central manchester clinical commissioning group …...achievement of the four hour access target for...

Central Manchester Clinical

Commissioning Group (CCG)

Annual Report

2015/16

Version: 1

Date Approved: May 2016

CMCCG Annual Report 2015/16

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Contents

- Title Page ........................................................................................................ 1

- Contents Page ................................................................................................. 2

- Introduction ...................................................................................................... 3

The Performance Report

1.0 Overview ......................................................................................................... 6

2.0 Performance Analysis.................................................................................... 12

The Accountability Report

3.0 Members’ Report ........................................................................................... 37

4.0 Governance Statement.................................................................................. 42

5.0 Remuneration Report .................................................................................... 54

6.0 Staff Report ................................................................................................... 63

The Audit Report

7.0 External Audit ................................................................................................ 68

Contact Details ........................................................................................................ 72

Appendices

Appendix A – Statement of Accountable Officer’s Responsibilities ......................... 73

Appendix B – Committee Information ...................................................................... 74

Appendix C – Financial Statements ........................................................................ 81


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Introduction

Welcome to the 2015/16 Annual Report for Central Manchester Clinical Commissioning Group (CCG). This report covers the work of Central Manchester CCG from April 2015 to March 2016. We are a clinically led organisation responsible for commissioning healthcare services on your behalf. This means we plan, arrange and fund local health services. We involve patients, clinicians and other stakeholders to make the best commissioning decisions. As an organisation built from our membership of general practices we continue to work in localities to ensure that our work is clinically led, connected to local people and delivered within communities. 2015/16 has been a challenging as well as an exciting year for the CCG. We are pleased with the progress made towards achieving our goals to improve the health of the population and to ensure people receive excellent healthcare services when they need them. Review of 2015/16 Developing care out of hospital has been a key focus of the year. Ensuring services in the community are well coordinated and supporting people to live independently in their own home is a cornerstone of our plans. We have built upon our integrated care teams comprising of GPs, community nurses and social workers to plan more coordinated care for people. We have continued to offer better access to primary care services, offering appointments at weekends and evenings through four sites across Central Manchester. We have seen the benefits of grants given to voluntary sector organisations to tackle social isolation in older people. We have continued to focus upon mental health services, progressing our improvement programme. We have seen improvements to dementia diagnosis, access for psychological therapies and fewer people have had to be admitted to beds outside of Greater Manchester. We are now implementing the single service for general surgery (surgery to the abdomen) across Manchester Royal Infirmary, Wythenshawe Hospital and Trafford General Hospital to improve outcomes for people who need emergency and high risk general surgery. We have also worked hard to reform our urgent care system ensuring good connections between A&E departments and community services. The Community Assessment Unit at Manchester Royal has been established to ensure peoples’ needs can be met without admission to hospital. We have worked hard with local authorities, CCGs and providers of services in Greater Manchester to plan for the devolution of health and social care. We have formally approved a Shared Strategy, with the 36 other Greater Manchester NHS and Local Authority organisations, which we will work towards together over the next five years. We have entered into formal agreements with those organisations to increase shared planning and decision making to ensure the fastest and greatest improvements in the health and wellbeing of our population. Our key achievements for 2015/16 have been:

A fall in the number of people requiring emergency admissions to hospital.

An improvement in the diagnosis rate for people with dementia.

An increase in the number of people who have died in their place of choice.

Achievement of key targets relating to waiting times for elective hospital services,

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treatment for cancer and ambulance response times for the most serious calls.

Delivery of a centralised model of stroke care across Greater Manchester, designed to provide local people with timely access to specialist care.

Improvements in the quality and safety of services, such as improved nutritional screening for adult and paediatric hospital inpatients; proactive assessment and management of patients who are at risk of venous thromboembolism (VTE); and reduced antibiotic prescribing in primary care.

New services have been established in the community including diabetes, musculoskeletal services and dermatology. We will also see the North West Ambulance Service (NWAS) return as our provider of patient transport services.

Achievement of our financial duties including delivering a balanced budget.

Implementation of the Manchester Care Record which connects records from different organisations to allow healthcare professionals to access a comprehensive record for a patient.

Our biggest challenges for 2015/16 have been:

Achievement of the four hour access target for urgent care in A&E

Access to psychological therapies

Ambulance turnaround times at A&E departments. Looking ahead 2016/17 is the first year of the new devolved system in Greater Manchester. In partnership with other NHS and Local Authority partners we will collectively manage the £6bn health and social care budget for Greater Manchester. This means decisions will be more tailored to the needs of our local populations and more linked up with other public services. This presents a massive challenge but also an opportunity to make faster improvements to the health of the population. We will also take on responsibility for commissioning primary medical care. This will mean more joined up commissioning of general practices with other care delivered in the community. This will enable us to develop upon our integrated care teams to ensure a truly ‘One Team’ approach to health and care services in the community. We will continue to support implementation of the Healthier Together programme to improve general surgery outcomes in Manchester and Trafford. We will also look at new opportunities for closer working between Manchester hospitals. The Manchester Mental Health and Social Care Trust will be acquired by one of the other Greater Manchester mental health trusts. We will oversee this process to ensure the best possible outcomes for people who need those services and those who work for the Trust. Building on our challenges in 2015/16 we will focus upon improvements to urgent care, access to psychological therapies and waiting times for hospital services (including diagnostic services). We will seek to strengthen primary care services and invest in services within the community. We will also focus upon supporting people with learning disabilities to live in the community instead of residing in institutional settings. The CCG and other public sector organisations will face significant financial challenges in the coming years. We will need to focus upon ensuring that we commission services as effectively and efficiently as possible to ensure we can provide a good service offer and service standards whilst working within our budget.


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The CCG will work more closely with North and South Manchester CCGs and Manchester City Council to ensure we can work in the most effective and joined up way to implement key priorities to achieve our goals and fulfil our duties as an organisation. We will also work more closely with the public, patients, carers and community groups to ensure that our plans are as effective as possible and that we have a collective aim and responsibility to improve our own health and that of our population. We are pleased with our achievements this year and by working together we will continue to build on the work we have done to improve health services for our local population. We would like to thank local people and our partners for their continued support in our work. The year ahead will be challenging but full of opportunity. Ian Williamson Chief Accountable Officer NHS Central Manchester CCG


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The Performance Report

1.0 Overview

1.1 History Central Manchester CCG was established as a statutory organisation on the 1st April 2013. This was part of changes implemented following the 2012 Health Act. The CCG was authorised without any conditions placed upon it. It is accountable as a statutory organisation to NHS England. This is our third year of operation.

The Central Manchester CCG offices are based at Parkway Business Centre, Princess Road, Manchester M14 7LU. Our Governing Body meetings are usually held bi-monthly at the Windrush Millennium Centre in Moss Side. The meetings are open to the public and further information is available on the CCG website at: https://www.centralmanchesterccg.nhs.uk/board-meetings

1.2 Activities of the CCG The CCG is a commissioning organisation that is responsible for buying healthcare from a range of providers who are then contractually required to provide these services to the local population of Central Manchester. These include:

Urgent and emergency care including A&E, ambulance and out-of-hours services

Older people’s healthcare services

Planned, non-emergency hospital care

Rehabilitation services

Mental health and learning disabilities services

Healthcare services for children

Community health services including continuing healthcare

Maternity services

Infertility services

Co-Commissioning of Primary Medical services with NHS England. We commission services from Central Manchester Foundation Trust and from other major acute providers including University Hospital South Manchester and Pennine Acute Hospital Trust and from a number of community and independent providers such as Primary Care Manchester Ltd and Go to Doc. For mental health and learning disabilities, our key provider is Manchester Mental Health and Social Care Trust. The CCG is clinically led and currently made up of 31 general practices totalling approximately 228,000 patients. Our ambition is that by 2021, residents of Manchester will:

Benefit from a transformed, integrated health and social care system in which they receive health and care interventions which are joined up, of high quality, and are affordable.

Be supported and encouraged to do what they can to remain healthy.

Live in a City which encourages them to make the right choices.

Be able to access more specialist support in the right place at the right time,

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appropriate to their needs and wishes.

The 31 practices in Central Manchester are grouped into four localities. These are Ardwick & Longsight; Hulme, Moss Side & Rusholme; Gorton & Levenshulme and Chorlton, Whalley Range & Fallowfield. These localities provide invaluable input to the full Group membership and to the Governing Body.

The full Group membership has a GP representative from each GP practice. The work of the CCG is overseen by the Governing Body. You can find out more about the governing body representatives in Section 3.3. The Governing Body meets every month, alternating between public meetings and board seminars (informal meetings). All CCG business and decisions are normally made at the public board meetings and the seminars usually focus on information sharing, development of ideas and learning for board members. It is the Governing Body that oversees the day to day running of the CCG. The Audit Committee and Remuneration Committee are required by statute and accountable to the Governing Body. Central Manchester CCG has established a number of other committees which also sit under the Governing Body. These are detailed in Appendix B. The CCG has a number of teams in place to support the full group membership, governing body and the committees of the CCG to effectively carry out its statutory functions. We have a core Central Manchester Team made up of Medicine Management, Urgent Care, Planned Care, Primary Care Development, Finance and Strategy and Planning teams. We also have a number of teams that we share with other CCGs. These are the:

Performance and Quality Team (shared between the Manchester and Trafford CCGs)

City Wide Commissioning Team

City Wide Corporate Services

City Wide Finance Team

City Wide Business Intelligence Team

City Wide Human Resources and Organisational Development Team.

1.3 Population Information Central Manchester CCG is made up of 11 wards stretching from Chorlton in the west to Gorton Central in the east. It is an area of contrast and diversity, containing both highly sought after residential locations, such as Chorlton, and neighbourhoods with concentrations of deprivation, such as Ardwick. Central Manchester has a resident population of 184,651. The number of patients registered with a GP practice in Central Manchester is higher, totalling 228,155. This figure includes patients who may live outside of the city but are still registered with a Central Manchester GP practice. Over the next 10 years, the resident population of Central Manchester is projected to increase by 5.9%. Central Manchester is also projected to continue to have the largest population in terms of the total number of people living in the area, compared to North and South Manchester. Central Manchester has significant numbers of children and young people and a significant student population who bring their own health challenges. For example,


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the birth rate has significantly increased over the last 5 years which is placing significant pressure on the child health services in community and secondary care, as well as on universal primary care services. Almost half of the people living in Central Manchester are from a Black and Minority Ethnic Background (BME), with some wards having a significantly high proportion of people from BME backgrounds such as Longsight, Moss Side and Rusholme. The BME make-up of Manchester continues to become more diverse and the BME population is growing. Information from Multilingual Manchester at the University of Manchester has indicated that 150 to 200 languages are spoken by long-term residents of Manchester and in the Greater Manchester area, making it one of the world’s most diverse places linguistically. Close to 20% of Manchester’s adult population declared a language other than English as their main language in the 2011 census. Average life expectancy for males in Central Manchester is 75.4 and for females it is 80.3, which is one of the lowest in the country for both men and women. The number of years a person would expect to live in good health (healthy life expectancy) is 56.1 years for men and 54.4 years for women. The life expectancy gap within Manchester remains starkly wide. A boy born in the most affluent parts of Manchester is expected to live 8.8 years longer than a boy born in the most deprived areas of the city. Similarly a girl born in the most affluent parts of Manchester is expected to live 7.4 years longer than a girl born in the most deprived parts of Manchester. Central Manchester has many areas of deprivation, many of which are classified as the most deprived in England. These include areas within the wards of Ardwick, Gorton, Hulme, Moss Side and Rusholme. All of the wards in Central Manchester, with the exception of Chorlton have an above England average percentage of people claiming out of work benefits. Central Manchester follows a national trend of an ageing population and with this comes an increasing number of age specific chronic diseases (with multiple long-term conditions, frailty and dementia), which create significantly increasing pressure on health and care services over time. If we look at the number of patients on disease registers for various conditions, we find that conditions related to hypertension, obesity, asthma, diabetes and depression have the highest number of patients on GP practice disease registers. The biggest underlying causes for deaths in Central Manchester are due to cancers and circulatory diseases such as heart disease and stroke. Mortality rates for cancer, cardiovascular diseases, respiratory and liver disease are higher than the national average. In 2013 Manchester was ranked bottom in terms of early deaths from cancer, heart disease, stroke, lung disease and liver disease. Around 80% of deaths from the major diseases that contribute to low life expectancy and ill health are attributable to lifestyle risk factors – alcohol, smoking, physical activity and diet. The rate of child poverty is one of the highest in the country. There are substantial variations within the area. At ward level, the proportion of children living in poverty ranges from 10% in Chorlton to over 50% in Moss Side, Hulme and Ardwick. Almost a quarter of year 6 primary school children (24.3%) in Central Manchester are obese, which is higher than the England average of 19%. Levels of obesity vary between wards with higher proportions of obese children living in Longsight and Rusholme.


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1.4 Strategic Direction The NHS is facing an unprecedented level of future pressure, driven by: an ageing population; increase in long term conditions; rising costs; public expectations and a challenging financial environment. To address these challenges, it is increasingly important that Manchester CCGs work more closely with our partners to achieve efficiencies, whilst improving quality and patient experience. The Five Year Forward View published by NHS England sets the direction for the NHS as a whole and therefore, the context within which we work. Partners across Manchester have responded by coming together to produce a Locality Plan which sets out the five year ambition for improving health and social outcomes across Manchester. By 2021, residents of Manchester will:

Benefit from a transformed, integrated health and social care system in which they receive health and care interventions which are joined up, of high quality, and are affordable.

Be supported and encouraged to do what they can to remain healthy.

Live in a city which encourages them to make the right choices.

Ensure that when they need access to more specialist support they receive it in the right place at the right time, appropriate to their needs and wishes.

A number of transformational initiatives have been developed to achieve the Locality Plan. The initiatives focus on: public health; cancer care; primary care; integrated community-based care mental health; learning disability; shared services across the acute sector; children and young people and housing and assistive living technology. These transformational areas of work will be driven through 3 key pillars:

A single commissioning system

One Team

A ‘Single Manchester Hospital Service’. The opportunities arising from the Greater Manchester Devolution of Health and Social Care will help deliver these transformations by allowing greater local control of how the entire budget on health and social care is spent in Manchester. Greater Manchester Health and Social Care Devolution From 1 April 2016, Greater Manchester has taken responsibility for Health and Social Care spending in excess of £6bn. Health and social care partners are working closely with other public service providers to deliver a vision, designed to: • improve the health and wellbeing of all of the residents of Greater Manchester,

moving from having some of the worst health outcomes to having some of the best

• close the health inequalities gap within Greater Manchester and between Greater Manchester and the rest of the UK faster

• deliver effective integrated health and social care across Greater Manchester • continue to redress the balance of care to move it closer to home where

possible • strengthen the focus on wellbeing, including greater focus on prevention and

public health • contribute to growth and to connect people to growth, e.g. supporting

employment and early years services; and • forge a partnership between the NHS, social care, universities and science

and knowledge industries for the benefit of the population.


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A Strategic Plan for Greater Manchester has been developed, setting out a framework for long-term health and social care reform. The plan has been endorsed by all 37 organisations involved in the devolution partnership, together with other partners, such as primary care providers. It provides a framework to direct the application of the £450m Greater Manchester transformation fund. This fund provides Greater Manchester with the ability to make strategic investments to support the creation of a sustainable and successful health and social care system by 2021. The Greater Manchester Strategic Plan is underpinned by 10 Locality Plans, one for each of the Greater Manchester Districts. These plans are a critical aspect of the process as they describe the specific work which will take place in each area to make Greater Manchester’s vision for transformed health and care a reality. To support the delivery of the programme, an Accountability Agreement with NHS England has been agreed. This agreement describes how Greater Manchester will be assured once, as a place, for delivery of the NHS Constitution and mandate, financial control and quality. Central Manchester CCG hosted the Devolution Manchester team in 2015/16 on behalf of the 12 Greater Manchester CCGs, 10 Local Authorities and NHS England. Within this arrangement the CCG acted as an ‘agent’, accounting for all the associated income and expenditure. The financial performance of the hosting arrangement was reviewed both internally by the Joint Finance Committee and externally by the Greater Manchester Health & Social Care Development Programme Board. Agreements are in place to support the hosting arrangement to ensure that the CCG is not exposed to any financial risk due to hosting this arrangement. In 2016/17, the hosting arrangement will continue until September, whilst the longer term organisational form for the Devolution Team is agreed. Healthier Together – Committees in Common/Shadow Joint Committee Healthier Together Committees in Common (HTCiC) was the decision making body for the Healthier Together programme. The Committees in Common comprised of representatives from each of the 12 Clinical Commissioning Groups (CCGs) in Greater Manchester. From December 2015, the Committees in Common became a Shadow Joint Committee, in the lead up to forming a Joint Committee in June 2016. The Transformation Unit are commissioned by the HTCiC to deliver the Healthier Together programme on behalf of the CCGs. 2015-16 has been the most significant year of the programme so far with unanimous decisions made by the HTCiC on the shape of future hospital services for Greater Manchester. These decisions are the culmination of three years of work by commissioners, providers, staff and our public including the largest response to a NHS consultation ever delivered and development of a new and innovative model of care that has shaped national health policy in the Keogh review of Urgent Care and the Five Year Forward View. The key achievements of the year are:

Following the consultation, HTCiC oversaw a bespoke decision making process delivered by the Transformation Unit, bringing together 30,000+ consultation responses and analysing a myriad of activity, estate, workforce, finance and Integrated Impact assessment information.

HTCiC members attended data familiarisation workshops and approved a Decision Making Business Case.


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All six decisions to determine the shape of hospital services were made in public at HTCiC meetings and all were unanimous. All were delivered as per the milestones agreed in November 2014.

1. Confirmation of the case for change

2. Is the model of care supported?

3. Are there any alternative options?

4. What criteria will be used?

5. How many single services should there be?

6. Which option should be implemented?

January 21st 2015

January 21st 2015

January 21st 2015

February 18th 2015

June 17th 2015

July 15th 2015

On the 15th July after 3 years of work and the largest NHS consultation ever completed, the 12 GM commissioners at the HTCiC unanimously confirmed the Healthier Together hospital model of care, the number and geography of the Healthier Together single services. The decision was made in public at Manchester Town Hall with over 60 members of the public in attendance, was live streamed on the Healthier Together website and featured as front page news in local papers and as well as being reported in national media.

July 15th

2015 – Geography of Healthier Together single services decided

Throughout the programme, the legal advisors have been clear that a legal challenge to any decision is likely. As such a Judicial Review was sought and granted in October 2015. During two days in court in December the programme successfully defended the decision, receiving the verdict that all grounds of challenge were dismissed in January 2016.

Following the successful defense of the Judicial Review the Implementation Phase has been established and programme governance revised. In this process the HTCiC has become the Healthier Together Joint Committee (HTJC; currently in Shadow form).

In the last quarter of 2015-2016 the programme structure, a Project Initiation Document and a 7 stage process for all sectors to implement the changes have been developed and approved by HTJC. This process will allow the


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HTJC to assure sectors at the end of each stage to make sure that adequate progress is being made and models developed are in line with the standards.

All sectors have now established programmes and governance to deliver the Healthier Together model of care and all rated at amber or amber/green in terms of progress. All sectors are at Stage 1 (establishing the programme) with the exception of NW Sector which is at Stage 2 (design of model of care), pending a review of completion of Stage 1.

By the end of 2016/17 it is anticipated that all sectors will have completed business cases, capital funding will be sourced and capital builds commissioned and commenced, additional workforce recruitment will have commenced, the NWAS triage tool will be agreed and the first sector will be close to being ready to move emergency and high risk elective general surgical patients.

1.5 Key Risks Information regarding the key risks for the CCG is included within the Governance Statement (Section 4).

1.6 Performance Summary 2015/16 has presented Manchester with some significant opportunities to work in partnership in order to reframe how our health and social care services are delivered to the benefit of our local population. Key strategic developments have included:

The devolution deal for Greater Manchester, which has enabled partners from across the conurbation to develop a strategic plan for the transformation of health and care services across the City Region.

System reform of urgent care through Manchester’s Urgent Care First Response programme, a provider-led redesign of urgent and emergency care services.

System reform of community services and the development of integrated care through ‘One Team,’ Manchester’s programme for place-based out of hospital care.

Alongside these strategic developments, the CCG retains a close focus on the delivery of key constitutional standards for our population. Performance is set out in detail later on in this document, but the headlines are provided below:

Referral to Treatment (RTT) incomplete pathways: These are being delivered at Central Manchester Foundation Trust (CMFT) and Pennine Acute Hospitals Trust (PAHT). Following the identification of data quality issues at University Hospital of South Manchester (UHSM), a significant validation process is taking place, with rigorous governance. The full impact on performance will not be known until the validation is complete. The focus will then turn to transition planning for recovery.

Diagnostic waits: Diagnostic waits at all three Trusts have been challenged during 2015/16, with diagnostic capacity a universal issue. Actions for recovery have been taken by each of the Trusts, with trajectories for performance to be back on track early in the 2016/17 financial year.

Cancer: Key cancer waiting time standards are being delivered – or projected to be delivered – across the three Trusts, with the exception of the 62 day waiting standard following GP referral at PAHT, which the Trust is projecting to fail following a challenging quarter four position. The Manchester CCGs are working with the Trusts to deliver focused improvement work regarding cancer services. In addition, significant work is taking place across the city and Greater Manchester, to model demand and capacity and ensure that suitable


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plans are in place to promote early diagnosis and treatment. This will include the delivery of the Greater Manchester Cancer Vanguard, led by Trafford CCG on behalf of the Greater Manchester CCGs.

A&E: Achievement of the A&E standard has proven to be significantly challenging during 2015/16, for all our Acutes but particularly at UHSM and PAHT. Contributing factors include bed capacity, lack of patient flow, patient acuity, complexity of discharges and community capacity. A significant recovery infrastructure has been mobilised in response, with leadership from System Resilience Groups and multi-agency support.

Ambulance response times: Ambulance response times have been subject to a significant improvement initiative during 2015/16. This has improved the Trust’s 8 minute response times for the most urgent calls but challenges remain and the response time targets were missed for 2015/16 at a North West contractual level. Performance can be challenged significantly by delayed ambulance handovers at our hospitals. The Manchester CCGs are working with our Acute providers and NWAS through our System Resilience Infrastructure and focused task and finish projects to understand and respond to these operational pressures.

IAPT: Performance against the standards has historically been challenged in Manchester and the Manchester CCGs will not achieve the standards by April 2016. A performance management response is in place with providers, alongside a review of capacity and funding to the service to support sufficient access.

As we move into 2016/17, the performance priorities of the CCG include:

Delivering system resilience across our localities

Improving the performance of our urgent care systems, in response to challenges regarding the achievement of the Accident and Emergency constitutional standard and to support the performance of the ambulance service

Providing assurance and improvement of elective access standards

Delivering the city’s cancer improvement programme, with a focus on achieving constitutional standards and improving patient journeys and outcomes

Improving our mental health services and enhancing timely access to these

Transforming our learning disability services

Working with our hospitals to ensure that national requirements regarding avoidable mortality are embedded and build on existing learning cultures

Working with our hospitals and wider health and social care partners to deliver the requirements of 7 day services as a Phase 1 delivery area

Maintaining our ongoing focus on improving quality and safety with our providers, including via a new clinical audit programme and smaller providers framework.


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2.0 Performance Analysis

2.1 Ensuring and driving quality, performance and improvement We are committed to ensuring that we commission high quality services which are safe, effective and provide a positive patient experience. This underpins everything that we do, and is increasingly important in the diverse provider marketplace through which health and social care services are delivered. This work is guided by the three dimensions of the NHS definition of quality1:

Patient Safety: commissioning high quality care which is safe, prevents all avoidable harm and risks to the individual’s safety; and having systems in place to protect patients

Clinical Effectiveness: commissioning high quality care which is delivered according to the best evidence as to what is clinically effective in improving an individual’s health outcomes. Making sure care and treatments achieve their intended outcome

Patient Experience: commissioning high quality care which looks to give the individual as positive an experience of receiving and recovering from the care as possible, including being treated according to what the individual wants or needs and with compassion, dignity and respect. It is about listening to the patient’s own perception of their care.

In addition we will ensure that the requirements set out for commissioners and providers of NHS services within the NHS national performance framework are met including:

The Five Year Forward View

CCG Outcome Indicator Set and Improvement and Assessment Framework

NHS Constitutional Standards

Quality Premium

Better Care Fund. To this end, robust systems and processes are in place to ensure that the best possible care is delivered to our patients. This approach has three integrated strands:

Performance: monitoring of performance against agreed standards. Identification of areas where agreed thresholds or trajectories have not been achieved, as the basis for managing and improving the service in real-time

Quality: monitoring of progress against agreed quality standards. Timely identification and resolution and/or escalation of issues relating to quality. Ensuring that lessons arising from incidents are learned to secure improvements in practice

Improvement: delivery of bespoke project approaches to areas of service delivery which require focused attention as a result of sustained concerns relating to performance and/or quality; and/or which represent CCG priority areas for delivery.

1 High Quality Care for All (2008)


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This is governed by the following principles, as set out in the Quality and Performance Assurance and Improvement Framework of the CCGs2:

Being transparent; using the national Quality and Performance Frameworks, guidance and contractual KPIs to describe what success looks like for the CCG and the expectations of providers

Supporting the CCG in analysing, challenging and working with providers with the aim of delivering clear objectives, performance and quality indicators and/or outcomes

Identifying measures and the evidence required to assess quality and performance

Encouraging a culture of high quality and performance

Ensuring accountability and ownership are clearly articulated and the consequences of any lapses in quality or underperformance are understood

Ensuring any performance and quality management interventions and actions are proportional to the scale of the anticipated risk and that a balance between challenge and support is maintained

Ensuring that responsible officers have the necessary information to manage performance within their team.

In line with our quality and performance assurance and improvement framework, we work closely with our providers to set clear contractual expectations around the quality and performance of the services which we commission. This covers all of our providers, including - for the first time in 2015/16 - our smaller providers. During 2016/17, we will build on our established processes to strengthen our oversight of the community services for Central and South Manchester. We will also continue to work with our smaller providers to ensure that they are supported to meet the governance requirements of our new Smaller Provider Framework. Performance and Quality Improvement is also embedded within the CCGs’ procurement processes. This helps us to ensure that the appropriate expertise is aligned to service redesign and associated procurements from the start. A robust operational framework is in place across the Manchester CCGs – and partner organisations where appropriate – to support the management of performance and quality, and associated escalation of issues arising. In simple terms, this involves:

Having well developed and embedded governance structures, with leadership from CCG Quality and Performance Committees; CCG Boards and health economy System Resilience Groups

Having SMART objectives for provider and CCG work programmes, through which providers and CCGs can be held to account

Having robust data about all providers – both quantitative and qualitative. This includes, but is not exclusive to, delivery against agreed performance and quality standards; feedback from incident reporting procedures; patient feedback; findings from CCG ‘walkrounds’ and progress against improvement/recovery plans where applicable. This forms the basis of assurance reporting – and escalation where necessary – via the governance structures described above.

2 CCGs Quality and Performance Assurance and Improvement Framework (2015)


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2.2 Finance The financial duties of a CCG as set out by NHS England are listed below:

Expenditure not to exceed the revenue resource limit in any one year

Expenditure not to exceed its capital resource limit in any one year

To remain within its cash limit in any one year

To remain within the running costs target of a maximum of £4,745k (based on £22.07 per head £4,516k plus Quality Premium £229k)

To deliver a recurrent 1% surplus. The table below demonstrates that Central Manchester CCG delivered all of its statutory duties in 2015/16.

Statutory Duty Target

(£k) Actual (£k) Variance

(£k) Duty Met?

Expenditure not to exceed Revenue Resource Limit 260,089 256,736 (3,353) Expenditure not to exceed Capital Resource Limit n/a n/a n/a -

To remain within its Cash Limit 256,705 253,116 (3,589) To remain within the running cost target of £22.07 per head 4,745 4,294 (451)

Expenditure not to exceed revenue resource limit Limits are set by NHS England for clinical commissioning groups, within which they must contain net expenditure for the year. These are termed “resource limits” and there are separate limits issued for revenue and capital. The CCG does not have a capital resource limit in 2015/16 and no capital expenditure. Central Manchester CCG’s revenue resource limit for 2015/16 was £260,089k. Against this, costs amounted to £256,736k and therefore the organisation has declared a surplus of £3,353k. To remain within cash limit All CCGs are set a limit on the amount of cash they can spend in a financial year. The cash limit for 2015/16 was £256,705k and the organisation drew down cash amounting to £253,116k. The CCG reviewed its cash position in March and made the decision to return funds amounting to £2,500k, making this available to be used within the wider health economy, this was an option within the month 12 national guidance. There was a further cash difference regarding the NHS Business Services Authority relating to prescribing, which equates to £191k, along with a M12 Allocation adjustment of £898k. As at 31st March 2016, the cash held by the CCG was £109k.


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To remain within the running costs target The CCG receives an allocation for running costs or administrative expenditure. The target limits the amount the CCG can spend on administrative functions, for instance back office functions, headquarters, training etc, to a maximum of £22.07 per head of population. In addition to this, the CCG received an in year Quality Premium allocation for £229k in respect of 2014/15 which was permissible to spend on the CCG’s running costs. The allocation for Central Manchester CCG in 2015/16 was £4,745k. During 2015/16 the CCG spent £4,294k on administrative expenditure, generating a £451k under spend against the target. In addition the CCG should comply with the Better Payment Practice Code, the code is summarised as: Target: to pay 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. Compliance: at least 95% of invoices paid (by the bank automated credit system or date and issue of cheque) within thirty days or within agreed contract terms. The table below highlights the performance both in terms of the number and value for non-NHS and NHS invoices.

Measure of compliance 2015-16 2015-16 Number £000 Non-NHS Payables Total Non-NHS Trade invoices paid in the Year 18,257 76,756 Total Non-NHS Trade Invoices paid within target 17,998 75,805

Percentage of Non-NHS Trade invoices paid within target 98.58% 98.76%

NHS Payables Total NHS Trade Invoices Paid in the Year 3,277 243,893 Total NHS Trade Invoices Paid within target 3,210 243,846

Percentage of NHS Trade Invoices paid within target 97.96% 99.98%

The above table shows that the performance measure has been met for NHS and non-NHS, by number and value. The financial statements detailed below are included in Appendix C:

Statement of Comprehensive Net Expenditure for the year ended 31st March 2016.

Statement of Financial Position as at 31st March 2016.

Statement of Changes in Taxpayers’ Equity for the year ended 31st March 2016.

Statement of Cash Flows for the year ended 31st March 2016.


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These accounts have been prepared for Central Manchester CCG under Section 17 of Schedule 1A of the National Health Service Act 2006 (as amended) in the form which the Secretary of State has, with the approval of the Treasury, directed. Income In total the CCG received funding of £266,158k in 2015/16. The majority of this funding (£260,089k) is received directly from NHS England in the form of allocations. Other income of £6,069k has been received in year from other organisations. Expenditure The Statement of Net Comprehensive expenditure included in Appendix C details income and expenditure split by programme and administration costs. The total costs within 2015/16 are £256,736k, of which £4,294k relates to administrative/running costs expenditure and £252,442k to healthcare (programme) spend. The CCG hosts a range of citywide services on behalf of both North Manchester Clinical Commissioning Group and South Manchester Clinical Commissioning Group. The CCG also hosts the Healthier Together and Devolution Manchester teams on behalf of the 12 CCGs of Greater Manchester and in the case of the latter team, the Association of Greater Manchester Authorities. Within the financial statements the expenditure and income associated with these hosted services are shown net in the accounts.


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The chart below details a breakdown of expenditure for the CCG in 2015/16.

Investments The CCG continued with most of the investments it made in 2014/15 and which formed part of the pooled budget, held with the City Council. These included:

Community IV therapy

Homeless Drop In Service (MPATH)

Practice Integrated Care Teams

Alternatives to Transfer

Integrated Care pathway for COPD & Intermediate Care Assessment and Treatment Team (ICATT).

These services were evaluated and had demonstrated an impact on keeping patients out of hospital. Moreover, the CCG invested additional resource in primary care standards including improved access, proactive management of patients with long term conditions and supporting practices to work together in localities to develop more integrated services.

Quality, Innovation, Prevention and Productivity (QIPP) The CCG delivered QIPP of £5.5m in the financial year 2015/16. In order to achieve this level of savings a range of initiatives were implemented from secondary care deflection schemes, integration and medicines management.


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These are outlined in the table below.

Area of Service £000s

Planned care 773

Mental health 1,038

Continuing health care 589

Medicines optimisation 1,091

Other 2,068

Total 5,559

A citywide approach across the three Manchester CCGs will continue in 2016/17. This will ensure that economies of scale can be achieved and management expertise can be utilised in the most economic, effective and efficient way. Better Care Fund The national Better Care Fund policy was introduced formally in 2015/16. The Better Care Fund enables health and social care partners to work collaboratively to meet a number of key common challenges, including for example, managing with scarce resources against rising demand and ageing populations, delivery of seven day integrated services and reducing admissions to residential care homes and unplanned admissions to hospital. For the first time in 2015/16, the CCG was mandated to contribute at least £12.564m to the Better Care Fund. Central Manchester CCG committed its full minimum sums to the Manchester Better Care Fund. There are four partners within the scope of the Manchester Better Care Fund, including, Manchester City Council, North Manchester CCG, South Manchester CCG and Central Manchester CCG. Manchester City Council hosts the Better Care Fund on behalf of the partners. There is a contract in place between the partners that describes how the Better Care Fund operates, including funding, governance, approved schemes and risk management arrangements.


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BCF Analysis 2015/2016 TOTAL POOLED BUDGET

2015/16

£000s

Gross Funding

Manchester City Council 6,223 Manchester CCGs 37,638

Total Funding 43,861

Expenditure

New Delivery Models of Integrated Care 17,580

Protection of Adult Social Care 12,219

Reablement 5,000

Non Elective Risk Reserve 3,159

Care Act Responsibilities 1,451

Capital 4,452

Total Expenditure 43,861

The intention from 2016-17 is to expand the pooled budget arrangement to encapsulate growth and the ‘One Team’ initiative at a value of £11.699m.

TOTAL

BUDGET

£'000

2015/16 Resource 12,564

2016/17 Growth 492

One Team additional 11,207

TOTAL 2016/17 24,263

Central Manchester CCG

Balance Sheet The Statement of Financial Performance (SoFP) shown in Appendix C is the CCG’s balance sheet. The CCG was established on the 1st April 2013 and inherited no legacy balances or capital assets. The CCG has no capital assets as all premises are leased through NHS Property Services Ltd and Community Health Partnerships. The CCG did not purchase any assets in the financial year as it only received a revenue allocation. A full set of the accounts can be viewed on the CCG Website: http://www.manchesterccgs.nhs.uk/ The CCG’s financial health is assured on a monthly basis at the CCG’s Governing Body meeting. The Governing Body also delegates much of this detailed scrutiny to the monthly Joint Finance Committee which is a committee of the Governing Body and has representation from lay members.

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Assurance is provided by External Audit who provide the following assurance to the Governing Body:

An opinion on the accounts

Regularity opinion on whether the expenditure has been incurred as intended by Parliament. Failure to meet statutory financial targets automatically results in a qualified regularity assertion

A conclusion on the arrangements put in place by the CCG to ensure value for money in the use of its resources.

External Audit work is supported by the Internal Audit work programme, which along with External Audit’s work programme, is agreed and monitored by the Audit Committee. 2016/17 Financial Landscape The CCG expects 2016/17 to be a challenging year financially for the health economy, with the need to work with partner organisations to deliver high quality, effective care whilst continuing to deliver efficiencies in the use of resources. The CCG takes responsibility for level 3 primary care commissioning from 1st April 2016, with a resultant increase in budget responsibility of £28.066m. The CCG is working in collaboration with the other two Manchester CCGs, Local Authority, three Acute providers and the Mental Health Trust to develop a strategic financial plan to ensure a balanced health economy position over a five year planning period. This is supported by the development of a locality plan. A copy of this plan will be published on the CCG website once it is finalised

2.4 Constitutional standards

The performance of the Manchester CCGs is directly influenced by the performance of our providers and this is where our improvement efforts are focused. For this reason, a number of metrics below show the provider performance as the primary area of focus. The figures relevant to all three Manchester CCGs are shown in the following tables.

Referral To Treatment (RTT)

(April 2015 – March 2016) Target CMFT UHSM PAHT

RTT: Incomplete pathways % within 18

weeks 92.0% 92.0% 85.6% 95.9%

Commentary

The RTT incomplete pathway standard is being achieved at CMFT and PAHT. The focus of 16/17 will be maintenance of aggregate performance, with scrutiny of relevant specialty/sub-specialty areas of underperformance.

Following the identification of data quality issues at UHSM, a significant validation process is taking place to ensure that the true performance against the incomplete pathway is understood, and that all long waiters are identified and treated appropriately. The full impact on performance for 15/16 will not be known until the validation is complete. A rigorous governance process is in place at the Trust with support from the CCGs and NHS England. This process and the resulting transition plan for recovery has been the priority for 15/16 and will be for the early part of 16/17.


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Diagnostic waits

(Apr 2015- March 2016) Target CMFT UHSM PAHT

Diagnostic Waiting Times % waiting > 6

weeks 1.0% 8.8% 1.8% 3.0%

Commentary

Diagnostic waits at all three Trusts have been challenged during 2015/16, with diagnostic capacity a universal issue.

CMFT has had the most challenged performance, which has been particularly affected by Endoscopy staffing and test capacity. The Trust is delivering a recovery plan which utilises additional diagnostic capacity in the short term and will establish appropriate future capacity (including staffing). The Trust is working to a recovery trajectory of the beginning of 2016/17.

Performance at UHSM has been affected by breaches across a number of test areas, and is being scrutinised at Directorate sub-specialty meetings and the Trust’s Patient Access Board to ensure visibility of performance and required recovery plans.

Performance at PAHT has predominantly been affected by Endoscopy capacity and increasing demand arising from Lower GI two week wait referrals. The Trust is working to a recovery plan with a trajectory of April 2016.

Cancer (YTD) Target CMFT UHSM PAHT

Cancer two week waits (urgent

referrals) (April 2015 – March 2016) 93.0% 95.1% 95.3% 93.9%

Cancer 31 day waits for first definitive

treatment (All cancers) (April 2015 –

March 2016)

96.0% 97.5% 98.7% 99.7%

Cancer 62 day waits following urgent

GP referral (April 2015 – March 2016) 85.0% 84.0% 88.0% 80.2%

Commentary

UHSM is delivering against the key cancer access standards and CMFT is projected to deliver all three key cancer access standards for the year following improvement in the 62 day GP referral standard during quarter four.

PAHT is delivering against the two week wait and 31 day wait standards, but is projecting to fail the 62 day GP referral standard following a challenged quarter four position.

During 15/16, performance against the cancer access standards at CMFT and PAHT has been an area of focused improvement work as a result of underperformance - particularly in relation to the 62 day GP referral standard. This has focused on developing appropriate recovery plans, aligned to national expectations regarding the high impact areas for the delivery of cancer pathways.

In addition, significant work is taking place across the city and Greater Manchester more widely, to model demand and capacity, and ensure that suitable plans are in place to promote early diagnosis and treatment. This will include the delivery of the Greater Manchester Cancer Vanguard, led by Trafford CCG on behalf of the Greater Manchester CCGs.


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A&E (April 2015 – March 2016) Target CMFT UHSM PAHT

Percentage of patients who spent 4

hours or less in A&E 95.0% 93.6% 84.4% 85.3%

Commentary

Achievement of the A&E standard has proven to be significantly challenging during 2015/16, for all our Acutes but particularly at UHSM and PAHT.

Key factors have included, but are not limited to, bed capacity; patient flow; acuity of patients; complexity of discharges; community capacity and the implications of infection control procedures (primarily Carbapenamase-producing Enterobacteriaceae (CPE) on bed availability and flexibility at CMFT and, to a lesser extent, UHSM.

A significant recovery infrastructure has been established with multi-agency leadership from the relevant System Resilience Groups (SRGs), intensive support from the CCGs Improvement Team and regular assurance to NHS England. This will continue into 2016/17, as the SRGs debrief the lessons from 2015/16 and direct resilience funding to best support local health and social care economies.

Ambulance response times

(April 2015 – March 2016) Target NWAS

CM

CCG

SM

CCG

NM

CCG

Cat A (Red 1) 8 Minute

Response (NWAS) 75.0% 74.8% 83.7% 78.8% 82.2%

Cat A (Red 2) 8 Minute

Response (NWAS) 75.0% 70.4% 73.8% 79.6% 75.4%

Cat A 19 Minute Transportation

Response Time (NWAS) 95.0% 92.6% 95.4% 95.2% 94.2%

Commentary

Ambulance provision is a large and complex contract, led by Blackpool CCG on behalf of the North West. The CCGs are held to account on the performance of the North West Ambulance Service (NWAS) against the aggregate (North West) response times. Blackpool CCG provides strategic leadership regarding performance and future commissioning intentions.

A significant improvement initiative has been undertaken with NWAS and our Acute providers as a result of significantly challenged performance in 2014/15 and into 2015/16. As a result, the Trust’s 8 minute response times during 2015/16 were better than that of last year. However, at a contractual level the standards have not been achieved, and challenges remain.

At a locality level, performance is stronger than the North West position.

The ambulance service can experience significant challenges in our localities as a result of pressures on A&E departments and handover delays. The CCGs are working with our Acute providers and NWAS through our System Resilience Infrastructure and focused task and finish projects to understand and respond to these operational pressures.


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Improving Access to

Psychological Therapies

(IAPT) (April 2015 – March

2016)

Target CM

CCG

SM

CCG

NM

CCG

IAPT Achieving better access Annual: 15.0% 6.7% 8.05% 6.80%

IAPT Recovery rate 50.00% 35.1% 44.3% 32.5%

IAPT Waiting times (6 weeks) 75.00% 33.5% 38.6% 29.1%

IAPT Waiting times (18 weeks) 95.00% 73.2% 80.7% 78.2%

Commentary

Performance against the standards has historically been challenged and the standards were not achieved for the 2015/16 year.

Two providers deliver the IAPT service, with differential performance. A performance management response is in place, with fortnightly meetings between the CCGs and the providers to monitor performance.

Capacity and funding present significant constraints to delivery. The CCGs have reviewed options to increase prevalence and recovery rates – investment will be made to support cumulative achievement of 15% prevalence for 2016/17 in Central and South Manchester and 20% in North Manchester.

The CCGs are working with appropriate Third Sector providers to identify the extent of existing therapeutic interventions which are in scope of delivery.

2.5

Improvement in Quality of Services The CCGs’ quality and performance assurance and improvement framework provides robust procedures for understanding and improving the quality and performance of the services that we commission. The strength of our relationships – be they formal or informal – is an essential element of this. We work in partnership with an array of health and social care organisations on a partnership basis with a view to improving the health and wellbeing of our population. Delivering Quality Improvement We proactively work with our providers and partners to improve quality in the services we commission through a number of approaches. Examples, including improvements that we achieved in 15/16, are provided below. CCG walkrounds: The delivery of an intensive programme of CCG walkrounds, with commissioner, clinician and patient representative input. These give the CCGs the opportunity to experience services ‘on the ground’ and identify good practice and areas for improvement in ‘real-time’. These have been undertaken in a range of Acute, Community and Smaller Provider services, and aligned to:

Local priority areas e.g. Accident and Emergency

Areas affected by key national reviews e.g. Maternity, to enable commissioners to see how national guidance is being implemented locally

Trust priorities – in recognition of the value added by the CCG walkrounds, providers have asked the CCGs to conduct walkrounds in specific areas.


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Key Lines of Enquiry: The alignment of quality lines of enquiry to priority clinical areas and constitutional standards, including:

Reviews of root cause analyses for breaches of cancer pathway standards, with a view to establishing any issues regarding patient experience or harm and opportunities for improvement

Audits of clinical notes in Accident and Emergency, with a view to understanding how quality of services are maintained/affected during times of pressure

Acting on themes arising from Serious Incidents such as late diagnosis of cancers

Completing Serious Incident deep dives regarding patient safety. This led to substantial programmes to reduce avoidable harms – in particular, pressure ulcers and falls.

Mock CQC Inspections: In a spirit of learning, improvement and support to our Trusts, the CCGs have been involved in the delivery of Mock CQC visits at USHM and PAHT. These enabled the Trusts proactively to identify areas of good practice and improvement requirements, in support of patient care and forthcoming CQC inspections. Clinical Leadership: CCG clinicians play a key role in supporting our assurance of the quality of our services and establishing expectations for improvements in delivery. Clinicians from across the Manchester CCGs – and often in partnership with Trafford CCG clinicians – have been actively involved during 2015/16, with examples including:

Providing clinical leadership of the city’s System Resilience Groups (SRGs), and associated challenge to our health and social care systems

Providing clinical reviews of notes for those patients identified as long waiters at UHSM via the RTT validation process, to identify if any harm was caused to the patients as a result of the delay in treatment

Providing clinical input to the CCGs’ QIPP programme, to set appropriate parameters with our Acute providers for the levels of improvement required, for example in the ratio of first to follow up appointments

Undertaking a clinical review of the impact of a ‘GP in A&E’ service at UHSM. Patient Experience: The CCGs are committed to putting our patients at the heart of our services and listening to what our patients tell us about their experience of health and care services. This is an important way in which we understand the quality of the services that we commission. Working with the CCGs’ Communication and Engagement Team, we do this through:

The Friends and Family Test - this is well embedded in our Acute providers, with updated requirements for maternity services for 2016/17. We are developing bespoke reports for community services in order to enhance the visibility of patient feedback

Feedback from complaints, comments and compliments, processes for which are well embedded across our providers

Themes arising from Serious Incidents. These are particularly well embedded within our Acutes, who are proactive in reporting and investigating Serious Incidents – including those identified retrospectively following internal audit processes

Feedback from the CCG walkrounds. These give patients and their families/carers the opportunity to talk to the walkround team about their experience of care. Patient representatives also have the opportunity to


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participate in the walkround process

Discussions at the CCGs’ Patient and Public Advisory Groups, which helps to inform service development across the city.

Where elements of service provision are not achieving the expected standards of performance, the CCGs mobilise a robust performance management approach in order to understand the issues affecting performance and the actions and trajectory for recovery. Examples of this during 2015/16 include:

Diagnostic Access: Working with CMFT to understand the issues affecting poor access to diagnostics, including facilitating a dialogue with NHSIQ. Performance managing the Trust’s progress against its recovery plan – including scrutiny of the Trust’s progress against delivery of additional capacity from the wider market place to support backlog clearance and the Trust’s establishment of effective substantive establishment going forwards.

RTT Validation: Working with UHSM to design and deliver a significant validation and assurance process relating to the incorrect recording of incomplete RTT pathways. This involves a clinical review process to assess any harms arising for long waiters identified and a robust assurance process with NHS England and Associate CCGs.

Where the CCGs identify longstanding issues or high risks relating to performance and/or quality, we mobilise a service improvement approach. In line with our strong working relationships with our providers and wider partners, this is delivered in a spirit of collaboration and utilises established improvement methodologies. These workstreams are generally aligned to constitutional standards and national ‘must dos’. Examples from 2015/16 include:

Urgent Care: Working closely with our SRGs to lead our urgent care systems and mobilise partnership responses - and resources - in support of performance recovery and improvement. This represents a significant work programme and partnership infrastructure relating to operational delivery. As part of this work, active involvement in Acute Trust improvement initiatives including ‘perfect weeks’ at each of our Acute providers and a focused event regarding Delayed Transfers of Care at PAHT.

Ambulance Improvement Programme: Working with the North West Ambulance Service, Blackpool CCG and our Acute Providers to undertake deep dives into local operational performance and identify partnership actions to support improvement with regard to ambulance handover times and crew release, and ultimately improved response times.

GM Centralised Stroke Services: Working as part of the Greater Manchester Stroke Operational Delivery Network to mobilise and quality assure a centralised model of hyperacute and acute stroke care for Greater Manchester and East Cheshire, to improve patient access to timely specialist services.

Cancer: Delivery of a cancer improvement programme to respond to challenges relating to delivery of the cancer access standards across the city; alongside wider pathway/model redesign for the city and Greater Manchester to ensure appropriate ‘fit’ for the needs of our population.

Mortality: Working with UHSM to establish an effective clinical process to interrogate the root causes of the Trust’s outlying status for weekend mortality.

Mental Health Improvement Programme: Delivery of an improvement programme for mental health, focused on improving access to timely and equitable mental health and IAPT services across the city.

Learning Disability Transformation: In line with the findings of Manchester’s Learning Disabilities Commissioning Stocktake, the learning from Winterbourne View, and the requirements set out in Building the Right support, development of


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a transformational programme for learning disability services in Manchester.

2.6 Reducing Inequalities A key factor in reducing health inequalities is the recognition that other factors such as deprivation also play a role in creating health inequalities. Despite the economic growth seen over the past decade, Central Manchester continues to suffer from significant levels of deprivation, particularly in the areas of Ardwick, Gorton, Hulme, Moss Side and Rusholme. All of the wards in Central Manchester, with the exception of Chorlton have more people claiming out of work benefits than the England average. Average life expectancy for males in Central Manchester is 75.4 years and for females it is 80.3 years, which is one of the lowest in the country for both men and women. The life expectancy gap within Manchester remains starkly wide. A boy born in the most affluent parts of Manchester is expected to live 8.8 years longer than a boy born in the most deprived areas of the city. Similarly a girl born in the most affluent parts of Manchester is expected to live 7.4 years longer than a girl born in the most deprived parts of Manchester. Manchester was ranked low in terms of early deaths from cancer, heart disease, stroke, lung disease and liver disease. Rates of emergency hospital admissions for chronic ambulatory care sensitive conditions are higher than the national average. Child poverty rates are high as well as high numbers of obese children. As a CCG we have a key role in addressing these health inequalities. We aim to make sure the services we commission offer fair access for all patients and reduce the barriers, disadvantages and poor health outcomes experienced by particularly vulnerable groups. During 2015/16, the CCG has delivered a number of work programmes that will help to reduce inequalities and improve outcomes. Some of these include:

Practice Integrated Care Team - certain areas of the city have particularly poor health outcomes. The purpose of the multi-disciplinary teams is to seek to bridge the gap between the best performing and the worst performing areas by working together to develop and deliver tailored care plans that meet the specific needs of complex patients with multiple long term conditions. Patients receive more joined up and effective care which keeps them healthy and out of hospital.

One Team – working with providers in health and social care to deliver more integrated and accessible out of hospital care in our neighbourhoods, building on the existing integrated care teams that operate in Central Manchester. In 15/16 the CCG has developed a ‘One Team’ specification and key providers are now working together to build an integrated model of care that delivers against the specification. Our work will continue into 16/17 during which time we aim to introduce neighbourhood hubs across all our localities. Offering a more integrated health and social care service in the neighbourhood will help to reduce unwarranted variations by providing a more personalised and tailored offer to the different needs of our diverse community.

Implementation of the Manchester Care Record which connects records from different organisations to allow healthcare professionals to access a comprehensive record for a patient. This gives staff a better picture of a patient’s specific health issues before commencing treatment.


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Moving more health services into the community – including a dermatology service, pain service and diabetes, this helps to improve access and choice and provides care closer to home which is particularly important for those people who may struggle travelling to hospital.

Minor ailment scheme – support patients, particularly those on a low income who are exempt from paying for their medicine, to be treated through their local community pharmacists for minor illnesses such as cold, hay-fever, diarrhoea.

Implementation of primary care standards – all our GP practices have signed up to improving standards particularly around access to their GP. This has helped to address any variations in standards that may have previously existed in our different locality areas.

Homeless patients – targeted work to ensure homeless patients are able to access and receive personalised treatment in the most appropriate setting, reducing their need to repeatedly go into hospital.

Home from Hospital – support patients over 60 who have been discharged from hospital. The support provided has helped to avoid them having to be readmitted into hospital, thereby improving their outcomes and quality of life.

The Manchester CCGs’ Equality Diversity and Human Rights (EDHR) Strategy 2015-19, sets out the CCGs’ clear direction and commitment to reducing health inequalities and promoting equality of opportunity for the people of Manchester. Our Annual Public Sector Equality Report provides examples of work we are delivering to address equality and diversity, health inequalities and identifies future areas for development. We aim to use our equality data for service improvement and use a range of tools to assist with this process. We are a key member of the local Health and Wellbeing Board and work with partners to commission services that improve the health outcomes and wellbeing and reduce the health inequalities of our population. The CCG has an EDHR policy in place through which equality impact analysis is required to be carried out to help inform any decision we make on the health services we commission for the people of Manchester. Equality impact analysis ensures that the health needs of people from different equality groups such as those with a disability, different ethnic groups or people of different ages are taken into account when commissioning health services. The CCG’s Equality Analysis Toolkit also assists managers in undertaking equality analysis, which now incorporates a section on addressing health inequalities. The CCG also works closely with Public Health Manchester in tackling inequalities in health that affect our population, identifying causes and working together to devise and implement effective interventions.

2.7 Public Engagement and Involvement As a CCG, we recognise that we cannot carry out our commissioning responsibilities effectively without understanding the needs, choices and experiences of local people. In the main, we carry out this work in partnership with the other two Manchester CCGs to ensure that it is simpler for local people to engage with and inform, the work of health commissioners in the city.

https://www.centralmanchesterccg.nhs.uk/publications



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We have continued to develop the ways we carry out our public engagement work and these include: Empowering, Facilitating and Supporting Volunteers Our Patient and Public Advisory Group (PPAG) is made up of volunteers from the local community who meet on a regular basis to discuss, design, feedback, inform and review a wide range of work programmes and business cases. All 36 volunteers give up their own time with the aim of benefiting and improving local NHS services for their communities. Individual group members also sit as a public voice on various committees throughout the CCG and these include Quality and Performance, Medicines Area Committee and Strategic Resilience Group. The Patient and Public Advisory Group is chaired by the lay member for patient and public involvement and reports directly to the CCG Board. Members throughout the year have been involved in the development of the One Team specification for the Living Longer Living Better programme of work, hosted a meeting with the lead commissioner for the Patient Transport Service to discuss patient experiences and will now be part of the contract monitoring group for Manchester in 2016. They have also taken part in walkrounds of both small and large providers of services in Manchester. We have three Patient and Public Advisory Groups in Manchester and members are now meeting together on a city-wide basis to discuss, inform and make recommendations on services and areas of work that cover all of the city. PPAG members have also co-designed a community engagement game which we will be using throughout the coming year. We also support over 60 volunteers who are participating in the Macmillan Cancer Improvement Partnership in various ways and co-designing new pathways around breast and lung cancer and in primary care working with GPs. People affected by cancer have shared their experiences with GPs and clinicians involved in the work programme so lessons can be learnt from them. You can watch our MCIP videos by visiting You Tube and searching for Manchester Cancer Improvement Partnership. If you are interested in volunteering for Manchester CCGs, you can email [email protected] or call 0161 765 4004. Engaging with Local Communities Holding information stalls in the community enables us to share information and resources and interact with people in places they visit on a regular basis and are part of their daily lives. Throughout the year we have held over 30 stalls across a range of venues including supermarkets, market stalls, community events and drop-ins, GP practices, hospital trusts and schools. There has also been a wide range of information and resources shared to inform the public about local services and how they can better use and access them. We commissioned a number of engagement projects with voluntary and community sector groups and organisations to engage with protected characteristic groups and communities of interest and identity. This has enabled partnership working and allowed lead commissioners to better understand the communities they are

mailto:[email protected]


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purchasing services for. During 2015/2016, projects were carried out with:

Big Life Families who engaged with Asian parents to understand their use of urgent care services in central Manchester. The report produced is being used to inform commissioning decisions and action being taken as part the Urgent Care Manchester programme.

Manchester Student’s Union who engaged with students to understand health needs and GP registration in Manchester. The report produced highlighted two main themes around support for mental health and support on diet and nutrition. We are continuing our work with the Student’s Union to bring relevant commissioners together to act on the recommendations.

Multi-lingual Manchester who is carrying out research into language barriers people face in accessing GP and local health services. This work is continuing into 2016/2017.

Alzheimer’s Society who engaged with people living with dementia, their carers and support groups to map out support services in Manchester and gather experiences of living with dementia. The mapping of support services can be viewed here: http://www.easymapmaker.com/map/cc2db26e15c76c00d5416e1df7057462

The Proud Trust who engaged with LGBT young people who co-designed a video with top tips for trans* well-being. The video can be viewed here - https://youtu.be/lMe9sAnxIzM A trans* awareness poster has also been developed for young people visiting their GP practices as well as carrying out a literature review of LGBT young people’s health in the UK focusing on needs, barriers and practice. All of these resources have been shared with commissioners across the city in health and social care.

Chances worked in partnership with the CCG’s safeguarding lead to engage with looked after children and care leavers. The learning from this event is being used to inform future engagement work with Looked after Children and Care Leavers within and around Greater Manchester. The key themes from the engagement event which took place included:

Information about Services - The need for better information was highlighted throughout the engagement.

Mental Health Services - Some young people stressed the importance of mental health and the need for better access to mental health services for them and their family.

Communication - Participants at the event stressed the importance of health professionals listening to Looked after Children and Young People and clarifying that they understand what has been said.

Primary Care Services - The majority of young people identified that they would go to their GP/Practice Nurse for advice but that health professionals do not always have a good understanding of the needs of Looked after Children and Care Leavers.

School Nurses/Specialist Looked after Children’s Nurses - Particular praise was given to Looked after Children’s Nurses by the young people.

Hospitals - The distress of lengthy hospital waiting times and cancelled appointments was identified as a concern by some young people.

Female Genital Mutilation (FGM) - Particular reference was made to FGM during the consultation.

Further information on any of the above projects is available by visiting the Manchester CCGs’ website - http://www.manchesterccgs.nhs.uk

http://www.easymapmaker.com/map/cc2db26e15c76c00d5416e1df7057462

https://youtu.be/lMe9sAnxIzM

http://www.manchesterccgs.nhs.uk/


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During the last three months of the year, we have been working with our partners at Manchester City Council and local NHS Trust to engage on the “A healthier Manchester” locality plan. Extensive media, social media and press activity took place along with information stalls and face to face discussion groups held for people to share their feedback. There was also an online survey. All of the information is being analysed and will be presented to the Health and Wellbeing board in June 2016. Digital Engagement Our social media presence has continued to develop and we now have three main platforms that are shared between the NHS North, Central and South Manchester CCGs. These are used to share information and resources, seek feedback on our plans and development, promote engagement opportunities and communicate news and updates about health and social care in Manchester. Using social media enables us to support and promote the activity and services provided by the voluntary and community sector groups in Manchester. We have over 25,000 Twitter followers, a Facebook page and over 800 followers on Pinterest. Listening to Patients and Service Users We have continued to facilitate and support our Mental Health Liaison Group which takes place on a bi-monthly basis and enables service users to have a face to face conversation with CCG commissioners in a group format. This group setting allows for commissioners to hear directly from service users on what is working well, what needs to be improved and to develop a working and trusted relationship. We are also supporting the development of the Charter Alliance, a user led group facilitated by Macc and members have started on a user-led engagement project to listen to experiences of people using crisis services in Manchester. We have also held 4 engagement events and 4 focus groups with people affected by cancer as part of the Macmillan Cancer Improvement Partnership and their work around development of specifications for breast and lung cancer services. Throughout the year we have used patient experience surveys to gather feedback on the use of local NHS services for long-term conditions such as Epilepsy, Dementia and Diabetes. The feedback from patients and carers has been used to inform developments in services.

Complaints and Enquiries Within the period April 2015-March 2016 there have been 124 PALS (Patient Advice and Liaison Service) enquiries for Central Manchester CCG.


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Please see the table below for information regarding the Complaints and enquiries received during that period:

Types of Contacts Central Manchester CCG

Complaint - Commissioner led investigation 12

Complaint - Led by another organisation 5

Complaint - Referred to another organisation 7

Compliment 1

MP Enquiry 6

Total 31

Number of PHSO (Parliamentary and Health

Service Ombudsman)Cases 1

Freedom of Information (FOI) Requests Within the period April 2015-March 2016 no FOI requests have been reported to the

Information Commissioner’s Office.

Please see the table below for information regarding FOI requests received in that period:

FOI Requests

Ap

ril

15

Ma

y 1

5

Ju

ne

15

Ju

ly 1

5

Au

g 1

5

Se

pt

15

Oc

t 1

5

No

v 1

5

Dec

15

Ja

n 1

6

Fe

b 1

6

Ma

r 1

6 Total

Answered within 20

working days 24 18 21 28 22 24 22 23 17 23 20 15 257

Answered in more than

20 working days 0 1 2 2 4 0 1 2 0 3 2 1 18

Ongoing 0 0 0 0 0 0 0 0 1 0 1 6 8

Withdrawn 0 1 0 1 0 0 0 0 1 1 0 1 5

Total 24 20 23 31 26 24 23 25 19 27 23 23 288

2.8

CCG Assurance Framework NHS England has a statutory duty to assess each CCGs performance. It meets this duty through its CCG Assurance Framework. The framework aims to provide confidence to stakeholders and wider public that the CCG is operating effectively to commission safe, high quality and cost effective services and driving continuous improvement in the quality of services and outcomes achieved for patients.


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Central Manchester has been assured as good in its most recent assessment. This means that on the whole the CCG is well led with good capability. If we break this down into the individual assessment components, we find the following:

Well-led Organisation – Assured as good

Performance delivery – Assured as good

Financial management – Assured as good

Planning – Assured as good

Delegated functions (out of hours and primary care co-commissioning) – Assured as good

This is an excellent outcome and shows an improvement from our baseline position at the start of the year where performance and finance were rated as 'limited assurance'.

2.9 Sustainability Performance As an NHS organisation and a spender of public funds, the CCG has an obligation to work in a way that has a positive effect on the communities for which we commission and procure healthcare services. Sustainability means spending public money well, smart and efficient use of natural resources and building healthy, resilient communities. By making the most of social, environmental and economic assets we can improve health both in the immediate and long term even in the context of the rising cost of natural resources. The CCG acknowledges this responsibility to our patients, local communities and the environment by working hard to minimise our footprint.


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The data below is provided by NHS Property Services (NHSPS) regarding the buildings in use by the CCG.

Tenant:

Occupancy Percentage

Electricity 2015/16

Use kWh 863,486

Cost £ 106,935

Carbon Emissions kgCO2 496,435

Use kWh 652,482

Cost £ 80,804


Gas 2015/16

Use kWh 621,926

Cost £ 20,173


Use kWh 53,274

Cost £ 1,728


Water 2013/14 2014/15 2015/16

Parkway 3: Use m3 4,012 1,696 1,396

Cost £ 50,519 11,781 11,118

Carbon Emissions kgCO2 4,223 1,785 1,469

Parkway 1 data is currently unavailable.

Waste 2013/14 2014/15 2015/16

Parkway 3:

Clinical Use t 0 0 0

Cost £ 0 0 0

Carbon Emissions* kgCO2 0 0 0

Domestic Use t 54 65 30

Cost £ 9,794 11,843 5,412

Carbon Emissions* kgCO2 10,746 12,935 5,970

Hazardous Use t 0 0 0

Cost £ 0 0 0


Recycling Use t 0 0 0

Cost £ 0 0 0


Confidential Use t 2 3 4

Cost £ 545 658 1,032


Parkway 1:

Clinical Use t 0 0 0

Cost £ 0 0 0


Domestic Use t 17 60 6

Cost £ 3,016 10,883 1,143

Carbon Emissions* kgCO2 3,383 11,940 1,194

Hazardous Use t 0 0 0

Cost £ 0 0 0


Recycling Use t 0 0 0

Cost £ 0 0 0


Confidential Use t 3 10 2

Cost £ 714 2,577 416


(Carbon conversion factors from SDU reporting template Jan 2016)

* waste carbon emissions may differ depending on exact disposal method


Summary

Parkway 3:

Parkway 1:

Central Manchester CCG occupies 23% of Parkway 3. The Citywide Services occupy 36% of Parkway 1. All data provided below is shown on a

whole building basis therefore the actual usage and cost figures are proportionally less than those detailed.

Parkway 3:

Parkway 1:

Leasehold Properties – Where NHSPS do not own the building, but rather hold a lease with a superior Landlord, information on both finance and consumption may be part of a larger superior service charge. NHSPS has, and continues to make all reasonable efforts to acquire the full breakdown. Water Consumption Calculation – Where we have charges from a superior Landlord the water consumption has been calculated from costs on the basis of using a conversion factor of £3.78 per cubic meter. This conversion figure is an average of the invoices that are invoiced directly to NHSPS by water suppliers.


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Electric Consumption Calculation – Where no details are available for electric consumption the consumption figures have been estimated using a conversion factor of 12.38 pence per unit. This conversion figure is based on an average taken from a representative sample (NHH supplies) of NHSPS properties, and includes all charges, not just the unit rate per kWh. Gas Consumption Calculation - Where no details are available for gas consumption the consumption figures have been estimated using a conversion factor of 3.244 pence per KWh. This conversion figure is based on an average taken from a representative sample of NHSPS properties, and includes all charges, not just the unit rate per kWh. Due to the seasonal nature of gas consumption there has only been minimal projection of the data. Waste Weight - The weight of all waste categories has been estimated based on cost using an appropriate conversion factor. Finance information included in this report is based on the information available at the time of the report’s release (March 2016).

2.10 Equality Performance The CCG is committed to equality, diversity and human rights (EDHR) and also reducing inequalities between patients in terms of their ability to access health services and outcomes. These core principles are a priority when planning and commissioning healthcare services in our region. The CCGs’ strategic aims for EDHR are to:

Reduce unlawful discrimination in all our functions as a commissioner and employer

Reduce inequalities in health among the different groups of people living in the city

Develop a holistic awareness and understanding of communities and their health needs

Commission services from providers who are able to be responsive to the diverse needs of individuals and their families

Promote equality of opportunity and inclusion so that all staff and patients can achieve their potential and have the best life chances possible

Become a strong community leader, championing equality in all aspects of our work with other local partner agencies.

The plans of how we will achieve this are detailed in our refreshed EDHR Strategy 2015-18 and our progress to date on this agenda can be found in our Annual Public Sector Equality Report 2015. Equality, Diversity and Human Rights Strategy (2015-16): https://www.centralmanchesterccg.nhs.uk/equality-diversity-and-human-rights-strategy-and-policy- Annual Public Sector Equality Duty Report 2015 https://www.centralmanchesterccg.nhs.uk/publishing-equality-information

2.11 As Accountable Officer, I approve and agree that the Performance Report is a true

and accurate account of the CCG’s performance.

…………….

https://www.centralmanchesterccg.nhs.uk/equality-diversity-and-human-rights-strategy-and-policy-

https://www.centralmanchesterccg.nhs.uk/equality-diversity-and-human-rights-strategy-and-policy-

https://www.centralmanchesterccg.nhs.uk/publishing-equality-information


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The Accountability Report

3.0 Members Report

3.1 Member Practices Ailsa Craig Medical Practice The Alexandra Practice

The Arch Medical Practice Ashcroft Surgery

Ashville Surgery Drs Chiu, Koh and Gan

Chorlton Family Practice Corkland Road Medical Practice

Cornbrook Medical Practice Dr Cunningham and Partners

The Docs Gorton Medical Centre

Hawthorn Medical Centre Levenshulme Medical Centre

Longsight Medical Practice Manchester Medical

Mount Road Surgery New Bank Health Centre

Drs Ngan and Chan Oswald Medical Practice

Parkside Medical Centre Princess Road Surgery

The Range Medical Centre The Robert Darbishire Practice

Dickenson Road Medical Centre Surrey Lodge Group Practice

West Gorton Medical Centre West Point Medical Centre

The Whitswood Practice The Wilbraham Surgery

Wilmslow Road Medical Centre

3.2 Primary Care The last year has been an exciting and challenging one, with a number of significant developments which have improved both the quality of care and services delivered in primary care; in addition the year has laid the foundations of our plans to transform the way primary care is delivered to our local population. At the beginning of 2015-16, the CCG, together with North and South Manchester CCGs, moved to level 2 joint commissioning of primary care services with NHS England. For us, this formalised what was already a productive relationship with NHS England based on a close working relationship and joint decision making in relation to primary care services. In spite of a difficult financial position, our changing commissioning responsibilities and the pressures currently facing primary care, progress has been achieved across a number of areas. Throughout 2015-16, all 31 of our GP member practices signed up to deliver the Primary Care Standards Engagement Scheme which focused on quality improvement across the following areas:

Improving In hours Access to Primary Care

Improving Outcomes for People Living with Long Term Condition(s)

Member Practice Engagement.

A further standard was implemented, with the aim of reducing the number of unplanned admissions, practices were asked to identify and proactively manage patients in the community that were at high risk of admission to hospital, to improve their overall quality of life and keep them healthier for longer.


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In addition, extended 7 day access to general practice has continued to be delivered across Central Manchester through Primary Care Manchester (our GP Federation). However, the service has grown as the three Manchester GP Federations came together to form the Manchester Primary Care Partnership and successfully bid against the Prime Minister’s Challenge Fund to expand the model already being delivered in Central Manchester. This has meant that all patients registered with a GP in Manchester now have access to general practice 7 days a week (8am-8pm) at a number of locations across the city. Another significant achievement has been our progress on estates developments across Central Manchester. Through collaborative, partnership working we have developed a Strategic Estates Plan which outlines our estates intentions, and how they will support delivery of integrated health and social care, over the next 5 years. The Gorton area has been agreed as a priority by all partners and work is progressing on the development of a multi-disciplinary health and social care hub to provide state of the art, integrated, out of hospital care facilities which will improve the health and wellbeing of our local population. As part of our phased approach, we have identified developments which will be implemented across the remaining three localities over the next few years. As the year has progressed, we have advanced our transformation plans as part of Greater Manchester Devolution, which are outlined in the Manchester Locality Plan. This includes delivering a new model of integrated out of hospital care through our One Team approach supported by estates and infrastructure developments (outlined above). This has involved practices adopting new ways of working to ensure primary care is sustainable and fit for the future; examples include GP practices working more closely together on locality and neighbourhood footprints, to ensure they are an integral part of the One Team approach. To support this, the three Manchester CCGs move to level 3 full delegation of commissioning from 1st April 2016; this will be a key enabler for implementation of our transformation plans moving forward. To ensure the CCG is in a position to transform primary care and take on its new commissioning responsibilities we have reviewed our working arrangements for primary care across the city. This has led to the formalisation of a citywide Primary Care Team which, in a short space of time, led to a number of demonstrable benefits. These include a sharing of knowledge and skills; clear, consistent and demonstrable leadership together with a reduction in duplication of work across the city. As part of this process, we have welcomed several new members to the team and successfully recruited an NHS Leadership General Management trainee. There are further plans to strengthen the team with the recruitment of specific estates and administrative roles. As we move forward, 2016-17 promises to be just as exciting as we take forward our transformation agenda for out of hospital care and make our ambitious, large scale plans a reality.


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3.3 Board Membership The 2015/16 CCG Board has consisted of the following:

Chair – Dr Mike Eeckelaers

Interim Chief Officer - Edward Dyson (from September 2015)

Chief Finance Officer - Joanne Newton. Joanne Newton was also Chief Officer from April 2015 - September 2015.

Clinical Director - Dr Ivan Benett (until January 2016)

Clinical Director - Dr Manisha Kumar (from February 2016)

Locality Chair: Moss Side, Hulme and Rusholme - Dr Manisha Kumar(until March 2016)

Locality Chair: Chorlton, Whalley Range and Fallowfield - Dr Anthony Larkin

Locality Chair: Ardwick and Longsight - Dr Parmjit Moyo

Locality Chair: Gorton and Levenshulme - Dr Dominic Hyland

Board Nurse - Julie Cheetham

Secondary Care Doctor - Peter Williams

Practice Development Manager - Margaret Everitt

Lay Member (Governance) - Grenville Page

Lay Member (Patient and Public Engagement) - Atiha Chaudry

Regular attendee: Deputy Clinical Director - Dr Faizan Ahmed (from February 2016)

Senior Managers regularly attend the Governing Body meeting but cannot vote on any decisions.

Further information about the Central Manchester CCG Board members can be found on our website at: http://www.centralmanchesterccg.nhs.uk/our-board-members Register of Interests The Register of Interests is available on the CCG website at: https://www.centralmanchesterccg.nhs.uk/publications this is updated on a regular basis to show all current staff. Information regarding Board Members who have now left the organisation is available on request. CCG Committees and Board Member Attendance Due to a redesign of the CCG structures, some of the Committees listed below have decreased the frequency of their meetings and changed their functions. Joint Committees take place with North and South Manchester Clinical Commissioning Groups as well as other relevant stakeholders.

Committee Board Member

Joint Executive Team Edward Dyson Dr Mike Eeckelaers Joanne Newton

Joint Finance Committee

Edward Dyson Joanne Newton Grenville Page

Joint Governance Committee

Edward Dyson Grenville Page

http://www.centralmanchesterccg.nhs.uk/our-board-members

http://www.centralmanchesterccg.nhs.uk/our-board-members



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Joint Clinical Commissioning Committee

Peter Williams

Manchester Primary Care Co-Commissioning Joint Committee

Dr Ivan Benett/Dr Faizan Ahmed Grenville Page

Clinical Quality and Performance Committee

Dr Ivan Benett/Dr Manisha Kumar Julie Cheetham Peter Williams

Clinical Reform and Redesign Committee

Dr Ivan Benett/Dr Manisha Kumar/Dr Faizan Ahmed

Executive Team

Dr Ivan Benett/Dr Manisha Kumar/Dr Faizan Ahmed Edward Dyson Dr Mike Eeckelaers Joanne Newton

Finance and Contracting Committee

Dr Mike Eeckelaers Margaret Everitt Joanne Newton Grenville Page

Governance Committee

Julie Cheetham Edward Dyson Grenville Page

Remuneration Committee See Remuneration Report (See 5.6)

Audit Committee See 3.4

3.4

Audit Committee Membership Grenville Page – Chair, Lay Member (Central Manchester CCG) Julie Cheetham – Board Nurse (Central Manchester CCG) Internal audit, external audit, the Chief Finance Officer, members of the finance team and members of the governance team are in attendance at the meetings. Other officers are invited to attend the meeting as required.

3.5 Personal Data Related Incidents Within the period April 2015-March 2016 the CCG has not had any personal data related incidents which have been formally reported to the Information Commissioner’s Office.

3.6 Board Members Statement The Board members know of no information which would be relevant to the auditors for the purposes of their audit report, and of which the auditors are not aware and have taken all the steps they ought to have taken to make themselves aware of any such information and to establish that the auditors are aware of it.


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3.7 Accountable Officer Statement The Accountable Officer knows of no information which would be relevant to the auditors for the purposes of their audit report, and of which the auditors are not aware and has taken all the steps they ought to have taken to make themselves aware of any such information and to establish that the auditors are aware of it. The Annual Report and accounts is a fair, balanced and understandable view of the organisation. As the Accountable Officer, I am responsible for the annual report and accounts and the judgements required to confirm that it is fair, balanced and understandable.


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4.0 Governance Statement

Introduction and context Central Manchester Clinical Commissioning Group was licenced from 1 April 2013 under provisions enacted in the Health and Social Care Act 2012, which amended the National Health Service Act 2006. The CCG operated in shadow form prior to 1 April 2013, to allow for the completion of the licensing process and the establishment of functions, systems and processes prior to the CCG taking on its full powers. As at 1 April 2015, the clinical commissioning group remains licensed without conditions. After a period of secondment the Chief Officer returned to their substantive role within the CCG on 2 May 2016. In taking up the role, the Chief Officer has reviewed the accounts and in conjunction with speaking to the Chief Finance Officer, the Acting Chief Officer and non executives, assured himself of the arrangements in place during the secondment period. Scope of responsibility As Accounting Officer, I have responsibility for maintaining a sound system of internal control that supports the achievement of the clinical commissioning group’s policies, aims and objectives, whilst safeguarding the public funds and assets for which I am personally responsible, in accordance with the responsibilities assigned to me in Managing Public Money. I also acknowledge my responsibilities as set out in my Clinical Commissioning Group Accountable Officer Appointment Letter. I am responsible for ensuring that the clinical commissioning group is administered prudently and economically and that resources are applied efficiently and effectively, safeguarding financial propriety and regularity. Compliance with the UK Corporate Governance Code We are not required to comply with the UK Corporate Governance Code. However, we have reported on our corporate governance arrangements by drawing upon best practice available, including those aspects of the UK Corporate Governance Code we consider to be relevant to the clinical commissioning group, namely:

Leadership Effectiveness Accountability Remuneration Relationships with stakeholders.

The Clinical Commissioning Group Governance Framework The National Health Service Act 2006 (as amended), at paragraph 14L(2)(b) states: The main function of the governing body is to ensure that the group has made appropriate arrangements for ensuring that it complies with such generally accepted principles of good governance as are relevant to it. The CCG Constitution states that in accordance with section 14L (2) (b) of the 2006 Act, 2014 the Group will at all times observe “such generally accepted principles of good governance” in the way it conducts its business. These include:


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the highest standards of propriety involving impartiality, integrity and objectivity in relation to the stewardship of public funds, the management of the organisation and the conduct of its business

the Good Governance Standard for Public Services the standards of behaviour published by the Committee on Standards in Public Life

(1995) known as the “Nolan Principles‟ the seven key principles of the NHS Constitution the Equality Act 2010 Standards for Members of NHS Boards and Governing Bodies in England.

Membership of NHS Central Manchester Clinical Commissioning Group is open to all practices that sit within, or take the majority of their patients from the wards of Ardwick, Chorlton, Fallowfield, Gorton North, Gorton South, Hulme, Levenshulme, Longsight, Moss Side, Rusholme and Whalley Range (see 1.2). It is also open to practices that lie outside of these wards but have formerly been members of CMCCG. As a clinically led organisation, 31 general practices collectively form the membership of NHS Central Manchester Clinical Commissioning Group. The CCG’s Governing Body takes overall responsibility for governance throughout the organisation but discharges some of its responsibilities to a number of committees, primarily the Audit, Finance, Quality, Remuneration and Governance Committees. In addition to governance, the Governing Body and its delegate Committees place a clear focus on the services, performance and patient safety of its commissioned providers. For a full list of committees, including their responsibilities and membership, please refer to Appendix B. The Governing Body and I are happy with the effectiveness of the Board and its Committee structure. Throughout the third year since authorisation, the Board has continued to evolve and review its priorities, effectiveness and vision for the organisation on a regular basis. The Board members are sufficiently diverse to contribute to a number of varying CCG duties and together I am assured we comprise an effective group of individuals that are capable of overseeing the effective running of the CCG. During the year training has been provided on a number of governance related topics to the Governing Body and its members. The Board meets on a monthly basis with alternate public and development meetings. The Clinical Commissioning Group Risk Management Framework The CCG Risk Management Framework (RMF) is designed to provide a guideline and strategy for the development of a robust risk management system across the organisation. It includes the key risk principles of initiation, identification, assessment and control. The organisation understands that it is imperative to embed the processes for managing risk within all its activities. Therefore, the RMF outlines that at the start of every new project, work stream or business plan the risk management framework must be considered and implemented. The RMF has been subject to scrutiny during a number of audits and improvements over the past year. Risk management is the priority of all staff and the successful management of risk relies on all staff initiating the risk management process. Training has been provided for all staff involved in managing risk at all levels of the organisation. Incident reporting is encouraged at the staff induction and by senior and line managers. The RMF is supplemented by a number of organisational policies and procedures that enhance the risk management capabilities of the CCG.


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Risk is also discussed with public and patient stakeholders. It is a subject matter presented as part of the Board Assurance Framework in the public section of the Board and individual risks are discussed at the Patient and Public Advisory Board on an ad hoc basis. The effectiveness of the Risk Management Framework is discussed later in this statement. Risk Assessment Risks are assessed in regards to the level of controls and assurances that are in place and are scored on the severity (or consequence) and likelihood of occurrence which is plotted on a 5x5 matrix. The resulting score is categorised as either ‘acceptable’, ‘manageable’ or ‘serious’. This outlines the organisation’s risk appetite. The CCG understands that realistically it is never possible to eliminate all risks. There will always be a range of risks identified within the organisation that would require us to go beyond ‘reasonable’ action to reduce or eliminate them and thus all risks graded between one and six are defined as ‘acceptable’. Manageable risk, scores between eight and fourteen, can realistically be reduced within a reasonable time scale through cost effective measures. Lastly serious risks, scoring over fifteen, may have serious consequences that could impact on the organisation and threaten its primary objectives. Risk is identified within the organisation in a number of ways, and not just through risk assessments. The CCG understands that incident reporting, complaints, claims, GP identified quality issues, internal and external audits, patient feedback and national or regional guidance can help to identify risk. Once identified, risk is controlled through actions from the CCG officer with designated responsibility for that risk and reported through the organisational governance structure depending on its grading and impact on objectives. All risks within the organisations are attached to a particular committee whose role it is to oversee the management of current risks and to deter and prevent future risks occurring. As part of the Board Assurance Framework, the Governing Body receives reports from each Committee detailing the delivery of work, and associated risks, within their specific remit. In addition, the Governing Body has a number of significant, strategic risks for its specific overview. During 2015/16, these risks have covered the following areas (details of how we manage and mitigate the risks can be found in our Board papers on the CCG’s website):

CCG financial challenges Financial challenges across the health and social care economy in Manchester Mental Health – service quality, sustainability and finance Capacity of the CCG Failure to manage demand on local services Capacity in Primary Care Ability to accurately measure progress against strategic objectives National targets Quality Managing partnerships and operating as an effective membership organisation Impact of Greater Manchester health and social care devolution.

The CCG shares a Joint Governance Committee with the other two CCGs in Manchester. This Committee keeps the RMF under review and monitors the effectiveness of risk management and reporting. The Clinical Commissioning Group 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.


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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. Controls Assurance Framework The CCG’s system of internal control has a key role in the management of governance issues and risks that are significant to the fulfilment of its business objectives. A sound system of internal control contributes to safeguarding the organisations business interests. The ‘Controls Assurance Framework’ facilitates the effectiveness and efficiency of operations, helps ensure the reliability of internal and external reporting and assists compliance with laws and regulations. The ‘Controls Assurance Framework’ forms the basis for monitoring the internal control systems throughout the CCG. Lead CCG officers are responsible for assessing all key business areas, providing a RAG rating, and identifying actions being taken to address any weaknesses in controls. The full Framework is reviewed on a regular basis at the Joint Governance Committee and reported on to the Board. The key business areas are as follows:

• Financial Reporting • Financial Management • Internal Control (Corporate Governance) • Regulation and Compliance • Planning, Commissioning and Value for Money • Organisational Development.

Information Governance The NHS Information Governance Framework sets the processes and procedures by which the NHS handles information about patients and employees, in particular personal identifiable information. The NHS Information Governance Framework is supported by an information governance toolkit and the annual submission process provides assurances to the clinical commissioning group, other organisations and to individuals that personal information is dealt with legally, securely, efficiently and effectively. We place high importance on ensuring there are robust information governance systems and processes in place to help protect patient and corporate information. This is reflected in our decision to boost managerial Information Governance capacity and capability, ceasing to ‘buy in’ our support and creating a specialist internal team instead. We have reviewed and developed our information governance management framework, improving our information governance processes and procedures in line with the information governance toolkit. We have ensured all staff undertake annual information governance training and have implemented a staff information governance handbook to ensure staff are aware of their information governance roles and responsibilities. We have carried out a series of Privacy Impact Assessments across all relevant areas and undertaken a review of our Information Asset Register. All Information Governance risks that have been highlighted in 2015/16 have either come from the Information Asset Register work which has been carried out during the year or from large risks identified with data management. The risks are identified through the Data Mapping Tool on the IG Toolkit then uploaded on the DATIX system where they are managed. The risk level is identified through the Data Mapping Tool on the IG Toolkit which is determined through confirmation of the data flows by the Information Asset Owners.


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There are processes in place for incident reporting and investigation of serious incidents. We have developed information risk assessment and management procedures and a programme is underway to fully embed an information risk culture throughout the organisation. The IG toolkit is subject to independent review by the internal auditors which has provided significant assurance. Review of economy, efficiency & effectiveness of the use of resources The CCG has an obligation to use its resources efficiently, effectively and economically. In addition it must meet financial requirements as set out by NHS England. This includes delivering a surplus position over and above a balanced budget. In order to mitigate and control risks associated with the CCGs use of resources, organisational financial health is checked and reported to the Governing Body on a monthly basis. The Governing Body has also delegated responsibility for some aspects of financial internal control to the Finance Committee. The CCG has produced an annual financial plan, in line with NHSE planning guidance and this has supported the agreement of an opening budget at the March Board. In addition to this plan, the Board has received strategic financial plans for the period to 2020/21.The CCG is working with partners at CMFT, UHSM, PAHT, MMHSCT, NMCCG, SMCCG and MCC to produce a health economy financial plan, to support the development of a locality plan for Manchester and an overall Greater Manchester Sustainability and Transformation plan. These have been reported to the Finance Committee and the Governing Body, providing assurance to the Governing Body and myself that the organisation is effectively managing its resources and understanding the key financial risks. The CCG has developed a robust process regarding business case approval which demonstrates effectiveness and value for money. In addition to internal controls, the CCG produces robust Quality, Innovation, Productivity and Prevention (QIPP) plans which aim to mitigate financial pressures and improve healthcare for the local population. The CCG completes monthly and periodic returns to NHS England to report upon how the CCG’s resources have been spent. Additionally the CCG undertakes a monthly self-assessment against the externally monitored financial indicators within ‘Domain 4’ of the national CCG Assurance Framework. Financial information is monitored by the Finance Committee and reported to the Governing Body on a routine basis. Feedback from delegation chains regarding business, use of resources and responses to risk The Governing Body of the CCG delegates responsibility for managing specified aspects of its business to the Committee structure detailed in Appendix B. As detailed above, the Governing Body receives reports from each Committee detailing the delivery of work, and associated risks, within their specific remit. Additionally, the Governing Body proactively identifies and assess risks and issues straddling Committees. These risks are specifically ‘owned’ and overseen at Governing Body level and scrutinised at each meeting to ensure appropriate management and reporting. The internal audit process is used to provide an in-depth examination of any areas of concern and the Controls Assurance Framework provides assurance that the statutory duties of the CCG are being managed appropriately at the different levels of the organisation.


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Review of the effectiveness of Governance, Risk Management & Internal Control As Accounting Officer, I have responsibility for reviewing the effectiveness of the system of internal control within the clinical commissioning group. Capacity to Handle Risk The Governing Body has placed great emphasis on the responsibility of staff to identify, manage and mitigate risk. As previously mentioned the Risk Management Framework, approved by the CCG Board, outlines the roles and responsibility for handling risks of all staff and places great emphasis on the role of all staff to be involved within the risk process. The CCG has procured a ‘live’ web based risk management system that has been tailored specifically for the organisation’s needs. This replaces a paper based system which was difficult to manage and labour intensive. The new system has increased the organisation’s capacity to handle risk. Key staff are provided with in-depth risk management training by the internal Corporate Governance Team as well as training on the web based risk management system. In addition to the approved Risk Management Framework further guidance has been developed for use by staff in handling risk. The organisation’s capacity to handle risk is effective. Review of Effectiveness My review of the effectiveness of the system of internal control is informed by the work of the internal auditors and the 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. The Risk and assurance framework provides me with evidence that the effectiveness of controls that manage risks to the clinical commissioning group achieving its principle objectives have been reviewed. This is supplemented by a number of differing effectiveness reviews such as the aforementioned Governance and Committee Structure Audits, internal and external audits and reporting by the committees to the board on key issues relevant to their discharged responsibilities of those committees. I have been advised on the implications of the result of my review of the effectiveness of the system of internal control by the Governing Body, the Audit Committee and the Joint Governance Committee and a plan to address weaknesses and ensure continuous improvement of the system is in place. Actions include:

Ensuring Governing Body discussions on risk are robust and detailed Working with commissioning partners in the city to develop joint decision making fora Ensuring that CCG risks are appropriately managed within the increasingly integrated

commissioning landscape in Manchester.

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.


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Introduction In accordance with Public Sector Internal Audit Standards, the Director of Internal Audit (HoIA) is required to provide an annual opinion, based upon and limited to the work performed, on the overall adequacy and effectiveness of the organisation’s risk management, control and governance processes (i.e. the organisation’s system of internal control). This is achieved through a risk-based plan of work, agreed with management and approved by the Audit Committee, which should provide a reasonable level of assurance subject to the inherent limitations described below. The purpose of this Director of Internal Audit Opinion is to contribute to the assurances available to the Accountable Officer and the Governing Body which underpin the Governing Body’s own assessment of the effectiveness of the organisation’s system of internal control. Opinion My overall opinion is: Significant Assurance, can be given that there is a generally sound system of internal control designed to meet the organisation’s objectives, and that controls are generally being applied consistently. However, some weaknesses in the design or inconsistent application of controls put the achievement of a particular objective at risk. This opinion is provided in the context that the CCG like other organisations across the NHS is facing some challenging issues in respect of financial sustainability. The Manchester Locality Plan outlines the vision for health and social care integration in Manchester and major transformation programmes that aim to address the local and citywide financial gaps over the next five years. Greater Manchester health and social care devolution is also gathering momentum and work is ongoing to finalise governance arrangements both at programme and provider levels in advance of full devolution from April 2016. The Greater Manchester Strategic Plan recently endorsed by the Strategic Partnership Board in December 2015 sets out the principles and approaches to transforming public services for Greater Manchester and has identified five transformational areas which include population health prevention, community based care and support, standardising acute and specialist care, clinical support and back office functions and enabling better care.

The CCG in association with Manchester City Council through its locality plan submissions into the Greater Manchester Sustainability and Transformation Plan, also has the opportunity to apply for access to additional funding that is crucial to support the required transformational change across Manchester.

These areas will bring new opportunities to allow for greater integrated working and improving outcomes, and the CCG will need to ensure that the governance arrangements to support these developments are robust and support the scale and level of pace of these projects. Basis of Forming the Opinion The basis for forming my opinion is as follows: Assurance Framework The organisation’s Assurance Framework requires improvement to meet NHS requirements and could be more visibly used by the Governing Body. The Assurance Framework clearly reflects the risks discussed by the Governing Body.


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Whilst there are enhancements to be made in respect of the format and use of the Assurance Framework, it is clear that the Governing Body has reviewed the strategic risks facing the organisation and that these have been scored and managed in accordance with the organisation’s Risk Management Framework. The full Assurance Framework is presented to the Governing Body and the agendas demonstrate that assurances are received in respect of the strategic risks. Areas for enhancement include:

Mapping risks to strategic objectives (e.g. cross referenced)

Including Governing Body ‘Assurances’ (and any gaps in assurance) for each risk

Ensuring that Governing Body minutes more clearly demonstrate assurances received by the Governing Body through GB reports, Committee minutes and/or Committee Chairs’ summary reports as well as actions/mitigations planned and required.

Assurance across the organisation’s critical business systems

ACCESS TO SERVICES Documentation, evaluation and review of Provider Contract Management arrangements, which provided significant assurance that adequate contract management processes are in place for the CCG to monitor, manage and report on the fulfillment of contractual obligations by main providers and to identify occasions where the providers do not deliver on their quality responsibilities. An area of improvement identified was to ensure sufficient coverage of the performance and quality of other smaller providers. TRANSPARENCY AND GOVERNANCE Mandated review of your Information Governance Toolkit concluded significant assurance as our assessment found a clear IG organisational structure with associated processes being developed and refined for identifying, improving and embedding Information Governance issues and improvements. This year’s IG Toolkit assessment agreed majority of the scores claimed by the CCG although some areas required maintenance of additional evidence to substantiate self-assessment scores. PATIENT PARTICIPATION AND CUSTOMER SERVICES Core processes underpinning the organisation’s systems for the management of Equality and Diversity in Commissioning received significant assurance based on the adoption of the Equality Delivery System 2 (EDS 2) as a systematic approach to compliance and the development and review of equality objectives through local engagement with patients, the public and other local stakeholders. Strategic and Operational plans also reflect the organisation’s responsibilities of ensuring all communities have equal access to health services commissioned. The CCG has also fulfilled its external reporting requirements.

INFORMED COMMISSIONING Significant assurance opinion on the baseline assessment of Primary Care Co- Commissioning arrangements confirming the establishment of the foundations for co-commissioning and a governance structure that overall, is in compliance with NHS England standards and guidance. Areas of improvement were identified in relation to supporting arrangements and staff capacity, in particular to ensure that the CCG fully discharges its duties in relation to contractual, performance and quality management of Primary Medical Care services. FOLLOW UP Follow-up review demonstrated good progress against action plans to improve systems and control, in line with agreed timeframes.


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Action has been agreed by Management to address the recommendations made in the internal audit reviews and we will continue to undertake follow up of the recommendations to provide assurance to the Joint Audit Committee that the issues raised have been addressed.

Contribution to Governance, Risk Management and Internal Control enhancements:

Detailed insight into the overall Governance and Assurance processes gained from liaison throughout the period with the Chief Finance Officer, Head of Corporate Services and Senior Management Team. Regular review of Governing Body papers and work to develop the Assurance Framework.

Ongoing discussion with lead Officers, Managers and Audit Committee Chairs throughout the period leading to changes to the audit plan in respect of deferral of the Governance Structures Review and reallocation of resources to deliver Medicines Management QIPP.

Effective utilisation of internal audit including communication, requests for support in NHS England: Financial Control Evaluation and Delegated Functions Self-Assessments.

Provision of MIAA briefings including Cyber Security and update on Investigations in the NHS.

Involvement through MIAA events, including Lay Member Learning Series, and Audit Committee Chairs.

Engagement with MIAA Insights benchmarking and outcome reporting, including Assurance Frameworks, Annual Governance Statements and Financial Control Evaluation Assessment.

In providing this opinion I can confirm continued compliance with the definition of internal audit (as set out in your Internal Audit Charter), code of ethics and professional standards. I also confirm organisational independence of the audit activity and that this has been free from interference in respect of scoping, delivery and reporting.

The opinion is derived from the conduct of risk based plans generated from a robust and organisation-led Assurance Framework. The opinion does not imply that Internal Audit have reviewed all risks and assurances relating to the organisation.

Tim Crowley Director of Audit, MIAA March 2016 Audit Review Outcomes and Delivery

Performance against Plan The Internal Audit Plan has been delivered in accordance with the schedule agreed with the Joint Audit Committee in October 2015. This position has been reported within the progress reports since then, with the final report concluding completion of the Internal Audit Plan, with the exception of Medicines Management QIPP. The review has been completed however, completion of the final report and agreement of management responses to the recommendations are still required. The review will be reported to the Joint Audit Committee and will form part of the 2016/17 Director of Audit Opinion.

Risk Based Reviews The audit assignment element of the Opinion is limited to the scope and objective of each of the individual reviews. Detailed information on the limitations to the reviews has been provided within the individual audit reports and through the Joint Audit Committee Progress reports throughout the year. The schedule below provides a summary of the reviews and overall objectives contributing to this element of the Opinion.


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HIGH ASSURANCE: Our work found some low impact control weaknesses which, if addressed would improve overall control. However, these weaknesses do not affect key controls and are unlikely to impair the achievement of the objectives of the system. Therefore we can conclude that the key controls have been adequately designed and are operating effectively to deliver the objectives of the system, function or process

None of the reviews were awarded High Assurance.

SIGNIFICANT ASSURANCE: There are some weaknesses in the design and/or operation of controls which could impair the achievement of the objectives of the system, function or process. However, either their impact would be minimal or they would be unlikely to occur.

Primary Care Co-Commissioning Objective: To assess the effectiveness of arrangements for co-commissioning to ensure newly established processes are operating as designed and that governance arrangements comply with NHS England standards and guidance. Key risks facing the CCGs in assuming delegated commissioning responsibilities were also considered. Recommendations: 0 x Critical, 1 x High, 6 x Medium, 1 x Low.

Provider Contract Management Objective: To evaluate the effectiveness of the contract management processes and to ensure there are mechanisms in place to ensure that the CCG receives assurance from the providers in relation to their performance and the quality of services commissioned. Recommendations: 0 x Critical, 0 x High, 3 x Medium, 2 x Low.

Equality and Diversity in Commissioning Objective: To provide assurance that the CCG has systems and processes in place to ensure that there is genuine local engagement with patients, the public and other local stakeholders in the development and review of equality objectives and compliance with section 149 of the Equality Act 2010 (Public Sector Equality Duty) through the Equality Delivery System 2 (EDS 2). Recommendations: 0 x Critical, 0 x High, 0 x Medium, 3 x Low.

Information Governance Objective: To provide an opinion on the adequacy of policies, systems and operational activities to complete, approve and submit its IG Toolkit scores. The review also provided an opinion on the validity of the scores based on the evidence available. Recommendations: N/A

LIMITED ASSURANCE: There are weaknesses in the design and/or operation of controls which could have a significant impact on the achievement of the key system, function or process objectives but should not have a significant impact on the achievement of organisational objectives.

None of the reviews were awarded Limited Assurance.

NO ASSURANCE: There are weaknesses in the design and/or operation of controls which [in aggregate] have a significant impact on the achievement of key system, function or process objectives and may put at risk the achievement of organisational objectives.

None of the reviews were awarded No Assurance.

CONTRIBUTION TO CONTROL ENVIRONMENT: Areas where MIAA have supported the organisation in strengthening arrangements in respect of governance, risk management and internal control.


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Delegated Functions: Self-Certification Objective: To review the process in relation to completing and finalising the quarterly self-certification returns to NHS England in respect of delegated functions (Out of Hours and Primary Care Co-Commissioning).

Financial Control Environment Objective: To support the CCG in its completion of the Financial Control Environment Self-Assessment Checklist.

MIAA Insight Briefings and Benchmarking Objective: To provide a range of briefing notes and benchmarking reports on topical issues to support organisations in keeping up to date on key issues, challenge questions and opportunity to compare themselves with other.

MIAA Events Objective: Our events and conference programmes attract leading speakers from the NHS, government, policy and voluntary sector, giving delegates access to the latest policy thinking, best practice and innovations across the UK, whilst also providing an ideal networking opportunity.

Follow up An important aspect of the internal audit process is the follow up to ensure that opportunities for enhancement are delivered. During the course of the year we have undertaken follow up reviews in respect of 27 assignments (160 recommendations) undertaken across the three CCGs (North, Central and South Manchester) since 2012/13, by the previous internal auditors. These include:

Adoption & Fostering

Value for Money/ QIPP

Payroll

Procurement

Healthier Together

Risk Management

Conflicts of Interest

Monitoring of Investment Projects

The review confirmed that 122 recommendations have either implemented or superseded out of 160. Actions identified as partially implemented included 9 rated as high with progress on implementation evidenced during follow up. We will continue to track and follow up outstanding actions and report progress to the Joint Audit Committee. End of Head of Internal Audit Opinion Data Quality During the organisation’s third year, reporting to the Board has been adapted and data quality has evolved to meet the expectation of myself and my fellow Governing Body members. The CCG has gained accreditation which helps in ensuring data quality is of the highest standard such as the Accredited Safe Haven work and the Secure Environment for Finance accreditation. Having assessed the quality of data submitted to and reviewed by the board (with advice taken from my fellow Board members), I am assured that the data is of sufficient quality that the Governing Body can carry out its duties.


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Business Critical Models The CCG has produced and maintains an organisational Information Asset Register which identifies business critical assets, HR assets, PCD assets and financial assets for each service within the CCG. Information Asset Owners and Information Asset Administrators have been assigned and all information assets are regularly reviewed. The SIRO is responsible for identifying and managing the information risks. The SIRO received regular reports highlighting any risks. Data Flow mapping has been completed which enables an understanding of the flows of information related to all information assets with the Information Asset Register. Information Asset Owners are responsible for providing updates and highlighting any risks to the SIRO. Business continuity plans are in place and regularly reviewed to ensure that controls are in place and any risks are mitigated appropriately. Data Security The Information Toolkit 2015/2016 was submitted and achieved a satisfactory level of compliance with Interim Accredited Safe Haven (ASH) status maintained. Discharge of Statutory Functions Arrangements put in place by the clinical commissioning group and explained within the corporate governance framework have been developed with legal input, to ensure compliance with the all relevant legislation. That legal advice also informed the matters reserved for Membership Body and Governing Body decision and the scheme of delegation. In light of the Harris Review, the clinical commissioning group has reviewed all of the statutory duties and powers conferred on it by the National Health Service Act 2006 (as amended) and other associated legislation and regulations. As a result, I can confirm that the clinical commissioning group is clear about the legislative requirements associated with each of the statutory functions for which it is responsible, including any restrictions on delegation of those functions. Responsibility for each duty and power has been clearly allocated to a lead Director. Directorates have confirmed that their structures provide the necessary capability and capacity to undertake all of the clinical commissioning group’s statutory duties. Conclusion In conclusion I feel that the CCG has no significant internal controls issues to report. Throughout the year some deficiencies were identified through proactive self-assessment audits as well as internal and external audits. Any issues identified have been fully rectified by the development and implementation of action plans to address the risks to the Governance framework. I am satisfied with the work of the CCG in the financial year of 2015/16 and look forward to continuing to deliver the CCG’s vision and progress its priorities. Ian Williamson Accounting Officer 26th May 2016


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5.0 Remuneration Report

5.1 The remuneration report covers the senior management of the clinical commissioning group. The definition of a senior manager is: “Those persons in senior positions having authority or responsibility for directing or controlling the major activities of the clinical commissioning group. This means those who influence the decisions of the clinical commissioning group as a whole rather than the decisions of individual directorates or departments. Such persons will include advisory and lay members”. The Government Financial Reporting Manual states that “information will be given in all circumstances and all disclosure in the Remuneration report will be consistent with identifiable information of those individuals within the financial statements”. The remuneration report covers the clinical commissioning group’s governing body including all people who are currently on the board plus any which have left their post during the 2015/16 financial year.

5.2 Employee Remuneration In line with the Health and Social Care Act each individual CCG may appoint persons to be employees as it considers appropriate and is able to:

Pay its employees remuneration and travelling or other allowances in accordance with determinations made by its governing body

Employ them on such terms and conditions as it may determine. The guidance produced by the Commissioning Board was used to support the employment of senior staff following the CCG becoming a statutory and employing body. Whilst it is recognised the CCGs have flexibility in determining remuneration levels, the remuneration committee followed the arrangements set out in the NCB guidance in determining, reviewing and operating their own pay arrangements for senior managers. The guidance was based on the principles, which have been informed by and are consistent with the principles set out in the Will Hutton Fair Pay Review. The remuneration of the Governing Body of the CCG is the responsibility of the Remuneration Committee. When taking any decision, any members who are personally affected by this decision are not included in any discussions or vote to avoid any conflict of interest.

5.3 Policy on Remuneration of Senior Managers The Remuneration Committee have responsibility for setting the pay of the CCG Governing Body and senior managers within the CCG. In making its decisions all relevant guidance has been followed including the NHS England document ‘CCGs – Remuneration Guidance for Chief Officers and Chief Finance Officers’ and ‘CCG Remuneration Guidance’ issued by the Hay Group. When considering pay awards the Remuneration Committee will consider national awards, affordability and benchmark data for similar size organisations to enable a recommendation to be reached.


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The pay of the Governing Body is not currently directly linked to performance, that is, there is no specific performance related pay. However, both the Governing Body and its individual members are subject to performance evaluation. Each member of the governing body is subject to an annual appraisal.

5.4 Policy on Senior Managers Contracts The contract for senior managers states that: If the employee wishes to terminate their employment, they must give the CCG an appropriate period of notice in writing - a maximum of 6 months. The CCG will give one week’s notice for each year of service subject to a minimum of one month and a maximum of 6 months. The CCG shall be entitled to terminate the individual’s employment summarily, i.e. without notice or pay in lieu of notice, without prejudice to any rights or claims it may have against them, if at any time they are guilty of gross misconduct or if they commit any serious breach of a material term of their contract of employment. If the individual is employed on a fixed term contract, their employment will terminate on the expiry of the fixed term without the need for the CCG to give any additional notice. The CCG may require an individual to take any outstanding annual leave entitlement during their notice period, whether notice to terminate is given by them or by the CCG.

Once the individual or the CCG has served notice to terminate employment, the CCG may require the individual to remain away from work and to cease to carry out their normal duties for the whole or any part of the notice period (known as “garden leave”). During any period of garden leave:

The CCG shall be under no obligation to provide the individual with any work but may require them to carry out alternative duties.

The individual will remain an employee of the CCG, bound by the terms of their contract and will continue to receive their salary in the usual way.

The CCG may exclude the individual from any of its premises but may require the individual to ensure that their line manager knows where they will be and how they can be contacted during each working day (except when they are on authorised annual leave, booked in the usual way).

The CCG may require the individual not to contact (or attempt to contact) any employee, client or supplier without the consent of their line manager.

There are no special provisions for termination due to redundancy other than those stated for all employees in the CCG’s Organisational Change policy.

5.5 Senior Managers Service Contracts There are members of the Governing Body whose services are via a Contract for Services. These are for a 3 year period from 1 April 2013 until 31 March 2016. The termination arrangements for these individuals are as follows: Continuation of their appointment is contingent on their continued satisfactory

performance and re-election/selection by the members as required by the Constitution. If the members do not re-elect the individual as a Governing Body


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Member in accordance with the Constitution, their appointment shall terminate automatically and with immediate effect.

The individual may resign from the CCG at any time by giving written notice to the Chair.

The CCG reserves the right to terminate their appointment with immediate effect and without payment of compensation by written notice.

On termination of the appointment, the individual shall only be entitled to accrued fees as at the date of termination, together with the reimbursement of any expenses properly incurred prior to that date.

Due to the terms in the contract for service there is no liability to the clinical commissioning group in the event of early termination.

5.6 Remuneration Committee Membership The Remuneration Committee has met three times in the last year in April, October and November. The membership for the meeting is:

Grenville Page – Lay Member (Governance)

Julie Cheetham – Board Nurse

Peter Williams – Secondary Care Doctor

Atiha Chaudry – Lay Member (Patient and Public Engagement) Regular attendees:

Sharmila Kar – Head of Human Resources (HR) and Organisational Development

Edna Gibson – HR Business Partner

5.7 Salaries & Allowances For each member of the Governing Body who has served during the financial year 2015/16, remuneration and pension benefits are shown below.

(a) Salary &

fees

(b)

Expense

Payments

(c)

Performan

ce-related

bonuses

(d) Long-

term

performance-

related

bonuses

(e) All

pension-

related

benefits

Total (a) Salary &

fees

(b) Expense

Payments

(c)

Performan

ce-related

bonuses

(d) Long-

term

performan

ce-related

bonuses

(e) All

pension-

related

benefits

Total

Name of senior

manager

Job title (and period of office if

relevant)

£000s

(Band of

£5,000)

(Nearest

£100)

£000s

(Band of

£5,000)

£000s

(Band of

£5,000)

£000s

(Band of

£2,500k)

£000s

(Band of

£5,000)

£000s

(Band of

£5,000)

(Nearest

£100)

£000s

(Band of

£5,000)

£000s

(Band of

£5,000)

£000s

(Band of

£2,500)

£000s

(Band of

£5,000)

Ed Dyson (1)Executive Board Member - Chief

Officer65-70 400 0 0 135-137.5 200-205 N/A 0 0 0 N/A N/A

Joanne New ton (2)Executive Board member - Chief

Finance Officer80-85 500 0 0 45-47.5 130-135 40-45 0 0 0 55-57.5 95-100

Kym Green (3)Executive Board member - Chief

Finance Officer20-25 300 0 0 35-37.5 55-60 N/A 0 0 0 N/A N/A

Craig HarrisExec Nurse & Director of City Wide

Commissioning & Quality35-40 500 0 0 22.5-25 60-65 35-40 0 0 0 30-32.5 70-75

Ivan Benett (4)Executive Board Member - Clinical

Director60-65 0 0 0 5-7.5 65-70 80-85 0 0 0 15-17.5 95-100

Michael Eeckelaers Executive Board Member - GP Chair 80-85 0 0 0 10-12.5 95-100 80-85 0 0 0 15-17.5 95-100

Anthony LarkinExecutive Board Member - Locality

Chair15-20 0 0 0 5-7.5 20-25 15-20 0 0 0 197.5-200 195-200

Manisha KumarExecutive Board Member - Locality

Chair20-25 0 0 0 27.5-30 50-55 10-15 0 0 0 (2.5-5) 10-15

Parmjit MoyoExecutive Board Member - Locality

Chair10-15 0 0 0 (0-2.5) 10-15 10-15 0 0 0 2.5-5 15-20

Dominic HylandExecutive Board Member - Locality

Chair10-15 0 0 0 22.5-25 35-40 10-15 0 0 0 (0-2.5) 10-15

Grenville Victor Page Board Member - Lay Member 10-15 0 0 0 0 10-15 10-15 0 0 0 N/A 10-15

Margaret Everitt (5)Board Member - Practice

Development Manager5-10 0 0 0 0 5-10 5-10 0 0 0 N/A 5-10

Dr Faizan Ahmed (7) Deputy Clinical Director 5-10 0 0 0 0 5-10 N/A N/A N/A N/A N/A N/A

Julie Cheetham (6) Board Nurse 15-20 0 0 0 0 15-20 15-20 0 0 0 N/A 15-20

Dr Peter Williams (6) Secondary Care Doctor 20-25 0 0 0 0 20-25 10-15 0 0 0 N/A 10-15

A Chaudry Lay Member Patient & Public

engagement5-10 0 0 0 0 5-10 N/A N/A N/A N/A N/A N/A

2015/16 2014/15


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Note 1 - Joanne Newton and Craig Harris are employed by Central Manchester CCG but are shared posts between Central Manchester CCG, North Manchester CCG and South Manchester CCG. The salary figures presented reflect Central Manchester CCG's share of the remuneration but the individuals total banded salary figures are: Joanne Newton £65k- £70k (reflecting secondment arrangements for the period as Accountable Officer) and Craig Harris £105k-£110k. Joanne Newton also reflects the period working solely for Central Manchester CCG. Note 2 - Ian Williamson is employed by Central Manchester CCG but during 2015/16 has been on secondment to the Healthier Together programme and Devolution Manchester, with no role within the CCG during the period and is therefore not included within the 2015-16 report. Note 3 - The following list highlights the movements in governing body membership during 2015/16: (1) Ed Dyson acted up to the Chief Officer Post from August 2015 – March 2016. (2) Joanne Newton acted up to the Chief Officer post from April 2015 – August 2015. (3) Kym Green acted up to the Chief Finance Officer post from June 2015 – August 2015. (4) Dr Ivan Benett left his role on 31st December 2015 and is over NRA therefore no CETV calculation applicable. (5) Margaret Everitt is not part of the pension scheme therefore no information applicable. (6) Julie Cheetham and Dr Peter Williams are seconded staff therefore no pension data available. (7) Faizan Ahmed commenced February 2016 pension details unavailable currently. (8) A Chaudry commenced in post in June 2015. Note 4 - Dr Mike Eeckelaers, Dr Ivan Benett, Dr Anthony Larkin, Dr Manisha Kumar, Dr Parmjit Moyo, and Dr Dominic Hyland are all salaried GPs who hold a contract with NHS England. Note 5 - The salary banding in the disclosure above relates only to the governing body role and excludes any other work which the individual may undertake for the CCG, for example clinical lead sessions etc. Note 6 - Non-Executive Board Members are not part of the pension scheme. Note 7 - The All Pensions Related benefits section is a calculation based on figures supplied by the NHS Pensions Agency. The clinical commissioning group is statutorily bound to use these figures however, a note of caution should be applied when interpreting them as: a) The clinical commissioning group has no way of interpreting or verifying the figures provided. b) They do not take into account any period of time where the individual may not have paid into the pension scheme due to a break in service

as an officer.


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c) They are calculated on a notional full time basis when staff are in fact part-time. d) The comparator figures provided may not be on a like for like role. For example some may be based on contributions made as a junior

doctor before taking up a GP role. e) The pensions related benefits note is based on an assumption as required on the Annual Reporting Guidance that individuals will be in

receipt of their pension for 20 years after they have retired.

There were no payments made to former senior managers during the financial year.


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Pensions The pensions information can be found in the table below:

Name Title

Real

Increase in

Pension at

age 60

(bands of

£2,500)

Real

Increase in

Pension

lump sum

at aged 60

(bands of

£2500)

Total accrued

pension at age

60 at 31 March

2016 (bands of

£5000)

Lump sum at

age 60 related

to accrued

pension at 31st

March 2016

(bands of

£5000)

Cash

Equivalent

Transfer

Value at 31

March 2016

Cash

Equivalent

Transfer

Value at 31

March 2015

Real

increase in

Cash

Equivalent

Transfer

Value

Employer's

contribution

to

stakeholder

pension

Real Increase

in Pension at

age 60 (bands

of £2,500)

Real Increase

in Pension

lump sum at

aged 60 (bands

of £2500)

Total accrued

pension at

age 60 at 31

March 2015

(bands of

£5000)

Lump sum

at age 60

related to

accrued

pension at

31st March

2015

(bands of

£5000)

Cash

Equivalent

Transfer

Value at 31

March 2015

Cash

Equivalent

Transfer

Value at 31

March 2014

Real

increase in

Cash

Equivalent

Transfer

Value

Employer's

contribution to

stakeholder

pension

£000 £000 £000 £000 £000 £000 £000 £000 £000 £000 £000 £000 £000 £000 £000 £000

Ed Dyson (1)Executive Board Member - Chief

Officer 5.0-7.5 12.5-15.0 20-25 55-60 262 179 79 10 N/A N/A 10-15 40-45 179 N/A N/A N/A

Joanne New ton (2)Executive Board member - Chief

Finance Officer 0-2.5 0-2.5 45-50 140-145 909 849 41 14 0-2.5 5.0-7.5 40-45 130-135 849 768 61 16

Kym Green (3)Executive Board member - Chief

Finance Officer 0-2.5 0-2.5 10-15 40-45 282 242 34 1 N/A N/A 10-15 35-40 242 N/A N/A N/A

Craig HarrisExec Nurse & Director of City Wide

Commissioning & Quality 0-2.5 (0-2.5) 15-20 45-50 218 203 10 15 0-2.5 2.5-5 15-20 45-50 203 173 25 14

Ivan Benett (4)Executive Board Member - Clinical

Director 0-2.5 (0-2.5) 20-25 60-65 0 481 -491 9 0-2.5 0-2.5 20-25 60-65 481 440 29 11

Michael Eeckelaers Executive Board Member - GP Chair0-2.5 0-2.5 15-20 45-50 342 317 19 12 0-2.5 2.5-5.0 10-15 40-45 317 282 27 12

Anthony LarkinExecutive Board Member - Locality

Chair 0-2.5 (0-2.5) 10-15 35-40 138 134 0 2 7.5-10 25-27.5 10-15 30-35 134 30 99 2

Manisha KumarExecutive Board Member - Locality

Chair 0-2.5 0-2.5 20-25 65-70 335 314 14 3 (0-2.5) (0-2.5) 20-25 65-70 314 305 0 2

Parmjit MoyoExecutive Board Member - Locality

Chair (0-2.5) (0-2.5) 10-15 30-35 221 218 -2 2 (0-2.5) (0-2.5) 10-15 30-35 218 208 5 2

Dominic HylandExecutive Board Member - Locality

Chair 0-2.5 0-2.5 10-15 30-35 174 157 14 2 (0-2.5) (0-2.5) 5-10 25-30 157 151 1 2

201516 2014/15


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Note 1 - As Non-Executive members do not receive pensionable remuneration, there will be no entries in respect of pensions for Non-Executive members. Note 2 - The following list highlights the movements in governing body membership during 2015/16: (1) Ed Dyson acted up to the Chief Officer Post from August 2015 – March 2016. (2) Joanne Newton acted up to the Chief Officer post from April 2015 – August 2015. (3) Kym Green acted up to the Chief Finance Officer post from Jun 2015 – August 2015. (4) Dr Ivan Benett left his role on 31st December 2015 and is over NRA therefore no CETV calculation applicable. (5) Margaret Everitt is not part of the pension scheme therefore no information applicable. (6) Julie Cheetham and Dr Peter Williams are seconded staff therefore no pension data available. (7) Faizan Ahmed Commenced February 2016 pension details not currently available. Note 3 – The pension’s information has been supplied by the NHS Pensions Agency and it has been confirmed that the figures disclosed relate only to the officer role within the clinical commissioning group and any other officer roles held. The clinical commissioning group has no means of interrogating or verifying the figures disclosed. Note 4 - Dr Mike Eeckelaers, Dr Ivan Benett, Dr Anthony Larkin, Dr Manisha Kumar, Dr Parmjit Moyo, and Dr Dominic Hyland are all salaried GP's who hold a contract with NHS England. Please note figures have been calculated using officer service only, and GP Practitioner service has not been included. Please note both sets of figures have been calculated using officer service only, and GP Practitioner service has not been included. Note 5 - All other CCG employees within the CCG are subject to agenda for change terms and conditions. Certain Members do not receive pensionable remuneration therefore there will be no entries in respect of pensions for certain Members.

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 values are the member’s accrued benefits and any contingent spouse’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. All other employees within the CCG are subject to national agenda for change terms and conditions. On the 16 March 2016, the Chancellor of the Exchequer announced a change in the Superannuation Contributions Adjusted for Past Experience (SCAPE) discount rate from 3% to 2.8%. This rate affects the calculation of the CETV figures in this report. Due to the lead time required to perform the calculations and prepare annual reports, the CETV figures quoted in this report for members of the NHS Pension Scheme are based on the previous discount rate and have not been recalculated.

Pay Multiples Reporting bodies are required to disclose the relationship between the remuneration of the highest-paid director/member in their organisation and the median remuneration of the organisation’s workforce. The banded remuneration of the highest paid director/member in Central Manchester Clinical Commissioning Group in the financial year 2015/16 was £165k-£170k (2014/15, £165k-£170k). This was 4.8 times (2014/15, 6.5 times, recalculated 4.4) the median remuneration of the workforce, which was £38k (2014/15, £26k, recalculated £35k). The 2014/15 figures were restated due to a change in the calculation methodology, the restated figures ensure that the figures are comparable between financial years. In 2015/16, no employees received remuneration in excess of the highest-paid member of the Governing Body, full-time equivalent (FTE). This is consistent with the prior financial year (2014/15). Remuneration ranged from £7k to the band indicated above (2014/15 less than £1k - £160k-£165k). 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.

Salaries exceeding £142,500 per annum The CCG has 6 senior clinical leaders who would have been paid more than £142,500 per annum had they worked on a full time basis. These clinicians provided clinical leadership and the CCG has satisfied itself that the remuneration is reasonable through the application of its remuneration policy.


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6.0 Staff Report

6.1 Staff Information (as at March 2016)

Equality Data

The number of persons of each sex who were on the Governing Body (12)

Female = 6 MKumar, JNewton, MEverett, JCheetham, PMoyo, AChaudry

Male = 6 GPage, PWilliams, MEeckelaers, DHyland, ALarkin, EDyson

The number of other senior managers of each sex who were a grade VSM (other than persons falling within the above disclosure)

Female = 0 Male = 4 CHarris, WHeppolette, IWilliamson, FAhmed

The number of persons of each sex who were employees of the clinical commissioning group

Female = 148 Male = 63


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Sickness Absence

Please refer to the employee benefits note in the Financial Statements for details of Sickness absence.

Staff sickness absence and ill health retirements

2015-16 2014-15

Number Number

Total Days lost 1,372 851 Total staff years 82 139

Average working days lost 8 6

Number of persons retiring on ill health grounds 0 0

The sickness and absence information for 2015-16 covers the period January – December 2015.

6.2 Staff Policies

1) For giving full and fair consideration to applications for employment

by the CCG made by disabled persons having regard to their particular aptitudes/abilities

The CCG aims to be an inclusive organisation which is committed to a culture and environment which promotes equality of access and treatment for all employees, contractors, visitors and members of the public. The Trust has a published Equality, Diversity and Human Rights Policy and a Disability Policy. We are currently reviewing and updating our recruitment and selection guidelines to ensure best practice is incorporated with regards to all aspects of recruitment and selection including the fair treatment of disabled people. The policies are updated on a regular basis. All recruitment and selection processes are undertaken in an inclusive way. All parts of the process are reviewed on a job by job basis to ensure that they are free from either direct or indirect discrimination including job adverts, job descriptions, person specifications, application process, testing, selection criteria, interviews, pre-employment checks and job offer. Training and support is provided to all recruiting managers to ensure the organisational policies and procedures are implemented effectively. The CCG has the “Two Ticks” Disability Award which means the organisation is committed to the following:

All people with a disability will be offered an interview providing they meet the minimum criteria for the job vacancy. Reasonable adjustments will be made to enable people with disabilities to access interviews/employment opportunities.

All employees with a disability will be invited to an annual meeting with their


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line manager to discuss their personal development needs and the CCG will make every effort to retain employees within the workplace if they become disabled.

The CCG ensures that all employees develop the appropriate level of disability awareness by providing awareness training.

An annual report is given to Job Centre Plus with a supported action plan for the following year.

The action plan is incorporated in the CCG’s Equality, Diversity and Human Rights Strategy action plan.

Reasonable adjustments to the recruitment process are proactively considered throughout as appropriate to ensure that disabled applicants are not “screened out” unfairly at any stage of the process.

2) For continuing the employment of and for arranging appropriate training for employees of the CCG who have become disabled persons during the period they were employed by the CCG

The organisation is committed to retaining in employment wherever possible any employee who has a temporary or long term disability. This process is facilitated through a dedicated Occupational Health provision available to all employees. As a reasonable adjustment to the Attendance Management processes, any absence related to a disability, or the management of a disability, will be recorded separately as “disability related absence” to ensure that a disabled employee is not taken through the Attendance Management processes more quickly in comparison to a non-disabled employee. Whilst the organisation reserves the right to set an expected level of attendance for all employees, including those with a disability, in this instance, individual triggers and targets will be discussed and agreed with the employee and monitored and reviewed in line with the usual processes taking into account the on-going needs of the employee and of the organisation. An agreed period of paid Disability Leave may be agreed on an individual basis with an employee to support them to manage their disability effectively. This would be discussed as part of the usual Attendance Management process and would be considered in consultation with Occupational Health. Paid Disability Leave would be up to 1 week in any 12 month period.

The organisation also operates a re-deployment register which means that any employee who is unable to continue in their existing role despite support and the implementation of reasonable adjustments, will be given priority consideration for other roles in the CCG. Where appropriate, external support and guidance is sought including Occupational Health, DWP Access to Work and other Disability specific support.

3) Training, career development and promotion of disabled person employed by the CCG

The CCG is committed to ensuring that all employees are developed and encouraged to enable them to meet the basic requirements of the job, perform to the standards expected and fulfill their potential. This involves making clear what is expected within clear timeframes, setting clear identifiable targets, monitoring performance, and providing appropriate training support and development.


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The CCG aims to ensure fairness and consistency in the treatment of all employees to ensure everyone receives the appropriate mandatory, professional and job related development to enable the organisation to achieve its purpose and meet future needs. The CCG is committed to ensuring that all employees with a disability have equal access to opportunities to develop their full potential. All career progression opportunities are made widely available to all employees in line with the best practice guidelines, also ensuring that any unfair bias and discrimination is eliminated. Full monitoring takes place and is reported in the Annual Public Sector Equality Duty report. Employees’ learning and development needs are identified on an individual basis in line with the Personal Development Review Process which will incorporate any reasonable adjustments required for ensuring that learning and development is fully accessible for all employees. Where the performance of an employee is affected by a disability, reasonable adjustments will be considered (which will include all aspects of the working arrangements) to support the employee in reaching and maintaining the appropriate standard of work and fulfilling their potential. This will be discussed with the employee in full.

6.3 Staff Consultation

During 2015, the organisation undertook a citywide staff survey. The question areas were reviewed and developed to include additional questions on the theme of employee satisfaction based on those used in the national staff survey. Over 50% of the workforce responded and the headline findings include:

• 83.70% are ≥ satisfied with their current jobs • 91.04% are ≥ satisfied with the CCGs as employees • 81.26% ≥ agreed they understand long term strategy • 80.64% ≥ agreed the CCGs are a good place to work • 82.40% ≥ agreed they balance work and home life • 91.53% feel that the organisations set a good equality example • 90.08% ≥ agreed that their manager is competent in their job • 86.88% are at least satisfied with their working environment • 83.47% ≥ agreed that they are kept informed • 85.84% ≥ agreed that they were satisfied with feedback opportunities • 81.90% ≥ agreed that they were satisfied with their training • 80.53% ≥ agreed that they are recognised for what they do

≥ agrees = agrees or strongly agrees

A number of areas for further development with employees have been identified and these have been included in a draft action plan. The organisation intends to continue this engagement going forward through the employee forum and the staff partnership forum. During 2015, an internal Intranet was launched which is now used on a regular basis to engage the views and feedback from all employees on draft employment policies and other initiatives.


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6.4 Expenditure of Consultancy The expenditure on consultancy in 2015/16 for the clinical commissioning group was £1.1m, of which £675k relates to the hosting arrangement for Devolution Manchester. The clinical commissioning groups expenditure on consultancy (2014/15: £471k).

6.5 Off Payroll Engagements The CCG has conducted a review of “off payroll” engagements to move to alternative arrangements. There were four off payroll engagements which related to the CCG hosting the Greater Manchester programmes Healthier Together and Devolution. There was a one off payroll appointment for Board Members which was the Interim Chief Finance Officer for a two month period. Due to the role and the short-term

nature this was the only option available to cover this key role.

Table 1 Number

Number of existing engagements as of 31st March 2016 4

Of which, the number that have existed:

- For less than one year at the time of reporting 1

- For between one and two years at the time of reporting 1

- For between two and three years at the time of reporting 2

- For between three and four years at the time of reporting 0

- For four or more years at the time of reporting 0

Table 2 Number

Number of new engagement or those that reached six months in duration, between 1 April 2015 and 31st March 2016.

1

Number of the above which include contractual clauses giving the Clinical Commissioning Group the right to request assurance in relation to Income tax and National Insurance obligations.

0

Number for whom the assurance has been requested 4

Of which;

Assurance has been received 1

Assurance has not been received 0

Engagements terminated as a result of assurance not being received 0

No of Off payroll engagements of Board members, and/or senior officers with significant financial responsibility during the year.

1

No of individuals that have been deemed "board members, and/or senior officers with significant financial responsibility" during the financial year. This figure include both off payroll and on payroll.

15

6.6

Exit Packages There have been no exit packages within the clinical commissioning group in 2015/16 (2014/15: £101k).


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The Audit Report

7.0 External Audit

The CCG’s external auditor is Ernst & Young LLP. The fees for 2015-16 are £45k plus VAT, giving a total cost of £54k. Central Manchester CCG does not commission any other services from Ernst & Young LLP. Internal Audit was provided by Deloitte LLP for the period up to September 2015. For the remainder of the financial year, internal audit was provided by Mersey Internal Audit Agency, hosted by Royal Liverpool & Broadgreen NHS Trust, with Counter Fraud provided by TIAA Ltd, so there is no conflict of interest.

INDEPENDENT AUDITOR’S REPORT TO THE MEMBERS OF THE GOVERNING BODY OF CENTRAL MANCHESTER CLINICAL COMMISSIONING GROUP

We have audited the financial statements of Central Manchester Clinical Commissioning Group for the year ended 31 March 2016 under the Local Audit and Accountability Act 2014. The financial statements comprise the Statement of Comprehensive Net Expenditure, the Statement of Financial Position, the Statement of Changes in Taxpayers’ Equity, the Statement of Cash Flows and the related notes 1 to 17. The financial reporting framework that has been applied in their preparation is applicable law and International Financial Reporting Standards (IFRSs) as adopted by the European Union, and as interpreted and adapted by the 2015-16 Government Financial Reporting Manual (the 2015-16 FReM) as contained in the Department of Health Group Manual for Accounts 2015-16 and the Accounts Direction issued by the NHS Commissioning Board with the approval of the Secretary of State as relevant to the National Health Service in England (the Accounts Direction). We have also audited the information in the Remuneration and Staff Report that is subject to audit, being:

the table of salaries and allowances of senior managers and related narrative notes on page 59-61;

the table of pension benefits of senior managers and related narrative notes on page 62-63;

the tables of exit packages on page 69;

the analysis of staff numbers and related notes on page 65; and

the table of pay multiples and related narrative notes on page 64. This report is made solely to the members of the Governing Body of Central Manchester CCG in accordance with Part 5 of the Local Audit and Accountability Act 2014 and for no other purpose as set out in paragraph 43 of the Statement of Responsibilities of Auditors and Audited Bodies published by Public Sector Audit Appointments Limited. Our audit work has been undertaken so that we might state to the members of the Governing Body of the CCG those matters we are required to state to them in an auditor’s report and for no other purpose. To the fullest extent permitted by law, we do not accept or assume responsibility to anyone other than the members as a body, for our audit work, for this report, or for the opinions we have formed.


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Respective responsibilities of the Accountable Officer and auditor As explained more fully in the Statement of Accountable Officer’s Responsibilities set out on page 76, the Accountable Officer is responsible for the preparation of the financial statements and for being satisfied that they give a true and fair view and is also responsible for ensuring the regularity of expenditure and income. Our responsibility is to audit and express an opinion on the financial statements in accordance with applicable law and International Standards on Auditing (UK and Ireland). Those standards require us to comply with the Auditing Practices Board’s Ethical Standards for Auditors. We are also responsible for giving an opinion on the regularity of expenditure and income in accordance with the Code of Audit Practice prepared by the Comptroller and Auditor General as required by the Local Audit and Accountability Act 2014 (the “Code of Audit Practice”). As explained in the Annual Governance Statement the Accountable officer is responsible for the arrangements to secure economy, efficiency and effectiveness in the use of the CCG’s resources. We are required under Section 21(1)(c) of the Local Audit Accountability Act 2014 to be satisfied that the CCG has made proper arrangements for securing economy, efficiency and effectiveness in its use of resources. Section 21(5)(b) of the Local Audit and Accountability Act 2014 requires that our report must not contain our opinion if we are satisfied that proper arrangements are in place. We are not required to consider, nor have we considered, whether all aspects of the CCG’s arrangements for securing economy, efficiency and effectiveness in its use of resources are operating effectively. Scope of the audit of the financial statements An audit involves obtaining evidence about the amounts and disclosures in the financial statements sufficient to give reasonable assurance that the financial statements are free from material misstatement, whether caused by fraud or error. This includes an assessment of:

whether the accounting policies are appropriate to the CCG’s circumstances and have been consistently applied and adequately disclosed;

the reasonableness of significant accounting estimates made by the Accountable Officer; and

the overall presentation of the financial statements. In addition, we read all the financial and non-financial information in the annual report and accounts to identify material inconsistencies with the audited financial statements and to identify any information that is apparently materially incorrect based on, or materially inconsistent with, the knowledge acquired by us in the course of performing the audit. If we become aware of any apparent material misstatements or inconsistencies we consider the implications for our report. In addition, we are required to obtain evidence sufficient to give reasonable assurance that the expenditure and income recorded in the financial statements have been applied to the purposes intended by Parliament and the financial transactions conform to the authorities which govern them. Scope of the review of arrangements for securing economy, efficiency and effectiveness in the use of resources We have undertaken our review in accordance with the Code of Audit Practice, having regard to the guidance on the specified criterion issued by the Comptroller and Auditor General in November 2015, as to whether the CCG had proper arrangements to ensure it took properly


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informed decisions and deployed resources to achieve planned and sustainable outcomes for taxpayers and local people. The Comptroller and Auditor General determined this criterion as that necessary for us to consider under the Code of Audit Practice in satisfying ourselves whether the CCG put in place proper arrangements for securing economy, efficiency and effectiveness in its use of resources for the year ended 31 March 2016. We planned our work in accordance with the Code of Audit Practice. Based on our risk assessment, we undertook such work as we considered necessary to form a view on whether, in all significant respects, the CCG had put in place proper arrangements to secure economy, efficiency and effectiveness in its use of resources. Opinion on regularity In our opinion, in all material respects the expenditure and income reflected in the financial statements have been applied to the purposes intended by Parliament and the financial transactions conform to the authorities which govern them. Opinion on the financial statements In our opinion the financial statements:

give a true and fair view of the financial position of Central Manchester CCG as at 31 March 2016 and of its net operating costs for the year then ended; and

have been properly prepared in accordance with the Health and Social Care Act 2012 and the Accounts Directions issued thereunder.

Opinion on other matters In our opinion:

the parts of the Remuneration and Staff Report to be audited have been properly prepared in accordance with the Annual Report Directions made under the National Health Service Act 2006 (as amended by the Health and Social Care Act 2012); and

the other information published together with the audited financial statements in the annual report and accounts is consistent with the financial statements.

Matters on which we are required to report by exception We are required to report to you if:

in our opinion the governance statement does not comply with the guidance issued by the NHS Commissioning Board; or

we refer a matter to the Secretary of State under section 30 of the Local Audit and Accountability Act 2014 because we have reason to believe that the CCG, or an officer of the CCG, is about to make, or has made, a decision which involves or would involve the body incurring unlawful expenditure, or is about to take, or has begun to take a course of action which, if followed to its conclusion, would be unlawful and likely to cause a loss or deficiency; or

we issue a report in the public interest under section 24 of the Local Audit and Accountability Act 2014; or

we make a written recommendation to the CCG under section 24 of the Local Audit and Accountability Act 2014; or

we are not satisfied that the CCG has made proper arrangements for securing economy, efficiency and effectiveness in its use of resources for the year ended 31 March 2016.

We have nothing to report in these respects.


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Certificate We certify that we have completed the audit of the accounts of Central Manchester CCG in accordance with the requirements of the Local Audit and Accountability Act 2014 and the Code of Audit Practice.

Hassan Rohimun

Hassan Rohimun For and on behalf of Ernst & Young LLP 100 Barbirolli Square, Manchester, M2 3EY. 27 May 2016


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Contact Details

If you require any further information or have any questions regarding this report please contact: [email protected] Further Information can also be found at: https://www.centralmanchesterccg.nhs.uk/publications Alternatively a Freedom of Information request can be made via: https://www.centralmanchesterccg.nhs.uk/contact-us

mailto:[email protected]


https://www.centralmanchesterccg.nhs.uk/contact-us


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Appendix A - Statement of Accountable Officer’s Responsibilities

Statement of the Chief Operating Officer’s Responsibilities as the Accountable Officer of Central Manchester Clinical Commissioning Group (CCG)

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 the Chief Operating Officer to be the Accountable Officer of the Clinical Commissioning Group.

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

Under the NHS Act 2006 (as amended), NHS England has directed each Clinical Commissioning Group to prepare for each financial year financial statements in the form and on the basis set out in the Accounts Direction. The financial statements are prepared on an accruals basis and must give a true and fair view of the state of affairs of the Clinical Commissioning Group and of its net expenditure, changes in taxpayers’ equity and cash flows for the financial year.

In preparing the financial statements, the Accountable Officer is required to comply with the requirements of the Manual for Accounts issued by the Department of Health and in particular to:

Observe the Accounts Direction issued by NHS England, including the relevant accounting and disclosure requirements, and apply suitable accounting policies on a consistent basis;

Make judgements and estimates on a reasonable basis; State whether applicable accounting standards as set out in the Manual for Accounts

issued by the Department of Health have been followed, and disclose and explain any material departures in the financial statements; and,

Prepare the financial statements on a going concern basis.

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

Ian Williamson Accountable Officer


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Appendix B – Committee Information

Audit Committee The committee is comprised of:

Lay Member – Governance (Chair)

Board Non-Executive Nurse In attendance:

The Group’s Chief Finance Officer

Head of Corporate Services

Internal Audit Officer

External Audit Officer

The Local Counter Fraud Specialist

The Secretary to the Committee

Other senior managers as appropriate The CCG’s Audit Committee is established in accordance with the Clinical Commissioning Group’s Constitution; it has a responsibility for reviewing the establishment and maintenance of an effective system of integrated governance, risk management and internal control, across the whole of the organisation’s activities. It also oversees an effective internal and external audit function, as well as reviewing the findings of other significant assurance functions. Lastly the Committee shall ensure that there is effective review of the work of the Local Counter Fraud Officer as set out by the Secretary of State and as required by the Director of Counter Fraud and Security Management Services. Finance & Contracting Committee (disbanded September 2015) The Committee is comprised of:

Chair of the CCG (Chair)

Nominated Board GP (Vice-Chair)

Lay member – Governance

Nominated Board Practice Manager

Accountable Officer

Chief Finance Officer In attendance:

Head of Finance or representative

Head of Performance or representative

Head of Commissioning & Quality or representative

Business Intelligence Lead

Senior Contracts Manager

Executive Nurse & Director of City Wide Commissioning

The role of the committee is to support the Board in the oversight of all key aspects including risks in relation to finance, contracting and information relevant to Central CCG with key actions and recommendations reported to the Board. Its responsibilities include budget setting; financial monitoring and reporting; monitoring of QIPP and activity shifts required under the Living Longer Living Better Programme and Better Care Fund; contract monitoring; oversee procurement process; monitoring performance of CCG and providers.


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Governance Committee (disbanded January 2016) The Committee is comprised of:

Lay Member – Governance (Chair)

CCG Board Nurse

Chief Officer

Clinical Director In attendance:

Senior Planning Manager

Head of Commissioning & Quality

Corporate Governance Manager

Public Health Consultant

Head of Finance

Head of Organisational Development

Secretary The Governance Committee is responsible for ensuring the maintenance of risk management, internal control and assurance systems for the CCG. It is also responsible for monitoring progress against external reports and audits, ensuring the CCG are compliant with relevant legislation through policy and reviewing lapses in quality and making recommendations for improvements. Clinical Reform and Redesign Committee The committee is comprised of:

the Group’s Clinical Director (chair)

the Group’s Deputy Clinical Director (vice chair)

the Group’s Head of Commissioning and Quality

Managerial Leads from Commissioning and Finance

Managerial Leads from other functions as appropriate

Patient and public involvement representative

Public Health Consultant

Other appropriate CCG clinical leads The Central Manchester Clinical Commissioning Group’s Clinical Reform and Redesign Committee is established in accordance with the Clinical Commissioning Group’s constitution. The role of the committee is to ensure that the Clinical Commissioning Group (CCG) effectively discharges all its duties with regard to clinical and service reform and redesign. It is responsible for ensuring that the Commissioning Strategy of the CCG and the plans for the QIPP (Quality, Innovation, Productivity and Prevention) programme are effectively delivered. Clinical Quality & Performance Committee The committee is comprised of:

Board Nurse (chair)

The Group’s Clinical Director

Board Secondary Care Doctor

Board Lead for Practice Development

GP Locality Lead

GP Education Lead

Head of Commissioning and Quality

Head of Organisational Development

CMCCG Medicines Management

Associate Director Performance

CMCCG Quality Lead


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CMCCG Engagement Lead

Primary Care Devolvement

Assistant Chief Officer

Representative from Patient & Public Advisory Group

Practice Nurse Lead

Executive Nurse

Deputy Executive Nurse The role of the Committee will be to ensure that the Clinical Commissioning Group (CCG) effectively discharges all its duties with regard to Clinical Quality and Performance. It will be responsible for promoting a culture of quality and improvement within Central Manchester as a means by which the Group’s strategic objectives are met. This involves incorporating quality at each stage of the commissioning cycle, monitoring performance of CCG and providers, evaluating commissioning schemes and ensuring all information flows comply with information governance requirements. The Committee has a broad remit, focusing on:

Quality and performance of commissioned services

Quality improvement in primary care

Patient and public engagement

Medicines optimisation

Effective use of resources policies

Organisational development and education.

Executive Team The Committee is comprised of:

the Chair of the CCG

the Clinical Director

the Deputy Clinical Director

the Chief Officer

the Chief Finance Officer


Head of Commissioning and Quality

Head of Finance


Head of Organisational Development.

Performance Lead

Executive Nurse, Director of Citywide Commissioning The Central Manchester Clinical Commissioning Group’s Executive Team is established in accordance with the Clinical Commissioning Group’s constitution. It is responsible for linking strategic direction with operational delivery and co-ordinating all the functions of the CCG. It acts as the executive function of the CCG Board for operational delivery and supports the Board in strategy and decision-making. Patient and Public Advisory Group The Group is comprised of:

Lay Member for Patient and Public Involvement (Chair)

11 members – volunteers from across Central Manchester. http://www.centralmanchesterccg.nhs.uk/our-patient-group The Patient and Public Advisory Group provide advice and guidance to the CCG Board from a patient, public and community perspective. It supports CCG members and staff by ensuring the impact of CCG activity on local communities is understood, and informs decision-making and strategic development.

http://www.centralmanchesterccg.nhs.uk/our-patient-group


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Remuneration Committee The Committee is comprised of:

the CCG’s two lay members

the Board Non-Executive Nurse

the Board Secondary Care Doctor. In attendance:

Head of HR and Organisational Development

Senior HR Business Partner The Remuneration Committee was established in accordance with NHS Central Manchester Clinical Commissioning Group’s (CMCCG) constitution, whereby it is required to discharge its statutory function of being required to act effectively, efficiently and economically. The committee makes recommendations to the governing body on determinations about pay and remuneration for:

Non Agenda for Change (AfC) senior managers of Central Manchester clinical commissioning group

Non AfC senior managers where Central Manchester CCG have delegated authority

Governing body members and clinical leads of the clinical commissioning group

Allowances under any pension scheme it might establish as an alternative to the NHS pension scheme

Reviewing the performance of the Accountable Officer and other senior team members and determining annual salary awards, as appropriate

Considering the severance payments of the Accountable Officer and usually of other very senior staff or board members, seeking HM Treasury approval as appropriate in accordance with the guidance ‘Managing Public Money’ (available on the HM Treasury.gov.uk website).

All aspects of salary are considered by the remuneration committee, including:

Performance-related elements and bonuses where applicable

Provisions for other benefits, including pensions

Arrangements for termination of employment and other contractual terms (decisions requiring dismissal shall be referred to the Board).

Joint Committees 2015/16

Joint Executive Team Membership of the Committee consists of: North Manchester CCG

Chief Clinical Officer

Chief Operating Officer

Board Clinician

Programme Director(s)


Chair

Chief Officer

Clinical Director

Head of Commissioning


South Manchester CCG

Chair

Chief Officer


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Clinical Lead

Deputy Chief Officer

Head of Commissioning

Citywide teams

Chief Finance Officer

Director of Citywide Commissioning

Head of HR & OD


Associate Director of Performance and Quality The Joint Executive Team (JET) has been formed to facilitate agreement between the 3 Manchester CCGs on city wide issues. It is proactive in developing, monitoring and scrutinising programmes of work common to each of the three CCGs in Manchester and agree a coherent, citywide view on issues spanning the three. It ensures decision making and delivery on citywide issues is carried out as swiftly and efficiently as possible and will drive best use of internal capacity to deliver the CCGs’ responsibilities. Joint Clinical Commissioning Committee Membership of the Committee consists of:

Lay Member of the CCG Board – Chair

Chief Clinical Officer (North Manchester CCG) – Deputy Chair

Executive Nurse and Director of Commissioning, Quality and Safeguarding

City Wide Clinical Lead – Mental Health

Chief Officer (Central Manchester CCG) or deputy

Chief Officer (South Manchester CCG) or deputy

Deputy Director of Commissioning (City Wide Team)

Deputy Executive Nurse and Deputy Director of Quality (City Wide Team)

Deputy Director of Safeguarding (City Wide Team)

PPAG representative

Patient and Public Governing Body Member

Head of Strategic Commissioning (Manchester City Council)

Public Health Lead

Chief Finance Officer

Clinical Governing Body Member The Joint Clinical Commissioning Committee is responsible for overseeing and monitoring service redesign, quality, performance, finance and efficiency schemes for the following areas:

Learning Disability Services

All local Mental Health Services

Children’s, Maternity and Neonate Services

Continuing Healthcare

Deprivation of Liberties for Health

Children’s and Adult’s Safeguarding

Local Specialist Services

Funded Nursing Care

Personal Health Budgets.


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Joint Primary Care Commissioning Committee Membership of the Committee consists of:

South Manchester CCG Lay Member (PPI) (Chair/Vice Chair) (v)

North Manchester CCG Lay Member (PPI) (Chair/Vice Chair) (v)

Central Manchester CCG Lay member (Governance) (v)

CCG Chief Officer/Managerial lead for Primary Care (x 3) (v)

CCG Chief Finance Officer

North Manchester CCG rep (clinical)

Central Manchester CCG rep (clinical)

South Manchester CCG rep (clinical)

NHS England (AT) Director of Commissioning (v)

Manchester City Council Senior Officer

Director of Public Health

Patient and Public Advisory Group representative

Healthwatch Representative

Health & Wellbeing Board Representative x 2 The role of this Joint Committee between NHS England and the three Manchester CCGs is to carry out the functions relating to the co-commissioning of primary medical services under section 83 of the NHS Act (except which have been reserved to NHS England). This includes the following activities:

Overseeing the development of GP services in Manchester

Designing and agreeing enhanced services (“Local Enhanced Services” and “Directed Enhanced Services”). NB Individual CCG Boards retain the ability to establish additional enhanced services if they so wish

Designing and agreeing local incentive schemes as an alternative to the Quality Outcomes Framework (QOF)

Designing and agreeing out of hospital services commissioned from GP practices

Decision making on whether to establish new GP practices in an area

Approving practice mergers

Promoting quality within GP practice service provision.

Joint Finance Committee Membership of the Committee consists of:

North CCG Lay Member (with governance responsibility)

North CCG Nominee Two

North CCG Nominee Three

South CCG Lay Member (with governance responsibility)

South CCG Nominee Two

South CCG Nominee Three

Central CCG Lay Member (with governance responsibility)

Central CCG Nominee Two

Central CCG Nominee Three

Chief Finance Officer - North, Central, South The Committee is a Joint Committee of the three Manchester CCGs and has the following responsibilities:

Ensuring that financial accountability is integral to the CCGs; alongside considering risks in delivering organisational goals and objectives.

Providing assurance that the CCGs are operating within Standing Orders, Standing Financial Instructions, Scheme of Reservation and Delegation, Statutory and Regulatory duties, NHS Codes of Conduct and local policies.


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The annual recommendation of the strategic financial plan to the individual CCG Board(s) and annual budget setting at CCG and practice level.

Scrutiny of financial reports and assurance to the individual CCG Board(s) of financial probity.

Reviewing the timely and regular information flows with regards to the range of contracts, performance and financial matters relevant to the CCG providing financial assurance to the individual Board(s).

Monitoring the delivery and outcome of the CCGs contracts and procurement of health services, ensuring that performance meets the CCGs Strategic Commissioning Plan and the NHS Greater Manchester’s statutory and regulatory duties.

Ensuring that the CCGs fulfil their contracting role as co-ordinating commissioner(s).

Monitoring the identification and delivery of QIPP plans and ensure these are integrated into the strategic financial plan.

Ensuring there is a process for approval and prioritisation of investment areas; that the business documents to support such schemes are of sufficient quality for the size and complexity of the scheme to enable the Board(s) to make sound decisions and that these are then procured/contracted for, delivering value for money.

Joint Governance Committee Membership of the Committee consists of:

North Manchester CCG Board Lay Member (with governance responsibility)

Central Manchester CCG Board Lay Member (with governance responsibility)

South Manchester CCG Board Lay Member (with governance responsibility)

North Manchester CCG Chief Officer (or with delegated responsibility)

Central Manchester CCG Chief Officer (or with delegated responsibility)

South Manchester CCG Chief Officer (or with delegated responsibility)

Chief Finance Officer (or with delegated responsibility)

Head of Corporate Services The role of the Joint Governance Committee is to:

Ensure that the Manchester CCGs are governed in accordance with statutory guidance from a number of sources (such as NHS England, NHS Litigation Authority etc).

Ensure the establishment and maintenance of an effective system of corporate governance, risk management and internal control, across the CCGs’ activities that support the achievement of the organisation’s objectives.

Ensure that the CCGs have policies and procedures in place to be compliant with relevant regulatory, legal and code of conduct requirements, and to approve such policies.

Receive and monitor progress against reports from internal and external audit and any further reports obtained from external agencies.

Identify and review lapses in adherence to corporate governance structures and systems and make recommendations for improvements.

Work collaboratively to identify and promote “Best Practice”, the sharing of experience, expertise and success across the three Manchester CCGs.

Monitor the progress of all statutory reporting, such as the CCGs’ Annual Reports and Annual Governance Statement.

Receive and monitor information regarding Health and Safety on behalf of the three Manchester CCG Boards.


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Appendix C – Financial Statements

Foreword to the Accounts

Central Manchester Clinical Commissioning Group was licensed from 1st April 2013 under provisions enacted in the Health & Social Care Act 2012, which amended the National Health Service Act 2006.

These accounts for the year ending 31st March 2016 have been prepared by Central Manchester Clinical Commissioning Group under Section 17 of schedule 1A of the National Health Service Act 2006 (as amended) in the form which the Secretary of State has, with approval of the treasury directed.

The National Health Service Act 2006 (as amended) required Clinical Commissioning Groups to prepare their Annual Report and Annual Accounts in accordance with the Directions issued by NHS England.


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Statement of Comprehensive Net Expenditure for the year ended 31st March 2016

2015-16 2014-15

Note £000 £000

Total Income and Expenditure

Employee benefits 4.1.1 5,051 4,210

Operating Expenses 5 257,754 244,257

Other operating revenue 2 (6,069) (3,273)

Net operating expenditure before interest 256,736 245,194

Investment Revenue 0 0

Other (gains)/losses 0 0

Finance costs 0 0

Net operating expenditure for the financial year 256,736 245,194

Net (gain)/loss on transfers by absorption 0 0

Total Net Expenditure for the year 256,736 245,194

Of which:

Administration Income and Expenditure



Other operating revenue 2 (247) (275)

Net administration costs before interest 4,294 4,492

Programme Income and Expenditure



Other operating revenue 2 (5,822) (2,998)

Net programme expenditure before interest 252,442 240,702

Other Comprehensive Net Expenditure 2015-16 2014-15

£000 £000

Impairments and reversals 0 0

Net gain/(loss) on revaluation of property, plant & equipment 0 0

Net gain/(loss) on revaluation of intangibles 0 0

Net gain/(loss) on revaluation of financial assets 0 0

Movements in other reserves 0 0

Net gain/(loss) on available for sale financial assets 0 0

Net gain/(loss) on assets held for sale 0 0

Net actuarial gain/(loss) on pension schemes 0 0

Share of (profit)/loss of associates and joint ventures 0 0

Reclassification Adjustments 0 0

On disposal of available for sale financial assets 0 0

Total comprehensive net expenditure for the year 256,736 245,194

The notes on pages 101 to 107 form part of this statement.


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Statement of Financial Position at 31st March 2016

31 March 2016 31 March 2015

Note £000 £000

Non-current assets:

Property, plant and equipment 0 0

Intangible assets 0 0

Investment property 0 0

Trade and other receivables 0 0

Other financial assets 0 0

Total non-current assets 0 0

Current assets:

Inventories 0 0

Trade and other receivables 8 7,511 4,934

Other financial assets 0 0

Other current assets 0 0

Cash and cash equivalents 9 109 32

Total current assets 7,620 4,966

Non-current assets held for sale 0 0

Total current assets 7,620 4,966

Total assets 7,620 4,966

Current liabilities

Trade and other payables 10 (27,606) (22,144)

Other financial liabilities 0 0

Other liabilities 0 0

Borrowings 0 0

Provisions 11 (1,265) (453)

Total current liabilities (28,871) (22,597)

Non-Current Assets plus/less Net Current Assets/Liabilities (21,251) (17,631)

Non-current liabilities

Trade and other payables 0 0

Other financial liabilities 0 0

Other liabilities 0 0

Borrowings 0 0

Provisions 0 0

Total non-current liabilities 0 0

Assets less Liabilities (21,251) (17,631)

Financed by Taxpayers’ Equity

General fund (21,251) (17,631)

Revaluation reserve 0 0

Other reserves 0 0

Charitable Reserves 0 0

Total taxpayers' equity: (21,251) (17,631)

The notes on pages 97 to 114 form part of this statement.


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The financial statements on pages 81 to 114 were approved by the Governing body on the 26th May 2016 and signed on its behalf by: Ian Williamson Accountable Officer 26th May 2016


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Statement of Changes in Taxpayers Equity for the year ended 31 March 2016

General

fund Revaluation reserve

Other reserves

Total reserves

£000 £000 £000 £000

Changes in taxpayers’ equity for 2015-16

Balance at 1 April 2015 (17,631) 0 0 (17,631)

Transfer between reserves in respect of assets transferred from closed NHS bodies 0 0 0 0

Adjusted NHS Clinical Commissioning Group balance at 1 April 2015 (17,631) 0 0 (17,631)

Changes in NHS Clinical Commissioning Group taxpayers’ equity for 2015-16

Net operating expenditure for the financial year (256,736) (256,736)

Net gain/(loss) on revaluation of property, plant and equipment 0 0

Net gain/(loss) on revaluation of intangible assets 0 0


Total revaluations against revaluation reserve 0 0 0 0

Net gain (loss) on available for sale financial assets 0 0 0 0 Net gain (loss) on revaluation of assets held for sale 0 0 0 0

Impairments and reversals 0 0 0 0

Net actuarial gain (loss) on pensions 0 0 0 0

Movements in other reserves 0 0 0 0

Transfers between reserves 0 0 0 0 Release of reserves to the Statement of Comprehensive Net Expenditure 0 0 0 0 Reclassification adjustment on disposal of available for sale financial assets 0 0 0 0

Transfers by absorption to (from) other bodies 0 0 0 0

Reserves eliminated on dissolution 0 0 0 0

Net Recognised NHS Clinical Commissioning Group Expenditure for the Financial Year (256,736) 0 0 (256,736)

Net funding 253,116 0 0 253,116

Balance at 31 March 2016 (21,251) 0 0 (21,251)


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General

fund Revaluation

reserve Other

reserves Total

reserves

£000 £000 £000 £000

Changes in taxpayers’ equity for 2014-15

Balance at 1 April 2014 (17,524) 0 0 (17,524) Transfer between reserves in respect of assets transferred from closed NHS bodies

0 0 0 0

Adjusted NHS Commissioning Board balance at 1 April 2014 (17,524) 0 0 (17,524)

Changes in NHS Commissioning Board taxpayers’ equity for 2014-15

Net operating costs for the financial year (245,194) (245,194)

Net gain/(loss) on revaluation of property, plant and equipment 0 0

Net gain/(loss) on revaluation of intangible assets 0 0


Total revaluations against revaluation reserve 0 0 0 0

Net gain (loss) on available for sale financial assets 0 0 0 0

Net gain (loss) on revaluation of assets held for sale 0 0 0 0

Impairments and reversals 0 0 0 0

Net actuarial gain (loss) on pensions 0 0 0 0

Movements in other reserves 0 0 0 0

Transfers between reserves 0 0 0 0 Release of reserves to the Statement of Comprehensive Net Expenditure 0 0 0 0 Reclassification adjustment on disposal of available for sale financial assets 0 0 0 0

Transfers by absorption to (from) other bodies 0 0 0 0

Reserves eliminated on dissolution 0 0 0 0

Net Recognised NHS Commissioning Board Expenditure for the Financial Year (245,194) 0 0 (245,194)

Net funding 245,087 0 0 245,087

Balance at 31 March 2015 (17,631) 0 0 (17,631)


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Statement of Cash Flows for the year ended 31 March 2016 2015-16 2014-15

Note £000 £000

Cash Flows from Operating Activities

Net operating expenditure for the financial year (256,736) (245,194)

Depreciation and amortisation 0 0

Impairments and reversals 0 0

Movement due to transfer by Modified Absorption 0 0

Other gains (losses) on foreign exchange 0 0

Donated assets received credited to revenue but non-cash 0 0

Government granted assets received credited to revenue but non-cash 0 0

Interest paid 0 0

Release of PFI deferred credit 0 0

Other Gains & Losses 0 0

Finance Costs 0 0

Unwinding of Discounts 0 0

(Increase)/decrease in inventories 0 0

(Increase)/decrease in trade & other receivables 8 (2,577) 205

(Increase)/decrease in other current assets 0 0

Increase/(decrease) in trade & other payables 10 5,462 (295)

Increase/(decrease) in other current liabilities 0 0

Provisions utilised 0 0

Increase/(decrease) in provisions 11 812 161

Net Cash Inflow (Outflow) from Operating Activities (253,039) (245,123)

Cash Flows from Investing Activities

Interest received 0 0

(Payments) for property, plant and equipment 0 0

(Payments) for intangible assets 0 0

(Payments) for investments with the Department of Health 0 0

(Payments) for other financial assets 0 0

(Payments) for financial assets (LIFT) 0 0 Proceeds from disposal of assets held for sale: property, plant and equipment 0 0

Proceeds from disposal of assets held for sale: intangible assets 0 0

Proceeds from disposal of investments with the Department of Health 0 0

Proceeds from disposal of other financial assets 0 0

Proceeds from disposal of financial assets (LIFT) 0 0

Loans made in respect of LIFT 0 0

Loans repaid in respect of LIFT 0 0

Rental revenue 0 0

Net Cash Inflow (Outflow) from Investing Activities 0 0

Net Cash Inflow (Outflow) before Financing (253,039) (245,123)

Cash Flows from Financing Activities

Grant in Aid Funding Received 253,116 245,087

Other loans received 0 0

Other loans repaid 0 0 Capital element of payments in respect of finance leases and on Statement of Financial Position PFI and LIFT 0 0

Capital grants and other capital receipts 0 0

Capital receipts surrendered 0 0

Net Cash Inflow (Outflow) from Financing Activities 253,116 245,087

Net Increase (Decrease) in Cash & Cash Equivalents 9 77 (36)

Cash & Cash Equivalents at the Beginning of the Financial Year 32 69 Effect of exchange rate changes on the balance of cash and cash equivalents held in foreign currencies 0 0

Cash & Cash Equivalents (including bank overdrafts) at the End of the Financial Year 109 33


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Notes to the Financial Statements 1. Accounting Policies

NHS England has directed that the financial statements of clinical commissioning groups shall meet the accounting requirements of the Manual for Accounts issued by the Department of Health. Consequently, the following financial statements have been prepared in accordance with the Manual for Accounts 2015-16 issued by the Department of Health. The accounting policies contained in the Manual for Accounts 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 Manual for Accounts 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 the going concern basis (despite the issue of a report to the Secretary of State for Health under Section 30 of the Local Audit and Accountability Act 2014).

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 Acquisitions & Discontinued Operations Activities are considered to be ‘acquired’ only if they are taken on from outside the public sector. Activities are considered to be ‘discontinued’ only if they cease entirely. They are not considered to be ‘discontinued’ if they transfer from one public sector body to another.


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1.4 Movement of Assets within the Department of Health 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 Group are accounted for in line with IAS 20 and similarly give rise to income and expenditure entries.

1.5 Pooled Budgets Where the clinical commissioning group has entered into a pooled budget arrangement under Section 75 of the National Health Service Act 2006, 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. During 2015/16 the pooled budget operated on a ‘host basis’, with Manchester City Council acting as the host organisation, and not undertaking a lead commissioner role. This is an agent relationship, with both parties accounting for the transaction ‘net.’ 1.6 Critical Accounting Judgements & Key Sources of Estimation Uncertainty In the application of the clinical commissioning group’s accounting policies, management is required to make judgements, estimates and assumptions about the carrying amounts of assets and liabilities that are not readily apparent from other sources. The estimates and associated assumptions are based on historical experience and other factors that are considered to be relevant. Actual results may differ from those estimates and the estimates and underlying assumptions are continually reviewed. Revisions to accounting estimates are recognised in the period in which the estimate is revised if the revision affects only that period or in the period of the revision and future periods if the revision affects both current and future periods.

1.6.1 Critical Judgements in Applying Accounting Policies

The following are the critical judgements, apart from those involving estimations (see below) that management has made in the process of applying the clinical commissioning group’s accounting policies that have the most significant effect on the amounts recognised in the financial statements:


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a) Judgement that the clinical commissioning group remains a going concern.

b) During 2015-16 the CCG has assessed the underlying relationship

between the CCG and other parties with which it works together, namely citywide corporate functions, Healthier Together and Devolution Manchester management team. Having considered the legal and underlying relationships the CCG has determined that these are joint operations and should therefore be accounted for as though the CCG is incurring the expenditure directly, rather than contributing to a fund and the CCG only accounting for its share of the associated income and expenditure.

The definition of a Joint Operation is where activities are undertaken by the CCG in conjunction with one or more parties but which are not performed through a separate entity. This is the case for citywide corporate functions, Healthier Together and the Devolution Manchester management team. The accounting treatment for these services is net accounting.

c) Legacy balances in respect of assets and liabilities arising for

transactions or delivery of care prior to 31st March 2013 are accounted for by NHS England. The clinical commissioning group's arrangements in respect of settling NHS Continuing Healthcare claims are disclosed in Note 11 to these financial statements.

1.6.2 Key Sources of Estimation Uncertainty

The following are the key estimations that management has made in the process of applying the clinical commissioning group’s accounting policies that have the most significant effect on the amounts recognised in the financial statements:

a) Estimates of acute activity undertaken in March 2016.

The clinical commissioning group has estimated activity for the final month of the year to assess its liabilities under the Payment by Results regime. Actual activity data is not available until after the completion of the accounts. These estimates have been agreed with the providers of these services and are based on historic activity trends plus the provider's local knowledge of activity undertaken during the month in question. For NHS providers, these estimates are agreed as part of the annual Agreement of Balances exercise.

b) Estimates of prescribing costs not yet presented to the clinical commissioning group (£4.4m accrual at year end). The clinical commissioning group has estimated the cost of primary care prescribing activity not yet presented to the NHS Business Services Authority and incorporated into the charge to the clinical commissioning group's cash limit. The estimate is based on the NHS Business Services


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Authority's forecast which it provides on a monthly basis and is validated by the clinical commissioning group's medicines management team.

c) Other Accruals There are a number of areas where the clinical commissioning group does not have up to date activity or cost information. These are individually not material, but in each case the clinical commissioning group seeks to make an appropriate estimate through its understanding of trends, local intelligence and third party evidence where possible.

1.7 Revenue

Revenue in respect of services provided is recognised when, and to the extent that, performance occurs, and is measured at the fair value of the consideration receivable.

Where income is received for a specific activity that is to be delivered in the following year, that income is deferred.

1.8 Employee Benefits

1.8.1 Short-term Employee Benefits

Salaries, wages and employment-related payments 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.

1.8.2 Retirement Benefit Costs

Past and present employees are covered by the provisions of the NHS Pensions Scheme. The scheme is an unfunded, defined benefit scheme that covers NHS employers, General Practices and other bodies, allowed under the direction of the Secretary of State, in England and Wales. The scheme is 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 scheme is accounted for as if it were a defined contribution scheme: the cost to the clinical commissioning group of participating in the 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.


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1.9 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.

Expenses and liabilities in respect of grants are recognised when the clinical commissioning group has a present legal or constructive obligation, which occurs when all of the conditions attached to the payment have been met.

1.10 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.

1.10.1 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.

1.11 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.


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1.12 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:

Timing of cash flows (0 to 5 years inclusive): Minus 1.55% (2014-15: minus 1.5%)

Timing of cash flows (6 to 10 years inclusive): Minus 1% (2014-15: minus 1.05%)

Timing of cash flows (over 10 years): Minus 0.80% (2014015: plus 2.20%)

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.

1.13 Clinical Negligence Costs

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

1.14 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 Litigation Authority and, in return, receives assistance with the costs of claims arising. The annual membership contributions, and any excesses payable in respect of particular claims are charged to operating expenses as and when they become due.


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1.15 Continuing Healthcare Risk Pooling In 2014-15 a risk pool scheme has been introduced by NHS England for continuing healthcare claims, for claim periods prior to 31 March 2013. Under the scheme clinical commissioning groups contribute annually to a pooled fund, which is used to settle the claims.

1.16 Contingencies

A contingent liability is a possible obligation that arises from past events and whose existence will be confirmed only by the occurrence or non-occurrence 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, contingencies are disclosed at their present value.

1.17 Financial Assets Financial assets are recognised when the clinical commissioning group becomes party to the financial instrument contract or, in the case of trade receivables, when the goods or services have been delivered. Financial assets are derecognised when the contractual rights have expired or the asset has been transferred.

Financial assets are classified into the following categories:

Financial assets at fair value through profit and loss;

Held to maturity investments;

Available for sale financial assets; and,

Loans and receivables. The classification depends on the nature and purpose of the financial assets and is determined at the time of initial recognition.

1.17.1 Financial Assets 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 assets at fair value through profit and loss. They are held at fair value, with any resultant gain or loss recognised in calculating the clinical commissioning group’s surplus or deficit for the year. The net gain or loss incorporates any interest earned on the financial asset.


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1.17.2 Held to Maturity Assets

Held to maturity investments are non-derivative financial assets with fixed or determinable payments and fixed maturity, and there is a positive intention and ability to hold to maturity. After initial recognition, they are held at amortised cost using the effective interest method, less any impairment. Interest is recognised using the effective interest method. 1.17.3 Available For Sale Financial Assets

Available for sale financial assets are non-derivative financial assets that are designated as available for sale or that do not fall within any of the other three financial asset classifications. They are measured at fair value with changes in value taken to the revaluation reserve, with the exception of impairment losses. Accumulated gains or losses are recycled to surplus/deficit on de-recognition.

1.17.4 Loans & Receivables Loans and receivables are non-derivative financial assets with fixed or determinable payments which are not quoted in an active market. After initial recognition, they are measured at amortised cost using the effective interest method, less any impairment. Interest is recognised using the effective interest method. Fair value is determined by reference to quoted market prices where possible, otherwise by valuation techniques. The effective interest rate is the rate that exactly discounts estimated future cash receipts through the expected life of the financial asset, to the initial fair value of the financial asset. At the end of the reporting period, the clinical commissioning group assesses whether any financial assets, other than those held at ‘fair value through profit and loss’ are impaired. Financial assets are impaired and impairment losses recognised if there is objective evidence of impairment as a result of one or more events which occurred after the initial recognition of the asset and which has an impact on the estimated future cash flows of the asset. For financial assets carried at amortised cost, the amount of the impairment loss is measured as the difference between the asset’s carrying amount and the present value of the revised future cash flows discounted at the asset’s original effective interest rate. The loss is recognised in expenditure and the carrying amount of the asset is reduced through a provision for impairment of receivables. If, in a subsequent period, the amount of the impairment loss decreases and the decrease can be related objectively to an event occurring after the impairment was recognised, the previously recognised impairment loss is reversed through expenditure to the extent that the carrying amount of the receivable at the date of the impairment is reversed does not exceed what the


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amortised cost would have been had the impairment not been recognised.

1.18 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 de-recognised when the liability has been discharged, that is, the liability has been paid or has expired.

Loans from the Department of Health are recognised at historical cost. Otherwise, financial liabilities are initially recognised at fair value.

1.18.1 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,

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

1.18.2 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. 1.18.3 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, 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.

1.19 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.


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1.20 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.

1.21 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).

1.22 Research & Development

Research and development expenditure is charged in the year in which it is incurred, except insofar as development expenditure relates to a clearly defined project and the benefits of it can reasonably be regarded as assured. Expenditure so deferred is limited to the value of future benefits expected and is amortised through the Statement of Comprehensive Net Expenditure on a systematic basis over the period expected to benefit from the project. It should be re-valued on the basis of current cost. The amortisation is calculated on the same basis as depreciation.

1.23 Accounting Standards That Have Been Issued But Have Not Yet Been Adopted

The Government Financial Reporting Manual does not require the following Standards and Interpretations to be applied in 2014-15, all of which are subject to consultation:

IFRS 9: Financial Instruments

IFRS 14: Regulatory Deferral Accounts

IFRS 15: Revenue for Contract with Customers The application of the Standards as revised would not have a material impact on the accounts for 2015-16, were they applied in that year.


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2. Other Operating Revenue

2015-16 2015-16 2015-16 2014-15

Total Admin Programme Total

£000 £000 £000 £000

Recoveries in respect of employee benefits 0 0 0 0

Patient transport services 0 0 0 0

Prescription fees and charges 148 0 148 100

Dental fees and charges 0 0 0 0

Education, training and research 291 2 289 133

Charitable and other contributions to revenue expenditure: NHS 0 0 0 0

Charitable and other contributions to revenue expenditure: non-NHS 0 0 0 0

Receipt of donations for capital acquisitions: NHS Charity 0 0 0 0

Receipt of Government grants for capital acquisitions 0 0 0 0

Non-patient care services to other bodies 4,597 77 4,520 3,046

Income generation 0 0 0 0

Rental revenue from finance leases 0 0 0 0

Rental revenue from operating leases 0 0 0 0

Other revenue 1,033 168 865 (6)

Total other operating revenue 6,069 247 5,822 3,273

3. Revenue

2015-16 2015-16 2015-16 2014-15


£000 £000 £000 £000

From rendering of services 5,964 247 5,717 3,246

From sale of goods 105 0 105 27

Total 6,069 247 5,822 3,273

The clinical commissioning group receives £105k income from sale of goods. This is relating to the Manchester Integrated Care Gateway (MICG) which provides a service to other public sector organisations. MICG is a city wide service hosted by NHS Central Manchester CCG and 37.79% of the income is reflected within the financial statements of Central Manchester CCG.


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4. Employee Benefits and Staff Numbers

4.1.1 Employee benefits

2015-16 Total Admin Programme Total

To

tal

Perm

an

en

t E

mp

loy

ees

Oth

er

To

tal

Perm

an

en

t E

mp

loy

ees

Oth

er

To

tal

Perm

an

en

t

Em

plo

yees

Oth

er

2014-1

5

£000 £000 £000 £000 £000 £000 £000 £000 £000 £000

Employee Benefits

Salaries and wages 4,304 3,421 883 2,581 2,335 246 1,723 1,086 637 3,521

Social security costs 294 293 1 208 208 0 86 85 1 262

Employer Contributions to NHS Pension scheme 453 452 1 316 316 0 137 136 1 406

Other pension costs 0 0 0 0 0 0 0 0 0 0 Other post-employment benefits 0 0 0 0 0 0 0 0 0 0 Other employment benefits 0 0 0 0 0 0 0 0 0 0

Termination benefits 0 0 0 0 0 0 0 0 0 21

Gross employee benefits expenditure 5,051 4,166 885 3,105 2,859 246 1,946 1,307 639 4,210

Less recoveries in respect of employee benefits (note 4.1.2) 0 0 0 0 0 0 0 0 0 0 Total - Net admin employee benefits including capitalised costs 5,051 4,166 885 3,105 2,859 246 1,946 1,307 639 4,210

Less: Employee costs capitalised 0 0 0 0 0 0 0 0 0 0 Net employee benefits excluding capitalised costs 5,051 4,166 885 3,105 2,859 246 1,946 1,307 639 4,210

4.1.2 Recoveries in Respect of Employee Benefits

The Clinical Commissioning Group had no recoveries in respect of employee benefits disclosed separately in 2015-16. (£nil in 2014-15).

4.2 Average Number of People Employed

2015-16 2014-15

Total Permanently

employed Other Total

Number Number Number Number

Total 94 86 8 86

Of the above:

Number of whole time equivalent people engaged on capital projects 0 0 0 0


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4.3 Staff Sickness Absence and Ill Health Retirements

2015-16 2014-15

Number Number

Total Days Lost 1,372 851

Total Staff Years 182 139

Average working Days Lost 8 6

2015-16 2014-15

Number Number

Number of persons retired early on ill health grounds 0 0

£000 £000

Total additional Pensions liabilities accrued in the year 0 0

The 2015/16 information relates to the period January to December 2015.

Where the Clinical Commissioning Group has agreed early retirements, the additional costs are met by the Clinical Commissioning Group and not by the NHS Pension Scheme.

4.4 Exit Packages Agreed in the Financial Year

There are no exit costs in 2015-16 (£101,372 in 2014-15)

2014-15

2014-15

2014-15

Compulsory redundancies

Other agreed departures

Total

Number

£

Number

£

Number

£

Less than £10,000 0

0

0

0

0

0

£10,001 to £25,000 0

0

0

0

0

0

£25,001 to £50,000 1

25,280

0

0

1

25,280

£50,001 to £100,000 1

76,092

0

0

1

76,092 £100,001 to £150,000 0

0

0

0

0

0

£150,001 to £200,000 0

0

0

0

0

0

Over £200,001 0

0

0

0

0

0

Total 2

101,372

0

0

2

101,372

* As a single exit package can be made up of several components each of which will be counted separately in this table, the total number will not necessarily match the total number in the table above, which will be the number of individuals. These tables report the number and value of exit packages agreed in the financial year.


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Exit costs are accounted for in accordance with relevant accounting standards and at the latest in full in the year of departure.

4.5 Pension Costs

Past and present employees are covered by the provisions of the NHS Pension Scheme. Details of the benefits payable under these provisions can be found on the NHS Pensions website at www.nhsbsa.nhs.uk/Pensions.

The Scheme is an unfunded, defined benefit scheme that covers NHS employers, GP practices and other bodies, allowed under the direction of the Secretary of State, in England and Wales. The Scheme is 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 Scheme is accounted for as if it were a defined contribution scheme: the cost to the clinical commissioning group of participating in the Scheme is taken as equal to the contributions payable to the Scheme for the accounting period. The Scheme is subject to a full actuarial valuation every four years (until 2004, every five years) and an accounting valuation every year. An outline of these follows:

4.5.1 Full Actuarial (funding) Valuation

The purpose of this valuation is to assess the level of liability in respect of the benefits due under the Scheme (taking into account its recent demographic experience), and to recommend the contribution rates to be paid by employers and scheme members. The last such valuation, which determined current contribution rates was undertaken as at 31 March 2012 and covered the period from 1 April 2008 to that date. Details can be found on the NHS Pensions website at www.nhsbsa.nhs.uk/Pensions.

For 2015-16, employers’ contributions of £453k were payable to the NHS Pension Scheme (2014-15: £406k) at the rate of 14.3% of pensionable pay. The schemes’ actuary reviews employer contributions, usually every four years and now based on HMT Valuation Directions, following a full scheme valuation. The latest review used data from 31 March 2012 and was published on the Government website on 09 June 2014 (http://www.nhsbsa.nhs.uk/Pensions/806.aspx).

http://www.nhsbsa.nhs.uk/Pensions

http://www.nhsbsa.nhs.uk/Pensions/806.aspx


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5. Operating Expenses 2015-16 2015-16 2015-16 2014-15


£000 £000 £000 £000

Gross employee benefits

Employee benefits excluding governing body members 4,609 2,663 1,946 4,029

Executive governing body members 442 442 0 181

Total gross employee benefits 5,051 3,105 1,946 4,210

Other costs

Services from other CCGs and NHS England 2,387 394 1,993 2,523

Services from foundation trusts 148,436 19 148,417 141,152

Services from other NHS trusts 35,614 2 35,612 34,407

Services from other NHS bodies 107 0 107 135

Purchase of healthcare from non-NHS bodies 30,451 0 30,451 31,584

Chair and Non-Executive Members 127 125 2 125

Supplies and services – clinical 2 0 2 6

Supplies and services – general 6,467 99 6,368 1,518

Consultancy services 1,146 5 1,141 591

Establishment 481 80 401 434

Transport 14 5 9 18

Premises 937 543 394 1,494

Impairments and reversals of receivables 0 0 0 0

Inventories written down 0 0 0 0

Depreciation 0 0 0 0

Amortisation 0 0 0 0

Impairments and reversals of property, plant and equipment 0 0 0 0

Impairments and reversals of intangible assets 0 0 0 0

Impairments and reversals of financial assets 0 0 0 0

· Assets carried at amortised cost 0 0 0 0

· Assets carried at cost 0 0 0 0

· Available for sale financial assets 0 0 0 0

Impairments and reversals of non-current assets held for sale 0 0 0 0

Impairments and reversals of investment properties 0 0 0 0

Audit fees 54 54 0 72

Other non-statutory audit expenditure

· Internal audit services 0 0 0 0

· Other services 0 0 0 0

General dental services and personal dental services 0 0 0 0

Prescribing costs 28,860 0 28,860 28,705

Pharmaceutical services 0 0 0 0

General ophthalmic services 92 0 92 101

GPMS/APMS and PCTMS 278 0 278 361

Other professional fees excl. audit 350 26 324 327

Grants to other public bodies 374 0 374 0

Clinical negligence 0 0 0 0

Research and development (excluding staff costs) 0 0 0 0

Education and training 245 74 171 151

Change in discount rate 0 0 0 0

Provisions 812 0 812 161

Funding to other group bodies 0 0 0 0

CHC Risk Pool contributions 509 0 509 347

Other expenditure 11 10 1 45

Total other costs 257,754 1,436 256,318 244,257

Total operating expenses 262,805 4,541 258,264 248,467


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The Clinical Commissioning Group hosts the citywide corporate functions which are recharged to NHS North Manchester Clinical Commissioning Group and NHS South Manchester Clinical Commissioning Group on the basis of actual costs incurred. Total costs are apportioned based on running costs for the majority of services, although there are a small number of corporate functions where a different methodology is applied. The accounting treatment of this arrangement is net accounting as opposed to showing the gross income and expenditure. NHS Central Manchester Clinical Commissioning Group also hosts the Healthier Together and Devolution Manchester management teams on behalf of the 12 Greater Manchester CCGs, and Manchester City Council for Devolution. The CCG acts as an agent in this arrangement and net accounting has been applied to the associated income and expenditure.

6. Better Payment Practice Code

6.1 Measure of Compliance

Measure of compliance 2015-16 2015-16 2014-15 2014-15

Number £000 Number £000

Non-NHS Payables

Total Non-NHS Trade invoices paid in the Year 18,257 76,756 17,514 75,654

Total Non-NHS Trade Invoices paid within target 17,998 75,805 17,308 75,472

Percentage of Non-NHS Trade invoices paid within target 98.58% 98.76% 98.82% 99.76%

NHS Payables

Total NHS Trade Invoices Paid in the Year 3,277 243,893 2,968 242,101

Total NHS Trade Invoices Paid within target 3,210 243,846 2,857 241,383

Percentage of NHS Trade Invoices paid within target 97.96% 99.98% 96.26% 99.70%

The Better Payment Practice Code is summarised as below: Target: to pay 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. Compliance: at least 95% of invoices paid (by the bank automated credit system or date and issue of a cheque) within thirty days or agreed contract terms.

6.2 The Late Payment of Commercial Debts (Interest) Act 1998

The Clinical Commissioning Group had not incurred any late payment charges within 2015-16 (£nil in 2014-15).

7. Operating Leases

7.1 As Lessee The Clinical Commissioning Group leases buildings from NHS Property Services Ltd and Community Health Partnerships, with the transactions conveying the right to use the asset in return for a payment or series of payments, in the absence of formal lease documentation.


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7.1.1 Payments Recognised as an Expense

2015-16 2014-15

Land Buildings Other Total Total

£000 £000 £000 £000 £000

Payments recognised as an expense

Minimum lease payments 0 883 0 883 1,429

Contingent rents 0 0 0 0 0

Sub-lease payments 0 0 0 0 0

Total 0 883 0 883 1,429

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

7.2 As Lessor

The Clinical Commissioning Group does not own any assets and is not a lessor in 2015-16 (£nil in 2014-15).

8. Trade and Other Receivables

Current Non-current Current Non-current

2015-16 2015-16 2014-15 2014-15

£000 £000 £000 £000

NHS receivables: Revenue 3,279 0 2,430 0

NHS receivables: Capital 0 0 0 0

NHS prepayments 58 0 327 0

NHS accrued income 2,473 0 0 0

Non-NHS receivables: Revenue 892 0 1,673 0

Non-NHS receivables: Capital 0 0 0 0

Non-NHS prepayments 364 0 430 0

Non-NHS accrued income 365 0 0 0

Provision for the impairment of receivables 0 0 0 0

VAT 94 0 79 0 Private finance initiative and other public private partnership arrangement prepayments and accrued income 0 0 0 0

Interest receivables 0 0 0 0

Finance lease receivables 0 0 0 0

Operating lease receivables 0 0 0 0

Other receivables (14) 0 (5) 0

Total Trade & other receivables 7,511 0 4,934 0

Total current and non-current 7,511 4,934

Included above:

Prepaid pensions contributions 0 0

The great majority of trade is with NHS England. As NHS England is funded by the Government to provide funding to clinical commissioning groups to commission services, no credit scoring of them is considered necessary.


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8.1 Receivables Past their Due Date but not Impaired

2015-16 2014-15

£000 £000

By up to three months 2,943 646

By three to six months 139 147

By more than six months 28 20

Total 3,110 813

8.2 Provision for Impairment of Receivables

The Clinical Commissioning Group had no provision for impairment of receivables in 2015-16 (£nil in 2014-15).

9. Cash and Cash Equivalents 2015-16 2014-15

£000 £000

Balance at 1 April 2015 32 69

Net change in year 77 (37)

Balance at 31 March 2016 109 32

Made up of:

Cash with the Government Banking Service 109 32

Cash with Commercial banks 0 0

Cash in hand 0 0

Current investments 0 0

Cash and cash equivalents as in statement of financial position 109 32

Bank overdraft: Government Banking Service 0 0

Bank overdraft: Commercial banks 0 0

Total bank overdrafts 0 0

Balance at 31 March 2016 109 32

Patients’ money held by the clinical commissioning group not included above 0 0


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10. Trade and Other Payables


2015-16 2015-16 2014-15 2014-15

£000 £000 £000 £000

Interest payable 0 0 0 0

NHS payables: revenue 2,209 0 2,428 0

NHS payables: capital 0 0 0 0

NHS accruals 4,143 0 3,424 0

NHS deferred income 0 0 0 0

Non-NHS payables: revenue 2,591 0 3,574 0

Non-NHS payables: capital 0 0 0 0

Non-NHS accruals 18,146 0 12,661 0

Non-NHS deferred income 17 0 0 0

Social security costs 0 0 0 0

VAT 0 0 0 0

Tax 0 0 0 0

Payments received on account 0 0 0 0

Other payables 500 0 57 0

Total Trade & Other Payables 27,606 0 22,144 0

Total current and non-current 27,606 22,144

11. Provisions


2015-16 2015-16 2014-15 2014-15

£000 £000 £000 £000

Pensions relating to former directors 0 0 0 0

Pensions relating to other staff 0 0 0 0

Restructuring 4 0 232 0

Redundancy 0 0 0 0

Agenda for change 0 0 0 0

Equal pay 0 0 0 0

Legal claims 0 0 0 0

Continuing care 0 0 (0) 0

Other 1,261 0 221 0

Total 1,265 0 453 0

Total current and non-current 1,265 453


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Pensions Relating

to Former Directors

Pensions Relating to Other Staff

Restructuri

ng Redund

ancy

Agenda for

Change Equal Pay

Legal Claims

Continuing Care Other Total

£000s £000s £000s £000s £000s £000s £000s £000s £000s £000s

Balance at 1 April 2015 0 0 232 0 0 0 0 (0) 221 453

Arising during the year 0 0 0 0 0 0 0 0 1,187 1,187

Utilised during the year 0 0 0 0 0 0 0 0 0 0

Reversed unused 0 0 (228) 0 0 0 0 0 (147) (375)

Unwinding of discount 0 0 0 0 0 0 0 0 0 0

Change in discount rate 0 0 0 0 0 0 0 0 0 0

Transfer (to) from other public sector body 0 0 0 0 0 0 0 0 0 0

Balance at 31 March 2016 0 0 4 0 0 0 0 (0) 1,261 1,265

Expected timing of cash flows: Within one year 0 0 4 0 0 0 0 (0) 1,261 1,265

Between one and five years 0 0 0 0 0 0 0 0 0 0 After five years 0 0 0 0 0 0 0 0 0 0

Balance at 31 March 2016 0 0 4 0 0 0 0 (0) 1,261 1,265

A £232k provision was available in 2015-16 relating to costs payable to North West Commissioning Support Unit relating to services, which the Clinical Commissioning Group has given notice on. In year £228k has been charged, leaving £4k to be used wholly within the next year. A £1,187k provision has been made in 2015-16 relating to the procurement of mental health services across Manchester, based on assessment of unavoidable costs relating to this. The provision of £75k relates to restructuring costs at Central Manchester University Hospitals Foundation Trust (CMUHFT) as a result of the closure of Trafford Hospital. The provision is based on a Heads of Terms agreement between CMUHFT and the Greater Manchester CCGs. Agreement was reached in 2012-13 that each Greater Manchester CCG would contribute to the costs as part of a Greater Manchester risk share agreement. The costs are based on an agreed transition arising as a result of the new Health Deal within Trafford and the process has been signed off by the Secretary of State and was subject to wider assurances provided in advance of the Secretary Of State decision.


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The termination costs (redundancy and contracts) originally had a combined maximum limit of £11.0m (with a maximum of £6.5m for GM CCGs as £4.5m was previously settled by GM SHA) final actual values have to be signed off by CMUHFT and Trafford CCG as the lead responsible CCG. In 2013-14 £1,828k was charged and £4,322k provided for across GM. In 2014-15 these figures have been revised and a further £1,048k was charged and £3,274k provided for. In 2015-16 these figures have again been revised with a further charge of £1,533k and a remaining £1,741k provided for. The exact value is not as yet definitive and the exact timing of the discharge of costs is uncertain but likely to be wholly within the next year. Under the Accounts Directions issued by NHS England on 12 February 2014, NHS England is responsible for accounting for liabilities regarding NHS Continuing Healthcare claims relating to periods of care before the establishment of the CCG. However, the legal liability remains with the CCG. The total value of legacy NHS Continuing Healthcare provisions accounted for by NHS England on behalf of Central Manchester Clinical Commissioning Group is £1,078k.

12. Financial Instruments

12.1 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.

12.1.1 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 and therefore has low exposure to currency rate fluctuations. 12.1.2 Interest Rate Risk The Clinical Commissioning Group borrows from the government for capital expenditure, subject to affordability as confirmed by NHS England. The


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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 risk.

12.1.3 Credit Risk

Because the majority of the NHS Clinical Commissioning Group and revenue comes from 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.

12.1.3 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.

12.2 Financial Assets

At ‘fair value through profit and

loss’ Loans and

Receivables Available for

Sale Total

2015-16 2015-16 2015-16 2015-16

£000 £000 £000 £000

Embedded derivatives 0 0 0 0

Receivables:

· NHS 0 5,752 0 5,752

· Non-NHS 0 1,257 0 1,257

Cash at bank and in hand 0 109 0 109

Other financial assets 0 (14) 0 (14)

Total at 31 March 2016 0 7,104 0 7,104

At ‘fair value through profit and

loss’ Loans and

Receivables Available for

Sale Total

2014-15 2014-15 2014-15 2014-15

£000 £000 £000 £000

Embedded derivatives 0 0 0 0

Receivables:

· NHS 0 2,430 0 2,430

· Non-NHS 0 1,673 0 1,673

Cash at bank and in hand 0 32 0 32

Other financial assets 0 (5) 0 (5)

Total at 31 March 2015 0 4,130 0 4,130


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12.3 Financial Liabilities

At ‘fair value through

profit and loss’ Other Total

2015-16 2015-16 2015-16

£000 £000 £000

Embedded derivatives 0 0 0

Payables:

· NHS 0 6,352 6,352

· Non-NHS 0 21,236 21,236

Private finance initiative, LIFT and finance lease obligations 0 0 0

Other borrowings 0 0 0

Other financial liabilities 0 0 0

Total at 31 March 2016 0 27,588 27,588

At ‘fair value through

profit and loss’ Other Total

2014-15 2014-15 2014-15

£000 £000 £000

Embedded derivatives 0 0 0

Payables:

· NHS 0 5,852 5,852

· Non-NHS 0 16,292 16,292

Private finance initiative, LIFT and finance lease obligations 0 0 0

Other borrowings 0 0 0

Other financial liabilities 0 0 0

Total at 31 March 2015 0 22,144 22,144

13. Operating Segments

The Clinical Commissioning Group considers they have only one segment: commissioning of healthcare services. This is consistent with the position reported in 2014-15.

14. Pooled Budgets NHS Central Manchester CCG has a pooled budget arrangement with Manchester City Council for health and social care spend in line with arrangements for the Better Care Fund. Manchester City Council hosts the pool and the CCG’s share of income and expenditure is outlined in the table below. Of the £12.5m, £4m was an allocation for Social Care.


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2015-16

2014-15

£000

£000

Income 0

0

Expenditure (12,564)

0

15. Healthier Together & Devolution Manchester The Clinical Commissioning Group contributes and hosts the Healthier Together programme on behalf of the Greater Manchester clinical commissioning groups. This project supports the objectives of the overall programme for Greater Manchester health and social care reform. The Healthier Together project is shown net within the accounts. The Healthier Together project (including Judicial Review), is shown net within the accounts in 2015-16 with a total income of £2,508k and expenditure of £3,006k. The expenditure shows in 2014-15 shows a net total of £737k of which £468k is contributed by NHS England through an IAT adjustment and £269k from Central Manchester CCG. Central Manchester Clinical Commissioning Group contributes £163k into the project from within its own resource allocation (£269k in 2014-15). There are no assets and liabilities associated with this arrangement at 31st March 2016 (£nil in 2014-15).

The income and expenditure associated with the CCG hosting the Devolution Manchester team are shown net within the accounts for 2015-16. This team was not in existence in 2014-15. The expenditure in 2015-16 shows a net total of £1,393k, of which £1,350k is contributed by NHS England through an allocation transfer and £43k from Central Manchester Clinical Commissioning Group. Central Manchester Clinical Commissioning Group contributes £43k into the project from its own resource (£nil in 2014-15).


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16. Related Party Transactions

Payments to Related

Party

Receipts from

Related Party

Amounts owed to Related Party

Amounts due from Related Party

£'000 £'000 £'000 £'000

Alexandra Practice A Larkin 51 0 0 0

Ashcroft Surgery D Hyland 42 0 0 0 Gtr Mcr Centre for Voluntary Org G Page/A Chaudry 0 0 0 0

CMFT I Williamson/E Dyson 132,488 (0) (9,425) 0

Range Medical Practice I Bennett 70 0 10 0 Healthier Together- Ian Williamson I Bennett 237 (192) 465 (11)

Go To Doc Ltd I Bennett 1,941 0 181 0

Robert Derbyshire Practice M Kumar 88 0 (0) 0

Whitswood Practice M Kumar 21 0 0 0

West Gorton Medical Centre M Eeckelaers 37 0 0 0

Longsight Medical Practice P Moyo 17 0 0 0

Beacon Medical Services P Moyo 254 0 59 0

Primary Care Manchester Ltd I Bennett/P Moyo/M Eeckelaers/M Kumar 784 0 0 0

Royal Liverpool University Hospital P Williams 108 0 2 0

NHS South Manchester C Harris/J Newton 639 681 103 (1,654)

NHS North Manchester C Harris/J Newton/G Page 780 894 (42) (1,849) Greater Manchester West NHSFT C Harris 1,559 0 524 0

NHS England C Harris 512 (137) 0 0

Survivors Manchester C Harris 34 0 0 0

Total 139,662 1,246 (8,123) (3,514)

The disclosure above identifies the governing board member and the total transactions with the related party organisation identified within the declaration of interests. 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 the entities for which the Department is regarded as the parent department. For example: - NHS England (including commissioning support units) - NHS Foundation Trusts - NHS Trusts - NHS Litigation Authority; and - NHS Business Services Authority 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 Manchester City Council.


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17. Events After the End of the Reporting Period There are no post balance sheet events which will have a material effect on the financial statements of the Clinical Commissioning Group (£nil in 2014-15).

NHS England recently announced details of the Clinical Commissioning Groups approval to take on greater delegated responsibility, or to jointly commission GP services from 1st April 2016. The new primary care co-commissioning arrangements, are part of a series of changes set out in the NHS Five Year Forward View to deliver a new deal for primary care and another step towards plan set out by NHS England early last year to give patients, communities and clinicians more involvement in deciding local health services. Central Manchester CCG will assume full responsibility for contractual GP performance management, budget management and the design and implementation of local incentive schemes from 1st April 2016. The 12 Greater Manchester CCGs and NHS England have agreed that the services provided by the former Greater Manchester Commissioning Support Unit (GMCSU), will be hosted by Oldham CCG from 1st April 2016. Formal transfer of services is now completed with the staff complement now being directly employed by NHS Oldham CCG, the business unit is to be known as ‘Greater Manchester Shared Services’ (GMSS). With effect from the 1st April 2016 GMSS accounts will be consolidated on Oldham CCG’s ledger and this will be on a ‘gross accounting’ basis. The GM CCGs agreed unanimously that collaboration is integral to the successful implementation of joint strategies designed to benefit local health populations, especially under Greater Manchester Devolution, whilst recognising each CCG’s individual sovereignty and the need for decision making to be locally driven. Oldham CCG will be exposed to the risks and rewards associated with the GMSS Commissioning Support Services and will be the principle risk-holder from 1 April 2016. Whilst Oldham CCG gained agreement from the remaining GM CCGs to ameliorate any financial risks and credit risks relating to the GMSS, and any future reconfiguration of the GMSS service, each GM CCG will need to agree separately to such terms in a negotiated settlement. Oldham CCG retains any risk relating to the GMSS which cannot be mitigated.


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18. Financial Performance Targets

2015-16 2015-16 2014-15 2014-15

Target Performance Target Performance

£000 £000 £000 £000

Expenditure not to exceed income 266,251 262,896 252,349 248,465

Capital resource use does not exceed the amount specified in Directions 0 0 0 0

Revenue resource use does not exceed the amount specified in Directions 260,089 256,734 249,078 245,194

Capital resource use on specified matter(s) does not exceed the amount specified in Directions 0 0 0 0

Revenue resource use on specified matter(s) does not exceed the amount specified in Directions 0 0 0 0

Revenue administration resource use does not exceed the amount specified in Directions 4,745 4,292 5,917 4,491

For the purposes of "expenditure not to exceed income", expenditure is defined as the aggregate of gross expenditure on revenue and capital in the financial year; and, income is defined as the aggregate of the notified maximum revenue resource, notified capital resource and all other amounts accounted as received in the financial year (whether under the provision of the Act or from other sources and included here on a gross basis). For the purposes of "Capital resource use does not exceed the amount specified in Directions" and " Capital resource used on specified matter(s) does not exceed the amount specified in Directions" are not applicable as the clinical commissioning group has no capital resources in 2014-15.

For the purposes of "Revenue resource use does not exceed the amount specified in Directions", income is defined as the notified maximum revenue resource limit, compared to revenue expenditure.

For the purposes of "Revenue administration resource use does not exceed the amount specified in Directions", the revenue administration resource has been identified as the notified allocation and all other amounts accounted as received in the financial year (whether under the provision of the Act or from other sources and included here on a gross basis).

All performance targets were met in 2015-16, 2014-15 and 2013-14.

central manchester clinical commissioning group …...achievement of the four hour access target for...

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