NHS Tower Hamlets CCG – Insert name of document here
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Tower Hamlets Clinical Commissioning Group
Annual Report and Accounts 2018/19
Website: www.towerhamletsccg.nhs.uk Email: [email protected]
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Abbreviations used in this report
AC Audit Committee
AGS Annual Governance Statement
ACS Accountable Care System
BHR Barking and Dagenham, Havering and Redbridge
CCG Clinical Commissioning Group
CCP Community Commissioning Panel
CQRG Clinical Quality Review Group
CQRM Contract and Quality Review Meetings
EPPR emergency preparedness, resilience and response
F&D Finance and Delivery
FFT friends and family test
FRPB Financial Recovery Programme Board
GB Governing Body
HWB Health and Wellbeing Board
ICPB Integrated Care Partnership Board
INEL Inner North East London
JC Joint Committee
JCAF Joint Committee assurance framework
JCC Joint Commissioning Committee
MRSA Methicillin-resistant Staphylococcus aureus (a type of bacteria that is widely resistant to
antibiotics)
MSA mixed-sex accommodation
NEL north east London
NELCA North East London Commissioning Alliance
NELFT NELFT NHS Foundation Trust
NHSE NHS England
NHSI NHS Improvement
NICE National Institute for Health and Care Excellence
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PEF Patient Engagement Forum
PPI patient and public involvement
QI quality improvement
QIPP quality, innovation, productivity and prevention (a large-scale transformation
programme which aims to deliver a better quality service for less money)
RTT referral to treatment time
RSM RSM Internal Auditors
UEC urgent and emergency care
WEL Waltham Forest and East London
WELC Waltham Forest, East London and City and Hackney
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Contents Introduction ........................................................................................................................................ 5
A. PERFORMANCE REPORT ............................................................................................................ 7 A1. Performance overview ................................................................................................................ 8
A1(1) Accountable Officer’s perspective on performance .......................................................... 8 A1(2) Managing Director’s perspective on performance .......................................................... 10 A1(3) The purpose, activities and objectives of the CCG ........................................................ 11 A1(4) Our Year in Review – Commissioning Successes in 2018/19 ........................................ 16 A1(5) Working With Our Partners ............................................................................................. 19 A1(6) The key issues and risks of the CCG ............................................................................. 23 A1(7) Going concern opinion .................................................................................................... 23 A1(8) Performance summary ................................................................................................... 23 A2. Performance analysis ........................................................................................................... 25 A2(1) Financial performance .................................................................................................... 25 A2(2) How the CCG measures and checks performance ........................................................ 28 A2(3) Other performance matters ............................................................................................ 36
B. ACCOUNTABILITY REPORT ...................................................................................................... 46 B1 Corporate governance report ................................................................................................. 47 B1(1) Members’ report ............................................................................................................. 47 B1(2) Statement of Accountable Officer’s Responsibilities ...................................................... 55 B1(3) Governance Statement .................................................................................................. 56 B1(4) Head of Internal Audit Opinion ....................................................................................... 79 B1(5) Review of the effectiveness of governance, risk management and internal control ....... 83 B2. Remuneration and Staff Report ............................................................................................ 85 B2(1) Remuneration report ...................................................................................................... 86 B2(2) Staff report ...................................................................................................................... 93 Parliamentary Accountability and Audit Report ......................................................................... 102 B3(1) Audit certificate and report ........................................................................................... 103
ANNUAL ACCOUNTS .................................................................................................................... 104
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Introduction We are proud to present the 2018/19 annual report and accounts for NHS Tower Hamlets 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 Tower Hamlets 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.
Tower Hamlets 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 ‘outstanding’ 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. 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. Examples include arts activities, gardening, cookery, healthy eating advice and a range of
sports.
We have continued to pioneer integration of care through Tower Hamlets Together, our local integrated
partnership of providers and commissioners. We would like to thank all of our partners, the London Borough of
Tower Hamlets, local healthcare partners, the Tower Hamlets GP Care Group, 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 and we look forward to continuing to work
together to innovate, explore and improve the health and care of people living and working in Tower Hamlets.
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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Jane Milligan Accountable Officer NHS Tower Hamlets CCG
Selina Douglas Managing Director NHS Tower Hamlets CCG
Sir Sam Everington Chair NHS Tower Hamlets CCG
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A. PERFORMANCE REPORT
Jane Milligan
Accountable Officer
24 May 2019
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A1. Performance overview
A1(1) Accountable Officer’s perspective on performance
We are proud to present the 2018/19 annual report and accounts for Tower Hamlets 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 Tower Hamlets a healthier and happier place to live.
Tower Hamlets 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.
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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 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 Tower Hamlets.
The following report provides an overview of NHS Tower Hamlets CCG’s performance in 2018/19 as well as
the annual accounts.
Jane Milligan
Accountable Officer
24 May 2019
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A1(2) Managing Director’s 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 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 improved utilisation of local capacity
and maximised capital opportunities.
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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 are necessary, via the e-
referral system.
Workforce – a 200% increase in the number of Physicians Associates employed into primary 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
The CCG is responsible for planning and buying most healthcare services in Tower Hamlets. It's our job to
identify how health services in Tower Hamlets can best meet the needs of local people, both now and in the
future and we have a statutory duty to address and reduce health inequalities in the borough. To do this, we
work closely with clinicians, patients, carers, our local authority colleagues and the local voluntary and
community sector to ensure NHS resources deliver the best possible health outcomes for our population, and
in the most efficient way.
We are a clinically-led membership organisation, made up of the 35 general practices in Tower Hamlets. Our
organisation is led by GPs and healthcare professionals who, between them, have many years’ experience
caring for patients.
We want to make a real improvement to the health of our local people. As a clinically-led organisation, we are
committed to working with our stakeholders, patients and their families – together we make the best use of
resources and staff across health and social care.
Our GP membership is involved in setting the CCG's overall aims, strategic commissioning direction and
priorities. Responsibility for detailed planning and operational commissioning of local health services is
delegated to the CCG's Governing Body.
Our borough and population
Tower Hamlets is unique. Home to around 305,000 people, the local community is diverse, with 33% from
White British or Irish ethnic groups and 67% from other ethnic groups, the largest of which (32%) is the
Bangladeshi community. Religion continues to play a prominent role in the lives of many local people, with
65% having a religious belief including 35% of residents that identify as Muslim. The borough has a young
population with 37% of people aged 20-34, compared with 20% across England as a whole.
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Tower Hamlets also has one of the fastest growing populations in London and is expected to reach around
354,000 by 2025. The borough is adjacent to commercial development, including the site of the London 2012
Olympic and Paralympic Games, Thames Gateway and projects in Canary Wharf. The borough has seen
significant residential development over the last few years and this is projected to continue, providing
opportunities for local regeneration.
The vibrancy of Tower Hamlets is also apparent in its physical and cultural assets including the many
waterways, Victoria and Mile End parks, a variety of museums and markets, and the Tower of London (from
which the borough derives its name). All of these elements contribute to the borough's unmatched sense of
place, identity and pride.
Key Health Statistics
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%
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Our Challenges – Reducing Health Inequalities
Tower Hamlets is a vibrant and dynamic London borough - based in the heart of the East End with a strong
tradition of diversity. When we commission services, to meet the health needs of all local people, we need to
consider the following key facts.
Tower Hamlets is:
Young: 37 % of our population is aged between 20-34, compared to 20% nationally
Densely populated and continues to grow: we have around 305,000 residents and this is set to grow to
354,000 by 2025
Ethnically diverse: 33% of our population are from a White British or Irish ethnic group and 67% from
other ethnic groups. The largest of which is the Bangladeshi community (32%).
Deprivation
Tower Hamlets is a borough of contrasts, it is both one of the most deprived areas in England yet it is also
home to one the country's main financial centres in Canary Wharf. The level of deprivation in the borough has
an adverse impact on the health and wellbeing of local people and places a significant demand on public
services. Tower Hamlets has the highest worklessness rate in London, at 7.7%, and the highest rate of
poverty as well – 39%. Child poverty is higher here than in any other borough as well, with 43% of children
living in poverty and rates of infant mortality and premature mortality are also significantly above the London
average.
However, the population is changing due to the level of development within the borough. In 2010, Tower
Hamlets was ranked the 7th most deprived borough in the country with 70% of people living in the 20% most
deprived areas of the country. In 2015, it was ranked the 10th most deprived with 58% living in the 20% most
deprived areas. This change reflects growth of new populations in the borough, but significant health
inequalities remain. Life expectancy is 7.7 years lower for men and 4.3 years lower for women in the most
deprived areas of Tower Hamlets compared with those living in affluent areas.
A significantly higher percentage of households in Tower Hamlets are socially rented (40%) compared to the
rest of London (24%) and, despite the substantial housing growth, high levels of overcrowding persist. The
borough also has less green space than the national average, with 0.89 hectares per 1,000 people compared
to the local open space standard of 1.2 hectares per 1,000.
Unemployment remains an issue with 64% of the working age population in work, compared to 69% across
London. Just over 3% of the borough's population provide more than 20 hours of unpaid care per week and, of
that group, more than half provide more than 50 hours.
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Sources: https://www.trustforlondon.org.uk
https://www.towerhamlets.gov.uk/lgnl/health__social_care/joint_strategic_needs_assessme/joint_strategic_ne
eds_assessme.aspx
Health Headlines
Many people in Tower Hamlets are living with a long-term condition and hospital admission rates for heart
disease and stroke are above the national average. According to the 2011 Census results, 13.5% of people in
Tower Hamlets stated they had a long-term health problem or disability that limited their day to day activities
(34,300 people). This is slightly lower than the regional and national rates (14.1% in London and 17.6% in
England).
Other health headlines include:
• We have the highest child poverty rate in the UK
• Life expectancy in Tower Hamlets remains lower than rest of country (78.7 years compared to 79.5
years nationally for males and 82.4 compared to 83.1 for females)
• 8.3% of all babies born in Tower Hamlets have a low birth weight.
• A quarter (26.8%) of children aged 10 to 11 years old are obese.
• Premature death rates from circulatory disease, cancer and respiratory disease are among the highest
in the UK.
Healthy life expectancy
The high levels of deprivation in Tower Hamlets have a direct impact on the number of years that people
remain healthy later in their lives. This means that they begin to develop multiple health problems far earlier in
life than elsewhere.
On average, a man living in the borough starts to develop health problems from the age of 61.3 compared to
63.3 in the rest of the country. For a woman, it is 55.6 compared to 63.9. Healthy life expectancy ranks 55th
lowest for men and third lowest for women among all local authorities.
This has an effect on both the demand for health services and the complexity of health issues. The annual GP
consultation rate for adults aged 50-64 in the most deprived parts of the borough is up to twice as high as in
wealthier parts of the country. The problems that people go to their GP for help with are also, on average,
more than twice as complex.
Given the significant health inequalities within the borough, the CCG takes a life course approach to planning
and commissioning services, from birth to the last years of life. The Joint Strategic Needs Assessment (JSNA),
produced by the London Borough of Tower Hamlets Public Health team, supports us to understand the health
needs of our population better.
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Delivery of our Equalities Strategy is overseen by our Executive Committee which reports directly to our
Governing Body and provides assurance on our work in this area. The committee is chaired by a local GP. We
have a nominated lead for equalities on our Governing Body and a senior manager to drive forward our
equalities agenda.
Our corporate objectives and how we measure success
As a CCG we are always seeking to improve services and ensure the financial and other resources we are
given are used in the best way to commission safe, effective and high-quality healthcare for local people.
People's experiences and views, good and bad, help us to understand what we are getting right but more
importantly we know if we engage with service users we are better able to improve services through our
commissioning priorities. We have a statutory duty to engage with patients and we work hard to ensure that
the concerns of patients and feedback we receive is used to help us to learn and continually improve services.
Our corporate objectives relate to the CCG in its entirety, providing the organisation with a clear direction for
commissioning intentions; they reflect where we are now as a CCG, and where we want to be in the future as
well as our obligation to fulfil our statutory duties. The objectives develop our approach to performance and
risk management, and provide a framework for performance management.
They are:
a. To work in partnership to commission high-quality hospital services that are accessible, provide
the appropriate treatment in the right place, and achieve good patient outcomes for people of all
ages living in the borough
b. To commission person-centred, integrated health and care services that are sustainable and that
equally meet the mental and physical needs of our residents
c. To contribute towards a financially sustainable and responsive health and care economy which
delivers value for money and innovation and supports the appropriate use of services
d. To support local people and stakeholders to have a greater influence on services we commission
e. To promote equality both as an employer and a commissioner of health care services
f. To create a high performing and sustainable workforce that continuously learns and is engaged in
delivering our ambitions.
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A1(4) Our Year in Review – Commissioning Successes in 2018/19
Transformation
End of Life
This year the CCG implemented Coordinate My Care (CMC) to deliver better integrated, coordinated and
personalised medical care for people at end of life. Over the course of the year, CMC has been rolled out to all
Tower Hamlets GP practices and as of February 2019, 212 Tower Hamlets patients with end of life care needs
have had a CMC care plan created. The CMC plans mean that GPs are having and recording conversations
with people at the end of life about their choices and preferences and that this can then be shared with other
services involved in their care. Over 2019/20, we will be looking to increase the number of care plans in the
borough, as well as rolling this out to other services, including Barts Health and our community teams.
Cancer
During 2018/19, the CCG continued with driving its commitment to seeing cancer as long term condition and
has invested in improving recorded prevalence at local level. Since the implementation of the Cancer
Prevalence Network Incentive Scheme 2017/18, 545 more Tower Hamlets patients have been identified as
having a cancer diagnosis, equal to a 17% rise in recorded prevalence. Future plans for 2019/20 will include
continuing to pioneer mainstreaming cancer care across the north east London footprint and undertaking a
collaborative research project in primary care to review patients diagnosed with cancer between 2016 and
2018 with a view to understanding avoidable delays to diagnosis.
Diabetes
The Healthier You: NHS Diabetes Prevention Programme (NHS DPP) identifies those at high risk of Type 2
diabetes and refers them onto a behaviour change programme. As of December 2018 we’ve had 293 people
complete the programme in Tower Hamlets and a further 413 are still actively engaged. Also, we have used
the NHS England Diabetes Transformation fund as an opportunity to focus on improvement in care for people
with Type 1 diabetes. This funding has been used to fund staff to provide multi-disciplinary care for people
with Type 1 diabetes.
Personalisation
Tower Hamlets are now at the forefront of developing Personalisation in London. We have 530 Personal
Health Budgets (PHBs), the most PHBs in London. We have also been working on improving quality of
person-centred holistic planning as part of the Personalised Care Programme (PCP), for which we have been
a demonstrator site, to help shape the roll out of this approach nationally with NHS England, the aims of which
are included in chapter one of the Long Term Plan. The main focus of the work has been working on
improving the system for adults with learning disabilities, people with severe mental health needs, people with
2 or more long term conditions and children with Special Educational Needs and Disabilities (SEND).
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Social prescribing
Social prescribing in Tower Hamlets has gone from strength to strength. We led on possibly the first
econometric evaluation of social prescribing and, based on work by the CCG’s Financial Strategy team, the
CCG was able to agree an increased, recurrent budget for the local service which has set it on a sustainable
footing for the foreseeable future. We were also delighted to hear that NHS England will make funding
available to primary care networks for social prescribing link workers, which dramatically enhance the scope
and research of the service across primary, secondary, community and social care.
Planned Care
The Planned Care programme has had some significant successes in 2018/19. The national Paper Switch Off
(PSO) programme set a contractual requirement for all GP referrals to consultant-led first outpatient
appointments to be made via the NHS e-Referral Service (eRS) from 1 October 2018. An ambitious training
and engagement process was undertaken in general practice, in collaboration with Barts Health. Utilisation of
the e-referral service is now around 97%, a significant increase from the approximately 30% utilisation prior to
the programme commencing. The e-Referral Service offers improved patient safety, transparency and
supports informed patient choice. It also offers additional features for GPs, including Advice & Guidance and
Referral Assessment Services, which aim to provide rapid access to consultant support and advice and
ensure that patients are treated in the right place at the right time.
2018/19 also saw the launch of a new Minor Eye Conditions Service (MECS) that aims to provide convenient,
high quality care for minor eye conditions in the community. MECS offers local residents an alternative to
hospital eye care and operates across five locations in Tower Hamlets. MECS helps to ensure that patients
are seen in the right service at the right time and frees up capacity in hospital for patients who need to be seen
by a specialist and increases access for patients with less complex eye issues that still require input from an
Optometrist.
Another success for the Planned Care programme in 2018/19 was a pilot project to support primary care staff
to initiate suitable, low risk patients on NOACs (Non Vitamin-K Antagonist Oral Anticoagulants). Prior to the
pilot, patients had to be referred into hospital to start NOACs, which are a type of anticoagulation medication.
This increased the time patients had to wait to start anticoagulation therapy and also presented a significant
cost pressure for the CCG. In 2018, the CCG worked with the Barts Health Anticoagulation service and the GP
Care Group to develop a new patient pathway (that aimed to deliver care quicker and closer to home) and
design training and support for primary care staff to initiate NOACs. Two training sessions have been
delivered by Barts Health to primary care staff and some practices are starting to initiate suitable patients on
NOACs. More training sessions are planned for next year and the pilot will be expanded to all practices who
wish to participate.
Limited capacity and increasing demand remains a key challenge for Planned Care, particularly in outpatients
where waiting times are long in a number of specialties. To combat this we are working closely with GPs to
reduce the variation in referral rates across the borough and encourage uptake of Advice & Guidance and
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Referral Assessment Services. The CCG is also taking a more collaborative approach to planning and
commissioning services and transformation projects in high priority areas, through our Tower Hamlets
Together (THT) partnership board, and by working with Waltham Forest, Newham and City & Hackney CCGs.
Mental Health
In 2018/19, Tower Hamlets took a lead role in the Learning from Deaths National Programme and completed
18 mortality case reviews for people with a learning disability making it the leading London CCG. Findings
from this research will influence our future commissioning and delivery of service and help us to improve the
health inequality faced by people with a learning disability by tackling their drastically lower life expectancy.
Alongside this, our continued focus on improving health outcomes for people with a learning disability has
seen us make steady improvements in the number of adults and young people who have an annual health
check in the Borough with the process being embedded within the Primary Care system for the coming years.
Working with the Community Learning Disability Service and Primary Care, we are reviewing people with a
learning disability prescribed anti-psychotic medication as part of the ‘Stopping Over Medication of people with
learning disabilities’ programme.
We have continued our commitment to the Transforming Care national programme to reduce hospital
admissions and improve care for children and adults with a learning disability and/or autism. Development of
risk registers and steering groups has brought a multitude of agencies together to address this.
We are working with Barts Health NHS Trust and Tower Hamlets Council to allow support workers and carers
to provide care to those individuals admitted to hospital ensuring continuity of care and improved experiences
whilst in hospital.
We continue to work with Tower Hamlets Council to improve employment opportunities and address the
accommodation assets within Tower Hamlets for people with a learning disability. We are reviewing the Barts
Health NHS Trust ‘Hospital Passport’ with the aim of redeveloping this onto an electronic platform.
Improving Access to Psychological Treatment (IAPT)
From 1 October 2018, the CCG has commissioned East London NHS Foundation Trust (ELFT) to provide the
Tower Hamlets Talking Therapies Service which provide IAPT and counselling services. The previous IAPT,
bilingual counselling, bereavement counselling and general counselling services were brought together
creating a single point of access through which all services can be accessed.
The new contract aims to meet the ambitions in the National Mental Health Strategy - the Five Year Forward
View, including more people accessing talking therapy, and more people with long-term health conditions
benefiting from the service. It will also mean clearer pathways between physical and mental health services
and between primary and secondary care.
NHS Tower Hamlets CCG – Annual Report
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Launch of Tower Hamlets Mental Health Crisis Line
A mental health crisis line was launched in October 2018 to support people living and working in Tower
Hamlets, provided by ELFT. The mental health crisis line is available 24 hours a day and callers will be given
support and advice from mental health professionals.
It has been designed as a ‘first port of call’ for anyone experiencing a mental health crisis and to remove the
need for those people to seek help via hospital A&E services.
This is a service to help people in Tower Hamlets when they are experiencing a real mental health situation
and they cannot reach other healthcare professionals who would normally provide the support they need. The
team can help assess the urgency of the situation and ensure the appropriate advice is provided, help is put in
place or individuals are signposted to the team or service best placed to provide the care needed.
Mental Health Employment Support
The CCG together with the Local Authority commissions the Work & Wellbeing Hub. This service provides
mental health recovery focused support that enables people to develop skills, confidence and knowledge that
supports people to achieve their training and/or employment goals. People can also get advice and
information about volunteering opportunities. The service can offer advice and support to people who are
thinking about self-employment or the development of a new social enterprise.
For people already in employment it is also able to provide job retention support who may be at risk of being
unemployed due to mental health issues. It can also provide information to employers about mental health.
The CCG is also working to increase access to Individual Placement and Support (IPS) services by 2020/21,
enabling more people who experience a severe mental illness to find and retain employment.
A1(5) Working With Our Partners
Local Integration – Tower Hamlets Together
Tower Hamlets Together (THT) is a partnership of local health and social care organisations working towards
delivering and improving integrated care in Tower Hamlets, so that our patients receive more joined up and
person-centred services. As well as the CCG the partnership includes:
• Tower Hamlets Council
• TH GP Care Group
• East London Foundation Trust
• Barts Health Trust
• TH Council for Voluntary Service
NHS Tower Hamlets CCG – Annual Report
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During 2018 the CCG continued to play a leading role in the development of Tower Hamlets Together, working
to provide services in a more coordinated way – reducing duplication and improving the experience and
outcomes for the people who need them.
From joint planning, joint commissioning, and alignment of operational health and care teams in the
community our efforts have been to work together to design services that address local priorities. At the same
time, we have been working with wider planning footprints to ensure our system as a whole secures the best
possible outcomes and maximum value for our collective investment.
Our outcomes framework and emerging working structures have been aligned across the needs of our
population rather than across diseases or services, and highlights forward thinking to support people and their
communities in helping them lead fulfilling lives. A place based approach is also being developed via the
Locality Health and Well Being Committees.
We are continuing to develop our joint infrastructure which encompasses more co-location and the joint
management of staff, as well as a shared focus on services for the whole course of life.
Key highlights from 2018/19 are:
• The recent appointment of an Independent Chair for Tower Hamlets Together Board to strengthen the
partnership’s decision making and accountability arrangements. The post holder is due to start in April
2019.
• The three life course workstreams whose membership is made up of senior and operational staff from the
partnership have taken a leading role in the delivery of the CCGs commissioning cycle. This has been the
vehicle through which opportunities have been identified to improve outcomes, reduce costs, system
duplication and promote joint working in developing system priorities.
• The appointment of a Joint Director of Integrated Commissioning between the CCG and LBTH has
helped improve partnership working with LBTH. A joint division for commissioning has been established
and this is a step in the right direction as the best means of meeting the financial challenges ahead.
A THT Finance Summit was held in August 2018 by the THT Board, where Finance Directors from each of the
partner organisations presented and agreed the following actions as priorities for 2018/19. These are:
1. Identify the resources available for the lifecourse workstreams to fully align around the populations
they are set up to serve
2. Further align and pool budgets across commissioning
3. Further align/integrate commissioning and service delivery
4. Develop a framework for governance and accountability for the THT system to include decision
making and risk share
NHS Tower Hamlets CCG – Annual Report
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The four Locality Health and Well Being Committees were established and have been meeting monthly which
has General Practice at its core. The committees have a wider remit that will involve not only the delivery of
integrated care but also delivery of the broader population health strategy. They are developing involvement
from communities which links with the learning from the Communities Driving Change (CDC) Programme led
by Public Health.
The Community Health Services ’Alliance’ contract delivers the Multi-Disciplinary Team (“MDT”) arrangements
now operating across the borough. These are supported by locality based community health teams and the
intention is to integrate mental health teams into the locality model. In addition, the council has realigned its
operational adults social care services around the locality footprints in order to integrate better with its
counterparts in health.
During the first year, as a system, progress was made to establish and mobilise the alliance partnership
between the CCG, Barts Health, East London Foundation Trust and Tower Hamlets GP Care Group for
community services. In the second year of the contract the CCG have been looking at the value added of
these partnership arrangements, by reviewing and refreshing the contractual monitoring arrangements,
together with the outcomes framework which is a core component of the contract. In particular, there is a
desire to align the community health service outcomes with those in primary care, to ensure there are system
wide incentives to support partners in collaborating to meet the health and wellbeing needs of the population.
The scope of this contract is likely to increase over time as organisations and alliance arrangements mature.
This means that the alliance will look to take on more services to potentially include the Local Authority and
Voluntary/Independent sector in the future.
We are further strengthening the framework for involvement of communities in the work of Tower Hamlets
Together. Recently all engagement leads from across Tower Hamlets came together to develop a charter for
coproduction. Working with THT partners in this way has also paved the way for the development of a THT
wide engagement framework, which outlines how local people will be involved in the emerging THT structures.
This is an ambitious plan whose aim is to embed patient involvement in the key decision-making structures
and gives local people a voice where it matters most in the system and brings all of the THT partners together
to coordinate engagement work, reduce duplication and share best practice that plays to strengths and
expertise within the THT partnership. We now have user engagement in all three lifecourse workstreams
acting as equal partners in the decisions and discussions around services.
Over the past year, we have taken a new approach to staff engagement events. We have worked with our
Tower Hamlets Together partners to create a ‘whole system’ approach to staff engagement and have
combined our efforts to hold quarterly events where the whole system can engage together and create a
streamlined mechanism for staff to have their say about all health and care services in Tower Hamlets. We
have held 14 events since 2015 with more than 1000 staff attending.
NHS Tower Hamlets CCG – Annual Report
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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 new training and
development opportunities for midwives, physician associates and GP practice managers
ensured that every pregnant woman is offered information and choice of places to give birth and we
are leading the way across London in terms of continuity of carers with 26.9% of pregnant women
across East London receiving care from the same carers throughout 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 improved delivery on the cancer 62 day standard
enhanced our NHS 111 service so you not only get advice from a clinician but you can make
appointments at some of our urgent care services
secured over £7m to improve our digital infrastructure, ‘switched-off’ paper referrals for hospital
outpatient appointments and doubled the number of views of the electronic patient record making it
easier for clinicians to provide better advice and treatment – no matter 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
NHS Tower Hamlets CCG – Annual Report
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A1(6) The key issues and risks of the CCG
The local system and its challenges are outlined in ‘Challenges – Reducing Health Inequalities’ section of this
report. However, the following risks were identified by the CCG as significant during 2018/19 and remedial
work to address the issues continues:
• Failure to ensure effective systems and processes are in place to monitor, challenge and support
Barts Health NHS Trust delivery of NHS Constitution targets and CQC action plan could result in the
increased likelihood of poor quality, poor patient experience, delivery of poor clinical outcomes and the
trust remaining in special measures in the longer term.
• The financial deficit of one of our main providers, Barts Health NHS Trust.
• Overspending in a number of acute services.
• Sustainability and resilience of General Practice in Tower Hamlets.
• The newly established Community Healthcare Services Alliance failing to deliver its targets and losing
its organisational form, thus impacting the healthcare of Tower Hamlets patients
• The possible impact of the deteriorating position of Continuing Healthcare, and the resulting increase
in financial pressures and decrease in quality and performance.
• Failure to deliver the CCGs QIPP target and 2018/19 operating plan
• The CCG’s ability to meet its statutory requirements in regards to Safeguarding and Looked After
Children
• Potential impacts to the CCG in regards to the UK’s exit from the European Union
• Lack of clarity in the development of local commissioning arrangements.
A1(7) Going concern opinion
As at 31 March 2019 the CCG had net liabilities of £63,121,000 (£54,727,000 as at 31 March 2018). The
ability of the CCG to continue as a going concern is dependent upon its ability to secure future funding from
NHSE. The budget for 2019/20 has already been agreed with NHSE. On this basis, there is no reason to
believe that sufficient funding will not be made available to the CCG in the 12 months from the date of
approval of these Financial Statements.
As such the Financial Statements in Section C have been prepared on a going concern basis.
A1(8) 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.
NHS Tower Hamlets CCG – Annual Report
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NHSE assesses CCGs against the national CCG Improvement and Assessment Framework.
CCGs measure and monitor performance against a range of national and local key performance indicators
(KPIs) that measure the quality of services offered to local people.
This section summarises key performance issues, with more detailed information later in this report,
particularly in the performance analysis section (A2).
Financial performance
We are accountable for how we spend public money and achieve good value for money for people in Tower
Hamlets. This is the sixth year of the CCG’s existence and good financial control and management continues
to be vital.
We aim to improve the health and wellbeing of the people in the borough by ensuring that patients and their
carers experience the highest possible standards of health and social care. We have a commissioning budget
of around £446 million to do this work, which is allocated in the finance sections in this report.
CCG Improvement and Assessment Framework
Through a number of measures, NHSE assessed the NHS Tower Hamlets CCG’s performance in the
indicators in four domains: better health, better care, sustainability and leadership. In 2017-18 NHS Tower
Hamlets CCG were rated as outstanding.
Key successes for NHS Tower Hamlets CCG were-
The quality of diabetes care and treatment.
The number of people in Tower Hamlets with a learning disability receiving an annual health check.
The number of people in Tower Hamlets diagnosed with cancer receiving treatment in a timely way.
Provision of high quality primary care.
As a CCG, we still have a much to do to improve the quality of care and the health and well-being of people in
Tower Hamlets. The key challenges being-
Improving the patient experience in cancer and maternity services.
Improving access to psychological therapies.
Primary care performance
The quality of primary care in Tower Hamlets is good and the Care Quality Commission rated all of our
practices as good or outstanding.
All of our practices offer extended access and most people rate their experience of primary care as good.
NHS Tower Hamlets CCG – Annual Report
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KPI performance
We commission a range of services from a number of providers. Our main acute hospital services provider is
the Royal London Hospital, which is part of Barts Health NHS Trust. We also commission some acute services
from other providers. Our community and mental health services provider is East London NHS Foundation
Trust.
The performance analysis section below contains detailed information on the local trusts’ performance against
the KPIs, which are also summarised here:
We are doing well in the following areas:-
People are getting diagnostic tests in a timely way.
People with suspected cancer are people seen quickly.
People with psychosis are being seen within 2 weeks.
Key areas that we need to seek improvements are as follows:-
Referral to treatment times. We need to ensure people are seen in a timely way and our not waiting
more than 18 weeks.
People are not waiting more than 4hrs in Accident and Emergency.
Better access to psychological therapies for our local population.
More detail is provided in the performance analysis section that follows.
A2. Performance analysis
A2(1) Financial performance
The financial statements contained within the report provide a summary of the CCG’s financial position and
performance for 2018/19. This section of the report talks about how we manage our money and how our
financial performance is measured.
We are accountable for how we spend public money and achieve good value for money for our patients. This
is the sixth year of the CCG, and good financial control and management is vital for the development of the
organisation.
NHS Tower Hamlets CCG – Annual Report
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Funding
In 2018/19 Tower Hamlets CCG was given funding of £446,360,000 from NHSE, which included Tower
Hamlets CCG’s brought forward surplus of £13,239,000. Within the total funding given for 2018/19, the CCG is
allowed to spend £6,504,000 on the running costs of the organisation. As at 31 March 2019 the CCG had net
liabilities of £63,121,000 (£54,727,000 as at 31 March 2018).
How we spent the money
Our budget includes:
• £199 million for hospital care and ambulance services, £151.4 million of which is spent at Barts
Health NHS Trust and a total of £10.4 million spent on ambulance services
• £52 million on community health services, £35.1 million of which is spent on Tower Hamlets
Community Health Services Contract.
• £49.1 million on mental health services, £42.7 million provided by East London Foundation Trust
• £61.3 million on primary care, £45.3 million relates to primary care co-commissioning
• £33.1 million on prescribing
• £15.9 million spent on the provision of continuing healthcare
The majority of the CCG’s spend is used to purchase services from NHS Trusts and NHS Foundation Trusts.
NHS Tower Hamlets CCG – Annual Report
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How we did
The CCG has been able to invest in schemes to develop services to patients further, particularly in the
community, to help reduce demand on our acute hospitals. Some of our key achievements are:
We achieved the Mental Health Investment Standard, which requires us to invest 4% above the
previous year’s spend year on year
Our overall investment growth in the acute sector has increased by 21% over the last 5 years to
address growth in non-elective demand and outpatient referral waiting lists
We are in the second successful year of operation of our innovative alliance partnership providing
Community Health Services
We continue to invest heavily in Continuing Health Care (i.e. for people with life-limiting illnesses) where
the growth this year has been 8% compared to last year
We work very closely with LBTH to ensure we utilise the Better Care Fund to support joint working
across health and social care, bringing the total CCG & LBTH investment to £48.6m in 2018/19.
Acute (199,079)
Mental Health (49,128)
Community (52,111)
Continuing Care (15,990)
Other Non Acute (4,537)
Prescribing (33,139)
Primary Care Co-Commissioning(45,271)
Other Primary Care (16,062)
NHS Tower Hamlets CCG – Annual Report
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Financial pressures
The financial environment continues to be very demanding. Our recurrent programme baseline allocation in
2018/19 increased by £13.5 million (3.7%) and over the six years as a CCG by 14.7%. However, the
population has increased significantly over this period, placing ever greater demands on the system.
Nationally, the NHS faces increasing pressures and in Tower Hamlets we are no different. Accident and
Emergency attendances have increased by 3.8% compared to last year.
Our main acute service provider, Barts Health, of which the Royal London Hospital is the prime hospital site in
our area, has consequently seen costs of acute services rise above expectations. In the year, we have been
working closely with them to ensure we provide efficient, effective services.
As set out in the 2018/19 NHS Planning Guidance, CCGs were required to hold a 0.5% reserve uncommitted
from the start of the year, created by setting aside 0.5% of the monies that CCGs were otherwise required to
spend non-recurrently locally. Majority of this reserve was used to offset the systems risk across North East
London.
In 2018/19, to comply with the requirements to meet the Sustainability and Transformation Plan control totals
across the sector, NHS Tower Hamlets CCG has transferred £1.3 million to NHS Waltham Forest CCG as part
of the systems risk agreement across North East London.
Future years
NHS Tower Hamlets CCG’s in-year funding allocation for the financial year 2019/20 will be £455.6 million, an
increase of 5.9%. 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 1.6% 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
The KPIs are drawn from a range of frameworks including those contained within the CCG Improvement and
Assurance Framework (IAF).
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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.
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.
Local rating
Tower Hamlets CCG was given an overall rating of ‘Outstanding’. The CCG was also rated against the six
clinical priority areas identifying the Five Year Forward View.
IAF Clinical Priority Area IAF Assessment
Better Health
Diabetes Outstanding
Better Care
Cancer Good
Dementia Requires Improvement
Learning Disability Good
Maternity Requires Improvement
Mental Health Requires Improvement
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 Tower Hamlets CCG – Annual Report
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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.
Planned Care
The Minor Eye Conditions Services (MECS) was launched in February. The service is designed to offer
convenient care for minor medical eye conditions, offering appointments with 24-48 hours at locations across
Tower Hamlets. The service has seen referrals come in from GP practices and the Emergency Department at
Royal London since it opened offering patients a more convenient way to access specialist support.
Primary care performance
Tower Hamlets primary care services continues to be the best rated in London by the Care Quality
Commission (CQC). All Practices in Tower Hamlets as of March 2019 have either been rated as providing
outstanding or good quality of care. See below:
CQC Performance 2016-
2017
2017-
2018
2018-19
General Practices rated as ‘outstanding’ by CQC: 8% 8% 8%
General Practices rated as 'good' by CQC 83% 89% 92%
General Practices rated as 'requires improvement' by CQC 6% 3% 0%
General Practices rated as 'inadequate' by CQC 3% 0% 0%
NHS Tower Hamlets CCG – Annual Report
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Patients experience of GP services Primary care access – percentage of
registered population offered full extended
access
77.9% of people rated their experiences as good 100% of practices in the CCG offering ‘full
provision’
Tower Hamlets GPs continue to be the best performers in London with regards to the flu vaccination
campaign. For the over 65, under 65 and at risk as well as the pregnant women cohorts, Tower Hamlets
Primary services performed the best in London for the 2018/19 campaign.
NHS Tower Hamlets CCG monitor the performance of our providers on a monthly basis through contract
meetings. The performance monitoring is key to us ensuring that our local population are receiving good
quality care in a timely way
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.
Barts Health NHS Trust resumed national RTT reporting from Apr-18. Year-end performance was 86.88% of
people were seen within 18 weeks at Barts Health NHS Trust. Below is the % of incomplete pathways
performance for Barts Health NHS Trust in 2018-19.
NHS Tower Hamlets CCG works closely with Barts NHS Trust to support improvements in performance.
Diagnostic waiting times
The national standard for diagnostics is that less than 1% of patients should wait six weeks or more for a
diagnostic test.
Barts NHS Trust are meeting the national standard. Current performance at the time of writing the report there
were 0.8% of people were waiting over 6 weeks for their diagnostic test and 99.2% of people were seen within
6 weeks at Barts Health NHS Trust.
Apr-18 May-18 Jun-18 Jul-18 Aug-18 Sep-18 Oct-18 Nov-18 Dec-18 Jan-19 Feb-19 Mar-19
86.22% 87.55% 87.57% 84.98% 87.36% 87.11% 86.52% 85.89% 84.94% 83.24% 82.53% 83.45%
Apr-18 May-18 Jun-18 Jul-18 Aug-18 Sep-18 Oct-18 Nov-18 Dec-18 Jan-19 Feb-19 Mar-19
99.50% 99.68% 99.75% 99.46% 99.08% 99.00% 99.04% 99.24% 99.19% 98.36% 99.61% 99.23%
NHS Tower Hamlets CCG – Annual Report
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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.
In 2018-19 for Barts Health is 85.58% of people were seen, treated or discharged within four hours. At the
Royal London Hospital 84.45% of people were seen, treated or discharged within four hours. Below is the A/E
performance for Barts Health NHS Trust for 2018-19.
NHS Tower Hamlets are working closely with Barts Health NHS Trust to support and achieve delivery of the
four-hour standard through the Accident and Emergency Delivery Board and the local Tower Hamlets Urgent
Care Working Group. We are also working closely with our general practices to ensure people are seen in the
right place at the right time through extended access in general practice.
Cancer waiting times
Cancer performance is one of the eight national priorities for delivery. There are eight national cancer waiting
times standards against which performance is monitored.
Two weeks from urgent GP referral for suspected cancer to first appointment (93%)
Two weeks from referral for breast symptoms (whether cancer is suspected or not) to first appointment
(93%)
62 days from urgent GP referral for suspected cancer to first treatment (85%)
62 days from urgent referral from NHS Cancer Screening Programmes to first treatment (90%)
62 days from a consultant's decision to upgrade the urgency of a patient to first treatment (no operational
standard set)
31 days from diagnosis (decision to treat) to first treatment for all cancers (96%)
31 days from decision to treat/earliest clinically appropriate date to second/subsequent treatment (surgery
or radiotherapy) (94%)
31 days from decision to treat/earliest clinically appropriate date to second/subsequent treatment (drug
therapy) (96%)
Barts Health NHS Trust and NHS Tower Hamlets CCG were meeting all the cancer waiting standards at the
end of quarter 4 2018-19.
Apr-18 May-18 Jun-18 Jul-18 Aug-18 Sep-18 Oct-18 Nov-18 Dec-18 Jan-19 Feb-19 Mar-19
86.22% 87.55% 87.57% 84.98% 87.36% 87.11% 86.52% 85.89% 84.94% 83.24% 82.53% 83.45%
All Cancers
Symptomatic
breast patients 1st Treatment 2nd/sub (surgery) 2nd/sub (Chemo) 2nd/sub (RT) Urgent Referral Screening
Operational Standard 93% 93% 96% 94% 98% 94% 85% 90%
Barts Health NHS Trust 97.5% 98.8% 98.8% 100.0% 100.0% 99.3% 85.9% 94.40%
NHS Tower Hamlets CCG 97.1% 99.3% 97.5% 100.0% 100.0% 100.0% 88.4% 100.0%
2 week wait 31 day wait 62 day wait
Description
NHS Tower Hamlets CCG – Annual Report
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Mixed-sex accommodation
The NHS Operating Framework for 2012-2013 confirmed that all providers of NHS funded care are expected
to eliminate mixed-sex accommodation, except where it is in the overall best interest of the patient.
Barts Health reported 231 mixed sex accommodation breaches year to date as of January 2019. The number
of mixed sex accommodation breaches at The Royal London Hospital site have remained low with the hospital
reporting 42 year to date including 3 breaches in January 2019.
Friends and family test (FFT)
The FFT measures how likely a patient would be to recommend the ward or department to their friends and
family if they needed similar care or treatment. The table below outlines the position as of the end of quarter
three 2018.
Ward/Department Area Percentage of patients who
would recommend the ward or
department to their friends and
family at Barts Health NHS
Trust
Percentage of patients
who would recommend
the ward or department
to their friends and
family at The Royal
London Hospital
In-patients 90.6 91.5
Accident and Emergency 71.9 74.2
Maternity 97.8 97.6
Incidents of Methicillin-Resistant Staphylococcus Aureus (MRSA)
MRSA is a type of bacteria that is resistant to several widely used antibiotics. This means infections with
MRSA can be harder to treat than other bacterial infections.
The full name of MRSA is methicillin-resistant Staphylococcus aureus. It is also referred to as a "superbug".
MRSA infections mainly affect people who are staying in hospital. They can be serious, but can usually be
treated with antibiotics that work against MRSA.
The target set by NHSE for all trusts is zero tolerance of cases of MRSA.
NHS Tower Hamlets CCG – Annual Report
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The rate of MRSA assigned bacteraemia cases for Barts Health is five year to date as of January against a
zero tolerance. The rates are below that of 17-18.
On behalf of the CCG, the North East London Commissioning Support Unit Infection Control and Prevention
Team works collaboratively with Barts Health IPC team to review all trust-apportioned MRSA. Each case is
subject to root cause analysis to support learning and prevention.
Incidents of Clostridium Difficile Infections
Clostridium difficile, also known as C. difficile or C. diff, is bacteria that can infect the bowel and cause
diarrhoea. The infection most commonly affects people who have recently been treated with antibiotics. It can
spread easily to others. C. difficile infections are unpleasant and can sometimes cause serious bowel
problems, but they can usually be treated with another course of antibiotics.
Barts Health NHS Trust has a target of 81 clostridium difficile infections. Year to date, the trust has reported
44 Trust apportioned cases. This is below the threshold of 61 YTD. At this time last year, the Trust reported 73
trust-apportioned CDI cases.
On behalf of the CCG the he North East London Commissioning Support Unit Infection
Control and Prevention Team collaboratively with Barts Health Infection Prevention and Control team
to review lapses in care for clostridium difficile infections.
Incidents of venous thromboembolism (VTE)
Venous thromboembolism (VTE) is a condition in which a blood clot (thrombus) forms in a vein. It may
dislodge from its original site and travel in the blood, a process known as embolism. It needs to be identified
and treated early.
Risk assessment for VTE is a national quality requirement and 95% of all adults admitted to hospital as
inpatients need to be risk assessed according to the criteria set out in the national VTE risk assessment tool.
Providers are required to undertake root cause analysis of any cases that meet the criteria and are not risk
assessed. Audits of provision of prophylaxis are also undertaken.
The average monthly performance for Barts Health NHS Trust was 96.8% and for the Royal London Hospital,
it was 95.8%.
Mental health - Improving Access to Psychological Therapies (IAPT)
The annual target is that 15% of those with a reported prevalence for depression should have access to
talking therapies.
Mental Health Improving Access to
Psychological
Therapy
Improving Access to
Psychological
Therapy
Improving Access to
Psychological
Therapy
Improving Access to
Psychological
Therapy
NHS Tower Hamlets CCG – Annual Report
35
Rolling Quarterly
Access Rate (Sep
2018) – Published
(Target = 4.48%)
Rolling Quarterly
Access Rate
(December 2018) –
Provisional
(Target = 4.61%)
IAPT Access Rate
Contractually
agreed with
Provider to be
delivered in Q4
2018/19
Access Rate (YTD) –
Provisional
(Target = 15.0%)
3.88% 3.03% 4.75% 12.5%
NHS Tower Hamlets CCG commissioned East London Foundation Trust (ELFT) to Provide IAPT in October
2018. The CCG are working with to improve the access rate and plans are in place to roll out appointments for
people with long term conditions.
Mental health - Early Intervention Psychosis
The standard is for 50% of people experiencing a first episode of psychosis to be treated with a NICE-
approved care package within two weeks of referral.
East London Foundation Trust provide early intervention psychosis. The 50% standard has been consistently
met throughout the year with on average of 95.5% of people being seen within two weeks of referral.
NHS Tower Hamlets CCG – Annual Report
36
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 new ambulance dataset was introduced from August 2017, focusing on four main areas:
1. Identifying the most seriously ill patients as early as possible through processes known as ‘pre-triage
sieve’ and ‘nature of call’.
2. Giving control room staff more time (up to 240 seconds) to assess incidents through a process known
as ‘dispatch on disposition’.
3. Developing new clinical code sets and response categories using the best available clinical evidence
4. Developing new targets, indicators and measures
A2(3) Other performance matters
Sustainable development
We are committed to embedding sustainability into our operations and to encourage key partners and
stakeholders to do the same. As a CCG we must ensure that the six principles of sustainability, outlined in our
Sustainability Policy, are embedded into its business decisions.
1. Commissioning
The CCG is committed to taking a whole system approach to sustainable commissioning to seek ways to reduce
costs and resources, produce health benefits and embrace sustainable procurement.
2. Waste
We continue to move towards our aim of becoming a paperless organisation by reducing the number of printers
we have and using 'follow me' printing which cuts down on unnecessary printing and wastage. We have also
issued to all staff and Governing Body members mobile devices that enable our meetings to reduce use of paper.
3. Training
The CCG is committed to the ongoing training and education of its staff so it is able to deliver its services in the
most effective and sustainable manner possible.
NHS Tower Hamlets CCG – Annual Report
37
4. Energy
The CCG is committed to minimising its consumption of non-renewable energy sources and to continually
research alternative sources and technology to reduce consumption of energy across all activities. We continue to
support the widespread use of mobile devices and tablets for all staff in meetings to reduce power consumption
and paper usage with the aim of minimising the use of paper. We have also increased the use of recycled paper
and toners for printers. Our staff are encouraged to take responsibility for energy consumption and carbon
reduction within their work environment, including turning off equipment and lights when not in use. Our motion
sensitive lighting means that we do not unintentionally leave lights on overnight.
5. Transport
The CCG is aware of the environmental impacts of its transport operations and will develop a comprehensive
management plan to focus on reducing the environmental impact of transport, including unnecessary travel. Good
practice in sustainable and healthy travel choices is promoted in a number of ways. We encourage and support
staff to take up cycling and reduce driving (in turn reducing carbon emissions). Employees also have access to
two Brompton folding bicycles for work journeys.
6. Procurement
The CCG advocates that procurement managers and suppliers working with the CCG ensure that products,
services and materials it purchases are as sustainable as practical.
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’.
The United Kingdom’s Exit from the European Union – Preparedness and Response
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: -
NHS Tower Hamlets CCG – Annual Report
38
Each STP area nominated an SRO for EU-Exit to co-ordinate activities for the CCGs and main NHS
providers within and STP. The individual acted as a contact point for NHSE regional / national teams,
commissioners, providers and local authorities for data and information requests, queries and support.
The NELCA SRO hosted teleconferences between CCG emergency planners and also with local
providers to ensure all EU-Exit related activities for commissioners / providers were carried out to time
as required by NHS England / Improvement. The key domains for preparation covered were
o Operational readiness
o Communications and engagement – with Governing Bodies, key providers (including primary
care) staff and key stakeholders via local resilience forums
o Workforce
o Medicines & medicinal products
o Clinical consumables supplies
o Non clinical consumables
o Data sharing processes and access – security and continuity
o Reciprocal healthcare arrangements and health demand
o Finance
o Assurance via NHSE
Governing Bodies and Senior Executive teams were frequently updated and able to scrutinise
activities in relation to EU exit preparations
CCGs undertook review of their Business Continuity Plans and risk registers with mitigation where
necessary.
CCGs worked with their Local Resilience Forums to identify and mitigate any potential system
impacts.
Daily and weekly situation reporting was completed by the CCG via the NHS Digital Strategic Data
Collection Service.
EU-Exit preparations and contingency planning will continue into 2019/20 until such time as stood down by
NHS England.
NHS Tower Hamlets CCG – Annual Report
39
Improving quality
Barts Health NHS Trust were taken out of special quality measure in 2018 following the Care Quality
Commission (CQC) inspections. We still need to work collaboratively to improve quality of care at the Royal
London Hospital. East London Foundation Trust have been rated as an outstanding provider by the CQC.
NHS Tower Hamlets Commissioning Group have a duty to ensure that our local population are receiving
services that are safe, effective and of good quality.
As a CCG, we monitor on a monthly basis the performance and quality of services at the following meetings:-
• Governing body meetings where a report is provided on performance and quality of the services we
commission. This is an opportunity for the governing body to review the performance and quality
and make decisions on any actions that need to be taken to secure improvements in an open and
transparent way.
• Quality, Activity and Performance Committee, which is a sub-committee of our governing body.
This provides an opportunity to review performance and quality in detail and escalate to our
governing body any issues that need highlighting.
• Monthly Clinical Quality Review Meetings with our main providers. These are contractual meetings
and provide an opportunity for the CCG to seek assurance on the quality of service being provided.
• Contract review meetings where performance against the NHS constitutional standards and local
key performance indicators is reviewed and monitored.
We also undertake regular visits to our providers to seek assurance that services we commission are safe,
effective and of good quality. The visits provide us with an opportunity to get feedback from patients, relatives
and carers on their experience.
For information on CCGs’ performance against a number of indicators, please visit the My NHS website which
publishes data on NHS performance. All CCGs are assessed against a number of metrics in the following
groups: better care, better health, sustainability and well-led, and each is then given an overall score. The
overall score for Tower Hamlets CCG is ‘Outstanding’.
Quality improvement in primary care
Work has started at Wellington Way which will provide modern and expanded premises for two nearby
practices, Stroudley Walk and Merchant Street. The site will open later in the year.
The EQUIP (Enabling Quality Improvement in Practice) programme, which supports practices around QI,
resilience, and team development has seen some impressive results in Quarter 1, with an upward shift in
NHS Tower Hamlets CCG – Annual Report
40
Friends and Family Results for the practices that have been participating in the programme. The team also
delivered training to colleagues in Public Health and are continuing to spread QI knowledge and skills.
The new GP Contract has been released offering a 5 year deal for GPs, with a strong emphasis on developing
Primary Care Networks for populations of 30,000-50,000 people. Tower Hamlets has led the way nationally
and will be celebrating 10 years of networks in 2019. The GP contract further strengthens our networks and
we will be working with networks and the GP Care Group over coming months to understand how we make
best use of this opportunity.
Engaging people and communities
Tower Hamlets CCG puts the voice of local people at the heart of everything we do. We believe services
should be based on local need and focus on the priority issues for our community. That is why involving
patients and the wider public is central to service planning and provision, vital for service improvement and
leads to a more positive experience of care. Involving local people also gives them a greater sense of
ownership of the health services they use and their own health.
We have sought to ensure that health services are provided in a way which promotes the NHS Constitution
and are in line with our own Public and Patient Involvement Strategy. We have promoted awareness of the
NHS Constitution and our Public and Patient Involvement Strategy among patients, staff and members of the
public through our website, key meetings and other channels.
We have the core values of the NHS Constitution embedded within our own Constitution. We take great care
to engage with patients and the wider public to ensure that they have a genuine influence in how their local
services are designed and delivered. There are seven key principles and values set out in the NHS
Constitution that guide the way it operates. Principle four states that "the NHS aspires to put patients at the
heart of everything it does."
As part of this principle, we have actively encouraged feedback from the public, patients and staff and actively
use it to improve services. We also strive to include ‘seldom heard’ voices by working with the community and
voluntary sector and other key stakeholders to use existing links into communities who might struggle to
access services or navigate the health system due to a variety of complex factors. Our aim is to create a
system that provides equal access for all, regardless of background, and we recognise the value of community
leaders and organisations in helping us to achieve this aim.
We have held our providers to account regarding the standard of patient involvement that they offer by
embedding key patient experience indicators within contracts and have worked with patient groups to identify
meaningful patient experience indicators such as the Tower Hamlets Together outcome framework.
We ensure patients are able to make informed decisions regarding their care by giving them robust
information about the healthcare services available in the borough and ensuring they have choice and control
over their care. We also ensure that information about care is offered in a variety of formats and languages to
make sure everyone is able to access and understand information about their care.
NHS Tower Hamlets CCG – Annual Report
41
We have commissioned services that deliver patient-centred care and support, planning for people with long-
term conditions and mental health needs who are most at risk of a hospital admission. A key feature of this is
the care planning process where the patient and clinician work in partnership to develop a plan addressing the
patient's current and future needs. This care plan is then shared across all providers involved in the patient's
care.
We have also invested heavily to support patients taking control of their health by:
keeping our member GPs informed about quality and performance standards at our local providers, so
they can have informed conversations with their patients at the point of referral
undertaking extensive engagement with patients, the public and stakeholders to inform higher
standards of co-production in the transformation of a variety of local healthcare services. This included
working with new groups of residents including the ‘working well’ and people who use the NHS less
frequently and in different ways than other population groups.
working in partnership with the Tower Hamlets Together partners to establish a system wide approach
to engagement and involvement.
developing an outcomes framework in partnership with local people and reflecting all aspects of what
local people need to live well in Tower Hamlets.
We work closely and share best practice with our neighbouring CCGs and partners on patient and public
involvement, and have done this increasingly over the past year working with the East London Health and
Care Partnership (ELHCP). We have worked with the seven CCGs in north east London to inform the public
about ELHCP and have collaborated on workshops and events designed to gather insight about how specific
services might be improved across the ELHCP footprint.
Engagement with Tower Hamlets Together – towards a system-wide approach
Over the past year, we have been embedding a whole system approach to involvement working with our
Tower Hamlets Together (THT) partners (East London Foundation Trust, Barts Health, Healthwatch, Tower
Hamlets Council for Voluntary Services, London Borough of Tower Hamlets and the GP Care Group) to
combine our efforts and create a streamlined mechanism for patients to have their say about all health
services in Tower Hamlets.
Working with THT partners in this way has also paved the way for the development of a THT wide
engagement framework, which outlines how local people will be involved in the emerging THT structures. This
is an ambitious plan whose aim is to embed patient involvement in the key decision-making structures and
gives local people a voice where it matters most in the system. It also brings all of the THT partners together
to coordinate engagement work, reduce duplication and share best practice that plays to strengths and
expertise within the THT partnership.
NHS Tower Hamlets CCG – Annual Report
42
Community Commissioning Panel
2018/19 was the second year of the Community Commissioning Panel (CCP) being in place at the CCG. The
aim of our CCP is to bring a local voice to decision-making and help shape healthcare in Tower Hamlets from
a patient’s perspective. Twelve people from diverse backgrounds who live in Tower Hamlets make up the
CCP.
The CCP provides the patients’ voice and perspective on appropriate committees, focus groups and patient
panels that feed into our decision-making processes. This enables us to improve and enhance services and
identify areas for improvement. The CCP also provides challenge where appropriate to ensure the needs of
service users, patients and carers remain central to the way we work while providing support to the CCG to
maximise involvement of key community groups and individuals.
In order for the panel to influence commissioning in a meaningful way, it is integrated into our formal
governance structure and is chaired by the Patient and Public Involvement (PPI) lay member who sits on the
Governing Body. This lay member is able to champion the work and purpose of the panel to the Governing
Body and to other key stakeholders.
This year, the CCP helped shape over 15 pieces of work. Some key achievements include:
• shaping the CCG PPI evaluation and action plan and commissioning intensions 2018-19 for areas
such as urgent and primary care and reviewing the design of consultation tools such as
questionnaires;
• improving and enhancing services, for example contributing ideas around improvements to urgent and
primary care
• identifying areas for improvement, for example helping to identify how engagement plans and
materials for pain management and the promotion of different birthing options could be improved.
• providing challenge to ensure the needs of service users, patients and carers remain central to the
way we work, for example in suggesting new ways of communicating with people on the medicines
optimisation and supporting a re-design of marketing materials.
Patient stories
We have promoted the involvement of patients, their carers and representatives in decisions that relate to their
care in a variety of ways, including filmed ‘patient stories’ that focus on a specific patient’s experience of using
a health service in Tower Hamlets.
The patient stories are shared at the beginning of each Governing Body meeting and provide patient insight
into a specific service while providing suggestions for improvement or the opportunity to share best practice
and success stories both internally and externally. The videos are also available to view on the THCCG
website www.towerhamletsccg.nhs.uk/our-work/tell-us-your-story.htm
NHS Tower Hamlets CCG – Annual Report
43
The patient stories are another way that the CCG ensures patients’ voices and opinions are not only heard but
are given the platform to influence change wherever possible.
NHS England Assurance Rating
In the website-based review of our Public and Patient Involvement activities, undertaken by NHS England in
Sept 2017, we achieved a Green Star Rating in July 2018, one of only two given in the London region. We are
awaiting the results of the recent assessment in March 2019. This assessment reflects the innovative
approaches we have taken to meeting our statutory duty to involve patients in all that we do.
Reducing inequalities and the health and wellbeing strategy
The local system and its challenges are outlined in ‘Challenges – Reducing Health Inequalties’ section of this
report. The CCG works closely with Tower Hamlets Council and other partners across the health, voluntary
and community sectors as part of the Tower Hamlets Health and Wellbeing Board. After seeking input from
local residents, carers, health professionals and patient groups, the Board has developed a health and
wellbeing strategy to tackle inequalities and improve health and wellbeing for everyone in the borough. Read
the strategy on the council’s website.
The Health and Wellbeing Board sits at the apex of the borough’s health and social care partnerships, and
includes senior representatives from the local authority, the CCG, Barts Health, East London Foundation Trust
(ELFT) and the local voluntary sector. As part of its work, it has been consulted on the CCG’s Annual Report
and has supported its development to ensure it accurately communicates the CCG’s and Health and Social
Care sector’s successes and challenges in 2017/18 and the CCG’s contribution to the delivery of the joint
health and wellbeing strategy.
The Tower Hamlets Health and Wellbeing Board has identified integration of health and care services as one
of its five priorities for 2019/20 and beyond. The THT system will support the Tower Hamlets Health and
Wellbeing Board with delivering against this priority, including the discharge of its duty under s.195 of the
Health & Social Care Act 2012 to encourage health and social care services to work in an integrated manner.
There is a recognition from Tower Hamlets CCG and the London Borough of Tower Hamlets that both
organisations need to work together to tackle the wider determinants of health and wellbeing. Working in
partnership will create real opportunities to learn from each other’s experiences and lessons and create a
more joined up coherent system of care for the residents of Tower Hamlets. This will improve outcomes and
service user experience, two of the key priority areas for staff and senior management. It should also drive
improvements in the quality of care and services commissioned and in turn deliver efficiencies and savings
necessary to keep the system sustainable now and in the future. Tower Hamlets is driving joint working
through the work of the Joint Commissioning Executive, which is another key component of the Tower
Hamlets Together system.
NHS Tower Hamlets CCG – Annual Report
44
Equality disclosures
The CCG works towards an Equality and Diversity strategy which provides a blueprint for creating an inclusive
environment for all staff and a framework to tackle health inequality in the way we commission services. The
key objectives are:
• establishing a robust evidence base to inform commissioning
• improving access to services
• embedding patient and stakeholder involvement in commissioning
• developing leadership capacity and competency
In support of the delivery of this strategy, the CCGs Equality and Diversity Working Group (EDWG) meets
every 6 weeks, to drive the objectives of the strategy and provide assurance to the wider organisation that the
CCG is meeting its duties under the Equalities Act 2010. The group has representatives from teams across
the CCG. The CCGs lay member for Patient and Public involvement is the Governing Body’s champion for
equality and diversity.
Equalities Work in 2018/19
Equality and Diversity is critical in ensuring we achieve our strategic objectives and commission services that
meet the needs of the patients we serve. During 2017/18, we began to strengthening links with agencies in the
borough that have supported us with our equality and diversity learning and development needs and
commissioning processes throughout 2018/19. An excellent example of this is our work with the East London
Out Project as part of a piece of work to improve protected characteristics data collection in our commissioned
services.
During 2018/19 we worked closely with our providers to ensure progression with the Workforce Race Equality
Standard (WRES), which seeks to enable employees from black and minority ethnic backgrounds (BAME) to
have equality of access to career opportunities and ensure they work in a fair and inclusive workplace. The
CCG Governing Body received assurance from Barts Health and ELFT in January 2019, who presented their
current position against the WRES and wider diversity and inclusion objectives. The trusts showcased
information on the programmes they have in place to improve work and career opportunities for BAME
colleagues including staff networks, career development and mentoring programmes that have won national
recognition opportunities to learn from role models in senior positions, including the Chief Executive of ELFT,
Navina Evans. The trusts noted progress against WRES indicators as well as highlighting the journey of
improvement they are on.
With the aim of creating an environment that is inclusive and celebrates equality and diversity, the EDWG
oversees a comprehensive programme of activities that enable this for the CCG workforce. Throughout the
year we celebrate and promote equality and diversity through a range of national campaigns including LGBT
Awareness Month, Pride, Black History Month and International Women’s Day. During Black History month
NHS Tower Hamlets CCG – Annual Report
45
for example we held a session for staff to come and discuss experiences as BAME employees, within the NHS
and our organisation. The session saw a range of BAME and non-BAME colleagues coming together to share
these experiences, positive and negative, and sought to enable wider reflection and understanding. We
ensure our health related campaigns have an equality and diversity focus, for example Movember, Cervial
Screen Awareness Month and World Aids Day and we have celebratory events around key religious festivals
including Eid, Diwali and Christmas, which involve staff bringing and sharing food and coming together to learn
about each other’s cultures.
We also ensure that our approach to learning and development and staff engagement seeks to creative
equality and inclusivity at all levels. For example, our staff development session ‘Working Together’ focused
on how professionals collaborate to establish and maintain a positive workplace culture where staff both
understand and value equality and diversity, welcome the challenges it brings, as well as the opportunities it
offers to address and eliminate discrimination, bullying and harassing behaviour wherever it occurs. The
session allowed staff to discuss workplace scenarios based on the nine protected characteristics and start to
have deeper conversations with a focus on unconscious bias. At an individual level, we encourage staff to
consider and discuss their personal development with an equalities perspective, encouraging people to
undertake mentoring with people they feel act as role models to support their development needs and
promoting and supporting staff to apply for national leadership development programmes with an equality and
diversity perspective, for example the NHS Leadership Academy programme ‘Ready Now’ for BAME
employees. We run breakfast sessions to give staff the opportunity to develop relationships with and hear
from the organisation’s senior managers. An inspirational session in February 2018 focused on the career
experiences of a Black female senior manager, giving staff the time and space to consider how her story
reflects their experiences and discuss ideas about empowerment, as well as help people develop trust, feel
solidarity and see a role model.
As our Equality and Diversity Strategy runs from 2016-2020 and as we look towards working more
collaboratively with neighboring CCGs, we will assess and audit our current approach to equalities and
diversity, to seek to continue our strengths and identify areas for development when establishing new ways of
working.
NHS Tower Hamlets CCG – Annual Report
46
B.1 ACCOUNTABILITY REPORT
Jane Milligan
Accountable Officer
24 May 2019
NHS Tower Hamlets CCG – Annual Report
47
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
Full details about our governance arrangements, our committees and their responsibilities can be found in the
annual governance statement along with information about data security and associated breaches and
disclosure statements. The members report details the composition of the Governing Body, a list of our
member practices, the members of our committees and the register of interests. Unless otherwise specified,
the time period relating to the membership of all committees is for the financial year and up to the signing of
the annual report and accounts.
Member profiles
The Chair of the CCG is Sir Sam Everington, a local GP who has worked in Tower Hamlets since 1989 and is
currently based in Bromley by Bow. Our Accountable Officer is Jane Milligan, who has worked locally in the
NHS for the past 17 years in both provider and commissioner roles. Since December 2017, Jane has been the
Accountable Officer for the North East London Commissioning Alliance, the alliance of the seven CCGs
across North East London.
NHS Tower Hamlets CCG maintains local accountability via its Membership, its Governing Body and the role
of the CCG’s Managing Director. 2018/19 saw the continued progression of the CCG’s integrated approach to
commissioning across wider footprint and, in December 2018, Selina Douglas became the CCG’s Joint
Managing Director across Waltham Forest, Tower Hamlets and Newham CCGs and the first joint Managing
Director for commissioning in Inner East London. Until November 2018, the CCG Managing Director post was
held by Simon Hall.
Our website gives more details about our Governing Body, including profiles of members:
www.towerhamletsccg.nhs.uk
Member practices
Over 2018/19, the CCG's membership was made up of 35 local general practices. These member practices
are grouped together in eight commissioning networks and work in pairs to form larger localities (North West,
North East, South West and South East). Details are shown below and a full list of these practices can also be
found on the CCG website here:
http://www.towerhamletsccg.nhs.uklabout/ccg-member-practices.htm.
NHS Tower Hamlets CCG – Annual Report
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The CCG’s membership elects GP representatives from the Tower Hamlets primary care footprint in
accordance with our constitution. These GPs, who are allocated a locality each to represent, form the clinical
leadership of the CCG. An overview of the composition of the Governing Body and its committees, including a
full list of the Governing Body members, can be found in the Governance Statement included in this report.
Composition of Governing Body
The members are detailed below and more information about the Governing Body and its work is contained in
the Governance Statement (section B1(3) of this report).
Name Title Responsibilties
Executive Members
Jane Milligan Single Accountable Officer Single Accountable Officer –
NELCA CCGs
NHS Tower Hamlets CCG – Annual Report
49
Executive Lead – East London
Health and Social Care
Partnership
Henry Black Chief Finance Officer / Joint
Chief Finance Officer
Chief Finance Officer – NELCA
Finance Lead – East London
Health and Social Care
Partnership
Senior Information Risk Owner
Simon Hall Managing Director (Until
November 2018)
Managing Director (Until
November 2018)
Selina Douglas Joint WEL Managing Director Joint WEL Managing Director
(From December 2018)
Warwick Tomsett Joint Director of Integrated
Commissioning
Commissioning & Integration
Lay Members
Noah Curthoys Lay Member for Corporate
Affairs
Audit Committee
Remuneration Committee
IFR Panel
Joint Commissioning Committee
Strategic and Finance
Investment Committee (Chair)
Julia Slay Lay Member for Public and
Patient Involvement
Patient and Public Involvement
Remuneration Committee
Primary Care Co-
Commissioning Committee
(Chair)
Mariette Davis Lay Member for Governance
and Audit Chair
Audit Committee (Chair)
Conflict of Interest Guardian
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Remuneration Committee
Primary Care Co-
Commissioning Committee
Strategic and Finance
Investment Committee
Performance and Quality
Committee
Independent Clinicians
Maggie Buckell Registered Nurse Remuneration Committee
(Chair)
Children & Young People
Programme Lead
Safeguarding Children Lead
Primary Care Commissioning
Committee
Community Health Services
CQRM (Chair)
Tan Vandal Secondary Care Doctor (Until
September 2018)
Performance and Quality
Committee (Chair)
Finance Performance and
Quality Committee
Barts Health CQRM
Audit Committee
Primary Care Commissioning
Committee
Remuneration Committee
GP Network Representatives
Sam Everington Chair of Tower Hamlets CCG Chair Of CCG
Chair of Chairs (NELCA)
NHS Tower Hamlets CCG – Annual Report
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Remuneration Committee
Khyati Bakhai Locality Representative (From
November 2018)
Prescribing
Rajeevi Sanjeevi Locality Representative (From
November 2018)
Safeguarding Adults
Shah Ali Locality Representative Planned Care
Victoria Tzortziou-Brown Locality Representative Principal Clinical Lead
Integrated Care Lead
Last Years of Life Lead
Research and Development
Lead
Sarit Patel Network Representative (Until
October 2018)
Children and Young People
Lead
Imrul Kayes Network Representative (Until
October 2018)
Education and Workforce
Equality and Diversity
Judith Littlejohns Network Representative (Until
October 2018)
Mental Health Lead
Adult Safeguarding
Osman Bhatti Network Representative (Until
October 2018)
Caldicott Guardian*
Community Health Services
and Continuing Care Lead
Caldicott Guardian (*role
continued as clinical lead)
Information Technology
Lead
Isabel Hodkinson Network Representative (Until
October 2018)
Principal Clinical Lead
Prescribing
Primary Care Transformation
Practice Members
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52
Virginia Patania Practice Manager
Representative
Urgent Care Lead
EQUIP Lead
Linda Aldous Practice Nurse Representative Children & Maternity
Prescribing
Local Authority Representatives
Somen Banerjee Director of Public Health Local Authority Representative
Denise Radley Corporate Director, Health,
Adults & Community
Local Authority Representative
The following members of staff are not voting members of the Governing Body but are part of the
Senior Management Team:
Name Role Responsibilities
Ellie Hobart Acting Director of
Corporate Affairs
Patient and Public Engagement
Membership Engagement
Organisation Development and Education
Corporate Governance
Archna Mathur Director of Quality and
Performance
Quality
Performance
Safeguarding
WEL Winter Director
Sandra Moore Deputy Director of Quality
and Performance
Quality
Performance
Safeguarding
Andrea Antoine Deputy Director of
Finance
Finance
Steve Collins Finance Advisor
Finance
NHS Tower Hamlets CCG – Annual Report
53
Jenny Cooke Deputy Director of Primary
and Urgent Care
Primary Care
Urgent Care
Estates and GP IT
Rahima Miah Deputy Director of
Commissioning
Commissioning and Transformation
Carrie Kilpatrick Deputy Director of Mental
Health Commissioning
Mental Health
Committees and Governance Structure
Details of membership of other committees are also contained in the Governance Statement.
Register of Interests
We publish a register of members’ and senior managers’ interests on the CCG’s website. This is updated as
and when changes are notified to the CCG.
NHS Tower Hamlets CCG – Annual Report
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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.
Personal data related incidents
The NHS Information Governance (IG) Framework sets the processes and procedures by which the NHS
handles information about patients and employees, in particular personal identifiable information. The
framework is supported by an IG toolkit and the annual submission process provides assurances to the CCG,
other organisations and to individuals that personal information is dealt with legally, securely, efficiently and
effectively.
We place high importance on ensuring there are robust IG systems and processes in place to help protect
patient and corporate information. We have established an IG management framework and have implemented
IG processes and procedures in line with the IG toolkit. We ensure all staff undertake annual IG training and
have provided staff with guidance on their IG roles and responsibilities.
We use local clinical and corporate incident management and reporting tools to record and report incidents
and record all internal incidents. We notify the Department of Health and the Information Commissioner’s
Office (ICO) of serious incidents that require investigation via the national IG incident reporting tool.
During the reporting period, the CCG has had 0 serious incidents involving data loss or confidentiality
breaches that require formal reporting to the ICO.
Statement of disclosure to auditors
Each individual who is a member of the GB at the time the Members’ Report is approved confirms:
so far as the member is aware, there is no relevant audit information of which the CCG’s auditor is
unaware that would be relevant for the purposes of their audit report
the member has taken all the steps that they ought to have taken in order to make him or herself aware of
any relevant audit information and to establish that the CCG’s auditor is aware of it.
Modern Slavery Act
NHS Tower Hamlets 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.
NHS Tower Hamlets CCG – Annual Report
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B1(2) Statement of Accountable Officer’s Responsibilities
The National Health Service Act 2006 (as amended) (the NHS Act 2006) states that each Clinical
Commissioning Group (CCG) 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 Tower Hamlets CCG.
The responsibilities of an Accountable Officer are set out under the NHS Act 2006, Managing Public Money
and in the Clinical Commissioning Group Accountable Officer Appointment Letter. They include
responsibilities for:
The propriety and regularity of the public finances for which the Accountable Officer is answerable;
Keeping proper accounting records (which disclose with reasonable accuracy at any time the financial
position of the CCG and enable them to ensure that the accounts comply with the requirements of the
Accounts Direction);
Safeguarding the CCG’s assets (and hence for taking reasonable steps for the prevention and
detection of fraud and other irregularities);
The relevant responsibilities of accounting officers under Managing Public Money,
Ensuring the CCG exercises its functions effectively, efficiently and economically (in accordance with
Section 14Q of the NHS Act 2006) and with a view to securing continuous improvement in the quality
of services (in accordance with Section14R of the NHS Act 2006),
Ensuring that the CCG complies with its financial duties under Sections 223H to 223J of the NHS Act
2006.
Under the NHS Act 2006 (as amended), NHS England has directed each CCG 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 CCG and of its
income and expenditure, Statement of Financial Position and cash flows for the financial year.
In preparing the accounts, 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 accounts;
and,
Confirm that the Annual Report and Accounts as a whole is fair, balanced and understandable
and take personal responsibility for the Annual Report and Accounts and the judgements required
for determining that it is fair, balanced and understandable.
NHS Tower Hamlets CCG – Annual Report
56
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 Tower Hamlets 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.
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, whilst safeguarding the
public funds and assets for which I am personally responsible, in accordance with the responsibilities assigned
to me in Managing Public Money. I also acknowledge my responsibilities as set out under the National Health
Service Act 2006 (as amended) and in my Clinical Commissioning Group Accountable Officer Appointment
Letter.
I am responsible for ensuring that the clinical commissioning group is administered prudently and
economically and that resources are applied efficiently and effectively, safeguarding financial propriety and
regularity. I also have responsibility for reviewing the effectiveness of the system of internal control within the
clinical commissioning group as set out in this governance statement.
Governance arrangements and effectiveness
The main function of the governing body is to ensure that the group has made appropriate arrangements for
ensuring that it exercises its functions effectively, efficiently and economically and complies with such
generally accepted principles of good governance as are relevant to it.
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The overarching governance arrangements are set out in the Constitution which includes the CCG
Governance Structure, Standing Orders, Prime Financial Policies and the Scheme of Reservation and
Delegation. The CCG has delegated to the Governing Body decision making and responsibility for the delivery
of all its duties with the exception of decisions to:
• Determine the arrangements by which the members of the group approve those decisions that are
reserved for the membership.
• Consider and approve applications to NHS England on any matter concerning changes to the group's
constitution, including terms of reference for the group's Governing Body and its committees,
• membership of committees, the overarching scheme of reservation and delegated powers,
arrangements for taking urgent decisions, standing orders and prime financial policies.
• Approve of the group's overarching scheme of reservation and delegation.
• Approve the arrangements for identifying practice members to represent practices in matters
concerning the work of the group, and
• Appoint clinical leaders to represent the group's membership on the group's Governing Body, for
example through election (if desired).
• Approve the appointment of Governing Body members, the process for recruiting and removing non-
elected members to the Governing Body (subject to any regulatory requirements) and succession
planning.
• Approve arrangements for identifying the group's proposed Accountable Officer.
The Governing Body has supplemented the governance framework by the formal adoption of the Nolan
Principles on Standards in Public Life, the Code of Conduct and Accountability for NHS Boards, the CCG
Code of Conduct, Standards of Business Conduct Policy, Gifts and Hospitality Policy, Anti-Bribery Policy, and
a Conflicts of Interest Policy.
Using the NHS England guidance "The Functions of Clinical Commissioning Groups" and published legal
guidance, the CCG has reviewed its statutory duties and is satisfied that it has in place all the necessary
complete and lawful arrangements to ensure the proper discharge of those functions.
To undertake and ensure the systematic discharge of its functions and duties, the membership established a
Governing Body and complementary sub committees. Details of their roles are set out in the following
sections.
The CCG Constitution
Our Constitution sets out the principles and processes that the organisation will adhere to in delivering its role
and functions. It describes how the Governing Body will operate, confirms matters reserved for Governing
Body decision, and other areas where certain powers will be delegated within the organisation. It sets out our
NHS Tower Hamlets CCG – Annual Report
58
key processes for decision making, including arrangements for securing transparency in the decision making
of the CCG and the Governing Body, and the arrangements for discharging its duties with regard to registers
of interest and managing conflicts of interest. We review these arrangements each year to ensure they remain
fit for purpose, enabling us to do everything within our power to support the commissioning of the best
possible NHS services for the residents of Tower Hamlets.
Our governance structure was created to ensure that clinicians and patients remain at the heart of decision
making, whilst delivering on the CCG's corporate objectives. We oversaw a number of internal governance
changes, where the Governing Body voted to delegate authority to new committees, and reorganise the
CCG’s Governance structure to better correspond with local partner structures and provide clarity and focus
for two areas of high risk to the CCG’s Corporate Objectives; quality and finance. The resulting structure saw
the establishment of the North East London Commissioning Alliance Joint Commissioning Committee.
In addition, we recognised that our Governing Body needed to continue to be resilient and robust in regards to
local leadership and supporting the wider health economy. In order to support these developments, the CCG
adjusted of the composition of the Governing Body, reducing 8 network representatives to 4, with GP
representatives elected on a borough wide basis and then allocated a lead locality. This limits duplication of
effort between CCG and the local GP Federation, reduces number of meetings and frees up experienced
clinical leadership capacity to support local transformation. The minimum of GP partners on the Governing
Body has been reduced from 5 to 3, and the number of salaried GPs has been reduced from 2 to 1. The Chair
of the CCG remains a GP and is an additional Governing Body member to the locality representatives. Clinical
leadership and majority on CCG Governing Body has been maintained throughout these changes and has
released valued resource in to other areas of the Tower Hamlets healthcare system.
The CCG also applied for and was granted the following constitutional changes:
Addition of the ability to hold ‘Committees in Common’ with other CCGs. This supports the development of
local governance arrangements and allows for a joint approach when it is recognised by the CCG
Governing Bodies that it is beneficial to do so.
Delegation of responsibility for education is now given to the Community Education Provider Network
(CEPN). This ensures that there is a localised and provider-led model for the planning and delivery of
education and training for the health and social care workforce within the community.
Adjustment of maximum term of office from 6 to 9 years for Governing Body Members. This is to ensure
stability of leadership at the CCG during a time of change and aligns the terms of office with best
governance practice.
Addition of new protocols for Membership engagement, where a joint forum (Primary Care Forum) in
partnership with the local GP Federation will be the main avenue for membership engagement. Conditions
in which decisions pertaining to the constitution or where courses of action can be agreed are outlined.
This minimises the risk of duplication in Tower Hamlets Healthcare system meetings and frees up
NHS Tower Hamlets CCG – Annual Report
59
experienced clinical leadership capacity to support transformation at local level. It will enable greater focus
on the delivery of integrated care at a locality level by combining provider and commissioning discussions.
These changes were reflected in our constitution after Membership Approval and submission to NHS England
in April 2018. Our submission met NHS England standards for applying for constitutional changes as per NHS
England Guidelines published here:
https://www.england.nhs.uk/publication/procedures-for-clinical-commissioning-groups-to-apply-for-constitution-
change-merger-or-dissolution/
Highlights of the Work of the Governing Body Committees
The roles of each of the Governing Body committees are set out below. The committees have authority under
the scheme of delegation to establish sub-committees or sub-groups to enable them to fulfil their role.
Each of the Governing Body committees has terms of reference and is authorised by the Governing Body to
pursue any activity within them and within the Scheme of Reservation and Delegation of Powers. The
Schemes of Delegation of each Governing Body committee are referenced within the CCG Constitution and
are available on the CCG website: www.towerhamletsccg.nhs.uk.
During 2018/19 the Governing Body met on six occasions in public. Business items for each meeting were
recorded on an annual planner and the meeting agendas were structured to address key matters of
performance, operations, commissioning and strategy. The main areas of focus for the Governing Body
throughout year were:
Community Health Services Alliance development
Developing local sustainable system transformation
North East London Sustainability and Transformation Plan
London Health Care Devolution
WEL System Transformation
The quality of service providers including Care Quality Commission (CQC) findings
Re-procurement of Urgent and Emergency Care Services (111)
Establishment of governance arrangements to support new ways of working, both borough-led and
North East London-led
Establishment and appointment of key leadership roles such as the Managing Director and Joint Chief
Finance Officer
WRES and Quality Statements from key providers
Presentations from local providers such as the GP Care Group, Accelerate CIC, Barts Health and the
East London Foundation Trust
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Local winter planning and A&E Recovery
Agreement of the Better Care Fund Initiative
Strategic Finance Management
Constitution Adjustments
Governing Body
22.05.2018 Sam Everington, Simon Hall, Jane Milligan, Henry Black, Mariette Davis, Isabel
Hodkinson, Judith Littlejohns, Victoria Tzortziou-Brown, Tan Vandal, Noah Curthoys,
Linda Aldous, Maggie Buckell, Julia Slay, Somen Banerjee, Osman Bhatti, Shah Ali,
Virginia Patania, Archna Mathur, Denise Radley, Ellie Hobart, Alison Blair, Steve
Collins.
24.07.2018 Sam Everington, Simon Hall, Jane Milligan, Henry Black, Mariette Davis, Isabel
Hodkinson, Judith Littlejohns, Victoria Tzortziou-Brown, Noah Curthoys, Linda
Aldous, Maggie Buckell, Julia Slay, Warwick Tomsett, Somen Banerjee, Osman
Bhatti, Virginia Patania, Archna Mathur, Ellie Hobart, Steve Collins.
25.09.2018 Sam Everington, Simon Hall, Jane Milligan, Mariette Davis, Victoria Tzortziou-Brown,
Linda Aldous, Maggie Buckell, Julia Slay, Warwick Tomsett, Virginia Patania, Archna
Mathur, Ellie Hobart, Steve Collins
27.11.2018 Sam Everington, Simon Hall, Jane Milligan, Henry Black, Mariette Davis, Victoria
Tzortziou-Brown, Linda Aldous, Maggie Buckell, Julia Slay, Warwick Tomsett,
Virginia Patania, Archna Mathur, Noah Curthoys, Shah Ali, Rajivi Sanjeevi, Khyati
Bakhai, Ellie Hobart, Ellie Hobart, Steve Collins, Jenny Cooke.
22.01.2019 Sam Everington, Selina Douglas, Jane Milligan, Henry Black, Mariette Davis, Victoria
Tzortziou-Brown, Linda Aldous, Maggie Buckell, Julia Slay, Warwick Tomsett,
Virginia Patania, Archna Mathur, Noah Curthoys, Shah Ali, Rajivi Sanjeevi, Khyati
Bakhai, Somen Banerjee, Ellie Hobart, Steve Collins, Sandra Moore
26.03.2019 Sam Everington, Selina Douglas, Henry Black, Mariette Davis, Victoria Tzortziou-
Brown, Linda Aldous, Maggie Buckell, Julia Slay, Virginia Patania, Noah Curthoys,
Shah Ali, Rajivi Sanjeevi, Somen Banerjee, Ellie Hobart, Steve Collins, Sandra
Moore.
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The Audit Committee
The Audit Committee is a statutorily mandated committee of the CCG, established in accordance with the
CCG Constitution. Its role is to seek assurance that financial reporting and internal control principles are
applied, and to maintain an appropriate relationship with the organisation's auditors, both internal and
external.
The Audit Committee offers scrutiny of and advice to, the Governing Body about the reliability and
robustness of the CCG's processes of internal control.
The Audit Committee (under its terms of reference) provides an annual report of its work to the Governing
Body. The Committee met six times during the period and was quorate at each meeting. The third member
to the Audit Committee was not recruited to as the Committee moved towards meeting in common with
other WEL CCGs. 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
committee's key areas of focus during the year included:
• Review of emerging governance arrangements for new organisational structure with formation of
North East London Commissioning Alliance and East London Healthcare Partnership
• Assurance from CCG managers regarding Continuing Healthcare
• Assurance from NELCA directors regarding CSU-inhousing and NELCA developments
• Review of CCG arrangements in regards to Business Continuity Planning and the UKs Exit from
the European Union
• Risk management and the Board Assurance Framework
• Assurance on current governance arrangements
• The management of conflicts of interest
• Financial risks and waivers of standing orders
• Amendments to the Constitution
• Internal audit reports
• Reports from counter fraud specialists
• Year-end financial statements and annual governance statement
• Liaison with internal and external auditors
• Review of internal control system through internal audit
The Audit Committee met 6 times during 2018/19:
Audit Committee
08.05.2018 Mariette Davis, Noah Curthoys
NHS Tower Hamlets CCG – Annual Report
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21.05.2018 Mariette Davis, Noah Curthoys
10.07.2018 Mariette Davis, Noah Curthoys
30.10.2018 Mariette Davis, Noah Curthoys
10.01.2019 Mariette Davis, Noah Curthoys
20.03.2019 Mariette Davis, Noah Curthoys
Audit Committees Meeting in Common
2018/19 also saw the first Audit Committees meeting in common between Waltham Forest and Tower Hamlets
CCGs, with Newham to joining the Committees meeting in common later in April 2019.
Meeting in common has allowed useful discussion, contrast and comparison to take place whilst ensuring
each CCG continues to meet it statutory functions and legal requirements. The Audit Committees meeting in
common have supported the extensive governance PMO work programme which is reviewing areas of
commonality across the WEL CCGs and best practice, with the view that it will eventually form the basis of
future joint working across WEL.
The Remuneration Committee
The Remuneration Committee is a statutorily mandated committee of the CCG, established in
accordance with the CCG Constitution. Its aim is to set and review the salaries and pensions for Very
Senior Managers (VSM), which presently are the Accountable Officer, Managing Director and Joint
Director of Commissioning and Chief Finance Officer.
In addition, the committee oversees the remuneration of any member of the CCG not covered by national
agreed pay scales.
The Remuneration Committee met twice in 2018/19.
Remuneration Committee
26th June 2018 Maggie Buckell, Mariette Davis, Noah Curthoys, Jane Milligan
20th March 2019 Maggie Buckell, Noah Curthoys, Julia Slay, Steve Collins, Sam Everington
Remuneration Committees Meeting in Common
2018/19 also saw the continuation of Remuneration Committees meeting in common between NEL CCGs and
Newham, Waltham Forest and Tower Hamlets CCGs. Meeting in common across NEL and WEL has allowed
for useful discussion, mutual agreement and robust scrutiny of joint or shared VSM appointments and their
associated remuneration.
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63
The Performance, Activity and Quality Committee
The Performance, Activity and Quality Committee monitors the CCG's performance and quality of providers
commissioned by the CCG. Safeguarding activity is monitored through the safeguarding subcommittee which
reports to and provides advice to the Performance, Activity and Quality Committee.
The Performance, Activity and Quality Committee was established during 2017/18 along with the Strategic
Finance and Investment Committee as a result of the internal governance changes that were implemented in
order to provide more focus on performance and quality and better support the development of partnership
working.
The Performance, Activity and Quality Committee met 8 times during 2018/19.
Performance and Quality Committee
25.04.2018 Mariette Davis, Simon Hall, Sandra Moore
23.05.2018 Mariette Davis, Simon Hall, Sandra Moore, Andrea Antoine, Warwick Tomsett,
27.06.2018 Mariette Davis, Simon Hall, Carrie Kilpatrick, Sandra Moore, Andrea Antoine,
Warwick Tomsett
25.07.2018 Sandra Moore, Mariette Davis
26.09.2018 Mariette Davis, Sandra Moore
31.10.2018 Sandra Moore, Mariette Davis, Andrea Antoine
28.11.2018 Sandra Moore, Mariette Davis
27.02.2019 Sandra Moore, Mariette Davis, Andrea Antoine
Executive Committee
The Executive Committee is made up of the CCG senior management team, and the Governing Body Chair,
Vice-Chair and principal clinical leads and is a committee that holds key management oversight of many areas
of CCG Business. The committee's duties include key strategic and clinical management of the CCG,
management of financial performance against plans, promote the development, partnership and resilience of
healthcare and social care providers and partners and provide clinical and organisation scrutiny of business
cases, strategies and all other commissioning decisions where necessary. During 2018/19, the Committee
focused on work areas such as:
• Governing Body advice and agenda setting
• Strategic and System Development
• Local healthcare strategy development
NHS Tower Hamlets CCG – Annual Report
64
• Equality and Diversity including Work Race Equality Standards (WRES) and promotion of strategy
• Emergency Preparedness, Resilience and Response
• General Practice Resilience
• Policy setting and agreement
• Winter Planning
• Local and system governance and risk management
The Executive Committee met six times during 2018/19.
Executive Committee
24.04.2018 Simon Hall, Archna Mathur, Sam Everington, Jenny Cooke, Alison Blair, Steve
Collins
19.06.2018 Simon Hall, Archna Mathur, Sam Everington, Jenny Cooke, Steve Collins, Ellie
Hobart, Isabel Hodkinson.
07.08.2018 Simon Hall, Archna Mathur, Sam Everington, Jenny Cooke, Steve Collins, Ellie
Hobart, Isabel Hodkinson, Warwick Tomsett
18.10.2018 Simon Hall, Sam Everington, Steve Collins, Ellie Hobart, Isabel Hodkinson,
Sandra Moore.
15.01.2019 Selina Douglas, Sam Everington, Steve Collins, Ellie Hobart, Isabel Hodkinson,
Sandra Moore, Victoria Tzortziou Brown, Jenny Cooke, Osman Bhatti.
19.02.2019 Ellie Hobart, Isabel Hodkinson, Victoria Tzortziou Brown, Jenny Cooke, Osman
Bhatti
Primary Care Commissioning Committee
Delegated commissioning arrangements took effect from April1 2015. Tower Hamlets CCG established a
Primary Care Commissioning Committee as a Committee of the Governing Body with responsibility for
delegated commissioning arrangements. The Committee is quorate with three of the seven voting members
in attendance, with at least one Lay member present. Non-voting GP observers are excluded from Committee
discussions and decisions regarding topics where they have a conflict of interest. The Primary Care
Commissioning Committee is made up of the following roles:
Voting members: Lay Member for PPI (Chair), Governing Body Nurse (Vice Chair) , Lay member for
Governance, Governing Body Secondary Care Consultant, CCG Chief Finance Officer, Independent
Clinical Adviser, CCG Accountable Officer.
Non-voting members: Health and Wellbeing Board representative, Public Health representative, Healthwatch
NHS Tower Hamlets CCG – Annual Report
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representative, LMC representative, two additional CCG GP representatives, NHS England representative.
The functions delegated by NHS England, and upon which the Committee makes decisions include:
decisions in relation to Enhanced Services,
decisions in relation to Local Incentive Schemes (including the design of such schemes),
decisions in relation to the establishment of new GP practices (including branch surgeries)
and closure of GP practices,
decisions about 'discretionary' payments,
decisions about commissioning urgent care (including home visits as required) for out of
area registered patients,
the approval of practice mergers,
planning primary medical care services in the Area, including carrying out needs
assessments,
undertaking reviews of primary medical care services in the Area,
decisions in relation to the management of poorly performing GP practices and including,
without limitation, decisions and liaison with the CQC where the CQC has reported non
compliance with standards (but excluding any decisions in relation to the performers list),
management of the Delegated Funds in the Area
Premises Costs Directions Functions,
coordinating a common approach to the commissioning of primary care services with other
commissioners in the Area where appropriate,
• Other ancillary activities that are necessary in order to exercise the Delegated Functions.
The Committee met on six occasions during the year with attendance at follows.
Primary Care Commissioning Committee Attendance
11.04.2018 Julia Slay, Maggie Buckell, Mariette Davis, Tan Vandal, Steve Collins, Virginia
Patania, Jenny Cooke
11.07.2018 Julia Slay, Maggie Buckell, Mariette Davis, Steve Collins, Virginia Patania,
Jenny Cooke, Simon Hall
12.09.2018 Julia Slay, Maggie Buckell, Mariette Davis, Simon Hall, Steve Collins, Jenny
Cooke,
14.11.2018 Julia Slay, Mariette Davis, Virginia Patania, Jenny Cooke
16.01.2019 Maggie Buckell, Selina Douglas, Virginia Patania, Jenny Cooke
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13.02.2019 Julia Slay, Mariette Davis, Jenny Cooke, Virginia Patania,
The Strategic Finance and Investment Committee
The Strategic Finance and Investment Committee oversees the planning and strategic direction of the CCG,
with the delegated authority to approve medium-term financial plans (3 to 5 years), and from it the annual
operating plans for each year to ensure the organisation is making financial decisions that support the strategic
direction of care and ensure plans are affordable, sustainable and enable statutory duties and business planning
rules to be met. SFIC is the committee that provides recommendations to the Governing Body, on an annual
basis, that the commissioning intentions are affordable and approve requests for new in-year investments and
confirming funding source. Additionally, SFIC is the CCG vehicle to oversee the CCG process for managing
clinical procurement activity, with the Procurement Working Group reporting into SFIC on a monthly basis. The
Strategic Finance and Investment Committee was established during 2017/18 as a result of the internal
governance changes that were implemented in order to better support the development of partnership working.
The monitoring of finance was previously conducted by the Finance, Performance and Quality Committee which
was stepped down in 2017.
The procurement working group oversees the detailed supervision of procurements and provides a clear
audit trail for the Strategic Finance and Investment Committee.
Key areas of review included:
• Quality, Innovation, Productivity and Prevention Management
• Commissioning Proposals
• Medium/Long Term Strategic analytic Output
• Commissioning Intentions
• Contract Variation Process 2019/20
• Procurement decisions and awards
• Transformation programmes
• Operating plan 18/19
• Long term financial planning
Strategic Finance and Investment Committee
21.03.2018 Sam Everington, Simon Hall, Isabel Hodkinson, Steve Collins Mariette Davis, Andrea Antoine, Victoria Tzortziou Brown
20.04.2018 Andrea Antoine, Steve Collins, Jenny Cooke
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16.05.2018 Noah Curthoys, Steve Collins, Andrea Antoine
20.06.2018 Noah Curthoys, Mariette Davis, Andrea Antoine, Steve Collins, Warwick Tomsett
18.07.2018 Noah Curthoys, Andrea Antoine, Steve Collins, Warwick Tomsett
22.08.2018 Andrea Antoine, Sandra Moore, Elliot Hobart
19.09.2018 Noah Curthoys, Mariette Davis, Simon Hall, Victoria Tzortziou Brown, Andrea Antoine, Warwick Tomsett Steve Collins
17.10.2018 Victoria Tzortziou Brown, Mariette Davis, Steve Collins
21.11.2019 Noah Curthoys, Mariette Davis, Victoria Tzortziou Brown, Steve Collins, Warwick Tomsett, Andrea Antoine.
19.12.2018 Noah Curthoys, Steve Collins, Andrea Antoine, Carrie Kilpatrick, Rahima Miah, Jenny Cooke
30.01.2019 Noah Curthoys, Mariette Davis, Warwick Tomsett, Andrea Antoine, Steve Collins
27.02.2019 Noah Curthoys, Mariette Davis, Warwick Tomsett, Steve Collins
19.03.2019 Noah Curthoys, Mariette Davis, Steve Collins, Andrea Antoine
Locality Board
The Locality Board was established to provide a formal platform for two-way dialogue between CCG constituent
practices and the governing body. It has a key role in ensuring the CCG develops and maintains effective two-way
engagement between the governing body members and member practices. The Locality Board also ensures that
feedback from localities is used to support decision making in developing health services for Tower Hamlets.
Individual Funding Request (IFR) Panel
The Individual Funding Request panel oversees cases where an individual funding request can be made by a
clinician treating a patient if they believe that there are clinical circumstances that are exceptional and the patient
would benefit from a treatment or service that isn’t routinely offered by the NHS. The management of Individual
Funding Requests for Tower Hamlets CCG, Waltham Forest and Newham CCGs has been outsourced to the
North East London Commissioning Support Unit, and our Governing Body Lay Member for Corporate Affairs,
Noah Curthoys, is a member and our CCG representative.
The responsibility of the IFR panel and appeal panels includes:
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To uphold and work within the legal context to decision making, Consider and determine eligible IFRs
where the clinical commissioning group is the responsible commissioner of NHS care, according to
the principles set out in the CCG's IFR policy, and in the IFR panel and appeal panel terms of
reference
Refer to the relevant CCG adopted clinical policies to determine whether a patient who does not meet
the criteria in the policy can be considered to be exceptional taking the information provided within
the application into account
The appeal panel will review applications where the applicant appeals the decision making process
of the IFR panel and does not provide any new information for consideration.
IFR panel and appeal panel Chair
The chair is responsible for ensuring that:
• Reasonable effort has been made to acquire adequate data and intelligence to inform the decision
• All material factors have been taken into account and that immaterial factors have been appropriately
handled
• The rationale for the decision has been explicitly recorded, against the terms of this policy, and that
the conflicting arguments have been managed
• They are available to approve the minutes and letters within the specified time frame following IFR
panel meetings and to ensure that decisions made are correctly reflected
• The IFR panel meetings are quorate in line with the Terms of Reference.
• The Chair is accountable to their CCG Governing Body for the delivery of this role.
Governance Developments in North East London
Our 2017/18 Annual Report introduced the new approaches in which the NHS in North East London proposed
to address the significant challenges of providing care for a growing population and continuing to meet the
health needs of some of the most deprived areas in the UK. In order to achieve quality services for our
patients, Tower Hamlets CCG and its partners and colleagues in the local health and social care system have
come to together and recognised a greater need for partnership working to address the pressures in the health
and social care system and achieve the aims of the NHS Long Term plan and the Sustainability and
Transformation Plan.
North East London CCG Governance Developments – The North East London Commissioning Alliance
(NELCA) and Waltham Forest and East London (WEL)
In order to facilitate the success of these changes and continue the quality provision of care to patients both
locally and at a system level, governance arrangements to support partnership working was an area of focus
for the CCG in 2018/19. Work has continued to develop across local footprints in North East London to
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establish these new arrangements, namely closer working with our CCG colleagues in Waltham Forest and
Newham and the North East London Commissioning Alliance, made of the 7 CCGs in North East London.
CCGs in North East London Commissioning Alliance (NELCA) acknowledged that in order to support much
needed developments, adjustments to both local and system governance would need to take place in order to
enhance the ability for CCGs to work in partnership with each other for the benefit of local patients, promote
an aligned commissioning strategy to support long term viability of local acute providers, promote a clear and
constructive commissioning system and work with Local Authority Partners to provide a truly integrated service
for patients.
These key developments included:
Recruitment and appointment of Joint Chief Finance Officer for Tower Hamlets CCG, Waltham
Forest CCG, Newham CCG, Barking, Havering and Redbridge CCGs and City and Hackney
CCGs.
Recruitment of a Managing Director for Waltham Forest, Tower Hamlets and Newham CCGs
(called the Joint WEL Managing Director)
Recruitment of senior executives at NELCA to lead on areas such as Transformation
First Audit Committees Meeting in Common held between Tower Hamlets CCG and Waltham
Forest CCG
Respective NEL CCG Governing Bodies felt that undertaking certain functions once across the NEL CCGs
would release valuable time and resource within the North East London health economy, in turn allowing
added focus for the local, borough based integrated care systems. It was also agreed that establishing these
governance systems would promote working together across larger footprints and reduce duplicity in work
streams.
The Tower Hamlets Governing Body recognised that the appointment of a joint Managing Director, with the
appropriate governance in place, would provide stable leadership across a wider geographical location,
support collaboration between CCGs and would further enable essential transformation resources to be
transferred to WEL and NEL. The Tower Hamlets CCG Governing Body also felt that it would provide an
opportunity to more effectively manage the complex issues faced by local providers that could impact on the
quality of services and equality of care being delivered in Tower Hamlets and across North East London. The
Tower Hamlets CCG Governing Body therefore approved the recruitment of a Joint WEL Managing Director,
with Selina Douglas (previously Newham CCG’s Managing Director) being successfully recruited to the role in
November 2018.
The Joint NELCA Commissioning Committee was established, with combined membership of NEL CCGs and
Lay Members to drive areas which will be approached at NEL level such as:
• the commissioning of specialist services
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• the strategic development of primary care
• the commissioning of services common to all such London Ambulance Service (LAS) and services
outside the scope of the ACSs
• the agreement of acute services strategy including the approaches to payment
• workforce development
• development of the framework for commissioning of local ACSs
• first line of communication for NHSE on critical areas of system performance and change and the
delivery of the Five Year Forward View (FYFV)
• Committees in Common for functions where CCGs wish to collaborate at a system level.
Whilst many of the governance arrangements are currently in their infancy or working in shadow form, it is a
significant step towards working together across North East London to meet the needs of current and future
patients in a sustainable way and close the gaps in health, finance and quality of care.
With these changes in motion, it was also recognised that local accountability and the achievement of local
CCG objectives would still need to be maintained and supported in order to ensure the development and
delivery of each local integrated care system, which in Tower Hamlets is Tower Hamlets Together. More
information on Tower Hamlets Together is available in the ‘Working With Our Partners’ Section.
Governance Management at Tower Hamlets Clinical Commissioning Group
UK Code of Corporate Governance
Whilst the detailed provisions of the UK Corporate Governance Code are not mandatory for public sector
bodies, compliance is considered to be good practice. This Governance Statement is intended to demonstrate
the CCG’s compliance with the principles set out in the Code (insofar as this applies to CCGs).
For the financial year ended 31 March 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.
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.
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Responsibility for each duty and power has been clearly allocated to a lead director. Directorates have
confirmed that their structures provide the necessary capability and capacity to undertake the CCG’s statutory
duties.
Risk management arrangements and effectiveness
The CCG uses a fully embedded comprehensive risk management framework which has been designed to
identify strategic and operational risks, responsibilities, and mitigating actions at directorate and system levels.
Risks are identified in a number of ways, including proactive risk assessments, performance reports, service
alerts, incident reports, complaints, audit and regulator reports and activity and financial forecasts. The CCG
identifies categories for its risks against the CCG’s strategic objectives which are outlined in the performance
section of this report. The CCG Governing Body does not willingly accept risks that significantly impact on our
ability to deliver against our strategic, corporate, principal or business objectives but we recognise that risks
are influenced by both internal and external factors and that the degree of their control and assurances will
vary upon the level of stakeholder influence.
The Senior Management Team and Governing Body have a responsibility for identifying and managing risks to
the organisations key strategic objectives. Additionally, individual teams are accountable for managing
operational risks associated with their areas of responsibility. Each Senior Manager is responsible for ensuring
that the Board Assurance Framework reflects key risks, controls and assurances related to strategic
objectives, and that these are reviewed regularly.
Through CCG Committees, Governing Body and committee reports, the Senior Management Team and the
Corporate and Team Risk Registers, high level risks are escalated to the Governing Body using the Board
Assurance Framework as the reporting tool to outline the controls, mitigations, appetite and actions.
Each Board Assurance Framework risk identified is assigned a Lead Committee, Governing Body Lead and
Management Lead. The risk, its mitigations and its gaps are discussed in the lead committee in order to
provide assurance to the Governing Body that the risk has appropriate controls in place and that objectives
are pursued within the CCG’s predetermined risk parameters. Horizon scanning also takes place at committee
level, as well as at Governing Body meetings and OD sessions, and deep dives are requested by the Audit
Committee for areas which appear to be challenged or require additional oversight and scrutiny.
The Board Assurance Framework and the supporting establishment and maintenance of the CCG’s system of
integrated governance, risk management and internal controls are reviewed by the Audit Committee ensure
the achievement of the CCG's strategic and operational objectives.
Capacity to handle risk
There is a Governing Body and management commitment to effective risk management across the CCG. The
Governing Body reviews its risk appetite at least on an annual basis and more (especially during times of
increased uncertainty or adverse changes). The periodic review and arising actions will be informed by an
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assessment of risk maturity, which in turn enables the Governing Body to determine the organisational
capacity to manage risk.
The Governing Body and all committees have clearly defined responsibilities for risk management including
review and discussion of risk registers, escalation of risks to the Board Assurance Framework and providing
effective and detailed narrative to the Governing Body. All staff are invited to undertake local risk training to
ensure they can identify, describe and evaluate a risk and our induction programme includes mandatory training
on high risk areas such as information governance, equality and diversity, safeguarding and health and safety.
Guidance, both specialist materials and induction packages, are based on best practice in order to ensure that
staff reflect current and high levels of professionalism and align to accepted healthcare industry standards.
Specialist Information Governance, Corporate Governance and Organisational Development expertise is sought
from specialists from the Information Governance Directorate of the NEL CSU in order to bolster the
understanding and management of risk and inform its management.
Risk assessment
At an operational level, the individual CCG teams review all relevant risks each quarter ensuring that risks are
effectively identified, assessed, managed and monitored providing assurance and tracking of effective internal
controls that provide reasonable assurance of effective and efficient operations, financial stewardship, probity
and compliance with laws and policies.
Incident reporting processes have been communicated to all staff through briefings and information on the
CCG file sharing structures and intranet. An incident reporting policy has been implemented and processes to
ensure learning from incident reports is captured and fed into the risk management process.
CCG has a varying risk appetite, responding to areas where it is required to take on risk to develop
transformation. The following risks were identified by the CCG as significant during 2018/19 and remedial
work to address the issues continues:
• Failure to ensure effective systems and processes are in place to monitor, challenge and support
Barts Health NHS Trust delivery of NHS Constitution targets and CQC action plan could result in
the increased likelihood of poor quality, poor patient experience, delivery of poor clinical outcomes
and the trust remaining in special measures in the longer term.
• The financial deficit of one of our main providers, Barts Health NHS Trust.
• Overspending in a number of acute services.
• Sustainability and resilience of General Practice in Tower Hamlets.
• The newly established Community Healthcare Services Alliance failing to deliver its targets and
losing its organisational form, thus impacting the healthcare of Tower Hamlets patients
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• The possible impact of the deteriorating position of Continuing Healthcare, and the resulting
increase in financial pressures and decrease in quality and performance.
• Failure to deliver the CCGs QIPP target and 2018/19 operating plan
• The CCG’s ability to meet its statutory requirements in regards to Safeguarding and Looked After
Children
• Potential impacts to the CCG in regards to the UK’s exit from the European Union
• Lack of clarity in the development of local commissioning arrangements.
The CCG approached all risks with vigour, and ensured mitigations were in place in order to address the
severity and likelihood via consistent review by the Governing Body and its committees to ensure that actions
to address any gaps had been implemented. We will continue to work to address areas where a current risk
rating exceeds the organisation's risk appetite for that risk.
Other sources of assurance
Internal control framework
A system of internal control is the set of processes and procedures in place in the clinical commissioning
group to ensure it delivers its policies, aims and objectives. It is designed to identify and prioritise the risks, to
evaluate the likelihood of those risks being realised and the impact should they be realised, and to manage
them efficiently, effectively and economically.
The system of internal control allows risk to be managed to a reasonable level rather than eliminating all risk; it
can therefore only provide reasonable and not absolute assurance of effectiveness.
The CCG's strategic objectives have been in place since the beginning of 2017/18 and were set by the
Governing Body. From these objectives, the main risks to their achievement were identified at a risk
identification workshop with Governing Body members in 2018/19. The BAF and the Corporate Risk Register
are the key control measures used in the management of risk and have been in place since April 1 2013.
Each risk identified is attributed a senior manager risk lead and lead committee of the Governing Body who
are held accountable for the management of these risks. The BAF is refreshed bi-monthly through meetings
with the senior manager risk leads and is reported to the Audit Committee and the Governing Body.
The management processes for the BAF were reviewed in 2018/19 by our internal auditors, and we received
“reasonable assurance” opinion with a small number of recommendations and examples of best practice to be
implemented. The Internal Audit Opinion noted that, “taking account of the issues identified, the Governing
Body can take reasonable assurance that the controls upon which the organisation relies to manage the
identified risk(s) are suitably designed, consistently applied and operating effectively.” Overall, RSM UK noted
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a number of well-designed controls with good application, highlighting NHS Tower Hamlets CCG’s proactive
approach to appropriate risk management.
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.
Tower Hamlets CCG commissioned Risk Assurance Services LLP (RSM) to conduct audits on the CCG’s
internal controls including the CCG’s Conflict of Interest and Gifts and Hospitality Functions. RSM report to the
Governing Body board via the Governing Body’s Audit Committee, which is chaired by the CCG’s Lay Member
for Governance and Conflict of Interest Guardian, Mariette Davis. RSM conduct audits based on a plan
approved by the Audit Committee at the beginning of the financial year and report at every audit Committee on
their findings and recommended actions the CCG should implement.
In January 2019, an audit was undertaken by RSM at Tower Hamlets Clinical Commissioning Group (CCG) to
evaluate the design and operating effectiveness of the arrangements that the CCG has in place to manage
conflicts of interest and gifts and hospitality, including compliance with NHS England’s statutory guidance on
managing conflicts of interest for CCGs. After an extensive review of the CCG’s Conflict of Interest and Gifts
and Hospitality controls, RSM considered the CCG to be fully compliant and received a substantial opinion
which indicates Conflicts of Interest arrangements to be strong. The audit highlighted many well designed and
applied controls, noting that the CCG followed best practice and had initiated areas of control that supported
the effective management of Conflicts of Interest.
Recommendations for the improvement of the application and administration of the CCG’s Conflicts of Interest
procedures were actioned in February 2019 and RSM reported these findings and subsequent actions to the
March 2018 Audit Committee.
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Data quality
We use an array of data from various sources to support our Governing Body and our strategic and
operational decision making and we recognise the importance that data quality plays in both service provision
and service planning. Our Senior Management review the quality of information that supports and influences
our governance, working with the Governing Body’s committees to ensure the quality of data used by the
Governing Body is accurate and fit for purpose. All data that is forwarded to the Governing Body has been
discussed and analysed at a committee meeting prior to being submitted for discussion, noting or a formal
decision at the Governing Body.
In line with the “need to know” principles set out in the Caldicott 2 Information Governance Review Report, the
CCG ensures that information presented to the Governing Body and other governance forums does not
include any personally identifiable data and that commercially sensitive information is not made publicly
available. In the CCG’s Annual Governing Body Survey, 94% of Governing Body members were confident in
the quality of the data they had received.
Information governance
The NHS Information Governance Framework sets the processes and procedures by which the NHS handles
information about patients and employees, in particular personal identifiable information. The NHS
Information Governance Framework is supported by an information governance toolkit and the annual
submission process provides assurances to the 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 are developing information governance processes and procedures in line with
the information governance toolkit. We have ensured all staff undertake annual information governance
training and have implemented a staff information governance handbook to ensure staff are aware of their
information governance roles and responsibilities.
The information assets provided by the Commissioning Support Unit to the CCG are covered by the
overarching Information Technology Service Level Agreement between the CSU and the CCG. For these
assets they are then further protected by the CSU IT infrastructure controls, data disaster recovery and
backup services and network security controls including firewalls, antivirus and encryption programs.
There are also role based access controls for information assets which staff require which are approved by
NEL CSU IT once signed off by local managers so that staff have only access to those assets which are
needed for their work and at the right level of access especially for services using personal data.
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The CSU operates as an Accredited Safe Haven (ASH) and as a Controlled Environment for Finance to
ensure that patient confidential data is used in ways that prevent the identity of individuals to whom that data
relates from being identified and thereby limiting the personal confidential data received by the CCG.
The CCG conducted a Data Flow Mapping exercise to identify and record uses of data across the organisation
and the controls in place to ensure its legitimate and secured use. Any potential new flows at the CCG are
reviewed with the CSU IG team to ensure any potential risks to the data are assessed and any actions
required are implemented.
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 of face to face training,
awareness materials and information sessions has been established to fully embed an information risk culture
throughout the organisation against identified risks. As part of this embedded culture of Information
Governance best practice, this year saw the introduction of the CCG’s Information Governance Steering
Group, chaired by the CCG’s Senior Information Risk Owner and is made up of key CCG leaders, data users
and governing body members to ensure the CCG’s oversight of information governance risk is robust and is
championed by all levels of staff.
The CCG’s historic approach to Information Governance provided a substantial platform to reach compliance
by GDPR’s introduction on 25 May 2018 and work has continued beyond the introduction of the Regulation,
where the CCG has worked with the CSU to introduce new policies and procedures which are reflective of
best practice and guidance as released by the Information Commissioners Office.
As part of the CCG’s annual Information Governance processes, the CCG assessed itself using the Data
Security Toolkit against established standards in the areas of Information Governance Management,
Confidentiality and Data Protection Assurance, Information Security Assurance and Clinical Information
Assurance. The CCG were assessed as fully compliant in all relevant standards.
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.
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Control issues
There were no control issues identified via the Month 9 Governance Statement return.
Review of economy, efficiency and effectiveness of the use of resources
The 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
Governing Body receives regular summary reports concerning the CCG's financial performance, and has
delegated authority both to the Strategic Finance and the Audit Committee to conduct more detailed scrutiny
and report back.
Strategic Finance and Investment Committee (SFIC) convenes monthly to scrutinise the detailed operational
financial performance of the CCG. The committee receives detailed and timely reports covering both corporate
CCG management costs and all aspects of commissioning spend, as well as considering key risks and
opportunities. The committee reviews the reports in detail and instructs the relevant CCG management function
to carry out investigations into areas of concern, and prepare remedial action plans if necessary. The SFIC is
chaired by the Lay Member for Corporate Affairs and is also attended by the lay Member for Governance,
Managing Director, Director of Integrated Commissioning and the Chief Finance Officer.
The Audit Committee is chaired by the Governing Body Lay Member for Governance. The Lay Member for
Corporate Affairs and the Secondary Care Clinician 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 the Board Assurance Framework ensuring that conflicts of interest are managed in line with the CCG's
Constitution.
Underpinning the CCG's governance framework are the Prime Financial Polices which set out the key business
rules which govern the organisation, including internal control, audit, standards of business conduct and
budgetary control. They also incorporate the scheme of delegation. This sets out the level of authority to act
and make decisions which has been delegated from the CCG 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.
CCG Internal Audit Arrangements
The reports issued following our internal audit reviews have received substantial or reasonable assurance
opinions and have not identified any significant control issues. The CCG is a delegated commissioner of
primary care and its arrangements for managing this function are subject to regular review by internal audit
and the Audit Committee. Other areas of significant risk are also reviewed and in 2018/19 this focused on
statutory functions (such as conflict of interest management and Finance Management), governance
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arrangements as new collaborative working is developed and additional areas such as QIPP and Continuing
Healthcare.
Delegation of functions
Much of the CCG's commissioning spend is covered by functions contracts delegated to commissioned by the
CCG to the North East London Commissioning Support Unit (NEL CSU) through a service level agreement.
The nature of the CSU as an arm's length but not fully independent entity means that NHSE do not have
comprehensive processes of internal audit or controls assurance in place, instead commissioning an external
supplier to conduct a service audit and prepare a report for customers at the end of the year.
To address this significant area of business management and risk, RSM Risk Assurance Services LLP have
been commissioned by Tower Hamlets CCG to conduct a more comprehensive assurance process of the
CSU in addition to the CCG’s internal audit contract. With support from the Internal Auditors, the Chief Finance
Officer and relevant directors meet with the CSU lead staff regularly to discuss performance and agree actions
where there are concerns.
The CSU provides advice and support across many areas of commissioning to 12 clinical commissioning
groups in the North Central and East London areas, including the following for Tower Hamlets CCG:
• Procurement Services
• Continuing Healthcare Management
• Contract Management
• Human Resources
• Complaints
• Information Governance
• Communications
• IT Services
RSM UK’s CSU Quality Assurance Audit Plan covers these delegated areas. In 2018/19 RSM stated that the
CSU have been assigned reasonable assurance opinions in all areas reviewed, with the exception of the
review of Procurement where a partial assurance opinion was assigned. This means that the Governing Body
can take partial assurance that the controls to manage risks were suitably designed and consistently applied,
and that action was needed to strengthen the control framework to manage the identified risks.
Based on the work undertaken in 2018/19, RSM UK stated that there is a generally sound system of internal
control, designed to meet the CCG’s objectives, and controls are generally being applied consistently.
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Counter fraud arrangements
NHS Tower Hamlets Clinical Commissioning Group is committed to tackling fraud and bribery and ensuring
that all staff are aware of the reporting lines that should be followed should any suspicions or concerns arise.
The CCG has contracted an accredited Local Counter Fraud Specialist (LCFS) from RSM UK, whose purpose
is to raise fraud awareness across the CCG, ensure weaknesses within systems are identified, making
recommendations where necessary to strengthen these and that the organisation has the necessary controls
in place to mitigate the risk of fraud or bribery occurring.
LCFS are also responsible for investigating allegations of fraud and bribery and managing the work plan and
annual submission against the NHS Counter Fraud Authorities Standards 2018/19. It is recognised that the
existence of fraud and bribery prevents NHS funds providing maximum benefit to patients and that this needs
to be reduced to an absolute minimum through awareness, fostering a supportive reporting culture and
ensuring counter fraud arrangements are considered at all points of the commissioning cycle.
The LCFS provides an accessible point of contact for any concerns regarding fraud or bribery issues. In order
to achieve greater awareness, during 2018/19, LCFS has provided fraud and bribery training for the Governing
Body members, CCG employees, GPs and practice staff via the locality meetings.
Additionally, as part of the Counter Fraud Specialist Service:
• The CCG Audit Committee receives a report against each of the Standards for Commissioners at least
annually. There is executive support and direction for a proportionate proactive work plan to address
identified risks.
• Appropriate action is taken regarding any NHS Counter Fraud Authority quality assurance
recommendations.
The Chief Finance Officer, as an executive member of the Governing Body, is proactively and demonstrably
responsible for tackling fraud, bribery and corruption and works closely with the CCG’s Governance Team and
Governing Body to ensure that appropriate counter fraud work is proactive and proportionate in addressing
identified risks. The Chief Finance Officer also provides executive support and direction for the LCFS work
plan, and attends the Audit Committee, Executive Committee and Governing Body to ensure appropriate link
in within the CCG Governance Structure and leadership.
B1(4) Head of Internal Audit 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.
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The Head of Internal Audit Opinion
For the 12 months ended 31 March 2019, our head of internal audit opinion for NHS Tower Hamlets 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 assurances relating to the
organisation;
• the opinion is substantially derived from the conduct of risk-based plans generated from a robust and
organisation-led assurance framework. As such, the assurance framework is one component that the
Governing Body takes into account in making its annual governance statement (AGS);
• the opinion is based on the findings and conclusions from the work undertaken, the scope of which
has been agreed with management / lead individual;
• the opinion is based on the testing we have undertaken, which was limited to the area being audited,
as detailed in the agreed audit scope;
• where strong levels of control have been identified, there are still instances where these may not
always be effective. This may be due to human error, incorrect management 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 system which 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 risk management,
internal control and governance, and for the prevention and detection of material errors, loss or fraud.
The work of internal audit should not be seen as a substitute for management’s responsibilities around
the design and effective operation of these systems.
Factors and findings which have informed our 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
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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
The reports issued following our internal audit reviews have received substantial or reasonable assurance
opinions and have not identified any significant control issues.
Substantial Assurance
• Financial Planning, Budget Setting, Delivery and Reporting – Substantial Assurance
• Conflicts of Interest – Substantial Assurance
• QIPP - WELC CCGs joint report Effectiveness – Substantial Assurance
Reasonable Assurance
• NEL CCGs joint report Commissioning and Contract Management – Reasonable Assurance
• QIPP - WELC CCGs joint report Design and Application – Reasonable Assurance
• Primary Care Delegated Commissioning –Reasonable Assurance
• Board Assurance Framework – 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.
CSU Quality Assurance Plan
We have provided reasonable assurance in the areas reviewed, with the exception of the review of
Procurement where a partial assurance opinion was assigned, meaning that the Governing Body can take
partial assurance that the controls to manage risks were suitably designed and consistently applied, and that
action was needed to strengthen the control framework to manage the identified risks.
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Procurement
Two main areas within the Procurement process have driven the partial assurance opinion. It should be noted
that exceptions within our testing were only applicable to certain CCGs, whilst the controls assessed were
applicable to all CCGs to which NELCSU provide the service.
The first area we found issues in related to the Conflicts of Interest arrangements which meant that the CoI
documentation for two procurement exercises were not held, whilst for two procurement exercises no registers
of interests were held on the corresponding procurement files.
The second main area is around ensuring the SLA in place between the individual CCGs and the CSU clearly
documents the roles and responsibilities around Procurement and is subsequently signed off by both parties.
This would enable the expectations of both the CCGs and the CSU to be clarified.
Other issues related to the monitoring and reporting on Procurement activity produced by the CSU and the
feedback mechanism in place around customer (CCG) service feedback following individual procurement
exercises, so lessons can be learnt if required.
The CCG have provided additional commentary regarding this assurance opinion below.
Reasonable Assurance
We also issued the following reviews with Reasonable Assurance opinions:
• GP IT – Reasonable Assurance
• IT Business Continuity and Disaster Recovery – Reasonable Assurance
• Individual Funding Requests – Reasonable Assurance
• HR Support – Reasonable Assurance
• Acute and Non-Acute Contracting and Data Quality and Performance Management (Draft) –
Reasonable Assurance
• Provider Quality Management – Quality Assurance (Draft) - Reasonable Assurance
We issued an Advisory report on General Data Protection Regulations and a further advisory report currently
in draft on Data Security Protection Toolkit.
Topics judged relevant for consideration as part of the annual governance statement
Based on the work we have undertaken to date on the CCG’s system on internal control, we do not consider
that within these areas there are any issues that need to be flagged as significant control issues within the
Annual Governance Statement (AGS), although the CCG may wish to consider the potential significance of
the control issues identified during the course of the CSU Procurement review which was assigned a partial
assurance opinion. The CCG may wish to consider whether any other issues have arisen, as well as
recognise the challenging financial environment within which the CCG is operating, including the results of any
NHS Tower Hamlets CCG – Annual Report
83
external reviews, when determining whether anything should be highlighted within the Annual Governance
Statement.
CCG Commentary on CSU Procurement Assurance Opinion
An audit of the North East London Commissioning Support Unit’s Procurement service, which is delivered on
behalf of the CCG, was conducted as part of the approved Assurance Plan for 2018/19. This review assessed
the various processes and controls in place at the CSU to ensure that the CCG is provided with a high-quality
service, achieves the highest value for money from the procurement process and ensures that the procurement
process is open, transparent and is in line with NHS requirements. The review focused on the service provided
to the 12 North East London CCGs and included the service provided to Tower Hamlets CCG. A Partial
Assurance Opinion was issued, predominately based on the review of the overall procurement process
undertaken by the CSU on behalf of the CCGs.
RSM raised several management actions in relation to the application of the control framework. The audit
acknowledged that a number of actions requires the CSU to work with the CCGs to establish and agree the
procurement processes, clarify roles and responsibilities between the organisations and highlighted the need
for the service specifications between the parties to be strengthened. In addition, the review raised several areas
of note in relation to conflict of interest management during the procurement process. The CCG conducted an
investigation during 2018-19 in relation to a COI breach during a procurement process for a pilot service. Due
to this, the CCG issued a number of actions for the CSU to complete, above and beyond those raised in the
audit report. We will continue to work with our CCG colleagues and NEL CSU colleagues to achieve delivery of
these management actions, and have implemented local improvement plans which have been built on the review
of the procurement strategy, its accompanying processes and the establishment of the procurement working
group at the CCG.
B1(5) Review of the effectiveness of governance, risk management and internal
control
As Accountable Officer I have responsibility for reviewing the effectiveness of the system of internal control
within the CCG.
My review of the effectiveness of the system of internal control is informed by the work of the internal auditors,
executive managers and clinical leads within the clinical commissioning group who have responsibility for the
development and maintenance of the internal control framework. I have drawn on performance information
available to me. My review is also informed by comments made by the external auditors in their annual audit
letter and other reports.
Our assurance framework provides me with evidence that the effectiveness of controls that manage risks to the
clinical commissioning group achieving its principles objectives have been reviewed.
NHS Tower Hamlets CCG – Annual Report
84
I have been advised on the implications of the result of this review by:
The board
The audit committee
If relevant, the risk / clinical governance / quality committee
Internal audit
Other explicit review/assurance mechanisms.
Conclusion
I am satisfied the systems outlined in this statement reflect an organisation that operates with effective and
sound systems of internal control and confirm that there have been no internal control issues to report during
2018/19.
NHS Tower Hamlets CCG – Annual Report
85
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.
NHS Tower Hamlets CCG – Annual Report
86
B2(1) Remuneration report
Remuneration Committee
Details regarding the Remuneration Committee Membership and agreements are highlighted in the
governance section of this report.
Policy on the remuneration of senior managers
The Remuneration Committee is a statutorily mandated committee of the CCG, established in accordance with
the CCG Constitution. Its aim is to set and review the salaries and pensions for very senior managers (VSM),
during 2018/19. In addition, the committee oversees the remuneration of any member of the CCG not covered
by national agreed pay scales.
The Committee will exercise delegated authority from the CCGs Governing Body to agree rates of
remuneration for CCG members and very senior management staff. This will cover:
• all aspects of salary (including any performance-related elements/bonuses)
• provisions for other benefits, including pensions and cars
• arrangements for termination of employment and other contractual terms
The Remuneration Committee will make recommendations to the Governing Body 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.
Further information about the Remuneration Committee, such as key areas of discussion and membership,
can be found in the annual governance statement.
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 NELCA remuneration committee in line with the national guidance for VSM
salaries. Salary levels have been benchmarked against equivalent roles in the other 4 London CCG
Commissioning Alliances and London Providers.
The Accountable Officer was appointed within 16 months, with the market tested through an open competitive
process.
Contractual arrangements
NHS Tower Hamlets CCG – Annual Report
87
The chair, clinical directors and lay members are appointed by the CCG. Clinical directors and lay members
are on fixed term contracts of up to nine years in length, depending on individual circumstances. The
Accountable Officer and other Executive Directors are on permanent contracts, subject to the notice periods of
either three or six months.
Senior manager remuneration (including salary and pension entitlements) (subject to audit)
The table below shows the Salaries and Allowances of Senior Managers in 2018/19.
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 been achieved.
Salary
Expense
Payments
(taxable)
Performance
pay and
Bonuses
Long term
Performance
pay and
bonuses
All Pension-
Related
Benefits
Total
(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
1Ms Jane Milligan NELCA Accountable Officer 20k to 25k 0 0k to 5k 0 7.5k to 10k 30k to 35k 01/04/2018 31/03/2019
2
Mr Henry Black Chief Finance Officer - Tow er Hamlets
& Waltham Forest CCG
to 30 November 2018 (TH CCG share)
NELCA Chief Finance Officer
from 1 December 2018 (TH CCG
share)
50k to 55k 0 0 0 25k to 27.5k 75k to 80k 01/04/2018 31/03/2019
4 Mr Simon Hall Acting Managing Director
to 30 November 2018
85k to 90k 0 0 0 70k to 72.5k 155k to 160k 01/04/2018 30/11/2018
3 & 4 Selina Douglas WEL Managing Director
from 1 December 2018
10k to 15k 0 0 0 2.5k to 5k 15k to 20k 01/12/2018 31/03/2019
Non-Executive Director
Linda Aldous Practice Nurse - Governing Body
Member
15k to 20k 0 0 0 0 15k to 20k 01/04/2018 31/03/2019
Shah Ali GP - Governing Body Member 15k to 20k 0 0 0 0 15k to 20k 01/04/2018 31/03/2019
Dr Khyati Bakhai Commissioning Netw ork 5 & 6
Representative
from 1 October 2018
5k to 10k 0 0 0 0 5k to 10k 01/10/2018 31/03/2019
7 Somen Banerjee LA Representative, Director of Public
Health
0 0 0 0 0 0 01/04/2018 31/03/2019
4 Osman Bhatti GP - Governing Body Member
to 30 September 2018
5k to 10k 0 0 0 0 5k to 10k 01/04/2018 30/09/2018
Maggie Buckell Registered Nurse Representative 15k to 20k 0 0 0 0 15k to 20k 01/04/2018 31/03/2019
Noah Curthoys Lay Member for Corporate Affairs 10k to 15k 0 0 0 0 10k to 15k 01/04/2018 31/03/2019
Mariette Davis Lay member on Governing Body 10k to 15k 0 0 0 0 10k to 15k 01/04/2018 31/03/2019
Sam Everington Chair 110k to 115k 0 0 0 0 110k to 115k 01/04/2018 31/03/2019
4&5 Isabel Hodkinson Principal Clinical Lead
to 30 September 2018
60k to 65k 0 0 0 0 60k to 65k 01/04/2018 30/09/2018
4&5 Dr Mohammed Imrul Kayes Commissioning Netw ork 2
Representative
to 30 September 2018
5k to 10k 0 0 0 0 5k to 10k 01/04/2018 30/09/2018
4 Judith Littlejohn GP Partner Board Member
to 30 September 2018
10k to 15k 0 0 0 0 10k to 15k 01/04/2018 30/09/2018
Virginia Patania Practice Manager - Governing Body
Member
15k to 20k 0 0 0 0 15k to 20k 01/04/2018 31/03/2019
7 Denise Radley LA Representative - Corporate
Director, Health, Adults & Community
0 0 0 0 0 0 01/04/2018 31/03/2019
Dr Rajivi Sanjeevi Commissioning Netw ork 3 & 4
Representative
from 1 October 2018
5k to 10k 0 0 0 0 5k to 10k 01/10/2018 31/03/2019
Julia Slay Lay Member, Lead for Patient and
Public Involvement
10k to 15k 0 0 0 0 10k to 15k 01/04/2018 31/03/2019
5&6 Dr Victoria Tzortziou Brow n Principal Clinical Lead 65k to 70k 0 0 0 0 65k to 70k 01/04/2018 31/03/2019
4 Tan Vandal Secondary Care Consultant
to 31 May 2018
0k to 5k 0 0 0 0 0k to 5k 01/04/2018 31/05/2018
Note Name Title
2018/19 Dates served
From To
NHS Tower Hamlets CCG – Annual Report
88
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 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 3 CCGs with effect from 1st 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. These members were in post for part of the 2018/19 financial year.
5. These members are GP’s with a contract for service and salary figure includes employer pension contributions
6. Salary includes £24k for non-governing body services
7. No remuneration is paid to these members for their Governing Body services
The table below shows the Salaries and Allowances of Senior Managers in 2017/18
Notes:
1. Ms Jane Milligan held the position of Accountable Officer for NHS Tower Hamlets CCG throughout the period. However
from 1 December 2017 she took on the Accountable Officer role for NHS Barking and Dagenham, Havering, Redbridge,
Waltham Forest, Newham, Tower Hamlets and City and Hackney. Her total salary for the 12 month period for these NHS
Salary
Expense
Payments
(taxable)
Annual
Performance
pay and
Bonuses
Long term
Performance
pay and
bonuses
All Pension-
Related
Benefits
Total
(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 Directors
1 Ms Jane MilliganChief Officer to 30 Nov 2017
90 to 95 0 0 0 17.5 to 20 105 to 110 01/04/2017 30/11/2017
1 Ms Jane Milligan NELCA Accountable Officer from 1 Dec
2017 5 to 10 0 0 0 0 to 2.5 5 to 10 01/12/2017 31/03/2018
Mr Simon Hall Acting Chief Officer
Acting Managing Director115 to 120 0 0 0 50 to 52.5 165 to 170 01/04/2017 31/03/2018
2 Mr Henry BlackChief Finance Officer to 31 Jan 2018
115 to 120 0 0 0 20 to 22.5 120 to 125 01/04/2017 31/01/2018
2 Mr Henry Black
Chief Finance Officer - Tower Hamlets &
Waltham Forest CCG
(TH CCG share) from 1 Feb 2018
5 to 10 0 0 0 0 to 2.5 10 to 15 01/02/2018 31/03/2018
3 Mr Josh PotterInterim Director of Commissioning
Deputy Director of Commissioning20 to 25 0 0 0 62.5 to 65 85 to 90 01/04/2017 30/06/2017
3 Ellie Hobart Acting Commissioning Director 25 to 30 0 0 0 0 25 to 30 01/07/2017 31/10/2017
Alison Blair Acting Commissioning Director 80 to 85 0 0 0 0 80 to 85 01/11/2017 31/03/2017
Other Members
Julia SlayLay Member, Lead for Patient and Public
Involvement10 to 15 0 0 0 0 10 to 15 01/04/2017 31/03/2018
Maggie Buckell Registered Nurse Representative 20 to 25 0 0 0 0 20 to 25 01/04/2017 31/03/2018
Mariette Davis Lay member on Governing Body 10 to 15 0 0 0 0 10 to 15 01/04/2017 31/03/2018
Tan Vandal Secondary Care Consultant 25 to 30 0 0 0 0 25 to 30 01/04/2017 31/03/2018
Noah Curthoys Lay Member for Corporate Affairs 10 to 15 0 0 0 0 10 to 15 01/04/2017 31/03/2018
Sam Everington Chair 105 to 110 0 0 0 0 105 to 110 01/04/2017 31/03/2018
4 Isabel Hodkinson Principal Clinical Lead 125 to 130 0 0 0 0 125 to 130 01/04/2017 31/03/2018
4&5 Dr Victoria Tzortziou Brown Principal Clinical Lead 65 to 70 0 0 0 0 65 to 70 01/04/2017 31/03/2018
Judith Littlejohn GP Partner Board Member 15 to 20 0 0 0 0 15 to 20 01/04/2017 31/03/2018
6 Somen BanerjeeLA Representative, Director of Public
Health0 0 0 0 0 0 01/04/2017 31/03/2018
Osman Bhatti GP - Governing Body Member 15 to 20 0 0 0 0 15 to 20 01/04/2017 31/03/2018
3 Dr Sarit Patel Commissioning Network 4 Representative 5 to 10 0 0 0 0 5 to 10 01/04/2017 30/09/2017
Shah Ali GP-Governing Body Member 15 to 20 0 0 0 0 15 to 20 01/04/2017 31/03/2018
Virginia PataniaPractice Manager - Governing Body
Member15 to 20 0 0 0 0 15 to 20 01/04/2017 31/03/2018
4 Dr Mohammed Imrul Kayes Commissioning Network 2 Representative 15 to 20 0 0 0 0 15 to 20 01/04/2017 31/03/2018
Linda Aldous Practice Nurse - Governing Body Member 15 to 20 0 0 0 0 15 to 20 01/04/2017 31/03/2018
6 Denise RadleyLA Representative - Director of Adult
Services0 0 0 0 0 0 01/04/2017 31/03/2018
Note Name Title
2017/18 Dates served
From To
NHS Tower Hamlets CCG – Annual Report
89
roles was £140k-£145k, expenses £nil and pension-related benefits £27.5k-£30k. Corresponding entries are shown in the
other CCG accounts.
2. Mr Henry Black held the position of Chief Financial Officer for NHS Tower Hamlets CCG throughout the period. However
from 1 February 2018 he took on the Chief Financial Officer role for Tower Hamlets and Waltham Forest. His total salary
for the 12 month period for these NHS roles was £115k-£120k, expenses £nil and pension-related benefits £25k-£27.5k.
Corresponding entries are shown in Waltham Forest CCG accounts.
3. These members were in post for part of the 2017/18 financial year.
4. This member is a GP with a contract for services and salary figure includes employer pension contributions
5. Salary includes £21k for non-governing body services.
6. No remuneration is paid to these members for their Governing Body services.
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 which the individual has transferred to the NHS pension scheme. They also include any
additional pension benefit accrued to the member as a result of their purchasing additional years of pension
service in the scheme at their own cost. CETVs are calculated within the guidelines and framework prescribed
by the Institute and Faculty of Actuaries.
Real increase in CETV
This reflects the increase in CETV that is funded by the employer. It does not include the increase in accrued
pension due to inflation or contributions paid by the employee (including the value of any benefits transferred
from another scheme or arrangement).
Pension Contribution Rates
All staff including senior managers are eligible to join the NHS pension scheme. The scheme has fixed the employer’s
contribution at 14.38% of the individual’s salary, per NHS pension regulations. Employee contribution rates for CCG
officers and practice staff are as follows:
NHS Tower Hamlets CCG – Annual Report
90
Pension Benefits of Senior Managers
The table below shows the Pension Benefits of Senior Managers in 2018/19.
Note:
1. The NEL Commissioning Alliance Accountable Officer and the NEL Commissioning Alliance Chief Finance Office are the
appointed officers for 7 CCGs: NHS Barking and Dagenham, Havering, Redbridge, Waltham Forest, Newham, Tower Hamlets and City and Hackney. Their total Pensions figures are shown above.
2. The WEL Managing Director is the appointed officer for 3 CCGs with effect from 1st December 2018 - Waltham Forest, Newham and Tower Hamlets. Her total Pensions figure 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.
The table below shows the Pension Benefits of Senior Managers in 2017/18
Full time pensionable pay/earnings
used to determine contribution rate2018/19
Full time pensionable pay/earnings
used to determine contribution rate2017/18
Up to £15,431.99 5.00% Up to £15,431.99 5.00%
£15,432.00 to £21,387.99 5.60% £15,432.00 to £21,477.99 5.60%
£21,488.00 to £26,823.99 7.10% £21,478.00 to £26,823.99 7.10%
£26,824.00 to £49,472.99 9.30% £26,824.00 to £47,845.99 9.30%
£49,473.00 to £70,630.99 12.50% £47,846.00 to £70,630.99 12.50%
£70,631.00 to £111,376.99 13.50% £70,631.00 to £111,376.99 13.50%
£111,377.00 and over 14.50% £111,377.00 and over 14.50%
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
(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)
£000 £000 £000 £000 £000 £000 £000 £00
Ms Jane Milligan NELCA Accountable Officer 2.5k to 5k 2.5k to 5k 45k to 50k 110k to 115k 732 137 899 0
Mr Henry Black Chief Finance Officer - Tower Hamlets
& Waltham Forest CCG
to 30 November 2018 (TH CCG share)
NELCA Chief Finance Officer
from 1 December 2018 (TH CCG
share)
2.5k to 5k 5k to 7.5k 25k to 30k 55k to 60k 312 90 431 0
Mr Simon Hall Acting Managing Director
to 30 November 2018
2.5k to 5k 2.5k to 5k 50k to 55k 125k to 130k 803 97 991 0
Selina Douglas WEL Managing Director
from 1 December 2018
0k to 2.5k 0 5k to 10k 0 57 20 96 0
2018/19
Name Title
NHS Tower Hamlets CCG – Annual Report
91
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, City and Hackney. Her total Pensions figures are shown
below.
2. The Chief Finance Officer is the appointed officer for NHS Tower Hamlets CCG and, from 1st February, NHS Waltham
Forest CCG. His total Pensions figures are shown below:
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
(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)
£000 £000 £000 £000 £000 £000 £000 £00
Ms Jane Milligan
Chief Officer to 30 Nov 2017
NELCA Accountable Officer
from 1 Dec 2017
0 to 2.5 -2.5 to 0 40 to 45 100 to 105 666 59 732 0
Mr Simon Hall
Acting Chief Officer
Acting Managing Director
2.5 to 5 2.5 to 5 45 to 50 115 to 120 710 86 803 0
Mr Henry Black
Chief Financial Officer to 30 Nov 2017
Chief Finance Officer - Tower Hamlets
& Waltham Forest CCG
(TH CCG share) from 1 Feb 2018
0 to 2.5 -2.5 to 0 20 to 25 50 to 55 272 6 312 0
Mr Josh Potter
Interim Director of Commissioning
Deputy Director of Commissioning
0 to 2.5 0 to 2.5 15 to 20 30 to 35 123 9 161 0
Ellie Hobart Acting Commissioning Director -2.5 to 0 0 20 to 25 0 210 -1 210 0
Name
2017/18
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
(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)
£000 £000 £000 £000 £000 £000 £000 £00
Ms Jane Milligan
Chief Officer to 30 Nov 2017
NELCA Accountable Officer
from 1 Dec 2017
0 to 2.5 -2.5 to 0 40 to 45 100 to 105 666 59 732 0
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
(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)
£000 £000 £000 £000 £000 £000 £000 £00
Mr Henry Black
Chief Financial Officer to 31 Jan 2018
Chief Finance Officer - Tower Hamlets
& Waltham Forest CCG
(TH CCG share) from 1 Feb 2018
0 to 2.5 -2.5 to 0 20 to 25 50 to 55 272 6 312 0
NHS Tower Hamlets CCG – Annual Report
92
Compensation on early retirement of for loss of office
No payments of this kind took place in financial year of 2018/19.
Payments to past members
No payments of this kind took place in financial year of 2018/19.
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 NHS Tower Hamlets CCG in the financial year
2018/19 was £110k - £115k (2017/18: £115k - £120k). This was 5.08 times (2017/18: 2.69) the median
remuneration of the workforce, which was £21,786 (2017/18: £43,618).
In 2018/19, 1 employee received remuneration in excess of the highest-paid director/Member. Remuneration
ranged from £0k - £5k to £135k - £140k (2017/18: £0k - £5k to £115k - £120k)
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.
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.
NHS Tower Hamlets CCG – Annual Report
93
B2(2) Staff report
Staff numbers and composition (subject to audit)
Staff costs
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 1,861 283 2,145 2,356 1,541 3,897 4,218 1,824 6,042
Social security costs 213 0 213 343 0 343 556 0 556
Employer contributions to the NHS Pension Scheme 183 0 183 386 0 386 569 0 569
Other pension costs 0 0 0 0 0 0 0 0 0
Apprenticeship Levy 15 0 15 0 0 0 15 0 15
Other post-employment benefits 0 0 0 0 0 0 0 0 0
Other employment benefits 0 0 0 0 0 0 0 0 0
Termination benefits 7 0 7 0 0 0 7 0 7
Gross employee benefits expenditure 2,280 0 283 2,563 3,085 0 1,541 4,626 5,365 0 1,824 7,189
Less recoveries in respect of employee benefits 0 0 0 0 0 0 0 0 0
Total - Net admin employee benefits including capitalised
costs 2,280 283 2,563 3,085 1,541 4,626 5,365 1,824 7,189
Less: Employee costs capitalised 0 0 0 0 0 0 0 0 0
Net employee benefits excluding capitalised costs 2,280 283 2,563 3,085 1,541 4,626 5,365 1,824 7,189
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 1,859 675 2,534 3,461 1,744 5,205 5,320 2,419 7,739
Social security costs 210 0 210 376 0 376 586 0 586
Employer contributions to the NHS Pension Scheme 207 0 207 416 0 416 622 0 622
Other pension costs 0 0 0 0 0 0 0 0 0
Apprenticeship Levy 13 0 13 0 0 0 13 0 13
Other post-employment benefits 0 0 0 0 0 0 0 0 0
Other employment benefits 0 0 0 0 0 0 0 0 0
Termination benefits 0 0 0 0 0 0 0 0 0
Gross employee benefits expenditure 2,289 675 2,964 4,253 1,744 5,997 6,541 2,419 8,961
Less recoveries in respect of employee benefits 0 0 0 0 0 0 0 0 0
Total - Net admin employee benefits including capitalised
costs 2,289 675 2,964 4,253 1,744 5,997 6,541 2,419 8,961
Less: Employee costs capitalised 0 0 0 0 0 0 0 0 0
Net employee benefits excluding capitalised costs 2,289 675 2,964 4,253 1,744 5,997 6,541 2,419 8,961
Total
TotalAdmin Programme
Admin Programme
Staff Type Male Female
Employees 31% 69%
VSM 40% 60%
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Sickness absence data
Our sickness absence rate is defined as the percentage of Full Time Equivalent days lost, from those that were
available to be worked within the period in question.
Source: NHS Digital - Sickness Absence Publication - based on data from the ESR Data Warehouse
Period covered: January to December 2018
ESR does not hold details of normal number of days worked by each employee. Data on days available and days recorded sick
are based on a 365-day year.
Average Annual Sick Days per FTE has been estimated by dividing the estimated number of FTE-days sick by the average
FTE, and multiplying by 225 (the typical number of working days per year).
There may be inconsistencies between these data and the statutory basis for accounts, in terms of the organisation against
which staff are reported for a particular month.
Total FTE Days Lost
Sum of FTE Days Available
Average Annual Sick Days per FTE
Occurrences (Months of Data)
Tower Hamlets CCG (08V)
405 32835 2.8 12
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Staff policies
We have developed our equality and diversity strategy which provides a framework to support the CCG in
delivering its strategic priorities and focus on the public sector equality duty in the provision of services and to
our workforce. The strategy contains the mechanisms to ensure equality and diversity is integral in day to day
business planning and decision making processes and informs our policies relating to staff at the CCG.
The nine protected characteristics under the public sector equality duty include disabled staff. We have made
full and fair consideration to job applicants who are disabled and have adapted the recruitment process
accordingly in order to enable them to participate fully in the process.
In 2018/19 we trained several members of staff at the CCG as Display Screen Equipment (DSE) assessors,
and conducted a local awareness plan to raise the profile of the Health and Safety (Display Screen
Equipment) Regulations 1992 which applies to a majority of CCG staff. The initial DSE assessment is now
included as part of staff inductions and periodically reviewed during staff appraisal processes. As part of this
work, we have adapted a number of work stations to better suit our staff and their individual needs.
After consultation with our staff through lunch meetings and staff surveys, we reviewed our flexible working
policy in order to give more transparency in the process and support managers to assess business needs
against requests.
Where the CCG has staff who are disabled we ensure adjustments are made to allow full integration into the
workforce including training and learning development opportunities. A copy of our equality and diversity
strategy can be found on the NHS Tower Hamlets CCG website. www.towerhamletsccg.nhs.uk.
Trade union facility time
Number of employees who were relevant union officials during the relevant period
Full-time equivalent employee number
1 1
B1: Relevant union officials
Percentage of time Number of employees
0% N/A
1%-50% 1
51%-99% N/A
100% N/A
Percentage of time spent on facility time
Total cost of facility time 0
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Total pay bill 0
Percentage of the total pay bill spent on facility time 0
Percentage of pay bill spent on facility time
Time spent on paid trade union activities as a percentage of total paid facility time hours
3%
Paid trade union activities
Other staff matters
Developing our workforce
Our workforce is our most important resource and we are committed to supporting people to learn, develop
and grow. We recognise that people need to learn within their current roles and to have opportunities to
develop their potential for new roles and responsibilities. The ongoing learning and development of our
workforce is especially important in times of change where adaptability and collaboration is crucial.
Enabling learning and development is crucial for our whole workforce; our staff, Governing Body and Clinical
Leads. Through the engagement of our workforce, we seek to embed a learning culture that enables people
to develop the skills, knowledge and experience needed to achieve our vision, objectives and develop their
own potential. Our appraisal processes hones in on performance development through feedback and
development activities that are eclectic and suited to learning needs. We promote learning through
relationships and networks such as mentoring, coaching and peer support, encouraging people to reflect on
the goals they seek to achieve and how these relationships could support these needs.
We run monthly lunch and learn sessions which see staff from across the organisation coming together to
learn about a particular topic or area as a group. For example, sessions on fraud awareness, safeguarding
and quality improvement. In supporting our organisation through change and development we plan and
deliver specific development for teams and groups of staff, such as sessions for finance colleagues across
organisations allowing them to consider how change feels, develop new relationships and focus on where
they could work more collaboratively or for business managers, focusing on developing confidence in public
speaking, understanding ways of working and getting the best from each other and developing improvement
projects.
At the clinical level, we run monthly OD sessions for our Governing Body and clinical leads, giving our senior
leaders time to undertake deep dive analysis into specific areas of work or develop new strategic direction,
develop leadership skills, hone relationships with partners and maintain a high level of expertise within
important areas required as the Governing Body of the CCG, including conflicts of interest, safeguarding and
patient and public involvement. We ran a comprehensive induction programme for new members of our
Governing Body this year to enable them to develop the skills and relationships required to govern the CCG
NHS Tower Hamlets CCG – Annual Report
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effectively. This saw new members meeting with senior leads across partner organisations, buddying with
outgoing members for peer support and undertaking specific training and 1-1 executive coaching.
We are committed to the ensuring the safety and welfare of our workforce. We work hard to ensure new
starters comply with the statutory legislation and mandatory requirements identified by national and local
guidelines and all staff, Governing Body members and Clinical Leads must undertake and keep up to date
with mandatory training requirements.
Our overall 2018/19 compliance rate for mandatory training was 96%. The table below shows the compliance
levels for each of the six mandatory training modules.
Mandatory training module Compliance
Information Governance 95%
Conflicts of Interest 92%
Safeguarding Adults – level 1 99%
Safeguarding Children – level 1 98%
Equality, Diversity and Human Rights 97%
Engaging with our staff
The engagement and involvement of our workforce is central to the way that we operate and achieve our
goals. We believe that staff know what works and we want to hear from staff about their experience of
working for the organisation. Through this co-design we create a culture that is high performing and supports
staff motivation and well-being.
We have a range of ways in which we consistently engage and involve staff. At an individual level we ensure
that managers undertake regular 1-1s and provide best practice for these. At a team level we make sure team
meetings and team huddles occur frequently, with consistency and are engaging and open, with a back and
forth flow of information and ideas. We have a staff committee which oversees all areas of OD, with
nominated representatives from each team providing ideas, steer and acting as a voice for the workforce.
Committee members act as conduits and advocates for their teams, consulting, engaging and taking forward
actions and bringing feedback and items to the committee.
The committee has a formal link to CCG senior management team (SMT) who are given feedback and
required to action recommendations and report back to the committee. For all staff we run bi-annual away
days, monthly ‘watercooler’ sessions where staff get to hear from and ask questions of the Managing Director
and SMT and focused opportunities to spend time with, learn from and work with leaders through breakfast
sessions.
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We have taken part in the national staff survey for the fourth year, a commitment which we feel is extremely
important, although not mandatory for CCGs. This year we also ran our third staff awards programme,
presented at our Christmas party and worked with partners to host an excellent garden party in celebration of
the 70th birthday of the NHS, seeing over 800 local people, patients and staff come together to share in our
history and celebrate the achievements of the NHS.
Health and well-being
For people to thrive at work they need to feel empowered, engaged, motivated and valued and our overall
approach to OD, staff engagement, learning and development underpins our ambition to create this type of
culture and environment at Tower Hamlets CCG. As well as these fundamentals, we provide and offer a
range of activities that support physical and mental health and well-being including yoga, meditation, fruit
supplied to the office to offer healthy snacks and an annual sports day! We publicise a programme of national
campaigns that support health and well-being including mental health and healthy eating weeks. Going
forward we would like to work with our WEL CCG colleagues to develop a new programme of work that will
support staff health and well-being as our organisations work together.
Education, training, research and development
As a CCG, we have a key role in developing the commissioning system and improving outcomes by using
and promoting innovation, research, education and training. We know high quality commissioning is
underpinned by robust research evidence and this is an integral part of managing a healthcare system.
In light of this, we have adopted an evidence-based approach and culture with our commissioning functions
that promotes research, innovation, education and training as the key delivery mechanisms to achieve
improvement and better outcomes for patients.
We have promoted innovation, research, education and training through our research and evaluation
strategy, led by a Governing Body clinical lead. We aim to build a culture of research locally through
leadership, partnership and professional development and education.
We have supported the development of our Community Education Provider Network (CEPN) to ensure our
future workforce has the right skills for the NHS of tomorrow. We continue to fund protected learning time
sessions for the primary care workforce, which is delivered in partnership with CEPN.
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As part of our ongoing commitment to an evidenced based approach, we commission the Clinical
Effectiveness Group and Queen Mary University to undertake research on our behalf and identify best
practice in commissioning. We are also members of UCLP, an academic science health partnership, in
which we have actively sought to create and develop improvements for local people.
We have embedded a quality improvement approach across general practice, supporting practices to use data
and a learning approach to develop the capacity and capability to make sustainable improvements to the care
and experience patients receive.
Expenditure on consultancy
Expenditure on consultancy for 2018/19 is shown in the table below:
Total (£000) Admin Programme
40 0 40
Off-payroll engagements
Table 1: Off-payroll engagements longer than 6 months For all off-payroll engagements as at 31 March 2019, for more than £245 per day and that last longer than six months:
Number
Number of existing engagements as of 31 March 2019 14
Of which, the number that have existed:
for less than one year at the time of reporting 6
for between one and two years at the time of reporting 4
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 0
Table 2: New off-payroll engagements
Where the reformed public sector rules apply, entities must complete Table 2 for all new off-payroll engagements, or those that reached six months in duration, between 1 April 2018 and 31 March 2019, for more than £245 per day and that last for longer than 6 months:
Number
Number of new engagements, or those that reached six months in duration, between 1 April 2018 and 31 March 2019
22
Of which:
Number assessed as caught by IR35 8
Number assessed as not caught by IR35 14
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Number engaged directly (via PSC contracted to department) and are on the departmental payroll
0
Number of engagements reassessed for consistency / assurance purposes during the year 14
Number of engagements that saw a change to IR35 status following the consistency review 0
Table 3: Off-payroll engagements / senior official engagements
For any off-payroll engagements of Board members and / or senior officials with significant financial responsibility, between
01 April 2018 and 31 March 2019.
Number of off-payroll engagements of board members, and/or senior officers with significant financial responsibility, during the financial year.
1
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.
21
Exit packages, including special (non-contractual) payments
Redundancy and other departure cost have been paid in accordance with the provisions of Agenda for Change. Exit costs in this note are accounted for in full in the year of departure. Where Tower Hamlets CCG has agreed early retirements, the additional costs are met by Tower Hamlets 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.
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 6,844
£10,000 -
£25,000
£25,001 -
£50,000
£50,001 -
£100,000
£100,001 -
£150,000
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£150,001 -
£200,000
>£200,000
TOTALS 1 6,844 Agrees to A
below
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*
Exit payments following Employment Tribunals or court orders
Non-contractual payments requiring HMT approval**
TOTAL A – agrees to
total in table 1
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 Table 1 which will be the number of individuals.
*any non-contractual payments in lieu of notice are disclosed under “non-contracted payments requiring HMT approval” below.
**includes any non-contractual severance payment made following judicial mediation, and amounts relating to non-contractual payments in lieu of notice.
No non-contractual payments were made to individuals where the payment value was more than 12 months’ of their annual salary.
The Remuneration Report includes disclosure of exit packages payable to individuals named in that Report.
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Parliamentary Accountability and Audit Report
Tower Hamlets 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 at section B3(1) below.
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B3(1) Audit certificate and report
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ANNUAL ACCOUNTS
Jane Milligan
Accountable Officer
28 May 2019
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