2014-15_AnnRept_ELRCCG-2

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East Leicestershire and Rutland CCG Annual Report | 2014-15

Annual Report and Accounts | 2014-15

NHS EAST LEICESTERSHIRE AND RUTLANDCLINICAL COMMISSIONING GROUP

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High quality care for all, now and for future generations

“It is there to improve our health and wellbeing, supporting us to keep mentally and physically well, to get better when we are ill and, when

we cannot fully recover, to stay as well as we can to the end of our lives. It works at the limits of science - bringing the highest levels of human knowledge and skill to save lives and improve

health.

It touches our lives at times of basic human need, when care and compassion are what matter most.

The NHS is founded on a common set of principles and values that bind together the

communities and people it serves - patients and public - and the staff who work for it.”

The NHS Constitution

The NHS belongsto the people

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Contents

Foreword from our Chair and Managing Director . . . . . . . 4New services in a year of challenge . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 4Clinically led . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6Informing, involving, innovating . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .6Thinking like a patient, acting like a taxpayer . . . . . . . . . . . . . . . . . . . . . . . . . 7Transforming how we do things . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 7Supporting our Staff . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 8

Member Practices’ Introduction . . . . . . . . . . . . . . . . . . . . . . .9Our reflection on Progress and Performance . . . . . . . . . . . . . . . . . . . . . . . . . . 9The power of clinical leadership . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 10Patient advocates . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 10Evaluation of our effectiveness . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 10

Strategic Report . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .15Who we are and what we do . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 15Our Vision and Values . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 16Our strategic aims and commissioning priorities . . . . . . . . . . . . . . . . . . . . . . 17Working in partnerships across Leicester, Leicestershire and Rutland . . . . . . . 17Our population, the communities we serve and their health needs . . . . . . . . 17Our priorities for new investment in 2014-15 . . . . . . . . . . . . . . . . . . . . . . . . 21Quality and patient safety . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 28Patient Experience . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 29The Berwick Review . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 32The Francis Inquiry . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 33Winterbourne View . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 34Compassion in practice nursing, midwifery and care staff - our vision and strategy . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 35Staff satisfaction . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 36Safeguarding . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 38Our commissioning activities and who we commission from . . . . . . . . . . . . 39Operating and Financial Review . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 40Development and performance in year and in the future . . . . . . . . . . . . . . . .30The Resources, Principal Risks and Relationships that mayaffect long-term performance . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 40

Better payments practice code . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 44Prompt payments code . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 44Cost Allocation & Setting of Charges for information . . . . . . . . . . . . . . . . . . 44Governing Body’s policy for managing risk . . . . . . . . . . . . . . . . . . . . . . . . . . 45The CCG’s priorities for the next two years (2014-16) . . . . . . . . . . . . . . . . . 45Position of the organisation . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 46Sustainability Report . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 46Equality and Diversity Report . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 47Equality Objectives 2013 – 2015 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 47Publication of Information . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 49Workforce . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 50Information relating to activities of the CCG . . . . . . . . . . . . . . . . . . . . . . . . 50

Members’ Report . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 51Governing Body members’ profiles . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 52Members of committees of the Governing Body . . . . . . . . . . . . . . . . . . . . . 61Sickness absence data . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 68Pension liabilities . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 68External audit . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 68Disclosure of serious untoward incidents . . . . . . . . . . . . . . . . . . . . . . . . . . . 68Principles for Remedy . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 69Employee Consultation . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 69Disabled Employees . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 69Emergency preparedness, resilience and response . . . . . . . . . . . . . . . . . . . . 69Statement as to Disclosure to Auditors . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 70

Remuneration Report . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 71Salary & Pension Disclosure Tables . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 73Pension Benefits . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 77Cash Equivalent Transfer Values . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 79

Statements by the Accountable Officer . . . . . . . . . . . . . . 81Statement of the Managing Director’s responsibilities as theAccountable Officer of NHS East Leicestershire and RutlandClinical Commissioning Group . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 81Governance Statement . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 82Appendix 1: Annual Accounts 2014-15 . . . . . . . . . . . . . . . . . . . . . . . . . . . . 99

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Foreword from our Chair and Managing Director

On behalf of East Leicestershire and Rutland CCG and the people who work in and with it, we’re delighted to present our second Annual Report . We’re still a relatively new organisation, having become a statutory body just over two years ago . Our aim is quite simple: to improve health by meeting our patients’ needs with high quality and efficient services, led by clinicians and delivered closer to home .

We don’t do that on our own, but by working with our partners and stakeholders in the local NHS, local government, the voluntary sector and user and patient groups. Having had the chance to read this Report, we hope you’ll agree that whilst there is plenty we still need to do, there is already plenty of which we can be proud .

As an NHS organisation, established under the Health and Social Care Act 2012, we have a number of legal and constitutional duties .

These can be accessed at: www .eastleicestershireandrutlandccg .nhs .uk/our-strategies-and-plans

The publication of this Annual Report is amongst one of our most important duties . It ensures we are publicly accountable to the communities and people we serve . It sets out our aims and strategies and how we performed against them . It explains who we are, how we work and the partnerships in which we are involved .

NEW SERVICES IN A YEAR OF CHALLENGE

There is no doubt that 2014-15 has been a challenging year for everyone involved in organising and delivering health and social care to the people of East Leicestershire and Rutland . This Report sets out how we’ve risen to this challenge .

In the midst of what Simon Stevens, NHS Chief Executive, has called “the longest period of austerity our health and social care services have faced since the Second World War”, we are pleased that we have been able to implement a number of changes to enhance local services . You can read about many of them in this Report, including:• New Urgent Care Centres – used by over 4,000 people in their first few weeks of existence;• New integrated health and care teams - delivered through the Better Care Fund - helping hundreds of people get support and treatment in their own home rather than having to go to hospital or be able to get home from hospital earlier after treatment; • Advanced care planning – supporting GPs to develop care plans for people living in care homes, and those with terminal illnesses, so that we can understand their wishes, communicate between different services and better meet their needs;• Introducing Personal Health Budgets so that people can take control of their care provision in a way that suits them; and• Training GPs in managing heart failure and treatment of atrial fibrillation, thereby preventing some high risk people from suffering a stroke .

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Melton Mowbray

Oakham

Lutterworth

Enderby MarketHarborough

LEICESTER

RUTLAND

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Oadby

Wigston

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Enderby

LEICESTER

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Wigston

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Urgent Care Centres

Accident & Emergency

GPs in ELRCCG practices

Loughborough

NOTTINGHAMSHIRE

Nottingham

Derby

Grantham

Peterborough

Kettering

Corby

Rugby

Coventry

Nuneaton

Hinckley

NORTHAMPTONSHIRE

WARWICKSHIRE

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Where our care is delivered

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Figure 1: Map of East Leicestershire and Rutland

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CLINICALLY LED

As an organisation, we are proud to say we are “clinically led” and praised by our local NHS England colleagues for visibly being so.

That’s not simply a phrase we use . It’s central to what we’re about and how we do things . It means that our aims and priorities are driven by local family doctors and other clinicians, rooted in their own local communities across East Leicestershire and Rutland . Clinicians are in the majority in our decision makers .

These people are trusted by local people and their families to have their best interests at heart and deeply committed to helping them get healthy and stay healthy . Or when they fall ill, to make sure they get the very best treatment and care possible, in the right place at the right time, and delivered with compassion and respect .

We were particularly pleased in February 2015 to be selected by NHS England to be one of the first wave of CCGs to take on responsibility for commissioning GP services from April 2015. This will give patients, communities and clinicians more scope in deciding how local services are developed .

Our Clinical Vice Chairs and Locality Leads explain more about what Clinical Leadership means in the Member Practices Introduction of this Report.

INFORMING, INVOLVING, INNOVATING

The timeless values of the NHS drive everything we do. As the NHS Constitution says “The NHS belongs to the people”.

That’s why we’re constantly looking for ways, new and old, to listen to people’s concerns and views, then do something about what they tell us and – crucially - be seen to do so .

That’s not just good in principle, it’s good in practice . It means we’re much more likely to get things right first time or be able to put things right if they’re not working as they should .

As this Report hopefully shows, we’ve had some real successes over the past year in this regard, including:• taking a ‘Listening Booth’ to over 25 locations across East Leicestershire and Rutland to enable our patients, the public and carers to tell us in their own words how they feel about local healthcare;• collating Patient Stories, captured direct on film from individual patients and discussed as a standing item at Governing Body meetings – including experiences with infection control, care in acute hospital wards, support for patients at risk of self- harm, bowel cancer diagnosis and end of life care; and• conducting detailed engagement exercises around Urgent Care and Community Services .

Going forward in 2014-15, we intend to build on these foundations by designing and implementing an integrated web, social media and mobile engagement strategy – to put us right at the forefront of the NHS digital revolution .

Figure 2: Our Listening Booth visited over 25 locations

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THINKING LIKE A PATIENT, ACTING LIKE A TAXPAYER

We are constantly looking at ways in which we can work with our partners across health and social care, as well as with the voluntary sector, to continue to deliver the best possible outcomes for local people whilst being conscious of the need to deliver value for money . This Report shows how we’ve done during 2014-15, delivering successfully against all our financial targets, as follows:• Achieving our planned expenditure against budget;• Producing a planned surplus of £3.3m; and• Achievement of in year financial savings plan of £9m.

TRANSFORMING HOW WE DO THINGS

Everybody knows money is tight - exceptionally so - and the financial challenge is not going to go away any time soon . Our local health economy in Leicester, Leicestershire and Rutland faces a deficit of almost £400 million by 2018-19 if we do not fundamentally redesign and transform the way we do things . That gives us an opportunity to design services that are more convenient for patients, whilst making the best use of every penny of taxpayers’ money we receive . So our plans concentrate on transforming from a system that over relies on people having to stay in hospital beds to one that supports and manages people within their local communities and in their own homes .

Building on these foundations, our Two Year Operational Plan focuses on transforming services to enhance the quality of life for people with long-term health conditions, improve quality of care, reduce inequalities in access to healthcare and improve joint working and integration with social care .

In particular, in 2015-16, we plan to:• Lay strong foundations for delivery of new and integrated models of care in line with the Better Care Together programme and our Better Care Funds to drive transformational change and improve outcomes for our patients and population;• Prioritise programmes of work which offer the best patient outcomes delivering qualitative change at pace across our health and social care economy; and• Focus on developments that deliver financial balance and value for money redesign which maximises modernisation and transformation of our providers .

In practical terms, this will include:• Improved performance in waiting at Accident and Emergency;• Introduction of 7-day working in primary care and improved integration with community services; • Improved access to psychological services, through more investment and joint working with colleagues in West Leicestershire CCG;• Improved patient choice and delivery of national standards in the time taken between referral to treatment, cancer and diagnostic standards;• Increased investment in dementia care management;• Better outreach for people with complex or multiple needs;• Rapid access to diagnostics for our frail older people;• Reduction in avoidable admissions to hospital;• Improved end of life care, with more people dying in their place of choice; and• Implementation of a unified prevention plan, including weight management, physical activity and sexual health .

Figure 3: Public feedback

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SUPPORTING OUR STAFF

Nothing we do or achieve happens by accident . It is the result of an awful lot of hard work, dedication and imagination by our own staff and thousands of people in the organisations with whom we work and engage .

We take seriously our responsibilities to support and develop our staff and those with whom we work . For example, during the past year, we have provided large scale educational events (protected learning time) for GPs and practice staff and undertaken a detailed staff survey to help us listen to our staff about the things that matter to them .

We’d like to take this opportunity to thank them all for all they do .

Karen English Graham MartinManaging Director Chair(Accountable Officer)

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Member Practices’ Introduction

East Leicestershire and Rutland Clinical Commissioning Group (ELR CCG) is a NHS organisation set up by the Health and Social Care Act 2012 to commission and organise the delivery of NHS.

During 2014-15, ELR CCG served 321,580 patients registered with 32 GP practices in Blaby, Lutterworth, Market Harborough, Rutland, Melton Mowbray, Oadby and Wigston and the surrounding areas .

OUR REFLECTION ON PROGRESS AND PERFORMANCE

Overall, we believe the CCG has made good progress during the 2 years since it moved from shadow form . In particular, our clinical leaders highlight the following achievements/new services that have particularly benefited local patients and clinicians:• The introduction of new Urgent Care Centres in Oadby, Market Harborough, Oakham and Melton Mowbray – offering increased access to care for patients at weekends, evenings and bank holidays;• Improving services for patients with mental health needs, through redesign of the acute mental health pathway (how we treat patients), plus a new crisis house for those finding themselves in immediate need of support; • Advanced care planning, with everyone proactively planning and working together to meet the needs of people in care homes and on the palliative care list;• Expansion of Increasing Access to Psychological Treatment (IAPT) services, delivering patient-initiated contact that has resulted in improved take-up;

• Strengthening the crisis pathway for patients with mental health needs, particularly for those with urgent needs, but not in crisis, so they are now seen within 5 days; • Major improvements in mental health out of area placements, working with our colleagues in Leicestershire Partnership Trust to reduce out of area places from 37 down to single figures;• Introducing a training programme for GPs in all practices in atrial fibrillation, reducing the chance of patients suffering from blood clots or stroke; • Developing the first Allliance agreement in the country to bring together out- patient, day case and diagnostic services to be delivered in the community, closer to patients and their homes, and freeing up bed capacity in the acute sector hospitals for patients who need them;• Extending patient choice, reducing waiting times and backlogs through delivering national standards on Referral to Treatment Times (RTT);• Ensuring the voice of children and young people is heard in decisions over local health and care strategies and delivery, recognising that the children of today are the adults of the future;• Improving services for children and young people with eating disorders; • Coming below the national average for antibiotic prescribing, helping avoid unnecessary use of antibiotics; and• Development of the intensive community support (ICS) service, provided by Leicestershire Partnership Trust (LPT), comprising 48 at home places (virtual beds) across ELR for utilisation for both step up and step down . The service is able to respond promptly to unscheduled care requests and is integrated into the Intensive Community Response Service and night assessment services .

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THE POWER OF CLINICAL LEADERSHIP

We estimate that during a typical year, well over 2 million individual consultations take place in doctors’ surgeries in our area . That’s an average of around 5,500 every day .

The insight gleaned from family doctors and other health professionals carrying out these consultations gives them a powerful and unique insight into the real health needs of local people and their families, as well as how the healthcare system works in day-to-day reality . Together with their clinical colleagues working in hospitals and other health settings, they hold unique knowledge that simply cannot be obtained elsewhere .

Clinical leadership is all about harnessing that knowledge and placing it at the heart of NHS decision-making and local strategies. Our Governing Body membership includes GP clinical leads, a board nurse and a secondary care clinician . It means our decisions are informed by direct recent experience of real work at the NHS coalface, addressing real problems and challenges, looking after the needs of real patients, their families and carers .

Family doctors are natural problem solvers and good at making practical decisions . They have a strong tendency to focus on the quality of care their patients receive from local NHS providers, helping us to hold them to account and provide practical, constructive challenge to our own organisation . They are also natural communicators, trusted by patients to tell them the truth. GPs and local clinicians have an awareness of the needs not just of the patient in front of them, but all patients in their local area . They are good at prioritising what best meets local needs and, as natural pragmatists, tend to concentrate on what is necessary to ‘get the job done’ .

PATIENT ADVOCATES

GPs are the CCG’s patient advocates. In our role as clinical leads, we act as the voice for over 300,000 people registered with our surgeries. In fulfilling that role, we continually ask:• What’s the real work needed, the real problems and challenges, the real needs of our patients?• Is what the CCG proposing going to work for my patients?• Is it going to work in Primary Care?• Is it practical? Is it necessary? Will it work?

Will it deliverfor patients?

Will itwork?

What are the real needs?

What are the real challenges?

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By concentrating as patient advocates on the quality of what we are commissioning and the outcomes it delivers, we play a crucial role in holding local providers to account .

In our working lives in surgeries and treatment rooms, in primary care as well as the secondary sector, we constantly provide constructive challenge to ourselves and our colleagues .

In our role with the CCG, we bring that constructive challenge to those who are commissioning services .

Clinical Leadership

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EVALUATION OF OUR EFFECTIVENESS

During 2014-15 the Governing Body evaluated its own performance through facilitation by an external consultant which led to the review of the Board Development programme for the members of the Governing Body, both individually and collectively . Governing Body development sessions have taken place at agreed intervals during 2014-15 which involved sessions focusing on roles, responsibilities, enhancing leadership skills and focusing on collective and individual responsibility . These sessions are aimed to support members of the Governing Body to function more effectively as a Governing Body .

Information sessions have also taken place for members of the Governing Body providing them with an opportunity to review national guidance / initiatives in greater depth and its implications on the clinical commissioning group’s business; develop further insight into performance issues with key providers; enhance their knowledge on a specific topics; and receive detailed information on key national requirements . Our Governing Body GP members have played a full and active part in all its activities, with excellent attendance rates including development/information sessions as well as public meetings .

ENGAGING AND EMBARKING ON CHANGE

We are embarking upon significant change to commissioning future community and primary care services which has been clearly articulated in a number of strategic documents including the CCG’s Integrated Community Services Strategy, Primary Care Operating Framework: A GP Guide November 2014 and health economy wide Better Care Together Programme.

The emergence of GP Federated models is also underway and offers the opportunity for partnership working to strengthen any new community services model that is commissioned .

To achieve our proposed model for the future of community services we have spent time engaging with local stakeholders including providers, Local Authority, voluntary sector and GP locality groups.

Our engagement process has enabled us to understand current issues and the breadth of potential for bringing together community and primary care servicesWe have identified a number of areas which need to be addressed through the proposed model to ensure a solid foundation for community services . We will be embarking on a further round of engagement in the Autumn to ensure we get things absolutely right .

These areas are not exhaustive and include:• Changing the current model of community services commissioning to give the CCG and its GPs more accountability to influence how services are delivered;• Creation of joint GP/provider posts to enhance accountability;• Delivery of a rehabilitation and re-ablement model that moves services from a hospital to a home environment;• Improving access to community services that are currently considered sub optimal including physiotherapy;• Expanding the times when care is available both at home and in health facilities;• Establishing clinical support networks and services in acute and primary care to identify, enable and manage both complex care, frail elderly and sub-acute care locally;• Making the most of the land and estate available to deliver local services avoiding unnecessary travel to acute hospitals;• Minimising service barriers through simplified specifications and joint commissioning of primary, social and community services; and• Changing the model of community services commissioning to focus on outcomes rather than inputs .

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WHAT FEEDBACK TELLS US

During 2014-15 we carried out detailed Practice Member engagement - visiting our practices and hearing their views, ideas and concerns. A review of this engagement has clarified many of the problems encountered by patients, carers and GPs when accessing health services. Our programme of change and improvement during 2015-16 is designed to address these challenges .

These include:• Home First as a prominent principle of service delivery; • Demographic pressures – more people in the CCG area will be over 70 years of age by 2030 and many of those people will be living with a range of complex health issues requiring rehabilitation and reablement;• Patients find accessing care confusing and setting up a care package for a patient is confusing and time consuming for primary care; • Recruitment of GPs is becoming more difficult and it is likely that recruitment locally will not be able to keep pace with demand;• GPs will be managing a higher acuity patient in the home;• GPs and commissioners have little influence over the community services provided for their population and good response times are not consistently achieved;• Community service communication is often poor;• Significant recruitment and retention issues in community nursing workforce with a high vacancy rate;• Community services set up to deliver care aimed at avoiding hospital admissions is impacted by inability to recruit staff and the pace of Better Care Together changes;• Current estate condition in ELR is in variable condition and is - in parts - poorly utilised; • Small numbers of physical beds are spread across four sites which risks compromising clinical quality (limited peer review, isolation of staff) and is not cost effective; and• Under-utilisation of current Intensive Community Support (ICS) beds .

Figure 4: A Word Cloud of what our GP Practices told us via our Practice Engagement Feedback

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Dr Andy Ker Clinical Vice Chair

Dr Richard HurwoodGP Locality Lead, Melton, Rutland and Harborough

Dr Richard PalinClinical Vice Chair

Dr Hilary FoxGP Locality Lead Melton, Rutland and Harborough

Dr Girish PurohitGP Locality Lead, Melton, Rutland and Harborough

Dr Nick GloverGP Locality Lead, Blaby and Lutterworth

Dr Graham JohnsonGP Locality Lead, Blaby and Lutterworth

Dr Vivek VarakantamGP Locality Lead, Oadby and Wigston

Representing our Practices

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Strategic Report

WHO WE ARE AND WHAT WE DO

East Leicestershire and Rutland Clinical Commissioning Group (ELR CCG) is a NHS organisation created by the Health and Social Care Act 2012.

We operate from offices at Thurmaston in Leicester and employed 84 staff as at end March 2015 .

We organise the delivery of NHS services for patients covered by 32 GP member practices across three localities: • Melton Mowbray, Rutland and Market Harborough; • Oadby and Wigston; and • Blaby and Lutterworth .

We do this by ‘commissioning’ or buying health and care servicesincluding:• Primary Care;• Planned hospital care;• Urgent Care;• Rehabilitation care;• Community health services; and• Non-urgent patient transport .

Our area of operations contains:• 5 community hospitals;• 1 large acute provider;• 1 large non-acute provider;• 2 local authorities; and• 4 district/borough councils .

We commission acute services from out-of-county Trusts and a range of independent sector providers such as Spire Leicester and Nuffield Leicester and Circle Healthcare based at the Nottingham Treatment Centre.

Furthermore, ELR CCG provides grants for some voluntary sector providers including the Alzheimer’s Society (carer’s support service), Carer’s Action (carer’s support), Leicestershire Organisation for the Relief of Suffering (LOROS) for end-of-life care, and The Laura Centre (support for adults and children affected by the death of a child) .

We act as the co-ordinating commissioning body to manage the following contracts on behalf of all three Leicester, Leicestershire and Rutland CCGs:• NHS111 - Non Emergency Urgent Care number providing call handling and triage, the Provider is Derbyshire Health United (DHU);• Out of Hours - GP clinical assessment service during the Out of Hours period, the Provider is Central Nottinghamshire Clinical Service (CNCS);• out-of-county contracts (acute);• out-of-county community health services;• East Midlands Ambulance Service;• non-emergency patient transport services – Arriva Transport Solutions;• any qualified provider contracts;• Leicester, Leicestershire and Rutland voluntary sector arrangements;• community based elective care alliance arrangement;• home oxygen service contract;• ELR CCG also works with our LLR CCG partners to support the management of contracts across the three CCGs in line with the NHS Standard Contract Management Framework .

On 1 February 2015, NHS England announced that from 1 April, we would take on the management of primary care medical for all the practices in our area .

Planned care Urgent care

Community care

Primary care

Mental health Maternity and neonates /Children and young people

Long termconditions

Rehabilitation care Non-urgentpatient transfer

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OUR VISION AND VALUES

Our vision and values guide what we are trying to achieve and how we wish go about it .

Our vision is “to improve health by meeting our patients’ needs with high quality and efficient services, led by clinicians and delivered closer to home.”In pursuing this vision, we are guided by nine values:

• Quality - ensuring quality underpins everything we do;

• Involvement - involving our patients, practices, staff, partners and the public in all aspects of our work, with a strong commitment to listen, learn and act on their views;

• Innovation - embracing new ideas, seeking creative solutions to deliver the best results;

• Progression - looking ahead to identify and seize opportunities;

• Inspiration - striving for excellence, inspiring confidence and trust in others;

• Respect - championing equality, treating our patients and each other with respect, dignity and professionalism;

• Education - improving services and quality through effective training and development for staff and clinicians;

• Economy - spending wisely and preventing waste; and

• People - developing a team people want to work with, where staff are valued and involved .

To improve health by meeting our patients’ needs with high quality and efficient services led by clinicians and delivered closer to home

Quality

Involvement

Innovation

Progression

InspirationRespect

Education

Economy

People

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OUR STRATEGIC AIMS AND COMMISSIONING PRIORITIES

Our values and strategic aims are based on the views of our member practices, clinicians, our patients and carers, our staff and partner organisations. We have spent time talking and listening to people about the changes they would like to see in local healthcare and where we should be focusing our efforts.

The broad themes that stood out in what people told us are: • care delivered closer to home including access to services in patients’ own homes and other alternatives to hospital admissions;• closer working with social care to improve care pathways; • more work on prevention (reducing diseases through screening, advice and health checks); and • better quality and more effective services .

Taking into account these themes, we developed the following strategic aims: • Transform Services and enhance quality of life for people with long- term conditions - with a particular focus on COPD, diabetes, dementia, mental health and learning disabilities; • Improve the quality of care - focusing on clinical effectiveness, safety and patient experience, with specific goals to deliver excellent community health services, acute care, mental health care and improve the quality of primary care;• Reduce inequalities in access to healthcare - targeting areas and population groups with the greatest need;• Improve integration of local services - between health and social care and between acute and primary/community care;• Listening to our patients and public - our commitment is to listen, and to act on, what our patients and public tell us; and • Living within our means - the effective use of public money .

The CCG’s vision and values are based on ethical, open and transparent behaviour and all business practices follow this approach . These visions and values are communicated to staff on commencement in post and office holders receive contract / terms of office from HR which detail staff code of conduct and behaviour expected and the consequences of non-compliance .

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WORKING IN PARTNERSHIPS ACROSS LEICESTER, LEICESTERSHIRE AND RUTLAND

Partnership working is vital to East Leicestershire and Rutland Clinical Commissioning Group and it is the best way to bring about many of the changes we wish to see implemented . Over the last year ELR CCG has actively engaged with partner organisations to build on existing relationships, and develop new and improved relations with clinicians, patients and carers, public members, staff, partner organisations, including local authorities, and other commissioning agencies .

We have many partners, and have established key working relationships with the following: • Leicester City and West Leicestershire CCGs; • Leicestershire County Council and Rutland County Council (particularly with social service commissioners and through Health and Wellbeing Boards) as well as the borough and district councils within our CCG boundaries;• Our providers including University Hospitals of Leicester, Leicestershire Partnership NHS Trust, East Midlands Ambulance Service, voluntary sector providers and charities; • Healthwatch Leicestershire, Healthwatch Rutland, and other patient and carer representative bodies;• Leicestershire Police and Leicestershire Fire and Rescue Services; • De Montfort University and the University of Leicester;• Arden and Greater East Midlands Commissioning Support Unit (AGEM CSU); and• Health Education East Midlands (HEEM).

In order to achieve our vision and values we will be work closely with our local authority, CCG and provider partners to develop our five-year Leicester, Leicestershire and Rutland strategy . Furthermore, we are working with our local authority partners to develop our two-year plans, now known as the Better Care Fund, to ensure health and social care work more closely together .

The CCG is committed to making care more integrated in order to improve health for its population .

We are working with our local authority partners to ensure that resources are used effectively . We will do this through the Better Care Fund, strengthening our joint commissioning and working arrangements to deliver integrated care for older people and supporting people with long-term conditions (LTCs) . This is particularly crucial if our CCG is to meet its financial challenges through the transformation of care systems, and improve the quality of healthcare across all our providers .

Public health input into the development and implementation of the CCG’s strategic priorities is vital, and we base our priorities and initiatives upon the Joint Strategic Needs Assessment (JSNA) and the Health and Wellbeing Strategy of the county council. Public health staff continue to help the CCG to understand local needs and issues of our diverse population . This contribution is critical to both inform and develop our strategies, as well as in delivering our priorities .

We are an active partner key in the Better Care Together (BCT) programme . This is a significant programme of work which will transform the health and social care system in Leicester, Leicestershire and Rutland (LLR) by 2019 . BCT brings together partners, including local NHS organisations and councils, to ensure that services change to meet the needs of local people . We are also working closely with public and patient involvement (PPI) representatives to develop plans for change .

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A quarter of the population (23 .6%) of East Leicestershire and Rutland is under the age of 20, and around

25% are aged 60 and over (26 .2%) .

50.6% of our population is female, which is similar to the England average of 50.2%.

The average life expectancy within East Leicestershire and Rutland is 80 .5 years for men,

and 83 .9 years for women, both of which are higher than the England average .

The number of people aged 60 and over is higher than the England average (22 .6%), and our older

population is predicted to increase over the next 10 years, with an estimated 19,000 additional people

aged 60 years and over .

In NHS East Leicestershire and Rutland CCG, only a small proportion of people live in deprived areas . Nevertheless, there are significent pockets of disadvantage in areas on the edges of

Leicester City and within the market towns . We have to ensure this deprivation is not overlooked .

OUR POPULATION, THE COMMUNITIES WE SERVE AND THEIR HEALTH NEEDS

The population of ELR CCG as a whole has relatively low levels of material deprivation, compared to other parts of England . In comparing the various areas where our population live against the rest of England, we rank overall as 200 out of 211 CCGs for deprivation (where 1 is the most deprived) .

Within the CCG, there are areas that have poorer health outcomes . The main areas affected are in Oadby and Wigston . These inequalities in health need to be addressed. In one area of Wigston, residents have a significantly higher rate of mortality from all causes and mortality from respiratory diseases than the England average. Although not significantly higher, rates of mortality from circulatory disease and mortality from stroke are higher than the England average .

Although not as significant as in Wigston, other pockets of greater need exist in other parts of East Leicestershire and Rutland, including Melton, Harborough and Blaby .

These inequalities in health need to be addressed. Significant health inequalities exist for other minority and seldom heard ps, e .g ., Black and Minority Ethnic (BME), and travelling families within specific areas. Hence our plans address issues relating to diabetes, cardiovascular disease, COPD, dementia, access to primary care services and mental health .Figure 5: Our CCG population

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Evidence suggests that the most effective way to reduce the gap in life expectancy in the short term is to improve the management of diseases (including CVD and COPD) and their risk factors (including smoking, alcohol, hypertension and diabetes) that predominately affect the socially excluded . .

Accounting for 69% of all deaths, the major killers for East Leicestershire and Rutland CCG are: • cancer (29%)• cardiovascular disease – CVD - (27%)• respiratory disease (13%) .

The health of our local population is generally better than the overall population of England. However, there is a significant number of people affected by ill health, including GP -diagnosed coronary heart disease (10,739 people), hypertension (47,770 people), and diabetes (16,625 people) .

The CCG currently has high levels of non- elective activity when benchmarked against similar health economies . Without a focused approach and active intervention, the ageing population will increase the gap between expected and actual activity . Elective activity is consistent with the national average .

Figure 6: The major killers

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OUR PRIORITIES FOR NEW INVESTMENT IN 2014-15

Our priorities for new investment in 2014-15, and our spending and investment therein, were:• Transforming Primary Care;• Redesigning Community Services;• Delivering an effective Urgent Care System;• Improving Mental Health and delivering parity of esteem;• Developing services for people with long term conditions; and• Delivering maternity, children and young people’s services .

Transforming Primary care Evidence shows that there are significant pressures in primary care. There is an increased patient expectation, attendances have gone up 75% since 1998, and there has been a slow drift of work from secondary care and community care, which has put added pressure on staff time and resources .

2014-15 has seen significant developments in Primary Care. A full programme of engagement with all of our member practices supported the design of the GP operating framework, which sets out the plan for practices working together in federation to support improved patient outcomes and alleviate some of the pressure on general practice from increased demand of an ageing population . In 2015-16 we expect all of our practices to have formally joined into 8/9 federations to deliver services for a greater population size .

This development of federations has taken place in parallel to the CCG’s successful bid for delegated responsibility for primary care contracts in 2015-16 . This management of the whole primary care commissioning process will give the CCG a fantastic opportunity to improve patient care and access whilst addressing the capacity and workforce gaps in both general practice and community services .

There will be a continued commitment to annual clinical visits to practices to inform our future commissioning intentions and to assure the CCG that practices are following best practice guidelines .

Redesigning Community Services

During 2014-15 we developed a Community Services Strategy, setting out our vision for a fully integrated, co-ordinated model for health and social care, delivering seven day services that put people’s care needs at the centre and reduce the need for bed based provision .

Our vision is supported by a ‘home first’ philosophy. The Strategy aligns with the Better Care Together five year strategic plan and our Better Care Fund plans and outlines a model of care with the following key components:• co-ordinated services with the patient at the centre of care;• multi-disciplinary teams (primary, community and social care) wrapped round the patient/citizen offering 24/7 services;• focus on early intervention along with reablement and promoting independence;• specialist medical input as required;• services that offer an alternative to hospital stay;• community hospital beds where ‘home first’ is not possible;• harness the power of the wider community;• patients will receive education and support to understand and manage their condition;• increasing use of Personal Health Budgets;• carers will receive ‘carer assessments’ and have their needs recognised;• harnessing the voluntary and independent sectors in the delivery of services that are co-ordinated with statutory services;• an innovative environment that embraces the use of new technology; and• a workforce delivering caring and compassionate care and with the training and education to take on new roles that support the integration of health and social care .

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The proposed structure for service delivery outlined in our Community Services Strategy combines wrapping services around primary care, with seamless delivery of care that is integrated across organisations . The platform for delivery of services will be the Primary Care localities and GP hubs (GP groups within the localities, each with a registered population of 30-35,000) . Services will be delivered through co-ordinated pathways of care with integrated working within healthcare and across health and social care where possible .

The Community Services Strategy has been developed alongside the CCG’s Primary Care Operating Framework to ensure a fully integrated approach.

End-of-life CareThe CCG’s overall emphasis on delivering end-of-life care between 2014-2016 is to support patients to die in their place of choice and to work with our GP practices to improve the quality of care for patients who are at the end of their life .

In 2014/2015, the focus for the CCG has centred on identifying patients within primary medical care that are approaching the end of their life and ensuring that an effective care plan is developed with the patient and/or their carer . There has been continued working with care homes to ensure that care plans are developed appropriately within the care home environment and communicated effectively with care home staff .

Delivering an effective Urgent Care System

In line with the national vision Leicester, Leicestershire and Rutland (LLR) has identified priorities for emergency and urgent care for the next two to five years.

There has been significant emphasis over the last year on operational delivery and the flow of patients through A&E. While this still remains an imperative, the wider health and social care strategy for urgent and emergency care must be in line with the local priorities, national policies and the needs of the people in Leicester, Leicestershire and Rutland .

Work was undertaken early in 2014-15 to build on the initiatives undertaken in primary care and community services, including the existing actions to improve patient flow at the emergency care front door.

To determine the scale of the urgent and emergency care network required, we used a detailed understanding for our area of:• patient flows;• the number and location of emergency and urgent care facilities;• the service they provide; and• the most pressing needs for our population .

We worked with social care partners to review and model care for those leaving hospital care and requiring support for their continuing health and social care needs .

We recognise the contribution of independent sector providers to support step-down and support for discharge, and how we can work with these partners to effectively and appropriately transfer care . Appropriate and effective services available seven day a week underpinned all the initiatives in order to improve timely access, continuity of care, and continuing care close to home . This system based approach was critical to ensure that we were better prepared for winter 2014-15 .

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Good mental health is fundamental to our well-being, yet mental health conditions are commonplace and living with the burden of a mental illness can exact a heavy price on individuals and those who care for them . It is well recognised that good mental health is linked to good physical health and more work is needed to achieve parity of esteem in mental health support when compared with the emphasis placed on physical health conditions . Mental health has been identified as a key priority for joint action within our five-year Better Care Together Strategic Plan.

During 2014-15 ELR CCG worked with their partners and stakeholders to sign the Leicester, Leicestershire and Rutland Crisis Care Concordat which outlines how police, mental health services, ambulance professionals and health professionals will work together to help and support individuals going through a mental health crisis. Plans to deliver this joined up approach have been developed .

Improving mental health and delivering parity of esteem

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Developing services for people with long term conditions

Respiratory disease Respiratory disease is a major cause of morbidity and mortality being the third leading cause of death in England after circulatory disease and cancer . It is also one of the principal reasons for emergency admissions to hospital and, as a result, it accounts for a substantial proportion of NHS expenditure.

In England, around 23,000 people die from chronic obstructive pulmonary disease (COPD) each year, equivalent to one death every 20 minutes .

Acute exacerbation of COPD is itself a high-mortality condition: 15% of those admitted to hospital with COPD die within three months which is higher than the rate for acute myocardial infarction at 13% .

In 2013-2014 and 2014-15, the CCG developed a programme of delivery within primary medical care linked to secondary and community care regarding the management of COPD and asthma.

The key components of the improvement programme are:• case finding patients to increase accurate diagnosis;• spirometric competency assessed through specialist respiratory clinicians to confirm the diagnosis of COPD; and• inhaler technique training with primary healthcare professionals .

Average prevalence rates have increased from 1 .2% (2010-2011) to an overall average of 1 .48% (2011-2012) and 1 .57% (2012-2013) for all ages of our registered patient population .

Spirometric competency assessment is a rolling programme across our 32 general medical practices working with our practice nurses . For 2013, just over two thirds of our practices had achieved an up-to-date spirometry competency assessment with the remainder of the practices planning to update their competency training in line with the rolling programme of assessment .

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Dementia Dementia is a term used to describe various different brain disorders where a loss of brain function is progressive and eventually severe . The most common form of dementia is Alzheimer’s disease followed by vascular dementia . Symptoms include loss of memory, mood changes and problems with communication and reasoning .

Dementia is a long-term condition and people may live with dementia 7-12 years after their diagnosis. Nationally one in four females and one in five males over the age of 85 have dementia . The higher prevalence in females is to some degree due to longer life expectancy . In terms of mortality, 10% of deaths in men over 65 years and 15% of deaths in women have been found to be attributable to dementia in a UK study (this equates to 59,685 deaths annually) .

In 2014 there were 130,400 people over the age of 65 years within Leicestershire County and Rutland . This is predicted to rise to 186,900 by 2030, an increase of 43 .3% . The following information details the number of estimated people diagnosed with dementia in 2014 and the numbers predicted for the future .

Area 2014 2030 Increase Numbers

% Increase

Leicestershire 8,881 15,411 6,530 73 .5%

Rutland 611 1,164 553 90 .5%

Table 1: Number of estimated people diagnosed with dementia in 2014 and future predictions

Although the dementia registers and the figures show an increase in the prevalence of dementia over time, 60% of people living with dementia in Leicestershire and Rutland remain undiagnosed .

The 2013-14 prevalence figures for dementia within Leicestershire and Rutland indicate similar figures to the England average:

Detail East Leicestershire and Rutland Clinical Commissioning Group

List size 321,461

Register Count 2,080

Prevalence (unadjusted) 0 .647%

Similar to England average

Table 2: 2013/14 prevalence figures for dementia

Work continued during 2014/2015 to develop services that can meet the needs of an ageing population . This included work to develop the care of dementia within general medical practice as well as working closely with community and secondary care to ensure dementia has a key focus on care delivery .

For example, the Alzheimer’s Society began delivery of their Hospital Liaison Dementia Support Service within University Hospitals of Leicester during 2014-15 to support carers and people with dementia within a hospital setting, providing information, and guidance on coping strategies, diagnosis and support to access community services post hospital stay .

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During 2014-15, we worked with our local authority partners, supporting the development of local authority services for people with dementia and their carers . These services provide advice, information and support to help people with dementia and their carers to maintain their independence and to continue to live at home .

Supporting people with dementia

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Over the last few years we have seen an increase in the number of births and an increase in complexity . Although we have better than or average rates in relation to, perinatal / infant mortality, teenage pregnancy and breastfeeding rates, it is widely accepted that we have pockets of deprivation where these rates are significantly higher. This high level of need results in a greater demand on maternity and neonatal services .

We provide high quality safe maternity and neonatal services based on best practice and which are easily accessible . These services will be supported by the appropriate infrastructure across both primary and secondary care .

During 2014-15 the following developments took place:• Primary Mental Health Professional Advice Telephone service was expanded to be available throughout office hours;• introductory courses in child mental health were delivered to over 600 staff across a range of partner agencies;• an independent review of CAMHS community service was commissioned and completed ; and• expansion of family therapy service to support educational psychology and social care practitioners .

Delivering maternity, childrenand young people services

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QUALITY AND PATIENT SAFETY

Quality, patient safety, clinical effectiveness and the experience of patients underpins the delivery of health and social care services .

A number of recent high profile cases (Winterbourne View [DH, 2012], the Report of the Mid Staffordshire NHS Public Enquiry by Robert Francis QC [2013], and the Saville Inquiry [2013] have identified that vulnerable people were not afforded basic standards of care and their fundamental rights to dignity were not respected . We must not allow this scale of poor quality care and abuse to occur in the services we commission .

We recognise the need for service improvements to deliver better quality of patient care and experience in the long-term, whilst reducing clinical variation, eliminating waste and delivering better value for money .

We will achieve this through the development of short, medium and long-term investment in delivering the work that supports our strategic priorities . This will include accompanying QIPP programmes. Alongside this, through CCG contractual arrangements with providers we will ensure effective quality indicators are in place which allow for a greater understanding of the impact of health interventions on patients and the standard of services commissioned .

During 2014 we have made considerable progress in ensuring that we have embedded effective systems to ensure that the CCG is able to monitor, challenge and scrutinise provider performance to ensure improvements in the quality of care commissioned .

Some examples of this are:• The continued assessment of ‘patient experience dashboards’ for all of our out-of-county acute contracts;• Regular contacts through Quality Contracting Teams with our neighbouring CCGs to monitor the quality of care being provided by our out of county providers; • Continued work with our local Healthwatch organisations to act on intelligence received about provider performance;• Understanding and scoping quality assurance systems within primary care;• Development of quality schedules for Optometry, Pharmacy and General Practice Community Based Services contracts. This will allow the CCG to assure itself of the quality of care being provided by these services, and work with providers to improve where necessary;• Agreeing systems with NHS England to establish closer links and share intelligence of primary care quality risks including establishing systems of escalation where necessary; • Development of a Care Home Strategy group to ensure all teams within the CCG whose work involves care homes is executed in a streamlined manner, to ensure quality care is delivered and compliance is monitored effectively by maintaining an overview of work streams to deliver a care home plan setting out aims, objectives, metrics, leads and time scales; and• Systematic scrutiny and oversight of settings of care for people within inpatient settings in learning disability services to ensure that safe and effective discharge arrangements are in place .

However, the CCG is not complacent. We continue to review and refresh the data sets used against the domains of the NHS Outcomes Framework and ensure consistency and validation of data sources .

Alongside this we have embedded systems which allow for feedback from service users using Healthwatch members and stakeholder events as well as via our Listening Booths .

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PATIENT EXPERIENCE

The CCG is committed to ensuring that the patient and service user voice is at the heart of what we do . Improving patient experience has been a key area of focus for East Leicestershire and Rutland Clinical Commissioning Group . During 2014-15 the CCG baselined the various elements of patient experience data routinely collected . We have used this to identify key themes, trends and identify any information gaps and take action as required .

‘Patient experience dashboards’ have been developed for our main acute providers as well as the local out of county providers where our residents may choose to access hospital services, that is:• University Hospitals of Leicester NHS Trust;• Kettering General Hospital NHS Foundation Trust;• United Lincolnshire Hospitals NHS Trust;• Northampton General Hospital NHS Trust;• Nottingham University Hospital NHS Trust;• Oxford University Hospitals NHS Trust;• Peterborough and Stamford NHS Foundation Trust; and• University Hospitals Coventry and Warwickshire.

Nine indicators have been developed, incorporating publicly available data and data sourced by contracting teams . Indicators include a selection of patient safety and patient experience indicators to provide a high level overview of the quality of care being provided at each Trust . The dashboards are reported to the ELR CCG Quality and Performance Committee on a quarterly basis.

Patient Participation Groups (PPGs) are in place at the majority of ELR CCG GP practices. The CCG engages regularly with Patient Participation and Reference Group (PPRG) to strengthen the voice of the patient within the work of the CCG .

Our Chair convenes a quarterly Patient and Public Engagement Groups group. The group comprises attendees from local third sector organisations, PPG/PRG Chairs, and members of local Healthwatch. The group provides a sense check on CCG plans and supports two way communication .

WE ARE LISTENING PROJECT

The “We are Listening” project has continued throughout the year. We have travelled to over 25 locations, speaking to almost 200 people with the ELR CCG branded listening booth . The listening booth allows ELR CCG to speak to the public, patients and carers outside of health locations; approaching people when they are feeling relaxed and have the time to talk about their experiences of healthcare . The idea is to focus on how people feel and their attitudes and opinions . The booth is designed to complement the data already available through patient surveys and other large scale feedback mechanisms .

During the exercise, we collected positive and negative feedback from patients . We went out to visit diverse groups including Sure Start centres, Learning Disability groups, market stalls and lunch clubs across all localities of the CCG area . The Listening Booth formed an integral part of the Urgent Care Consultation, and by accessing a wide range of locations with the listening booth, representatives of seldom heard groups were able to participate in the consultation .

Figure 7:Listening Booth Word Cloud

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The feedback received via the listening booth has been broken down into themes and trends, with feedback also provided to providers of services . This information has been used to influence changes in the way we commission services, and also to influence improvements in the quality of care being provided, where patients have highlighted issues .

Patient stories have become an integral part of our public Governing Body meetings. We use patient stories to drive changes and influence commissioning decisions through clinical discussions in these meetings . In the last year, we have been able to demonstrate meaningful changes arising out of the use of patient stories at Governing Body meetings. Our Patient Stories allow real patients to tell us their real-life experiences in their own words .

Some highlights include:• Improvements to managing the risk of clostridium difficle infection; • Input into the acute mental health pathway redesign;• Focus on complex children’s care system; • the impact of fragmentation of pathways for patients who live on borders; and• continuing challenges around the cancer diagnosis/treatment pathway .

WEB AND DIGITAL COMMUNICATIONS AND ENGAGEMENT STRATEGY

We are proud of some of the innovations we have trialled during 2014-15 to inform and involve local people and stakeholders in what we do and how we do it . Moving forward, we intend to introduce further major innovations, including:• a groundbreaking responsive web and digital communications and engagement strategy, built on a ‘digital first’ integrated approach to our website and other channels;• a significant expansion of social media, based around a ‘communitarian’ approach that values and engages our stakeholders and communities as equals and partners in our social space, rather than simply seeing them as passive recipients of ‘just another set of broadcast channels’;

• trialling mobile capabilities, harnessing the power of a true understanding of the unique opportunities that mobile brings, recognising the opportunities for engagement afforded by individualisation, location and context awarenesss and user-selected push notifications; • combining traditional methods with the power of web, mobile and social media to reach out to hard to reach groups and those beyond the ‘usual suspects’ who traditionally have been involved in health and care discussion and debate; and being recognised as true innovators in NHS digital and mobile engagement .

This will enable us to communicate with more people in new and additional ways, at times and through ways that offer greater choice, convenience and reach .

Figure 8: Blipfoto - one of our new social media channels being trialled

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QUALITY AND EXCELLENCE

We continue to be committed to improving the quality of patient care, by a focus on clinical effectiveness, patient safety and patient experience with specific goals to deliver excellent health services and improve the quality of patient care .

This will be achieved by: • continuously improving the quality of care within providers, including acute, mental health and community services using contractual processes as a lever;• combining commissioning and provider data with patient safety data and carer feedback, including complaints, reference groups and engagement events, to inform areas requiring improvement and attention and to ensure on-going improvement;• reducing variations in primary care for example access to primary care services, appropriate prescribing, equitable access to health checks for all patients including hard to reach groups; • extending patient choice of provider for a range of community and mental health services through the use of local and national AQP processes; • delivering efficiency by maximising use of community services through an integrated care approach with health and social care, to provide a seamless service for patients; and• assuring delivery through collaboration with main providers ensuring ‘value for money’ for all partners .

Our plans for 2015-16 include a review of all quality schedules and local Commissioning for Quality and Innovation (CQUIN) schemes to ensure improvements areas have a greater focus .

We routinely review data published by the Care Quality Commission (CQC) to inform our quality monitoring arrangements . Where providers have received action plans following inspection visits we monitor progress against these through our quality contracting processes . During 2015-16 we will be extending this to include CQC intelligence within our quality data sets for Care Homes and primary GP practices.

We have built positive relationships with our local CQC inspectors and have developed joint meetings with Local Authority colleagues to ensure intelligence sharing around providers; this supports our responsibility following the Francis Publication in 2013.

Improving quality of patient care

Excellent Community Health Services

Improving quality of acute services

Improving quality of Mental Health Services

High Quality ResponsivePatient Care

Patient Safety Clinical Effectiveness

Patient Experience

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PATIENT SAFETY

During 2014-15 we continued to focus our efforts on ensuring providers actively reduce healthcare acquired infections such as Methicillin Resistant Staphylococcus Aureus (MRSA) bacteraemia, Clostridium Difficile infection (CDiff) MSSA and E Coli . This is achieved through monitoring compliance with and achievement of nationally set trajectories for MRSA, Blood Stream Infections (BSI) and CDiff and MRSA .

In the last year the CCG has:• undertaken infection control review of patients in the community with a stool sample reported as positive for CDiff that was sent from a GP surgery or within 3 days of admission to UHL;• addressing antimicrobial prescribing identified as not being in line with LLR antibiotic guidance for primary care and audit of Proton Pump Inhibitator prescribing; and• continuing to support the combination of infection control data with the data held by the CCG Medicines Management Team in relation to QIPP and prescribing targets .

This has identified key learning themes, which have been shared via locality meetings with our membership .

We have continued to review existing programmes associated with patient safety themes, including:• reviewing the findings of the Berwick review to reflect how commissioners can support behavioural change with regard to patient safety;• ensuring robust investigations of all serious incidents from all providers are undertaken and submitted in a timely manner; • continuing with systematic reviews of all serious incidents to identify areas for targeted work – across providers; • implementation of the intelligence reporting system across primary care for GPs to raise issues and concerns to establish themes and trends that may be developing; • working with providers to eliminate avoidable pressure ulcers and working in partnership with the local authorities to eliminate avoidable pressure ulcers in care homes by including a pressure ulcer CQUINs into Care Home contracts;

• reviewing the outcomes of the Leicester, Leicestershire and Rutland learning lessons review across primary and secondary care and identify key work- streams which will improve pathways and outcomes for patients; and• reviewing locally set infection control indicators in line with Department of Health set objectives to improve infection control outcomes for patients;

THE BERWICK REVIEW

The publication of “A promise to learn - a commitment to act: Improving the Safety of Patients in England” Berwick (2013) set out a number of commitments for clinicians, managers and all staff of the NHS and for organisations leaders and Boards . These commitments being:• Listen to and involve patients and carers in every organisational process and at every step in their care;• Monitor the quality and safety of care constantly, including variation within the organisation;• Respond directly, openly faithfully and rapidly to safety alerts, early warning systems and complain from staff . Welcome all of these .• Embrace complete transparency;• Train and support all staff all of the time to improve processes of care;• Join multi-organisational collaborative – networks in which team can learn from and teach each other; and • use evidence based tools to ensure adequate staffing levels.

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During 2014-15 we ensured that mechanisms were in place via our contractual arrangements with providers to respond to the Berwick recommendations . This has included:• reviewing and monitoring provider mechanisms to ensure that there are early warning systems embedded in practice, evidenced by reviewing of nursing and ward based safety metrics and actions in place where risks are identified;• publication of staffing levels in line with “Hard Truths” and NICE staffing guidance;• ensuring triangulation of patient experience data such as surveys, friends and family test, feedback from enquires and learning from complaints;• identification of areas focus through learning from patient safety incidents and serious incidents; and • triangulation of provider data with data from GP concerns to improve quality of discharge summaries to GPs following and inpatient stay.

Our contractual processes are only one way of ensuring the cultural change needed to ensure a reduction in harm and improve safety across health services . In August 2014 across Leicester, Leicestershire and Rutland the health community published the “Learning Lessons to Improve Care”, a case note audit review of care for people who died in 2012-13 . ELR CCG is represented on the Clinical Task Force convened to oversee the implementation of actions arising from the review .

During quarter 3 of 2014-15 the East Midlands Patient Safety Collaborative was convened . Early priorities are being agreed to shape the work plans for the coming year and ELR CCG are supporting the development of this work plan through attendance and positive contribution to the collaborative .

Alongside this the Leicester Improvement Innovation and Patient Safety Unit (LIPS) collaboration between University Hospitals of Leicester and Leicester University has been set up during 2014 . ELR CCG has been invited to join this collaboration to develop local patient safety initiatives . Both of these collaboratives have been convened to address the cultural changes required following publication of the Berwick and Francis reports .

The key safety priorities for 2015-16 will be:• a commitment to work with the East Midlands Patient Safety Collaborative;• a commitment to work collaboratively with the Leicester Improvement Innovation and Patient Safety Unit; and • Join the Sign up to Safety campaign .

THE FRANCIS INQUIRY

We welcomed the publication of the of the Francis Inquiry in February 2013 and actively engaged across the CCG including Governing Body members, staff, member practices and the practice nursing community .

We developed a comprehensive plan in response to the recommendations relevant to the CCG, including those relating to organisational culture which were built into the CCG’s visions and values .

One of the key outcomes associated with the Francis response has been the development and implementation of an automated GP intelligence reporting system. This enables real time reporting of GP concerns relating to patient safety and experience in any provider organisation .

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Contractual mechanisms continue with the strengthening of our approach to the monitoring of quality in providers . This has included the revision of quality schedules to ensure they reflect the Francis recommendations and a proactive approach to unannounced quality visits . The new approach to quality visits continues to incorporate a multi professional desk top review of various data sources to inform areas to visit, providers continue to welcome the increased level of scrutiny and respond positively to this approach .

The thematic analysis of GP concerns has identified two specific work streams that have commenced in 2014-15 these being: addressing quality of discharge letters from University Hospitals of Leicester; and scoping of quality and capacity within the district nursing services provided by Leicestershire Partnership Trust across LLR .

During 2014-15 the Managing Director and Chief Nurse and Quality Officer have been active contributors to the Leicestershire Area Team Quality Surveillance Group . This group brings together a range of organisations including: Public Health England, Local Authorities, Healthwatch Leicestershire and Healthwatch Rutland, Health Education England, Trust Development Agency, Care Quality Commission and partner CCGs . This is to ensure intelligence sharing about providers in order to prevent a replication of the care failings that occurred within Mid Staffordshire NHS Foundation Trust

The recent publication of “Freedom to Speak Up” in February 2015, sets out 20 principles for organisations within the NHS to adopt and embed to foster a change of culture which ensures patients are placed at the heart of everything we do .

Through 2015-16 we will:• Use intelligence gathered from the variety of data streams to focus on continuing quality and safety improvements; • Continue to work collaboratively across LLR to ensure the cultural changes required to improve care for our population are embedded; through active participation within the Clinical Task Group, EM Patient Safety Collaborative and LIPS; and • Further develop and embed systems to ensure that staff who raise concerns regarding poor quality care are listened to and supported in a non blame culture .

WINTERBOURNE VIEW

The CCG is committed to delivering against the Winterbourne View Concordat . This is to transform the way services are commissioned and delivered to:• stop people being placed in hospital inappropriately;• provide the right model of care and drive up the quality of care; and• that by 1 June 2014 there is a rapid reduction in hospital placements for this group of people .

More recently a joint Learning Disabilities Programme Board with clear terms of reference, governance structure and stakeholder reference group has been established . It includes representation from ELR CCG, local authority, Local Area Team children’s and adults’ commissioners. This Programme Board will oversee the development and delivery of the Winterbourne View action plan . The Programme Board links back to the Health and Wellbeing Board via an Integrated Commissioning Board that includes district council representation .

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A stakeholder reference group has been established to support this work . This includes families of children, young people and adults, commissioners and NHS providers. It is planned to use this group as a longer term stakeholder/advisory group for the Winterbourne View delivery plan . Additional members will be brought in as required . There will be a degree of overlap with other local authorities and CCGs in the Leicester, Leicestershire and Rutland area, and particularly in relation to work with providers .

During 2014-15 we are systematically reviewing placements for patients within inpatient settings commissioned by ELR CCG . In December 2014 the Chief Nurse and Quality Officer chaired Care and Treatment Review panels for commissioned placements to ensure appropriate arrangements were in place for ensuring effective discharge when service users are deemed medically fit to transfer to other settings .

During 2015-16 ELR CCG will:• as members of the Better Care Together ensure proactive contribution to the Learning Disability work plans; and • ensure strengthened mechanisms are in place to review discharge arrangements for those service users in hospital inpatient settings to ensure safe and effective transfers to out of hospital care .

COMPASSION IN PRACTICE NURSING, MIDWIFERY AND CARE STAFF - OUR VISION AND STRATEGY

We have used the publication of Compassion in Practice: Nursing, Midwifery and Care Staff Our Vision and Strategy (DH 2012) as a key enabler to the delivery of a long-term sustainable high quality nursing and care staff workforce which support dignity in care provision .

The Chief Nursing Officer for England has developed the ‘6Cs Live!’ website, which aims to build an online community of nurses and care givers across health and social care. We have been actively participating in a range of ‘6Cs Live!’ webinars that support delivery of the six action areas:

• Helping people to stay independent, maximising well-being and improving health outcomes;• Working with people to provide a positive experience of care;• Delivering high quality care and measuring impact;• Building and strengthening leadership;• Ensuring we have the right staff, with the right skills, in the right place; and• Supporting positive staff experience .

The Chief Nurse and Quality Officer has contributed to the work across the Leicestershire and Lincolnshire Area Team to support implementation of the 6Cs action areas .

Our Protected Learning Time sessions across the CCG have supported the development of a nursing forum for primary care nurses. The Practice Nurse Facilitator has supported inductions programmes for new primary care nurses, commenced reviewing competencies for clinical training programmes provided by the LLR GP Training Function (hosted by ELR CCG) and has developed a primary care nursing forum .

During 2014-15 we have demonstrated that through inclusion within quality schedules, there has been a strong focus on staffing and skills mix within our acute and non acute providers .

Through the use of “Safer staffing nursing” and “Birth right plus” staffing tools our acute providers have assured their Trust Boards that they have reviewed staffing establishments and published in line with “Hard Truths” monthly staffing data.

In 2015-16 we will:• continue to work with our providers to ensure effective recruitment; and retention practices of and reduction in the use of agency staff continues; and • Review and refresh our local plans to further develop the action areas within Compassion in Practice.

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STAFF SATISFACTION

Staff satisfaction is an important workforce measure of how content or satisfied employees are with their jobs and is typically measured using a staff opinion survey which asks staff for their views about topics such as: remuneration, workload and perceptions of management, flexibility, resources and teamwork.

The NHS National Staff Survey measures a range of aspects of working life and enables organisations to monitor how well they are doing against the pledges made to staff in the NHS Constitution. It has been, and will continue to be, an enabler for NHS organisations to listen to and act on the views of their staff. Perhaps more important is that evidence shows there to be a clear relationship between staff and patient experience so improving the working lives of staff also helps NHS organisations to provide better care for patients.

During 2014 the CCG implemented a number of actions in response to the previous year’s survey findings and to further build the level of staff satisfaction. Some examples include: continuing to improve internal communication by holding regular staff briefings; the fortnightly publication of an internal newsletter; and holding regular charity events and celebrations, e .g . the biggest coffee morning for Macmillan and a Diwali lunch .

For the second year, it was not compulsory for CCGs to undertake the National Survey, however, given its importance and the information it provides, the CCG commissioned Picker Institute Europe to provide the online survey and achieved an impressive 94% response rate which was a 2% improvement on the previous year . The results of the survey are shared with staff to produce departmental level action plans to address any areas of concern .

Jan’s Joggers are a new lunchtime group - aiming to get out for a walk every day at lunchtime for a 30 minute walk

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Some highlights from the results of the staff survey are:• The majority of staff have had an annual appraisal which helped themimprove how they do their job and agree clear objectives;• Communication with senior management is effective;• Team members have a set of shared objectives;• The majority of staff enjoy coming to work and are enthusiastic about their job;• Staff believe there are frequent opportunities for them to show initiative in their roles;• Three quarters of staff would recommend the CCG as a place to work; and• The number of alleged incidents of bullying and harassment from managers/ colleagues has significantly reduced and will remain an area of focus.

Listening to staff

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SAFEGUARDING

The CCG continues to have a strong focus on safeguarding vulnerable people . We have developed and adopted a range of policies which underpin how we approach safeguarding arrangements. The Quality and Performance Committee of the Governing Body has oversight and scrutiny of safeguarding arrangements for the CCG. The Chief Nurse and Quality Officer is the Executive Lead for safeguarding and is a member of the Leicestershire and Rutland Local Safeguarding Children Board (LSCB) and Safeguarding Adult Board (SAB) . The CCG is supported in its statutory duties by Designated Nurses and a Designated Doctor for safeguarding .

The CCG uses the Markers of Good Practice for Children and Safeguarding Adults Framework which meets the requirements set out in Safeguarding Vulnerable people in the reformed NHS - accountability and assurance framework published in March 2013 to assess provider compliance against statutory safeguarding duties .

During 2014-15 the CCG along with NHS England Local Area Team and the two other Leicester and Leicestershire CCGs, commissioned a review of the designated function to ensure capacity and capability of this function in supporting the CCG with delivering statutory duties .

This review has confirmed that the CCG has commissioned the appropriate level of Designated Doctor and Nurse time and we are reviewing local service levels agreements to ensure that quality of the service provision for 2015-16 .

There have been no serious case reviews commissioned by the Leicestershire and Rutland Safeguarding Board for people within East Leicestershire and Rutland CCG area during 2014-15. However the GP Locality forums have adopted a standardised approach to bringing any issues relating to safeguarding issues on a monthly basis . In the last year we have supported the partnership arrangements by contributing to the Child Sexual Exploitation campaign and we have a local Practice Nurse supporting the work of the multiagency subgroup within the LSCB .

The CCG has completed and submitted to the LSCB and SAB a self assessment against Section 11 audit and the Safeguarding Adults Assurance Framework .

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OUR COMMISSIONING ACTIVITIES AND WHO WE COMMISSION FROM

East Leicestershire and Rutland CCG (ELR CCG) commissioned health services totalling £328 million for people registered with our practices. We hold contracts ranging from small grants to the voluntary sector, to a £126 million contract with the main acute provider, University Hospitals of Leicester NHS Trust .

Although the picture of healthcare providers is becoming more complex with the roll out of initiatives such as ‘any qualified provider’ (AQP), offering patients a wider choice of organisations to provide their care, the local services we commission remain dominated by:• UHL which provides acute hospital services at three sites in Leicester and in local community hospitals. UHL provides secondary care to a catchment area of approximately one million people and specialised services for up to three million people . It is one of the largest acute trusts in the country;• Leicestershire Partnership NHS Trust, the main provider of community health and mental health services. LPT manages most of the community-based teams serving ELR CCG and is a key provider at the six community hospitals; and• East Midlands Ambulance Service NHS Trust provides emergency 999 and urgent care crews across Derbyshire, Leicestershire, Rutland, Lincolnshire (including North and North East Lincolnshire), Northamptonshire and Nottinghamshire .

We commission acute services from out-of-county NHS trusts and a range of independent sector providers such as Spire Leicester, Nuffield Leicester and Circle, based at the Nottingham Treatment Centre .

Furthermore, ELR CCG provides grants for some voluntary sector providers including the Alzheimer’s Society (carer’s support service), Carer’s Action (carer’s support), Leicestershire Organisation for the Relief of Suffering (LOROS) for end-of-life care, and The Laura Centre (support for adults and children affected by the death of a child) .

We act as the co-ordinating commissioning body to manage the following contracts on behalf of all three Leicester, Leicestershire and Rutland CCGs:• out-of-county contracts (acute);• out-of-county community health services;• East Midlands Ambulance Service;• non-emergency patient transport services – Arriva Transport Solutions;• any qualified provider contracts;• Leicester, Leicestershire and Rutland voluntary sector arrangements; • community based elective care alliance arrangement; and• home oxygen service contract .

ELR CCG also works with our Leicester, Leicestershire and Rutland CCG partners to support the management of contracts across the three CCGs in line with the NHS Standard Contract Management Framework.

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OPERATING AND FINANCIAL REVIEW

I certify that the Clinical Commissioning Group has complied with the statutory duties laid down in the National Health Service Act 2006 (as amended by the Health & Social Care Act 2012) and prepared the accounts under the Directions issued by NHS Commissioning Board under the National Health Service Act 2006 (as amended) . Appendix 1 provides the Annual Accounts for 2014-15 .

DEVELOPMENT AND PERFORMANCE IN YEAR AND IN THE FUTURE

During 2014-15 the CCG’s Finance and Performance Committee (and towards the end of the year by the Finance and Activity Committee) monitored all performance indicators on a monthly basis, and is responsible for assuring the Governing Body of compliance. This in turn was assured by the NHS England’s Area Team at their checkpoint meetings with the CCG .

The CCG had a total allocation of £338,493,000 in the 2014-15 financial year. NHS England had set a target for the CCG to achieve a surplus of £3,308,000. Table 3 sets out the 2014-15 summary financial performance for the CCG. The CCG over-achieved its target by delivering a surplus of £3,310,011.

East Leicestershire and Rutland Clinical Commissioning Group Summary Financial Performance

Budget

£

Actual

£

Variance - Under/

Overspend)£

Total allocation 338,493,000 338,493,000 0

Total Acute Commissioning 154,290,935 160,217,997 5,927,062

Total Non-acute Commissioning 105,584,715 109,084,218 3,499,504

Total Practice Prescribing 46,063,205 46,494,454 431,249

Total Primary Care Services 6,173,187 5,830,086 -343,101

Miscellaneous (inc reserves) 16,134,753 6,394,161 -9,740,592

Total Commissioned Healthcare Expenditure

328,246,795 328,020,917 -225,878

Total Running Costs 6,938,205 7,162,073 223,868

Total Expenditure 335,185,000 335,182,989 -2,011

Surplus £ £ £

Programme control total 2,308,000 2,512,083 204,083

Running Costs control total 1,000,000 797,927 -202,073

Total control total 3,308,000 3,310,011 2,011

Table 3: ELR CCG 2014-15 Summary Financial Performance

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The financial performance of the whole of the health economy in 2014-15 has been difficult with the main provider of acute services (University Hospitals of Leicester NHS Trust) reporting a sizeable deficit.

The LLR CCGs have continued to work closely with the trust to ensure that services to patients have not suffered as a result of the financial problems. The Commissioning Plans of the CCGs are supportive of the trust in achieving a financial balance in the next two years. This will result in changes to the way services are currently provided and the location in which they are provided . To this end the CCG has significant new investments in community and social care services with the aim of relieving the reliance and pressure on acute services. The CCG has also worked alongside Leicestershire Partnership NHS Trust to develop and improve inpatient services for people who have a mental health issue .

Also during this year the CCG monitored the NHS Outcomes Framework, the NHS Constitution and the new Quality Premium. The former is to drive local improvements in quality and outcomes for patients and the Constitution to ensure that patients’ rights and pledges were maintained through contracts with service providers. The Quality Premium brings together a composite of indicators from the outcomes framework and constitution, and incentivises the CCGs to improve performance .

One of the ways we measure performance is setting and monitoring Key Performance Indicators which include descriptions and measures (please see Table 4) .

Whilst we are pleased with performance in many areas of activity (e .g . progress on time taken from referral to treatment) in several areas over the last year we and our partners have not managed to hit national performance targets, with highly publicised challenges at several of our providers including accident and emergency services at Leicester Royal Infirmary, the Bradgate mental health unit (Leicestershire Partnership NHS Trust) and East Midlands Ambulance Service. During 2014-15 the CCG worked closely with all service providers and partners across health and social care to support the implementation of plans to drive up quality of care and performance .

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The following tables set out East Leicestershire and Rutland CCG’s position on the expected rights and pledges from the NHS Constitution 2014-15 and includes thresholds that the NHS Commissioning Board will use when assessing organisational delivery.

EAST LEICESTERSHIRE & RUTLAND CCG. NHS CONSTITUTION KEY PERFORMANCE INDICATORS. Performance achieved

2014-15Standard

2014-15

Referral to Treatment (non-admitted) 95% 95 .6%(All Providers)

Referral to Treatment (incomplete) 92% 95%(All Providers)

Cancer waits - two weeks from urgent referral with breast symptoms 93% 92 .99%(All Providers)

Cancer waits - 31 days for subsequent cancer treatment (drug) 98% 94 .29%(All Providers)

Cancer waits - 31 days for subsequent cancer treatment (radiotherapy) 94% 92 .4%(All Providers)

Care Programme Approach: The proportion of people under adult mental illness specialties on CPA who were followed up within 7 days of discharge from psychiatric in-patient care during the period

95% 96 .1%(LPT)

Table 4: Key Performance Indicators

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EAST LEICESTERSHIRE & RUTLAND CCG. NHS CONSTITUTION KEY PERFORMANCE INDICATORS. Performance achieved

2014-15Standard

2014-15

Referral to Treatment (admitted) 90% 86 .4%(All Providers)

Cancer waits - two weeks from urgent GP referral 93% 92 .9%(All Providers)

Cancer waits - 31 days to first definitive treatment

96% 94 .2% (All Providers)

Cancer waits - 31 days for subsequent cancer treatment (surgery) 94% 92 .4% (All Providers)

Cancer waits – 62 days from urgent GP referral to treatment 85% 82 .8% (All Providers)

Cancer waits - 62 days from NHS screening service to treatment 90% 80 .8% (All Providers)

Cancer waits - 62 days for treatment following a consultant’s decision to upgrade the priority of the patient

100% 92 .3% (All Providers)

Diagnostic waiting times 99% 98 .5%(All Providers)

Patients should be admitted, transferred or discharged within 4 hours of their arrival at an A&E department

95% 92% (UHL only)

Category A Red 1 incidents response within 8 minutes - (conditions that may be immediately life threatening and the most time critical)

75% 73 .2% EMAS

Category A Red 2 incidents, response within 8 minutes - (conditions which may be life threatening but less time critical than Red 1)

75% 70 .09% EMAS

Category A calls resulting in an ambulance arriving at the scene within 19 minutes 95% 93 .2% EMAS

Cancelled ops - All patients who have operations cancelled, for non-clinical reasons, to be offered date within 28 days, or funded at the time and hospital of the patient’s choice .

100% 95 .6%(UHL Only)

Mixed Sex Accommodation Breaches 0 breaches 5(All Providers)

NB: Indicators rated as ‘amber’ meet the lower threshold, but do not meet the nationally set target . For example: Referral to treatment (admitted) has a target of 90%, the lower threshold is 85%, therefore a position of 88 .7% is between the target and the lower threshold, giving an amber indicator .

Table 5: Key Performance Indicators

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THE RESOURCES, PRINCIPAL RISKS AND RELATIONSHIPS THAT MAY AFFECT LONG-TERM PERFORMANCE

The CCG had an allocation of £338,493,000 in 2014-15. This was managed through the Accountable Officer and the Chief Finance Officer. The financial performance of the CCG was monitored on a monthly basis by the Governing Body and the Finance and Performance Committee (and towards the end of the year by Finance and Activity Committee) chaired by a lay member .

The main financial risk that the CCG faced throughout the year was over performance in the Acute Sector against the backdrop of significant emergency activity pressures experienced during the year . The overspend in the acute sector at the end of 2014-15 was £5.93 million, as shown in Table 6.

Acute Commissioning Overspend £m

UHL Contract 3 .25

Out of County Contracts 1 .29

Non Contracted Activity 0 .15

Independent Sector 1 .24

Total overspend 5 .93

Other key financial risks included:• increasing expenditure within continuing healthcare;• Winter Pressures across the health and social care economy;• Potential non-achievement of QIPP plans; and• In year management of allocation movements as funding was stabilised .

These risks were mitigated following extensive discussions with providers of services . Where appropriate, risk sharing strategies were adopted . A number of the risks were shared on a collaborative basis with the other Leicester and Leicestershire CCGs alongside underspending in other areas .

The CCG had a total of £7,960,000 to spend on running costs in 2014-15 and a total of £7,162,073 million was spent (see Table 3).

BETTER PAYMENTS PRACTICE CODE

The Better Payment Practice Code requires the Clinical Commissioning Group to aim to pay all valid invoices by the due date or within 30 days of receipt of a valid invoice, whichever is later. The NHS aims to pay at least 95% of invoices within 30 days of receipt, or within agreed contract terms . Details of compliance with the code are given in the notes to the financial statements. In 2014-15 all NHS and Non-NHS invoice payments have exceeded the 95% target for number of invoices paid and also for value of invoices paid. [See note 6 in the financial statements for further details].

PROMPT PAYMENTS CODE

On 28 February 2014 the CCG became an approved signatory of The Prompt Payment Code. This initiative was devised by the government with The Institute of Credit Management (ICM) to tackle the crucial issue of late payment and to help small businesses. Suppliers can have confidence in any company that signs up to the code that they will be paid within clearly defined terms, and that there is a proper process for dealing with any payments that are in dispute . Approved signatories undertake to:• pay suppliers on time;• give clear guidance to suppliers and resolve disputes as quickly as possible; and• encourage suppliers and customers to sign up to the code .

COST ALLOCATION & SETTING OF CHARGES FOR INFORMATION

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

Table 6: Acute Commissioning

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GOVERNING BODY’S POLICY FOR MANAGING RISK

The CCG Governing Body is committed to commissioning safe and effective care and leading the organisation to deliver its objectives . It uses approved risk management strategy and policy to lead the organisation forward to deliver its objectives .

The CCG acknowledges that risk can bring with it positive advantages, benefits and opportunities and aims to create an environment where risk is considered as a matter of course and appropriately identified and managed. A culture of open reporting is promoted and upheld throughout the CCG to ensure that risks are identified, evaluated, documented and managed by all who may encounter them .

Risk management is a core organisational process and is an integral part of its philosophy, practices and business planning and that responsibility for its implementation is accepted at all levels of the organisation . The CCG recognises the importance of involving local stakeholders in its risk management processes and of working in partnership to identify, prioritise and control shared risks, such as through collaborative arrangements .

Strategic risks (or principle risks) identified are those that represent major threats to achieving the CCG’s strategic objectives or to its continued existence . Strategic risks are recorded in the Board Assurance Framework (the corporate risk register) and managed by the Executive Management Team and regularly reported to the Audit Committee and Governing Body .

THE CCG’S PRIORITIES FOR THE NEXT TWO YEARS (2014-16)

The CCG’s Operational Plan 2014-16 details the key priorities for the next two years and our intentions to further develop partnership and collaborative working with our local authority partners, neighbouring CCGs and stakeholders in order to deliver the system redesign that is needed to address our local challenges and issues . The key priorities include:• Reshaping community services to deliver locally based provision that enables patients to remain independent for as long as possible and have a better quality of life;• Further integration of health and social care provision to transform care that is strong, sustainable and person centred which enables the health and social care system meet the future demands;• Service improvements which deliver better quality care and patient experience whilst reducing clinical variation, eliminating waste and delivering better value for money;• Reducing pressure within our urgent care system to prevent avoidable admissions and reduce length of stay for patients who could be cared for at home;• Support general practice to come together with new ways of joint working to enable primary care health teams to have more time to proactively manage patients with multiple illnesses, at the end of life, in care homes or at risk of admission;• Children and their families will continue to be an important priority for the CCG; and• Working with our mental health providers, clinicians and service users to improve our acute mental health pathway .

The CCG is working in partnership with NHS England and other Leicester and Leicestershire CCG partners, Local Authorities and providers to formulate a five year strategy that focuses on some strategic health priorities .

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POSITION OF THE ORGANISATION

The CCG has applied national guidance and policies to the production of the financial statements and, as far as the CCG is aware, Arden and GEM CSU has followed the same process. No use has been made of financial instruments (including derivatives). There been no significant transactions that are outside the normal trading activities of our organisation in the 2014-15 financial year . There are no pension liabilities . The CCG is not impacted by interest rate changes. The CCG has established effective standard financial management arrangements, including:

• standing orders and standing financial instructions;• committee structures, including the Audit Committee and the Finance and Performance Committee (and then the Finance and Activity Committee);• scheme of reservation and delegation;• internal financial/management reporting;• key financial systems such as accounts payable and receivable, cash and bank;• internal audit, including arrangements for liaison between internal audit and the Arden and GEM CSU’s commissioning support unit’s internal audit provider; and • counter-fraud and corruption .

We certify that the clinical commissioning group has complied with the statutory duties laid down in the National Health Services Act 2006 (as amended).

SUSTAINABILITY REPORT

There is a clear need for the NHS to take a lead in energy reduction to reduce the impact that healthcare activities have on the environment, to improve health, to improve sustainability and to reduce expenditure on energy. The NHS aims to reduce its carbon footprint by 10 per cent between 2009 and 2015 .

Reducing the amount of energy used in our organisation contributes to this goal. We remain committed to supporting the NHS in achieving the challenging national targets and acknowledge the responsibility we have to our patients, local communities and the environment by working hard to minimise our footprint .

All of the energy use relating to the CCG’s operations arises from occupation of rented office spaces. The CCG operates from a single unit based in Thurmaston, Leicestershire. The property is leased and Raynsway are the landlords with NHS Horizons supporting the building maintenance through a contract with a facility management team .

Climate change brings new challenges to our business, in direct effects to the healthcare estates but also to patient health . Examples in recent years have included the effects of heat waves and prolonged periods of cold, floods and droughts .

Greenhouse Gas Emissions The majority of greenhouse gas emissions attributable to the CCG’s activities are likely to come from energy used in the buildings the organisation occupies and from the business travel that staff undertake . Greenhouse gas emissions information will be published in future annual reports .

Business travel makes a significant contribution to the greenhouse gas emissions from NHS England’s activities.

Procurement The CCG’s standard terms and conditions of contract, which are referenced on all purchase orders, have given consideration to sustainability . They include requirements for timely payment of sub-contractors and requirements for suppliers to give consideration to environmental factors and to act in accordance with all applicable law relating to the environment and the disposal of goods .

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Health & Wellbeing The benefit to individuals, the CCG and the broader economy that a healthy, committed and engaged workforce can create is at the core of the organisation’s approach to employee health and wellbeing . Through the Organisational Development Plan the CCG aims to develop into an excellent organisation and an exemplary employer, with a particular focus on the health and wellbeing of the people that work within the organisation .

Organisations are being encouraged to develop a local strategy, measure their success with regular reporting, and evaluate their progress as well as joining up with local Health and Wellbeing Boards.

Sustainability issues are included in our analysis of risks facing our organisation, there is a statutory duty to assess the risks posed by climate change and the outcome of these risk assessments inform the review and management of the local policies and procedures in place . We are reviewing our business continuity policy and plans to address the potential need to adapt the organisation’s activities and infrastructure to climate change and adverse weather events . One of the ways in which we will measure our impact as an organisation on corporate social responsibility is through the use of the good corporate citizenship (GCC) tool .

During 2014-15 we have undertaken an initial assessment and compiled our Sustainable Plan which includes an action plan. The action plan seeks to achieve measurable sustainable development objectives in accordance with the NHS national strategy. The CCG seeks to implement the principles of sustainability within commissioning, and in respect to consumption of energy and procurement of supplies, by minimising waste, reducing unnecessary travel and providing training .

For 2015-2018 the action plan will focus on:• Staff awareness• Waste, energy and carbon reduction• Travel and transport .

EQUALITY AND DIVERSITY REPORT

NHS East Leicestershire and Rutland CCG is committed to improving equality and respect to the whole of the community as well as patients, CCG employees and potential employees . We are committed to treating everyone who we come into contact with fairly and not discriminate against anyone because of their age, disability, gender, gender reassignment, pregnancy and maternity, race, religion or belief, sexual orientation or whether they are married or in a civil partnership .

Our aim is to ensure that we commission accessible, high-quality health services, working on prevention and intervention initiatives aimed at reducing health inequalities and establishing a culture of inclusion that enables us to meet the needs of all our diverse communities within the organisation’s culture, employment practices and commissioning systems .

Public Sector Equality Duty (PSED)The CCG aims to meet the requirements of the Public Sector Equality Duty (PSED) and the ‘three aims’ of the duty. The ‘three aims’ are to have due regard to the need to: • eliminate unlawful discrimination, harassment, victimisation and any other conduct that is prohibited by or under act • advance equality of opportunity between people who share a relevant protected characteristic and those who do not share it, and • foster good relations between persons who share a relevant protected characteristic and persons who do not share it .

The Equality Act 2010 also outlines specific duties on public bodies to meet the PSED more effectively. These specific duties are to:• Publish information to demonstrate their compliance with the Equality Duty at least annually; and• Set equality objectives at least every four years .

In October 2013 the CCG approved 3 equalities objectives aligned to the Two Year Operating Plan and published equalities information in January 2014.

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The CCG’s Equality Objectives for 2013–2015 are set out below:

i) Addressing needs of older people and access to services

Year 1 - undertake baseline to identify what access looks like at present and identify gaps . Aligning this to the duty to have regard to reducing health inequalities, improving access and health outcomes .

Year 2 - review the results of the baseline and identify areas to address / change . Develop plans for improving access for older people as identified through the baseline .

ii) Targeting provision and access to seldom heard people and groups – travelling families, BME, LGBT, rural deprivation

Year 1 - define what is meant by “seldom heard individuals, groups / communities” in relation to East Leicestershire and Rutland population in comparison to Leicester, Leicestershire and Rutland . Review how the CCG is currently engaging with these groups and how these mechanisms can be strengthened . Identify and map existing mechanisms of engagement through which the CCG accesses / or can access these groups / communities to gather intelligence . Consider how the CCG engages with the local authorities in strengthening engagement with these groups / communities .

Year 2 - using the information / intelligence gathered in year 1, identify how the CCG is going to target / prioritise provision .

iii) Access to early intervention and prevention of Mental Health issues

Year 1 - evaluate and understand local mental health issues in relation to young people and other groups . Review access to early intervention and identify what is currently available in order to prioritise and improve health outcomes across East Leicestershire and Rutland .

Year 2 - baseline to be undertaken will determine actions for year 2 . For example this could be work with young people to identify mechanisms for improving access to mental health services . Year 2 will be about using the information to improve outcomes for patient and prioritise mental health services .

The equality objectives have been developed to make sure that they are relevant with focus on outcomes for our patients and are aligned with the CCG’s strategic aims and refreshed commissioning intentions .

During 2014-2015 the CCG has made positive progress against the public sector equality duty and achieving our equality objectives . Our achievements include the following: • focussed outreach work to enable the CCG to seek the views of representatives from each of the nine protected characteristics on the future of urgent care services in the area;• the Better Care Together Programme has launched an engagement campaign to ascertain the impact the Programme is having on patients, this includes engagement with seldom heard groups including Learning Disability groups;• development of a Community Services Strategy in 2014-15 to deliver our vision to meet the needs of an increasing older population, particularly the frail and those with long term conditions through ‘a fully integrated, co-ordinated model for health and social care, delivering seven day services that puts peoples’ care needs at the centre .’ This Strategy is primarily concerned with the service pathways for Frail Older People and Long-Term Conditions delivered in the settings of ‘Self Care, Education and Prevention’, ‘Community and Social Care Services’ and ‘Crisis Response, Reablement and Discharge;• Membership of ELR CCG’s advisory Public and Patient Engagement Group (PPEG) has also been reviewed and invitations to join this group have been extended to groups / individuals representing the nine characteristics;• we continue into 2015-16 with the listening booth which will be visiting a range of community and voluntary groups to try to access the views of seldom heard groups in particular . We will also be paying particular attention to those areas of deprivation within our CCG area .

We continue to work in conjunction with local partners such as our neighbouring CCGs, our providers, Leicestershire County Council, Rutland County Council, our local District and Borough Councils and the voluntary sector – to create and maximise shared opportunities for communication and engagement enabling and promoting equality, human rights and inclusion .

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PUBLICATION OF INFORMATION

The CCG has used the Equality Delivery System 2 (EDS2) as the framework to evidence compliance with the Public Sector Equality Duty over the last year. EDS2 is a tool to support organisations to continuously improve their equality performance and to help meet the requirements of the public sector Equality Duty of the Equality Act 2010 . EDS2 has four goals supported by eighteen outcomes . The four goals are: • Better health outcomes; • Improved patient access and experience; • A representative and supported workforce; and• Inclusive leadership .

In meeting the duty to publish information the CCG has collected evidence, which should provide an understanding of how the CCG is approaching equality and inclusion in its activities .

The table of evidence which we published on our website, at: www .eastleicestershireandrutlandccg .nhs .uk/equality-diversity-and-human-rightsdemonstrates how the CCG has approached equality and inclusion and how it will be continuing to develop this over the next year in line with its strategic priorities and equality objectives .

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WORKFORCE

NHS East Leicestershire and Rutland CCG employed 85 members of staff (headcount figure as at 31 March 2015) and, therefore it is not required to produce detailed staff profiles by protected characteristics. This also protects the privacy of employees as any profiles of protected characteristics may allow individuals to be identified. The table below provides an overview of the number of persons of each sex who were on the Governing Body and the number of persons of each sex who were employees of the CCG as at 31 March 2015:

Sex All employees Governing BodyAll members of the Governing

Body

GP members on the Governing

BodyDisclosed 85 16 8

Female 69 5 1

Male 16 11 7

Total 85 16 8

The CCG is committed to ensuring the working environment is inclusive and appropriate support is provided to any member of the organisation that may require it .

All of the CCG’s internal workforce policies have been developed, and continued to be updated, in line with current legislative requirements, including the Equality Act 2010 .

These policies cover the recruitment, selection and appointment process as well as all aspects of working for the CCG, including:• giving full and fair consideration to applications for employment made by disabled persons, having regard to their particular aptitudes and abilities;• continuing the employment of, and for arranging appropriate training for, employees who have become disabled persons during the period; and• training, career development and promotion of disabled employees .

In addition, the CCG has developed its organisational vision and values to support continued organisational development in supporting and valuing the diversity of its employees and creating an inclusive working environment .

INFORMATION RELATING TO ACTIVITIES OF THE CCG

In order to structure the available evidence that demonstrates how the CCG is working to meet the Public Sector Equality Duty (PSED), the CCG utilised the following guidance:• Technical Guidance of the Public Sector Equality Duty England, Equality and Human Rights Commission (EHRC), Jan 2013;• Equality Delivery System (EDS) and EDS2, NHS England, Nov 2013.

Equality and inclusion work is an on-going activity for the CCG that will be consistently incorporated across all of its functions .

Karen English Managing Director (Accountable Officer)

28 May 2015

Table 7: Workforce

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Members’ Report NHS East Leicestershire and Rutland Clinical Commissioning Group (ELR CCG) is led by a Governing Body comprising elected GP members, a secondary care clinician and lead nurse and independent lay members as detailed below .

Name Position

Mr Graham Martin Lay Chair

Dr Andrew Ker (from 1 July 2014) Clinical Vice Chair

Dr Richard Palin (from 1 July 2014) Clinical Vice Chair

Mrs Karen English (interim Managing Director from 1 January 2015; substantive Managing Director from 4 March 2015)

Managing Director (Accountable Officer)

Dr Nicholas Glover Blaby and Lutterworth GP Locality Lead

Dr Graham Johnson Blaby and Lutterworth GP Locality Lead

Dr Hilary Fox (from 1 July 2014) Melton, Rutland and Harborough GP Locality Lead

Dr Richard Hurwood Melton, Rutland and Harborough GP Locality Lead

Dr Girish Purohit(from 1 September 2014)

Melton, Rutland and Harborough GP Locality Lead

Dr Vivek Varakantam(from 1 September 2014)

Oadby and Wigston GP Locality Lead

Mr Warwick Kendrick Independent Lay Member

Mr Alan Smith Independent Lay Member

Dr Tabitha Randell Consultant Paediatric Endocrinologist (secondary care clinician)

Mrs Carmel O’Brien Chief Nurse and Quality Officer

Mrs Donna Enoux Interim Chief Finance Officer

Mrs Jane Chapman Chief Strategy and Planning Officer

Mr Tim Sacks Chief Operating Officer

Dr Tim Daniel Consultant in Public Health Medicine (in attendance)

Table 8: Members’ Report

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GOVERNING BODY MEMBERS’ PROFILES

Mrs Karen EnglishManaging Director (Accountable Officer)4 March 2015 to date

Interim Managing Director1 January 2015 - 3 March 2015

Chief Finance Officer and Deputy Accountable OfficerJanuary 2013 - 31 December 2014

Karen joined East Leicestershire and Rutland Clinical Commissioning Group as chief finance officer in January 2013 and was appointed as Managing Director in March 2015 after a rigorous assessment process .

She studied BA (Hons) in Business Studies at Liverpool, and a Post Graduate Diploma in Managing and Commissioning in Primary Care in Southampton in 2005 .

Since joining the NHS as a Graduate Trainee from the private sector in 1983, Karen has held a range of senior finance roles for a variety of NHS organisations. Her wealth of experience includes working at an executive level within the NHS and she has substantial and successful experience as a senior finance professional in complex health environments in the North West and West Midlands .

Karen is a member of the Institute of Public Finance and Accountancy (CIPFA) and a CIPFA consultation panel member.

Dr David BriggsManaging Director (Accountable Officer)To 31 January 2015

Dr Briggs qualified as a doctor in 1996 after studying at Leicester Medical School. He became a GP Principal practicing in Melton Mowbray in 2001 and was a professional executive committee member for NHS Leicestershire County and Rutland Primary Care Trust for five years until Clinical Commissioning Groups (CCGs) formed .

In April 2011, as part of reforms to the NHS, Dr Briggs was elected by his peers to the role of clinical chair of East Leicestershire and Rutland Clinical Commissioning Group (ELR CCG) .

Throughout 2011/12 his ability to place clinicians at the forefront of decision making strengthened leadership within ELR CCG . Dr Briggs was appointed to the role of managing director (the organisation’s accountable officer), leaving full-time general practice . Dr Briggs left ELR CCG in January 2015 to resume his practice as a GP.

In addition to managing the business of ELR CCG, Dr Briggs played a key leadership role across the local NHS as part of the collaborative working arrangements between the three Leicester, Leicestershire and Rutland CCGs .

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Mr Graham MartinChair

Mr Martin worked in the NHS for over ten years and has recently retired from leading the European operations of a large international management consulting firm.

He is an advisor on healthcare and human resource issues to Management consulting firms and is a practicing Executive Coach .

He has long-standing connections with the NHS and has been a non-executive director for Nottingham City Hospital NHS Trust, a lay member with the Leicestershire County and

Rutland community services board and more recently with East Leicestershire and Rutland Clinical Commissioning Group .

Mr Martin holds an MA(Econ), Post graduate Diploma in Management Studies and is a Fellow of the Charted Institute of Personnel and Development

Dr Andy KerClinical Vice Chair 1 July 2014 to date

Locality lead - Melton, Rutland and HarboroughTo 31 June 2014

Dr Andy Ker is a senior partner at Oakham Medical Practice in Rutland.

In 1983 he trained as a doctor at Westminster Medical School in London, achieving a MBBS, and then completed his GP Vocational Training in Guildford in 1987. He went on a travelling “gap year” in 1989 where he ended up working for six

months in general practice in Christchurch, New Zealand .

He started work as a GP in Oakham in 1990 and has a particular interest in the musculoskeletal system. He has also worked as an appraiser and trainer of GPs and been a prison medical officer.

Dr Ker is a governing body member for East Leicestershire and Rutland Clinical Commissioning Group and one of the Clinical Vice Chairs .

He is the clinical lead for community services and out of county contracts. His project work includes leading the dementia strategy and developing the integrated health and social care strategy, and he also represents the CCG on the Rutland Health and Wellbeing Board.

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Dr Richard PalinClinical Vice Chair 1 July 2014 to date

Locality lead – Oadby and WigstonTo 31 June 2014

Dr Palin has been a GP Partner at Bushloe End Surgery in Wigston since 2004. He is currently the locality lead representing practices in Oadby and Wigston and a governing body member .

He is one of the Clinical Vice Chairs on the Governing Body .

Dr Graham JohnsonLocality lead – Blaby and Lutterworth

Dr Johnson is a partner at Wycliffe Medical Practice in Lutterworth.

He attended the University of Nottingham Medical School where he achieved a first class BMedSci (hons) degree in 1992, followed by a BMBS (hons) in 1994 . In 1995 he worked at the Queen’s Medical Centre hospital in Nottingham, before completing a GP Vocational Training Scheme in Nottingham from 1995-1998 . In 1998 Dr Johnson qualified as a GP and started work at Wycliffe Medical Practice.

His areas of interest include prescribing and cardiovascular medicine, and between 2006 and 2010 he worked as a clinical assistant in cardiology at Glenfield Hospital in Leicester.

He is a governing body member for East Leicestershire and Rutland Clinical Commissioning Group (ELR CCG) and is the clinical lead for mental health across the three CCGs in Leicester, Leicestershire and Rutland .

One of two locality leads for Blaby and Lutterworth, Dr Johnson is also a member of the ELR CCG quality and clinical governance committee and is one of two board members on the Leicester, Leicestershire and Rutland Serious Incident review group . .

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Dr Nick GloverLocality lead – Blaby and Lutterworth

Dr Nick Glover gained a Bachelor of Medicine and Bachelor of Surgery (MBChB) degree at Leicester Medical School in 1992 and a Diploma Royal College of Obstetricians and Gynaecologists (DRCOG) in 1996. He completed his training in general practice in Leicester (MRCGP) in 1996 and becoming a GP partner at Northfield Medical Centre in Blaby in 1997.

He has been training doctors coming into general practice since 2005 .

Dr Glover is the locality lead for Blaby and Lutterworth and a GP governing body member. With a main responsibility for primary care, he sits on the quality and clinical governance committee, the primary care development group, and the serious incident sign-off group .

Dr Richard S HurwoodLocality lead – Melton, Rutland and Harborough

Dr Richard Hurwoodhas worked at The County Practice based at Syston Health Centre since 1984, becoming a senior partner in 2000. He studied medicine at Guy’s Hospital medical school in London and graduated MBBS from The University of London in 1977 .

Dr Hurwood has been involved in GP and medical student education, and has served on South Charnwood Primary Care Group and Melton, Rutland and Harborough Primary Care Trust’s Professional Executive Committee. He

was also a member of Rutland Accident Care Scheme (now EMICS) from 1997 to 2004. He has served as an officer in the Territorial Army and is a Deputy Lieutenant of Leicestershire .

He represents the Syston, Long Clawson and Melton Mowbray practices within the Melton, Rutland and Harborough locality and is a governing body member with portfolio responsibilities for prescribing and urgent care .

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Dr Hilary Fox Locality lead - Melton, Rutland and Harborough

Dr Hilary Fox is a GP in Uppingham, Rutland, and locality lead for Melton, Rutland and Harborough. She is a GP trainer and a GP appraiser for NHS England. Her CCG portfolio includes planned care and end of life care .

Dr Hilary Fox graduated from the University of Leicester in 1985. In 2013 Hilary was appointed a Fellow of the Royal College of General Practitioners. She also holds the Diploma in Child Health, and the Diploma of the Royal College of

Obstetricians and Gynaecologists plus a Masters in Sports and Exercise Medicine .

After GP training on the Leicester Vocational Training Scheme, she became a partner at Market Harborough Medical Centre before moving to Uppingham in 2001 . She has an interest in sports injury and health promotion through exercise, and in family planning including IUD (coil) fittings. She is a GP trainer and clinical governance lead for the practice and a GP appraiser for NHS England. In July 2014 she was appointed to the governing body of East Leicestershire and Rutland Clinical Commissioning Group .

In her spare time Dr Fox is a keen cyclist, church bell-ringer and French Horn player .

Dr Girish PurohitLocality lead - Melton, Rutland and Harborough

Dr Girish Purohit is the locality lead for Melton, Rutland and Harborough.He is currently a GP Principal at the Jubilee Medical Practice in Syston, where he has been since July 2012 .

He previously held the posts of Clinical Lead for Service Innovation and Improvement and a Teaching Lead in Hammersmith and Fulham Primary Care Trust.

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Dr Vivek Varakantam Locality lead - Oadby and Wigston

Dr Vivek Varakantam is the GP locality lead in Oadby and Wigston .

He has been a partner at the Croft Medical Centre in Oadby since 2009 .

He also works as a GP Appraiser and GP Registrar Associate Trainer, provides foundation year-two training to those on the way to becoming GPs, and tutors University of Leicester medical students at his practice .

Dr Tabitha RandellSecondary Care Clinician

Dr Tabitha Randell has been a consultant paediatrician since 2003 .

She graduated from Manchester Medical School in 1992 with an MBChB degree and further qualified as MRCP(UK) in 1996 and FRCPCH in 2005 .

After completing specialist paediatric training in the West Midlands and Sydney, Australia, Dr Randell worked as a consultant paediatrician at Stafford General Hospital from March 2003 to October 2005 . She then became consultant

in paediatric endocrinology and diabetes at Nottingham University Hospitals in October 2005, and is the Deputy Head of Service for Nottingham Children’s Hospital.

She has been the secondary care representative on East Leicestershire and Rutland Clinical Commissioning Group’s governing body since November 2012 .

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Mrs Donna EnouxInterim Chief Finance Officer1 January 2015 to date

Mrs Donna Enoux joined East Leicestershire and Rutland Clinical Commissioning Group in June 2013 as Deputy Chief Finance Officer and became Interim Chief Finance Officer in January 2015 .

She studied a Genetics Degree at Sheffield University and joined the NHS in 1999 as part of the National Financial Management Training Scheme . During

this time she undertook a variety of NHS work placements whilst studying for her CIMA Accountancy qualification which she obtained in 2003.

Previous to joining the CCG she held senior finance posts in Acute and Non Acute Provider Trusts, Primary Care Trusts and NHS England.

Mrs Carmel O’BrienChief Nurse and Quality Officer

Mrs Carmel O’Brien took up the role of Chief Nurse and Quality Officer for East Leicestershire and Rutland Clinical Commissioning Group in May 2012 .

She has a strong background in quality and patient safety, with over 25 years’ experience in both clinical and management roles across acute, community and primary care .

Mrs O’Brien studied in the West Midlands, becoming a registered general nurse in 1989

and a registered midwife in 1991, and worked for three years as a midwife in Australia. She has a BA in Health Studies and a Masters in Leadership across Health and Social Care.

She was previously the associate director for nursing and quality for NHS Leicestershire County and Rutland Community Health Services and the associate director for quality for NHS Leicestershire County and Rutland Primary Care Trust .

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Mr Tim SacksChief Operating Officer

Mr Tim Sacks joined the NHS in 2003 through the national management training scheme, bringing eight years work experience in the private sector from a large insurance company and a Masters in Health Care Management.

Following strategic and operational roles in West Kent PCT, Medway Foundation Trust and the NHS Confederation, he moved to the Leicester, Leicestershire and Rutland health community in 2005 and carried out predominately operational roles at Leicester University Hospitals and as head of primary care at Leicestershire County and

Rutland PCT.

He joined East Leicestershire and Rutland Clinical Commissioning Group (ELR CCG) during its shadow period in 2011 and was appointed to his current role as chief operating officer in February 2013.

Tim welcomes the opportunity to work closely with GPs, stakeholders and patients to collaboratively deliver high quality care .

Jane ChapmanChief Strategy and Planning Officer

Jane Chapman began her career in health in 1996 when she joined Leicester Royal Infirmary. She held a variety of positions in both administration and management. Prior to this she was a weapon analyst with the Royal Navy and she served from 1976 until 1982 on HMS Excellent . She then worked within the retail sector and held a position as a training and development manager for Next from 1988 to 1996 .

She has spent all of her NHS career working in Leicestershire, apart from three years when she

worked for the Arden Cancer Network in Warwickshire . She was part of the award-winning Leicestershire Lung Cancer Team .

In 2003 she completed a post graduate diploma in Health and Social Care at De Montfort University. She joined Leicestershire County and Rutland Primary Care Trust in 2007 and was the associate director for the 18 weeks programme and then the deputy director of contracting, procurement and performance . She was appointed to her current role as chief strategy and planning officer for East Leicestershire and Rutland Clinical Commissioning Group in May 2012 .

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Mr Warwick KendrickIndependent Lay Member - Finance & Performance

Mr Warwick Kendrick studied accountancy at Birmingham College of Commerce and was admitted as a Fellow of the Chartered Institute of Management Accountants (FCMA) in 1982 .

He has held senior finance appointments including Group Financial Controller and Company Secretary of Vislink Plc, and senior posts with BOC Healthcare, Mannesmann Group and MacLellan Group Plc.

In 2001 Warwick established his own consultancy business providing accountancy services, financial and commercial advice, business development, strategic planning and general business advice to public and private companies .

Between 2006 and 2011 he was a Non Executive Director of Leicestershire County and Rutland Primary Care Trust and was Chair of the Audit Committee, and Finance and Performance, Charitable Funds and Competition and Procurement Committees. Following the NHS reforms, he was appointed an Independent Lay Member of East Leicestershire and Rutland Clinical Commissioning Group and chairs the Audit Committee and is a member of the Remuneration Committee .

Mr Alan SmithIndependent Lay Member

Mr Alan Smith has been an independent lay member of East Leicestershire and Rutland Clinical Commissioning Group since January 2013. He is a Governing Body and Audit Committee member, and also chairs the Finance and Performance and Remuneration Committees .

He has held a range of senior appointments during his career including group finance director and group managing director of Anglian Water plc, as well as working in local authority posts . He has also worked in non-executive, part-time

positions for several pharmaceutical and biotech companies including Acambis Plc, Avlar Bioventures, CeNeS Pharmaceuticals and Medical Device Innovations Ltd .

He is a member of the Chartered Institute of Public Finance and Accountancy (Honours) and completed an Advanced Management Programme at Harvard Business School in 1992 .

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MEMBERS OF COMMITTEES OF THE GOVERNING BODY

Members of the committees of the Governing Body are detailed within the Governance Statement . Details in respect of Governing Body members’ declarations of interest are as follows .

Declarations of Interest Register

Declarations of Interest - 2014 - 2015

Name Job Title Category 1 - Direc-torships

Category 2 - Remunerated employment, office, profession etc .

Category 3 - Appoint-ments

Category 4 - Mem-bership

Category 5 - Owner-ship

Category 6 - Share-holdings

Category 8 - Miscellaneous

Mrs Karen English (interim from 1 January 2015, substantive from 4 March 2015)

Managing Director

N/A N/A N/A Member of Chartered Institute of Public Finance and Accountancy .

Holds a 30% share in Graham English Con-sultancy Ltd (a consultan-cy business) .

N/A N/A

Dr David Briggs (until 31 January 2015)

Managing Director

N/A Returning to GP role in General Practice in early 2015 (reported on 8 December 2014) .

N/A Member of the Brit-ish Medical Associa-tion .

N/A N/A Former partner at Latham House Medical Practice.

Wife is a partner at St John’s Medical Cen-tre in Lincolnshire . This Practice is also a minor shareholder in Ladhams which is a provider of community care services .

Dr Nicholas Glover

GP Govern-ing Body Member, Blaby and Lutterworth Locality Lead

N/A GP Partner at Northfield Medi-cal Centre, Blaby .

GP Trainer, East Midlands Deanery .

N/A Member of the Royal College of General Practitioners, British Medical Association and member of the Leicestershire Local Medical Committee .

N/A The Northfield Medical Centre is a minor shareholder in Leicester, Leicestershire and Rutland Provider Company Ltd . (LLR Provider Company Ltd).

N/A

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Name Job Title Category 1 - Directorships

Category 2 - Remunerated employment, office, profes-sion etc .


Category 4 - Membership

Category 5 - Ownership



Dr Graham Johnson

GP Govern-ing Body Member, Blaby and Lutterworth Locality Lead

N/A GP Partner at Wycliffe Medi-cal Practice.

N/A Member of the Leicestershire Local Medical Committee

N/A Wycliffe Medical Practice is a minor shareholder in Leices-ter, Leicestershire and Rutland Provider Com-pany Ltd. (LLR Provider Company Ltd) .

N/A

Dr Hamant Mistry(until 30 June 2014)

GP Govern-ing Body Member, Melton, Rutland and Har-borough Locality Lead

N/A GP Partner at Market Harborough Medical Centre and Husbands Bosworth Sur-gery .

Practice is a provider of minor injury services .

N/A Fellow of Royal College of GPs and British Med-ical Association Member .

N/A Market Harborough Medical Centre and Husbands Bosworth Surgery are minor shareholders in Leices-ter, Leicestershire and Rutland Provider Com-pany Ltd (LLR Provider Company Ltd) .Shareholder Market Harborough Medi-cal Services Limited . Owner of Market Har-borough Pharmacy.

N/A

Dr Richard Hurwood (from October 2013)


N/A GP Principal at The County Practice Syston Health Cente.

Deputy Lieutenant of Leicester-shire

Member of British Medical Association .

Fellow Royal College of GPs.

Syston Health Consortium (1 of 10 part-ners owning Syston Health Centre)

The County Practice is a shareholder in Leicester, Leicester-shire and Rutland Provider Company Ltd. (LLR Provider Company Ltd) .

Registered with GP in the area .

Wife is an accu-puncturist in private practice .

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Cate-gory 3 - Appoint-ments





Dr David Andrew James Ker

GP Govern-ing Body Member, Clinical Vice Chair

N/A GP Partner in Oakham Medical Practice and Mar-ket Overton and Somerby Surgery .

Practice is a provider of minor injury services .

N/A Member of the British Medical Association and Royal College of General Practition-ers .

N/A Minor Shareholder in the Leicester, Leices-tershire and Rutland Provider Company Ltd. (LLR Provider Company Ltd) .

Oakham Medical Practice and Market Overton and Somerby Surgery are minority shareholders in The Leicester, Leicester-shire and Rutland Provider Company Ltd. (LLR Provider Company Ltd) .

Wife is a partner at Oakham Medical Practice and Market Overton and Somerby Surgery. The Practices are minority share-holders in The Leices-ter, Leicestershire and Rutland Provider Com-pany Ltd. (LLR Provider Company Ltd

Dr Richard Palin

GP Govern-ing Body Member, Clinical Vice Chair

N/A GP Partner at Bushloe End Sur-gery, Wigston .

GP at HMYOI Glen Parva. Leicestershire Partnership Trust Clinical Director HMYOI Glen Parva HMP Gartree and HMP Leicester .

N/A Member Royal College of General Practitioners and British Medical As-sociation Member .

N/A N/A N/A

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Dr Hilary Fox (from 1 July 2014)


N/A GP Partner at The Upping-ham Surgery, Northgate, Uppingham, Rutland, Leices-tershire .

GP Trainer (Health Ed-ucation East Midlands) .GP Appraiser for NHS Eng-land .

N/A Fellow Royal College of General Practitioners and British Medical As-sociation member .

N/A The Uppingham Surgery is a share-holder in the Leicester, Leicestershire and Rutland Provider Com-pany Ltd (LLR Provider Company Ltd) .

N/A

Dr Girish Puro-hit(from 1 Sep-tember 2014)


Director Holiday Club 4 Kids Ser-vices Ltd and Nurseries ‘R’ Us Ltd - child care and nursery manned by wife .

GP Partner at The Jubi-lee Medical Practice, Syston Health Centre, Syston, Leices-tershire .

N/A Member of the Royal College of General Practition-ers .

Member of the British Medical Association .

See Director-ship section .

The Jubliee Medical Practice is a share-holder in The Leices-ter, Leicestershire and Rutland Provider Com-pany Ltd (LLR Provider Company Ltd) .

Wife is dental practi-tioner at Briar Mead Dental Practice, Oadby .

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Dr Vivek Varakantam(from 1 Sep-tember 2014)

GP Govern-ing Body Member, Oadby and Wigston

Director Bush-by Lodge Med-ical Personal Health Services (Out of Hours)

GP Partner at The Croft Med-ical Centre, Oadby, Leices-ter .

N/A Member of the Royal College of General Practi-tioners and British Medical Associa-tion member .


Bushby Lodge Med-ical .

The Croft Medical Centre is a sharehold-er in the Leicester, Leicestershire and Rutland Provider Com-pany Ltd (LLR Provider Company Ltd) .

Wife is shareholder in Bushby Lodge Med-ical (medical services company) .

Wife commenced post in Interserve in care at home (therefore con-flicted with e.g. CHC) - March 2015 .

Mr Warwick Kendrick

Independ-ent Lay Member

N/A N/A N/A Member of Char-tered Institute of Management Ac-countants (CIMA) .

N/A N/A N/A

Mr Graham Anthony Mar-tin

Independ-ent Lay Chair

N/A Ad-hoc con-sulting work for Hay Group, an internation-al management consulting firm that does provide services for the NHS.Adviser for Beamans Management Consultants (Isle of Man) .

N/A N/A N/A N/A N/A

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Mr Alan Fred-erick Smith

Independ-ent Lay Member

N/A N/A N/A Member of the Chartered Institute of Public Finance and Accountancy .

N/A N/A N/A


N/A N/A N/A N/A N/A N/A Wife was a partner at Oakham Medical Practice (from 1st July 2013 - end February 2015) .

Mrs Carmel O’Brien

Chief Nurse and Quality Officer

N/A N/A N/A Member of Royal College of Nursing .

N/A N/A N/A

Mrs Donna Enoux (from 1 January 2015)

Interim Chief Finance Officer

N/A N/A N/A Member of the Chartered Institute of Management Accountants .

N/A N/A N/A

Mrs Jane Chapman

Chief Strat-egy and Planning Officer

Partner is owner of Hol-lyview Health – business consultancy, predominantly healthcare, likely to under-take business with the local NHS.

N/A N/A Member of the Institute of Health Care Management .


N/A Daughter is employed at University Hospi-tals of Leicester as a midwife .

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Category 2 - Remu-nerated employ-ment, office, profession etc .




Category 6 - Shareholdings


Dr Tim Daniel Consultant in Public Health Medicine

N/A Consultant in Public Health Medicine – Leicestershire Coun-ty Council (from 01 .04 .2013); East Midlands Public Health Foundation Programme Director for LNR; Salaried GP Kegworth and Gotham Medical Practice; Sessional GP for Nottingham Emergency Medical Services .

N/A Member of Royal College of General Practitioners and British Medical Association . Fel-low of Faculty of Public Health

N/A N/A Wife appointed as Non-Executive Director at Derby Hospitals Founda-tion Trust (since October 2014) .

Dr Tabitha Louise Randell

Consultant Paediatric Endocrinol-ogist (Board member: secondary care clini-cian)

N/A Consultant Paediatric Endocrinologist, Not-tingham University Hospitals NHS Trust. Clinical Lead for Paediatric Diabetes, NHS Diabetes (until 31 .03 .13) .

Associate Clinical Professor, Warwick Medical School .

N/A Member of British Society of Paediat-ric Endocrinology and Diabetes . Member of British Medical Associ-ation . Fellow of the Royal College of Paediatrics and Child Health.

N/A N/A Husband is em-ployed by Leices-tershire Partnership Trust as Paediatric Advanced Nurse Practitioner.

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Table 9: Declarations of Interest Register

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SICKNESS ABSENCE DATA

Employees as at 31 March 2015 - 85 (excluding Chair, Lay and GPs)

ELR CCG’s staff consisted of 85 employees at the end of the year . We recognise the valuable contribution made by each employee to the delivery of its services and we are committed to the promotion of their health, safety and well-being . The organisation is also committed to acting as a reasonable employer at all times in dealing with employees who suffer ill health or incapacity either of a temporary or permanent nature .

In order to maintain and promote a healthy organisation and ensure the continued provision of high quality patient care, it is essential that absence due to ill health is monitored and managed effectively and that managers and employees are aware of their responsibilities in this process . While accepting that some absence due to ill health is inevitable, high absence rates not only affect individuals but place increased pressure on colleagues which may ultimately lead to deterioration in services that ensure overall quality of patient care . To that end we are currently reviewing our Absence Policy to ensure it is fit for purpose.

Staff Sickness Absence 2014-15

Total number of staff years 73

Total Days Lost 814

Average absences per staff year 11 .1

The CCG’s absence rates outlined in the table above, at an average of 11 .1 days per employee per year is higher than the Public Services average, specifically within Health, of 9.6 days, in accordance to the CIPD. However, the average absence rates are affected significantly by a small number of staff who have taken long term sick leave . If the absence data for those 7 staff is removed then the average rate falls below the Public Service average.

PENSION LIABILITIES

There are no pension liabilities . See Financial Statements and Remuneration Report .

EXTERNAL AUDIT

The CCG’s external auditor is Grant Thornton UK LLP and the annual external audit fee for 2014-15 is £84,000 (inc VAT) relating to the statutory audit.

DISCLOSURE OF SERIOUS UNTOWARD INCIDENTS

We place high importance on ensuring there are robust information governance systems and processes in place to help protect patient and corporate information . There are processes in place for incident reporting and investigation of serious incidents relating to information governance. Please see our Governance Statement where details of disclosures required for incidents involving data loss or confidentiality breaches can be found. We can confirm that there have been no serious or untoward incidents relating to data security breaches, and no other incidents that were required to be reported to the Information Commissioner .

Table 10: Staff Sickness Absence

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PRINCIPLES FOR REMEDY

ELR CCG’s Policy for Dealing with Complaints is guided by the Principles of Good Complaints Handling published by the Parliamentary and Health Service Ombudsman for public bodies:• getting it right;• being customer focussed;• being open and accountable;• acting fairly and proportionately;• putting things right; and• seeking continuous improvement .

This is how we interpret the principles and how we will handle complaints:• complaints are dealt with efficiently and confidentially • complaints are properly investigated, monitored and recorded• complainants receive, so far as reasonably practicable, assistance to enable them to understand the procedure or advice on where assistance should be available• complainants receive a timely and appropriate response• complainants are told of the outcome of the investigation of their complaint and action is taken, if necessary, in the light of the outcome of a complaint• the process for dealing with complaints should be, and be seen to be, impartial and fair to both staff and complainant alike • complainants will be treated with respect and courtesy• complainants will not be discriminated against for making a complaint and making a complaint will not adversely affect future treatment• information will be provided to senior management to help services to be reviewed and improved • all complainants will receive a sympathetic and caring response and, where appropriate, an apology given or an expression of regret; and• staff will receive appropriate training in handling complaints .

EMPLOYEE CONSULTATION

The CCG is committed to informing, communication and consulting with the workforce as appropriate on its strategic direction, performance and delivery, and any proposed changes that may affect staff .

There are a number of mechanisms in place which include:• Bi-annual communication events for all CCG staff;• Formal consultation processes with staff and their representatives regarding any proposed changes that affect staff . During 2014-15 the CCG initiated two consultation processes, one regarding a proposed transfer of a small number of staff to an NHS provider and the other to restructure a team to create some roles that are aligned to primary care;• Informal partnership arrangements with trades unions via Arden GEM Commissioning Support Unit;• Monthly team briefings; and • Two weekly newsletter .

DISABLED EMPLOYEES

The Equality Report provides further detail about the CCG’s policy in relation to disabled employees .

EMERGENCY PREPAREDNESS, RESILIENCE AND RESPONSE

We certify that the clinical commissioning group has incident response plans in place, which are fully compliant with the NHS Commissioning Board Emergency Preparedness Framework 2013. The clinical commissioning group regularly reviews and makes improvements to its major incident plan and has a programme for regularly testing this plan, the results of which are reported to the Governing Body .

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STATEMENT AS TO DISCLOSURE TO AUDITORS

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

So far as the member is aware, that there is no relevant audit information of which the clinical commissioning group’s external auditor is unaware; and,

That the member has taken all the steps that they ought to have taken as a member in order to make them self aware of any relevant audit information and to establish that the clinical commissioning group’s auditor is aware of that information .


28 May 2015

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Remuneration Report As a public sector body, Clinical Commissioning Groups are required to disclose information about senior managers’ remuneration . The disclosure includes the remuneration of ‘those in senior positions having authority or responsibility for directing or controlling the activities of the NHS body’; this has been interpreted as Chief Officers, Lay member and GPs who are members of the CCG’s Governing Body .

The following information is subject to formal audit:• Table 12 Salaries and Allowances of senior managers and related narratives;• Table 13 Pensions Benefits of Senior Managers and related narratives; and • Statement on pay multiples and related narratives

The Remuneration Committee is made up of the following members:

Name Position

Mr Alan Smith Independent Lay Member, Remuneration Committee Chair

Mr Warwick Kendrick Independent Lay Member, Audit Committee Chair


The Remuneration Committee, which comprises of the Chairman of the Governing Body and the two Independent Lay Members, reviews the remuneration arrangements of its most senior managers including the sessional rates for GP members of the Governing Body, taking into account market rates and agenda for change pay awards determined nationally . The Committee held 5 meetings during 2014-15 all of which were quorate and attended by all three members .

Policy on Remuneration of Senior ManagersEast Leicestershire and Rutland Clinical Commissioning Group’s Accountable Officer is remunerated according to the Very Senior Manager (VSM) Framework. NHS England’s Remuneration Guidance for Chief Officers (where the senior manager also undertakes the accountable officer role) and Chief Finance Officers. This guidance has been used to set the Managing Director, Chief Finance Officer and Chief Nurse and Quality Officers’ salary.

All other chief officers employed by East Leicestershire and Rutland Clinical Commissioning Group are paid according to the NHS Agenda for Change pay scale at a level that is consistent with the contents of the officer’s job role.

East Leicestershire and Rutland Clinical Commissioning Group carried out regional benchmarking of Managing Director, GP and Lay member CCG Governing Body members’ remuneration rates for the annual review of remuneration . Decisions approved by the Remuneration Committee were presented to the Governing Body for noting . Remuneration for Lay members was reviewed and the Managing Director and the Lay Chair .

GP members are treated as office holders of the CCG. They are paid via the payroll, with deductions taken at source .

Senior managers’ performance related payThe Managing Director (accountable officer) is the only officer that is eligible to receive performance related pay under the VSM Framework . The Chair of the Governing Body assesses the accountable officer’s performance against the objectives and advises the Remuneration Committee accordingly . There were no bonus payments made in 2014-15 .

Policy on senior managers’ contractsAll chief officers, excluding the Managing Director, are employed under the agenda for change terms and conditions .

Table 11: Remuneration Committee

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Senior managers’ service contractsGP Member practices elected the GP members of East Leicestershire and Rutland CCG’s Governing Body to their posts for a period of three years . Six months’ prior notice must be given in writing by either party to terminate the agreement early . The Clinical Vice Chairs were appointed to their positions following expressions of interest put forward by GPs from member practices and an interview process .

The independent lay members are appointed for a term of 3 years from when they commenced in post . The secondary care clinician position on the Governing Body was appointed for three years from commencement in post following an open recruitment process .

Payments to Past Senior ManagersThere have been no payments outside of contractual entitlements made to CCG past senior managers in this financial year.

Salaries and allowancesTable12 shows the remuneration for all Governing Body members .

Salary includes:• all amounts paid or payable by the NHS body including recharges from any other health body• the gross cost of any arrangement whereby a senior manager• receives a net amount and an NHS body pays income tax on their behalf• any financial loss allowances paid in place of remuneration• geographical allowances such as London weighting, and• any other allowance which is subject to UK taxation and any ex-gratia payments .

Salary excludes:• recharges to any other health body• reimbursement of out-of-pocket expenses• reimbursement of “travelling and other allowances” (paid under determination order) including home to work travel costs• taxable benefits• employers’ superannuation and National Insurance contributions• performance related bonuses (these are recorded separately)• golden hellos and compensation for loss of office (these are recorded separately), and• any amount paid which the director must subsequently repay .

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SALARY & PENSION DISCLOSURE TABLESTable 12: Salaries and allowances

Name and title (a) Salary

(bands of £5,000)

(b) Expense pay-ments (taxa-

ble) to nearest £100

(c)Performance pay & bonus-es (bands of

£5,000)£000

(d)Long term per-formance pay &

bonuses (bands of £5,000)

£000

(e)All pension-relat-

ed benefits(bands of £2,500)

£000

(f)TOTAL (a-e)(bands of £5,000)

£000

Karen English -Managing Director and Accountable Officer

CFO to 31/12/14 . Appointed Interim Managing Direc-tor on 01/01/15 . Appointed to the substantive post on 04/03/15 .

2014-15 110-115 10 - 12 .5 125-130

2013-14 100-105 0 - 2 .5 105 - 110

Dr David Briggs - Managing Director and Accountable Officer

Left the post on 31/01/15 .

2014-15 120-125 10 - 12 .5 130-135

2013-14 140-145 22 .5 - 25 165 - 170

Jane Chapman -Chief Strategy and Planning Officer

2014-15 90-95 7 .5 - 10 100-105

2013-14 85-90 5 - 7 .5 95 - 100

Carmel O’Brien -Chief Nurse and Quality Officer

2014-15 80-85 25 - 27 .5 105 - 110

2013-14 75-80 67 .5 - 70 145 - 150

Timothy Sacks - Chief Operating Officer

Expenses payments and benefits in kind relates to a leased car .

2014-15 70-75 22 10 - 12 .5 80-85

2013-14 65-70 12 32 .5 - 35 100 - 105

Donna Enoux - Interim Chief Finance Officer

Appointed interim Chief Finance Officer with effect from 01/01/15 .

2014-1515-20 7 .5 - 10 25 - 30

Paul Sherriff - Chief Corporate Affairs Officer


2013-14 10-15 57 .5 - 60 70 - 75

74



(bands of £5,000)


ble) to nearest £100 £000


£5,000)£000



£000



£000


£000

Dr Hilary Fox - Locality Representative

Appointed on 01/07/14 . Locality Representatives are Office Holders and not employees of the CCG .

2014-15 45-50 n/a 45-50

Dr Nick Glover - Local-ity Representative

Locality Representa-tives are Office Hold-ers and not employ-ees of the CCG .

2014-15 60-65 n/a 60-65

2013-14 60-65 n/a 60-65

Dr Richard Hurwood – Locality Representative

Appointed on 01/10/13 . Locality Representatives are Office Holders and not employees of the CCG .

2014-15 60-65 n/a 60-65

2013-14 30-35 n/a 30-35

Dr Graham Johnson – Locality Representative

Locality Representa-tives are Office Hold-ers and not employ-ees of the CCG .

2014-15 70-75 n/a 70-75

2013-14 65-70 n/a 65-70

Dr Andy Ker – Clinical Vice Chair

Appointed to Clin-ical Vice Chair on 01/07/14 .

2014-15 65-70 n/a 65-70

2013-14 60-65 n/a 60-65

Dr Hamant Mistry – Locality Representative

Left the post on 30/06/14 . Locality Representatives are Office Holders and not employees of the CCG .

2014-15 20-25 n/a 20-25

2013-14 70 -75 n/a 70 -75

75



(bands of £5,000)


ble) to nearest £100 £000


£5,000)£000



£000



£000


£000

Dr Richard Palin – Clinical Vice Chair

Locality Represent-ative to 30/06/14 . Appointed to Clin-ical Vice Chair on 01/07/14 .

2014-15 65-70 n/a 65-70

2013-14 60-65 n/a 60-65

Dr Girish Purohit – Lo-cality Representative

Appointed to the CCG on 01/09/14 . Locality Representa-tives are Office Hold-ers and not employ-ees of the CCG .

2014-15 35-40 n/a 35-40

Dr Vivek Varakantam – Locality Represent-ative

Appointed to the CCG on 01/09/14 . Locality Representa-tives are Office Hold-ers and not employ-ees of the CCG .

2014-15 35-40 n/a 35-40

Dr Simon Wooding - Locality Representative

Left the post 09/09/2013 . Locality Representatives are Office Holders and not employees of the CCG .

2013/14 25-30 n/a 25-30

Dr Tabitha Randell - Secondary Care Clinician

Employed by Not-tingham University NHS Trust to whom the CCG reimburses a proportion of the salary .

2014-15 30-35 n/a 30-35

2013-14 30-35 n/a 30-35

76



(bands of £5,000)

(b) Expense

payments (taxable) to nearest £100

£000

(c)Performance pay & bonuses (bands of

£5,000)£000

(d)Long term

performance pay & bonuses (bands of

£5,000)£000

(e)All pension-

related benefits(bands of £2,500)

£000


£000

Dr Tim Daniels - Public Health Consultant

Employed by Leices-tershire County Council, there is no charge for the time .

2014-15 n/a n/a n/a n/a n/a n/a

2013/14 n/a n/a n/a n/a n/a n/a

Mr Graham Martin - Governing Body Chair

Independent Lay Member and not an employee of the CCG .

2014-15 30-35 n/a 30-35

2013/14 25-30 n/a 25-30

Mr Warwick Kendrick – Independent Lay Member


2014-15 10-15 n/a 10-15

2013/14 10-15 n/a 10-15

Mr Alan Smith – Inde-pendent Lay Member


2014-15 5-10 n/a 5-10

2013/14 5-10 n/a 5-10

Notes [1] The calculation of the remuneration information is in accordance with the guidance and includes all agreed remuneration allowances such as that for participating in on-call arrangements . [2] Pension benefits are applicable to all senior managers unless they wish to opt out of membership of the NHS pension scheme. The GP members of the governing body are not subject to this disclosure as they make their NHS pension scheme contributions via the GP solo arrangements. Similarly the Lay members of the governing body do not contribute to the NHS pension scheme and so are not subject to the disclosure.

Table 13: Salary and Pension Disclosure

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Table 13: PENSION BENEFITS

Name and title (a)Real in-

crease in pension

at age 60 (bands of £2,500)

£000

(b)Real in-

crease in pension

lump sum at aged 60(bands of £2,500)

£000

(c)Total accrued

pension at age 60 at 31 March 2015 (bands of £5,000)

£000

(d)Lump sum at

age 60 related to accrued

pension at 31 March 2015 (bands of £5,000)

£00

(e)Cash

Equivalent Transfer

Value at 1 April 2015

£000

(f)Real

increase in Cash Equiv-alent

Transfer Value£000

(g)Cash

Equivalent Transfer Value at 31 March

2015£000

(h)Employer’s contribu-tion to

stakeholder pension

£000

Karen English -Managing Director and Accountable Officer

CFO to 31/12/14 . Appoint-ed Interim Managing Director on 01/01/15 . Appointed to the substan-tive post on 04/03/15 .

2014-15 0 - 2 .5 (0) - (2 .5) 20 - 25 55 - 60 455 507 39 n/a

2013-14 0 - 2 .5 (0) - (2 .5) 20 - 25 55 - 60 398 455 49 n/a

Dr David Briggs - Managing Director and Accountable Officer


2014-15 0 - 2 .5 2 .5 - 5 10 - 15 40 - 45 175 201 18 n/a

2013-14 0 - 2 .5 5 - 7 .5 10 - 15 35 - 40 142 175 30 n/a

Jane Chapman – Chief Strategy and Planning Officer

2014-15 0 - 2 .5 2 .5 - 5 10 - 15 40 - 45 247 280 26 n/a

2013-14 0 - 2 .5 0 - 2 .5 10 - 15 35 - 40 222 247 21 n/a

Carmel O’Brien - Chief Nurse and Quality Officer

2014-15 0 - 2 .5 2 .5 - 5 25 - 30 85 - 90 447 501 41 n/a

2013-14 2 .5 - 5 10 - 12 .5 25 - 30 75 - 80 369 447 70 n/a

Timothy Sacks - Chief Operating Officer

2014-15 0 - 2 .5 0 - 2 .5 10 - 15 30 - 35 130 149 16 n/a

2013-14 0 - 2 .5 5 - 7 .5 5 - 10 25 - 30 99 130 28 n/a

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Name and title (a)Real in-

crease in pension

at age 60 (bands of £2,500)

£000

(b)Real in-

crease in pension

lump sum at aged 60(bands of £2,500)

£000

(c)Total accrued

pension at age 60 at 31 March 2015 (bands of £5,000)

£000

(d)Lump sum at

age 60 related to accrued

pension at 31 March 2015 (bands of £5,000)

£00

(e)Cash

Equivalent Transfer

Value at 1 April 2015

£000

(f)Real

increase in Cash Equiv-alent

Transfer Value£000

(g)Cash

Equivalent Transfer Value at 31 March

2015£000

(h)Employer’s contribu-tion to

stakeholder pension

£000

Donna Enoux - Interim Chief Finance Officer

Appointed interim Chief Finance Officer with effect from 01/01/15 .

2014-15 0 - 2 .5 0 - 2 .5 10 - 15 40 - 45 202 226 5 n/a

Dr Tabitha Randell - Secondary Care Clini-cian

Employed by Nottingham University NHS Trust to whom the CCG reimburses a proportion of the salary .

2014-15 n/a n/a n/a n/a n/a n/a n/a n/a

Dr Tim Daniels - Public Health Consultant

Employed by Leicester-shire County Council, there is no charge for the time .

2014-15 n/a n/a n/a n/a n/a n/a n/a n/a

Table 12: Pension Benefits

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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 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 membership of the pension scheme . This may be for more than just their service in a senior capacity to which disclosure applies (in which case this fact will be noted at the foot of the table). 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 CETVThis reflects the increase in CETV effectively funded by the employer. It takes account of the increase in accrued pension due to inflation, contributions paid by the employee (including the value of any benefits transferred from another scheme or arrangement) and uses common market valuation factors for the start and end of the period .

Pay MultiplesReporting bodies are required to disclose the relationship between the remuneration of the highest paid Director in their organisation and the median remuneration of the organisation’s workforce .

The mid-point of the banded remuneration of the highest paid member of the Governing Body in the Clinical Commissioning Group as at March 2015 on an annualised basis was £132,500 (2013-14 - £140,000 to £145,000). This was 4 .03 (2013-14 - 4 .05) times the median remuneration of the workforce, which was £32,898 (2013-14 - £34,530).

In 2014-15, no employees received remuneration in excess of the highest-paid member of the Governing Body . Total remuneration includes salary, non-consolidated performance-related pay and benefits in kind. It does not include severance payments, employer pension contributions and the cash equivalent transfer value of pensions .

Exit PackagesThere were no exit packages made during 2014-15 to individuals named in the Remuneration report in Table 12 .

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Off-payroll engagements

Off-payroll engagements as of 31 March 2015, for more than £220 per day and that last longer than six months are as follows:

Number

Number of existing engagements as of 31 March 2015 9

Of which, the number that have existed:

for less than one year at the time of reporting 3

for between one and two years at the time of reporting 4

for between 2 and 3 years at the time of reporting 2

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

For all new off-payroll engagements between 1 April 2014 and 31 March 2015, for more than £220 per day and that last longer than six months:

NumberNumber of new engagements, or those that reached six months in duration, between 1 April 2014 and 31 March 2105

10

Number of new engagements which include contractual clauses giving East Leicestershire and Rutland CCG the right to request assurance in relation to income tax and National Insurance obligations

Number for whom assurance has been requested 10

Of which:

assurance has been received 10

assurance has not been received 0

engagements terminated as a result of assurance not being received

0

Number

Number of off-payroll engagements of board members, and/or senior officers with significant financial responsibility, during the year

0

Number of individuals that have been deemed “board members, and/or senior officers with significant financial responsibility” during the financial year. This figure includes both off-payroll and on-payroll engagements

0


28 May 2015

Table 14a: Off-payroll engagements

Table 14b: Off-payroll engagements

Table 14c: Off-payroll engagements

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Statements by the Accountable OfficerSTATEMENT OF THE MANAGING DIRECTOR’S RESPONSIBILITIES AS THE ACCOUNTABLE OFFICER OF NHS EAST LEICESTERSHIRE AND RUTLAND CLINICAL COMMISSIONING GROUP

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

The responsibilities of an Accountable Officer, including responsibilities for the propriety and regularity of the public finances for which the Accountable Officer is answerable, for keeping proper accounting records (which disclose with reasonable accuracy at any time the financial position of the Clinical Commissioning Group and enable them to ensure that the accounts comply with the requirements of the Accounts Direction) and for safeguarding the Clinical Commissioning Group’s assets (and hence for taking reasonable steps for the prevention and detection of fraud and other irregularities), are set out in the Clinical Commissioning Group Accountable Officer Appointment Letter.

Under the National Health Services Act 2006 (as amended), NHS England has directed each Clinical Commissioning Group to prepare for each financial year financial statements in the form and on the basis set out in the Accounts Direction .

The financial statements are prepared on an accruals basis and must give a true and fair view of the state of affairs of the Clinical Commissioning Group and of its net expenditure, changes in taxpayers’ equity and cash flows for the financial year.

In preparing the financial statements, the Accountable Officer is required to comply with the requirements of the Manual for Accounts issued by the Department of Health 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 Manual for Accounts issued by the Department of Health have been followed, and disclose and explain any material departures in the financial statements; and,• Prepare the financial statements on a going concern basis.

To the best of my knowledge and belief, I have properly discharged the responsibilities set out in my Clinical Commissioning Group Accountable Officer Appointment Letter .


28 May 2015

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GOVERNANCE STATEMENT

Introduction and ContextThe clinical commissioning group was licensed from 1 April 2013 under provisions enacted in the Health and Social Care Act 2012, which amended the National Health Service Act 2006.

NHS East Leicestershire and Rutland Clinical Commissioning Group (ELR CCG or the CCG) is a clinically led membership organisation which comprises 32 GP member practices across three localities: Melton Mowbray, Rutland and Market Harborough; Oadby and Wigston; and Blaby and Lutterworth. The CCG is responsible for commissioning healthcare services for patients across the three localities . Information about the commissioning priorities and the population the CCG serves can be found in the Strategic Report .

There is a need to demonstrate probity and governance commensurate with our considerable responsibilities for our patients’ healthcare and taxpayers’ money . This means ensuring that we have open, robust and transparent processes which will give the communities we service the confidence that, through the appropriate governance arrangements, we can demonstrate how we will play our part in ensuring that the services our patients receive are safe and delivered with care and compassion .

Scope of responsibilityAs 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 in my Clinical Commissioning Group Accountable Officer Appointment Letter.

I am also 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.

Compliance with the UK Corporate Governance CodeWe are not required to comply with the UK Corporate Governance Code . However, we have reported on our Corporate Governance arrangements by drawing upon best practice available, including those aspects of the UK Corporate Governance Code we consider to be relevant to the CCG and best practice .

For the financial year ended 31 March 2015, and up to the date signing this statement, the CCG has applied the principles of the Code as we have considered relevant to the CCG including drawing on other best practice available . This is evident, for example through the following:• there was clear division of responsibilities between the Membership Body, the Governing Body and the executive responsibilities for running the organisation . The Chair was responsible for leading the Governing Body and ensuring it is effective in its role, and organising appropriate development sessions support the Governing Body’s role;• the Committees of the Governing Body consisted of a balance of skill, knowledge, independence and experience for them to carry out duties and responsibilities;• information was supplied to the Governing Body and its committees in a timely manner and of a quality that enables the clinical commissioning group to discharge its duties;• the Governing Body assessed the nature and extent of the significant risks it is willing to take in achieving the strategic objectives of the clinical commissioning group; and it maintains a sound system of risk management and internal control; and• The Remuneration Committee had oversight of the arrangements in relation to policy on the remuneration of members of the Governing Body

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The Clinical Commissioning Group Governance FrameworkThe National Health Service Act 2006 (as amended), at paragraph 14L(2)(b) states:

The main function of the governing body is to ensure that the group has made appropriate arrangements for ensuring that it complies with such generally accepted principles of good governance as are relevant to it .

The clinical commissioning group has in place a Constitution, which provides its corporate governance framework, as agreed by its member practices . The CCG’s Constitution consists the following: information about the membership, Standing Orders, Scheme of Reservation and Delegation and Prime Financial Policies. The Scheme of Reservation and Delegation clearly details matters reserved to the membership and authority delegated to the Governing Body, its committees and officers.

The clinical governance group reviewed its Constitution in May 2014 and again in January 2015 . In respect of the review, legal support was obtained as required ensuring that governance arrangements remain current, robust, fit for purpose and remain in line with legal functions and duties . This includes duties being delegated to the CCG from NHS England, namely in relation to primary care co-commissioning. The composition of the Governing Body was refined and roles strengthened in line with the review of the Constitution during 2014-15 .

The Prime Financial Policies and the Scheme of Reservation and Delegation are underpinned by Detailed Financial Policies and an Operational Scheme of Delegation respectively .

84


MembershipThe clinical commissioning group Membership consists 32 GP Practices as detailed below::

Blaby and Lutterworth locality

Countesthorpe Health CentreCentral Street, Countesthorpe,Leicestershire . LE8 5QJ .

Wycliffe Medical PracticeGilmorton Road,Lutterworth,Leicestershire, LE17 4EB .

Kingsway Surgery23 KingswayNarborough Road South,Leicester, LE3 2JN .

The Limes Medical Centre65 Leicester Road,Narborough,Leics LE19 2DU

Glenfield Surgery111 Station Road,Glenfield,Leicestershire, LE3 8GS .

Forest House Medical Centre2a Park Drive,Leicester Forest East,Leicester, LE3 3FN .

Northfield Medical CentreVillers Court, Blaby,Leicestershire, LE8 4NS .

Hazelmere Medical Centre58 Lutterworth Road,Blaby,Leicester, LE8 4DN .

Narborough Health CentreThornton Drive, NarboroughLeicestershire, LE19 2GX

The Masharani PracticeGilmorton Road, Lutterworth, Leicestershire, LE17 4EB .

Enderby Medical CentreShortridge Lane, EnderbyLeicestershire, LE19 4LY

Oadby and Wigston locality

Bushloe End SurgeryTwo Steeples Health Centre, Abingdon Close, Wigston, Leicestershire, LE18 2EW

Central SurgeryBrooksby Drive, OadbyLeicester, LE2 5AA .

Rosemead Drive Surgery103 Rosemead Drive Oadby, Leicestershire, LE2 5PP.

The Croft Medical Centre2 Glen Road, OadbyLeicestershire, LE2 4PE.

Wigston Central SurgeryTwo Steeples Health Centre, Abingdon Close, Wigston, Leicestershire, LE18 2EW

South Wigston Health Centre80 Blaby RoadSouth WigstonLeicestershire, LE18 4SE .

Long Street SurgeryTwo Steeples Health Centre, Abingdon Close, Wigston, Leicestershire, LE18 2EW

Severn Surgery159 Uplands RoadOadby, Leicestershire, LE2 4NW .

85


Melton, Rutland and Harborough locality

Kibworth Health CentreSmeeton Road, Kibworth,Leicestershire, LE8 0LG .

Market Harborough Medical Centre67 Coventry Road,Market Harborough,Leicestershire, LE16 9BX .

Oakham Medical PracticeCold Overton RoadOakham,Rutland, LE15 6NT

Market Overton Surgery (& Somerby)Thistleton Road, Market Overton, Oakham,Leicestershire, LE15 7PP.

Long Clawson Medical PracticeLong Clawson, Nr Melton MowbrayLeicestershire, LE14 4PA.

Billesdon Surgery4 Market Place, BillesdonLeicestershire, LE7 9AJ .

Dr Kilpatrick & Partners2a Station RoadKibworth,Leicestershire, LE8 0LN .

Latham House Medical PracticeSage Cross Street Melton Mowbray,Leicestershire, LE13 1NX .

The County PracticeSyston Health CentreMelton Road, SystonLeicestershire, LE7 2EQ .

Empingham Medical CentreMain Street, EmpinghamOakham, RutlandLeicestershire,LE15 8PR

The Uppingham SurgeryNorthgateUppingham,Rutland,Leicestershire, LE15 9EG .

The Jubilee Medical Practice1330 Melton Road Syston,Leicestershire, LE7 2EQ .

Husbands Bosworth Surgery Kilworth RoadHusbands BosworthLeicestershire, LE17 6JZ .

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The clinical commissioning group is led by a Governing Body comprising elected GP members, a secondary care clinician and lead nurse and independent lay members as detailed below .

Name Position


Dr Andrew Ker Clinical Vice Chair

Dr Richard Palin Clinical Vice Chair

Mrs Karen English Managing Director

Dr Nicholas Glover Blaby and Lutterworth GP Locality Lead

Dr Graham Johnson Blaby and Lutterworth GP Locality Lead

Dr Richard Hurwood Melton, Rutland and Harborough GP Locality Lead

Dr Girish Purohit Melton, Rutland and Harborough GP Locality Lead

Dr Hilary Fox Melton, Rutland and Harborough GP Locality Lead

Dr Vivek Varakantam Oadby and Wigston GP Locality Lead

Mr Warwick Kendrick Independent Lay Member

Mr Alan Smith Independent Lay Member

Dr Tabitha Randell Consultant Paediatric Endocrinologist (secondary care clinician)

Mrs Carmel O'Brien Chief Nurse and Quality Officer

Mrs Donna Enoux Interim Chief Finance Officer

Mrs Jane Chapman Chief Strategy and Planning Officer


Dr Tim Daniel Consultant in Public Health Medicine (in attendance)

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The overall responsibility for the management of internal control lies with me as the Accountable Officer. The Governing Body, in line with authority delegated to it by the Membership, collectively and individually ensured that robust systems of internal control and management were in place . This responsibility was supported through an effective committee structure, including joint committees established with the local authorities; and collaborative arrangements established with Leicester City CCG and West Leicestershire CCG in respect of services commissioned collaboratively across the three CCGs .

Following an internal review of the governance arrangements during 2014-15 the committee structure was changed to reflect the outcomes of the review. The table below provides details of committees and members of each committee along with date of establishment of new committees and disestablishment of previous committees .

Title First Name

Last Name Governing Body

Audit Committee

Finance and Per-

formance Commit-

tee (up to October

2014)

Finance and Activity

Committee(from

November 2014)

Quality and Clin-ical Gov-ernance

Committee (up to

October 2014)

Quality and Per-

formance Commit-tee (from November

2014)

Remunera-tion Com-

mittee

Strategy, Planning and Com-missioning Committee

Primary Care Commissioning

Committee(from March

2015)

Mrs . Karen English √ √ √ √

Mrs . Jane Chapman √ √ √ √ √

Mrs . Carmel O'Brien √ √ √ √ √

Mr . Timothy Sacks √ √ √ √ √ √

Mrs Donna Enoux √ √ √ √ √

Dr Nicholas Glover √ √ √ √

Dr Hilary Fox √ √ √

Dr Richard Hurwood √ √

Dr Graham Johnson √ √ √ √

Dr Girish Purohit √ √

Dr Vivek Varakantam √ √ √ √

Dr Andy Ker √ √ √ √ √

Dr Richard Palin √ √ √

Dr Tabitha Randell √ √ √ Chair

Dr Tim Daniel √ √ √ √ √

Mr . Graham Martin Chair √ √ Chair

Mr . Warwick Kendrick √ Chair √ Chair √ √

Mr . Alan Smith √ √ Chair Chair Chair

Table 15: Committees and Members

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The committee structure has supported the identification and management of internal controls and risks as follows :• Audit Committee – the Audit Committee (statutory committee), which is accountable to the group’s governing body . The Audit Committee has responsibility for reviewing and ensuring that the organisation has established and is maintaining robust and effective systems of integrated governance, risk management and internal control across all areas of its business . It is responsible for providing assurance to the Governing Body that the Executive Management Team has appropriate and adequate systems in place to ensure links between risk management, financial risk, corporate and clinical governance. The Audit Committee terms of reference were reviewed and approved in January 2015 to include an additional scrutiny role for reviewing decision making processes in respect of primary care commissioning decisions to provide an additional level of assurance demonstrating the management of conflicts on interest. The Audit Committee reviewed the Board Assurance Framework at every meeting to provide assurance to the Governing Body that the organisation’s risk management processes are effective and risks are being effectively controlled. The Committee received regular reports on the work and findings of the internal and external auditors; reports from counter fraud team; reports from management in relation to follow-up and progress in relation to implementation of audit recommendations . The Audit Committee of significant assurance from the Head of Internal Audit on the degree of assurance that can be derived from the system of internal control. The Audit Committee is chaired by an independent lay member . The Committee has a schedule to meet at least 6 times a year, which it has done so in 2014-15 with all meetings being quorate, well attended and supported by the Head of Corporate Governance and Legal Affairs.

• Remuneration and Nominations Committee – the Remuneration and Nominations Committee (statutory committee), is accountable to the group’s governing body makes 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 . The governing body has approved and keeps under review the terms of reference for the remuneration committee, which includes information on the membership of the remuneration committee . The Remuneration and Nominations Committee is chaired by an Independent Lay Member . The Committee convened as required during the year with all meetings being quorate and supported by the Head of Corporate Governance and Legal Affairs in relation to corporate governance matters .

• Quality and Clinical Governance Committee – the Quality and Clinical Governance Committee, which is accountable to the group’s governing body seeks assurance and has oversight of quality and clinical governance mechanisms, ensuring quality and patient safety is integral to commissioning processes and to the monitoring arrangements for all commissioned services . The Quality and Clinical Governance Committee monitored risks in relation to patient safety (e .g . themes and trends from incidents and serious incidents), quality of care and patient experience (e .g . themes and trends from patient surveys, complaints) . The Committee was chaired by an Independent Lay Member and met on a monthly basis . The Committee held 4 meetings during 2014 /15 and all meetings were quorate. Two meetings cancelled. Risks identified through this Committee were brought to the attention of the Governing Body and monitored through the Committee .

• Following the internal governance review in 2014-15 the Quality and Clinical Governance Committee was disestablished in October 2014 and the Quality and Performance Committee established in November 2014. Previously the Quality and Clinical Governance Committee had a responsibility in respect of review of the information governance toolkit compliance and information governance related risk; and ensured systems and processes change to mitigate these risks . Following the governance review, it was agreed that Information Governance reports are to presented and reviewed at the Governing Body providing assurance in relation to information governance risks and end of year compliance with the Information Governance Toolkit standards .

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• Quality and Performance Committee - the Quality and Performance Committee, which is accountable to the group’s governing body was established in November 2014 following an internal governance review . The Committee has oversight of quality, performance and clinical governance mechanisms, ensuring quality and patient safety is integral to commissioning processes and to the monitoring arrangements for all commissioned services’ . The Committee is also responsible for seeking assurance and adopting an integrated approach to clinical governance; performance monitoring; and research governance The Quality and Performance Committee monitored risks in relation to patient safety (e.g. themes and trends from incidents and serious incidents), quality of care and patient experience (e .g . themes and trends from patient survey, and in addition monitored risks against performance . The Committee is chaired by the Secondary Care Clinician and meets on a monthly basis . The Committee held 5 meetings during 2014 /15 since it was established and all meetings were quorate . Risks identified through this Committee were brought to the attention of the Governing Body via a regular summary report from the Committee.

• Finance and Performance Committee – the Finance and Performance Committee, which was accountable to the group’s governing body, was responsible for overseeing the development of the annual financial plan. The Finance and Performance Committee monitored performance and risks relating to finance and the performance of the main providers and approved corrective action should excess variances occur . The Committee monitored income and expenditure against planned levels and made recommendations to the governing body . The Committee was chaired by an Independent Lay Member . The Committee held 3 meetings during 2014-2015 and 3 were cancelled . All 3 meetings were quorate . This Committee was disestablished in October 2014 .

• Finance and Activity Committee - the Finance and Activity Committee was established in November 2014 and is accountable to the group’s governing body . The Committee monitor the ‘in year’ and end of year financial position and activity position of the CCG ensuring systems and processes are in place to accurately report on and deliver the agreed control total; and ensure adherence to the CCG’s Prime and Detailed Financial Policies. The Finance and Activity Committee monitored risks relating to finance and the performance of the main providers and approves corrective action should excess variances occur. The Committee monitored income and expenditure against planned levels and makes recommendations to the governing body .

• Strategy, Planning and Commissioning Committee – the Strategy, Planning and Commissioning Committee is a committee of the Governing Body and was established in December 2013 . Its purpose is to oversee the development and delivery of the CCG’s commissioning plans, strategies and intentions, ensuring effective monitoring arrangements are in place and risks associated with this escalated to the Governing Body, ensuring the total resource available is invested in good quality services that support the delivery of the commissioning intentions . The Committee is chaired by a clinical vice chair . The Committee meets on a monthly basis and has held 8 meetings during 2014-15 and all meetings have been quorate .

• Primary Care Commissioning Committee – the Primary Care Commissioning Committee is a committee established by the Clinical Commissioning Group in January 2015 to exercise the primary care commissioning functions that have been delegated from NHS England as of 1 April 2015. The Committee held an initial meeting in March 2015 and thereafter will hold monthly meetings in public . The meetings are chaired by a lay member .

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The clinical commissioning group has joint committees with the following local authorities:• Leicestershire County Council• Rutland County Council .

In addition, collaborative arrangements have been established under a Memorandum of Agreement with Leicester City Clinical Commissioning Group and West Leicestershire Clinical Commissioning Group in respect of services commissioned collaboratively across the three organisations and this arrangement reports to the Governing Body .

During 2014-15 the Governing Body evaluated its own performance through facilitation by an external consultant which led to the review of the Board Development programme for the members of the Governing Body, both individually and collectively . Governing Body development sessions have taken place at agreed intervals during 2014-1515 which involved sessions focusing on roles, responsibilities, enhancing leadership skills and focusing on collective and individual responsibility . These sessions are aimed to support members of the Governing Body to function more effectively as a Governing Body .

Information sessions have also taken place for members of the Governing Body providing them with an opportunity for Governing Body members to, for example, review national guidance / initiatives in greater depth and its implications on the clinical commissioning group’s business; develop further insight into performance issues with key providers; enhance their knowledge on a specific topics; and receive detailed information on key national requirements. Governing Body members’ attendance record at both the Governing Body development / information sessions and the public meetings of the Governing Body are positive, all meetings of the Governing Body throughout 2014-15 have been quorate and all or the majority of the of the Governing Body members being present .

The Clinical Commissioning Group Risk Management FrameworkRisk management is an integral part of good management processes and the proactive and continuous management of risk is essential to the efficient and effective delivery of an organisation’s objectives. The organisation’s Risk Management Strategy and Policy sets the strategic and operational frameworks of successful management and evaluation of risk . The CCG’s chosen method of risk scoring is based on the Australian and New Zealand risk management standard AS/NZ 4360:1999, which is widely adopted .

ELR CCG adopted a common framework for the assessment and analysis of all risks whether they are clinical, financial, information or organisational. The actions required to manage the risks were documented on the risk registers, which were updated as risks continued to be assessed and treated .

A two-tier process involving local directorate based registers and a corporate register (Board Assurance Framework) have been implemented to reflect the organisation’s risk profile. The aim of the two tier approach was to ensure that the strategic picture did not become clouded by the day to day risk management issues that can and were dealt with as a matter of course at local level, whilst still providing a clear route for significant local issues to influence the strategic risk profile.

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The Board Assurance Framework (corporate risk register), which aligned to the CCG strategic aims and objectives, provided the organisation with a comprehensive method for the effective and focused management of the principle risks with action plans in place to mitigate risks identified. During 2014-15 the Board Assurance Framework has been reviewed and updated on a regular basis . The Audit Committee, Governing Body members and the Executive Management Team have been integral in the review and development of the Board assurance Framework and format; and in the review of the risk profile and oversight of individual risks and action plans . The Executive Management Team has been and continues to be responsible for ensuring corporate risks facing the CCG are current; have been captured and evaluated appropriately; and actions undertaken in a timely manner .

Each directorate had a directorate (operational) risk register where they monitored their local risks . Risks were linked to strategic aims / objectives and the likelihood and impact were assessed to ascertain risk appetite depending on the category of risk, the inherent risk and residual risk and individual leads were assigned to actions . The Board Assurance Framework was built around the proactive and reactive assessment of risks that may have an impact on the achievement of corporate objectives. This simplified reporting and the prioritisation of action plans which, in turn, allowed for more effective performance management. Strategic and operational risks on the corporate and local risk registers were regularly reviewed by the Corporate Management Team with the objective of ensuring risks were effectively managed . These registers were used to record risks using the 5 x 5 risk scoring matrix . Risks were reported and escalated in line with the CCG’s Risk Management Strategy and Policy.

The Risk Management Strategy and Policy is due for a review in May / June 2015 to ensure that the governance arrangements for managing corporate business risks and operational risks continue to be robust and reflect the ongoing changing requirements of the organisation. Summary updates and reports on the status of key risks were presented to the Executive Management Team (EMT) via the EMT meetings and at every meeting of the Audit Committee and at agreed intervals to the Governing Body .

Whilst the CCG considered risks to the organisation in meeting its objectives and to its staff, it also considered those to whom a service is provided, the organisations and also the patients themselves . The CCG received risk reports and, where appropriate, assurances and mitigation plans from those organisations from which it commissioned a service .

The Internal Audit programme of work has been completed and the interim Head of Internal Audit has provided an opinion of significant assurance.

The Clinical Commissioning Group Internal Control FrameworkA 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 system of internal control has been in place in the clinical commissioning group for the year ended 31 March 2015 and up to the date of the approval of the Annual Report and Accounts .

The organisation continued to operate through its comprehensive committee structure which ensures identification, robust management, reporting and accountability for risk management .

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The Governing Body sought assurance through regular review of the Board Assurance Framework at the Governing Body meetings, outcomes from the Executive Management Team meetings and the Audit Committee (e .g . in relation to effectiveness of internal control mechanisms) . The Quality and Clinical Governance Committee, and then the Quality and Performance Committee, received assurance reports to monitor areas of risk e.g. safeguarding, patient safety, serious incidents, patient complaints etc. The Finance and Performance Committee received assurance reports in relation to financial and performance risks. From November 2014 performance risks were escalated via the Quality and Performance Committee and the finance risks via the Finance and Activity Committee. Regular summary reports from these Committees were presented to the Governing Body drawing the Governing Body’s attention to key financial, performance, and patient safety and quality risks .

In addition, reports on specific updates and areas of risk were directly reported to the Governing Body including reports on safeguarding adults and children and serious incident reports . The Governing Body reviewed these reports and sought assurance to demonstrate that providers are learning from incidents . All these groups had a role to provide regular monitoring to identify themes and trends for learning and sustained improvements . Where provider performance risks were considered significant and escalated to the Governing Body action was taken by the Governing Body to invite the providers concerned to the Governing Body meeting to seek assurance .

In addition the Governing Body received assurance reports demonstrating compliance with statutory obligations including compliance with the Public Sector Duty of Equality .

Delivery of the Risk Management Strategy and Policy was also achieved through the implementation of associated policies and procedures, for example, health and safety policies / procedures, incident reporting, claims policy, Counter Fraud Policy, HR policies etc. Progress and performance in achieving the aims of the strategy and adherence to the policy was monitored by the Corporate Management Team, the Chief Nurse and Quality Officer (as the executive lead) and ultimately the Governing Body via the Audit Committee .

The policies and procedures in place across the CCG aimed to, as far as possible, prevent the identified risks from arising; policies, procedures and codes of conduct were made available to staff through various mechanisms including through the CCG newsletter . Statutory and mandatory training included raising awareness about countering fraud, identifying potential risks and also identifying where risks may have materialised (for example, through the incident reporting process) . Equality analysis is integral to core business processes, policies and processes across the organisation . Relevant systems and processes were implemented to support the policies and procedures, for instance the CCG’s Constitution (which includes the Standing Orders, Scheme of Reservation and Delegation and Prime Financial Policies) clearly stipulated the delegations to budget holders which was then reflected within the Shared Business Service system to ensure appropriate level of authorisation is obtained for approval of invoices . Where risks have materialised the Corporate Management Team would review the controls in place to determine how the controls need to be improved and whether assurances need to be sought from alternative sources .

Control measures are in place to ensure that all the clinical commissioning group’s obligations under equality, diversity and human rights legislation are complied with .

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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 framework and have developed and continue to further develop 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 / leaflets to ensure staff are aware of their information governance roles and responsibilities.

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

The CCG had in place an Information Governance Strategy and Policy. The final year end self-assessment for 2014-15 was approved at the Governing Body meeting in March 2015. Specific requirements were submitted to Internal Audit for which the Auditor’s provided an opinion of “significant assurance”. Information risks are clearly defined within the Risk Management Strategy and Policy including the role of the Senior Information Risk Officer and the Information Asset Owners, which supports the requirements for identifying and managing information risk .

The NHS Data Mapping exercise was undertaken during 2014 / 15 and involved identification of personal identifiable information (PII) data flows into and out of the organisation. Systems and processes are in place to ensure the security of data; and to ensure encryption of all electronic PII data transfers, e.g., via email and PII held on mobile devices such as laptops . All staff are required to complete the annual e-learning training module on information governance . In addition, the CCG’s Executive Management Team has mandated that all staff attend an organisation specific information governance training event arranged on-site and facilitated by the information governance lead .

Pension ObligationsAs an employer with staff entitled to membership of the NHS Pension Scheme, control measures are in place to ensure all employer obligations contained within the scheme regulations are complied with . This includes ensuring that deductions from salary, employer’s contributions and payments into the scheme are in accordance with the scheme rules, and that member pension scheme records are accurately updated in accordance with the timescales detailed in the regulations .

Equality, Diversity and Human Rights ObligationsControl measures are in place to ensure that the clinical commissioning group complies with the required public sector equality duty set out in the Equality Act 2010 .

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Sustainable Development ObligationsThe clinical commissioning group is required to report its progress in delivering against sustainable development indicators .We are developing plans to assess risks, enhance our performance and reduce our impact, including against carbon reduction and climate change adaptation objectives . This includes establishing mechanisms to embed social and environmental sustainability across policy development, business planning and in commissioning .

We will ensure the clinical commissioning group complies with its obligations under the Climate Change Act 2008, including the Adaptation Reporting power, and the Public Services (Social Value) Act 2012. We are also setting out our commitments as a socially responsible employer.

Risk Assessment in Relation to Governance, Risk Management and Internal Control

The Executive Management Team and members of the Governing Body in the main identified the risks considering the political, economic, social, technological environment (PEST analysis) in which the CCG operates. In the regular review of the Board Assurance Framework, risks identified from “bottom-up” are also considered, for example, review of directorate level risk registers, cluster of incidents, cluster of complaints, through performance management arrangements .Risk identification and management had been incorporated into key processes within East Leicestershire and Rutland CCG ensuring embeddedness of the principles of risk management and encouraging a proactive approach to identifying risks . The core business processes, for instance, included the review of risk and the impact on strategic decision making. The organisation’s business cases required leads to identify the risk of not implementing a scheme and the benefits realisation of the scheme . In addition, it includes the requirement to undertake equality analysis for each case of need .

The following principal risks were identified and captured within the Board Assurance Framework during 2014-15; the following risks are as at end March 2015:• The quality of care provided by providers does not match commissioner’s expectation with respect to quality and safety;• An innovative organisational culture and organisational development may not be actively encouraged;• The CCG fails to ensure effective contract monitoring through hosted contracting arrangements which results in over performance of contracts and poor outcomes for patients;• The CCG fails to deliver the outcomes of the programmes of care as identified in the Annual Plan as a result of external influences e.g. changes in demand across providers, Local Area Team etc . In particular failure to deliver its plans on planned and unplanned care;• Inability to deliver against the QIPP agenda resulting in failure to transform services;• Capacity of primary and community services to manage left shift;• Patients could receive sub-optimal care as a result of increasing pressures in urgent care pathway;• In year over performance in acute sector (including Independent and out of county providers) continues throughout the year and culminates in a large overspend against the SLA by the end of the year. The financial risk is further increased by the pressures in the Urgent Care pathway;• LLR Learning Lessons to Improve Care published July 2014, potential risk of loss of confidence in local NHS providers;• Continuing Healthcare over performance occurs in year, culminating in a large overspend by year end; and• Co-Commissioning responsibility

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Review of Economy, Efficiency and Effectiveness of the Use of ResourcesThe effectiveness of the use of resources and financial performance of the CCG was monitored on a monthly basis by the Governing Body and the Finance and Performance Committee which is a Committee of the Governing Body chaired by a lay member. Corporate risks in respect of financial performance and use of resources are captured in the Board Assurance Framework and directorate level risk registers and reported to the Audit Committee at each meeting and the Governing Body every six months .

In addition, where services were commissioned collaboratively in 2014-15 with Leicester City CCG and West Leicestershire CCG provider performance was monitored via the collaborative arrangements. This in the main was through the Performance Collaborative Board and the Commissioning Collaborative Board arrangements for which principles of collaboration are detailed within the Memorandum of Agreement between the three CCGs .

The main financial risk that the CCG has faced throughout the year is the over performance in the acute sector against the backdrop of significant emergency activity pressures experienced during the year . The over performance at the end of 2014-15 was mitigated .

The Audit Committee included within the internal audit plan for 2014-15 the following audit reviews: Budgetary Control and Financial Reporting; and Key Financial Systems – Payroll. Both audit reviews were provided with an opinion of “significant assurance”. These reports identified areas where efficiency could be gained, for example, the Budgetary Control audit report identified areas where the reporting system could be used to support budget holders by working with the system provider to ensure the system is user-friendly. The Finance Team in conjunction with the Finance and Performance Committee (and the Finance and Activity Committee) also reviewed the content of finance reports to the Governing Body. Reassessing the adequacy of the reports ensured that information was portrayed more clearly for the Finance and Performance Committee and the Governing Body enabling them to develop a better understanding of the position and make decisions based on the information .

Review of the Effectiveness of Governance, Risk Management and Internal ControlAs the Accountable Officer I have responsibility for reviewing the effectiveness of the system of internal control within the clinical commissioning group.

Capacity to Handle RiskAs stated above, the overall responsibility for the management of risk lies with me as the Accountable Officer and operational implementation with the Executive Management Team . The Governing Body collectively and individually ensured that robust systems of internal control and management were in place . This responsibility was supported through an effective Governing Body and committee structure as detailed earlier .

Specialist advice on risk assessment and management has been available to the organisation through: the organisation’s Head of Corporate Governance and Legal Affairs, Health and Safety Adviser (external), the Information Security lead (external); Information Governance support (external) Local Security Management Consultant (external, and the Local Counter Fraud specialist . Over the last year there has been continued increase in awareness at all levels of the organisation of the importance and relevance of risk management to operational processes . This has been through team meetings, one-to-one meetings with individuals, the requirement for all staff to complete the e-learning and face-to-face training modules covering all aspects of risk (e .g . information, health and safety), circulation of a variety of policies e.g. finance budget manual, prime and operational financial policies, information security and information governance policies, clinical policies, policy on Fraud, Corruption and bribery, risk management strategy and policy etc .

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Review of EffectivenessMy review of the effectiveness of the system of internal control is informed by the work of the internal auditors and the executive managers (the Executive Management Team) 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 reports . The Board Assurance Framework itself provides me with evidence that the effectiveness of controls that manage risks to the clinical commissioning group achieving its principle objectives have been reviewed .

I have been advised on the implications of the result of my review of effectiveness of the system of internal control by the Governing Body, the Audit Committee, the Quality and Clinical Governance Committee, the Quality and Performance Committee, the Finance and Performance Committee, the Finance and Activity Committee; the Strategy, Planning and Commissioning Committee, and the performance and commissioning collaborative boards. A plan to address weaknesses and ensure continuous improvement of the system is in place .

The above committees and a number of processes, including the following, have been integral to maintaining and reviewing the effectiveness of the system of internal control: internal audit; quarterly checkpoint assurance meetings with the NHS England Central Midlands. The specific role of the Governing Body and its committees in reviewing effectiveness of systems of internal control and risk management is provided earlier .

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

I am pleased to report that we are providing the CCG with Significant Assurance as there is a generally sound system of internal control, designed to meet objectives, and that controls are generally being applied consistently . This opinion is determined through our review of your Governing Board Assurance Framework (GBAF) and associated processes and the work that we have undertaken throughout the year .

During the year the Internal Audit did not issue any audit report with a conclusion of limited assurance .

During the year the Internal Audit did not issue any audit report with a conclusion of no assurance .

I am not aware of any deficiencies as a result of risks that have materialised. I confirm neither have there been any serious incidents in the last year involving personal data where the incident is attributable to the CCG . The CCG continues to monitor risks at both operational and corporate level, including review of systems, processes and policies to ensure ongoing continuous improvement in systems .

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An internal audit was carried out by Deloitte LLP during 2014-15 which reviewed the processes / procedures of Greater East Midlands Commissioning Support Unit (GEM CSU). The findings of the report concluded that there was reasonable assurance that appropriate controls were in place in GEM CSU. Furthermore, many of the exceptions noted in this internal audit report did not apply to Leicestershire based customers of GEM CSU . For those exceptions noted or process improvements that did relate to Leicestershire CCGs, GEM CSU has confirmed that an action plan is currently being produced.ELR CCG has therefore concluded that the findings of this report would not adversely affect the opinion given by our own internal auditors.

Data QualityGood information underpins sound decision making within the CCG. The CCG is committed to improving data quality and information flows throughout the organisation and in particular through its committees to the Governing Body and to the membership . Following feedback throughout the year from Governing Body members and its committees the quality of both qualitative and quantitative data and information has improved . This has enabled information in relation to performance monitoring and consideration of future commissioning of services to be based on more current information . Internal audit have undertaken various audits throughout the year where the quality of both data and information was reviewed to provide assurance to the Audit Committee and the Governing Body .

We have submitted a satisfactory level of compliance with the information governance toolkit assessment .

Discharge of Statutory FunctionsDuring establishment, the arrangements put in place by the clinical commissioning group and explained within the Corporate Governance Framework were developed with extensive expert external legal input, to ensure compliance with all relevant legislation . Legal advice also informed the matters reserved for the Membership Body and Governing Body decision and the scheme of delegation .

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

ConclusionThere are no significant internal control issues that have been identified.


28 May 2015

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We can provide versions of this plan summary in other languages and formats such as Braille and large print on re-quest . Please contact the Engagement Team, telephone 0116 295 1486 .

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Appendix 1: Annual Accounts 2014-15

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East Leicestershire and Rutland CCGUnit 2-3 (Ground Floor)Bridge Business Park674 Melton RoadThurmastonLeicestershireLE4 8BL

T: 0116 295 5105 W: www.eastleicestershireandrutlandccg.nhs.uk

INDEPENDENT AUDITOR'S REPORT TO THE MEMBERS OF NHS EASTLEICESTERSHIRE AND RUTLAND CLINICAL COMMISSIONING GROUP

We have audited the financial statements of NHS East Leicestershire and Rutland ClinicalCommissioning Group (CCG) for the year ended 31 March 2015 under the AuditCommission Act 1998. The financial statements comprise the Statement of ComprehensiveNet Expenditure, the Statement of Financial Position, the Statement of Changes inTaxpayers' Equity, the Statement of Cash Flows and the related notes. The financialreporting framework that has been applied in their preparation is applicable law and theaccounting policies directed by the NHS Commissioning Board with the consent of theSecretary of State as relevant to the National Health Service in England.

We have also audited the information in the Remuneration Report that is subject to audit,being:

the table of salaries and allowances of senior managers and related narrative note onpages 73 to 76

• the table of pension benefits of senior managers and related narrative notes on pages77 to 78

• the disclosures on pay multiples on page 79.

This report is made solely to the members of NHS East Leicestershire and Rutland CCG inaccordance with Part II of the Audit Commission Act 1998 and for no other purpose, as setout in paragraph 44 of the Statement of Responsibilities of Auditors and Audited Bodiespublished by the Audit Commission in March 2014. To the fullest extent permitted by law, wedo not accept or assume responsibility to anyone other than the CCG's members and theCCG as a body, for our audit work, for this report, or for the opinions we have formed.

Respective responsibilities of the Accountable Officer and auditor

As explained more fully in the Statement of Accountable Officer's Responsibilities, theAccountable Officer is responsible for the preparation of the financial statements and forbeing satisfied that they give a true and fair view. Our responsibility is to audit and expressan opinion on the financial statements in accordance with applicable law and InternationalStandards on Auditing (UK and Ireland). Those standards also require us to comply with theAuditing Practices Board's Ethical Standards for Auditors.

Scope of the audit of the financial statements

An audit involves obtaining evidence about the amounts and disclosures in the financialstatements sufficient to give reasonable assurance that the financial statements are free frommaterial misstatement, whether caused by fraud or error. This includes an assessment of:whether the accounting policies are appropriate to the CCG's circumstances and have beenconsistently applied and adequately disclosed; the reasonableness of significant accountingestimates made by the Accountable Officer; and the overall presentation of the financialstatements. In addition, we read all the financial and non-financial information in the annualreport which comprises the Foreword, Member Practice's Introduction, Strategic Report,Members Report, Remuneration Report and Statements by the Accountable Officer toidentify material inconsistencies with the audited financial statements and to identify anyinformation that is apparently materially incorrect based on, or materially inconsistent with,the knowledge acquired by us in the course of perForming the audit. If we become aware ofany apparent material misstatements or inconsistencies we consider the implications for ourreport.

In addition, we are required to obtain evidence sufficient to give reasonable assurance thatthe expenditure and income reported in the financial statements have been applied to thepurposes intended by Parliament and the financial transactions conform to the authoritieswhich govern them.

Opinion on regularity

In our opinion, in all material respects the expenditure and income reported in the financialstatements have been applied to the purposes intended by Parliament and the financialtransactions conform to the authorities which govern them.

Opinion on financial statements

In our opinion the financial statements:

give a true and fair view of the financial position of NHS East Leicestershire andRutland CCG as at 31 March 2015 and of its net operating costs for the year thenended; andhave been prepared properly in accordance with the accounting policies directed bythe NHS Commissioning Board with the consent of the Secretary of State as relevantto the National Health Service in England.

Opinion on other matters

In our opinion:

the part of the Remuneration Report subject to audit has been prepared properly inaccordance with the requirements directed by the NHS Commissioning Board withthe consent of the Secretary of State as relevant to the National Health Service inEngland; andthe information given in the annual report for the financial year for which the financialstatements are prepared is consistent with the financial statements.

Matters on which we report by exception

We report to you if:• in our opinion the governance statement does not reflect compliance with NHS

England's Guidance;we refer a matter to the Secretary of State under section 19 of the Audit CommissionAct 1998 because we have reason to believe that the CCG, or an officer of the CCG,is about to make, or has made, a decision involving unlawful expenditure, or is aboutto take, or has taken, unlawful action likely to cause a loss or deficiency; or

• we issue a report in the public interest under section 8 of the Audit Commission Act1998.

We have nothing to report in these respects.

Conclusion on the CCG's arrangements for securing economy, efficiency andeffectiveness in the use of resources

Respective responsibilities of the CCG and auditor

The CCG is responsible for putting in place proper arrangements to secure economy,efficiency and effectiveness in its use of resources, to ensure proper stewardship andgovernance, and to review regularly the adequacy and effectiveness of these arrangements.

We are required under Section 5 of the Audit Commission Act 1998 to satisfy ourselves thatthe CCG has made proper arrangements for securing economy, efficiency and effectivenessin its use of resources. The Code of Audit Practice issued by the Audit Commission requiresus to report to you our conclusion relating to proper arrangements, having regard to relevantcriteria specified by the Audit Commission in October 2014.

We report if significant matters have come to our attention which prevent us from concludingthat the CCG has put in place proper arrangements for securing economy, efficiency andeffectiveness in its use of resources. We are not required to consider, nor have weconsidered, whether all aspects of the CCG's arrangements for securing economy, efficiencyand effectiveness in its use of resources are operating effectively.

Scope of the review of arrangements for securing economy, efficiency andeffectiveness in the use of resources

We have undertaken our review in accordance with the Code of Audit Practice, havingregard to the guidance on the specified criteria, published by the Audit Commission inOctober 2014, as to whether the CCG has proper arrangements for:

securing financial resiliencechallenging how it secures economy, efficiency and effectiveness.

The Audit Commission has determined these two criteria as those necessary for us toconsider under the Code of Audit Practice in satisfying ourselves whether the CCG put inplace proper arrangements for securing economy, efficiency and effectiveness in its use ofresources for the year ended 31 March 2015.

We planned our work in accordance with the Code of Audit Practice. Based on our riskassessment, we undertook such work as we considered necessary to form a view onwhether, in all significant respects, the CCG had put in place proper arrangements to secureeconomy, efficiency and effectiveness in its use of resources.

Conclusion

On the basis of our work, having regard to the guidance on the specified criteria published bythe Audit Commission in October 2014, we are satisfied that, in all significant respects, NHSEast Leicestershire and Rutland CCG put in place proper arrangements to secure economy,efficiency and effectiveness in its use of resources for the year ending 31 March 2015.

Certificate

We certify that we have completed the audit of the accounts of NHS East Leicestershire and Rutland CCG in accordance with the requirements of the Audit Commission Act 1998 and

Code of Audit Practice issued by the Audit Commission.

John Gregory for and on behalf of Grant Thornton UK LLP, Appointed Auditor

Galmore Plaza 20 Galmore Circus Birmingham West Midlands 84 6AT

28 May 2015

NHS East Leicestershire and Rutland Clinical Commissioning Group -Annual Accounts 2014-15

Statement of Financial Position as at31 March 2015

31 March 31 March2015 2014

Note £000 £000Non-current assets: Property, plant and equipment 9 1,320 802Intangible assets 10 46 42Total non-current assets 1,366 844

Current assets: Trade and other receivables 11 4,663 3,881 Cash and cash equivalents 12 121 {308)Total current assets 4,784 3,573

Total Assets 6,150 4,417

Current liabilities Trade and other payables 13 (16,664) (23,077)Provisions 14 (84) {89}Total current liabilities (16,748) (23,166)

Total assets less Current Liabilities (10,598) (18,749)

Financed by Taxpayers' EquityGeneral fund (10,601) (18,752)Revaluation reserve 3 3Total taxpayers' equity: (10,598) (18,749)

The notes on pages five to twenty nine form part of this statement

The financial statements on pages one to four were approved by the Audit Committee on 26th May2015 and signed on its behalf by:

Mrs Karen English Managing Director (Acc�ntable Officer)

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