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NHS Sutton CCG
Annual Report and
Accounts
2015/16
SECTI
Welcom
Who w
Our vis
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Joint
Joint
Joint
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chievement
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utton Home
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utton Uplift
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utton Integr
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pital care ..
elivering hig
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RFORMAN
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what we d
trategy .....
ellbeing Bo
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our money
in 2015/16
ts for 2015
care ........
es of Care
care ........
ment of com
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services ...
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Adolesce
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rated Digita
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gh quality
atient pathw
ospital serv
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do .............
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ng Strategy
sessment
Care Strate
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mmunity se
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Re
Dia
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Prior
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Com
Revie
Remun
Our sta
Appe
SECTI
mmittee me
ew of Effec
neration Re
aff ............
endix 1: He
ON 3: AC
mbership a
ctiveness .
eport ........
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ead of Inte
CCOUNTS
and attend
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rnal Audit
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dance .......
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Opinion 20
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SEC
CTION 1: PEERFORRMANCCE REEPORTT
Page 5
WelAs we we havsuccesCCG). We havreally mthem. At the sour bidsolutionprogramacross informa AnotheDigital staff anand sonumbesocial ctreatme We havservicecommuRoyal Mmental Anotheconcepbut I amthat we As welconsidedecisiothat asthe CCwith it aworkingassura
come reach the
ve come ovssful year it
ve seen a make a diff
start of thed for Vanguns for imprmme is cacare home
ation on th
er developmCare Reco
nd possibleocial care per of servicecare recordent, withou
ve also maes. During unity healthMarsden H health car
er success ption servicm really plee know is v
l as changerable shif
on to take os well as plaCG will takea clear reqg with colle
ance for ea
end of the ver the lastt has been
number ofference to
e year we ruard statusroving healled Suttones in Suttoe program
ment for Sord (SIDCRe thanks topartners in es will be ad, enablingut comprom
ade significthe year wh services Hospital Fore service,
story for Sces locallyeased thatvery valuab
es to servift in its landon the roleanning ande on the saquirement feagues in ch other.
2015/16 fit twelve m
n for NHS S
f projects lathe health
received ths, a nationalth system
n Homes oon through
mme’s prog
utton CCGR). This is o the strongthe borougable to seeg them to pmising the
cant progrewe success
now calledoundation T Sutton Up
Sutton CCG; this has bt we have fble to many
ices and ndscape. On of delegatd buying hame role fofor very robsouth west
inancial yeonths, andSutton Clin
aunching n of our res
he exciting al program
ms across thof Care; it a
a range ofress can b
G has beena new devg working gh. The SIe an extracprovide musecurity of
ess in comsfully re-tend Sutton CTrust and wplift, which
G was the been a diffifinally beeny of our pa
ew projectne of the nted primarospital, co
or primary cbust govert London t
ear, I have d what an anical Comm
new servicidents and
news thatmme set up
he countryaims to impf new partn
be found la
n the launcvelopment relationshiDCR mean
ct of their puch more ef the inform
mmissioningndered for
Community we also rolwas launc
move to bicult area fn able to catients.
ts, nationanew areas y care commmunity acare (i.e. Grnance arrao help prov
been refleaction-packmissioning
es and patd the servic
we had beto develop
y. Our Vangprove the qnership initter in this r
h of the Sufor health ps we havns that staf
patient’s/cliefficient andmation.
g some of othe provisiServices aled out the
ched on 1 J
etter fund for the CCGcommission
lly the NHSfor 2016 w
mmissioninand mentalGP practiceangementsvide indep
ecting on hked and Group (Su
thways thaces availab
een succesp innovativguard quality of ctiatives. Mreport.
utton Integand social
ve with our ff across aient’s GP ad effective
our key heion of our and still rue new primJuly 2015.
assisted G for somen a local se
S has seenwill be the Cng. This mel health sees). This bs and we apendent
Page 6
ow far
utton
at will ble to
ssful in ve
are ore
rated l care health
a and
ealth
n by mary
e time, ervice
n a CCG’s eans rvices, rings
are
We knofacing opportuto com At a reLondonnew SWpartneralso ourecommlocal N As we phase to manimprov I wouldour comresults Dr BreChair May 20
ow that as GP practicunities ande together
gional leven and 2016W London rship includur four hosmendation
NHS, althou
move into in the histo
nage this yeve services
d like to takmmitted CC.
endan Hud
016
we move ces nationad we are plr to form a
el, we have6 saw us wand Surre
des not onpital Trustss that will a
ugh they ar
2016/17, oory of the Near, but we
s to better m
ke this oppCG staff w
dson
further intoally is goingleased thasingle GP
e continuedwelcome Suey Downs Hnly the six Ss. The grouaddress thre not chal
our fourth yNHS. We ke are confimeet the n
portunity to who togethe
o 2016 andg to be immt the majorfederation
d to work wurrey DowHealthcareSW Londoup is work
he financialllenges un
year as a Cknow that odent that w
needs of ou
thank all oer have en
d beyond, tmense; burity of our G
n.
with CCG cwns CCG ine partnershn CCGs aning hard tol and staffiique to our
CCG, we aour financewe can conur local pop
of our partnabled us to
the changet this also GP practic
colleaguesnto the grouhip (SWLSDnd Surrey o produce ng challenr area.
are enterines will be mntinue to depulation.
ners and so achieve s
e and chalprovides
ces have ag
s in south wup to form DHP). ThisDowns CC
nges facing
g a differemore challeevelop and
stakeholdesuch great
Page 7
lenges
greed
west the
s new CG, but
g our
nt enging d
rs and t
WhoSutton practiccommiin Sutto We wohealth Counciwellbeito high In Aprilmonitohealthywe com Hos
outp Urg
cen Ser Com Reh Ser
exa Fro
Eng We comprovidetable o
o we aCCG is a es in the Lssioning loon.
ork in partnservices, pil), the voluing, reduce quality he
l 2013, weoring the quy, and carinmmission in
spital servipatient app
gent and emntre and A&
rvices for p
mmunity he
habilitation
rvices to suample, for p
om 1 April 2gland to co
mmission hers and meoverleaf.
are andclinically-le
London Borocal health
nership withpharmacistuntary secte health ineealthcare s
became ruality of locng for themnclude:
ces (for expointments
mergency &E departm
people with
ealth servi
n services (
upport peopeople with
2016, Suttoommission
healthcareental health
d whated memberough of S services.
h the local ts and dentor and ourequalities aervices.
esponsiblecal healthcm if they be
xample, sps).
care (for ements).
h mental he
ces (for ex
(for examp
ople with “fuh learning
on CCG haprimary m
e services fh providers
t we dership orgaSutton into
We serve
NHS – hontists, the Lr local comand ensure
e for planncare for peoecome ill a
pecialist inv
example, o
ealth cond
xample, dis
ple, physiot
ully fundeddisabilities
as been demedical serv
from acutes. Our ma
do anisation brone organ
e a populat
spitals, coLondon Bommunity to e people in
ing, commople in Sut
and need e
vestigation
ut of hours
itions.
strict nursin
therapy).
d NHS cons or who ar
elegated revices (GP
e hospitals,in local pro
ringing togisation resion of over
mmunity srough of Simprove h
n Sutton ha
missioning (tton - helpixtra suppo
s, routine o
s GP servic
ng).
tinuing heare physical
esponsibilitservices).
communitoviders are
gether 26 Gsponsible for 190,000 p
services, mSutton (Sutealth and ave equal
(pay for) anng them st
ort. The se
operations
ce, urgent
althcare” (flly frail).
ty by NHS
ty healthcae shown in
Page 8
GP or people
mental ton
access
nd tay ervices
s,
care
for
are the
Main lo Provid
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ocal NHS
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orge’s sity Hospitoundation
oyal Marsdoundation
not commal basis bys, neonata//www.eng
providers
rustdon
HS
tal
den
mission spey NHS Engl critical caland.nhs.u
s
Acute Services
ecialised holand and in
are and speuk/commiss
s ComSer
ospital servnclude servecialist mesioning/spe
mmunity rvices
vices. Thesvices such
ental healthec-service
Mental Health Service
se are comh as bariatrh services. s/).
es
CanSer
mmissionedric surgery
Page 9
ncer rvices
d on a , renal
Our As docpatient Our visjoint wophysica “Workin Sutton page” wfor prog The plaensure During continu
Health
The Heof publchildrehealth
Joint
The Jothe heabetweefrom 20
Joint
The Jolocal pohealth Health JSNA c
Joint
DeveloCCG ato addr
r visionctors, nursets first and
sion is to coorking withal, mental
ng togethe
CCG devewhich is avgrammes o
an was deve that we a
2016/17 wue to reflec
h and We
ealth and Wic health sn's serviceand wellbe
Health a
oint Health alth and ween commun013 to 201
Strategi
oint Strategopulation. and wellbeand Wellb
can be fou
Health a
oped and aand Sutton ress the ch
n and es and othimprove h
ommissionh health anand social
er to build t
eloped a svailable onof work for
veloped in re focused
we are revict where w
ellbeing
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and Wellb
and Wellbellbeing of nities. The6. It is ava
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and Socia
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n high qualnd social ca wellbeing
the best af
trategic plan our websir the CCG.
conjunctiod on the ne
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Board
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being St
being Strateeveryone
e strategy iailable on
Assess
Assessmehe JSNA toces in the begy and th
w.suttonjsn
al Care S
n 2014, ouor the integwe face in
egy are professices in Sut
lity healthcare organis needs are
ffordable h
an for 2014ite. The “p
on with oureeds of our
vision andbe as an o
WB) considmmissioning
social careulation.
rategy
egy (JHWSin Sutton ais mediumSutton Co
ment
nt (JSNA) o inform anborough – he Joint Hena.org.uk.
Strategy
r strategy gration of hour Borou
sionals, wetton.
care for thesations to ee met. It ca
ealthcare f
4 – 2016. plan” sets o
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d values torganisation
ers matterg of adult se and the i
S) sets outand reduci term and uncil’s web
analysed tnd guide ouincluding,
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sets out thhealth and gh.
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for Sutton”
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he joint visisocial care
gether to p
n Sutton thrat patients’
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e our “planority health
nd partners
e that they
to the provices and these on th
oach to impinequalitie
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Page 10
put
rough
s:
n on a h areas
s to
y
vision
he
proving s years
our ing of nt The
Sutton locally
BuildindirectestrategSutton ordinat The str
g on the Joed support,gic docume
CCG and ted care.
rategy is av
oint Health personal b
ents such aSutton Co
vailable on
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n our webs
being Strantegrated scare strategto develop
site: Joint h
tegy (JHWservices angies and m and comm
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Page 11
elf-
ies, red, co-
y
HeaOur b
Sutton popula Age Sutton young is expefor Eng The chEnglaninward The agpopula EthnicIn the 2minorit(mainlyethnic whole. DeprivSutton and Loavoida Fewer and the Overalunemp Howevdeprive Life exOveralthere isand leafor menwomenyears.
alth anborough
is a vibranation of ove
is a youngpeople age
ected to risgland as a
hild populatnd average
migration
ge profile isation and th
city 2011 censty groups. Ty South Afrminority, m
vation is a health
ondon averble conditi
children live England
l the borouployment.
ver, inequaed in the co
xpectancyl life expecs a differenast depriven was 78.5n life expec
d well
nt place to er 190,000
g borough ed 0-19 m
se by almoswhole.
tion and the and incre
of people
s also increhis is forec
us, a fifth oTaking intorican, Polis
making Sut
hy place torage) for boons.
ve in poveraverage.
ugh has go
alities are inountry – an
y ctancy at bnce of aboued wards w5 years ovectancy was
lbeing
live. We hpeople tha
compared aking up ast 20% by
he parent-aasing at a to Sutton.
easing. Ovast to rise
of people ino account psh and Iristton’s profil
o live with goth men an
rty and the
ood educat
ncreasing. nd certain
birth in Suttut eight ye
within the berall and ras 82.4 year
g of pe
have an incat is adding
to the Engalmost a qu
2021, com
age populafaster rate
ver 65-yearby 18.7%
n Sutton wpeople fromh) almost tle more lik
good life exnd women
ere is less i
tional attain
Sutton haareas hav
ton is longeears for botborough. Foanged fromrs overall a
eople i
creasingly dg to the ric
gland averuarter (23.5mpared to 1
ation (35-44e. The chan
r olds makeby 2021, i
were from bm non-Britthree in ten
ke London
xpectancy with fewe
infant mort
nment and
s areas thae become
er than theth men andor the perio
m 74.5 yeaand ranged
n Sutt
diverse anchness of o
age with c5%) of the 14.5% for L
4) are alsonge sugge
e up 14.3%n line with
black, Asiatish white cn people coand less lik
(higher thar people dy
tality comp
d less long-
at are in thmore depr
e England ad women bod 2006-10rs to 82.6 yd from 79.1
ton
nd multicultour commu
children andpopulation
London an
o higher thaests a signi
% of the London.
an and ethncommunitieome from ke England
an the natiying from
pared to Lo
-term
he 20% morived since
average, bbetween th0 life expeyears. For1 years to
Page 12
tural unity.
d n. This nd 7.9%
an the ficant
nic es an d as a
ional
ondon
ost e 2007.
but e most ctancy
87
Life ex(from 1men an ReligioAccordcompareligionprofile current DisabiCensusterm illEnglan The chWe havconditiosurgerisupporcommuto helpneed to The popopulaby 202 Our poBlack aCombinSutton’of diveUrdu a The agof Suttoincreas PeopleMeanwand me This mdemanservicewith ouwill del
pectancy h1994-96 to nd four yea
on ding to the ared to 48.4n, the next of religioust ethnic div
lity s data shoness. This
nd (17.6%)
hallenges ve an ageions. More ies, commrted to live unity would
p people who work mo
opulation oation of our1.
opulation isand Minoritned, 29% o’s communrsity has in
and Tamil c
ge profile oon’s populse by 19%
e are now lwhile medicedicines ar
eans that tnd is contines will not bur clinical civer the ca
has increas2008-10)
ars for wom
2011 cens4% in Londmost com
s affiliationversity of th
ows 14.3% s was simila.
we face ng populatand betterunity servihealthier l
d make us ho need spre closely t
f our borour borough w
s becomingty Ethnic (Bof our popnities morencreased mcommunitie
of our borouation and b.
iving longecal technolre made av
there is monuing to incbe able to colleagues are that our
sed by foucompared
men.
sus 58.4% don and 59monly spe
n in Sutton he borough
of people ar to the fig
tion and mr services nces and, wives and toless relian
pecialist catogether.
ugh is increwas 191,12
g more diveBAME) comulation are
e like Londomarkedly oes.
ugh is alsoby 2021 th
er often witogy continvailable to
ore demancrease. Thkeep paceand local r residents
ur years for to an aver
of people 9.4% natioecified relig
is closer toh.
living in Sugure for Lo
many more need to be
where appro avoid bent on hospiare. All hea
easing. Ac23. This is
erse. In 20mmunities
e from diveon and les
over recent
o increasinhe number
th one or mnues to adv
patients.
nd than evehe funds we with this rpeople to a
s deserve w
r men and rage acros
living in Sunally. Of th
gions were o the natio
utton repoondon (14.
people livie provided ropriate, atcoming ill. tals, which
alth service
ccording toprojected
011, 21% o compared
erse commss like the nt years with
g – over 65of over 65
more long tvance as n
er on our hwe have avarise in demagree howwithin the f
three yearss London
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Page 13
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Page 14
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ManSutton the Boaprincipmanag There ithroughStrateg The Bomeetinmitigatrisks fo Ris
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or Sutton C
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Page 15
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Page 16
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Page 17
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Page 18
o and in This
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Sutton as partMarch
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Jon RDept oqualitya num
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ar we haveers in healtry sector, tomes, with ty and quali
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nents:
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Page 19
ogress
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rking are support
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er supportand wellbe
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eing.
said: “GPsme set asidservice. The– all have spinion’.”
role represquality of lifs a nurse an
training I we I have worthis issue angnificantly d
care and vy improve lex long te
are home s
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the GP prarelationsh
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t care homeing review
es workingo consider
s who tookde for care e nurses a
said to me
sents a reallfe. At the sand take on a
was able to qrked for thend since chdecrease.”
voluntary scare for earm conditio
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me residenws to care
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k part in thehomes me
also feel emat one time
ly positive came time it gadditional re
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Page 20
ual ntal
ce staff
ursing ovide
es as and
give rs can rd to all
dents
P each g
ve said can that er, ‘I’m
our he ies.
nges to ave had are
The Rea big d
concerrelevaneffectiv It also glasseshospita(which red bagresiden A shortso thatto play
Dr Stehome providquesti “Beingprope
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ed Bag: Imdifference
rn. This ment informatvely.
has room fs, hearing al. When pdetails eve
g so that cnts arrive b
t film was mt they wouland what
ephanie Maand the GP
ded throughions to ask
g part of theerly and focu
en Care Homger said, “Thed, one of re. We got tal staff. Thhe returned arge letter a
arly days, blent with everd in the ca
mproving l
eans that ation and de
for personaid, dentuatients areery aspect
care home back home
made to prd understathey need
achin, GP, aP, which alloh the Vangu
GPs and ou
e Vanguard us on being
me in SuttonThe Red Bagf our resident the Red Bahe resident
home fit anand medica
but the commeryone invore we provi
life for car
In Nlaupeorecnee Theabometak
ambulanceetermine th
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e ready to gt of the carstaff have
e.
rovide a quand why th to do – Re
added: “Theows for pre
uard meansur weekly re
d project hasg proactive r
n was the fig is a simplnts fell and ag ready anand Red Ba
nd well and,tion.
munication olved workinde for our r
re home r
November unched a bople living ceive quicked to go in
e Red Bagout the resedical condking, as wee and hosphe treatmen
ngs (such and stays wgo home, are they recaccess to
uick and eahe Red Baged Bag info
ere is increa-empting ofcare home
eview meet
s given us arather than
first to use thle idea that we suspect
nd completeag went off , importantly
around resng togetherresidents.”
esidents:
2015 Suttrilliantly simin care ho
k and effecto hospital
g contains ssident’s genditions theyell as highlipital staff cant a reside
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ased commuf conditionsstaff are no
tings are be
as GPs the reactive.”
he Red Bagmakes a bi
ted that saded the formsto hospital y, with the R
sidents’ hospr. The Red B
A small c
ton Homesmple initiatmes in thetive treatml in an eme
standardisneral healty have, meghting the an easily a
ent needs q
for day of ient whilst heir dischaospital) willrtant inform
g tool for cportant, thevideo
unication be. The new, ow more aw
etter directed
gift of the tim
g. Kim Kerwig differencedly he mights for the amand to our dRed Bag co
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s of Care tive to helpe borough tment shouldergency.
sed informath, any exisedication th
current heaccess all quickly and
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care home e role they
etween the enhanced t
ware of the d.
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wood, Eothee. On the dt have a
mbulance crdelight two
omplete with
er process he is a great
Page 21
aking
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ation sting
hey are ealth
d more
, n mary d in the en their
staff, need
care training
ur job
en day it was
rew and weeks
h a
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Out o
Re-pro
During provideprovideability tof peop
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Sutton closelyfrequenfamilies The semedicadisadvawith SpCare P The chneeds assistaexpand Childrelanguahelp re WorkinCQC inIn JanuQualitythree raand tw Those - a framtogetheSutton practicimprovtook coclear thapproabasis. Tpractic
of hospita
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the year wer for Comer would coto provide ple in Sutto
ren’s ser
CCG comy with the Sntly work ins in Sutton
ervices thatal support tantage andpecial EducPlans.
hildren’s hoat home a
ants at schoded to inclu
en’s therapage therapyeduce waiti
ng with prnspectionuary 2015,y Commissated “Goodo rated ‘Ina
rated ‘inadmework witer to ensurCCG workes to ensu
vement delonsiderablehat the onlyach with visThe outcomes were re
al care
t of comm
we successmunity Seontinue to sustainablon.
rvices
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t we commto childrend their famcational Ne
ome care nnd school,ool) to undude a paed
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ractices to process seven pra
sion. The od’”, two ratadequate’.
dequate’ wthin which re a timely ked with bo
ure that activered acroe CCG timy way to asibility withme followinemoved fro
munity serv
sfully ran arvices in Sbe The Role, safe an
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mission incl that are v
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hin the pracng re-inspeom special
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quality: S
Sutton werewere variabquires Imp
d in speciaNHS Engl
dinated ressations andwere put inonth timescource, as its was a ‘hactices on aection wasmeasures
tract
procuremAugust 201den, who haality service
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munity paeddue to diseupport for ntributing t
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cupational ditional staf
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e routinelyble with rovement’
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sponse. d the n place andcale. This t became ands on’ a regular s that both s.
ent proces5 we annoad demonses to meet
es for childrsitors in Sues to childr
diatrics, whease, disabthe assessto Educatio
to children carers (inc
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g GP prac
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s
d
ss to appoiounced thastrated thet the health
ren, workinutton. We ren and the
hich providbility and/osment of con, Health
with compcluding tea
m recently
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d by the Ca
Page 22
nt a at the eir h needs
ng
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des or hildren and
plex aching
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ponse to tht and relev
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en Januaryand all sixto Sutton
st possible
tion, in Janspectoratelarly suppo
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n Uplift
hed in Julyal part of Ntment to ofpsycholog
ervice - 'Supartners: I
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ates in theting positivational guid
“Excellen(Practice “Thank yand colla(Sutton G “Feeling m(Adminis
is, Sutton vant experiMarch 201rs and receprocess a
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dent when itedical secre
ogether a ssist practim ran seveto provide properly p
dividual praess meetinthem to be
x further Cating’. Thot, encourag
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e new primn-going comry care mes to Sutton
rovided bytton, Off th
nity and prwellbeing following:
ing for a CQ
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it’s our turn etary)
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QC inspecose practicegement an
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mary care mmmissioninental health's commun
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rovides a hfocusing o
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articularly thes who havve and help
ctions werees have exd time inve
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mental heang strategieh services nities.
t George’sand the Su
holistic appon early int
on.”
y. It feels re
ected.”
duals with action Readd at GPs, nailed knowor it.
hose notifive had thepful.
e carried oxpressed thested to en
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proach to tervention
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Page 23
a wide diness. nurses, ledge
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ntary rs
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Page 24
ce also e and enings
ent wledge sical, e in ce
n GPs, people
ment of d to ndon e an n.
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vice;
elop ealth
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utton IDCRal records fcare record
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Page 25
ed to an do
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o reduce u
ent educatioge conditio
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om hospitaes, home obased resp
oups creatike across
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ndition ando to hospita
ts with LTCmeetings port the ea respirator
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piratory teasions and a
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Page 26
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Page 27
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Page 28
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Page 29
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Page 30
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by performr all but oneSutton pa
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Page 31
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ndard 7.
mance e tients eeks.
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is now onlyospital regisunity provis
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estimated uivalent to e year.
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he national dementia. work is req
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d to reflect mber peopP practice’sver 65 that n and care ade significto record d, as of Feb
meet the sta
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people wits and appromunity bas
to assure sorder (ASHealth tha
delivered.
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t person-ceocal peopl
s that do arnt risk regsability Ass
ing disabilderway to d
ety or depr%, and the
communityn they neeves in 2016
the age rale, over 65
s dementiaare likely tprovided to
cant progrediagnosis obruary 2016andard in 2
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th Learningopriate pat
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people witSD), their fat our comm
with local aning disabtion shouldnities.
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rise, and prister have surance m
ity or ASD discharge t
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ange cover5 years of aa register ato have o those pe
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g Disabilitietients withi
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Page 32
access the
nd the we are
red in age,
as a
eople in hout f ance is
View
es (LD) in
ng d o the
to autism, e that
ased group; ure eloped ch is
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ities for i
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are three dges 35 andn CCGs anoard.
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y, the Suttohe 8 minut
mbulance Rmbulance R
response tied 1 perforer since th
at A 19 minssioners inplan.
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CCG has berove urgentpatients witmmunity. Sour standastandard, werformancecontinue tod by Sutton
rmance ha
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he LAS didn 8 minute
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nute targetn London, w
ment
d
target, wace for the y that morecharged th
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with full yeae of 94.5%.o be discun CCG’s C
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o plan at 95ue to monit
y missed by.5% as of Jwaited longHS aspires
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cal Officer.
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towards thor the five mback.
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to nationa
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Sutton o73% 66.9%
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et 95%). Ass against
CCG in 201016, againshours to be
ally.
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or Sutton CWorking Gr
verage for
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ndon-widement plan in
mple in Feb
only
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Alongside fthe agreed
Page 33
5/16, st a e
cal nd opriate , which
A&E did ected in CCG for roup
e table other
e for n
bruary
ory, r 2015;
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Page 34
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Page 35
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Page 37
arget pril ected he year arget at
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2015/16 wtter Care F
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ch 2016.
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une 2014.
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Page 38
er re ration ed by
t under
ity ment ng
ve been ti-d them.
ate based s, a ogether diate eceived
tart the y of our the end
rovide vice is ts to k to
and ble and run ervices clear n e to be a
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that were hhrough the Collaborativ
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o provide a
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Page 39
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Page 40
hich ct that
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Page 41
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Page 42
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Page 43
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17
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Page 44
he data
t in 15.
ver the f 67% cular
15/16
e to
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Page 45
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Page 46
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Page 47
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ence of recccording tospect.
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Page 48
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Appe
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Audit Oppinion 20015/16
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Page 103
SUTTON CLINICAL COMMISSIONING
GROUP
Head of internal audit opinion 2015/2016
19 April 2016
Sutton Clinical Commissioing Group Draft head of internal audit opinion 2015/2016 | 1
1.1 The head of internal audit opinion
Our opinion, based on work undertaken up to 19th April 2016, is set out as follows:
Head of internal audit opinion 2015/2016
The organisation has an adequate and effective framework for risk management, governance and internal
control.
However, our work has identified further enhancements to the framework of risk management, governance
and internal control to ensure that it remains adequate and effective.
1.2 Factors and findings which have informed our opinion
Based on the work undertaken in 2015/16 there is a generally sound system of internal control, designed to meet the
CCG’s objectives, and that controls are generally being applied consistently. However, some weaknesses have been
identified in that we have issued one AMBER/RED rated report on Conflict of Interest (COI); i.e. for the this area the
Governing Body can take partial assurance that the controls to manage risks are suitably designed and consistently
applied, and that action is needed to strengthen the control framework to manage the identified risks.
The Conflict of Interest review highlighted a number of non-compliance issues with specific high priority issues raised
around there being no central register being maintained to ensure individual Conflicts of Interests are being
consistently reported across all Groups/Committee. We also highlighted that no COI Declaration Forms were held by
the Head of Governance to support any of the COI schedules presented at the various Committees. In addition, at the
time of our review in December 2015, the CCG had not undertaken an annual COI declaration exercise with either
Governing Body Members or staff.
We have agreed a clear action plan to address the issues raised and we will follow up on this report. The CCG is
making good progress on implementing the management actions to make the necessary improvements in the control
environment. All of the actions should be implemented by 30th April 2016.
All other reviews have resulted in either a reasonable (AMBER/GREEN) or substantial (GREEN) assurance opinion
being provided.
1.3 Further issues relevant to this opinion
We have considered the findings of the interim Service Auditor report carried out by the internal auditors of NHS England at South East CSU, on behalf of the CSU customers, including Sutton CCG, covering the first six months of
1 HEAD OF INTERNAL AUDIT OPINION
In accordance with the 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, control and governance
processes. The opinion should contribute to the organisation's annual governance statement.
This document provides our annual internal audit opinion for 2015/16 as at 19 April 2016. The final
opinion will be set out in our annual internal audit report after year end.
Sutton Clinical Commissioing Group Draft head of internal audit opinion 2015/2016 | 2
the financial year. Whilst we note a total of two identified exceptions, we have liaised with the CSU and do not believe that there is anything significant requiring inclusion within the Annual Governance Statement. We will review the final Service Auditor Report once issued and if material it will need to be reflected in a revised opinion. Issues judged relevant to the preparation of the annual governance statement
Based on the work we have undertaken on the CCG’s system on internal control we do not consider that within these
areas there are any issues that need to be flagged as significant internal control issues within the annual governance
statement (AGS). However, the CCG may 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.
1.4 Scope of the opinion
The opinion does not imply that internal audit has reviewed all risks and assurances relating to the organisation. The
opinion is substantially derived from the conduct of risk-based plans generated from a robust and organisation-led
assurance framework. As such, the assurance framework is one component that the Governing Body takes into
account in making its annual governance statement (AGS).
Sutton Clinical Commissioing Group Draft head of internal audit opinion 2015/2016 | 3
As a practising member firm of the Institute of Chartered Accountants in England and Wales (ICAEW), we are subject to its ethical and other
professional requirements which are detailed at http://www.icaew.com/en/members/regulations-standards-and-guidance.
The matters raised in this report are only those which came to our attention during the course of our review and are not necessarily a
comprehensive statement of all the weaknesses that exist or all improvements that might be made. Recommendations for improvements should be
assessed by you for their full impact before they are implemented. This report, or our work, should not be taken as a substitute for management’s
responsibilities for the application of sound commercial practices. We emphasise that the responsibility for a sound system of internal controls rests
with management and our work should not be relied upon to identify all strengths and weaknesses that may exist. Neither should our work be relied
upon to identify all circumstances of fraud and irregularity should there be any.
This report is supplied on the understanding that it is solely for the use of the persons to whom it is addressed and for the purposes set out herein.
Our work has been undertaken solely to prepare this report and state those matters that we have agreed to state to them. This report should not
therefore be regarded as suitable to be used or relied on by any other party wishing to acquire any rights from RSM Risk Assurance Services LLP
for any purpose or in any context. Any party other than the Board which obtains access to this report or a copy and chooses to rely on this report (or
any part of it) will do so at its own risk. To the fullest extent permitted by law, RSM Risk Assurance Services LLP will accept no responsibility or
liability in respect of this report to any other party and shall not be liable for any loss, damage or expense of whatsoever nature which is caused by
any person’s reliance on representations in this report.
This report is released to you on the basis that it shall not be copied, referred to or disclosed, in whole or in part (save as otherwise permitted by
agreed written terms), without our prior written consent.
We have no responsibility to update this report for events and circumstances occurring after the date of this report.
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Street, London EC4A 4AB.
Sutton Clinical Commissioing Group Draft head of internal audit opinion 2015/2016 | 4
The following shows the full range of opinions available to us within our internal audit methodology to provide you with
context regarding your internal audit opinion.
Annual opinions
The organisation has an adequate and effective framework for risk
management, governance and internal control.
The organisation has an adequate and effective framework for risk
management, governance and internal control.
However, our work has identified further enhancements to the framework of
risk management, governance and internal control to ensure that it remains
adequate and effective.
There are weaknesses in the framework of governance, risk management
and control such that it could be, or could become, inadequate and
ineffective.
The organisation does not have an adequate framework of risk
management, governance or internal control.
APPENDIX A: ANNUAL OPINIONS
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CTION 3: ACCCOUNTS
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105
INDEPENDENT AUDITOR’S REPORT TO THE MEMBERS OF THE GOVERNING BODY OF NHS SUTTON CLINICAL COMMISSIONING GROUP We have audited the financial statements of NHS Sutton Clinical Commissioning Group (CCG) for the year ended 31 March 2016 under the Local Audit and Accountability Act 2014 (the "Act"). The financial statements comprise the Statement of Comprehensive Net Expenditure, the Statement of Financial Position, the Statement of Changes in Taxpayers’ Equity, the Statement of Cash Flows and the related notes. The financial reporting framework that has been applied in their preparation is applicable law and International Financial Reporting Standards (IFRSs) as adopted by the European Union, and as interpreted and adapted by the 2015/16 Government Financial Reporting Manual (the 2015/16 FReM) as contained in the Department of Health Group Manual for Accounts 2015/16 (the 2015/16 MfA) and the Accounts Direction issued by the NHS Commissioning Board with the approval of the Secretary of State as relevant to the National Health Service in England (the Accounts Direction). This report is made solely to the members of the Governing Body of NHS Sutton Clinical Commissioning Group, as a body, in accordance with Part 5 of the Act and as set out in paragraph 43 of the Statement of Responsibilities of Auditors and Audited Bodies published by Public Sector Audit Appointments Limited. Our audit work has been undertaken so that we might state to the members of the Governing Body of the CCG those matters we are required to state to them in an auditor's report and for no other purpose. To the fullest extent permitted by law, we do not accept or assume responsibility to anyone other than the CCG and the members of the Governing Body of the CCG, as a body, for our audit work, for this report, or for the opinions we have formed. Respective responsibilities of the Accountable Offi cer and auditor As explained more fully in the Statement of Accountable Officer’s Responsibilities, the Accountable Officer is responsible for the preparation of the financial statements and for being satisfied that they give a true and fair view and is also responsible for ensuring the regularity of expenditure and income. Our responsibility is to audit and express an opinion on the financial statements in accordance with applicable law and International Standards on Auditing (UK and Ireland). Those standards require us to comply with the Auditing Practices Board’s Ethical Standards for Auditors. We are also responsible for giving an opinion on the regularity of expenditure and income in accordance with the Code of Audit Practice prepared by the Comptroller and Auditor General as required by the Act (the "Code of Audit Practice"). As explained in the Annual Governance Statement, the Accountable Officer is responsible for the arrangements to secure economy, efficiency and effectiveness in the use of the CCG's resources. We are required under Section 21 (1)(c) of the Act to be satisfied that the CCG has made proper arrangements for securing economy, efficiency and effectiveness in its use of resources and to report our opinion as required by Section 21(4)(b) of the Act. We are not required to consider, nor have we considered, whether all aspects of the CCG's arrangements for securing economy, efficiency and effectiveness in its use of resources are operating effectively.
106
Scope of the audit of the financial statements An audit involves obtaining evidence about the amounts and disclosures in the financial statements sufficient to give reasonable assurance that the financial statements are free from material misstatement, whether caused by fraud or error. This includes an assessment of: whether the accounting policies are appropriate to the CCG’s circumstances and have been consistently applied and adequately disclosed; the reasonableness of significant accounting estimates made by the Accountable Officer; and the overall presentation of the financial statements. In addition, we read all the financial and non-financial information in the Annual Report to identify material inconsistencies with the audited financial statements and to identify any information that is apparently materially incorrect based on, or materially inconsistent with, the knowledge acquired by us in the course of performing the audit. If we become aware of any apparent material misstatements or inconsistencies we consider the implications for our report. In addition, we are required to obtain evidence sufficient to give reasonable assurance that the expenditure and income recorded in the financial statements have been applied to the purposes intended by Parliament and the financial transactions conform to the authorities which govern them. Scope of the review of arrangements for securing ec onomy, efficiency and effectiveness in the use of resources We have undertaken our review in accordance with the Code of Audit Practice, having regard to the guidance on the specified criteria, issued by the Comptroller and Auditor General in November 2015, as to whether the CCG had proper arrangements to ensure it took properly informed decisions and deployed resources to achieve planned and sustainable outcomes for taxpayers and local people. The Comptroller and Auditor General determined these criteria as that necessary for us to consider under the Code of Audit Practice in satisfying ourselves whether the CCG put in place proper arrangements for securing economy, efficiency and effectiveness in its use of resources for the year ended 31 March 2016, and to report by exception where we are not satisfied. We planned our work in accordance with the Code of Audit Practice. Based on our risk assessment, we undertook such work as we considered necessary to form a view on whether, in all significant respects, the CCG had put in place proper arrangements to secure economy, efficiency and effectiveness in its use of resources. Opinion on financial statements In our opinion the financial statements:
• give a true and fair view of the financial position of NHS Sutton Clinical Commissioning Group as at 31 March 2016 and of its expenditure and income for the year then ended; and
• have been prepared properly in accordance with IFRSs as adopted by the European Union, as interpreted and adapted by the 2015/16 FReM as contained in the 2015/16 MfA and the Accounts Direction.
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Opinion on regularity In our opinion, in all material respects the expenditure and income recorded in the financial statements have been applied to the purposes intended by Parliament and the financial transactions in the financial statements conform to the authorities which govern them. Opinion on other matters In our opinion:
• the parts of the Remuneration and Staff Report to be audited have been properly prepared in accordance with IFRSs as adopted by the European Union, as interpreted and adapted by the 2015/16 FReM as contained in the 2015/16 MfA and the Accounts Direction; and
• the other information published together with the audited financial statements in the annual report and accounts is consistent with the financial statements.
Matters on which we are required to report by excep tion We are required to report to you if:
• in our opinion the governance statement does not comply with the guidance issued by the NHS Commissioning Board; or
• we refer a matter to the Secretary of State under section 30 of the Act because we have reason to believe that the CCG, or an officer of the CCG, is about to make, or has made, a decision which involves or would involve the body incurring unlawful expenditure, or is about to take, or has begun to take a course of action which, if followed to its conclusion, would be unlawful and likely to cause a loss or deficiency; or
• we issue a report in the public interest under section 24 of the Act; or • we make a written recommendation to the CCG under section 24 of the Act; or • we are not satisfied that the CCG has made proper arrangements for securing
economy, efficiency and effectiveness in its use of its resources for the year ended 31 March 2016.
We have nothing to report in these respects. Certificate We certify that we have completed the audit of the accounts of NHS Sutton Clinical Commissioning Group in accordance with the requirements of the Act and the Code of Audit Practice. Sarah Ironmonger for and on behalf of Grant Thornton UK LLP, Appointed Auditor Fleming Way, Manor Royal, Crawley, RH10 9GT 26 May 2016
NHS Sutton CCG - Annual Accounts 2015-16
Page Number
The Primary Statements:
Statement of Comprehensive Net Expenditure for the year ended 31st March 2016 1Statement of Financial Position as at 31st March 2016 2Statement of Changes in Taxpayers' Equity for the year ended 31st March 2016 3Statement of Cash Flows for the year ended 31st March 2016 4
Notes to the AccountsAccounting policies 5-9Other operating revenue 10Revenue 10Employee benefits and staff numbers 11-13Operating expenses 14Better payment practice code 15Income Genereation Activities 15Operating leases 16Property, plant and equipment 17Trade and other receivables 18Cash and cash equivalents 19Trade and other payables 20Provisions 21Contingencies 22Commitments 22Financial instruments 23-24Operating segments 25Pooled budgets 26Related party transactions 27Events after the end of the reporting period 28Losses and special payments 28Financial performance targets 29Analysis of charitable reserves 29
CONTENTS
NHS Sutton CCG - Annual Accounts 2015-16
Statement of Comprehensive Net Expenditure for the year ended31-March-2016
2015-16 2014-15Note £000 £000
Total Income and ExpenditureEmployee benefits 4.1.1 3,385 2,283Operating Expenses 5 245,702 218,560Other operating revenue 2 (9,697) (4,516)Total Net Expenditure for the year 239,390 216,327
Of which:Administration Income and ExpenditureEmployee benefits 4.1.1 1,850 1,858Operating Expenses 5 2,632 2,644Other operating revenue 2 (410) (218)Net administration costs before interest 4,072 4,284
Programme Income and ExpenditureEmployee benefits 4.1.1 1,535 425Operating Expenses 5 243,070 215,916Other operating revenue 2 (9,287) (4,298)Net programme expenditure before interest 235,318 212,043
The notes on pages 5 to 29 form part of this statement
Page 1
NHS Sutton CCG - Annual Accounts 2015-16
Statement of Financial Position as at31-March-2016
2015-16 2014-15
Note £000 £000Non-current assets:Property, plant and equipment 9 109 74Total non-current assets 109 74
Current assets:Trade and other receivables 10 3,646 2,621Cash and cash equivalents 11 96 4Total current assets 3,742 2,625
Total assets 3,851 2,699
Current liabilitiesTrade and other payables 12 (15,326) (11,494)Total current liabilities (15,326) (11,494)
Non-Current Assets plus/less Net Current Assets/Liabilities (11,475) (8,795)
Total non-current liabilities 0 0
Assets less Liabilities (11,475) (8,795)
Financed by Taxpayers’ EquityGeneral fund (11,475) (8,795)Total taxpayers' equity: (11,475) (8,795)
The notes on pages 5 to 29 form part of this statement
The financial statements on pages 1 to 29 were approved by the Governing Body and signed on its behalf by:
Dr Chris ElliottChief Clinical Officer and Accountable Officer24-May-16
Page 2
NHS Sutton CCG - Annual Accounts 2015-16
Statement of Changes In Taxpayers Equity for the year ended31-March-2016
General fund£000
Changes in taxpayers’ equity for 2015-16
Balance at 1 April 2015 (8,795)
Changes in NHS Clinical Commissioning Group taxpayers’ equity for 2015-16
Net operating expenditure for the financial year (239,390)
Net Recognised NHS Clinical Commissioning Group Expenditure for the Financial Year (239,390)
Net funding 236,710
Balance at 31 March 2016 (11,475)
General fund
£000
Changes in taxpayers’ equity for 2014-15
Balance at 1 April 2014 (11,502)
Changes in NHS Commissioning Board taxpayers’ equity for 2014-15
Net operating costs for the financial year (216,327)
Net Recognised NHS Commissioning Board Expenditure for the Financial Year (216,327)
Net funding 219,034
Balance at 31 March 2015 (8,795)
The notes on pages 5 to 29 form part of this statement
Page 3
NHS Sutton CCG - Annual Accounts 2015-16
Statement of Cash Flows for the year ended31-March-2016
2015-16 2014-15Note £000 £000
Cash Flows from Operating ActivitiesNet operating expenditure for the financial year (239,390) (216,327)Depreciation and amortisation 9 25 0(Increase)/decrease in trade & other receivables 10 (1,026) (422)Increase/(decrease) in trade & other payables 12 3,832 (1,963)Increase/(decrease) in provisions 0 (315)Net Cash Inflow (Outflow) from Operating Activities (236,560) (219,027)
Cash Flows from Investing Activities(Payments) for property, plant and equipment 9 (59) (74)Net Cash Inflow (Outflow) from Investing Activities (59) (74)
Net Cash Inflow (Outflow) before Financing (236,619) (219,101)
Cash Flows from Financing ActivitiesGrant in Aid Funding Received 236,710 219,034Net Cash Inflow (Outflow) from Financing Activities 236,710 219,034
Net Increase (Decrease) in Cash & Cash Equivalents 11 92 (67)
Cash & Cash Equivalents at the Beginning of the Financial Year 4 71
Cash & Cash Equivalents (including bank overdrafts) at the End of the Financial Year 96 4
The notes on pages 5 to 29 form part of this statement
Page 4
NHS Sutton CCG - Annual Accounts 2015-16
Notes to the financial statements
1 Accounting Policies
NHS England has directed that the financial statements of clinical commissioning groups shall meet the accounting requirements of the Manual for Accounts issued by the Department of Health. Consequently, the following financial statements have been prepared in accordance with the Manual for Accounts 2015-16 issued by the Department of Health. The accounting policies contained in the Manual for Accounts follow International Financial Reporting Standards to the extent that they are meaningful and appropriate to clinical commissioning groups, as determined by HM Treasury, which is advised by the Financial Reporting Advisory Board. Where the Manual for Accounts permits a choice of accounting policy, the accounting policy which is judged to be most appropriate to the particular circumstances of the clinical commissioning group for the purpose of giving a true and fair view has been selected. The particular policies adopted by the clinical commissioning group are described below. They have been applied consistently in dealing with items considered material in relation to the accounts.
1.1 Going ConcernThese accounts have been prepared on the going concern basis.
Public sector bodies are assumed to be going concerns where the continuation of the provision of a service in the future is anticipated, as evidenced by inclusion of financial provision for that service in published documents.
Where a clinical commissioning group ceases to exist, it considers whether or not its services will continue to be provided (using the same assets, by another public sector entity) in determining whether to use the concept of going concern for the final set of Financial Statements. If services will continue to be provided the financial statements are prepared on the going concern basis.
These accounts have been prepared under the going concern basis as;
* the CCG is a continuing entity and has its revenue resource limit set for the following 3 financial years.* the 5 year financial model shows the CCG meeting its financial targets* the CCG is able to meet its current liabilities.* the CCG is a member of the SWL risk sharing arrangements to manage in-year risk, which is part of the wider NHS arrangements to support CCGs where appropriate; and* the services the CCG commissions will continue to be commissioned.
1.2 Accounting ConventionThese accounts have been prepared under the historical cost convention modified to account for the revaluation of property, plant and equipment, intangible assets, inventories and certain financial assets and financial liabilities.
1.3 Acquisitions & Discontinued Operations
Activities are considered to be ‘acquired’ only if they are taken on from outside the public sector. Activities are considered to be ‘discontinued’ only if they cease entirely. They are not considered to be ‘discontinued’ if they transfer from one public sector body to another.
1.4 Charitable FundsFrom 2013-14, the divergence from the Government Financial Reporting Manual that NHS Charitable Funds are not consolidated with bodies’ own returns is removed. Under the provisions of IAS 27: Consolidated & Separate Financial Statements, those Charitable Funds that fall under common control with NHS bodies are consolidated within the entities’ accounts.
The governing Body does not consider the activities of the charity to be material to NHS Sutton CCG and accordingly has decided not to consolidate the Charitable Funds accounts with that of the CCG.
1.5 Pooled Budgets
The clinical commissioning group has entered into a pooled budget arrangement under Section 75 of the National Health Service Act 2006 with the London Borough of Sutton relating to the commissioning of health and social care services within the Better Care Fund. The clinical commissioning group accounts for its share of the assets, liabilities, income and expenditure arising from the activities of the pooled budget, identified in accordance with the pooled budget agreement. The S75 clearly sets out the accounting, risk share and governance arrangements.
The accountable body for the Better care Fund is the local authority which holds the fund. It is managed through a joint management committee that reports to the local Health and Wellbeing Board.
The clinical commissioning group accounts for the Better Care Fund pooled budget on a gross basis, with all contributions, costs and income shown gross.
1.6 Critical Accounting Judgements & Key Sources of Estimation UncertaintyIn the application of the NHS Sutton CCG'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.
Page 5
1.6.1 Critical Judgements in Applying Accounting PoliciesThe CCG has not made any critical judgements, apart from those involving estimations (see below) in the process of applying NHS Sutton CCG's accounting policies, so there are no significant effects on the amounts recognised in the Financial Statements.
Sutton CCG is the corporate trustee of the Sutton and Merton CCG's charitable funds. The Governing Body does not consider the activities of the charity to be material to NHS Sutton CCG. The net assets of the charitable funds at £1.9m represents 0.8%of the £241.7m revenue resource of NHS Sutton CCG and the net income of the charitable funds in 2015/16 of £0.03m represents 0.01% of the CCG's resource outturn position. Accordingly, the Governing Body has decided not to consolidate the Charitable Funds accounts with that of the CCG.
As at 31st March 2016, the CCG had £9k of receivables that were more than 30 days past their due date and therefore considered that no receivables required impairing.
The accounting arrangements for balances transferred from predecessor PCT's ("legacy" balances) are determined by the Accounts Direction issued by NHS England on 12 February 2014. The Accounts Directions state that the only legacy balances to be accounted for by the CCG are in respect of property, plant and equipment (and related liabilities) and inventories. All other legacy balances in respect of assets or liabilities arising from transactions or delivery of care prior to 31 March 2013 are accounted for by NHS England.
1.6.2 Key Sources of Estimation Uncertainty
The following are the key estimations that management has made in the process of applying the clinical commissioning group’s accounting policies that have the most significant effect on the amounts recognised in the financial statements:
The largest estimated cost in the CCGs accounts relates to the February and March 2016 practice prescribing accrual. This accrual has been calculated at £3,679k and is based on the forecast outturn calculation provided to the CCG by the NHS Business Services Authority who monitor and report prescribing spend.
1.7 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.
In respect of accepted and agreed NHS recharges there the CCG hosts a service, the recharge is not shown as revenue but is netted against the initial cost incurred. Otherwise recharges are shown as revenue to the CCG.
1.8 Employee Benefits
1.8.1 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.
1.8.2 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.
1.9 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.
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1.10 Property, Plant & Equipment
1.10.1 RecognitionProperty, plant and equipment is capitalised if:* It is held for use in delivering services or for administrative purposes;* It is probable that future economic benefits will flow to, or service potential will be supplied to the clinical commissioning group;* It is expected to be used for more than one financial year;* The cost of the item can be measured reliably; and,* The item has a cost of at least £5,000; or,* Collectively, a number of items have a cost of at least £5,000 and individually have a cost of more than £250, where the assets are functionally interdependent, they had broadly simultaneous purchase dates, are anticipated to have simultaneous disposal dates and are under single managerial control; or,
* Items form part of the initial equipping and setting-up cost of a new building, ward or unit, irrespective of their individual or collective cost.
Where a large asset, for example a building, includes a number of components with significantly different asset lives, the components are treated as separate assets and depreciated over their own useful economic lives.
1.10.2 Valuation
All property, plant and equipment are measured initially at cost, representing the cost directly attributable to acquiring or constructing the asset and bringing it to the location and condition necessary for it to be capable of operating in the manner intended by management. All assets are measured subsequently at fair value.
NHS Sutton CCG does not own any land or buildings. On the dissolution of the former NHS Sutton & Merton Primary Care Trust, all land and buildings were transferred to NHS Property Services.
Fixtures and equipment are carried at depreciated historic cost as this is not considered to be materially different from fair value.
1.10.3 Subsequent ExpenditureWhere subsequent expenditure enhances an asset beyond its original specification, the directly attributable cost is capitalised. Where subsequent expenditure restores the asset to its original specification, the expenditure is capitalised and any existing carrying value of the item replaced is written-out and charged to operating expenses.
1.11 Depreciation, Amortisation & Impairments
Depreciation and amortisation are charged to write off the costs or valuation of property, plant and equipment, less any residual value, over their estimated useful lives, in a manner that reflects the consumption of economic benefits or service potential of the assets. The estimated useful life of an asset is the period over which the clinical commissioning group expects to obtain economic benefits or service potential from the asset. This is specific to the clinical commissioning group and may be shorter than the physical life of the asset itself. Estimated useful lives and residual values are reviewed each year end, with the effect of any changes recognised on a prospective basis.
At each reporting period end, the clinical commissioning group checks whether there is any indication that any of its non-current assets have suffered an impairment loss. If there is indication of an impairment loss, the recoverable amount of the asset is estimated to determine whether there has been a loss and, if so, its amount.
A revaluation decrease that does not result from a loss of economic value or service potential is recognised as an impairment charged to the revaluation reserve to the extent that there is a balance on the reserve for the asset and, thereafter, to expenditure. Impairment losses that arise from a clear consumption of economic benefit are taken to expenditure. Where an impairment loss subsequently reverses, the carrying amount of the asset is increased to the revised estimate of the recoverable amount but capped at the amount that would have been determined had there been no initial impairment loss. The reversal of the impairment loss is credited to expenditure to the extent of the decrease previously charged there and thereafter to the revaluation reserve.
1.12 LeasesLeases are classified as finance leases when substantially all the risks and rewards of ownership are transferred to the lessee. All other leases are classified as operating leases.
1.12.1 The Clinical Commissioning Group as Lessee
Property, plant and equipment held under finance leases are initially recognised, at the inception of the lease, at fair value or, if lower, at the present value of the minimum lease payments, with a matching liability for the lease obligation to the lessor. Lease payments are apportioned between finance charges and reduction of the lease obligation so as to achieve a constant rate on interest on the remaining balance of the liability. Finance charges are recognised in calculating the CCG’s surplus/deficit.
Operating lease payments are recognised as an expense on a straight-line basis over the lease term. Lease incentives are recognised initially as a liability and subsequently as a reduction of rentals on a straight-line basis over the lease term.
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1.13 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.
1.14 Provisions
Provisions are recognised when NHS Sutton CCG has a present legal or constructive obligation as a result of a past event, it is probable that NHS Sutton 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.
When some or all of the economic benefits required to settle a provision are expected to be recovered from a third party, the receivable is recognised as an asset if it is virtually certain that reimbursements will be received and the amount of the receivable can be measured reliably.
The NHS Discount rates for 2015/16 are;* 0-5 years : -1.55% (2014-15: -1.90%)* 6-10 years : -1.00% (2014-15: -0.65%)* > 10 years: -0.80% (2014-15: +2.20%)
1.15 Clinical Negligence Costs
The NHS Litigation Authority operates a risk pooling scheme under which the CCG pays an annual contribution to the NHS Litigation Authority which in return settles all clinical negligence claims. The contribution is charged to expenditure. Although the NHS Litigation Authority is administratively responsible for all clinical negligence cases the legal liability remains with NHS Sutton CCG. The total vale of clinical negligence provisions carried by the NHSLA on behalf of the clinical commissioning group is disclosed at note 13.
1.16 Non-clinical Risk Pooling
NHS Sutton 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 the NHS Litigation Authority and, in return, receives assistance with the costs of claims arising. The annual membership contributions, and any excesses payable in respect of particular claims are charged to operating expenses as and when they become due.
1.17 Continuing healthcare risk pooling
In 2014-15 a risk pool scheme has been introduced by NHS England for continuing healthcare claims, for claim periods prior to 31 March 2013. Under the scheme clinical commissioning groups contribute annually to a pooled fund, which is used to settle the claims.
1.18 Contingencies
A contingent liability is a possible obligation that arises from past events and whose existence will be confirmed only by the occurrence or non-occurrence of one or more uncertain future events not wholly within the control of the CCG, or a present obligation that is not recognised because it is not probable that a payment will be required to settle the obligation or the amount of the obligation cannot be measured sufficiently reliably. A contingent liability is disclosed unless the possibility of a payment is remote.
A contingent asset is a possible asset that arises from past events and whose existence will be confirmed by the occurrence or non-occurrence of one or more uncertain future events not wholly within the control of NHS Sutton CCG. A contingent asset is disclosed where an inflow of economic benefits is probable.
Where the time value of money is material, contingencies are disclosed at their present value.
1.19 Financial Assets
Financial assets are recognised when NHS Sutton 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.
The classification depends on the nature and purpose of the financial assets and is determined at the time of initial recognition.
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1.20 Loans and 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.
Fair value is determined by reference to quoted market prices where possible, otherwise by valuation techniques.
At the end of the reporting period, NHS Sutton CCG 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 directly/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.
1.21 Financial Liabilities
Financial liabilities are recognised on the statement of financial position when NHS Sutton CCG 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.
1.22 Value Added Tax
Most of the activities of NHS Sutton 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.
1.23 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 NHS Sutton CCG not been bearing its own risks (with insurance premiums then being included as normal revenue expenditure).
1.24 Subsidiaries
Material entities over which NHS Sutton CCG has the power to exercise control so as to obtain economic or other benefits are classified as subsidiaries and should be consolidated.
1.25 Accounting Standards That Have Been Issued But Have Not Yet Been AdoptedThe Government Financial Reporting Manual does not require the following Standards and Interpretations to be applied in 2015-16, all of which are subject to consultation:· IFRS 9: Financial Instruments· IFRS 14: Regulatory Deferral Accounts
· IFRS 15: Revenue for Contract with Customers
The application of the Standards as revised would not have a material impact on the accounts for 2015-16, were they applied in that year.
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NHS Sutton CCG - Annual Accounts 2015-16
2 Other Operating Revenue
2014-15Total Admin Programme Total
£000 £000 £000 £000
Education, training and research 264 181 83 156Non-patient care services to other bodies 7,468 167 7,301 1,234Other revenue 1,965 62 1,903 3,126
Total other operating revenue 9,697 410 9,287 4,516
Admin revenue is revenue received that is not directly attributable to the provision of healthcare or healthcare services.
Programme revenue is directly attributable to the provision of healthcare or healthcare services.
Revenue in this note does not include cash received from NHS England, which is drawn down directly into the bank account of the CCG andcredited to the Genral Fund.
3 Revenue2014-15
Total Admin Programme Total£000 £000 £000 £000
From rendering of services 9,697 410 9,287 4,516
Total 9,697 410 9,287 4,516
2015-16
2015-16
Revenue is totally from the supply of services. The clinical commissioning group receives no revenue from the sale of goods.
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NHS Sutton CCG - Annual Accounts 2015-16
4. Employee benefits and staff numbers
4.1.1 Employee benefits Total Admin Programme
2015-16 TotalPermanent Employees Other Total
Permanent Employees Other Total
Permanent Employees Other
£000 £000 £000 £000 £000 £000 £000 £000 £000Employee BenefitsSalaries and wages 2,877 2,490 387 1,545 1,425 120 1,332 1,065 267Social security costs 222 222 0 131 131 0 91 91 0Employer Contributions to NHS Pension scheme 286 286 0 174 174 0 112 112 0Gross employee benefits expenditure 3,385 2,998 387 1,850 1,730 120 1,535 1,268 267
4.1.2 Employee benefits Total Admin Programme
2014-15 TotalPermanent Employees Other Total
Permanent Employees Other Total
Permanent Employees Other
£000 £000 £000 £000 £000 £000 £000 £000 £000Employee BenefitsSalaries and wages 1,916 1,860 56 1,563 1,543 20 353 317 36Social security costs 171 171 0 142 142 0 29 29 0Employer Contributions to NHS Pension scheme 196 196 0 153 153 0 43 43 0Gross employee benefits expenditure 2,283 2,227 56 1,858 1,838 20 425 389 36
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NHS Sutton CCG - Annual Accounts 2015-16
4.2 Average number of people employed2014-15
TotalPermanently
employed Other TotalNumber Number Number Number
Total 55 45 10 38
4.3 Staff sickness absence and ill health retirements2015-16 2014-15Number Number
Total Days Lost 158 52Total Staff Years 44 25Average working Days Lost 3.60 2.08
2015-16 2014-15Number Number
Number of persons retired early on ill health grounds 0 0
£000 £000Total additional Pensions liabilities accrued in the year 0 0
Ill health retirement costs are met by the NHS Pension Scheme
4.4 Exit packages agreed in the financial year
NHS Sutton CCG was not required to make any payments relating to exit packages in the financial year.
2015-16
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NHS Sutton CCG - Annual Accounts 2015-16
4.5 Pension costs
Past and present employees are covered by the provisions of the NHS Pension Scheme. Details of the benefits payable under these provisions can be found on the NHS Pensions website at www.nhsbsa.nhs.uk/Pensions.
The Scheme is an unfunded, defined benefit scheme that covers NHS employers, GP practices and other bodies, allowed under the direction of the Secretary of State, in England and Wales. The Scheme is not designed to be run in a way that would enable NHS bodies to identify their share of the underlying scheme assets and liabilities.
Therefore, the Scheme is accounted for as if it were a defined contribution scheme: the cost to the clinical commissioning group of participating in the Scheme is taken as equal to the contributions payable to the Scheme for
The Scheme is subject to a full actuarial valuation every four years (until 2004, every five years) and an accounting valuation every year. An outline of these follows:
4.5.1 Full actuarial (funding) valuation
The purpose of this valuation is to assess the level of liability in respect of the benefits due under the Scheme (taking into account its recent demographic experience), and to recommend the contribution rates to be paid by employers and scheme members. The last such valuation, which determined current contribution rates was undertaken as at 31 March 2012 and covered the period from 1 April 2008 to that date. Details can be found on the pension scheme website at www.nhsbsa.nhs.uk/pensions .
For 2015-16, employers’ contributions of £286,159 were payable to the NHS Pensions Scheme at the rate of 14.3%of pensionable pay (2014-15: £196,522 at the rate of 14%). The scheme’s actuary reviews employer contributions,usually every four years and now based on HMT Valuation Directions, following a full scheme valuation. The latestreview used data from 31 March 2012 and was published on the Government website on 9 June 2014. These costsare included in the NHS pension line of note 4.1.1.
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NHS Sutton CCG - Annual Accounts 2015-16
5. Operating expenses2014-15
Total Admin Programme Total£000 £000 £000 £000
Gross employee benefitsEmployee benefits excluding governing body members 3,048 1,513 1,535 2,034Executive governing body members 337 337 0 249Total gross employee benefits 3,385 1,850 1,535 2,283
Other costsServices from other CCGs and NHS England 18,721 1,787 16,934 17,635Services from foundation trusts 29,646 0 29,646 17,381Services from other NHS trusts 130,458 0 130,458 136,192Purchase of healthcare from non-NHS bodies 34,521 0 34,521 19,206Chair and Non Executive Members 147 147 0 85Supplies and services – clinical 266 0 266 201Supplies and services – general 1,140 16 1,124 915Consultancy services 599 130 469 448Establishment 330 100 230 428Transport 128 2 126 57Premises 340 90 250 38Depreciation 25 25 0 0Audit fees 57 57 0 76Other non statutory audit expenditure· Internal audit services (RSM) 53 53 0 36· Other services 0 0 0 1Prescribing costs 23,763 0 23,763 23,005General ophthalmic services 30 0 30 27GPMS/APMS and PCTMS 3,251 0 3,251 2,246Other professional fees excl. audit 915 195 720 22Grants to other public bodies 150 0 150 150Education and training 293 (13) 306 262Provisions 0 0 0 (315)CHC Risk Pool contributions 731 0 731 303Other expenditure 138 43 95 161Total other costs 245,701 2,631 243,070 218,560
Total operating expenses 249,087 4,482 244,605 220,843
Administration expenditure is expenditure incurred that is not a direct payment for the provision of healthcare or healthcare services.
Programme revenue is directly attributable to the provision of healthcare or healthcare services.
2015-16
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NHS Sutton CCG - Annual Accounts 2015-16
6 Better Payment Practice Code
Measure of complianceNumber £000 Number £000
Non-NHS PayablesTotal Non-NHS Trade invoices paid in the Year 8,419 £41,925 5,660 £25,676Total Non-NHS Trade Invoices paid within target 8,152 £40,934 5,519 £25,001Percentage of Non-NHS Trade invoices paid within target 96.83% 97.64% 97.51% 97.37%
NHS PayablesTotal NHS Trade Invoices Paid in the Year 2,725 £178,870 2,652 £173,540Total NHS Trade Invoices Paid within target 2,641 £178,941 2,567 £172,773Percentage of NHS Trade Invoices paid within target 96.92% 100.00% 96.79% 99.56%
7 Income Generation Activities
NHS Sutton CCG does not undertake any income generation activities.All revenue shown in note 2 principally relates to either education and training funding, or joint funding operations.
2015-16 2014-15
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NHS Sutton CCG - Annual Accounts 2015-16
8. Operating Leases
8.1 As lessee
8.1.1 Payments recognised as an ExpenseLand Buildings Other Total Land Buildings Other Total£000 £000 £000 £000 £000 £000 £000 £000
Payments recognised as an expenseMinimum lease payments 0 79 0 79 0 35 0 35Contingent rents 0 0 0 0 0 0 0 0Sub-lease payments 0 0 0 0 0 0 0 0Total 0 79 0 79 0 35 0 35
8.1.2 Future minimum lease paymentsLand Buildings Other Total Land Buildings Other Total£000 £000 £000 £000 £000 £000 £000 £000
Payable:No later than one year 0 80 0 80 0 6 0 6Between one and five years 0 232 0 232 0 0 0 0After five years 0 0 0 0 0 0 0 0Total 0 312 0 312 0 6 0 6
Whilst our arrangements with Community Health Partnership's Limited and NHS Property Services Limited fall within the definition of operating leases, rental charge for future years has not yet been agreed . Consequently this note does not include future minimum lease payments for the arrangements only
NHS Sutton CCG rents 314 Malden Road, Cheam from the London Borough of Sutton for use as its headquarters. The CCG entered into a formal lease agreement for a 5 year period (with a break clause after 3 years) from 28th February 2015. The charge below is the rental charge for 2015-16. There are no purchase options attached to this rental
2015-16 2014-15
2015-16 2014-15
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NHS Sutton CCG - Annual Accounts 2015-16
9 Property, plant and equipment
2015-16
Buildings excluding dwellings
Information technology
Furniture & fittings Total 2014-15
Buildings excluding dwellings
Information technology
Furniture & fittings Total
£000 £000 £000 £000 £000 £000 £000Cost or valuation at 01-April-2015 38 0 36 74 Cost or valuation at 1 April 2014 0 0 0 0
Additions purchased 0 45 14 59 Additions purchased 38 0 36 74Cost/Valuation At 31-March-2016 38 45 50 133 Cost/Valuation At 31 March 2015 38 0 36 74
Depreciation 01-April-2015 0 0 0 0 Depreciation 1 April 2014 0 0 0 0
Charged during the year 13 0 12 25 Charged during the year 0 0 0 0Depreciation at 31-March-2016 13 0 12 25 Depreciation at 31 March 2015 0 0 0 0
Net Book Value at 31-March-2016 25 45 38 109 Net Book Value at 31 March 2015 38 0 36 74
Asset financing: Asset financing:
Owned 0 45 38 83 Owned 0 0 0 0Held on lease 0 0 36 36
Held on finance lease 25 0 0 25 Held on finance lease 38 0 0 38
Total at 31-March-2016 25 45 38 109 Total at 31-March-2016 38 0 36 74
Revaluation Reserve Balance for Property, Plant & Equipment
BuildingsInformation technology
Furniture & fittings Total
£000's £000's £000's £000'sBalance at 01-April-2015 0 0 0 0Other movements 0 0 0 0At 31-March-2016 0 0 0 0
9.1 Economic lives
Buildings excluding dwellings 3 3Information technology 3 3Furniture & fittings 3 3
Minimum Life (years)
Maximum Life (Years)
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NHS Sutton CCG - Annual Accounts 2015-16
10 Trade and other receivablesCurrent Non-current Current Non-current
£000 £000 £000 £000
NHS receivables: Revenue 762 0 842 0NHS prepayments 876 0 627 0NHS accrued income 311 0 281 0Non-NHS receivables: Revenue 1,537 0 823 0Non-NHS prepayments 160 0 22 0VAT 0 0 26 0Total Trade & other receivables 3,646 0 2,621 0
Total current and non current 3,646 2,621
Included above:Prepaid pensions contributions 0 0
10.1 Receivables past their due date but not impaired 2015-16 2014-15£000 £000
By up to three months 9 0By three to six months 0 42By more than six months 0 10Total 9 52
£0 of the amount above has subsequently been recovered post the statement of financial position date.
10.2 Provision for impairment of receivables
After review of the Aged Debtor position, NHS Sutton CCG has not provided a provision for the impairment of any receivables.
Concentration of credit risk is limited due to the fact that the customer base is large and composed of government bodies. Due to this, the Governing Body believes that there is no future risk provision required in excess of the normal provision for doubtful receivables.
The great majority of trade is with NHS organisations and local authorities. As NHS organisations and local authorities are ultimately funded by Government, no credit scoring of them is considered necessary.
2015-16 2014-15
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NHS Sutton CCG - Annual Accounts 2015-16
11 Cash and cash equivalents
2015-16 2014-15£000 £000
Balance at 01-April-2015 4 71Net change in year 92 (67)Balance at 31-March-2016 96 4
Made up of:Cash with the Government Banking Service 96 4Balance at 31-March-2016 96 4
Patients’ money held by the clinical commissioning group, not included above 0 0
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NHS Sutton CCG - Annual Accounts 2015-16
Current Non-current Current Non-current£000 £000 £000 £000
NHS payables: revenue 6,198 0 4,497 0NHS accruals 56 0 198 0Non-NHS payables: revenue 1,816 0 1,677 0Non-NHS accruals 6,589 0 4,796 0Social security costs 38 0 27 0Tax 44 0 33 0Other payables 585 0 266 0Total Trade & Other Payables 15,326 0 11,494 0
Total current and non-current 15,326 11,494
Other payables include £56,000 outstanding pension contributions at 31 March 2016 (£35,000 at 31 March 2015).
12 Trade and other payables2015-16 2014-15
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NHS Sutton CCG - Annual Accounts 2015-16
13 Provisions
Current Non-current Current Non-current£000 £000 £000 £000
Total 0 0 0 0
Total current and non-current 0 0
NHS Sutton CCG has no reportable provisions at 31st March 2016.
Under the Accounts Direction issued by NHS England on 12 February 2014, NHS England is resposible for accounting for liabilities relating to NHS continuing healthcare claims relating to periods of care before the establishment of Clinical Commissioning Groups. However, the legal liability remains with the CCG. The total value of legacy NHS Continuing Healthcare provisions is accounted for by NHS England on behalf of this CCG at 31 March 2016 is £1.116m (2014/15 £1.832m).
Legal claims are calculated from the number of claims currently lodged with the NHS Litigation Authority and the probabilities provided by them. £Nil is included in the provisions of the NHS Litigation Authority as at 31 March 2016 in respect of clinical liabilties of the Clincial Commissioning. Legal claims are calculated from the number of claims currently lodged with the NHS Litigation Authority and the probabilities provided by them.
2015-16 2014-15
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NHS Sutton CCG - Annual Accounts 2015-16
14 Contingencies
15 Commitments
NHS Sutton CCG has no reportable commitments at 31st March 2016.
No outstanding claims in 2015/16 are considered to have a likelihood that deems them reportable as a contingent liability in 2015/16.
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NHS Sutton CCG - Annual Accounts 2015-16
16 Financial instruments
16.1 Financial risk management
16.1.1 Currency risk
16.1.2 Interest rate risk
16.1.3 Credit risk
16.1.4 Liquidity risk
The Clinical Commissioning Group borrows from government for capital expenditure, subject to affordability as confirmed by NHS England. The borrowings are for 1 to 25 years, in line with the life of the associated assets, and interest is charged at the National Loans Fund rate, fixed for the life of the loan. The clinical commissioning group therefore has low exposure to interest rate fluctuations.
Because the majority of the NHS Clinical Commissioning Group and revenue comes parliamentary funding, NHS Clinical Commissioning Group has low exposure to credit risk. The maximum exposures as at the end of the financial year are in receivables from customers, as disclosed in the trade and other receivables note.
NHS Clinical Commissioning Group is required to operate within revenue and capital resource limits, which are financed from resources voted annually by Parliament. The NHS Clinical Commissioning Group draws down cash to cover expenditure, as the need arises. The NHS Clinical Commissioning Group is not, therefore, exposed to significant liquidity risks.
Financial reporting standard IFRS 7 requires disclosure of the role that financial instruments have had during the period in creating or changing the risks a body faces in undertaking its activities.
Because NHS Sutton Clinical Commissioning Group is financed through parliamentary funding, it is not exposed to the degree of financial risk faced by business entities. Also, financial instruments play a much more limited role in creating or changing risk than would be typical of listed companies, to which the financial reporting standards mainly apply. The clinical commissioning group has limited powers to borrow or invest surplus funds and financial assets and liabilities are generated by day-to-day operational activities rather than being held to change the risks facing the clinical commissioning group in undertaking its activities.
Treasury management operations are carried out by the finance department, within parameters defined formally within the NHS Clinical Commissioning Group standing financial instructions and policies agreed by the Governing Body. Treasury activity is subject to review by the NHS Clinical Commissioning Group and internal auditors.
The NHS Clinical Commissioning Group is principally a domestic organisation with the great majority of transactions, assets and liabilities being in the UK and sterling based. The NHS Clinical Commissioning Group has no overseas operations. The NHS Clinical Commissioning Group and therefore has low exposure to currency rate fluctuations.
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NHS Sutton CCG - Annual Accounts 2015-16
16 Financial instruments cont'd
16.2 Financial assets
At ‘fair value through profit
and loss’Loans and
ReceivablesAvailable for
Sale Total£000 £000 £000 £000
Embedded derivatives 0 0 0 0Receivables:· NHS 0 1,073 0 1,073· Non-NHS 0 1,537 0 1,537Cash at bank and in hand 0 96 0 96Other financial assets 0 0 0 0Total at 31-March-2016 0 2,706 0 2,706
At ‘fair value through profit
and loss’Loans and
ReceivablesAvailable for
Sale Total£000 £000 £000 £000
Embedded derivatives 0 0 0 0Receivables:· NHS 0 842 0 842· Non-NHS 0 823 0 823Cash at bank and in hand 0 4 0 4Other financial assets 0 0 0 0Total at 31-March-2015 0 1,669 0 1,669
16.3 Financial liabilities
At ‘fair value through profit
and loss’ Other Total£000 £000 £000
Embedded derivatives 0 0 0Payables:· NHS 0 6,254 6,254· Non-NHS 0 8,990 8,990Private finance initiative, LIFT and finance lease obligations 0 0 0Other borrowings 0 0 0Other financial liabilities 0 0 0Total at 31-March-2016 0 15,244 15,244
At ‘fair value through profit
and loss’ Other Total£000 £000 £000
Embedded derivatives 0 0 0Payables:· NHS 0 4,694 4,694· Non-NHS 0 6,740 6,740Private finance initiative, LIFT and finance lease obligations 0 0 0Other borrowings 0 0 0Other financial liabilities 0 0 0Total at 31-March-2015 0 11,434 11,434
2014-15
2015-16
2014-15
2015-16
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NHS Sutton CCG - Annual Accounts 2015-16
17 Operating segments
Gross expenditure
Income Net expenditure Total assets Total liabilities Net assets
£'000 £'000 £'000 £'000 £'000 £'000Commissioning of healthcare 249,087 (9,697) 239,390 3,851 (15,326) (11,475)Total 249,087 (9,697) 239,390 3,851 (15,326) (11,475)
Reconciliation between Operating Segments and SoCNE
31-Mar-16£'000
Total net expenditure reported for operating segments
239,390
Reconciling items:Total net expenditure per the Statement of Comprehensive Net Expenditure
239,390
Reconciliation between Operating Segments and SoFP
31-Mar-16£'000
Total assets reported for operating segments
3,851
Reconciling items:Total assets per Statement of Financial Position
3,851
31-Mar-16£'000
Total liabilities reported for operating segments
(15,326)
Reconciling items:Total liabilities per Statement of Financial Position
(15,326)
NHS Sutton CCG considers it has only one segment: commissioning of healthcare services.
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NHS Sutton CCG - Annual Accounts 2015-16
18 Pooled budgets
2015-16 2014-15£000 £000
Income 5,672 0Expenditure (11,290) 0
The NHS Clinical Commissioning Group shares of the income and expenditure handled by the pooled budget in the financial year were:
The clinical commissioning group had entered into a pooled budget with London Borough of Sutton. The pool is hosted by London Borough of Sutton.
Under the arrangement, funds are pooled under Section 75 of the NHS Act 2006 for the Better Care Fund and Integrated Community Equipment Services.
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NHS Sutton CCG - Annual Accounts 2015-16
19 Related party transactions
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
Dr Brendan Hudson - Chair 35 0 0 0 8 0 0 0
Dr Chris Elliott - Chief Clinical Officer 9 0 0 0 36 0 0 0
Dr Jonathan Cockbain - Clinical Lead for Urgent Care 86 0 0 0 6 0 0 0
Dr Dino Pardhanani - Clinical Lead for Local Care Centres and Service Redesign 10 0 0 0 20 0 0 0
Karol Selvey - Clinical Lead for Community & Long Term Conditions 87 0 0 0 113 0 0 0
227 0 0 0 183 0 0 0
Note that these payments are made to the individuals General Practice for clinical services commissioned by the CCG, and not to the individual themselves.
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
Sutton GP Services Ltd 160 0 0 0 0 0 22 0
Sutton GP Services Ltd is the local GP federation which exists to facililiatate network working and mutual support across practices and encourage greater efficiency through the sharing of administrative functions.
The Department of Health is regarded as a related party. During the year the clinical commissioning group has had a significant number of material transactions with entities for which the Department is regarded as the parent Department.
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
Epsom & St Helier University Hospitals NHS Trust 101,942 0 1,863 (775) 99,912 0 923 (537)
NHS Business Services Authority 20,119 0 3,814 0 19,290 0 3,781 0
South West London & St George's Mental Health NHS Trust 16,374 0 258 0 15,759 0 257 0
St George's University Hospitals NHS Foundation Trust 13,171 0 904 (64) 2,028 0 216 (58)
St George's Healthcare NHS Trust 0 0 0 0 10,971 0 0 0
NHS Merton Clinical Commissioning Group 14,768 (1,105) 344 (655) 14,180 (2,176) 441 (790)
The Royal Marsden NHS Foundation Trust 7,049 0 1,555 0 6,730 0 589 0
London Ambulance Service NHS Trust 6,057 0 53 0 5,501 0 397 0
NHS South London CSU 2,726 (17) 97 (22) 2,833 0 29 (17)
Croydon Health Services NHS Trust 1,540 0 23 (8) 1,505 0 0 (78)
Guy's & St Thomas' NHS Foundation Trust 1,316 0 67 0 1,241 0 136 0
Kingston Hospital NHS Foundation Trust 1,138 0 0 (90) 1,039 0 300 (20)
Health Education England 0 (144) 0 0 0 (156) 0 0
NHS England 731 (4) 0 (58) 271 (84) 32 0
Community Health Partnerships 0 0 (46) 0 0 0 0 0
186,931 (1,270) 8,932 (1,672) 181,260 (2,416) 7,101 (1,500)
In addition, the clinical commissioning group has had a number of material transactions with local government bodies.
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 Sutton 12,037 (5,896) 356 (1,497) 2,450 (505) 359 (734)
2015/16 2014/15
2015/16 2014/15
Details of related party transactions with individuals are as follows:2015/16 2014/15
2015/16 2014/15
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NHS Sutton CCG - Annual Accounts 2015-16
20 Events after the end of the reporting period
21 Losses and special payments
There are no post statement financial events which will have a material effect on the financial statements of NHS Sutton CCG.
NHS Sutton CCG suffered no reportable losses or made any special payments to report in 2015/16.
NHS Sutton CCG has been succesful in its application to participate in delegated Primary Care co-commissioning from 1st April 2016. The associated income and expenditure will appear in the CCG's 2016/17 financial statements.
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NHS Sutton CCG - Annual Accounts 2015-16
22 Financial performance targets
NHS Clinical Commissioning Group have a number of financial duties under the NHS Act 2006 (as amended).
NHS Clinical Commissioning Group performance against those duties was as follows:
Target Performance Variance Target Target Performance Variance Target£'000 £'000 £'000 Met £'000 £'000 £'000 Met
Expenditure not to exceed income 251,441 249,087 (2,354) Yes 223,586 220,917 (2,669) Yes
Capital resource use does not exceed the amount specified in Directions 75 59 (16) Yes 75 74 (1) Yes
Revenue resource use does not exceed the amount specified in Directions 241,744 239,390 (2,354) Yes 218,995 216,327 (2,668) Yes
Capital resource use on specified matter(s) does not exceed the amount specified in Directions 0 0 0 N/A 0 0 0 N/A
Revenue resource use on specified matter(s) does not exceed the amount specified in Directions 0 0 0 N/A 0 0 0 N/A
Revenue administration resource use does not exceed the amount specified in Directions 4,385 4,072 (313) Yes 4,754 4,284 (470) Yes
23 Analysis of charitable reserves
NHS Sutton CCG is the corporate trustee of the Sutton and Merton CCG's charitable funds. The Governing Body does not consider theactivities of the charity to be material to NHS Sutton CCG. The net assets of the charitable funds at £1.8m represents 0.7% of the £241.7m revenue resource of NHS Sutton CCG and the net income of the charitable funds in 2015/16 of £0.004m represents less than0.01% of the CCG's resource outturn position. Accordingly, the Governing Body has decided not to consolidate the Charitable Funds accounts with that of the CCG.
2015-16 2014-15
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