropriate
Annual report and accounts: 2017/18
45
The membership of the GB and attendance record for GB and JC meetings is outlined below:
BD CCG GB
meetings
BHR CCGs’ JC
meetings
Name of GB member
(further details of roles and
dates in ‘Composition of
Governing Body’ table) 23 M
ay 2
017
26 M
ay 2
017
18 J
uly
2017
26 S
ep
t 2017
30 N
ov 2
017
14 D
ec 2
017
25 J
an
2018
29 M
ar
2018
Total
attended
/ total
possible
CL
INIC
AL
DIR
EC
TO
RS
Dr Ravali Goriparthi x x x 6/8
Dr Anju Gupta x x 6/8
Dr Ramneek Hara x x 7/8
Dr Jagan John x x 6/8
Dr Gurkirit Kalkat 8/8
Dr Waseem Mohi x x x 5/8
Dr Kanika Rai x 7/8
LA
Y
ME
MB
ER
S
Kash Pandya 8/8
Sahdia Warraich 8/8
SE
NIO
R M
ANAGER
S
Conor Burke x x x x 4/8
Jacqui Himbury x x 6/8
Jane Milligan 3/3
Sharon Morrow x x 6/8
Steve Rubery 1/1
Gina Shakespeare 2/2
Tom Travers 8/8
B4: GB and JC membership and attendance
Note: Grey shaded boxes indicate the individual was not a member of the Committee at the time of
the meeting.
Governing Body Effectiveness Review
In April the GB agreed an annual work-plan that covered many of the areas of focus outlined
above. Members of all three CCGs have considered the GB and JC effectiveness this year and
their comments on this included:
Barking and Dagenham Clinical Commissioning Group
46
Things that went well:
the meeting is well organised, with a more focussed agenda
there has been an improvement since the JC was established with good understanding of
all BHR views and priorities.
collaborative working across BHR.
Areas for improvement:
the large agenda can limit time for discussion and for individual contributions
could consider holding pre-meetings for individual CCGs
increased understanding of conflicts of interest issues and their management
more challenge on decisions.
Committees of the Governing Body
The GB has authority under the scheme of delegation to establish sub committees or sub
groups to enable it to fulfil its role. Each of the GB Committees has terms of reference and the
roles of each are set out broadly below. Each Committee is authorised by the GB to pursue any
activity within their terms of reference and within the scheme of reservation and delegation of
powers.
Audit and Governance Committee – meeting as one ‘in common’ with fellow BHR CCGs
The BHR CCGs’ AGCs (‘the Committee’) meet as one ‘in common’. The report refers to the
work of that committee. This report is produced in line with the requirements of the NHS Audit
Committee Handbook and summarises the activities of the AGC for the financial year 2017/18.
The Committee was established in accordance with the constitutions of the three CCGs and
reports directly to the GBs. The Committee provides assurance and advice to the GBs and to
the Accountable Officer on:
the proper stewardship of resources and assets, including value for money
financial reporting
the effectiveness of audit arrangements (internal and external)
risk management, and
control and integrated governance arrangements within the CCG.
The membership and attendance record of the AGC are outlined below:
Name of AGC member
24 A
pr
2017
24 M
ay 2
017
11 J
uly
2017
10 O
ct
2017
5 D
ec 2
017
13 F
eb
2018
Total
attended /
total
possible
Kash Pandya 6/6
Sahdia Warraich x 5/6
Richard Coleman x x 4/6
Khalil Ali x 5/6
Charles Beaumont 6/6
B5: AGC membership and attendance
Annual report and accounts: 2017/18
47
The meeting is also attended regularly by:
Tom Travers - Chief Finance Officer, BHR CCGs
Marie Price - Director of Corporate Services, BHR CCGs
Charlie Nicholl / Erin Sims - Local Counter Fraud Service, RSM
Nick Atkinson / John Elbake - Internal Auditor, RSM
Kevin Suter / Stephen Bladen - External Auditor, Ernst & Young (to September 2017)
Neil Thomas / Richard Hewes - External Auditor, KPMG (from September 2017)
During the year another BHR CCGs director attended each meeting to outline their directorate’s
current highest areas of risk and the mitigations in place to demonstrate effective risk
management and allow the Committee to keep abreast of emerging risks and offer support.
The GBs have other committees that have a monitoring and oversight role and Audit
Committee members who attend other committees are able to feed back and make linkages
which strengthens the Committee’s role. More recently Sahdia Warraich has been appointed to
the Quality and Safety Committee and will provide feedback to this Committee.
All meetings were quorate and the minutes of each meeting, once agreed, were presented to
the GBs with a summary report from the Chair highlighting key issues and advising the GBs of
emerging risk.
The Audit and Governance Committee’s work in 2017/18
This annual report summarises the work undertaken during the year and is divided into a
number of sections that reflect the key duties of the Committee as set out in the terms of
reference.
1. Governance, risk management and internal control
In April 2017 the Committee reviewed the 2016/17 Annual Governance Statement (AGS)
together with the Head of Internal Audit opinion, external audit opinion and other appropriate
independent assurances. It confirmed that the AGS was consistent with the Committee’s view
of the CCG’s system of internal control. Accordingly, the Committee recommended to the GB
that it approve the AGS and adopt the annual accounts for 2016/17. This same process for
2017/18 commenced in February 2018 in preparation for close down in May 2018.
The Committee has established underlying assurance processes that indicate the degree to
which the CCG’s objectives are achieved. In year the Committee reviewed the JCAF and
believes that the framework used was fit for purpose. The Committee also considered the
Corporate Risk Register updates and is of the opinion that adequate systems for risk
management are in place but still wishes to address risk appetite in the coming year.
2. Internal Audit
RSM has provided the internal audit service this year. The Committee has worked effectively
with internal audit throughout the year to strengthen the CCGs’ internal control processes. This
included several private meetings with RSM to seek assurances about the effectiveness of the
internal audit service. During the year there has been a robust procurement process to appoint
internal auditors as the current contract expired in March 2018. The Committee were pleased to
approve the appointment of the preferred provider, RSM, for a further period.
The Committee approved the 2017/18 Internal Audit Plan and received regular progress reports
from internal audit on the delivery of the annual audit plan, including reports and opinions. The
Committee also considered regular reports from the CSU Quality Assurance Plan which
covered work conducted by RSM at NEL CSU. The CSU Assurance Plan has been modified to
Barking and Dagenham Clinical Commissioning Group
48
take account of the Service Auditor Report, now provided by Deloitte, in its role as Internal
Auditor to NHSE and the CSU in particular.
The Committee considered the findings of the internal audit reports and was assured that
management had responded in an appropriate and timely manner. The Committee regularly
followed up on the recommendations auditors made to management to ensure they were being
implemented and was pleased to note speedier turn-around this year.
Internal Audit were able to conclude in their Head of Internal Audit Opinions in April 2018 that
the organisation had an adequate and effective framework for risk management, governance
and internal control. The Committee will continue to press for enhancements to ensure the
CCG’s controls remained adequate and effective.
3. External Audit
Ernst & Young were the CCG’s external auditors until September 2017 when they were
replaced by the newly-appointed external auditors, KPMG. The Committee agreed the new
External Audit Plan in December 2017.
Both Barking and Dagenham and Redbridge had received unqualified opinions on both their
financial statements and regulatory process. Havering had received an unqualified opinion on
their financial statements but a qualified regulatory opinion as the auditors had to issue a
Section 30 report to the Department of Health. This was because Havering CCG had failed to
contain its 2016/17 spend within its resource limit.
Because the three CCGs had been placed under Directions by NHSE, an ‘except for’ qualified
money for money conclusion had to be issued to all BHR CCGs. The BHR financial position
was supported through the receipt of risk pool funding from NEL.
The External Audit Annual Management Letters that confirmed the audit findings were reviewed
and formally approved by the GBs in September 2017.
4. Other Assurance Functions also reviewed in year:
Counter Fraud Services
RSM also provides the local counter fraud service to the CCGs. Their work-plan was reviewed
in March 2017 for the 2017/18 financial year. It had been agreed that this should be linked with
the internal audit plan wherever possible to make most effective use of available resources.
The Committee was concerned about the limited level of reactive local counter fraud work by
NHSE in primary care but was advised that it was consistent with that in other CCGs. However,
there has been work on fraud awareness training and ad-hoc investigations at the CCGs’
request.
Governance
The Committee received regular updates on risk management from individual directors and
their review of the JCAF. The JCAF includes a relatively high number of red risks that have
arisen mainly through the BHR CCGs’ difficult financial positions and performance above
planned activity levels by acute providers. These risks and mitigations in place were considered
regularly and the continual strengthening of risk processes was recognised. Suggestions were
made for the recognition of emerging risks such as the appointment of a Single Accountable
Officer for NEL and related new governance arrangements.
Changes in national guidance on conflicts of interest, gifts and hospitality and sponsorship led
to a peak of work in developing new local policy and procedures, including online mandatory
training. The Committee welcomed these developments. The Committee’s working group
continues to meet to review conflicts of interest declarations received.
Annual report and accounts: 2017/18
49
Procurement and contracts
The Committee considered the appropriateness of tender waivers approved by officers under
their delegated powers and remains concerned that they are still being used on a relatively
frequent basis to clear up a backlog of procurements. A new procurement policy was approved
in-year that strengthened arrangements and a procurement oversight group was established to
improve the planning and delivery of procurements. The Committee has asked for regular
feedback on the outcomes achieved by the group.
Information Governance
The Committee received a briefing on the requirements of the General Data Protection
Regulations (due for implementation in May 2018) and the anticipated impact on our
providers/GPs. The Committee recommended the requirements are included in 2018/19
contracts with our providers. They received updates on the development of the 2018
Information Governance Toolkit which they agreed to support following internal audit review.
Directorate risk
As mentioned earlier, the Committee developed a rolling programme of director briefings to the
Committee to enable directors to outline their directorate’s highest risk areas and explain the
mitigations in place. This programme of assurance will continue into 2018/19.
5. Financial reporting
In line with its terms of reference, the Committee reviewed aspects of the CCG’s financial
management, internal controls and financial reporting.
The Committee approved the procurement strategy and looked at the use of the Better Care
Fund. The Committee requested a report on the benefits of the application of Better Care Fund
monies and was provided with assurances on better joint working with partners to secure
improved patient outcomes.
The Committee also monitored completion of the interim accounts for 2017/18 required at
month 9 where deadlines were achieved.
The Chief Finance Officer provided regular updates on the three CCGs’ financial position and
ongoing and escalated risks and the mitigating actions put in place. Of serious concern to the
Committee was the difficulty in reaching agreement with NELFT and the acute providers on
contractual over-performance and delivery of savings and on the continued growth in demand.
There was significant financial uncertainty due to the difficulties in year to reach an agreed
financial year end position with BHRUT, our main provider. The Committee was kept abreast of
these developments, including the Expert Determination process that is in progress to resolve
these differences.
New risk management arrangements have been established across the ELHCP area to
manage 2017/18 risk and address 2018/19 QIPP requirements earlier.
The Committee will receive the unaudited draft financial statements at its April 2018 meeting
and the final documentation at its May 2018 meeting prior to gaining approval at the late May
GBs.
6. Ensuring probity
The Audit Committee kept under review the arrangements in place for ensuring probity in the
conduct of business by the CCGs, as described in the Committee’s terms of reference.
There has been much focus this year on conflicts of interest, gifts and hospitality and
sponsorship requirements. National guidance was received in June 2017 and updated with
Barking and Dagenham Clinical Commissioning Group
50
specific guidance for CCGs in September 2017, with an implementation date for a new policy
set for November. This happened but has since been slightly amended as issues have arisen
and further clarity was required.
In line with the new guidance, in late 2017 there was a new round of collection of updated
declarations by staff, GB members, committee members and GPs in a decision-making role. A
new register was required for the public website that details declarations by those in a decision-
making role. This work was completed in time for the February annual internal audit review and
the outcome was a substantial assurance rating. Mandatory training for decision-makers has
been rolled out and is due to complete in May 2018. The Conflicts of Interest Guardian
continues to be the AGC Committee Chair.
Following each Committee meeting, the Chair provides a feedback report to the GB to
accompany the minutes to cover its duty in providing the GB with assurance that effective
internal control arrangements are in place. These reports are available on the website within
the GB/JC reports.
7. Committee effectiveness review
At year end members were asked to review the Committee’s work for the year and list what has
gone well and whether there were any gaps in assurance. The feedback for 2017/18 included:
Things that went well:
members welcomed the presentation and discussion of directorate risk reviews by directors
and SROs, which provided an insight into the risks they were considering
members welcomed the very good contribution to the work of the Committee by internal and
external auditors
members commended the timely compliance by officers of key deadlines despite stretched
resources, including the production of the month nine draft accounts, year-end annual
reports and annual accounts and the IG Toolkit submissions
the effectiveness of the Committee was helped through the good and varied lay members’
contribution, critical challenge at meetings, the excellent chairing and the governance and
finance teams’ support.
Areas for improvement:
Due to the complexity and depth of financial and quality challenge, the reports received
have sometimes been excessively long. While welcoming the comprehensive and
detailed reports, a six page cap should be considered.
The need to continue to press for reduction and elimination of long-standing risks
together with more detailed consideration of improvement plans and actions.
It is suggested key external reports on CCG performance should feature at this meeting.
A recognition that there will be the need to work more closely with NEL and London Audit
Committee colleagues and benchmark areas for learning e.g. continuing care.
8. Conclusion
The Committee will take action in 2018/19 to respond to the comments received on its own
effectiveness review and adjust the running work-plan as necessary.
Review from the Chair
As Committee Chair, I remain concerned about the CCG’s challenging financial position and
the likely scale of the savings that might be required to bring about a financial balance. This will
only be achieved through closer working with partners, in particular the acute providers, as
difficult decisions will need to be made and delivered that will impact on all of us. With that in
Annual report and accounts: 2017/18
51
mind, I am continuing to build stronger links with provider auditor chairs and joint working where
possible to deliver change.
I am pleased that our internal auditors, RSM, were able to give an overall assurance that there
is a generally sound system of internal control. As we approach the year-end 2017/18 the
Committee expects to receive assurance that KPMG has completed their audit of the CCG’s
annual accounts to the required timelines and give an unqualified audit opinion. My thanks are
extended to all the staff and auditors who have helped achieve the challenging submission
deadlines.
The Committee is of the view that it has taken the appropriate steps to perform its duties as
delegated by the GBs and it has no cause to raise any other issues of significance arising from
its work during 2017/18, however there are a number of important matters that have arisen in
during the year that will require ongoing scrutiny and/or a higher priority on the Committee
agenda in 2018/19. These include:
Assessing the progress made in identifying and delivering the savings required to meet the
Directions placed on the CCG by the NHSE. The Committee will support these
developments by drawing on good practice from other CCGs that have had Directions
placed on them.
Monitoring the progress made in implementing the recommendations set out in the
Independent Financial Management and Governance Review by PwC and the Well-led
Review report on the CCG by Deloitte.
Developing strong working arrangements with the audit committees of the other
organisations in the ELHCP to ensure that the new governance and financial management
arrangements that have been established also safeguard the statutory responsibilities of
the CCG.
Continuing to identify opportunities to strengthen the CCG’s risk management
arrangements in line with best practice.
Assessing the effectiveness of the new arrangements established to manage conflicts of
interest.
I would like to thank the Accountable Officer, Clinical Directors and all CCG staff for their
support and contributions to the Committee, in addition to the valued service provided by
internal auditors and external auditors.
Kash Pandya
Chair
Joint Quality and Safety Committee (formerly ‘in common’) for BHR CCGs
The BHR CCGs’ Quality and Safety Committees met as one ‘in common’ for the first part of the
year. In December the ‘in common’ arrangement was changed to establish a joint Quality and
Safety Committee. This report refers to the work of both the ‘in common’ and the joint
committee.
The Committee’s original terms of reference were revised in December 2017. They cover the
following areas:
assurance that the outcomes of serious incident and ‘never event’ investigations are acted
upon and learning taken forward; ratification and closure of CCG serious incidents
the provision of oversight and assurance to the GBs on the quality of services
commissioned, patients’ experience, specific QI initiatives and any serious failure in quality
Barking and Dagenham Clinical Commissioning Group
52
seeking assurance that the CCGs’ commissioning strategy fully reflects all elements of
quality (patient experience, effectiveness and patient safety).
In 2017/18 the Committee has:
received assurance by regularly receiving minutes of the Safeguarding Assurance
Committee, the Serious Incident Panel and BHRUT’s, BH’s and NELFT’s CQRM meetings
regularly reviewed the serious incidents recorded by local trusts and sought improvements
to root cause analysis learning and seeking evidence of mitigating action
challenged ‘never events’ recorded by trusts, particularly if there was repetition
reviewed infection control against trajectories
reviewed mortality rates at BHRUT with benchmarking and sought assurance on mitigations
considered the directorate risk register, noted risks escalated to the JCAF and
recommended courses of action to the executive committee and GBs
approved strategy updates on safeguarding and looked-after children
approved policies on safeguarding adults, safeguarding children, safeguarding allegations
against staff, prevent policy, domestic and violent abuse, and procedures of limited clinical
effectiveness
reviewed the clinical harm review process
reviewed GP alert status reports
reviewed NELFT bed occupancy data and BHRUT acute discharges
approved the pandemic flu plan
reviewed the quality accounts from main local provider trusts
considered an audit on unwell babies
reviewed recommendations from Regulation 28 coroner reports.
The Committee also carried out more in depth reviews into areas of concern:
NELFT suicides and learning from deaths
BHRUT never events
BHRUT mortality reduction plan
Annual report and accounts: 2017/18
53
The membership and attendance record of the Quality and Safety Committee – both ‘in
common’ and joint - is outlined below. ‘In common’ meetings
Joint
meetings
Name of Committee member
25 A
pri
l 2017
27 J
un
e 2
017
1 S
ep
t 2017
24 O
ct
2017
19 D
ec 2
017
27 F
eb
2018
Total
attended /
total
possible
Dr Ah-Fee Chan – Chair
SECONDARY CARE CONSULTANT x 5/6
Sahdia Warraich
LAY MEMBER x * 1/2
CL
INIC
AL
DIR
EC
TO
RS
Dr Ann Baldwin
Havering x 1/2
Dr Anita Bhatia
Redbridge x * 1/2
Dr Ravali Goriparthi
Barking and Dagenham x x x x 0/4
Dr Anju Gupta
Barking and Dagenham x x 2/4
Dr Ramneek Hara
Barking and Dagenham x *D x 0/2
Dr Sarah Heyes
Redbridge x x 4/6
Dr Kanika Rai
Barking and Dagenham x 1/2
Dr Maurice Sanomi
Havering x x 2/4
Dr Muhammed Tahir
Redbridge x x 2/4
SE
NIO
R M
AN
AG
ER
S
Jacqui Himbury x D x D 4/6
Louise Mitchell
Redbridge x 1/2
Sharon Morrow
Barking and Dagenham x 1/2
Steve Rubery 1/1
Gina Shakespeare 3/3
Alan Steward
Havering 2/2
B6: Quality and Safety Committee membership and attendance
Note: Grey shaded boxes indicate the individual was not a member of the Committee at the time of
the meeting. D Member unable to attend but a deputy attended in their place
* New members of the joint committee were unable to attend the first meeting due to short notice of
the date (but the meeting was still quorate due to presence of ex CD member as deputy)
Barking and Dagenham Clinical Commissioning Group
54
Other attendees with responsibilities such as safeguarding, maternity, medicines management
were invited to meetings to respond directly to the Committee about particular issues of
concern and avoid delay in seeking further information.
In 2017/18 attendance at meetings improved as members arranged for a colleague to deputise
for them if they were unable to attend.
The Transformation Programme Directors – Louise Mitchell, Sharon Morrow and Alan Steward
- moved to new roles from 31 July 2018. Following that, the Director of Delivery and
Performance (first covered in part by Regina Shakespeare, then Steve Rubery) represented all
three CCG positions on the Committee. The Clinical Directors now represent all BHR CCGs on
the JC.
Committee effectiveness review
At year end, members have been considering if all of their duties outlined in the Committee’s
terms of reference were fulfilled, what had gone well and areas for improvement going forward:
Things that went well:
Improved attendance and good contribution from members
Excellent and robust understanding of statutory requirements and good clinical focus
Evidence of a good quality and safety team who worked well together
Members welcomed the attendance of leads for key areas e.g. child and adult safeguarding,
nursing homes, medicines management
Regularly meeting to discuss key concerns
Good level of detail on recent issues to aid understanding
Time allowed for deep dives into highest risk areas as the prime agenda item.
Areas for improvement:
Recognition that behind the scenes many front line people work hard to improve quality and
safety but improvements are slow and take time
A zero tolerance approach does not seem feasible
To ensure attendance to keep to the planned meeting schedule
Meetings need to be active and in real time
Reliance on the effectiveness of other committees; lack of real time data.
Real time actions; more power to intervene whenever appropriate with timescale for actions
Pre-meets and more input from providers outlining specifics of change in response to SUIs.
Conclusion
Quality and safety is everyone’s business and so this Committee has a very wide remit, as
indicated by the terms of reference. The agendas are ambitious and often routine items are
taken over by pressing serious incidents where a risk to patient safety is identified and requires
Committee consideration. Nevertheless, with the improved attendance and additional deep dive
sessions this year the Committee has seen more robust challenge of local providers and
pushing back when assurance was not adequate.
The attendance of specific service leads such as safeguarding has been helpful. In addition the
quality and safety team has continued to review and revise strategies, policies and procedures
to remain up to date with guidance and new issues. The effectiveness review has identified a
number of areas for further strengthening and these will be considered by the Committee and
built into the Committee work-plan going forward.
Annual report and accounts: 2017/18
55
As Chair of the Committee I would like to take this opportunity to thank the BHR quality and
safety team for their good work, members for their valuable contributions and expertise and the
Committee secretary for her administrative support.
Ah-Fee Chan
Chair
Remuneration and Workforce Committee – meeting as one ‘in common’ with fellow BHR
CCGs
The main purpose of the committee is to make recommendations to the GBs on determinations
about pay and remuneration for employees of the CCG, in particular very senior staff.
The committee’s duties also include:
determining the remuneration and conditions of service of the senior team
reviewing the performance of senior team members and determining annual salary awards,
if appropriate
considering the severance payments of the Accountable Officer and other senior staff,
seeking HM Treasury approval as appropriate in accordance with the guidance ‘Managing
Public Money’
considering other workforce issues and receiving reports on HR related issues, such as
sickness, turnover etc.
considering and reviewing succession planning arrangements for the CCG.
The membership and attendance record of the Remuneration and Workforce Committee is
outlined below:
Name of Committee member
27 A
pri
l 2017
11 J
uly
2017
10 O
ct
2017
9 N
ov 2
017
Total
attended /
total
possible
LA
Y M
EM
BE
RS
Khalil Ali
Redbridge x 3/4
Richard Coleman
Havering x 3/4
Kash Pandya
Chair 4/4
Sahdia Warraich
Barking and Dagenham 4/4
CC
G C
HA
IRS
Dr Atul Aggarwal x 3/4
Dr Anil Mehta 4/4
Dr Waseem Mohi x 3/4
B7: Remuneration and Workforce Committee membership and attendance
The meeting was also regularly attended by Conor Burke (Chief Officer to 30 November 2017,
then Acting Managing Director), Marie Price (Director of Corporate Services) and Beverley
Watkins (Head of Human Resources at NEL CSU). The meetings were all quorate.
Barking and Dagenham Clinical Commissioning Group
56
The following key topics were discussed by the Committee in 2017/18:
HR policy updates
workforce reports
mandatory training
clinical lead appointments
Executive Team Structure and director appointment
senior staff and office holder remuneration
ELHCP leadership, NEL Accountable Officer appointment and managing director
arrangements
review of meetings attendance.
Committee effectiveness review
Members have considered Committee effectiveness this year. Their comments received
included:
Things that went well:
has met the statutory requirements of such a Committee
the interface with the NEL-wide Remuneration Committee
the handling of some contentious issues
good quality reports from the Director of Corporate Services
Areas for improvement:
keeping pace with senior management transition arrangements
close focus on management costs in the new governance arrangements
focus on strategic development of workforce and talent management
feedback from the NEL-level Committee
benchmarking of the work of other Remuneration Committees across NEL
Conclusion
The Committee has supported and challenged the Accountable Officer, where necessary, in
transitioning CCG staff into new working arrangements that are better suited to the new
challenges facing the BHR CCGs.
The Committee has also worked closely with Remuneration Committees across NEL to appoint
the new Accountable Officer and a managing director for the CCGs.
A key priority for the Committee in 2018/19 will be to support succession planning and staff
development and strengthening relationships with other Remuneration Committees in NEL as
new operating models are developed.
Kash Pandya
Chair
Annual report and accounts: 2017/18
57
Joint Finance and Delivery Committee (formerly ‘in common’) for BHR CCGs
From April to December 2017 the three BHR CCGs’ F&D Committees met as committee ‘in
common’. The Terms of Reference were reviewed at the December meeting and it was agreed
that the committee ‘in common’ would become a joint committee. The first meeting in that
format took place in March 2018.
The Joint F&D Committee provides assurance to the GBs that there are robust and integrated
mechanisms in place to ensure detailed review and oversight of the CCGs’ financial position. It
also provides assurance that all aspects of financial management are operating effectively,
through focus upon the key financial risk areas and ensures that CCGs are delivering their
financial targets within the System Delivery Plan (SDP).
The duties of the Committee are to:
Review and consider the financial and delivery plans and make recommendations to the
GBs.
Review significant risks identified by the Committee, the Chief Finance Officer, Executive or
GBs. Facilitate deep dives into Finance and Activity Data where required.
Report to the GBs on the overall status of financial and operational performance, assessing
potential shortfalls and risks and recommend GB-level mitigating actions to address them.
Review plans and progress reports on the delivery of SDP initiatives and ensure that plans
are supported by robust activity and financial information. Review in detail SDP schemes
that have been escalated to the group as high risk, and ensure that mitigating actions are in
place to enable recovery.
Receive reports on progress against action plans already in place.
Review and consider detailed monitoring reports and year end forecasts relating to financial
performance and performance of the CCGs against core standards, national and local
targets and the operating plan as required.
The membership and attendance record of the F&D Committee - both ‘in common’ and joint -
is outlined in the table below.
Note: Grey shaded boxes indicate the individual was not a member of the Committee at the time of
the meeting.
* Rotated as Chair when the committees met ‘in common’.
** Chair of joint committee D Indicates attendance by Deputy Chief Finance Officer (for the Chief Finance Officer)
Barking and Dagenham Clinical Commissioning Group
58
‘In common’ meetings
Jo
int
meeti
ng
Name of Committee member
27 A
pri
l 2017
28 J
un
e 2
017
29 A
ug
2017
25 O
ct
2017
21 D
ec 2
017
15 M
ar
2018
Total
attended /
total
possible
LA
Y
ME
MB
ER
S
Kash Pandya ** 6/6
Khalil Ali 4/4
CL
INIC
AL
DIR
EC
TO
RS
Dr Atul Aggarwal *
Havering x x 4/6
Dr Ann Baldwin
Havering x 0/1
Dr Sarah Heyes
Redbridge x x x 2/5
Dr Jagan John
Barking and Dagenham x 0/1
Dr Gurkirit Kalkat
Barking and Dagenham x x 3/5
Dr Anil Mehta
Redbridge 1/1
Dr Mehul Mathukia *
Redbridge x x 4/6
Dr Waseem Mohi *
Barking and Dagenham x x x x 2/6
Dr Gurdev Saini
Havering 1/1
Dr Maurice Sanomi
Havering x x x x 1/5
Dr Jyoti Sood
Redbridge x x x 2/5
Dr Muhammed Tahir
Redbridge x x 3/5
Dr Alex Tran
Havering x 4/5
SE
NIO
R M
AN
AG
ER
S
Sharon Morrow
Barking and Dagenham 2/2
Louise Mitchell
Redbridge x x 0/2
Steve Rubery 1/1
Gina Shakespeare 3/3
Alan Steward
Havering 2/2
Tom Travers x D x D x D 3/6
F&D Committee members and attendees
Annual report and accounts: 2017/18
59
The following key topics were discussed by the Committee in 2017/18:
regular reports on the financial risk overview
regular updates on the financial recovery programme
regular updates of the Borough Risk Register
regular review of System Delivery Framework
the Integrated Performance Report
current acute and non-acute contract performance
the 2017/19 Standard Contract
ELHCP arrangements, including risk share
locality updates
continuing healthcare pressures
In addition to sub group notes the Committee received the minutes of the Procurement
Oversight Group, BHR local Estates forum and ELHCP strategic objectives working group.
The committee also set time aside for more detailed deep dives into a number of areas, such
as Bariatric Surgery, ENT, Gastroenterology, Urology, Barts Health expenditure and day cases.
Committee effectiveness review
Comments were received from members on what they felt had gone well this year and what
could be improved.
Things that went well:
the attendance of senior clinicians has improved the debate
establishing a joint BHR meeting has improved the focus and is a better arrangement
better communication and a good chair, ensuring neutrality
better quality financial and performance reports
good level of challenge and discussion
the deep dives have helped to improve the understanding of underlying issues.
Areas for improvement:
more time could be allowed for key reports
more analysis of issues would improve the deep dive discussions
further clarity on the different role of the FRPB
ensuring that risks raised were referred to the assurance framework
continue to seek good attendance and member contribution
Conclusion
The establishment of a Joint F&D Committee has strengthened the focus on the financial
challenges facing the BHR health economy as a whole and the actions needed to address
them. The inclusion of senior clinicians on the Committee has provided a better link between
financial and clinical needs and facilitated focussed discussions on, for example, how demands
might be reduced, pathway developments and deep dives into areas of concern, for example,
day cases.
The Committee is very concerned about the financial position of the BHR CCGs and the
significant uncertainty that still remains in arriving at an agreed 2017/18 end of year contractual
position with BHRUT. This is currently subject to an Expert Determination but its outcome could
increase the level risk facing the CCGs. The Committee is committed to strengthening the
financial position of the CCGs and to bring the accounts into balance. However, it believes that
this will not be achieved in the shorter term and will require the commitment and closer working
Barking and Dagenham Clinical Commissioning Group
60
relationships with all major local providers, in particular BHRUT, to make it happen. To this end,
the Committee is very supportive of efforts being made to develop joint financial recovery and
delivery plans, new clinical pathways with BHRUT and new contractual arrangements that offer
more financial stability to stakeholders across the health economy.
Kash Pandya
Chair
Financial Recovery Programme Board
The FRPB was established to lead and drive financial recovery of the CCG so it can return to
recurrent financial balance within the NHS accounting rules as quickly as possible, consistent
with patient safety and quality. The board is authorised by the GB to investigate any activity
within its terms of reference. It is authorised to seek any information it requires in this regard
from any employee and all employees are directed to cooperate with any request made by the
FRPB.
The FRPB meets on a fortnightly basis. No attendance table is produced for this report as, due
to the frequency of meetings, it is recognised that members are not able to attend all the
meetings. However attendance levels overall have been sufficiently high for the board to
effectively transact its business over the course of the year.
The membership of the FRPB is outlined below:
Name Role
Tom Travers Chief Finance Officer, BHR CCGs
Dr Waseem Mohi Chair of Barking and Dagenham CCG
Dr Atul Aggarwal Chair of Havering CCG
Dr Anil Mehta Chair of Redbridge CCG
Dr Ravali Goriparthi Clinical Director, B&D CCG (to January 2018)
Dr Jagan John Clinical Director, B&D CCG
Dr Maurice Sanomi Clinical Director, Havering CCG (to January 2018)
Dr Gurdev Saini Clinical Director, Havering CCG
Dr Ann Baldwin Clinical Director, Havering CCG
Dr Mehul Mathukia Clinical Director, Redbridge CCG
Dr Sarah Heyes * Clinical Director, Redbridge CCG (to January 2018)
Kash Pandya Lay Member – Governance, BHR CCGs
Khalil Ali Lay Member, Redbridge CCG (from January 2018)
Conor Burke Chief Officer / Acting Managing Director
Gina Shakespeare Recovery Director / Interim Director of Delivery and Performance (from
June to December 2017)
Jacqui Himbury Nurse Director, BHR CCGs
Steve Rubery Director, Delivery and Performance (from February 2018)
B9: FRPB membership
Note: pre-January 2018, PPI Lay members for each CCG attended where necessary to support the
management conflicts of interest. From January 2018 Khalil Ali was able to fulfil this function as a
core member, along with the lay member for governance.
* Ceased to be a member in January 2018 but still attends as an attendee
Annual report and accounts: 2017/18
61
The meeting is also regularly attended by: Marie Price (Director of Corporate Services); James
Gregory and Jeremy Kidd (Director and Head of PMO respectively); Sarah See (Director of
Primary Care Transformation); Louise Mitchell and Sharon Morrow (SROs); and other officers,
as required to present their PIDs.
The FRPB has an agenda largely made up of standing items, with a particular focus on the
approval of business cases. The following key topics were discussed in 2017/18:
Development and regular updates on system recovery plan
Contract review and recommendations
Consideration and approval of business cases to deliver QIPP including:
Consultations on changes to prescribing and limiting some procedures for local patients
Single point of referral scheme
Community UEC proposals
Agency staff arrangements
Healthy London Partnership
Reviews of terms of reference
Committee effectiveness review
Things that went well:
Better reporting and improved quality of reports
Chance to question in real time
Focus and scrutiny on financial performance on a regular basis by key members
Areas for improvement:
More clinicians and keep agenda clinical
Greater follow-up on schemes that are failing to deliver
Have one topic as main agenda item to give more clinical scrutiny
Earlier distribution of papers
Joint Executive Committee (formerly known as Joint Executive Team/Executive
Committee) meeting as one ‘in common’ with fellow BHR CCGs
The CCGs did have a joint executive committee, which had begun to act as a committee ‘in
common’, however given the review of the CCGs’ financial situation and recommendation to
further integrate governance, the functions of the committee were folded into the new JC,
described earlier in this AGS.
Primary Care Commissioning Committee – meeting as one ‘in common’ with fellow BHR
CCGs
The CCGs established this committee in 2015 to function as a corporate decision-making body
for the management of the delegated functions and exercise of delegated powers. The
committee accounts directly to NHSE to ensure that all residents have access to a GP and that
GP practices deliver safe, high quality services to their patients.
The membership and attendance record of the GB members on the Primary Care
Commissioning Committee is outlined below:
Barking and Dagenham Clinical Commissioning Group
62
Name of Committee member
12 A
pr
2017
5 J
uly
2017
13 S
ep
t 2017
11 O
ct
2017
13 D
ec 2
017
14 F
eb
2018
Total
attended /
total
possible
LA
Y M
EM
BE
RS
Khalil Ali 6/6
Richard Coleman x 5/6
Kash Pandya x 5/6
Sahdia Warraich x 5/6
CL
INIC
AL
DIR
EC
TO
RS
Dr Atul Aggarwal x x x 3/6
Dr Shabana Ali 6/6
Dr Gurkirit Kalkat x 5/6
Dr Anil Mehta 6/6
Dr Waseem Mohi x x x x 2/6
Dr Alex Tran x x x x 2/6
SE
NIO
R
MA
NA
GE
RS
Conor Burke x x x 3/6
Jacqui Himbury x x x x x 1/6
Tom Travers x x x x 2/6
Dr Ah-fee Chan *
SECONDARY CARE CONSULTANT x x x x x x 0/6
B10: Primary Care Commissioning Committee membership and attendance
* Unable to attend due to planned clinical commitments. Consideration is being given to rescheduling
the regular meeting times.
The meeting is also regularly attended by: Sarah See (Director of Primary Care
Transformation); GPs, Healthwatch, Local Medical Committees, councillors and directors of
public health from all three boroughs; the Head of Primary Care at NHSE; and an independent
GP from outside BHR.
The following key topics were discussed
primary care budgets
APMS procurements
primary care improvement schemes
PMS review
discretionary payments and contract variations
primary care premises
primary care performance issues.
Annual report and accounts: 2017/18
63
Committee effectiveness review
Things that went well:
the committee has settled well into its role
it is chaired well and keeps to time
good, transparent, open discussion
collaborative working across BHR
NHSE representation at meetings is useful for clarification on items
good quality reports
challenge to manage conflicts of interest.
Areas for improvement:
financial information not always detailed enough
agenda and debate needs to be more patient focussed
clarity on sections of meetings
reports need to be less technical and easier to understand
assurance on the development of metrics, standards and comparative performance data
agenda and papers to be circulated a week in advance of meetings.
UK Corporate Governance Code
NHS Bodies are not required to comply with the UK Code of Corporate Governance.
Whilst the detailed provisions of the UK Corporate Governance Code are not mandatory for
public sector bodies, compliance is considered to be good practice. This Governance
Statement is intended to demonstrate the CCG’s compliance with the principles set out in the
Code (insofar as this applies to CCGs).
For the financial year ended 31 March 2018, and up to the date of signing this statement, we
complied with the provisions set out in the Code, and applied the principles of the Code.
Discharge of statutory functions
In light of recommendations of the 1983 Harris Review, the CCG 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
CCG is clear about the legislative requirements associated with each of the statutory functions
for which it is responsible, including any restrictions on delegation of those functions.
Responsibility for each duty and power has been clearly allocated to a lead director.
Directorates have confirmed that their structures provide the necessary capability and capacity
to undertake the CCG’s statutory duties.
Risk management arrangements and effectiveness
The CCG recognises that the establishment of effective risk management systems is
fundamental to ensuring effective governance. It has a risk management assurance framework
in place, the aim of which is to continually improve the quality of health service commissioning
through the identification, prevention, control and containment of risks of all kinds. It is based
on good practice and DH guidance. The framework supports the assessment and management
of risk throughout the organisation through a defined structure and clear systems and
processes. It applies to all members, office holders and employees, permanent or temporary, of
the CCG.
Barking and Dagenham Clinical Commissioning Group
64
The risk management structure of the BHR CCGs is shown below.
B11: BHR CCGs’ risk management structure
The risk management structure shows the linkages between the operational level risks at team
level, and the strategic risks which are managed at senior organisational or CCG GB level.
Risks are identified in various ways:
Proactive risk assessments
Incident reports (including serious incidents and never events)
Complaints
Audits
Serious case reviews
Feedback from Healthwatch, the PEF and Health Scrutiny Committee
Service improvement programmes
General stakeholder feedback.
Risk management is embedded in the organisation in a number of ways.
The JCAF is presented to every JC meeting at the beginning of the agenda to provide context
for later items related to finance, quality, performance, commissioning and strategy. There are
further detailed reports in the assurance section of the agenda directly following the JCAF on
the most high risk elements identified.
Annual report and accounts: 2017/18
65
Declarations of conflicts of interest features at the start of each JC meeting and the register of
interests is included at the start of the agenda and within the pack. The register of interests is
reviewed periodically by the AGC Chair and a smaller working group of governance and legal
officers.
All reports to the JC, AGC and other committees require a cover-sheet which asks document
authors to consider the following:
Risk implications
Impact on equality and diversity
Resource/ investment requirements
The integrated risk management framework is available on the staff intranet, together with the
CCG’s policies in relation to standards of business conduct, conflicts of interest, gifts and
hospitality, whistleblowing and fraud prevention.
Where risks are common across the three BHR CCGs they are included in the collaborative
risk register. Risks are discussed each month at the CCGs’ executive management meeting.
Based on criteria set out in the risk management framework and the current risk rating,
significant risks are escalated from the collaborative risk register to the JCAF. Some of the risks
that are rated as severe (red rated) are escalated to the JCAF where that risk is deemed to
pose a significant threat to the achievement of the CCG’s corporate objectives. When rating
risks, other factors are also taken into consideration, such as whether they are common to a
number of departments / functions or more than one CCG or where additional controls have not
succeeded in reducing the risk grading.
The risk management scoring system is used systematically in each review of the risk register.
This ensures that risks are escalated appropriately to the JCAF. Risks escalated to the JCAF
are reviewed with the relevant director prior to JC meetings.
The AGC periodically reviews the management process that is in place for the management of
risks and receives reports on specific emerging risks and risk mitigation.
Prevention and deterrence of risk has been promoted through staff training and development
sessions for JC members. This has included specific training on counter fraud and conflicts of
interest.
The organisation's ‘risk appetite’ is captured by the ‘target risk rating’ for each risk on the JCAF
and on the risk register.
Equality Impact Assessments (EIAs) are factored into the CCG’s core business through being
considered for all new developments. An EIA is carried out for all proposed service changes
and any revised or new policies that are developed across BHR CCGs. New spend in the
organisation must be agreed through a PID approval process and as part of this an EIA must
be developed and agreed by the CCGs’ Financial Recovery Performance Delivery Monitoring
meeting. Confirmation that an EIA has been completed is assured by including templates in
the standard paperwork for all projects and a date the EIA was carried out is included on all
revised and new polices. From a health and safety perspective, staff complete the mandatory
health and safety training. We have a facilities officer who makes regular inspection of our
office floors to ensure that any obstacles are dealt with to prevent incidents.
Where it is identified that a risk impacts on the CCGs’ stakeholders, including partner
commissioners, providers or the wider public, the CCG engages with them to manage and
mitigate such risks – for example with BHRUT in tackling performance risks on RTT and A&E
performance. There are also discussions with Healthwatch and patient groups on high risk
areas, including over the past year on the BHR CCGs’ challenging financial position.
Barking and Dagenham Clinical Commissioning Group
66
Healthwatch colleagues are invited to and attend the CCGs’ GB/JC meetings, providing the
patient input when the assurance framework and other specific risk areas are discussed.
Capacity to handle risk
The Accountable Officer provides leadership to the risk management process and, as a
member of the JC, ensures that the CCG’s approach to risk management is transparent and
the organisational structure supports effective systems and processes.
The management of risk across each team or function is led and reported by the relevant
Director / SRO with support from the corporate services team. Directors / SROs are involved in
regular reviews of the risk register and the assurance framework. The Director of Corporate
Services presents the JCAF to each JC meeting.
Training is seen as key to encouraging a culture where risk management is seen by the JC
members and our staff as essential. Presentations on counter fraud have been given to JC
members and at the all-staff briefing and the counter fraud officer holds monthly drop-in
sessions for staff to talk about any issues.
Members have also received briefings in relation to conflicts of interest.
Risk is also explicitly discussed and mitigation reviewed at the following meetings:
Senior management team meetings for identification and recording of borough risks
Monthly meetings with the relevant director / SRO and risk lead
Monthly executive management team meetings
F&D committee
Quality and safety committee
Primary care commissioning committee
AGC
BHR CCGs’ JC
The process in place ensures that there are regular forums to collaboratively review the
common risks, raise new risks, discuss and constructively challenge the effectiveness of the
mitigating actions and suggest changes as appropriate.
Risk assessment
The key risks to the CCG are as follows:
1. Barts Health performance improvement for 18 weeks RTT standard:
Management and mitigation:
RTT recovery improvement plan work is being implemented by Barts Health with
oversight by the co-ordinating commissioner (Newham CCG)
RTT and monthly performance meetings are held with the Trust
Real time validation of the patient target list until return to reporting by the Trust
Monthly confirmation sought via the lead commissioner of the exact number of BHR
patients waiting over 52 weeks
Completion of demand and capacity modelling that achieves compliance with the RTT
standard by September 2019
Attendance by BHR CCGs’ quality lead at the patient safety / harm reduction group.
2. CCGs’ financial recovery:
Management and mitigation:
BHR CCGs have developed the System Delivery Framework and Plan as a mechanism
to drive system recovery
Annual report and accounts: 2017/18
67
Implementation of our action plan from the Well Led Review and the associated System
Delivery Framework and Plan
Established the System Delivery and Performance Board to assure recovery plans and
ensure system-wide awareness and assistance (monitored via the F&D Committee).
The SDPB is now the Provider Alliance Board and led by provider colleagues.
Fortnightly FRPB chaired by the Chief Finance Officer
Financial Recovery Planning, Delivery and Monitoring group established, with
responsibility for oversight of the QIPP development process and monitoring delivery
against plan, reporting to the FRPB
Financial risk mitigation via our integrated financial strategy across the ELHCP area,
with continued development through the ELHCP process and supported by the risk
share agreement
Aim to overachieve the QIPP requirement so that schemes make bigger savings
Revised year end forecast agreed with NHSE
Forecast methodology assured through internal audit and a sub group of the AGC.
3. BHRUT’s mortality rate, as the number of patients dying in BHRUT for certain clinical
conditions is higher than what would be expected for those conditions:
Management and mitigation:
A contract performance notice was issued in August 2017 in respect of non- assurance
of BHRUT's mortality action plan (which is still open)
Revised action plan being implemented
Commissioners are fully assured that the Trust is compliant with the learning from
deaths guidance
Further assurance on the mitigating actions reported in the quality report presented to
the Quality and Safety Committee.
4. Poor quality of care and / or suffering harm as a result of BH's failure to achieve quality
indicators (never events, levels of healthcare-acquired infections and management
processes for serious incidents and complaints):
Management and mitigation:
Specific concerns formally escalated to the co-ordinating commissioner through the
NEL Quality Leads meeting
BHR CCGs' quality team attends Whipps Cross CQRM, which reviews performance
against all quality indicators and considers remedial action plans.
5. Missed or delayed diagnosis due to lack of robust systems and processes to report
radiological scans at BHRUT:
Management and mitigation
Assurance sought at the CQRG on radiological results backlog reduction; the
dissemination process for incidental findings and escalation by CQRG to contract
management group.
Other sources of assurance
Internal control framework
A system of internal control is the set of processes and procedures in place in the CCG to
ensure it delivers its policies, aims and objectives. It is designed to identify and prioritise the
Barking and Dagenham Clinical Commissioning Group
68
risks, to evaluate the likelihood of those risks being realised and the impact should they be
realised, and to manage them efficiently, effectively and economically.
The system of internal control allows risk to be managed to a reasonable level rather than
eliminating all risk; it can therefore only provide reasonable and not absolute assurance of
effectiveness. The earlier section on risk outlines how this process works for the CCG and
across the wider BHR CCG collaborative.
Annual audit of conflicts of interest management
The revised statutory guidance on managing conflicts of interest for CCGs (published June
2016) requires CCGs to undertake an annual internal audit of conflicts of interest management.
To support CCGs to undertake this task, NHSE has published a template audit framework.
The CCG’s internal auditors have carried out their annual internal audit of conflicts of interest
review, the outcome of which was that there was ‘substantial assurance’. There were two low
priority actions identified, relating to publicising the role and duties of the COI Guardian and to
ensuring the recording in meeting minutes that there were no interests to be declared.
Data quality
The CCG receives activity and financial data from NEL CSU as part of a contract it has for a
range of services from that organisation. The quality of the data used by the GB is considered
to be acceptable.
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 level of compliance demonstrated by completion of the IG Toolkit
is high – with a score of level 2.
We place high importance on ensuring there are robust information governance systems and
processes in place to help protect patient and corporate information. We have established an
information governance management framework and have developed information governance
processes and procedures in line with the information governance toolkit. We have ensured all
staff undertake annual information governance training and have implemented a staff
information governance handbook to ensure staff are aware of their information governance
roles and responsibilities. There are processes in place for incident reporting and investigation
of serious incidents. We are developing information risk assessment and management
procedures and a programme will be established to fully embed an information risk culture
throughout the organisation against identified risks.
Business critical models
An appropriate framework and environment is in place to provide quality assurance of business
critical models via NEL CSU, in line with the recommendations in the Macpherson report. No
business critical models have been identified that require information about quality assurance
processes for those models to be provided to the Analytical Oversight Committee chaired by
the Chief Analyst in the Department of Health.
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69
Third party assurances
The CCG commissions NEL CSU to run elements of our commissioning function – such as
contracting, business intelligence, communications and HR. The service standards are
monitored as part of an SLA and the AGC receives regular auditor reports on contracted-for
services.
Service Auditor report
We have considered the findings of the Service Auditor report covering the first half of this year,
carried out by the internal auditors of NHSE, where services are provided to the CCG from NEL
Commissioning Support Unit. Although there were issues raised, there were none which we
consider to be significant in this period. Prior to concluding this opinion, we will seek to review
the Service Auditor report for the remaining months of the financial year as well as the Service
Auditor report from the internal auditors of NHS Shared Business Services.
Financial transactions are carried out on behalf of the CCG by National Shared Business
Services (SBS), operating under a contract between NHSE and SBS. NHSE holds this contract
on behalf of all CCGs. A third party assurance statement will be shared by NHSE with the
CCGs following its receipt from the auditors of SBS.
Control issues
In the Month 9 Governance Statement return to NHSE, the CCG reported on the CCGs’
challenged financial position and the legal directions in respect of this (as referenced at the
beginning of this Governance Statement).
Review of economy, efficiency and effectiveness of the use of resources
The CCG has a comprehensive governance and reporting framework in place to monitor use of
resources, identify any issues and ensure the appropriate measures are taken to address any
variance from plans. The GB and newly-established JC receive regular summary reports
concerning the CCG’s financial performance, and the F&D Committee has authority to conduct
more detailed scrutiny and report back.
The F&D Committee convenes five times a year to scrutinise the detailed operational financial
performance of the CCG.
Given the CCG’s financial position, and that of the fellow BHR CCGs, enhanced governance
and scrutiny of spend is in place. The FRPB considers all investments and disinvestments, all
of which go through a prior and rigorous assurance process at the weekly Financial Recovery
Planning, Delivery and Monitoring group meeting.
The AGC is chaired by the GB Lay Member for Governance. The Lay Member for PPI is also a
member. The AGC performs the role of oversight and scrutiny of CCG policies, procedures and
systems of internal control, and had a focus on ensuring that conflicts of interest are managed
in line with the CCG’s Constitution. The Chair/Committee also reviews the self-certification
submissions that the CCG submits to NHSE each quarter regarding delegated primary care
commissioning
Underpinning the CCG’s governance framework are the Prime Financial Policies which set out
the key business rules which govern the organisation, including internal control, audit,
standards of business conduct and budgetary control. They also incorporate the scheme of
delegation. This sets out the level of authority to act and make decisions which has been
delegated from the CCG GB to the various executive committees, in addition to the
authorisation limits set by the GB for the management posts within the organisation to authorise
expenditure.
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70
Much of the CCG’s commissioning spend is covered by contracts managed on our behalf by
the CSU. The CCG received assurances on CSU performance through regular contractual
meetings, key performance indicator monitoring and minutes of the CSU/pan-CCG assurance
meeting to the AGC.
The CCG is rated as ‘requires improvement’, recognising the challenged financial position. A
‘well-led’ review and action plan developed in response to the BHR CCGs’ financial directions
has led to significant strengthening and improvement in the CCGs oversight and approach to
financial governance and QIPP delivery.
Delegation of functions
NEL CSU manages contracts with key providers on behalf of the CCG. The process is
overseen by the CCG and regularly reviewed through the internal audit process and discussion
at the AGC. In addition the Chief Finance Officer and relevant directors meet with the CSU lead
staff regularly to discuss performance and agree actions where there are concerns. Generally
the process has worked well over the past financial year.
The CCG is a delegated commissioner of primary care. The CCG’s arrangements for managing
this function are subject to regular review by internal audit and the AGC.
Counter fraud arrangements
The CCG has sound arrangements in place to counter fraud fully in line with the NHS Counter
Fraud Authority’s Standards for Commissioners: Fraud, Bribery and Corruption. This includes:
An Accredited Counter Fraud Specialist is contracted via RSM to undertake counter fraud
work proportionate to identified risks.
The AGC receives a report against each of the Standards for Commissioners at least
annually. There is executive support and direction for a proportionate proactive work plan
to address identified risks.
The Chief Finance Officer is responsible for tackling fraud, bribery and corruption.
Appropriate action is taken regarding any NHS Counter Fraud Authority quality assurance
recommendations.
B1(4) Head of Internal Audit Opinion
Following completion of the planned audit work for the financial year for the CCG, the Head of
Internal Audit issued an independent and objective opinion on the adequacy and effectiveness
of the Clinical Commissioning Group’s system of risk management, governance and internal
control.
In accordance with Public Sector Internal Audit Standards, the Head of Internal Audit is
required to provide an annual opinion, based upon and limited to the work performed, on the
overall adequacy and effectiveness of the organisation’s risk management, contro l and
governance processes. The opinion should contribute to the organisation's AGS.
The opinion
For the 12 months ended 31 March 2018, the Head of Internal Audit opinion for the CCG is that
the organisation has an adequate and effective framework for risk management, governance
and internal control. However, their work has identified further enhancements to the framework
of risk management, governance and internal control to ensure that it remains adequate and
effective.
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71
Internal audit plan
The formation of the opinion is achieved through a risk-based plan of work, agreed with
management and approved by the audit committee.
Based on the work undertaken in 2017/18 there is a generally sound system of internal control,
designed to meet the CCG’s objectives, and controls are generally being applied consistently,
although there are some specific areas where only partial assurance could be provided over
the design and operation of the systems of control to achieve the intended outcomes.
Either a substantial or reasonable level of assurance was provided in the areas reviewed under
the Internal Audit Plan, with two exceptions.
Partial assurance
Two reports were issued - GP Alerts and QIPP-phase one - where ‘partial assurance’ opinions
were assigned, meaning that the CGG can take partial assurance that the controls to manage
risks were suitably designed and consistently applied, and that action was needed to
strengthen the control framework to manage the identified risks.
GP Alerts
GP Alerts were reviewed following a specific request from management. Issues identified within
the GP Alerts control environment related to the need to have procedural guidance in place to
help staff implement a consistent approach to resolving alerts. The absence of this had led to
inefficiencies in resolving alerts.
There had been a backlog of alerts which could not be resolved in a timely manner, in the main
due to the absence of engagement from providers, but the CCGs had been working on bringing
in additional resource to deal with the backlog and stop it recurring.
The GPs were also not always kept informed about progress on resolving their alerts, which
meant there was a lack of assurance at times on how improvements to services were being
delivered.
QIPP - Phase One
There was a process, assurance mechanism and governance arrangements in place which
were adequately designed and complied with, but a ‘partial assurance’ opinion was given
based predominantly on under-delivery of the QIPP schemes.
The delivery against a very challenging target and without the input from the local acute Trust
compared favourably given the overall size of the QIPP challenge. Despite this, there were
considerable risks that the CCG would not meet the QIPP targets by the end of the year as set
by NHSE.
Action plans were agreed to address the issues raised in both of the above reports and follow
up confirmed that management had implemented the actions within the implementation dates
agreed.
Substantial assurance
Two reviews on Conflicts of Interest and on Primary Care Delegated Commissioning were
assigned ‘substantial assurance’ opinions.
Reasonable assurance
Two reviews on Budget Setting, Control and Financial Reporting and on the Board Assurance
Framework were assigned ‘reasonable assurance’ opinions.
Barking and Dagenham Clinical Commissioning Group
72
Advisory review
An advisory review on the Information Governance Toolkit (version 14.1) was completed. No
significant control issues were identified.
CSU Quality Assurance Plan
In relation to the CSU Quality Assurance Plan either a substantial or reasonable level of
assurance was provided in the areas reviewed, with one exception. This related to
Procurement where a ‘partial assurance’ opinion was assigned, meaning that the GB can take
partial assurance that the controls to manage risks were suitably designed and consistently
applied, and that action was needed to strengthen the control framework to manage the
identified risks.
Procurement
While a number of actions have been raised within this report it should be acknowledged that
the CCG does have well established controls in place over procurement reporting to the
Procurement Oversight Group, as well as controls around SFI limits. However, there are
continuing lessons to be learnt from the issues identified, which relate to a limited service
specification within the SLA with the CSU. Greater clarity was required over definition of roles
and responsibilities of the two parties, while confirming the CCG expectations on reporting and
monitoring on procurement from the CSU. It was found that there was also inadequate
documentation held on the conflicts of interest declarations and quotation documentation for a
sample of procurement exercises undertaken by the CSU.
A clear action plan was agreed to address the issues raised, which internal audit will continue
to follow up and report on progress through their progress report to the audit committee.
Topics judged relevant for consideration as part of the annual governance statement
Based on the work they have undertaken to date on the CCG’s system on internal control,
internal audit do not consider that within these areas there are any issues that need to be
flagged as significant control issues within the Annual Governance Statement (AGS). They
noted the CCG may wish to consider the potential significance of the control issues identified
during the course of the CCG reviews on GP Alerts; and QIPP and the CSU review on
Procurement for which all three were provided with partial assurance. They further noted that
the CCG may also wish to consider whether any other issues have arisen, including the results
of any external reviews, which it might want to consider for inclusion in the Annual Governance
Statement.
Internal audit management actions
Management agreed actions to address all of the findings reported by internal audit during
2017/18.
Follow up of actions agreed to address previous years’ (ie pre 2017/18) internal audit findings
showed that there were no such actions remaining outstanding at the end of March 2018.
Internal audit reports
During the year, Internal Audit issued the following audit reports:
Annual report and accounts: 2017/18
73
Area of Audit Level of Assurance Given
QIPP report – phase 1 Partial assurance
GP Alerts Partial assurance
Conflicts of Interest Substantial assurance
Assurance Framework and Risk Management Reasonable assurance
Primary Care Delegated Commissioning Substantial assurance
Information Governance Toolkit Advisory
B12: Internal audit reports
B1(5) Review of the effectiveness of governance, risk management
and internal control
As Accountable Officer I have responsibility for reviewing the effectiveness of the system of
internal control within the CCG.
Review of effectiveness
My review of the effectiveness of the system of internal control is informed by the work of
the internal auditors who have produced satisfactory assurance reports on our governance
system and framework. It is also informed by the directors and clinical leads within the CCG
who have responsibility for the development and maintenance of the internal control
framework. My attendance at the GB and JC of the BHR GBs enables me to gain
assurance that the system of internal control is operating effectively. I also regularly meet
with the senior manager risk lead to review our effectiveness in managing risk and the
supporting systems and processes we have in place.
I have drawn on performance information available to me and on the minutes and chairs’
reports presented to the GB/JC meetings from the Finance and Delivery Committee, the
Financial Recovery Programme Board, the Quality and Safety Committee, the Audit and
Governance Committee and the Remuneration and Workforce Committee and am assured
by the arrangements in place. I also regularly meet with the Lay Member for Governance
and with the Chair of the GB to reflect on effectiveness and improvements needed.
I have taken account of the review of effectiveness undertaken with GB/JC members and
the Audit and Governance Committee. These both reflected a good degree of confidence in
our systems and processes but recognised that there is scope for further improvement.
My review is also informed by comments made by the external auditors in their
management letter and other reports.
The JCAF itself provides me with evidence that the effectiveness of controls that manage
risks to the CCG achieving its principal 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 GB, the Audit and Governance Committee and other
Committees of the GB. Plans to address weaknesses, learn from best practice and ensure
continuous improvement of the system are in place.
Barking and Dagenham Clinical Commissioning Group
74
Following completion of the planned audit work for the financial year for the CCG, the Head
of Internal Audit issues an independent and objective opinion on the adequacy and
effectiveness of the CCG’s system of risk management, governance and internal control. I
also use this information to inform my view on the effectiveness of our arrangements.
Conclusion
None of the auditors’ reports considered by the Audit and Governance Committee during
2017/18 raised significant internal control issues and I am satisfied that the systems outlined in
this statement reflect an organisation that generally operates with effective and sound systems
of internal control.
As reported in the 2016/17 annual report, the BHR CCGs were issued with legal directions in
respect of the challenged financial position. There has been improvement in the CCG’s
systems and processes in response, but it must be noted that the directions remain. We will
continue our focus in the coming year in delivering against all of the requirements, and plan
effectively, with our system partners for a more sustainable financial future for the borough and
BHR.
B2. Remuneration and Staff Report
B2(1) Remuneration report
Remuneration and Workforce Committee
CCGs are required to have a remuneration committee to oversee the pay, terms and conditions
of service of senior managers. Because we have a joint management team across Barking and
Dagenham, Havering and Redbridge CCGs, which includes a number of joint director level, lay
member and secondary care consultant posts, we operate a number of joint committees and
committees ‘in common’ (where all three CCG committees meet at the same time, and some
members are there to represent two or more committees in the same meeting).
The Remuneration and Workforce Committee is a committee ‘in common’. Details of the
membership and its work during the last year are contained in the Governance Statement
(section B1(3)).
The main function of the committee is to make recommendations on the remuneration,
allowances and terms of service of other officer members to ensure they are fairly rewarded for
their individual contribution to the organisation, having regard for the organisation’s
circumstances and performance, and taking into account national arrangements.
The committee received professional HR advice from NEL CSU, whose remit includes advising
BHR CCGs on all workforce matters. The committee is satisfied that the advice received was
objective and independent. The service is provided under terms of the service level agreement
with the CSU.
Policy on the remuneration of senior managers
The NHS has adopted the recommendations outlined in the Greenbury report in respect of the
disclosure of senior managers’ remuneration and the manner in which it is determined. Senior
managers are defined as those persons in senior positions having authority or responsibility for
directing or controlling the major activities of the CCG. This means those who influence the
decisions of the CCG as a whole rather than the decisions of individual directorates or
departments. Such persons will include advisory and lay members. This report outlines how
those recommendations have been implemented by the CCG in the year to 31 March 2018.
Annual report and accounts: 2017/18
75
The remuneration of senior managers is determined by the Remuneration and Workforce
Committee in line with national NHS ‘Agenda for Change’ and very senior manager pay
guidance. The Committee reviews information about director and GB members’ responsibilities,
as well as comparing remuneration in similar organisations to set pay.
Remuneration of Very Senior Managers
The CCG did not employ any individual whose gross salary was greater than £150,000.
Contractual arrangements
The chair, clinical directors and lay members are appointed by the CCG. Clinical directors and
lay members are on fixed term contracts of up to five years in length, depending on individual
circumstances. The Accountable Officer and other Executive Directors are on permanent
contracts, subject to the notice periods of either three or six months.
Barking and Dagenham Clinical Commissioning Group
76
Senior manager remuneration (including salary and pension entitlements) (subject to audit)
2017/18 2016/17
Name and title
Salary
(bands of
£5,000)
Expense
payments
(taxable) to
nearest
£100
All
pension-
related
benefits
(bands of
£2,500)
Total
(bands of
£5,000)
Salary
(bands of
£5,000)
Expense
payments
(taxable) to
nearest
£100
All
pension-
related
benefits
(bands of
£2,500)
Total
(bands of
£5,000)
£000s £000s £000s £000s £000s £000s £000s £000s
Directors
Jane Milligan
Accountable Officer, from 1/12/17 5 - 10 n/a 0 - 2.5 5 - 10
Conor Burke
Acting Managing Director (1/12/17 - 31/3/18) 10 - 15 n/a 2.5 - 5 15 - 20
Conor Burke
Accountable Officer (1/4/13 - 30/11/17), 25 - 30 n/a 5 - 7.5 30 - 35 35 - 40 n/a nil 35 - 40
Tom Travers
Chief Finance Officer, from 1/5/14 35 - 40 n/a 2.5 - 5 40 - 45 35 - 40 n/a 10 - 12.5 45 - 50
Sarah See
Director of Primary Care Transformation, from
1/7/14
25 - 30 n/a 10 - 12.5 35 - 40 25 - 30 n/a 10 - 12.5 35 - 40
Jane Gateley
Director of Strategy and Integration, from 1/4/13 20 - 25 n/a 0 20 - 25 20 - 25 n/a 0 - 2.5 20 - 25
Jacqui Himbury
Nurse Director, from 1/4/13 25 - 30 n/a 7.5 - 10 35 - 40 25 - 30 n/a 12.5 - 15 40 - 45
Marie Price
Director of Corporate Services, from 1/4/13 20 - 25 n/a 2.5 - 5 25 - 30 20 - 25 n/a 0 - 2.5 20 - 25
Regina Shakespeare
Director of Delivery and Performance, 31/7/17 -
21/12/17
15 - 20 n/a n/a 15 - 20
Steve Rubery
Director of Delivery and Performance, from 5/2/18 0 - 5 n/a 42.5 - 45 45 - 50
Rob Meaker
Programme Director Innovation, 1/4/14 - 30/7/17 5 - 10 n/a 5 – 7.5 15 - 20 25 - 30 n/a 0 - 2.5 25 - 30
Annual report and accounts: 2017/18
77
2017/18 2016/17
Name and title
Salary
(bands of
£5,000)
Expense
payments
(taxable) to
nearest
£100
All
pension-
related
benefits
(bands of
£2,500)
Total
(bands of
£5,000)
Salary
(bands of
£5,000)
Expense
payments
(taxable) to
nearest
£100
All
pension-
related
benefits
(bands of
£2,500)
Total
(bands of
£5,000)
£000s £000s £000s £000s £000s £000s £000s £000s
Sharon Morrow,
Mental Health and LD Transformation Programme
Director, 1/4/13 - 30/7/17
35 - 40 n/a 37.5 - 40 70 - 75 100 - 105 n/a 50 - 52.5 150 - 155
Clinical directors
Dr Waseem Mohi
Chair, from 1/4/13 60 - 65 n/a n/a 60 - 65 60-65 n/a n/a 60-65
Dr Ravali Goriparthi
Clinical Director, from 1/4/14 45 - 50 n/a n/a 45 - 50 45-50 n/a n/a 45-50
Dr Jagan John
Clinical Director, from 1/4/13 45 - 50 n/a n/a 45 - 50 45-50 n/a n/a 45-50
Dr Rami Hara
Clinical Director, from 1/4/13 45 - 50 n/a n/a 45 - 50 45-50 n/a n/a 45-50
Dr Gurkirit Kalkat
Clinical Director, from 1/4/13 45 - 50 n/a n/a 45 - 50 45-50 n/a n/a 45-50
Dr Anju Gupta
Clinical Director, from 1/9/15 45 - 50 n/a n/a 45 - 50 45-50 n/a n/a 45-50
Dr Kanika Rai
Clinical Director, from 1/4/16 45 - 50 n/a n/a 45 - 50 35-40 n/a n/a 35-40
Lay members and secondary care consultant
Kash Pandya, Vice Chair; Lay Member –
Governance, from 1/4/13 10 -15 n/a n/a 10 -15 10-15 n/a n/a 10-15
Charles Beaumont, Associate Independent Lay
Voting Member, from 1/5/13 0 - 5 n/a n/a 0 - 5 0-5 n/a n/a 0-5
Sahdia Warraich
Lay Member PPI, from 1/4/13 15 - 20 n/a n/a 15 - 20 15-20 n/a n/a 15-20
Dr Steve Ryan
Secondary Care Consultant, 4/1/16 - 31/3/17 10-15 n/a n/a 10-15
B13: Senior manager remuneration
Barking and Dagenham Clinical Commissioning Group
78
Salaries and allowances of senior managers 2017/18 (Full remuneration as paid by Redbridge CCG on behalf of all BHR CCGs before recharge to Barking and Dagenham and Havering CCGs) (subject to audit)
2017/18 2016/17
Name and title Note: dates in previous table
Salary (bands of £5,000)
Expense payments (taxable) to nearest £100
All pension-related benefits (bands of £2,500)
Total (bands of £5,000)
Salary (bands of £5,000)
Expense payments (taxable) to nearest £100
All pension-related benefits (bands of £2,500)
Total (bands of £5,000)
£000s £000s £000s £000s £000s £000s £000s £000s
Directors
Jane Milligan* Accountable Officer
50 - 55 n/a 20 – 22.5 70 - 75
Conor Burke Acting Managing Director
45 - 50 n/a 7.5 - 10 55 - 60
Conor Burke Accountable Officer
105 - 110 n/a 35 - 37.5 145 - 150 145 - 150 n/a 0 145 - 150
Tom Travers Chief Finance Officer
140 - 145 n/a 12.5 - 15 155 - 160 140 - 145 n/a 37.5 - 40 180 - 185
Sarah See Director of Primary Care Transformation
105 - 110 n/a 35 - 37.5 145 - 150 100 - 105 n/a 37.5 - 40 140 - 145
Jane Gateley Director of Strategy and Integration
75 - 80 n/a 0 75 - 80 75 - 80 n/a 0 - 2.5 75 - 80
Jacqui Himbury Nurse Director
105 - 110 n/a 30 - 32.5 135 - 140 100 - 105 n/a 50 - 52.5 150 - 155
Marie Price Director of Corporate Services
80 - 85 n/a 12.5 - 15 95 - 100 80 - 85 n/a 0 - 2.5 85 - 90
Regina Shakespeare Director of Delivery and Performance
65 - 70 n/a n/a 65 - 70
Steve Rubery Director of Delivery and Performance
15 - 20 n/a 157.5 - 160 170 - 175
Rob Meaker Programme Director Innovation
30 - 35 n/a 25 – 27.5 60 - 65 100 - 105 n/a 5 - 7.5 110 - 115
Lay members
Kash Pandya Vice Chair; Lay Member – Governance
40 - 45 n/a n/a 40 - 45 40 - 45 n/a n/a 40 - 45
Charles Beaumont, Associate Independent Lay Voting Member
5 - 10 n/a n/a 5 - 10 5 - 10 n/a n/a 5 - 10
B14: Salaries and allowances of senior managers * Jane Milligan held the position of Accountable Officer from 1 December 2017. During that time she was Accountable Officer at Barking and Dagenham, Havering, Redbridge, Waltham Forest, Newham, Tower Hamlets, City and Hackney CCGs. Her total salary, which is paid through Tower Hamlets CCG, for the 12 month period in 2017-18 was Salary: £140k to £145k; Pension Related Benefits: £20k to £22.5k; Total £160k to £165k. Corresponding entries are shown in the accounts of the other CCGs.
Annual report and accounts: 2017/18
79
Salary and pension benefits of directors and senior managers as at 31 March 2018 (subject to audit)
The following schedule discloses further information regarding remuneration and pension entitlements
Name and title
Real increase in pension at pension age
Real increase in pension lump sum at pension age (bands of £2,500)
Total accrued pension at pension age at 31 March 2018 (bands of £5,000)
Lump sum at pension age related to accrued pension at 31 March 2018 (bands of £5,000)
Cash equivalent transfer value at 1 April 2017 (to nearest £1,000)
Real increase in cash equivalent transfer value (to nearest £1,000)
Cash equivalent transfer value at 31 March 2018 (to nearest £1,000)
Employer's contribution to stakeholder pension (to nearest £1,000)
£000 £000 £000 £000 £000 £000 £000 £000
Jane Milligan Accountable Officer
0 - 2.5 0 40 - 45 100 - 105 666 20 732 0
Conor Burke Accountable Officer/ Acting Managing Director
0 - 2.5 0 25 - 30 55 - 60 392 48 444 0
Tom Travers Chief Finance Officer
0 - 2.5 2.5 - 5 30 - 35 95 - 100 603 66 675 0
Sarah See Director of Primary Care Transformation
2.5 - 5 0 - 2.5 25 - 30 55 -60 342 51 397 0
Jane Gateley Director of Strategy and Integration
0 – 2.5 0 25 - 30 70 - 75 489 21 515 0
Jacqui Himbury Nurse Director
0 - 2.5 0 - 2.5 20 - 25 55 -60 342 52 397 0
Marie Price Director of Corporate Services
0 – 2.5 0 10 - 15 n/a 132 21 154 0
Steve Rubery Director of Delivery and Performance
0 – 2.5 0 – 2.5 55 - 60 100 - 105 792 8 856 0
Rob Meaker Programme Director Innovation
0 - 2.5 0 30 - 35 85 -90 464 17 521 0
Sharon Morrow Mental Health and LD Transformation Programme Director
0 - 2.5 2.5 - 5 40 - 45 125 - 130 819 34 928 0
Pension benefits
Note: yellow shading indicates full remuneration paid by Redbridge CCG
Barking and Dagenham Clinical Commissioning Group
80
Cash equivalent transfer values
A cash equivalent transfer value (CETV) is the actuarially assessed capital value of the pension
scheme benefits accrued by a member at a particular point in time. The benefits valued are the
member’s accrued benefits and any contingent spouse’s (or other allowable beneficiary’s)
pension payable from the scheme.
A CETV is a payment made by a pension scheme or arrangement to secure pension benefits in
another pension scheme or arrangement when the member leaves a scheme and chooses to
transfer the benefits accrued in their former scheme. The pension figures shown relate to the
benefits that the individual has accrued as a consequence of their total membership of the
pension scheme, not just their service in a senior capacity to which disclosure applies.
The CETV figures and the other pension details include the value of any pension benefits in
another scheme or arrangement which the individual has transferred to the NHS pension
scheme. They also include any additional pension benefit accrued to the member as a result of
their purchasing additional years of pension service in the scheme at their own cost. CETVs are
calculated within the guidelines and framework prescribed by the Institute and Faculty of
Actuaries.
Real increase in CETV
This reflects the increase in CETV that is funded by the employer. It does not include the
increase in accrued pension due to inflation or contributions paid by the employee (including
the value of any benefits transferred from another scheme or arrangement).
Pensions
All staff, including senior managers, are eligible to join the NHS pensions scheme. The scheme
has fixed the employer’s contribution at 14.38% of the individual’s salary as per the NHS
Pension Agency regulations. Employee contribution rates for CCG officers and the prior year
comparators, are as follows:
Member Contribution Rates before tax relief (gross) from 1 April 2015
The table below sets out the member contribution rates that will apply in both the 1995 and
2008 Sections, as well as the new 2015 Scheme from 1 April 2015 until 31 March 2019:
Tier Full-time pensionable pay/earnings used to
determine contribution rate
Contribution rate (before tax relief) (gross)
1 April 2015 to 31 March 2019
1 Up to £15,431.99 5.0%
2 £15,432.00 to £21,477.99 5.6%
3 £21, 478.00 to £26,823.99 7.1%
4 £26,824.00 to £47,845.99 9.3%
5 £47,846.00 to £70,630.99 12.5%
6 £70,631.00 to £111,376.99 13.5%
7 £111,377.00 and over 14.5%
B16: Contribution rates before tax relief (gross)
Scheme benefits are set by the NHS Pensions Agency and are applicable to all members.
Past and present employees are covered by the provisions of the NHS pension scheme. For
full details of how pension liabilities are treated please see note 4.4 in the annual accounts.
Annual report and accounts: 2017/18
81
Termination agreements or exit packages (subject to audit)
Termination arrangements are applied in accordance with statutory regulations as modified by
national NHS conditions of service agreements (specified in Agenda for Change), and the NHS
pension scheme. Specific termination arrangements will vary according to age, length of
service and salary levels. The remuneration committee will agree any severance arrangements.
During the financial year there were no payments made in relation to payments to past
members.
Pay multiples (subject to audit)
Reporting bodies are required to disclose the relationship between the remuneration of the
highest-paid director/Member in their organisation and the median remuneration of the
organisation’s workforce.
The banded remuneration of the highest paid director/member in Barking and Dagenham CCG
in the financial year 2017/18 was £105,000 – £110,000 (2016/17: £100,000 - £105,000). This
was 8.68 times (2016/17: 9.20) the median remuneration of the workforce, which was £12,348
(2016/17: £11,290).
In 2017/18, no employees received remuneration in excess of the highest-paid
director/Member. Remuneration ranged from £0 to £110,000 (2016/17: £0 to £105,000)
Total remuneration includes salary, non-consolidated performance-related pay, benefits-in-kind,
but not severance payments. It does not include employer pension contributions and the cash
equivalent transfer value of pensions.
B2(2) Staff report
Staff numbers, costs and composition (subject to audit)
Information on staff numbers can be found in note 4.2 of the financial statements.
The tables below show numbers of senior managers by band, staff numbers and costs (for all
staff) and the staff composition in terms of the number of people of each sex on the GB and all
other staff.
Band No.
VSM 4
Band 9 4
Off payroll 1
Other* 10
Total 19
B17: Number of senior managers by band
* Other relates to clinical directors, lay members and secondary care clinical consultants
Type Male Female Total
Governing Body* 11 8 19
Other 51 124 175
Total 62 132 194
B18: Staff composition
* GB numbers include senior managers
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82
Employee benefits
2017-18 Total Admin Programme
Total Permanent
employees Other Total
Permanent
employees Other Total
Permanent
employees Other
£000s £000s £000s £000s £000s £000s £000s £000s £000s
Employee benefits
Salaries and wages 2,945 541 2,404 1562 509 1,053 1,383 32 1,351
Social security costs 63 63 0 59 59 0 4 4 0
Employer
Contributions to
NHS Pension
scheme
72 72 0 72 72 0 0 0 0
Termination benefits 25 25 0 0 0 0 25 25 0
Gross employee
benefits
expenditure
3,105 701 2,404 1,693 640 1,053 1,412 61 1,351
Net employee
benefits excluding
capitalised costs
3,105 701 2,404 1,693 640 1,053 1,412 61 1,351
B19: Employee benefits 2017/18
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83
2016-17 Total Admin Programme
Total Permanent
employees Other Total
Permanent
employees Other Total
Permanent
employees Other
£000s £000s £000s £000s £000s £000s £000s £000s £000s
Employee benefits
Salaries and wages 3,163 586 2,577 1,594 557 1,037 1,569 29 1,540
Social security costs 67 67 0 64 64 0 3 3 0
Employer
Contributions to
NHS Pension
scheme
70 70 0 70 70 0 0 0 0
Gross employee
benefits
expenditure
3,300 723 2,577 1,728 691 1,037 1,572 32 1,540
Net employee
benefits excluding
capitalised costs
3,300 723 2,577 1,728 691 1,037 1,572 32 1,540
B20: Employee benefits 2016/17
As per the Manual for Accounts the overarching principle is that transactions should be accounted for in accordance with International Financial
Reporting Standards, with all treatments having been agreed by both parties. Generally, this determines that revenue income and expenditure should be
recorded gross, unless the transaction is of a non-trading nature and an organisation is deemed to be acting solely as an agent and does not gain any
economic benefit from the transaction. Therefore employee benefits are shown on a net basis as disclosed within note 5. Only the element of the salary
relating to the CCG has been recorded as expenditure as in substance the employee works for both organisations and the recharge is merely an
administrative arrangement.
As per note 1.4.1 a proportion of the pay costs incurred in the year by the CCG have been recharged to and from Barking and Dagenham CCG and
Havering CCG. Redbridge CCG and these two organisations operate within an integrated management support structure.
Barking and Dagenham Clinical Commissioning Group
84
Sickness absence data
Sickness absence data is reported below for the calendar year (January to December 2017).
2017 Number
Total days lost 136
Total number of staff years 13
Average working days lost per staff year 11
B21: 2017 staff sickness absence
Staff policies on employment of people with disabilities
Our approach to ensuring equality of opportunity in the employment of people with a disability
and how we give full and fair consideration to job applications made by people with a disability
is set out in several policies, particularly our Recruitment and Selection and Absence
Management policies.
We offer interviews to all applicants with a disability, providing their application scores
sufficiently highly against the essential criteria for the job. Employees with a disability, or who
become disabled while employed by us, are encouraged to inform us about any ‘reasonable
adjustments’ to their employment or working conditions which they consider to be necessary or
which they think would help them to carry out their job. We carefully consider all proposals like
this and, where we can, make the adjustments. There may, however, be circumstances where
it will not be reasonable or reasonably practicable to do this and so where less favourable
treatment may be justified in accordance with the statutory provisions. Our policies also outline
what we do to help existing employees to continue working for us if they get a disability,
including making sure we arrange for appropriate training. They detail any other arrangements
regarding training, career development and promotion of people with a disability who are
employed by the CCG.
Expenditure on consultancy
2017-18
Total
2017-18
Admin
2017-18
Programme
2016-17
Total
£000 £000 £000 £000
36 11 25 12
B22: Expenditure on consultancy
Off-payroll engagements
For all off-payroll engagements as of 31 March 2018, for more than £245 per day and that last
for longer than six months:
Number of existing engagements as of 31 March 2018 4.05
Of which, the number that have existed:
for less than one year at the time of reporting 1.89
for between one and two years at the time of reporting 0.54
for between 2 and 3 years at the time of reporting 0.54
for between 3 and 4 years at the time of reporting 1.08
for 4 or more years at the time of reporting -
B23: Off-payroll engagements longer than 6 months
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85
For all new off-payroll engagements between 1 April 2017 and 31 March 2018, for more than
£245 per day and that last longer than six months:
Number of new engagements, or those that reached six months in duration, between 1 April 2017 and 31 March 2018
5.13
Of which:
number assessed as caught by IR35 3.24
number assessed as not caught by IR35 1.89
and
number engaged directly (via PSC contracted to department) and are on the departmental payroll
-
number of engagements reassessed for consistency/ assurance purposes during the year.
-
number of engagements that saw a change to IR35 status following the consistency review.
-
B24: New off-payroll engagements
For any off-payroll engagements of Board members and / or senior officials with significant
financial responsibility, between 1 April 2017 and 31 March 2018:
Number of off-payroll engagements of board members, and/or senior officers with significant financial responsibility, during the financial year
0.27
Total no. of individuals on payroll and off-payroll that have been deemed “board members, and/or, senior officials with significant financial responsibility”, during the financial year. This figure should include both on payroll and off-payroll engagements.
0.54
B25: Off-payroll engagements / senior official engagements
Exit packages, including special (non-contractual) payments
Termination arrangements are applied in accordance with statutory regulations as modified by
national NHS conditions of service agreements (specified in Agenda for Change), and the NHS
pension scheme. Specific termination arrangements will vary according to age, length of
service and salary levels. The remuneration committee will agree any severance arrangements.
Exit package cost band (including any
special payment element)
Number of
compulsory
redundancies
Cost of compulsory
redundancies
Number £s
£25,001 - £50,000 1 25,200
Totals 1 25,200
B26: Costs of exit packages
Redundancy and other departure costs have been paid mirroring the provisions of the NHS
Agenda for Change Terms and Conditions. Exit costs in note 4.3 are the full costs of
departures agreed in the year.
The redundancy cost shown relates to the BHR CCGs’ Accountable Officer role following the
establishment of a single Accountable Officer covering the seven CCGs within North East
London.
Barking and Dagenham Clinical Commissioning Group
86
Trade union facility time
Number of employees who were relevant union
officials during the relevant period Full-time equivalent employee number
1 1.0
B27: Relevant union officials
Percentage of time Number of employees
0% Nil
1-50% 1
51%-99% Nil
100% Nil
B28: Percentage of time spent on facility time
Total cost of facility time £1,810
Total pay bill £2,688,829
Percentage of the total pay bill spent on facility
time 0.067%
B29: Percentage of pay bill spent on facility time
Time spent on paid trade union activities as a
percentage of total paid facility time hours 14.36%
B30: Paid trade union activities
B3. Parliamentary Accountability and Audit Report
Barking and Dagenham CCG is not required to produce a Parliamentary Accountability and
Audit Report.
Where relevant, disclosures on remote contingent liabilities, losses and special payments, gifts,
and fees and charges are included as notes in the Financial Statements of this report at
Section C. The disclosure on losses and special payments is at note 18.
An audit certificate and report is also included in this Annual Report at section B3(1) below.
Annual report and accounts: 2017/18
87
B3(1) Audit certificate and report
INDEPENDENT AUDITOR’S REPORT TO THE MEMBERS OF THE GOVERNING BODY OF
NHS BARKING AND DAGENHAM CLINICAL COMMISSIONING GROUP
REPORT ON THE AUDIT OF THE FINANCIAL STATEMENTS
Opinion
We have audited the financial statements of NHS Barking and Dagenham Clinical
Commissioning Group (“the CCG”) for the year ended 31 March 2018 which comprise the
Statement of Comprehensive Net Expenditure, Statement of Financial Position, Statement of
Changes in Taxpayers Equity and Statement of Cash Flows, and the related notes, including
the accounting policies in note one.
In our opinion the financial statements:
give a true and fair view of the state of the CCG’s affairs as at 31 March 2018 and of its
income and expenditure for the year then ended; and
have been properly prepared in accordance with the accounting policies directed by the
NHS Commissioning Board with the consent of the Secretary of State as being relevant to
CCGs in England and included in the Department of Health Group Accounting Manual
2017/18.
Basis for opinion
We conducted our audit in accordance with International Standards on Auditing (UK) (“ISAs
(UK)”) and applicable law. Our responsibilities are described below. We have fulfilled our
ethical responsibilities under, and are independent of the Trust in accordance with, UK ethical
requirements including the FRC Ethical Standard. We believe that the audit evidence we have
obtained is a sufficient and appropriate basis for our opinion.
Going concern
We are required to report to you if we have concluded that the use of the going concern basis
of accounting is inappropriate or there is an undisclosed material uncertainty that may cast
significant doubt over the use of that basis for a period of at least twelve months from the date
of approval of the financial statements. We have nothing to report in these respects.
Other information in the Annual Report
The Accountable Officer is responsible for the other information presented in the Annual Report
together with the financial statements. Our opinion on the financial statements does not cover
the other information and, accordingly, we do not express an audit opinion or, except as
explicitly stated below, any form of assurance conclusion thereon.
Our responsibility is to read the other information and, in doing so, consider whether, based on
our financial statements audit work, the information therein is materially misstated or
inconsistent with the financial statements or our audit knowledge. Based solely on that work we
have not identified material misstatements in the other information. In our opinion the other
information included in the Annual Report for the financial year is consistent with the financial
statements.
Annual Governance Statement
We are required to report to you if the Annual Governance Statement does not comply with
guidance issued by the NHS Commissioning Board. We have nothing to report in this respect.
Barking and Dagenham Clinical Commissioning Group
88
Remuneration and Staff Report
In our opinion the parts of the Remuneration and Staff Report subject to audit have been
properly prepared in accordance with the Department of Health Group Accounting Manual
2017/18.
Accountable Officer’s responsibilities
As explained more fully in the statement set out on page 41, the Accountable Officer is
responsible for: the preparation of financial statements that give a true and fair view; such
internal control as they determine is necessary to enable the preparation of financial statements
that are free from material misstatement, whether due to fraud or error; assessing the CCGs
ability to continue as a going concern, disclosing, as applicable, matters related to going
concern; and using the going concern basis of accounting unless they have been informed by
the relevant national body of the intention to dissolve the CCG without the transfer of its
services to another public sector entity.
Auditor’s responsibilities
Our objectives are to obtain reasonable assurance about whether the financial statements as a
whole are free from material misstatement, whether due to fraud or error, and to issue our
opinion in an auditor’s report. Reasonable assurance is a high level of assurance, but does not
guarantee that an audit conducted in accordance with ISAs (UK) will always detect a material
misstatement when it exists. Misstatements can arise from fraud or error and are considered
material if, individually or in aggregate, they could reasonably be expected to influence the
economic decisions of users taken on the basis of the financial statements.
A fuller description of our responsibilities is provided on the FRC’s website at
www.frc.org.uk/auditorsresponsibilities
REPORT ON OTHER LEGAL AND REGULATORY MATTERS
Qualified opinion on regularity
We are required to report on the following matters under Section 25(1) of the Local Audit and
Accountability Act 2014.
In our opinion, except for the effects of the matter described below, 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.
Basis for qualified opinion on regularity
The CCG reported a deficit of £5.7 million in its financial statements for the year ending 31
March 2018, thereby breaching its duty under the National Health Service Act 2006, as
amended by paragraph 223I of Section 27 of the Health and Social Care Act 2012, to ensure
that its revenue resource use in a financial year does not exceed the amount specified by NHS
England.
Report on the CCG’s arrangements for securing economy, efficiency and effectiveness
in its use of resources
Under the Code of Audit Practice we are required to report to you if the CCG has not made
proper arrangements for securing economy, efficiency and effectiveness in its use of resources.
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89
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 reflect compliance with guidance
issued by the NHS Commissioning Board; or
We issue a report in the public interest under section 24 of the Local Audit and
Accountability Act 2014; or
We make a written recommendation to the CCG under section 24 of the Local Audit and
Accountability Act 2014.
We have nothing to report in respect of the above responsibilities.
Other matters on which we are required to report by exception – proper arrangements
for securing economy, efficiency and effectiveness
Qualified conclusion
Except for the matters in the basis for qualified conclusion paragraph below we are satisfied
that in all significant respects NHS Barking and Dagenham CCG put in place proper
arrangements for securing economy, efficiency and effectiveness in the use of resources for
the year ended 31 March 2018.
Basis for qualified conclusion
In considering the CCG’s arrangements for securing sustainable resource deployment, we
identified that the CCG reported a deficit of £5.7 million in its financial statements for the year
ending 31 March 2018.
Respective responsibilities in respect of our review of arrangements for securing
economy, efficiency and effectiveness in the use of resources
As explained more fully in the statement set out on page 69, the Accountable Officer is
responsible for ensuring that the CCG exercises its functions effectively, efficiently and
economically. We are required under section 21(1)(c) of the Local Audit and Accountability Act
2014 to be satisfied that the CCG has made proper arrangements for securing economy,
efficiency and effectiveness in its use of resources.
We are not required to consider, nor have we considered, whether all aspects of the CCGs
arrangements for securing economy, efficiency and effectiveness in the use of resources are
operating effectively.
We have undertaken our review in accordance with the Code of Audit Practice, having regard
to the specified criterion issued by the Comptroller and Auditor General (C&AG) in November
2017, 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. We planned our work in accordance with the Code of Audit Practice and
related guidance. Based on our risk assessment, we undertook such work as we considered
necessary.
Statutory reporting matters
We are required by Schedule 2 to the Code of Audit Practice issued by the Comptroller and
Auditor General (‘the Code of Audit Practice’) to report to you if:
We refer a matter to the Secretary of State under section 30 of the Local Audit and
Accountability Act 2014 because we have reason to believe that the CCG, or an officer of
the CCG, is about to make, or has made, a decision which involves or would involve the
Barking and Dagenham Clinical Commissioning Group
90
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 Local Audit and
Accountability Act 2014; or
We make a written recommendation to the CCG under section 24 of the Local Audit and
Accountability Act 2014.
In relation to the above on 21 May 2018 we wrote to the Secretary of State in accordance with
Section 30(b) of the 2014 Act in respect of the CCG’s breach of its revenue resource limit. The
CCG’s financial statements for financial year end 31 March 2018 identified a deficit of £5.7
million in 2017/18 against its revenue resource limit.
THE PURPOSE OF OUR AUDIT WORK AND TO WHOM WE OWE OUR
RESPONSIBILITIES
This report is made solely to the Members of the Governing Body of NHS Barking and
Dagenham CCG, as a body, in accordance with Part 5 of the Local Audit and Accountability Act
2014. Our audit work has been undertaken so that we might state to the Members of the
Governing Body of the CCG, as a body, 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 Members of the Governing Body, as a
body, for our audit work, for this report or for the opinions we have formed.
CERTIFICATE OF COMPLETION OF THE AUDIT
We certify that we have completed the audit of the accounts of NHS Barking and Dagenham
CCG in accordance with the requirements of the Local Audit and Accountability Act 2014 and
the Code of Audit Practice.
Neil Thomas
for and on behalf of KPMG LLP, Statutory Auditor
Chartered Accountants
15 Canada Square
Canary Wharf
London
E14 5GL
X May 2017
Annual report and accounts: 2017/18
91
Section C. ANNUAL ACCOUNTS
Jane Milligan
Accountable Officer
24 May 2018
Barking & Dagenham CCG - Annual Accounts 2017-18
Statement of Comprehensive Net Expenditure for the year ended
31 March 2018
2017-18 2016-17
Note £'000 £'000
Income from sale of goods and services 2 (1,055) (2,334)
Other operating income 2 (382) (272)
Total operating income (1,437) (2,606)
Staff costs 4 3,105 3,300
Purchase of goods and services 5 308,088 304,446
Provision expense 5 3,382 8
Other Operating Expenditure 5 407 436
Total operating expenditure 314,982 308,190
Net Operating Expenditure 313,545 305,584
Comprehensive Expenditure for the year ended 31 March 2018 313,545 305,584
Statement of Financial Position as at
31 March 2018
2017-18 2016-17
Note £'000 £'000
Current assets
Trade and other receivables 8 3,571 3,535
Cash and cash equivalents 9 9 25
Total current assets 3,580 3,560
Total assets 3,580 3,560
Current liabilities
Trade and other payables 10 (26,772) (24,248)
Provisions 11 (5,235) (1,868)
Total current liabilities (32,007) (26,116)
Non-Current Assets plus/less Net Current Assets/Liabilities (28,427) (22,556)
Non-current liabilities
Provisions 11 - (6)
Total non-current liabilities 0 (6)
Assets less Liabilities (28,427) (22,562)
Financed by Taxpayers’ Equity
General fund (28,427) (22,562)
Total taxpayers’ equity (28,427) (22,562)
The notes on pages x to xx form part of this statement
Jane Milligan
Accountable Officer
The financial statements on pages [ ] to [ ] were approved by the Governing Body on 24th May 2018 and
signed on its behalf by:
Barking & Dagenham CCG - Annual Accounts 2017-18
Statement of Changes In Taxpayers Equity for the year ended
31 March 2018 2017-18 2016-17
£'000 £'000
Balance at 01 April (22,562) (19,898)
Net Recognised NHS CCG Expenditure for the Financial Year (313,545) (305,584)
Net funding 307,680 302,920
Balance at 31 March (28,427) (22,562)
Statement of Cash Flows for the year ended
31 March 2018
2017-18 2016-17
Note £'000 £'000
Cash Flows from Operating Activities
Net operating expenditure for the financial year (313,545) (305,584)
(Increase)/decrease in trade & other receivables 8 (36) (78)
Increase/(decrease) in trade & other payables 10 2,524 2,723
Provisions utilised 11 (21) (19)
Increase/(decrease) in provisions 11 3,382 8
Net Cash Inflow (Outflow) from Operating Activities (307,696) (302,950)
Net Cash Inflow (Outflow) before Financing (307,696) (302,950)
Cash Flows from Financing Activities
Net Funding Received 307,680 302,920
Net Cash Inflow (Outflow) from Financing Activities 307,680 302,920
Net Increase (Decrease) in Cash & Cash Equivalents 9 (16) (30)
Cash & Cash Equivalents at the Beginning of the Financial Year 25 55
Cash & Cash Equivalents (inc bank overdrafts) at the End of the Financial Year 9 25
The notes on pages x to xx form part of this statement
Barking & Dagenham CCG - Annual Accounts 2017-18
Notes to the financial statements
1. Accounting Policies
NHS England has directed that the financial statements of clinical commissioning groups (CCGs) shall meet
the accounting requirements of the Group Accounting Manual issued by the Department of Health and
Social Care. Consequently, the following financial statements have been prepared in accordance with the
Group Accounting Manual 2017-18 issued by the Department of Health and Social Care. The accounting
policies contained in the Group Accounting Manual follow International Financial Reporting Standards to the
extent that they are meaningful and appropriate to CCGs, as determined by HM Treasury, which is advised
by the Financial Reporting Advisory Board. Where the Group Accounting Manual permits a choice of
accounting policy, the accounting policy which is judged to be most appropriate to the particular
circumstances of the CCG for the purpose of giving a true and fair view has been selected. The particular
policies adopted by the CCG 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 despite the issue of a report to the
Secretary of State for Health under section 30 of the Local Audit and Accountability Act 2014.
As at 31st March 2018 the CCG had net liabilites of £28,427,000 (£22,562,000 as at 31st March 2017).
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.
The ability of the CCG to continue as a going concern is dependent upon its ability to secure future funding
from NHS England. The funding for 2018/19 has already been agreed with NHS England. On this basis,
there is no reason to believe that sufficient funding will not be made available to the CCG in the 12 months
from the date of approval of these Financial Statements. As such the Financial Statements have been
prepared on a going concern basis.
Where a CCG ceases to exist, it considers whether or not its services will continue to be provided (using the
same assets, by another public sector entity) in determining whether to use the concept of going concern for
the final set of Financial Statements. If services will continue to be provided the financial statements are
prepared on the going concern basis.
1.2 Accounting Convention
These accounts have been prepared under the historical cost convention modified to account for the
revaluation of property, plant and equipment, intangible assets, inventories and certain financial assets and
financial liabilities.
1.3 Pooled Budgets
The CCG has entered into a pooled budget arrangement with the London Borough of Barking and
Dagenham under Section 75 of the National Health Service Act 2006. The CCG has assessed the
accounting treatment of the pooled budget arrangement having regard to IFRS10, IFRS11, and IAS28. The
CCG have assessed that while joint control over the pooled budget is present, the substance of the
arrangement is that the parties to the pooled budget are each responsible for commissioning services from
providers, with the risks and rewards arising from the contractual obligation remaining with each respective
commissioner. The CCG has therefore recognised in its financial statements:
- The assets it controls
- The liabilities it controls
- The expenses it incurs
- Its share of the income from the pooled budget activities
1.4 Critical Accounting Judgements & Key Sources of Estimation Uncertainty
In the application of the clinical commissioning group’s accounting policies, management is required to
make judgements, estimates and assumptions about the carrying amounts of assets and liabilities that are
not readily apparent from other sources. The estimates and associated assumptions are based on historical
experience and other factors that are considered to be relevant. Actual results may differ from those
estimates and the estimates and underlying assumptions are continually reviewed. Revisions to accounting
estimates are recognised in the period in which the estimate is revised if the revision affects only that period
or in the period of the revision and future periods if the revision affects both current and future periods.
Barking & Dagenham CCG - Annual Accounts 2017-18
1.4.1 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:
Partially completed spells
Expenditure relating to patient care spells that are part-completed at the year-end are apportioned across
the financial years on the basis of length of stay at the end of the reporting period compared to expected
total length of stay. The CCG use figures as agreed with local Providers.
Maternity pathways
Expenditure relating to all antenatal maternity care is made at the start of the pathway. As a result, at the
year-end part completed pathways are treated as a prepayment. The CCG use figures as agreed with local
Providers.
Accruals
For goods and/or services that have been delivered but for which no invoice has been received/sent, the
CCG has made an accrual based upon known commitments, contractual arrangements that are in place
and legal obligations.
Prescribing liabilities
NHS England actions monthly cash charges to the CCG for prescribing contracts. These are issued
approximately 8 weeks in arrears. The CCG use information provided by the NHS Business Authority as
part of the estimate for full year expenditure.
Continuing healthcare retrospective case provision
Provisions comprise an estimated amount which the CCG believe it will be liable to pay in relation to
continuing healthcare retrospective claims to be received for activities for periods of care post 1st April
2012. The CCG use the National Framework for NHS Continuing Healthcare and NHS Funded Nursing
Care to evaluate a claim and forms an opinion on the likelihood of that claim being upheld.
Pay and non pay recharges
A proportion of the pay and non pay costs incurred in the year by the CCG have been recharged to NHS
Redbridge CCG and NHS Havering CCG. NHS Barking & Dagenham CCG and these two organisations
operate within an integrated management support structure. Shared costs incurred by the other two CCGs
have also been recharged to the CCG.
Costs which are specific to the running of each CCG are not recharged and remain costs within each
specific CCG's Statement of Comprehensive Net Expenditure. Shared payroll costs are recharged across
the three CCGs based upon geographical population or an estimate of the underlying activity. Shared non
pay costs are also recharged on this basis as it is considered a reasonable proxy of the relative share of
expenditure.
Pay recharges are shown net within the Statement of Comprehensive Net Expenditure. Non pay and
agency cost items are shown net of related income.
Better Care Fund accounting
The CCG has recorded transactions in line with a lead commissioning arrangement whereby the risks and
rewards of the contractual obligation of the pool fund budget lay with each respective lead commissioner.
2017-18 Acute Over Performance
The CCG has estimated contractual over performance for acute activity. The amounts recognised within
these financial statements are estimated at the level the CCG believes it may be liable to pay once
contractual and activity issues have been resolved which will occur post the balance sheet date.
1.5 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.
Barking & Dagenham CCG - Annual Accounts 2017-18
1.6 Employee Benefits
1.6.1 Short-term Employee Benefits
Salaries, wages and employment-related payments are recognised in the period in which the service is
received from employees, including bonuses earned but not yet taken.
The cost of leave earned but not taken by employees at the end of the period is recognised in the financial
statements to the extent that employees are permitted to carry forward leave into the following period.
1.6.2 Retirement Benefit 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.
1.7 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 clinical commissioning group has a
present legal or constructive obligation, which occurs when all of the conditions attached to the payment
have been met.
1.8 Leases
All leases are classified as operating leases.
1.8.1 The CCG as Lessee
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.
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.
1.9 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 CCG’s cash management.
1.10 Provisions
Provisions are recognised when the CCG has a present legal or constructive obligation as a result of a past
event, it is probable that the CCG will be required to settle the obligation, and a reliable estimate can be
made of the amount of the obligation. The amount recognised as a provision is the best estimate of the
expenditure required to settle the obligation at the end of the reporting period, taking into account the risks
and uncertainties.
1.11 Clinical Negligence Costs
NHS Resolution operates a risk pooling scheme under which the CCG pays an annual contribution to NHS
Resolution which in return settles all clinical negligence claims. The contribution is charged to expenditure.
Although NHS Resolution is administratively responsible for all clinical negligence cases, the legal liability
remains with the CCG.
1.12 Non-clinical Risk Pooling
The CCG participates in the Property Expenses Scheme and the Liabilities to Third Parties Scheme. Both
are risk pooling schemes under which the CCG pays an annual contribution to NHS Resolution and, in
return, receives assistance with the costs of claims arising. The annual membership contributions, and any
excesses payable in respect of particular claims are charged to operating expenses as and when they
become due.
Barking & Dagenham CCG - Annual Accounts 2017-18
1.13 Continuing healthcare risk pooling
In 2014-15 a risk pool scheme was introduced by NHS England for continuing healthcare claims, for claim
periods prior to 31 March 2013. Under the scheme, CCGs contributed annually to a pooled fund, which is
used to settle the claims. The final year that CCGs were required to contribute the pool was 2016/17.
1.14 Financial Assets
Financial assets are recognised when the CCG 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.
All financial assets are classified as loans and receivables.
1.14.1 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.
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.
1.15 Financial Liabilities
Financial liabilities are recognised on the statement of financial position when the CCG group becomes
party to the contractual provisions of the financial instrument or, in the case of trade payables, when the
goods or services have been received. Financial liabilities are de-recognised when the liability has been
discharged, that is, the liability has been paid or has expired.
1.16 Value Added Tax
Most of the activities of the CCG 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.
1.17 Foreign Currencies
The CCG’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 CCG's surplus/deficit in the period in which they arise.
1.18 Losses & Special Payments
Losses and special payments are items that Parliament would not have contemplated when it agreed funds
for the health service or passed legislation. By their nature they are items that ideally should not arise. They
are therefore subject to special control procedures compared with the generality of payments. They are
divided into different categories, which govern the way that individual cases are handled.
Losses and special payments are charged to the relevant functional headings in expenditure on an accruals
basis, including losses which would have been made good through insurance cover had the CCG not been
bearing its own risks (with insurance premiums then being included as normal revenue expenditure).
Barking & Dagenham CCG - Annual Accounts 2017-18
1.19 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 clinical commissioning group records its share of
the income and expenditure; gains and losses; assets and liabilities; and cash flows.
1.20 Accounting Standards That Have Been Issued But Have Not Yet Been Adopted
The DHSC Group accounting manual does not require the following Standards and Interpretations to be
applied in 2017-18. These standards are still subject to FREM adoption and early adoption is therefore not
permitted.
· IFRS 9: Financial Instruments ( application from 1 January 2018)
· IFRS 14: Regulatory Deferral Accounts ( not applicable to DH groups bodies)
· IFRS 15: Revenue for Contract with Customers (application from 1 January 2018)
· IFRS 16: Leases (application from 1 January 2019)
· IFRS 17: Insurance Contracts (application from 1 January 2021)
· IFRIC 22: Foreign Currency Transactions and Advance Consideration (application from 1 January 2018)
· IFRIC 23: Uncertainty over Income Tax Treatments (application from 1 January 2019)
The application of the Standards as revised would not have a material impact on the accounts for 2017-18,
were they applied in that year.
Barking & Dagenham CCG - Annual Accounts 2017-18
2. Other Operating Revenue2016-17
Total Admin Programme Total
£'000 £'000 £'000 £'000
Education, training and research 7 7 - 15
Non-patient care services to other bodies 1,048 119 929 2,319
Other revenue 382 71 311 272
Total other operating revenue 1,437 197 1,240 2,606
Administration revenue is that which is not directly attributable to the provision of healthcare or healthcare services.
3. Revenue
4. Employee benefits and staff numbers
4.1 Employee benefits 2016-17
TotalPermanent
EmployeesOther Total
£'000 £'000 £'000 £'000
Salaries and wages 2,945 541 2,404 3,163
Social security costs 63 63 - 67
Employer contributions to the NHS Pension Scheme 72 72 - 70
Termination benefits 25 25 - -
Gross employee benefits expenditure 3,105 701 2,404 3,300
4.2 Average number of people employed
2016-17
TotalPermanently
employedOther Total
Number Number Number Number
Total 47 11 36 57
2017-18
Other Operating Revenue does not include cash received from NHS England; this is drawn down directly into the CCG's bank
account and credited to the General Fund.
A proportion of the pay costs incurred in the year by the CCG have been recharged from Havering and Redbridge CCGs; this is in
relation to the integrated management support structure which the CCG operates with these two organisations.
The element of permanent staff recharged from Havering and Redbridge CCGs is included within "Other".
Revenue is generated wholly from the supply of services; the CCG receives no revenue from the sale of goods.
2017-18
2017-18
Barking & Dagenham CCG - Annual Accounts 2017-18
4.3 Exit packages agreed in the financial year
Number £ Number £
£25,001 to £50,000 1 25,200 - -
Total 1 25,200 - -
4.4 Pension costs
4.4.1 Accounting valuation
4.4.2 Full actuarial (funding) valuation
Compulsory redundancies
2016-17
Compulsory redundancies
2017-18
These tables report the number and value of exit packages agreed in the financial year. The expense associated with these
departures may have been recognised in part or in full in a previous period.
Redundancy and other departure costs have been paid mirroring the provisions of the NHS Agenda for Change Terms &
Conditions.
Past and present employees are covered by the provisions of the two NHS Pension Schemes. Details of the benefits payable
and rules of the Schemes can be found on the NHS Pensions website at www.nhsbsa.nhs.uk/nhs-pensions.
Both are unfunded defined benefit schemes that cover NHS employers, GP practices and other bodies, allowed under the
direction of the Secretary of State in England and Wales. They are not designed to be run in a way that would enable NHS
bodies to identify their share of the underlying scheme assets and liabilities.
Therefore, each scheme is accounted for as if it were a defined contribution scheme: the cost to the NHS body of participating
in each scheme is taken as equal to the contributions payable to that scheme for the accounting period.
In order that the defined benefit obligations recognised in the financial statements do not differ materially from those that would
be determined at the reporting date by a formal actuarial valuation, the FReM requires that “the period between formal
valuations shall be four years, with approximate assessments in intervening years”. An outline of these follows:
A valuation of scheme liability is carried out annually by the scheme actuary (currently the Government Actuary’s Department)
as at the end of the reporting period. This utilises an actuarial assessment for the previous accounting period in conjunction with
updated membership and financial data for the current reporting period, and is accepted as providing suitably robust figures for
financial reporting purposes. The valuation of the scheme liability as at 31 March 2018, is based on valuation data as 31 March
2017, updated to 31 March 2018 with summary global member and accounting data. In undertaking this actuarial assessment,
the methodology prescribed in IAS 19, relevant FReM interpretations, and the discount rate prescribed by HM Treasury have
also been used.
The latest assessment of the liabilities of the scheme is contained in the report of the scheme actuary, which forms part of the
annual NHS Pension Scheme Accounts. These accounts can be viewed on the NHS Pensions website and are published
annually. Copies can also be obtained from The Stationery Office.
The purpose of this valuation is to assess the level of liability in respect of the benefits due under the schemes (taking into
account recent demographic experience), and to recommend contribution rates payable by employees and employers.
The last published actuarial valuation undertaken for the NHS Pension Scheme was completed for the year ending 31 March
2012. The Scheme Regulations allow for the level of contribution rates to be changed by the Secretary of State for Health, with
the consent of HM Treasury, and consideration of the advice of the Scheme Actuary and employee and employer
representatives as deemed appropriate.
The next actuarial valuation is to be carried out as at 31 March 2016 and is currently being prepared. The direction assumptions
are published by HM Treasury which are used to complete the valuation calculations, from which the final valuation report can
be signed off by the scheme actuary. This will set the employer contribution rate payable from April 2019 and will consider the
cost of the Scheme relative to the employer cost cap. There are provisions in the Public Service Pension Act 2013 to adjust
member benefits or contribution rates if the cost of the Scheme changes by more than 2% of pay. Subject to this ‘employer cost
cap’ assessment, any required revisions to member benefits or contribution rates will be determined by the Secretary of State
for Health after consultation with the relevant stakeholders.
For 2017-18, employer's contributions of £78,261 were payable to the NHS Pensions Scheme (2016-17: £73,791) at the rate of
14.38% 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 2012.
Barking & Dagenham CCG - Annual Accounts 2017-18
5. Operating expenses2017-18 2017-18 2017-18 2016-17
Total Admin Programme Total
£'000 £'000 £'000 £'000
Gross employee benefits
Employee benefits excluding governing body members 2,819 1,406 1,413 2,990
Executive governing body members 286 286 - 310
Total gross employee benefits 3,105 1,692 1,413 3,300
Other costs
Services from other CCGs and NHS England 2,975 1,969 1,006 3,255
Services from foundation trusts 70,366 - 70,366 71,791
Services from other NHS trusts 133,395 - 133,395 128,744
Purchase of healthcare from non-NHS bodies 35,364 - 35,364 34,532
Purchase of social care 4,862 - 4,862 4,747
Chair and Non Executive Members 407 401 6 436
Supplies and services – general 2,484 328 2,156 4,339
Consultancy services 36 11 25 12
Establishment 327 55 272 104
Premises 835 32 803 881
Audit fees 51 51 - 50
Prescribing costs 26,797 - 26,797 27,044
GPMS/APMS and PCTMS 29,873 - 29,873 28,201
Other professional fees excl. audit 161 131 30 124
Legal fees 66 69 (3) 184
Education and training 496 19 477 -
Provisions 3,382 (8) 3,390 8
CHC Risk Pool contributions - - - 438
Total other costs 311,877 3,058 308,819 304,890
Total operating expenses 314,982 4,750 310,232 308,190
6. Better Payment Practice Code
Measure of compliance 2017-18 2017-18 2016-17 2016-17
Number £'000 Number £'000
Non-NHS Payables
Total Non-NHS Trade invoices paid in the Year 10,625 78,082 11,425 77,204
Total Non-NHS Trade Invoices paid within target 10,141 75,982 10,772 73,129
Percentage of Non-NHS Trade invoices paid within target 95% 97% 94% 95%
NHS Payables
Total NHS Trade Invoices Paid in the Year 2,646 212,345 2,847 208,224
Total NHS Trade Invoices Paid within target 2,496 206,134 2,606 207,168
Percentage of NHS Trade Invoices paid within target 94% 97% 92% 99%
The fee to the CCG's external auditors, KPMG LLP, is £42,450 excluding VAT. The figure shown in the note above includes
irrecoverable VAT at 20%.
The contract, signed on the 21 December 2017, states that the liability of KPMG, its members, partners and staff (whether in
contract, negligence or otherwise) shall in no circumstances exceed £500k, aside from where the liability cannot be limited by law.
This is in aggregate in respect of all services.
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
In 2017-18 no payments were made in relation to claims under the Late Payment of Commerical Debts (Interest) Act 1998 (nil in
2016-17).
Barking & Dagenham CCG - Annual Accounts 2017-18
7. Operating Leases
7.1 As lessee
7.1.1 Payments recognised as an Expense 2017-18 2016-17
Buildings Total Buildings Total
£'000 £'000 £'000 £'000
Payments recognised as an expense
Minimum lease payments 701 701 798 798
Total 701 701 798 798
7.1.2 Future minimum lease payments 2017-18 2016-17
Buildings Total Buildings Total
£'000 £'000 £'000 £'000
Payable:
No later than one year 87 87 74 74
Between one and five years 178 178 222 222
After five years - - - -
Total 265 265 296 296
As part of the lease agreement with Dooba Investments III Limited the CCG negotiated a period of time
which was classed as "rent free". The rent free period benefit equates to £9,318 and is recognised as a
reduction of rental expense over the lease term, on a straight line basis. The carry forward value for the rent
free period is £5,799; this is contained within Other Payables and Accruals in Note 10 Trade and Other
Payables.
Minimum lease payments for 2017-18, therefore, include payments made to both organisations, however,
nothing has been included in future minimum lease payments.
The CCG holds a lease agreement with Dooba Investments III Limited for the use of office space. The
lease is for 5 years, from 20th April 2016 to 19th April 2021 and the annual rental payment is £88,724 with
no rental reviews taking place in this period.
In accordance with directions from NHS England payments made to NHS Property Services Limited and
Community Health Partnerships Limited in respect of the use of property assets are being treated as
operating leases under IFRIC4 and IAS17 but, as no formal contract is in place, it is not possible to disclose
future cost arrangements.
Barking & Dagenham CCG - Annual Accounts 2017-18
8. Trade and other receivablesCurrent Current
2017-18 2016-17
£'000 £'000
NHS receivables: Revenue 991 946
NHS prepayments 1,418 1,474
NHS accrued income 834 808
Non-NHS and Other WGA receivables: Revenue 75 71
Non-NHS and Other WGA prepayments 133 70
Non-NHS and Other WGA accrued income 71 124
VAT 49 42
Other receivables and accruals - -
Total Trade & other receivables 3,571 3,535
8.1 Receivables past their due date but not impaired 2017-18 2017-18 2016-17
£'000 £'000 £'000
DH Group
Bodies
Non DH
Group
Bodies
All
receivables
prior years
£'000 £'000 £'000
By up to three months 16 24 317
By three to six months - 19 9
By more than six months - (3) 58
Total 16 40 384
9. Cash and cash equivalents
2017-18 2016-17
£'000 £'000
Balance at 01 April 2017 25 55
Net change in year (16) (30)
Balance at 31 March 2018 9 25
Made up of:
Cash with the Government Banking Service 9 25
Balance at 31 March 2018 9 25
10. Trade and other payables Current Current
2017-18 2016-17
£'000 £'000
NHS payables: revenue 1,747 6,272
NHS accruals 6,416 2,058
Non-NHS and Other WGA payables: Revenue 3,709 2,975
Non-NHS and Other WGA accruals 14,324 12,424
Social security costs 14 16
Tax 11 13
Payments received on account 8 6
Other payables and accruals 543 484
Total Trade & Other Payables 26,772 24,248
Other payables include a total pension liability of £292,473. This includes outstanding pension contributions for CCG
employees of £13,422 (16/17 £14,071) as at 31 March 2018; the balance relates to GP Pension contributions.
Barking & Dagenham CCG - Annual Accounts 2017-18
11. Provisions
Current Non-current Current Non-current
2017-18 2017-18 2016-17 2016-17
£'000 £'000 £'000 £'000
Continuing care 934 - 955 -
Other 4,301 - 913 6
Total 5,235 - 1,868 6
Total current and non-current 5,235 1,874
Continuing
CareOther Total
£'000 £'000 £'000
Balance at 01 April 2017 955 919 1,874
Arising during the year - 4,301 4,301
Utilised during the year (21) - (21)
Reversed unused - (919) (919)
Transfer (to) from other public sector body under absorption - - -
Balance at 31 March 2018 934 4,301 5,235
Expected timing of cash flows:
Within one year 934 4,301 5,235
Between one and five years - - -
After five years - - -
Balance at 31 March 2018 934 4,301 5,235
Continuing Care
Other
12. Contingencies
A contingent liability is a potential obligation that may result, but is not likely to result because the event causing the
obligation is improbable.
There were no contingent liabilities in 2017-18 (nil in 2016-17).
Two provisions have been fully reversed: that held in respect of a rent free period for an operating lease has been set
up as a payable in 'Other payable and accruals'; that for the Life Study Centre was not required.
The CCG continues to recognise a provision under IAS 37 in respect of continuing healthcare retrospective claims
received for activities covering periods post 1 April 2012.
During 2017-18 £21,032 was utilised to settle continuing healthcare cases; the CCG deemed these cases, which had
not been funded previously, to be eligible for continuing health care status.
The amount carried forward represents the estimated value of outstanding restitution payments still currently under
review. Cases are reviewed in line with the National Framework for NHS Continuing Healthcare and NHS Funded
Nursing Care guidance.
The item arising relates to a provision the CCG is holding for its anticipated financial outturn with providers.
NHS Resolution is holding a provision of £246k in its accounts as at 31 March 2018 with respect to Barking and
Dagenham CCG; this is in relation to the Existing Liabilities Scheme (ELS).
Barking & Dagenham CCG - Annual Accounts 2017-18
13. Financial instruments
13.1 Financial risk management
13.1.1 Currency risk
13.1.2 Interest rate risk
13.1.3 Credit risk
13.1.4 Liquidity risk
13.2 Financial assets
Loans and
Receivables
Loans and
Receivables
2017-18 2016-17
£'000 £'000
Receivables:
· NHS 1,825 1,755
· Non-NHS 146 195
Cash at bank and in hand 9 25
Total at 31 March 1,980 1,975
13.3 Financial liabilities
Other Other
2017-18 2016-17
£'000 £'000
Payables:
· NHS 8,163 8,330
· Non-NHS 18,576 15,883
Total at 31 March 26,739 24,213
The CCG borrows from government for capital expenditure, subject to affordability as confirmed by NHS England. The borrowings
are for 1 to 25 years, in line with the life of the associated assets, and interest is charged at the National Loans Fund rate, fixed for
the life of the loan. The CCG therefore has low exposure to interest rate fluctuations.
Because the majority of the CCG and revenue comes parliamentary funding, the CCG has low exposure to credit risk. The
maximum exposures as at the end of the financial year are in receivables from customers, as disclosed in the trade and other
receivables note.
The CCG is required to operate within revenue and capital resource limits, which are financed from resources voted annually by
Parliament. The CCG draws down cash to cover expenditure, as the need arises. The CCG is not, therefore, exposed to significant
liquidity risks.
Financial reporting standard IFRS 7 requires disclosure of the role that financial instruments have had during the period in creating
or changing the risks a body faces in undertaking its activities.
Because the CCG is financed through parliamentary funding, it is not exposed to the degree of financial risk faced by business
entities. Also, financial instruments play a much more limited role in creating or changing risk than would be typical of listed
companies, to which the financial reporting standards mainly apply. The CCG has limited powers to borrow or invest surplus funds
and financial assets and liabilities are generated by day-to-day operational activities rather than being held to change the risks
facing the CCG in undertaking its activities.
Treasury management operations are carried out by the finance department, within parameters defined formally within the CCG
standing financial instructions and policies agreed by the Governing Body. Treasury activity is subject to review by the CCG and
internal auditors.
The CCG is principally a domestic organisation with the great majority of transactions, assets and liabilities being in the UK and
sterling based. The CCG has no overseas operations. The CCG and therefore has low exposure to currency rate fluctuations.
Barking & Dagenham CCG - Annual Accounts 2017-18
14. Related party transactions
Entities are considered to be a related party if Redbridge CCG can: *have direct or indirect control of the other party *have influence over the financial and operational policies of the other party; or the parties are subject to common control or influence from the same source.
The below individuals declared interests which related to the full financial year for the CCG unless stated.
Name Position in CCG Name of organisation where interest held Nature of interestDr Waseem Mohi Governing Body Member - CCG Chair Markyate Surgery GP
Together First Ltd ShareholderLondon Wellbeing care Ltd DirectorHistoric - Kensington & Chelsea CCG GP Partner
Dr Gurkirit Kalkat Governing Body Member - Clinical Director Thames View Health Centre GP principalPrimary Clinical Partnership Ltd Director/Shareholder
Apex Healthcare Ltd (who own Knightswood
Residential Care Home
Director/Shareholder
Queen Mary Medical School-London Honorary LecturerTogether First ShareholderBHR CCGs Area Prescribing Committee Chair
Dr Jagan John Governing Body Member - Clinical Director King Edwards Medical Group GP partner and other GPs are family membersHealth 1000 Director. PMCF leadProactive Care Clinical Lead
Healthy London Partnerships Clinical LeadMonifieth Ltd Director/ShareholderNHS England Clinical LeadNorth East London Foundation trust GPwSI - Cardiology serviceTogether First ShareholderBarking, Dagenham and Havering LMC MemberHarley Fitzrovia Health Ltd Director and Shareholder
Dr Ravali Goriparthi Governing Body Member - Clinical Director Tulasi Medical Centre GP partner. Spouse is practice managerTulasi Properties Ltd Director/ShareholderHealth & Happiness Clinic Ltd Director/ShareholderTogether First Ltd ShareholderBarking, Dagenham and Havering LMC MemberRoyal College of GPs Member
Ramneek Hara Governing Body Member - Clinical Director Urswick Medical Centre GP PrincipalTogether First Ltd ShareholderLondon Deanery GP registrar and GP appraiser mainly in Havering
Barts Hospital & Queen Mary's University Under-graduate tutorMedimmune (Astrazeneca) Spouse is medical directorHistoric - Pharmaceutical companies Speaker and chair at educational lectures and meetings
Anju Gupta Governing Body Member - Clinical Director Abbey Medical Centre GP Principal.BHR CCGs Diabetes leadTogether First Ltd Shareholder
NELFT GPwSI -Diabetes
NHSE GP AppraiserLondon Deanery GP TrainerWilson Mason PLC(Architects) Spouse is a consultant
Kanika Rai Governing Body Member - Clinical Director White House surgery, Barking GP partner. Sister is a GP partner and is also GPwSI dermatology. Brother is also a
partner.
Together First Ltd Shareholder. Brother is also a directorMacMillan GP for Barking and DagenhamNEL Cancer Cancer LeadLondon Deanery FY2 Superviser and GP trainer
Queen Mary University & Imperial College Under-graduate tutor
Barking & Dagenham CCG - Annual Accounts 2017-18
14. Related party transactions
Jane Milligan Employee - Governing Body Executive Member - Accountable Officer, NEL CCGs NEL Commissioning Support Unit Partner is employed substantivelyNHSE Partner on secondment to London Regional Director for primary careAction for stammering partner is a TrusteeFamily Mosaic Housing Association Non-executive directorStonewall Ambassador
Peabody Housing Association Non-executive directorUniversity Schools Trust, East London Director (resigned)Chartered Physiotherapists Member (non-practising)
Conor Burke Employee - Acting Managing Director CPB Healthcare Consulting Ltd Director & ownerTom Travers Employee - Governing Body Executive Member - Chief Finance Officer Royal Free Foundation Trust Wife employed in the Finance DepartmentSteve Rubery Employee - Governing Body Executive Member - Director of Delivery & Performance BHR CCGs Co-habiting partner is Planned Care Programme LeadJacqui Himbury Employee - Governing Body Executive Member - Nurse director NoneSharon Morrow Employee - Governing Body Executive member - Unplanned Care SRO NoneKash Pandya Governing Body Member - Lay member, Governance NHS Havering CCG Lay member, Governance and Audit Chair
NHS Redbridge CCG Lay member, Governance and Audit ChairUniversity of Essex Independent Audit Committee memberSouthend-on-Sea Borough Council Independent Audit Committee memberBrentwood Citizen's Advice Bureau General AdvisorEssex Ministry of Justice Advisor Committee Lay member, Governance and Audit ChairPriceWaterhouse Cooper Son is employed as a management consultantAccenture Son is employed as Legal Counsel
Historic - Her Majesty's Inspector of Constabulary Associate InspectorHistoric - Hillcroft College for Women (Surbiton) Council member & honorary treasurerHistoric - Health & Safety Executive Independent Audit Committee member
Sahdia Warraich Governing Body member - Lay member, PPI Forum for Health & Wellbeing Director (paid employee)Newham Deanery CIO TrusteeRedbridgeHealthwatch MemberLondon Borough of Redbridge Husband is a Councillor
Dr Arnold Furtig Independent GP member of BHR CCGs Primary Care Commissioning Committee BHR CCGs Lay member PPI (Havering CCG) PPI is brother in lawArthur Rank Hospice Charity - Cambridge TrusteePriceWaterhouse Cooper Son is a partner (south Korea)Mayor of London(Sadiq khan) Son is a speech writerUniversity Hospital, Birmingham Son is an employee in middle management
Charles Beaumont Independent Lay Member of BHR CCGs Audit & Governance NoneDr Adedayo Adedeji GP member and member of BHR CCGs Primary Care Commissioning Committee Halbutt Street Surgery GP
PELC Council MemberTogether First Ltd Board Member & shareholder
Primary Care Clinical partnership Ltd ShareholderJane Gateley Employee - Director, Strategy & Integration PHP (Hurley Group) Spouse is Programme DirectorMarie Price Employee - Corporate Services Director Greater London Authority (GLA) Husband is area regeneration manager for North East London
Lower Clapton GP practice Registered as a patient where City & Hackney CCG Chair is based.Robert Meaker Employee - Innovation & Information Technology Senior Responsible Officer Vertergi Limited Holder of 100% of the company shares
MCB Software Holder of 100% of the company sharesSarah See Employee - Primary Care Transformation Director NELFT Partner is an employee working within Redbridge CAMHSLucy Botting Employee - Deputy Director, Primary Care Transformation Care UK (surrey wide) Nurse Practitioner, Clinical Lead - bank work
Greenbrook Healthcare (London wide) Nurse Practitioner, Clinical Lead - bank workMole Valley District Council Local district councillor
Alan Steward System OD and Transition SRO (currently on secondment) Steward and Steward Ltd Director. Partner is also a director.Louise Mitchell Governing Body Executive Member - Planned Care SRO None
Barking & Dagenham CCG - Annual Accounts 2017-18
14. Related party transactions continued
The transactions listed below are in relation to interests declared.
2017-18 2017-18 2017-18 2017-18 2016-17 2016-17 2016-17 2016-17
Payments to
Related
Party
Receipts
from
Related
Party
Amounts
owed to
Related
Party
Amounts
due from
Related
Party
Payments to
Related
Party
Receipts
from
Related
Party
Amounts
owed to
Related
Party
Amounts
due from
Related
Party
£000 £000 £000 £000 £000 £000 £000 £000
Primary Clinical Partnership Services Limited 290 - - - 338 - 33 -
Abbey Medical Centre 22 - - - 14 - - -
Barking, Havering and Redbridge LMC 68 - 23 - 85 - - -
Health 1000 12 - - - 10 - - -
Together First Ltd 1,023 - - - 790 - 96 -
Tulasi Medical Centre 80 - - - 76 - - -
King Edwards Medical Group 53 - - - 9 - - -
Care Uk (Urgent Care) Ltd 1 - - - - - - -
Care Uk Clinical Services Ltd 3,533 - (39) - 2,831 - 321 -
Care Uk Community Partnerships Ltd 1,302 - - - 932 - - -
Greenbrook Healthcare 6 - - - 2 - - -
Markyate Surgery 9 - - - 5 - - -
Partnership Of East London Co-Operatives Ltd 1,994 - - - 1,814 - 72 -
London Borough Of Redbridge 8 - 70 - - - - -
Barts Health NHS Trust 23,747 - 227 (434) 24,234 - 224 (434)
NHS North and East London CSU 2,186 - 286 - 2,675 - 169 -
NHS Redbridge CCG 1,666 (341) 516 (153) 1,632 (917) 982 (747)
NHS Havering CCG 98 (156) 234 (98) 111 (598) - (399)
NHS England - (392) 6 (553) 438 (410) - (513)
North East London Foundation Trust 58,911 - 2,358 - 58,191 (128) 629 -
Nhs West London (Kensington And Chelsea, Queen'S Park And Paddington) Ccg- - - - - - - -
Imperial College Healthcare Nhs Trust 387 - - (192) 449 - 61 -
University Hospital Birmingham Nhs Foundation Trust 35 - 1 - 14 - 9 -
Royal Free London NHS Foundation Trust 617 - - (242) 748 - 308 (2)
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 Local Authorities.
Barking & Dagenham CCG - Annual Accounts 2017-18
14. Related party transactions continued
2017-18 2017-18 2017-18 2017-18 2016-17 2016-17 2016-17 2016-17
Payments
to Related
Party
Receipts
from
Related
Party
Amounts
owed to
Related
Party
Amounts
due from
Related
Party
Payments
to Related
Party
Receipts
from
Related
Party
Amounts
owed to
Related
Party
Amounts
due from
Related
Party
£000 £000 £000 £000 £000 £000 £000 £000
London Borough of Barking and Dagenham 5,798 (80) 479 (9) 6,092 (295) 151 (12)
2017-18 2017-18 2017-18 2017-18 2016-17 2016-17 2016-17 2016-17
Payments
to Related
Party
Receipts
from
Related
Party
Amounts
owed to
Related
Party
Amounts
due from
Related
Party
Payments
to Related
Party
Receipts
from
Related
Party
Amounts
owed to
Related
Party
Amounts
due from
Related
Party
£000 £000 £000 £000 £000 £000 £000 £000
Barking Havering and Redbridge University Hospitals NHS 97,353 - 2,013 (968) 92,442 - 1,368 (1,031)
North East London NHS Foundation Trust 58,911 - 2,358 - 58,191 (128) 629 -
Barts Health NHS Trust 23,747 - 227 (434) 24,234 - 224 (434)
London Ambulance Service NHS Trust 8,549 - 47 - 8,294 - 618 -
NHS North and East London CSU 2,186 - 286 - 2,675 - 169 -
Mid Essex Hospital Services NHS Trust 1,027 - - (66) 1,107 - - (7)
Basildon and Thurrock University Hospital NHS Foundation 854 - 261 - 654 - 53 -
University College London Hospitals NHS Foundation Trust 1,668 - 106 (10) 2,162 - 276 -
NHS Redbridge CCG 1,666 (341) 516 (153) 1,632 (917) 982 (747)
NHS Havering CCG 98 (156) 234 (98) 111 (598) - (399)
Moorfields Eye Hospital NHS Foundation Trust 2,564 - 157 - 2,554 - 211 -
Homerton University Hospital NHS Foundation Trust 2,595 - 232 - 2,584 - 870 -
NHS England - Parent Entity - (392) 6 (553) - (410) 438 (513)
Guy's And St Thomas' NHS Foundation Trust 1,735 - - (140) 1,888 - 360 -
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 of Health is considered the parent department.
The CCG is part of a risk share agreement across the North East London CCGs (Barking & Dagenham CCG, City & Hackney CCG, Havering CCG,
Newham CCG, Redbridge CCG, Tower Hamlets CCG and Waltham Forest CCG). In 2017/18 the CCG received funds from the risk share from C&H CCG
(£388k) and Tower Hamlets CCG (£135k).
Barking & Dagenham CCG - Annual Accounts 2017-18
14. Related party transactions continued
2017-18 2017-18 2016-17 2016-17 2017-18 2017-18 2016-17 2016-17
Payments
to Related
Party
Amounts
owed to
Related
Party
Payments
to Related
Party
Amounts
owed to
Related
Party
Payments
to Related
Party
Amounts
owed to
Related
Party
Payments
to Related
Party
Amounts
owed to
Related
Party
£000 £000 £000 £000 £000 £000 £000 £000
Thames View Health Centre – Dr. Kalkat 53 - 9 - Heathway Medical Centre – Dr. Ashraff 13 - 6 -
Dr. Ansari Practice 32 - 17 - Dr. Eshan Practice 10 - - -
King Edwards Medical Centre – Dr. John 53 - 9 - The Surgery – Dr. Ola’s Practice 14 - 6 -
Abbey Medical Centre – Dr. Haq 22 - 14 - Laburnum Health Centre – Dr. Sharma & Dr. Kalra 33 - 12 -
John Smith House – Dr. Jaleel 6 - 3 - Parkview Medical Centre – Dr. Shah 17 - 7 -
Faircross Health Centre – Dr. Prasad 4 - 3 - The Becontree Medical Centre – Dr. Moghal 16 - 7 -
The VM Surgery 8 - 3 - Church Elm Lane Medical Centre – Dr. Goyal 29 - 15 -
The White House – Dr. Rai & Dr. Sharma 17 - 6 12 Dr. I.A. Moghal & Ptnrs (Parsloes & Ripple Road) 0 - - -
Dr. R. Chibbers Practice 13 - 7 - Five Elms Health Centre - Dr. Bhatia 16 - 13 -
Shifa Medical Practice – Dr. Rashid & Dr. Esham 4 - 3 - Julia Engwell Health Centre – Dr. Bajpai & Dr. Jaiswal 22 - 8 -
The Barking Group Practice – Dr. Tolia 36 - 13 1 Gables Surgery Dr. Ghosh 12 - 9 5
Victoria Medical Centre – Dr. Niranjar 12 - - - Markyate Surgery – Dr. Mittal 9 - 5 -
Child & Family Centre 38 - 15 - Broad Street Medical Centre – Dr, Annan 15 - 7 -
Porters Avenue – Dr. Akinsanya 38 - 13 - Dr. Quansah Practice 24 - 8 -
Dr. Kashyap Marks Gate Health Centre 8 - 7 - Dr. M. Fateh Practice 17 - 9 -
Dr. Teotia Practice 12 - - - Dr. Ahmad & Dr. Monteiro Practice 31 - 16 -
Highgrove Surgery – Dr. Lawrence 29 - 12 - Urswick Medical Centre – Dr. Mohan - - 10 -
The Surgery Drs. Haider & Finnegan 11 - 7 - Dr. Alkaisy, Dr. Ahmed & Dr. Islam 22 - 10 -
Tulasi Medical Centre – Dr. Goripathi 80 - 76 - Dr. A. Arif & Dr. U. Afser 12 - 6 -
Health1000 12 - 10 -
The constitution of NHS Barking & Dagenham CCG sets out the arrangements to meet its responsibilities for commissioning care for the people who it is responsible. The transactions listed below are in relation to
GP practice members listed within the constitution.
Barking & Dagenham CCG - Annual Accounts 2017-18
14. Related party transactions continued
2017-18 2016-17 2017-18 2016-17
Payments
to Related
Party
Payments
to Related
Party
Payments
to Related
Party
Payments
to Related
Party
£000 £000 £000 £000
Thames View Health Centre – Dr. Kalkat 1,075 1,043 Heathway Medical Centre – Dr. Ashraff 457 418
Dr. Ansari Practice 698 793 Dr. Eshan Practice 290 177
King Edwards Medical Centre – Dr. John 1,033 1,032 The Surgery – Dr. Ola’s Practice 303 276
Abbey Medical Centre – Dr. Haq 821 905 Laburnum Health Centre – Dr. Sharma & Dr. Kalra 1,351 1,335
John Smith House – Dr. Jaleel 425 477 Parkview Medical Centre – Dr. Shah 526 520
Faircross Health Centre – Dr. Prasad 267 254 The Becontree Medical Centre – Dr. Moghal 1,000 943
The VM Surgery 188 144 Church Elm Lane Medical Centre – Dr. Goyal 655 815
The White House – Dr. Rai & Dr. Sharma 505 514 Dr. I.A. Moghal & Ptnrs (Parsloes & Ripple Road) - 761
Dr. R. Chibbers Practice 457 476 Five Elms Health Centre - Dr. Bhatia 442 431
Shifa Medical Practice – Dr. Rashid & Dr. Esham 249 247 Julia Engwell Health Centre – Dr. Bajpai & Dr. Jaiswal 601 512
The Barking Group Practice – Dr. Tolia 1,478 1,433 Gables Surgery Dr. Ghosh 609 577
Victoria Medical Centre – Dr. Niranjar 511 299 Markyate Surgery – Dr. Mittal 495 392
Child & Family Centre 1,658 1,921 Broad Street Medical Centre – Dr, Annan 842 1,090
Porters Avenue – Dr. Akinsanya 1,412 1,496 Dr. Quansah Practice 608 591
Dr. Kashyap Marks Gate Health Centre 538 451 Dr. M. Fateh Practice 644 571
Dr. Teotia Practice 465 256 Dr. Ahmad & Dr. Monteiro Practice 569 582
Highgrove Surgery – Dr. Lawrence 744 736 Urswick Medical Centre – Dr. Mohan - 667
The Surgery Drs. Haider & Finnegan 585 536 Dr. Alkaisy, Dr. Ahmed & Dr. Islam 463 475
Tulasi Medical Centre – Dr. Goripathi 2,494 1,301 Dr. A. Arif & Dr. U. Afser 374 346
Health1000 213 133
As of 1st April 2015 the CCG accepted delegated co-commissioning arrangements where by spend has been transferred to the CCG by NHS England. This
expenditure is shown within the Statement of Comprehensive Net Expenditure statement.
The transactions listed below are in relation to GP practice members listed within the constitution for expenditure in relation to the delegated co-commissioning
arrangement.
Barking & Dagenham CCG - Annual Accounts 2017-18
15. Operating segments
The CCG consider they have only one operating segment that being commissioning of healthcare services.
16. Pooled budgets
2017-18 2016-17
£'000 £'000
Income - -
Expenditure (13,415) (13,131)
17. Events after the end of the reporting period
18. Losses and Special Payments
The CCG had no losses and made no special payments during the 2017-18 Financial Year (nil in 2016-17).
19. Financial performance targets
The CCG have a number of financial duties under the NHS Act 2006 (as amended).
The CCG's performance against those duties was as follows:
2017-18 2017-18 2017-18 Duty 2016-17 2016-17 2016-17 Duty
Target Performance Achievement Achieved Target Performance Achievement Achieved
£000 £000 £000 £000 £000 £000
Expenditure not to exceed income 309,265 314,982 (5,717) No 308,190 308,190 - Yes
Revenue resource use does not exceed the amount
specified in Directions307,828 313,545 (5,717) No 305,584 305,584 - Yes
Revenue administration resource use does not
exceed the amount specified in Directions4,554 4,553 1 Yes 4,503 4,503 - Yes
On 1st April 2015 the CCG entered into a section 75 pooled budget arrangement with the London Borough of Barking and Dagenham Local Authority which is the host of the
pool.
In line with IFRS 11 joint control over the pooled funds exists, however, the members of the fund have agreed to have one lead body to commission services from providers.
As a result the CCG has entered into a lead commissioning arrangement whereby the risks and rewards of the contractual obligation of the pool fund budget lay with each
respective commissioner.
There are no events to report after the end of the reporting period in 2017-18
The CCG shares of the income and expenditure handled by the pooled budget in the financial year were:
All financial risks and rewards appropriate to the CCG are included within the Statement of Comprehensive Net Expenditure.
Ground Floor Maritime House
1 Linton Road Barking
Essex IG11 8HG
Tel: 020 3182 3304 / 3309
Chair: Dr Jagan John
Managing Director: Ceri Jacob
NHS Barking and Dagenham Clinical Commissioning Group
24 May 2018
Dear Sirs
This representation letter is provided in connection with your audit of the financial statements of NHS Barking and Dagenham Clinical Commissioning Group (“the CCG”), for the year ended 31 March 2018, for the purpose of expressing an opinion:
as to whether these financial statements give a true and fair view of the state of the financial position of the CCG as at 31 March 2018 and of the net operating expenditure for the financial year then
ended; and;
whether the CCG’s financial statements have been prepared in accordance with the accounting policies directed by NHS England with consent of the Secretary of State as relevant to Clinical
Commissioning Groups in England and the Department of Health Group Accounting Manual (GAM).
These financial statements comprise the Statement of Financial Position, the Statement of Net Expenditure, the Statement of Cash Flows, the Statement of Changes in Taxpayers Equity and notes, comprising a summary of significant accounting policies and other explanatory notes.
The Governing Body confirms that the representations it makes in this letter are in accordance with the
definitions set out in the Appendix to this letter.
The Governing Body confirms that, to the best of its knowledge and belief, having made such inquiries
as it considered necessary for the purpose of appropriately informing itself:
Financial statements
1. The Governing Body has fulfilled its responsibilities for the preparation of financial statements that:
i. give a true and fair view of the financial position of the CCG as at 31 March 2018 and of the net operating expenditure for that financial year; and
ii. have been prepared in accordance with the accounting policies directed by NHS England with consent of the Secretary of State as relevant to Clinical Commissioning Groups in England and
the GAM 2017/18.
The financial statements have been prepared on a going concern basis.
2. Measurement methods and significant assumptions used by the Governing Body in making
accounting estimates, including those measured at fair value, are reasonable.
For the attention of Mr N Thomas
Partner KPMG LLP 15 Canada square London
E14 5GL
Page 2 of 5
3. All events subsequent to the date of the financial statements and for which IAS 10 Events after the
reporting period requires adjustment or disclosure have been adjusted or disclosed.
4. The effects of uncorrected misstatements are immaterial, both individually and in aggregate, to the financial statements as a whole. There are no uncorrected adjustments above £250k following the audit of the 2017/18 financial statements.
Information provided
5. The Governing Body has provided you with:
access to all information of which it is aware, that is relevant to the preparation of the financial statements, such as records, documentation and other matters;
additional information that you have requested from the Governing Body for the purpose of the
audit; and
unrestricted access to persons within the CCG from whom you determined it necessary to obtain
audit evidence.
6. All transactions have been recorded in the accounting records and are reflected in the financial
statements.
7. The Governing Body confirms the following:
i. The Governing Body has disclosed to you the results of its assessment of the risk that the financial statements may be materially misstated as a result of fraud.
Included in the Appendix to this letter are the definition of fraud, including misstatement arising from fraudulent financial reporting and from misappropriation of assets.
ii. The Governing Body has disclosed to you all information in relation to:
a) Fraud or suspected fraud that it is aware of and that affects the CCG and involves:
management;
employees who have significant roles in internal control; or
others where the fraud could have a material effect on the financial statements; and
b) allegations of fraud, or suspected fraud, affecting the CCG’s financial statements communicated by employees, former employees, analysts, regulators or others.
In respect of the above, the Governing Body acknowledges its responsibility for such internal control as it determines necessary for the preparation of financial statements that are free from material misstatement, whether due to fraud or error. In particular, the Governing Body acknowledges its responsibility for the design, implementation and maintenance of internal control to prevent and detect fraud and error.
8. The Governing Body has disclosed to you all known instances of non-compliance or suspected non-compliance with laws and regulations whose effects should be considered when preparing the financial statements. The Governing Body also confirms that, in all material respects, the expenditure and income recognised in the financial statements has been applied to purposes intended by
Parliament and the financial transactions conform to the authorities which govern them.
9. The Governing Body has disclosed to you and has appropriately accounted for and/or disclosed in the financial statements, in accordance with IAS 37 Provisions, Contingent Liabilities and Contingent Assets, all known actual or possible litigation and claims whose effects should be considered when preparing the financial statements.
Page 3 of 5
10. The Governing Body has disclosed to you the identity of the CCG’s related parties and all the related party relationships and transactions of which it is aware. All related party relationships and transactions have been appropriately accounted for and disclosed in accordance with IAS 24 Related Party Disclosures. Included in the Appendix to this letter are the definitions of both a related party
and a related party transaction as we understand them and as defined in IAS 24.
11. The Governing Body confirms that all intra-NHS balances included in the Statement of Financial Position (SOFP) at 31 March 2018 in excess of £100,000 have been disclosed to you and that the CCG has complied with the requirements of the Intra NHS Agreement of Balances Exercise. The Governing Body confirms that Intra-NHS balances includes all balances with NHS counterparties, regardless of whether these balances are reported within those SOFP classifications formally deemed
to be included within the Agreement of Balances exercise.
12. The Governing Body confirms that:
a) The financial statements disclose all of the key risk factors, assumptions made and uncertainties surrounding the CCG’s ability to continue as a going concern as required to provide a true and
fair view.
b) Any uncertainties disclosed are not considered to be material and therefore do not cast significant
doubt on the ability of the CCG to continue as a going concern.
c) related party and a related party transaction as we understand them and as defined in IAS 24.
13. The Governing Body confirms that the total quantum of liabilities reflected in the financial statements for the expert determination with Barking, Havering and Redbridge University Hospital NHS Trust represents a materially accurate estimate of the outcomes from that process.
This letter was tabled and agreed at the meeting of the Governing Body on 24 May 2018.
Yours faithfully
Tom Travers Chief Financial Officer, for and on behalf of the Governing Body of NHS Barking and Dagenham CCG Kash Pandya Chair Audit and Governance Committee
Page 4 of 5
Appendix to the Governing Body Representation Letter: Definitions
Financial Statements
IAS 1.10 states that a complete set of financial statements comprises:
a statement of financial position as at the end of the period;
a statement of comprehensive income for the period;
a statement of changes in equity for the period;
a statement of cash flows for the period;
notes, comprising a summary of significant accounting policies and other explanatory information;
comparative information in respect of the previous period; and
a statement of financial position as at the beginning of the earliest comparative period when an entity applies an accounting policy retrospectively or makes a retrospective restatement of items in its
financial statements, or when it reclassifies items in its financial statements.
Material Matters
Certain representations in this letter are described as being limited to matters that are material.
IAS 1.7 and IAS 8.5 state that:
“Material omissions or misstatements of items are material if they could, individually or collectively, influence the economic decisions that users make on the basis of the financial statements. Materiality depends on the size and nature of the omission or misstatement judged in the surrounding circumstances. The size or nature of the item, or a combination of both, could be the determining
factor.”
Fraud
Fraudulent financial reporting involves intentional misstatements including omissions of amounts or
disclosures in financial statements to deceive financial statement users.
Misappropriation of assets involves the theft of an entity’s assets. It is often accompanied by false or misleading records or documents in order to conceal the fact that the assets are missing or have been
pledged without proper authorisation.
Error
An error is an unintentional misstatement in financial statements, including the omission of an amount or
a disclosure.
Prior period errors are omissions from, and misstatements in, the entity’s financial statements for one or
more prior periods arising from a failure to use, or misuse of, reliable information that:
a) was available when financial statements for those periods were authorised for issue; and
b) could reasonably be expected to have been obtained and taken into account in the preparation and presentation of those financial statements.
Such errors include the effects of mathematical mistakes, mistakes in applying accounting policies,
oversights or misinterpretations of facts, and fraud.
Management
Page 5 of 5
For the purposes of this letter, references to “management” should be read as “management and, where
appropriate, those charged with governance”.
Related parties
A related party is a person or entity that is related to the entity that is preparing its financial statements (referred to in IAS 24 Related Party Disclosures as the “reporting entity”).
a) A person or a close member of that person’s family is related to a reporting entity if that person:
i. has control or joint control over the reporting entity;
ii. has significant influence over the reporting entity; or
iii. is a member of the key management personnel of the reporting entity or of a parent of the
reporting entity.
b) An entity is related to a reporting entity if any of the following conditions applies:
i. The entity and the reporting entity are members of the same group (which means that each parent, subsidiary and fellow subsidiary is related to the others).
ii. One entity is an associate or joint venture of the other entity (or an associate or joint venture of a
member of a group of which the other entity is a member).
iii. Both entities are joint ventures of the same third party.
iv. One entity is a joint venture of a third entity and the other entity is an associate of the third entity.
v. The entity is a post-employment benefit plan for the benefit of employees of either the reporting entity or an entity related to the reporting entity. If the reporting entity is itself such a plan, the
sponsoring employers are also related to the reporting entity.
vi. The entity is controlled, or jointly controlled by a person identified in (a).
vii. A person identified in (a)(i) has significant influence over the entity or is a member of the key management personnel of the entity (or of a parent of the entity).
Related party transaction
A transfer of resources, services or obligations between a reporting entity and a related party, regardless of whether a price is charged.