South Lincolnshire CCG NHS Annual Report 2018/19 by Orchard House Media Ltd

Annual Report and Accounts 2018/19

Lincolnshire Clinical Commissioning Group 02 South Annual Report 2018/19

South Lincolnshire Clinical Commissioning Group Annual Report and Accounts 2018/19

South Lincolnshire Clinical Commissioning Group Annual Report 2018/19

Contents Statement by the CCG Chair and Accountable Officer

Performance Report Performance Overview

Performance Summary

Performance Analysis

Key Achievements in 2018/19

Financial Summary

Improving Health, Reducing Health Inequalities and Prevention

Sustainable Development

Improvement in Quality

Delegated Commissioning of Primary Care

Patient, Public and Stakeholder Involvement and Engagement

Let’s Get Social

Equality and Diversity

Compliments, Concerns and Complaints

Freedom of Information

Corporate Governance Report Members’ Report

Statement of Accountable Officer’s Responsibilities

Annual Governance Statement

Remuneration and Staff Report

Remuneration Report Staff Report

62 70

Financial Statements Annual Accounts

Auditor’s Report

103

South Lincolnshire Clinical Commissioning Group Annual Report 2018/19

Statement by the CCG Chair and Accountable Officer We welcome you to the 2018/19 Annual Report for South Lincolnshire Clinical Commissioning Group, which covers the period between 1 April 2018 and 31 March 2019. The Annual Report has been prepared in accordance with the National Health Service Act 2006 (as amended 2012) Directions by NHS England, in respect of Clinical Commissioning Groups’ annual reports.

Mr John Turner, Accountable Officer

Dr Kevin Hill, GP Chair

This report gives us the opportunity to provide you with some insight into the work of the CCG and what we have done over the past 12 months, including a number of areas we are particularly keen to highlight. We hope that it also provides some evidence as to how seriously we take our responsibilities as commissioners. In South Lincolnshire CCG we are proud of our NHS, and remain committed to improving the health of the people we serve, and the quality of health care they receive. The 5th July 2018 marked the 70th birthday of the NHS. The NHS celebrated this milestone by holding a number of celebratory events over the year which demonstrated pride in our Health Service’s enduring success, and in the shared social commitment it represents. At the same time we had a national debate about the future of our NHS where we shared concerns about funding, staffing, increasing inequalities and pressures from a growing and ageing population. There was also much pride in our NHS and optimism for the future about the possibilities for continuing medical advances and better outcomes of care. The NHS continues to face significant challenges; in particular ongoing workforce and funding pressures need to be met with long-term thinking to ensure that quality of care is not compromised in the future. On 7th January 2019, the NHS Long-Term Plan (formerly known as the ten-year plan) was published setting out key ambitions for the service over the next ten years.

To succeed, we must keep all that’s good about our health service and its place in our life, but we need to address head-on the pressures our staff face, while making our funding go as far as possible. As we do so, we must accelerate the redesign of patient care to future-proof the NHS for the decade ahead. The publication of the NHS Long Term Plan provides confirmation of the overall direction of travel for us, and an overview and summary of the NHS Long Term Plan can be found at: https://www.longtermplan. nhs.uk/online-version/overview-andsummary/ Reflecting on 2018/19, the last 12 months have proven exceptionally challenging as we try to maintain and develop healthcare, and there is no doubt that the close working relationships we have forged with our neighbouring CCGs, our local provider organisations and a wide range of third sector/voluntary bodies are becoming increasingly valuable. Continuing a trend identified in last year’s Annual Report and Accounts, we have worked particularly closely with South West Lincolnshire CCG, with whom we share an executive team. Looking ahead, the direction of travel for the NHS in Lincolnshire includes closer system working and eventually the development of Integrated Care Systems, that will take the best of what health and social care has to offer.

Lincolnshire Clinical Commissioning Group 06 South Annual Report 2018/19

As a system, Lincolnshire CCGs and the provider organisations, including Lincolnshire Community Health Services NHS Trust (LCHS), Lincolnshire Partnership NHS Foundation Trust, and North West Anglia NHS Foundation Trust (NWAFT) and United Lincolnshire Hospitals NHS Trust (ULHT), are working ever more closely and this will continue. We also value our relationships with colleagues in Lincolnshire County Council and District Councils, and across the voluntary and third sector too. This increasingly collaborative working not only makes sense but is a necessity too.

We have recently launched the Healthy Conversation 2019, which is a significant and wide-ranging engagement exercise where we will talk about the future of the NHS in Lincolnshire with the people of Lincolnshire. The Healthy Conversation is considering a number of proposals for the future of health services in the county and you can find out more here www.lincolnshire.nhs.uk/healthyconversation and also later in this report. We encourage you to review all of the material on the Healthy Conversation 2019 website and to provide us with feedback.

As part of the closer working arrangements a decision was taken in 2018 to appoint a single Accountable Officer across the four Lincolnshire CCGs, and as a result John Turner took up this post on 1 April 2019. This development will help foster closer working across the CCGs, with our provider organisations and in conjunction with our partner organisations described earlier.

Nationally there is a drive to shift care out of hospitals and into the community. Our work on this continues, in partnership with our neighbouring CCGs and our provider organisations, and the emerging Neighbourhood Teams have a particularly important role to play. Having said that, for higher acuity patients, hospitals will still have a vital part to play. As our main provider of acute hospital services NWAFT plays a crucial role and we need to work together to help it meet its challenges, so that outcomes are improved for our patients.

The appointment of a single Accountable Officer will be pivotal as we continue to have to make some very difficult decisions going forwards. There remains a demand on us to find further efficiencies, building on what we have previously achieved, to satisfy the requirements placed on us and this will inevitably lead to a need for some hard and very honest conversations with you about the services we offer. It will be especially important that we continue to talk with you, our patients and population throughout the course of the year.

Our GPs remain crucial to the work of the CCG and it being clinically-led. They and their practices are under constant pressure, and yet they deliver excellent care to our population, for most of whom they are the first port of call in the NHS.

across the country. Further details are available later in this report and a video of the case study is available on YouTube https://www.youtube.com/ watch?v=qSs7SnVgRHY All of us have a vital role to play going forwards, to ensure that the NHS is truly sustainable. We are immensely grateful to the whole CCG staff team - their dedication and commitment to the CCG’s work is deeply impressive and very much appreciated by both of us and the rest of the CCG’s Governing Body and members. We would like to take this opportunity to thank both Dr Kieron Wiscombe, Chair of the Council of Members and Dr Ian Wheatley, GP Governing Body member, who have both moved on to different roles in 2019. We wish them all the best for the future in their new endeavours. Finally, the CCG will be holding its Annual Public Meeting under a ‘Committees in Common’ arrangement with South West Lincolnshire CCG in September 2019, where you will have the opportunity to ask questions about this report, our work this year and our plans moving forward. We hope that you will enjoy reading our Annual Report and Accounts, should you have any questions please do not hesitate to let us know using the contact details on the rear outer page of this report.

First Contact Practitioners is a good example of the innovative work being led by our practices, and was initially carried out as part of a pilot at the Deepings Practice. The pilot has proved very successful and NHS England (NHSE) is planning to roll out the concept

South Lincolnshire Clinical Commissioning Group Annual Report 2018/19

Performance Report Overview The purpose of this overview is to give a brief summary of the CCG, its purpose and activities, demographic profile, how we work in the local health system, and with whom we have contracts. It also summarises our performance against key targets, risks to achieving our strategic objectives and what our main challenges have been this year. We have provided more detail on all these areas later in the report.

About Us NHS South Lincolnshire Clinical Commissioning Group (SLCCG) is a clinically led commissioning organisation authorised by the Government to plan, buy and monitor healthcare services for approximately 162,000 people living in South Lincolnshire. The CCG is a body corporate established by NHS England on 1 April 2013 under the Health and Social Care Act 2012. The CCG is a membership organisation made up of 13 GP practices who provide primary care services to people living in the area.

Purpose and Activities of the CCG Our purpose is to ensure provision of high quality, efficient and cost effective healthcare services for our geographical area, which covers Stamford, Bourne, Market Deeping, Spalding, Long Sutton and surrounding areas. The main hospitals serving this population are Peterborough Hospital, Stamford and Rutland Hospital, Johnson Community Hospital, Queen Elizabeth Hospital, Kingâ&#x20AC;&#x2122;s Lynn, and Pilgrim Hospital, Boston. We have a Clinical Chair, Dr Kevin Hill, who provides overall clinical leadership. Our Accountable Officer is Mr John Turner who has overall responsibility for managing the work of the CCG. The work of the CCG is overseen by a Governing Body which includes GPs, other health professionals, Lay Members and NHS Managers.

Lincolnshire Clinical Commissioning Group 08 South Annual Report 2018/19

Our main responsibilities are: ▶▶ Ensuring safe, high quality provision of healthcare. ▶▶ Listening to patients, carers and local people to understand health needs, and take their views into account to create meaningful choices. ▶▶ Providing information and empowering people to manage their own health. ▶▶ Analysing the health and social care needs of our local population – working with the Lincolnshire Health and Wellbeing Board. ▶▶ Planning health services for the next year and for the future – working with our practices, partners and local people. ▶▶ Commissioning other organisations to provide services in line with our plans. ▶▶ Agreeing service contracts and managing performance against those agreements. ▶▶ Making the best use of the resources we have to provide healthcare.

Our commissioning budget in 2018/19 was £234.5 million and the services we commission or buy are:

CCG Practices

Abbeyview Surgery, Crowland Health Centre PE6 0AL

Beechfield Medical Centre, Beechfield Gardens, Spalding PE11 1UN

Deepings Practice, Godsey Lane, Market Deeping PE6 8DD

Galletly Practice, 40 North Road, Bourne PE10 9BT

Gosberton Medical Centre, Lowgate, Gosberton PE11 4NL

Hereward Medical Centre, Exeter Street, Bourne PE10 9XR

11. Lakeside Healthcare Stamford (incorporating St Mary’s Medical Centre, Wharf Road, Stamford, PE9 2DH and New Sheepmarket Surgery, Ryhall Road, Stamford, PE9 1YA)

Littlebury Medical Centre, Fishpond Lane, Holbeach PE12 7DE

12. Sutterton Surgery, Spalding Road, Sutterton, Boston PE20 2ET

Moulton Medical Centre, Moulton PE12 6QB

13. Long Sutton Medical Centre, Trafalgar Square, Long Sutton, Spalding PE12 9HB

▶▶ Rehabilitative Care

We also work with a number of providers of health care in acute settings, the community and mental health.

▶▶ Urgent and emergency care

Our main acute providers are:

▶▶ Planned hospital care

▶▶ Most community health services

▶▶ North West Anglia NHS Foundation Trust (NWAFT)

▶▶ Mental health and learning disability services

▶▶ United Lincolnshire Hospitals NHS Trust (ULHT)

Our main providers of services In 2018/19 we continued to have full delegated responsibility from NHS England to commission primary care services.

Munroe Medical Centre, West Elloe Avenue, Spalding PE11 2BY

▶▶ Queen Elizabeth Hospital NHS Foundation Trust, Kings Lynn (QEH) ▶▶ Ramsay Health Care ▶▶ Lincolnshire Community Health Services NHS Trust (LCHS)

10. Pennygate Health Centre, 210 Pennygate, Spalding PE11 1LT (closed in September 2018) – the service is currently provided by Lincolnshire Community Health Services under a caretaker arrangement at Johnson Community Hospital, Spalding)

▶▶ Lincolnshire Partnership NHS Foundation Trust (LPFT) ▶▶ East Midlands Ambulance Services NHS Trust (EMAS) In addition, GP out of hours services are provided by Lincolnshire Community Health Services NHS Trust. The local provider of the NHS 111 service is Derbyshire Health United. Non-Emergency Transport Services are provided by Thames Ambulance Services Limited (TASL).

South Lincolnshire Clinical Commissioning Group Annual Report 2018/19

Our Mission, Vision and Values Vision Working in partnership with others we will make the most effective use of the resources we have available to achieve the best health outcomes for the people of South Lincolnshire.

Mission For the people of South Lincolnshire to live longer and healthier lives.

Values We will uphold the principles, values and rights set out in the NHS Constitution.

As a public body, we adhere to the seven principles of public life (Nolan Committee). These are: ▶▶ ▶▶ ▶▶ ▶▶ ▶▶ ▶▶ ▶▶

Selflessness Integrity Objectivity Accountability Openness Honesty Leadership

In addition, the values underpinning the work of the CCG are:

QUALITY

AMBITION

LEADERSHIP

We will ensure that quality is central to everything that the CCG does.

We will seek to achieve the highest standards in commissioning and secure the best health outcomes that we can for the people of South Lincolnshire.

We will act as leaders within the NHS and with others who contribute to improving the health of the people of South Lincolnshire.

RESPECT, FAIRNESS AND EQUALITY

HONESTY AND TRANSPARENCY

LISTENING AND LEARNING

We will treat everyone equally, recognising and valuing diversity and ensuring everyone has the opportunity to fulfil their potential. We will treat patients, the public, our staff and others with respect and dignity.

We will be open, honest and transparent about the decisions we make, explaining and sharing our decisions with the people of South Lincolnshire.

We will listen to patients, local people, health professionals and others who support the CCG. We will learn from others within and beyond the NHS to inform our decisions and strategic plans.

EFFICIENCY We will spend public money wisely, ensuring efficiency and value for money. Lincolnshire Clinical Commissioning Group 10 South Annual Report 2018/19

Our Strategic Objectives and Priorities Lincolnshire faces a number of healthcare challenges related to the rural geography, poor transport infrastructure, ageing population and an under developed market of service provision. As a result of these challenges health services in Lincolnshire are changing. The Lincolnshire Sustainability and Transformation Partnership (STP) has set out its vision for these changes linked to the NHS Long Term Plan (LTP), 2019. This includes doing more to integrate services, to provide care closer to peoples’ homes, and keeping people well and healthier for longer. Providing tools, information and support within communities will help people to make healthier lifestyle choices and take more control over their own care. This will improve the quality of life for people who live with health conditions and reduce the numbers of people dying early from diseases that can be prevented. This work will link to the Lincolnshire Joint Health and Wellbeing Strategy (JHWS) key themes and the Joint Strategic Needs Assessment (JSNA).

These workstreams focus on the needs of our local population and the intelligence that our membership GP practices provide, gathered alongside wider engagement work we undertake to help us to monitor current services and plan for the future. The CCG prioritises quality and safety identified through what our patients tell us, what our local clinicians tell us, our quality assurance processes and national and regional best practice. They dovetail into our commissioning strategy and contribute to the delivery of our mission, values and organisational objectives. Improving quality is a continuous cycle and is enshrined in the Health and Social Care Act 2012, outcomes both clinical and patient are a key element for improvement. Our quality priorities will be aligned to the CCG’s Quality Strategy and the National Improvement and Assessment Framework. National key policy initiatives will inform the way the CCG will work with our stakeholders, including patients, to commission, monitor and measure the quality of care. The constantly shifting landscape of general practice and the wider NHS presents significant challenges which require the introduction of new ways

of working. Primary Care Networks will enable ‘Working at Scale’ and development of services with the main aim of improving patient care. An element of this will be primary care working alongside Neighbourhood Teams to deliver integrated care across populations of circa 30-50,000 as a minimum. This approach will also integrate with acute hospital services with staff working across organisational boundaries and out of different premises. The seven NHS organisations in Lincolnshire are collaborating to address the challenges of improving quality, recruiting and retaining excellent people and addressing the financial gap through the STP. There will be a move to having integrated care systems in Lincolnshire. This means bringing together NHS providers and commissioners, local authorities and the third (voluntary) sector to work in partnership to improve health and care in the local area. An aspiration of this would be to improve population health by tackling the causes of illness and the wider determinants of health. The work of the STP is crucial to the sustainability of healthcare in Lincolnshire and in achieving our strategic objectives; these will be reviewed regularly and revised if required.

South Lincolnshire Clinical Commissioning Group Annual Report 2018/19

Our population ▶▶ Overall, the South Lincolnshire CCG has relatively low levels of deprivation, as measured by the Index of Multiple Deprivation (IMD), although there are differences across the CCG. The highest levels of multiple deprivation are in Long Sutton and Sutterton and the lowest being in Stamford and Market Deeping. ▶▶ Over a fifth (22.7%) of the population are aged 65 years and over, higher than the England average (17.3%).

An estimated 1.8% of the population cannot speak English well or at all, which is similar to that in England overall (1.7%). ▶▶ Overall life expectancy at birth in the CCG is significantly higher than the England average for both females 83.6years and males 80.3% years.

▶▶ There is an increasing trend in relation to some long term conditions, for example diabetes in adults, which has a higher prevalence (7.6%) than in England (6.8%). ▶▶ Over a fifth (22.1%) of reception year children have excess weight and this is over a third (34.2%) for year six children.

▶▶ The overall premature mortality rate (deaths < 75 years) is significantly lower than that for England.

▶▶ The latest Census (produced in 2011) identifies that the Black and Minority Ethnic (BME) population represent 2.3% of the CCG population. Need Funding

Area

Indicator

Elderly population % Population characteristics for healthcare needed

Disease Prevalence for high cost disease categories

England

SWLCCG

SLCCG

LECCG

LWCCG

Percentage Aged 60-79

18.00%

23.40%

22.90%

26.10%

20.10%

Percentage aged 80+

4.90%

5.70%

6.20%

6.60%

5.20%

Annual Percentage Growth in Population aged 60-79

1.00%

1.70%

1.60%

1.30%

-0.60%

Annual Percentage Growth in Population aged 80+

2.00%

2.50%

1.20%

1.90%

-1.00%

Cancer

3.67

3.72

3.58

3.08

Cardiovascular disease – primary prevention

1.24

1.12

1.29

1.14

Dementia

0.74

0.93

1.05

0.85

Diabetes mellitus

7.54

7.62

8.89

6.83

1.54

1.31

1.43

0.97

Heart failure Obesity

11.89

11.66

12.59

11.41

Stroke and transient ischaemic attack

2.06

2.24

2.72

1.96

Social, community and human rights issues

Working with partners and key stakeholders

The CCG places a high priority on ensuring that it discharges its obligations as a good corporate citizen and takes into account is responsibilities towards serving and meeting the needs of local people, including safeguarding their human rights.

We work with a number of partners including clinicians, NHS England, providers, Public Health, social care, other CCGs and voluntary sector providers. This ensures we understand the needs of our communities so that the services we commission are of the very highest quality, delivered in the right place and improve health outcomes.

We ensure equality and diversity run through our work as described in detail in our section on equality and diversity later in this report.

Lincolnshire Clinical Commissioning Group 12 South Annual Report 2018/19

The CCG has a particularly close working relationship with South West Lincolnshire CCG with a number of senior shared roles across both organisations, including the Accountable Officer, Chief Finance Officer, Secondary Care Doctor and CCG Corporate Secretary/Manager. There is also one senior leadership team across both CCGs. In addition both CCGs have a number of Committees that meet under a ‘Committees in Common’ approach. Further details are set out in the Annual Governance Statement presented later in the report.

We have continued our close working with Public Health colleagues on a number of areas including the development of the Joint Strategic Needs Assessment, Joint Health and Wellbeing Strategy and social prescribing, which are referred to later in the report. A member of the Public Health team also attends our Governing Body to further enhance collaborative working. We work with Healthwatch Lincolnshire to ensure that the views of the public and people who use services are heard. The Chief Executive of the Lincolnshire Healthwatch group regularly attends CCG Governing Body and Primary Care Commissioning Committee meetings, and other representatives participate in the Quality and Patient Experience Committee and Patient Council.

Key issues and risks to achieving our objectives

The most notable risks identified during 2018/19 related to the delivery of key constitutional standards in urgent and planned (elective) care, A&E, cancer and quality risks. Robust improvement plans are in place and the CCG is working with partner organisations to address the quality and performance issues identified.

Going Concern Public sector bodies are assumed to be going concerns where the continuation of the provision of a service in the future is anticipated, as evidenced by inclusion of financial provision for that service in published documents. The following is clear evidence that South Lincolnshire CCG meets the requirements as set out in the Department of Health Manual of Accounts: ▶▶ The CCG was established on 1 April 2013 as a statutory body.

During 2018/19, the Lincolnshire health and social care system has continued to face significant challenges concerning delivery of financial targets and underperformance against NHS Constitutional standards. The four CCGs and provider organisations in Lincolnshire need to work together to resolve these. The CCG has a Joint Risk Management Group (JRMG) with South West Lincolnshire CCG. This Group ensures a consistent approach across both CCGs to risk assessment and measurement, and also forward-scans and assesses the impact of possible future risks as well as ensuring the CCGs can respond to unknown risks. The JRMG reviews the Risk Register and Governing Body Assurance Framework at every meeting. All risks (both clinical and non-clinical) are managed in accordance with the CCG’s Joint Risk Management Framework, which is referred to in further detail in the Annual Governance Statement.

▶▶ The CCG has an agreed Constitution which it is operating to for the governance of its activities. ▶▶ The CCG has been allocated funds from NHS England for 2019/20. ▶▶ The CCG has been allocated indicative allocations to 2023/24. ▶▶ The CCG is allocated a cash drawdown which is based on the cash requirements of the CCG.

The budget for 2019/20 has already been agreed with NHS England. On this basis, there is no reason to believe that sufficient funding will not be made available to the CCG in the 12 months from the date of approval of the Financial Statements. As such the Financial Statements which feature later in this report have been prepared on a going concern basis.

South Lincolnshire Clinical Commissioning Group Annual Report 2018/19

Performance Summary The following section details our performance against the Improvement and Assessment Framework and NHS Constitutional Standards.

How are we performing The CCG continues to be monitored against the Improvement and Assessment Framework (IAF) that was introduced in April 2016. The implementation of the IAF replaced the CCG Assurance Framework and aims to provide a greater focus on assisting improvement alongside the delivery of statutory functions. The IAF brings together the NHS Constitution and other core and finance performance targets that we regularly monitor through our Governing Body Meetings. The four domains within the IAF framework and

six clinical priority areas are set out on this page. ▶▶ Better Care – requires improvement in cancer, dementia and urgent care ▶▶ Better Health – outstanding performance in diabetes ▶▶ Leadership – is amber overall ▶▶ Sustainability – in year financial performance is red.

The CCG’s year end rating rating for 2017/18 was ‘requires improvement’. This was deterioration on the 2016/17 rating of ‘good’ and is a reflection of the pressures being seen across the local health system.

The details are publically available on the My NHS website: https://www.nhs.uk/service-search/performance/search

Lincolnshire Clinical Commissioning Group 14 South Annual Report 2018/19

Performance Analysis NHS Constitutional Standards Delivery of the NHS constitutional standards is a key priority for the CCG but maintaining and improving performance in 2018/19 has proven difficult in some areas. Positive performance is visible but there are concerns over certain key indicators such as the A&E 4 hour target, Ambulance Response Indicators, cancer performance and Referral to Treatment Times (RTT) for Planned Care.

Urgent Care (Table A) The CCG continues to focus on improving A&E performance although this has been particularly challenging during 2018/19. For the A&E 4 hour standard (95%) the CCG performance for 2018/19 across all providers was 81.7%. This was a small deterioration on 2017/18 performance of 83.8%. For South Lincolnshire CCG, the majority of patients access care outside of Lincolnshire at North West Anglia Foundation Trust (NWAFT) where 2018/19 performance was 83.3%, an improvement compared to 2017/18 performance that was 80.7%. At the CCGâ&#x20AC;&#x2122;s second biggest provider ULHT, performance for 2018/19 was 68.6% which deteriorated from 75.1% in 2017/18. Performance at the CCGâ&#x20AC;&#x2122;s main providers is reflective of the issues they have experienced during the last twelve months, with both providers having struggled to achieve the improvement trajectories agreed with NHSI throughout the year. Performance did improve during the middle of the year but despite a mild winter maintaining this towards the end of the year has been difficult. At NWAFT, performance at the Peterborough Hospital Site for March 2019 was 66.2%. The Peterborough Hospital site is accessed by the majority of South Lincolnshire patients due to its proximity to the south of Lincolnshire. The CCG is working with the provider to manage increases in urgent care activity and improve performance. The Urgent Care Delivery Board is in place to monitor and support NWAFT and the CCG is an important stakeholder of this group. A key area of focus for this group and NWAFT is the urgent care plan that is vital to stabilising and improving urgent care services moving forward. NWAFT have now introduced a new patient administration system in A&E, although due to issues with its implementation towards the end of the year performance was negatively impacted. At ULHT performance for 2018/19 was 68.86%. Grantham Hospital A&E performance is much stronger than the Lincoln County Hospital and Pilgrim Hospital, Boston sites. At Lincoln County Hospital performance in March 2019 was 63.66% and at Boston Pilgrim performance was 72.84%.

South Lincolnshire Clinical Commissioning Group Annual Report 2018/19

A&E Delivery - Table A Description

Target

17/18 Outturn 18/19 Outturn

A&E A&E Waiting Time - % of people who spend 4 hours or less in A&E (SUS - CCG)

95.00%

83.8%

81.7%

A&E Waiting Time - % of people who spend 4 hours or less in A&E (NWAFT)

95.00%

80.7%

83.3%

A&E Waiting Time - % of people who spend 4 hours or less in A&E (ULHT)

95.00%

75.1%

68.6%

A&E Waiting Time - % of people who spend 4 hours or less in A&E (QEH)

95.00%

85.5%

82.5%

Trolley waits in A&E - Number of patients who have waited over 12 hours in A&E from decision to admit to admission (NWAFT)*

Trolley waits in A&E - Number of patients who have waited over 12 hours in A&E from decision to admit to admission (ULHT)*

Trolley waits in A&E - Number of patients who have waited over 12 hours in A&E from decision to admit to admission (QEH)*

Ambulance handover time - Number of handover delays of 30-60 minutes (Peterborough City)

2038

1852

Ambulance handover time - Number of handover delays of >1 hour (Peterborough City)

1090

650

Ambulance handover time - Number of handover delays of 30-60 minutes (Boston)

5893

4640

Ambulance handover time - Number of handover delays of >1 hour (Boston)

3810

2576

Trolley Waits

Ambulance Handover

* Trolley Waits are at provider level and not CCG One of the main issues at ULHT for urgent care is recruitment and staffing levels. Despite continued attempts to recruit the Trust have limited inpatient and A&E capacity, despite the use of agency staff. The CCG is working with partner organisations across the Lincolnshire system to offer support.

Ambulance Services (Table B)

Work is also ongoing with the national NHS Pathways team to understand the factors behind the increases in NHS 111 activity passed through to EMAS and to identify any areas of improvement that could be made. Remedial action plans are in place via the Lincolnshire Co-ordinating commissioner and continue to be monitored. Category 1

The East Midlands Ambulance Service NHS Trust (EMAS) performance continues to fail against the majority of targets introduced with the Ambulance Response Programme (ARP). At SLCCG performance improved across all categories except for Category 3 90th centile (02:00:00) and Category 4 90th centile (03:00:00) compared to when the targets were introduced in July 2018.

SLCCG

Ambulance Services Table B

Category 2

Category 3

Category 4

Mean

90th centile

Mean

90th centile

National standard

00:07:00

00:15:00

00:18:00

00:40:00

02:00:00

03:00:00

EMAS

00:07:29

00:13:29

00:26:31

00:54:33

02:44:40

02:53:37

Lincolnshire

00:08:45

00:16:34

00:33:25

01:09:14

03:22:32

03:28:56

SLCCG

00:11:31

00:19:20

00:33:58

01:06:27

02:51:36

03:12:10

Lincolnshire Clinical Commissioning Group 16 South Annual Report 2018/19

Planned Care (Table C) The CCG did not achieve the 92% referral to treatment (RTT) standard for 2018/19. This is for patients to receive treatment within 18 weeks from the date of referral on non-emergency pathways. At the CCG’s main provider North West Anglia Foundation Trust (NWAFT) performance for CCG patients in 2018/19 was 88.0%. This is a reduction on 2017/18 performance which was above the 92% target. At the CCG’s other providers, ULHT performance for 2018/19 for CCG patients was below the 92% target at 88.6% and QEH 80.5%. The CCG has a target of zero 52 weeks breaches but this has not been achieved with ten breaches being recorded in 2018/19. The diagnostic waiting time standard of 99% of patients being seen in less than six weeks was not achieved for CCG patients. 97.6% of patients were seen in less than six weeks for 2018/19. The target was missed for CCG patients at the following providers NWAFT (97.0%), ULHT (98.4%) and QEH (98.9%).

Planned Care - Table C Target

17/18 Outturn

18/19 Outturn

RTT - Incomplete Pathways (CCG)

92.00%

92.1%

88.6%

RTT - Incomplete Pathways (CCG for ULHT)

92.00%

89.9%

88.6%

RTT - Incomplete Pathways (CCG for NWAFT)

92.00%

92.7%

88.0%

RTT - Incomplete Pathways (CCG for QEH)

92.00%

86.5%

80.5%

Diagnostic Test Waiting Time <6 wks (CCG)

99.00%

98.5%

97.6%

Diagnostic Test Waiting Time <6 wks (CCG for ULHT)

99.00%

98.2%

98.4%

Diagnostic Test Waiting Time <6 wks (CCG for NWAFT)

99.00%

98.5%

97.0%

Diagnostic Test Waiting Time <6 wks (CCG for QEH)

99.00%

98.8%

98.9%

Description RTT - Incompletes

RTT - No. Over 52 weeks within incomplete pathways (CCG)

Diagnostics

18/19 Dec YTD

Cancelled Operations Cancelled Operations - % of patients cancelled for non-

Cancer Care (Table D) The CCG is committed to improving cancer services for patients and ensuring that patients are seen quickly as possible is a key priority. Performance for 2018/19 has seen deterioration against some indicators from 2017/18 but there were also improvements against Cancer 31 Day Waits - first definitive treatment and Cancer 31 Day Waits - subsequent treatment, Radiotherapy. Performance was maintained at 100% for Cancer 31 Day Waits -subsequent treatment, chemotherapy. Indicators that were achieving at 2017/18 outturn but are now below the required standard are Cancer 2 Week Wait - suspected cancer, and Cancer 31 Day Waits - subsequent treatment, surgery. Three standards that were not achieved in 17/18 and remain unachieved for 2018/19 are Cancer 2 Week Wait- breast symptomatic referrals, Cancer 62 Day Waits - first definitive treatment, GP referral and Cancer 62 Day Waits - treatment from screening referral.

0.00%

6.6%

9.1%

0.00%

16.2%

14.8%

0.00%

12.5%

11.6%

Healthcare acquired infection (HCAI) measure (MRSA) (CCG)

Healthcare acquired infection (HCAI) measure (Clostridium difficile infections) (CCG)

Mixed Sex Accommodation (MSA)

Never Events (CCG)

clinical reasons not re-admitted within 28 day (ULHT)

Cancelled Operations - % of patients cancelled for nonclinical reasons not re-admitted within 28 day (NWAFT)

Cancelled Operations - % of patients cancelled for nonclinical reasons not re-admitted within 28 day (QEH)

HCAI’S

Other

South Lincolnshire Clinical Commissioning Group Annual Report 2018/19

For CCG patients the majority of cancer care is delivered from our two main providers ULHT and NWAFT. Both providers have experienced issues in meeting the cancer standards in certain areas and this is also linked to delays caused by diagnostic waits. The CCG has a Contract Performance Notice (CPN) open at NWAFT for Cancer 62 Day Waits - first definitive treatment, GP referral. Key issues affecting performance are increased demand on the imaging department impacting turnaround times and endoscopy delays impacting pathways. Other issues impacting performance at NWAFT include increased referrals and vacancies in medical imaging. At ULHT issues that are impacting performance include the lack of radiologist availability, capacity issues in oncology and diagnostic pressures. Two week wait breast continues to be a fragile service that is overseen closely by the Lincs STP and NHSI. This is due to fluctuating issues with workforce between radiology/ surgical capacity and nursing capacity.

The Lincolnshire Sustainability and Transformation Partnership (STP) will be supporting a cancer work programme for 2019/20 and have determined the key areas of intervention: ▶▶ Maintain achievement of all constitutional standards for cancer. ▶▶ Diagnose cancers earlier and faster. ▶▶ Prepare in 2019 for moving towards the faster diagnosis standard 28 days. ▶▶ Ensure every patient has access to optimal, personalised treatment, needs assessment, care plan and effective follow up including health and wellbeing information advice and support. ▶▶ Improve patient experience. ▶▶ Lincolnshire STP will support the East Midlands Cancer Alliance (EMCA) with implementing partnerships for fragile services with Nottingham and Leicester providers.

Key areas of work for Lincolnshire includes strengthened links with Public Health to ensure that the screening

Cancer Care - Table D Description

Standard

17/18 Outturn

18/19 Outturn

Cancer 2 Week Wait - suspected cancer

93.0%

89.2%

Cancer 2 Week Wait - breast symptomatic referrals

93.0%

91.4%

82.7%

Cancer 31 Day Waits - first definitive treatment

96.0%

97.3%

97.4%

Cancer 31 Day Waits - subsequent treatment, surgery

94.0%

96.8%

90.8%

Cancer 31 Day Waits - subsequent treatment, chemotherapy

98.0%

100%

Cancer 31 Day Waits - subsequent treatment, radiotherapy

94.0%

97.8%

97.9%

Cancer 62 Day Waits - first definitive treatment, GP referral

85.0%

80.4%

75.6%

Cancer 62 Day Waits - treatment from screening referral

90.0%

76.6%

68.9%

No standard

92.7%

90.6%

Cancer 62 Day Waits - treatment from Consultant upgrade

Lincolnshire Clinical Commissioning Group 18 South Annual Report 2018/19

and prevention programmes align with the national programme and the needs of local people, improving all eight constitutional standards including 62 day cancer performance and supported improvement in clinical pathways so that these align with the national best practice optimal pathways, these include Lung, Prostate and Colorectal / Faecal Immunochemical Testing (FIT) pathway.

Mental Health (MH) (Table E)

▶▶ Continuing to increase the dementia diagnosis rate and in early 2019 launched the new Admiral Nurse Service in partnership with St Barnabas to help support families of people with dementia.

With one in four of us suffering from a mental health issue during our lifetime, it’s really important that services in Lincolnshire are a priority, especially for children and young people. In Lincolnshire, we have worked collaboratively across the county and have made excellent progress, including:

▶▶ Upgrading some of our older adult inpatient wards to provide single bed rooms with en-suite bathrooms and improved living spaces; work that is due to finish later in 2019/20.

▶▶ Significantly expanding perinatal MH services across Lincolnshire, enabling us to offer care and support to more women who experience mental ill health during pregnancy or after the baby is born.

We are absolutely committed to valuing mental health as equally as physical health. Our close working with partners across the county is ongoing to ensure we continue to reduce A&E attendances for those patients who have a mental health need, and we are to continuing to transform our community mental health and learning disability teams to enable more patients to be cared for at home without the need to come into hospital.

Mental Health - Table E Target

17/18 Outturn

18/19 Outturn

Early Intervention in Psychosis - Patients treated within 2 weeks (CCG)

50.0%

78.6%

57.1%

Early Intervention in Psychosis - Patients treated within 2 weeks (CCG - LPFT)

50.0%

78.6%

57.1%

Description Early Intervention in Psychosis (EIP)

▶▶ Opening a ten bed psychiatric intensive care unit (PICU) in July 2017, and from the time it opened until January of 2018 no male patient needed to be treated outside of the county for this intensive level of care. ▶▶ Opening of the psychiatric clinical decision unit and expansion of our home treatment teams using funding that was previously spent on services outside Lincolnshire, enabling us to better support people experiencing a severe episode of mental ill health or crisis. ▶▶ Expansion of our bed managers service, helping to ensure that patients remain in hospital for as short a period as is necessary and helping those patients being treated outside of Lincolnshire to be cared for closer to their family and friends. ▶▶ Halving the number of patients being treated out of area when acutely unwell and we will continue this. ▶▶ Launching our new emotional wellbeing service for children and young people – offering support for young people, parents and carers, as well as training for professionals in education and childrens’ services.

Improving Access to Psychological Therapies (IAPT)

18/19 Feb YTD

IAPT Access (CCG)

15.0%

17.4%

20.1%

IAPT Recovery Rate (CCG)

50.0%

49.6%

52.1%

IAPT 6 Weeks Waiting (CCG)

75.0%

84.1%

96.5%

IAPT 18 Weeks Waiting (CCG)

95.0%

98.6%

100.0%

IAPT Roll Out (CCG - LPFT)

15.0%

17.0%

19.1%

IAPT Recovery Rate (CCG - LPFT)

50.0%

50.5%

52.2%

% of patients under adult mental illness on CPA who were followed up within 7 days of discharge from psychiatric in-patient care (CCG)

95.0%

94.3%

93.0%

% of patients under adult mental illness on CPA who were followed up within 7 days of discharge from psychiatric in-patient care (LPFT)

95.0%

100.0%

94.3%

% of patients under adult mental illness on CPA who were followed up within 7 days of discharge from psychiatric in-patient care (CPFT)

95.0%

100.0%

66.7%

61.4%

64.2%

Care Programme Approach (CPA)

Dementia Estimated diagnosis rate for people with dementia

South Lincolnshire Clinical Commissioning Group Annual Report 2018/19

Dementia We are working with the Alzheimerâ&#x20AC;&#x2122;s Society and local partners including Lincolnshire County Council, to encourage people to talk to their GP if they are concerned that either they or a friend or relative has dementia. Dementia is not a specific disease, itâ&#x20AC;&#x2122;s an overall term describing a group of symptoms associated with a decline in memory or other thinking skills severe enough to reduce a personâ&#x20AC;&#x2122;s ability to perform everyday activities. The dementia diagnosis rate for SLCCG patients has improved during 2018/19 from 60.95% in April 2018 to 64.21% in March 2019.

We are committed to doing everything we can to support people to live healthy lives in order to reduce the risk of developing dementia and improve identification and early diagnosis to ensure people can be better enabled to live well with dementia through provision of meaningful support and services. In February 2019 we launched the Lincolnshire Joint Strategy for Dementia 2018-2021, which sets out our vision and priorities for dementia services in Lincolnshire over the next three years. Working in partnership with the other Lincolnshire Clinical Commissioning Groups and Lincolnshire County Council, we will support more people following a diagnosis to live at home, independently, for longer. The Joint Dementia Strategy 2018-2021 is available on the Lincolnshire County Council website here: https://www.lincolnshire.gov. uk/adult-care/professionals-andproviders/professionals/strategiespolicies-and-plans/joint-dementiastrategy-2018-21/121668.article

Key Achievements in 2018/19 Referral Facilitation Service (RFS) The CCG introduced a Referral Facilitation Service (RFS) to act as a single point of access for patient referrals to community and secondary care in October 2018. The RFS facilitates the patient referral process from initial GP referral to first outpatient appointment and is designed to reduce the administrative burden on practices and providers. The RFS undertakes an administrative review of referrals to ensure all relevant forms, tests and results are available, and in certain specialties, also undertake a clinical assessment to ensure the patient is cared for in the right setting at the right time. The clinical assessment is undertaken by local GPs. The RFS also supports the patient in making their choice of hospital or provider, and provides advice and guidance to the GP if appropriate. The service also provides information on referral trends to identify gaps in services

and support the design and development of new local services.

First Contact Practitioner The CCG introduced an Musculoskeletal (MSK) First Contact Practitioner Service at the Deepings practice as part of an NHS England (NHSE) pilot to provide proof of concept. For defined MSK conditions patients within these Practices are navigated for a first consultation with an Enhanced Scope Physiotherapist (ESP) rather than have an appointment with their GP. The ESP is able to order diagnostics, blood tests, request prescriptions, refer for community physiotherapy and/or refer on to Secondary Care or back to a GP if needed. The pilots have proved extremely successful and NHSE is now planning to roll-out the concept across the Country. The pilot at the Deepings Practice has also been shortlisted for a BMJ award.

Lincolnshire Clinical Commissioning Group 20 South Annual Report 2018/19

Diabetes During 2018/19, there have been developments in provision for both those at high risk of developing Type 2 diabetes and those living with diabetes within our population. Over 7.6% of the population in South Lincolnshire are living with diabetes (9.1% Lincolnshire STP, 6.8% nationally). The CCG has been working collaboratively with system partners to raise awareness of the risks associated with diabetes and opportunities for lifestyle changes which can reduce the risk of being diagnosed with Type 2 Diabetes. The National Diabetes Prevention Programme has been operating across the CCG since summer 2016. This behaviour change programme offers intensive lifestyle support to those identified at high risk of developing diabetes. In South Lincolnshire 1,317 people commenced the course by the end of 2018; with a high proportion of those who complete six months of the programme continuing to deliver results which reduce their risk of developing Type 2 diabetes in the future.

Working alongside both our Prevention Programme provider: ICS Health and Wellbeing and Diabetes UK, the CCG has focused on broadening its reach in terms of raising awareness. We have introduced interactive engagement events, workplace education opportunities and extended utilisation of social media to share key messages. As part of Diabetes Prevention Week in April 2019 we held public and staff engagement events and launched a Diabetes Pledge initiative;

encouraging individuals to learn more about the condition and committing to simple lifestyle changes to reduce their own risk. Further interactive public and workplace education events will form a key focus of prevention activity in the coming year. Further changes are planned as identified below: ▶▶ A series of training days to support GP practice staff in providing good quality diabetes care. ▶▶ Practice-level support from specialist nurses for key practices to facilitate improved quality of care delivery. ▶▶ Increased diabetes specialist nurse capacity in the community setting. ▶▶ ‘Living with Diabetes Days’ - patient education sessions for those with Type 2. ▶▶ Improved Multi-Disciplinary Footcare services at Pilgrim Hospital, Boston.

Care Portal The Care Portal continues to be developed and rolled out across the health economy in Lincolnshire. In 2018/19 over 4,000 staff have been given access and regularly use the system, including GP practices, practices, ULHT and LCHS. This is allowing people working across health and social care to view information about patients that is relevant to their job role. During 2019 it is anticipated that more practices and providers will be signed up to further improve communication between professionals. Work is already in progress with East Midlands Ambulance Service, Northern Lincolnshire and Goole Hospitals NHS Foundation Trust (NLAG) and North West Anglia Foundation Trust as well as Lincolnshire County Council. The patient portal is due to go live in April 2019 and development work has focussed around supporting the Better Births Maternity Transformation Programme. Patients will be able to

self-refer into the ULHT maternity service and view some areas of their clinical record. During 2019/20 the patient portal will be expanded to include other areas, such as connecting wearable devices and extending the use of smart forms to support other services. This will allow patients to view information about themselves and give them the opportunity to play a more active part in leading their own care.

RightCare RightCare is a programme committed to reducing unwarranted variation to improve people’s health and reduce inequalities in health access, experience and outcomes. It makes sure that the right person has the right care, in the right place, at the right time, making the best use of available resources. The CCG was part of wave one of the national programme which was supported by a range of partners including NHS England and Public Health. The Commissioning for Value packs provide information and indicative data across the ten highest spending programmes of care within our health economy. The CCG is clustered with ten other CCGs who have the most similar populations. This comparator group is used to identify realistic key value opportunities to improve health and healthcare for the population. The packs are used in conjunction with local intelligence to determine priorities for commissioning / service improvement supporting the vision of the NHS Five Year Forward View (FYFV) and the NHS Long Term Plan. Publication of focus packs provide detailed information on the opportunities to improve in the highest spending programmes highlighted within the Commissioning forValue Packs. They include a wider range of outcomes measures and information on the most common procedures and diagnoses for the condition covered. The aim is to reduce unwarranted variation/inequalities, improve health outcomes and maximise funding efficiencies and savings.

South Lincolnshire Clinical Commissioning Group Annual Report 2018/19

▶▶ Endocrine - transforming the diabetes services ▶▶ Gastrointestinal - refine pathways for Lower & Upper GI ▶▶ Cancer - refine pathways for Lung, Prostate, Lower & Upper GI ▶▶ Neurology – refine pathways for syncope and headaches; transform community Parkinson’s service NHS England has identified circulatory and respiratory conditions as national RightCare priorities, CCGs are required to develop RightCare plans for these two areas and one other area in 2019/20. The CCG is working with the other three Lincolnshire CCGs to develop system focussed RightCare plans to support and align with system working – these will build on the existing RightCare plans and work for these areas.

Neighbourhood Working The CCG is working on seven areas for priority focus: ▶▶ Musculoskeletal - review of hip / knee and pain management pathways; First Contact Physiotherapist pilot – South Lincolnshire is one of a number of early adopter sites. ▶▶ Circulatory / Cardiovascular - redesign of heart failure pathway; review of hypertension pathway; optimal primary care management. Piloting of a multidisciplinary heart failure clinic has improved management of care for symptomatic heart failure patients and will ensure care is delivered closer to home. ▶▶ Respiratory - review of Asthma and COPD pathways; optimal primary care management. The pathway review has included the commissioning of additional community support leading improved patient care for people prescribed oxygen.

Neighbourhood working has continued to develop across the CCG area throughout 2018/19, building networks across the primary locality areas of Bourne and Market Deeping, Spalding and Stamford. The key priority of the teams is to help people remain in their own home for as long as possible, avoiding unplanned hospital admissions and, if an admission does happen, support with a timely discharge. The teams are wrapped around groups of GP practices and aspire to deliver a population-based model of care, where wellbeing is maximised through communities, voluntary and statutory services working together. Key developments for neighbourhood working during the year included: ▶▶ Recruitment of Neighbourhood Leads, with a responsibility to oversee development at a locality level, facilitating engagement of appropriate parties and leading on key programmes of work. ▶▶ The introduction of Practice Care Co-ordinator roles, based within GP practices, with a responsibility

Lincolnshire Clinical Commissioning Group 22 South Annual Report 2018/19

to focus on individualised care delivery, for the most vulnerable and frail members of the community. Including supporting complex discharge, where appropriate. ▶▶ Building integrated multi-disciplinary relationships and functions across health and care services, engaging public, private and voluntary sectors. ▶▶ Identification of key population cohorts for intervention. ▶▶ Individualised care planning and delivery. ▶▶ Improved integration with hospitals to facilitate reduced lengths of stay in hospital and improved care on discharge. ▶▶ Monitoring of impact of new ways of working on hospital demand and cost.

Emergency Preparedness, Resilience and Response (EPRR) Each year CCGs and all NHS provider organisations are assessed for their compliance against the national Core Standards for Emergency Preparedness, Resilience and Response (EPRR). For the year 2018/19 South Lincolnshire CCG is Fully Compliant with the EPRR core standards. A dedicated EPRR officer and NonExecutive Director provide support to the CCG Accountable Emergency Officer (AEO) and meet on a quarterly basis. Compliance with the Core Standards is assessed annually by the Governing Body. Each year a separate deep dive topic is investigated. In 2018/19 the deep dive topic was “Governance”. The action required of the CCG was to develop a mechanism that allows the AEO to mobilise a response team to incidents and ensure funding/resources are in place to support this team. The response team involves development of a formal on-call rota of tactical commanders to support the existing CCG Strategic Commanders’ rota. The response team is there to provide

both internal support to the CCG and primary care, but also under their responsibilities of the Civil Contingencies Act they have a role in coordinating the wider health system’s response to any incident. As such the CCG AEO and EPRR lead have been part of the assurance process with all NHS provider organisations to ensure their satisfactory compliance with the EPRR Core Standards. As further best practice, the CCG has been asked to hold a table-top exercise in 2019 in relation to a potential pandemic incident. This is in order to provide further staff confidence and assurance in our response and recovery processes with regard to this type of incident.

Clinical Assessment Service (CAS) In 2016 Lincolnshire was the first NHS system in the country to develop a Clinical Assessment Service (CAS) to supplement the current NHS 111 service. The CAS is run by Lincolnshire Community Health Services and is supported by local GPs, senior nurses and pharmacists. Now mandated nationally in all areas the CAS is well established and takes 112,000 calls a year on average (just over 9,000 a month). Over 50% of all NHS 111 calls that require a patient to speak to a clinician are put through to Lincolnshire CAS. CAS re-triages selected calls from 111 where the outcome of the 111 call was to ask a patient to attend A&E. Of these calls up to 70% are ‘downgraded’ and patients, after speaking directly to a clinician, are reassured that they are able to go to an alternative setting in urgent care or their GP, or they are able to be heard and treated over the phone. CAS receive calls directly from other health and care professionals who are seeking a senior clinician’s advice and guidance - for example from paramedics who are on scene to help them decide where to transfer a patient, or for advice/ guidance on treatment that can be provided straight away. In a similar way care homes are also able to contact CAS

for advice and as a result of these direct routes there has been a reduction in the need for ambulance conveyances to hospital for these patients. In 2019 CAS will be developing its services further with the addition of more pharmacists to assist with taking calls at known peak times of the week when patients call regarding medicines advice. The pharmacists will also be able to prescribe and CAS and the 111 service have direct connections to community pharmacies so prescriptions can be sent/picked up from the call. Another exciting development this year will be the increasing use of video-consultation for appropriate calls, so patients can confidentially show physical symptoms to help aid a diagnosis over the phone. In 2019 CAS clinicians will also be able to increasingly direct book appointments for patients where this is deemed suitable in urgent care settings or with GPs. This gives greater confidence to patients that they have an appointment time rather than them waiting in long queues in either urgent care settings or A&E.

Extended Access There was a national commitment to deliver improved extended access to GP services across all CCG populations by 1st October 2018. The CCG worked with Allied Health South Lincolnshire (AHSL) Federation and Lakeside Stamford to deliver this new service. The services operate from hubs in Bourne, Spalding, Deepings and Stamford. These hubs offer bookable appointments via your registered practice from 18:30 to 20:00 Monday to Friday and on Saturdays, Sundays and Bank Holidays. There are data sharing arrangements in place so that the GP, Nurse or Physiotherapist can see your records, with your consent.

been good and the structures in place to govern the project are robust. There was recognition that the CCG, AHSL and Lakeside Stamford had delivered a positive partnership approach, whilst maintaining appropriate professional lines of responsibility.

Primary Care Delivery Facilitators In September 2018 two Primary Care Delivery Facilitators were appointed by South West and South Lincolnshire CCGs to further embed working relationships with member practices on joint CCG and primary care QIPP initiatives. It also created first points of contact at the CCGs for primary care colleagues to raise any queries or concerns. The facilitators collaborate with the Commissioning and QIPP teams to ensure joined up working and priority of projects, and work proactively to identify efficiency savings, linked to emerging and published national or local guidance. Part of their role has been to identify and address practice variation and then work with practices to identify solutions to these variances. The Primary Care Delivery Facilitators have supported review of clinical pathways, changes to referral processes and communicated these changes to practices. The role has been well received by member practices and contributes positively to the work of the CCG.

The service was fully operational by 1 October 2018 and met the core criteria that needed to be in place. NHSE held assurance meetings with the CCG and AHSL regarding the new service in December and with Lakeside Stamford in January 2019. Their report assessed that clinical and patient engagement has South Lincolnshire Clinical Commissioning Group Annual Report 2018/19

Financial Summary The annual accounts of the CCG have been prepared in accordance with the National Health Service Act 2006 (as amended) Directions by the NHS Commissioning Board, in respect of Clinical Commissioning Groups’ annual accounts. The accounts have been prepared on a going concern basis. The annual accounts are detailed in full from page 74 in this report. CCGs are set a Revenue Resource Limit (RRL) by NHS England that represents the maximum that can be spent in the year. At the start of the financial year, the CCG planned to contain expenditure within the RRL for the year.

Summary Headline Financial Information South Lincolnshire CCG has achieved its financial targets for 2018/19 as follows: 2018/19

2017/18

£000

Revenue Resource Limit

234,458

229,168

Net Operating Expenditure

234,455

233,448

Surplus/(deficit)

(4,280)

▶▶ The CCG managed its administration functions within the allocated Running Costs Allowance of £3.5 million. ▶▶ Cash payments were also managed within the Maximum Cash Drawdown limit as allocated by NHS England. ▶▶ The Better Payment Practice code requires the CCG to aim to pay all valid invoices by the due date or within 30 days of receipt of a valid invoice, whichever is later. The 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 Note Six to the accounts. The operating expenditure of the CCG can be split into two types: Programme – this is expenditure on the purchase of healthcare. The CCG spent 98.6% of its resources on programme expenditure.

Administration – costs that are not for the purchase of healthcare, but relate to the direct running costs of the CCG. The CCG spent 1.4% of its resources on administration expenditure. The CCG is an approved signatory to the Prompt Payments 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 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.

Lincolnshire Clinical Commissioning Group 24 South Annual Report 2018/19

Analysis of the CCG’s expenditure can be seen in the pie charts below.

£6,310 £6,036

3% 3% Hospital Services

10%

£23,391

Mental Health Services

Community Health Services

12% Continuing Healthcare

£27,172

2018/19 Analysis of Healthcare Expenditure (£’000)

Prescribing

£11,823

GP Services

49% £114,618

£20,982

Other Services in GP Practises

9% £20,862

Other Services

3% 5%

£97

6% £196

£157

Staff Costs

Commissioning Support Costs

Governing Body Members

Training

35% £1,134

2018/19 Analysis of Administration Expenditure (£’000)

51% £1,678

Other Expenditure

South Lincolnshire Clinical Commissioning Group Annual Report 2018/19

Improving Health, Reducing Health Inequalities and Prevention The CCG has continued to work with partners, including Lincolnshire County Council, and the Lincolnshire Health and Wellbeing Board (HWB) to improve the health of our population with a focus on improving life expectancy, reducing premature mortality and addressing the health inequalities that exist within the CCG. During the year, work has taken place to address areas in the CCG Improvement and Assessment Framework (IAF). For example, interventions to address the NICE Three Treatment Targets (NHS England Treatment and Care Programme) and programmes to reduce smoking in pregnancy. Contributing to the delivery of the priorities in the Lincolnshire Health and Wellbeing Strategy will continue to support the delivery of the IAF indicators, for example, in relation to childhood obesity, falls and dementia.

Joint Health and Wellbeing Strategy (JHWS) A statutory duty under the Health and Social Care Act 2012 requires the Local Authority and each of its partner clinical commissioning groups to produce a Joint Health and Wellbeing Strategy (JHWS) for meeting the needs identified in the Joint Strategic Needs Assessment (JSNA). The purpose of the JHWS is to set out the strategic commissioning for all organisations who commission services in order to improve the health and wellbeing of the population and reduce inequalities. The HWB has undertaken significant engagement on the development of the new JHWS for Lincolnshire (produced in June 2018).

The new Strategy has the following priority areas: ▶▶ Mental Health & Emotional Wellbeing (Children & Young People) ▶▶ Mental Health (Adults) ▶▶ Carers ▶▶ Physical Activity ▶▶ Housing and Health ▶▶ Obesity ▶▶ Dementia

Lincolnshire Clinical Commissioning Group 26 South Annual Report 2018/19

The aims of the Strategy are to: ▶▶ Have a strong focus on prevention and early intervention; ▶▶ Take collective action across a range of organisations to deliver the JHWS; ▶▶ Focus on tackling inequalities and equity of service provision to meet the population needs. ▶▶ Deliver transformational change in order to improve the health and wellbeing.

The common themes around all priorities are to: ▶▶ Embed prevention across all health and care services; ▶▶ Develop joined up intelligence and research opportunities to improve health and wellbeing; ▶▶ Support people working in Lincolnshire through workplace wellbeing and support them to recognise opportunities to work with others to support and improve their health and wellbeing; ▶▶ Harness digital technology to provide people with tools that will support prevention and self-care; ▶▶ Ensure safeguarding is embedded throughout the Joint Health and Wellbeing Strategy.

Joint Strategic Needs Assessment As referred to under the previous section, under the Health and Care Act 2012, local authorities and CCGs have an equal and joint duty to prepare a Joint Strategic Needs Assessment (JSNA) through the Health and Wellbeing Board. The JSNA looks at a wide range of information sources to identify the key health and wellbeing needs of people living in Lincolnshire. The Lincolnshire JSNA is facilitated by

Lincolnshire Public Health and brings together a range of experts from partner organisations including Lincolnshire County Council, the four Lincolnshire Clinical Commissioning Groups, Healthwatch Lincolnshire, NHS Providers, District Councils and representatives from the voluntary and community sector to ensure evidence is gathered which reflects the key health and wellbeing issues in Lincolnshire. The JSNA is made up of 35 topics grouped under six theme areas. Each topic page contains a commentary with hyperlinks to a range of national and local evidence sources. The CCG has participated in the recent comprehensive review of the JSNA, which resulted in the document being updated. The new JSNA is available as an interactive web resource on the Lincolnshire Research Observatory. http://www.research-lincs.org.uk/JointStrategic-Needs-Assessment.aspx

Refugees The CCG is part of the Lincolnshire Refugee Resettlement Partnership and works in collaboration with the Local Authority to support the Vulnerable Persons Resettlement Scheme. This national scheme plans to resettle Syrian refugees from refugee camps in Jordan, Lebanon, Iraq, Egypt and Turkey over the period from September 2015 to May 2020.

Homelessness The Lincolnshire Homelessness Strategy (2017-21) produced by Lincolnshire housing authorities sets out the key challenges, priorities and objectives for preventing and tackling homelessness across Lincolnshire over the next five years. There is a long term trend of a rise in homelessness both nationally and locally. The Strategy has five priorities which includes preventing homelessness, and protecting the most vulnerable from experiencing homelessness, including tackling rough sleeping.

Needs Assessment. This topic includes information on the number of families and households who are accepted as homeless and are in priority need for accommodation. South Kesteven is one of the district areas seeing the highest numbers. Housing and Health is one of the priorities in the JHWS. One of the objectives in the delivery plan is to have concerted action across partners to tackle homelessness. The Housing, Health and Care Delivery Group oversees the delivery of this plan.

Better Care Fund The Better Care Fund was announced in June 2013 as part of the 2013 Spending Round. It provides an opportunity to transform local services so that people are provided with better integrated care and support. The Fund is an important enabler to take the integration agenda forward at scale and pace, acting as a significant catalyst for change. The Lincolnshire CCGs and Lincolnshire County Council continue to work to the joint commissioning arrangements across Proactive Care; Children and Maternity; Mental Health and Learning Disabilities. These arrangements align to the Lincolnshire Sustainability and Transformation Partnership (STP) to achieve significant improvements in quality and outcomes whilst generating efficiencies to bridge the gap between available resources and demand. The Better Care Fund priorities for 2018/19 focused on the ongoing development of Community Learning Disability and Child and Adolescent Mental Health Services (CAMHS) to support “Transforming Care” and the continued provision of services to keep patients in their own homes and support the early discharge from hospital services. The Better Care Fund and the associated Section 75 agreements will underpin the joint agenda of service integration and will support health and social care joint working as part of Neighbourhood Teams.

Housing and Health is one of the topics in the Lincolnshire Joint Strategic South Lincolnshire Clinical Commissioning Group Annual Report 2018/19

Sustainable Development Sustainability in this context is about the smart and efficient use of natural resources, to reduce the immediate and long-term social, environment and financial risks. Commissioning for Sustainable Development is the process by which commissioners improve both the sustainability of an organisation and the way it provides services and interacts with people in the community. The health sector has a major role to play in the creation and maintenance of sustainable, resilient, healthy people and places. At the time of increasing cost pressures, the need to ensure that local health systems remain strong has become of paramount importance. Every individual has a role to play in this, with the current emphasis being on the role of self-care and individual responsibility in managing long-term conditions, with reviews of medication to reduce the level of un-needed prescriptions, and new models of care being introduced through GP practices. As an NHS organisation, and as a provider of public funds, the CCG has an obligation to work in a way that has a positive impact on the communities for which we commission and procure services. In order to fulfil our responsibilities for the role we play the CCG has established a Sustainability Management Plan (available on the CCG website), which sets out how the CCG operates in an ethical and sustainable way and which identifies clear targets for measuring success. The responsibility for scrutinising how the drive for sustainability is working is embedded within the CCG’s core business processes, practices and Constitution.

Premises

Resource

Up until 31 July 2018 the CCG rented premises at Eventus, Market Deeping. From 1 August 2018 the CCG, along with South West Lincolnshire CCG, moved to new premises in Bridge House, Sleaford, which is privately owned but comes under the remit of NHS Property Services. Information on the CCG’s use of energy and water is detailed below for the period 1 August 2018 to 31 March 2019. Information on recycling is not available as the CCG headquarters are based on a site which includes a number of other organisations and recycling is carried out on a collective basis. However, we are committed to reducing our environmental impact and have adopted the following principles: ▶▶ Turning off lights when leaving a room and at the end of the day. ▶▶ Turning off PCs, monitors and all chargers when not in use. ▶▶ Turning off all equipment when not in use. ▶▶ When heating or cooling a room close the windows. ▶▶ Closing window coverings at night to keep room temperature stable. ▶▶ Ensuring that heating and cooling are not on at the same time and that they are set to comfortable levels. ▶▶ Implementing a building/area shut down procedure so at the end of the day everything is turned off before the premises are closed down. Resource

2018/19

Electricity Use (kWh)

30,640

Total Energy Spend

£3,954

Lincolnshire Clinical Commissioning Group 28 South Annual Report 2018/19

Water Sewerage

2018/19 M3

122

Spend

£189

Spend Total Water & Sewerage Spend

110 £239 £428

In September 2018 some of our staff members participated in a clean up of the bank outside of the back of our building entitled ‘Operation Clean Up Mrs Tigglewinkle’s Home’. This was carried out to remove a considerable amount of rubbish; thereby improving the outlook and also the environment for the local wildlife.

Partnerships and Governance The CCG works in partnership with the public sector across Lincolnshire for emergency planning and resilience operations, and with its providers and suppliers to ensure that services are provided in line with current best practice.

Workforce Staff members are an essential resource and the workplace itself is an influencing factor on the sustainability of an organisation. As referred to under the Staff Report later in this document, the CCG supports the principles of the Mindful Employer charter (which supports good mental health in the workplace). In 2018/19 the CCG has also continued with the following actions: ▶▶ Reducing business travel for CCG staff by increasing the use of telephone conferences; ▶▶ Reduction in the use of paper, moving as far as possible to electronic documents for all staff, including increasing the use of laptops by CCG staff and reducing the printing of Governing Body, Executive Committee, Members’ Council and all internal meeting papers to a bare minimum. ▶▶ Agreed flexible working arrangements to enable staff to work from home to reduce travel time and encourage productivity, and reduce pressure on office space.

South Lincolnshire Clinical Commissioning Group Annual Report 2018/19

Improvement in Quality

Health onal Professi Feedback

The CCG has continued to assure the quality of commissioned services utilising a multi-faceted approach and has deployed a wide range of mechanisms to generate a comprehensive picture of service quality (as depicted in our Continuous Quality Improvement Model pictured opposite). In 2018/19 the four Lincolnshire CCGs have sustained their collaborative quality assurance and delivery approach in order to maximise effectiveness, retain local organisational memory and skills and realise benefits of scale. The federated teams developed a collaborative model to help ensure that each CCG discharges its duties in relation to quality assurance. The model opposite illustrates the collaborative approach between the four Lincolnshire CCGs.

Lincolnshire Clinical Commissioning Group 30 South Annual Report 2018/19

EW I V

We collectively recognise the need for service improvements to deliver better quality of patient care and experience, whilst reducing clinical variation, eliminating waste and delivering better value for money. We continue to develop this through the existing CCG contractual arrangements with providers to ensure effective quality indicators/quality schedules are in place which allow for a greater understanding of the impact of health interventions on patients and the standard of services commissioned.

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However, during 2018/19 the CCG and partner health services faced real challenges in delivery of improved outcomes and accessible high quality care for patients against a backdrop of increased demand and constrained financial resources.

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The CCG has continued to build on the robust systems and processes in place for assuring the quality of commissioned services throughout 2018/19. The CCG has retained its focus on quality and remains committed to commissioning high quality services which are safe, effective and patient led.

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Quality Visits

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An integral part of the CCGâ&#x20AC;&#x2122;s approach to intelligence gathering regarding the quality and safety of services provided to its population, is the programme of provider Quality Assurance Visits. The CCG has yet again conducted over 25 visits to providers throughout 2018/19 and focused on a wide range of services to ensure that the patientâ&#x20AC;&#x2122;s journey is fully represented. As described within the engagement section, our provider Quality Assurance Visits continue in partnership with Health Watch Lincolnshire and our Lay Member for Patient and Public Involvement to ensure that the voice of patients is absolutely central and opinions and experiences of patients are captured at each visit. Quality Assurance visits are based upon the monthly review of harm free care metrics and issues explored and addressed during visits. Quarterly reports of visits conducted are reported into our Quality and Patient Experience Committee. This year has also seen the continued development of the CCG Quality and Patient Experience Committee (QPEC), as a Committees in Common with South West Lincolnshire CCG. The Quality and Patient Experience Committee is Chaired by our Lay Member for Patient and Public Involvement and conducts its role in a number of ways including scrutinising the clinical effectiveness of commissioned health care providers both in and out of the county. This work involves crosschecking multiple sources of information that we receive, such as complaints data, patient experience feedback, performance data, incidents, infection rates and staffing levels. The Committee can make recommendations and oversee corrective actions and provides assurance to the CCG Governing Body that commissioned services are being delivered in a high quality and safe manner, ensuring that quality sits at the heart of everything the CCG does.

Looking forward the CCGs will be further improving the methodology for assuring quality within the Lincolnshire system alongside the delivery of the Sustainability and Transformation Plan (STP) for Lincolnshire.

Patient Safety With our partner Lincolnshire CCGs we continue to undertake a robust system for continuing to drive improvement in patient safety. All safety incidents are monitored and themed for trends across the health community system and reported using the National Reporting and Learning System. Individual organisations are assessed for their level of reporting, enabling an assessment of both the trends of incidents occurring within the organisation, as well as assessment of their reporting culture. Providers are invited to the Serious Incident Review Group, attended by all Lincolnshire CCGs, to support learning and provide greater assurance. All serious incidents are subject to a root cause analysis reviewed at executive level within the provider and then by the four CCGsâ&#x20AC;&#x2122; Chief Nurses prior to closing. Action plans are monitored and learning is disseminated. These plans are then monitored through the commissioner led quality assurance visits and quality review meetings to ensure that they are embedded in practice. Never events that occur within an organisation are subject to an enhanced level of scrutiny including never event summits, with representation from the CCG and our providers, ensuring that appropriate lessons are learnt, as well as creating opportunities to share lessons across the health and social care community system. Another opportunity to improve patient safety is offered through the learning of lessons and systematic analysis of mortality indicators at individual provider level. All providers are required to have a formal system in place to monitor mortality data.

South Lincolnshire Clinical Commissioning Group Annual Report 2018/19

In addition, a collaborative Lincolnshire mortality review group meets regularly and continues to provide a forum for secondary care and primary care to review case notes of a selected cohort of patients to better understand mortality in the community and create a further opportunity to drive improvement in patient mortality.

Patient experience The Continuous Listening Model (referred to in further detail on page 36) ensures robust mechanisms are in place which enables patient experience to influence our plans and drive improvement. The Friends & Family Test is utilised across all relevant providers and performance monitored at both trust and ward level. A rigorous approach is applied to the management of complaints and the triangulation of soft intelligence. During 2017/18 the CCG reviewed its engagement function, produced the Communication and Engagement Strategy, and latterly relaunched the Patient and Public Council. All Patient Participation Group Chairs are now invited to attend the Patient and Public Council, along with representatives from community and voluntary groups. This enables wider participation and broader feedback in relation to the patient experiences to not only provide feedback on current commissioned services but also to shape services for the future.

Transforming Care The ambition for Lincolnshire is to ensure that all patients receive care in the right place at the right time. There are a number of work-streams across the Lincolnshire system which addresses this ambition. One of these is the Transforming Care programme for People with Learning Disabilities and or Autism Lincolnshire has had a significant impact

in ensuring that people with Learning Disabilities and or Autism are not admitted unnecessarily to assessment and treatment units for protracted periods of time; whilst good progress has been made we are committed to ensuring that there is a continued focus upon providing the right support for individuals to succeed in living well in their own communities, and if additional support and specialised healthcare is necessary this is provided as far as possible within mainstream services with reasonable adjustments. In line with national directions from the Government, Lincolnshire has established a Transforming Care Partnership to ensure that those with learning disabilities and / or autism are provided with services to meet their needs in the community and to reduce the reliance on in-patient hospital care. We were set a trajectory to discharge people who had been in hospital for a long period of time and to try to ensure that a minimum number of patients were admitted. Of the original cohort of individuals who had been in hospital for long periods of time we have successfully developed appropriate community care packages for a significant number of patients. However, there is still work to do to achieve our ambitions - with this in mind we have reshaped our Programme Board during 2018/19 and are committed to ensure that services are developed that help people stay well in the community and if they require hospital admission this is kept to a minimum.

Safeguarding Lincolnshire CCGs have a range of statutory duties in relation to safeguarding the population of the county. The four CCGs discharge their statutory safeguarding duties through the Federated Safeguarding Team (FST) hosted by SWLCCG with the Chief Nurse providing executive leadership for

Lincolnshire Clinical Commissioning Group 32 South Annual Report 2018/19

safeguarding across Lincolnshire. The FST comprises a Designate Doctor and Designate Nurse for Safeguarding Adults Children and Looked After Children, Named Doctor, Head of Safeguarding Adults, Head of Safeguarding Children, Safeguarding Lead Nurse Adults and Children and Mortality Review/ Safeguarding Lead Nurse. The function of the team is supported by a Safeguarding Co-ordinator/Project Officer. The team is highly experienced in the management of complex safeguarding cases and has a collective knowledge of all aspects of safeguarding practice. The team actively contributes advice and expertise to ensure that safeguarding implications are considered at every step of the commissioning process and obtain assurance that providers of care are doing the same. The FST are fully immersed in the work of the local Safeguarding Children and Adult Boards with our inter-agency partners to include contribution to Serious Case Reviews, Safeguarding Adult Reviews and Domestic Homicide Reviews, in addition to supporting strategic and operational board meetings and executive meetings associated sub groups. The CCG also supports development of the safeguarding board priorities and local and national policy. Additionally the Federated Safeguarding Team provide safeguarding support and expertise to a wide range of health professionals, including GP surgeries and providers, to support with complex case management, performance management and policy development. The remit of the team is also to gain assurance against key safeguarding themes from all levels of health providers to ensure compliance levels for staff training, support robust practices to ensure staff are able to report concerns and share information in a timely and responsive way to ensure positive safeguarding outcomes for individuals who have contact with their services.

Over the last two years the Federated Safeguarding Team has worked hard to embed robust safeguarding practice within Lincolnshire care homes. Safeguarding Ambassadors have been identified within every care home and are providing support to their colleagues to improve care for the residents and identify areas of practice that require escalation to further support and/or referral to Social Care. The work within Care Homes will be further developed over 2019/20 with a focus on continued support, awareness of safeguarding issues, early recognition of issues and prompt escalation. This is a positive development for members of our population residing within our care home community. The FST provide Level 3 safeguarding adult and children training to GP surgery staff and CCG staff. GP forums are facilitated across the county to share good practice, provide peer support and share up to date information in relation to key safeguarding issues locally and nationally. Information is also circulated to GP practices via a safeguarding newsletter three times a year, providing general safeguarding information and contacts to support decision making. The FST Named Doctor, as part of her role works to embed effective safeguarding practice within primary care. Following the success of the Safeguarding Conference “Behind Closed Doors” in 2018 the FST are planning a further conference in October 2019 and are currently scoping key issues for inclusion that will improve outcomes for vulnerable patients. The FST recognises that there are a number of areas for improvement for 2019/20 which include an improvement in the completion of Initial Health Assessments for Looked After Children within statutory timescales. The FST have fully engaged the support of the

commissioning CCG, Community Health provider and Local Authority to address the performance issues.

Health Protection The Lincolnshire NHS CCGs Federated Health Protection function is hosted by South Lincolnshire CCG but serves all four Lincolnshire NHS CCGs equally. The team’s work responsibilities and activities are based on assessed risk. Preventing Healthcare Associated Infections (HCAI) remains a priority for the CCG and the reduction of Gram Negative Blood Stream Infections was included within the CCG Quality Premium. The Health Protection team has two main functions: Infection Prevention and Control and Communicable Disease Control: The Infection Prevention and Control element incorporates strategic assurance reporting to the Chief Nurses and their respective CCGs, strategic support and advice to commissioners of NHS funded services and an infection prevention and control supportive oversight to General Practice. The CCG federated function also leads on the whole health economy infection prevention and control group which facilitates sharing of best practice, updates on current issues and joint working strategies. This group feeds in to each Lincolnshire CCG Governing Body via the Chief Nurses.

The Communicable Disease Control element is largely reactive in nature, however, the Public Health England (PHE) Collaborative Tuberculosis Strategy for England 2015 to 2020 recognises that there is a real benefit in proactively seeking and treating high risk individuals with Latent Tuberculosis Infection (LTBI) and proposes a screening programme commissioned and led by CCGs. The single biggest risk to health in the UK is a large scale communicable disease outbreak, such as pandemic influenza.

Quality Surveillance Group The CCG has continued to be an active member of the Central Midlands Quality Surveillance Group (QSG) during 2018/19. QSGs systematically bring together the different parts of the health and care system across a geographical area to share information regarding the quality of providers and are a proactive forum for collaboration. This whole system approach provides the health economy with a shared view of risks to quality through sharing intelligence; an early warning mechanism of risk about poor quality; and opportunities to coordinate actions to drive improvement, respecting statutory responsibilities of and ongoing operational liaison between organisations.

Lincolnshire Quality Forum Finally the infection prevention and control element leads on both serious and non-serious HCAI investigations that are non-acute Trust attributed. This is done using the Post Infection Review and Root Cause Analysis investigation methodology. All of these actions combine to reduce the risk of patients acquiring Health Care Associated Infections wherever healthcare is delivered.

During 2018/19 the Lincolnshire Quality Forum has continued to bring together key professionals from each of the constituent sections of the health community to enable whole system approaches to quality issues and drive improvements. It provides a forum for open debate and learning and is able to drive quality projects that require a system wide approach across Lincolnshire.

South Lincolnshire Clinical Commissioning Group Annual Report 2018/19

Delegated Commissioning of Primary Care Primary Care Since 1 April 2015 the CCG has had full delegated responsibility from NHS England to commission primary care services. Delegated primary care commissioning has meant that the CCG has taken on the responsibility for improving and monitoring the quality and patient safety of services provided in primary care. The oversight of this is provided by the Primary Care Quality Assurance Group chaired by the Deputy Director of Nursing and Quality and reports on an exception basis bi-monthly to the Primary Care Commissioning Committee (PCCC). The group considers the Primary Care Dashboard at each meeting along with other quality metrics and triangulates this with patient experience data to understand potential risks. We have continued with our Continuous Improvement in Primary Care Programme launched last year and are committed to work with our GP Practices to improve quality. To assist with this during 19/20 we will be re focusing the work of our quality team to work closely with general practices and neighbourhood teams to improve quality as acknowledgement that primary care services are the cornerstone of the NHS. We have continued with our annual quality assurance visits to our member practices during 2018/19 with the inclusion of our Lay Member for Patient and Public Involvement and PPG Chairs of Practices to ensure the patient voice is central to quality assurance.

GP Practices In 2018 the Primary Care Commissioning Committee was required to make a decision regarding the provision of GP services for patients registered at the Pennygate Health Centre. This followed the decision by the sole practitioner to retire from general practice in September 2018.

An interim arrangement to ensure Pennygate patients could continue to access GP services whilst longer term plans were considered was established; provided by Lincolnshire Community Health Services (LCHS) from 10 September 2018. The CCG undertook a public consultation on the longer term plans over a 13 week period between 1st October and 31st December 2018. As part of the consultation process the documentation was made available in a range of formats to give GP patients, members of the public, staff and stakeholders various opportunities to get involved and share their views. In January 2019 the CCG Primary Care Commissioning Committee met to consider the outcome of the public consultation and make a decision on the future of GP services for patients previously registered at the Pennygate Health Centre, Spalding. The Committee’s preference was to see the development of a GP practice on the west side of Spalding, however, since this is not currently feasible, the Committee agreed to approve a contract procurement for a new GP practice to be based at the Johnson Community Hospital, Spalding with the option to move when an alternative site on the west side of the town becomes available. It was acknowledged that as housing developments progressed this was likely to increase the demand for GP services to be delivered on the west side of Spalding; therefore it was agreed that the contract will provide the ability to be flexible in line with the expected growth of Spalding. Detailed feedback from a series of engagement events held late 2018 was presented to the Committee and played a key role in its considerations. The CCG recognised how important transport links to Johnson Hospital are and discussions with local councillors and Sir John Hayes, MP, will be on-going through 2019 to see how local needs can be met. In addition, the parking arrangements, particularly for disabled patients, will also be considered.

Lincolnshire Clinical Commissioning Group 34 South Annual Report 2018/19

The current interim arrangement at the Johnson GP Centre expires at the end of September 2019, and between now and then the CCG will undertake a contract procurement to identify a longer-term provider of services. Crucially this contract will allow us the flexibility in the future to look again at options in the west of Spalding when we know more about housing developments on this side of the town.

Patient, Public and Stakeholder Involvement and Engagement

Estates Strategy In 2016 the CCG commissioned an estates review of its GP practices and the planned population growth. This has been the basis of the strategic plans regarding primary care estate and neighbourhood team population based care including extended access, urgent and planned care. Working with South Holland District Council (SHDC) regarding OPE, there are potential opportunities to look at the public estate in Holbeach and discussions have started to look at a population based model of care in that area and a potential primary care hub development. The local development plans from South Kesteven District Council (SKDC), SHDC and North Kesteven District Council (NKDC) highlight growth in the main towns of Bourne, Stamford, Market Deeping and Spalding areas. The primary care estate has been developed to accommodate this planned growth and the CCG has been working with all three planning authorities regarding supporting the hub and spoke Neighbourhood Team (NT) model through any Section 106 monies that are agreed. For example, the Galletly Practice in Bourne has this year completed a significant extension part funded through the NHS Estate Technology Transformation Fund (ETTF).

Meetings The PCCC usually meets on a bi-monthly basis, with meetings held in public. The papers are available on the CCG website. Further information on the PCCC is also detailed in the Annual Governance Statement later in this report.

The CCG is committed to understanding the needs of our population and empowering patients to have more choice and control over their condition, in the development of future services and by identifying priorities. We aim to improve local health services and respond to the health needs of everyone in the area by ensuring patients and the public are at the heart of decision making. This is demonstrated in our Values where we commit to listening to local people, health professionals and others who support the CCG and learning from others within and beyond the NHS to inform our decisions and strategic plans. Strong engagement, clinically and with our patients, communities and stakeholders to involve all of them in our decision-making process, plays a vital role in shaping the future of health and social care services in the county. Our Communications and Engagement Strategy https://southlincolnshireccg. nhs.uk/about-us/key-documents/ public-engagement/2217-slccgcommunications-and-engagementstrategy-2017-2019/file sets out how we will involve patients, members of the public and stakeholders in our decision making to help continually improve services. The strategy also outlines how we will adhere to our statutory responsibilities to carry out effective consultation and engagement, and is aligned to our equalities work programme to ensure that we work with our whole population and groups who may be under represented.

Our Patient and Public Involvement Annual Report http:// southlincolnshireccg.nhs.uk/get-involved/ public-engagement-reports-documentsand-publications also highlights all of the key engagement processes and activities we have in place over the previous year. Our successful approach to patient and public involvement has been demonstrated through our ‘green’rating of the NHS England Improvement Assurance Framework (IAF) Community Participation Indicator, showing the assurance NHS England (NHSE) has in our approach to and impact of engagement. We will continue to improve the way we engage and involve patients and the public working with the NHSE Planning for Improvement Tool recently launched.

“Good communication is important for effective engagement; where service users are engaged, satisfaction with health services rises. Therefore, first class communications that fosters engagement is fundamental to the CCG’s performance and it’s ability to deliver first class healthcare for our patients.”

South Lincolnshire Clinical Commissioning Group Annual Report 2018/19

Engagement function

Continuous Listening Model

Our CCG has an embedded engagement function which sits within the Quality Team, and is led by the Director of Quality and Executive Nurse at the core of our organisation, demonstrating our commitment to putting patients and the public at the heart of our decision making. Strategic consultation and engagement advice and development is provided by the Optum Commissioning Support Service. As a key member of our Governing Body, Quality and Patient Experience Committee (QPEC) and Patient and Public Council, our Lay Member, Patient and Public Involvement champions engagement at many levels of the organisation, and offers advice to the CCG from a patient perspective to influence the system.

▶▶ Each of our practice PPGs will be represented by a member on the Patient and Public Council, bringing patient feedback directly into the CCG along with members of other local networks and voluntary and community sectors

They also provide invaluable support to patient participation groups within the local GP practices, valuing the impact they can have on their local practices and the wider CCG as a whole.

▶▶ Our Quality and Patient Experience Committee will receive the systematic local patient experience intelligence reports which will

▶▶ The wider population voice will be heard through a range of engagement activities undertaken and reported to the Primary Care Quality Assurance Group, Patient and Public Council, Quality and Patient Experience Committee and occasionally directly to the Governing Body. Feedback is also received from involvement with HealthWatch locality groups and the Health & Wellbeing Partnerships Groups.

Governance and assurance Our Continuous Listening Model clearly demonstrates the robust governance and assurance processes in place to ensure the CCG is able to listen to the views, opinions and experiences of its patients, public and stakeholders, ensuring patients are at the centre of driving quality and service improvement. This model enables us to listen and respond to the population on a continuous basis, not just through specific engagement and consultation exercises. The Continuous Listening Model supports us in triangulating national patient experience data with local knowledge, opinion and feedback. Our Quality and Patient Experience Committee (QPEC), which receives a range of information, including issues being raised through the Patient and Public Council and other networks, triangulates this with other intelligence and performance information to establish an overall picture of services received by our patients or establishes gaps in service availability. Lincolnshire Clinical Commissioning Group 36 South Annual Report 2018/19

include complaints, national patient experience survey result and feedback from other public feedback mechanisms triangulated with quality and safety data. ▶▶ The Quality and Patient Experience Committee reports quarterly to our Governing Body. ▶▶ Our Member Practices will each have a representative on the Council of Members and representatives sit on our Governing Body.

Patient and Public Council (PPC) The Patient and Public Council’s primary remit is to ensure the patient voice is heard loud and clear in relation to any commissioning decisions the CCG makes. The model in the top right hand corner on the opposite page demonstrates that patients and the public are at the centre and demonstrates the two-way role of the patient representative and CCG in the Patient and Public Council, and how this

is escalated and utilised within the CCG. Our Patient and Public Council reports directly into the Quality and Patient Experience Committee to strengthen the patient experience section for Committee members to consider and triangulate with other forms of intelligence it receives and to enable timely response and action to patient and public representative feedback. One of our aims is to get patients involved in our commissioning cycle. How we will do this is demonstrated by the Department of Health Engagement Cycle that illustrates how engagement fits with the commissioning cycle and how involvement at an early stage of the commissioning cycle enables more successful involvement at subsequent stages. This is detailed in the diagram below to the right.

Principles for Engagement South Lincolnshire CCG follows the Cabinet Office principles for consultation and best practice principles for engagement. We will ensure that we are always: ▶▶ Open, honest and transparent ▶▶ Accurate, fair and balanced ▶▶ Timely and relevant ▶▶ Reflecting the diversity of our population in our engagement ▶▶ Respectful of all our stakeholders ▶▶ Involving communities that experience the greatest health inequalities and poorest health ▶▶ Tailor and target our engagement to involve different groups, including hard to reach groups ▶▶ Explaining how we will use information gathered through public involvement ▶▶ Evaluating our activities to learn from them ▶▶ Cost effective ▶▶ Clear, using plain English and accessible, in line with the NHS England information

South Lincolnshire Clinical Commissioning Group Annual Report 2018/19

Enabling and supporting those who want to get involved

people with protected characteristics to further develop our Virtual Involvement Network. The CCG will continue to ensure that the database is maintained and utilised to ensure that all relevant key stakeholders and groups can be involved in developing CCG projects and influence our decisions

During 2018/9 the CCG has worked hard to ensure that people of all backgrounds are supported to get involved. Some of the ways we have supported those who want to get involved are shown below: ▶▶ Support to PPGs - we have worked closely with our PPGs and the National Association of Patient Participation to help improve effectiveness and encourage collaborative working between PPGs, the CCG and other community groups. We offer bespoke support and guidance to PPGs via our Engagement Manager, recognising that different PPGs have differing aspirations and challenges.

Our PPI Lay Member and Healthwatch Lincolnshire attend Quality Assurance Visits with clinicians and CCG staff to ensure patient experience is a key element of consideration when triangulating information about a provider or practice. All commissioned services receive an annual quality assurance visit and this includes all of our member practices. This year we asked all of our practices to include their PPG Chair on the day of our visit to ensure patient issues were central to discussions.

▶▶ Feedback into the Patient and Public Council – we support patient participation group and community group representatives to feed their views and patient experience into the CCG via the Patient and Public Council. For ease, we have developed a simple feedback form for representatives to submit their information, especially if they are unable to attend in person or from diverse local groups with barriers preventing them from attending meetings. The CCG is committed to providing a response to the issues and feedback received from the representatives so they can be reported back to their wider, collective groups.

Impact of Participation

▶▶ Virtual Involvement Network - during 2018/19 we continued strengthening our stakeholder database with contacts of local stakeholder groups, including community, groups from the voluntary sector, and organisations representing

Equality Delivery System 2 -This year, we have built upon the unique approach to our EDS2 by undertaking engagement with our patients, public, staff and stakeholders. Our engagement asked for their views on how they felt the CCG had worked towards a number of

The CCG recognises that there is no ‘one size fits all’ approach to engagement and involvement. We use a variety of ways to review and listen to how patients, carers and service users feel about the health services they have used. This patient experience data is monitored via the CCG’s Quality and Patient Experience Committee (QPEC), and is used to influence the CCG’s commissioning plans and decisions. Some of the ways we listen to and involve patients, carers, stakeholders, partners and our community are outlined in the diagrams opposite:

Lincolnshire Clinical Commissioning Group 38 South Annual Report 2018/19

GETTING INFORMATION

GIVING INFORMATION

EXHIBITIONS

PHONE CALLS

LEAFLETS, NEWSLETTERS

QUESTIONNAIRES INTERVIEWS

MEDIA FEEDBACK FORMS STAFF OPEN DAYS

DISCUSSIONS

PARTICIPATION

PARTNERSHIPS

FOCUS GROUPS

PATIENT STORIES

COMMUNITY PROJECTS

PUBLIC MEETINGS

SHADOWING

SEMINARS

CITIZEN JURIES

CONFERENCES

PATIENT REPRESENTATIVES

SERVICE CHANGE LSP’S

COMMUNITY & VOLUNTARY NETWORKS

COMMUNITY PLANS

HEALTH PANELS

CITIZEN PANELS

EDS2 statements – this was considered alongside CCG evidence at an EDS2 Assessors Group to collectively review and score our progress against these statements and also identify Equality Objectives for the coming year. The Assessors Group was made up of CCG officers, including staff from the Quality, Engagement and Equalities team, Patient Representatives and our PPI Lay Member. This is an improvement to previous self assessments undertaken in the past and has ensured patient views have been considered alongside CCG feedback and enabled patient representatives to inform the EDS2 work moving forward. Primary Care – Following the closure of Pennygate Health Centre in Spalding, we successfully conducted a formal consultation into the long term primary medical services provision for patients previously registered at the practice. This included an online and paper survey as well as five open public sessions. In addition, we reviewed all comments, concerns and compliments as well as information provided by Healthwatch Lincolnshire from an independently hosted public session. The feedback from patients

and the public helped determine the longer term plan for services in Spalding and the CCG is now in the process of procuring a new GP Practice for the residents of Spalding.

a translation feature which is of particular importance to ensure our website is accessible to all.

Better Births for Lincolnshire – this countywide project to implement the recommendations identified in the National Maternity review project has been co-produced with women and families from the start and is already making a difference Lincolnshire wide. The team have undertaken extensive engagement via listening clinics, events and surveys, which have taken place across the whole of Lincolnshire, to ensure that new service developments, and the commissioning decisions we make are what women, families and babies want and need. An example of this has been the development of the Community Hubs where the public and staff have designed the services needed in these hubs across the county and also the information they want to be able to access online and via social media. By listening to this our Better Births website was developed to make information about maternity services more accessible to women and families, and also includes

During the year, we have continued to talk to and engage with members of the public, staff, volunteers and other key stakeholders across the county to hear their views and inform the development of our five year health plan, the Sustainability and Transformation Partnership (STP). The STP is a national requirement and since April 2016 we have been working alongside other health organisations in the county, with input from Lincolnshire County Council and other key local partners, to develop a plan to improve the quality of care that we provide, improve health and wellbeing, and ensure that we bring the health system back into financial balance by 2021. We built our STP on the basis of the work already undertaken through Lincolnshire Health and Care which started work in 2014 to develop a new model of care for Lincolnshire where we reached over 18,000 residents.

Focussed Engagement

South Lincolnshire Clinical Commissioning Group Annual Report 2018/19

360 Degree Stakeholder Survey Report 2018 It is necessary for South Lincolnshire Clinical Commissioning Group, to have strong relationships with a range of health and care partners in order to be successful commissioners within their local health and care systems. Each year NHS England conducts a survey to find out how CCGs are doing locally, this is known as the 360° Stakeholder Survey. NHS England commissions Ipsos MORI, an independent research agency, to conduct the survey. The responses to the survey provide CCGs with information, advice and knowledge to help them make the best possible commissioning decisions and provide insight into key areas for improvements in their relationships with stakeholders and provide information on how stakeholders’ views have changed over time. The results give the CCG the opportunity to further refine and improve our continuous focus to engage and communicate more widely and develop positive relationships with partners in health, the local authorities and community and voluntary sectors. A copy of the full report can be found at www.southlincolnshireccg.nhs.uk

Engagement through the Sustainability and Transformation Partnership In summer 2018, all of Lincolnshire’s commissioner and provider organisations worked together as Lincolnshire’s Sustainability and Transformation Partnership (STP) to undertake an engagement exercise designed to help inform the ongoing process of developing the emerging options for healthcare services in Lincolnshire. The exercise consisted of: ▶▶ A series of nine engagement events held in different locations across the

county and at various times of the day to maximise attendance and accessibility for all; ▶▶ An engagement questionnaire was available online and in paper format which enabled the public, staff and other stakeholders to share their views. Both the events and the questionnaire explored general issues affecting healthcare and hospital services in the county, with an additional focus on specific service areas, namely breast services, trauma and orthopaedics, general surgery, stroke services, women’s and children’s services, urgent and emergency care, haematology and oncology, and urology. The STP invited a wide range of attendees and stakeholders to come and join senior health and care leaders in localised discussions and we distributed over 20,000 invitations to get involved. We received over 3,000 comments and 150 pages of feedback from the engagement events and online survey, which was collated and analysed by an independent organisation, Opinion Research Services. The information gathered has informed the emerging options that are contained in the county’s Acute Service Review about the hospital services in Lincolnshire. The full report can be found at https:// www.lincolnshire.nhs.uk/together/july-

2018-engagement-events.

Healthy Conversation 2019 In March 2019, all Lincolnshire NHS commissioner and provider organisations launched ‘Healthy Conversation 2019’ where our public, patients, staff and stakeholders were asked to continue the dialogue about hospital services but also

Lincolnshire Clinical Commissioning Group 40 South Annual Report 2018/19

to start other conversations too. To begin the conversations four engagement events were held in Boston, Louth, Skegness and Grantham, accompanied by an online survey, both of which covered the following: ▶▶ Looking after ourselves and each other – getting this right is the best way to be healthy and reduce the strain on the NHS. You might hear this referred to as ‘prevention’ and ‘self-care’. ▶▶ Joined up care close to home – services delivered in the community or your own home. ▶▶ Mental health and learning disabilities – one quarter of us will develop a mental health illness at some point in our lifetime so getting these services right is paramount. ▶▶ Hospital Services – this year we will be talking with you about these services and the emerging options for their future sustainability. ▶▶ Enabling factors – this is how we refer to such things as travel and transport, IT and digital opportunities, recruitment and estates and buildings – not the services themselves, but big influencers on our ability to deliver them well. ▶▶ The NHS Long Term Plan – and how we can make this work best for Lincolnshire. We have developed our vision and proposals for change by working closely with the public, patients, staff, volunteers, local health professionals and other key stakeholders such as our local politicians and local high interest groups. We believe that our new plan to transform health and care services will only be successful if we worked with the people of Lincolnshire to understand how they wish to access care and what we can do to support them to stay well and healthy.

Let’s Get Social! FACEBOOK

NHS South Lincolnshire Clinical Commissioning Group strongly supports the use of social media as a positive communication channel to provide members of the public, GP practices and other stakeholders with information about what we do and the services we commission. We use social media to provide opportunities for genuine, open, honest and transparent engagement with stakeholders; giving them a chance to participate and influence decision making. Social media is a great opportunity for us to listen and have conversations with the people we wish to influence. It not only allows us to make announcements e.g. health news, service information, up-coming events, it allows people to respond to whatever we post and encourages conversation and feedback. Unlike other methods of promotion, social media encourages twoway communications in real time. Our ongoing interactive content strategy is focused on increasing proactive staff input and public engagement, supporting both national campaigns and CCG priorities. Our purpose across stakeholder groups is to inform, engage, educate and inspire.

TWITTER

Facebook allows us to share news, pictures and videos, and also have two-way discussions with the public. By ‘liking’ / following our page, users will see our updates in their news feed and can engage with us by reacting to the post, commenting or sharing posts with their friends and family. We currently have 533 followers (March 2019), which is an increase of 93% on this time last year (March 2018). Many of our GP practices are using Facebook as a way of communicating with their patients and keeping them up-todate on practice news, events and healthcare advice.

1,417 379,394 Total Posts

@NHS_SouthLincs We use Twitter to share snippets of health news and local information, or to have a direct conversation with our partners, patients and other stakeholders. We currently have 3,330 followers (March 2019) which is an increase of 13.7% on this time last year (March 2018). We are always looking to increase our number of followers and encourage people join the conversation.

1,422 423,318 Total Posts

Impressions

4,274

people reached

engagements

25,763

engagements 1,239 Likes

937 Retweets 588 Comments

3,615 Likes

2,409 Shares

37 Replies/ Mentions

WEB SITE www.southlincolnshireccg.nhs.uk Our website is a portal to communicate and engage with members of the public. We want to ensure that people can easily access information about the CCG and the services available to them. We carry out regular content reviews and continue to develop the site to make it informative, user friendly, easy to navigate and to promote campaigns, events and CCG priorities.

11,870 25,763

Users/Visitors

engagements

90.2%

were new visitors to the site

The CCG actively engages with national campaigns, and develops targeted local campaigns to help raise awareness of specific health and care challenges in our area. Some examples are: • Cervical Cancer Prevention Week • #SmearForSmear • #SockitToEatingDisorders

South Lincolnshire Clinical Commissioning Group Annual Report 2018/19

Equality and Diversity 2018 saw good progress in Equality, Diversity and Human Rights (EDHR) work, which has paved the way for ongoing improvements within the CCG. As part of the implementation of EDS2 (Equality Delivery System 2), EDHR objectives and a four year action plan (2018 – 22) were developed and approved from which key actions have been achieved laying good foundations for implementation of more specific work to be accomplished in the coming years. Key accomplishments over the last year include: Development of an Equality Forum: Implementation of CCG priorities has been incorporated into the work of the Equality Forum. The forum was set up in July to enable both CCGs staff members responsible for EDHR and engagement to work together to accomplish joint objectives and initiatives for the benefit of the workforce, service users and communities. The forum acts as a supportive mechanism for staff to discuss ongoing work priorities, implement key actions, monitor and review action plan objectives and publish outcomes in line with our duties under the Equality Act 2010. ‘Hidden Voices’ – Diversity listening events: We have key legal and business responsibilities to ensure that we respond appropriately to the needs of the diverse population we serve, and do the utmost to eliminate discrimination, advance equality of opportunity and foster good relations amongst our staff and service users. To meet this purpose, SLCCG assisted in the organising and participation of two diversity engagement events during this period; the first in May 2018 (organised as part of Diversity and Human Right week) and the second in early January 2019. Each event was Lincolnshire Clinical Commissioning Group 42 South Annual Report 2018/19

open to community and voluntary groups representing different protected characteristics and focused on different health topics to enable those seldomly heard groups, for example migrant workers, transgender, disability, armed forces and mental health, to share their experiences of accessing health services. The events opened dialogue, between community groups and staff through presentations, information sharing and discussion, giving all those who attended the chance to share, listen, learn as well as plan together key service improvement outcomes to support different protected characteristics and communities in Lincolnshire. Feedback from participants was twofold. Those representing voluntary/ community groups indicated a sense of empowerment to speak out and have their voices heard, whilst health service staff felt they learnt a great deal from listening to individual personal experiences and the barriers people from different protected characteristics faced. From their suggestions and recommendations, action plans have been produced and work has commenced on priority areas to support specific needs of different groups in Lincolnshire. Equality webpages: The equality and diversity webpage, which was developed in early 2018, has continued to evolve over the year. It is constantly updated with a range of key features relating to CCG work including important events, sharing of good practice, patient stories, information about forums and networks, and presentations and reports relating to the diversity engagement events. http://southlincolnshireccg.nhs.uk/aboutus/equality-and-diversity Equality Frameworks and policies: To ensure ongoing compliance with Equality Act, Human Rights Act and NHS constitution, we reviewed and updated essential framework documents that support the collation of information and data on EDHR. A new simplified

template for conducting Equality Impact Assessments (EIAs) on new and existing health policies and activities was introduced, and is being utilised by CCG staff. Frameworks that assess the work of our providers were also revised to ensure that the data collected represented each area of compliance associated with the Equality Act Public Sector Equality Duty (PSED) e.g. EDS2, Workforce Race Equality Standard (WRES) and Accessible Information Standard (AIS). We updated our recruitment and selection processes to make them fair and inclusive to all people and to enable applicants to be targeted as wide a field as possible.

A great deal has been accomplished over the last year and we recognise that more work needs to be done towards achieving successful health outcomes. We will continue to review our commitments around Equality and Diversity annually and proactively work towards improving our health related policies, practices and services internally and with the diverse communities we serve.

A new Equality, Diversity and Human Rights Policy was also developed during this period to show our ongoing commitment to this agenda towards our staff, service users and communities. The CCG continues to work with seldom heard groups such as the A8 migrant community, the homeless, travellers, ex-offenders and young people recently leaving care to understand the challenges and barriers to accessing primary care, with the aim of seeking solutions to improve uptake of primary care.

Staff Training Training staff on the various equality and diversity issues has been another important aspect of the progress made last year. All staff are expected to compete the online Equality and Diversity training. A new appraisal policy and process, introduced in 2017, ensures training and development is discussed, actioned and monitored through monthly 1:1s and the appraisal process. Additional training is identified at the appraisal. The CCG is at 80% compliance for Equality and Diversity training and aims to reach 100% over the coming years, and extend the training wider to our Governing Body and Committees.

South Lincolnshire Clinical Commissioning Group Annual Report 2018/19

Compliments, Concerns and Complaints During 2018/19 we received 17 formal complaints, both directly from patients and the public, and from Members of Parliament on behalf of their constituents. This is in line with the 17 complaints received in 2017/18. The CCG views compliments, concerns and complaints as a valuable source of information, and we act on all feedback received for services we commission, making sure that any concern or complaint raised is dealt with compassionately, effectively and in a timely manner. Our responses to concerns and complaints are administered in line with the Local Authority Social Services and National Health Service (England) Regulations 2009.

Breakdown of all Complaints 2018/19

By Resident Population

Quarter 1

Quarter 2

Quarter 3

Quarter 4

Totals

Principles for Remedy The CCG follows the principles of the Health Service Ombudsman as set out in the ‘Principles for Remedy’ document, which outlines guidance on how public bodies provide remedies for injustice or hardship resulting from their maladministration or poor service.

The Principles for Remedy can be viewed at https://www.ombudsman.org.uk/about-us/ our-principles/principles-remedy The six Principles for Remedy are: ▶▶ Getting it right ▶▶ Being customer focused ▶▶ Being open and accountable ▶▶ Acting fairly and proportionately ▶▶ Putting things right ▶▶ Seeking continuous improvement

South Lincolnshire CCG has adopted all of the six Principles for Remedy in the development of its complaints handling procedure and they form a core part of the CCG’s complaints handling policy that clearly sets out the organisation’s process for handling complaints in

MONTH FOIs received into CCG

No of FOIs received into the CCG

Percentage of FOIs processed within 15 working day KPI

Percentage of FOIs processed within 20 working day KPI

Mode category of requester

Mode category of topic

Mar-19

100% compliance

Corporate

Contracting & Commissioning

67%

Individual Corporate

Contracting & Commissioning

Corporate l

Contracting & Commissioning

50% Feb-19

9 FOI responses took longer than 15 working days to draft up for approval by the CCG

92%

6 FOI responses took longer than 20 working days to draft up for approval by the CCG

100%

Jan-19

1 FOI responses took longer than 15 working days to draft up for approval by the CCG

Dec-18

100%

Individual/ MP/ Student

Contracting & Commissioning

Nov-18

87%

100%

Corporate/ Individual

Contracting & Commissioning

Oct-18

91%

100%

Corporate l

Continuing Healthcare

Sep-18

56%

73%

Corporate l

Governance

Aug-18

35%

50%

Corporate

Treatments and Clinical Procedures

Jul-18

100%

Corporate

Treatments and Clinical Procedures

Jun-18

100%

Corporate

Contracting & Commissioning

May-18

100%

Corporate

Contracting & Commissioning

Apr-18

100%

Corporate

Treatments and Clinical Procedures/Finance

Total

243

Lincolnshire Clinical Commissioning Group 44 South Annual Report 2018/19

1 FOI responses took longer than 20 working days to draft up for approval by the CCG

order for the CCG to meet statutory requirements. The complaints policy sets out how the CCG takes responsibility, acknowledges failures, provides an apology and uses the learning from any complaint investigation to improve their services. These remedies can either be financial or non-financial.

Freedom of Information The Freedom of Information Act 2000 (FOI) gives people a general right to access information held by or on behalf of public authorities. It is intended to promote a culture of openness and accountability amongst public sector bodies and to facilitate a better public understanding of how public authorities carry out their duties, why they make the decisions they do and how they spend public money. Exemptions deal with instances where a public authority may withhold information under the Freedom of Information Act or Environmental Information Regulations. Exemptions mainly apply where releasing the information would not be in the public interest, for example, where it would affect law enforcement or harm commercial interests. Requests are handled in accordance with the terms of the Freedom of Information Act 2000 and wherever possible, best practice guidelines from the Information Commissionerâ&#x20AC;&#x2122;s Office and the Ministry of Justice are followed to maximise openness and transparency such as the Information Commissionerâ&#x20AC;&#x2122;s Office Section 45 Code of Practice which was issued on 4th July 2018. In 2018/19 the CCG received 243 individual FOI requests, resulting in 3,745 questions being raised. This compares to 206 received in 2017/18.

John Turner Accountable Officer May 2019

South Lincolnshire Clinical Commissioning Group Annual Report 2018/19

THE ACCOUNTABILITY REPORT Corporate Governance Members’ Report The Members Report has been prepared by the CCG Governing Body members. The following table details the 13 practices that comprise the membership of the CCG.

Practice Abbeyview Surgery, Crowland Health Centre, Thorney Road, Crowland PE6 0AL Beechfield Medical Centre, Beechfield Gardens, Spalding PE11 1UN Deepings Practice, Godsey Lane, Market Deeping, PE6 8DD Galletly Practice, 40 North Road, Bourne PE10 9BT Gosberton Medical Centre, Lowgate, Gosberton PE11 4NL Hereward Medical Centre, Exeter Street, Bourne PE10 9XR Littlebury Medical Centre, Fishpond Lane, Holbeach PE12 7DE Moulton Medical Centre, Moulton PE12 6QB Munro Medical Centre, West Elloe Avenue, Spalding PE11 2BY Pennygate Health Centre, 210 Pennygate, Spalding PE11 1LT (closed in September 2018) – the service is currently provided by Lincolnshire Community Health Services under a caretaker arrangement at Johnson Community Hospital, Spalding) Lakeside Healthcare Stamford (incorporating St Mary’s Medical Centre, Wharf Road, Stamford PE9 2DH and New Sheepmarket Surgery, Ryhall Road, Stamford PE9 1YA Sutterton Surgery, Spalding Road, Sutterton, Boston PE20 2ET Long Sutton Medical Centre, Trafalgar Square, Long Sutton, Spalding PE12 9HB (also Sutton Bridge Surgery)

Chair and Accountable Officer (Chief Officer) Dr Kevin Hill has been Chair for the financial year 2018/19. Mr John Turner has been the Accountable Officer (Chief Officer) for the financial year 2018/19.

Lincolnshire Clinical Commissioning Group 46 South Annual Report 2018/19

Composition of the Governing Body The composition of the Governing Body and the Audit and Risk Committee through the year and up to the signing of the Annual Report and Accounts (including advisory and Lay Members) is outlined in this section. Details of members of other Committees and SubCommittees are set out in the Annual Governance Statement. The Governing Body is responsible for ensuring the CCG has appropriate arrangements in place to exercise its functions effectively, efficiently and economically and in accordance with the CCGâ&#x20AC;&#x2122;s principles of good governance. The CCG Governing Body consists of the GP Chair, five GP members, the Accountable Officer (Chief Officer), Chief Finance Officer, Executive Nurse, Secondary Care Doctor, three Lay Members for Governance, Finance and Primary Care Commissioning and Patient and Public involvement, and managerial support and representatives from Public Health, Healthwatch and the Lincolnshire Health and Wellbeing Board. The profiles for the Governing Body members are detailed on the CCG website at: www.southlincolnshireccg.nhs.uk

Name

Role

Dr Kevin Hill

CCG Chair, and GP Member, Long Sutton Practice

Dr Majid Akram

GP Member, The Deepings Practice (Clinical Vice Chair from January 2019)

Dr Saleem Ajumal

GP Member (from 1 March 2019)

Mrs Elizabeth Ball

Director of Nursing and Quality

Dr Abhi Banerjee

GP Member

Ms Hilary Daniels

Lay Member, Finance and Primary Care Commissioning

Mrs Debbie Galloway

Practice Manager Representative (attendee) up to 31 December 2018

Mr Graham Felston

Lay Member, Governance (Vice Chair)

Mrs Sarah Fletcher

Healthwatch Representative (attendee)

Mr Preston Keeling

Lay Member, Patient and Public Involvement

Dr Naseer Khan

GP member

Dr Miles Langdon

GP member

Dr Isabel Perez

Public Health Representative

Dr Raghu Ramaiah

Secondary Care Doctor, Clinical Member (joint role with South West Lincolnshire CCG)

Mr Andrew Rix

Chief Operating Officer (attendee)

Mr John Turner

Chief Officer (joint role with South West Lincolnshire CCG)

Dr Ian Wheatley

GP member (Clinical Vice Chair up to 31 December 2018)

Councillor Sue Woolley

Councillor and Chair of the Health and Wellbeing Board (attendee)

Miss Jo Wright

Chief Finance Officer (joint role with South West Lincolnshire CCG)

South Lincolnshire Clinical Commissioning Group Annual Report 2018/19

Governing Body Committees

Audit and Risk Committee

To discharge its duties effectively, the Governing Body has a number of formally constituted Committees with delegated responsibilities as set out in the CCG Constitution and Scheme of Reservation and Delegation:

The membership of the Audit and Risk Committee during 2018/19 comprised: The following people are also in attendance:

▶▶ Audit and Risk Committee (Committees in Common with South West Lincolnshire CCG) ▶▶ Finance and QIPP Delivery Committee (Committees in Common with South West Lincolnshire CCG) ▶▶ Quality and Patient Experience Committee (Committees in Common with South West Lincolnshire CCG) ▶▶ Remuneration Committee (Committees in Common with South West Lincolnshire CCG)

Miss Jo Wright, Chief Finance Officer Mrs Julie Ellis-Fenwick, CCG Corporate Secretary/Manager Internal Audit representatives, PwC External Audit representatives, KPMG Local Counter Fraud Specialist

Other Governing Body Committees For details on our Remuneration Committee please refer to the Remuneration Report section. All other Committees of the Governing Body are referred to in the Annual Governance Statement.

▶▶ Primary Care Commissioning Committee ▶▶ Clinical Committee ▶▶ Council of Members The East Midlands Affiliated Commissioning Committee (EMACC) has also been established as a joint Committee shared with other CCGs within East Midlands. The function of the Committee is to work collaboratively on the development and maintenance of policies for services which CCGs have responsibility for commissioning, and identified as being appropriate for implementation on a regional scale.

The CCG is responsible for the stewardship of significant public resources when making decisions about the commissioning of health and social care services. In order to ensure and be able to evidence that these decisions secure the best possible services for the population it serves, the CCG must demonstrate accountability to relevant stakeholders (particularly the public), and probity and transparency in the decisionmaking process. A key element of this assurance involves management of conflicts of interest with respect to any decisions made. The CCG manages conflicts of interest as part of its day-to-day activities. Effective handling of such conflicts is crucial for the maintenance of public trust in the commissioning system. Importantly, it also serves to give confidence to patients,

Name

Role

Mr Graham Felston

Lay Member, Governance and Chair of the Audit and Risk Committee

Ms Hilary Daniels

Lay Member, Finance and Primary Care Commissioning

Mr Preston Keeling

Lay Member, Patient and Public Involvement

Lincolnshire Clinical Commissioning Group 48 South Annual Report 2018/19

providers, parliament and tax payers that the CCG’s commissioning decisions are robust, fair, transparent and offer value for money. The CCG has established a Standards of Business Conduct and Conflicts of Interest Policy. This policy sets out clear and robust procedures on how the CCG manages conflicts of interest. The Lay Member for Governance has been confirmed as the CCG Conflict of Interest Guardian.

Personal data related incidents There have been no serious incidents in 2018/19 relating to loss of personal data. Further details of the CCG’s Information Governance arrangements can be found within the Annual Governance Statement.

Statement as to disclosure to Auditors So far as the members are aware there is no relevant audit information of which the CCGs auditors are unaware, and that the member has taken all the steps that they ought to have taken as a member in order to make themselves aware of any relevant audit information and to establish that the CCG auditor is aware of that information.

Modern Slavery Act South Lincolnshire CCG fully supports the Government’s objectives to eradicate modern slavery and human trafficking but does not meet the requirements for producing an annual Slavery and Human Trafficking Statement as set out in the Modern Slavery Act 2015.

Statement of Accountable Officer’s Responsibilities The NHS 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 John Turner to be the Accountable Officer of NHS South Lincolnshire Clinical Commissioning Group.

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

They include responsibilities for: ▶▶ The propriety and regularity of the public finances for which the Accountable Officer is answerable. ▶▶ For keeping proper accounting records (which disclose with reasonable accuracy at any time the financial position of the Clinical Commissioning Group and enable them to ensure that the accounts comply with the requirements of the Accounts Direction). ▶▶ For safeguarding the Clinical Commissioning Group’s assets (and hence for taking reasonable steps for the prevention and detection of fraud and other irregularities). ▶▶ The relevant responsibilities of accounting officers under Managing Public Money. ▶▶ Ensuring the CCG exercises its functions effectively, efficiently and economically (in accordance with Section 14Q of the National Health Service Act 2006 (as amended) and with a view to securing continuous improvement in the quality of services (in accordance with Section14R of the National Health Service Act 2006 (as amended)).

▶▶ Ensuring that the CCG complies with its financial duties under Sections 223H to 223J of the National Health Service Act 2006 (as amended). Under the National Health Service Act 2006 (as amended), NHS England has directed each Clinical Commissioning Group to prepare for each financial year a statement of accounts in the form and on the basis set out in the Accounts Direction. The accounts are prepared on an accruals basis and must give a true and fair view of the state of affairs of the Clinical Commissioning Group and of its income and expenditure, Statement of Financial Position and cash flows for the financial year. In preparing the accounts, the Accountable Officer is required to comply with the requirements of the Government Financial Reporting Manual 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;

▶▶ Confirm that the Annual Report and Accounts as a whole is fair, balanced and understandable and take personal responsibility for the Annual Report and Accounts and the judgements required for determining that it is fair, balanced and understandable. To the best of my knowledge and belief, I have properly discharged the responsibilities set out under the National Health Service Act 2006 (as amended), Managing Public Money and in my Clinical Commissioning Group Accountable Officer Appointment Letter. I also confirm that: ▶▶ As far as I am aware, there is no relevant audit information of which the CCG’s auditors are unaware, and that as Accountable Officer, I have taken all the steps that I ought to have taken to make myself aware of any relevant audit information and to establish that the CCG’s auditors are aware of that information.

▶▶ Make judgements and estimates on a reasonable basis; ▶▶ State whether applicable accounting standards as set out in the Government Financial Reporting Manual have been followed, and disclose and explain any material departures in the accounts; and ▶▶ Prepare the accounts on a going concern basis; and

John Turner Accountable Officer May 2019

South Lincolnshire Clinical Commissioning Group Annual Report 2018/19

Annual Governance Statement 2018/19 South Lincolnshire CCG - 99D Introduction and context South Lincolnshire Clinical Commissioning Group is a body corporate established by NHS England on 1 April 2013 under the National Health Service Act 2006 (as amended). The Clinical Commissioning Group’s statutory functions are set out under the National Health Service Act 2006 (as amended). The CCG’s general function is arranging the provision of services for persons for the purposes of the health service in England. The CCG is, in particular, required to arrange for the provision of certain health services to such extent as it considers necessary to meet the reasonable requirements of its local population. As at 1 April 2018, the Clinical Commissioning Group is not subject to any directions from NHS England issued under Section 14Z21 of the National Health Service Act 2006.

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

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

Governance arrangements and effectiveness The main function of the Governing Body is to ensure that the CCG has made appropriate arrangements for ensuring that it exercises its functions effectively, efficiently and economically and complies with such generally accepted principles of good governance as are relevant to it. The governance framework of the Clinical Commissioning Group is detailed in the CCG’s Constitution. The Constitution sets out the details of practices with membership of the CCG, together with arrangements around joining or leaving the CCG and how disputes between member practices should be handled. The Constitution also reflects the mission, values, function and duties of the CCG and refers to the key governance documents that the CCG has produced – Standing Orders, Prime Financial Policies and Scheme of Reservation and Delegation.

Lincolnshire Clinical Commissioning Group 50 South Annual Report 2018/19

South Lincolnshire CCG and South West Lincolnshire CCG continue to operate as two statutory bodies with a shared leadership team (Chief Officer, Chief Finance Officer and Corporate Secretary are all shared roles). The administrative functions of the organisations are now based in the same premises and the majority of support staff operate across both organisations. As a result of shared leadership, the Governing Bodies of South Lincolnshire and South West Lincolnshire CCGs have also been working more closely together. Joint development sessions are held on a bi-monthly basis and cover topics such as Risk Management, Long Term Plan, Lincolnshire Acute Services Review, Neighbourhood Teams and Collaborative Working across Lincolnshire. Each CCG has its own Primary Care Commissioning Committee. The following governance Committees continue to meet “in common” across the two organisations -

▶▶ Finance and QIPP Delivery Committee ▶▶ Quality and Patient Experience Committee ▶▶ Audit and Risk Committee ▶▶ Remuneration Committee

The key Committees of the CCG and their responsibilities, as operated by the CCG at 31 March 2019, are summarised in the diagram opposite.

South Lincolnshire Clinical Commissioning Group Annual Report 2018/19

The CCG’s Committee structure supports the CCG’s governance processes and ensures that there is effective monitoring and accountability arrangements for the systems of internal control. The Terms of Reference for these committees have been reviewed during the year to ensure robust governance and assurance.

Council of Members – Chair, Dr Kieron Wiscombe The Council of Members meets at least four times a year and is chaired by a GP member who was elected by the Membership (practices in the CCG). The Council of Members consists of a representative from each of the member practices. The Committee met eight times in 2018/19 and has had 68% attendance from member practices. The Council of Members provides a forum for practice representatives to: ▶▶ Set strategic priorities and direction. ▶▶ Approve strategic and operational plans. ▶▶ Approve CCG constitutional arrangements. ▶▶ Ensure CCG clinical governance. ▶▶ Oversee quality of providers and support external arrangements. ▶▶ Make decisions and exercise powers reserved to the members, as listed in the Scheme of Reservation and Delegation. ▶▶ Challenge and hold to account the Governing Body for the discharge of the functions and responsibilities delegated to it.

In 2018/19 the Council of Members has:

▶▶ Ensure safeguarding compliance

▶▶ Approved the Annual Accounts and Annual Report for 2017/18.

▶▶ Manage conflict of interest issues according to guidance

▶▶ Updated the Constitution to reflect changes to the operation and duties of the CCG

▶▶ Monitor statutory duties and

▶▶ Identified planning priorities for South Lincolnshire ▶▶ Contributed to the Sustainability and Transformation Plan for Lincolnshire in particular around the development of Neighbourhood Teams and the Acute Services Review and; ▶▶ Supported the establishment of the Lincolnshire (Shadow) Joint Committee – a “once for Lincolnshire” approach. The Council of Members has been effective in setting the strategic direction for the CCG during 2018/19. The Annual Report and Accounts for 2018/19 will be received at the Council of Members meeting in May 2019.

Governing Body – Chair, Dr Kevin Hill The Governing Body meets on a bi-monthly basis. In the intervening months, the Governing Body has a development session held jointly with South West Lincolnshire CCG Governing Body. The Governing Body is chaired by a GP member who is elected by the Membership. The Governing Body has met six times in 2018/19 and has had 83% attendance from Lay Members. There has been 89% attendance from GPs. The Governing Body exists to: ▶▶ Ensure good governance and that the organisation functions effectively, efficiently and economically ▶▶ Monitor quality, safety, risk and progress

Lincolnshire Clinical Commissioning Group 52 South Annual Report 2018/19

▶▶ Oversee employee remuneration The Governing Body receives monthly updates on quality, finance, risk and performance. During 2018/19 it has: ▶▶ Undertaken a comprehensive Governing Body Development Programme. This has been held jointly with South West Lincolnshire CCG. ▶▶ Supported the ongoing development of the Lincolnshire Sustainability and Transformation Partnership. ▶▶ Supported the establishment of the Lincolnshire (Shadow) Joint Committee – a “once for Lincolnshire” approach. ▶▶ Established a Finance and QIPP Delivery Committee to give greater assurance on financial and delivery matters. The Governing Body has performed effectively throughout 2018/19 in ensuring good governance around the CCG’s decision making processes and in setting up a robust committee structure to manage areas of risk and priority for the CCG.

Clinical Committee – Chair, Dr Kevin Hill The Clinical Committee is a formal committee of the Governing Body which provides a forum for member practices to meet, discuss and provide clinical advice and input into CCG strategy and developments.

The Clinical Committee is chaired by the Clinical Chair of the CCG. The Committee has met four times in 2018/19 and has had 73% attendance from member practices. The Committee has also held three joint meetings with the Clinical Executive Committee from South West Lincolnshire CCG. There has been 82% attendance from member practices. The Clinical Committee has met the objective of improving working relationships across the CCG membership. Its key achievements have been: ▶▶ Commitment from all practices to the progression of the challenging QIPP (Quality, Improvement, Productivity, Prevention) programme during 2018/19 and looking ahead to 2019/20 to support CCG financial balance. ▶▶ Commitment to develop and use standardised patient pathways. ▶▶ Joint working with South West Lincolnshire CCG around community services and care closer to home.

Audit and Risk Committee – Chair, Mr Graham Felston The Audit and Risk Committee meets at least four times a year or additionally as required and is chaired by the Lay Member for Governance. The Committee has met four times in 2018/19 and has had 67% attendance from Lay Members. The Audit and Risk Committee meets ‘in common’ with the Audit and Risk Committee from South West Lincolnshire CCG.

The Audit and Risk Committee’s role is to: ▶▶ Give assurance on governance, risk management and internal controls. ▶▶ Ensure adherence to prime financial policies. ▶▶ Ensure financial governance and ensure stewardship of the financial allocation and compliance with financial regulations. The Audit and Risk Committee has been attended by, and updates have been received from, the CCG’s Internal and External auditors as well as its Counter Fraud Service at each meeting. It also receives and reviews the minutes of the Joint Risk Management Group.

Quality and Patient Experience Committee – Chair, Mr Preston Keeling The Quality and Patient Experience Committee is chaired by the Lay Member for Patient and Public Involvement. The Committee has met four times in 2018/19 and has had 75% attendance from Lay Members. The Quality and Patient Experience Committee conducts its role in a number of ways including scrutinising the clinical effectiveness of commissioned health care providers both in and out of the county. This work involves crosschecking multiple sources of information that we receive, such as complaints data, patient experience feedback, performance data, incidents, infection rates and staffing levels. The Committee can make recommendations and oversee corrective actions and provides assurance to the CCG Governing Body that commissioned services are being delivered in a high quality and safe manner, ensuring that quality sits at the heart of everything the CCG does.

Remuneration Committee – Chair, Mr Graham Felston The Remuneration Committee meets as required throughout the year and is chaired by the Lay Member for Governance. The Committee meets “in Common” with the Remuneration Committee from South West Lincolnshire CCG. The Committees in Common have met twice in 2018/19 and have had 75% attendance from lay members. The Committee’s role is to determine remuneration and conditions of service for the senior team. During 2018/19 the Remuneration Committee has approved continuation of remuneration packages for the Chief Officer and Chief Finance Officer for joint working with South West Lincolnshire CCG. The Committee has also approved the remuneration package for the single Accountable Officer for the four Lincolnshire CCGs from 1 April 2019. The Remuneration Committee manages conflicts of interest carefully during the meetings, with members and attendees leaving the meeting when their own remuneration is discussed.

Primary Care Commissioning Committee – Chair, Ms Hilary Daniels The Primary Care Commissioning Committee (PCCC) meets bi-monthly. The PCCC is chaired by the Lay Member for Finance and Primary Care. The Committee has met seven times in the year, and has had 95% attendance from Lay Members.

South Lincolnshire Clinical Commissioning Group Annual Report 2018/19

The Committee was established to provide assurance to the CCG over the management of primary care contracts, and provide a decision making body, managing conflict of interest issues. During the year the Committee has considered: ▶▶ Updates on the delivery of the GP Forward View in South Lincolnshire. ▶▶ Actions required as a result of reports and actions from the Care Quality Commission (CQC) affecting South Lincolnshire General Practices. ▶▶ General Practice future sustainability. ▶▶ Actions taken to ensure an interim solution for GP services in Spalding following GP retirement. ▶▶ Management of budgets for commissioning primary medical care services.

Finance and QIPP Delivery Committee – Chair, Ms Hilary Daniels The Finance and QIPP Delivery Committee meets as a Committee in Common with South West Lincolnshire CCG. The Committee meets bi-monthly and is chaired by the South Lincolnshire CCG Lay Member for Finance and Primary Care. The Committee met six times in the year, and has had 83% attendance from Lay Members. The Committee was established to provide further assurance to the CCGs on the management of financial matters, QIPP delivery and associated contract performance.

During the year the Committee has reviewed: ▶▶ Delivery and risks to delivery of the financial position and the QIPP programme ▶▶ Financial issues relating to the deficit position of the CCGs during 2018/19 ▶▶ Deep dives into QIPP projects including Neighbourhood Teams, Prescribing and Pathology. ▶▶ Detailed review of the CCG’s underlying financial position. Items of particular note or risk from all Committees are escalated to the Governing Body.

UK Corporate Governance Code NHS Bodies are not required to comply with the UK Code of Corporate Governance. For the financial year ended 31 March 2019, and up to the date of 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: ▶▶ The CCG is headed by an effective Governing Body with a Chair and the full complement of all positions on the Governing Body. Meetings are held regularly in public to consider agenda items and make decisions. Members of the public attend and have the opportunity to ask questions and raise issues with the Chair and Governing Body members during breaks in the meeting. The Chair of the CCG is separate from the Accountable Officer.

Lincolnshire Clinical Commissioning Group 54 South Annual Report 2018/19

The roles of the Governing Body are set out in the Constitution which details: mission, values and aims, functions and general duties; decision making structures; roles and responsibilities; standards of business conduct; transparency, ways of working and standing orders. ▶▶ The Committees of the Governing Body consisted of a balance of skill, knowledge, independence and experience for them to carry out duties and responsibilities. A skills audit across Lay Members has been carried out covering both South Lincolnshire and South West Lincolnshire CCGs as part of the closer working arrangements. The organisation learns and improves its performance through continuous monitoring and review of the systems and processes in place for meeting its objectives and delivering appropriate outcomes. ▶▶ There are clear accountability arrangements in place throughout the organisation. There are processes in place for effective management of ‘conflicts of interest’ and a robust process for risk management and internal control through regular reporting and interaction with internal and external audit. The Governing Body ensures that there are proper and independent assurances given on the soundness and effectiveness of the systems and processes in place for meeting its objectives and delivering appropriate outcomes. ▶▶ The Governing Body assessed the nature and extent of the significant risks it is willing to take in achieving the strategic objectives of the CCG. It maintains a sound system of risk management and internal control.

▶▶ The Governing Body receives escalation reports of items of particular note or risk from each of its Committees. ▶▶ Remuneration for Very Senior Managers is set by the Remuneration Committee which is a Committee of the Governing Body. The Remuneration Committee advises on determinations about the remuneration, fees and other allowances for employees and for people who provide services to the organisation. Drawing on benchmarking and expert HR advice, the Remuneration Committee has advised the Governing Body on appropriate remuneration and contractual arrangements for Governing Body members and others not covered by Agenda for Change terms and conditions. ▶▶ The CCG holds regular meetings and briefing sessions for the membership through its Members’ Council. Engagement with the public and other stakeholders also takes place through patients groups, partners and the local authority. There are partnership arrangements with the local authority via the local Health and Wellbeing Board. There are a range of other partnerships relevant to stakeholder groups including Patient Participation Groups (PPGs), the Local Safeguarding Boards, collaborative arrangements and meetings with NHS England, both to provide assurance and as cocommissioner. Arrangements are in place to effectively share information between partners. The CCG achieves a dialogue with stakeholders based on the mutual understanding of the objectives by engaging stakeholders in strategic planning rounds and in specific clinical leadership events.

Discharge of Statutory Functions In light of recommendations of the 1983 Harris Review, the Clinical Commissioning Group has reviewed all of the statutory duties and powers conferred on it by the National Health Service Act 2006 (as amended) and other associated legislative and regulations. As a result, I can confirm that the Clinical Commissioning Group is clear about the legislative requirements associated with each of the statutory functions for which it is responsible, including any restrictions on delegation of those functions. Responsibility for each duty and power has been clearly allocated to a lead Officer. Officers have confirmed that their structures provide the necessary capability and capacity to undertake all of the Clinical Commissioning Group’s statutory duties.

Risk assessment, management arrangements and effectiveness The CCG identifies, evaluates and controls its risks through the committee structure it has in place. The CCG embeds risk management through: ▶▶ The CCG committees (including the Joint Risk Management Group and the Audit and Risk Committee) ▶▶ Governing Body Assurance Framework (GBAF) ▶▶ Risk Register ▶▶ Policies and Procedures ▶▶ Prime Financial Policies and Standing Orders All staff are responsible for the identification and management of risk appropriate to their own role in the organisation.

South Lincolnshire Clinical Commissioning Group Annual Report 2018/19

The use of Quality Impact Assessments, Privacy Impact Assessments and Equality Impact Assessments as part of our project management framework also helps to identify risks. The Joint Risk Management Group (JRMG) is chaired by the Chief Finance Officer and is held across both South Lincolnshire and South West Lincolnshire CCGs. It is attended by the CCG Senior Leadership Team covering both CCGs. The membership is noted within the Joint Risk Strategy and Risk Management Framework which outlines the CCGâ&#x20AC;&#x2122;s approach to risk management and sets an open culture for identifying, responding to and reporting risk. All risks are reviewed on a regular basis by the risk owner, with robust confirm and challenge taking place at the Joint Risk Management Group. This ensures a consistent approach to risk assessment and measurement across the CCGs. The Group also horizon scans to assess the impact of future risks as well as ensuring the CCG can respond to unknown risks. The Joint Risk Management Group reviews the risk register and GBAF at every meeting. It also considers financial risk and has strengthened reporting to Governing Body and to the Finance and QIPP Delivery Committee. Where possible, risks are managed to eliminate or reduce them to a level acceptable to the CCG. The GBAF provides the CCG with a comprehensive method for the effective and focussed management of the principal risks to meeting its objectives. The assurance framework is underpinned by risk management which maps the CCGâ&#x20AC;&#x2122;s principal objectives to risk, controls and assurances. Any gaps in control or assurances have an action plan which is reviewed by the CCG Senior Leadership Team and the Governing Body.

The risk structure of the CCG is designed to manage risks to a reasonable level rather than to eliminate all risk, and to provide reasonable assurance of effectiveness. The annual mandatory training programme for all staff of the CCG focuses on risk management. The Joint Risk Strategy and Management Framework ensures that the organisation operates within the corporate governance framework, including the rules and regulations specified in the Standing Orders and Prime Financial Policies. During December 2018, the Governing Body dedicated part of the joint development session held across both CCGs to develop a refreshed and revised GBAF document. Risks discussed included workforce planning, financial risk and the impact of Brexit. This session was led by Internal Audit and included a discussion on the organisationsâ&#x20AC;&#x2122; risk appetite. Following consideration of the impact of Brexit, it is not felt to be a high risk for the CCG at this time. Figure Two opposite identifies the major risks for the CCG, both currently and going forward into 2019/20. These risks were considered by the Audit and Risk Committee at its March 2019 meeting when the risk register and GBAF were reviewed.

Commissioning Support Unit The CCG purchased the majority of its commissioning support services from Optum Commissioning Support Services throughout 2018/19. Continuing Healthcare and Individual Funding Requests are all provided by Arden GEM Commissioning Support Unit.

Lincolnshire Clinical Commissioning Group 56 South Annual Report 2018/19

Joint Commissioning The Joint Executive Team (JET) has been established to give oversight to commissioning matters arising jointly between the Lincolnshire CCGs and Lincolnshire County Council. The JET has oversight of the Better Care Fund (BCF) schemes, performance managing the delivery of the national BCF metrics across Lincolnshire and the allocation of resources. The BCF plan continued to commit to reduce avoidable emergency admissions and delayed transfers of care in 2018/19. The oversight of the BCF, along with governance and reporting arrangements surrounding the fund were subject to an internal audit during 2018/19. The audit concluded that there had been improvements made during the year and that findings had moved from high to medium risk. Risks associated with the BCF are captured on a risk register that is presented to the JET meeting on a regular basis. NHS England (NHSE) has recently confirmed that there are no identified risks to compliance with the CCG licence.

Capacity to Handle Risk The Accountable Officer has overall responsibility for the management of risk by the CCG. All employees have a responsibility to identify and manage risk appropriate to their own role in the organisation. The role of each senior officer is to ensure that appropriate arrangements are in place for the identification and elimination or reduction of risk to an acceptable level. Officers must also ensure compliance with policies, procedures and statutory requirements.

Figure 2: MAJOR RISKS FOR SOUTH LINCOLNSHIRE CCG Risk

Management & Mitigation

How outcomes are assessed

For the next three financial years being unable to commission a full range of services which are currently commissioned within the CCGâ&#x20AC;&#x2122;s financial allocation that meet the health needs and constitutional targets of the South and South West Lincolnshire population.

Review of total expenditure, jointly led by clinicians and finance.

QIPP Programme Board.

Non-delivery of performance and quality standards for cancer leading to actual or potential patient harm.

Patients in receipt of fully funded Continuing Health Care, Funded Nursing Care, fast tracks and Joint Packages of Care, do not receive timely reassessments resulting in lack of assurance in relation to quality and appropriateness of placements.

Potential harm to patients in the Emergency Department at Pilgrim Hospital

NHS England sign off of plans following confirm and challenge process.

Balanced financial plans, regular monitoring reports.

Finance and QIPP Delivery Committee New approach to whole system contracting and Governing Body scrutiny of plans and delivery arrangements. and efficiency. Hosted cancer service led by Lincolnshire West CCG. Patient level analysis weekly. Quality input into Lincolnshire pathways clinical work group. Performance reporting to Chief Nurse/ Deputy Chief Nurse. In-housing of CHC service to Lincolnshire West CCG led service. QIPP project to clear backlog and improve processes. Quality improvement plan in place with monthly oversight board including Pilgrim Hospital Urgent and Emergency Care improvement plan.

Quality and Patient Experience Committee. Governing Body review of performance standards and deep dive reports on Cancer standards. Quality and Patient Experience Committee. Senior Leadership Team oversight of inhousing. QIPP Programme Board.

Governing Body review of performance standards and regular updates on quality improvement plan. Lincolnshire East presence in the department on a regular basis.

CQC regular visits to department.

NHS England (NHSE) has recently confirmed that there are no identified risks to compliance with the CCG licence.

Other Sources of Assurance Internal Control Framework A system of internal control is the set of processes and procedures in place in the Clinical Commissioning Group to ensure it delivers its policies, aims and objectives. It is designed to identify and prioritise the risks, to evaluate the likelihood of those risks being realised and the impact should they be realised, and to manage them efficiently, effectively and economically.

The system of internal control allows risk to be managed to a reasonable level rather than eliminating all risk; it can therefore only provide reasonable and not absolute assurance of effectiveness. The CCG demonstrates internal control by a variety of mechanisms. The CCG committee structure as described earlier in the report ensures that a systematic and controlled process is in place to review and approve relevant

policy documentation and ensure robust governance is in place. The Joint Risk Management Group has specific responsibility for reviewing, managing and reporting risk to the Audit and Risk Committee and Governing Body. There are financial controls in place to comply with good practice and these are audited by internal and external auditors each year. The internal audit programme is extensive and covers key areas of the CCG business to review the CCGâ&#x20AC;&#x2122;s

South Lincolnshire Clinical Commissioning Group Annual Report 2018/19

compliance with policies and procedures and to recommend strengthening where appropriate. Annual audit of conflicts of interest management The revised statutory guidance on managing conflicts of interest for CCGs (published June 2017) requires CCGs to undertake an annual internal audit of conflicts of interest management. The CCGâ&#x20AC;&#x2122;s internal auditors have carried out audits of conflicts of interest within the following audits during 2019/20 (as detailed in the table below). Data Quality There have been no new data quality issues during 2018/19. Data quality has improved over the past year at the main acute trust in Lincolnshire. United Lincolnshire Hospitals Trust (ULHT) has continued to resolve the issues from their historical Patient Administration System (PAS) migration. Peterborough Orthopaedic Specialist Spinal Hospital (OSSH) began submitting data to the Secondary Uses Service (SUS) for reconciliation and validation, however the record counts are not reflective of their internal activity monitoring (SLAM) and this is being investigated.

More robust checks between SUS and SLAM will be taking place for all providers to reconcile differing data sources for reporting purposes, especially to support the Planning Round. Improvements have been made on centrally available reporting for CCG and GP members including the Practice Activity Reports and the Practice Care Quality Dashboard.

The local mental health trust, Lincolnshire Partnership Foundation Trust (LPFT), continues to improve the quality of their data submissions. A number of new community data flows have been introduced over the past 12-24 months. The quality of these is improving but will require further work in 2019/20 to ensure they meet the standards for robust reporting, contract monitoring and commissioning purposes. In October 2018, LPFT reported a problem to NHS Digital that an error in the submission of appointment data has resulted in no appointment data for October 2018 and broken pathways that will affect the providerâ&#x20AC;&#x2122;s recorded outcomes for several months. Based on the unpublished data provided by the Trust, all standards have been achieved.

Follow up of previous year audit

Findings implemented

Corporate Governance

Finance & QIPP Delivery Committee observation. Ensure Conflicts of Interest are accurately recorded in the minutes (Low risk)

Primary Care Commissioning

Ensure Conflicts of Interest are declared at the start of the meeting. Include definitions for Conflicts of Interest with the agenda. (Low risk)

STP Year End Update

Ensure that each meeting has formally recorded minutes included appropriately documented conflicts of interest considerations. (High risk)

Lincolnshire Clinical Commissioning Group 58 South Annual Report 2018/19

Information Governance The NHS Information Governance Framework sets the processes and procedures by which the NHS handles information about patients and employees, in particular personal identifiable information. The NHS Information Governance Framework is supported by a data security and protection toolkit and the annual submission process provides assurances to the Clinical Commissioning Group, other organisations and to individuals that personal information is dealt with legally, securely, efficiently and effectively. The CCG places high importance on ensuring there are robust information governance systems and processes in place to help protect patient and corporate information. The CCG has established an information governance management framework and has developed information governance processes and procedures in line with the new Data Security and Protection Toolkit. All staff undertake annual Data Security Awareness training and the CCG has implemented a staff information governance handbook 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. The CCG has developed information risk assessment and management procedures. A programme to fully embed an information risk culture throughout the organisation against identified risks has been established. The CCG buys its Information Governance services from Optum Commissioning Support Service. Business Critical Models The CCG does not use any business critical models at this time and will continue to review any models that it uses in the future to ensure quality assurance of such models.

Third party assurances Optum Commissioning Support Services Optum Health Solutions (UK) Ltd provides the CCG with commissioned support services including a range of financial processing services. To deliver assurance to the CCG, Optum have engaged 360 Assurance to provide an independent Service Auditor’s Report on the description of controls, their design and operating effectiveness for key financial processes as noted below. Optum have shared the Service Auditor report which was prepared in accordance with the guidance set out in the International Standards on Assurance Engagements 3000 and 3402 (“ISAE 3000 and 3402”) and the Institute of Chartered Accountants in England and Wales Technical Release AAF 01/06 (“AAF 01/06”). The report is a type II report, which provides assurance over the suitability of the design and operating effectiveness of the controls that are necessary to achieve the control objectives specified for a given period. The report covers the period 1 April 2018 to 28 February 2019, covering:▶▶ ▶▶ ▶▶ ▶▶ ▶▶ ▶▶

Accounts Payable Accounts Receivable Financial Ledger Financial Reporting HR and Payroll Treasury & Cash Management

360 Assurance’s independent audit opinion has concluded that the controls were suitably designed and the test provides reasonable assurance that the control objectives were achieved and operated effectively throughout the period. NHS Digital NHS England has shared an Independent Service Auditor Report in relation to NHS Digital’s Description of its Control System for GP payments to providers of General Practice services in England. This is a Type II ISAE3402 report for the period 1st April 2018 to 31st March 2019.

The report confirms the description fairly presents the GP Payments system for processing customers’ throughout the period The controls related to the control objectives stated in the accompanying description were suitably designed and operated effectively throughout the period. Capita Business Services Capita Business Services Limited provides Primary Care Support Services to NHS England and CCGs across the country. The CCG received a Type II Service Auditor Report in respect of these services which assessed the effectiveness of the control environment design for the financial year 2018/19’. The report identifies exceptions with 3 out of the 16 control objectives during the 12 month period – the design of the controls is robust, but, these controls have not been applied consistently. Work has taken place to strengthen the controls during the year and at year end, only one exception remained relating to the arrangements for managing user access to systems. NHS Shared Business Services NHS Shared Business Services provides Employment Services (Payroll, Pensions etc) to CCGs across the country. The CCG received a Type II Service Auditor Report in respect of these services which assessed the effectiveness of the control environment design which covers the period 1 April 2018-31 March 2019. The report issued was unqualified across the 16 identified control objectives, confirming that controls were suitably designed and operated effectively throughout the period.

Control Issues There are no significant control issues facing the CCG.

Review of economy, efficiency & effectiveness of the use of resources The CCG sets a financial plan at the beginning of the year, based on the priorities set by the Council of Members and agreed by the Governing Body. The plan is monitored on a monthly basis and reported to the Governing Body. The CCG also uses non-financial measures to manage its day to day business and to give a comprehensive and balanced view of performance. The Governing Body reviews the performance report on a monthly basis. Internal audit has reviewed the systems and processes in place during the year and published reports detailing the required actions within specific areas to ensure economy, efficiency and effectiveness of the use of resources is maintained. Recommendations are managed by the Chief Finance Officer and progress against the identified actions is reported quarterly to the Audit and Risk Committee. The ratings for the Quality of Leadership indicator of the CCG Improvement and Assessment Framework 2018/19 are due to be published at the time of reporting.

Delegation of functions The CCG received delegated authority for Primary Care Commissioning budgets from 1st April 2015. These consisted of GP contract budgets, and related areas of expenditure. To assure itself of the effective use of resources for delegated budgets the CCG accesses monthly payment information, which is reviewed and challenged for understanding and further information if required. A financial report is taken monthly to the Primary Care Commissioning Committee of the CCG which allows review and challenge by Lay Members.

South Lincolnshire Clinical Commissioning Group Annual Report 2018/19

There is a risk register covering Primary Care risks and emerging risks. This is reviewed by the Primary Care Commissioning Committee at each meeting. Escalation reports from the Primary Care Commissioning Committee are reviewed at the Governing body, and the delegated budgets form part of the overall financial report of the CCG.

Counter fraud arrangements The CCG is largely compliant with the Counter Fraud Authority for Commissioners: Fraud, Bribery and Corruption. The CCG contracts with PwC for an accredited Counter Fraud Specialist (CFS) service to undertake counter fraud work. The CFS works with the CCG to conduct a self-assessment of the position against the Standards for Commissioners on an annual basis which is approved by the Audit and Risk Committee and submitted to the Counter Fraud Authority on an annual basis. The CFS reports to each Audit and Risk Committee, an update of counter fraud work and progress against the Standards for Commissioners. The Chief Finance Officer has lead responsibility for tackling fraud, bribery and corruption. Anti-fraud work is very proactive in the CCG.

Our opinion is as follows: “controls are generally satisfactory with some improvements required.” Governance, risk management and control in relation to business critical areas is generally satisfactory. However, there are some areas of weakness and/ or non-compliance in the framework of governance, risk management and control which potentially put the achievement of objectives at risk. Some improvements are required in those areas to enhance the adequacy and/or effectiveness of the framework of governance, risk management and control. In summary, our interim opinion is based on the following: ▶▶ Medium risk rated weaknesses identified in individual assignments that are not significant in aggregate to the system of internal control; and/or ▶▶ High risk rated weaknesses identified in individual assignments that are isolated to specific systems or processes; ▶▶ None of the individual assignment reports have an overall classification of critical risk.”

Head of Internal Audit Opinion Following completion of the planned audit work for the financial year for the Clinical Commissioning Group, the Head of Internal Audit issued an independent and objective opinion on the adequacy and effectiveness of the Clinical Commissioning Group’s system of risk management, governance and internal control. The Head of Internal Audit concluded that: Lincolnshire Clinical Commissioning Group 60 South Annual Report 2018/19

The Audit and Risk Committee approved the Internal Audit plan that had been developed in conjunction with the Senior Leadership Team. During the year, Internal There is one audit report with a high risk identified. The actions that the CCG is taking to address the identified weakness are noted below. Area of Audit

Level of Risk

Corporate Governance

Low

Risk Management

Low

Information Governance

Low

Performance Management

Low

Finance

Low

Contract Management

Medium

Joint Commissioning (Better Care Fund)

Medium

Primary Care Co-Commissioning Personal Health Budgets

Low Medium

Quality

Low

Complex Case Team

High

STP Review Audit Follow Up

Medium N/A

There is one audit report with a high risk identified. The actions that the CCG is taking to address the identified weakness are noted below. Complex Case - A considerable amount of work has already taken place to improve processes and specifications within the Complex Case Team. There is further work to be completed around IT systems training and data cleansing to improve system reliability as well as completion of procedure notes.

The Audit and Risk Committee acknowledges the risks identified in the reports presented. The areas for audit were selected due to concerns about the controls in place. The Committee will closely monitor the delivery of action plans to address the weaknesses identified. During the year, Internal Audit did not issue any audit reports with a conclusion of critical risk.

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

Conclusion There have been no significant control issues in South Lincolnshire CCG in 2018/19. During the year, the CCG has developed and improved its governance arrangements. The CCG will continue to use the Governing Body Assurance Framework to assure the Governing Body and others that the CCG’s key controls to manage strategic risks are being assessed and improved continuously.

My review of the effectiveness of the system of internal control is informed by the work of the internal auditors, executive managers and clinical leads within the Clinical Commissioning Group who have responsibility for the development and maintenance of the internal control framework. I have drawn on performance information available to me. My review is also informed by comments made by the external auditors in their annual audit letter and other reports. Our assurance framework provides me with evidence that the effectiveness of controls that manage risks to the Clinical Commissioning Group achieving its principal objectives have been reviewed. I have been advised on the implications of the result of this review by:

▶▶ ▶▶ ▶▶ ▶▶ ▶▶

Governing Body Audit and Risk Committee Finance and QIPP Delivery Committee Joint Risk Management Group and Quality and Patient Experience Committee.

A plan to address weaknesses and ensure continuous improvement of the system is in place.

John Turner Accountable Officer May 2019

South Lincolnshire Clinical Commissioning Group Annual Report 2018/19

Remuneration and Staff Report Remuneration Report As required by the Companies Act 2006 the CCG has prepared a Remuneration Report containing information about director’s remuneration. This report is in respect of the senior managers of the South Lincolnshire CCG. The definition of “senior managers” is: ‘those persons in senior positions having authority or responsibility for directing or controlling the major activities of the CCG. This means those who influence the decisions of the CCG as a whole rather than the decisions of individual directorates or departments. Such persons will include advisory and lay members.’ Tables 1 and 2 on subsequent pages of this report summarise the remuneration (excluding National Insurance contributions) and pension status of the CCGs Governing Body members and other senior managers for the year ended 31 March 2019.

Remuneration Committee The CCG’s Remuneration Committee, which is a Committee of the Governing Body sets the principles of the pay and rewards strategy for the CCG to ensure that it is both equitable and fair. The Committee approves the overall approach and methodology for determining pay

and conditions of staff subject to local terms. It also ensures that the CCG’s most senior managers are appropriately and fairly rewarded for their contributions, conforming to the CCG’s probity and financial integrity as part of the corporate governance arrangements. The membership of the Remuneration Committee and their attendance at meetings throughout the financial year was as follows:

Policy on the Remuneration of Senior Managers The notice period for executive directors is six months and the arrangements for compensation payments for early termination of contract will comply with NHS regulations.

Remuneration of Very Senior Managers The remuneration for executive directors does not include any performance related bonuses and none of the executives receives personal pension contributions other than their entitlement under the NHS Pension Scheme.

Name

Attendance

Dr Kevin Hill, CCG Chair

2 out of 2

100

Ms Hilary Daniels, Lay Member, Finance and Primary Care Commissioning (attendee)

2 out of 2

100

Mr Graham Felston, Lay Member, Governance

2 out of 2

100

Mr Preston Keeling, Lay Member, Patient and Public Involvement

2 out of 2

100

Dr Raghu Ramaiah, Secondary Care Doctor, Clinical Member

1 out of 2

Lincolnshire Clinical Commissioning Group 62 South Annual Report 2018/19

Table 1: Salaries and Allowances for the year ending 31 March 2019

Name and Title

Start Date in-year

End Date in-year

Dr Kevin Hill, Clinical Chair

Salary (bands of £5000)

Expense Payments (taxable) total to nearest £100

Annual Performance Related Bonuses

Long-Term Performance Related Bonuses

All Pension Related Benefits (bands of £2,500)

£’000

£’00

£’000

Total (bands of £5,000)

£’000

75-80

Dr Ian Wheatley, GP Member and Clinical Vice Chair

31/12/2018

5-10

0-5

Dr Kieron Wiscombe Chair - Council of Members

31/03/2019

0-5

Mr Graham Felston, Lay Member - Governance

5-10

Mr Preston Keeling, Lay Member - Patient and Public Involvement

5-10

Mr John Turner*, Chief Officer

140-145

145-150

Mrs Elizabeth Ball, Director of Quality & Executive Nurse

85-90

Dr Majid Akram GP Member and Clinical Vice Chair (from 01/01/19)

10-15

Dr Abhi Banerjee, GP Member

5-10

Dr Naseer Khan, GP Member

5-10

Dr Miles Langdon, GP Member

5-10

0-5

5-10

0-5

Dr Saleem Ajumal, GP Member Ms Hilary Daniels, Lay Member - Finance and Primary Care Commissioning

01/03/2019

57.5-60

South Lincolnshire Clinical Commissioning Group Annual Report 2018/19

145-150

Table 1B: Staff Sharing Arrangements for the year ending 31 March 2019 Table 1B shows the remuneration details for the staff sharing arrangements.

Salary (bands of £5000)

Expense Payments (taxable) total to nearest £100

Annual Performance Related Bonuses

Long-Term Performance Related Bonuses

All Pension Related Benefits (bands of £2,500)

£’000

£’00

£’000

Miss. Joanne Wright*, Chief Finance Officer, South West Lincolnshire CCG

40-45

45-50

Miss. Joanne Wright*, Chief Finance Officer, South Lincolnshire CCG

50-55

55-60

Mr John Turner**, Chief Officer, South West Lincolnshire CCG

60-65

65-70

Mr John Turner**, Chief Officer, South Lincolnshire CCG

75-80

Name and Title

Start Date in-year

End Date in-year

Total (bands of £5,000)

Notes to the Remuneration Report *Joanne Wright remains the Chief Finance Officer for both South West Lincolnshire CCG and South Lincolnshire CCG. Joanne Wright remains an employee of South West Lincolnshire CCG and the share for each organisation of the Staff Sharing Arrangement is shown in Table 1B. **John Turner remains the Chief Officer for both South West Lincolnshire CCG and South Lincolnshire CCG. John Turner remains an employee of South Lincolnshire CCG and the share for each organisation of the Staff Sharing Arrangement is shown in Table 1B. Salaries and Allowances Notes 1. Total remuneration includes salary and non-consolidated performance-related pay as well as severance payments. It does not include employer pension contributions and the cash equivalent transfer value of pensions. 2. None of the CCG’s senior employees are entitled to performance related bonuses. 3. There were no service contracts with senior managers during the financial year. 4. There were no payments or awards made to past senior managers, payments made for loss of office during the financial year or payments to anyone who was not a senior manager but has previously been a senior manager at any time. 5. The expense payments relate to Lease Car entitlement.

Lincolnshire Clinical Commissioning Group 64 South Annual Report 2018/19

Prior Year 2017/18 Table 1: Salaries and Allowances for the year ending 31 March 2018

Salary (bands of £5000)

Expense Payments (taxable) total to nearest £100

Annual Performance Related Bonuses

Long-Term Performance Related Bonuses

All Pension Related Benefits (bands of £2,500)

£’000

£’00

£’000

Dr Kevin Hill, Clinical Chair

75-80

Dr Ian Wheatley, Clinical Vice Chair

5-10

Dr Kieron Wiscombe, Chair Members Council

0-5

Mr Graham Felston, Lay Member - Governance

5-10

Mr Preston Keeling, Lay Member - Patient and Public Involvement

5-10

10-15

Mr John Turner, Chief Officer

140-15

992.5-995

140-145

Mrs Elizabeth Ball, Director of Quality & Executive Nurse

80-85

47.5-50

130-135

Dr Andrew Sykes, GP Member

5-10

Dr Abhi Banerjee, GP Member

5-10

Dr Naseer Khan, GP Member

5-10

Dr Miles Langdon, GP Member

5-10

Ms Hilary Daniels, Chair - Finance & QIPP Delivery Committee

5-10

Name and Title

Date

Total (bands of £5,000)

£’000

South Lincolnshire Clinical Commissioning Group Annual Report 2018/19

Prior Year 2017/18 Table 1: Salaries and Allowances for the year ending 31 March 2018 Salary (bands of £5000)

Expense Payments (taxable) total to nearest £100

Annual Performance Related Bonuses

Long-Term Performance Related Bonuses

All Pension Related Benefits (bands of £2,500)

£’000

£’00

£’000

Miss. Joanne Wright*, Chief Finance Officer, South West Lincolnshire CCG

45-50

5-10

55-60

Miss. Joanne Wright*, Chief Finance Officer, South Lincolnshire CCG

45-50

5-10

55-60

Mr John Turner**, Chief Officer, South West Lincolnshire CCG

70-75

5-10

80-85

Mr John Turner**, Chief Officer, South Lincolnshire CCG

70-75

5-10

80-85

Name and Title

Start Date in-year

End Date in-year

Total (bands of £5,000)

Notes to the Remuneration Report *Joanne Wright remains the Chief Finance Officer for both South West Lincolnshire CCG and South Lincolnshire CCG. Joanne Wright remains an employee of South West Lincolnshire CCG and the share for each organisation of the Staff Sharing Arrangement is shown in Table 1B. **John Turner became the Chief Officer for both South West Lincolnshire CCG and South Lincolnshire CCG from 01/04/2017. John Turner was already the Chief Officer of South Lincolnshire CCG. John Turner remains an employee of South Lincolnshire CCG and the share for each organisation of the Staff Sharing Arrangement is shown in Table 1B. Salaries and Allowances Notes 1. Total remuneration includes salary and non-consolidated performance-related pay as well as severance payments. It does not include employer pension contributions and the cash equivalent transfer value of pensions. 2. None of the CCG’s senior employees are entitled to performance related bonuses. 3. There were no service contracts with senior managers during the financial year. 4. There were no payments or awards made to past senior managers, payments made for loss of office during the financial year or payments to anyone who was not a senior manager but has previously been a senior manager at any time. 5. The expense payments relate to Lease Car entitlement.

Lincolnshire Clinical Commissioning Group 66 South Annual Report 2018/19

Table 2: Pension Benefits for the year ending 31 March 2019

Real increase in pension at pension age (bands of £2,500)

Real increase in pension lump sum at pension age (bands of £2,500)

Total accrued pension at pension age at 31 March 2018 (bands of £5,000)

Lump sum at pension age related to accrued pension at 31 March 2018 (bands of £5,000)

Cash Equivalent Transfer Value at 1 April 2017

Real increase in Cash Equivalent Transfer Value

Cash Equivalent Transfer Value at 31 March 2018

Employer’s contribution to stakeholder pension

£’000

Mr John Turner, Chief Officer

70-75

5-10

80-85

Mrs Elizabeth Ball, Director of Quality & Executive Nurse

70-75

5-10

80-85

Name and Title

Pension Benefit Notes The above information is based on data provided by the NHS Pensions Agency. The employer’s contribution rate to pension benefits is 14.38% of pensionable pay Staff are able to make additional voluntary contributions alongside their regular contributions. Cash Equivalent Transfer Values A Cash Equivalent Transfer Value (CETV is the actuarially assessed capital value of the pension scheme benefits accrued by a member at a particular point in time. The benefits valued are the member’s accrued benefits and any contingent spouse’s (or other allowable beneficiary’s) pension payable from the scheme. CETVs are calculated in accordance with the Occupational Pension Schemes (Transfer Values) Regulations 2008. Real Increase in CETV This reflects the increase in CETV effectively funded by the employer. It takes account of the increase in accrued pension due to inflation, contributions paid by the employee (including the value of any benefits transferred from another scheme or arrangement) and uses common market valuation factors for the start and end of the period.

Table 3: Pay Multiples for the year ending 31 March 2019 Description

2018-19

2017-18

Band of highest paid directors’ total remuneration (£’000)

155-160

145-150

45-50

Median Total Ratio

Reporting bodies are required to disclose the relationship between the remuneration of the highest-paid director or member in the organisation and the median remuneration of the organisation’s workforce. The banded remuneration in thousands of the highest paid member in NHS South Lincolnshire CCG in the financial year 2018/19 was £155k-£160k (2017/18,£145-£150k). This was 3.23 times in 2018/19,(2017/18,3.13 times) the median remuneration of the workforce, which was £45k-£50k (2017/18,£45-£50k). The banded remuneration in thousands of the lowest paid member in clinical commissioning group in the financial year was annualised full time equivalent remuneration of £15k-£20k (2017-18, £10k-£15k). In 2018/19 there were zero employees (2017/18,zero), when their pay was annualised who received remuneration in excess of the highest paid member. Total remuneration includes salary, non-consolidated performance-related pay, benefits-in-kind, but not severance payments. It does not include employer pension contributions and the cash equivalent transfer value of pensions. South Lincolnshire Clinical Commissioning Group Annual Report 2018/19

Table 4: Exit Packages for the year ending 31 March 2019

Number of compulsory redundancies

Cost of complusory redundancies

Number of other departures agreed

Cost of other departures agreed

Total number of exit packages

Total cost of exit packages

Number of departures where special payments have been made

Number

Less than £10,000

£10,001 to £25,000

£25,001 to £50,000

£50,001 to £100,000

£100,001 to £150,000

£150,001 to £200,000

Over £200,001

Total

Exit Package cost band (including any special payment element)

Number of departures where special payments have been made

Redundancy and other departure costs have been paid in accordance with the provisions of the Agenda For Change redundancy policy. Exit costs in this note are accounted for in full in the year of departure. Where the CCG has agreed early retirements, the additional costs are met by the CCG and not by the NHS pensions scheme. Ill-health retirement costs are met by the NHS pensions scheme and are not included in the table. This disclosure reports the number and value of exit packages agreed in the year. Note: the expense associated with these departures may have been recognised in part or in full in a previous period.

Table 5: Other Agreed Departures for the year ending 31 March 2019 Agreements

Total value of Agreements

Number

Voluntary redundancies including early retirement contractual costs

Mutually agreed resignations (MARS) contractual costs

Early retirements in the efficiency of the service contractual costs

Contractual payments in lieu of notice*

Exit payments following Employment Tribunals or court orders

Non-contractual payments requiring HMT approval**

Total CCG

Other Agreed Departures

Lincolnshire Clinical Commissioning Group 68 South Annual Report 2018/19

South Lincolnshire CCG: Off Payroll Engagements 2018/19 Table 1: Existing Off Payroll engagements

Table 2: New Off Payroll engagements

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

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

2018-19

Table 3: Off Payroll board members/senior official engagements For any off-payroll engagements of board members, and/or, senior officials with significant financial responsibility, between 1 April 2018 and 31 March 2019.

Number Number of existing engagements as of 31 March 2019

Of which, the number that have existed: for less than one year at the time of reporting

for between one and two years at the time of reporting

for between 2 and 3 years at the time of reporting

for between 3 and 4 years at the time of reporting

for 4 or more years at the time of reporting

No. of new engagements, or those that reached six months in duration, between 1 April 2019 and 31 March 2019

2018-19

Number

Of which, the number that have existed: No. assessed as caught by IR35

No. assessed as not caught by IR35

No. engaged directly (via PSC contracted to the entity) and are on the departmental payroll

No. of engagements reassessed for consistency / assurance purposes during the year.

No. of engagements that saw a change to IR35 status following the consistency review

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

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 onpayroll engagements

South Lincolnshire Clinical Commissioning Group Annual Report 2018/19

Staff Report Our employees are vital to our success. During 2018/19 our teams have continued to make significant contributions to our agreed priorities and in the most recent national NHS staff survey, staff reported a high level of engagement when compared to organisations of a similar type.

programme focusing on leadership styles, critical thinking and influencing.

employees who contributed to future ideas for staff engagement.

Band 2-5 Development Programme

This work is ongoing and will also support the broader requirements set out in the Agenda for Change framework agreement to improve levels of attendance through a focus on staff health and wellbeing initiatives at both a national and local level.

In 2018 the CCG embarked on a number of key employee development activities, aligned with its organisational objectives, which addressed the outcome of the national NHS staff survey. These included:

Following feedback from our staff, the CCG launched a new programme to employees in Bands 2 to 5. The programme was designed to enhance working across teams, encourage team participation and resilience, and provide the opportunity for personal reflection and learning.

Senior Leadership Team 360º Feedback

Staff Survey and employee engagement

In line with good practice and an NHS England sponsored programme, five members of the Senior Leadership Team undertook this survey. The purpose of the survey was for managers to gain insight into their leadership and help identify areas for their future development based on feedback on their performance and behaviours.

Seventy eight percent (78%) of our staff completed the NHS staff survey with 81% recommending the CCG as a place to work. Staff who completed the survey highlighted improvements recieving appraisals from 64% (2017) to 85% in 2018.

Band 7-8 Leadership Development Programme The aim of this programme was to enhance the leadership and professional development of leaders and future leaders. Eight managers completed the

The CCG recognised that there were areas for improvement and during 2018 we established a staff engagement group to identify how we could support our teams and deliver on the outcomes from the staff survey. The work of the group culminated in a launch event attended by over 30 CCG

Our Staff Engagement Team During the year the team have been working hard to develop a thematic approach to staff engagement. A number of activities are planned throughout the year based on ideas developed by our staff around the themes of: ▶▶ Living values and giving back ▶▶ Letting teams get social ▶▶ Encourage learning and development ▶▶ Supporting charities and volunteering ▶▶ Looking after your wellbeing ▶▶ Employee benefits

Lincolnshire Clinical Commissioning Group 70 South Annual Report 2018/19

Payscale Band 2 Band 3 Band 4 Band 5 Band 6 Band 7

Band 8a

Band 8b Band 8c Band 8d Band 9 GP GP Members Other and Non Agenda for Change (Including Very Senior Managers)

Gender

Total WTE

Female

Male

Female

1.43

Male

Female

1.6

Male

Female

Male

Female

8.8

Male

Female

Male

Female

Male

Female

Male

Female

Male

Female

Male

Female

0.56

Male

0.09

Female

0.15

Male

0.77

Female

0.5

Male

0.5

Grand Total

27.4

Staff Absence We monitor a number of human resource indicators, including staff sickness rates, vacancy rates and staff turnover. This allows us to explore further the management of such issues and to gain assurance around the proactive support offered to staff regarding their health and wellbeing. In the first half of 2018/19 sickness absence within the CCG has been consistently low with the CCG meeting its absence target for the whole twelve month period from April 2018 to March 2019.

Month

Apr-18 May-18 Jun-18

Jul-18

Aug-18

Sep-18

Oct-18

Nov-17

Dec-18

Jan-19

Feb-19

Mar-19

Monthly Sickness %

4.02%

3.84%

0.00%

4.23%

0.10%

0.00%

0.44%

1.40%

0.72%

4.38%

1.33%

0.82%

Cumulative Sickness

0.27%

0.1%

0.02%

0.01%

0.03%

0.05%

0.09%

0.08%

Cost of Sickness (£)

£412

£118

£0

£4,829

£118

£0

£670

£1,317

£767

£12,114

£2,788.00

£796.00

South Lincolnshire Clinical Commissioning Group Annual Report 2018/19

Lincolnshire Clinical Commissioning Group 72 South Annual Report 2018/19 0 1,301

0 1,366

Total - Net admin employee benefits including capitalised costs

1,445

(144) 1,301

0 1,301

1,510

(144) 1,366

0 1,366

Gross employee benefits expenditure

Less recoveries in respect of employee benefits (note 4.1.2)

Total - Net admin employee benefits including capitalised costs

Net employee benefits excluding capitalised costs

Less: Employee costs capitalised

1,167 125 153 0 0 0 0 0

Permanent Employees £'000

1,232 125 153 0 0 0 0 0

Total £'000

Employee Benefits Salaries and wages Social security costs Employer contributions to the NHS Pension Scheme Other pension costs Apprenticeship Levy Other post-employment benefits Other employment benefits Termination benefits

4.1.1 Employee benefits

Net employee benefits excluding capitalised costs Total

(144) 1,301

(144) 1,366

Less recoveries in respect of employee benefits (note 4.1.2)

2017-18

1,445

1,510

Gross employee benefits expenditure

Less: Employee costs capitalised

1,167 125 153 0 0 0 0 0

Permanent Employees £'000

Total

1,232 125 153 0 0 0 0 0

Total £'000

2018-19

Employee benefits

Employee benefits and staff numbers

Other £'000

65 0 0 0 0 0 0 0

1,284

(144)

1,428

1,166 117 145 0 0 0 0 0

Total £'000

1,284

(144)

1,428

1,166 117 145 0 0 0 0 0

Total £'000

1,219

(144)

1,363

1,101 117 145 0 0 0 0 0

Permanent Employees £'000

Admin

1,219

(144)

1,363

1,101 117 145 0 0 0 0 0

Permanent Employees £'000

Admin

Other £'000

65 0 0 0 0 0 0 0

Total £'000

66 8 8 0 0 0 0 0

Other £'000

66 8 8 0 0 0 0 0

Permanent Employees £'000

Other £'000

Programme

66 8 8 0 0 0 0 0

Permanent Employees £'000

Programme

0 0 0 0 0 0 0 0

Staff Policies Disabled Employees In the last year we have successfully transitioned from the ‘Two Ticks’ Quality Mark to become a Disability Confident Employer. We are therefore committed to: ▶▶ Interviewing all disabled applicants who meet the minimum requirements for a job vacancy and to consider them on their abilities ▶▶ Discussing with disabled employees, at any time, but at least once a year, what we can do to make sure they can develop and use their abilities ▶▶ Making every effort when employees become disabled to make sure they stay in employment ▶▶ Taking action to ensure that all employees develop the appropriate level of disability awareness needed to make these commitments work ▶▶ Reviewing these commitments annually

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

We are also a Mindful Employer and make our equality Information available on our website. This information is part our public commitment to meeting the equality duties placed upon us by legislation and we pledge to update this regularly.

John Turner Accountable Officer May 2019

South Lincolnshire Clinical Commissioning Group Annual Report 2018/19

Financial Statements South Lincolnshire CCG - Annual Accounts 2018-19 CONTENTS The Primary Statements: Statement of Comprehensive Net Expenditure for the year ended 31st March 2019 Statement of Financial Position as at 31st March 2019 Statement of Changes in Taxpayers' Equity for the year ended 31st March 2019 Statement of Cash Flows for the year ended 31st March 2019 Notes to the Accounts Note 1 Accounting policies Note 2 Other operating revenue Note 3 Revenue Note 4 Employee benefits and staff numbers Note 5 Operating expenses Note 6 Better payment practice code Note 7 Income generation activities Note 8 Investment revenue Note 9 Other gains and losses Note 10 Finance costs Note 11 Net gain/(loss) on transfer by absorption Note 12 Operating leases Note 13 Property, plant and equipment Note 14 Intangible non-current assets Note 15 Investment property Note 16 Inventories Note 17 Trade and other receivables Note 18 Other financial assets Note 19 Other current assets Note 20 Cash and cash equivalents Note 21 Non-current assets held for sale Note 22 Analysis of impairments and reversals Note 23 Trade and other payables Note 24 Other financial liabilities Note 25 Other liabilities Note 26 Borrowings Note 27 Private finance initiative, LIFT and other service concession arrangements Note 28 Finance lease obligations Note 29 Finance lease receivables Note 30 Provisions Note 31 Contingencies Note 32 Commitments Note 33 Financial instruments Note 34 Operating segments Note 35 Joint arrangements - interests in joint operations Note 36 NHS Lift investments Note 37 Related party transactions Note 38 Events after the end of the reporting period Note 39 Third party assets Note 40 Losses and special payments Note 41 Financial performance targets Note 42 Analysis of charitable reserves Note 43 Impact of implicationof IFRS 15 on the current year closing balances Lincolnshire Clinical Commissioning Group 74 South Annual Report 2018/19

South Lincolnshire CCG - Annual Accounts 2018-19 Statement of Comprehensive Net Expenditure for the year ended 31 March 2019 Note

2018-19 ÂŁ'000

2017-18 ÂŁ'000

Income from sale of goods and services Other operating income Total operating income

2 2

(2,163) 0 (2,163)

(3,823) (38) (3,861)

Staff costs Purchase of goods and services Provision expense Other Operating Expenditure Total operating expenditure

4 5 5 5

1,579 234,850 7 183 236,618

1,511 235,557 110 131 237,309

Net Operating Expenditure

234,455

233,448

Net expenditure for the year

234,455

233,448

Total Net Expenditure for the Financial Year

234,455

233,448

Comprehensive Expenditure for the year ended 31 March 2019

234,455

233,448

South Lincolnshire Clinical Commissioning Group Annual Report 2018/19

South Lincolnshire CCG - Annual Accounts 2018-19 Statement of Financial Position as at 31 March 2019

Non-current assets: Total non-current assets

Note

2018-19

2017-18

£'000

£'000 0

3,874 61 3,936

4,472 159 4,631

Total current assets

3,936

4,631

Total assets

3,936

4,631

(17,531) (98) (17,629)

(17,941) (103) (18,045)

(13,693)

(13,414)

(29) (29)

(13,723)

(13,443)

(13,723) (13,723)

(13,443) (13,443)

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

Current liabilities Trade and other payables Provisions Total current liabilities

17 20

23 30

Non-Current Assets plus/less Net Current Assets/Liabilities Non-current liabilities Provisions Total non-current liabilities Assets less Liabilities Financed by Taxpayers’ Equity General fund Total taxpayers' equity:

The notes on pages 79 to 102 form part of this statement

The financial statements on pages 74 to 102 were approved by the Council of Members on 23rd May 2019 and signed on its behalf by: Mr John Turner Accountable Officer May-19

John Turner Accountable Officer May 2019

Lincolnshire Clinical Commissioning Group 76 South Annual Report 2018/19

South Lincolnshire CCG - Annual Accounts 2018-19 Statement of Changes In Taxpayers Equity for the year ended 31 March 2019 General fund £'000

Changes in taxpayers’ equity for 2018-19 Balance at 01 April 2018

(13,443) (13,443)

Adjusted NHS Clinical Commissioning Group balance at 31 March 2018 Changes in NHS Clinical Commissioning Group taxpayers’ equity for 2018-19 Net operating expenditure for the financial year

(234,455)

Total revaluations against revaluation reserve

Net Recognised NHS Clinical Commissioning Group Expenditure for the Financial Year Net funding

(234,455) 234,176 (13,723)

Balance at 31 March 2019

General fund £'000

Changes in taxpayers’ equity for 2017-18 Balance at 01 April 2017 Adjusted NHS Clinical Commissioning Group balance at 31 March 2018

(12,226) (12,226)

Changes in NHS Clinical Commissioning Group taxpayers’ equity for 2017-18 Net operating costs for the financial year

(233,448)

Total revaluations against revaluation reserve

Net Recognised NHS Clinical Commissioning Group Expenditure for the Financial Year Net funding Balance at 31 March 2018

(233,448) 232,231 (13,443)

The notes on pages 79 to 102 form part of this statement

South Lincolnshire Clinical Commissioning Group Annual Report 2018/19

South Lincolnshire CCG - Annual Accounts 2018-19 Statement of Cash Flows for the year ended 31 March 2019 Cash Flows from Operating Activities Net operating expenditure for the financial year (Increase)/decrease in trade & other receivables Increase/(decrease) in trade & other payables Provisions utilised Increase/(decrease) in provisions Net Cash Inflow (Outflow) from Operating Activities

Note 17 23 30 30

Net Cash Inflow (Outflow) from Investing Activities Net Cash Inflow (Outflow) before Financing Cash Flows from Financing Activities Grant in Aid Funding Received Net Cash Inflow (Outflow) from Financing Activities Net Increase (Decrease) in Cash & Cash Equivalents Cash & Cash Equivalents at the Beginning of the Financial Year Effect of exchange rate changes on the balance of cash and cash equivalents held in foreign currencies Cash & Cash Equivalents (including bank overdrafts) at the End of the Financial Year

The notes on pages 79 to 102 form part of this statement

Lincolnshire Clinical Commissioning Group 78 South Annual Report 2018/19

2018-19 ÂŁ'000

2017-18 ÂŁ'000

(234,455) 597 (410) (12) 7 (234,273)

(233,448) (507) 1,643 0 110 (232,202)

(234,273)

(232,202)

234,176 234,176

232,231 232,231

(98)

159 0 61

130 0 159

South Lincolnshire CCG - Annual Accounts 2018-19 Notes to the financial statements 1

Accounting Policies NHS England has directed that the financial statements of clinical commissioning groups (CCG) shall meet the accounting requirements of the Group Accounting Manual issued by the Department of Health and Social Care. Consequently, the following financial statements have been prepared in accordance with the Group Accounting Manual 2018-19 issued by the Department of Health and Social Care. The accounting policies contained in the Group Accounting Manual follow International Financial Reporting Standards to the extent that they are meaningful and appropriate to clinical commissioning groups, as determined by HM Treasury, which is advised by the Financial Reporting Advisory Board. Where the Group Accounting Manual permits a choice of accounting policy, the accounting policy which is judged to be most appropriate to the particular circumstances of the clinical commissioning group for the purpose of giving a true and fair view has been selected. The particular policies adopted by the clinical commissioning group are described below. They have been applied consistently in dealing with items considered material in relation to the accounts.

1.1

Going Concern These accounts have been prepared on a going concern basis. Public sector bodies are assumed to be going concerns where the continuation of the provision of a service in the future is anticipated, as evidenced by inclusion of financial provision for that service in published documents. Where a clinical commissioning group ceases to exist, it considers whether or not its services will continue to be provided (using the same assets, by another public sector entity) in determining whether to use the concept of going concern for the final set of financial statements. If services will continue to be provided the financial statements are prepared on the going concern basis.

1.2

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

1.3

Movement of Assets within the Department of Health and Social Care Group Transfers as part of reorganisation fall to be accounted for by use of absorption accounting in line with the Government Financial Reporting Manual, issued by HM Treasury. The Government Financial Reporting Manual does not require retrospective adoption, so prior year transactions (which have been accounted for under merger accounting) have not been restated. Absorption accounting requires that entities account for their transactions in the period in which they took place, with no restatement of performance required when functions transfer within the public sector. Where assets and liabilities transfer, the gain or loss resulting is recognised in the Statement of Comprehensive Net Expenditure, and is disclosed separately from operating costs. Other transfers of assets and liabilities within the Department of Health and Social Care Group are accounted for in line with IAS 20 and similarly give rise to income and expenditure entries.

1.4

Subsidiaries Entities over which the clinical commissioning group has the power to exercise control are classified as subsidiaries and are consolidated. The clinical commissioning group has control when it has the ability to affect the variable returns from the other entity through its power to direct relevant activities. The income, expenses, assets, liabilities, equity and reserves of the subsidiary are consolidated in full into the appropriate financial statement lines. The capital and reserves attributable to non-controlling interests are included as a separate item in the Statement of Financial Position. Appropriate adjustments are made on consolidation where the subsidiary’s accounting policies are not aligned with the clinical commissioning group or where the subsidiary’s accounting date is not coterminous. Subsidiaries that are classified as ‘held for sale’ are measured at the lower of their carrying amount or ‘fair value less costs to sell’.

1.5

Associates Material entities over which the clinical commissioning group has the power to exercise significant influence so as to obtain economic or other benefits are classified as associates and are recognised in the clinical commissioning group’s accounts using the equity method. The investment is recognised initially at cost and is adjusted subsequently to reflect the clinical commissioning group’s share of the entity’s profit/loss and other gains/losses. It is also reduced when any distribution is received by the clinical commissioning group from the entity. Associates that are classified as ‘held for sale’ are measured at the lower of their carrying amount or ‘fair value less costs to sell’.

1.6

Joint arrangements Arrangements over which the clinical commissioning group has joint control with one or more other entities are classified as joint arrangements. Joint control is the contractually agreed sharing of control of an arrangement. A joint arrangement is either a joint operation or a joint venture. A joint operation exists where the parties that have joint control have rights to the assets and obligations for the liabilities relating to the arrangement. Where the clinical commissioning group is a joint operator it recognises its share of, assets, liabilities, income and expenses in its own accounts. A joint venture is a joint arrangement whereby the parties that have joint control of the arrangement have rights to the net assets of the arrangement. Joint ventures are recognised as an investment and accounted for using the equity method.

1.7

Pooled Budgets The clinical commissioning group has entered into a pooled budget arrangement under section 75 of the National Health Services Act 2006, hosted by Lincolnshire County Council. The clinical commissioning group accounts for its share of the assets, liabilities, income and expenditure arising from the activities of the pooled budget, identified in accordance with the pooled budget agreement.

1.8

Operating Segments Income and expenditure are analysed in the Operating Segments note and are reported in line with management information used within the clinical commissioning group.

1.9

Revenue The transition to IFRS 15 has been completed in accordance with paragraph C3 (b) of the Standard, applying the Standard retrospectively recognising the cumulative effects at the date of initial application. In the adoption of IFRS 15 a number of practical expedients offered in the Standard have been employed. These are as follows; • As per paragraph 121 of the Standard the clinical commissioning group will not disclose information regarding performance obligations part of a contract that has an original expected duration of one year or less, • The clinical commissioning group is to similarly not disclose information where revenue is recognised in line with the practical expedient offered in paragraph B16 of the Standard where the right to consideration corresponds directly with value of the performance completed to date. • The FReM has mandated the exercise of the practical expedient offered in C7(a) of the Standard that requires the clinical commissioning group to reflect the aggregate effect of all contracts modified before the date of initial application.

South Lincolnshire Clinical Commissioning Group Annual Report 2018/19

South Lincolnshire CCG - Annual Accounts 2018-19 Notes to the financial statements

Revenue in respect of services provided is recognised when (or as) performance obligations are satisfied by transferring promised services to the customer, and is measured at the amount of the transaction price allocated to that performance obligation. Where income is received for a specific performance obligation that is to be satisfied in the following year, that income is deferred. Payment terms are standard reflecting cross government principles. The value of the benefit received when the clinical commissioning group accesses funds from the Government’s apprenticeship service are recognised as income in accordance with IAS 20, Accounting for Government Grants. Where these funds are paid directly to an accredited training provider, noncash income and a corresponding non-cash training expense are recognised, both equal to the cost of the training funded. 1.10 1.10.1

Employee Benefits Short-term Employee Benefits Salaries, wages and employment-related payments, including payments arising from the apprenticeship levy, are recognised in the period in which the service is received from employees, including bonuses earned but not yet taken. The cost of leave earned but not taken by employees at the end of the period is recognised in the financial statements to the extent that employees are permitted to carry forward leave into the following period.

1.10.2

Retirement Benefit Costs Past and present employees are covered by the provisions of the NHS Pensions Schemes. These schemes are unfunded, defined benefit schemes that cover NHS employers, General Practices and other bodies allowed under the direction of the Secretary of State in England and Wales. The schemes are not designed to be run in a way that would enable NHS bodies to identify their share of the underlying scheme assets and liabilities. Therefore, the schemes are accounted for as though they were defined contribution schemes: the cost to the clinical commissioning group of participating in a scheme is taken as equal to the contributions payable to the scheme for the accounting period. For early retirements other than those due to ill health the additional pension liabilities are not funded by the scheme. The full amount of the liability for the additional costs is charged to expenditure at the time the clinical commissioning group commits itself to the retirement, regardless of the method of payment. The schemes are subject to a full actuarial valuation every four years and an accounting valuation every year. The CCG has no members of staff in the Local Government Superannuation Scheme.

1.11

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

1.12

Grants Payable Where grant funding is not intended to be directly related to activity undertaken by a grant recipient in a specific period, the clinical commissioning group recognises the expenditure in the period in which the grant is paid. All other grants are accounted for on an accruals basis.

1.13

Property, Plant & Equipment The CCG has no Property, Plant or Equipment.

1.14

Intangible Assets The CCG has no Intangible Assets.

1.14.3

Depreciation, Amortisation & Impairments The CCG has no Depreciation, Amortisation or Impairments to include in the Annual Accounts.

1.15

Donated Assets The CCG has no Donated Assets.

1.16

Government grant funded assets Government grant funded assets are capitalised at current value in existing use, if they will be held for their service potential, or otherwise at fair value on receipt, with a matching credit to income. Deferred income is recognised only where conditions attached to the grant preclude immediate recognition of the gain.

1.17

Non-current Assets Held For Sale The CCG has no Assets Held for Sale.

1.18

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

1.18.1

The Clinical Commissioning Group as Lessee Property, plant and equipment held under finance leases are initially recognised, at the inception of the lease, at fair value or, if lower, at the present value of the minimum lease payments, with a matching liability for the lease obligation to the lessor. Lease payments are apportioned between finance charges and reduction of the lease obligation so as to achieve a constant rate on interest on the remaining balance of the liability. Finance charges are recognised in calculating the clinical commissioning group’s surplus/deficit. Operating lease payments are recognised as an expense on a straight-line basis over the lease term. Lease incentives are recognised initially as a liability and subsequently as a reduction of rentals on a straight-line basis over the lease term. Contingent rentals are recognised as an expense in the period in which they are incurred. Where a lease is for land and buildings, the land and building components are separated and individually assessed as to whether they are operating or finance leases.

1.18.2

The Clinical Commissioning Group as Lessor Amounts due from lessees under finance leases are recorded as receivables at the amount of the clinical commissioning group’s net investment in the leases. Finance lease income is allocated to accounting periods so as to reflect a constant periodic rate of return on the clinical commissioning group’s net investment outstanding in respect of the leases.

Lincolnshire Clinical Commissioning Group 80 South Annual Report 2018/19

South Lincolnshire CCG - Annual Accounts 2018-19 Notes to the financial statements 1.19

Private Finance Initiative Transactions The CCG does not hold any Private Finance Initiative Transactions.

1.20

Inventories Inventories are valued at the lower of cost and net realisable value.

1.21

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

1.22

Provisions Provisions are recognised when the clinical commissioning group has a present legal or constructive obligation as a result of a past event, it is probable that the clinical commissioning group will be required to settle the obligation, and a reliable estimate can be made of the amount of the obligation. The amount recognised as a provision is the best estimate of the expenditure required to settle the obligation at the end of the reporting period, taking into account the risks and uncertainties. Where a provision is measured using the cash flows estimated to settle the obligation, its carrying amount is the present value of those cash flows using HM Treasury’s discount rate as follows: Early retirement provisions are discounted using HM Treasury’s pension discount rate of positive 0.29% (2017-18: positive 0.10%) in real terms. All general provisions are subject to four separate discount rates according to the expected timing of cashflows from the Statement of Financial Position date: • A nominal short-term rate of 0.76% (2017-18: negative 2.42% in real terms) for inflation adjusted expected cash flows up to and including 5 years from Statement of Financial Position date. • A nominal medium-term rate of 1.14% (2017-18: negative 1.85% in real terms) for inflation adjusted expected cash flows over 5 years up to and including 10 years from the Statement of Financial Position date. • A nominal long-term rate of 1.99% (2017-18: negative 1.56% in real terms) for inflation adjusted expected cash flows over 10 years and up to and including 40 years from the Statement of Financial Position date. • A nominal very long-term rate of 1.99% (2017-18: negative 1.56% in real terms) for inflation adjusted expected cash flows exceeding 40 years from the Statement of Financial Position date. All 2018-19 percentages are expressed in nominal terms with 2017-18 being the last financial year that HM Treasury provided real general provision discount rates. When some or all of the economic benefits required to settle a provision are expected to be recovered from a third party, the receivable is recognised as an asset if it is virtually certain that reimbursements will be received and the amount of the receivable can be measured reliably. A restructuring provision is recognised when the clinical commissioning group has developed a detailed formal plan for the restructuring and has raised a valid expectation in those affected that it will carry out the restructuring by starting to implement the plan or announcing its main features to those affected by it. The measurement of a restructuring provision includes only the direct expenditures arising from the restructuring, which are those amounts that are both necessarily entailed by the restructuring and not associated with on-going activities of the entity.

1.23

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

1.24

Non-clinical Risk Pooling The clinical commissioning group participates in the Property Expenses Scheme and the Liabilities to Third Parties Scheme. Both are risk pooling schemes under which the clinical commissioning group pays an annual contribution to the NHS Resolution and, in return, receives assistance with the costs of claims arising. The annual membership contributions, and any excesses payable in respect of particular claims are charged to operating expenses as and when they become due.

1.25

Carbon Reduction Commitment Scheme The Carbon Reduction Commitment scheme is a mandatory cap and trade scheme for non-transport CO2 emissions. The clinical commissioning group is registered with the CRC scheme, and is therefore required to surrender to the Government an allowance for every tonne of CO2 it emits during the financial year. A liability and related expense is recognised in respect of this obligation as CO2 emissions are made. The carrying amount of the liability at the financial year end will therefore reflect the CO2 emissions that have been made during that financial year, less the allowances (if any) surrendered voluntarily during the financial year in respect of that financial year. The liability will be measured at the amount expected to be incurred in settling the obligation. This will be the cost of the number of allowances required to settle the obligation. Allowances acquired under the scheme are recognised as intangible assets.

1.26

Contingent liabilities and contingent assets A contingent liability is a possible obligation that arises from past events and whose existence will be confirmed only by the occurrence or nonoccurrence of one or more uncertain future events not wholly within the control of the clinical commissioning group, or a present obligation that is not recognised because it is not probable that a payment will be required to settle the obligation or the amount of the obligation cannot be measured sufficiently reliably. A contingent liability is disclosed unless the possibility of a payment is remote. A contingent asset is a possible asset that arises from past events and whose existence will be confirmed by the occurrence or non-occurrence of one or more uncertain future events not wholly within the control of the clinical commissioning group. A contingent asset is disclosed where an inflow of economic benefits is probable. Where the time value of money is material, contingent liabilities and contingent assets are disclosed at their present value.

South Lincolnshire Clinical Commissioning Group Annual Report 2018/19

South Lincolnshire CCG - Annual Accounts 2018-19 Notes to the financial statements 1.27

Financial assets Assetsare recognised when the clinical commissioning group becomes party to the financial instrument contract or, in the case of trade Financial receivables, when the goods or services have been delivered. Financial assets are derecognised when the contractual rights have expired or the asset has been transferred. Financial assets are classified into the following categories: · Financial assets at amortised cost; · Financial assets at fair value through other comprehensive income and ; · Financial assets at fair value through profit and loss. The classification is determined by the cash flow and business model characteristics of the financial assets, as set out in IFRS 9, and is determined at the time of initial recognition.

1.27.1

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

1.27.2

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

1.27.3

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

1.27.4

Impairment For all financial assets measured at amortised cost or at fair value through other comprehensive income (except equity instruments designated at fair value through other comprehensive income), lease receivables and contract assets, the clinical commissioning group recognises a loss allowance representing the expected credit losses on the financial asset. The clinical commissioning group adopts the simplified approach to impairment in accordance with IFRS 9, and measures the loss allowance for trade receivables, lease receivables and contract assets at an amount equal to lifetime expected credit losses. For other financial assets, the loss allowance is measured at an amount equal to lifetime expected credit losses if the credit risk on the financial instrument has increased significantly since initial recognition (stage 2) and otherwise at an amount equal to 12 month expected credit losses (stage 1). HM Treasury has ruled that central government bodies may not recognise stage 1 or stage 2 impairments against other government departments, their executive agencies, the Bank of England, Exchequer Funds and Exchequer Funds assets where repayment is ensured by primary legislation. The clinical commissioning group therefore does not recognise loss allowances for stage 1 or stage 2 impairments against these bodies. Additionally DHSC provides a guarantee of last resort against the debts of its arm's lengths bodies and NHS bodies and the clinical commissioning group does not recognise allowances for stage 1 or stage 2 impairments against these bodies. For financial assets that have become credit impaired since initial recognition (stage 3), expected credit losses at the reporting date are measured as the difference between the asset's gross carrying amount and the present value of the estimated future cash flows discounted at the financial asset's original effective interest rate. Any adjustment is recognised in profit or loss as an impairment gain or loss.

1.28

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

1.28.1

Financial Guarantee Contract Liabilities Financial guarantee contract liabilities are subsequently measured at the higher of: · The premium received (or imputed) for entering into the guarantee less cumulative amortisation; and, · Assets.

The amount of the obligation under the contract, as determined in accordance with IAS 37: Provisions, Contingent Liabilities and Contingent

1.28.2

Financial Liabilities at Fair Value Through Profit and Loss Embedded derivatives that have different risks and characteristics to their host contracts, and contracts with embedded derivatives whose separate value cannot be ascertained, are treated as financial liabilities at fair value through profit and loss. They are held at fair value, with any resultant gain or loss recognised in the clinical commissioning group’s surplus/deficit. The net gain or loss incorporates any interest payable on the financial liability.

1.28.3

Other Financial Liabilities After initial recognition, all other financial liabilities are measured at amortised cost using the effective interest method, except for loans from Department of Health and Social Care, which are carried at historic cost. The effective interest rate is the rate that exactly discounts estimated future cash payments through the life of the asset to the net carrying amount of the financial liability. Interest is recognised using the effective interest method.

1.29

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

1.30

Foreign Currencies The clinical commissioning group’s functional currency and presentational currency is pounds sterling and amounts are presented in thousands of pounds unless expressly stated otherwise. Transactions denominated in a foreign currency are translated into sterling at the exchange rate ruling on the dates of the transactions. At the end of the reporting period, monetary items denominated in foreign currencies are retranslated at the spot exchange rate on 31 March. Resulting exchange gains and losses for either of these are recognised in the clinical commissioning group’s surplus/deficit in the period in which they arise. 9

Lincolnshire Clinical Commissioning Group 82 South Annual Report 2018/19

South Lincolnshire CCG - Annual Accounts 2018-19 Notes to the financial statements 1.31

Third Party Assets Assets belonging to third parties (such as money held on behalf of patients) are not recognised in the accounts since the clinical commissioning group has no beneficial interest in them.

1.32

Losses & Special Payments Losses and special payments are items that Parliament would not have contemplated when it agreed funds for the health service or passed legislation. By their nature they are items that ideally should not arise. They are therefore subject to special control procedures compared with the generality of payments. They are divided into different categories, which govern the way that individual cases are handled. Losses and special payments are charged to the relevant functional headings in expenditure on an accruals basis, including losses which would have been made good through insurance cover had the clinical commissioning group not been bearing its own risks (with insurance premiums then being included as normal revenue expenditure).

1.33

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

1.33.1

Critical accounting judgements in applying accounting policies The following are the judgements, apart from those involving estimations, that management has made in the process of applying the clinical commissioning group's accounting policies and that have the most significant effect on the amounts recognised in the financial statements. - It is appropriate to prepare the accounts on a 'going concern' basis - That all arrangements containing leases have been correctly identified in accordance with the relevant interpretation issued by the International Financial Reporting Interpretations Committee (IFRIC 4); and - Having reviewed all leases, that they have been correctly identified in accordance with the relevant International Accounting Standard (IAS 17) as being an operating or finance lease. - Continued healthcare retrospective claims (CHC) prior to 31 March 2013 and which relate to the population of the clinical commissioning group are not directly recognised in the accounts. Rather, they are managed via a national risk pool. The costs recognised in the accounts represent our share of the national risk pool rather than the costs of our own residents. - For a proportion of expenditure, including some mental health services and some community services, there have been local agreements across 4 x Lincolnshire clinical commissioning groups (Lincolnshire West CCG, Lincolnshire East CCG, South Lincolnshire CCG and South West Lincolnshire CCG) to continue to operate risk share agreements. reported expenditure in these areas is on the basis of agreed share of total costs rather than the direct costs of the clinical commissioning group's population. - The Better Care Fund reporting has been agreed with Lincolnshire County Council and the 4 x Lincolnshire clinical commissioning groups. This is shown on a net accounting basis in the accounts. Note 35, Pooled Budgets provides further details.

1.33.2

Sources of estimation uncertainty The most significant area of estimation uncertainty relates to the estimation of accruals for healthcare in the later months of the year for which actual data was not received prior to the closure of the accounts. The major accruals relate to hospital activity, provision of healthcare by private sector and GP prescriptions. - Provisions have been made for the clinical commissioning group's liability for continuing healthcare (CHC) for care provided after 1 April 2013. Claims have been made by the public where they have borne the costs but believe that there was a health need which should have been met by the clinical commissioning group. Each case has its own set of circumstances and appeals can be made against the initial ruling.

1.34

Gifts Gifts are items that are voluntarily donated, with no preconditions and without the expectation of any return. Gifts include all transactions economically equivalent to free and unremunerated transfers, such as the loan of an asset for its expected useful life, and the sale or lease of assets at below market value. The CCG have not received any such gifts.

1.35

Accounting Standards that have been issued but have not yet been adopted The DHSC GAM does not require the following IFRS Standards and Interpretations to be applied in 2018-19. These Standards are still subject to HM Treasury FReM adoption, with IFRS 16 being for implementation in 2019-20, and the government implementation date for IFRS 17 is still subject to HM Treasury consideration. ● IFRS 16 Leases – Application required for accounting periods beginning on or after 1 January 2019, but not yet adopted by the FReM: early adoption is not therefore permitted. ● IFRIC 23 Uncertainty over Income Tax Treatments – Application required for accounting periods beginning on or after 1 January 2019.

South Lincolnshire Clinical Commissioning Group Annual Report 2018/19

South Lincolnshire CCG - Annual Accounts 2018-19 2 Other Operating Revenue

Income from sale of goods and services (contracts) Non-patient care services to other bodies Prescription fees and charges Other Contract income Recoveries in respect of employee benefits Total Income from sale of goods and services Other operating income Other non contract revenue Total Other operating income Total Operating Income

2018-19 Total

2017-18 Total

ÂŁ'000

597 895 259 412 2,163

2,929 751 0 144 3,823

0 0

38 38

2,163

3,861

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

Lincolnshire Clinical Commissioning Group 84 South Annual Report 2018/19

South Lincolnshire Clinical Commissioning Group Annual Report 2018/19

0 0 0

Patient transport services

422 175 597

Non-patient care services to other bodies £'000 0 597 597

0 0 0

Education, training and research £'000 0 0 0

Not later than 1 year Later than 1 year, not later than 5 years Later than 5 Years Total

0 0 0

0 0 0 0

£000s

Revenue expected from NHSE Bodies

2018-19 Total

0 0 0

Contract revenue expected to be recognised in the future periods related to contract performance obligations not Revenue expected from Other DHSC Group Bodies £000s

0 0 0

£'000

3.2 Transaction price to remaining contract performance obligations

Timing of Revenue Point in time Over time Total

Source of Revenue NHS Non NHS Total

Patient transport services

Non-patient care services to other bodies

Education, training and research

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

South Lincolnshire CCG - Annual Accounts 2018-19

0 0 0

Revenue expected from Non-DHSC Group Bodies £000s

0 895 895

£'000

Prescription fees and charges

0 895 895

£'000

Prescription fees and charges

0 0 0

£'000

Dental fees and charges

0 0 0

£'000

Dental fees and charges

0 0 0

£'000

Income generation

0 0 0

£'000

Income generation

0 259 259

£'000

Other Contract income

4 255 259

£'000

Other Contract income

0 412 412

£'000

Recoveries in respect of employee benefits

412 0 412

£'000

Recoveries in respect of employee benefits

South Lincolnshire CCG - Annual Accounts 2018-19 4. Employee benefits and staff numbers 4.1.1 Employee benefits

Total Permanent Employees £'000

Employee Benefits Salaries and wages Social security costs Employer Contributions to NHS Pension scheme Gross employee benefits expenditure

2018-19

Other £'000

Total £'000

1,259 149 159 1,567

12 0 0 12

1,270 149 159 1,579

Less recoveries in respect of employee benefits (note 4.1.2) Total - Net admin employee benefits including capitalised costs

(412) 1,155

0 12

(412) 1,167

Less: Employee costs capitalised Net employee benefits excluding capitalised costs

0 1,155

0 12

0 1,167

4.1.1 Employee benefits

Total Permanent Employees £'000

Employee Benefits Salaries and wages Social security costs Employer Contributions to NHS Pension scheme Gross employee benefits expenditure

2017-18

Other £'000

Total £'000

1,168 125 153 1,446

65 0 0 65

1,233 125 153 1,511

Less recoveries in respect of employee benefits (note 4.1.2) Total - Net admin employee benefits including capitalised costs

(144) 1,302

0 65

(144) 1,367

Less: Employee costs capitalised Net employee benefits excluding capitalised costs

0 1,302

0 65

0 1,367

4.1.2 Recoveries in respect of employee benefits

Permanent Employees £'000

Employee Benefits - Revenue Salaries and wages Social security costs Employer contributions to the NHS Pension Scheme Total recoveries in respect of employee benefits

(339) (31) (42) (412)

Lincolnshire Clinical Commissioning Group 86 South Annual Report 2018/19

2018-19 Other £'000

Total £'000 0 0 0 0

(339) (31) (42) (412)

2017-18 Total £'000 (115) (13) (15) (144)

South Lincolnshire CCG - Annual Accounts 2018-19 4.2 Average number of people employed

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

2018-19

2017-18

Permanently employed Number

Other Number

Total Number

Permanently employed Number

Other Number

Total Number

30.88

1.00

31.88

29.64

0.50

30.14

4.3 Staff Sickness absense and ill health retirements This information is disclosed in the Annual Report 4.4 Exit packages agreed in the financial year

Less than £10,000 £10,001 to £25,000 £25,001 to £50,000 £50,001 to £100,000 £100,001 to £150,000 £150,001 to £200,000 Over £200,001 Total

2018-19 Compulsory redundancies Number £ 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0

2018-19 Other agreed departures Number £ 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0

Less than £10,000 £10,001 to £25,000 £25,001 to £50,000 £50,001 to £100,000 £100,001 to £150,000 £150,001 to £200,000 Over £200,001 Total

2017-18 Compulsory redundancies Number £ 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0

2017-18 Other agreed departures Number £ 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0

Less than £10,000 £10,001 to £25,000 £25,001 to £50,000 £50,001 to £100,000 £100,001 to £150,000 £150,001 to £200,000 Over £200,001 Total

2018-19 Departures where special payments have been made Number £ 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0

2017-18 Departures where special payments have been made Number £ 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0

Analysis of Other Agreed Departures

Voluntary redundancies including early retirement contractual costs Mutually agreed resignations (MARS) contractual costs Early retirements in the efficiency of the service contractual costs Contractual payments in lieu of notice Exit payments following Employment Tribunals or court orders Non-contractual payments requiring HMT approval* Total

2018-19 Other agreed departures Number £ 0 0 0 0 0 0 0 0 0 0 0 0 0 0

Number 0 0 0 0 0 0 0 0

2018-19 Total

2017-18 Total

£ 0 0 0 0 0 0 0 0

2017-18 Other agreed departures Number £ 0 0 0 0 0 0 0 0 0 0 0 0 0 0

These tables report the number and value of exit packages agreed in the financial year. The expense associated with these departures may have been recognised in part or in full in a previous period. Exit costs are accounted for in accordance with relevant accounting standards and at the latest in full in the year of departure.

Where CCG has agreed early retirements, the additional costs are met by NHS CCG and not by the NHS Pension Scheme, and are included in the tables. Ill-health retirement costs are met by the NHS Pension Scheme and are not included in the tables.

Zero non-contractual payments (£0) were made to individuals where the payment value was more than 12 months’ of their annual salary. The Remuneration Report includes the disclosure of exit payments payable to individuals named in that Report.

South Lincolnshire Clinical Commissioning Group Annual Report 2018/19

South Lincolnshire CCG - Annual Accounts 2018-19 4.5 Pension costs Past and present employees are covered by the provisions of the two NHS Pension Schemes. Details of the benefits payable and rules of the Schemes can be found on the NHS Pensions website at: www.nhsbsa.nhs.uk/pensions Both are unfunded, defined benefit schemes that cover NHS employers, General Practices and other bodies allowed under the direction of the Secretary of State for Health in England and Wales. The schemes are not designed to be run in a way that would enable NHS bodies to identify their share of the underlying scheme assets and liabilities. Therefore, each scheme is accounted for as if it were a defined contribution scheme: the cost to the NHS body of participating in a scheme is taken as equal to the contributions payable to the scheme for the accounting period. In order that the defined benefit obligations recognised in the financial statements do not differ materially from those that would be determined at the reporting date by a formal actuarial valuation, the FReM requires that “the period between formal valuations shall be four years, with approximate assessments in intervening years”. An outline of these follows: 4.5.1 Accounting valuation A valuation of scheme liability is carried out annually by the scheme actuary (currently the Government Actuary’s Department) as at the end of the reporting period. This utilises an actuarial assessment for the previous accounting period in conjunction with updated membership and financial data for the current reporting period, and is accepted as providing suitably robust figures for financial reporting purposes. The valuation of the scheme liability as at 31 March 2019 is based on valuation data as 31 March 2018, updated to 31 March 2019 with summary global member and accounting data. In undertaking this actuarial assessment, the methodology prescribed in IAS 19, relevant FReM interpretations, and the discount rate prescribed by HM Treasury have also been used. The latest assessment of the liabilities of the scheme is contained in the report of the scheme actuary, which forms part of the annual NHS Pension Scheme Accounts. These accounts can be viewed on the NHS Pensions website and are published annually. Copies can also be obtained from The Stationery Office.

4.5.2 Full actuarial (funding) valuation The purpose of this valuation is to assess the level of liability in respect of the benefits due under the schemes (taking into account recent demographic experience) and to recommend contribution rates payable by employees and employers. The latest actuarial valuation undertaken for the NHS Pension Scheme was completed as at 31 March 2016. The results of this valuation set the employer contribution rate payable from April 2019. The Department of Health and Social Care have recently laid Scheme Regulations confirming that the employer contribution rate will increase to 20.6% of pensionable pay from this date. The 2016 funding valuation was also expected to test the cost of the Scheme relative to the employer cost cap set following the 2012 valuation. Following a judgment from the Court of Appeal in December 2018 Government announced a pause to that part of the valuation process pending conclusion of the continuing legal process. For 2018-19, employers’ contributions of £159,000 were payable to the NHS Pensions Scheme (2017-18: £153,000) were payable to the NHS Pension Scheme at the rate of 14.38% of pensionable pay. These costs are included in the NHS pension line of note 4.1.1.

Lincolnshire Clinical Commissioning Group 88 South Annual Report 2018/19

South Lincolnshire CCG - Annual Accounts 2018-19 5. Operating expenses

Purchase of goods and services Services from other CCGs and NHS England Services from foundation trusts Services from other NHS trusts Services from Other WGA bodies Purchase of healthcare from non-NHS bodies Prescribing costs General Ophthalmic services GPMS/APMS and PCTMS Supplies and services – general Consultancy services Establishment Transport Premises Audit fees Other non statutory audit expenditure · Internal audit services · Other services Other professional fees Legal fees Education, training and conferences Total Purchase of goods and services Provision expense Provisions Total Provision expense Other Operating Expenditure Chair and Non Executive Members Other expenditure Total Other Operating Expenditure Total operating expenditure

2018-19 Total £'000

2017-18 Total £'000

1,462 86,740 45,525 201 39,773 28,814 68 26,238 4,118 428 181 3 725 46

1,041 86,477 47,043 0 39,892 30,773 68 24,902 3,995 223 169 3 767 48

48 10 1 10 459 234,850

0 57 7 91 235,557

7 7

110 110

157 26 183

130 0 131

235,040

235,798

Depreciation and impairment charges The CCG has no such expenditure during 2018/19 (2017/18, £0)

South Lincolnshire Clinical Commissioning Group Annual Report 2018/19

South Lincolnshire CCG - Annual Accounts 2018-19 6.1 Better Payment Practice Code Measure of compliance Non-NHS Payables Total Non-NHS Trade invoices paid in the Year Total Non-NHS Trade Invoices paid within target Percentage of Non-NHS Trade invoices paid within target NHS Payables Total NHS Trade Invoices Paid in the Year Total NHS Trade Invoices Paid within target Percentage of NHS Trade Invoices paid within target

2018-19 Number

2018-19 £'000

2017-18 Number

2017-18 £'000

9362 9229 98.58%

78015 77474 99.31%

9934 9810 98.75%

75480 75110 99.51%

2705 2695 99.63%

138797 137863 99.33%

2731 2722 99.67%

135287 135186 99.93%

The target is to pay at least 95% of all NHS and non-NHS trade creditors within 30 calendar days of receipt of goods or a valid invoice (whichever is later) unless other payment terms have been agreed. The performance for 2018/19 indicates this was achieved. 6.2 The Late Payment of Commercial Debts (Interest) Act 1998

2018-19 £'000

Amounts included in finance costs from claims made under this legislation Compensation paid to cover debt recovery costs under this legislation Total

2017-18 £'000 0 0 0

0 0 0

7. Income Generation Activities The Clinical Commissioning Group does not undertake any income generation activities (2017/18, £0). 8. Investment revenue The CCG received no investment revenue during 2018/19 (2017/18, £0). 9. Other gains and losses Other gains and losses are largely associated with the disposal of fixed assets, and changes in the value of financial assets and liabilities. The CCG had no such gains or losses during 2018/19 (2017/18, £0). 10. Finance costs Finance costs are largely associated with interest charges on loans, PFI contracts and LIFT contracts. The CCG had no such costs during 2018/19 (2017/18, £0). 11. Net gain/(loss) on transfer by absorption Absoption accounting is explained in paragraph 1.4 of Note 1 (Accounting Policies). The CCG had no such costs during 2018/19 (2017/18, £0).

Lincolnshire Clinical Commissioning Group 90 South Annual Report 2018/19

South Lincolnshire CCG - Annual Accounts 2018-19 12. Operating Leases The CCG has entered into lease arrangements with the following: Buildings 1) The CCG's lease with Lincolnshire County Council for the use of office space ceased on 31 July 2018. 2) The CCG has, through South West Lincolnshire, a new arrangement for the use of office space from August 2018. The CCG is working in partnership with South West Lincolnshire CCG and shares the office space and therefore the cost. This has a term of 10 years including a rent review after 5 years. The annual rent is £75k with an open market value revew after 5 years. This has been accounted for on a straight-line basis. 3) The CCG also incurs costs from NHS Property Services for other properties during 2018/19. Other 1) The cost relating to the use of two photocopiers in 2018/19 is £3k, (2017/18, £3k). 2) The remaining balance relates to lease cars. 12.1 As lessee 12.1.1 Payments recognised as an Expense Payments recognised as an expense Minimum lease payments Contingent rents Sub-lease payments Total

Land £'000

Buildings £'000 0 0 0 0

2018-19 Total £'000

Other £'000 34 0 0 34

Land £'000 36 0 0 36

2 0 0 2

Buildings £'000 0 0 0 0

2017-18 Total £'000

Other £'000 25 0 0 25

29 0 0 29

3 0 0 3

Whilst our arrangements with NHS Property Services Limited (except for the office space lease) fall within the definition of operating leases, rental charge for future years has not yet been agreed . Consequently this note only includes future minimum lease payments for the office space lease arrangement. 12.1.2 Future minimum lease payments Payable: No later than one year Between one and five years After five years Total

Land £'000

Buildings £'000 0 0 0 0

2018-19 Total £'000

Other £'000 0 0 0 0

12.2 As lessor 12.2.1 Rental revenue Recognised as income Rent Contingent rents Total

12.2.2 Future minimum rental value

Receivable: No later than one year Between one and five years After five years Total

1 0 0 1

2018-19 £'000

Land £'000

Buildings £'000 0 0 0 0

2017-18 Total £'000

Other £'000 30 53 0 83

2 0 0 2

32 53 0 85

2017-18 £'000 -

2018-19 £'000 NHSE Bodies

2018-19 £'000 Other DHSC Group Bodies -

2018-19 £'000 Non DH Group Bodies -

2017-18 £'000 DH Group Bodies

2017-18 £'000 Non DH Group Bodies -

13. Property, plant and equipment The CCG did not own any property, plant or equipment during 2018/19, (2017/18, £0). 14. Intangible non-current assets The CCG did not own any intangible non-current assets during 2018/19 (2017/18, £0). 15. Investment property The CCG had no investment property as at 31st March 2019 (2017/18, £0). 16 .Inventories The CCG had no investment property as at 31st March 2019 (2017/18, £0).

South Lincolnshire Clinical Commissioning Group Annual Report 2018/19

South Lincolnshire CCG - Annual Accounts 2018-19

23 Trade and other payables

Current 2018-19 £'000

NHS payables: Revenue NHS accruals Non-NHS and Other WGA payables: Revenue Non-NHS and Other WGA accruals Social security costs VAT Tax Payments received on account Other payables and accruals Total Trade & Other Payables

1,371 2,858 1,243 6,630 25 0 30 11 5,363 17,531

Total current and non-current

17,531

Non-current 2018-19 £'000

Current 2017-18 £'000 0 0 0 0 0 0 0 0 0 0

Non-current 2017-18 £'000

1,068 4,207 2,588 6,338 21 44 21 0 3,654 17,941 17,941

There are no liabilities included in the above Note due in future years under arrangements to buy out the liability for early retirement over 5 years, (31 March 2018, £0k). Other payables include £225k outstanding pension contributions at 31 March 2019 (2017/18, £173k) 24 Other financial liabilities The CCG had no financial liabilities during 2018/19 (2017/18, £0). 25 Other liabilities The CCG had no other liabilities during 2018/19 (2017/18, £0). 26 Borrowings The CCG had no borrowings during 2018/19 (2017/18, £0). 27 Private finance initiative, LIFT and other service concession arrangements The CCG had no private finance initiatives, LIFT schemes or other service concession arrangements during 2018/19 (2017/18, £0). 28 Finance lease obligations The CCG had no finance lease obligations during 2018/19 (2017/18, £0). 29 Finance lease receivables The CCG had no finance lease receivables during 2018/19 (2017/18, £0).

Lincolnshire Clinical Commissioning Group 92 South Annual Report 2018/19

0 0 0 0 0 0 0 0 0 0

South Lincolnshire CCG - Annual Accounts 2018-19 18 Other financial assets The CCG had no other financial assets as at 31 March 2019 (2017/18, £0). 19 Other current assets The CCG had no other current assets as at 31 March 2019 (2017/18, £0). 20 Cash and cash equivalents 2018-19 £'000

Balance at 01 April 2018 Net change in year Balance at 31 March 2019 Made up of: Cash with the Government Banking Service Cash in hand Cash and cash equivalents as in statement of financial position Total bank overdrafts Balance at 31 March 2019 No patients’ money held by the CCGG during 2018/19 (2017/18, £0).

159 (98) 61

2017-18 £'000

130 29 159

61 0 61

159 0 159

159

The CCG achieved the target closing balance as at 31 March 2019. This national target is 1.25% of the monthly cash drawdown value. 21 Non-current assets held for sale The CCG has no property, plant or equipment to disclose in these accounts (2017/18, £0). 22 Analysis of impairments and reversals The CCG had no investment property or inventories during 2018/19 (2017/18, £0). The CCG has no impairments or reversals to disclose in these accounts (2017/18, £0).

South Lincolnshire Clinical Commissioning Group Annual Report 2018/19

South Lincolnshire CCG - Annual Accounts 2018-19

23 Trade and other payables

Current 2018-19 £'000

1,371 2,858 1,243 6,630 25 0 30 11 5,363 17,531

Total current and non-current

17,531

Non-current 2018-19 £'000

Current 2017-18 £'000 0 0 0 0 0 0 0 0 0 0

Non-current 2017-18 £'000

1,068 4,207 2,588 6,338 21 44 21 0 3,654 17,941 17,941

Lincolnshire Clinical Commissioning Group 94 South Annual Report 2018/19

0 0 0 0 0 0 0 0 0 0

South Lincolnshire Clinical Commissioning Group Annual Report 2018/19

41 57 98 127

0 0 0 0 0 0 0 0 0 0 0 0

Arising during the year Utilised during the year Reversed unused Unwinding of discount Change in discount rate Transfer (to) from other public sector body Transfer (to) from other public sector body under absorption Balance at 31 March 2019

Expected timing of cash flows: Within one year Between one and five years After five years Balance at 31 March 2019 0 0 0 0

0 0 0 0 0 0 0 0

£'000

0 0 0 0

0 0 0 0 0 0 0 0

132

35 69 103

Restructuring

Current 2017-18 £'000

Pensions Relating to Other Staff

Non-current 2018-19 £'000 0 29 29

£'000

0 0 0 0

0 0 0 0 0 0 0 0

0 29 29

Redundancy

Non-current 2017-18 £'000

£'000

Agenda for Change

0 0 0 0

0 0 0 0 0 0 0 0

£'000

0 0 0 0

0 0 0 0 0 0 0 0

Equal Pay £'000

0 0 0 0

0 0 0 0 0 0 0 0

Legal Claims

£'000

41 0 0 41

62 0 (55) 0 0 0 0 41

Continuing Care

57 29 0 86

0 (12) 0 0 0 0 0 86

£'000

Other

£'000

Total

98 29 0 127

62 (12) (55) 0 0 0 0 127

132

A provision has been included within Other for Excess Travel. This relates to the change of base for all CCG employees.

Other

NHS England is responsible for accounting for liabilities relating to NHS Continuing Healthcare claims relating to periods of care before the establishment of the Clinical Commissioning Group (CCG). The CCG is responsible for liabilities, legal and financial, relating to NHS Continuing Healthcare claims relating to periods of care since the establishment of the CCG. The total value of NHS Continuing Healthcare provisions as at March 2019 is £41k (2017/18, £35k).

Continuing Care relates to the anticipated costs of continuing care claims where it is probable the CCG will incur costs. The provision is for claimants' retrospective entitlement to health costs and includes administration and interest costs.

Continuing Care

Legal claims are calculated from the number of claims currently lodged with NHS Resolution and the probabilities provided by them. £0 is included in the provisions of the NHS Resolution as at 31st March in respect of clinical negligence liabilities of the CCG.

Legal Claims

Pensions Relating to Former Directors £'000

Current 2018-19 £'000

Balance at 01 April 2018

Total current and non-current

Continuing care Other Total

30 Provisions

South Lincolnshire CCG - Annual Accounts 2018-19

South Lincolnshire CCG - Annual Accounts 2018-19 31 Contingencies Contingent liabilities Continuing Healthcare Net value of contingent liabilities Contingent assets Net value of contingent assets

2018-19 £'000

2017-18 £'000 26 26

11 11

0 26

0 11

The CCG is responsible for liabilities, legal and financial, relating to NHS Continuing Healthcare (CHC) claims for periods of care since the establishment of the CCG. The CCG has provided for the anticipated costs of continuing care claims (see Note 30 Provisions above) where it is probable that the CCG will incur costs. Note 31 Contingencies discloses the difference between the estimated value of claims and the recorded provisions as £18k as at 31st March 2019 (2017/18, £17k). The four Lincolnshire CCGs (Lincolnshire East, Lincolnshire West, South Lincolnshire and South West Lincolnshire) are progressing with the appointment of one Executive Team to support all four organisations in 2019/20 and have already appointed one Accountable Officer. It not currently known if there will be any redundancy costs relating to South Lincolnshire CCG employees. 32. Commitments The CCG had no other financial commitments during 2018/19 (2017/18, £0). 33. Financial instruments 33.1 Financial risk management Financial reporting standard IFRS 7 requires disclosure of the role that financial instruments have had during the period in creating or changing the risks a body faces in undertaking its activities. Because NHS clinical commissioning group is financed through parliamentary funding, it is not exposed to the degree of financial risk faced by business entities. Also, financial instruments play a much more limited role in creating or changing risk than would be typical of listed companies, to which the financial reporting standards mainly apply. The clinical commissioning group has limited powers to borrow or invest surplus funds and financial assets and liabilities are generated by day-to-day operational activities rather than being held to change the risks facing the clinical commissioning group in undertaking its activities. Treasury management operations are carried out by the finance department, within parameters defined formally within the NHS clinical commissioning group standing financial instructions and policies agreed by the Governing Body. Treasury activity is subject to review by the NHS clinical commissioning group and internal auditors. 33.1.1 Currency risk The NHS clinical commissioning group is principally a domestic organisation with the great majority of transactions, assets and liabilities being in the UK and sterling based. The NHS clinical commissioning group has no overseas operations. The NHS clinical commissioning group and therefore has low exposure to currency rate fluctuations. 33.1.2 Interest rate risk The clinical commissioning group borrows from government for capital expenditure, subject to affordability as confirmed by NHS England. The borrowings are for 1 to 25 years, in line with the life of the associated assets, and interest is charged at the National Loans Fund rate, fixed for the life of the loan. The clinical commissioning group therefore has low exposure to interest rate fluctuations. 33.1.3 Credit risk Because the majority of the NHS clinical commissioning group and revenue comes parliamentary funding, NHS clinical commissioning group has low exposure to credit risk. The maximum exposures as at the end of the financial year are in receivables from customers, as disclosed in the trade and other receivables note. 33.1.4 Liquidity risk NHS clinical commissioning group is required to operate within revenue and capital resource limits, which are financed from resources voted annually by Parliament. The NHS clinical commissioning group draws down cash to cover expenditure, as the need arises. The NHS clinical commissioning group is not, therefore, exposed to significant liquidity risks. 33.1.5 Financial Instruments As the cash requirements of NHS England are met through the Estimate process, financial instruments play a more limited role in creating and managing risk than would apply to a non-public sector body. The majority of financial instruments relate to contracts to buy non-financial items in line with NHS England's expected purchase and usage requirements and NHS England is therefore exposed to little credit, liquidity or market risk.

Lincolnshire Clinical Commissioning Group 96 South Annual Report 2018/19

South Lincolnshire CCG - Annual Accounts 2018-19 33 Financial instruments cont'd 33.2 Financial assets Financial Assets measured at amortised cost 2018-19 £'000 Trade and other receivables with NHSE bodies Trade and other receivables with other DHSC group bodies Trade and other receivables with external bodies Cash and cash equivalents Total at 31 March 2019

Equity Instruments designated at FVOCI 2018-19 £'000

1,209 1,089 701 61 3,061

Total 2018-19 £'000 1,209 1,089 701 61 3,061

33.3 Financial liabilities Financial Liabilities measured at amortised cost 2018-19 £'000 Trade and other payables with NHSE bodies Trade and other payables with other DHSC group bodies Trade and other payables with external bodies Other financial liabilities Private Finance Initiative and finance lease obligations Total at 31 March 2019

Other 2018-19 £'000

2,168 6,976 2,958 5,363 0 17,465

Total 2018-19 £'000

2,168 6,976 2,958 5,363 0 17,465

34 Operating segments The CCG and consolidated group consider they only have one segment - commissioning of healthcare services.

South Lincolnshire Clinical Commissioning Group Annual Report 2018/19

Lincolnshire Clinical Commissioning Group 98 South Annual Report 2018/19 0 0 0 0 0

0 0 0 0 0

18,023

Liabilities

Grand Total

15,906

6,633 930 6,178 2,164 15,906

2018-19 £'000

7,553 1,051 6,976 2,444 18,023

Lincolnshire West Clinical Commissioning Group

Lincolnshire East Clinical Commissioning Group

Assets

Expenditure Section 75 - Proactive Care Section 75 - Integrated Community Equipment Services Section 75 - Learning Disabilities Section 75 - Child and Adolescent Mental Health

Income Section 75 - Proactive Care Section 75 - Integrated Community Equipment Services Section 75 - Learning Disabilities Section 75 - Child and Adolescent Mental Health

2018/19

35.1 Interests in joint operations

10,930

4,597 635 4,219 1,478 10,930

0 0 0 0 0

South Lincolnshire Clinical Commissioning Group 2018-19 £'000

The Clinical Commissioning Group’s share of the income and expenditure as handled by the pooled budgets in the financial year were:

8,858

3,717 516 3,425 1,200 8,858

0 0 0 0 0

South West Lincolnshire Clinical Commissioning Group 2018-19 £'000

102,622

65,570 6,426 76,331 8,011 156,337

(22,500) (20,798) (7,286) (3,132) (53,716)

2018-19 £'000

Lincolnshire County Council

Lincolnshire County Council is responsible for the production of memorandum accounts for the pooled budget. These will not be produced until after the publication of the CCG's accounts.

All cash is transacted by all parties in the month concerned. There are no outstanding cash balances or liabilities at each period end for all organisations concerned.

The pooled budget represents contibutions to the areas of identified spend; it is quite likely that the respective organisations have spend with schemes etc. over and above these contributions.

156,337

88,069 9,558 97,130 15,296 210,053

(22,500) (20,798) (7,286) (3,132) (53,716)

2018-19 £'000

Grand Total

The 2018-19 pooled budgets are for Learning Disabilities, Child and Adolescent Mental Health Services, Proactive Care and Integrated Community Equipment Services. These budgets are predominantly hosted and managed on a day to day basis by Lincolnshire County Council, in instances where this is not the case CCGs jointly host and manage. As a commissioner of healthcare services, the CCG makes a contribution to the pool which is then used to purchase healthcare services. The CCG accounts for its share of the assets, liabilities, income and expenditure of the pool as determined by the pooled budget agreement in line with the Group Accounting Manual and as defined in IFRS 11.

Prior to 2015-16 the CCG had entered into two pooled budget arrangements with Lincolnshire County Council under s75 of the National Health Service Act 2006 for Learning Disabilities and Child and Adolescent Mental Health Services. With effect from 1 April 2015 these existing pooled budgets formed elements of the Better Care Fund. The Better Care Fund was announced in June 2013 to drive the transformation of local services to ensure that people receive better and more integrated care and support. The Care Act 2014 amended the NHS Act 2006 to provide the legislative basis for the Better Care Fund.

35. Joint arrangements - interests in joint operations

South Lincolnshire CCG - Annual Accounts 2018-19

South Lincolnshire Clinical Commissioning Group Annual Report 2018/19

0 0 0 0 0

The CCG had no LIFT investments during 2018/19, (2017/18, £0).

36. NHS Lift investments

15,431

The CCG had no interests in entities not accounted for under IFRS 10 or IFRS 11 during 2018/19, (2017/18, £0).

35.2 Interests in entities not accounted for under IFRS 10 or IFRS 11

17,482

Liabilities

Grand Total

6,750 814 5,706 2,161 15,431

2017-18 £'000

7,673 919 6,443 2,447 17,482

Lincolnshire West Clinical Commissioning Group

Lincolnshire East Clinical Commissioning Group

Assets

Expenditure Section 75 - Proactive Care Section 75 - Integrated Community Equipment Services Section 75 - Learning Disabilities Section 75 - Child and Adolescent Mental Health

Income Section 75 - Proactive Care Section 75 - Integrated Community Equipment Services Section 75 - Learning Disabilities Section 75 - Child and Adolescent Mental Health

2017/18

10,547

4,616 556 3,896 1,479 10,547

0 0 0 0 0

South Lincolnshire Clinical Commissioning Group 2017-18 £'000

8,560

3,747 451 3,163 1,199 8,560

0 0 0 0 0

South West Lincolnshire Clinical Commissioning Group 2017-18 £'000

95,734

62,713 5,408 71,623 8,010 147,755

(22,786) (19,208) (7,286) (2,740) (52,020)

2017-18 £'000

Lincolnshire County Council

147,755

85,500 8,148 90,831 15,296 199,775

(22,786) (19,208) (7,286) (2,740) (52,020)

2017-18 £'000

Grand Total

Lincolnshire Clinical Commissioning Group 100 South Annual Report 2018/19

Dr Abhijit Banerjee Dr Naseer Khan Dr Naseer Khan Dr Ian Pace Dr Majid Akram Dr Kieron Wiscombe Dr Ian Wheatley Dr Carl Pears Dr Kevin Hill Dr Miles Langdon Dr Miles Langdon Dr Miles Langdon Dr Melanie Denton Dr Melanie Denton Dr Robert Mitchell Dr Robert Mitchell Councillor Woolley Dr Saleem Ajumal Dr Andrew Hughes Dr Kevin Hill Dr Kevin Hill Dr Douglas Burgess Ms Teresa Hare Dr Salman Quadar Mr John Turner* Miss Joanne Wright** Mrs Hilary Daniels*** Dr Azmeena Nathu Dr Raghu Ramaiah Dr Andrew Hughes Dr Kevin Hill Dr Majid Akram Mr Preston Keeling

Name

Governing Body & Members Council Member Governing Body & Members Council Member Governing Body & Members Council Member Members' Council Member Governing Body Member Members' Council Member Members' Council Member Members' Council Member Clinical Chair CCG Governing Body & Members Council Member Governing Body & Members Council Member Governing Body & Members Council Member Member's Council Member Member's Council Member Member's Council Member Member's Council Member Member Governing Body Governing Body & Members' Council Member Members' Council Member Governing Body Member Governing Body Member Members' Council Member Members' Council Member Members' Council Member Chief Officer Chief Finance Officer Chair, Finance & QIPP Delivery Committee Members' Council Member Governing Body - secondary care doctor Members' Council Member Members' Council Member Governing Body & Members Council Member Lay Member Governing Body (PPI)

Title

Partner, Abbeyview Surgery Member,Allied Health Partner, Beechfield Medical Centre Partner, Bourne Galletly Practice CQC Specialist Advisor Partner, Gosberton Medical Centre Partner, Hereward Medical Practice Partner, Hereward Medical Practice Director KPH locums Chief Medical Officer, Lakeside Healthcare Group Partner Lakeside healthcare Stamford Partner Lakeside healthcare Stamford Partner Lakeside healthcare Stamford Partner Lakeside healthcare Stamford Partner Lakeside healthcare Stamford Partner Lakeside healthcare Stamford Executive Member LCC and political party representative Partner, Littlebury Medical Centre Partner, Littlebury Medical Centre Partner Long Sutton Medical Centre Stakeholder Governor, Lincolnshire Partnership Foundation Trust Partner, Moulton Medical Centre Partner, Munro Medical Centre Partner, Munro Medical Centre Chief Officer, NHS South West Lincolnshire CCG Chief Finance Officer, NHS South West Lincolnshire CCG Chair, Finance & QIPP Delivery Committee, NHS South West Lincolnshire CCG Partner, Pennygate Surgery Owner of Quest Medical Locumns Partner, Sutterton Surgery Partner, Sutterton Surgery Partner, The Deepings Practice Chief Executive The Respite Association

Related Party Description

01/04/2018 01/04/2018 01/04/2018 01/04/2018 01/04/2018 01/04/2018 01/04/2018 01/04/2019 01/01/2019 01/04/2018 01/04/2018 01/04/2018 01/04/2018 01/04/2018 01/04/2018 01/04/2018 01/04/2018 01/04/2018 01/03/2019 01/04/2018 01/04/2018 01/04/2018 01/04/2018 01/12/2018 01/04/2018 01/04/2018 01/04/2018 01/04/2019 01/04/2018 01/04/2018 01/04/2018 01/04/2018 01/04/2018

Start Date

04/09/2018

31/12/2018

End Date

0 0 1 0 0 0 0 0 0 0 0 0 0 0 0 0 768 0 0 0 2 0 0 0 300 300 300 0 0 0 0 0 0

£'000

£'000 1,122 1,389 2,587 1,939 0 2,300 2,353 2,353 0 4,736 0 4,476 0 4,476 0 4,476 9,319 1,244 1,244 3,822 10,866 1,923 2,919 2,919 1,481 1,481 1,481 221 0 1,240 1,240 4,012 0

Receipts from Related Party

Payments to Related Party

The Department of Health is regarded as a related party. During the year the clinical commissioning group has had a significant number of material transactions with entities for which the Department is regarded as the parent Department. For example: NHS England NHS Foundation Trusts NHS Trusts; and NHS Business Services Authority

Notes *John Turner holds a joint role as Chief Officer across South Lincolnshire CCG and South West Lincolnshire CCG. ** Miss Joanne Wright holds a joint role as Chief Finance Officer across South Lincolnshire CCG and South West Lincolnshire CCG *** Hilary Daniels holds a joint role as Chair of the Finance and QIPP Delivery Committee across South Lincolnshire CCG and South West Lincolnshire CCG. ****Pennygate Surgery closed on 4th Sept 18 following the retirement of the Sole GP Partner. Johnson GP Centre opened on 5 Sept 2018 to provide care for the patients registered at the former Pennygate Surgery.

Abbeyview Surgery Alliance Health Federation Beechfield Medical Centre Bourne Galletly Practice CQC Gosberton Medical Centre Hereward Medical Practice Hereward Medical Practice KPH Locums Ltd Lakeside Healthcare Group St. Mary's Medical Centre Sheepmarket Surgery St. Mary's Medical Centre Sheepmarket Surgery St. Mary's Medical Centre Sheepmarket Surgery Lincolnshire County Council Littlebury Medical Centre Littlebury Medical Centre Long Sutton Medical Centre LPFT Moulton Medical Centre Munro Medical Centre Munro Medical Centre NHS South West Lincolnshire CCG NHS South West Lincolnshire CCG NHS South West Lincolnshire CCG Pennygate Surgery**** Quest Medical Locums Sutterton Surgery Sutterton Surgery The Deepings Practice The Respite Association

Name of Related Party

Details of related party transactions with individuals are as follows:

37 Related party transactions

South Lincolnshire CCG - Annual Accounts 2018-19

£'000

80 0 243 153 0 131 143 143 0 0 57 365 57 365 57 365 138 55 55 100 193 97 182 182 375 375 375 35 0 35 35 325 0

Amounts owed to Related Party

£'000

0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 415 0 0 0 242 0 0 0 341 341 341 0 0 0 0 0 0

Amounts due from Related Party

South Lincolnshire Clinical Commissioning Group Annual Report 2018/19

101

Dr Kevin Hill

Dr Robert Mitchell

Mr John Turner* Miss Joanne Wright**

Dr Kieron Wiscombe Dr Ian Wheatley Dr Miles Langdon Cllr Sue Woolley Dr Andrew Sykes Dr Kevin Hill Dr Douglas Burgess

Dr Abhijit Banerjee Dr Naseer Khan

Name

Members' Council Member Governing Body Member Members' Council Member Members' Council Member Members' Council Member Members' Council Member Governing Body Member Governing Body Member Members' Council Member Governing Body Member Members' Council Member Members' Council Member Chief Officer Chief Finance Officer Members' Council Member Members' Council Member Members' Council Member Governing Body Member

Title

Partner, Abbeyview Medical Centre Member, Beechfield Medical Practice Member Practice of CCG Member Practice of CCG Partner, Gosberton Medical Centre Partner, Hereward Practice, Bourne Chief Medical Officer, Lakeside Healthcare GroupExecutive Member, Lincolnshire County Council Partner, Littlebury Medical Centre Stakeholder Governor, Lincolnshire Partnership Foundation Trust Partner, Moulton Medical Centre Member Practice of CCG NHS South West Lincolnshire CCG NHS South West Lincolnshire CCG Member Practice of CCG Partner, Sheepmarket Surgery Member Practice of CCG Suttons Medical Group

Related Party Description

01/04/2017 01/04/2017 01/04/2017 01/04/2017 01/04/2017 01/04/2017 01/04/2017 01/04/2017 01/04/2017 01/04/2017 01/04/2017 01/04/2017 01/04/2017 01/04/2017 01/04/2017 01/04/2017 01/04/2017 01/04/2017

Start Date

End Date £'000 1,038 2,616 1,957 4,251 2,345 2,186 2,718 8,587 1,251 0 1,921 3,008 518 518 542 3,735 1,250 3,759

In addition, the clinical commissioning group has had a number of material transactions with other government departments and other central and local government bodies. Most of these transactions have been with Lincolnshire County Council.

£'000

0 0 0 0 0 0 0 384 0 0 0 0 73 73 0 0 0 0

Payments to Receipts Related from Related Party Party

Abbeyview Medical Centre Beechfield Medical Practice Bourne Galletly Practice Deepings Practice Gosberton Medical Centre Hereward Practice, Bourne Lakeside St Mary's Practice Lincolnshire County Council Littlebury Medical Centre LPFT Moulton Medical Centre Munro Medical NHS South West Lincolnshire CCG NHS South West Lincolnshire CCG Pennygate Health Centre Sheepmarket Surgery GP Sutterton Medical Suttons Medical Group

Name of Related Party

Details of related party transactions with individuals during 2017/18 are as follows:

2017/18

37. Related party transactions

South Lincolnshire CCG - Annual Accounts 2017-18

Amounts Amounts owed to due from Related Related Party Party £'000 £'000 14 0 22 0 20 0 42 0 140 0 24 0 44 0 256 1,278 6 0 0 0 2 0 21 0 0 0 0 0 5 0 0 0 7 0 36 0

South Lincolnshire CCG - Annual Accounts 2018-19 38 Events after the end of the reporting period There are no events after the end of the reporting period which will have a material impact on the financial statements of the CCG in 2018/19. 39 Third party assets The CCG did not hold any third party asets in 2018/19 ( 2017/18,£0). 40 Losses and special payments Losses The total number of NHS clinical commissioning group losses and special payments cases, and their total value, was as follows: Total Number of Cases 2018-19 Number Fruitless payments Total

1 1

Total Value of Cases 2018-19 £'000 2 2

Total Number of Cases 2017-18 Number 0 0

Total Value of Cases 2017-18 £'000 0 0

Special payments Total Number of Cases 2018-19 Number Total

Total Value of Cases 2018-19 £'000

Total Number of Cases 2017-18 Number

Total Value of Cases 2017-18 £'000

2018-19 Target 236,621 0 234,458 0 0 3,527

2018-19 Performance 236,618 0 234,455 0 0 3,262

2017-18 Target 233,029 0 224,883 0 0 3,488

2017-18 Performance 237,309 0 233,448 0 0 3,428

41 Financial performance targets NHS Clinical Commissioning Group have a number of financial duties under the NHS Act 2006 (as amended). NHS Clinical Commissioning Group performance against those duties was as follows:

Expenditure not to exceed income Capital resource use does not exceed the amount specified in Directions Revenue resource use does not exceed the amount specified in Directions Capital resource use on specified matter(s) does not exceed the amount specified in Directions Revenue resource use on specified matter(s) does not exceed the amount specified in Directions Revenue administration resource use does not exceed the amount specified in Directions

42 Analysis of charitable reserves The CCG did not hold any chariatable reserves during 2018/19 ( 20/17/18, £0).

43 Effect of application of IFRS 15 on current year closing balances The application of IFRS 15 has not any impact on the current year closing balances.

Lincolnshire Clinical Commissioning Group 102 South Annual Report 2018/19

South Lincolnshire Clinical Commissioning Group Annual Report 2018/19

103

Lincolnshire Clinical Commissioning Group 104 South Annual Report 2018/19

South Lincolnshire Clinical Commissioning Group Annual Report 2018/19

105

Lincolnshire Clinical Commissioning Group 106 South Annual Report 2018/19

South Lincolnshire Clinical Commissioning Group Annual Report 2018/19

107

Lincolnshire Clinical Commissioning Group 108 South Annual Report 2018/19

South Lincolnshire Clinical Commissioning Group Annual Report 2018/19

109

NHS South Lincolnshire Clinical Commissioning Group Bridge House The Point, Lions Way Sleaford NG34 8GG Tel: 01522 573939 Follow us on Twitter @NHS_SouthLincs and Facebook Web address: www.southlincolnshireccg.nhs.uk Visit the NHS Confederationâ&#x20AC;&#x2122;s Acronym Buster for help with NHS acronyms and abbreviations: https://www.nhsconfed.org/acronym-buster Documents are available in different formats e.g. large print, audio CD and other languages.