annual report - walsall ccg · week breach during the year. there are still many challenges ahead...

REPORTAND ACCOUNTS2018 ~ 2019

ANNUAL

1. Chair’s Foreword ...................................... 4

2.1 Performance Overview ........................... 6

2.1.1 About us ........................................................... 9

2.1.2 Our purpose and activities .............................. 9

2.1.3 Our member practices and localities .................................................10

2.1.4 Our providers ..................................................10

2.1.5 Health of the borough ...................................10

2.1.6 Reducing health inequalities .........................11

2.1.7 Health and wellbeing strategy .......................12

2.1.8 The challenges ..............................................14

2.1.9 CCG Improvement and Assessment Framework (IAF) ...........................15

2.1.10 Walsall Together..............................................16

2.1.11 The Black Country Sustainability Transformation Partnership .......................18

2.1.12 The NHS Long Term Plan ................................19

2.1.13 Financial Overview ........................................26

2.2 Performance Analysis ............................ 28

2.2.1 18 week Referral-to-Treatment (RTT) ................30

2.2.2 A&E four hour wait ..........................................30

2.2.3 Ambulance handover delays ........................32

2.2.4 Mixed Sex Accomodation breaches (MSA) ..............................................32

2.2.5 Additional Mental Health measures ..............33

2.2.6 Improving Access to Psychological Therapies (IAPT) ...............................................33

2.3 Sustainability Report ............................ 34

2.4 Improving Quality .................................. 36

2.4.1 Holding providers to account..........................36

2.4.2 Patient safety ...................................................37

2.4.3 Staff satisfaction ..............................................37

2.4.4 Safeguarding children, young people, adults and Looked-After-Children ...................38

2.5 Engaging people and communities .......................................... 40

2.5.1 Patient Voice Panel .........................................41

2.5.2 Patient Participation Groups (PPGs) ..................42

2.5.3 Patient Participation Liaison Group (PPLG) ..................................................42

2.5.4 Patient Participation Conference 2018 & development of Patient Participation Group Charter ................................................43

2.5.5 Patient Stories ..................................................43

2.5.6 Website, social media and e-newsletters ..................................................43

2.5.7 Governing Body meetings ..............................44

2.5.8 Stakeholder, workforce and system engagement .................................................44

2.5.9 Other Communications & Engagement activity ......................................45

2.5.10 Future plans ...................................................46

2.6 Primary Care Commissioning .............. 47

2.6.1 GPFV Transformation Funding ..........................47

2.6.2 Access ............................................................47

2.6.3 Primary Care Offer ..........................................48

2.6.4 GP contract re-procurement ..........................48

2.6.5 Investing in our Primary Care workforce ..............................................50

2.6.6 Primary Care contracting ...............................50

2.6.7 Primary Care workforce – working with CCGs across the Black Country ..............50

3. Accountability Report ........................... 53

3.1 Corporate Governance Report ......................53

3.1.1 Members Report ................................................

3.1.2 Statement of Accountable Officer’s Responsibilities ...............................................61

3.1.3 Governance Statement .................................62

3.2 Remuneration and Staff Report .....................90

3.2.1 Remuneration Report .....................................90

3.2.2 Staff Report ...................................................101

3.3 Parliamentary Accountability and Audit Report .................................................111

4. Annual Accounts ................................. 104

5. Glossary ............................................... 156

CONTENTS

For more information about Walsall Clinical Commissioning Group visit www.walsall.nhs.uk

Please contact 01922603054 or email [email protected] to request this document in a different language or format.

We will RESPECT and VALUE people

We will LISTEN to local people

We recognise and embrace CLINICAL LEADERSHIP

We have a clear sense of personal ACCOUNTABILILTY and TRANSPARENCY

We will strive to be at the forefront of INNOVATION

We will promote PREVENTION of poor health, starting early with families,

children and young people

We will work in PARTNERSHIP with other health services, local authority and voluntary sector organisations

We will create PUBLIC VALUE through our commissioning arrangements

OUR VALUES

NHS Walsall Clinical Commissioning Group (CCG) is an ambitious organisation that continually strives to

improve the health and wellbeing of, and reduce health inequalities for our local population.

In this document we aim to show how the services we commission have performed throughout the year,

as well as information about the work we have been doing to progress the redesign and transformation

of other services.

Recently, we welcomed the publication of The Long Term Plan for the NHS which describes how we

will work over the next ten years, and this is very closely aligned with our plans in Walsall. A draft new

contract for General Practice to support the delivery of The Long Term Plan will see Primary Care

building on the changes we have already seen and further investing in caring for the people of Walsall.

The CCG has continued to build on its work with local health and care partners to develop the Walsall

Together Integrated Care Partnership (ICP). Plans for the creation of the ICP are well developed and a

shadow form of the ICP Board has already met.

Going into 2019/20, we are collaborating with CCGs across the Black Country on key system-wide

service review and development initiatives which are set out in our shared Black Country Clinical

Strategy, and will continue to meet our challenges and make the most of our opportunities. I look

forward to working with our wider system partners as well as the local community to achieve our plans

to deliver integrated care.

In the year that we marked the 70th anniversary of the NHS, I would like to take this opportunity to

thank everyone who contributes to the success of the NHS in Walsall; whether they be staff, patient

representatives, or partner organisations – your contributions help us to empower our borough to start

well, live well and age well. Thank you.

Dr Anand Rischie - Chair

NHS Walsall Clinical Commissioning Group

1.0 CHAIR’S FOREWORDWelcome to our Annual Report

page 4

REPORTPERFORMANCE

2.0

page 6 page 7

Welcome to the 2018/19 annual report for NHS

Walsall Clinical Commissioning Group (CCG).

The following section is designed to provide a

short summary that details the work of the CCG,

our purpose, the key risks and challenges to the

achievement of our objectives and how we have

performed during the year.

The start of 2019 saw NHS England publish their

Long Term Plan (LTP). The blueprint to make the

NHS fit for the future will use the latest technology,

such as digital GP consultations for all those

who want them, coupled with early detection

and a renewed focus on prevention to stop an

estimated 85,000 premature deaths each year.

Locally, we are already committed to working

with partners across the Black Country and it is

clear that much of our existing work is coherent

with the LTP. Our place based work to integrate

community and primary care is recognised in

the plan and for the first time in the NHS’ 70-year

history there is a new guarantee that investment

in primary, community and mental health care

will grow faster than the growing overall NHS

budget, with a view to treating more people

within the community and away from hospital

where possible.

Strong primary care is at the heart of this

approach and supporting our GP colleagues to

work in different ways and investing in our Primary

Care Networks is essential to achieve this aim.

We are proud of the improvement we have seen

in the Care Quality Commission (CQC) ratings

with 93.6% of GP practices in Walsall being rated

good or outstanding.

Increasing access for residents to GP services

has been a priority for the CCG. We introduced

an Extended Access Programme in 2017, which

was then expanded to provide a 4th hub from

November 2018. The hubs provide appointments

at times that are convenient to patients outside of

their normal GP opening hours such as evenings,

weekends and bank holidays. The feedback we

have received from patients using this service has

been excellent, and the service has been utilised

to almost maximum capacity consistently.

We are also investing in the safer and more

appropriate use of medicines in Walsall,

through our Prescription Ordering Direct pilot.

This trial service enables patients to have their

medication reviewed and regular medications

re-ordered over the phone, reducing medicines

waste, increasing productivity for practices and

improving patient experience.

Local people remain at the heart of our work

and we have taken a number of approaches

to connect with different communities and talk

to them about current provision, new service

design and service change through a number

of consultations which have focused on topics

such as Black Country learning disability services,

GP services and urgent care. The feedback we

have received from residents has been really

valuable and most importantly it has informed

our decision-making processes; a notable

example being the successful implementation

of changes to the acute stroke pathway.

At its 2017 inspection, our lead provider Walsall

Healthcare Trust (WHT) was rated overall as

‘requires improvement’. At the time, the CQC

found improvements in ratings for all acute

services with the exception of maternity and

gynaecology which remained as ‘inadequate’.

An improvement plan was put in place for these

services and we are pleased to report that the

2018 CQC rating for Maternity at the Trust has

progressed to ‘Requires Improvement’. The Trust

is awaiting the outcome of CQC visit in February

2019 and it is anticipated further improvements

will be reported.

Urgent care performance has significantly

improved in Walsall and is no longer in the

bottom quartile. We have also made significant

improvements in meeting the NHS constitutional

standards for Referral to Treatment (RTT). We

are now ahead of trajectory and national

performance levels and have seen only one 52-

week breach during the year.

There are still many challenges ahead for the

CCG; however, we would like to assure people

that as an organisation we are fully committed

to commissioning high quality health services

that provide good value for money for the

people of Walsall. Financial performance

has been sustained during the year, with the

Quality Innovation Productivity and Prevention

(QIPP) programme, control total and surplus

requirement met.

We believe, looking to the future, that partnership

working will be key to our ongoing success and

sustainability, and as such we have continued

our great work with partners on local and regional

transformation programmes, most significantly

our Local Care Strategy, ‘Walsall Together’ and the

Black Country Sustainability and Transformation

Partnership (STP).

Bringing together health and social care

organisations to develop a whole system

approach to the delivery of services will mean

a more consistent and united approach based

on a shared model of care, ultimately helping

to deliver the best health for all. We know care

works best when it’s joined up, because it offers

improved quality of service to individuals and

makes better use of our resources, to deliver the

outcomes that matter most to Walsall residents.

We are continuing to develop the Walsall

Together programme into a full Integrated Care

System and as always, we will continue to have

conversations with our communities about the

choices we need to make collectively.

More information on our strategic commissioning

approach, including Walsall Together and the

Black Country & West Birmingham Sustainability

Transformation Partnership, is set out in the

Performance section of this report.

Finally, I would like to thank everyone we have

worked with this year, and I look forward to

working with you in the year ahead to continue

to transform health services for the benefit of our

population and progress our plans for integrated

care.

I hope you enjoy reading this annual report. If

you have any comments on it, or the information

contained within it, please let us know using the

contact information on the back of this report.

Paul Maubach - Accountable Officer

22 May 2019

2.0 Performance Overview

2.0

page 09

2.1.1 About usNHS Walsall Clinical Commissioning Group (CCG) is responsible for commissioning community, hospital and mental health services for local people. In April 2016 the CCG also became responsible for commissioning primary care services (GP services) with NHS England.

Commissioning looks at:

• Understanding the health needs of the population • Designing and redesigning services • Buying the services • Measuring the impact of services

The CCG was formed on 1 April 2013 and is a clinically-led organisation which means that local GPs and lay representatives use their local knowledge and personal experiences to plan, buy and monitor the quality standards of local NHS services.

CCGs put local GPs at the heart of deciding what health services local people need and receive. All of our GPs use their experience and knowledge to influence and shape the decisions the CCG makes, with some more heavily involved as members of the Governing Body.

The CCG Chair is elected by the GP practice members. Governing Body members include GPs, lay members, a secondary care consultant and CCG executive officers. It is the Governing Body that holds the CCG to account and the senior management team who manage the day to day running of the organisation which involves the service development, contracting and performance management of local health services.

As a membership organisation, the CCG represents local GPs who work at 52 local practices across Walsall. The CCG has a total budget of £444.7 million.

Walsall CCG aims to:

• Effectively commission services which will improve the health and wellbeing for our population • Comply with our statutory duties and responsibilities and keep people safe • Ensure strong leadership and governance arrangements

2.1.2 Our purpose and activities Our responsibilities are delegated to the CCG from NHS England; the national body with a formal mandate to oversee the commissioning of health services in England by the Secretary of State for Health (apart from public health services, which are commissioned by local authorities). The accounts direction for CCGs is determined by NHS England and approved by the Department of Health (Secretary of State) and made under the following legislation: Health and Social Care Act 2012 c.7 Schedule 2 s.17.

2.0

page 10 page 11

2.1.3 Our member practices and localities NHS Walsall CCG has a membership of 52 GP practices, who all play a pivotal role in clinically led commissioning. Clinicians and patients are at the heart of our decision-making. In 2018/19 we engaged and consulted widely with our membership on a number of topics including GP online services and the development of Primary Care Networks, which was reflected in the response rate we received from stakeholders to the 360 degree survey.

2.1.4 Our providers Walsall CCG uses the term ‘provider’ to describe any organisation commissioned to supply a health or care-based service. Examples include; hospital trusts, mental and community health trusts, GP practices and federations (a group of general practices or surgeries forming an organisational entity and working together within the local health economy), voluntary and third sector organisations, social workers, home support (care) workers, health visitors and district nurses. Walsall Healthcare Trust (WHT) is the main providers of acute care for Walsall residents and provides the majority of local community services. Dudley and Walsall Mental Health Trust (DWMHT) provide mental health services.

The CCG also commissions services from other hospitals in nearby counties, social care providers, community healthcare and the voluntary sector to give patients the opportunity to choose their preferred provider.

2.1.5 Health of the borough

Walsall is one of four towns in the Black Country which is in the West Midlands Region. The population is 281,293 as at June 2017 (ONS mid-year estimate) and we are coterminous with Walsall Council. Our town has great contrasts, with significant deprivation in the west of the borough and relative affluence in the east. Differences in deprivation levels and lifestyles (smoking, excessive consumption of alcohol, etc.) lead to poorer health outcomes for our communities in the west. This leads to high levels of infant mortality and lower adult life expectancy.

In line with our statutory duties we have contributed to the development of the Joint Strategic Needs Assessment (JSNA) with our partners from Walsall Council. The JSNA which is available via this link http://www.walsallintelligence.org.uk/themedpages-walsall/JSNA sets out a number of key messages about the nature of the population we serve and which informs our commissioning plans.

2.1.6 Reducing health inequalities The most recent assessment of the health needs of the Walsall population are set out in the Joint Strategic Needs Assessment (JSNA), the preparation of which is led by the Director of Public Health at Walsall MBC. The CCG contributes to the JSNA and to the Walsall Plan which it informs.

On average, people in Walsall have poorer health than the England average across a range of measures. The prevalence of long term illness is high and the healthy life expectancy of the population is lower than the national average.

The borough has higher than average levels of obesity, both in children and adults. Uptake of health screening is lower than national targets. Although smoking rates have reduced in recent years they are still relatively high: tackling this is a priority, particular smoking in pregnancy.

As well as Walsall’s relatively poor position compared to other areas of the country there are also significant inequalities in health outcomes between different parts of the borough.

The CCG has a number of projects designed to tackle areas of health inequality:

• The Bowel Cancer Screening Project works with general practice to increase the update on bowel cancer screening. Having started as a pilot in practices with the lowest uptake we have now secured funding to extend the project to all Walsall practices.

• The Latent Tuberculosis (TB) initiative is working to identify patients at high risk of having TB and ensuring that they receive treatment.

• We have been working with the provider of our cardiac and pulmonary rehabilitation service to improve uptake of the service by people from black and minority ethnic populations as we had identified that access to these services from these population groups is not as high as we would have expected based on their needs.

All change proposals developed by the CCG are assessed using an equality impact assessment to ensure that, in making our plans, we give due consideration to our duties under the Equalities Act and in relation to the health inequalities and commissioning managers have received training to ensure that these assessments are carried out consistently and effectively across all of our areas of work.RISING TO 290,200 BY 2024

WALSALL’S HEALTH: AN OVERVIEW289,088 PEOPLE LIVING IN WALSALL Life expectancy in Walsall

is lower than regional and national averages.

A woman born in Walsall can expect to live to 82.0, compared to 82.7 in the West Midlands and 83.1 as a national average. A man born in Walsall can expect to live to 77.2 - 1.6 years less than the average male in the West Midlands and 2.3 years less than the average male nationally.

• 29.2% of children in Walsall live in poverty

• More than 1/4 of 10-11 year olds in Walsall are obese

• Teenage pregnancy in Walsall remains higher than the national average

• Walsall is 33rd most deprived LA in country

• 12.3% of residents claim out of work benefits

• An estimated 10,722 residents are dependant on alcohol

CHALLENGES IN WALSALL

* Source - Public Health Walsall

2.0

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2.1.7 Health and wellbeing strategy The Walsall Plan “Our Health and Wellbeing Strategy 2017-2020” includes three priorities for which the CCG is the lead organisation:

Priority 7: Remove unwarranted variation in healthcare and ensure access to services with consistent quality

Priority 8: Enable those at risk of poor health to access appropriate health and care, with informed choice

Priority 12: Deliver prevention and intervention through health and care locality delivery models

NHS Right Care

NHS Right Care is a national programme which provides tools, support and a structured approach to identifying and tackling unwarranted variation in healthcare provision and outcomes.

The CCG has worked with local partners to run a local NHS Right Care programme, focussing first on the areas with the greatest improvement opportunity.

One example of this work is the iMSK service: in October 2017 we commissioned a physiotherapy led triage process for GP referrals for orthopaedics, pain management and rheumatology. The service has continued to develop during 2018/19 and have seen its impact in a reduced number of referrals to hospital orthopaedic services. This has reduced waiting times for consultant appointments and we are now achieving the national 18 weeks referral to treatment standard for orthopaedic surgery at Walsall Healthcare Trust.

Access to General Practice

We have made good progress this year improving access to general practice. The table below shows the increase in appointments in general practice in Walsall from January 2018 to January

We established four hubs – one in each locality – offering extended access appointments in the evenings and at weekends. The table below shows the significant improvement which this initiative has had in increasing the number of additional GP appointments offered in Walsall over the last year.

Monthly trend in appointments by appointment Type for NHS Walsall CCG practices 2018-01 to 2019-01

2,000,000

1,800,000

1,600,000

1,400,000

1,200,000

1,000,000

800,000

600,000

400,000

200,000

Face-to-Face

Home Visit

Telephone

APPOINTMENT MADE

0

SELECTED CCG

NATIONAL AVAERGAE

AVER

AGE

NUM

BER

OF

EXTE

ND

ED A

CC

ESS

DAY

S PE

R W

EEK

Trend in practice average extended access days for NHS Walsall CCG practices relative to national average

5.0

4.5

4.0

3.5

3.0

2.5

2.0

1.5

1.0

0.5

0.0

2016-10 2017-03 2017-09 2018-03 2018-03

National NHS Diabetes Programme

Walsall has a very high prevalence of diabetes. Data from GP practices tells us that the CCG rates well for the treatment of diabetes in primary care when compared to other similar CCGs but the numbers of people referred for structured education, which can support them to understand and better manage their illness, was relatively low. We are now offering more sessions at a wider range of venues and have been working with practices to identify ways in which more people can be encouraged to attend. In 2018/19 almost 90% more people attended structured education than two years previously which was before the project started.

Walsall has also benefited from some national funding to increase capacity in the multi-disciplinary foot care team and we have started to see the benefits of this project, with a 23% reduction in the number of lower limb amputations in 2018 compared to 2017.

Locality delivery model

Place based teams have been established in each of the four Walsall localities as a key component of our Walsall Together programme and there is an on-going initiative to realise the benefits of more integrated working.

2.0

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Central to this work is the development of Multi-Disciplinary Team (MDT) meetings where GPs alongside health & care staff from the integrated teams discuss patients with more complex needs and develop joint plans to ensure that their on-going care and treatment is being effectively co-ordinated between the professionals involved.

Multi-Disciplinary Teams are currently running at 20 of our 52 practices, giving coverage of 38.5% of practices covering the Walsall population. We are aiming in 2019/20 to roll out MDT working to cover the whole of the Walsall population.

2.1.8 The Challenges Challenges exist in terms of the system, finance, performance, health and quality.

System challenges

The key challenges facing the Walsall health and social care economy are:

• A growing demand for healthcare from a growing and ageing population

• The financial sustainability of our NHS partners

• Budgetary challenges facing Walsall Metropolitan Borough Council, in relation to public health, adult social care and children’s services

• The need to secure effective transformation in leadership and cultural terms at a local level to ensure our new model of care is capable of delivery

• The need to secure full clinical engagement from clinicians across primary, community and secondary care

• A primary care system that is under strain and requires radical change to become sustainable

• An acute services provider facing performance and quality challenges

Financial challenges

The CCG’s financial plan has been constructed to deliver a sustainable NHS in Walsall. We set out how we intend to implement a financial plan that meets all our duties and the business rules set out in the planning guidance, as well as the associated risks and mitigations. The Walsall Together business case recognises that our transformation programme for implementing the new service model will require some additional non-recurrent resource over the next three years, including support to front line teams and some dual-running as new ways of working are established.

Performance challenges

There are specific performance challenges in relation to the A&E 4-hour waiting standard and the referral to treatment time standard for planned care. The CCG Integrated Assurance Framework (IAF) also identifies areas for improvement in performance and outcomes.

Health challenges

2011 Census results show that overall health is poorer in Walsall than the England and Wales average. One in five residents have a limiting health condition: 10.4% are limited a lot, and a further 10.3% limited a little. 77.3% of residents say their health is good or very good – lower than the 81.2% nationally – with 7.3% experiencing bad or very bad health (5.6% nationally).

The borough has adopted the Marmot principles on health inequalities and these principles have informed the Health and Well Being Strategy for the borough. Overall life expectancy is gradually increasing for both males and females and the gap with comparator areas has shown positive signs of narrowing. However, the focus continues to be on prolonging a healthy life expectancy and understanding and planning for the implications that will have on service need and provision. Walsall has a lower healthy life expectancy age compared to regional and national comparators. Female healthy life expectancy is lower than males.

Care and quality challenges

• Walsall’s main provider, Walsall Healthcare Trust, is currently under scrutiny by NHS regulators and had been rated as ‘requires improvement’ by the CQC in June 2017. The Trust remains in special measures. This has had a significant impact on both providers and commissioners to ensure the required action is taken to improve its services. A further CQC inspection was undertaken in February 2019 and the report is awaited.

• Concerns have been raised regarding reporting of maternity service serious incidents and the Trust’s oversight of its governance arrangements.

• We need to ensure appropriate triangulation of serious incidents and the embedding of actions in light of a number emerging themes including: Surgical Never Events, diagnostic, treatment and follow-up delays.

• We need to gain assurance of Safeguarding quality metrics and Multi Agency Safeguarding Hub (MASH) services compliance with providing a health presence.

• We need to improve our assurance in terms of safety and quality of care within care homes and build stronger partnerships with Council colleagues to ensure patients are safe.

2.1.9 CCG Improvement and assessment framework (IAF)

The CCG Improvement and assessment framework (IAF) was updated for 2018/19. It built on the IAF introduced in April 2016, which replaced both the existing CCG assurance framework and CCG performance dashboard, and was designed to provide a greater focus on assisting improvement, alongside our statutory assessment function.

The IAF aligns with NHS England’s Mandate and Planning guidance, with the aim of unlocking change and improvement in a number of key areas. This approach aims to reach beyond CCGs, enabling local health systems and communities to assess their own progress from ratings published online.

2.0

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This framework is intended to be a focal point for joint work and support between NHS England and CCGs. It draws together the NHS Constitution, performance and finance metrics and transformational challenges and plays an important part in the delivery of the Five Year Forward View.

The framework for 2018/19 contained 58 indicators grouped into four domains of Better Health, Better Care, Sustainability and Leadership. Performance against these indicators is published in a quarterly basis on the MyNHS website: www.nhs.uk/Service-Search/performance/search.

2.1.10 Walsall TogetherWalsall Together is the approach we have developed in Walsall for the integration of place-based services. During 2018/19 we have been working with partners to develop a business case to create a more formal structure for Walsall Together to develop an Integrated Care Partnership. The partnership will be hosted by Walsall Healthcare Trust who will lead the integration of services through the development and implementation of a new Operating Model.

The principle purpose of the Integrated Care Partnership will be to lead the integration of local health and care services and to design and implement news ways of working, based on the Outline Operating Model that has been developed through the Walsall Together Programme:

During 2018/19 we developed an Outcomes Framework with partners which will help us to set priorities and to measure progress against a broad range of metrics that are important indicators of the health and wellbeing of local people:

Tier 1 - Integrated Primary. Long term condition management, Social and CommunityServicesPrimary Care at scale and integrated health and care teams, working through a hub and spoke modelacross each locality.

Tier 2 - Specialist Community ServicesOutpatients and Diagnostics services delivered from locality based Health & WellbeingCentres or the home.

Tier 3 - Intermediate, Unplanned and Crisis ServicesNetwork of specialist care delivered from Health & Wellbeing Centres, preventingunnecessary hospital admissions and facilitating early discharge from hospital.

Tier 4 - Acute Hospital ServicesAccess to high quality acute hospital services for patients when they need specialist interventionprovided at locally and at a Black Country, Regional or National level where necessary.

��

��

Tiers of Care

Walsall TogetherTier 0 - Resillient

CommuniteesAn integrated prevention andearly intervention offer to all

Walsall citizens

Single Point ofAccess (SPA)Care access

navigation andco-ordination

includingclinical triage

Walsall Integrated Care Partnership Outcomes Framework (0.6)A healthy

populationAccessible,

co-ordinated andresponsive care

Strong communities

System enablers

Living healthier, longer lives

The best possible start in life

Greater equality in health outcomes across Walsall

A good experience of care

Access to the right support in the

right place at the right time

The best possible care for people with long term conditions and

the most complex needs

The best possible end-of-life care

People are supported to feel in control of their

health and wellbeing

People are active and engaged in

their communities

Families and friends who provide

informal care are well-supported

making a difference to the wider aspects

of daily life (such as housing, work, education and so-

cial connectedness) which can improve people’s health and

wellbeing

Health and care services which work together

Sharing of knowledge and best practice

A capable and adequately staffed

workforce

Safeguarding of our population and workforce

Patient participation and

voice

We will continue to work with partners during 2019/20 to develop the use of the Outcome Framework and in particular to plan improvements in priority areas:

• Ensuring that integrated teams work effectively with GPs to address the complex needs of patients • To improve the management of long-term conditions, focussing on diabetes, respiratory conditions, frail patients, those with complex needs and end of life patients • To improve outcomes for people with mental health conditions.

2.0

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2.1.11 The Black Country and West Birmingham Sustainability Transformation Partnership (STP)We continue to work collaboratively with partners in the Black Country and West Birmingham Sustainability and Transformation Partnership (STP).

The collective aim of the Partnership is to deliver sustainable, integrated health and care services that improve the health, wellbeing and prosperity of our residents.

As a member of the STP, we contribute to the development of system-wide improvement plans that deliver financially and clinically sustainable services across the Black Country and West Birmingham. Through this work, the STP have identified three distinct but interconnected ‘accountabilities’ that outline what we are trying to achieve together. They are:

• Working at scale across the Black Country with the Combined Authority, our local councils and other stakeholders to address the wider, economic and social determinants of health that can make a positive difference to people’s wellbeing.

• Collaborating on key areas such as mental health and cancer services that will enable us to deliver higher quality healthcare to our communities and better outcomes for patients.

• Integrating hospital, community, primary and social care services on a place-by-place basis.

During 2018/19, the STP strengthened its governance arrangements by appointing a Senior Responsible Officer, Independent Chair, Portfolio Director and a Project Management Office (PMO) team.

Achievements over the year include:

• A Maternity ‘You Said, We Did’ event to demonstrate how the views of over 200 women and families were used to develop personalised, family-friendly maternity services across the Black Country and West Birmingham.

• A new specialist perinatal mental health service, secured with £1.2m of investment. The service provides timely support and treatment for pregnant women and new mums.

• Bringing together more than 60 mental health professionals to improve the joint commissioning and delivery of a range of mental health services across the Black Country.

• Developing a clinical strategy with local clinicians and agreeing 12 health priorities for the next five years. The clinical strategy will support health and care organisations to raise the quality of services provided to patients and commit to a culture of continuous improvement and co-production - ensuring better health, better care and better value of services.

• Introducing new workforce schemes that encourage GPs to stay in the primary care workforce. Up to £400,000 was made available to the STP, to promote new ways of working and offer additional support to local GPs. As part of this work, the Black Country and West Birmingham was named a GP Retention Intensive Support Site and to date have received over 200 expressions of interest from local GPs to participate in the workforce schemes.

• A cash injection of £79.4 million to modernise and transform NHS services and healthcare facilities across the Black Country and West Birmingham. The modernisation projects include £36.2m on a new emergency department and acute medical unit at Walsall Manor Hospital, £20.3m on a redesign of Russells Hall Hospital’s emergency department, £15.4m on Information & Technology (IT) and estate upgrades at Birmingham City Hospital and £7.5m on a new purpose built facility for people with learning disabilities.

As the year has progressed, so too has our journey towards an Integrated Care System (ICS), both in our neighbourhoods and across the Black Country and West Birmingham. Our integrated health and care relationships will continue to grow and strengthen during 2019/20 as we take collective responsibility for delivering improvements set out in the NHS Long Term Plan and when we involve and listen to the views of our local communities as we develop our response to the Long Term Plan.

2.1.12 Delivering the NHS Long Term Plan in WalsallIn January this year, health and care leaders published a Long Term Plan (LTP) to make the NHS fit for the future, and to get the most value for patients out of every pound of taxpayers’ investment.

The ambitions set out in the plan focus around three main areas:

Making sure everyone gets the best start in life

• reducing stillbirths and mother and child deaths during birth 50%

• ensuring most women can benefit from continuity of carer through and beyond their pregnancy, targeted towards those who will benefit most

• providing estra support for expectant mothers at risk of premature birth

• expanding support for perinatal mental health conditions

• taking further action on childhood obesity

• increasing funding for children and young people’s mental health

• bringing down waiting times for autism assessments

• providng the right care for children with learning disability

• delivering the best treatments available for children with cancer, including CAR-T and proton beam therapy

Delivering world-class care for major health problems

• preventing 100,000 heart attacks, strokes and dementia cases

• providing education and exercise programmes to tens of thosands more patients with heart problems, preventing up to 14,000 premature deaths

• saving 55,000 more lives a year by diagnosing more cancers early

• investing in spotting and treating lung conditions early to prevent 80,000 stays in hospital

• spending at least £2.3bn more a year on mental health care

• helping 380,000 more people get therapy for depression and anxiety by 2023/24

• delivering community-based physical and mental care for 370,000 people with severe mental illness a year by 2023/24

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Supporting people to agewell

• increasing funding for primary and community care by at least £4.5bn

• bringing together different professionals to coordinate care better

• helping more people to live independently at home for longer

• developing more rapid community response teams to prevent unnecessary hospital spells and speed up discharges home

• upgrading NHS staf support to people living in care homes

• improving the recognition of carers and support they receive

• making further progress on care for people with dementia

• giving more people more say about the care they receive and where they receive it, particularly towards the end of their lives

The Walsall Together programme is strongly aligned to the ambitions for integrated out of hospital services described in the Long Term Plan and we have already made progress in the development of some of the service improvements. The table below provides an outline of key areas in the plan as they relate to the Walsall Together programme.

LONG TERM PLANS WALSALL TOGETHER

• Improved responsiveness of community health crisis response services• Reablement care within two days of referral

• The Walsall Rapid Response Service is already in place for response within 2 hours providing rehabilitation linked to reablement as appropriate. • During 2019/20 we plan to develop this further by increasing capacity, extending skill mix and linking to a local place based Single Point of Access for urgent community services.

• Expanded community MDTs aligned with new PCNs based on neighbouring GP practices

• We have been piloting community MDTs as part of the Walsall Together programme and plan to roll this out across the CCG during 2019/20, aligned to the new Primary Care Networks.

• Significant changes to the GP Quality and Outcomes Framework (QOF)

• Changes to the GP QOF have been agreed as part of changes to the national GP contract. We have also designed a new GP offer for Walsall which complements the QOF. This includes new investment of £1m to enhance the quality and range of services offered by general practice.


• Upgraded NHS support to all care home residents who would benefit• EHCH model rolled out across the whole country

• We have been piloting community MDTs as part of the Walsall Together programme and plan to roll this out across the CCG during 2019/20, aligned to the new Primary Care Networks.

• Significant changes to the GP Quality and Outcomes Framework (QOF)

• Changes to the GP QOF have been agreed as part of changes to the national GP contract. We have also designed a new GP offer for Walsall which complements the QOF. This includes new investment of £1m to enhance the quality and range of services offered by general practice.

• Upgraded NHS support to all care home residents who would benefit• EHCH model rolled out across the whole country

• Walsall Care Home Support Nurse Team is already in place providing effective support that has reduced conveyance, linked to Rapid Response Service. This includes pro-active nurse-led ‘ward rounds’ with GP cover and support, and an educational and training programme for care homes. Planned developments include implementing the ‘Red Bag’ scheme to support residents admitted or discharged from hospital.

• PCNs will assess local populations by risk of unwarranted outcomes and work with local community services to make support available where it is most needed

• Through the Walsall Together Partnership PCNs will be aligned to integrated community health and social care teams as well as public health and voluntary sector organisations.

• Greater recognition and support for carers

• The outcomes framework development for the Walsall Together programme recognises the important role that carers have in support people with health and care needs.

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• Improving care to people with dementia/delirium in hospital or at home

• The Walsall Memory Assessment Service model is accredited by the Royal College of Psychiatrists’ Memory Services National Accreditation Programme.

• The CCG will continue to enhance the existing dementia pathway with the Personal Assistants: Dementia, who provide post diagnostic support and maintenance cognitive stimulation therapy, by supporting Walsall GPs in a yearly review of the person with dementia’s care plan.

• Single multidisciplinary CAS within integrated NHS 111, ambulance dispatch and GP out of hours services

• NHS 111 Clinical Assessment Service (CAS) is in place with direct access for Ambulance crews and direct booking in to the GP out-of-hours service. Booking for UCC appointments and in-hours GP appointments is currently being trialled.

• Fully implemented UTC model by autumn 2020 with option of appointments booked through a call to NHS 111

• The current UCC co-located at the Manor Hospital will fully meet the national requirements for an Urgent Treatment Centre once direct booking for appointments by NHS 111 is in place by June 2019.

• Improving performance at getting people home without unnecessary delay when they are ready to leave hospital

• Through the Walsall Together programme Walsall has already established an integrated health and social care intermediate care service incorporating discharge planning and discharge to assess pathways for complex patients.

• Social prescribing for a wider/ more diverse/ accessible range of support

• Link workers in PCNs will work with people to develop tailored plans and connect them to local groups and support services

• The social prescribing pilot established in 2018/19 will be evaluated and the learning will help shape the programme which includes the recruitment of link workers to be integral members of the multidisciplinary teams and to support the emerging PCNs


• Accelerated roll out of Personal Health Budgets

• The CCG has plans in place to achieve the target increase in Personal Health Budgets set for 2019/20.

• NHS will personalize care, to improve end-of-life care

• Walsall CCG is part of the ‘Wave 1 Demonstrator Site for personalisation across the Black Country. Our aim is to increase the number of people in Walsall benefiting from personalised care when they need it. We will do this by working collaboratively to achieve optimum health enabling people to live well and achieve the outcomes in their care plans.

• Redesigned services so that over the next 5 years patients will be able to avoid up to 1/3 of face-to-face outpatient visits

• The Walsall Together Outline Operating Model includes an ambition to develop a new model for out-patient services in which cases would be referred to a specialist within the community with only the more complex.

• Supporting local approaches to blending health and social care budgets where councils and CCGs agree this makes sense

• The Walsall Together Partnership involves NHS and local authority partners and local approaches to blending health and social care budgets will be considered as part of the Partnership’s development programme.

• Implementation and delivery of five-year action plan on Antimicrobial Resistance

• Anti-Microbial Stewardship work programme with the continuation of the scheme to ensure appropriate high quality and cost effective prescribing in general practice.

• Local providers will be able to take control of budgets to reduce avoidable admissions, enable shorter lengths of stay and end out of area placements

• We are developing plans with Dudley and Walsall Mental Health Partnership Trust to tackle out of area placements, including the option of the provider taking responsibility for the budget.

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• Appropriate preventative treatments for individuals with high risk conditions, offered in a timely way with support for pharmacists and nurses in PCNs to case find and treat

• PCNs will have a critical role in improving prevention diagnosis and management of disease. The national Testbed programme will test approaches to detect undiagnosed patients and support optimal treatment

• Better support from MDTs in PCNs for people with heart failure/valve disease

• Our NHS Right Care Programme for Problems of Circulation has a plan in place for the development of MDT specialist heart team working with local place based teams to provide effective community based support at the point of exacerbation or after hospital discharge.

• More to support those with respiratory disease to receive and use the right medication. 90% of NHS spend on asthma

• Medicine reviews by pharmacists in PCNs, including educating patients on the correct use of inhalers and contributing to multidisciplinary working

• Practice based pharmacists offer medication reviews for long term conditions including respiratory patients to improve compliance, inhaler technique and to minimise clinical risk for example ‘step down reviews’ and ‘triple therapy reviews’.

• Walsall pharmacists also deliver GP education campaigns for long term conditions through ‘IMPACT’.

• Walsall Joint Formulary contains cost effective respiratory medication to provide optimal therapy with value for the NHS.

• Expand access to IAPT services with a focus on those with long- term conditions

• During 2018/19 we have expanded access to IAPT services to include people with diabetes, following £300k investment in the service.

• Further additional funding in 2019/20 will allow the IAPT service to meet increasing national access targets going forward, and deliver required waiting times and recovery rates.

LONG TERM PLANS

• Integrated primary and community mental health care supporting adults with severe mental illnesses

• The ‘Walsall Together’ model will bring community services together to allow greater integration between physical and mental health.

WALSALL TOGETHER

• Direct access to MSK First Contact Practitioners (FCP)

• We will learn from the STP pilot project to inform the development of our local plans for the implementation of MSK First Contact Practitioners.

As we start 2019/20 we will continue to work with local people to develop our plans to meet the other expectations set out in the long term plan.

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2.1.13 Financial overview The CCG’s financial plan for 2018/19 and future years was constructed to deliver a sustainable NHS in Walsall. However, the delivery of a financially sound health economy is not without its challenges and this has proved to be the case in 2018/19.

The CCG, however, has had a successful year financially. Note 2 of the accounts section of this re-port details how the CCG has met all of its financial performance targets, delivering an in year break-even position, meeting the target of break-even as required by NHS England.

Performance against key finance indicators

NHS Clinical Commissioning Groups have a number of financial duties under the NHS Act 2006 (as amended).

Walsall CCGs performance against these financial duties during 2018-19 were

2018-19Actual

Duty Achieved

2018-19Target

STATUTORY DUTIES:

Expenditure not to exceed income £0m £0m YES

Capital resource use does not exceed the amount specified in Directions £0.1m £0.1m YES

Revenue resource use does not exceed the amount specified in Directions £438.9m £438.9m YES

Capital resource use on specified matter(s) does not exceed the amount specified in Directions 0 0 N/A

Revenue resource use on specified matter(s) does not exceed the amount specified in Directions 0 0 N/A

Revenue administration resource use does not exceed the amount specified in Directions £6.1m £5.8m YES

NON STATUTORY DUTIES:

Better Payment Practice Code – NHS 95.0% 99.59% YES

Better Payment Practice Code – Non NHS 95.0% 98.37% YES

Efficiency of cash – closing bank balance to be no greater than 1.25% of monthly drawdown 1.25% Achieved YES

QIPP programme (Quality, Innovation, Productivity and Prevention £15.1m £15.1m YES

As set out in the 2018/19 NHS Planning Guidance, CCGs were required to invest in the Five Year Forward View transformation priorities to the extent that risks did not arise or were being effectively mitigated through other means.

To achieve this, a Quality, Innovation, Productivity and Prevention (QIPP) programme was developed to provide real cash releasing savings as well as delivering improvements in productivity, outcomes and quality. The value of the internal QIPP programme (excluding provider tariff deflator) was £15.1m in 2018/19. The main focus of initiatives in 2018/19 has been admission avoidance (Emergencies £3.3m, Electives £1.8m) more effective hospital discharge schemes £1.2m, mental health external placements £1.3m and optimising the use of medicines £3.3m.

In delivering an in year break-even position, the CCG had a resource limit of £438.9m and net expenditure of £438.9. This is detailed in the accounts section of this report, in particular notes 3, 4 and 5. The chart below shows how the £438.9m was spent.

TOTAL CCG PERCENTAGE SPEND FOR 2018/19

In the Financial year 2018/19 Walsall CCG spent £275.7m on providing NHS Healthcare for 289,088 patients on behalf of our 52 GP practices at an average cost of £1,519 per patient.

In summary, the CCG has met its financial objectives over the last twelve months but we have had to manage a number of key risks, the main ones being increasing financial instability in the provider sector nationally; increasing demand; and pressures of a challenging efficiency programme, including the Better Care Fund (BCF). This was achieved through effective management of CCG resources.

Moving forwards, financial plans have been constructed to make sure the CCG meets its duties but we intend to manage our finances in a way that allows us to invest in the services outlined in our strategic plan over the next five years, allowing us to fully deliver place-based care in Walsall.

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2.2 Performance Analysis A key part of our work is to ensure the services we commission meet the needs of local people as well as national quality and safety standards. To provide assurance to our residents and regulator that these requirements are being achieved locally we monitor our performance against a range of measures published within the NHS Constitution core rights and pledges. This covers a number of pledges on how long patients need to wait to be seen and to receive treatment.

The Governing Body is responsible for discharging the duties of its constitution, which includes monitoring and scrutinising the performance of our service providers. The Governing Body receives a performance report at the bi-monthly public meetings. Formal committees of the Governing Body scrutinise in more detail how our health providers are delivering contracted services; these are Finance & Performance, Quality & Safety, Primary Care Commissioning, and Commissioning Committees.

Through these arrangements we continue to work hard with our local providers to deliver these standards but have found it challenging to achieve some of these due to a range of factors which include increasing demand, increased patient acuity and financial pressures. Although of little comfort, it is clear that the local challenges we face are also mirrored nationally and the decline seen across the NHS during 2018/19 continues to be the subject of intense media scrutiny.

The CCG also holds monthly contract review meetings with each of our main providers, to review their performance and to gain assurance where issues arise that robust action is being taken. Where continued underperformance is experienced, the CCG has ensured that all contractual mechanisms are being appropriately utilised to ensure rapid improvements are made in these areas. In addition, triangulation meetings are held between the relevant CCG teams to discuss these issues in detail to ensure the CCG speaks with one voice and has a consistent approach in dealing with our providers.

Our performance in 2018/19 against the requirements of the NHS Constitution is summarised in the table 1 below:

Table 1 Walsall CCG Performance 2018/19 - NHS Constitutional Standards

Year-end Performance Period

Year End Target

NHS Constitution – Rights and Pledges

18 weeks Referral to Treatment –Patients on incomplete or non-emergency pathways >92% R 89.9% Mar YTD

Diagnostic tests waiting times <1% G 0.30% Mar

A&E 4-hour waits (Walsall Healthcare NHS Trust only) >95% R 85.9% Mar YTD

Cancer 2-week waits – urgent referral >93% A 92.7% Mar YTD

Cancer 2-week waits – breast symptomatic >93% R 86.0% Mar YTD

Cancer 31-day waits – first treatment >96% G 96.8% Mar YTD


Year End Target

NHS Constitution – Rights and Pledges

Cancer 31-day waits – surgery >94% A 93.2% Mar YTD

Cancer 31-day waits – drugs >98% G 99.2% Mar YTD

Cancer 31-day waits – radiotherapy >94% A 91.8% Mar YTD

Cancer 62-day waits – first treatment >85% R 79.4% Mar YTD

Cancer 62-day waits – screening service >90% A 88.6% Mar YTD

Ambulance calls – Category 1 average G 6 mins response time <7 mins 46 secs Mar

Ambulance calls – Respond to 90% of G 11 mins Category 1 calls in 15 mins <15 mins 50 secs Mar

Ambulance calls – Category 2 average G 11 mins response time <18 mins 58 secs Mar




NHS Constitution Support Measures

Mixed Sex Accommodation Breaches 0 R 36 Mar YTD

Cancelled Operations (not offered alternative date within 28 days) 0 R 7 Mar YTD

Mental Health CPA 7-day follow up >95% G 96.8% Mar YTD

The number of Referral to Treatment incomplete pathways greater than 52 weeks 0 R 24 Mar YTD

Patients who have waited over 12 hours in A&E from decision to admit to admission 0 G 0 Mar YTD

Urgent operations cancelled for non-clinical reasons for a second time 0 G 0 Mar YTD

Ambulance handover delays of over 30 minutes (WHNHST) 0 R 1,486 Mar YTD

Ambulance handover delays of over 60 minutes (WHNHST) 0 R 155 Mar YTD

Indicator Short Name


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We recognise that where we have underachieved we need to do more to ensure our residents receive the highest quality of care possible and this will remain a key focus for us during 2019/20.

To secure the improvements required we will continue to work closely with local providers to ensure improvements are made where this currently is not the case. We are also very clear that whilst we are gaining assurance on improvement processes with our stakeholders to bring performance back on track patient care and safety remains paramount.

It is clear from the assessment there remains a number of ongoing challenges facing the CCG under the core NHS Constitution and support measures, in delivering the required standards particularly in; 18 weeks’ referral to treatment, urgent care, cancer, and mixed sex- accommodation. Actions underway to address these issues are summarised below.

18 weeks Referral to Treatment (RTT)

Good progress has been made in improving performance at WHT from around 85% at the start of the year to 91% by March 2019, this is ahead of the recovery trajectory agreed with the Trust and just short of the national standard of 92%. This trend is opposite to the national picture which declined over the same period from 87.5% in April 18 to 86.7% by March 2019. Key factors contributing to this improvement have been improved pathway management for underperforming specialities, reducing DNAs and waiting list initiatives where necessary.

In addition to this, the CCG continues to support the Trust through the introduction of a number of elective demand management initiatives including; a programme of practice-level peer reviews, supported by the regular sharing of comparative referral information and continued application of the national musculoskeletal triage specification.

The CCG is continuing discussions with WHT around the achievement of the 92% national standard during 2019/20.

A&E four hour wait

Delivering the A&E four-hour standard has been a national issue during 2018/19 and the Walsall system is no exception. This is highlighted by the fact that local performance of Walsall Healthcare Trust has only exceeded 90% during one month through the year. There are a number of factors which continue to drive Walsall’s 4 hour wait performance;

• Increased unplanned attendances in the A&E departments from patients with more complex care needs (for example, the frail and elderly) whether admitted or not.

• Conversion of attendance to admission rate remains high with clinicians reporting high levels of patient acuity

• Increased ambulance conveyances to the hospital

• Sustained increases in emergency admissions to the hospital

• New hospital processes not delivering the improvements expected are therefore not working well for patients and require further work to improve patient flow

A whole system approach continues to be adopted to improve urgent care performance and resilience. Walsall’s Urgent & Emergency Care Improvement Board (UECIB) has undertaken a thorough review of all improvements actions underway to ensure they are complaint with the five nationally mandated initiatives and assigned accountability to each responsible organisation with clear milestones and specific actions for delivery. The Boards improvement plan sets out priority actions to reduce the number of breaches seen in A&E by focusing work on the following work streams;

i) Emergency & urgent care attendance,

(ii) Patient Flow in Hospital

(iii) Hospital discharge pathways and integrated intermediate care

Through these work streams the focus on a number of areas will continue during 2019/20 which include:

• Further development of A&E attendance avoidance schemes (Rapid Response, Care Home Support, HIUs) together with work with ambulance service focused upon reducing conveyance of category 3 and 4 patients and reducing unwarranted variation in attendance by GP Practice.

• Further development of SDEC to reduce admissions from A&E i.e. increasing flow through ambulatory and frailty pathways.

• Improve the extent to which SAFER and R2G followed in the wards to reduce LoS.

• Continue implementation of integrated intermediate care and hospital discharge to deliver earlier discharge via reduced super stranded, MSFD and DToC.

Progress against these priority areas will continue to be monitored by an operational group, which has been established by the A&E Delivery Board, to report back on any slippages to the A&E Delivery Board. Both groups have representatives from the CCG, Walsall Healthcare Trust, Walsall Council and the Mental Health Trust.

Cancer

The cancer constitutional standards have largely been delivered for CCGs patients when considering performance of WHT but CCG performance also includes the performance of other providers where Walsall patients are treated. There are currently 8 cancer waits measures which have nationally set targets, with performance for each of these reported at both a Commissioner and Provider level. Walsall CCG performance under these measures has deteriorated during the last two months and as a consequence the CCG failed to achieve 6 of the 8 targets on a year-end basis.

Detailed analysis of breaches has identified that Walsall CCG performance for these 6 measures has been negatively impacted by performance at the Royal Wolverhampton Trust (RWT) for Walsall patients. If RWT performance was excluded from Walsall CCG performance, then Walsall CCG would have achieved in 5 of these 6 measures.

We have sought assurance from Wolverhampton Clinical Commissioning Group that robust action is being taken to address the performance position at RWT and we have been assured that Wolverhampton CCG has agreed a Remedial Action Plan with RWT for cancer performance with a planned recovery to the 8 national standards by June 2019. Escalation meetings are held fortnightly

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involving NHS England and NHS Improvement and is continuing to receive support from the NHS Improvement Intensive Support Team.

Ambulance handover delays

Ambulance handover delay targets are frequently breached, both locally and nationally. This is again largely due to increased pressures on both the acute and ambulance services. Walsall is no different and has seen significant increases in demand through the year with increasing occurrences when over 90 ambulances per day have arrived at Walsall Healthcare Trust.

There have been significant actions taken to reduce handover delays which can impact adversely on patient safety and care. We will continue to work with Walsall Healthcare Trust and West Midlands Ambulance Service through the A&E Delivery Board to understand and respond to these operational pressures.

Mixed sex accommodation breaches

There has been a significant reduction in the number of breaches reported by WHT due to the improvement actions driven by the CCG and WHT resulting in a 85% reduction between 2015/16 and 2018/19 with breaches coming down from 124 to 18.

Historically WHT always faced challenges in delivering zero breaches as there were no step down beds available in the critical care unit where historically all mixed sex accommodation (MSA) breaches have been reported. However, the opening on the new critical care unit in December 18, which has step down beds should address this gap going forward.

In the meantime, the CCG is working with the WHT to review and strengthen their operational policies to ensure breaches are eliminated or minimised as we know patients do not want to be routinely cared for in mixed sex accommodation units except for exceptional clinical circumstances. We are clear that maintaining the privacy and dignity of our patient at all times is of paramount importance and to make the patient experience as good as possible at all times.

Additional mental health measures

In addition to the NHS Constitution requirements, there are a number of priority mental health areas with national targets which all CCGs report against. Walsall CCG has worked closely with providers throughout the year to achieve high levels of service against these targets. Performance under these measures is summarised in the following table:

Table 2 Walsall CCG Performance 2018/19 - NHS Planning Round


Year End Target

NHS National Planning Round

% dementia diagnosis rate >66.7% G 67.3% Mar

Improving access to psychological therapies (IAPT) Feb YTD – access levels >15.1% A 15.0% (YTD target 15.8%)

The proportion of people who complete IAPT treatment who are moving to recovery >50% G 50.5% Feb YTD

The proportion of people that wait 6 weeks or less to enter IAPT treatment >75% G 99.1% Feb YTD

The proportion of people that wait 18 weeks or less to enter IAPT treatment >95% G 99.9% Feb YTD


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Improving access to psychological therapies (IAPT)

Although CCG patients who enter the service receive prompt treatment and a high proportion are deemed to be ‘moving to recovery’ upon completion of their treatment, the overall number of patients receiving psychological therapies is currently lower than the national expectation.

The CCG is working closely with our lead mental health provider, Dudley & Walsall Mental Health Partnership Trust, to improve the access rate to achieve and sustain the standards set under the NHS Five Year Forward View.

2.3 Sustainable Development As an NHS organisation, funded by taxpayers, we have an obligation to work in a way that has a positive effect on the communities for which we commission and procure healthcare services. Sustainability means spending public money well, the smart and efficient use of natural resources and building healthy, resilient communities. By making the most of by social, environmental and economic assets we can improve health both in the immediate and long term even in the context of rising cost of natural resources. Spending money well and considering the social and environmental impacts is enshrined in the Public Services (Social Value) Act (2012).

The CCG acknowledges this responsibility to our patients, local communities and the environment by working hard to minimise our footprint. The CCG recognise the importance of embedding sustainability within our business and continue to develop sustainability initiatives in the following areas:

Transport and Travel

• We have available two communal bikes for staff to utilise when travelling to and from local meetings. These bikes are fully provisioned and are kept in the CCG ‘bike shed’ which is also regularly used by staff to store their own bicycles.

• We now have two provisioned audio visual (AV) conference rooms which we use to host and participate in video conferences, which reduce the requirement for staff to travel to and from meetings across the country.

• We have a further a two meeting rooms which are provisioned with 75” touch screens for presentations and are used to host local and regional meetings, further reducing the need for staff to travel

• We have invested in two electronic vehicle charging points for staff and visitors to utilise.

Technology

• All staff are now provisioned with laptop computers which have provided a greater degree of flexibility in our working practice and have contributed to the Agile Working agenda. These laptops are fully compatible with the previously referenced AV and presentation equipment and have a greater energy rating efficiency than the older desktop models they have replaced, resulting in less energy consumption.

• We employ three multi-functional devices (MFDs) for all of our printing, scanning and photocopying purposes. When these devices were purchased, we ensured that they were energy efficient and fully utilised by all staff to reduce our overall paper consumption and contribute to the paper light agenda targets of 2020.

Commissioning and Procurement processes including:

• An assessment of environmental impacts;

• An assessment of social impacts

• A consideration of suppliers’ sustainability policies

We are committed to promoting sustainability with our employees, including waste minimisation and management, a reduction in paper usage in line with the NHS Paper Free by 2020 targets and the re-use and recycling of redundant ICT equipment and furniture. We have recently refurbished our meeting rooms and replaced desks and chairs throughout the CCG, recycling the old and upcycling furniture available from other NHS organisations and donating unwanted furniture to local charity organisations.

The CCG is a tenant in offices at Jubilee House, leased by NHS Property Services and for the purpose of this annual report; it is not possible for NHS Property Services to provide full sustainability information in relation to these offices however the following information provides details of electricity, gas and water usage. Table 1 is the 69.9% portion the CCG occupy but estimated for the full 2018/19 year.

Table 1 – Tenant Occupancy 69.9% - Estimated for Full Year Effect 18/19

Utility Period Consumption Detail

Electricity 01/04/18 to 31/01/19 + EDF 2 Month Estimate 491,746kWh Energy Supply

Gas 01/04/18 to 31/01/19 + Corona 2 Month Estimate 457,748kWh Energy Supply

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2.4 Improving Quality Walsall CCG places quality at the core of all functions and commissioning practice, and at the centre of all discussions with providers. We do this by making our expectations clear and measurable and then monitoring these standards closely.

There are five elements which drive the work of the Quality and Safety team:

• Patient Safety

• Clinical Effectiveness

• Responsiveness

• Patient experience

• Being well-led

2.4.1 Holding providers to account The CCG has continued to work with our providers across primary, community and secondary care to develop clear clinical quality standards for their services, focusing on improving patient outcomes, for inclusion in contracts which are monitored and mapped to the NHS outcomes framework. We have also worked with our providers to further refine quality and safety performance dashboards to gain assurance services delivered are safe and of a high quality standard. This will continue through 2019/20.

The quality and safety of care is monitored through the Clinical Quality Review Meeting (CQRM) process and mortality and morbidity meetings, including the use of national metrics alongside other qualitative intelligence such as complaints and incidents.

The data enables key quality and safety information to provide intelligence to quality visits, audits and keys lines of enquiry. The approach has been extended to Primary Care with a database of information under development (triangulate data). The systems are used in order to identify where quality or performance is sub-standard; where it has been identified that this is the case for a collaborative quality improvement. The CCG recognise that in all services there are areas for improvement and relish the opportunity to ensure that the services within Walsall are of the highest standard.

The CCG governing body takes every opportunity to hear the experiences and views of local people and build their feedback into the service design process.

The CCG encourages a collaborative quality improvement approach, and where emergent patterns or themes are identified these are explored and shared across providers and the wider system to ensure lessons can be learnt, for example, the development of the Walsall Suicide Prevention Strategy.

2.4.2 Patient safetyThe processes described in place to oversee this work and other contract review processes held between the CCG and providers report through to the CCG Quality and Safety Committee, which in turn provides the governing body with a comprehensive exception report at each meeting. With a clear view on the level of assurance that can be provided and the specific actions that the CCG are taking if full assurance cannot be offered at that time, with indicative timescales of when full assurance will be offered to the board.

The Quality and Safety Committee have an extensive patient safety agenda with a responsibility for oversight of:

• Development of locally sensitive quality indicators and metrics to continually improve the quality outcomes of services

• The review of all children and adult safeguarding issues

• Monitoring all of the performance of service provider’s quality improvement plans, including those to address shortfalls in the standards of quality and safety to ensure remedial actions are taken to comply with the expected standards. These reviews include monitoring of a suite of key indicators including Health Care Associated Infections (HCAI) data, patient complaints and compliments, and patient experience information i.e. family and friends test data, safety thermometer data and quality visit feedback

• The review of any notification, advice or instruction issued by the National bodies and Regulators

• The review of any notification, advice or whistleblowing issued by other agencies or individuals

• The monitoring of incident data (Serious Incidents, Never Events, unexpected deaths) and actions associated with taking remedial actions

• The oversight of quality exceptions reported (such as whistleblowing, serious case review, adverse media reports).

2.4.3 Staff satisfactionWe will use nationally reported staff surveys to focus on the views of staff and to encourage their engagement.

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2.4.4 Safeguarding children, young people, adults and children looked-afterWalsall CCG is committed to safeguarding the most vulnerable people in the borough. The CCG has a statutory duty under legislation and statutory guidance to ensure that adults, children, young people, families and children looked after are safeguarded and that all NHS bodies make arrangements to safeguard and promote the welfare of all children and adults. These duties must be discharged in cooperation with the Council and the Police.

New measures include three fundamental changes to safeguarding children arrangements. Local Safeguarding Children Boards (LSCBs) will be replaced by Multi Agency Safeguarding Arrangements (MASA). The current system of serious case reviews will be replaced with a two-tier system comprising of a National Panel responsible for commissioning and publishing reviews into the most serious and complex cases, which will lead to a national learning and local Child Safeguarding Practice Reviews (CSPRs) managed by the MASA. The responsibility for child deaths will transfer from LSCBs to the CCG and Local Authority and will be reviewed over a population size that gives a sufficient number of deaths to be analysed for patterns, themes and trends.

The CCG will review the link between the Children and Adult Safeguarding Boards, whilst also implementing the statutory changes to the children’s safeguarding agenda. The Director of Children’s Services (Local Authority), Borough Commander (Police) and Chief Nursing Officer/Director of Quality (CCG), are the three statutory partners and will be instigative in driving the change in order to progress the ‘think family’ agenda, avoid duplication and to consider a leaner and more efficient way of working.

Adult and Children Safeguarding Boards (or any future MASA) and Corporate Parenting Board are statutory functions, and the CCG must be a member of these boards. It is also a statutory requirement for CCGs to employ, or have in place, a contractual agreement to secure the expertise of designated professionals (Designated Nurses for Safeguarding Adults, Children and Children Looked After and Designated Doctors for Safeguarding and Children Looked After).

It remains the responsibility of every NHS-funded organisation and each individual healthcare professional working in the NHS to ensure that the principles and duties of safeguarding adults and children are holistically, consistently and conscientiously applied, with the wellbeing of those adults and children at the heart of what we do. For adult safeguarding this also needs to respect the autonomy of adults and the need for empowerment of individual decision-making, in keeping with the Mental Capacity Act and its Code of Practice.

As a member of Local Safeguarding Boards, the CCG must ensure that their duty to safeguard and promote the welfare of children and adults is carried out in such a way as to improve outcomes for people in the borough. Wherever possible, evidence of impact on improving outcomes for children should be identified. Walsall CCG Chief Nursing Officer is the vice chair of statutory safeguarding boards.

For the Local Safeguarding Boards or MASA to maintain oversight of the effectiveness of safeguarding practice across the borough, and of the extent to which it is continuously improving, the key Section 11 agencies are expected to provide information on the arrangements they have in place to protect and promote the welfare of children and young people. This includes Walsall CCG as a statutory member of the Safeguarding Children Board.

NHS England have developed a Self-Assessment Tool (SAT) which has been completed for 2017/18 and updated for 2018/19 by the CCGs Safeguarding Team to provide assurances to NHS England that the responsibilities for Safeguarding Children, Adults and Children Looked After are being met. This will be replaced in 2019/20 with a new improved version, making it easier to complete and less repetitive.

The CCG, as the commissioner of local health services, needs to assure itself that the organisations from which they commission have effective safeguarding arrangements in place (Safeguarding Vulnerable People in the NHS – Accountability and Assurance Framework 2015). Safeguarding forms part of the NHS standard contract (service condition 32) and commissioners need to agree with their providers, through local negotiation, what contracting monitoring processes are used to demonstrate compliance with safeguarding duties. The CCG must gain assurance from all its commissioned services throughout the year to ensure continuous improvement. Assurance may consist of assurance visits, section 11 audits (children), formal reports, dashboards and attendance at provider safeguarding committees. Contracts specify compliance with CQC Essential Standards and related legislation, including the Mental Health Act, Mental Capacity Act (Deprivation of Liberty Safeguards) and the Care Act. The CCG will be reviewing this part of the quality schedule with main providers for 2019/20 to ensure that contractual levers can be applied where there are concerns with the level of safeguarding provision that is being provided.

The CCG Safeguarding Quality Review Meeting (SQRM) aims to safeguard Walsall residents by effective high quality formal communication and partnership working, applying the Local Safeguarding Board’s priorities (children and adults) in order to achieve the best local outcomes. Walsall CCG seeks assurance from all providers regarding safeguarding arrangements. The SQRM is established within the Quality and Safety Committee structure in accordance with Walsall CCG statutory safeguarding responsibilities and aims to provide assurance regarding the health economy actions for the Walsall Safeguarding Boards as necessary.

Other mechanisms to ensure accountability and assurance, built into the health system, include contract monitoring and commissioner assurance mechanisms and local health overview and scrutiny committees. These can call local health organisations to account for their safeguarding arrangements. In order to ensure that service developments and redesigns consider the statutory safeguarding element, the CCG Safeguarding Team are in the process of developing a safeguarding Commissioning and Procurement framework, aligned to a set of standards which going forward will be included in all future contracts.

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Since August 2017 the CCG has worked towards safeguarding and improving the lives of those that are suffering Domestic Abuse by commissioning the IRIS (Identify, Refer and Improve Safety) protect. April 2018 the funding was increased to cover all GP Practices in Walsall and to date 47 (96%) have sign up and are either trained or are in the process of training resulting in many vulnerable adults and children getting the support and help they need to maintain their safety and wellbeing.

2.5 Engaging people and communities

The CCG understands that public engagement and involvement is essential to how services are planned, commissioned, delivered and reviewed. There is also a duty on the CCG to involve the public under section 14Z2 of the Health & Social Care Act 2012.

Throughout 2018/19 we have continued to develop creative methods of listening, engaging and involving patients and the public which have ensured that their insight and experiences have influenced our commissioning decisions. We have successfully engaged stakeholders, patients and the public in a range of activities to facilitate community involvement in how we design, deliver and improve local health services.

We have an ambitious vision for the future and the CCG Communications and Engagement Strategy sets this out how we will achieve this. The strategy is available on the CCG website under ‘Publications’.

We have set values that mark the standards of how we communicate and engage with people and organisations. We ensure to always be:

• Accessible and inclusive, to all people in our community

• Clear and professional, demonstrating pride and credibility

• Open, honest and transparent

• Accurate, fair and balanced

• Timely and relevant

• Sustainable, to ensure on-going mutually beneficial relationships

• Facilitating con

• Facilitating conversations, we don’t just talk, we listen

• Cost effective, always demonstrating value for money

We know that where services are designed around the needs of patients and carers, the outcomes for both the service and the individual are improved. Working together with patients, carers and communities, increases understanding of and confidence in the NHS, and helps us to design and deliver services that meet local needs.

During the last year we have made excellent progress towards delivering our aim that patients, carers and the local community understand our commissioning plans, and both plans and services reflect the participation and priorities of local people.

2.5.1 Patient voice panel The CCG has continued to develop the ‘virtual’ patient voice panel mechanism for public engagement. The panel is made up of a database of people who have signed up to work with us to better understand and help to shape local health services.

This is an effective way of engaging with local people who face barriers that prevent them from attending meetings or public events, such as mobility difficulties, conflicting demands on time, or financial constraints. The ‘virtual’ nature of the group also allows people to get involved at a time and place that is convenient to them. People of all ages, experience and backgrounds can get involved.

The atient voice panel gives people the opportunity to:

• Actively participate in online surveys and other online health-related activities

• Give ideas on how health services can be improved

• Be part of group discussions and share feedback

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2.5.2 Patient advisory groupThis CCG initiative is a private meeting made up of specific patient representatives, local voluntary sector organisations and representatives from local system partners which has been implemented to provide a ‘safe space’ for the discussion of developments which are not yet in the public domain, to allow the CCG to gauge public and stakeholder opinion on particular issues prior to publication.

2.5.3 Patient Participation Groups (PPGs) and the Patient Participation and Liaison Group (PPLG)

The CCG promotes community involvement through our cohort of Patient Participation Groups (PPGs). We ensure that the local intelligence gained from these groups’ links into the commissioning process. All GP surgeries based in Walsall have established a Patient Participation Group, many of which we have supported over the last twelve months and continue to do so. We also have a proactive Patient and Participation Liaison Group (PPLG) that consist of PPG Chairs and PPG representatives from across Walsall practices and provide a forum for networking and sharing best practice.

The network is chaired by one of the PPG chairs, and a Vice-Chair who is the CCG Lay Member for Patient and Public Participation on the Governing Body.

The CCG has provided the PPLG with support to facilitate meetings. This has included arranging meeting schedules and venues, supporting the administration of meetings such as minute taking, as well as facilitating communication between members of the group.

2.5.4 Patient Participation Conference 2018 and development of a Patient Participation Group Charter On June 7 2018, the CCG hosted its first Patient Participation Group (PPG) Conference at Walsall Art Gallery, open to anyone with an interest in Patient Participation.

The aim of the event was to promote the role and benefits of PPGs to patients, public and health professionals, to create more understanding of the value of true patient participation also to promote the support available from the CCG and raise awareness of the wider health agenda.

Some of the agenda items and guest speakers are also listed below:

• Funded membership of the National Association of Patient Participation (NAPP)

• Introduction the One Walsall who support local VCS and community organisations

• Walsall Manor Hospital Care Quality Commission (CQC) inspection outcome

• Reducing prescribing of over-the-counter medicines – NHS England public consultation

• Big Conversation community engagement on local NHS services including urgent care and primary care

As a result of this event, a working group was formed with patient representatives, local voluntary sector organisations and commissioners to co-produce a patient participation charter that set out the commitments of all parties to encourage and develop patient participation.

2.5.5 Patient stories Walsall CCG are committed to ensuring that patient stories are at the heart of our decision making. To ensure that this purpose is kept at the forefront of our thoughts, patient stories are shared at the beginning of each Governing Body meeting to provide insight into a specific service while also proposing suggestions for improvement or highlighting an opportunity to share best practice and success stories.

An example of a powerful patient story from the last year was that of Martha, a single mother with multiple complex conditions and social challenges who had been presenting to Urgent and Emergency care services on a weekly basis. Martha’s care was handed over to the Multi-Disciplinary Team who were able to jointly review her complex diagnoses, make changes to her medicine and link her to social support; a pathway that has seen Martha’s symptoms improve (so she now presents at scheduled check-ups only, has given her a social network of support and one which Martha described as having ‘given her’ her life back.

2.5.6 Website, social media and e-newslettersThis year we undertook a critical appraisal of the website and commissioned a rebuild to make the site more user-friendly and responsive to viewing on different devices and for people with assistive tech software such as screen readers. The new website, due to go live early in the new financial year, is also clearer, faster and easier to navigate.

The new site gives key information about our work, features a health and social service directory to help signpost people to the most appropriate service for their needs, details current engagement and consultation opportunities for people to get involved in (as well as all of the other ways that you can get involved on an ongoing basis), and feeds back on how services have been shaped by public involvement.

This broadcasting tool is supplemented with our social media and our three e-newsletters (for staff, GPs, and the public).

Social media and influencer marketing is now the most-widely used and cost-effective way of communicating with stakeholders and here at Walsall CCG we have invested in a suite of coordinated communication channels.

In 2017/18 we were only active on one social media platform – Twitter. In 2018/19 Walsall CCG now also has active Facebook, Instagram and YouTube accounts, with over 6,500 followers across all platforms. We structure our communications across all channels to provide timely and targeted information about local health services, and to share key news stories, events and updates that are of interest to our local population.

We have also invested in the production of video communications for these channels, including a video produced to address some of the common myths around the flu vaccination and flu nasal spray. This was developed in response to confusion in our local Muslim population around the use of gelatine in the production of the flu nasal spray. The film was presented by a local GP of Muslim faith and discussed the stance of Muslim faith leaders on the subject.

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Our quarterly public newsletter is distributed through member practices, Patient Participation Groups, voluntary, community and faith sector organisations, MPs, Councillors and a newly compiled database of interested members of the public. It is also posted on the CCG website and social media to reach a wider audience, and you can sign up to the distribution list via the website. The content includes information about engagement opportunities, news, patient stories as well as being a valuable vehicle for delivering health messages and local updates.

2.5.7 Governing Body meetingsThe CCG publish papers for the Governing Body on our website and hold the meetings in public. There is always an agenda item where members of the public can ask a question of the governing body. Our Governing Body has four lay members – two with responsibility for championing patient and public involvement.

2.5.8 Stakeholder, workforce and system engagement The CCG has an extensive list of stakeholders and takes a proactive approach to networking and communicating across our borough and the wider Black Country and West Birmingham STP footprint. We work closely with patient groups and networks around planned service redesign, gathering feedback through: focus groups, surveys and patient involvement on steering groups. As a commissioner, we also contract providers to gather patient experience data through routine surveys that can be used to support service improvements. We also gather general feedback by attending a number of externally organised events.

We produce regular briefings for MPs and councillors and reports to Walsall’s Health Overview and Scrutiny Committee, which examines the planning and delivery of health and social care services. We have fed into the Joint Health Overview and Scrutiny Committee that has examined our plans to improve quality and consistency across our patch and created partnerships with community and voluntary sector organisations where appropriate.

We also ask our stakeholders to participate in the national 360 degree survey – in 2018/19 Walsall CCG improved its overall response rate and 93% of stakeholders rated the effectiveness of their working relationship with the CCG as ‘fairly’ or ‘very’ good. 80% of responses rated the CCG as ‘fairly’ or ‘very’ good at improving health outcomes for its population.

2.5.9 Other communication & engagement activity 18/19 • During 2018 the CCG and Walsall Council launched a public engagement exercise to give Walsall residents the opportunity to give their views on the proposal of an outcomes framework for the Walsall Integrated Care Partnership, ‘Walsall Together’. The feedback from the engagement exercise demonstrated support for a change from counting units of activity to measuring outcomes achieved and to measure these outcomes not just for the people who are referred to individual services but for the whole population.

• Walsall CCG, as part of the Black Country Local Maternity System have been looking at how maternity services are currently delivered and what needs to change to deliver the vision described in the national maternity review. As part of our commitment to engaging women and their families in the transformation of maternity services, ‘Whose Shoes?’ workshops have been organised across the Black Country, with a view to bring people that are involved in, or that have experienced maternity services, together to share their views, highlight recurrent themes and share best practice.

• To promote the launch of a fourth extended access GP hub in Walsall in November 2018, the CCG marketed the service extension using cardboard cut-out GPs bearing flyers, and a 3-month run of TV screen advertisements in the Saddler’s shopping centre (this advert was extended for a further 6 months to ensure awareness of the extended access service during the relocation of the Walsall town centre Urgent Care service in early April 2019). Walsall CCG was named an ‘exemplar’ CCG by NHS England for the implementation and delivery of the extended access GP service.

• In February 2019, the CCG held two ‘health bus’ events, where staff manned a red double decker bus parked in Walsall Town Centre and invited the Walsall Public Health team to join us and provide free health checks to the public, while we talked to them about a number of interventions, including winter messaging, the self-care agenda, and items that are no longer routinely prescribed.

• In early 2019, Walsall CCG along with the other organisations involved in delivering the Transforming Care Partnership (TCP) agenda in the Black Country, worked with service users, their families and carers to develop a new model of community care that works for them. The public engagement exercise conducted in Spring 2019 sought people’s views on the community-based services that have been put in place in the Black Country and the impact on specialist inpatient assessment and treatment beds for adults with learning disabilities.

• As well as engaging patients and the public on specific commissioning proposals, this year Walsall CCG also held a conference to engage the public and representatives from our existing network of PPGs on our overall approach to engagement and participation.

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2.5.9 Future plansGiven the CCG’s responsibilities, influences and risks, we have identified some communications and engagement aims that all current and future communications and engagement work and messages that are part of it, contribute to meeting:

We want patients and the public to:

• Understand our work and role and our reasons for making decisions with the resources we have;

• Understand the range of NHS services that are available to them;

• Use services wisely and appropriately;

• Understand the transformation/integration agenda and the reasons for change;

• Understand how to keep themselves and their families well;

• Be involved in our engagement work to help us do our job to best effect;

• Have confidence in the local NHS, the CCG and the services that are commissioned by us.

We want Walsall GPs and practice staff to:

• Understand and be part of the work of the CCG;

• Be supported with health campaign information to aid talks with patients.

We want CCG staff to:

• Understand our role and contribute to our success in the same consistent way;

• Enjoy being part of the CCG team.

We want partner agencies, providers of NHS services, local, regional and national opinion formers to:

• Understand our work and role;

• Understand what is happening in health and social care in Walsall;

• Recognise our work to raise the profile of Walsall and the Black Country and make it an attractive place to work in the NHS.

These core aims will drive our communications and engagement work planning as we go forward. The actions to meet these aims are a combination of business as usual/routine actions and new areas of work for the CCG.

2.6 Primary Care CommissioningFrom 1 April 2016 the CCG received full delegation to commission general medical services from NHS England so that we could focus on ensuring that we deliver high quality primary care services for our local population

We have a Primary Care Commissioning Committee that has been established to fulfil our delegated commissioning functions. The Committee meets in public on a monthly basis, and all papers are published on the CCG web-site in advance of the meetings. In 2018/19 we were compliant in discharging our delegated commissioning and contracting activities for primary care, assured by external audit.

Over the past year we have continued to make progress in delivering the ambition and improvements set out in the five-year General Practice Forward View (GPFV) which was published in 2016.

2.6.1 GPFV transformation funding Between April 2017 and March 2019 CCGs have been expected to spend the equivalent of £3 per head of population to support GP practice transformation. The criteria for investment was to stimulate development of at scale providers, to improve access, and to stimulate implementation of the actions to free up GP time and secure sustainability of general practice. The CCG has supported a range of projects which have included the piloting of new clinical roles in general practice and the development of social prescribing link workers to support the multi-disciplinary teams.

2.6.2 AccessOur patients have told us that getting timely access to primary care is important and we have opened extended access hubs to provide more appointments. In December 2017 three hubs were opened in response to the need for additional appointments during winter. During 2018-19 the CCG has built on the success of the winter pressures service and the extended access service now operates from four hubs across Walsall providing appointments with GPs and Health Care Practitioners in the evening, weekends and bank holidays. The service has received positive patient feedback, with over 95% of patients rating their clinical consultation as good or excellent and has supported general practice and the urgent care system in Walsall.

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10%

20%

30%

40%

50%

60%

70%

80%

90%

100%

2.6.3 Primary care offer During 2018 the CCG released recurrent savings of approximately £1 million to reinvest in Primary Care services in 2019-20. The CCG has been working up a new Primary Care Offer to invest this funding in GP practices and to support the CCG’s clinical priorities for 2019/20. The scheme will see improvements in:

• the quality of care for patients who would benefit from support from a Multi-Disciplinary Team;

• the identification and management of patients with osteoporosis;

• the identification and management of patients that are at the end of their life;

• the levels of access to GP/Clinical appointments;

• the support given to carers;

• the identification and management of patients who are frail;

• Identification and increased referrals to support services for patients who smoke or would benefit from a lifestyle intervention prior to conception.

2.6.4 GP contract re-procurement The CCG had a number of time limited General Practice contracts that were due to come to an end in 2018. The CCG carried out a formal consultation on the options for re-procurement and undertook comprehensive patient engagement with patients from the practices to help the CCG to support and shape the re-provision of these primary care services.

On 1st September 2018, four new GP contracts commenced following a formal procurement process. The new contracts mean all four practices serving a total of 37,000 patients are open from 8am – 6.30pm every weekday, with no half-day closing and all four practices provide some evening and weekend appointments. In addition, the CCG has set a series of standards for services that will be monitored to ensure patients continue to receive high quality primary care from the new GP provider.

Assurance on Primary Care Quality

Figure 1

% of total % of total April 2018 Number Practices April Number Practices Rated 2019 Rated

Overall Number Overall Number Practices Inspected 57 98% Practices Inspected 52 91%

Outstanding 3 5% Outstanding 3 5%

Good 49 84% Good 46 80%

Requires Requires Improvement 5 9% Improvement 3 5%

Inadequate 0 0% Inadequate 0 0%

Not Rated 1 2% Not Rated 5 8%

Overall Number

Practices Inspected

Outstanding Good Requires Improvement

Inadequate Not Rated

CQC Rating - April 18 V April 19

Figure 2

April 18 April 19

0%

REPORTACCOUNTABILITY

2.6.5 Investing in our primary care workforce The CCG has historically supported general practice through funding an extensive network of clinical pharmacists that work in practice and from April 2019 the CCG has commissioned a repeat Prescribing Hub that will both look to improve medicines optimization but also reduce the administrate burden for practices

During 2018/19 the CCG has also invested heavily in support and training for practices. Ten practices took part in the national “Time to care programme” and a further eight were supported through “learning in action. “By March 2019, 33 training courses for practices will have been run on a wide variety of topics (eg clinical correspondence management, active signposting, capacity and demand in practice).

In January 2019 protected learning time training events for GPs and the wider primary care team were re-established and a facilitated practice manager forum has run throughout the year. The CCG will continue to support these programmes during 2019/20.

2.6.6 Primary care contracting Under fully delegated co-commissioning arrangements the CCG has to discharge its responsibility of confirming contractual compliance of all primary medical contracts that fall under its governance. The CCG has been continuing to undertake visits during 2018 as part of a three rolling programme of contract monitoring visits.

In addition, during 2018 the CCG undertook a series of practice visits to review opening hours. The CCG is now working with practices to respond to the results of the national GP patient survey and issues raised by patients about access.

2.6.7 Primary care workforce – working with CCGs across the Black Country In 2018/19 we have continued to work collaboratively with other CCGs across the Black Country particularly in relation to developing and retaining our workforce. The CCGs across the Black Country received national funding in 2018 to develop projects that would support local GPs stay in practice. Schemes were developed with local GPs and included peer support, coaching and mentoring, establishing a network for newly qualified GPs, opportunities for continued professional development and a forum for GPs considering retirement to consider how to retain their knowledge and skills in general practice. Funding has been secured to build on the success of these projects in 2019/20.

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3.0 Accountability Report The purpose of the accountability section of our annual report is to meet key accountability requirements to Parliament. These requirements are set out in the Companies Act 2006 and associated Statutory Instruments with a separate Directors’ Report (our Members) and Remuneration Report. The requirements of the Companies Act 2006 have been adapted for the public sector and only need to be followed by entities which are not companies to the extent that they are relevant.

3.1 Corporate Governance ReportMembers ReportWalsall Clinical Commissioning Group (CCG) is a clinically led membership organisation made up of 52 practices which are set out into four geographical areas. Each locality has an elected clinical lead that represents their locality practices on the Governing Body (the Board of the CCG).

Member profilesName Job TitleMr Paul Maubach Accountable Officer

Dr Anand Rischie Clinical Chair

Mr Mike Abel Lay Member Commissioning

Dr Sandeep Kaul Trans Locality Lead

Dr Nasir Asghar North Locality Lead

Dr Joo Teoh South East Locality Lead

Dr Hewa Vitarana Clinical Executive Finance & IT

Dr Rajcholan Mohan Medical Director

Mr Matthew Hartland Strategic Finance Lead

Mr Tony Gallagher Chief Finance Officer

Mr Paul Tulley Director of Commissioning

Dr Barbara Watt Director of Public Health, Walsall Council

Professor Simon Brake Chief Officer

Dr Carsten Lesshafft Clinical Executive Commissioning

Dr Ravinder Sandhu West Locality Lead

Dr Harinder Baggri Clinical Executive Primary Care Commissioning

Ms Paula Furnival Executive Director Adult Social Care, Walsall Council

Mr Gulfam Wali Lay Member PPI

Mrs Donna Macarthur Director of Primary Care and Integration

Mr Manjit Jhooty Lay Member Audit and Governance

Miss Rachel Barber Lay Member PPI

Mrs Sarah Shingler Chief Nursing Officer/Director of Quality

Dr Parijat De Secondary Care Consultant

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Member practices All localities

North Locality

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West localities – 1 & 2 East Locality

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South localities – 1 & 2 Composition of Governing BodyThe governing body reviewed its committee structure in May 2018 and strengthened the Human Resource functions of the committee and created an operational Human Resource and Operational group to help progress these agendas and implement the associated plans.

The Governing Body committees are:

Safety and Quality Committee

Finance and Performance Committee

Audit and Governance Committee

Remuneration and Human Resources Committee

Commissioning Committee

Primary Care Commissioning Committee

Register of Interests

Walsall CCG maintains a register of interest of interests for its members, staff and committee members on its website. Declarations of interest

Personal data related incidents

During 2018-19, Walsall CCG has not had any personal data related incidents that required formal reporting to the Information Commissioners Office.

Complaints

A complaint is an expression of dissatisfaction, however made, about the standard of service, actions or lack of action by the service or its staff requiring investigation and formal, written response within the statutory complaints regulations. A total of 113 complaints, concerns and MP enquires were received during 2018/19. 21 formal complaints were dealt with by the CCG, three of which were re-opened cases 79 were re-directed to appropriate organisations and 13 were MP enquiries or informal concerns. One complaint was withdrawn. Complainants who remain dissatisfied on conclusion of Local Resolution can seek Independent Review by the Parliamentary and Health Service Ombudsman in accordance with statutory regulations and guidance. In April 2018 the CCG received an Ombudsman request for additional information on a closed complaint. We responded to these requests promptly. After reviewing the information provided, the Ombudsman confirmed that the case was closed and there was no requirement to investigate any further. There have been no other Ombudsman referrals.

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Statement of disclosure to auditors

Each individual who is a member of the CCG at the time the Members’ Report is approved confirms:

• so far as the member is aware, there is no relevant audit information of which the CCG’s auditor is unaware that would be relevant for the purposes of their audit report

• the member has taken all the steps that they ought to have taken in order to make him or herself aware of any relevant audit information and to establish that the CCG’s auditor is aware of it.

Modern slavery act

Walsall CCG fully supports the Government’s objectives to eradicate modern slavery and human trafficking Our Slavery and Human Trafficking Statement for the financial year ending 31 March 2019 published on our website. Modern Slavery Statement

Health and safety

NHS Walsall Clinical Commissioning Group is fully committed to providing a vibrant working environment that values wellbeing and diversity. The organisation recognises wider legal and moral obligation to provide a safe and healthy working environment for its employees, visitors and members of the public that may be affected by its activities. This has been demonstrated through the organisations statement of intent, organisational structure and arrangements for the management of its legal duties in line with the requirements outlined in the Health and Safety at Work Act 1974.

The CCG has implemented a robust Health and Safety Management System based on the Health and Safety Executives publication HSG65 working in partnership with NHS Arden and GEM CSU. The work program undertaken by the Clinical Commissioning Group included the following:

• A full review of the organisations policy and procedures.

• A full review of the organisations risk assessment templates.

• Training of employees and individuals with roles and responsibilities as defined in the organisations Health and Safety policy arrangements.

This review has created a positive culture and pro-active stance on health and safety that aims to promote excellence and an accountable approach to manage statutory duties imposed on the Clinical Commissioning Group.

Effectiveness of whistle blowing arrangements

Walsall CCG has revised the Whistle Blowing policy and in line with the latest guidance has nominated the Audit Chair to be the ‘Speak up Guardian’ for the organisation. There have been no whistle blowing reports during 2018/19. Any reports which are made are managed in line with the policy and reported to the Remuneration and Human Resources Committee where compliance with the process would be monitored along with any issues or learning. The focus on the investigation is on improving the service and where improvements are identified this will be shared appropriately across the organisation ensuring anonymity is maintained at all times. The Governing Body would receive similar high level detail through the assurance report. Where relevant the Audit and Governance Committee would seek additional assurance if there were outstanding risks or issues.

3.1.2 Statement of Accountable Officer’s Responsibilities The National Health Service Act 2006 (as amended) states that each Clinical Commissioning Group shall have an Accountable Officer and that Officer shall be appointed by the NHS Commissioning Board (NHS England). NHS England has appointed the Accountable Officer to be the Accountable Officer of Walsall CCG.

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

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

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

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

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

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

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

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

In preparing the accounts, the Accounting Officer is required to comply with the requirements of the Government Financial Reporting Manual and in particular to:

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

• Make judgements and estimates on a reasonable basis;

• State whether applicable accounting standards as set out in the Government Financial Reporting Manual have been followed, and disclose and explain any material departures in the accounts; and,

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• Prepare the accounts on a going concern basis; and

• Confirm that the Annual Report and Accounts as a whole is fair, balanced and understandable and take personal responsibility for the Annual Report and Accounts and the judgements required for determining that it is fair, balanced and understandable.

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

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

Paul MaubachAccountable Officer

22 May 2019

3.1.3 Governance StatementIntroduction and context

Walsall CCG is a body corporate established by NHS England on 1 April 2013 under the National Health Service Act 2006 (as amended).

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

As at 1 April 2019, the clinical commissioning group is not subject to any directions from NHS England issued under Section 14Z21 of the National Health Service Act 2006. It was rated as ‘requires improvement’ in 2017 by NHS England under the Improvement and Assurance Framework for CCGs and progressed to ‘good’ in 2018.

Scope of responsibility

As Accountable Officer, I have responsibility for maintaining a sound system of internal control that supports the achievement of the clinical commissioning group’s policies, aims and objectives, whilst safeguarding the public funds and assets for which I am personally responsible, in accordance with the responsibilities assigned to me in Managing Public Money. I also acknowledge my responsibilities as set out under the National Health Service Act 2006 (as amended) and in my Clinical Commissioning Group Accountable Officer Appointment Letter.

I am responsible for ensuring that the clinical commissioning group is administered prudently and economically and that resources are applied efficiently and effectively, safeguarding financial propriety and regularity. I also have responsibility for reviewing the effectiveness of the system of internal control within the clinical commissioning group as set out in this governance statement.

Governance arrangements and effectiveness

The main function of the governing body is to ensure that the group has made appropriate arrangements for ensuring that it exercises its functions effectively, efficiently and economically and complies with such generally accepted principles of good governance as are relevant to it.

The Constitution

The CCG will at all times observe such generally accepted principles of good governance in the way it conducts its business. Reference is made to the seven key principles of the NHS Constitution, the Good Governance Standard for Public Services, the ‘Nolan Principles’, Standards for Members of NHS Boards and Clinical Commissioning Group Governing Bodies in England and the Equality Act 2010. The CCG will expect the highest standards of propriety involving, integrity and objectivity in relation to the stewardship of public funds, the management of the organisation and the conduct of its business.

The governing body comprises of five executive directors, an elected Clinical Chair, four appointed clinical executives, four elected clinical leads, an appointed secondary care consultation and four appointed lay members. It is through the composition of its membership, its meetings in public and the publication of key documentation that the CCG is able to demonstrate its accountability to its members, the public, its stakeholders and NHS England. The CCG expects the highest standards of propriety involving, integrity and objectivity in relation to the stewardship of public funds, the management of the organisation and the conduct of its business.

Walsall CCG Governing Body shall be responsible for and shall be delegated by its Member Practices the power to conduct the overall management and strategic direction of Walsall CCG and the achievement or furtherance of the functions.

The Governing Body has detailed in the Scheme of Reservation and Delegation, the committees and their delegated responsibilities and accountabilities. Each terms of reference for these committees details the frequency and communication of activity with the Governing Body. Each Governing Body committee has a Clinical Executive and Executive Director from the Governing Body within the committee membership. Each member practice is part of a locality group which has a Locality Lead representing their group at the Governing Body. Decisions are taken by Governing Body consensus and if this is not possible a vote is taken.

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Walsall CCG has the following values which govern our wider approach to commissioning; these values are part of our strategies.

I. Respect and value people – individuals are at the core of what we do

II. Listen to local people – We are committed to involving patients, clinicians and communities in the design and improvement of their services

III. Clinical leadership - We recognise and embrace the need for clinical leadership in service planning and redesign to ensure highest levels of quality, safety and efficiency

IV. Clear accountability and transparency – We value feedback and a clear sense of personal accountability and responsibility

V. Innovation – We will make the best use of all new technology, particularly striving to be at the forefront of innovation in exploitation of information technology

VI. Prevention – We will prevent poor health starting early with families, children and young people

VII. Partnership – We will work closely with our partners in health, local authority and voluntary sectors to ensure a holistic approach to promoting health and equality in the community.

VIII. ‘Public Value’ - through our commissioning and procurements arrangements we will promote the creation of public value as measured by the social, economic and environmental impact on the community.

NHS England approved the revised constitution in June 2018 following the implementation of the recommendations from the Governance review by the Good Governance Institute. The committee structure and functions were refreshed which was reflected in the scheme of reservation and delegation.

Black Country Joint


Fianance & Performance Copmmittee

Remunertion & HR

Committee

Quality &Safety

Committee


PrimaryCare


Auditand

Governance Committee

Black Country CCGWalsall Clinical

Commissioning Group Governing Body

The Black Country CCGs established a Black Country Joint Commissioning Committee as a mechanism to commission services delegated to it from the four Black Country CCGs.

The Governing Body refreshed the corporate objectives in May setting out the priorities in each area with an end of year measure. This was reported to Governing Body each quarter to monitor progress and manage risks. Each objective was allocated to a director to lead on the objective with monitoring arrangements through the governing body committee structure. The assurance framework was refreshed to incorporate these changes.

Aim 1 To effectively commission services which will improve the health and wellbeing for Walsall people

Objective Year-end measure Lead Cmt

1. Developing the Walsall Together programme into a full Integrated Care Partnership with a clearly defined care model, supported by a new contractual arrangement from April 2019

New population-based contract for the model agreed and in place for 19/20 onwards (incorporating BCF)

Dir Commissioning CC

2. Further development of GP involvement in the Walsall together programme

New GP LES – primary care outcomes framework in place Arrangements in place that align to the model

Dir Primary Care & Integration

PCCC

3. To establish new commissioning arrangements for MH and LD in collaboration with the BC STP

New BC contract in place for BC services; local contract for Walsall services incorporated into place based model (obj 1).

Chief Nurse CC / JCC

4. To establish new commissioning arrangements for Acute service in collaboration with the BC STP

New BC contract arrangement in place for priority services

Dir of Commissioning CC / JCC

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Aim 2 To comply with our statutory duties and responsibilities and keep people safe


5. To maintain financial sustainability and ensure delivery of the QIPP programme (For 18/19 and plan for 19/20)

18/19 QIPP and financial targets delivery.19/20 plans and contracts agreed.

Chief Finance Officer (for assurance reporting)

F&P

6. To deliver the CCG quality and safety responsibilities to improve the incident reporting, assurance and ensure that robust Quality Assurance Processes are in place for all commissioned services.

Improved CQC rating at WHT from Requires Improvement to Good. QA processes fully implemented for all complex case management services

Chief Nurse Q&S

7. To ensure effective performance across the system to deliver the locally agreed targets – both key measures such as A&E and RTT but also improvement in all measures, especially ones in the lower quartile

Overall net CCG improvement on key measures. Clear plans built into 19/20 contracts for any required changes.

Chief OfficerChief Finance Officer

F&P

8. To improve the communication and engagement with system partners, providers and GPs – developing a clear CCG vision for the future which has stakeholder support

Alignment of Walsall alliance and BC arrangements to our strategy.

Improvement in 360 results.

Chief Officer GB

Aim 3 To ensure strong leadership and governance arrangements


9. Continuing organisational development of system and CCG leadership and capability to ensure on-going resilience and effectiveness

New alliance arrangements in place; new strategic BC commissioning and Walsall place arrangements fully established

Chief Officer A&G.

GB

10. Supporting the evolution of the Black Country STP towards a Black Country Integrated Care System

Outcome of ICS plans on trajectory for implementation

Accountable Officer JCC / GB

Information about the membership body and governing body

The CCG is a clinically led membership organisation which is comprised of 52 general practices which make up the membership. The constitution set out the governance and decision making arrangements for the organisation as well as describing the arrangements for carrying out its statutory duties.

The Governing Body meets in public six times a year. In March 2019 the CCG called an extraordinary Governing Body meeting to approve the contracts for 2019/20, the financial plans, operational plan and the corporate objectives.

The Governing Body has four elected GP locality leads which represent the membership and contribute to the clinical leadership of the CCG. There are also four selected clinical executives who take a lead on commissioning, primary care, finance and quality. There are four lay members that bring specific expertise and experience to the Governing Body which is impartial and aims to bring an external view which is removed from in the operational day to day business of the CCG. They are supported by a secondary care consultant who is out of the area to strengthen the independence that they bring.

The Governing Body has delegated specific duties to a number of committees which report their progress and activity at each Governing Body meeting.

The Governing Body Committees are as follows:

The Quality and Safety Committee which is responsible for ensuring the commissioned services are of good quality, deliver safe effective care in line with the corporate objectives.

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The Finance and Performance Committee which is responsible for independently contributing to the governing body’s overall process for ensuring that the effective scrutiny and control of in year financial performance in terms of revenue, capital and cash is maintained. It contributes to the governing body’s overall process for ensuring that contracts are awarded, monitored and performance managed appropriately which includes a robust process to ensure the delivery of QIPP schemes. It provides executive oversight and monitoring of the CCG’s performance management framework in order to ensure remedial action plans are developed and put in place to address any areas of unsatisfactory performance and to monitor and receive progress in the implementation and effectiveness of these plans.

The Commissioning Committees role is to oversee the delivery of the commissioning strategy, create in partnership with relevant committees the commissioning intentions for the CCG and oversee and inform the integrated commissioning agenda. The commissioning committee will provide assurance and update the governing body on relevant matters relating to the quality innovation productivity and prevention programme.

The aim for the Primary Care Commissioning Committee is to commission primary care medical services for the people of Walsall registered within the Walsall CCG member practice geographical area. The committee will make collective decisions on the review, planning and procurement of primary care services in Walsall under delegated authority from NHS England.

The Remuneration and Human Resources Committee is responsible for making recommendations to the Governing Body on the appropriate remuneration and terms of service for the employees of the clinical commissioning group and people who provide service to the clinical commissioning group. The human resources includes the organisational agenda which is fundamental in the driving forward of the Oganisational Development agenda, particularly by bringing in experience and expertise of non-executive directors to the consideration of our organisational culture, memory and strategic goals.

The Audit and Governance Committee is a mandatory committee of the Clinical Commissioning Group. Its key function is to independently contribute to the Governing Body’s overall process for ensuring that an effective governance, risk management and internal control system is maintained.

The Black Country Joint Commissioning Committee is established in accordance with the NHS Dudley Clinical Commissioning Group’s (CCG) constitution, NHS Wolverhampton CCG constitution, NHS Sandwell & West Birmingham CCG constitution and NHS Walsall CCG constitution. The purpose of the Joint Commissioning Committee is to establish a single commissioning view in line with the Sustainable Transformation Plan (STP) arrangements for key services across the Black Country through the creation of a Joint Commissioning Committee of the four CCGs. Individual CCGs will remain accountable for meeting their statutory duties. Each CCG has nominated its representative members and the Joint Commissioning Committee will have delegated authority from each CCG to make binding decisions on behalf of each CCG.

Committee Attendance 18/19

Governing Body Committee – 7 meetings – member attendance average of 80

Accountable Officer

Clinical Chair

Lay Member Commissioning

Lay Member Audit & Governance

Trans Locality Lead

North Locality Lead

Chief Finance Officer

South East Locality Lead

Clinical Executive Finance & IT

West Locality Lead & Medical Director

Secondary Care Consultant

Strategic Finance Lead

Director of Commissioning

Mr Paul Maubach

Dr Anand Rischie

Mr Mike Abel

Mr Jim Oatridge

Dr Sandeep Kaul

Dr Nasir Asghar

Mr Tony Gallagher

Dr Joo Teoh

Dr Hewa Vitarana

Dr Rajcholan Mohan

Mr Robert Freeman

Mr Matthew Hartland

Mr Paul Tulley

1 April 2018

1 April 2018

1 April 2018

1 April 2018

1 April 2018

1 April 2018

1 April 2018

1 April 2018

1 April 2018

1 April 2018

1 April 2018

1 April 2018

1 April 2018

31 March 2019

31 March 2019

31 March 2019

30 September 2018

31 March 2019

31 March 2019

31 March 2019

31 March 2019

31 March 2019

31 March 2019

31 July 2018

31 March 2019

31 March 2019

100

86

86

100

100

100

86

86

100

100

100

100

86

0

14

14

0

0

0

14

14

0

0

0

0

14

0

0

0

0

0

0

0

0

0

0

0

0

0

Job TitleNameFrom To

Attendance

%Apologies

DNAIn Office

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page 70 page 71

Committee Attendance 18/19 (continued)

Governing Body Committee – 7 meetings – member attendance average of 80

Director of Public Health, Walsall Council

Chief Officer

Clinical Executive Commissioning

West Locality Lead

Clinical Executive Primary Care CommissioningExecutive Director Adult Social Care, Walsall Council

Lay Member PPI

Director of Primary Care and Integration

Lay Member Audit and Governance

Lay Member

Chief Nursing Officer/Director of Quality


Dr Barbara Watt

Professor Simon Brake

Dr Carsten Lesshafft

Dr Ravinder Sandhu

Dr Harinder Baggri

Ms Paula Furnival

Mr Gulfam Wali

Mrs Donna Macarthur

Mr Manjit Jhooty

Miss Rachel Barber

Mrs Sarah Shingler

Dr Parijat De

1 April 2018

1 April 2018

1 April 2018

1 April 2018

1 April 2018

1 April 2018

1 April 2018

1 April 2018

September 2018

1 April 2018

1 April 2018

October 2018

31 March 2019

31 March 2019

31 March 2019

31 March 2019

31 March 2019

31 March 2019

31 March 2019

31 March 2019

31 March 2019

31 March 2019

31 March 2019

31 March 2019

43

86

67

86

71

0

71

71

50

86

86

60

57

14

33

14

29

100

29

29

50

14

14

40

0

0

0

0

0

0

0

0

0

0

0

0

Job TitleNameFrom To

Attendance

%Apologies

DNAIn Office


Percentage Attendance for Committees to the Board (excluding the Governing Body meetings)

Accountable Officer

Clinical Chair

Lay Member Commissioning

Lay Member Audit & Governance

Trans Locality Lead

North Locality Lead

Chief Finance Officer

South East Locality Lead

Clinical Executive Finance & IT

West Locality Lead & Medical Director


Strategic Finance Lead


Mr Paul Maubach

Dr Anand Rischie

Mr Mike Abel

Mr Jim Oatridge

Dr Sandeep Kaul

Dr Nasir Asghar

Mr Tony Gallagher

Dr Joo Teoh

Dr Hewa Vitarana

Dr Rajcholan Mohan

Mr Robert Freeman

Mr Matthew Hartland

Mr Paul Tulley

n/a

n/a

100%

n/a

n/a

n/a

78%

n/a

100%

n/a

n/a

67%

67%

n/a

n/a

100%

n/a

84%

75%

92%

92%

n/a

n/a

100%

n/a

100%

n/a

n/a

100%

n/a

n/a

n/a

100%

n/a

n/a

n/a

100%

n/a

n/a

n/a

n/a

n/a

100%

n/a

n/a

n/a

n/a

n/a

92%

n/a

n/a

83%

n/a

n/a

100%

100%

n/a

n/a

n/a

n/a

n/a

n/a

n/a

n/a

n/a

n/a

100%

100%

100%

n/a

n/a

n/a

n/a

n/a

n/a

n/a

n/a

n/a

Membership Membership Finance & Performance Commissioning

Primary Care

Safety & Quality

Audit & Governance

Remuneration & HR

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Director of Public Health, Walsall Council

Chief Officer

Clinical Executive Commissioning

West Locality Lead

Clinical Executive Primary Care CommissioningExecutive Director Adult Social Care Walsall Council

Lay Member PPI

Director of Primary Care and Integration

Lay Member Audit and Governance

Lay Member

Chief Nursing Officer/Director of Quality


QIPP & PMO Manager

Dr Barbara Watt

Professor Simon Brake

Dr Carsten Lesshafft

Dr Ravinder Sandhu

Dr Harinder Baggri

Ms Paula Furnival

Mr Gulfam Wali

Mrs Donna Macarthur

Mr Manjit Jhooty

Miss Rachel Barber

Mrs Sarah Shingler

Dr Parijat De

Mr Lee Dukes

n/a

33%

n/a

n/a

n/a

n/a

n/a

n/a

n/a

n/a

78%

n/a

n/a

n/a

n/a

92%

75%

92%

n/a

n/a

67%

n/a

n/a

100%

14%

92%

n/a

n/a

n/a

n/a

n/a

n/a

n/a

100%

n/a

82%

91%

33%

n/a

n/a

n/a

n/a

n/a

n/a

n/a

n/a

100%

56%

100%

83%

n/a

n/a

n/a

n/a

n/a

n/a

n/a

n/a

n/a

n/a

100%

n/a

n/a

n/a

n/a

n/a

n/a

n/a

n/a

n/a

n/a

67%

n/a

100%

100%

n/a

n/a

n/a


Primary Care

Safety & Quality

Audit & Governance

Remuneration & HR



Consultant Public Health, Walsall Council

Walsall Council

Clinical Advisor

Deputy Chief Nurse

Consultant Public Health

Healthwatch Manager, Walsall

Deputy Chief Nurse

Head of Performance and Delivery

Dr Paulette Myers

Councillor Robertson membership (April to May 2018)

Dr Sushma Manthri

Mrs Sara Bailey

Dr Uma Viswanathan

Mr Paul Higgitt

Mrs Yvonne Higgins Membership one month, April 2018

Mr Kam Mavi

n/a

n/a

n/a

n/a

n/a

n/a

n/a

100%

78%

92%

n/a

n/a

n/a

n/a

n/a

n/a

n/a

84%

n/a

50%

n/a

n/a

n/a

n/a

n/a

n/a

82%

n/a

n/a

83%

89%

100%

100%

100%

n/a

90%

n/a

n/a

n/a

n/a

n/a

n/a

n/a

n/a

100%

n/a

n/a

n/a

n/a

n/a

n/a

n/a

n/a

94%


Primary Care

Safety & Quality

Audit & Governance

Remuneration & HR

Committee average attendance

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COMMITTEE HIGHLIGHTS

Safety and Quality • Committee Terms of Reference reviewed and agreed, new Chair appointed.• Sustained emphasis and focus on driving improvements across the system within Maternity Services, Emergency Department and Transforming Care • Increased focus on individual case management and transparency in reporting and understanding key risks • Strengthened Children’s Safeguarding and Looked After Children resource and reporting arrangements • Commissioned Independent governance review into stillbirths and maternity governance processes at WHT

Finance and Performance

• Contractual timetable plan• Successful agreement of 2018/19 contracts• Finance report and challenge thereof• Continued monitoring and improvement of A&E & RTT trajectories and performance

Audit and Governance

• Received the 2017-18 external audit report and approved the accounts and annual report• Received internal audit reports giving assurance on systems and processes• Reviewed and made recommendations to the risk management arrangements, Assurance Framework and Committees risk registers


• Responsible for delivery of Commissioning QIPP target - £11.286m• Oversight of commissioning health programmes• Agreed revised Individual Funding Requests policy, receiving quarterly monitoring reports• Agreed revised policy on Procedures of Limited Clinical Value, incorporating changes in national guidance• Approval for commissioning plans and specifications for service procurements, including AQP ultrasound, termination of pregnancy services and clinical peer review.• Received reports for approval and assurance from STP health programmes including cancer, elective care transformation, mental health, Transforming Care, Personalisation and the local maternity system.


Primary Care Commissioning Committee

• Reviewed the APMS GP contracts and launched a re-procurement for services following extensive consultation – led to a consolidation of services, fewer contracts offering additional services and released significant savings of £1.8 million recurrently for reinvestment• Delivered 4 extended hours hubs, in line with national requirements for increasing access to general practice. Flexed capacity at periods of high demand in order to deliver the higher aspirational target of 45 mins per 1000 list size• Rolled out second year of 3 year programme of GP contract monitoring visits and undertook targeted programme of practice visits to review opening hours • Provided significant investment in support and training for practices – 10 practices took part in the national “Time to care programme” and a further 8 supported through “learning in action”. By March 2019, 33 training courses for practices will have been run on a wide variety of topics (eg clinical correspondence management, active signposting, capacity and demand in practice). Re-establishment of protected learning time for GPs and wider team. Established a facilitated practice manager forum • Launched application for GP transformation funding with a practice event – ideas generated and built on by working group – now supporting a range of projects to deliver on 10 high impact changes in general practice• Developed a revised primary care offer for implementation in 2019/20 – to include components on access, MDT working , end of life care, and support to the right care programme areas• Built on the geographical revisions to the CCG locality structure to lay the foundations for the establishment of primary care networks. Developed a local PCN scheme with 100% practice sign up to support practices prepare for national DES and new ways of working• Strong partnership working with primary care leads across the STP which has led to effective collaboration on the primary care workforce programme of work.

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Remuneration and Organisational Development Committee

• CCG staff values and roll out programme agreed• Remit of REM COM would be extended to include OD, with a split agenda and change of membership for the OD discussions• Flexible working policy reviewed and agreed• Annual staff survey action plan agreed.• VSM pay performance framework agreed• PDR policy agreed for staff that join or get promoted to the next band as of 1 April 19.• Existing PDR policy reviewed, PDR cycle in line with quarter 1• Social and corporate responsibility policy agreed• Whistleblowing policy refined as per the whistleblowing protection guidelines• A number of masterclasses arranged for all staff to attend:• 4 successful staff development days – 2 sessions were focused on the importance of the staff values and defining the values behaviour charter, 3rd session was dedicated to celebrating success – staff awards and the 4th session was on staff wellbeing and working well together during a period of change.• TOR for the committee reviewed.• Clinical leadership review• Committee effectiveness monitoring in place• HR and OD working group defined – deliver the OD plan• Workforce dashboard to include further breakdown of MT compliance and PDR per directorate.

The Governing Body development programme has covered a number of strategic discussions and awareness sessions. There is a set programme throughout the year with additional sessions that are allocated to issues and topics as they are presented throughout the year. A 360 degree questionnaire has been carried out by the Governing Body members and will be used along with the revised corporate objectives to inform the personal development reviews which are scheduled from April 2019 for the forthcoming year.

Performance of the Membership Body and Governing Body

The membership has had access to a varied organisational development programme covering over thirty topics ranging from human resource topics, leadership, clinical management, managing conflicts and risk management. In addition to this the CCG have held a number of practice manager network meetings, protected learning time events on pain management pathways, Primary Care Networks, and extended access.

The Governing Body development programme has covered a number of strategic discussions and awareness sessions including the place based care model – Walsall Together and the supporting outcomes framework, governance arrangements, mental health services and transforming care partnership. There were other sessions which covered the corporate objectives, declarations of interest, stakeholder survey, information governance and GDPR and risk. There is a set programme throughout the year with additional sessions that are allocated to issues and topics as they are presented throughout the year.

The governing body revisited the good governance institutes maturity matrix self -assessment in July to review the progress against eleven areas which are key for an effective governing body. Significant progress was made against six of the areas and good progress was made against the rest with all areas showing an improvement.

The Audit and Governance Committee details are part of the members report.

UK Corporate Governance Code

NHS Bodies are not required to comply with the UK Code of Corporate Governance.

We have however reported on our Corporate Governance arrangements by drawing upon best practice available, including those aspects of the UK Corporate Governance Code we consider to be relevant to the CCG and best practice.

Walsall CCG has a constitution compliant with the requirements set out in schedule 1A of the Health and Social Care Act 2012. There is effective board leadership with both an Accountable Officer and Chair which prevents one individual having all the final powers of decision making. The Chair is responsible for the leadership of the Governing Body and has made arrangements for each Governing Body member to have a personal development review to clarify the roles and set objectives for the year. The Governing Body has four lay member roles which cover audit and governance, commissioning and patient and public involvement to increase constructive challenge.

The new appointments to the governing body for the secondary care consultant and lay members were achieved through a rigorous, robust recruitment process through NHS jobs which incorporates transparency and addresses bias to appoint the best applicants to the role. All applicants complete a declaration of interest prior to appointment to ensure any conflicts of interest can be appropriately managed without adversely impacting on their ability to carry out their role.

Executive effectiveness is achieved through work plans, regular leadership meetings and personal development reviews. The committee effectiveness is achieved through annual committee report schedules, regular assurance reports from the committees which have delegated responsibility for board duties.

The corporate objectives are clearly aligned to risk management process which was reviewed and strengthened during the year.

The Remuneration and Human Resources Committee was compliant with the conflict of interest policy and benefited from benchmarking exercises across the neighbouring Black Country Clinical Commissioning Groups to help inform the decision making.

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Internal Audit conducts a review of the governance arrangements each year making recommendations which are monitored by the Audit and Governance Committee.

Discharge of Statutory Functions

In light of recommendations of the 1983 Harris Review, the clinical commissioning group has reviewed all of the statutory duties and powers conferred on it by the National Health Service Act 2006 (as amended) and other associated legislative and regulations. As a result, I can confirm that the clinical commissioning group is clear about the legislative requirements associated with each of the statutory functions for which it is responsible, including any restrictions on delegation of those functions.

Responsibility for each duty and power has been clearly allocated to a lead Director. Directorates have confirmed that their structures provide the necessary capability and capacity to undertake all of the clinical commissioning group’s statutory duties.

The CCG meets with NHS England on a regular basis to ensure that we continue to comply with the regulations and performance management framework that is set nationally for all CCGs. The CCG has complied with the requirements set out in the legal directions and as a result are now confident that they have the arrangements in place to meet all of the statutory functions.

Risk management arrangements and effectiveness

Walsall CCG recognises that systematically identifying risks and successfully managing these risks within its governance framework will provide invaluable opportunities to improve commissioning and thereby improve the quality and safety of patient care for the residents of Walsall.

The key elements of the risk management plan are to identify, assess, control and review the risks to the delivery of the corporate objectives. The committees identify the key risks and the operational risks are mainly identified through the project management office processes. The risks are assessed to indicate the likelihood and consequence which is recorded as a risk rating. This is entered onto the risk register along with actions to mitigate the risk.

Managing risk is part of every decision made and as such is a responsibility of each director, manager and ultimately each member of staff. The governance structure is such that each directorate has a clear reporting and accountability framework to ensure that risk is managed throughout the organisation. The organisation has a range of policies and processes in place as well as a suite of mandatory training courses to deter risks from arising. These range from interpretation of national policy as well as local policy. The implementation and monitoring of policy helps the organisation adopt a systematic and consistent approach which is a major control against risk. A positive reporting culture is supported in the CCG so that any near miss of incident can be investigated to maximise the learning opportunity and improve process and practice.

The Governing Body reviewed its corporate objectives and assigned each one to a committee of the governing body and allocated an executive director lead. The governing body is informed on the risks against the delivery of the corporate objectives and the other areas delegated to the committee through the committee assurance reports.

A revised risk management framework was agreed by the Audit and Governance Committee and implemented in quarter 3. This included a new tool for recording committee risks and aligned all residual red risks to the Board Assurance Framework. The committee risk registers now adopt the Board Assurance Framework format. By using this format the committees are required to identify the gaps in controls and assurance which leads to clarity on the actions required and has strengthened the use of control mechanisms. The risk register is now a live document which holds all identified risks in the CCG and includes an automatic effectiveness of controls which gives a summary for the governing body.

The implementation of the risk register included training at committee level to increase the accuracy of the use of the register. An in-house audit was carried out following implementation and further support was put into place following the results. The overall compliance with the use of the register is good with all committees holding and maintaining a committee risk register which is updated at each committee meeting.

The Programme Management Office includes risk management in their process. There is a detailed impact assessment which covers quality, equality and data privacy. Any risks identified through this process would be managed in the PMO process and if additional management was required escalated to the relevant committee.

The Governing Body members have attended a development session on the allocation of risk appetite which is expressed as the boundary above which the level of risk will not be accepted. The risk appetite is currently set at a residual risk rating of 15 which takes into consideration the challenges both internal and external. The Governing Body may amend the risk appetite at any point in the year as factors may change which impact on the tolerable level of risk.

The key elements for the way in which public stakeholders are involved in managing risks which impact on them, is set out in the engagement and consultation plan to support our five year commissioning strategy. This gives the public a voice where there are changes to services which impact on them.

Capacity to Handle Risk

The governing body provides strategic oversight for risk management by delegating authority to the audit and governance committee to approve the risk management arrangements and monitor the consistent implementation of the risk management framework throughout the committee and management structure.

The Governing Body at public meetings and development sessions and the Audit and Governance Committee have reviewed the risk management arrangements throughout the year contributing to the development of both the process and documentation. The Board Assurance Framework and risk registers have been reviewed throughout the year by the Governing Body, and Audit and Governance Committee. Internal audit carry out a review of the Board Assurance Framework and overall risk management arrangements on an annual basis. The findings of the 2018/19 audit were that the BAF was established, designed and operated to meet the requirements of the 18/19 annual governance statement to provide reasonable assurance that there is an effective system of internal control to manage the principle risks identified in the organisation.

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The governance structure is effective at managing risk as the risks identified at committee are now directly linked to the Board Assurance Framework. Each committee has a lead director who is responsible for the identification and management of risk. There is a clear escalation process throughout the organisation where each function is aligned to a committee or subcommittee making the line of responsibly and management of risk transparent and consistent.

The annually revised business cycle for the Governing Body and its committees ensures statutory functions have oversight and at least annual reporting. The Governing Body receives regular reports on the performance of the CCG and external scrutiny through internal audit supports the effectiveness of the arrangements in place.

Staff have attended risk awareness sessions which go through the risk management framework and their responsibilities and additional information and resources are available on the staff intranet. The staff newsletter is used to share best practice and lessons learnt.

Risk Assessment

The Governing Body have agreed that a risk appetite of risks rated 15 or above. Risks are rated using a 5 by 5 matrix with a maximum rating of 25. Throughout the year the Governing Body Committees identified and managed a number of risks around the following themes:

Performance

A&E Target: There continues to be an under performance of Accident & Emergency which impacts on the quality and timelines of urgent care services received by Walsall’s patients. The failure is being addressed at a health system level through the Urgent and Emergency Care Improvement Board. There is a potential for this to impact on the quality premium award for 2018/19.

62-day cancer target (urgent GP referral): There is continued failure of the 62-day standard for Walsall patients which is impacting on the quality and timeliness of services received by Walsall patients and also the reputation of the CCG. This is due mainly to substandard performance by out of area referrals and is being actioned through the contract. Failure to achieve this target will result in a 50% reduction in the quality component of the 2018-19 Quality Premium Scheme.

STP and Place based care

There is an element of inertia across the system to make change happen when the national picture of a move towards an STP is clear. This is creating a sustainability risk as the CCG has to respond to increasing demands on its resources whilst also continuing to deliver on Walsall Together and maintain its performance. The CCG has ensured the appropriate support and engagement activity to influence decisions.

Walsall Together contractual arrangements; there is a risk that the integrated care programme plan does not deliver in time for the contractual arrangements to be put in place by April 2019.

An implementation plan for the integrated care plan is to be agreed, clinical engagement is continuing to take place.

Workforce

Resilience of the General Practitioner workforce will result in pressures on current workforce and have a potential negative impact on patient care in primary care. The CCG has obtained partial NHS England assurance with respect to the GP Workforce strategy.

There are risks regarding the capacity within the multi-agency safeguarding hub, looked after children and complex care management. Recruitment is being undertaken with partners.

There are risks relating to the shortage of reviewers for the Black Country LeDeR Programme which is resulting in a backlog of cases. The CCGs are offering support by pooling reviewers and additional reviewers are being trained to manage the workflow.

The CCG is unable to make changes to the Respiratory Pathway, allowing more patients to be treated in community rather than being admitted to hospital due to capacity and recruitment issues.

Disputes

There are on-going disputes between NHS Property Services regarding lease arrangements and non-payment of invoices which has exposed a financial risk. The committee have ensured that meetings with NHS Property Service continue to resolve the issue. The CCG has also met with LMC representative representatives to discuss concerns.

The CCG continues to debate with Walsall Council on the contribution to be returned to the CCG for the individual client assessments backdated to April 2016. There is now agreement on the process for determining this and an independent assessor has been agreed to progress the issue.

Urgent Care Centre

The CCG has awarded the Urgent Care Centre (UCC) contract to a step in provider and the contract has been mobilised. Work is ongoing to assess the cost impact of the extended opening period of the Town Centre site and other costs.

Delay in closure of the UCC: The date for closure has been brought forward as a result of withdrawal of service by provider from 18 Dec 2018.

There are three risks with the new urgent care centre provider regarding discrepancies in medicines stock levels, non-compliance with infection control standards and reporting of data to support compliance. All areas of concern have an action plan which is reviewed at the clinical quality review meetings.

Walsall Healthcare Trust

There are six risks regarding quality and performance issues with the provider which are being addressed through the contract, management of serious incident reporting, unannounced visits and partnership working with the provider. The risks include Imaging where there are concerns regarding capacity and infection control, Infection Control where there is lack of compliance with infection prevention and control measures, Mortality where there is an increase in HSMR and SHMI trends with a lack of data to support the reason why, a surgical invasive Never Event, Capacity and performance issues within Emergency Department (ED) and in Urology where there is a backlog of urology reviews due to lack of capacity.

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The overall levels of emergency admissions are greater than the impact of the work on specified pathways. There are current pathway schemes in place for example Ambulatory, Rapid Response and ensuring that Care Home placements are being maximised which has had an impact on slowing the increase in the emergency department.

There is learning from the journeys of Children and Young People in Walsall regarding the equity of services for patients with leaning disability which has generated a review of commissioned services and an action plan being implemented

Partnership and Engagement

The CCG has limited engagement with clinicians across the health economy at a general level to change historical clinical practice to reduce avoidable emergency admissions. There has been increased communications and engagement to raise awareness of admission avoidance pathways, using case studies and clinical involvement in service redesign.

The Special Educational Needs and Disabilities (SEND) inspection report indicates a set of improvements only achievable by working in partnership. An action plan has been developed following the Care Quality Commission (CQC) report, supported by a Memorandum of Understanding (MOU). Governance processes are being established as well as a plan for joint commissioning to support.

There is a risk of lack of engagement from Walsall Healthcare Trust (WHT) to support the development and implementation of new pathways. The CCG has arranged workshops to engage with WHT clinicians.

The continuing health care service is benchmarking outside of the national financial arrangements and as such there are financial implications for the CCG which need to be addressed, specifically with regards to complex care placements and Learning Disability (LD) pooled budget arrangements.

There are no significant risks to compliance with our license.

Other sources of assurance

Internal Control Framework

A system of internal control is the set of processes and procedures in place in the clinical commissioning group to ensure it delivers its policies, aims and objectives. It is designed to identify and prioritise the risks, to evaluate the likelihood of those risks being realised and the impact should they be realised, and to manage them efficiently, effectively and economically.

The system of internal control allows risk to be managed to a reasonable level rather than eliminating all risk; it can therefore only provide reasonable and not absolute assurance of effectiveness.

The Audit and Governance Committee is responsible for approving and maintaining a comprehensive system of internal control including budgetary control that underpins effective, efficient and economic operations of the CCG. It achieves this through regular consideration of the applications of the CCGs key corporate governance policy including the standing orders, scheme

of delegation and reservation and prime financial policies. This schedule of reports is agreed at the start of the financial year and additional reports are requested where any areas of concern may have been raised. This is supported by the external and internal audit reports on the areas which are agreed in the work plans.

Annual audit of conflicts of interest management

The revised statutory guidance on managing conflicts of interest for CCGs (published June 2016) requires CCGs to undertake an annual internal audit of conflicts of interest management. To support CCGs to undertake this task, NHS England has published a template audit framework.

Walsall CCG has carried out the internal audit of conflicts of interest and gained significant assurance. The key issues for management to address include agreeing an escalation process for the individuals who do not return their declaration of interest forms in a timely manner, strengthen the documentation of the chairs management of conflicts of interest and complete a review of the registers against the suppliers that the CCG deals with in year.

Data Quality

The Quality and Safety and Finance and Performance Committees regularly review both the adequacy and presentation of the data it presents to the Governing Body through its committee.

The Quality and Safety Committee were challenged with testing the quality of the data included in the committee reports. This challenge was met with a series of revised dashboards, data sets and a programme to triangulate information received from providers including deep dives and including data analysis on unannounced visits.

Throughout the year the internal audit programme will cover elements of data quality and any recommendations are implemented by management. The financial data relating to contract monitoring is quality checked through a reconciliation process with each lead commissioner and provider.

The effectiveness of these initiatives has been sought and the Governing Body are assured with the quality of the data it receives.

Information Governance

The NHS Information Governance Framework sets the processes and procedures by which the NHS handles information about patients and employees, in particular personal identifiable information. The NHS Information Governance Framework is supported by the data protection and security toolkit and the annual submission process provides assurances to the clinical commissioning group, other organisations and to individuals that personal information is dealt with legally, securely, efficiently and effectively.

The CCG places high importance on ensuring there are robust information governance systems and processes in place to help protect patient and corporate information. We have established an information governance management framework and have developed information governance processes and procedures in line with the data protection and security toolkit. We have ensured all staff undertake annual information governance training and have implemented a staff information governance handbook to ensure staff are aware of their information governance roles and responsibilities.

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There are processes in place for incident reporting and investigation of serious incidents. We have developed information risk assessment and management procedures with a programme to fully embed an information risk culture throughout the organisation against identified risks.

The CCG published the Data Security and Protection Toolkit return, meeting all required 70 mandatory assertions. Evidence was reviewed by Internal Audit and the Data Protection Officer. There have been no serious information governance incidents or breaches which required reporting to the Information Commissioners Office by the CCG.

Business Critical Models

There is an appropriate framework and environment in place to provide quality assurance of business critical models, in line with the recommendations in the Macpherson report.

All business critical models have been identified and information about quality assurance processes for those models has been provided to the Analytical Oversight Committee, chaired by the Chief Analyst in the Department of Health.

Two key business critical models are the finance model and finance activity plans which have been submitted to the Department of Health as part of the overall planning submission. These have been subject to external scrutiny as part of our assurance framework.

Third party assurances

The main third party providers are the Arden and GEM and Midland and Lancashire Commissioning Support Units. Assurance on these arrangements is taken from the type 2 service auditors reports received by the CCG and included in the Head of internal audit opinion.

The other key third party provider arrangements are through service level agreements for information technology services, Occupational Health and ESR from Walsall Healthcare NHS Trust. Assurances are received through contract management review meetings and key performance indicators. There are a number of services which the CCG receive which are contracted on a national basis for example the Shared Business Services which is the financial accounting and procurement system. The CCG continues to work with the other Black Country CCGs to scope the back office functions that could be delivered at scale across the Black Country and West Birmingham to support the future commissioning arrangements.

Control Issues

The CCG has determined that it does not have any significant control issues. The month 9 governance statement return included the following areas

The Transforming Care Programme (TCP)

This is a national programme which is being managed at a regional Black Country level. It aims to transform health and care services for people with learning disabilities or learning disabilities and autism by supporting more people so that they can live in the community. Walsall CCG has secured the appropriate resources to deliver on the requirements of the programme and has achieved its trajectory target.

Walsall Healthcare Trust CQC maternity rated ‘Requires Improvement’

The CQC inspected the Trust in June 18 and whilst the safety and well led domains received ‘inadequate’ with an overall rating remaining as ‘requires improvement’. The cap for births remains in place. The CCG have commissioned an independent consultant to review the trusts serious incident processes within maternity.

Accident and Emergency (A&E)

The A&E performance continues to fall below the national average performance and the trajectory set by the A&E delivery board. There are priority actions are to reduce the number of breaches seen in A&E through three work streams focusing on emergency and urgent care attendance, patient flow in hospital and hospital discharge. The AA&E Delivery Board oversees A&E performance with routine analysis and reporting across three work-streams, via the Operational Group. All are based on an annual Demand and Capacity (D&C) Plan, and the D&C Plan for 2019/20 is currently in the process of being developed, ready for sign off in May 2019.

Referral to Treatment Time (RTT)

The referral to treatment time target has not met the trajectory target which was to be no higher in March 19 than the number in March 18. Drilling down into the figures there has been a significant impact on the out of area figures where Trusts are potentially trying to manage the impact of emergency treatments during the winter period. The Enhanced Ambulatory Project Group (EAPG) meets monthly for WHT to report to the CCG on RTT and Cancer and there are mitigating actions agreed as a result of these meetings.

Clinical leads internal audit report indicated moderate assurance

In May 2018 the clinical leads internal audit report concluded that there was no documented operational procedures in relation to clinical leadership roles and little consistency in work plan setting and review and gave an outcome of moderate assurance. During the summer of 2018 the CCG undertook a governance review with the support from the Good Governance Institute to establish the future governance requirements with the changing direction of commissioning with the establishment of integrated care systems. This work resulted in a redesign of the committees and membership of the Governing Body. The recommendations from the internal audit report have formed part of the outcomes from the review with documented procedures and processes to align the clinical leadership roles within the organisation.

Review of economy, efficiency & effectiveness of the use of resources

The Governing Body has overarching responsibility for ensuring that the CCG has appropriate arrangements in place in exercising its functions economically, efficiently, effectively and efficiently in the use of its resources and in line with its values, corporate objectives and statutory responsibilities. The Governing Body ensures that it has robust financial controls including policy and processes in place to manage risk. The Audit and Governance Committee receives opinion from internal and external auditors who are available to give advice to the Governing Body on the assurances available with regards to economic, efficient and effective use of resources by the CCG.

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The CCG continues to participate fully in the STP and ICS development with directors leading the emergency preparedness, resilience and response, children’s and cancer programmes. The CCG is leading the development of the place-based programme which has progressed the joint outcomes framework with the local authority, establishing the MDTs working in locality teams and rolling out an integrated health and social care intermediate care team.

The CCG Improvement and Assurance Framework (CCGIAF) draws together the NHS Constitution, performance and finance metrics and transformational challenges and plays an important part in the delivery of the five year forward view and long term plan. The CCG were successful in improving their rating to ‘good’ in 2017/18 from ‘requires improvement’ in 2016/17. This improvement was secured by the CCG improving its in year financial performance and also its quality of leadership scores which both improved from amber to green.

The improvements the CCG has secured in its financial performance and the quality of leadership since the inception of the CCGIAF is summarised in the table below:

2017/18

2016/17

2015/16

Green

Amber

Red

Green

Amber

Red

Fully compliant

Fully compliant

Fully compliant

Good

Requires Improvement

Inadequate

Reporting period

In year financial

performance(Green star,

green, amber, red which is the

lowest)

Quality of CCG leadership(Green star,

green, amber, red which is the

lowest)

Conflict of interest –

probity and corporate

governance

Overall Assessment

rating

The 2018/19 end of year assessment meeting took place on 25 March 2019 with NHSE and it is expected the results will be published on the MyNHS website in July 2019.

The Scheme of Reservation and Delegation sets out the arrangements within the CCG so that it can discharge its responsibilities accordingly. The Chief Finance Officer has delegated responsibility to determine the detailed financial policies that `under pin’ the CCGs prime financial policies.

The Governing Body approves the financial plan for the year which identifies budgets for commissioning programmes and running costs. The Chief Finance Officer produces a monthly finance report which is reviewed by the Finance and Performance Committee which has lay

representation as part of the membership. In addition, the CCG meets with NHSE assurance team to ensure that it is meeting its financial responsibilities in accordance with NHSE’s Regulations. The annual report and final accounts are audited by external auditors who report to the Audit and Governance Committee on behalf of the Governing Body.

The Financial Plan is based upon the previous years’ outturn with the implications of the NHS England Planning Guidance factored in. The Plan was approved by the CCG Governing Body in March 2019 and subsequently received assurance from NHS England. In year financial performance monitoring is overseen by the finance and performance committee. Key metrics associated with Finance are:-

1. To fully utilise funding available and deliver an in year break even position.

2. To operate within running costs

3. To hold a contingency of 0.5%

4. To deliver against QIPP target

5. To meet cash limit requirements

6. To comply with better payment practice code

The CCG receives a separate allocation for running costs. In 18/19 this amounted to £6,107. CCG’s are not permitted to spend more than their allocated resource on corporate costs. Expenditure for the year was £5,816k. The CCG has an obligation to ensure it achieves value for money. This is achieved through continual review of discretionary expenditure, comparison with peers and use of available benchmarking tools and the application of best practice where applicable and with collaborative working with our Right Care partners to improve care pathways.

Delegation of functions

The CCG has a number of functions which are provided through commissioning support units and other providers. For each key function there is a named lead within the CCG who is accountable for the sound delivery of the function. Each function would report into one of the Governing Body Committees as detailed in the committee’s terms of reference. Each Governing Body committee provides the Governing Body with an assurance report which would include any risks to delivery by exception, this may include evidence from internal controls failures and potentially information from whistle blowers. The internal audit programme is agreed at the Audit and Governance Committee and is based on the areas where additional assurance is identified from the Assurance Framework. This will give additional independent assurance on the arrangements for delegated services and functions within the CCG.

Counter fraud arrangements

The CCG contracts with CW Audit Services to obtain Local Counter Fraud Specialist (LCFS) support. The LCFS considers fraud risks both within and against the CCG, and agrees an annual work plan with the CCG’s Chief Finance Officer and Audit and Governance Committee based on both the level of risk identified locally and NHS Counter Fraud Authority (NHCFA) anti-fraud standards for commissioners. The work plan covers activities across the range of work expected by NHSCFA, including raising

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awareness among staff about fraud issues and routes for reporting concerns; ensuring that appropriate measures are in place to prevent and detect possible fraud; and investigating any issues that may be identified.

The CCG’s Chief Finance Officer has day to day responsibility for anti-fraud work within the CCG, and is the day to day point of contact for the LCFS. The LCFS also provides a progress report at intervals to the Audit and Governance Committee, outlining recent anti-fraud activity and highlighting any issues that the CCG needs to be aware of. In addition, the LCFS provided an annual report of anti-fraud work to the CCG, reporting activity against NHSCFA standards.

There have been no fraud related matters that have needed to be formally investigated by the LCFS in 2018-19, but the LCFS has worked in particular with the CCG’s Medicines Management team and local GP Practice Managers in connection with prescription-related issues such as lost and stolen prescriptions, and concerns around patients who may be seeking drugs inappropriately. In addition, advice and assistance has been provided to local GP practice managers regarding two issues where patients appear to have forged letters that purport to have come from either the practice itself or an NHS hospital. The LCFS has also maintained links with West Midlands Police around issues relating to attempts to obtain controlled drugs.

NHS CFA has a programme of quality assurance work linked to anti-fraud provision within all NHS bodies. The CCG has not been the subject of an inspection recently, but any recommendations from NHS CFA would be implemented as appropriate.

Head of Internal Audit Opinion

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

“My overall opinion is that Significant assurance can be given that there is a generally sound system of internal control, designed to meet the organisation’s objectives, and that controls are generally being applied consistently. However, some weaknesses in the design and or inconsistent application of controls, put the achievement of particular objectives at risk. At the time of writing this opinion statement there are four reviews completed where moderate assurance has been provided; clinical leads 2017/18, Better Care Fund 2017/18, PMO project management processes and Cyber security risk assessment.

Better Care Fund in 2017/18. We raised concerns with regard to the effectiveness of controls in 2017/18 including governance arrangements need to be strengthened and on-going risks regularly monitored. BCF outcomes should be formally monitored and reported through the BCF governance process. Follow up work undertaken during 2018/19 noted that two agreed actions have been implemented and the remaining actions are on track to be implemented by the originally agreed implementation dates that have not yet been reached.

Clinical leads in 2017/18: Clarity is required in relation to the roles and responsibilities of clinical leads and the procedures in place including processes for performance monitoring should be introduced.

PMO project management processes in 2018/19: Governance and PMO processes should be followed for all QIPP schemes, all projects should be developed in accordance with PMO principles and adequate supporting documentation should be retained.

Cyber security risk assessment in 2018/19: We identified a number of issues that present risk to the CCG and primary care providers including cyber security tools needed to be updated to next generation solutions, cyber security training for staff should be assessed and provided, the CCG and service provider should ensure business continuity/disaster recovery plans are appropriately integrated and aligned and cyber awareness assessments should be undertaken annually to assess the level of exposure.

I have not identified any significant internal control issues (as defined by HM Treasury) that must be reported within your Annual Governance Statement.”

During the year, Internal Audit gave significant assurance to the following audit reports:

Financial systems, Financial management, QIPP arrangements, Serious Incidents, HR processes (recruitment), Primary Care quality assurance, Provider contract management and assurance, Commissioning arrangements, Financial reporting and performance management, Follow up of Better Care Fund, Personal Health Budgets, Partnership arrangements and Conflicts of interest.

Review of the effectiveness of governance, risk management and internal control

My review of the effectiveness of the system of internal control is informed by the work of the internal auditors, executive managers and clinical leads within the clinical commissioning group who have responsibility for the development and maintenance of the internal control framework. I have drawn on performance information available to me. My review is also informed by comments made by the external auditors in their annual audit letter and other reports.

Our assurance framework provides me with evidence that the effectiveness of controls that manage risks to the clinical commissioning group achieving its principles objectives have been reviewed.

I have been advised on the implications of the result of this review by the Governing Body, the audit committee and internal audit. This review is supported by the report issued from the CCGs internal auditors, the counter fraud specialist and the external auditors work. The Assurance Framework provides me with evidence that the effectiveness of controls has been reviewed and plans are in place to address any weaknesses to ensure continued improvement in the framework.

Conclusion

There have been no significant control issues identified in 2018/19. There have been no serious lapses in internal control including information governance or conflict of interest breaches.


22 May 2019

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3.2 Remuneration and Staff Report 3.2.1 Remuneration Report The Remuneration and Staff Report sets out the organisation’s remuneration policy for directors and senior managers, reports on how that policy has been implemented and sets out the amounts awarded to directors, senior managers and where relevant the link between performance and remuneration.

This section describes the policies and procedures that we have in place to ensure that staff are treated fairly and remunerated appropriately.

Remuneration CommitteeOur Remuneration & HR Committee is the committee which ensures we are treating staff fairly and equally. It determines the appropriate pay and benefits for staff working within the organisation and has responsibility for the approval for all of our human resources policies. The committee oversees the assurance that our staff have annual personal development reviews, are trained appropriately including assurance that they have completed mandatory and statutory training and considers the health and wellbeing of our workforce as a priority.

The members of our Remuneration & HR Committee are described in the governance section of the report. In addition to the members of the Committee, the following individuals are invited to attend the committee:

Mr Paul Maubach Accountable Officer

Professor Simon Brake Chief Officer

Mr Matthew Hartland Strategic Finance Officer

Mrs Emma- Kate Fletcher Interim Director of Organisational Development & Human Resources

Sara Saville Head of Corporate Governance

Bobbie Tooray Senior Organisational Development and Human Resources Business Partner

Policy on the remuneration of senior managers All of the directors and the Accountable Officer are on Very Senior Manager (VSM) contracts. The remuneration for our Agenda for Change Senior Managers for 2018/19 is detailed in the table of salaries and allowances.

The salary of our Accountable Officer is linked to the size of our registered population as a membership organisation and was set at the establishment of the organisation in 2013 and each year consideration is given at Remuneration Committee on the additional complexity of the role, any changes to the remit of the role and the impact this may have on the annual salary of the Accountable Officer. The Chief Officer and Chief Finance Officer salary is set as a percentage of the Accountable Officer salary. The senior managers are eligible for performance related bonus dependant on the delivery of objectives set in the previous financial year. This process is overseen by the remuneration committee which sets the percentage for the bonus each year and makes a recommendation to the Governing Body.

The remuneration for our Very Senior Managers for 2018/19 is detailed in the table of salaries and allowances.

On 1st April 2018 the Accountable Officer was appointed as substantive Accountable Officer across two CCGs (Walsall CCG and Dudley CCG) and the salary has been calculated based on this significant change in responsibilities across two statutory and separate organisations. The salary is paid on behalf of the CCGs by Dudley CCG and totalled £170,075 in 2018/19. This salary is higher than the £150,000 national benchmark for senior managers’ salary equivalent to the Prime Ministers salary. The salaries paid are reflective of the responsibilities of these posts and is determined independently by the Remuneration & HR Committee.

The VSM Performance Related Pay is determined through categorisation based on individual performance.

Within the contractual terms and conditions for Very Senior Managers (VSM), they are eligible for an annual review of their pay, and we discharge this duty by considering the VSM salaries through the Performance Related pay policy. In July 2018 the Remuneration & HR Committee met and reviewed the performance of the eligible VSM members of staff for the year 2017/18. All were awarded a fixed value consolidated cost of living award equivalent to the national agenda for change pay award (£2,075). The Accountable Officer, Chief Officer, Strategic Finance Officer, Chief Finance Officer, Director of Primary Care and Integration and Director of Commissioning also received a performance bonus up to the value of 7%.

The Chief Finance Officer received an additional responsibility payment when they took on additional responsibilities for Wolverhampton CCG. On 1st April 2018 the Accountable Officer was appointed permanently across Dudley and Walsall CCG as two separate appointments.

Off payroll engagementsTreasury require public sector bodies to disclose arrangements whereby individuals are paid through their own companies (and so are responsible for their own tax and NI arrangements, not being classed as employees).

Table 1: Off-payroll engagements longer than 6 months

For all off payroll engagements as of 31 March 2019, for more than £245 per day and that last longer than six months:

Number

Number of existing engagements as of 31 March 2019 4

Of which, the number that have existed:

for less than one year at the time of reporting 2

for between one and two years at the time of reporting

for between two and three years at the time of reporting

for between three and four years at the time of reporting 1

for four or more years at the time of reporting 1

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Table 2: New off-payroll engagementsFor all new off-payroll engagements, or those that reached six months in duration, between 1 April 2018 and 31 March 2019, for more than £245 per day and that last for longer than six months:

Number

Number of new engagements or those that reached six months in duration, between 1 April 2018 and 31 March 2019 4

Of which...

Number assessed as caught by IR35 0

Number assessed as not caught by IR35 2

Number engaged directly (via PSC contracted to the entity) and are on the entity’s payroll 0

Number of engagements reassessed for consistency/assurance purposes during the year 0

Number of engagements that saw a change to IR35 status following the consistency review 0

Table 3: Off-payroll board member/senior official engagements

For any off payroll engagements of board members, and/or senior officials with significant financial responsibility, between 1 April 2018 and 31 March 2019:

Number

Number of off payroll engagements of board members, and/or, senior officials with significantfinancial responsibility, during the financial year 0

Number of individuals on payroll and off-payroll that have been deemed “board members, and/or, senior officials with significant financial responsibility,”

23

during the financial year. This figure must include both on payroll and off-payroll engagements

Exit packages including special (non-contractual) payments – audited

During 2018-19, there were no exit packages agreed for CCG staff (2017-18 nil).

Pension Liabilities

Details of how pension liabilities are treated in the CCG accounts can be found under Note 4.4 of the annual accounts – see pages 132.

Pension disclosures relating to senior managers are shown in the Remuneration and Staff Report within the Accountability Report – see page 95-99.

Better payments practice code

The Better Payment Practice Code requires the CCG to aim to pay all valid invoices by the due date or within 30 days of receipt of a valid invoice, whichever is later.

The CCG successfully achieved compliance with this code and further details are available in Note 6 to the accounts on page 136.

Prompt payments code

In addition, the CCG is a signatory to the Prompt Payments Code which sets standards for payment processes and best practice. It covers prompt payment as well as wider payment procedures so our suppliers can have confidence that the payments we make will be in line with the code and best practice.

Cost allocation and charges for information

We certify that the Clinical Commissioning Group has complied with HM Treasury’s guidance on cost allocation and the setting of charges for information.

Full guidance can be obtained from Chapter 6 of HM Treasury’s “Managing Public Money”.

External auditors remuneration

The CCGs appointed external auditors are Grant Thornton UK LLP, 20 Colmore Circus, Birmingham, B4 6AT.

Work performed by the auditors during 2018-19 related solely to the external audit and amounted to £53,760 including VAT.

This is shown within Audit Fees in Note 5 of the annual accounts on page 134.

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Trade Union Facility Time

The Trade Union (Facility Time Publication Requirements) regulations 2017 require public sector organisations to report on trade union facility time in their organisations. Facility time is paid time off for union representatives to carry out trade union activities and covers duties carried out for the trade union or as a union representation, such as accompanying an employee to a disciplinary or grievance hearing. It also covers training received and duties carried out under the Health and Safety at Work Act 1974.

The relevant information for Walsall CCG is as follows:

Table 1: Relevant Union Officials

Number of employees who were Full-time equivalent relevant union officials during 18-19 employee number

1 1.0

Table 2: Percentage of Time Spent on Facility Time

Percentage of time Number of employees

4.5% 1

Table 3: Percentage of Pay Bill Spent on Facility Time

£’000

Total cost of facility time 1.7

Total pay bill 5,152

Percentage of total pay bill spent on facility time 0.03%

Table 4: Paid Trade Union Activities

Time spent on trade union activities as a percentage of total paid facility time hours 0

SENIOR MANAGER REMUNERATION (INCLUDING SALARY AND PENSION ENTITLEMENTS) - AUDITED

(f)

Total

(bands of

£5,000)

£000

(e)

All

Pension

Related

Benefits

(bands of

£2,500)

£000

(d)

Long-Term

Perfor-

mance

Pay and

Bonuses

(bands of

£5,000)

(c)

Perfor-

mance

Pay and

Bonuses

(bands of

£5,000)

£000

(b)

Expense

Payments

(taxable)

to nearest

£100

£00

(a)

Salary

(bands of

£5,000)

£000

Name and Title

2017 - 2018

Mr P Maubach – Accountable Officer Note 1 110-115 182 5-103 0 30-32.5¹ 145-150

Prof S Brake – Chief Officer (from Apr ‘18)

Mr M Hartland – Strategic Finance Officer Note 1

100-105

80-85 18 2 5-10 3 0 22.5-25 ¹ 115-120

0 5-10 0 22.5-25 130-135

Mr T Gallagher – Chief Finance Officer Note 2 60-65 0 5-10 0 12.5-15 80-85

Mrs D MacArthur –

Director of Primary Care and Integration 90-95 0 5-10 0 20-22.5 115-120

Mr P Tulley – Director of Commissioning

(from Jun ’17) Note 3

Ms S Shingler – Chief Nursing Officer/Director of

Quality (from Feb ’18)

Dr B Watt – Director of Public Health,

Walsall Council

Ms P Furnival – Director of Adult Social Care

and Inclusion, Walsall Council

Mr R Freeman –

Secondary Care Specialist Note 5

Dr H Vitarana – Clinical Executive -

Finance and IT Note 7

Dr R Mohan – Clinical Executive -

Medical Director Note 7

Dr C Lesshafft – Clinical Executive -

Commissioning, and Transformation Note 7

Dr H Baggri – Clinical Executive –

Commissioning, Transformation and Performance

(from Apr 18) Note 7

75-80 0 5-10 0 0 80-85

15-20 0 0 0 5-7.5 20-25

Note 4

Note 4

10-15 0 0 0 42.5-454 55-604

35-40 0 0 0 0 35-40

45-50 0 0 0 0 45-50

55-60 0 0 0 0 55-60

45-50 0 0 0 0 45-50

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page 96 page 97

SENIOR MANAGER REMUNERATION (INCLUDING SALARY AND PENSION ENTITLEMENTS) - AUDITED (contiuned)

(f)

Total

(bands of

£5,000)

£000

(e)

All

Pension

Related

Benefits

(bands of

£2,500)

£000

(d)

Long-Term

Perfor-

mance

Pay and

Bonuses

(bands of

£5,000)

(c)

Perfor-

mance

Pay and

Bonuses

(bands of

£5,000)

£000

(b)

Expense

Payments

(taxable)

to nearest

£100

£00

(a)

Salary

(bands of

£5,000)

£000Name and Title

2017 - 2018

Dr A Rischie – Clinical Chair of Walsall CCG

Governing Body Note 7 80-85 0 0 0 0 80-85

Dr R Mandal – Locality Lead -

West (to May ’17)) Note 7

Dr A Asghar – Locality

Lead - North Note 7

Dr R Sandhu – Locality Lead –

West (from Jun ’17) Note 7

Dr J Teoh – Locality Lead -

South East Note 7

Mr J Oatridge – Interim Audit Chair and

Lay Member (from Dec ’17) Note 8

Dr R Sandhu – Locality Lead –

West (from Jun ’17) Note 7

Mr M Abel – Lay Member –

Service Transformation and Redesign

Mr G Wali – Lay Member –

Patient and Public Involvement

Mr J Duder – Lay Member –

Audit and Governance (to Nov ’17)

Miss R Barber – Lay Member –

Patient and Public Involvement (from Jan ’18)

0-5 0 0 0 0 0-5

60-65 0 0 0 0 60-65

30-35 0 0 0 0 30-35

35-40 0 0 0 0 35-40

0-5 0 0 0 0 0-5

30-35 0 0 0 0 30-35

15-20 0 0 0 0 15-20

5-10 0 0 0 0 5-10

5-10 0 0 0 0 5-10

0-5 0 0 0 0 0-5

¹ Figures provided by Dudley CCG and represent the total pension related benefits across both posts2 Figures restated to nearest £’003 Bonus figure for 17-18 incorrectly under-stated4 Figures restated for 17-18

PENSION BENEFITS AS AT 31 MARCH 2019As GPs and Lay Members do not receive pensionable remuneration, there will be no entries in re-spect of them in thetable below.

Employer’s

Contri-

bution to

Stakeholder

Pension

£000

Note 9

Cash

Equivalent

Transfer

Value at

31 March

2019

£000

Note 9

Real

Increase

in Cash

Equivalent

Transfer

Value

£000

Cash

Equivalent

Transfer

Value

at

1 April

2018

£000

Note 10

Lump Sum

at

pension

age

related to

Accrued

Pension

at

31 March

2019

(bands of

£5,000)

£000

Total

Accrued

Pension

at

pension

age at

31 March

2019

(bands of

£5,000)

£000

Note 9

Real

Increase

in Pension

Lump Sum

at

pension

age

(bands of

£2,500)

£000

Note 9

Real

Increase

in Pension

at

pension

age

(bands of

£2,500)

£000

Name and Title

Mr P Maubach –

Accountable Officer

Prof S Brake –

Chief Officer

Mr M Hartland –

Strategic Finance Officer

Mr T Gallagher – Chief

Finance Officer (to Mar ’19)

Ms D MacArthur –

Director of Primary Care

and Integration

Mr P Tulley –


Ms S Shingler –

Director of Governance,

Quality and Safety

Dr P De – Secondary Care

Consultant (from Sep ’18)

Mr R Freeman – Secondary

Care Specialist (to Aug ’18)

10-12.5 20-22.5 60-65 150-155 824 269 1,139 N/A

0-2.5 0 5-10 0 33 15 63 N/A

2.5-5 0-2.5 45-50 110-115 680 110 829 NA

7.5-10 22.5-25 40-45 130-135 761 252 1,055 N/A

0-2.5 0 35-40 95-100 653 84 770 N/A

5-7.5 12.5-15 40-45 95-100 558 179 768 N/A

5-7.5 12.5-15 20-25 55-60 237 135 392 N/A

0-2.5 0 35-40 75-80 565 41 673 N/A

0-2.5 2.5-5 35-40 90-95 573 58 746 N/A

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Notes:

Note 1 The Accountable Officer and Strategic Finance Officer were bought in on a part time basis from Dudley CCG to provide support to Walsall. The Accountable Officer’s role became a permanent arrangement from 1st April 2018 with the Strategic Officer’s role remaining on an interim basis until 1st April 2019. Dudley CCG remain the permanent employer and host payroll arrangements for Walsall, recharging accordingly.

Their salaries include an additional responsibility allowance which is fully funded by Walsall CCG as follows:

Accountable Officer - £29,267

Strategic Finance Officer - £36,580

For staff sharing arrangements, the CCG is required to disclose total salaries. The total basic salary of the Accountable Officer in 18-19 was £140,808 and that of the Strategic Finance Officer was £122,780. This excludes the additional responsibilities allowances.

The figures in the Pensions Table for these two appointments have been provided by Dudley CCG.

Note 2 The Chief Finance Officer and Strategic Finance Office from Dudley CCG have been supporting Wolverhampton CCG on a part time basis and their salaries are recharged accordingly. This table discloses salaries net of the recharge. The full time salary of the Chief Finance Officer for 18-19 was £122,151 of which £64,114 was recharged to Wolverhampton CCG.

Note 3 Previously seconded in at no cost from Shropshire CCG - now employed directly by Walsall CCG. Salary is shown net of an element of protected pay of £13,004, which is funded by Shropshire CCG.

Note 4 Salaries paid in full by Walsall Metropolitan Borough Council therefore no cost to the CCG.

Note 5 Recharge from Robert Jones & Agnes Hunt NHS Foundation Trust.

Note 6 Recharge from Sandwell & West Birmingham NHS Foundation Trust.

Note 7 GP Board Members employed under a contract for service are classed as ‘off payroll workers’. However, HMRC have deemed these long term contract holders as ‘office holders’ of the CCG which requires the CCG to deduct income tax and national insurance at source. Since the CCG have assurance around the tax and NI obligations of these ‘off payroll workers’, there is no requirement to disclose these arrangements under the ‘Off Payroll Engagements’ note on page 91-92.

The salary shown for GP Board Members may include additional sessions paid for clinical lead work they undertake for the CCG and the employer’s contribution through GP Solo forms to their pension as a Practitioner at the rate agreed with the NHS Pensions Agency.

Note 8 Interim shared arrangement with Wolverhampton CCG which has now ceased following employment of an Audit Chair at Walsall CCG

Note 9 A pensions multiplier of 3% has been applied in calculating the real increase in pension, lump sum and CETV

Note 10 No lump sum will be shown for senior managers who only have membership in the 2015 Scheme or 2008 Section (unless they chose to move their 1995 Section benefits to the 2008 Section under the Choice exercise)

All pension related benefits

This figure includes those benefits accruing to senior managers from membership of the NHS Pensions Scheme which is a defined benefit scheme (although accounted for by NHS bodies as if it were a defined contribution scheme). Any pension contributions made by the senior manager or any transferred in amounts are excluded from this figure.

The value of pension benefits accrued during the year is calculated as the real increase in pension multiplied by 20, less, the contributions made by the individual. The real increase excludes increases due to inflation or any increase or decrease due to a transfer of pension rights.

This value does not represent an amount that will be received by the individual. It is a calculation that is intended to convey to the reader of the accounts an estimation of the benefit that being a member of the pension scheme could provide.

The pension benefit table on page 97 provides further information on the pension benefits accruing to the individual.

Cash equivalent transfer values (CETV)

A Cash Equivalent Transfer Value (CETV) is the actuarially assessed capital value of the pension scheme benefits accrued by a member at a particular point in time. The benefits valued are the member’s accrued benefits and any contingent spouse’s (or other allowable beneficiary’s) pension payable from the scheme. CETVs are calculated in accordance with SI 2008 No.1050 Occupational Pension Schemes (Transfer Values) Regulations 2008.

A CETV is a payment made by a pension scheme or arrangement to secure pension benefits in another pension scheme or arrangement when the member leaves a scheme and chooses to transfer the benefits accrued in their former scheme. The pension figures shown relate to the benefits that the individual has accrued as a consequence of their total membership of the pension scheme, not just their service in a senior capacity to which disclosure applies.

The CETV figures and the other pension details include the value of any pension benefits in another scheme or arrangement which the individual has transferred to the NHS pension scheme. They also include any additional pension benefit accrued to the member as a result of their purchasing additional years of pension service in the scheme at their own cost. CETVs are calculated within the guidelines and framework prescribed by the Institute and Faculty of Actuaries.

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

Compensation on early retirement for loss of office During the year ended 31 March 2019, there have been no compensation payments made for early retirement or loss of office to current or past directors or senior managers.

Payments to past Directors During the year ended 31 March 2019, there have been no payments made to past directors not already disclosed elsewhere.

Pay multiples - audited Reporting bodies are required to disclose the relationship between the remuneration of the highest paid Director/Member in their organisation and the median remuneration of the organisation’s workforce.

The figures have been prepared in accordance with the Hutton Review of Fair Pay implementation guidance. The median remuneration of the reporting entity’s staff is the total remuneration of the staff member(s) lying in the middle of the linear distribution of the total staff, excluding the highest paid director. This is based on annualised, full-time equivalent remuneration as at the reporting period date. A median will not be significantly affected by large or small salaries that may skew an average (mean) – hence it is more transparent in highlighting whether a director is being paid significantly more than the middle staff in the organisation.

The banded remuneration of the highest paid Director/Member in NHS Walsall CCG in the financial year 2018-19 was £180k - £185k (2017-18, £190k - £195k). This was 3.9 times (2017-18 4.3 times) the median remuneration of the workforce, which was £46,331 (2017-18 £45,150).

In 2018-19, no employees (2017-18, one employee) received remuneration in excess of the highest paid Director/ Member. Remuneration ranged from £3k to £112k (2017-18 £6k to £120k).

Total remuneration includes salary, non-consolidated performance-related pay and benefits-in-kind but not severance payments. It does not include employer pension contributions and the cash equivalent transfer value of pensions.

The highest paid Director is the CCGs Accountable Officer who works jointly across both Walsall and Dudley CCGs. Their banded remuneration is inflated as it is based on the full-time annualised salary from both employments and not just Walsall’s share of the remuneration as disclosed in the Senior Manager Remuneration table on page 95-96. Their remuneration includes an additional allowance which is fully funded by Walsall CCG.

The increase in the median and change in the pay multiple from 2017-18 is partly a direct result of the employment of three additional locality GP representatives working on the Walsall Together Programme. This is because the median remuneration of the workforce is disproportionally inflated by the annualised full time equivalent costs of GP board members, clinical advisors and lay members who work on a sessional basis.

3.2.2. Staff Report Our staff are the most important asset of our organisation. Together with our members and our clinical leadership, we strive to work hard to improve the health and care services that patients receive and we can only achieve this through the work our staff do. Our values (trustworthy, accountable, transparent, innovation) are at the core of what we do and how we commit to treat each other. We have a very low turnover of staff and are looking to use our values to recruit new members of our team and to develop our staff policies. We recruit without discrimination and offer equal opportunities to all members of our team. Our performance and review policy assesses individuals against their demonstration of our values and completion of their objectives. We will also be looking to introduce 360 degree appraisals for all staff with management responsibility.

Our Star of the month is nominated by staff and chosen every month at our weekly team brief for recognition of good work, we are looking to refresh the criteria to include staff that have displayed the CCG values. We also have annual staff awards where our staff are recognised for their hard work and efforts. Our staff survey results have shown sustained improvement in some areas with staff continuously reporting feeling proud to work for the CCG, feeling the CCG supports a work life balance and feeling valued for the work that they do. The staff survey results for 2018/2019 were discussed at April 2019 Remuneration & HR Committee and then shared with the senior management team, staff and Governing Body members.

As part of our health and wellbeing programme, we are looking to buy into an employee assistance programme (EAP) that all staff have access to. The EAP programme offers practical and emotional support to employees such as access to independent advice and counselling.

Number of senior managers

There are seven Senior Managers including the Accountable Officer and three Chief Officers as follows:

Name Title Pay Band Gender

Paul Maubach Accountable Officer VSM Male

Matthew Hartland Strategic Finance Officer VSM Male

Anthony Gallagher Chief Finance Officer VSM Male

Donna Macarthur Director of Primary Care and Integration VSM Female

Paul Tulley Director of Commissioning VSM Male

Sarah Shingler Chief Nurse VSM Female

Simon Brake Chief Officer VSM Male

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Staff numbers and costs – audited Staff numbers

Medical and Dental 1.32 1.45 2.77

Administration and Estates 63.29 8.77 72.06

Nursing, Midwifery and Health Visiting Staff 5.00 0.87 5.87

Scientific, Therapeutic and Technical Staff 4.35 1.00 5.35

Total 73.96 12.09 86.05

Permanently EmployedNumber *(Average)

Other

Number(Average)

Total

Number(Average)

Staff Group

2018 - 2019

Medical and Dental 0.20 1.40 1.60

Administration and Estates 61.59 8.06 69.65

Nursing, Midwifery and Health Visiting Staff 3.57 1.22 4.79

Scientific, Therapeutic and Technical Staff 4.62 0 4.62

Total 69.98 10.68 80.66

Permanently EmployedNumber *(Average)

Other

Number(Average)

Total

Number(Average)

Staff Group

2017 - 2018

* Excludes Non Executives, Lay Members and GP Governing Body Members

Staff costs

Employee Benefits

Salaries and wages 4,234 3,827 407 3,195 2,858 337 1,039 969 70

Social Security Costs 418 388 30 332 308 24 86 80 6

Employer Contributions to

NHS Pension Scheme 494 471 23 393 376 17 101 95 6

Other Pension Costs - - - - - - - - -

Apprenticeship levy 6 6 - 6 6 - - - -

Other Post-Employment Benefits - - - - - - - - -

Other Employment Benefits - - - - - - - - -

Termination Benefits - - - - - - - - -

Gross Employee Benefits Expenditure 5,152 4,692 460 3,926 3,548 378 1,226 1,144 82

Less recoveries in respect of

employee benefits - - - - - - - - -

Total – Net Admin Employee Benefits including Capitalised Costs 5,152 4,692 460 3,926 3,548 378 1,226 1,144 82

Less: Employee Costs Capitalised - - - - - - - - -

Net Employee Benefits excluding Capitalised Costs 5,152 4,692 460 3,926 3,548 378 1,226 1,144 82

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Total Admin Programme

2018 - 2019

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Staff costs (Continued)

Employee Benefits

Salaries and wages 4,053 3,614 439 3,121 2,766 355 932 848 84

Social Security Costs 393 368 25 315 296 19 78 72 6

Employer Contributions to

NHS Pension Scheme 456 441 15 374 365 9 82 76 6

Other Pension Costs 0 - - - - - 0 - -

Apprenticeship levy 4 4 - 4 4 - 0 - -

Other Post-Employment Benefits - - - - - - - - -

Other Employment Benefits - - - - - - - - -

Termination Benefits - - - - - - - - -

Gross Employee Benefits Expenditure 4,906 4,427 479 3,814 3,431 383 1,092 996 96

Less recoveries in respect of

employee benefits - - - - - - - - -

Total – Net Admin Employee Benefits including Capitalised Costs 4,906 4,427 479 3,814 3,431 383 1,092 996 96

Less: Employee Costs Capitalised - - - - - - - - -

Net Employee Benefits excluding Capitalised Costs 4,906 4,427 479 3,814 3,431 383 1,092 996 96

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Total Admin Programme

2017 - 2018

Staff composition

We employ 113 members (excluding duplicates) of staff (including governing body members and clinical leads) who work within the following five key directorates:

• Quality & Safety: Safeguarding, Continuing Healthcare

• Corporate: Governance, Human Resources, Communications, Performance and Delivery

• Primary Care and Integration: Medicines Management

• Commissioning

• Finance and Resource Management: contracting and procurement

Walsall CCG full time and part time breakdown is set out below. These figures are based on staff in post as at 31 March 2019.

Governing Body 21.1% 78.9%

Other Senior Management (Band 8C +) 100% 0%

Clinical Advisors/Walsall Together 0% 100%

All other employees 72.5% 27.5%

Grand total 60.2% 39.8%

Staff GroupingFull- time Part- time

% by participation

Governing Body 5 14 19

% 26.3% 73.7%

=Other Senior Management (Band 8C +) 4 2 6

% 66.7% 33.3%

Clinical Advisors/Walsall Together 3 5 8

% 37.5% 62.5%

All other employees 66 14 80

% 82.5% 17.5%

Staff GroupingFemale

Headcount by gender

Walsall CCG gender distribution is set out below. These figures are based on staff in post as at 31 March 2019.

Female Total

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Equality and diversity within our workforce

We strive to employ a workforce that is diverse and reflective of our local community.

Everyone who works for Walsall CCG is treated fairly and equally regardless of age, disability, race, nationality, ethnic origin, gender, religion, beliefs, sexual orientation, domestic and social circumstance, employment status, HIV status, gender reassignment, political affiliation or trade union membership.

In a number of areas such as sexual orientation and religion the majority of staff have chosen not to disclose.

One area where we do have sufficient levels of disclosure is Ethnicity as described in the table below:

Ethnicity Ratios 2018 - 2019

Sickness Absence Data

The sickness for the CCG is relatively low and the CCG supports a proactive and supportive approach to sickness management.

Black and ethnic minorities make up 37% of the workforce. Walsall CCG ensures that all recruitment processes and other policies are equitable to all.

All of our recruitment and equality and diversity policies promote equality for all and encourage recruitment from a diverse range of backgrounds. We will be reviewing our recruitment selection techniques to include values based recruitment for all roles advertised.

Sum of FTE Sum of FTE Average Average days sick days sick annual sick FTE 2019 available days per FTE

621 30,947 4.5 84.79

Source: NHS Digital – Sickness Absence Publication – based on data from the ESR Data Warehouse

Period covered: January to December 2018.

ESR does not hold details of the normal number of days worked by each employee. Data on days available and days recorded sick are based on a 365-day year.

Average annual sick days per FTE has been estimated by dividing the number of FTE-days sick by the average FTE, and multiplying by 225 (the typical number of working days per year).

The average number of staff sick days lost per full time equivalent (FTE) in 2018/19 was 4.5 (6.7 in 2017/18).

Ill Health Retirements

No-one from the Clinical Commissioning Group retired early on the grounds of ill health in 2018-19 (none 2017-18). Ill health retirement costs are met by the NHS Pension Scheme.

The Clinical Commissioning Group did not agree any early retirements in 2018-19 (none 2017-18). Any additional costs such as pension liabilities would have been met by the Clinical Commissioning Group and not by the NHS Pension Scheme.

Staff policies

We offer equal opportunities for all members of our team and are committed to building a workforce whose diversity reflects our local community. We ensure BME colleagues have equal access to recruitment, career and development opportunities, and work in an environment free from bullying and harassment.

We have three members of staff who have made a positive disability disclosure, a small proportion of our staff declined the opportunity to disclose.

We have processes in place to refresh and update our policies and ensure that we have appropriate policies in place to ensure equal opportunities are there for all. We are an organisation that offers development opportunities for our staff and ensure that all access to development and training opportunities are equitable for all.

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Other Employee Matters

We have a number of mechanisms to meaningfully engage and consult with staff. One of these being staff council that is held every six weeks. The council is chaired by an elected member of the council and is represented well from each department, including representation from the formal recognised union. Membership is reviewed annually through a constituency voting mechanism and council. The membership is due for re-election and we are in the process of re-electing members and reviewing the terms of reference for the council.

Other forms of staff engagement include our weekly staff briefing sessions and the staff newsletter which has been re designed to ensure staff effective communication. We actively engage CCG staff in developments and ensure that policies are not ratified by our committees until staff engagement has demonstrably taken place. Our process for policy review is that we share our updated or new policies with all staff who have the opportunity to raise any issues either directly with the policy author or at the next scheduled Staff Council meeting.

We have been working closely with the Staff Council to review a number of our policies for staff. Several of these outline how we expect our staff to behave and the values we expect them to uphold. These policies cover topics such as flexible working, personal development review, corporate and social responsibility policy. We will continue to review all other policies.

Apprenticeship scheme

The CCG continues to work in partnership with Walsall College, to attract and retain business administration apprentices. We continued our commitment to the apprentice programme in 2018/2019 by employing an apprentice across the CCG.

Commissioning Support

We buy support for payroll, recruitment and ESR from Walsall Healthcare Trust. In addition to this in 2018/2019 we contracted NHS Arden and Greater East Midlands Commissioning Support Unit to support with Equality & Diversity.

In addition, the CCG purchased HR and OD support through a partner CCG, Sandwell and West Birmingham CCG which ceased in Dec 2018.

The Audit and Governance Committee approves the CCG’s counter fraud work plan on an annual basis and monitors progress on the implementation of counter fraud activities at each of its meetings.

Consultancy expenditure

The CCG have spent a total of £285,100 during the financial year on external consultancy fees. Some of the main areas of spend are detailed below:

A consultant appointment dedicated to children and young people’s services prior to the CCG undertaking a restructure of the commissioning department and establishing a dedicated post for this £122,188.

Continuing provision of assessment and support around Continuing Healthcare and Personal Health Budgets at a cost of £29,798.

Commissioning of an external review of the CCGs’ governance arrangements with recommendations made to the Governing Body £27,652.

Consultancy to support the commissioning of care for a learning disabilities client with significant complex needs £20,034.

Facilitation of Chair’s and Accountable Officer engagement on the future arrangements for the Black Country CCGs – this cost has been split equally across all four CCGs - £10,000.

All consultancy spend is assessed for Value for Money prior to appointment and a review undertaken to ensure all objectives were met.

3.3 Parliamentary Accountability and Audit ReportWalsall Clinical Commissioning Group is not required to produce a Parliamentary Accountability and Audit Report. Disclosures on losses and special payments are included as Note 22 in the Financial Statements of this report at Page 154. An audit report is also included in this Annual Report at page 155.


22 May 2019

ACCOUNTSANNUAL

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NHS Walsall Clinical Commissioning Group

These accounts for the year ended 31 March 2019 have been prepared

by NHS Walsall Clinical Commissioning Group in accordance with

sections 17(4)(a) and (b) of Schedule 1A of the National Health Service

Act 2006 (as amended) in the form which the NHS

CONTENTS The Primary Statements:

Statement of Comprehensive Net Expenditure for the year ended 31st March 2019 ................ 114

Statement of Financial Position as at 31st March 2019............................................................. 115

Statement of Changes in Taxpayers’ Equity for the year ended 31st March 2019 ...................... 116

Statement of Cash Flows for the year ended 31st March 2019 ................................................. 117 Notes to the Accounts:

Accounting policies ..................................... 118

Going Concern ............................................ 118

Accounting Convention ............................... 118

Movement of Assets within the Department of Health and Social Care Group..................... 118

Joint Arrangements ...................................... 119

Pooled Budgets ............................................ 119

Operating Segments .................................... 119

Revenue....................................................... 119

Short-term Employee Benefits ...................... 120

Retirement Benefit Costs .............................. 120

Other Expenses ............................................ 121

Property, Plant & Equipment ......................... 121

Intangible Assets .......................................... 122

Leases .......................................................... 124

Cash & Cash Equivalents ............................. 124

Clinical Negligence Costs ............................ 124

Non-clinical Risk Pooling ............................... 125

Financial Assets ............................................ 125

Financial Liabilities ........................................ 126

Value Added Tax .......................................... 127

Foreign Currencies ....................................... 127

Financial Performance Targets ..................... 128

Other Operating Revenue ............................ 130

Employee Benefits and Staff Numbers ......... 131

Average Number of People Employed ........ 132

Exit Packages Agreed in the Financial Year .. 132

Pension costs ................................................ 132

Full Actuarial (Funding) Valuation .................. 133

Better Payment Practice Code ..................... 136

The Late Payment of Commercial Debts (Interest) Act 1998 .............................. 136

As Lessee ..................................................... 137

Payments Recognised as an Expense ......... 137

Property, Plant and Equipment ..................... 138

Economic Lives ............................................ 139

Intangible Non-Current Assets ...................... 139

Economic Lives ............................................ 140

Trade and Other Receivables ...................... 141

Receivables Past their Due Date but not Impaired .......................................... 142

Loss Allowance on Assets Classes ................ 142

Cash and Cash Equivalents ......................... 143

Trade and Other Payables ........................... 144

Provisions ...................................................... 144

Contingencies ............................................. 145

Commitments .............................................. 146

Financial Liabilities ........................................ 147

Operating Segments .................................... 148

Interests in Joint Arrangements ..................... 148

NHS LIFT Investments..................................... 149

Related Party Transactions ............................ 150

Report on the Audit of the Financial Statements .................................... 156

Report on other legal and regulatory requirements – Certificates .......................... 159

Glossary ....................................................... 160

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2018-19 2017-18

£’000 £’000 Note

Income from sale of goods and services (705) 3

Other operating income (964) (590) 3

Total Operating Income (964) (1,295)

Staff costs 5,152 4,906 4

Purchase of goods and services 434,156 422,893 5

Depreciation and impairment charges 71 - 5

Provision expense - (2) 5

Other operating expenditure 570 489 5

Total Operating Expenditure 439,949 428,286

Net Operating Expenditure 438,985 426,991

Comprehensive Expenditure for the Year Ended 31 March 2019 438,985 426,991

Statement of Comprehensive Net Expenditure for the Year Ended 31 March 2019

31 Mar 19 31 Mar 18

£’000 £’000 Note

Non-Current Assets:

Property, plant and equipment 323 325 8

Intangible assets 74 29 9

Trade and other receivables - - 10

Total Non-Current Assets 397 354

Current Assets:

Trade and other receivables 10,982 10,485 10

Cash and cash equivalents 99 48 11

Total Current Assets 11,081 10,533

Total Assets 11,478 10,887

Current Liabilities

Trade and other payables (37,701) (33,944) 12

Provisions - - 13

Total Current Liabilities (37,701) (33,944)

Non-Current Assets plus/less Net Current Assets/Liabilities (26,223) (23,057)

Non-Current Liabilities

Trade and other payables - - 12

Provisions - - 13

Total Non-Current Liabilities - -

Assets less Liabilities (26,223) (23,057)

Financed by Taxpayers’ Equity

General fund (26,223) (23,057)

Revaluation reserve - -

Total Taxpayers’ Equity: (26,223) (23,057)

Statement of Financial Position as at 31 March 2019

The notes on pages 118 - 155 form part of this statement.The financial statements on pages 114 to 117 were approved by the Governing Body on 21st May 2019 and signed on its behalf by:


22 May 2019

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Statement of changes in taxpayers equity for the year ended 31 march 2019

General Revaluation Other Total fund reserve reserves reserves

£’000 £’000 £’000 £’000

Change in Taxpayers’ Equity for 2018-19

Balance at 1 April 2018 (23,057) - - (23,057)

Changes in NHS Clinical Commissioning Group Taxpayers’ Equity for 2018-19

Net operating expenditure for the financial year (438,985) - - (438,985)

Net Recognised NHS Clinical Commissioning Group Expenditure for the Financial Year (462,042) (462,042)

Net funding 435,819 435,819

Balance at 31 March 2019 (26,223) (26,223)

General Revaluation Other Total fund reserve reserves reserves

£’000 £’000 £’000 £’000

Change in Taxpayers’ Equity for 2017-18

Balance at 1 April 2017 (17,158) - - (17,158)

Changes in NHS Clinical Commissioning Group Taxpayers’ Equity for 2017-18

Net operating costs for the financial year (426,991) - - (426,991)

Net Recognised NHS Clinical Commissioning Group Expenditure for the Financial Year (444,149) - - (444,149)

Net funding 421,092 - - 421,092

Balance at 31 March 2018 (23,057) - - (23,057)

The notes on pages 118 - 155 form part of this statement.

2018-19 2017-18

£’000 £’000 Note

Cash Flows from Operating Activities

Net operating expenditure for the financial year (438,985) (426,991)

Depreciation and amortisation 71 - 5

Impairments and reversals - - 5

(Increase)/decrease in trade & other receivables (497) (922) 10

Increase/(decrease) in trade & other payables 4,015 6,874 12

Provisions utilised - - 13

Increase/(decrease) in provisions - (2) 13

Net Cash Inflow (Outflow) from Operating Activities (435,396) (421,041)

Cash Flows from Investing Activities

(Payments) for property, plant and equipment (321) (55)

(Payments) for intangible assets (51) (29)

Net Cash Inflow (Outflow) from Investing Activities (372) (84)

Net Cash Inflow (Outflow) before Financing (435,768) (421,125)

Cash Flows from Financing Activities

Parliamentary funding received 435,819 421,092

Net Cash Inflow (Outflow) from Financing Activities 435,819 421,092

Net Increase (Decrease) in Cash & Cash E quivalents 51 (33) 11

Cash & Cash Equivalents at the Beginning of the Financial Year 48 81

Cash & Cash Equivalents (inc Bank Overdrafts) at the End of the Financial Year 99 48

The notes on pages 118 - 155 form part of this statement.

Statement of Cash Flows for the Year Ended 31 March 2019

Clinical Commissioning Groups typically run with a high level of trade and other payables – this is mainly as a result of the delays in being charged for items such as prescribing costs (typically 8 weeks in arrears) and over performance on healthcare contracts.

The Clinical Commissioning Group receives a maximum cash drawdown limit each year (adjusted for forecasts of end of year payables and receiv-ables balances) which is used to cover their net outgoings. The deficit above of £26.22m reflects the difference between the Clinical Commissioning Groups cash funding in the year and their net expenditure and is covered by the net current liabilities as shown in the Statement of Financial Position.

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Notes to the Financial Statements1 Accounting Policies

NHS England has directed that the financial statements of Clinical Commissioning Groups shall meet the accounting requirements of the Group Accounting Manual issued by the Department of Health. Consequently, the following financial statements have been prepared in accordance with the Group Accounting Manual 2018-19 issued by the Department of Health and Social Care. The accounting policies contained in the Group Accounting Manual follow International Financial Reporting Standards to the extent that they are meaningful and appropriate to Clinical Commissioning Groups, as determined by HM Treasury, which is advised by the Financial Reporting Advisory Board. Where the Group Accounting Manual permits a choice of accounting policy, the accounting policy which is judged to be most appropriate to the particular circumstances of the Clinical Commissioning Group for the purpose of giving a true and fair view has been selected. The particular policies adopted by the Clinical Commissioning Group are described below. They have been applied consistently in dealing with items considered material in relation to the accounts.

1.1 Going Concern

These accounts have been prepared on a going concern basis.

Public sector bodies are assumed to be going concerns where the continuation of the provision of a service in the future is anticipated, as evidenced by inclusion of financial provision for that service in published documents.

Where a Clinical Commissioning Group ceases to exist, it considers whether or not its services will continue to be provided (using the same assets, by another public sector entity) in determining whether to use the concept of going concern for the final set of financial statements. If services will continue to be provided the financial statements are prepared on the going concern basis.

1.2 Accounting Convention

These accounts have been prepared under the historical cost convention modified to account for the revaluation of property, plant and equipment, intangible assets, inventories and certain financial assets and financial liabilities.

1.3 Movement of Assets within the Department of Health and Social Care Group

Transfers as part of a reorganisation fall to be accounted for by use of absorption accounting in line with the Government Financial Reporting Manual, issued by HM Treasury. The Government Financial Reporting Manual does not require retrospective adoption, so prior year transactions have not been restated. Absorption accounting requires that entities account for their transactions in the period in which they took place, with no restatement of performance required when functions transfer within the public sector. Where assets and liabilities transfer, the gain or loss resulting is recognised in the Statement of Comprehensive Net Expenditure, and is disclosed separately from operating costs.

Other transfers of assets and liabilities within the Department of Health and Social Care Group are accounted for in line with IAS 20 and similarly give rise to income and expenditure entries.

1.4 Joint Arrangements

Arrangements over which the Clinical Commissioning Group has joint control with one or more other entities are classified as joint arrangements. Joint control is the contractually agreed sharing of control of an arrangement. A joint arrangement is either a joint operation or a joint venture.

A joint operation exists where the parties that have joint control have rights to the assets and obligations for the liabilities relating to the arrangement. Where the Clinical Commissioning Group is a joint operator, it recognises its share of assets, liabilities, income and expenses in its own accounts.

1.5 Pooled Budgets

The Clinical Commissioning Group has a Section 75 pooled budget arrangement with Walsall MBC relating to the commissioning of health and social care services under the Better Care Fund (BCF). This fund was established by the Government with the requirement that the Clinical Commissioning Group and the council establish a pooled fund for this purpose.

The fund is hosted by Walsall MBC and the partners each commission services for each individual scheme on behalf of each other.

1.6 Operating Segments

Income and expenditure are analysed in the Operating Segments note and are reported in line with management information used within the Clinical Commissioning Group.

1.7 Revenue

The transition to IFRS 15 has been completed in accordance with paragraph C3 (b) of the Standard, applying the Standard retrospectively recognising the cumulative effects at the date of initial application.

In the adoption of IFRS 15 a number of practical expedients offered in the Standard have been employed. These are as follows:

• As per paragraph 121 of the Standard the Clinical Commissioning Group will not disclose information regarding performance obligations part of a contract that has an original expected duration of one year or less,

• The Clinical Commissioning Group is to similarly not disclose information where revenue is recognised in line with the practical expedient offered in paragraph B16 of the Standard where the right to consideration corresponds directly with value of the performance completed to date.

• The FReM has mandated the exercise of the practical expedient offered in C7(a) of the Standard that requires the Clinical Commissioning Group to reflect the aggregate effect of all contracts modified before the date of initial application.

The application of IFRS 15 has not had a material effect on the Clinical Commissioning Group’s accounts for 2018-19 and therefore there has been no effect of its application on current year closing balances. The main sources of income relate to prescription incentive rebates from drug companies and recharges.

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Revenue in respect of services provided is recognised when (or as) performance obligations are satisfied by transferring promised services to the customer, and is measured at the amount of the transaction price allocated to that performance obligation.

Where income is received for a specific performance obligation that is to be satisfied in the following year, that income is deferred.

Payment terms are standard reflecting cross government principles.

The value of the benefit received when the Clinical Commissioning Group accesses funds from the Government’s apprenticeship service are recognised as income in accordance with IAS 20, Accounting for Government Grants. Where these funds are paid directly to an accredited training provider, non-cash income and a corresponding non-cash training expense are recognised, both equal to the cost of the training funded.

1.8 Employee Benefits

1.8.1 Short-term Employee Benefits

Salaries, wages and employment-related payments, including payments arising from the apprenticeship levy, are recognised in the period in which the service is received from employees, including bonuses earned but not yet taken.

1.8.1 Short-term Employee Benefits (cont.)

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 Schemes. These schemes are unfunded, defined benefit schemes that cover NHS employers, General Practices and other bodies allowed under the direction of the Secretary of State in England and Wales. The schemes are not designed to be run in a way that would enable NHS bodies to identify their share of the underlying scheme assets and liabilities. Therefore, the schemes are accounted for as though they were defined contribution schemes: the cost to the Clinical Commissioning Group of participating in a 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.

The schemes are subject to a full actuarial valuation every four years and an accounting valuation every year.

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.

1.10 Property, Plant & Equipment

1.10.1 Recognition

Property, plant and equipment is capitalised if:

• It is held for use in delivering services or for administrative purposes;

• It is probable that future economic benefits will flow to, or service potential will be supplied to the clinical commissioning group;

• It is expected to be used for more than one financial year:

• The cost of the item can be measured reliably; and,

• The item has a cost of at least £5,000; or,

• Collectively, a number of items have a cost of at least £5,000 and individually have a cost of more than £250, where the assets are functionally interdependent, they had broadly simultaneous purchase dates, are anticipated to have simultaneous disposal dates and are under single managerial control; or,

• Items form part of the initial equipping and setting-up cost of a new building, ward or unit, irrespective of their individual or collective cost.

Where a large asset, for example a building, includes a number of components with significantly different asset lives, the components are treated as separate assets and depreciated over their own useful economic lives.

1.10.2 Measurement

All property, plant and equipment is 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.

Assets that are held for their service potential and are in use are measured subsequently at their current value in existing use. Assets that were most recently held for their service potential but are surplus are measured at fair value where there are no restrictions preventing access to the market at the reporting date

Revaluations are performed with sufficient regularity to ensure that carrying amounts are not materially different from those that would be determined at the end of the reporting period. Current values in existing use are determined as follows:

• Land and non-specialised buildings – market value for existing use; and,

• Specialised buildings – depreciated replacement cost.

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Properties in the course of construction for service or administration purposes are carried at cost, less any impairment loss. Cost includes professional fees but not borrowing costs, which are recognised as expenses immediately, as allowed by IAS 23 for assets held at fair value. Assets are re-valued and depreciation commences when they are brought into use.

IT equipment, transport equipment, furniture and fittings, and plant and machinery that are held for operational use are valued at depreciated historic cost where these assets have short useful economic lives or low values or both, as this is not considered to be materially different from current value in existing use.

An increase arising on revaluation is taken to the revaluation reserve except when it reverses an impairment for the same asset previously recognised in expenditure, in which case it is credited to expenditure to the extent of the decrease previously charged there. A revaluation decrease that does not result from a loss of economic value or service potential is recognised as an impairment charged to the revaluation reserve to the extent that there is a balance on the reserve for the asset and, thereafter, to expenditure. Impairment losses that arise from a clear consumption of economic benefit are taken to expenditure. Gains and losses recognised in the revaluation reserve are reported as other comprehensive income in the Statement of Comprehensive Net Expenditure.

1.10.3 Subsequent Expenditure

Where subsequent expenditure enhances an asset beyond its original specification, the directly attributable cost is capitalised. Where subsequent expenditure restores the asset to its original specification, the expenditure is capitalised and any existing carrying value of the item replaced is written-out and charged to operating expenses.

1.11 Intangible Assets

1.11.1 Recognition

Intangible assets are non-monetary assets without physical substance, which are capable of sale separately from the rest of the Clinical Commissioning Group’s business or which arise from contractual or other legal rights. They are recognised only:

• When it is probable that future economic benefits will flow to, or service potential be provided to, the Clinical Commissioning Group;

• Where the cost of the asset can be measured reliably; and,

• Where the cost is at least £5,000.

Software that is integral to the operating of hardware, for example an operating system, is capitalised as part of the relevant item of property, plant and equipment. Software that is not integral to the operation of hardware, for example application software, is capitalised as an intangible asset. Expenditure on research is not capitalised but is recognised as an operating expense in the period in which it is incurred. Internally-generated assets are recognised if, and only if, all of the following have been demonstrated:

• The technical feasibility of completing the intangible asset so that it will be available for use;

• The intention to complete the intangible asset and use it;

• The ability to sell or use the intangible asset;

• How the intangible asset will generate probable future economic benefits or service potential;

• The availability of adequate technical, financial and other resources to complete the intangible asset and sell or use it; and,

• The ability to measure reliably the expenditure attributable to the intangible asset during its development.

1.11.2 Measurement

Intangible assets acquired separately are initially recognised at cost. The amount initially recognised for internally-generated intangible assets is the sum of the expenditure incurred from the date when the criteria above are initially met. Where no internally-generated intangible asset can be recognised, the expenditure is recognised in the period in which it is incurred.

Following initial recognition, intangible assets are carried at current value in existing use by reference to an active market, or, where no active market exists, at the lower of amortised replacement cost or the value in use where the asset is income generating. Internally-developed software is held at historic cost to reflect the opposing effects of increases in development costs and technological advances. Revaluations and impairments are treated in the same manner as for property, plant and equipment.

1.11.3 Depreciation, Amortisation & Impairments

Freehold land, properties under construction, and assets held for sale are not depreciated.

Otherwise, depreciation and amortisation are charged to write off the costs or valuation of property, plant and equipment and intangible non-current assets, less any residual value, over their estimated useful lives, in a manner that reflects the consumption of economic benefits or service potential of the assets. The estimated useful life of an asset is the period over which the Clinical Commissioning Group expects to obtain economic benefits or service potential from the asset. This is specific to the Clinical Commissioning Group and may be shorter than the physical life of the asset itself. Estimated useful lives and residual values are reviewed each year end, with the effect of any changes recognised on a prospective basis. Assets held under finance leases are depreciated over their estimated useful lives.

At each reporting period end, the Clinical Commissioning Group checks whether there is any indication that any of its property, plant and equipment assets or intangible non-current assets have suffered an impairment loss. If there is indication of an impairment loss, the recoverable amount of the asset is estimated to determine whether there has been a loss and, if so, its amount. Intangible assets not yet available for use are tested for impairment annually.

A revaluation decrease that does not result from a loss of economic value or service potential is recognised as an impairment charged to the revaluation reserve to the extent that there is a balance on the reserve for the asset and, thereafter, to expenditure. Impairment losses that arise from a clear consumption of economic benefit are taken to expenditure. Where an impairment loss subsequently reverses, the carrying amount of the asset is increased to the revised estimate of the

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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 Leases

Leases are classified as finance leases when substantially all the risks and rewards of ownership are transferred to the lessee. All other leases are classified as operating leases.

1.12.1 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 Clinical Commissioning Group’s surplus/deficit.

Operating lease payments are recognised as an expense on a straight-line basis over the lease term. Lease incentives are recognised initially as a liability and subsequently as a reduction of rentals on a straight-line basis over the lease term.

Contingent rentals are recognised as an expense in the period in which they are incurred.

Where a lease is for land and buildings, the land and building components are separated and individually assessed as to whether they are operating or finance leases.

1.13 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 Clinical Commissioning Group’s cash management.

1.14 Clinical Negligence Costs

NHS Resolution operates a risk pooling scheme under which the Clinical Commissioning Group pays an annual contribution to NHS Resolution, which in return settles all clinical negligence claims. The contribution is charged to expenditure. Although NHS Resolution is administratively responsible for all clinical negligence cases, the legal liability remains with Clinical Commissioning Group.

1.15 Non-clinical Risk Pooling

The Clinical Commissioning Group participates in the Property Expenses Scheme and the Liabilities to Third Parties Scheme. Both are risk pooling schemes under which the Clinical Commissioning Group pays an annual contribution to the NHS Resolution and, in return, receives assistance with the costs of claims arising. The annual membership contributions, and any excesses payable in respect of particular claims are charged to operating expenses as and when they become due.

1.16 Financial Assets

Financial assets are recognised when the Clinical Commissioning Group becomes party to the financial instrument contract or, in the case of trade receivables, when the goods or services have been delivered. Financial assets are derecognised when the contractual rights have expired or the asset has been transferred.

Financial assets are classified into the following categories:

• Financial assets at amortised cost;

• Financial assets at fair value through other comprehensive income and;

• Financial assets at fair value through profit and loss.

The classification is determined by the cash flow and business model characteristics of the financial assets, as set out in IFRS 9, and is determined at the time of initial recognition.

1.16.1 Financial Assets at Amortised cost

Financial assets measured at amortised cost are those held within a business model whose objective is achieved by collecting contractual cash flows and where the cash flows are solely payments of principal and interest. This includes most trade receivables and other simple debt instruments. After initial recognition these financial assets are measured at amortised cost using the effective interest method less any impairment. The effective interest rate is the rate that exactly discounts estimated future cash receipts through the life of the financial asset to the gross carrying amount of the financial asset.

1.16.2 Financial assets at fair value through other comprehensive income

Financial assets held at fair value through other comprehensive income are those held within a business model whose objective is achieved by both collecting contractual cash flows and selling financial assets and where the cash flows are solely payments of principal and interest.

1.16.3 Financial assets at fair value through profit and loss

Financial assets measure at fair value through profit and loss are those that are not otherwise measured at amortised cost or fair value through other comprehensive income. This includes derivatives and financial assets acquired principally for the purpose of selling in the short term.

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1.16.4 Impairment

For all financial assets measured at amortised cost or at fair value through other comprehensive income (except equity instruments designated at fair value through other comprehensive income), lease receivables and contract assets, the Clinical Commissioning Group recognises a loss allowance representing the expected credit losses on the financial asset.

The Clinical Commissioning Group adopts the simplified approach to impairment in accordance with IFRS 9, and measures the loss allowance for trade receivables, lease receivables and contract assets at an amount equal to lifetime expected credit losses. For other financial assets, the loss allowance is measured at an amount equal to lifetime expected credit losses if the credit risk on the financial instrument has increased significantly since initial recognition (stage 2) and otherwise at an amount equal to 12 month expected credit losses (stage 1).

HM Treasury has ruled that central government bodies may not recognise stage 1 or stage 2 impairments against other government departments, their executive agencies, the Bank of England, Exchequer Funds and Exchequer Funds assets where repayment is ensured by primary legislation. The Clinical Commissioning Group therefore does not recognise loss allowances for stage 1 or stage 2 impairments against these bodies. Additionally, DHSC provides a guarantee of last resort against the debts of its arm’s lengths bodies and NHS bodies and the Clinical Commissioning Group does not recognise allowances for stage 1 or stage 2 impairments against these bodies.

For financial assets that have become credit impaired since initial recognition (stage 3), expected credit losses at the reporting date are measured as the difference between the asset’s gross carrying amount and the present value of the estimated future cash flows discounted at the financial asset’s original effective interest rate. Any adjustment is recognised in profit or loss as an impairment gain or loss.

1.17 Financial Liabilities

Financial liabilities are recognised on the statement of financial position when the Clinical Commissioning Group becomes party to the contractual provisions of the financial instrument or, in the case of trade payables, when the goods or services have been received. Financial liabilities are de-recognised when the liability has been discharged, that is, the liability has been paid or has expired.

1.17.1 Financial Guarantee Contract Liabilities

Financial guarantee contract liabilities are subsequently measured at the higher of:

• The premium received (or imputed) for entering into the guarantee less cumulative amortisation; and

• The amount of the obligation under the contract, as determined in accordance with IAS 37: Provisions, Contingent Liabilities and Contingent Assets.

1.17.2 Financial Liabilities at Fair Value Through Profit and Loss

Embedded derivatives that have different risks and characteristics to their host contracts, and contracts with embedded derivatives whose separate value cannot be ascertained, are treated as financial liabilities at fair value through profit and loss. They are held at fair value, with any resultant gain or loss recognised in the Clinical Commissioning Group’s surplus/deficit. The net gain or loss incorporates any interest payable on the financial liability.

1.17.3 Other Financial Liabilities

After initial recognition, all other financial liabilities are measured at amortised cost using the effective interest method, except for loans from Department of Health and Social Care, which are carried at historic cost. The effective interest rate is the rate that exactly discounts estimated future cash payments through the life of the asset, to the net carrying amount of the financial liability. Interest is recognised using the effective interest method.

1.18 Value Added Tax

Most of the activities of the Clinical Commissioning Group are outside the scope of VAT and, in general, output tax does not apply and input tax on purchases is not recoverable. Irrecoverable VAT is charged to the relevant expenditure category or included in the capitalised purchase cost of fixed assets. Where output tax is charged or input VAT is recoverable, the amounts are stated net of VAT.

1.19 Foreign Currencies

The Clinical Commissioning Group’s functional currency and presentational currency is pounds sterling and amounts are presented in thousands of pounds unless expressly stated otherwise. Transactions denominated in a foreign currency are translated into sterling at the exchange rate ruling on the dates of the transactions. At the end of the reporting period, monetary items denominated in foreign currencies are retranslated at the spot exchange rate on 31 March. Resulting exchange gains and losses for either of these are recognised in the Clinical Commissioning Group’s surplus/deficit in the period in which they arise.

1.20 Critical accounting judgements and key sources of estimation uncertainty

In the application of the Clinical Commissioning Group’s accounting policies, management is required to make various judgements, estimates and assumptions. These are regularly reviewed.

1.20.1 Critical accounting judgements in applying accounting policies

The following are the judgements, apart from those involving estimations, that management has made in the process of applying the Clinical Commissioning Group’s accounting policies and that have the most significant effect on the amounts recognised in the financial statements.

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Better Care Fund

The Clinical Commissioning Group’s management has made a critical judgement in relation to applying accounting policies to the Better Care Fund (BCF). This relates to the arrangements described in the section 75 agreement it has with Walsall Metropolitan Borough Council. The substance of each programme that forms part of the BCF Pooled Budget has been assessed as to whether it meets the principles within IFRS 11: ‘Joint Arrangements’. Specific programmes have been assessed as either:

(1) Joint commissioning arrangements under which each pool partner accounts for their share of expenditure and balances with the end provider;

(2) Lead commissioning arrangements under which the lead commissioner accounts for expenditure with the end provider and other partners report transactions and balances with the lead commissioner; or

(3) Sole control arrangements under which the provisions of IFRS 11 do not apply.

1.20.2 Sources of estimation uncertainty

The following are assumptions about the future and other major sources of estimation uncertainty that have a significant risk of resulting in a material adjustment to the carrying amounts of assets and liabilities within the next financial year.

Healthcare accruals - A significant degree of estimation is required for healthcare accruals in the latter part of the year where the activity data has not been received before closure of the accounting period.

1.21 Accounting Standards that have been issued but have not yet been adopted

The DHSC GAM does not require the following IFRS Standards and Interpretations to be applied in 2018-19. These Standards are still subject to HM Treasury FReM adoption, with IFRS 16 being for implementation in 2019-20, and the government implementation date for IFRS 17 still subject to HM Treasury consideration.

• IFRS 16 Leases – Application required for accounting periods beginning on or after 1 January 2019, but not yet adopted by the FReM: early adoption is not therefore permitted.

• IFRS 17 Insurance Contracts – Application required for accounting periods beginning on or after 1 January 2021, but not yet adopted by the FReM: early adoption is not therefore permitted.

● • IFRIC 23 Uncertainty over Income Tax Treatments – Application required for accounting periods beginning on or after 1 January 2019.

2 Financial Performance Targets

Duty 2018-19 2018-19 Duty 2017-18 2017-18 Duty

Target Performance Achieved Target Performance Achieved

Expenditure not to

exceed income 0 (4) YES 0 (1,852) YES

Capital resource use

does not exceed

the amount specified

in Directions 117 114 YES 415 354 YES

Revenue resource use

does not exceed

the amount specified

in Directions 438,989 438,985 YES 428,842 426,990 YES

Capital resource use

on specified

matter(s) does not exceed

the amount

specified in Directions - - N/A - - N/A

Revenue resource use

on specified

matter(s) does not

exceed the amount

specified in Directions - - N/A - - N/A

Revenue administration

resource use

does not exceed the

amount specified

in Directions 6,107 5,816 YES 6,073 5,920 YES

Note 1 2017-18 figures have been restated for consistency purposes

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3 Other Operating Revenue

2018-19 2017-18 Total Total £000 £000

Income from Sale of Goods and Services (Contracts)

Education, training and research - 58

Non-patient care services to other bodies - 648

Total Income from Sale of Goods and Services - 706

Other Operating Income

Charitable and other contributions to revenue expenditure: non-NHS 238 238

Non-cash apprenticeship training grants revenue 1 1

Other non-contract revenue 725 350

Total Other Operating Income 964 589

Total Operating Income 964 1,295

Revenue in this note does not include cash received from NHS England, which is drawn down directly into the bank account of the Clinical Commissioning Group and credited to the General Fund.

Treasury has mandated that the transition to IFRS 15 should be applied retrospectively with the cumulative effect recognized as an adjustment to opening balances. There has been no material effect to the Clinical Commissioning Group as a result of IFRS 15 and the 17-18 closing balances have not been re-stated.

4 Employee Benefits and Staff Numbers 4.1.1 Employee Benefits

2018-19 Total Total Permanent Other Employees £000 £000 £000

Employee Benefits

Salaries and wages 4,234 3,827 407

Social security costs 418 388 30

Employer contributions to NHS Pension scheme 494 471 23

Apprenticeship Levy 6 6 -

Gross Employee Benefits Expenditure 5,152 4,692 460

2017-18 Total Total Permanent Other Employees £000 £000 £000

Employee Benefits

Salaries and wages 4,053 3,614 439

Social security costs 393 368 25

Employer contributions to NHS Pension scheme 456 441 15

Apprenticeship Levy 4 4 -

Gross Employee Benefits Expenditure 4,906 4,427 479

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4.2 Average Number of People Employed

2018-19 2018-19 2018-19 2017-18 Total Permanently Other Total Number Employed Number Number Number

Total 86.05 73.96 12.09 80.66

Of the above:

Number of whole time equivalent people

engaged on capital projects - - - -

A more detailed breakdown of staff numbers can be found in the Staff Report on page 102.

4.3 Exit Packages Agreed in the Financial Year

The Clinical Commissioning Group did not agree any exit packages during the 18-19 financial year

(2017-18 nil).

4.4 Pension costs

Past and present employees are covered by the provisions of the two NHS Pension Schemes. Details of the

benefits payable and rules of the Schemes can be found on the NHS Pensions website at www.nhsbsa.nhs.uk/

pensions.

Both are unfunded, defined benefit schemes that cover NHS employers, GP practices and other bodies

allowed under the direction of the Secretary of State for Health in England and Wales. They are not designed

to be run in a way that would enable NHS bodies to identify their share of the underlying scheme assets and

liabilities.

Therefore, each schemes is accounted for as if it were a defined contribution scheme: the cost to the NHS

body of participating in each scheme is taken as equal to the contributions payable to that scheme for the

accounting period.

In order that the defined benefit obligations recognised in the financial statements do not differ materially

from those that would be determined at the reporting date by a formal actuarial valuation, the FReM requires

that “the period between formal valuations shall be four years, with approximate assessments in intervening

years”. An outline of these follows:

4.4.1 Accounting Valuation

A valuation of scheme liability is carried out annually by the scheme actuary (currently the Government

Actuary’s Department) as at the end of the reporting period. This utilises an actuarial assessment for the

previous accounting period in conjunction with updated membership and financial data for the current

reporting period, and is accepted as providing suitably robust figures for financial reporting purposes. The

valuation of the scheme liability as at 31 March 2019, is based on valuation data as 31 March 2018,

updated to 31 March 2019 with summary global member and accounting data. In undertaking this actuarial

assessment, the methodology prescribed in IAS 19, relevant FReM interpretations, and the discount rate

prescribed by HM Treasury have also been used.

The latest assessment of the liabilities of the scheme is contained in the report of the scheme actuary, which

forms part of the annual NHS Pension Scheme Accounts. These accounts can be viewed on the NHS Pensions

website and are published annually. Copies can also be obtained from The Stationery Office.

4.4.2 Full Actuarial (Funding) Valuation

The purpose of this valuation is to assess the level of liability in respect of the benefits due under the schemes

(taking into account recent demographic experience), and to recommend contribution rates payable by

employees and employers.

The latest actuarial valuation undertaken for the NHS Pension Scheme was completed as at 31 March 2016.

The results of this valuation set the employer contribution rate payable from April 2019. The Department of

Health and Social Care have recently laid Scheme Regulations confirming that the employer contribution rate

will increase to 20.6% of pensionable pay from this date.

The 2016 funding valuation was also expected to test the cost of the Scheme relative to the employer cost

cap set following the 2012 valuation. Following a judgement from the Court of Appeal in December 2018

Government announced a pause to that part of the valuation process pending conclusion of the continuing

legal process.

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5 Operating Expenses

2018-19 2017-18 Total Total £000 £000

Purchase of goods and services

Services from other CCGs and NHS England 1,597 1,592

Services from foundation trusts 34,755 35,427

Services from other NHS trusts 239,359 228,689

Services from other WGA bodies 2 (6)

Purchase of healthcare from non-NHS bodies 58,821 56,315

Purchase of social care 739 629

Prescribing costs 48,263 50,075

General ophthalmic services 518 386

GPMS/APMS and PCTMS 42,735 41,835

Supplies and services – clinical 89 93

Supplies and services – general 791 1,025

Consultancy services 285 255

Establishment 1,235 1,556

Transport 111 90

Premises 4,455 4,179

Audit fees 56 55

Other professional fees 85 67

Legal fees 49 342

Education, training and conferences 211 287

Total Purchase of Goods and Services 434,156 422,891

Depreciation and Impairment Charges

Depreciation 65 -

Amortisation 6 -

2018-19 2017-18 Total Total £000 £000

Total Depreciation and Impairment Charges 71 -

Provision Expense

Provisions - (2)

Total Provision Expense - (2)

Other Operating Expenditure

Chair and non-executive members 509 489

Expected credit loss on receivables 60 -

Non cash apprenticeship training grants 1 1

Other expenditure - 1

Total Other Operating Expenditure 570 491

Total Operating Expenditure 434,797 423,380

The liability in respect of partially completed spells is included within the Statement of Financial position with the movement each year being shown within operating costs above. The movement in 2018-19 is £309k and this is included within Services from Foundation Trusts and other NHS Trusts.

The prepayment in respect of maternity services is included within the Statement of Financial position with the movement each year shown within operating costs above. The movement of £52k in 2018-19 is included within Services from Foundation Trusts and other NHS Trusts.

Under IFRS 9, there is a presumption that all receivables will be subject to an expected credit loss from day one – the expected credit loss for 2018-19 is shown under other operating expenditure.

In accordance with SI 2008 no.489, The Companies (Disclosure of Auditor Remuneration and Liability Limitation Agreements) Regulations 2008, the Clinical Commissioning Group must disclose the principal terms of the limitation of the auditor’s liability. This is detailed as follows:

For all defaults resulting in direct loss or damage to the property of the other party - £2m limit.

In respect of all other defaults, claims, losses or damages arising from breach of contract, misrepresentation, tort, breach of statutory duty or otherwise – not exceed the greater of the sum of £2m or a sum equivalent to 125% of the contract charge paid or payable to the supplier in the relevant year of the contract.

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6 Better Payment Practice Code

2018-19 2018-19 2017-18 2017-18 Number £000 Number £000

Measure of Compliance

Non-NHS Payables

Total non-NHS trade invoices paid in the year 13,677 116,656 13,126 110,159

Total non-NHS trade invoices paid within target 13,542 114,746 13,036 108,314

Percentage of non-NHS trade invoices paid within target 99.01% 98.37% 99.31% 98.33%

NHS Payables

Total NHS trade invoices paid in the year 2,903 278,666 2,841 266,546

Total NHS trade invoices paid within target 2,824 277,527 2,790 266,059

Percentage of NHS trade invoices paid within target 97.28% 99.59% 98.20% 99.82%

The Better Payment Practice Code requires the Clinical Commissioning Group to aim to pay all valid invoices by the due date or within 30 days of receipt of a valid invoice, whichever is later.

The Clinical Commissioning Group is a signatory to the Prompt Payment Code which sets standards for payment practices and is administered by the Chartered Institute of Credit Management.

6.1 The Late Payment of Commercial Debts (Interest) Act 1998

The Clinical Commissioning Group made no payments in respect of late payments in 2018-19 (2017-18 nil)

7.1 As Lessee7.1.1 Payments Recognised as an Expense

Land Buildings Other 2018-19 Land Buildings Other 2017-18 Total Total £000 £000 £000 £000 £000 £000 £000 £000

Payments Recognised as an Expense

Minimum lease payments - 4,435 - - - 4,158 - 4,158

Total - 4,435 - - - 4,158 - 4,158

The Clinical Commissioning Group occupies property owned and managed by Community Health Partnerships Limited and NHS Property Services Limited. The property costs have been invoiced at market rents and include charges for void space and subsidies allocated to commissioners responsible for specific buildings. The costs also include management overheads for the property companies. This is reflected in Note 7.1.1.

While our arrangements with Community Health Partnerships Ltd and NHS Property Services Ltd fall within the definition of operating leases, the rental charge for future years has not yet been agreed. Consequently, this note does not include future minimum lease payments for these arrangements.

7.2 As Lessor

The Clinical Commissioning Group is not a lessor and therefore does not receive any rental revenue.

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8 Property, Plant and Equipment

Land Buildings Dwellings Assets Plant & Transport Information Furniture Total exc under Machinery Equipment Technology & Fittings Dwellings Construction 2018-19 & Payment on Accounts

£000 £000 £000 £000 £000 £000 £000 £000 £000

Cost/Valuation at 01 April ’18 b/fwd - - - - - - 325 - 325

Additions purchased - - - - - - 63 - -

Cost/Valuation at 31 March ‘19 - - - - - - 388 - 388

Depreciation 01 April ’18 b/fwd - - - - - - - - -

Charged during the year - - - - - - 65 - 65

Deprecation at 31 March ‘19 - - - - - - 65 - 65

Net Book Value at 31 March ‘19 - - - - - 323 - 323

Purchased - - - - - - 323 - 323

Total at 31 March ‘19 - - - - - - 323 - 323

Asset Financing:

Owned - - - - - - 323 - 323

Total at 31 March ‘19 - - - - - - 323 - 323

Revaluation Reserve Balance for Property, Plant & Equipment

The Clinical Commissioning Group has not revalued any property, plant or equipment and therefore does not have a revaluation reserve.

8.1 Economic Lives

Minimum Life (years) Maximum Life (Years)

Buildings excluding dwellings 0 0

Dwellings 0 0

Plant & machinery 0 0

Transport equipment 0 0

Information technology 5 5

Furniture & fittings 0 0

9 Intangible Non-Current Assets

2018-19 Computer Computer Licences Patents Development Total Software: Software: and Expenditure Purchased Internally Trademarks Internally Generated Generated

£000 £000 £000 £000 £000 £000

Cost/Valuation at 01 April ’18 b/fwd 29 - - - - 29

Additions purchased 51 - - - - 51

Cost/Valuation at 31 March ‘19 80 - - - - 80

Amortisation 01 April ‘18 - - - - - -

Charged during the year 6 - - - - 6

Amortisation at 31 March ‘19 6 - - - - 6

Net Book Value at 31 March ‘19 74 - - - - 74

Purchased 74 - - - - 74

Total at 31 March ‘19 74 - - - - 74

Revaluation Reserve Balance for Intangible Assets

The Clinical Commissioning Group has not revalued any intangible assets and therefore does not have a revaluation reserve.

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9.1 Economic Lives

Minimum Life (years) Maximum Life (Years)

Computer Software: Purchased 5 5

Computer Software: Internally Generated 0 0

Licences and Trademarks 0 0

Patents 0 0

Development Expenditure (Internally Generated) 0 0

10 Trade and Other Receivables

Current Non- Current Non- Current Current 2018-19 2018-19 2017-18 2017-18 £000 £000 £000 £000

NHS receivables: revenue - - 3,569 -

NHS prepayments 1,463 - 1,411 -

NHS accrued income 1,548 - 1,127 -

NHS non contract trade receivables (ie pass through funding) 3,638 - - -

Non-NHS and other WGA receivables: revenue - - 3,591 -

Non-NHS and other WGA prepayments 168 - 199 -

Non NHS and other WGA accrued income 9 - 586 -

Non NHS and other WGA non contract trade receivables (ie pass through funding) 4,191 - - -

Expected credit loss allowance – receivables (60) - - -

VAT 27 - 2 -

Total Trade and Other Receivables 10,982 - 10,485 -

Total Current and Non-Current 10,982 - 10,485 -

Included above:

Prepaid pensions contributions - - - -

The majority of trade is within the NHS England group. As NHS England is funded by Government to provide funding to Clinical Commissioning Groups to commission services, no credit scoring of them is considered necessary.

NHS prepayments consist of tariff payments for maternity services relating to activity primarily with Walsall Healthcare NHS Trust. As this reflects an advance payment for services that will be delivered, there is no risk to the Clinical Commissioning Group.

Under IFRS 15, receivable balances are classed as either contract or non-contract. As the Clinical Commissioning Group have no material IFRS 15 contract balances, the 18-19 NHS and non NHS & other WGA receivables balances are shown as non-contract (pass through funding). The 17-18 closing balances have not been restated in this regard.

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10.1 Receivables Past their Due Date but not Impaired

2018-19 2018-19 2017-18 2017-18 DHSC Non DHSC DHSC Non DHSC Group Group Group Group Bodies Bodies Bodies Bodies £000 £000 £000 £000

By up to three months 308 - - 30

By three to six months - - 23 67

By more than six months 2,008 - 2,062 2,204

Total 2,316 - 2,085 2,301 Under IFRS 9, there is some expectation that all receivables will be subject to some form of expected credit loss from day one. This excludes the impairment of Department of Health group bodies as it’s expected that these will be settled by the issue of credit notes. Therefore, this table excludes those entities outside of the Department of Health group.

Note 10.2 below shows the expected credit loss for those entities outside of the Department of Health group. This is shown in operating costs (note 5).

10.2 Loss Allowance on Assets Classes

2018-19 2018-19 2018-19 Trade & Other Other Total Receivables Financial Non DHSC Assets Group Bodies £000 £000 £000

Balance at 1st April 2018 - - -

Allowance for Credit Losses at 1st April 2018 - - -

Lifetime expected credit losses on trade & other receivables – Stage 3 (60) - (60)

Allowance for Credit Losses at 31 March 2019 (60) - (60)

11 Cash and Cash Equivalents

2017-18 2017-18 £000 £000 Balance at 1 April 2018 48 81

Net change in year 51 (33)

Balance at 31 March 2019 99 48

Made up of:

Cash with the Government Banking Service 99 48

Cash in hand - -

Cash and Cash Equivalents as in Statement of Financial Position 99 48

Balance at 31 March 2019 48

Patients’ money held by the Clinical Commissioning Group, not included above - -

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12 Trade and Other Payables

Current Non-Current Current Non-Current

2018-19 2018-19 2017-18 2017-18

NHS payables: revenue 5,787 - 4,983 -

NHS accruals 2,924 - 2,387 -

NHS deferred income 55 52

Non-NHS and other WGA payables: revenue 4,051 - 6,805 -

Non-NHS and other WGA payables: capital 12 - 270 -

Non-NHS and other WGA accruals 24,154 - 18,582 -

Non NHS and other WGA deferred income 150 -

Social security costs 64 - 57 -

Tax 53 - 57 -

Other payables and accruals 451 - 751 -

Total Trade and Other Payables 37,701 - 33,944 -

Total Current and Non-Current 37,701 33,944

NHS accruals includes £1,786k in respect of partially completed patient spells – of this amount, £1,386k is attributable to Walsall Healthcare NHS Trust.

Other payables include £207k outstanding pension contributions at 31 March 2019 (of this amount £127k relates to GP’s outstanding contributions under delegated commissioning).

The movement in non NHS & other WGA accruals is largely accounted for as a result of the Clinical Commissioning Group having to account for a forecast for joint assessments with Walsall MBC, a recharge for mental health assessments and an estimate for urgent care step in costs.

13 ProvisionsThe Clinical Commissioning Group does not have any provisions on the balance sheet at the 31st March 2019 (2017-18 nil).

14 Contingencies The Clinical Commissioning Group does not have any contingencies at the end of March 2019 that require disclosing.

15 Commitments 15.1 Capital Commitments

The Clinical Commissioning Group had no capital commitments at the end of March 2019 (2017-18 nil).

15.2 Other financial commitments

The Clinical Commissioning Group had no non-cancellable contracts (which were not leases, private finance initiative contracts or other service concession arrangements) as at 31 March 2019 (2017-18 nil).

16 Financial Instruments16.1 Financial Risk Management

Financial reporting standard IFRS 7 requires disclosure of the role that financial instruments have had during the period in creating or changing the risks a body faces in undertaking its activities.

Since NHS Clinical Commissioning Groups are financed through Parliamentary funding, they are 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’s 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.

16.1.1 Currency Risk

The 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 Clinical Commissioning Group has no overseas operations. The Clinical Commissioning Group therefore has low exposure to currency rate fluctuations.

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16.1.2 Interest Rate 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.

16.1.3 Credit Risk

Since the majority of the Clinical Commissioning Group’s revenue comes from Parliamentary funding, Clinical Commissioning Groups have 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.

16.1.3 Liquidity Risk

NHS Clinical Commissioning Groups are required to operate within revenue and capital resource limits, which are financed from resources voted annually by Parliament. The Clinical Commissioning Group draws down cash to cover expenditure, as the need arises. The Clinical Commissioning Group is not, therefore, exposed to significant liquidity risks.

16.1.5 Financial Instruments

As the cash requirements of NHS England are met through the Estimate process, financial instruments play a more limited role in creating and managing risk than would apply to a non-public sector body. The majority of financial instruments relate to contracts to buy non-financial items in line with NHS England’s expected purchase and usage requirements and NHS England is therefore exposed to little credit, liquidity or market risk.

16.2 Financial Assets Financial Equity Total Assets Instruments measured designated at Amortised at FVOCI

2018-19 2018-19 2018-19

£000 £000 £000

Trade and other receivables with NHSE bodies 1,377 - 1,377

Trade and other receivables with other DHSC group bodies 3,809 - 3,809

Trade and other receivables with external bodies 4,200 - 4,200

Cash and cash equivalents 99 - 99

Total at 31 March 2019 9,485 - 9,485

16.2.1 Impact of Application of IFRS 9 on Financial Assets at 1 April 2018

Total Cash & Trade & Trade & Trade & Other Cash Other Receivables Other Financial Equivalents Receivables -External Receivables Assets -NHSE DHSC Group -External Bodies Bodies

£000 £000 £000 £000 £000 £000

Classification under IAS 39 as at 31 March 2018

Financial assets held at amortised cost 8,920 48 1,019 3,677 4,176 -

Total at 31st March 2018 8,920 1,019 3,677 4,176 -

Classification under I FRS 9 as at 1st April 2018

Financial assets measured at amortised -cost 8,920 48 1,019 3,677 4,176 -

Total at 1st April 2018 8,920 48 1,019 3,677 4,176 -

16.3 Financial Liabilities Financial Other Total Assets measured at Amortised

2018-19 2018-19 2018-19

£000 £000 £000

Trade and other payables with NHSE bodies 560 - 560

Trade and other payables with other DHSC group bodies 21,042 - 21,042

Trade and other payables with external bodies 15,325 - 15,325

Other financial liabilities 244 - 244

Total at 31 March 2019 37,171 - 37,171

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16.2.1 Impact of Application of IFRS 9 on Financial Assets at 1 April 2018

Total Trade & Trade & Trade & Other Other Other Other Other Borrowings Financial Payables- Payables- Payables- (Including Liabilities NHSE Other External Finance Bodies DHSC Group Bodies

£000 £000 £000 £000 £000 £000

Classification under IAS 39 as at 31 March 2018

Financial liabilities held at amortised cost 33,518 530 6,840 26,148 - -

Total at 31st March 2018 33,518 530 6,840 26,148 - -

Classification under IFRS 9 as at 1st April 2018

Financial liabilities measured at amortised cost 33,518 530 6,840 26,148 - -

Total at 1st April 2018 33,518 530 6,840 26,148 - -

17 Operating Segments

Gross Income Net Total Total Net Expenditure Expenditure Assets Liabilities Assets

£000 £000 £000 £000 £000 £000

Commissioner 439,949 (964) 438,985 11,478 (37,701) (26,223)

Total 439,949 (964) 438,985 11,478 (37,701) (26,223)

18 Interests in Joint Arrangements

Name of Parties to the Description Assets Liabilities Income Exp Assets Liabililities Income Exp Arrangment Arrangment Principal Activities £000 £000 £000 £000 £000 £000 £000 £000

Pooled Walsall CCG The Budget commissioning Arrangement Walsall MBC of health and social care - - - 9,684 - - - 10,429 services under the Better Care Fund

18 Interests in Joint Arrangements (Cont’d) Workstream 2018-19 2018-19 2018-19 Budget Spend WMBC Spend

£000 £000 £000

A – Community Integration 4,376 992 3,380

B – Transitional Care Pathways – Non Bed Based 1,938 56 1,575

C – Transitional Care Pathways – Bed Based 11,225 5,870 5,161

D – Assistive Technology 1,219 449 770

E – Dementia 229 - 229

F – Mental Health 1,209 1,209 -

G – Support to Carers 470 - 470

H – Long Term Social Care Community & Residential Placements - - -

I – Independent Sector Impact on Hospital Flows - - -

J – Contingency 1,108 1,108 -

Sub Total Revenue Funding 21,774 9,684 11,585

Capital Funding 3,433 - 3,433

Total Better Care Fund 2018-19 25,207 9,684 15,018

Funding

Walsall Clinical Commissioning Group 21,774 10,189 11,585

Walsall MBC – Capital Funds 3,433 - 3,433

Total 25,207 10,189 15,018

19 NHS LIFT Investments

The Clinical Commissioning Group does not hold any investments in NHS LIFT schemes.

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Payments Receipts Amounts Amounts Payments Receipts Amounts Amounts Governing Body Members to Related from Related owed to due from to Related from owed to due from Party Party Party Party Party Party Party Party £000 £000 £000 £000 £000 £000 £000 £000

Mr P Maubach Accountable Officer (Dudley Clinical Commissioning Group) 484 32 57 - 247 59 258 12

Mr M Hartland Strategic Finance Officer & Chief Finance Officer (Dudley Clinical Commissioning Group) 484 32 57 - 247 59 258 12

Mr M Hartland Strategic Finance Officer & Chief Finance Officer (Wolverhampton Clinical Commissioning Group) 105 1,013 78 173 37 - 6 74

Mr T Galllagher Chief Finance Officer (Wolverhampton Clinical Commissioning Group) 105 1,013 78 173 37 - 6 74

Mr R Freeman Secondary Care Specialist (Robert Jones & Agnes Hunt NHS FT) 146 - - - 121 - 15 15

Dr P De Secondary Care Specialist (Sandwell & West Birmingham NHS FT) 4,895 - 44 - N/A N/A N/A N/A

Dr B Watt Director of Public Health (Walsall MBC) 27,028 10,066 7,306 3,717 27,018 9,349 6,263 3,458

Ms P Furnival Director of Adult Social Care and Inclusion (Walsall MBC) 27,028 10,066 7,306 3,717 27,018 9,349 6,263 3,458

Ms P Furnival Director of Adult Social Care and Inclusion (Walsall Healthcare NHS Trust) 173,785 98 2,365 1,981 N/A N/A N/A N/A

Dr S Kaul Locality Lead Trans (Acepay Ltd) 406 - 12 - 472 - - -

Dr A Rischie Clinical Chair of Governing Body (Walsall Alliance – GP Federation) 117 17 - - 97 33 - 7

Dr N Asghar Locality Lead North (Walsall Alliance – GP Federation) 117 17 - - 97 33 - 7

20 Related Party Transactions

During the year, certain members of the Governing Body or key members of staff declared interests with other organisations that have undertaken material transactions with the Clinical Commissioning Group.

Details of the related parties and those transactions are as follows:

2018-19 2017-18

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Dr H Vitarana Clinical Executive Finance and IT (Walsall Alliance – GP Federation) 117 17 - - 97 33 - 7

Dr J Teoh Locality Lead South East (Macmillan GP Facilitator) 24 - - - 19 * - - -

Dr S Kaul Locality Lead Trans (Walsall Alliance – GP Federation) 117 17 - - 97 33 - 7

Dr A Rischie Clinical Chair of Governing Body (Royal College of GPs) 72 - - - 24 - 20 -

2018-19 2017-18


Dr A Rischie – Clinical Chair of Governing Body (Pleck Heath Centre) 863 - 73 - 1,029 - 72 -

Dr A Rischie – Clinical Chair of Governing Body (New Invention Clinic) 667 - 89 - 624 - 74 -

Dr N Asghar – Locality Lead North (All Saints Surgery) 1,057 - 90 - 663 - 54 -

Dr H Vitarana – Clinical Executive – Finance and IT (Moxley Medical Centre) 407 - 37 - 408 - 27 -

Dr R Mohan – Clinical Executive – Medical Director (Sina Health Centre) 773 - 219 - 881 - 52 -

Dr J Teoh – Locality Lead South East (St Peters Surgery) 1,100 - 111 - 1,070 - 96 -

2018-19 2017-18

* 17-18 amount restated20 Related Party Transactions (continued)

Transactions with GPs are mostly for enhanced services which are processed through NHS England. These payments are made to the practices as a whole and do not specifically relate to individuals within a practice. The majority of these transactions are in accordance with nationally agreed contracts and are processed centrally under a contract held by NHS England. Walsall Clinical Commissioning Group has delegated authority for primary care commissioning.

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Dr S Kaul – Locality Lead Trans (Harden Health Centre) 350 - 26 - 472 - 19 -

Dr S Kaul – Locality Lead Trans (New Road Medical Centre) 202 - 20 - 260 - 26 -

Dr H Baggri – Clinical Executive, Commissioning, Transformation & Performance (Berkley Health Centre) 988 - 82 - 543 - 44 -

Dr R Sandhu – Locality Lead West (Kingfisher Health Centre) 998 - 82 - 781 - 62 -

2018-19 2017-18

The Department of Health & Social Care 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. For example: • NHS England

• Dudley and Walsall Mental Health Partnership NHS Trust

• The Royal Wolverhampton NHS Trust

• Sandwell & West Birmingham NHS FT

• NHS Sandwell & West Birmingham CCG

• Walsall Healthcare NHS Trust

• Birmingham Women’s & Children’s Hospital NHS Foundation Trust

• Black Country Partnership NHS Foundation Trust

• Heart of England NHS Foundation Trust

• The Royal Orthopaedic Hospital NHS Foundation Trust

• The Dudley Group NHS Foundation Trust

• University Hospitals Birmingham NHS Foundation Trust

• West Midlands Ambulance Service NHS Foundation Trust

• NHS Property Services Limited

• Community Health Partnerships Limited

In addition, the Clinical Commissioning Group has had a number of material transactions with other government departments and other central and local government bodies. Most of these transac-tions have been with Walsall Metropolitan Borough Council in respect of joint enterprises.

21 Events after the End of the Reporting PeriodThe Clinical Commissioning Group considers that there are no significant post balance sheet events.

22 Losses and Special PaymentsThe Clinical Commissioning Group had no losses and special payments cases during 2018-19 (2017-18 nil).

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Independent auditor’s report to the members of the Governing Body of NHS Walsall Clinical Commissioning GroupReport on the Audit of the Financial StatementsOpinion

We have audited the financial statements of NHS Walsall Clinical Commissioning Group (the ‘CCG’) for the year ended 31 March 2019, which 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 notes to the financial statements, including a summary of significant accounting policies. 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 Department of Health and Social Care Group Accounting Manual 2018-19.

In our opinion, the financial statements:

• give a true and fair view of the financial position of the CCG as at 31 March 2019 and of its expenditure and income for the year then ended; and

• have been properly prepared in accordance with International Financial Reporting Standards (IFRSs) as adopted by the European Union, as interpreted and adapted by the Department of Health and Social Care Group Accounting Manual 2018-19; and

• have been prepared in accordance with the requirements of the Health and Social Care Act 2012.

Basis for opinion

We conducted our audit in accordance with International Standards on Auditing (UK) (ISAs (UK)) and applicable law. Our responsibilities under those standards are further described in the ‘Auditor’s responsibilities for the audit of the financial statements’ section of our report. We are independent of the CCG in accordance with the ethical requirements that are relevant to our audit of the financial statements in the UK, including the FRC’s Ethical Standard, and we have fulfilled our other ethical responsibilities in accordance with these requirements. We believe that the audit evidence we have obtained is sufficient and appropriate to provide a basis for our opinion.

Conclusions relating to going concern

We have nothing to report in respect of the following matters in relation to which the ISAs (UK) require us to report to you where:

• the Accountable Officer’s use of the going concern basis of accounting in the preparation of the financial statements is not appropriate; or

• the Accountable Officer has not disclosed in the financial statements any identified material uncertainties that may cast significant doubt about the CCG’s ability to continue to adopt the going concern basis of accounting for a period of at least twelve months from the date when the financial statements are authorised for issue.

Other information

The Accountable Officer is responsible for the other information. The other information comprises the information included in the Annual Report, other than the financial statements and our auditor’s report thereon. Our opinion on the financial statements does not cover the other information and, except to the extent otherwise explicitly stated in our report, we do not express any form of assurance conclusion thereon.

In connection with our audit of the financial statements, our responsibility is to read the other information and, in doing so, consider whether the other information is materially inconsistent with the financial statements or our knowledge obtained in the audit or otherwise appears to be materially misstated. If we identify such material inconsistencies or apparent material misstatements, we are required to determine whether there is a material misstatement in the financial statements or a material misstatement of the Grant Thornton UK LLP. 2 other information. If, based on the work we have performed, we conclude that there is a material misstatement of the other information, we are required to report that fact.

We have nothing to report in this regard.

Other information we are required to report on by exception under the Code of Audit Practice

Under the Code of Audit Practice published by the National Audit Office on behalf of the Comptroller and Auditor General (the Code of Audit Practice) we are required to consider whether the Governance Statement does not comply with the guidance issued by the NHS Commissioning Board or is misleading or inconsistent with the information of which we are aware from our audit. We are not required to consider whether the Governance Statement addresses all risks and controls or that risks are satisfactorily addressed by internal controls.

We have nothing to report in this regard.

Opinion on other matters required by the Code of Audit Practice

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 Department of Health and Social Care Group Accounting Manual 2018-19 and the requirements of the Health and Social Care Act 2012; and

• based on the work undertaken in the course of the audit of the financial statements and our knowledge of the CCG gained through our work in relation to the CCG’s arrangements for securing economy, efficiency and effectiveness in its use of resources, the other information published together with the financial statements in the Annual Report for the financial year for which the financial statements are prepared is consistent with the financial statements.

Opinion on regularity required by the Code of Audit Practice

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.

Matters on which we are required to report by exception

Under the Code of Audit Practice, we are required to report to you if:

• we issue a report in the public interest under Section 24 of the Local Audit and Accountability Act 2014 in the course of, or at the conclusion of the audit; or

• we refer a matter to the Secretary of State under Section 30 of the Local Audit and Accountability Act 2014 because we have reason to believe that the CCG, or an officer of the CCG, is about to make, or has made, a decision which involves or would involve the 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

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• we make a written recommendation to the CCG under Section 24 of the Local Audit and Accountability Act 2014 in the course of, or at the conclusion of the audit.

We have nothing to report in respect of the above matters.

Responsibilities of the Accountable Officer and Those Charged with Governance for the financial statements

As explained more fully in the Statement of Accountable Officer’s responsibilities set out on pages 56 to 57, the Accountable Officer, is responsible for the preparation of the financial statements in the form and on the basis set out in the Accounts Directions, for being satisfied that they give a true and fair view, and for such internal control as the Accountable Officer determines is necessary to enable the preparation of financial statements that are free from material misstatement, whether due to fraud or error.

In preparing the financial statements, the Accountable Officer is responsible for assessing the CCG’s ability to continue as a going concern, disclosing, as applicable, matters related to going concern and Grant Thornton UK LLP. 3 using the going concern basis of accounting unless they have been informed by the relevant national body of the intention to dissolve the CCG without the transfer of its services to another public sector entity.

The Accountable Officer is responsible for ensuring the regularity of expenditure and income in the financial statements.

The Audit & Governance Committee is Those Charged with Governance. Those charged with governance are responsible for overseeing the CCG’s financial reporting process.

Auditor’s responsibilities for the audit of the financial statements

Our objectives are to obtain reasonable assurance about whether the financial statements as a whole are free from material misstatement, whether due to fraud or error, and to issue an auditor’s report that includes our opinion. Reasonable assurance is a high level of assurance, but is not a guarantee that an audit conducted in accordance with ISAs (UK) will always detect a material misstatement when it exists. Misstatements can arise from fraud or error and are considered material if, individually or in the aggregate, they could reasonably be expected to influence the economic decisions of users taken on the basis of these financial statements.

A further description of our responsibilities for the audit of the financial statements is located on the Financial Reporting Council’s website at: www.frc.org.uk/auditorsresponsibilities. This description forms part of our auditor’s report.

We are also responsible for giving an opinion on the regularity of expenditure and income in the financial statements in accordance with the Code of Audit Practice.

Report on other legal and regulatory requirements – Conclusion on the CCG’s arrangements for securing economy, efficiency and effectiveness in its use of resources

Matter on which we are required to report by exception - CCG’s arrangements for securing economy, efficiency and effectiveness in its use of resources

Under the Code of Audit Practice, we are required to report to you if, in our opinion we have not been able to satisfy ourselves that the CCG has made proper arrangements for securing economy, efficiency and effectiveness in its use of resources for the year ended 31 March 2019.

We have nothing to report in respect of the above matter.

Responsibilities of the Accountable Officer

As explained in the Governance Statement, the Accountable Officer is responsible for putting in place proper arrangements for securing economy, efficiency and effectiveness in the use of the CCG’s resources.

Auditor’s responsibilities for the review of the CCG’s arrangements for securing economy, efficiency and effectiveness in its use of resources

We are required under Section 21(1)(c) and Schedule 13 paragraph 10(a) of the Local Audit and Accountability Act 2014 to be satisfied that the CCG has made proper arrangements for securing economy, efficiency and effectiveness in its use of resources and to report where we have not been able to satisfy ourselves that it has done so. 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.

We have undertaken our review in accordance with the Code of Audit Practice, having regard to the guidance on the specified criterion issued by the Comptroller and Auditor General in November 2017, as to whether in all significant respects, 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 this criterion as that necessary for us to consider under the Code of Audit Practice in satisfying ourselves whether the CCG put in place Grant Thornton UK LLP. 4 proper arrangements for securing economy, efficiency and effectiveness in its use of resources for the year ended 31 March 2019, 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 be satisfied that the CCG has put in place proper arrangements for securing economy, efficiency and effectiveness in its use of resources.

Report on other legal and regulatory requirements – Certificate

We certify that we have completed the audit of the financial statements of NHS Walsall Clinical

Commissioning Group in accordance with the requirements of the Local Audit and Accountability Act 2014 and the Code of Audit Practice.

Use of our report

This report is made solely to the members of the Governing Body of the CCG, as a body, in accordance with Part 5 of the Local Audit and Accountability Act 2014. Our audit work has been undertaken so that we might state to the members of the Governing Body of the CCG 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.

John Gregory

Director

for and on behalf of Grant Thornton UK LLP, Local Auditor - Birmingham

23 May 2019

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Acronym Meaning A&E Accident & Emergency

AV Audio Visual

BC Black Country

CAS Clinical Assessment Service

CCG Clinical Commissioning Group

CQC Care Quality Commission

CQRM Clinical Quality Review Meeting

CSPR Child Safeguarding Practice Reviews

DoH Department of Health

DToC Delayed Transfers of Care

DWMHT Dudley & Walsall Mental Health Trust

EHCH Enhanced Health in Care Homes

FCP First Contact Practitioners

FYFV Five-Year Forward View

GP General Practitioner

GPFV General Practice Forward View

HCP Health Care Practitioner

HIU High Intensity User

HOSC Health Overview and Scrutiny Committee

IAF Integrated Assurance Framework

IAF Improvement & Assessment Framework

IAPT Improving Access to Psychological Treatments

ICP Integrated Care Partnership

ICS Integrated Care System

ICT Information and Computer Technology

IRIS Identify, Refer and Improve Safety

IT Information Technology

JSNA Joint Strategic Needs Assessment

LA Local Authority

LCS Local Care Strategy

LMS Local Maternity System

LOS Length of Stay

LSCB Local Safeguarding Children Boards

LTC Long Term Conditions

LTP Long Term Plan

MAS Memory Assessment Service

MASA Multi-Agency Safeguarding Arrangements

MASH Multi-Agency Safeguarding Hub

Glossary of termsAcronym Meaning

MBC Metropolitan Borough Council

MDT Multi-Disciplinary Team

MFD Multi-Functional Devices

MSA Mixed Sex Accommodation

MSFD Medical Fit for Discharge

MSK Musculo-skeletal

NAPP National Association of Patient Participation

NHS National Health Service

NHSPS National Health Service Property Services

ONS Office of National Statistics

OOH Out-of-Hours

OOM Outline Operating Model

PC Primary Care

PCN Primary Care Network

PHB Personal Health Budgets

POD Prescription Ordering Direct

PPG Patient Participation Group

PPLG Patient Participation Liaison Group

PVP Patient Voice Panel

QIPP Quality, Innovation, Productivity and Prevention

QOF Quality and Outcomes Framework

R2G Red To Green (used in SAFER)

RCP Right Care Programme

RCP Royal College of Psychiatrists

RRS Rapid Response Service

RTT Referral to Treatment

SAFER Patient Flow Tool

SAT Self-Assessment Tool

SDEC Same Day Emergency Care

SQRM Safeguarding Quality Review Meeting

STP Sustainability and Transformation Partnerships

TB Tuberculosis

UCC Urgent Care Centre

UECIB Urgent & Emergency Care Improvement Board

UTC Urgent Treatment Centre

VCS Voluntary Community Sector

WHT Walsall Healthcare Trust

WT Walsall Together

NHS Walsall Clinical Commissioning GroupJubilee House | Bloxwich Lane | Walsall | WS2 7JL

01922 618388

[email protected]

https://walsallccg.nhs.uk/

@WalsallCCG

@WalsallNHS

NHS Walsall Clinical Commissioning GroupJubilee House | Bloxwich Lane | Walsall | WS2 7JL

01922 618388

[email protected]

https://walsallccg.nhs.uk/

@WalsallCCG

@WalsallNHS

annual report - walsall ccg · week breach during the year. there are still many challenges ahead...

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