NHS West Leicestershire CCG Annual Report 2017/18

161 Pages·2017·3.11 MB·English

NHS West Leicestershire CCG

Annual Report 2017/18
NHS West Leicestershire CCG Annual Report 2017/18

Table of Contents
Foreword ......................................................................................................................................... 5
Performance Report ........................................................................................................................ 7
Performance Overview ................................................................................................................ 8
About us, who we are and what we do ..................................................................................... 8
Our purpose and activities ....................................................................................................... 8
Our mission .............................................................................................................................. 9
Our goals ................................................................................................................................. 9
Our population ......................................................................................................................... 9
Our member practices............................................................................................................ 10
Our main providers ................................................................................................................ 11
Assurance on how well we are doing ..................................................................................... 12
Statement from the Managing Director on our performance ................................................... 14
Performance Analysis ................................................................................................................ 15
How we performed in 2017/18 ............................................................................................... 15
Our achievements in 2017/18 ................................................................................................ 19
Urgent and Emergency Care.................................................................................................. 19
Long Term Conditions ............................................................................................................ 20
End of Life Care ..................................................................................................................... 21
Primary medical care and federation development ................................................................. 21
How we work in partnership ................................................................................................... 28
Improve quality ...................................................................................................................... 33
Engaging people and communities ........................................................................................ 37
Quality assurance .................................................................................................................. 43
Consultations ......................................................................................................................... 44
Complaints ............................................................................................................................. 44
Equal opportunities ................................................................................................................ 45
The Human Rights Act (1988) – Meeting our Statutory Requirements ................................... 45
Freedom of Information (FOI) ................................................................................................. 46
Reducing health inequality ..................................................................................................... 47
Health and wellbeing strategy ................................................................................................ 48
System resilience in Leicester, Leicestershire and Rutland .................................................... 48
Looking forward ..................................................................................................................... 50
The Accountability Report ............................................................................................................. 51
Corporate Governance Report .................................................................................................. 52
Our Governing Body .............................................................................................................. 52
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NHS West Leicestershire CCG Annual Report 2017/18
Statement of Disclosure to Auditors ....................................................................................... 53
Committees ............................................................................................................................ 53
Declarations of interest .......................................................................................................... 56
Personal data related incidents .............................................................................................. 58
Statement of Disclosure to Auditors ....................................................................................... 58
Counter Fraud ........................................................................................................................ 58
Prompt Payment Code ........................................................................................................... 58
Modern Slavery Act ................................................................................................................ 59
Statement of Accountable Officer’s Responsibilities ............................................................... 59
Governance Statement .............................................................................................................. 61
Introduction and context ......................................................................................................... 61
Scope of responsibility ........................................................................................................... 61
Governance arrangements and effectiveness ........................................................................ 61
UK Corporate Governance Code ........................................................................................... 65
Discharge of Statutory Functions ........................................................................................... 65
Risk management arrangements and effectiveness ............................................................... 65
Capacity to Handle Risk ......................................................................................................... 67
Risk Assessment ................................................................................................................... 68
Other sources of assurance ................................................................................................... 68
Review of the effectiveness of governance, risk management and internal control ................. 73
Conclusion ............................................................................................................................. 74
Remuneration and Staff Report ................................................................................................. 75
Remuneration Committee meetings and attendance (not subject to audit) ............................. 75
Remuneration Committee Terms of Reference (not subject to audit) ..................................... 75
Policy on senior managers contracts (not subject to audit) ..................................................... 78
Payments to past senior managers ........................................................................................ 78
Senior managers’ performance related pay ............................................................................ 79
Service contract for each Director/Member of CCG Governing Body (not subject to audit) .... 79
Senior manager remuneration (including salary and pension entitlements) (subject to audit)
2017/18 .................................................................................................................................. 81
Senior manager remuneration (including salary and pension entitlements) (subject to audit)
2016/17 .................................................................................................................................. 83
Pension benefits as at 31 March 2018 (subject to audit) ........................................................ 84
Pensions benefits – required disclosure 2016/17 (subject to audit) ........................................ 85
Pay multiples (subject to audit) .............................................................................................. 87
Compensation on early retirement or for loss of office ........................................................... 87
Analysis of employee benefits that has been part of the Accounts in previous years
(subject to audit) .................................................................................................................. 88
Staff report ............................................................................................................................. 89
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NHS West Leicestershire CCG Annual Report 2017/18
CCG employed staff ............................................................................................................... 90
Parliamentary Accountability and Audit Report .......................................................................... 93
The Primary Financial Statements and Notes to the Accounts ...................................................... 94
Introduction ............................................................................................................................... 95
Statement of Comprehensive Net Expenditure for the year ending 31 March 2018 ................... 96
Statement of Financial Position as at 31 March 2018 ................................................................ 97
Statement of Cash Flows for the year ending 31 March 2018 .................................................... 98
Financial Performance Targets .................................................................................................. 99
Running Costs ......................................................................................................................... 100
Better Payment Practice Code ................................................................................................ 100
Related Party Transactions ..................................................................................................... 101
Appendices ................................................................................................................................. 108
Appendix One - Surgeries by locality ....................................................................................... 109
Appendix two - Declaration of interest ..................................................................................... 110
Appendix Three - Board Profiles .............................................................................................. 116
Appendix Four - Contact Details .............................................................................................. 122

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NHS West Leicestershire CCG Annual Report 2017/18
Foreword
By Toby Sanders, Managing Director and Professor Mayur Lakhani, Chairman
Welcome to the annual report for West Leicestershire Clinical Commissioning Group (CCG) which
covers the period 1 April 2017 to 31 March 2018.
Before we reflect on the key developments during the year, we wanted to say thank you to our
staff, our 48 member GP practices and all our partners. In particular we would like to thank our
patients and wider public who have continued to have their say in the way we shape health and
care services. Their combined efforts led to us being rated as ‘outstanding’ in 2016/17 by NHS
England as part of the national assurance ratings for all Clinical Commissioning Groups (CCGs) -
one of approximately 10% of all CCGs in the country to have received the highest possible rating.
Of our 48 practices, covering a population of 366,000 patients, 18 offered extended services five
days a week from 7am – 7pm or 8am – 8pm and we continue to expand this through our practice
hub model. It is our good working relationship with our member practices and with our three GP
federations in North & South Charnwood and Hinckley & Bosworth which has been key to the way
we’re developing our extended access scheme.
To improve patient experience of urgent care services we also carried out a successful pilot of our
clinical navigation hub which allows patients calling NHS 111 to be transferred directly to a
clinician where appropriate. The pilot demonstrated a reduction in visits to the Emergency
Department (ED) and in the number of ambulances being dispatched. Following a review of the
pilot, the service has been rolled out and patients can also be booked into appointments directly
with the Urgent Care Centre, the hubs in the City and GP practices via 111 further reducing
pressure on ED.
Together with our neighbouring CCGs – and to build on our already strong performance in relation
to dementia diagnosis rates we awarded the Alzheimer’s Society a new contract to deliver a
revitalised Dementia Support Service. The service, which launched on 2 October 2017, was
developed to benefit people living with dementia and their carers across the region.
You’ll see further details of this year’s performance and continued achievements from page 14 of
this report.
As a result of a challenging financial year in 2017/18, the CCG has overspent against its in year
allocation by £1.55 million. The CCG faced a scale of financial risks in excess of this figure, but
successfully developed and delivered a formal financial recovery plan. Consequently the CCG has
failed in its statutory duty to break even.
As we begin a new financial year we face increasing demands for services locally as a result of
changes in our population, the impact of poor lifestyle choices and from further advances in clinical
care; we will need to make some tough decisions so that we can continue to transform our
services in the future. West Leicestershire CCG has a QIPP programme target of £20.4m
The national QIPP programme is used to continually review and evaluate the quality,
efficiency and effectiveness of healthcare services - while identifying unnecessary expenditure.
We must ensure that each pound we spend brings maximum benefit and quality care to our
patients and service users while local services continue to meet your needs and are still of the
highest quality.
By far the majority of the savings and changes we have identified and are considering
implementing will not be noticeable to patients as they go about seeking and receiving NHS care
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NHS West Leicestershire CCG Annual Report 2017/18
and are related to the transformation of services to reduce waste and duplication. Inevitably
however, with the tough financial situation we face, we continue to have to make difficult decisions.
We are continually looking at how we can innovate and be more effective with the way we plan our
day to day operations.
We have reviewed all areas of corporate expenditure including the configuration of our Governing
Body and the roles and operational responsibilities of our senior management team – improving
efficiency and unnecessary duplication not only within our own area but throughout the Leicester,
Leicestershire & Rutland region.
Over the past few months the boards of all three Leicestershire Clinical Commissioning Groups
have finalised proposals for closer collaboration and the creation of a shared senior management
team under one Accountable Officer enabling us and our provider partners under the Better Care
Together Partnership to progress with one shared strategic vision for the next five years shaping
the future of our healthcare services and improving the health and wellbeing for our population.

Toby Sanders Professor Mayur Lakhani CBE FRC GP
Managing Director (Accountable Officer) Chairman

24 May 2018 24 May 2018
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NHS West Leicestershire CCG Annual Report 2017/18

Performance Report

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NHS West Leicestershire CCG Annual Report 2017/18
Performance Overview
About us, who we are and what we do
West Leicestershire CCG is the clinically-led local NHS organisation covering North West
Leicestershire, Charnwood and Hinckley and Bosworth. We were set up in 2011, in line with
the Health and Social Care Bill (now the Health and Social Care Act 2012) which included
the radical reform of the way that health care was commissioned in England. Having worked
in shadow form for two years, we officially came into being on 1 April 2013, replacing the
Primary Care Trust and operate from premises in central Loughborough. We received full
authorisation – licensed without conditions, which was approved by a subcommittee of NHS
England, on 22 March 2013. This meant that we had no conditions limiting our freedom to
plan and purchase the majority of local hospital and community services for our population of
approximately 391,800 people (as of 1st January 2018).

The CCG represents 48 GP practices and covers Hinckley and Bosworth, North Charnwood,
North West Leicestershire and South Charnwood. We plan and purchase acute and
community hospital care along with mental health care and from 1 April 2015 also co-
commission local primary care (GP) services with NHS England. NHS England still plans
and purchases pharmacies, dentists, opticians and specialised commissioning services.
Our purpose and activities
Our responsibilities have been delegated to us from NHS England, a national body which
has been given a formal mandate to oversee the commissioning of health services in
England by the Secretary of State for Health (apart from public health services, which are
commissioned by local authorities). The accounts direction for CCGs are determined by
NHS England and approved by the Department of Health (Secretary of State) and made
under the following legislation: Health and Social Care Act 2012 c. 7 Schedule 2 s.17

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NHS West Leicestershire CCG Annual Report 2017/18
Our commissioning budget in 2017/18 was £479m and the services we commission or buy
are:
 Planned hospital care
 Rehabilitative care
 Urgent and emergency care
 Most community health services including a number jointly with Local Authorities
 Mental health and learning disability services
 Co-commissioning of primary care

The CCG has complied with HM Treasury’s guidance – Managing Public Money (July 2013),
chapter 6 Fees, charges and levies, on setting charges for information.
Our mission
Patients, practices and partners working together to create the best value healthcare for the
population of West Leicestershire.
Our goals
We are committed to continually improve the:
 Health and well-being of our local population;
 Quality of our local health services
 Way in which our NHS resources (staff, equipment and buildings) are used

We will reach our goals through these ten strategic objectives:
 Tackling major causes of premature death
 Reducing health inequalities
 Ensuring our providers deliver high quality services
 Ensuring our patients get timely and appropriate access to services
 Increasing service integration across health, social care and other partners
 Supporting self-care and personalisation
 Reducing inappropriate clinical variation
 Pushing providers to become more efficient
 Stimulating innovation and service transformation
 Shifting resources to support service provision closer to home

We work closely with our public health colleagues within Leicestershire County Council to
understand and address the health needs of the population we serve.
Our population
Our planned activities undertaken in 2017/18 were made in consideration of the implications
of:
A growing and ageing population
 Between 2014 and 2039 (25 years) it has been projected that the total population of
West Leicestershire will grow by 18.8% to 454,000:
o 162.2% increase in people aged 85 years and over
o 49.5% increase in people aged 65-84 years
o 12.3% increase in children and young people aged 0-24 years
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NHS West Leicestershire CCG Annual Report 2017/18
o 6.1% increase in people aged 25-64 years
Source: ONS, 2014 based Subnational Population Projections for Clinical Commissioning Groups in England
Life Expectancy
 In 2014–16, life expectancy at birth for males in Leicestershire was 80.7 years and for
females it was 84.0 years. This is significantly higher than the average life expectancy
for England (79.5 years for males and 83.1 years for females).
 Since data was first collected in 2001-03, life expectancy has gradually increased, from
77.8 years for males and 81.6 years for females.
Source: PHE, PHOF
 For West Leicestershire specifically, the most recent data is from 2011-15. This shows
that the life expectancy at birth for males is 80.2 years, significantly better than
England's 79.4 years. For females in West Leicestershire, life expectancy at birth is
83.7 years, significantly better than England's 83.1 years. Please note, figures reflect
mortality of those living in the West Leicestershire during that time period, rather than
mortality amongst those born in West Leicestershire. Therefore, this does not present
the number of years a new born could expect to live, as mortality rates are likely to
change in the future. Here, life expectancy was calculated using ONS data, where
deaths were extracted and aggregated from known output area geographies and
aggregated to produce life expectancies.
Source: PHE, Local Health
Healthy Life Expectancy
 Healthy life expectancy captures the degree to which people enjoy good health in their
lives. In 2014–16 in Leicestershire, healthy life expectancy was 65.2 years for males
and 65.8 years for females.
 The rate for both males and females is significantly better than the England average at
63.3 years and 64.1 years respectively. These are average rates for both males and
females and therefore we know that a significant proportion of our population will
already be affected by poor health before they reach retirement age.
Source: PHE, PHOF
Health Inequalities
 For 2014–16, the gap in life expectancy between the most deprived areas and the
least deprived areas in Leicestershire as a whole was 6.2 years for males and 5.3
years for females. Health inequalities are differences in health status between different
population groups. Different levels of health needs in our population are driven by
wider social inequalities such as poverty and social exclusion.
Source: PHE, PHOF
Our member practices
Our 48 GP practices, with their practice teams, play a key role in making clinically-led
commissioning a reality. They are divided into four localities: North Charnwood, South
Charnwood, Hinckley and Bosworth and North West Leicestershire. A full list of our member
practices shown within each locality is in Appendix One.
The locality structure is fundamental to how we operate as a CCG and is supported by a
well-established Service Improvement and Delivery Team who work closely with clinical
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