NHS Newham Clinical Commissioning Group

Annual Report and Accounts 2018/19

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Abbreviations used in this report

AGC Audit and Governance Committee

AGS Annual Governance Statement

BHR Barking and Dagenham, Havering and Redbridge

BHRUT Barking Havering and Redbridge University Hospitals NHS Trust

CCG Clinical Commissioning Group

CQRG Clinical Quality Review Group

CQRM Contract and Quality Review Meetings

ELFT East London NHS Foundation Trust

ELHCP East London Health and Care Partnership

EPPR emergency preparedness, resilience and response

F&D Finance and Delivery

FFT friends and family test

FRPB Financial Recovery Programme Board

FTE Full Time Equivalent

GB Governing Body

HWB Health and Wellbeing Board

IAF Improvement Assessment Framework

ICPB Integrated Care Partnership Board

JC Joint Committee

JCAF joint committee assurance framework

JCB Joint Commissioning Board

MRSA Methicillin-resistant Staphylococcus aureus (a type of bacteria that is widely resistant to antibiotics)

MSA mixed-sex accommodation

NEL north east London

NELFT NELFT NHS Foundation Trust

NHSE NHS England

NHSI NHS Improvement

NICE National Institute for Health and Care Excellence

PEF Patient Engagement Forum

PPI patient and public involvement

QI quality improvement

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QIPP quality, innovation, productivity and prevention (a large-scale transformation programme which aims to deliver a better quality service for less money)

RTT referral to treatment time

STP Sustainability and Transformation Plan

UEC urgent and emergency care

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Contents

Abbreviations used in this report ........................................................................................... 2

Introduction ........................................................................................................................... 5

Section A. PERFORMANCE REPORT .................................................................... 6 A1. Performance overview.................................................................................................... 7

A1(1) Accountable Officer’s perspective on performance ............................................. 7

A1(2) Managing Director’s local perspective on performance ....................................... 8

A1(3) The purpose, activities and objectives of the CCG .............................................. 9

A1(4) The key issues and risks of the CCG ................................................................ 18

A1(5) Going concern opinion ...................................................................................... 18

A1(6) Performance summary ...................................................................................... 18

A2. Performance analysis ................................................................................................... 22

A2(1) Financial performance ....................................................................................... 22

A2(2) How the CCG measures and checks performance ............................................ 23

A2(3) Other performance matters ............................................................................... 30

Section B. ACCOUNTABILITY REPORT .............................................................. 48 B1. Corporate governance report ........................................................................................ 49

B1(1) Members’ report ................................................................................................ 49

B1(2) Statement of Accountable Officer’s Responsibilities .......................................... 59

B1(3) Governance Statement ..................................................................................... 60

B1(4) Head of Internal Audit Opinion .......................................................................... 69

B2. Remuneration and staff report ...................................................................................... 70

B2(1) Remuneration report ......................................................................................... 71

B2(2) Staff report ........................................................................................................ 82

B3. Parliamentary Accountability and Audit Report ............................................................. 91

B3(1) Audit certificate and report ................................................................................ 91

Section C. ANNUAL ACCOUNTS ......................................................................... 92

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Introduction We are proud to present the 2018/19 annual report and accounts for NHS Newham Clinical Commissioning Group (CCG). It gives an overview of what we have achieved in the last 12 months as we continue to strive to make Newham a healthier and happier place to live and highlights how we have built on our strengths in governance, finance and performance to ensure high quality services that are continuously improving.

Newham is a unique, dynamic and diverse borough, and our health and social care services reflect the needs of our community. Over the last year we have continued to make significant progress working alongside patients, the public and health and social care providers to improve our understanding of what our community needs and to develop services that best meet those needs.

In January 2019 we were given a rating of ‘good’ by NHS England (NHSE) and our system leadership came to the fore during a year which Waltham Forest, Newham and Tower Hamlets CCGs come under one Managing Director. Each CCG retains its own Governing Body and the majority of decision-making still takes place at a local level. However, the three CCGs will work collaboratively together, alongside the NEL Commissioning Alliance, where it is in the best interests of patients to do so.

We also made great strides in improving people’s health and wellbeing through working in partnership with those who use our services, tapping into their personal assets and those of their communities, not least through social prescribing which involves activities typically provided by voluntary and community sector organisations.

We would like to thank all of our partners, the London Borough of Newham, local healthcare providers, Healthwatch and the voluntary and community groups that we have worked with over the last year. We have only achieved these successes by working in partnership with these dedicated professionals.

As we move into the new financial year we face a new and exciting time in the NHS where integration with local health and care partners is central to making the best use of resources and patients have ever greater opportunities for taking an active role in their health and care choices. We remain committed to doing our very best for local people and look forward to working together through 2019 and beyond.

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A1. Performance overview The performance overview offers an insight into the work, successes and challenges faced by Newham CCG, which are explained more fully in later sections of the annual report. The overview includes details about our core business, our financial performance, how we measure the CCG’s performance using the Improvement and Assessment Framework and that of the services we commission using standard key performance indicators.

A1(1) Accountable Officer’s perspective on performance

Newham CCG is part of the North East London Commissioning Alliance (NELCA) which brings together the following seven CCGs – City and Hackney, Newham, Waltham Forest, Tower Hamlets, Barking and Dagenham, Havering and Redbridge of which I AM the Accountable Officer. I am also the executive lead for the North East London STP – the East London Health and Care Partnership. I am delighted with the progress we have made by working closely together with our neighbouring CCGs and partners. Highlights of this collaboration are outlined below.

At a north east London (NEL) level the Joint Commissioning Committee (JCC), which brings together representatives from all our CCGs and local authorities, has now met several times in public. Key areas discussed in detail include: outpatients, maternity, cancer diagnostics and urgent and emergency care. The committee has also looked at things like performance and finance activity across the seven CCGs. The purpose of the JCC is to discuss common issues and, in a limited number of areas, take decisions on services that are commissioned once across NEL. The JCC meetings have been held in public with people given the opportunity to ask questions about the issues discussed.

Engaging and involving our local population is a key priority for us and working together as seven CCGs has enabled us to bring together our CCG Lay Members with a focus on developing a co-production charter – aimed at working in equal partnership with the people who use our services in order to create better outcomes.

Working together has been beneficial in a number of other areas such as the joint development of a north east London commissioning framework which brought together our commissioning ambitions across the whole system for the first time. We also successfully launched our integrated clinical assessment service (NHS 111) across all of north east London in the summer of 2018 and through working collaboratively we have also aligned approaches on areas such as acute mental health beds and health based places of safety.

Over the past year we have made great strides in developing our integrated care partnerships (ICP) – working collaboratively with our partners. These ICPs bring together our local authority and provider colleagues at a place based level to focus on a range of priorities and outcomes.

City and Hackney’s focus is on children and young people’s mental health, prevention, planned and unplanned care while BHR’s priorities include older people, frailty and end of life, children and young people, long term conditions, mental health, medicines optimisation, maternity and cancer.

We continue to work closely with our providers who are working hard to deliver quality services for our local population. In terms of CQC ratings we are delighted that East London Foundation Trust remains outstanding and NELFT and Homerton remain as good. BHRUT are making

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progress towards moving out of requires improvement and Barts Health NHS Trust has been taken out of quality special measures with the Royal London Hospital moving from requires improvement to good. This is testament to the hard work and dedication of all the staff.

Across our CCGs there have been a number of individual successes to celebrate. In Tower Hamlets, the success of the vanguards programme has been reflected in the refreshed GP contract launched this year. In BHR an NHS Financial Recovery Plan has been agreed with all local NHS organisations formally signed up to and committed to delivering this. Newham CCG celebrated their HSJ award win in the autumn for their work around tackling TB. City and Hackney has been recognised for its achievements in managing diabetes and Waltham Forest CCG has again been recognised for its successful cancer survival rates.

Looking ahead to 2019/20 we will continue to build on these successes and focus on implementing the requirements of the NHS Long Term Plan, using these as a basis for a refresh of our north east London plan. The direction of travel is to keep on developing our approach to integrated care partnerships and ensuring we are working with our partners to deliver the best care possible for our patients.

I would also like to express thanks and appreciation to our primary care members, CCG staff and members of the public for their ongoing commitment and dedication to improving the health and wellbeing of local people. We look forward to continuing to work together to innovate, explore and improve the health and care of people living and working in Newham.

The following report provides an overview of Newham CCG’s performance in 2018/19 as well as the annual accounts.

A1(2) Managing Director’s local perspective on performance

In Waltham Forest and East London (WEL), the collaborative group of CCGs that includes Newham, Waltham Forest and Tower Hamlets is building on our history of close working to maximise the benefits for patients and improve the quality of our services.

We know that our local populations continue to grow and often have complex health needs, meaning that we have to innovate and transform the way we deliver services, within the resources available. By working together we can make our resources go further and focus on improving the health outcomes of our local populations.

As we move forward with delivering the long-term plan and implementing strategic commissioning across WEL, we will continue to build on the partnership work we have seen over recent years through closer joined up working with providers, local authorities and the voluntary and community sector.

A key aspect of this is working under a single management team for WEL. The implementation of a single management team started with the appointment of the single managing director for WEL in December 2018 and it is anticipated the full team will be in place by autumn 2019. This will help to stabilise and embed new working practices across WEL that we believe will have a positive impact on how we commission, improving health outcomes for local people.

We are also systematically developing close and integrated working relationships with our health and care partners across inner north east London (INEL) to develop a whole system partnership approach to transforming services and improving the lives of people living in north

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east London.

City and Hackney, Newham, Tower Hamlets and Waltham Forest CCGs along with the Homerton, Barts Health, East London Foundation Trust and North East London Foundation Trust are part of the INEL System Transformation board (STB), which will work collectively to address the challenges facing the health and social care system. The STB replaces the former Transforming Services Together programme (TST), which has been responsible for a number of significant system successes across North East London including improvements to diagnostics and the introduction of the electronic referral system.

The INEL STB is currently setting the priority areas, which include: • Outpatients – aim of reducing outpatient face to face contacts by a third• Urgent care – taking responsibility for the urgent pathway to reduce unnecessary

attendance• Health and well-being of rough sleepers and homeless people – currently being scoped

with local authority and health leads• Clinical configuration and provider collaboration – we will continue to work across INEL

looking at surgical configuration across sites, mental health provision, and improvedutilisation of local capacity and maximised capital opportunities.

Achievements we have already made include: • Outpatients - a big increase in the utilisation (98%) of the paperless e-referral system by

Barts Health and the roll out of advice and guidance for GPs to determine if referrals arenecessary, via the e-referral system.

• Workforce – a 200% increase in the number of Physicians Associates employed intoprimary care settings since 2016.

While we are working through a time of change, introducing new ways of working and challenging existing system deficiencies, it is an exciting time for all those involved in developing health services as we work to meet the needs of our local population now and into the future.

A1(3) The purpose, activities and objectives of the CCG

Our history, background and structure

NHS Newham Clinical Commissioning Group (CCG) is a membership body, made up of local GPs, that plans and buys public healthcare services for around 353,000 people in Newham. We plan healthcare by working with local partners to identify the health needs of the population and forecast what services might be needed in the years to come. Find out more about the health challenges we face in Newham in the section about our population.

We are a clinically led organisation with a governing body made up of a majority of local GPs, a Managing Director, Selina Douglas, along with other independent members and representatives from partner organisations. All our Governing Body meetings are open to the public and all agenda items are available on our website. Our decision making structure is detailed in our members report.

We are part of the North East London Commissioning Alliance (NELCA) along with Tower Hamlets, Waltham Forest, City and Hackney, Barking and Dagenham, Havering and Redbridge CCGs. NELCA is led by Jane Milligan our Single Accountable Officer who is also the lead

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officer for East London Health and Care Partnership (ELHCP). Newham CCG recognises that some of our objectives to improve health outcomes for our residents can only be realised if we work constructively with our partners and being part of NELCA and ELHCP will allow us to achieve that. We also participate in the local Health and Wellbeing Board for the purpose of making sure that residents and patients get better and more joined up health and social care services.

Our key healthcare providers in Newham are Barts Health NHS Trust and East London NHS Foundation Trust who offer medical, surgical and emergency services for the local community and a range of mental health support for our residents and the GP Federation, Newham Health Collaborative. The main hospital in Newham is Newham University Hospital, part of Barts Health NHS Trust. East London NHS Foundation Trust is the provider for community based and mental health services in Newham. We also work with Healthwatch Newham, the London Ambulance Service, NHS England and with the London Borough of Newham as part of our health and care commissioning.

As a publicly funded NHS organisation we are first accountable to our patients and local people and at the core of our work is engagement with local health and care partners and the local community to provide quality services that best meet local need. You can read about our extensive engagement work in our section on engaging people and communities.

We are also responsible for making sure that the healthcare providers we buy services from offer value for money and give patients the right quality care. The standards we monitor are set out in national priorities through the national NHS operating framework, which you can read more about on NHS England’s website.

Our population

Newham with an estimated resident population of around 353,000 is the 18th largest borough in the country and fourth largest in London. It is the fifth youngest borough in the country with a median age of 30.8 years and second youngest in London. It is the most diverse community with 75% of the population from Black and Asian communities (BAME) which is the highest in the country. For the adult population BAME communities form 70% of the population. The estimated projections based on natural change (births and deaths) and internal and international migration suggest an increase of 15% for adult population from 2016 to 2026. The greatest percentage increase is expected in the 65 -74 years age group (27%) and lowest in the 18-49 years group (8%).

Newham has moved its’ ranking from being the second most deprived borough in England in 2010 to the 25th most deprived in 2015, which now places it in the second most deprived decile (20% most deprived) compared with most deprived decile (10% most deprived) as measured by the Index of multiple deprivation (IMD). As these measures are relative and not suitable for time trends, it cannot be said for certain how much of it is absolute change. Based on the 2015 IMD, Newham is performing well on education similar to other London boroughs, and falls in the middle range for employment and health based on proportion of small areas in Newham falling in the 10% most deprived decile in the country. It ranks lower in the income and ranks the worst for crime and barriers to goods and services. The health of people in Newham is varied compared with the England average, while life expectancy for both men and women is similar to the England average. The chart below provides some key health and population indicators and the comparative data for other local CCG populations, Greater London and England.

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Our commissioning activity

NHS Newham CCG is responsible for commissioning the full range of health services in order to meet the needs of the local population. This includes mental health, urgent and acute care, out of hospital, primary care, mental health, children’s and maternity and specialist services such as continuing healthcare, palliative care and services for people with learning disabilities and long-term conditions.

We have a commissioning committee that is responsible for leading, monitoring and approving commissioning decisions for the CCG. This committee oversees the development and delivery of the CCG’s commissioning strategy as articulated in the operating plan. While NHS Newham works locally to decide how most of the local NHS services are commissioned, where it makes sense and is in the best interest of patients we work with the seven CCGs as part of the North East London Commissioning Alliance through the joint commissioning committee to discuss common issues and, in a limited number of areas, take decisions on services that are commissioned once across NEL.

During 2018/19 we have been working to deliver services that support delivery of the Five Year Forward View. This means that we have been working towards a greater emphasis on prevention, through programmes such as the Diabetes Prevention Programme and Newham Community Prescription; we have been working towards greater service integration, providing networks of care that can be accessed out of hospital, through programmes such as our 24 hour mental health crisis line; and we have been empowering patients through IT and digital

Newham Tower Hamlets

Waltham Forest

Greater London England

Estimated population (2017) 353,245 317,203 283,524 8,835,500 55,609,600

% of population aged 0-15 (2015) 22.7% 20.1% 22% 13.9% 19%

% of population aged 65+ (2015) 7.3% 6.1% 10.3% 12.5% 17.7%

% of population from BAME groups (2017) 72.6% 53.6% 49.7% 42.5% ---

Unemployment rate (2015) 6.3% 9.7% 3.9% 6.1% 5.1%

Male life expectancy (2012-14) 79.2% 78.6% 79.3% 80.3 79.5

Female life expectancy (2012-14) 83.1% 82.3% 83.9% 84.2 83.2

Childhood obesity (2015-16) 28% 27% 26% 23.2 19.8

Prevalence of diabetes, age 17+ 8.6% 6.7% 6.8% 6.0 6.2

Under 75 mortality from preventable respiratory diseases per 100,000

19.8 25.2% 19.9% 171.8 183.9

Under 75 mortality from preventable cardiovascular diseases per 100,000

59.1 55.8% 54.5% 171.8 183.9

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improvements that have seen the introduction of online consultations with GPs for Newham residents.

As we move into 2019/20 we will be looking at how our commissioning of local services supports the delivery of the NHS Long Term Plan by continuing to invest in out of hospital access to care, improving access to primary care services, further developments in digital technology and reducing duplication by working closely with health and social care partners across north east London.

Working as part of the East London Health and Care Partnership

The ELHCP is made up of the eight councils, seven CCGS, three hospital trusts, two community trusts, London Ambulance Service, Community Voluntary Services, Partnership of East London Cooperatives and seven primary care Federations that serve over 1.9 million people in north east London, and this will rise to around 2.25 million people in the next 15 years putting exceptional pressure on our health and care services.

To address this, we must transform the way we work together to improve the health and wellbeing of local people and create services that are sustainable and affordable. Our partnership will make sure we can do this.

Since 2016, our partnership has delivered our Sustainability and Transformation Plan (STP) and its programmes and projects to transform the care and health services our communities rely upon. This has included work on workforce, mental health, urgent care, prevention and primary care.

We have:

• introduced new schemes to recruit and keep GPs in our boroughs and provide newtraining and development opportunities for midwives, physician associates and GPpractice managers

• ensured that every pregnant woman is offered information and choice of places to givebirth and we are leading the way across London in terms of continuity of carers with26.9% of pregnant women across East London receiving care from the same carersthroughout the three phases of the maternity journey. The London average is 18%

• secured over £5 million to develop a new Cancer early diagnosis centre and improveddelivery on the cancer 62 day standard

• enhanced our NHS 111 service so you not only get advice from a clinician but you canmake appointments at some of our urgent care services

• secured over £7m to improve our digital infrastructure, ‘switched-off’ paper referrals forhospital outpatient appointments and doubled the number of views of the electronicpatient record making it easier for clinicians to provide better advice and treatment – nomatter where they are working

• Improved support on stopping smoking and diabetes.

All of this complements and enables the local planning and delivery in each CCG. But we want to do much more and the NHS Long Term Plan published in January 2019 gives us the opportunity to refresh our Sustainability and Transformation Plan with much greater involvement of local people and stakeholders than before. For more information visit www.eastlondonhcp.nhs.uk

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Our corporate objectives and how we measure success

NHS Newham CCG worked towards two corporate objectives during 2018/19:

1. To commission a Newham based integrated health and care system that delivers high quality services for the people of Newham, in accordance with statutory requirements

2. To commission and develop GP services that are modern, accessible and for the future in caring for the local population

Commissioning a Newham based integrated health and care system that delivers high quality services for the people of Newham, in accordance with statutory requirements Central to establishing integrated care in Newham is the Newham Wellbeing Partnership (NWP). The partnership comprises Newham Clinical Commissioning Group (CCG), London Borough of Newham, East London NHS Foundation Trust (community services provider), Barts Health and Newham Health Collaborative (the Newham GP Federation). It enables commissioners and providers to work together to improve the health and wellbeing of the people of Newham. Over the last 12 months, the partnership has focussed on the development and delivery of the integrated care system reviewing service modelling/redesign and exploring the structural options available for integration in the delivery of local health and care services. Together we have explored the different forms that integration can take e.g. the development of a prime provider model for MSK. Lessons from this have influenced the development of a new approach to our plans for community services (being considered through our Building Healthy Communities programme) moving the focus from a contractual form (Multispecialty Community Provider, MCP) to a co-produced model. Nationally the healthcare delivery landscape has changed, moving away from contractual models of integration to a clarity of what should be considered at neighbourhood, place/borough, system and regional levels. The NHS Long Term Plan will focus on creating genuinely integrated teams of GPs, community health and social care staff. This will be supported by a strengthened approach to prevention to reduce health inequalities and support the general health and wellness of the people of Newham. As part of its development the NWP has strengthened its relationship with the Newham Health and Wellbeing Board and the Cabinet lead for Adults and Health, Cllr Susan Masters is now a member of the NWP. The role of primary care has also been strengthened with CCG GP Board members joining the NWP alongside Newham Health Collaborative demonstrating their commitment to ensuring primary care is at the heart of integration. The Primary Care at Home pilots support this development.

Commissioning and developing GP services that are modern, accessible and for the future in caring for the local population Our focus is that wherever possible residents’ first point of care is accessing via their GP or health and wellbeing hub offering a range of services. Our vision is that residents’ who require on-going management of identified health and care needs takes place with their GP or in a health and wellbeing hub, rather than in a hospital setting. Central to providing this level of access and support for local residents is the investment into high quality, modern primary care facilities.

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During 2018/19 we have been part of a ground-breaking £200m venture between local health and social care providers that is set to dramatically change the provision of health and social care in the borough by acquiring and building new facilities to deliver integrated health and social care – moving us closer to providing health and wellbeing hubs for the people of Newham. Proposals for the £200 million scheme were developed by Newham CCG with Newham Council and local GPs and have now led to the creation of ‘Health and Care Space Newham’ (HCSN), a partnership between Newham Council and East London NHS Foundation Trust (ELFT) that will be responsible for managing the acquisition and development of the new hubs. HSCN will develop facilities that offer GP services alongside a range of community health, social care, out of hospital, and clinical services creating health and wellbeing hubs that will better meet the needs of local people. The facilities will also provide much-needed housing for sector staff. It is envisaged that this new development model will change the way health and social care services are delivered in Newham. Newham CCG have also been working with GPs on improving and investing into digital technology in order to make accessing the NHS more convenient, providing better digital services and offering improved access to medical records. One development that has meant patients have a much shorter wait for a doctors’ appointment is online consultations. Working in collaboration with NHS Newham CCG and digital healthcare solutions company Egton, local GPs have introduced an online triage service, where patients can digitally send information about their symptoms and concerns to GPs via an online consultation system that can be completed at any time 24 hours a day, seven days a week. GPs then personally identify those patients who require a face-to-face appointment, those who can be referred to a pharmacist or other specialists for appropriate treatment or advice, and those who require paperwork such as test results or repeat prescriptions. At Stratford Village Surgery, who have been an exemplar in introducing the new technology, the new system has cut average waiting times for appointments from two weeks to one or two days and all urgent cases are now seen on the day and feedback is really positive with patients praising the ease of use and speed of service. We have also been working with local GPs on introducing AccuRx, which allows GPs to send text messages directly to patients, reducing the need for letters and phone calls and giving patients immediate access to information they need. Evaluation of the new technology has shown significant benefits to using this text messaging approach, with patients no longer having to call or go to the surgery to check if a prescription is ready as they can now be sent a text confirmation instead. Using this digitally integrated system is allowing GPs to communicate directly with their patients, helping practices to become more efficient and better meet the needs of our local population by reducing the need for clinical administrative support – freeing up staff so they can focus on longer more complex tasks. At Woodgrange Medical Practice, who have been leading the way on introducing AccuRx, they have seen an estimated time saving of two hours per day through the reduction of administrative support needed to provide clinical services to their patients. Our investment into introducing and supporting new and innovative ways to deliver modern and efficient healthcare services to local people is set to continue and 2019/20 will see the launch of video consulting.

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With the imminent introduction of primary care networks influencing the delivery of future primary care services, closer working on integration and quality with our local GP Federation (Newham Health Collaborative) and the continued investment into supporting innovation that delivers better local services this is an exciting time for primary care.

Measuring success To measure our success the CCG has a performance framework in place that aims to embed the golden thread of ‘improving health and wellbeing outcomes with and for local people’ across our governance structures and the business of the CCG. The ‘golden thread’ provides a way of working across the CCG, and aligns our strategic and enabling priorities to the seven outcomes approved by the board and the measurable metrics. The seven outcomes that underpin our work are:

1. We will spend the Newham pound wisely, ensuring value for money and maintainingfinancial balance

2. We will have a borough based Integrated Care System that is utilised, understood andvalued by our residents

3. We will ensure we plan, design, and commission accessible high quality services for ourresidents with our residents

4. We will improve access to, and the quality of, primary care5. We will clearly be able to demonstrate how we have improved outcomes for our

residents6. We will support our entire CCG workforce to deliver what we need to for our residents7. We will promote equality as a commissioner of health services and as an employer

We will spend the Newham pound wisely, ensuring value for money and maintaining financial balance

For 2018/19 the CCG was allocated £517.6 million to commission services for the population of Newham. The CCG used its allocation to serve our residents while maintaining financial balance. Although 2018/19 was a challenging year we managed to achieve financial balance, while delivering our corporate objectives and improving care for local people. Examples of our successes and challenges can be seen throughout this report.

We will have a borough based Integrated Care Partnership that is utilised, understood and valued by our residents

The CCG has progressed the development of our local Integrated Care System jointly with our local authority. During 2018/19 we have focussed on setting up and empowering the partnership to make real sustainable change. Moving forward we are aiming to improve local services through integrated commissioning and ensure local residents are aware of and engaged in the partnership’s work. More detailed information about the integrated care system is included above.

We will ensure we plan, design, and commission accessible high quality services for our residents with our residents

Newham CCG are responsible for commissioning a wide range of services for local people including primary care, acute care and mental health services. The full list of services we commission is available on our website here. Over the last year we have worked with local providers, delivered care that achieves the vision of the five year forward view (which was

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developed with patient groups taking account of their needs) and worked with local residents to commission services that are making a real difference right here in Newham for local people. Below are just a few examples of how we are working to commission high quality care for and with local communities. In January 2019 we introduced the end of life advanced care pathway to provide support for individuals and their families who have chosen to be cared for at home as they approach the end of their life. The service was developed following feedback from a family who had been directly affected by the lack of provision for end of life support, which had caused considerable distress, and who wanted to see better provision for others in the same position. Prior to the launch of the service when families had concerns they would have to call an ambulance and go to A&E, but now they can contact a healthcare professional who can offer access to pain medication along with immediate guidance and/or support in the home avoiding the need for unnecessary hospital visits, especially at such a traumatic time for all involved. In Newham approximately 70,000 local residents experience a common mental health problem each year and 29,000 residents are affected by anxiety and depression at any one time. For residents with mental health support needs we now commission a 24/7 mental health crisis line, offering immediate access to mental health support. The helpline is for people of any age who require confidential expert advice and guidance, support and referrals to local services if needed. The service aims to provide the right care at the right time and prevent people spending unnecessary time at the Emergency Department. This service was developed in direct response to the recommendations in the five year forward view. Over recent months we have been working with local residents to commission a community based minor eye conditions service that removes the need to go to hospital when needing this type of care. A period of engagement was undertaken to find out whether local residents were wanted to see this service provided by optometrists in the community. The response was overwhelming positive with respondents stating that this would be better as it would reduce waiting times, improve access and reduce the need to travel to hospital. The minor eye conditions service is now being commissioned and is due to be launched early in 2019/20.

We will improve access to, and the quality of, primary care

Along with the developments detailed in the section above on our corporate objectives that are helping us deliver on our vision we have also been piloting a piece of work called ‘primary care at home’, which aims to:

• Improve access, responding to rising demand for appointments • Support a patient centred care approach • Enhance service quality, and new forms of consultation or advice • Optimise workflow within primary care • Encourage greater patient self-management

We also piloted an intensive case management approach, which provided a more holistic approach for ‘complex need patients’ who, too frequently, have to navigate fragmented pathways and at times struggle to manage alone in the community. This work provided easier access for patients who needed support to navigate the system by offering one point of access and case workers who understood their needs as a holistic package. Both pilots have been well received, by both staff and patients and a full review with recommendations will be delivered by summer 2019.

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We will clearly be able to demonstrate how we have improved outcomes for our residents

There are many areas where Newham CCG has made a difference to the health outcomes of local people and examples of our work can be seen throughout this annual report. We are particularly proud of the work that we have been doing on diabetes prevention. There is strong international evidence that demonstrates how behavioural interventions, which support people to maintain a healthy weight and be more active, can significantly reduce the risk of developing the condition. The Healthier You: NHS Diabetes Prevention Programme (NHS DPP) identifies those at high risk and refers them onto a behaviour change programme. Newham CCG (as part of the NEL STP) is one of the pilot boroughs for the diabetes prevention programme. We also provide the Newham Community Prescription (NCP) programme to support those at the greatest risk of developing Type 2 diabetes with access to lifestyle and health advice along with a programme of physical activity. We have achieved all the NICE recommended treatment targets for 2018/19 and for our work to prevent diabetes we have been rated as outstanding by NHS England. We have introduced specialist employment support for patients with a mental health diagnosis, which is making a significant difference for those individuals who have been able to take advantage of this service. The service was introduced following a successful bid for NHS England funding to expand specialist employment support for residents under the care of community mental health teams. In its first full the service (provided by MIND) has supported over 100 residents, many of whom have gone on to successfully gain and retain employment. The service provides one-to-one support alongside practical support through the job application process, the team then contacts employers and negotiate on a patient’s behalf to explore any necessary reasonable adjustments required to enable them to secure employment. The team continue to provide support beyond the job application process for as long as required by the individual. Having purpose and securing employment is central to personal health and wellbeing therefore we will be allocating additional funding on top of the NHS England bid for 2019/20 to ensure the service is able to grow and succeed. We have reduced our rate of latent TB significantly since 2014 and in 2018 won a HSJ award to recognise our achievement. As the TB capital of England, Newham has taken a lead on implementing and delivering a programme of testing and treating latent TB - by taking a prevention approach through raising awareness, providing screening and treatment we are improving the health of the local population and seeing progress year on year. In 2018/19, 83% of people diagnosed with latent TB completed a treatment programme compared with 75% in 2017/18. We are set to continue to address this health issue here in Newham and across London as due to our success we have been given the responsibility of lead commissioner for TB care.

We will support our entire CCG workforce to deliver what we need to for our residents

Here at NHS Newham we have a Board approved vision and set of values developed with our staff over the last year that build on the principles and core values for the NHS, but are specific to our organisation. Developing the values has allowed us to focus our attention to what matters most to staff across the organisation and captures this in a set of values and behaviours that can be seen in our working lives every day. As well as reinvigorating our values and setting our direction we have invested in our workforce by delivering training throughout the year that aids in personal and professional development and demonstrates our ongoing commitment to investing in and valuing our staff. We have also

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provided a range of activities and support mechanisms that contribute to each individuals’ personal health and wellbeing. More recently we have undertaken a staff survey to identify how we can continue a programme of work that meets the needs of our staff, helping them to deliver the best possible services, outcomes and quality for local people. We recognise that only by investing in our workforce and empowering them to deliver can we truly do our best as an organisation.

We will promote equality as a commissioner of health services and as an employer

We recognise that to improve health and wellbeing outcomes for Newham residents, particularly people who are most disadvantaged, requires building and establishing effective partnerships. That’s why we work closely with a wide-range of partner organisations to challenge health inequalities and help people lead healthy and happy lives. We also ensure that our commissioning plans address health inequalities and we undertake equalities impact assessments on all procurements. Read more about our work to tackle health inequalities.

A1(4) The key issues and risks of the CCG

The CCG has developed robust systems to support the delivery of effective and efficient risk management. Whilst these systems are in place, and have been assured by the CCG’s internal auditors a number of key risks remain. These risks we have identified are:

• Compliance with the NHS Constitutional Standards • The effective delivery of an integrated health and social care system • The effective delivery of our primary care strategy • The integration of our 111 service with our urgent care centre

Further detail on the CCG’s response to these risks, and assurance regarding our approach to risk management can be found in the accountability report (section B).

A1(5) Going concern opinion

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. The Statement of Financial Position of NHS Newham CCG as at 31 March 2019 shows a net liability position. This is as a result of the timing of working capital, and the very low level of non-current assets held, and not as a result of going concern or cash flow issues.

A1(6) Performance summary

CCGs are accountable for how they spend public money and achieve good value for money for their patients. They have a wide range of statutory duties they are required to meet. CCGs measure and monitor performance against a range of national and local key performance indicators (KPIs) that measure the quality and performance of services offered to local people.

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NHS England assess CCGs performance based on the Improvement Assessment Framework (IAF), and based on this provide an overall rating for the CCG. The IAF ratings are published the following financial year, therefore the 2018/19 CCG rating will be published in 2019/20, however for 2017/18 Newham CCG was rated as ‘Good’. This section summarises key performance issues, with more detailed information later in this report, particularly in the performance analysis section (A2).

Financial performance

2018/19 represented a difficult financial year for Newham CCG. It was a year in which we faced significant financial pressures emanating primarily from the acute sector must notably within the non-elective care setting. Within prescribing, the NCSO (no cheaper stock obtainable) issue has continued into 2018/19, this issue is supplier driven and in summary dictates that branded drugs have to be issued instead of cheaper generic drugs. 2018/19 was also a year where we showed remarkable financial resilience in delivering our duties. Newham CCG has delivered 99% of its 2018/19 QIPP delivery target (c. £12.6m). Newham CCG has achieved all of its statutory financial duties including delivering its planned surplus whilst maintaining an adequate and effective framework for risk management, governance and internal control.

CCG Improvement and Assessment Framework

Through a number of measures, NHSE assessed the Newham CCG’s performance in 2018 against the indicators in four domains: better health, better care, sustainability and leadership. Overall performance at NHS Newham CCG has been rated as ‘Good’ in the 2017/18 published results against the improvement and assessment framework (IAF). There are many areas where the CCG are performing well with our quality of leadership maintaining a green rating, along with our finances for meeting all of our financial targets and we have been highlighted as an exemplar at how we involved patients and the public in our work. Newham CCG also saw the biggest improvement with stakeholders (as part of the 360 stakeholder survey) to the question ‘If I had concerns about the quality of local services I would feel able to raise my concerns with the CCG’ with a change of 9.7% (up from 82.2% to 91.9%) demonstrating our commitment to working with and listening to our stakeholders. In our elective work we have remained compliant with the RTT standard and we have been commended on implementing an MSK triage high impact intervention, which was a requirement of the 2017/18 Elective Care Demand Management programme. In our mental health work we delivered the IAPT access standard over eight out of 12 months and delivered the IAPT recovery standard in 11 out of 12 months. We have also consistently met the six and 18 week waiting time standards for IAPT and consistently delivered the Dementia Diagnosis Rate standard (66.7%) and the Early Intervention in Psychosis (EIP) standard of treating 50% of patients within two weeks of referral. While we have received lots of positive feedback we also have a number of areas where we could be doing much better for local people. We have decreased the GP referral variance moving from 10.3% in April 2017 to 2.2% in March 2018, however, we have further work to do to move GP referrals to within the 2% threshold. We also need to improve our performance

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against the children’s mental health access rate, which was 14.6%, against the standard of 30%% when we were assessed. Additionally we know that we are the poorest performing CCG in London for overall experience of GP surgery with 73% rating Newham GPs as good/fairly good in the GP Patient Survey.

In relation to safeguarding, NHS England encouraged us to continue to develop our leadership and capacity to implement the requirements of Chapter 3 of the statutory guidance (Working Together to Safeguard Children, HM Government, 2018), which requires CCGs to work, as equal partners, with the police and the Local Authority to put together a safeguarding partnership and to set the safeguarding arrangements and we are already working with local partners to strengthen our safeguarding work. We can confirm that we as equal partners, with the police and the Local Authority have agreed to commission a piece of work that will strengthen our multi-agency safeguarding arrangements for children in Newham so that we can respond to emerging trends, risks and working as effectively as possible with the other statutory partnerships in the borough including the Safeguarding Adults Board, the Health and Wellbeing Board and the Community Safety Partnership. Additionally we have agreed in principle to work with health and Local Authority partners across the Waltham Forest, East London and the City (WELC) comprising City and Hackney, Newham, Tower Hamlets and Waltham Forest to develop WELC Child Death Review arrangement across the footprint.

Primary care performance

Overall 82% of Newham practices visited by the CQC up to 31 March 2018 were rated ‘good’ or ‘outstanding’. Out of the 12 practices inspected between 1 April 2018 and 31 March 2019, 42% of these were rated as ‘good’. However, we are currently ranked 191 of 196 CCGs nationally and 32 of 32 CCGs in London in respect of our CQC ratings. These ratings reflect local performance issues around leadership, safety and access. Where issues are identified we work closely with the practice to ensure that action is taken immediately to ensure safe and effective care is provided to patients.

The progress of practices rated as ‘inadequate’ or ‘requires improvement’ is monitored through a Practice Quality Improvement Group. Over the last year two of these practices have closed and the remainder are being actively monitored. We continue to work with all practices rated poorly by the CQC to resolve the issues identified and deliver improved care for patients.

The GP Forward View 10 high impact areas identify a number of ways to improve patient care and increase efficiency. The CCG commissioned a correspondence management programme which upskilled non clinical staff to improve document workflow and reduce GP administrative workload. Within the last year 28 practices and 125 staff have participated in the training. The feedback from practices has been positive and GP administration workload has reduced for practices covering over 221,000 patients. Improvements to date have included a up to a 65% reduction in administrative workload for GPs, the release of 2.5 hours per week of GP time, upskilling practice workforce and improvement in morale within administrative staff. It is hoped that this programme along with other areas of improvement detailed under quality improvement will start to see improvements to our primary care ratings by the CQC and in patient surveys.

KPI performance

Our local and national key performance indicators are on our contracts with our providers to ensure there is commitment by the CCG and providers to deliver against these standards. The CCG receives performance data and information, which is reported by the providers on a

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monthly or quarterly basis, we monitor this data and information to assure ourselves that the standards and targets are being achieved. We have a number of contractual forums with our providers where we hold our providers to account on delivery against the performance indicators and discuss actions to improve when standards and targets are not being met. With Barts Health we have a number of forums where we monitor delivery against national and local standards, such as the Contract Review Group and KPI Review Meetings, similarly with ELFT we have Service Performance Review Meetings. We also have the same approach with all our commissioned services to monitor delivery of against contract and the expected standards. The performance analysis section that follows contains more detailed information and explanations on performance issues and management.

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A2. Performance analysis

A2(1) Financial performance

2018/19 represented a challenging financial year for Newham CCG, a year in which we faced significant financial pressures but showed financial resilience in delivering our duties. Newham CCG has achieved all of its statutory financial duties in 2018/19 including delivering its planned control total whilst maintaining an adequate and effective framework for risk management, governance and internal control.

Funding

We are accountable for what we do with public money. In 2018/19, we achieved good value for money for our patients. We had a revenue resource limit of £517.6 million from NHS England (comprising the CCG’s total income for the year in addition to its brought forward surplus of £7.2m). This was made up of recurrent funding allocation (the money we get each year) of £503.2 million and £14.4 million of non-recurrent funding. The recurrent allocation equated to £1,230 per registered person in Newham for patient care (excluding admin costs). Non-recurrent funding is for specific in-year activities and does not form part of our long-term planning. In April 2018, the Governing Body agreed our annual operating plan that set out how we will commission services over the coming year in order to deliver on our commissioning strategy. These plans included achieving a surplus of £7.3 million for financial year 2018/19, which we have met.

How we spent the money

In 2018/19 Newham CCG spent its money as follows:

How we did

As a CCG we have a number of financial duties that we must achieve:

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• Capital Resource Limit: To remain within the CCG’s overall capital resource limit, in 2018/19 this duty has been achieved.

• Revenue Resource limit: To remain within the CCG’s overall revenue resource limit and to deliver the planned surplus, in 2018/19 this duty has been achieved.

• Cash limit: We did not have a cash funding limit; an internal cash limit was set by NHS England for internal controls purposes. However, we have managed our cash position efficiently so as not to affect the payment of creditors.

Financial pressures

2018/19 has been a challenging year with significant financial pressures emanating from the following expenditure categories:

• Acute Providers – mainly driven by non-elective activity • Continuing Health Care (CHC) – mainly driven by increased activity and London living

wage • Primary Care – mainly driven by activity in extended primary care schemes.

Future years

NHS Newham CCG’s in-year funding allocation for the financial year 2019/20 will be £533.9 million, an increase of 6.1%. In its dual role as local NHS commissioner and key partner in local public services delivery, our challenge is to improve the quality of services and meet the needs of our local population, while managing demand and the changing health system so that it is much more efficient and effective. In the past three years, we achieved sound financial positions and we maintained this in 2018/19. The plan for 2019/20 is to deliver 1.8% QIPP efficiencies in year. Wider reforms and tight financial settlements across the public sector will continue, although we aim to set plans to withstand the impact of constraints in resourcing that may be applied.

A2(2) How the CCG measures and checks performance

The performance management framework

NHS Newham CCG continues to work collaboratively with local partners, such as Barts Health NHS Trust, East London Foundation Trust and Tower Hamlets, Waltham Forest and City and Hackney CCGs, to ensure high quality healthcare services for people living in Newham. Newham CCG has systems in place to measure and monitor quality of services delivered by providers to influence and improve standards. This includes:

• clinical quality review meetings; these allow us to hold providers to account for the quality of their services

• our quality performance and finance committee; where we review quality based on our ‘approach to commissioning for quality’ strategy, as well as request and receive reports pertaining to the quality of services and provide assurance to the Governing Body as a result

• contractual levers; which are used to drive up quality in areas where improvements have taken some time to come to fruition. This has been done through supportive or facilitative processes

• quality assurance visits; these are undertaken with our providers through a structured framework, enabling us to see first-hand any improvements made and understand the quality of services

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• quality key performance metrics; these are based on national/regional and local standards and inserted into contracts with providers whose performance is then monitored on a monthly basis

• feedback from member practices; carried out through a system called Amber Alerts. A GP practice is able to alert us to a potential quality issue in a provider organisation and we seek investigation outcome responses and changes in processes if indicated from the provider for each of these alerts.

• patient feedback; this is invaluable in providing intelligence that is used in conjunction with other quality information to form a picture of services. This helps to determine if there are any potential areas of concern we need to explore.

• Attendance at a number of provider committee meetings to give greater assurance and support the provider in resolving and escalating issues that may involve commissioning processes or decisions

The performance management framework is based on the following; NHS constitutional targets, the Improvement and Assurance Framework (IAF), and other national policies such as the NHS Planning Guidance.

CCG Improvement and Assessment Framework

The CCG IAF outlines the metrics that inform NHS England’s assessment of CCGs in 2018/19. The framework covers a total of 58 indicators located in four domains: • Better health: this section looks at how the CCG is contributing towards improving the

health and wellbeing of its population, and bending the demand curve • Better care: this principally focuses on care redesign, performance of constitutional

standards, and outcomes, including in important clinical areas • Sustainability: this section looks at how the CCG is remaining in financial balance, and is

securing good value for patients and the public from the money it spends • Leadership across the ICS: this domain assesses the quality of the CCG’s leadership, the

quality of its plans, how the CCG works with its partners, and the governance arrangements that the CCG has in place to ensure it acts with probity, for example in managing conflicts of interest.

Local rating Overall performance at NHS Newham CCG was rated as ‘Good’ in the 2017/18 published results against the improvement and assessment framework (IAF). You can read more about our rating, our successes and challenges in the performance summary (section A1(5)). This year a small number of indicators have been added and a number of updates made to existing indicators, but the aim has been to maintain a high degree of continuity from previous years. This enables comparison over time. Cancer Mental Health Dementia Learning

Disabilities Diabetes Maternity

Requires Improvement

Requires Improvement

Outstanding Requires Improvement

Outstanding Requires Improvement

Cancer Newham CCG has been rated as requires improvement for cancer as we are not doing well enough at diagnosing cancer early at an early stage and we are not meeting the standards for

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the one-year survival rates. Across the STP the need to assist patients in identifying symptoms at a much earlier stage and provide our clinical staff with sufficient support to refer patients early is a key focus. Newham are working to provide some population awareness for 2019/20 across the year to increase patient awareness of signs and symptoms of cancer to help support staging early. Barts Health NHS Trust are also due to launch a diagnostic service aimed at supporting GPs refer patients early for unspecified cancers to help aide patient care. In terms of one year survival we recognise the importance of improving this target and how this is not simply a short term fix and links to identifying patients at an earlier stage to increase the possibility of survival. Since the IAF ratings being released Newham CCG one year survival has seen a significant improvement overall and in three of the key tumour sites (colorectal, breast, cervical) based on data released by the Office of National Statistics. This has shown a marked increase of exceeding the national proportional increase and in one year survival for lung this is an improvement three times the national average. Whilst there is still some work to get up to the national average this represents a significant improvement as Newham has previously seen the gap remain between national and local CCG survival in comparison to Newham CCG staff.

Mental health Newham CCG was rated as ‘requires improvement’ for mental health services in 2017/18 because of a failure to meet two key targets. The first was the target for increasing the number of people using Increasing Access to Psychological Therapies (IAPT) services. The second was the requirement for the CCG to develop its crisis services so that they met certain milestones. In 2018/19, commissioners have worked closely with the provider of IAPT services, East London NHS Foundation Trust, to ensure that more residents have been able to access the service. The hard work of the service has ensured that access rates have increased, while recovery rates and waiting times have been maintained. Extra investment is also planned for 2019/20, which will ensure that continued expansion can be sustained. While Newham CCG was not in a position to invest heavily in crisis services in 2018/19, the Mental Health Crisis Line was launched in December 2018. This allows residents experiencing a mental health crisis to speak to a qualified mental health professional at all hours of the day, seven days a week, either through NHS 111 or by calling the number directly. Significant investment has been agreed for 2019/20 that will enable a full transformation of crisis care and home treatment provision in Newham.

Learning disabilities In order to improve the CCG’s performance rating for learning disability services, commissioners have been undertaking a number of actions over the last year. To reduce unnecessary hospital admissions for residents with learning disabilities, we have increased the number of Care and Treatment Reviews (CTRs) undertaken in the community. These reviews have often resulted in increased support for residents at risk of hospital admission, and have enabled more people to remain living in the community. We have also worked closely with the new GP Clinical Lead for Learning Disabilities to monitor and increase the take up of physical health checks for people with learning disabilities. In the first six months of 2018/19, health checks had increased by 10 per cent in comparison to the same period of the previous year. Currently a review of adult learning disability health services is underway, which will highlight areas for further development and improvement. The move towards integrated commissioning between Newham CCG and the London Borough of Newham this year is also expected to bring

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additional benefits through improved links between health and care services for people with learning disabilities.

Maternity The IAF rating for maternity relates to outcomes for women and babies that focus on infant mortality, numbers of women smoking and rates of breastfeeding. We are working in close collaboration with Bart’s Health Trust and specifically Newham Hospital to improve our local maternity services. We are reviewing with Newham Hospital the implementation of the recently updated Saving Babies Lives Care Bundle, which outlines five key areas that improve these outcomes. This includes support to stop smoking in pregnancy (CO screening and intervention) which is the key modifiable factor in reducing infant mortality. The Care Bundle also includes service initiatives such as supporting parents to identify reduced fetal movements, services better identifying small for gestational age babies and effective monitoring of babies in labour (CTG). These are all in place locally and we need to ensure they are having the required impact. The updated Care Bundle also includes a focus on preventing prematurity which we will focus on in 2019 and beyond. We are also pleased to say in Newham that our maternity and community health services (health visiting) have reached stage two of the baby friendly initiative. This global programme is evaluated as increasing rates of breastfeeding and improving support. All local services are committed to reaching the final level three stage in 2020. There is more to do to make sure all infant feeding support is appropriate for all local women and families and we will be reviewing local support to ensure it meets local needs.

Future development of the framework The framework needs to be flexible to maintain its relevance and alignment to the highest local priorities for CCGs and their partners in STPs/ICSs. NHS England (NHSE) and NHS Improvement (NHSI) are developing with STPs/ICSs a set of principles that will underpin oversight:

• NHSE and NHSI speaking with one voice, setting consistent expectations for local health systems

• greater focus on the performance of the local healthcare system as a whole, alongside the performance of individual providers and commissioners

• working with and through the STP/ICS leadership, wherever possible, to tackle problems in individual organisations or localities, rather than making uncoordinated national interventions. This will thereby stimulate the further growth of self-governing systems.

This will be informed by a new integrated oversight framework that will form a key part of the regular performance discussions between NHSE, NHSI and STPs/ICSs. Alongside this, NHSE, NHSI and STPs/ICSs will continue to review trust-level data – and CCG-level data – to help agree when individual organisations need support or intervention and who should provide that support or intervention. Regulators envisage that this new framework will evolve to reflect a population-based approach to improving health outcomes and reducing health inequalities. Development of this framework will be informed by the long-term plan for the NHS, issued in January 2019, to ensure that the ambition described for the NHS is captured in the metrics that they use to assess and oversee CCGs and healthcare systems in the future.

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Trust performance against the KPIs

Key performance indicators are drawn from a range of frameworks including those contained within the CCG Improvement and Assurance Framework (IAF).

RTT Patients have a right to start their non-emergency NHS consultant-led treatment within a maximum of 18 weeks from referral, unless they choose to wait longer or it is clinically appropriate that they wait longer. The national standard is that 92% of patients should start their treatment within this time. As at March 2019 Newham CCG overall performance year to date is at 84.20%. This is largely to do with the Barts Health NHS Trust performance, which is at 85.4% as at March 2019. Following the identification of significant RTT data quality issues the Barts Health NHS Trust Board took the decision, with support of the NHS Intensive Support Team to suspend national RTT reporting as of September 2014. Since this time significant progress has been made to improve data quality and secure a single robust waiting list. This has included the validation of hundreds of thousands of pathways, as well as the implementation and standardisation of robust patient administration and waiting list management processes. As a result of the progress made the Barts Health Trust Board ratified the decision to return to national RTT reporting in May 2018. This decision was further supported by the findings of the commissioner procured external assurance. While the return to national reporting is a positive step, it is important to note Barts Health will not be compliant with the 92% RTT standard. A substantial recovery programme continues to support recovery of the standard in 2019/20 and to ensure that no patients are waiting more than 52 weeks by the end of the 2018/19 financial year.

Diagnostic waiting times Early diagnosis is important to patients and central to improving outcomes, for example early diagnosis of cancer improves survival rates. Bottlenecks in diagnostic services can significantly lengthen patient waiting times to start treatment. The purpose of this data is to measure waits and monitor activity for 15 key diagnostic tests (further information on the test can be found here (https://www.england.nhs.uk/statistics/statistical-work-areas). The national standard is that 99% of patients should have had their diagnostics within 6 weeks of referral. As at March 2019 Newham CCG overall performance year to date is at 99.26% above the target of 99%, with Barts Health year to date performance above target at 99.34%.

A&E total waiting times The national standard relating to A&E is that 95% of people should be seen and treated or discharged within four hours. Barts Health performance as at March 2019 is 83.4%. An A&E Improvement Plan is in place, which is being monitored at the A&E Delivery Board attended by Barts Health and Newham CCG. The Newham Hospital site will be looking at different pathways out of the Emergency Department to improve A&E performance over the coming year.

Cancer waiting times Cancer performance is one of the eight national priorities for delivery. There are eight national cancer waiting times standards against which performance is monitored.

• Two weeks from urgent GP referral for suspected cancer to first appointment (93%)

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• Two weeks from referral for breast symptoms (whether cancer is suspected or not) to first appointment (93%)

• 62 days from urgent GP referral for suspected cancer to first treatment (85%) • 62 days from urgent referral from NHS Cancer Screening Programmes to first treatment

(90%) • 62 days from a consultant's decision to upgrade the urgency of a patient to first

treatment (no operational standard set) • 31 days from diagnosis (decision to treat) to first treatment for all cancers (96%) • 31 days from decision to treat/earliest clinically appropriate date to second/subsequent

treatment (surgery or radiotherapy) (94%) • 31 days from decision to treat/earliest clinically appropriate date to second/subsequent

treatment (drug therapy) (96%)

Mixed-sex accommodation

From December 2010, the collection of Mixed-Sex Accommodation (MSA) data was introduced. This enabled the routine reporting of all occurrences of unjustified mixing of genders (i.e. breaches) in sleeping accommodation by providers of NHS funded health care. MSA breaches are reported to the CCG on a monthly basis and reported to our Quality Performance and Finance Committee. From April 2018 to February 2019 (the most recent data we have) there were 255 mixed sex accommodation breaches reported for Barts Health (Royal London, Whipps Cross, and Newham hospitals), of which 84 were at Newham University Hospital. The main reason for the breaches is delayed availability of a ward bed (of the right sex) for patients ready for discharge from the Intensive Care Unit. There has been significant work carried out across the Trust and services in the community in order to support timely discharges, which will support a reduction in mixed sex accommodation breaches. ELFT have reported no braches of mixed sex accommodation from their mental health or community inpatient facilities.

Friends and family test The friends and family test (FFT) measures how likely a patient would be to recommend the ward or department to their friends and family if they needed similar care or treatment. At Barts Health, the FFT is provided across inpatient wards, emergency care and in the maternity department. From April 2018 to December 2018, an average of 89% of inpatients’ responses recommended Barts Health (last year’s average percentage was 91%). The Newham University Hospital inpatient recommendation average was approximately 89% (last year’s average was 93%). Both are below the England average of 95%. During the same period, at Barts Health A&E department, an average of approximately 70% of responses recommended the service – the Newham University Hospital average was around 65%; both are below the England average of 86% for the same period. In maternity services provided by Barts Health, an average of 95% of respondents recommended the services – the Newham University Hospital average was 98%, against the England average of 97%. Barts Health changed the provider of its FFT survey in late 2017 to one that uses mobile text messages instead of paper surveys, which has had a major impact on the response rate, which in turn negatively affects the percentage recommended. The Trust has been supplementing the text message surveys with paper surveys and collating those manually, most successfully in maternity services, which is reflected in the recommendation rate, but the continued low

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response rate means that the recommendation rate is less reliable due to being based on fewer responses. At East London Foundation Trust the FFT is provided across all boroughs (Newham, City and Hackney, Tower Hamlets and Luton and Bedfordshire) for mental health inpatient and community services as well as Newham and Tower Hamlets community services. On average, 89% of responses for mental health services recommended the Trust (previous year average was 86.3%). This compares with 89% for the England average. For the Trust’s community services, 100% of responses recommended the Trust (previous year average was the same at 93.5%) compared with an NHS England average of 95.5% for the same period. Response rates remain quite low and the Trust is working to improve their response rates so that results are more reflective of the number of patients being cared for.

Incidents of MRSA The target set by NHSE for all trusts is zero tolerance of cases of MRSA. Barts Health reported five (5) MRSA BSI cases that have been assigned to the Trust (April 2018 – January 2019): two at Royal London Hospital, two at Whipps Cross Hospital (WXH) and one (1) in the neonatal unit at Newham Hospital (NUH) – the investigation is in its final stages. In addition, twelve (12) community-onset cases have been identified this year (April – December 2018) that have been assigned to the CCGs of the patients’ attribution. All cases were reviewed by the clinicians and the CCGs’ Infection Prevention and Control Team (NEL CSU on behalf of Newham CCG) to identify any learning and areas for improvement. The Trust has a 12-month rolling rate of 0.2 per 100,000 bed days, lower than the England average of 0.3. Learning from the investigations is part of the CQRM process.

Incidents of C. difficile Barts Health has a threshold of 81 hospital-apportioned cases for the year. April 2018 to December 2018, the Trust has reported 42 cases of trust-apportioned CDI, 19 cases under the threshold of 61 year to date. This is a significant reduction on previous years. All cases were reviewed and any ‘lapse in care’ identified. Examples of actions taken in response to lapses in care include providing education for the medical wards, including presentations from the antimicrobial pharmacist and practice development nurse.

Incidents of venous thromboembolism Providers must comply with guidance in relation to venous thromboembolism; perform root cause analysis of all confirmed cases of pulmonary embolism and deep vein thrombosis acquired in hospital and where there is a history of hospital admission within the last three months, and perform local audits of patients’ risk of venous thromboembolism and of the percentage of patients assessed for venous thromboembolism who receive the appropriate prophylaxis.

Mental health - Improving Access to Psychological Therapies (IAPT) The NHS England target is that by the end of 2018/19 19% of those with a reported common mental illness (such as depression or anxiety) should have access to talking therapies. In Newham, between April and March 2019 over 6,700 residents had initiated a course of treatment at Newham Talking Therapies (delivered by East London Foundation Trust), achieving a 19.5% access target for the year. The CCG has committed to increasing its investment in talking therapies during 2019/20 to enable the service to meet the rising access rate of 22% by the end of the March 2020.

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Mental health - Early Intervention Psychosis The standard is for 53% of people experiencing a first episode of psychosis to be treated with a NICE-approved care package within two weeks of referral. From April 2018 53% of people experiencing a first episode of psychosis should be treated with a NICE-approved care package within two weeks of referral. In Newham the service (delivered by East London Foundation Trust) consistently meets and exceeds this waiting time target, with on average 79.7% of patients initiating treatment within two weeks of referral. The CCG has committed to increasing its investment in Early Intervention in Psychosis services during 2019/20.

The London Ambulance Service The London Ambulance Service (LAS) is commissioned by Brent CCG on behalf of all London CCGs. They monitor and manage performance on our behalf. The national standard is that 75% of calls which are life-threatening (Cat A) should be responded to within eight minutes.

Ambulance response times

The ambulance standards intend to: • Prioritise the sickest patients quickly to ensure they receive the fastest response. • Ensure national response targets to apply to every patient for the first time – so ending

‘hidden waits’ for patients in lower categories. • Ensure more equitable response for patients across the call categories. • Improve care for stroke and heart attack patients through sending the right resource first

time. The four categories for LAS performance is:

• Category 1 is for calls about people with life-threatening injuries and illnesses. • Category 2 is for emergency calls. • Category 3 is for urgent calls. • Category 4 is for less urgent calls.

During 2018/19 LAS the year to date position shows LAS performed within the national standard for six of the nine response time measures. For further information on the indicators please refer to the guidance here https://www.england.nhs.uk/statistics/statistical-work-areas/ambulance-quality-indicators/

A2(3) Other performance matters

Sustainable development

As an NHS organisation, and as a spender of public funds, 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 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. Demonstrating that we consider the social and environmental impacts ensures that the legal requirements in the Public Services (Social Value) Act (2012) are met.

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We acknowledge this responsibility to our patients, local communities and the environment by working hard to minimise our footprint. As a part of the NHS, public health and social care system, it is our duty to contribute towards the level of ambition set in 2014 of reducing the carbon footprint of the NHS, public health and social care system by 34% (from a 1990 baseline) equivalent to a 28% reduction from a 2013 baseline by 2020. It is our aim to meet this target by reducing our carbon emissions 28% by 2020-21 using 2007/08 as a baseline year.

Policies In order to embed sustainability within our business it is important to explain where sustainability features in our processes and procedures. Area Is sustainability considered? Travel No Procurement (environmental) Yes Procurement (social impact) Yes Suppliers impact Yes

One of the ways in which an organisation can embed sustainability is through the use of a Sustainable Development Management Plan (SDMP). We will be developing an SDMP in the near future for consideration by the Board. Climate change brings new challenges to our business both in direct effects to the healthcare estates, but also to patient health. Examples of recent years include the effects of heat waves, extreme temperatures and prolonged periods of cold, floods, droughts etc. Our Board approved plans address the potential need to adapt the delivery of the organisation’s activities and infrastructure to climate change and adverse weather events. One of the ways in which we measure our impact as an organisation on corporate social responsibility is through the use of the Sustainable Development Assessment Tool (https://www.sduhealth.org.uk/sdat/) (SDAT) tool. The last time we used the SDAT self-assessment was in 2016/17 scoring 35%. As an organisation that acknowledges its responsibility towards creating a sustainable future, we help to achieve that goal by running awareness campaigns that promote the benefits of sustainability to our staff. We have not assessed the social and environment impacts for the organisation. Our statement on Modern Slavery is: Ensuring a living wage is paid for work provided, ensuring our providers also comply with the Modern Slavery Act (2015) We have not currently issued a statement on meeting the requirements of the Public Services (Social Value) Act.

Partnerships As a commissioning and contracting organisation, we need effective contract mechanisms to deliver our ambitions for sustainable healthcare delivery. The NHS policy framework already sets the scene for commissioners and providers to operate in a sustainable manner. Crucially for us as a CCG, evidence of this commitment will need to be provided in part through contracting mechanisms.

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Strategic partnerships are already established with the following organisations: East London Health and Care Partnerships. For commissioned services here is the sustainability comparator for our providers; please note this is published a year in arrears;

Organisation Name SDMP

On track for 34% reduction

SDAT Healthy transport plan

Adaptation SD Reporting score

Barts Health NHS Trust n/a n/a n/a n/a n/a n/a

Homerton University Hospital NHS Foundation Trust

No

No Sustainable Development Management Plan

n/a No No Minimum

East London NHS Foundation Trust

No On track to meet target n/a No No Poor

London Ambulance Service NHS Trust

No

Target included but no on track to be met

n/a No No Minimum

Moorfields Eye Hospital NHS Foundation Trust

No On track to meet target n/a No No Good

University College London Hospitals NHS Foundation Trust

No

Target included but not on track to be met

n/a No No Good

More information on these measures is available here: http://www.sduhealth.org.uk/policy-strategy/reporting/sdmp-annual-reporting.aspx

Performance

Organisation

As part of the NHS, public health and social care system, it is our duty to contribute towards the level of ambition set in 2014 of reducing the carbon footprint of the NHS, public health and social care system by 34% (from a 1990 baseline) equivalent to a 28% reduction from a 2013 baseline by 2020. It is our aim to meet this target by reducing our carbon emissions 0% by using as the baseline year. Here is how we have done:

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Commissioned activity

Organisation Name

Building energy use

Building energy use per WTE

Water Water use per WTE

Percent high cost waste

Waste cost increase

East London NHS Foundation Trust

0-10% increase

1.3 0-20% increase

14 >75% high cost

0-20% decrease

Homerton University Hospital NHS Foundation Trust

>10% decrease

2.2 0-20% increase

29 >89% high cost

>20% increase

Moorfields Eye Hospital NHS Foundation Trust

>10% increase

5.3 >20% increase

25 <=75% high cost

Data not available

London Ambulance Service NHS Trust

>10% decrease

1.4 0-20% decrease

16 <=75% high cost

Data not available

University College London NHS Foundation Trust

0-10% decrease

3.8 0-20% increase

27 >75% high cost

>20% increase

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Energy

Newham CCG has spent £31,356 on energy in 2018/19. This is a 34% decrease on energy spend from the 2013/14 baseline year. We will continue to look at ways that we can reduce the impact we have and to maximise the social, environmental and economic assets available to us.

Resource 2013/14 2014/15 2015/16 2016/17 2017/18 2018/19

Electricity & Gas

Use (kWh) 370,354 341,340 314,634 228,765 170,502

tCO2e 207.4 211.4 180.9 131.5 98.05 Total Energy CO2e

207.4 211.4 180.9 131.5 98.05 121.46

Total Energy Spend

£ 42,012 £ 41,596 £ 41,044 £ 37,187 £23,300 £31,356

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Emergency preparedness, resilience and response

Under the Civil Contingencies Act (2004) NHS organisations must show that they can deal with such incidents while maintaining services to patients. This work is referred to as ‘emergency preparedness, resilience and response’ (EPRR). CCGs have to meet a number of EPRR core standards and NHSE is responsible for ensuring that the CCG meets these via an annual assurance process, where a rating of compliance is issued. Following the 2018/19 process the CCG has been issued with a compliance rating of ‘substantial’.

Improving quality

NHS Newham CCG continues to work collaboratively with local partners, such as Barts Health NHS Trust, East London Foundation Trust and Tower Hamlets, Waltham Forest and City and Hackney CCGs, to ensure high quality healthcare services for people living in Newham. Newham CCG has systems in place to measure and monitor quality of services delivered by providers to influence and improve standards. This includes:

• clinical quality review meetings; these allow us to hold providers to account for the quality of their services

• our quality performance and finance committee; where we review quality based on our ‘approach to commissioning for quality’ strategy, as well as request and receive reports pertaining to the quality of services and provide assurance to the Governing Body as a result

• contractual levers, which are used to drive up quality in areas where improvements have taken some time to come to fruition. This has been done through supportive or facilitative processes

• quality assurance visits; these are undertaken with our providers through a structured framework, enabling us to see first-hand any improvements made and understand the quality of services

• quality key performance metrics; these are based on national/regional and local standards and inserted into contracts with providers whose performance is then monitored on a monthly basis

• feedback from member practices; carried out through an automated system called amber alerts. A GP practice is able to alert us to a potential quality issue in a provider organisation and we seek outcome responses from the provider for each of these alerts

• patient feedback; this is invaluable in providing intelligence that is used in conjunction with other quality information to form a picture of services. This helps to determine if there are any potential areas of concern we need to explore

• attendance a number of provider committee meetings to give greater assurance and support the provider in resolving issues and escalating issues that may involve commissioning processes or decisions

In delivering the above we work closely with Healthwatch who attend quality assurance visits with us, provide the CCG with patient experience intelligence in order to identify areas for improvement and are a member of the CCGs governing body. Healthwatch are members of our clinical quality review meetings where issues relating to patient experience can be discussed. For information on CCGs’ performance against a number of indicators, please visit the My NHS website which publishes data on NHS performance. All CCGs are assessed against a number

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of metrics in the following groups: better care, better health, sustainability and well-led, and each is then given an overall score. The overall score for Newham CCG is ‘Good’.

Quality improvement in primary care Quality improvement (QI) provides a systematic approach and tangible outcomes that can be used to analyse performance against local and national benchmarks and the CCG has been working with University College London Partners (UCLP) and practices to implement QI projects at practice and cluster level. The quality Improvement programme, assists practices with developing and undertaking a Plan-Do-Study-Act (PDSA) cycle to improve internal processes. Newham CCG has an ambition to formally build on the quality improvement capability and capacity that exists across all its practices. To help its workforce further develop the skills and confidence to lead change, it invited practice staff to participate in both a practice-based QI project and a geographic cluster-based project supported by Quality Improvement Champions (QIC). In order to support practices in delivering their practice and cluster QI projects, 11 QI Champions have been trained and affiliated to each cluster. Cluster projects have included increasing the delivery of Learning Disability Health Checks, increasing the uptake of cervical smear, increasing the number and quality of care plans for palliative care patients and reducing the number of ‘frequent flyers’ accessing Urgent Care. All projects have seen improvements in patient care, e.g. one practice ensured that 100% of all discharge summaries received by the practice resulted in a medicines reconciliation - this had a positive impact on medical secretarial workload and released 7.5 hours of time per week. The 2018/19 programme QI projects will be shared at a final summit on 2 May 2019.

Engaging people and communities

We engage patients and communities who experience the worst health outcomes as identified by the jointly developed Joint Strategic Needs Assessment. We don’t just expect patients and the public to come to us; we go to the places where communities come together. Following the successful procurement of our new Patient and Public Engagement provider, over 2018/2019 we led a successful mobilisation period achieving full service delivery by the first quarter of 2019. The Newham Patient View service is a pioneering initiative as it brings together global and local expertise in social mobilisation and community engagement. Intelligent Health and West Ham United Foundation along with the Staywell Partnership (a partnership of local grassroots community groups), lead the service creating an engagement powerhouse that will take our PPE beyond engagement to empowerment. The offer includes bespoke community engagement through West Ham United Foundation’s community outreach and networks, Patient Participation Group capacity development and an online platform for people to have their say on Newham Patient View.

Developing a new minor eye conditions service closer to home In December 2018 NHS Newham CCG asked Intelligent Health to use a combination of community outreach and their web platform “Newham Patient View” to deliver a survey to gauge the opinions of residents on the future commissioning of a Minor Eye Conditions Service (MECS) in the borough. The service would mean that patients would potentially be referred to a community optician/optometrist by their GP instead of being sent to A&E or other hospital eye services.

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West Ham United Foundation (WHUF) completed face-to-face engagement at a number of their existing community groups and by attending other community groups and services to speak to community members. The engagement took place in the following locations:

• WHUF “Any Old Irons” Christmas Lunch – 50 engagements • WHUF Walking Football Tournament – 19 engagements • Katherine Road Community Centre – Women’s only group – 20 engagements • Minhaj Al Quran Mosque – 9 engagements • 150 Club Newham Community Prescription – 21 engagements

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Researchers also completed waiting room engagement in three GP surgeries in Newham. These were identified for engagement as they were in the top ten surgeries in the borough for referrals to hospital eye services. In total 150 people responded to the MECS survey. All of these respondents stated that they were registered with a GP in Newham. In order to ensure that responses came from a wide variety of demographics and that respondents were reflective of the diversity of the population of Newham, respondents were asked demographic questions. Respondents were asked whether they thought the introduction of a community-based minor eye conditions service in Newham was a good idea.

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The response was overwhelmingly positive. Respondents were also asked why they thought a MECS was a good idea:

• “Better to go local.” • “Moorfields too far. Bother for patient’s transport. A lot of pressure for people to get

there.” • “Closer to home. Easy for me as I have kids.” • “This will take pressure off the main NHS services – enable specialist advice – speed up

waiting times – give the patient more confidence in diagnosis/treatment.” • “Will help mobility impaired from travelling too far.” • “To avoid the long queue at A&E.”

Next steps All survey respondents were given the opportunity to opt-in to participate in further engagement opportunities to develop the service - 28 respondents opted-in to participate. The engagement report has been shared with the lead commissioner and the feedback will be used to design the new service.

Re-procurement of community cardiology, dermatology, gynaecology and minor surgery services For a number of years, patients in Newham have had the option of going to a GP practice or local health centre to access cardiology, dermatology, gynaecology and minor surgery services, rather than going to hospital for these services. Without a community service, patients normally have to wait 18 weeks for routine treatment from referral by their GP to see a healthcare professional about their condition. Since we started offering these services locally waiting times have been reduced by an average of 10 weeks. In March 2019 the existing contract expires and we are planning to re-procure them. We are determined to get the best services in place for patients so before we go out to procurement, we reviewed the current pathway for all four services led by robust patient and public engagement. Over January 2019 we surveyed 151 patients across four clinic sites to understand their experience about the service. The full engagement report is available on our website.

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Survey to understand the experience of children and young people who attend A&E at Newham University Hospital (NUH) Over April 2019, we will be surveying children, young people and their families visiting Newham University Hospital’s accident and emergency department.

We know that unscheduled care attendances at A&E has increased year on year. Our data tells us 30% of unscheduled care activity at Newham University Hospital’s accident and emergency department is for children and young people under 18 years old, while 10% of all activity is for under 1’s – 50% were discharged back to the GP or required no follow up. The aim of this engagement activity is to examine inappropriate attendance of children and young people at A&E so that each child and young person receives the most appropriate advice and treatment in the right place, at the right time.

We have spent the first quarter of 2019 planning the engagement activity with the Emergency Department team at NUH. The survey will also give participants an opportunity to get involved in face to face engagement sessions over 2019. Feedback from all platforms will be used to shape the demand management programme.

Removing barriers to participation Our approach to patient and public engagement, enables us to bring the voices of some of the most vulnerable members of the community to the decision making table. The case studies below illustrate the different ways we are working to remove barriers to participation. Moreover, the three lenses approach to our equality analysis process in decision making and governance requires all commissioners to make decisions based on an analysis of the equality, engagement and health inequalities duties.

Improving primary care access for deaf patients - Since 2016 the CCG has been working in partnership with deaf patients via the Newham Deaf Forum and Healthwatch Newham to understand deaf patients’ experience of accessing primary care services. Deaf patients have told us, they find it challenging communicating with healthcare professionals and frontline staff in primary care. Though the CCG commissions a language and interpreting services in all GP practices in Newham, patients have told it’s not always easy accessing BSL support in practices.

As a result of what deaf patients have told us over 2018/2019 we:

• Developed a protocol for reception staff for booking interpreters via the Language Shop,with specific reference to BSL support. The protocol illustrates what the bookingprocess should look like to ensure a seamless service for patients (based on feedbackfrom deaf patients).

• In partnership with deaf patients, we developed ID cards for deaf patients that will makeit easier for them to access information and communication support, as well as raiseawareness in GP practices.

• We have co-produced our deaf awareness training offer for practice staff. Developed inpartnership with the Royal Association of Deaf People (RAD) the sessions will bedelivered at the end of March 2019 and in April 2019 by RAD and willcover: terminology, deafness – what is it, British Sign Language, communication andinterpreters – how to book/work with them. Outcomes of the sessions will empowerpractice staff with the skills to communicate well and serve customer needs, meet ourduties under the Equality Act 2010 and demonstrate that we are committed to inclusion.

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Designing new approaches to community participation

We have partnered with Citizens UK, experts in community organising, to develop an alternative way to mobilise our community. Following Board approval, we are working in partnership with Citizens UK and Birkbeck College to develop a model for participatory budgeting to help us engage more meaningfully with a diversity of voices. We are hopeful that the techniques of community organising, which harnesses the social capital in our communities by drawing on the power of community leaders to bring communities together, will bring us closer to our patient and public engagement vision to put the community at the centre of what we do.

Over the last quarter of 2018 a number of house meetings with a diverse range of community leaders and groups have been held, 90 people attended including young people, older people, the homeless and migrants. Participants have identified three issues that they would like the Board to consider in our commissioning intentions: Post-Traumatic counselling services for refugee communities, loneliness and a breast-feeding programme. Next steps include a scoping meeting with the mental health and maternity commissioners followed by a presentation and discussion at the April 2019 Board.

Newham Older People’s Reference Group

In partnership with Newham Council, we joint fund local groups to participate in co-production. One of the groups includes Age UK who facilitate the Older People's Reference Group, the largest service user/patient group in the borough with over 100 members. The CCG has engaged extensively with its members around hospital discharge, NHS 111 and the Urgent Care treatment Centre procurements, as well as our primary care and estates strategies. For 2018/2019 engagement and involvement activity please see the engagement tracker in downloads.

Newham Carers Service - putting Carers first

Newham has approximately 24,555 residents who are informal carers, this includes over 1,200 young carers. In partnership with Newham Council we commission Newham Carers Network, a local carer-led voluntary organisation.

The primary function of the service is to raise awareness of and identify carers in the borough; and to support them to recognise their needs, provide information, advice and referral to activities and services (universal, specialist and targeted), as well as provide feedback about health and care services.

The contract expires on the 31 March 2019, so we went out to procure a new service at the end of December 2018. Five carers were involved in the procurement as evaluators during two evaluation workshops in January 2019, as well as evaluating the bids. Prior to the procurement, to help us develop the service specification extensive engagement was done with carers from April to July 2018 as outlined in the engagement tracker on our website.

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Training for PPG members

Our PPE provider, Intelligent Health delivered three pilot training workshops to support the development of PPGs. Both practice staff and patient representatives from ten practices across the borough, were in attendance. The workshops provided practices with in depth knowledge of the fundamentals of PPGs, patient engagement and involvement, the importance of PPGs within GP practice culture and how to fully utilise their PPGs for effective patient engagement. The workshops also provided peer support, showcased examples of alternatives to the traditional PPG structure of meetings and generated new ideas and initiatives: e.g. coffee mornings, guest speakers, themed meetings, walking groups.

The workshops equipped PPG practice staff and patient members with the tools, skills and knowledge to:

• Effectively engage with individuals reflective of their patient demographics• Improve their PPG member retention levels.• Recruit new PPG members.• Raise awareness of their PPG’s.• Develop stronger community networks across the borough

Maternity Voices Partnership (MVP)

The MVP operates to support commissioners, clinicians and management leads to establish a user-led approach to informing their commissioning priorities. We commission a local voluntary sector organisation, Social Action for Health (SAFH), to deliver the MVP to enable the forum and local women to have autonomy and independence from maternity providers and commissioners.

The Newham MVP members agreed to focus on improving the following areas over the course of 2018/19:

• Increased use of Barking Community Birth Centre (BCBC) – a Newham UniversityHospital midwifery led unit

• Perinatal Mental Health support• Infant Feeding services• Ensure compassionate care as standard

The outreach information on Barking Community Birth Centre (BCBC) told us that 65% of women asked did not know about the existence of BCBC. Following a discussion at the MVP meeting with local mums and services, changing the name of the birth centre was suggested. The group felt that having the word Barking in the title is confusing for local women, resulting in women thinking that BCBC is only available to families from Barking. Discussions are on-going with the Associate Director of Nursing for Women’s and Children’s Services at Newham University Hospital, to change the name and re-launch the birth centre to increase awareness and use.

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The Perinatal Mental Health feedback resulted in a co-production sub-group with local mental health providers and mums with lived experience, working together to improve services. Priorities for the group are; information sharing, mapping perinatal mental health resources in Newham and supporting professionals and community groups to work together to improve perinatal mental health of local women. The next meeting is in March 2019, the group have already mapped referral pathways into local services, started to look at how to incorporate role-play into mental health training for midwives. Also, Newham Talking Therapies want to produce a video for their site about mental health and getting help involving local families from Newham.

Reducing inequalities and the health and wellbeing strategy

Health inequalities can cut across a range of social and demographic indicators including socio-economic status, occupation, geographical location and protected characteristics. There is clear evidence that reducing health inequalities improves life expectancy and reduces disability across the social gradient. Tackling health inequalities is therefore a core priority for Newham CCG to improve access to services, health outcomes and improve the quality of services and the experiences of people. Newham CCG’s discussions and decisions are driven by our commitment to improve the health and wellbeing outcomes for our diverse local communities. We keep local people’s needs at the heart of our strategies and plans to promote equality and reduce health inequalities. The implementation our equality and diversity strategy ensured that its objectives and our local priorities were aligned with the priorities of NHS England. The 2018/19 action plan from the strategy is aligned with our commissioning cycle and to ensure equity and equality in access to services by vulnerable and disadvantage groups, such as with our Minor Eye Conditions Service. Newham CCG has worked with ethnic groups including:

• new migrants as Gypsy and Romany Traveller community. • disabled people including people with learning disability and sensory impairment • lesbian gay and bi-sexual and transgender people • pregnant people and mothers of new born • children and young people • older people • delivered better access to primary and hospital care services and seven days a week

out of hours and urgent care • developed more joined up services • had better involvement of patients in the planning of treatment and care services • improved satisfaction amongst patients

We have involved patients from a number of communities in:

• better and inclusive engagement activities • continuous feedback from patients about commissioning • more effective utilisation of commissioning resources

You will find a good example of this in our community services survey page of our website and community services engagement report.

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Newham CCG understands the local population and has put in tangible interventions to address concerns from those who experience most inequalities. This is evidenced in our Governing Body meeting paper June 2018, item 3.4 pages 36-45 Equalities Action Plan paper. We recognise that to improve health and wellbeing outcomes for Newham residents, particularly people who are most disadvantaged, requires building and establishing effective partnerships. That’s why we work closely with a wide-range of partner organisations to challenge health inequalities and help people lead healthy and happy lives. In the 2018/19 we worked closely with local partners to achieve the best health outcomes for local people, taking account of national and local drivers on integrating health and social care as part of our approach. In our Equality, Diversity and Inclusion Strategy 2018-21 we developed an action plan to give voice to those who are possible the least likely to be heard and work with them to identify and address health inequality:

• The Citizens UK report demonstrates how we engaged to increase diversity of voices inputting to our commissioning intensions by using community based organisations and leaders to develop a participatory budgeting model.

• Working in partnership with Newham Council and carers we re-procured the Newham Carers Service ‘Newham Carers Service – putting carers first'.

• Based on feedback from deaf service users, we produced ‘Deaf Communication Cards’ for patients to help them get the support they have a right to - an interpreting service, CCG commissions to improve access in primary care. Deaf awareness training for practice staff including a deaf communication ID card for deaf patients, see 'improving primary care access for deaf patients'.

• We commission Social Action for Health a voluntary sector organisation that involves women in decisions about their care through 'Maternity Voices Partnership’. Social Action for Health engagement PPE outcomes 2019'.

• We provide easy to read versions of documents on our website, as per the NHS prescribing consultation. Our previous annual report, JSNA and our three lenses approach to our work ensures our PPE tackles inequalities to give a voice to those not always heard.

• In partnership with Newham Council we commission an Older People's Reference Group, see engagement 2018/19 tracker in 'Newham Older People's Reference Group' to provide a range of fitness services and health information in a familiar and trusted environment.

We feedback to patients and the public, including those who have been involved, about the difference their involvement has made to our work through various channels:

• Commissioners attend Healthwatch Advisory Group meetings, as well as their public events, to give an update on our plans to members/public (more information available at Healthwatch Update Advisory Group Meeting and Healthwatch Public Event).

• Building Healthier Communities following service modelling sessions, options model will require wider engagement, groups to include those we engaged during first PPE phase.

• We held our Annual General Meeting in public in September 2018 at a long standing community centre, patients and the public had the opportunity to hear about our plans as well as discuss issues important to them

The CCG reviews its involvement activity, including how effective it has been, and takes action in response to what it has learnt:

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• We ask commissioners to give us feedback on their PPE process/impact, community services survey - commissioner feedback will be used to improve future PPE projects.

• PPG members at our capacity development workshops told us they want a peer support network, we held a follow up workshop with members to explore what a network should look like, click on Training Report pages 8-9 under Training.

Feedback is communicated using creative and diverse methods:

• We developed Newham Patient View, our new online engagement platform to not only empower people to have their say but to also develop NPV as an online feedback platform.

• We used twitter to promote a workshop we delivered to coproduce with PPG members ideas for a PPG network

• During engagement activities we ask participants if they wish to get involved in future meetings. Following our recent MECS engagement activity, 28 people signed up to be involved further to shape the service. We will invite this group to participate in face to face meetings and evaluations.

Clear evidence of the difference that public involvement has made to commissioning, decision making and/or services:

• Engagement with deaf patients led to borough wide investment by the CCG to train practice staff in deaf awareness, sessions to be delivered by Royal Association for Deaf People, fourth point under 'improving primary care access for deaf patients'

• Social action for health PPE outcomes report outlines the impact of the feedback collated by this voluntary organisation

We scored above average (80%) for overall engagement in NHS England’s 360 Stakeholder Survey 2017/18 (Governing Board meeting papers form June 2018, item 3.5 p.80) and always strive to seek the views of patients and the public, and their representatives, about our approach to public involvement.

How we were involved in developing the HWB strategy

In Newham we have considerable health inequalities and are increasingly seeing greater income disparities. We are committed to tackling these health inequalities and work closely with the council and other partners through the Health and Wellbeing Board to drive forward improvements to health and social care services. A key part of the work on tackling health inequalities has been to collaborate with our partners on the Health and Wellbeing Board. The CCG is a joint chair of the Board and works with partners from London Borough of Newham, East London Foundation Trust, Healthwatch Newham, UCLPartners, University of East London and local voluntary organisations. We have worked effectively with partners and stakeholders to agree a Joint Strategic Needs Assessment that has enabled the Board to set wellbeing and health priorities that address key health challenges. There is a commitment from all partners that a ‘prevention’ strategy is vital as part of a sustainable approach to tacking health inequalities. We are working with our providers to ensure that they are compliant with the legal requirements such as the public sector equality duty and we make continuous progress by adopting the NHS England’s mandatory standards.

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As part of ensuring our commissioning plans address health inequalities, we undertake equalities impact assessments on all procurements that take into account:

• health outcomes • statutory and demographic specific equality groups • health inequalities • travel and access

We are committed to upholding the Human Rights Act 2000 and we have complied with all equality legislation including the Equality Act 2010 to ensure that we commission the best possible health care services for the people of Newham. During 2019/20 we will be reviewing and updating our equality strategy – making sure we continue to align with public health priorities and the CCG equality objectives for 2018-21.

Equality disclosures

As a clinical commission group we have a duty to have regard to the need to reduce inequalities between patients with respect to their ability to access health service, and to be more responsive to the needs and wishes of the public, all of whom will use our services at some point in their lives. We recognise that it is more important than ever to integrate equality considerations into all aspects of our commissioning and we will do this through the implementation of our Equality Delivery System (EDS2) and the Workforce Race Equality Standard (WRES). We have worked hard to ensure that public, patient and carer voices are at the centre of the services we commission. Commissioners are required to make decisions based on an analysis of the equality, engagement and health inequalities duties that mandates them to:

• complete equality impact assessments which then informs PPE action plans • complete in all board and committee reports a section that asks for evidence to

demonstrate how the three lenses approach have been met. No policy decision is made without an equality analysis of the policy. We regularly scrutinise our existing and new policies to ensure there is no unintended negative or disproportionate impact on groups that are protected by the Equality Act. At the CCG, our staff also receive appropriate training and support to complete equality analyses. The Governing Body report cover sheet includes a section specifically about equality impact to prompt managers to carry out an equality analysis of the policy or the function they are reporting to the Governing Body. We maintain a log of all our equality analyses and ensure the actions arising from the analyses are implemented and monitored. We have adopted the Equality Delivery System (EDS2) to manage our equality and diversity performance within the organisation and assess our performance against EDS2 two specific goals and eight outcomes to determine the grades that will inform our annual action planning. All NHS organisations are required to demonstrate progress against a number of indicators in the Workforce Race Equality Standard (WRES) including a specific indicator to address the low levels of black and minority ethnic (BME) board representation.

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At Newham CCG we value and enable our staff, Board and clinical leaders to learn and develop, thereby enabling them to deliver against the CCG Priorities. We launched an extensive learning and development programme including:

• Lunch and learn sessions• Invited guest speakers of specific topics• 360 peer survey and 90 minute individual feedback session• External training and development for staff up to £2000

We publish our WRES data showing our compliance against the WRES on our website. The report feeds into our equality objective setting and EDS2 grading processes. We are also working with NEL Commissioning Support Unit and our providers to implement the WRES and to ensure they meet the standards.

For the first time we are surveyed staff working in the clinical commissioning groups in the North East London Commissioning Alliance to find out more about their experience of working in one of these organisations. The information gathered will be examined and use to improve people’s working lives and so help to provide better care for patients.

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B1. Corporate governance report The purpose of the corporate governance report is to explain the composition and organisation of the CCG’s governance structures and how they support the achievement of our objectives.

B1(1) Members’ report

Member profiles

The Governing Body is responsible for the strategic direction of the CCG and for assuring the achievement of the key health, wellbeing, service, financial, and performance targets of the CCG. The Governing Body is accountable to the public, member practices and NHS England.

Key functions and areas of focus for the Governing Body are as follows:

• Ensuring the group has appropriate arrangements in place to exercise its functionseffectively, efficiently and economically and in accordance with the groups principles ofgood governance

• Determining the remuneration, fees and other allowances payable to employees orother persons providing services to the group and the allowances payable under anypension scheme it may establish under paragraph 11(4) of Schedule 1A of the 2006Act, inserted by Schedule 2 of the 2012 Act

• Approving any functions of the group that are specified in regulations• Leading and developing a clear vision and strategy for the group• Approving commissioning plans and consultation arrangements and performance

monitoring of those plans• Providing assurance against any strategic risks• Agreeing the CCG Annual Report and Accounts.

Our website gives more details about our GB, including profiles of members.

Member practices

Abbey Road Medical Practice Liberty Bridge Road Practice – Sir Ludwig Guttman Centre

Albert and Britannia Road Practices Lord Lister Health Centre (Dr Abiola)

Balaam Street Practice Lord Lister Health Centre (Dr Driver)

Birchdale Road Medical Practice Lord Lister Health Centre (Dr Swedan)

Boleyn Medical Centre Lucas Avenue

Boleyn Road Practice Market Street Health

Claremont Clinic Newham Medical Centre

First 4 Health @ Cumberland Road Medical Practice Newham Transitional Team

Custom House Surgery Plashet Medical Centre

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Dr Bhadra’s Surgery Royal Docks Medical Centre

Dr CM Patel Sangam Surgery

Dr Krishnamurthy Surgery St Bartholomew Surgery

Dr PCL Knight's Practice Star Lane Medical Centre

Dr Ruiz – St Lukes Medical Centre Stratford Health Centre

Dr Samuel & Dr Khan's Practice First 4 Health @ Stratford Village Surgery

E12 Medical Practice The Azad Practice

East End Medical Centre The Project Surgery

Esk Road Medical Practice The Shrewsbury Surgery

Essex Lodge The Summit Practice

First 4 Health @ Church Road Health Centre Tollgate Health Centre

Glen Road Medical Centre Upton Lane Medical Centre

Greengate Medical Practice Westbury Road Medical Centre

Lantern Health Woodgrange Medical Practice

Lathom Road Medical Centre Wordsworth Health Centre

First 4 Health @ Leytonstone Medical Practice

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Composition of Governing Body

Elections were held in June 2018 for new GP Governing Body members and a new Chair.

Title Dates

Voting clinical members Dr Prakash Chandra Chair and Elected GP Representative, Newham

CCG 01/04/15 – 20/06/18

Dr Clare Davison Elected GP Representative, Newham CCG 01/07/16 – 31/03/19

Dr Nadeem Faruq Elected GP Representative, Newham CCG 21/06/18 – 31/03/19

Dr Catherine Gaynor Elected GP Representative, Newham CCG 01/04/17 - 31/03/18

Dr Ambady Gopinathan Elected GP Representative, Newham CCG 01/04/16 – 20/06/18

Dr Nasim Joarder Elected GP Representative, Newham CCG 01/04/17 - 31/03/19

Dr Muhammad Naqvi Chair and Elected GP Representative, Newham CCG Chair from 28/6/18

01/04/16 – 31/03/19

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Dr Arpana Patel Elected GP Representative, Newham CCG 21/06/18 – 31/03/19

Dr Bapu Sathyajith Elected GP Representative, Newham CCG 01/07/16 – 31/03/19

Dr Rima Vaid Deputy Chair and Elected GP Representative, Newham CCG

01/04/16 – 31/03/19

Appointed voting members

Henry Black Chief Finance Officer, Newham CCG 01/12/18– 31/01/19

Wayne Farah Vice-Chair, Lay Member Patient & Public Engagement Newham CCG

01/04/16 – 31/01/19

Grainne Siggins Executive Director – Strategic Commissioning, LBN National Policy Lead & Trustee – ADASS

01/04/16 – 31/03/19

Ajith Lekshmanan Lay Member for Audit and Governance, Newham CCG

16/05/17- 31/03/19

Jane Milligan Accountable Officer, Newham CCG 01/12/17- 31/03/19

Ellie Robinson Lay Member Patient & Public Engagement Newham CCG

01/02/19 - 31/03/19

Fiona Smith Registered Nurse, Newham CCG 01/04/16 – 31/03/19

Lei Wei Interim Chief Finance Officer, Newham CCG 28/9/17 – 30/11/18

Appointed non-voting members

Andrea Lippett Lay Member Remuneration, Newham CCG 01/04/15 – 31/03/19

Livia Royle Director of Public Health (interim), LBN 01/04/18 – 31/03/19

Dr Ashwin Shah Co-opted Member, Newham CCG 01/07/16 – 20/06/18

Hazel Trotter Practice Manager Representative, Newham CCG 01/04/16 – 31/03/19

2018-19 Newham CCG Board meetings attendance log Apr-18 Jun-18 Sep-18 Oct-18 Dec-18 Feb-19

Members Dr Clare Davison Yes Apols Yes Apols Yes Yes Dr Nadeem Faruq n/a Yes Apols Yes Yes Yes Dr Catherine Gaynor Yes Yes Yes Yes Yes Apols Dr Nasim Joarder Yes Apols Yes Yes Apols Apols Dr Muhammad Naqvi Yes Yes Yes Apols Yes Yes

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Dr Arpana Patel n/a Yes Yes Yes Yes Yes Dr Bapu Sathyajith Yes Yes Yes Yes Yes Yes Dr Rima Vaid Yes Yes Yes Yes Yes Yes Ellie Robinson n/a n/a n/a n/a n/a Yes Grainne Siggins No Apols Yes Yes Apols Yes Ajith Lekshmanan Yes Yes Yes Yes Yes Yes Jane Milligan Yes Yes Yes Apols Yes Apols Henry Black n/a n/a n/a n/a Yes Apols Fiona Smith Apols Yes Yes Yes Yes Yes Andrea Lippett Apols Yes Yes Yes Yes Yes Livia Royle Yes Yes Yes Yes Yes Yes Selina Rodrigues Apols Yes Yes Yes Apols Yes Hazel Trotter Apols Yes Yes Yes Yes Apols Members Selina Douglas Yes Yes Yes Yes Yes Yes Satbinder Sanghera Yes Yes Yes Yes Apols Yes Chetan Vyas Yes Yes Yes Yes Yes Yes Steve Collins n/a n/a n/a n/a n/a Yes John Wicks n/a n/a n/a n/a n/a Yes Dr Prakash Chandra Yes n/a n/a n/a n/a n/a Ashwin Shah Yes n/a n/a n/a n/a n/a Dr Ambady Gopinathan Yes n/a n/a n/a n/a n/a Wayne Farah Yes Apols Yes Yes Apols n/a Lei Wei Yes Apols Yes Yes Yes n/a

Assessment of Governing Body effectiveness Over the last year Board members were developed through a Board Development programme, which has been a mixture of topic and skills-based. The Board has developed a set of high performing board behaviours statements, which they are working to.

Committees, including Audit Committee

Committee/ Position

Executive Audit Remuneration Quality

Chair

Dr Muhammad Naqvi

Ajith Lekshmanan

Andrea Lippett Fiona Smith

Member and SMT lead

Selina Douglas Steve Collins (not a member)

Satbinder Sanghera (not a member)

Chetan Vyas

Members Satbinder Sanghera Chetan Vyas Dr Rima Nicole Vaid Steve Collins

Andrea Lippett Wayne Farah (to 31/01/19) Ellie Robinson (from 01/02/19)

Ajith Lekshmanan Dr Rima Nicole Vaid Wayne Farah (to 31/01/19) Ellie Robinson (from 01/02/19)

Dr Rima Nicole Vaid Dr Bapu Sathyajith Dr Catherine Gaynor Andrea Lippett Selina Douglas Livia Royale Steve Collins

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NELCA Joint Commissioning Committee The JCC is comprised of members of the Governing Bodies (GB) from Barking & Dagenham CCG, City & Hackney CCG, Havering CCG, Newham CCG, Redbridge CCG, Tower Hamlets CCG and Waltham Forest CCG to jointly commission goods and services for the residents of the City of London Corporation and London Boroughs of Barking & Dagenham, Hackney, Havering, Newham, Redbridge, Tower Hamlets and Waltham Forest. The role of the JCC is to deliver the delegated functions and powers transferred to it by the seven NEL CCG Governing Bodies. These functions are where the Governing Bodies consider there is additional value in working collaboratively with other CCGs. The Committee has responsibility for the following service areas:

• Specialised commissioning • London Ambulance Service • Integrated Urgent Care • Maternity Planning • Mental health (acute beds only) • NHSE assurance (except through exception done elsewhere eg A&E) • Approve Integrated Care Systems framework

Committee/ position

Primary care commissioning

Commissioning Committee

Urgent care Medicines management

Chair

Andrea Lippett Dr Muhammad Naqvi

Clare Davison

Dr Barry Sullman

Deputy Chair

Fiona Smith

Dr Rima Nicole Vaid

None

Clinical Member

Nadeem Faruq Barry Sullman None Dr Rima Vaid

Clinical Member

None Dr Nadeem Faruq None None

Other members

Steve Collins Councillor Susan Masters Selina Douglas Alison Goodlad (on voting) Livia Royle )non voting) Selina Rodrigues (non voting) Greg Cairns (non voting) Dr Anil Shah (non voting)

Selina Douglas Grainne Siggins (LBN) Satbinder Sanghera Steve Collins Chetan Vyas John Wicks

Satbinder Sanghera Julie van Bussel Jenny Mazarelo Vincent Heneghan Olga Buck Colin Ansell (LBN) Helen Pace (CSU) Provider Representatives

Bola Sotubo (CCG) Maninder Kaur Singh (NHC) Gemma Heath (NCCG) Charity Okoli (ELFT CHN) Chined Ogbuefi (ELFT) Vikesh Patel (NEL LPC) Wajid Qureshi (NHC) Chetan Vyas (CCG) Ingrid Mckitty (CCG) Tanvir Ahmed (CCG) Tase Oputu (Barts Health)

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Commissioning Committee The Commissioning Committee leads, monitors and approves the Board’s programme of service redesign, transformation, innovation and research and development. The Committee supports the adoption and diffusion of innovative practice, and promotes research and development.

The Committee has responsibility for the following service areas:

• Community Children’s Services• Community Adult Health Services• Mental Health Services• Acute Services

Remit and responsibilities

• Oversee the development and delivery of the CCG‟s Commissioning Strategy asarticulated in the Operating Plan

• Oversee the development and delivery of joint commissioning strategies between theCCG and LBN

• Review all new and revised clinical and care pathways being proposed as part ofservice transformation, providing assurance by undertaking service Quality ImpactAssessments

• Support and review the development of business cases for service transformation• Make recommendations to the Board on commissioning strategy including associated

areas for investment and savings as a result of service transformation, innovation,research and development

• Review and approve proposals for innovation projects• Ensure that the CCG develops systems to promote research and development, locally

and in partnership with other organisations, such as UCLP and the ClinicalEffectiveness Group and actively horizon scan for innovative practice both nationallyand internationally.

• Focus on the principles of integrated care to ensure there is more coordination andintegration in care provision across the borough

• Support the Children’s and Adults Programme Boards to integrate services with LondonBorough of Newham where it can be demonstrated that it is in the interests of theNewham population

• Identify and recommend proposals for key enablers e.g. ICT, Workforce, Staff and UserEngagement, Communications

• Receive an annual report of the BCF Delivery Group and regular reports as required bythe Committee

• Receive an annual report of the Children’s and Adults programme Boards and regularreports as required by the Committee

• Agree, oversee and monitor the delivery of the CCGs Commissioning Divisions workplan

Quality performance and finance committee The Quality Performance and Finance committee reports directly to the Governing Body and is responsible for monitoring and oversight of the quality, performance and financial performance of the CCG’s work. The Quality, Performance and Finance committee has a remit and responsibility for:

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Quality

• Have oversight of the quality of commissioned services for the resident population of Newham and identify and deliver contracted improvements in quality of service and patient experience

• Reviewing the quality of primary care • Monitoring the performance of providers against quality indicators and CQUINs • Commissioning deep dive quality work • Providing quality inputs into the transformation programmes • Reviewing guidance and CQC provider reports, subsequently working with providers to

improve the quality of care provided • Reviewing and monitoring action plans to support quality improvements to ensure they

are fit for purpose • Receive reports regular updates and reports from the Joint Integrated Commissioning

Safeguarding Committee for matters relating to the safeguarding of children and adults

Performance

• Review the CCG’s benchmarked performance against the NHS Outcomes Framework and the CCG Assurance Framework

• Decide upon escalation actions where it has been reported to the Committee that contractually agreed activity levels have not been not met

• Approve the CCG’s mechanisms for performance reporting including scope, format and presentation

• Make annual recommendations on the operating plan and locally agreed standards

Finance

• Oversee and approve core financial processes, timetable and plans including Operating financial plans, CCG and STP Financial strategies and agreements, budget setting and risk assessment.

• Review, monitor and have oversight of programme, administrative, collaborative and capital budgets and financial performance

• Review business case and proposed procurement financial components to ensure appropriate identification and management of financial risk (including QIPP schemes, Transformation schemes, investment proposals and funding bids).

• Identify and recommend the allocation or reallocation of resources where appropriate to improve performance or ad hoc performance and financial issues that may arise.

• Review reporting arrangements on a regular basis to ensure these remain fit for purpose and appropriate to meet the CCG Board, Executive and Committee accountabilities and assurance in collaborative arrangements.

Audit committee

The audit committee is a statutorily mandated committee of the CCG, established in accordance with the CCG’s Constitution.

The audit committee reviews the establishment and maintenance of an effective system of integrated governance, risk management and internal control, across the whole of the CCG’s activities (both clinical and non-clinical), which supports the achievement of the CCG’s objectives. The Committee met six times during 2018/19. The committee's cycle of business enables it to carry out the key objectives necessary to support its assurances regarding the effectiveness of the organisation's internal controls. The key areas of focus during the year included:

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• The year-end Financial Statements and the Governance Statement. All risk and control related disclosure statements together with any accompanying head of internal audit statement, external audit opinion or other appropriate independent assurances, prior to endorsement by the Governing Body

• The underlying assurance processes that indicate the degree of achievement of corporate objectives, the effectiveness of the management of principal risks and the appropriateness of the above disclosure statements

• The policies for ensuring compliance with relevant regulatory, legal and code of conduct requirements and related reporting and self-certification

• The North East London Commissioning Support Unit (CSU) assurance group and associated assurance statements as provided through the work of the service auditor

• Reporting carried out by the internal auditors for NHS England and any individual quality assurance reports carried out on behalf of the clinical commissioning groups who use the CSU

• The review of the CCG’s risk management arrangements, including the review of the CCG’s internal board assurance framework deep dive process.

• Seeking assurance on governance arrangements and processes. • Revisions to the Constitution. • Managing Conflict of Interests and maintaining the registers of interests. The

Audit Chairman is the statutorily appointed conflict of interest guardian for the CCG.

• Reviewing financial controls and approving waivers of standing orders • Approving the Audit Plan and Audit Programme for the year. • Receiving audit reports from external and internal auditors and reviewing the

implementing of the action plans • Receiving reports from local counter fraud specialist and monitoring actions. The

Audit Chairman is now required to sign off NHS Counter Fraud Authority’s Self Review Tool, assessing the adequacy of the CCG’s counter fraud processes and systems.

• Liaising with Internal and External Auditors.

In carrying out its role the committee primarily uses the work of internal audit, external audit and other assurance functions, but is not limited to these sources. It also seeks reports and assurances from directors and managers as appropriate, concentrating on the over-arching systems of integrated governance, risk management and internal control, together with indicators of their effectiveness.

Remuneration committee The remuneration committee reports to the Governing Body their decisions on determinations about the remuneration, fees and other allowances for employees and for people who provide services to the group, and on determinations about allowances under any pension scheme that the group may establish as an alternative to the NHS pension scheme. In making decisions the committee will:

• Comply with current disclosure requirements for remuneration • Ensure that all remuneration packages are linked to the group’s performance

management framework with clear performance targets • Have regard to national legislation relating to equal pay acts and equality acts • Seek independent advice, where necessary, about remuneration for individuals • Ensure that decisions are based on clear and transparent criteria • Have full authority to commission any reports or surveys it deems necessary to help it

fulfil its obligations • Uphold the seven ‘Nolan Principles’ • Manage the business of the committee by way of risk

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• Be responsible for the development of patient and public engagement within the scope of its responsibilities

Executive committee The executive committee has been formed comprising clinicians and CCG managers, the chief operating officer and chief financial officer. This is a key forum to integrate the outputs of the programme boards and manage the detail of commissioning decisions, while ensuring the strategic direction determined by the Governing Body is followed. The executive committee has a remit and responsibility for:

• Ensuring the CCG is on track to deliver against the operating plan, QIPP plans and all transformation programmes

• Receiving reports from the QIPP leads on delivery against QIPP plans to take a holistic view of delivery

• Acting as a programme management committee to quality assure the work of each of the commissioning committees and transformation programmes

• Supporting the committees and programmes to unblock any areas that affect their ability to deliver

• Reporting to the CCG Governing Body

Practice council The Governing Body is accountable to the practice member council. The practice member council provides a platform for all GP member practices of the CCG to scrutinise, question and serve as a forum for debate with the Governing Body. In addition the Governing Body has delegated the function of approving changes to the Constitution (subject to NHS England approval) to its practice member council.

Register of interests

We publish a register of members’ and senior managers’ interests on the CCG’s website. This is updated as and when changes are notified to the CCG. The register gives details of company directorships or other significant interests held by members and senior managers where those companies are likely to do business, or are possibly seeking to do business with the NHS, where this may conflict with their managerial responsibilities. More information on how we approach conflicts of interest including our policy is available on our website.

Personal data related incidents

The NHS Information Governance (IG) Framework sets the processes and procedures by which the NHS handles information about patients and employees, in particular personal identifiable information. The framework is supported by an IG toolkit and the annual submission process provides assurances to the CCG, other organisations and to individuals that personal information is dealt with legally, securely, efficiently and effectively. We place high importance on ensuring there are robust IG systems and processes in place to help protect patient and corporate information. We have established an IG management framework and have implemented IG processes and procedures in line with the IG toolkit. We ensure all staff undertake annual IG training and have provided staff with guidance on their IG roles and responsibilities.

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We use local clinical and corporate incident management and reporting tools to record and report incidents and record all internal incidents. We notify the Department of Health and the Information Commissioner’s Office (ICO) of serious incidents that require investigation via the national IG incident reporting tool.

During the reporting period, the CCG has had no serious incidents involving data loss or confidentiality breaches that require formal reporting to the ICO.

Statement of disclosure to auditors

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

• so far as the member is aware, there is no relevant audit information of which the CCG’sauditor 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 orherself aware of any relevant audit information and to establish that the CCG’s auditor isaware of it.

Modern Slavery Act

Newham CCG fully supports the Government’s objectives to eradicate modern slavery and human trafficking but does not meet the requirements for producing an annual Slavery and Human Trafficking Statement as set out in the Modern Slavery Act 2015. We do however, take this issue seriously and set out our commitment on our website.

B1(2) Statement of Accountable Officer’s Responsibilities

The National Health Service Act 2006 (as amended) states that each Clinical Commissioning Group shall have an Accountable Officer and that Officer shall be appointed by the NHS Commissioning Board (NHS England). NHS England has appointed Jane Milligan to be the Accountable Officer of NHS City and Hackney Clinical Commissioning Group.

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

● The propriety and regularity of the public finances for which the Accountable Officer isanswerable;

● For keeping proper accounting records (which disclose with reasonable accuracy at anytime the financial position of the Clinical Commissioning Group and enable them toensure that the accounts comply with the requirements of the Accounts Direction);

● Safeguarding the Clinical Commissioning Group’s assets (and hence for takingreasonable steps for the prevention and detection of fraud and other irregularities);

● The relevant responsibilities of accounting officers under Managing Public Money;

● Ensuring the Clinical Commissioning Group exercises its functions effectively, efficientlyand economically (in accordance with Section 14Q of the National Health Service Act2006 (as amended)) and with a view to securing continuous improvement in the qualityof services (in accordance with Section14R of the National Health Service Act 2006 (asamended)) and with a view to securing continuous improvement in the quality ofservices (in accordance with Section14R of the National Health Service Act 2006 (asamended));

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● Ensuring that the Clinical Commissioning Group 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 financial statements, the Accountable 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 financial statements;

● 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.

As the 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 NHS Newham Clinical Commissioning Group’s auditors are aware of that information. So far as I am aware, there is no relevant audit information of which the auditors are unaware.

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.

B1(3) Governance Statement

Introduction and context

NHS Newham CCG is a body corporate established by NHS England on 1 April 2013 under the National Health Service Act 2006 (as amended). The CCG’s statutory functions are set out under the National Health Service Act 2006 (as amended). The CCG’s general function is arranging the provision of services for persons for the purposes of the health service in England. The CCG is, in particular, required to arrange for the provision of certain health services to such extent as it considers necessary to meet the reasonable requirements of its local population.

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As at 1 April 2018, the CCG is not subject to any directions from NHS England issued under Section 14Z21 of the National Health Service Act 2006.

Scope of responsibility

As Accountable Officer, I have responsibility for maintaining a sound system of internal control that supports the achievement of the clinical commissioning group’s policies, aims and objectives, while 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. More information about our governing body and committees is contained in the members’ report of this annual report. The governance structure of NHS Newham CCG was designed to ensure that there was a balance between having robust governance arrangements for the organisation and being able to be flexible and responsive to organisational priorities. Newham CCG has effective governance processes in place to ensure quality and patient safety, with clear accountability and reporting arrangements. Accountability for quality lies with the chief officer and the quality, performance and finance committee. A wide range of key staff and clinicians are responsible and involved in the quality assurance processes supporting the CCG – demonstrating that quality and patient safety is embedded in our commissioning processes. We have eight geographically close GP clusters. All clusters report into an elected board. Since April 2015, along with the WEL CCGs, Newham CCG has been authorised as a delegated (full) co-commissioner for the commissioning, contract monitoring and performance management of the 51 practices in agreement with NHS England jointly.

UK Corporate Governance Code Whilst the detailed provisions of the UK Corporate Governance Code are not mandatory for public sector bodies, compliance is considered to be good practice. This Governance Statement is intended to demonstrate the CCG’s compliance with the principles set out in the Code (insofar as this applies to CCGs). For the financial year ended 31 March 2019, and up to the date of signing this statement, we complied with the provisions set out in the Code, and applied the principles of the Code.

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Discharge of statutory functions In light of recommendations of the 2013 Harris Review, the CCG has reviewed all of the statutory duties and powers conferred on it by the National Health Service Act 2006 (as amended) and other associated legislative and regulations. As a result, I can confirm that the CCG is clear about the legislative requirements associated with each of the statutory functions for which it is responsible, including any restrictions on delegation of those functions. Responsibility for each duty and power has been clearly allocated to a lead director. Directorates have confirmed that their structures provide the necessary capability and capacity to undertake the CCG’s statutory duties.

Risk management arrangements and effectiveness

NHS Newham CCG has an approved risk management framework that outlines the CCG’s approach to risk management. The CCG has a responsibility to ensure it is effectively governed in accordance with best practices across corporate, clinical and financial governance, and that risk management effectively supports, and underpins, governance arrangements. Risk management is embedded into all levels of the organisation. A systematic and consistent approach to risk management has been established. This extends from board assurance to operational risk by way of standardised risk registers that are used throughout the organisation to identify, monitor and report on operational risks to enable effective assessment and escalation of risks to the Governing Body where appropriate. The board assurance framework (BAF) and risk registers are comprehensive in scope and cover all strategic and operational areas. Effective risk management aims to draw attention to actual or potential problems and to encourage the appropriate response to them; risks are managed by the people who have the greatest ability to control them. NHS Newham CCG’s risk management processes ensure that risks are identified, assessed, controlled, and when necessary, escalated. These main stages are carried out through:

• Clarifying our objectives • Identifying risks to completing the objectives • Defining and recording risks • Completion of the risk register and identifying actions • Escalation of risks • Scrutiny of the risks, the risk ratings and controls and actions in place to manage the

risk Where this is done well, this ensures the safety of our patients, visitors, and staff, and that as an organisation the Newham CCG Governing Body and management is not surprised by risks that could, and should, have been foreseen. Our internal auditors undertake an annual review of the NHS Newham CCG risk management system as part of the internal audit programme. As a result of the outcome of the annual audit, the CCG has developed an action plan to ensure that we are able to demonstrate year on year improvements in the effectiveness of our risk management processes. All activities that Newham CCG undertakes or commissions others to undertake on its behalf, will bring with it some element of risk that could present a potential threat to the CCG.

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Considered risk-taking is encouraged, together with innovation within authorised and defined limits. The priority is to reduce those risks that impact on safety, and reduce our financial, operational and reputational risks through awareness, competence and management.

Whistle-blowing Newham CCG is committed to conducting our business with honesty and integrity, and we expect all staff to maintain high standards in accordance with our Code of Conduct. However, all organisations face the risk of things going wrong from time to time, or of unknowingly harbouring illegal or unethical conduct. A culture of openness and accountability is essential in order to prevent such situations occurring or to address them when they do occur. To support this we have in place a whistle blowing policy, which aims to:

• encourage staff to report suspected wrongdoing as soon as possible, in the knowledge that their concerns will be taken seriously and investigated as appropriate, and that their confidentiality will be respected.

• provide staff with guidance as to how to raise those concerns. • reassure staff that they should be able to raise genuine concerns without fear of

reprisals, even if they turn out to be mistaken. This policy takes account of the Whistleblowing Arrangements Code of Practice issued by the British Standards Institute and Public Concern at Work.

Capacity to handle risk The BAF is the primary mechanism for internal and external assurance that the CCG is sighted on its risks and has a robust system of internal control. The primary purpose of the BAF is to:

• Act as a mechanism for alerting and appraising the Governing Body of the main risks to achieving the CCG’s strategic objectives as set out in the operating plan

• List, evaluate and provide assurance to the Governing Body regarding the mitigations in place to reduce the likelihood or impact of the risk

• Summarise the remedial or proposed actions that further mitigate the likelihood or impact of the risk

In 2018/19 the Board approved the CCG’s strategic objectives, enabling priorities and key measurable outcomes. The link between the strategic objectives, enabling priorities and key measurable outcomes underpins the work of the CCG’s Board sub committees and ensured that the governance regime of the Committees and the Board will support their delivery. Board assurance framework risks are linked to the core strategic objectives and enabling priorities of the CCG, as outlined in the operating plan. The BAF is reviewed with relevant senior management risk leads and reported to each meeting of the Governing Body in order to ensure that risks are being proactively managed and that early trends in risks are identified and appropriate actions taken to reduce and mitigate risk. The CCG has developed and implemented a robust deep dive process into the risks on the BAF. The deep dive process allows the committees to assess whether or not they feel:

• risk definitions were clear • risk controls are effective and can be evidenced

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• additional mitigations can be identified • risk dependencies have been identified • gaps in control are being effectively managed • satisfied with the level of assurance provided.

The deep dive process allows the committees to provide the Board with assurance that risks are being effectively managed throughout the CCG and, where necessary, allows for escalation of risks to the Board where it is identified that the committee cannot be assured by the effectiveness of the management of risk, or there are concerns regarding any identified gaps in control, emerging or foreseeable threats. Oversight of risk management by committees also provides the Board with assurance regarding the standardisation and consistency of the CCG’s approach to risk management.

Risk assessment Risk ratings are determined in consultation between risk owner and the risk lead, and take into consideration the following criteria, which helps to provide a standardised baseline for the assessment and grading of risk throughout the organisation:

• Estimated severity of risk • Objectives/projects • Harm/injury to patients, staff, visitors and others • Potential for complaints/claims • Service/business disruption • Staffing and competence • Financial • Inspection/audit • Adverse publicity

As with all risks identified, the way in which a particular risk is managed and recorded was proportionate to its potential for damaging or harming the interests of the CCG. All risks are managed through the board assurance framework (BAF) and reported to the Governing Body. The CCG’s schedule of deep dives undertaken at committee level seeks to support the risk management and assurance process by ensuring that we are able to balance objectivity and subjectivity in the risk assessment process. The significant risks identified during the financial year 2018/19 were the:

• failure to meet the NHS Constitutional standards • failure to effectively integrate health and social care by progressing BHC and ACS • failure to effectively deliver a primary care strategy that is adequately resourced to

service Newham residents and secure a sustainable and viable GP Federation • failure to effectively develop and implement the re-designed urgent care pathway and

understand the inter-dependencies with the NHS 111 procurement

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

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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 governance framework and accountability of committees to the Governing Body supported by financial management arrangements provide assurance that the system of internal control has been in place in the CCG for the year ended 31 March 2019 and up to the date of approval of the annual report and accounts.

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. The audit was completed to provide assurance that the provisions in place within the CCG to manage Conflicts of Interest (COI) are in line with NHSE statutory guidance. In our 2018/19 review we received a “Reasonable Assurance” opinion on the control framework and compliance against the NHSE guidelines. The internal auditors concluded that the CCG was compliant in four of the six COI criteria areas. The other two areas; governance arrangements including policies and procedures, and local fraud investigation on declaration of interest, the CCG were partially compliant. An action plan has been developed that will be overseen by the CCG’s Executive Committee.

Data quality The CCG has robust processes and governance arrangements in place to ensure that the quality of data used by the membership body and Governing Body is accurate and fit for purpose. All data that is forwarded to the Governing Body has been discussed, and analysed at a minuted committee meeting prior to being submitted for discussion, noting or a formal decision at the Governing Body.

Information governance The NHS Information Governance Framework sets the processes and procedures by which the NHS handles information about patients and employees, in particular personal identifiable information. The NHS Information Governance Framework is supported by a data security and protection 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.

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

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

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Business critical models An appropriate framework and environment is in place to provide quality assurance of business critical models via NEL CSU, in line with the recommendations in the Macpherson report. No business critical models have been identified that require information about quality assurance processes for those models to be provided to the Analytical Oversight Committee chaired by the Chief Analyst in the Department of Health.

Third party assurances The CCG commissions NEL CSU to run elements of our commissioning function – such as contracting, business intelligence, communications and HR. The service standards are monitored as part of an SLA and the Audit Committee receives regular auditor reports on contracted-for services.

EU-Exit Preparedness The CCG Governing Body has retained close overview of the planning and preparations for the UK leaving the EU. The plans had particular focus on the possibility of leaving without a secure deal but also the potential impact of the uncertainty created by EU-Exit and any possible effects in advance of the UK leaving the EU.

NHSE Issued Guidance in December 2018 to all NHS bodies and services in contract with or supplying the NHS. Commissioner and provider action cards within the guidance summarised the minimum expected preparations for every organisation.

The implementation of this guidance at local level was subject to regular NHSE assurance and the following steps taken to ensure compliance and readiness:

• Each STP area nominated an SRO for EU-Exit to co-ordinate activities for the CCGsand main NHS providers within and STP. The individual acted as a contact point forNHSE regional / national teams, commissioners, providers and local authorities for dataand information requests, queries and support.

• The NELCA SRO hosted teleconferences between CCG emergency planners and alsowith local providers to ensure all EU-Exit related activities for commissioners / providerswere carried out to time as required by NHS England / Improvement. The key domainsfor preparation covered were

o Operational readinesso Communications and engagement – with Governing Bodies, key providers

(including primary care) staff and key stakeholders via local resilience forumso Workforceo Medicines & medicinal productso Clinical consumables supplieso Non clinical consumableso Data sharing processes and access – security and continuityo Reciprocal healthcare arrangements and health demando Financeo Assurance via NHSE

• Governing Bodies and Senior Executive teams were frequently updated and able toscrutinise activities in relation to EU exit preparations

• CCGs undertook review of their Business Continuity Plans and risk registers withmitigation where necessary.

• CCGs worked with their Local Resilience Forums to identify and mitigate any potentialsystem impacts.

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• Daily and weekly situation reporting was completed by the CCG via the NHS DigitalStrategic Data Collection Service.

EU-Exit preparations and contingency planning will continue into 2019/20 until such time as stood down by NHS England.

Control issues

As at Month 9 2018/19, there were two known governance or performance issues significant enough to highlight via the CCG Governance Statement to NHS England. These were as follows:

• Quality and Performance - RTT 52 week wait• Quality and Performance – Accident & Emergency

The above two issues are mitigated as a result by the following specific actions:

• Overarching Demand and Capacity Group across NEL tracking delivery of the electiveplan, specifically; risks and mitigations, growth in the PTL and 'Over 52 week' waits. Atmonth 8 no significant risks were raised.

• There is a risk to delivery of the A&E standard and the 90% agreed trajectory. There isoversight with NHSE and action plans in place to focus on Q4 delivery.

In addition to these specific issues the NHS Newham CCG committee structure provides a forum for the review of NHS Newham CCG’s finances and QIPP delivery via Quality, Performance and Finance (QPF); it also gives the Governing Body information and an analysis of the financial position and helps shape the organisation’s financial strategy. The QPF committee reviews, oversees and approve core financial processes, timetable and plans including Operating financial plans, CCG and STP Financial strategies and agreements, budget setting and risk assessment. Review, monitor and have oversight of programme, administrative, collaborative and capital budgets and financial performance. Review business case and proposed procurement financial components to ensure appropriate identification and management of financial risk (including QIPP schemes, Transformation schemes, investment proposals and funding bids). Identify and recommend the allocation or reallocation of resources where appropriate to improve performance or ad hoc performance and financial issues that may arise. Review reporting arrangements on a regular basis to ensure these remain fit for purpose and appropriate to meet the CCG Board, executive and committee accountabilities and assurance in collaborative arrangements.

The Audit Committee was established in order to provide the Governing Body with an independent and objective review of their financial systems, financial information and compliance with laws, guidance and regulations governing the NHS. The committee critically reviews the CCG’s financial reporting and internal control principles and ensures an appropriate relationship with both internal and external auditors is maintained.

The Primary Care Commissioning Committee has been established to enable members to make collective decisions on the review, planning and procurement of primary care services in Newham under delegated authority from NHS England. The functions of the Committee are undertaken in the context increasing quality, efficiency, productivity and value for money. The Governing Body has overall responsibility and powers to decide and act on behalf of the CCG except where stated otherwise in law and within the CCG constitution. It ensures that the CCG has appropriate arrangements in place to exercise its functions effectively, efficiently and economically and in accordance with principles of good governance. It also approves

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commissioning plans and the performance monitoring of those plans and ensures value for money.

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

NHS Newham CCG has a comprehensive governance and reporting framework in place to monitor the use of resources, identify any issues and ensure the appropriate measures are taken to address any variance from plans. The Board receives regular finance reports concerning the CCG's financial performance, and has delegated its authority both to the Quality, Performance and Finance (QPF) and the Audit Committee to conduct more detailed scrutiny and report back.

QPF committee oversee and approve core financial processes, timetable and plans including operating financial plans, CCG and STP financial strategies and agreements, budget setting and risk assessment. Review, monitor and have oversight of programme, administrative, collaborative and capital budgets and financial performance. Review business case and proposed procurement financial components to ensure appropriate identification and management of financial risk (including QIPP schemes, transformation schemes, investment proposals and funding bids). Identify and recommend the allocation or reallocation of resources where appropriate to improve performance or ad hoc performance and financial issues that may arise. Review reporting arrangements on a regular basis to ensure these remain fit for purpose and appropriate to meet the CCG Board, executive and committee accountabilities and assurance in collaborative arrangements.

The Audit Committee is chaired by the Governing Body Lay Member for Audit and Governance. The Lay Member for Remuneration and the Lay Member for Patient Engagement are also members. The Audit Committee performs the role of oversight and scrutiny of CCG policies, procedures and systems of internal control, with a particular focus on ensuring that conflicts of interest are managed in line with the CCG's Constitution.

Underpinning the CCG's governance framework are the prime financial policies that set out the key business rules, which govern the organisation, including internal control, audit, standards of business conduct and budgetary control. They also incorporate the scheme of delegation. This sets out the level of authority to act and make decisions that has been delegated from the CCG Governing Body to the various executive committees, in addition to the authorisation limits set by the Governing Body for the management posts within the organisation to authorise expenditure.

Delegation of functions NEL CSU manages contracts with key providers on behalf of the CCG. The process is overseen by the CCG and regularly reviewed through the internal audit process and discussion at the Audit Committee. In addition the Chief Finance Officer and relevant directors’ meet with the CSU lead staff regularly to discuss performance and agree actions where there are concerns. Generally the process has worked well over the past financial year.

The CCG is a delegated commissioner of primary care. The CCG’s arrangements for managing this function are subject to regular review by internal audit and the Audit Committee.

Counter fraud arrangements NHS Newham CCG is committed to reducing fraud and bribery against the NHS and has appointed an accredited Local Counter Fraud Specialist (LCFS) through the CCG’s internal auditors, RSM. The LCFS works to a risk-based annual plan, agreed by the Chief Finance Officer and the Audit Committee. The plan is designed around the NHS Counter Fraud

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Authority Standards for Commissioners and compliance with these standards is reported to the Audit Committee. The LCFS provides advice and fraud awareness to CCG staff and members, and is the first line of defence against fraud and bribery within the CCG.

The CCG has anti-fraud and bribery policies in place, which are kept up to date to reflect current legislation. The CCG works closely with the NHS Counter Fraud Authority to implement any actions arising from quality assurance reviews, to ensure that our anti-fraud and bribery arrangements are sufficiently robust.

B1(4) Head of Internal Audit Opinion

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

The opinion

In accordance with Public Sector Internal Audit Standards, the head of internal audit is required to provide an annual opinion, based upon and limited to the work performed, on the overall adequacy and effectiveness of the organisation’s risk management, control and governance processes. The opinion should contribute to the organisation's annual governance statement.

Head of internal audit opinion 2018/19 For the 12 months ended 31 March 2019, our head of internal audit opinion for NHS Newham Clinical Commissioning Group is as follows:

Scope and limitations of our work

The formation of our opinion is achieved through a risk-based plan of work, agreed with management and approved by the audit committee. Our opinion is subject to inherent limitations, as detailed below:

• the opinion does not imply that internal audit has reviewed all risks and assurancesrelating to the organisation;

• the opinion is substantially derived from the conduct of risk-based plans generated froma robust and organisation-led assurance framework. As such, the assurance frameworkis one component that the Governing Body takes into account in making its annualgovernance statement (AGS);

• the opinion is based on the findings and conclusions from the work undertaken, thescope of which has been agreed with management / lead individual;

• the opinion is based on the testing we have undertaken, which was limited to the areabeing audited, as detailed in the agreed audit scope;

• where strong levels of control have been identified, there are still instances where thesemay not always be effective. This may be due to human error, incorrect management

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judgement, management override, controls being by-passed or a reduction in compliance;

• due to the limited scope of our audits, there may be weaknesses in the control systemwhich we are not aware of, or which were not brought to our attention; and

• it remains management’s responsibility to develop and maintain a sound system of riskmanagement, internal control and governance, and for the prevention and detection ofmaterial errors, loss or fraud. The work of internal audit should not be seen as asubstitute for management’s responsibilities around the design and effective operationof these systems.

Factors and findings which have informed our draft opinion

Based on the work undertaken in 2018/19, there is a generally sound system of internal control, designed to meet the CCG’s objectives, and controls are generally being applied consistently. We have however issued one partial assurance report on Procurement stemming from the CSU Quality Assurance Plan (details can be found further below). All remaining reports issued following our internal audit and quality assurance reviews have received substantial or reasonable assurance opinions and have not identified any significant control issues.

CCG Internal Audit Plan

• NEL CCGs joint report Commissioning and Contract Management – ReasonableAssurance

• Conflicts of Interest – Reasonable Assurance• Primary Care Delegated Commissioning – Reasonable Assurance• Financial Planning, Budget Setting, Delivery and Reporting – Reasonable Assurance• QIPP - WELC CCGs joint report

o Newham CCG Compliance and Application – Substantial Assuranceo Newham CCG Effectiveness – Reasonable Assurance

We have issued the advisory report relating to NELCA Governance and Workstreams which is in draft. In addition, we also conducted an Assurance Mapping exercise.

As part of all of the abovementioned reviews we have identified some areas for improvement and where those were highlighted, we have agreed actions with management with agreed deadlines for implementation. These are followed up on a regular basis and their status reported to each meeting of the Audit Committee. At the April 2019 meeting of the Audit Committee there were no overdue outstanding management actions. Where the NELCA Governance report is in draft, we have proposed management actions and are collating feedback from across the North East London CCGs, before confirming the management actions and finalising the report.

B2. Remuneration and staff report The remuneration and staff report sets out the CCG’s remuneration policy for directors and senior managers, reports on how that policy has been implemented and sets out the amounts awarded to directors and senior managers.

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B2(1) Remuneration report

Remuneration Committee

Details about the membership of the Remuneration Committee and its work can be found in the committees section of the annual report.

Policy on the remuneration of senior managers

The remuneration of the Governing Body is determined by the CCG’s Remuneration Committee. The process involves consideration of guidance produced by NHS England as well as a thorough process of benchmarking with other neighbouring CCGs.

Remuneration of very senior managers

During 2018/19, one senior manager’s combined salary across NELCA was more than £150,000 per annum (the salary of the prime minister). The pay was determined by the joint remuneration committee in line with the national guidance for VSM salaries. Salary levels have been benchmarked against equivalent roles in the other four London CCG Commissioning Alliances and London Providers. The Accountable Officer was appointed within 16 months, with the market tested through an open competitive process.

One senior manager’s combined salary within the CCG was more than £150,000 per annum.

Contractual arrangements

The chair, GP board members and lay members are appointed by the CCG. Clinical directors and lay members are on fixed term contracts of up to six years in length, depending on individual circumstances. The Accountable Officer and other Managing Director and directors are on permanent contracts, subject to the notice periods of either three or six months.

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Senior manager remuneration 2018/19 (including salary and pension entitlements)

Note Name Title

2018/19 Dates served

Salary Expense

Payments (taxable)

Performance pay and Bonuses

Long term Performance

pay and bonuses

All Pension-Related Benefits

Total

From To (bands of

£5000) (to

nearest £100)

(bands of £5000)

(bands of £5000)

(bands of £2,500)

(bands of £5000)

£000 £00 £000 £000 £000 £000

Executive Director

1 Jane Milligan NELCA Accountable Officer 20k to 25k 0 0 0 7.5k to 10k 30k to 35k 01/04/18 31/03/19

2 Henry Black NELCA Chief Finance Officer (from 1/12/18) 5k to 10k 0 0 0 2.5k to 5k 10k to 15k 01/12/18 31/03/19

3 Selina Douglas

Managing Director (voting member when Jane Milligan not in attendance)

90k to 95k 0 0 0 20k to 22.5k 110k to 115k 01/04/18 31/03/19

Lei Wei Interim Chief Finance Officer 75k to 80k 0 0 0 20k to

22.5k 100k to 105k 01/04/18 18/01/19

Non Executive Director Dr Prakash Chandra

Chair, GP Representative 20k to 25k 0 0 0 0 20k to 25k 01/04/18 21/06/18

Dr Muhammad Naqvi

Chair, Elected GP Representative 70k to 75k 0 0 0 0 70k to 75k 21/06/18 31/03/19

Dr Muhammad Naqvi

Joint Deputy Chair, Elected GP Representative

15k to 20k 0 0 0 0 15k to 20k 01/04/18 21/06/19

Dr Rima Vaid Deputy Chair and Elected GP Representative

45k to 50k 0 0 0 0 45k to 50k 01/07/18 31/03/19

Dr Rima Vaid Elected GP Representative 15k to 20k 0 0 0 0 15k to 20k 01/04/2018 30/06/2018

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4 Dr Clare Davison

Elected GP Representative 65k to 70k 0 0 0 0 65k to 70k 01/04/2018 31/03/2019

4 Dr Catherine Gaynor

Elected GP Representative 30k to 35k 0 0 0 0 30k to 35k 01/04/2018 31/03/2019

4 Dr Nasim Joarder

Elected GP Representative 30k to 35k 0 d 0 0 30k to 35k 01/04/2018 31/03/2019

4 Dr Arpana Patel Elected GP Representative 20k to 25k 0 0 0 0 20k to 25k 01/07/2018 31/03/2019

Dr Nadeem Faruq

Elected GP Representative 25k to 30k 0 0 0 0 25k to 30k 01/07/2018 31/03/2019

Dr Prakash Chandra

Chair, GP Representative 20k to 25k 0 0 0 0 20k to 25k 01/04/2018 21/06/2018

Dr Ambady Gopinathan

Elected GP Representative 5k to 10k 0 0 0 0 5k to 10k 01/04/2018 30/05/2018

Dr Bapu Sathyajith

Elected GP Representative 5k to 10k 0 0 0 0 0 to 5k 01/04/2018 30/06/2019

Ajith Lekshmanan

Lay Member for Audit and Governance 15k to 20k 0 0 0 0 15k to 20k 01/04/2018 31/03/2019

Wayne Farah Vice-Chair, Lay Member Patient & Public Engagement

25k to 30k 0 0 0 0 25k to 30k 01/04/2018 31/01/2019

Ellie Robinson Lay Member Patient & Public Engagement 0k to 5k 0 0 0 0 0k to 5k 01/02/2019 31/03/2019

Fiona Smith Registered Nurse 30k to 35k 0 0 0 0 30k to 35k 01/04/2018 31/03/2019

5 Grainne Siggins Director of Adult Social Services, LB Newham 0 0 0 0 0 0 01/04/2018 31/03/2019

Notes 1. The NEL Commissioning Alliance Accountable Officer is the appointed officer for 7 CCGs: NHS Barking and Dagenham, Havering, Redbridge,

Waltham Forest, Newham, Tower Hamlets and City and Hackney. Her total salary in 2018/19 across all organisations was Salary: £150k to£155k; Pension Related Benefits: £62.5k to £65k; Total: £215k to £220k. The Accountable Officer for the CCG receives an agreed annual salary.An element of this annual salary may be reclaimed in future periods if it is determined that objectives set for that individual have not beenachieved.

2. The NEL Commissioning Alliance Chief Finance Officer is the appointed officer for 7 CCGs: NHS Barking and Dagenham, Havering, Redbridge,Waltham Forest, Newham, Tower Hamlets and City and Hackney with effect from 1st December 2018. Until 20th November 2018 the Chief

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Finance Officer was appointed across NHS Tower Hamlets and Waltham Forest CCG’s. His total salary in 2018/19 across all organisations was Salary: £ 135k to £140k; Pension Related Benefits: £70k to £72.5k; Total: £205k to £210k.

3. The WEL Managing Director is the appointed officer for three CCGs with effect from 1 December 2018 - Waltham Forest, Newham and Tower Hamlets. Her total salary in 2018/19 across three organisations was: £125k to £130k; Pension Related Benefits: £27.5k to £30k; Total: £157.5k to £160k. The WEL Managing Director receives an agreed annual salary. An element of this annual salary may be reclaimed in future periods if it is determined that objectives set for that individual have not been achieved.

4. The salary figure for these member includes the total payments made in the year to the individual for all services provided to the CCG, and also the employer contribution to the NHS pension scheme

5. No remuneration is paid to these members for their Governing Body services. Where a member is a GP who is also paying into the NHS Pension scheme, the salary figures shown above include NHS Newham CCG's employer contribution to the scheme. This is in accordance with Department of Health guidance. The Pensions Related Benefits (PRB) figure is calculated using the method set out in the Finance Act 2004(1), and includes using the member's current and prior year pension and lump sum figures. Where there has been only a small increase in pension and lump sum benefits current year compared to last year, this formula can sometimes generate a negative figure. Where this is the case, Department of Health guidance states that a "zero" should be substituted for any negative figures.

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Senior manager remuneration in 2017/18 (including salary and pension entitlements)

Note Name Title

2017/18 Dates served

Salary Expense

Payments (taxable)

Annual Performance

pay and Bonuses

Long term Performance

pay and bonuses

All Pension-Related Benefits

Total

From To (bands of

£5000) (to nearest

£100) (bands of

£5000) (bands of

£5000) (bands of £2,500)

(bands of £5000)

£000 £00 £000 £000 £000 £000 Elected Voting Members

Dr Prakash Chandra Chair, Elected GP Representative 90k to 95k 0 0 0 0 90k to

95k 01/04/2017 31/03/2018

Dr Muhammad Naqvi Joint Deputy Chair, Elected GP Representative

60k to 65k 0 0 0 0 60k to 65k 01/04/2017 31/03/2018

1 Dr Bapu Sathyajith Elected GP Representative 30k to 35k 0 0 0 0 30k to

35k 01/04/2017 31/03/2018

2 Dr Clare Davison Elected GP Representative 40k to 45k 0 0 0 0 40k to

45k 01/04/2017 31/03/2018

Dr Catherine Gaynor Elected GP Representative 30k to 35k 0 0 0 0 30k to

35k 01/04/2017 31/03/2018

Dr Rima Vaid Elected GP Representative 60k to 65k 0 0 0 0 60k to

65k 01/04/2017 31/03/2018

Dr Nasim Joarder Elected GP Representative 30k to 35k 0 0 0 0 30k to

35k 01/04/2017 31/03/2018

Dr Ambady Gopinathan Elected GP Representative 30k to 35k 0 0 0 0 30k to

35k 01/04/2017 31/03/2018

Appointed Voting Members

Wayne Farah

Vice-Chair, Lay Member Patient & Public Engagement

35k to 40k 0 0 0 0 35k to 40k 01/04/2017 31/03/2018

Fiona Smith Registered Nurse 25k to 30k 0 0 0 0 25k to 30k 01/04/2017 31/03/2018

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Note Name Title

2017/18 Dates served

Salary Expense

Payments (taxable)

Annual Performance

pay and Bonuses

Long term Performance

pay and bonuses

All Pension-Related Benefits

Total

From To (bands of

£5000) (to nearest

£100) (bands of

£5000) (bands of

£5000) (bands of £2,500)

(bands of £5000)

£000 £00 £000 £000 £000 £000

Ajith Lekshmanan Lay Member for Audit and Governance

15k to 20k 0 0 0 0 15k to 20k 01/04/2017 31/03/2018

3 Grainne Siggins Director of Adult Social Services, LB Newham

0 0 0 0 0 0 01/04/2017 31/03/2018

4 Jane Milligan

Accountable Officer, Newham CCG share

5k to 10k 0 0 0 0k to 2.5k 5k to 10k 01/12/2017 31/03/2018

5 Steve Gilvin Chief Officer 70k to 75k 0 0 0 10k to 12.5k 85k to 90k 01/04/2017 30/11/2017

Chad Whitton Chief Finance Officer 45k to 50k 0 0 0 0 45k to 50k 01/04/2017 30/08/2017

Lei Wei Interim Chief Finance Officer 55k to 60k 0 0 0 27.5k to

30k 85k to 90k 01/09/2017 31/03/2018

Appointed Non-Voting Members

3 Meradin Peachey Director of Public Health, LB Newham

0 0 0 0 0 0 01/04/2017 31/03/2018

Hazel Trotter Practice Manager Representative

0k to 5k 0 0 0 0 0k to 5k 01/04/2017 31/03/2018

Andrea Lippett Lay Member Remuneration Newham CCG

10k to 15k 0 0 0 0 10k to 15k 01/04/2017 31/03/2018

6 Dr Ashwin Shah Co-opted Member 90k to 95k 0 0 0 0 90k to 95k 01/04/2017 31/03/2018

In Attendance

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Satbinder Sanghera Director of Partnerships and Governance

100k to 105k 0 0 0 65k to 67.5k

165k to 170k 01/04/2017 31/03/2018

Selina Douglas Deputy Chief Officer 110k to 115k 0 0 0 65k to

67.5k 175k to 180k 01/04/2017 31/03/2018

Chetan Vyas Director of Quality & Development

105k to 110k 0 0 0 47.5k to 50k

155k to 160k 01/04/2017 31/03/2018

3 Selina Rodrigues Healthwatch Newham 0 0 0 0 0 0 01/04/2017 31/03/2018

Notes pertaining to tables from previous years can be found in the 2017/18 annual report.

Pension benefits at 31 March 2018 (subject to audit)

Cash equivalent transfer values A cash equivalent transfer value (CETV) is the actuarially assessed capital value of the pension scheme benefits accrued by a member at a particular point in time. The benefits valued are the member’s accrued benefits and any contingent spouse’s (or other allowable beneficiary’s) pension payable from the scheme.

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

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

Real increase in CETV This reflects the increase in CETV that is funded by the employer. It does not include the increase in accrued pension due to inflation or contributions paid by the employee (including the value of any benefits transferred from another scheme or arrangement).

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2018/19

Not

e

Name Title

Real increase

in pension

at pension

age

Real increase in

pension lump sum at pension

age

Total accrued

pension at pension

age at 31st March 2019

Lump sum at pension age related to accrued pension at 31st March

2019

Cash equivalent

transfer value at 1st April

2018

Real increase in

cash equivalent

transfer value

Cash equivalent

transfer value at

31st March 2019

Employer's contribution

to stakeholder

pension

Dates served

(bands of £2,500)

(bands of £2,500)

(bands of £5,000)

(bands of £5,000)

(to nearest £1,000)

(to nearest £1,000)

(to nearest £1,000)

(to nearest £1,000) From To

£000 £000 £000 £000 £000 £000 £000 £00

1 Jane Milligan

NELCA Accountable Officer

2.5k to 5k 2.5k to 5k 45k to 50k 110k to 115k 732 137 899 0 01/04/18 31/03/19

Henry Black

NELCA Chief Finance Officer (from 1/12/18)

2.5k to 5k 5k to 7.5k 25k to 30k 55k to 60k 312 90 431 0 01/12/18 31/03/19

Lei Wei

Interim Chief Finance Officer- NCCG

0k to 2.5k 0 5k to 10k 0 35 8 59 0 01/04/18 18/01/19

2 Selina Douglas

Managing Director (voting member when AO is not in attendance)

0k to 2.5k 0 5k to 10k 0 57 20 96 0 01/04/18 31/03/19

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Notes 1. The NEL Commissioning Alliance Accountable Officer and the NEL Commissioning Alliance Chief Finance Officer are appointed officers for

seven CCGs. NHS Barking and Dagenham, Havering, Redbridge, Waltham Forest, Newham and Tower Hamlets. Their total Pensions figures are shown above.

2. The WEL Managing Director is the appointed officers for three CCGs. Waltham Forest, Newham and Tower Hamlets. Her total pension figures are shown above.

The Pensions Related Benefits (PRB) figure is calculated using the method set out in the Finance Act 2004(1), and includes using the member's current and prior year pension and lump sum figures. Where there has been only a small increase in pension and lump sum benefits current year compared to last year, this formula can sometimes generate a negative figure. Where this is the case, Department of Health guidance states that a "zero" should be substituted for any negative figures. Certain individuals disclosed in the Salary and Allowances table are not included in the Pension Benefits table. The reasons for this include:

• Non-executive members do not receive pensionable remuneration; • An executive director may have opted out of the pension scheme; or • For those Governing Body members who are GPs, and who have a contract for service, for their Governing Body duties, pension benefits

disclosures are not required.

79

2017/18

Not

e

Name Title

Real increase in pension at

pension age

Real increase

in pension

lump sum at

pension age

Total accrued

pension at pension age

at 31st March 2018

Lump sum at

pension age

related to accrued pension at 31st March 2018

Cash equivalent

transfer value at 1st April

2017

Real increase in

cash equivalent

transfer value

Cash equivalent

transfer value at

31st March 2018

Employer's contribution

to stakeholder

pension

Dates served

(bands of £2,500)

(bands of £2,500)

(bands of £5,000)

(bands of £5,000)

(to nearest £1,000)

(to nearest £1,000)

(to nearest £1,000)

(to nearest £1,000) From To

£000 £000 £000 £000 £000 £000 £000 £00

1 Jane Milligan

Accountable Officer, Newham CCG share

0k to 2.5k -2.5k to0k 40k to 45k 100k to

105k 666 59 732 0 01/12/17 31/03/18

Steve Gilvin Chief Officer 0k to 2.5k 0k to 2.5k 45k to 50k 140k to

145k 955 46 1,034 0 01/04/17 30/11/17

Chad Whitton

Chief Finance Officer -2.5k to 0k 5k to 7.5k 5k to 10k 20k to

25k 225 -95 0 0 01/04/17 30/08/17

2 Lei Wei Interim Chief Finance Officer 0k to 2.5k 0 5k to 10k 0 23 6 35 0 01/09/17 31/03/18

2 Satbinder Sanghera

Director of Partnerships and Governance

2.5k to 5k 0 50k to 55k 0 592 85 683 0 01/04/17 31/03/18

2 Selina Douglas

Deputy Chief Officer 2.5k to 5k 0 5k to 10k 0 21 36 57 0 01/04/17 31/03/18

Chetan Vyas

Director of Quality & Development 2.5k to 5k 2.5k to 5k 25k to 30k 70k to

75k 365 61 430 0 01/04/17 31/03/18

Notes pertaining to tables from previous years can be found in the 2017/18 annual report.

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Compensation on early retirement of for loss of office

There were no payments for compensation on early retirement in 2018/19 (nil in 2017/18). One exit package was incurred in year. For further details, please refer to the Exit Packages note 4.4 in the financial statements.

Payments to past members

No payments have been made to any person who was not a director at the time the payment was made, but who had been a director previously.

Termination agreements or exit packages (subject to audit)

Termination arrangements are applied in accordance with statutory regulations as modified by national NHS conditions of service agreements (specified in Agenda for Change), and the NHS pension scheme. Specific termination arrangements will vary according to age, length of service and salary levels. The remuneration committee will agree any severance arrangements. During the financial year there were no payments made in relation to payments to past members.

Pay multiples (subject to audit)

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

The banded remuneration of the highest paid director/member in Newham CCG in the financial year 2018/19 was £105k to £110k (2017-18, ££110k to £115k). The median pay in 18/19 has reduced significantly compared to 2017/18. This relates to the change in accounting treatment from Gross to Net Accounting, which results in staff costs now being shared across NELCA and the STP. This impacts inversely on the ratio of median pay to highest-paid, which has increased to 5.08 times in 2018/19 from 2.69 in 2017/18.

This was 4.88 times (2017-18, 2.55 times) the median remuneration of the workforce, which was £22,364 (2017-18, £43,385).

In 2018/19, no (2017-18, two) employees received remuneration in excess of the highest-paid director/member.

Remuneration ranged from £0k to £5k and £105k to £110k (2017-18 £0k to £5k and £125k to £130k).

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

2018/19 2017/18

The banded remuneration of the highest paid director / member 105k - 110k 110k - 115k

Median remuneration of the CCG workforce £22,364 43,385

81

Ratio of highest paid director / member to median paid employee 4.88 2.55

No. of employees who were paid more than the highest paid director / member 0 2

Remuneration ranges in the year 0k - 5k 105k - 110k

0k - 5k 125k - 130k

B2(2) Staff report

Staff numbers, costs and composition (subject to audit)

Numbers of staff

Permanent Other Substantive

GB Member / Office Holder

60 13 33

Sickness absence data

Sickness - April 2018 - March 2019 Number

FTE days sick 684 Average annual sick days per FTE 6.3

Gender breakdown by band Gender Banding Total Percentage Female Band 2 2 2.99%

Band 4 1 1.49% Band 5 2 2.99% Band 6 5 7.46% Band 7 10 14.93% Band 8A 13 19.40% Band 8C 10 14.93% Band 8D 2 2.99% Band 9 1 1.49% Spot Salary 21 31.34%

Female Total 67 Male Band 4 1 2.44%

Band 5 2 4.88% Band 6 1 2.44% Band 7 2 4.88% Band 8A 11 26.83% Band 8C 3 7.32% Band 8D 2 4.88% Band 9 2 4.88% Spot Salary 17 41.46%

Male Total 41 Grand Total 108

82

Number of staff by band Banding Total Band 2 2 Band 4 2 Band 5 4 Band 6 6 Band 7 12 Band 8A 24 Band 8C 13 Band 8D 4 Band 9 3 Spot Salary 38 Grand Total 108

Breakdown by age, disability, religion gender and sexual orientation

83

4.1.1 Employee benefits Admin Programme Total 2018-19

Permanent Employees Other Total

Permanent Employees Other Total

Permanent Employees Other Total

£'000 £'000 £'000 £'000 £'000 £'000 £'000 £'000 £'000 Employee Benefits Salaries and wages 3,157 40 3,197 1,019 2,202 3,222 4,176 2,242 6,418 Social security costs 359 - 359 125 - 125 485 - 485 Employer contributions to the NHS Pension Scheme 356 - 356 97 - 97 454 - 454 Other pension costs - - - - - - - - - Apprenticeship Levy 9 - 9 - - - 9 - 9 Termination benefits 7 - 7 - - - 7 - 7 Gross employee benefits expenditure 3,888 40 3,928 1,242 2,202 3,444 5,131 2,242 7,373

Less recoveries in respect of employee benefits (note 4.1.2) - - - - - - - - - Total - Net admin employee benefits including capitalised costs 3,888 40 3,928 1,242 2,202 3,444 5,131 2,242 7,373

Less: Employee costs capitalised - - - - - - - - - Net employee benefits excluding capitalised costs 3,888 40 3,928 1,242 2,202 3,444 5,131 2,242 7,373

4.1.1 Employee benefits Admin Programme Total 2017-18

Permanent Employees Other Total

Permanent Employees Other Total

Permanent Employees Other Total

£'000 £'000 £'000 £'000 £'000 £'000 £'000 £'000 £'000 Employee Benefits Salaries and wages 2,780 268 3,047 917 2,334 3,251 3,697 2,602 6,299 Social security costs 331 - 331 111 - 111 442 - 442

84

Employer contributions to the NHS Pension Scheme 306 - 306 102 - 102 408 - 408 Other pension costs - - - - - - - - - Apprenticeship Levy 7 - - - Termination benefits 170 - 170 - - - 170 - 170 Gross employee benefits expenditure 3,594 268 3,855 1,130 2,334 3,464 4,717 2,602 7,319

Less recoveries in respect of employee benefits (note 4.1.2) - - - - - - - - - Total - Net admin employee benefits including capitalised costs 3,594 268 3,855 1,130 2,334 3,464 4,717 2,602 7,319

Less: Employee costs capitalised - - - - - - - - - Net employee benefits excluding capitalised costs 3,594 268 3,855 1,130 2,334 3,464 4,717 2,602 7,319

85

Staff policies

We have a robust equal opportunities policy in place and we are committed to equality of opportunity for all employees. The promotion of equality and diversity is actively pursued through our policies to ensure that employees and potential employees receive fair, equitable and consistent treatment and are not subject to direct or indirect discrimination. Furthermore the CCG ensures that all revised HR policies as well as all major service changes require an equalities impact assessment. There has also been training and refresher training for staff on equalities and doing equalities impact assessments.

We promote, through the provision of training and guidance, the impartial application of all employment policies and procedures, and will take action to deal with all inappropriate behaviour.

Courses have been developed to meet specific development needs in relation to equality and diversity and appropriate training is provided for employees. Our equality and diversity responsibilities and those of our employees are incorporated into employee training at all levels from induction courses to senior management workshops.

The Equality Act 2010 legally protects people from discrimination in the workplace and in wider society. It replaced previous anti-discrimination laws with a single act, making the law easier to understand and strengthening protection in some situations. The intention of the general equality duty is to ensure that a public authority like NHS Newham CCG must, in the exercise of its functions as a public sector organisation, have due regard to the need to:

• Eliminate discrimination, harassment, victimisation and any other conduct that isprohibited by or under the Act.

• Advance equality of opportunity between persons who share a relevant protectedcharacteristic and persons who do not share it.

• Foster good relations between persons who share a relevant protected characteristicand persons who do not share it. We routinely analyse our existing and new policies toensure there is no unintended negative or disproportionate impact on equality groupsthat are protected by the Equality Act. At NHS Newham CCG no policy decision is madewithout an equality analysis of the policy.

Our governing body report cover sheet includes a section specifically about equality impact prompting managers to carrying out an equality analysis of the policy or the function they are reporting to the governing body. We maintain a log for all our equality analyses and ensure the actions arising from the analyses are implemented and monitored. Staff receive appropriate training and support to complete equality analysis.

Trade union facility time

While we meet the criteria for trade union facility time we have no facility time costs.

Other staff matters

Our workforce are central to being able to deliver on our corporate objectives, operating plan and strategy and investing into our workforce is a priority for Newham CCG. During the last year we worked together to identify the values and behaviours which we felt were important to us in relation to how we work together in doing our jobs. Our values are a key part of everything we do, from our commissioning intentions to decision making to how we interact with colleagues within and external to the CCG.

86

We are committed to providing staff with a fair and equitable environment to work in and have policies that guide our approach to managing our workforce including in matters relating to equality, recruitment and HR matters, career management and flexible working and access to training and support in the workplace. We recognise that only by investing in our workforce and empowering them to deliver can we truly do our best as an organisation.

Engaging with our staff We communicate with staff regularly through a variety of channels, including:

• ‘Your weekly update’ is a weekly email newsletter for all staff with a message from the Managing Director and updates on a variety of topics

• monthly face to face staff meetings for the Managing Director to update staff and hear concerns and ideas

• the CCG intranet which is accessible by all staff In addition to team meetings and one to ones with their line managers, staff are encouraged to have a voice in providing ideas, comments, concerns and compliments and there are a number of ways in which they can do this:

• an anonymous comments and suggestions post box in the staff kitchen • monthly face to face drop in sessions with a member of the senior management team • an anonymous electronic survey which staff can complete at any time • the staff barometer is an anonymous survey provides a means for senior managers to

sense check how staff are feeling and identify improvements to improve the working environment

Staff survey In January 2019 a survey of staff in Barking and Dagenham, Havering and Redbridge (BHR), City and Hackney, Newham, Tower Hamlets and Waltham Forest CCGs and the central North East London Commissioning Alliance and the East London Health and Care Partnership teams was carried out. It covered three broad areas:

• the respondent’s understanding of the current arrangements regarding NELCA and ELHCP and how they feel about potential change

• how the respondent feels about their work, including relationships with managers and health and well-being and personal development issues

• what the respondent thinks about staff communications and engagement within their CCG and with the Alliance.

Newham had a 65.9% response rate with some positive feedback, but also some areas of concern that will be addressed over the coming months. Key positive findings include:

• 61% of staff who responded look forward to coming to work • 63% feel that their manager is supportive • 65% believe that communication between senior managers and staff is effective • 86% know who the senior managers are

The survey highlighted that there are areas where we need to do better:

• only 18% of respondents felt valued for their work • over 50% had not had an appraisal in the last year • nearly 50% felt unwell due to work related stress

87

• 10% of respondents reported experiencing bullying or harassment The responses from the staff survey (published in early April 2019) are being reviewed and the managing director is looking at the detailed results to think about what needs to be done locally to address areas of concern and build on positive findings.

Developing our workforce In 2018/19 a total of £69,836 was spent on continuing personal and professional development. There were a total of 159 attendances for in-house training on a range of topics including an accredited certificate in commissioning, presentation skills, writing business cases, logic modelling. We held a series of bite-sized 1 hour sessions which provided informal opportunities for staff to share learning. Topics included project management skills, quality improvement, psychological adaption to change. We have encouraged staff to access coaching and mentoring provided by the London Leadership Academy. All line managers were offered 360 degree feedback based on our refreshed values and behaviours framework. The feedback was well received and valued. We also supported two apprenticeships during the year with one person continuing to work for the CCG after completing the scheme. Health and wellbeing We have engaged a new provider for occupational health and employee assistance provider (EAP). The CCG intranet staff health and wellbeing pages were reviewed and updated, providing staff with best practice advice and links to resources on a topics, such as healthy eating, smoking and alcohol and personal resilience.

Expenditure on consultancy

In 2018/19 consultancy expenditure was significantly lower than 2017/18, primarily because in 2017/18 a number of strategic estates projects commenced non-recurrently. These strategic estates projects have received national or regional funding from NHS England. 2018/19 total 2017/18 total £533k £900k

Off-payroll engagements

Off payroll engagements as of 31 March 2019, for more than £245 per day and that last longer than six months are as follows:

Number

Number of existing engagements as of 31 March 2019 7 Of which, the number that have existed: For less than one year at the time of reporting 1 For between one and two years at the time of reporting 0 For between 2 and 3 years at the time of reporting 3 For between 3 and 4 years at the time of reporting 1 For 4 or more years at the time of reporting 2

88

All existing off payroll engagements, outlined above, have at some point been subject to a risk based assessment as to whether assurance is required that the individual is paying the right amount of tax and, where necessary, that assurance has been sought.

Number No. of new engagements, or those that reached six months in duration, between 1 April 2017 and 31 March 2018 1 Of which: No. assessed as caught by IR35 0 No. assessed as not caught by IR35 1

No. engaged directly (via PSC contracted to department) and are on the departmental payroll 0 No. of engagements reassessed for consistency / assurance purposes during the year. 6 No. of engagements that saw a change to IR35 status following the consistency review 0

Number of off-payroll engagements of board members, and/or senior officers with significant financial responsibility, during the financial year (1) 0 Total no. of individuals on payroll and off-payroll that have been deemed “board members, and/or, senior officials with significant financial responsibility”, during the financial year. This figure should include both on payroll and off-payroll engagements.(2) 0

89

Exit packages, including special (non-contractual) payments

One exit package was made in 2018-19 as detailed below.

Exit package cost band (inc. any special payment element

Number of compulsory redundancies

Cost of compulsory redundancies

Number of other departures agreed

Cost of other departures agreed

Total number of exit packages

Total cost of exit packages

Number of departures where special payments have been made

Cost of special payment element included in exit packages

WHOLE NUMBERS ONLY £s

WHOLE NUMBERS ONLY £s

WHOLE NUMBERS ONLY £s

WHOLE NUMBERS ONLY £s

Less than £10,000

1 7

£10,000 - £25,000

£25,001 - £50,000

£50,001 - £100,000

£100,001 - £150,000

£150,001 –£200,000

>£200,000 TOTALS 1 7 Agrees to A

below

B1: Exit packages

Redundancy and other departure cost have been paid in accordance with the provisions of the NHS Agenda for Change Terms and Conditions. Exit costs in this note are accounted for in full in the year of departure. Where the Newham CCG has agreed early retirements, the additional costs are met by the Newham CCG and not by the NHS Pensions Scheme. Ill-health retirement costs are met by the NHS Pensions Scheme and are not included in the table.

90

Agreements Total value of agreements Number £000s

Voluntary redundancies including early retirement contractual costs Mutually agreed resignations (MARS) contractual costs Early retirements in the efficiency of the service contractual costs Contractual payments in lieu of notice*

1 7

Exit payments following employment tribunals or court orders Non-contractual payments requiring HMT approval** TOTAL 1 7

B2: Analysis of other departures

As a single exit package can be made up of several components each of which will be counted separately in this Note, the total number above will not necessarily match the total numbers in Note 4 which will be the number of individuals.

*any non-contractual payments in lieu of notice are disclosed under “non-contracted paymentsrequiring HMT approval” below.

The Remuneration Report includes disclosure of exit packages payable to individuals named in that Report.

B3. Parliamentary Accountability and Audit Report NHS Newham CCG is not required to produce a Parliamentary Accountability and Audit Report. Disclosures on remote contingent liabilities, losses and special payments, gifts, and fees and charges are included as notes in the financial statements of this report. An audit certificate and report is also included in this Annual Report.

B3(1) Audit certificate and report

91

92

information included in the Annual Report for the financial year is consistent with the financial statements.

Annual Governance Statement

We are required to report to you if the Annual Governance Statement does not comply with guidance issued by the NHS Commissioning Board. We have nothing to report in this respect.

Remuneration and Staff Report

In our opinion the parts of the Remuneration and Staff Report subject to audit have been properly prepared in accordance with the Department of Health and Social Care Group Accounting Manual 201'8/19.

Accountable Officer's responsibilities

As explained more fully in the statement set out on page 59, the Accountable Officer is responsible for: the preparation of financial statements that give a true and fair view; such internal control as they determine is necessary to enable the preparation of financial statements that are free from material misstatement, whether due to fraud or error; assessing the CCGs ability to continue as a going concern, disclosing, as applicable, matters related to going concern; and using the going concern basis of accounting unless they have been informed by the relevant national body of the intention to dissolve the CCG without the transfer of its services to another public sector entity.

Auditor's responsibilities

Our objectives are to obtain reasonable assurance about whether the financial statements as a whole are free from material misstatement, whether due to fraud or error, and to issue our opinion in an auditor's report. Reasonable assurance is a high level of assurance, but does not guarantee that an audit conducted in accordance with ISAs (UK) will always detect a material misstatement when it exists. Misstatements can arise from fraud or error and are considered material if, individually or in aggregate, they could reasonably be exp·ected to influence the economic decisions of users taken on the basis of the financial statements.

A fuller description of our responsibilities is provided on the FRC's website at www.frc.org.uk/auditorsresponsibilities

REPORT ON OTHER LEGAL AND REGULATORY MATTERS

Opinion on regularity

We are required to report on the following matters under Section 25(1) of the Local Audit and Accountability Act 2014.

In our opinion, 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 conform to the authorities which govern them.

Report on the CCG's arrangements for securing economy, efficiency and effectiveness in its use of resources

Under the Code of Audit Practice we are required to report to you if the CCG has not made proper arrangements for securing economy, efficiency and effectiveness in its use of resources.

We have nothing to report in this respect.

Respective responsibilities in respect of our review of arrangements for securing economy, efficiency and effectiveness in the use of resources

As explained more fully in the statement set out on page 59, the Accountable Officer is responsible for ensuring that the CCG exercises its functions effectively, efficiently and economically. We are required under section 21 (1 )(c) of the Local Audit and Accountability Act 2014 to be satisfied that the CCG has made proper arrangements for securing economy, efficiency and effectiveness in its use of resources.

93

94

Section C. ANNUAL ACCOUNTS

Jane Milligan Accountable Officer 28 May 2019

95

NHS Newham CCG - Annual Accounts 2018-19

Statement of Comprehensive Net Expenditure for the year ended31 March 2019

2018-19 2017-18Note £'000 £'000

Income from sale of goods and services 2 - (3,753)Other operating income 2 (3,760) (645)Total operating income (3,760) (4,398)

Staff costs 4 7,372 7,326Purchase of goods and services 5 506,208 489,711Depreciation and impairment charges 5 307 353Provision expense 5 73 -Other Operating Expenditure 5 166 152Total operating expenditure 514,126 497,542

Net Operating Expenditure 510,366 493,144

Finance income - -Finance expense - -Net expenditure for the year 510,366 493,144

Net (Gain)/Loss on Transfer by Absorption - -Total Net Expenditure for the Financial Year 510,366 493,144Other Comprehensive Expenditure

Comprehensive Expenditure for the year 510,366 493,144

96

NHS Newham CCG -Annual Accounts 2018-19

Statement of Financial Position as at 31 March 2019

Non-current assets: Property, plant and equipment Total non-current assets

Current assets: Trade and other receivables Cash and cash equivalents Total current assets

Total assets

Current liabilities Trade and other payables Provisions Total current liabilities

Assets less Liabilities

Financed by Taxpayers' Equity General fund Total taxpayers' equity:

The notes on pages 100 to 120 form part of this statement.

Note

9 10

11 12

2018-19 2017-18

£'000 £'000

----�.,...,,... 1,418 1,641 1,418 1,641

6,780 6,544 63 53

6,843 6,597

8,261 8,238

(67,354) (57,505)

-----------'-(73)

(67,427) (57,505)

(59,166) (49,267)

(59,166) (49,267) (59,166) (49,267)

The Financial statements on pages 96 to 120 were approved by the Governing Body on 17th May 2019 and signed on its behalf

97

NHS Newham CCG - Annual Accounts 2018-19

Statement of Changes In Taxpayers Equity for the year ended31 March 2019

General fund£'000

Changes in taxpayers’ equity for 2018-19

Balance at 01 April 2018 (49,267)Impact of applying IFRS 9 to Opening Balances (13)Impact of applying IFRS 15 to Opening Balances 0Adjusted NHS Clinical Commissioning Group balance at 31 March 2018 (49,280)

Changes in NHS Clinical Commissioning Group taxpayers’ equity for 2018-19Net operating expenditure for the financial year (510,366)

Net Recognised NHS Clinical Commissioning Group Expenditure for the Financial Year (559,646)Net funding 500,480Balance at 31 March 2019 (59,166)

General fund£'000

Changes in taxpayers’ equity for 2017-18

Balance at 01 April 2017 (37,323)Adjusted NHS Clinical Commissioning Group balance at 31 March 2018 (37,323)

Changes in NHS Clinical Commissioning Group taxpayers’ equity for 2017-18Net operating costs for the financial year (493,144)Reserves eliminated on dissolution 0Net Recognised NHS Clinical Commissioning Group Expenditure for the Financial Year (493,144)Net funding 481,200Balance at 31 March 2018 (49,267)

The notes on pages 100 to 121 form part of this statement.

98

NHS Newham CCG - Annual Accounts 2018-19

Statement of Cash Flows for the year ended31 March 2019

2018-19 2017-18Note £'000 £'000

Cash Flows from Operating ActivitiesNet operating expenditure for the financial year (510,366) (493,144)Depreciation and amortisation 5 307 353Non-cash movements arising on application of new accounting standards (13) 0(Increase)/decrease in inventories 0 0(Increase)/decrease in trade & other receivables 9 (236) (1,607)(Increase)/decrease in other current assets 0 0Increase/(decrease) in trade & other payables 11 9,803 13,223Increase/(decrease) in other current liabilities 0 0Increase/(decrease) in provisions 12 73 0Net Cash Inflow (Outflow) from Operating Activities (500,432) (481,175)

Cash Flows from Investing Activities(Payments) for property, plant and equipment (38) (24)Rental revenue 0 0Net Cash Inflow (Outflow) from Investing Activities (38) (24)

Net Cash Inflow (Outflow) before Financing (500,470) (481,199)

Cash Flows from Financing ActivitiesGrant in Aid Funding Received 500,480 481,200Net Cash Inflow (Outflow) from Financing Activities 500,480 481,200

Net Increase (Decrease) in Cash & Cash Equivalents 10 10 1

Cash & Cash Equivalents at the Beginning of the Financial Year 53 52Effect of exchange rate changes on the balance of cash and cash equivalents held in foreign currencies 0 0Cash & Cash Equivalents (including bank overdrafts) at the End of the Financial Year 63 53

The notes on pages 100 to 121 form part of this statement

99

NHS Newham CCG - Annual Accounts 2018-19

Notes to the financial statements

1 Accounting PoliciesNHS England has directed that the financial statements of NHS Newham CCG shall meet the accounting requirements of the Group Accounting Manual issued by the Department of Health and Social Care. Consequently, the following financial statements have been prepared in accordance with the Group Accounting Manual 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 the CCG, as determined by HM Treasury, which is advised by the Financial Reporting Advisory Board. Where the Group Accounting Manual permits a choice of accounting policy, the accounting policy which is judged to be most appropriate to the particular circumstances of the CCG for the purpose of giving a true and fair view has been selected. The particular policies adopted by Newham CCG are described below. They have been applied consistently in dealing with items considered material in relation to the accounts.

1.1 Going ConcernThese accounts have been prepared on 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.

The Statement of Financial Position of NHS Newham CCG as at 31 March 2019 shows a net liability position. This is as a result of the timing of working capital, and the very low level of non-current assets held, and not as a result of going concern or cash flow issues.

1.2 Accounting ConventionThese accounts have been prepared under the historical cost convention modified to account for the revaluation of property, plant and equipment, intangible assets, inventories and certain financial assets and financial liabilities.

1.3 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 Newham CCG is a joint operator it recognises its share of, assets, liabilities, income and expenses in its own accounts.Newham CCG operates a Better Care Fund under a Section 75 agreement with the London Borough of Newham. This joint operation involves shared investment and decision making between the CCG and Local Authority.

Newham CCG has no Joint Venture activity.

1.4 Pooled BudgetsWhere NHS Newham CCG has entered into a pooled budget arrangement under Section 75 of the National Health Service Act 2006 NHS Newham CCG accounts for its share of the assets, liabilities, income and expenditure arising from the activities of the pooled budget, identified in accordance with the pooled budget agreement.If NHS Newham CCG is in a “jointly controlled operation”, NHS Newham CCG recognises:· The assets NHS Newham CCG controls;· The liabilities NHS Newham CCG incurs;· The expenses NHS Newham CCG incurs; and,· NHS Newham CCG’s share of the income from the pooled budget activities.

If NHS Newham CCG is involved in a “jointly controlled assets” arrangement, in addition to the above, NHS Newham CCG recognises:

· NHS Newham CCG’s share of the jointly controlled assets (classified according to the nature of the assets);· NHS Newham CCG’s share of any liabilities incurred jointly; and,· NHS Newham CCG’s share of the expenses jointly incurred.

100

NHS Newham CCG - Annual Accounts 2018-19

Notes to the financial statements

1.5 RevenueThe 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 Newham CCG will not disclose information regarding performance obligations part of a contractthat has an original expected duration of one year or less,

• Newham CCG is to similarly not disclose information where revenue is recognised in line with the practical expedient offered inparagraph 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 commissioninggroup to reflect the aggregate effect of all contracts modified before the date of initial application.

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 Newham CCG 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.

1.60 Employee Benefits1.6.1 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.The cost of leave earned but not taken by employees at the end of the period is recognised in the financial statements to the extent that employees are permitted to carry forward leave into the following period.

1.6.2 Retirement Benefit CostsPast and present employees are covered by the provisions of the NHS Pensions 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.

1.7 Other ExpensesOther operating expenses are recognised when, and to the extent that, the goods or services have been received. They are measured at the fair value of the consideration payable.

1.8 Property, Plant & Equipment1.8.1 Recognition

Property, plant and equipment is capitalised if:·   It is held for use in delivering services or for administrative purposes;·   It is probable that future economic benefits will flow to, or service potential will be supplied to the clinical commissioning group;

·   It is expected to be used for more than one financial year;·   The cost of the item can be measured reliably; and,·   The item has a cost of at least £5,000; or,·   Collectively, a number of items have a cost of at least £5,000 and individually have a cost of more than £250, where the assetsare functionally interdependent, they had broadly simultaneous purchase dates, are anticipated to have simultaneous disposal dates andare 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 orcollective cost.Where a large asset, for example a building, includes a number of components with significantly different asset lives, the components aretreated as separate assets and depreciated over their own useful economic lives.

1.8.2 Subsequent ExpenditureWhere subsequent expenditure enhances an asset beyond its original specification, the directly attributable cost is capitalised. Where subsequent expenditure restores the asset to its original specification, the expenditure is capitalised and any existing carrying value of theitem replaced is written-out and charged to operating expenses.

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Notes to the financial statements

1.8.3 Depreciation, Amortisation & ImpairmentsFreehold 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, Newham CCG 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.

1.9 LeasesLeases are classified as finance leases when substantially all the risks and rewards of ownership are transferred to the lessee. All other leases are classified as operating leases.

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Notes to the financial statements

1.9.1 Newham CCG as LesseeProperty, plant and equipment held under finance leases are initially recognised, at the inception of the lease, at fair value or, if lower, at the present value of the minimum lease payments, with a matching liability for the lease obligation to the lessor. Lease payments are apportioned between finance charges and reduction of the lease obligation so as to achieve a constant rate on interest on the remaining balance of the liability. Finance charges are recognised in calculating the clinical commissioning group’s surplus/deficit.

Operating lease payments are recognised as an expense on a straight-line basis over the lease term. Lease incentives are recognised initially as a liability and subsequently as a reduction of rentals on a straight-line basis over the lease term.Contingent rentals are recognised as an expense in the period in which they are incurred.Where a lease is for land and buildings, the land and building components are separated and individually assessed as to whether they are operating or finance leases.

1.10 Cash & Cash EquivalentsCash is cash in hand and deposits with any financial institution repayable without penalty on notice of not more than 24 hours. Cash equivalents are investments that mature in 3 months or less from the date of acquisition and that are readily convertible to known amounts of cash with insignificant risk of change in value.In the Statement of Cash Flows, cash and cash equivalents are shown net of bank overdrafts that are repayable on demand and that form an integral part of Newham CCG's cash management.

1.11 ProvisionsProvisions are recognised when Newham CCG has a present legal or constructive obligation as a result of a past event, it is probable that the clinical commissioning group will be required to settle the obligation, and a reliable estimate can be made of the amount of the obligation. The amount recognised as a provision is the best estimate of the expenditure required to settle the obligation at the end of the reporting period, taking into account the risks and uncertainties.

Where the liabilities is expected to fall due within 12 months, no discount has been appliedEarly retirement provisions are discounted using HM Treasury’s pension discount rate of positive 0.29% (2017-18: positive 0.10%) in real terms.

1.12 Clinical Negligence CostsNHS Resolution operates a risk pooling scheme under which Newham CCG pays an annual contribution to NHS Resolution, which in return settles all clinical negligence claims. The contribution is charged to expenditure. Although NHS Resolution is administratively responsible for all clinical negligence cases, the legal liability remains with Newham CCG.

1.13 Non-clinical Risk PoolingNewham participates in the Property Expenses Scheme and the Liabilities to Third Parties Scheme. Both are risk pooling schemes under which Newham CCG 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.

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Notes to the financial statements

1.14 Financial AssetsFinancial assets are recognised when Newham CCG becomes party to the financial instrument contract or, in the case of trade receivables, when the goods or services have been delivered. Financial assets are derecognised when the contractual rights have expired or the asset has been transferred.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 isdetermined at the time of initial recognition.

1.14.1 Financial Assets at Amortised costFinancial assets measured at amortised cost are those held within a business model whose objective is achieved by collecting contractualcash flows and where the cash flows are solely payments of principal and interest. This includes most trade receivables and other simpledebt instruments. After initial recognition these financial assets are measured at amortised cost using the effective interest method lessany impairment. The effective interest rate is the rate that exactly discounts estimated future cash receipts through the life of the financialasset to the gross carrying amount of the financial asset.

1.14.2 Financial assets at fair value through other comprehensive incomeFinancial assets held at fair value through other comprehensive income are those held within a business model whose objective isachieved by both collecting contractual cash flows and selling financial assets and where the cash flows are solely payments of principaland interest.

1.14.3 Financial assets at fair value through profit and lossFinancial assets measure at fair value through profit and loss are those that are not otherwise measured at amortised cost or fair valuethrough other comprehensive income. This includes derivatives and financial assets acquired principally for the purpose of selling in theshort term.

1.14.4 ImpairmentFor all financial assets measured at amortised cost or at fair value through other comprehensive income (except equity instrumentsdesignated at fair value through other comprehensive income), lease receivables and contract assets, the clinical commissioning grouprecognises 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 lossallowance for trade receivables, lease receivables and contract assets at an amount equal to lifetime expected credit losses. For otherfinancial assets, the loss allowance is measured at an amount equal to lifetime expected credit losses if the credit risk on the financialinstrument 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 governmentdepartments, their executive agencies, the Bank of England, Exchequer Funds and Exchequer Funds assets where repayment is ensuredby primary legislation. The clinical commissioning group therefore does not recognise loss allowances for stage 1 or stage 2 impairmentsagainst these bodies. Additionally DHSC provides a guarantee of last resort against the debts of its arm's lengths bodies and NHS bodiesand 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.

1.15 Financial LiabilitiesFinancial liabilities are recognised on the statement of financial position when the clinical commissioning group becomes party to the contractual provisions of the financial instrument or, in the case of trade payables, when the goods or services have been received. Financial liabilities are de-recognised when the liability has been discharged, that is, the liability has been paid or has expired.

1.15.1 Financial Guarantee Contract LiabilitiesFinancial 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 andContingent Assets.

1.15.2 Financial Liabilities at Fair Value Through Profit and LossEmbedded derivatives that have different risks and characteristics to their host contracts, and contracts with embedded derivatives whoseseparate 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.

1.15.3 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.

1.16 Value Added TaxMost of the activities ofNewham CCG are outside the scope of VAT and, in general, output tax does not apply and input tax on purchases is not recoverable. Irrecoverable VAT is charged to the relevant expenditure category or included in the capitalised purchase cost of fixed assets. Where output tax is charged or input VAT is recoverable, the amounts are stated net of VAT.

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Notes to the financial statements

1.17 Losses & Special PaymentsLosses and special payments are items that Parliament would not have contemplated when it agreed funds for the health service or passed legislation. By their nature they are items that ideally should not arise. They are therefore subject to special control procedures compared with the generality of payments. They are divided into different categories, which govern the way that individual cases are handled.

Losses and special payments are charged to the relevant functional headings in expenditure on an accruals basis, including losses which would have been made good through insurance cover had Newham CCG not been bearing its own risks (with insurance premiums then being included as normal revenue expenditure).

1.18 Critical accounting judgements and key sources of estimation uncertaintyIn the application of the clinical commissioning group's accounting policies, management is required to make various judgements, estimates and assumptions. These are regularly reviewed.

1.18.1 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.NHS Newham CCG made no judgements that would have a material effect on the amounts recognised in the financial statements.

1.18.2 Key Sources of Estimation UncertaintyThe 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.

NHS Newham CCG had no material key sources of estimatioon uncertainty.1.19 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.

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2 Other Operating Revenue2018-19 2017-18

Total Total

£'000 £'000

Income from sale of goods and services (contracts)Education, training and research - 452Non-patient care services to other bodies - 3,301Total Income from sale of goods and services - 3,753

Other operating incomeOther non contract revenue 3,760 645Total Other operating income 3,760 645

Total Operating Income 3,760 4,398

To comply with IFRS 15 Newham CCG has reclassified income as Non Contract Income in 2018/19.

3 Disaggregation of Income - Income from sale of good and services (contracts)

Revenue is totally from the supply of services. NHS Newham CCG receives no revenue from the sale of goods.

Revenue in this note does not include cash received from NHS England, which is drawn down directly into the bank account of NHS Newham CCG and credited to the General Fund.

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4. Employee benefits and staff numbers

4.1.1 Employee benefits 2018-19

Permanent Employees Other Total

£'000 £'000 £'000Employee BenefitsSalaries and wages 4,176 2,242 6,418 Social security costs 484 - 484 Employer Contributions to NHS Pension scheme 454 - 454 Other pension costs - - - Apprenticeship Levy 9 - 9 Termination benefits 7 - 7 Gross employee benefits expenditure 5,130 2,242 7,372

Less recoveries in respect of employee benefits - - - Total - Net admin employee benefits including capitalised costs 5,130 2,242 7,372

Less: Employee costs capitalised - - - Net employee benefits excluding capitalised costs 5,130 2,242 7,372

4.1.1 Employee benefits 2017-18

Permanent Employees Other Total

£'000 £'000 £'000Employee BenefitsSalaries and wages 3,697 2,602 6,299 Social security costs 442 - 442 Employer Contributions to NHS Pension scheme 408 - 408 Apprenticeship Levy 7 - 7 Termination benefits 170 - 170 Gross employee benefits expenditure 4,724 2,602 7,326

Less recoveries in respect of employee benefits - - - Total - Net admin employee benefits including capitalised costs 4,724 2,602 7,326

Less: Employee costs capitalised - - - Net employee benefits excluding capitalised costs 4,724 2,602 7,326

Total

Total

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4.2 Average number of people employed

Permanently employed Other Total

Permanently employed Other Total

Number Number Number Number Number Number

Total 70.39 13.03 83.42 64.81 13.37 78.18

Of the above:Number of whole time equivalent people engaged on capital projects - - - - - -

4.4 Exit packages agreed in the financial year

Number £ Number £ Number £Less than £10,000 1 6,525 - - 1 6,525£10,001 to £25,000 - - - - - -£25,001 to £50,000 - - - - - -£50,001 to £100,000 - - - - - -£100,001 to £150,000 - - - - - -£150,001 to £200,000 - - - - - -Over £200,001 - - - - - -Total 1 6,525 - - 1 6,525

Number £ Number £ Number £Less than £10,000 1 10,000 - - 1 10,000£10,001 to £25,000 - - 1 13,219 1 13,219£25,001 to £50,000 - - - - - -£50,001 to £100,000 - - - - - -£100,001 to £150,000 - - - - - -£150,001 to £200,000 1 160,000 - - 1 160,000Over £200,001 - - - - - -Total 2 170,000 1 13,219 3 183,219

Analysis of Other Agreed Departures

Number £ Number £Contractual payments in lieu of notice - - 1 13,219Total - - 1 13,219

No early retirements were agreed in 2018/19 and 2017/18.

2017-18Other agreed departures

2018-19Compulsory redundancies

2017-18Compulsory redundancies

Other agreed departures

Other agreed departures

2018-19

2018-19

Total

2018-19

2018-19Other agreed departures Total

2017-18 2017-18

2017-18

There has been no departure in 2018/19.

The table reports the number and value of exit packages agreed in the financial year. The expense associated with these departures may have been Redundancy and other departure costs have been paid in accordance with / mirroring the provisions of the NHS Agenda for Change Terms & Conditions. Exit costs are accounted for in accordance with relevant accounting standards and at the latest in full in the year of departure.No early retirements were agreed in 2018/19 and 2017/18.No non-contractual payments were made to individuals where the payment value was more than 12 months’ of their annual salary.

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4.5 Pension costs

PENSION COSTS

Past and present employees are covered by the provisions of the two NHS Pension Schemes. Details of the benefits payable and rules ofthe Schemes can be found on the NHS Pensions website at www.nhsbsa.nhs.uk/pensions. Both are unfunded defined benefit schemesthat cover NHS employers, GP practices and other bodies, allowed under the direction of the Secretary of State for Health in England andWales. They are not designed to be run in a way that would enable NHS bodies to identify their share of the underlying scheme assets andliabilities. Therefore, each scheme is accounted for as if it were a defined contribution scheme: the cost to the NHS body of participating ineach 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 bedetermined at the reporting date by a formal actuarial valuation, the FReM requires that “the period between formal valuations shall be fouryears, with approximate assessments in intervening years”. An outline of these follows:

a) Accounting valuationA valuation of scheme liability is carried out annually by the scheme actuary (currently the Government Actuary’s Department) as at the endof the reporting period. This utilises an actuarial assessment for the previous accounting period in conjunction with updated membershipand financial data for the current reporting period, and is accepted as providing suitably robust figures for financial reporting purposes. Thevaluation of the scheme liability as at 31 March 2019, is based on valuation data as 31 March 2018, updated to 31 March 2019 withsummary global member and accounting data. In undertaking this actuarial assessment, the methodology prescribed in IAS 19, relevantFReM 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 NHSPension Scheme Accounts. These accounts can be viewed on the NHS Pensions website and are published annually. Copies can also beobtained from The Stationery Office.

b) Full actuarial (funding) valuationThe purpose of this valuation is to assess the level of liability in respect of the benefits due under the schemes (taking into account recentdemographic 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 setthe employer contribution rate payable from April 2019. The Department of Health and Social Care have recently laid Scheme Regulationsconfirming 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 2012valuation. Following a judgment from the Court of Appeal in December 2018 Government announced a pause to that part of the valuationprocess pending conclusion of the continuing legal process.

For 2018-19, employers’ contributions of £428k were payable to the NHS Pensions Scheme (2017-18: £408k) were payable to the NHS PensionScheme at the rate of 14.38% of pensionable pay. The scheme’s actuary reviews employer contributions, usually every four years and now based onHMT Valuation Directions, following a full scheme valuation. The latest review used data from 31 March 2012 and was published on the Governmentwebsite on 9 June 2012. These costs are included in the NHS pension line of note 4.1.

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5. Operating expenses2018-19 2017-18

Total Total£'000 £'000

Purchase of goods and servicesServices from other CCGs and NHS England 3,188 3,574Services from foundation trusts 113,542 111,350Services from other NHS trusts 229,851 222,943Purchase of healthcare from non-NHS bodies 32,880 30,652Prescribing costs 41,398 42,143GPMS/APMS and PCTMS 57,146 55,104Supplies and services – general 18,862 17,314Consultancy services 538 903Establishment 1,782 1,630Transport 1 -Premises 4,890 2,335

1 Audit fees 52 51Other professional fees 1,235 478Legal fees 24 31Education, training and conferences 819 1,203 Total Purchase of goods and services 506,208 489,711

Depreciation and impairment chargesDepreciation 307 353Total Depreciation and impairment charges 307 353

Provision expenseProvisions 73 -Total Provision expense 73 -

Other Operating ExpenditureChair and Non Executive Members 154 152Expected credit loss on receivables 12 -Total Other Operating Expenditure 166 152

Total operating expenditure 506,754 490,216

Explanatory notes as below

1.The fee to the CCG's external auditors, KPMG LLP, is £43k excluding VAT. The figure shown in the note above includes irrecoverable VAT at20%.

The contract, signed during 2018-19, states that the liability of KPMG, its members, partners and staff (whether in contract, negligence or otherwise) shall in no circumstances exceed £500k, aside from where the liability cannot be limited by law. This is in aggregate in respect of all services.

The Newham CCG will be required to obtain assurance from the external auditors over reported compliance with the requirements of the Mental Health Investment Standard. The CCG has received £10,000 of resource allocation in relation to this work. The final fee is not yet confirmed.

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6.1 Better Payment Practice Code

Measure of compliance 2018-19 2018-19 2017-18 2017-18Number £'000 Number £'000

Non-NHS PayablesTotal Non-NHS Trade invoices paid in the Year 10,005 114,223 9,267 102,488 Total Non-NHS Trade Invoices paid within target 9,556 111,841 8,839 98,579 Percentage of Non-NHS Trade invoices paid within target 95.51% 97.91% 95.38% 96.19%

NHS PayablesTotal NHS Trade Invoices Paid in the Year 3,619 356,944 2,792 337,061 Total NHS Trade Invoices Paid within target 3,469 342,685 2,585 333,671 Percentage of NHS Trade Invoices paid within target 95.86% 96.01% 92.59% 98.99%

7. Operating Leases

7.1 As lessee[Where the NHS clinical commissioning group is a lessee, include a general description of significant leasing arrangements, including:(a) basis on which contingent rent is determined(b) terms of renewal, purchase options or escalation clauses and(c) restrictions imposed by lease arrangements]

7.1.1 Payments recognised as an Expense 2018-19 2017-18Buildings Other Total Buildings Other Total

£'000 £'000 £'000 £'000 £'000 £'000Payments recognised as an expenseMinimum lease payments 4,000 11 4,011 2,204 13 2,217Contingent rents - - - - - -Sub-lease payments - - - - - -Total 4,000 11 4,011 2,204 13 2,217

7.1.2 Future minimum lease payments 2018-19 2017-18Buildings Other Total Buildings Other Total

£'000 £'000 £'000 £'000 £'000 £'000Payable:No later than one year 1,228 11 1,239 1,290 13 1,303Between one and five years 5,336 44 5,380 5,720 45 5,765After five years 5,553 - 5,553 6,478 - 6,478Total 12,117 55 12,172 13,488 58 13,546

Whilst our arrangements with Community Health Partnership's Limited and NHS Property Services Limited fall within the definition of operating leases, rental charge for future years has not yet been agreed . Consequently this note does not include future minimum lease payments for the arrangements only

NHS Newham CCG has a lease arrangement for the occupation of its headquarter premises. The lease is for 15 years, with a break clause at year 10.

In 2018-19, no payments were made in relation to claims under the Late Payment of Commercial Debts (Interest) Act 1998 (nil in 2017-18).

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8 Property, plant and equipment

8.1

2018-19Plant &

machineryInformation technology

Furniture & fittings Total

£'000 £'000 £'000 £'000

Cost or valuation at 01 April 2018 1,940 462 982 3,384

Additions purchased - 85 - 85Cost/Valuation at 31 March 2019 1,940 547 982 3,469

Depreciation 01 April 2018 859 421 464 1,744

Charged during the year 202 22 83 307Depreciation at 31 March 2019 1,061 443 547 2,051

Net Book Value at 31 March 2019 879 104 435 1,418

Purchased 879 104 435 1,418Total at 31 March 2019 879 104 435 1,418

Asset financing:

Owned 879 104 435 1,418

Total at 31 March 2019 879 104 435 1,418

8.1.1 Economic lives

Minimum Life (years)

Maximum Life (Years)

Plant & machinery 1 10Information technology 1 10Furniture & fittings 1 8

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9.1 Trade and other receivables Current Non-current Current Non-current2018-19 2018-19 2017-18 2017-18

£'000 £'000 £'000 £'000

NHS receivables: Revenue 2,779 - 3,409 -NHS prepayments 2,135 - 2,096 -NHS accrued income 923 - 177 -Non-NHS and Other WGA receivables: Revenue 826 - 447 -Non-NHS and Other WGA prepayments 47 - 291 -Non-NHS and Other WGA accrued income 10 - - -Expected credit loss allowance-receivables (25) - - -VAT 83 - 123 -Other receivables and accruals 2 - 1 -Total Trade & other receivables 6,780 - 6,544 -

Total current and non current 6,780 6,544

Included above:Prepaid pensions contributions - -

9.2 Receivables past their due date but not impaired2018-19 2018-19 2017-18 2017-18

DHSC Group Bodies

Non DHSC Group Bodies

DHSC Group Bodies

Non DHSC Group Bodies

£'000 £'000 £'000 £'000By up to three months 113 52 98 200By three to six months 18 - 6 (5)By more than six months 1,366 127 267 91Total 1,497 179 371 286

9.3 Impact of Application of IFRS 9 on financial assets at 1 April 2018Trade and other

receivables -NHSE bodies

Trade and other receivables - other DHSC

group bodies

Trade and other receivables -

external

Other financial assets

Total

£000s £000s £000s £000s £000sClassification under IAS 39 as at 31st March 2018Financial Assets held at FVTPL - - - - -Financial Assets held at Amortised cost - 1,578 2,009 447 4,034Financial assets held at FVOCI - - - - -Total at 31st March 2018 - 1,578 2,009 447 4,034

Changes due to change in measurement attribute - - - - -Other changes - - - - -Change in carrying amount - - - - -

9.4 Movement in loss allowances due to application of IFRS 9Trade and other

receivables -NHSE bodies

Trade and other receivables - other DHSC

group bodies

Trade and other receivables -

external

Other financial assets

Total

£000s £000s £000s £000s £000sLoss allowance under IFRS 9 as at 1st April 2018Financial Assets measured at amortised cost - - (13) - (13)Financial Assets measured at FVOCI - - - - -Total at 1st April 2018 - - (13) - (13)

Change in loss allowance arising from application of IFRS 9 - - (13) - (13)

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10 Cash and cash equivalents

2018-19 2017-18£'000 £'000

Balance at 01 April. 53 52Net change in year 10 1Balance as at 31 March. 63 53

Made up of:Cash with the Government Banking Service 63 53Current investments - -Cash and cash equivalents as in statement of financial position 63 53

Balance at 31 March. 63 53

Current Non-current Current2018-19 2018-19 2017-18

£'000 £'000 £'000

Interest payable - - -NHS payables: Revenue 8,749 - 8,924NHS accruals 10,813 - 7,769Non-NHS and Other WGA payables: Revenue 4,626 - 3,782Non-NHS and Other WGA payables: Capital 58 - 11Non-NHS and Other WGA accruals 41,170 - 36,142Non-NHS and Other WGA deferred income 10 - -Social security costs 77 - 73VAT 190 - -Tax 77 - 83Other payables and accruals* 1,584 - 721Total Trade & Other Payables 67,354 - 57,505

Total current and non-current 67,354 57,505

11.1 Impact of Application of IFRS 9 on financial liabilities at 1 April 2018

Trade and other

payables - NHSE

bodies

Trade andother

payables - other

DHSC group

bodies

Trade and other

payables - external

Other financial liabilities Total

£000s £000s £000s £000s £000sClassification under IAS 39 as at 31st March 2018Financial Assets held at FVTPL - - - - -Financial Assets held at Amortised cost (1,747) (22,240) (32,640) (721) (57,348)Total at 31st March 2018 (1,747) (22,240) (32,640) (721) (57,348)

Classification under IFRS 9 as at 1st April 2018Total at 1st April 2018 (1,747) (22,240) (32,640) (721) (57,348)

*Included in this balance is the value of outstanding pension contributions as at 31 March.

11 Trade and other payables

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NHS Newham CCG - Annual Accounts 2018-19

12 ProvisionsCurrent Current2018-19 2017-18

£'000 £'000Other 73 -Total 73 -

Total current and non-current 73 -

13 Financial instruments

13.1 Financial risk management

13.1.1 Currency risk

13.1.2 Interest rate risk

13.1.3 Credit risk

13.1.4 Liquidity risk

13.1.5 Financial Instruments

Potential costs across Newham, Tower Hamlets and Waltham Forest CCG's have been accounted for in equal shares under the terms of the MoU in place to manage the impact of transition.

The "other" costs reflects potential dilapidation charges that will arise under exisitng contract should CCG's negotiate early exit from their existing headquarters.

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.

The clinical commissioning group borrows from government for capital expenditure, subject to affordability as confirmed by NHS England. The borrowings are for 1 to 25 years, in line with the life of the associated assets, and interest is charged at the National Loans Fund rate, fixed for the life of the loan. The clinical commissioning group therefore has low exposure to interest rate fluctuations.

Because the majority of the NHS clinical commissioning group and revenue comes parliamentary funding, NHS clinical commissioning group has low exposure to credit risk. The maximum exposures as at the end of the financial year are in receivables from customers, as disclosed in the trade and other receivables note.

NHS clinical commissioning group is required to operate within revenue and capital resource limits, which are financed from resources voted annually by Parliament. The NHS clinical commissioning group draws down cash to cover expenditure, as the need arises. The NHS clinical commissioning group is not, therefore, exposed to significant liquidity risks.

Financial reporting standard IFRS 7 requires disclosure of the role that financial instruments have had during the period in creating or changing the risks a body faces in undertaking its activities.

Because NHS clinical commissioning group is financed through parliamentary funding, it is not exposed to the degree of financial risk faced by business entities. Also, financial instruments play a much more limited role in creating or changing risk than would be typical of listed companies, to which the financial reporting standards mainly apply. The clinical commissioning group has limited powers to borrow or invest surplus funds and financial assets and liabilities are generated by day-to-day operational activities rather than being held to change the risks facing the clinical commissioning

Treasury management operations are carried out by the finance department, within parameters defined formally within the NHS clinical commissioning group standing financial instructions and policies agreed by the Governing Body. Treasury activity is subject to review by the NHS clinical

The NHS clinical commissioning group is principally a domestic organisation with the great majority of transactions, assets and liabilities being in the UK and sterling based. The NHS clinical commissioning group has no overseas operations. The NHS clinical commissioning group and

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NHS Newham CCG - Annual Accounts 2018-19

13 Financial instruments cont'd

13.2 Financial assets

Financial Assets measured at

amortised cost Total2018-19 2018-19

£'000 £'000Trade and other receivables with NHSE bodies 1,705 1,705Trade and other receivables with other DHSC group bodies 2,007 2,007Trade and other receivables with external bodies 826 826Other financial assets 2 2Cash and cash equivalents 63 63Total at 31 March 2019 4,603 4,603

13.3 Financial liabilities

Financial Liabilities measured at

amortised cost Total2018-19 2018-19

£'000 £'000Trade and other payables with NHSE bodies 2,090 2,090Trade and other payables with other DHSC group bodies 23,922 23,922Trade and other payables with external bodies 39,404 39,404Other financial liabilities 1,584 1,584Private Finance Initiative and finance lease obligations - -Total at 31 March 2019 67,000 67,000

14 Operating segmentsNewham CCG has only one segment; Commissioning of Healthcare Services.

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NHS Newham CCG - Annual Accounts 2018-19

15 Joint arrangements - interests in joint operations

CCGs should disclose information in relation to joint arangements in line with the requirements in IFRS 12 - Disclosure of interests in other entities.

15.1 Interests in joint operations

Name of arrangement Parties to the arrangementDescription of

principal activities Assets Liabilities Income Expenditure Assets Liabilities Income Expenditure

£'000 £'000 £'000 £'000 £'000 £'000 £'000 £'000Better Care Fund LBN / NHS Newham CCG BCF 0 0 0 19,004 0 0 0 15,365

Amounts recognised in Entities books ONLYAmounts recognised in Entities books ONLY2018-19 2017-18

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NHS Newham CCG - Annual Accounts 2018-19

16 Related party transactions

Payments to Related PartyReceipts from Related Party

Amounts owed to

Related Party

Amounts due from Related

PartyRelated Party £'000 £'000 £'000 £'000

Newham GP Co-Operative Ltd 1,222 0 1,011 0Newham Heath Collaborative Ltd 1,346 0 871 0Patient first Social Enterprise 823 0 496 0

Carpenters Road – Lantern Health 2,132 0 0 0Dr T Krishnamurthy Practice 287 0 0 0Dr. CM Patel's Surgery 253 0 0 0Essex Lodge Surgery 1,753 0 4 0Greengate Medical Practice 1,025 0 0 0Lord Lister Health Centre 467 0 0 0Market Street Health Group 1,857 0 0 0Sangam Surgery 1,437 0 0 0St Luke's Medical Centre 569 0 0 0Tollgate Medical Centre 2,297 0 11 0Woodgrange Medical Practice 1,851 0 13 0

• Barts Health NHS Trust • Barking, Havering & Redbridge NHS Trust• East London NHS FT • Guys & St Thomas NHS FT• Homerton University Hospital NHS FT • London Ambulance Service NHS Trust• Moorfields Eye Hospital NHS FT • NHS NEL Commissioning Support Unit• University College London Hospitals NHS FT • NHS Tower Hamlets CCG• Imperial College Healthcare NHS Trust • Kings College Hospital NHS Trust• Royal Free NHS Trust • NHS Waltham Forest CCG

• London Borough of Newham

16.1 Related Party Transactions 2017-18

Payments to Related PartyReceipts from Related Party

Amounts owed to

Related Party

Amounts due from Related

PartyRelated Party £000 £000 £000 £000Community Barnet 4 0 0 0Newham GP Co-Operative Ltd 1,436 0 375 0Newham Heath Collaborative Ltd 1,856 0 288 0Patient first Social Enterprise 1,652 0 0 0

Details of related party transactions with individuals are as follows:

Employees of NHS Newham CCG are required to disclose any relevant and material interests they may have in other organisations (related parties). This is recorded in the Register of Interests.

The transactions listed below are payments made to the related parties declared by NHS Newham CCG's Governing Body members (other than payments to practices, other NHS bodies, and other government departments):

The transactions listed below are payments made to those practices where one of the GPs of that practice is or has been a member of NHS Newham CCG's Governing Body during 2017-18. These payments include GMS/PMS contract and ad hoc payments, but exclude prescribing payments:

NHS Newham CCG is part of a Risk Share agreement across the North East London CCG's (Barking & Dagenham CCG, City and Hackney CCG, Havering CCG, Newham CCG, Redbridge CCG, Tower Hamlet CCG and Waltham Forest CCG). In 2018/19 NHS Newham CCG paid £0.5 million to NHS Waltham Forest CCG, as part of the Risk Share agreement.

Employees of NHS Newham CCG are required to disclose any relevant and material interests they may have in other organisations (related parties). This is recorded in the Register of Interests.

The transactions listed below are payments made to the related parties declared by NHS Newham CCG's Governing Body members (other than payments to practices, other NHS bodies, and other government departments):

The transactions listed below are payments made to those practices where one of the GPs of that practice is or has been a member of NHS Newham CCG's Governing Body during 2018-19. These payments include GMS/PMS contract and ad hoc payments, but exclude prescribing payments:

The Department of Health is regarded as a related party. During 2018-19 and 2017-18 , NHS Newham CCG has had a significant number of material transactions (expenditure more than £1m) with the Department, and with other entities for which the department is regarded as the parent department, and NHS England the parent entity, including:

During 2018-19 and 2017-18, NHS Newham CCG has had a number of material transactions with other government departments and other central and local government bodies. The material transactions have been with:

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Payments to Related PartyReceipts from Related Party

Amounts owed to

Related Party

Amounts due from Related

Party

Practice Name £000 £000 £000 £000

Carpenters Road – Lantern Health 2,050 0 0 0

Dr T Krishnamurthy Practice 291 0 0 0

Essex Lodge Surgery 1,684 0 0 0

Greengate Medical Practice 1,023 0 0 0

Market Street Health Group 1,942 0 0 0

Sangam Surgery 1,569 0 0 0

St Luke's Medical Centre 553 0 0 0

Stratford Village Surgery 1,362 0 0 0

Tollgate Medical Centre 2,250 0 0 0

Woodgrange Medical Practice 1,780 0 8 0

• Barts Health NHS Trust• Barking, Havering & Redbridge NHS Trust

• East London NHS FT• Guys & St Thomas NHS FT

• Homerton University Hospital NHS FT• London Ambulance Service NHS Trust

• Moorfields Eye Hospital NHS FT• NHS NEL Commissioning Support Unit

• University College London Hospitals NHS FT• NHS Tower Hamlets CCG

• Imperial College Healthcare NHS Trust• Kings College Hospital NHS Trust

• London Borough of Newham• NHS Pensions

• HM Revenue and Customs

The Department of Health is regarded as a related party. During 2018-19 and 2017-18 , NHS Newham CCG has had a significant number of material transactions (expenditure more than £1m) with the Department, and with other entities for which the department is regarded as the parent department, and NHS England the parent entity, including:

In 2017/18, Newham CCG has made payments to its partner CCGs within the North East London Sustainability and Transformation Plan (NEL STP), namely Barking & Dagenham, Havering, Redbridge, Waltham Forest, Tower Hamlets and City & Hackney CCGs. These seven CCGs in the NEL STP have shared the same Accountable Officer since the 1st December 2017.

During 2017-18, NHS Newham CCG has had a number of material transactions with other government departments and other central and local government bodies. The material transactions have been with:

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NHS Newham CCG - Annual Accounts 2018-19

17 Events after the end of the reporting period

18 Financial performance targets

NHS Clinical Commissioning Group have a number of financial duties under the NHS Act 2006 (as amended).NHS Clinical Commissioning Group performance against those duties was as follows:

2018-19 2018-19 2017-18 2017-18Target Performance Target Performance

Expenditure not to exceed income 514,229 514,210 499,263 497,553Capital resource use does not exceed the amount specified in Directions 84 84 11 11Revenue resource use does not exceed the amount specified in Directions 510,385 510,366 494,854 493,144Capital resource use on specified matter(s) does not exceed the amount specified in Directions - - - -Revenue resource use on specified matter(s) does not exceed the amount specified in Directions - - - -Revenue administration resource use does not exceed the amount specified in Directions 7,679 7,622 7,561 7,532

Revenue Resource allocations is net of cumulative surplus of £7.2m.

19 Losses and Special Payments

There were no Losses or Special Payments in 2018-19 and 2017-18.

Newham CCG has no event after the end of the reporting period.

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