Hambleton, Richmondshire and Whitby Clinical Commissioning Group

Annual Report 2014/15

Draft, version 2 13 May 2015

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Contents

Welcome from our Chair and Clinical Chief Officer 3

Member Practices Report 4

Strategic Report 6

Our achievements this year 9

Our commitment to engaging 23

Our partners 24

Our commitment to the environment 26

Our commitment to equality and diversity 26

Emergency Preparedness 27

How we learn from you 27

Information governance 28

Our workforce 29

Performance 2014/15 30

Our future plans, performance and objectives 34

Financial Outlook 35

Financial commentary 36

Our Membership Body and Governing Body 39

Remuneration report 43

Statement of Accountable Officer’s Responsibilities 47

Statement as to disclosure to auditors 49

Independent Auditor’s Report 49

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Welcome from our Chair and Clinical Chief Officer

Welcome to our Annual Report 2014/15. We have achieved a great deal in our first two years. Some of what we have had to do has been challenging and has required us to work closely with partners, such as the reconfiguration of maternity and paediatric services at the Friarage Hospital and improving emergency ambulance response times. However, some achievements have also been ‘quick wins’, where we have identified clear, obvious opportunities for improvement and have simply made it happen. You can read more about our key achievements on pages XX-XX.

Public engagement has always been and always will be key for the CCG. We have been learning valuable lessons from you which influence our decisions. Public opinions, for example, have been vital in helping us develop a vision for health services in the Whitby area which is closely attuned to the wishes of local people.

While we can rightly celebrate what we have achieved so far, there is always much more to do. We are serious about real transformational change and that means tackling things that have traditionally been in the ‘too difficult’ box. This involves real integration of all the various fragmented bits of healthcare with social care to provide a seamless service that delivers what the patients need. To do that we need a different level of engagement with both the public and staff to help us shape these services to make them truly fit for the future.

The culture in the NHS is changing dramatically, led from the top by NHS England’s new Chief Executive Simon Stevens. His Five Year Forward View sets out how the NHS is now at a crossroads; and explores the challenges the NHS faces over the coming years. He states – and we agree – that to improve and sustain the NHS over the next five years in ways that the public and patient want, it needs to change substantially.

Locally, the most significant challenge we face is our growing older population and the increase in services needed to support them. We have a detailed strategy to enable ourselves and partner organisations to meet this challenge, but we can only measure the scale and impact of change retrospectively, not by pronouncing on its shape and content at the outset. In other words, judge us again in a year’s time, and please continue to challenge us. We believe our CCG is fit for purpose and has delivered significant improvements to local healthcare over the past couple of years. We will require refining to meet new challenges (notably co-commissioning of services with GP practices), but we will retain a lean, can-do approach to both the commissioning and delivery of services.

The NHS is hugely valued. Our challenge is to raise its value further among our local population, for the patients receiving health and social care, and for staff delivering excellent care day in, day out. Success breeds success. But the complexity and breadth of the challenge continues to grow. Our job is to maintain our focus, making sure that everything we do contributes to the success of the overall picture. It is our tapestry, unique to Hambleton, Richmondshire and Whitby, and we will continue the work this year with the same energy and drive that has characterised our past year.

David Williams Dr Vicky Pleydell Lay Chair Clinical Chief Officer

A full version of our accounts can be found on our website: www.hambletonrichmondshireandwhitbyccg.nhs.uk.

If you are reading this online and would like a hard copy please email HRWCC.HRWCCGenquiries@nhs.net or call 01609 767600 and we will gladly assist you.

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Member Practices Report

Overall, 2014/15 has been a very positive year for Hambleton, Richmondshire and Whitby Clinical Commissioning Group, building on our successes and achievements in our first year and laying the ground work for further improvements to local health services.

Clinical leadership has remained at the heart of the CCG, driven forward by our Council of Members. The Council comprises a representative from each GP practice in our area, and our roles include approving and overseeing the CCG’s strategic plan and making sure there is effective engagement with GP practices to ensure the plan continues to be implemented.

The Council of Members is responsible for making any major decisions for the CCG, which we do so collectively. However, we delegate the day to day running of the CCG to the Governing Body and the senior management team.

This year has been tougher for the CCG, like it has been across the vast majority of the NHS. Budgets have been tighter, hospital admissions and referrals continue to grow and focus on ensuring services can manage future needs grows ever acute.

Despite these challenges, there are plenty of significant achievements for us to be proud of which demonstrate the confidence local people can have in the CCG.

Care closer to home has been central to many of our achievements. Notably, we were delighted to work with St Teresa’s Hospice to run a satellite clinic in Richmond for patients who, due to their condition, found it difficult to go to Darlington for care. We’ve also worked very hard to bring back the eye clinic to Whitby Hospital – patients told us it was incredibly important that this happened.

Weekly clinics for frail elderly people in Hambleton and Richmondshire have been introduced as part of efforts to reduce unnecessary hospital admissions. This has been one element of our strong working relationship with South Tees Hospitals, which has seen us continue to work closely to deliver services locally.

Investing in technology has also been important for us. We have been delighted to closely support South Tees Hospitals’ investment in leading-edge robotic surgery for prostate cancer patients.

Underpinning all of our work has been our commitment to engagement and involvement. We have continued to take a proactive approach to involving key stakeholders and our local population in our decision-making and strategy development. The patient and public voice is a strong thread throughout our work. In addition, we have three members of the public elected to our Governing Body as Health Engagement Network representatives who are the voices of our communities.

One of the most significant developments over the past year has been the conclusion of the review into maternity and paediatrics services at the Friarage Hospital, Northallerton, which has been the result of more than two years of in-depth reviews, research and consultation.

The decision to change the service model was driven by clear patient safety and quality requirements. This change is supported by national independent experts and all local doctors and midwives and we know this will provide safer, better services for local mothers and children which will last into the future.

Since that decision, the temporary reduction in hours of the Paediatric Assessment Unit has caused concern among local people. The reasons South Tees Hospitals made this decision are understandable – patient safety and quality of care must be the main priorities. However, we have been disappointed that the opening hours have changed and it is not something that we support. We are continuing to work closely with the Trust to ensure that all is being done to resolve the staffing issues.

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Those twin factors of quality and patient safety which have been behind these changes at the Friarage underpin our strategic plan.

We understand fully how important the Friarage is to local people and the vital service it provides. We share this viewpoint, there is no doubt about that. Under our Fit 4 the Future banner, we are exploring how to ensure the hospital has a viable future and continues to provide a first class service for local people.

We have taken the same approach with our work in the Whitby area, which has also been carried out under Fit 4 the Future. The appointment of Virgin Care in March 2015 concluded an in-depth process to appoint a new provider of community and out of hours services. Due to conflicts of interest the Council of Members were unable to take part in the appointments process.

Aligned to this procurement process has been our engagement campaign in Whitby. We spoke extensively with local stakeholders and members of the public about the future remodelling of Whitby Hospital, what services they want in the town and how they could be run. This was a very useful exercise and what people have told us has been built into our vision for healthcare in the area and into the specification for services Virgin Care will run.

Looking ahead, it’s clear that the challenges we face will continue. Budgets will be tighter still, co-commissioning of services will be an ever increasing factor. Pressures on GP practices will continue to grow, as will demand for services, especially among older people.

We are very confident that by working together and thinking creatively when it comes to system redesign we can overcome these obstacles and deliver health services which meet the needs of local people. Our successes would not have been possible without the support, involvement and expertise of our partners in health and social care, our patients and carers and CCG staff. We are committed to continuing with meaningful engagement and ensuring that services across our area are Fit 4 the Future.

We hope you find this Annual Report interesting, and enjoy reading about our highlights from 2014/15.

Dr George CampbellGP Lead for Whitby

Dr Mark HodgsonGP Lead for Richmondshire

Dr Charles ParkerGP Lead for Hambleton

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Strategic Report

About us and our community

NHS Hambleton, Richmondshire and Whitby CCG is a clinical commissioning group. On 1 April 2013, we took over from the former Primary Care Trust (PCT), NHS North Yorkshire and York. We are responsible for planning and buying (commissioning) the vast majority of health services across our area. This includes hospital care, mental health and community services. We are accountable to our members, our patients and the public and we are overseen by NHS England. NHS England is also responsible for commissioning primary care services (such as GPs, dentists, pharmacists) and some specialised areas of commissioning.

We are based at offices at Stone Cross, Northallerton, which we share with Hambleton District Council. We are a clinically-led organisation in which local GPs, other clinicians and members of the public work together to improve health in our area.

We represent 22 GP practices across Hambleton, Richmondshire and Whitby. We serve a population of around 142,000 people and have an annual commissioning budget of £183 million. This budget is set by central government and is based on a complex funding formula which takes into account the overall health and wellbeing of people living in the area.

Our area is predominantly sparsely populated and rural, centred around eight market towns. Our rurality is one of our biggest challenges, as is the growing number of older people in our population.

Our responsibilities are slightly different to those of the former PCT as we are not responsible for commissioning primary care services (such as those provided by GP practices, pharmacies, dentists and opticians), specialist services or for public health. Public health is now provided by local authorities; which in this area is North Yorkshire County Council.

At the heart of our CCG is our Governing Body which includes local GPs, other healthcare professionals and lay members. Our Governing Body is supported by a small team of staff who help with the day-to-day commissioning of health services. This means that GPs and other healthcare professionals are able to continue with their clinical duties, which is important as it means they hear first-hand about any issues or opportunities for improvement.

This Annual Report has been prepared under a Direction issued by the NHS Commissioning Board under the National Health Service Act 2006 (as amended).

We certify that the CCG has complied with the statutory duties laid down in the National Health Service Act 2006 (as amended).

Dr Vicky PleydellClinical Chief Officer

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Our role

Our role is to commission the vast majority of services our local people may need to access in hospital or in the community such as:

Planned hospital care Urgent and emergency care Rehabilitation care Community health services Mental health and learning disability services

Other functions we undertake include:

Assessing the health needs of people living in the Hambleton, Richmondshire and Whitby area

Engaging with local people to understand their health needs and to receive feedback on local services

Monitoring the quality of health services Planning services to meet future health needs Undertaking long-term commissioning to reduce the potential years of life lost for conditions

amenable to healthcare, promote healthy living and improve the quality of services Working co-operatively with a number of partners and organisations to achieve our aims

including other NHS trusts and provider organisations, local authorities, voluntary sector groups, patients, carers and the wider public

Our vision, values and aims

Our mission is “To commission first class healthcare which improves the health of everyone in Hambleton, Richmondshire and Whitby.” Our patients are at the heart of everything we do and we want to work closely with our local communities to help us achieve our goals.

We are a values-driven organisation. We try to ensure that we genuinely adhere to these values in every aspect of our work, whether we are engaging with the public, developing service improvement plans with providers or managing contracts and performance. The values that we work to are:

Integrity Action Transparency Energy CollaborationCourage Focus

We have four core strategic aims which will help us to deliver our mission:

We will involve people in their care and as part of that we will encourage self-care We will buy quality services We will change services for the better and in doing so, we will provide care as close to

home as is possible that is easily accessible We will use the money we have in the best possible way

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We certify that Hambleton, Richmondshire and Whitby Clinical Commissioning Group has complied with the statutory duties laid down in the National Health Service Act 2006 (as amended) and that these accounts have been prepared on a going concern basis.

This report describes in detail the business model that the CCG has developed during 2014/15 to enable it to successfully deliver its goals, objectives and ambitions.

Our CCG area

Our GP practices

The Surgery, Topcliffe Lambert Medical Centre, Thirsk The Doctors’ Surgery, Thirsk Great Ayton Health Centre, Great Ayton The Health Centre, Stokesley Mayford House Surgery, Northallerton Mowbray House Surgery, Northallerton Glebe House Surgery, Bedale Catterick Village Medical Centre Doctor’s Lane Surgery, Aldbrough St John Quakers Lane Surgery, Richmond The Friary Surgery, Richmond Reeth Medical Centre Scorton Medical Centre, Scorton Central Dales Health Centre, Hawes Leyburn Medical Practice, Leyburn Harewood Medical Practice, Catterick Garrison Whitby Group Practice, Whitby Sleights and Sandsend Medical Practice, Sleights Staithes Surgery, Staithes

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Egton Surgery, Egton Danby Surgery, Danby

Our achievements this year

In our first year as a CCG (2013/14) we made very significant progress on delivering improvements to local healthcare services, supported by a Strategic Plan. However, as always, the NHS has moved forwards and a new range of national developments and local aspirations came onto our radar which we wanted to address. As a result, our original five-year Strategic Plan was refreshed and this updated plan (which is available on our website) has been influencing the work we have carried out over the past year and will continue to do so into the future.

Over the next few pages we have outlined our key achievements against this strategic plan under seven key headings – each of these areas is of equal importance to us to ensure we are able to develop and enhance local healthcare services to meet the needs of the local population.

Transforming the community system

Enhancing healthcare in the Whitby area

For the past few years HRW CCG has been exploring – along with key partners and members of the public – how to transform healthcare services in Whitby and the surrounding area to be able to cope with the increase in demand for services a growing older population will bring. This needs to be balanced with maintaining the excellent standards of care expected. Innovative approaches to how health and social care services work together are required.

The CCG is in the process of enhancing community health services in the area and remodelling the Whitby Hospital site, under a wide-ranging project called Fit 4 the Future.

The most significant milestone from 2014/15 is the appointment, following a rigorous and in-depth procurement process, of Virgin Care as the Preferred Bidder to provide community and out of hours healthcare services in Whitby and the surrounding area.

The procurement process for the seven-year contract was led by HRW CCG as commissioners, who assessed interested organisations on their ability to deliver services against very high quality targets.

The £6 million a year contract was out for tender because current service providers, York Hospitals NHS Foundation Trust, gave notice on its contract. Virgin Care will provide the services from 1 July 2015.

Virgin Care was chosen following the in-depth process because of their ability to meet the CCG’s key commissioning intentions for the Whitby area. Virgin Care demonstrated a strong commitment to ensuring the local community will benefit from enhanced services showing clearly how patients will receive high quality, appropriate care.

A range of key service improvements will be implemented by Virgin Care, some of which include:

• Enhanced medical input and continuity of medical cover• Involvement in the development of a health and wellbeing hub• Innovation fund to work with the local voluntary sector

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“We are looking forward to working in partnership with

Virgin Care and other local health and social care organisations

over the coming years to further enhance and develop health services in the Whitby area.”

Debbie Newton, HRW CCG Chief Operating and Finance Officer.

“The future of the hospital is a significant talking point in the

town and it was really encouraging to hear from so

many people.”

Abi Barron, HRW CCG Senior Transformation Manager.

• Rapid assessment for frail and elderly to help community teams manage patients in their own home for as long as possible• More streamlined district nursing with the use of mobile working• Neighbourhood Care Team – range of clinical individuals working together to provide care for people in the community

Aligned to the procurement process to select a new provider, The CCG took its refreshed and updated Vision for Community Health and Social Care Services in Whitby and the Surrounding Area out to the public for further engagement and discussion about what future healthcare services should look like.

Dozens of people from Whitby and the surrounding area had their say on future plans for the town’s hospital and local services. This included examining and debating plans examining the different options for the Whitby Hospital site in the future, which the CCG had drawn up as part of its work to appraise all future potential options for a hospital in Whitby.

As part of the public engagement programme, staff from HRW CCG spent a week at Scarborough Borough Council’s Tourist Information Centre in Whitby. They were on hand to speak with people about the plans. They also spent time in local GP practices and held a series of meetings across the area. This work was supported by a mail-out to 12,000 local households, a survey, social media promotion and visits to key local groups. Specific staff meetings were also held.

Investing in healthcare in Whitby

One view that people in Whitby and the surrounding area are very clear about is the strong desire to have local access to health services.

One such service is the outpatient eye (ophthalmology) clinics at Whitby Hospital, which were reinstated from April 2015 following work by the CCG to find a new provider.

South Tees Hospitals NHS Foundation Trust is now providing a full day eye clinic every other week. Due to staffing pressures in July 2014, the previous providers York Hospitals NHS Foundation Trust stopped the clinics at Whitby Hospital, and patients had to travel to Scarborough or elsewhere for care.

Across the country, pressures on ophthalmology departments have increased due to an ageing population and an increase in cataract surgery. There is also an increased workload for macular degeneration. In addition to this, there is a national shortage of ophthalmologists.

However, a solution has now been found to provide a local service for people in Whitby and the surrounding area. In addition, the Community Nursing Service covering Whitby and the surrounding area was extended to a 24/7 service in February 2015, meaning round the clock care is available for patients. The service, commissioned by the CCG and provided by staff from York Teaching Hospital NHS Foundation Trust, provides personalised healthcare programmes for a wide range of conditions and gives appropriate care for individuals, with dignity and respect, in their own homes as long as possible. It also helps to prevent

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“We completely understand that people in Whitby and the

surrounding area place great value on access to services close to home. It is something to which we are committed to preserving

and enhancing wherever it is clinically appropriate.”

Debbie Newton, Chief Operating and Finance Officer at HRW CCG.

“The benefits for patients of a 24/7 service are very clear. It has been demonstrated that patient

care is better with access to services closer to home and

overnight.”

Dr Vicky Pleydell, Clinical Chief Officer at HRW CCG.

unnecessary admissions to hospital by providing care overnight, as well as facilitating patients’ discharge from hospital back to their own home.

In addition to ensuring that care is provided at home, the service also works to reduce unnecessary admissions to hospitals or nursing homes.

Improving ambulance response times

Despite seeing the largest increase in demand in any area in which Yorkshire Ambulance Service NHS Trust (YAS) operates over the year, through close partnership working the CCG has been able to buck the trend and improve response times year on year – the only area in YAS’ patch to do so.

For the most serious call-outs, categorised red, the ambulance response time target is eight minutes. Statistics for the past two years show:

2013/14 2014/15Red (combined) 64/3% of calls reached within

eight minutes66.6%

Red 1 calls 68.4% 67.9%Red 2 calls 64.0% 66.5%

A number of initiatives have been particularly successful as part of the CCG’s overall for tackling ambulance response times and ensuring the best use of local resources.

One scheme which has been proving very effective has been to provide enhanced urgent care transport services to hospital when booked by local GPs.

365 Response and Medical Services North East Ltd, both of whom provide specialist services for managing 999 demand and patient transport services, now provide additional booking options for GPs, which is a safe and appropriate alternative to utilising an emergency ambulance and is easing the pressure on YAS. The scheme covers transport from any location when booked by a GP to hospital.

Initially a pilot until the end of the 2014/15 financial year, this scheme has been extended into 2015/16. The services are accessed via GP assessment where the GP has made the clinical decision that the patient does not require an emergency ambulance response (in either eight minutes or 19 minutes) with trained paramedic capability but still needs transferring to hospital.

The previous model of transport was via a paramedic-staffed ambulance and in the majority of occasions this category of ‘urgent’ patient did not require a paramedic staffed emergency ambulance for their journey to hospital. Previously the response time window was between one and four hours and was often delayed while ambulance crews attend more acutely ill patients. The service started with a new response time target of a maximum of two hours.

It is estimated that this initiative has freed up approximately 800 hours of extra emergency ambulance capacity for the most urgent calls. About 400 patients have received care from this service, with no complaints made and no issues raised.

Another key part of increasing the number of response times met has been the GP in-hours triage scheme. When an ambulance crew goes out to see a patient and it becomes clear that they may

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Sarah Fatchett, Managing Director for 365 Response: “The aim of the NHS right now is to be

creative, deliver great patient care and make sure resources are used in the best possible

way. We are excited to be able to support HRW CCG with this

brilliant innovation in ambulance care which, in turn, delivers

additional support to the NHS ambulance service, enabling

them to focus on critical emergency responses.”

not need care in A&E, the crew can call a GP for a conversation about the patient’s needs and decide on a course of action. This may include a home visit from the GP, a telephone consultation, an appointment with a GP or for the patient to be taken to the GP practice to be seen there. Approximately 240-280 patients over the year have received care in this manner, avoiding unnecessary hospital visits.

Investment has been made in new ambulance stations, meaning the fleet can be used in a more flexible manner to respond more quickly to emergencies. These new stations are in Richmond at the Friary Hospital, and at the GP practice in Catterick. In addition, investment has been made in an extra ambulance to serve the Northallerton area.

As part of resilience efforts lifesaving defibrillators have been installed across the area. Please see page XX for further information.

New frail elderly clinics in Northallerton and Richmond

Weekly clinics for frail elderly people in Hambleton and Richmondshire have been introduced as part of efforts to reduce unnecessary hospital admissions.

HRW CCG has invested in the new clinics, which are run by South Tees Hospitals NHS Foundation Trust.

These clinics take place on Monday afternoons at the Friary Community Hospital, Richmond, and on Thursday afternoons on the Rutson Ward at the Friarage Hospital, Northallerton. Transport is available for those patients who require it.

Each clinic undertakes a full multi-disciplinary assessment of four patients per clinic with a team of a consultant geriatrician, occupational therapist, nurse/case manager, physiotherapist and a social worker from North Yorkshire County Council. The clinics are already up and running and patients are referred to them by their GP.

The assessment includes looking at factors including a patient’s home environment, their communication and nutritional needs, their health and their mobility and then developing an individual care plan for them.

The type of patient that is typically seen at the clinic are those who will be able to be discharged from care at the end of the assessment with a clear plan in place, not those patients who will need an immediate hospital admission or referral on to another specialty. The whole focus of the clinics is on working proactively with patients to prevent unnecessary admissions to hospital.

Installing lifesaving defibrillators

North Yorkshire pub landlord and landlady David and Wendy Humphreys shunned the usual wedding gifts in favour of something to save lives in their local community – a defibrillator.

The couple, who are the landlords at The Stiddy in Lythe, near Whitby, are a shining example of the types of people who have stepped forward and worked with the CCG and Yorkshire Ambulance Service NHS Trust to install life-saving defibrillators in their communities.

When they got married, they thought it would be nice to give something back to the community and asked their

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“As a GP, I want to do as much as I can ensure the right care is provided to my patients as soon as possible. By referring patients

to this clinic they will receive appropriate support in a timely

manner.”

Dr Mark Hodgson, Aldborough St John GP and HRW CCG

Governing Body member.

“We are a village of people who are getting older, and a

defibrillator would be useful. Hopefully it never gets used, but

it’s right here if we need it. It’s here for the whole community.”

David Humphreys, landlord of The Stiddy pub, Lythe.

guests for money for charity instead of gifts. The defibrillator now has pride of place on the front wall of The Stiddy.

A defibrillator is a machine that delivers an electric shock to the heart when someone is having a cardiac arrest. Other communities are now being asked to come forward and purchase a machine for their village. Instrumental in the roll-out of the defibrillators has been the CCG’s Health Engagement Network representatives, who have led the community engagement element of the project and have worked hard to build links with communities.

The defibrillators are available to communities in areas of North Yorkshire thanks to HRW CCG and Yorkshire Ambulance Service NHS Trust, who together have been working with local communities to provide access to Community Public Access Defibrillators (cPADs), available 24/7.

The CCG kickstarted this project by purchasing the cabinets to house the defibrillator unit, which are secure and weatherproof and accessed by a coded lock. Each defibrillator itself will have to be bought by the community at a cost of £900, and the community is expected to work with the NHS to recommend a suitable site within their village.

There are now 58 boxes installed across the CCG’s area, due to go up to 79 by the end of June 2015. This map shows the geographical spread:

Meeting the Four Hour target at the Friarage

Another area in which the CCG and local healthcare providers has bucked the national trend has been to meet the target of 95% of all patients being seen within four hours at the Friarage Hospital. At the hospital, the target has been met for the full 2014/15 year and in each measured three month period in the year. This is primarily due to the dedicated staff at the Friarage, and the professional working relationships between all healthcare providers.

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The year saw 900 fewer A&E attendances at the Friarage. While some of this reduction is due to the changes to the maternity and paediatrics service (see page XX), a significant amount of it is due to the newly introduced GP in-hours triage scheme (see above), which has been diverting patients away from A&E if they can be appropriately cared for elsewhere.

This initiative has been supported by investment in an extra A&E consultant to help manage demand at the busiest times, afternoons and early evenings on Fridays and Saturdays. The year has also seen improvements to ambulance handover times, which now stand at between 6-8 minutes maximum (again, the best in the region). This improvement has come about due to the very efficient service between hospital staff and ambulance service crews.

There has been investment in the community to appropriately divert people away from A&E. This has included Urgent Care Practitioners in Leyburn, Catterick and Sleights, who can go out to patients and see and treat them.

Children’s Health

Maternity and Paediatrics Services at the Friarage

The most significant project in Children’s Health during 2014/15 was the conclusion of the re-design of maternity and paediatrics services at the Friarage Hospital, Northallerton.

While the CCG worked closely with South Tees NHS Foundation Trust to implement these agreed changes from October 2014, the history of the project goes back a couple of years.

Between April and June 2012, we began talking to the public about the issues facing maternity and children’s services at The Friarage Hospital, Northallerton and the possible options for the future. Proposals drawn from this engagement phase were then referred to the Secretary of State for Health for review by the North Yorkshire Scrutiny of Health Committee (OSC).

In May 2013, the Secretary of State gave the go ahead for a public consultation on these proposals to begin and we went live with this in September 2013. We asked people for their views on two options for the re-design of children’s and maternity services at the hospital which would ensure they would be clinically safe and sustainable for the future.

Our robust, comprehensive and transparent engagement process included nine formal public engagement meetings held across the patch attended by almost 300 people and a public survey which resulted in almost 80 responses. Alongside these we held 18 stakeholder and local community meetings and a number of focus groups with parent and child support groups. We

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“The final decision concerning the proposals lay with Secretary of State for Health Jeremy Hunt MP. He asked for advice from the Independent Reconfiguration Panel

(IRP) in April 2014 and accepted in full their recommendations. The IRP is made up of independent

national clinical experts who have carefully reviewed our proposed new service model and the process we have

followed. They agreed that a short stay paediatric assessment unit, a midwifery led unit and full outpatient and community services at the Friarage, in conjunction

with full consultant led services in our other local hospitals, deliver the best and safest services for mothers

and children in this locality.

“We hope that people who have had concerns about these plans will be reassured by the Secretary of State's

decision based on independent clinical advice, and are now confident that this is absolutely the right thing to do.

“This change is supported by all of the local doctors and midwives and we know this will provide safer, better

services for local mothers and children which will last into the future.

“We would like to thank all of the staff at the Friarage for their energy, dedication and persistence throughout the past few years and thank the patients, carers and public

who have helped shape the new services. We will continue to work closely with them.”

Dr Vicky Pleydell, HRW CCG Clinical Chief Officer.

also met with families of ‘open access’ children to co-create services which would support children in their own homes or in a community setting.

In our efforts to ‘leave no stone unturned’, we undertook an extensive fact-finding exercise, visiting CCGs across the UK to find out whether any existing good practice in maternity and children’s services could be adopted or adapted within our own future model. Three additional proposals were submitted for consideration. While an independent assessment by the National Clinical Advisory Team (NCAT) concluded that none of the three alternative proposals offered a complete clinically safe or sustainable plan, they did provide additional elements that could be worked into the model for the future, such as investing in community services.

All five options were shared with every GP practice, including our local military practices. Each practice then reviewed and voted on each option. On 7 February 2014, at an extraordinary meeting of the Council of Members, all practices submitted their votes and confirmed their preferred option to go forward for ratification by the Governing Body.

On 20 February 2014, we published our plans. Our proposed model would include the opening of a Midwifery Led Unit (MLU) and the development of a Paediatric Short Stay Assessment Unit (PSSAU), whilst continuing to deliver community paediatric nursing and consultant paediatric outpatient services at The Friarage. This was the model supported by 95% of the public who completed our survey and which had 100% clinical support from all 22 of our GP practices, as well as specialist doctors and nurses at The Friarage Hospital. NCAT, as independent experts, agreed that the option was safe and sustainable. The model was ratified by our Governing Body at an extraordinary meeting on 27 February.

However, on 14 March, North Yorkshire County Council’s Scrutiny of Health Committee decided to refer the decision to the Secretary of State – see the box above for his conclusions.

Shuttle bus proves increasingly popular

The number of passengers using the free shuttle bus between The Friarage Hospital, Northallerton, and James Cook University Hospital, Middlesbrough, continues to grow.

Figures collected by HRW CCG – which funds the bus – show that in March 2015 more than 200 people used the bus in a single week. This is almost triple the number of people using the bus back in November 2014. This growing success means HRW CCG has awarded the contract to current providers Procters Coach Hire, of Leeming Bar, until 31 March 2016. This was following an open tender process.

In partnership, HRW CCG and South Tees Hospitals NHS Foundation Trust introduced the shuttle bus at the beginning of October 2014 following the changes to children’s and maternity services at the Friarage Hospital.

The bus travels between the two hospitals ten times a day, and is available Monday to Friday (excluding public holidays). It picks up from outside The Friarage’s main entrance, and drops off outside the Women and Children’s entrance at James Cook Hospital.

The bus is available to use for hospital patients and their families, and staff, not just for those accessing children’s and maternity services.

Engaging young people

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“Arriving for a procedure is stressful enough and wondering where, or if, you can park adds to this stress. The shuttle bus made it a no pain experience

and, in addition, the staff on the ward were wonderful.”

A patient who has used the service.

Three young girls from Whitby have been busy raising money for charity as part of a North Yorkshire Police and HRW CCG challenge, winning an activity holiday in Lincolnshire as their prize.

Friends Esmeé Pearson, Milli Eglon and Hope Smith, who were all 10 years old at the time of the project, took part in the ‘Fit 4 the Future’ Lifestyle 2014 project, a challenge run by the Police and sponsored by the CCG.

The trio – under the name The Hounds Hairy – was one of a number of teams across North Yorkshire that took up the challenge in their spare time, which was aimed at encouraging young people to stay healthy and think about the health needs of people in their community.

They chose to raise money for the charity Cure Rett, which helps children and families affected by Rett syndrome, a rare non-inherited genetic postnatal neurological disorder that occurs almost exclusively in girls. They chose this because they have a friend who suffers from the illness. The girls held a fun day at the Hare and Hounds pub in Hawsker, raising a total of £314.

The CCG was also proud to support North Yorkshire Police’s Rock Challenge, a local heat of a national dance competition aimed at spreading the message that you can have fun without drink or drugs.

From the CCG’s area, teams from Bedale High School and Richmond School performed an eight-minute piece in front of a live audience and a team of qualified judges. Congratulations to winners Richmond School!

The CCG, working with Vale of York CCG and the Partnership Commissioning Unit, ran a series of workshops to encourage the young people to talk about mental health, their feelings, their coping mechanisms and where may turn to for help. This information is being used to support the CCG’s commissioning strategies over the coming years.

OFSTED report praises local children’s services

An OFSTED report into the North Yorkshire Safeguarding Children Board – which HRW CCG has representation on – highlighted a number of areas of good practice, resulting in an overall judgment of ‘good’.

The final report, published in June 2014, praised lead organisation North Yorkshire County Council for the effectiveness of its children’s services. The judgements made have placed North Yorkshire amongst the top authorities in the country for its care and protection of children.

The report highlighted how North Yorkshire County Council has taken very positive action to improve the quality of its children’s services. A newly appointed but experienced Director of Children’s Services and his leadership team, underpinned by a robust leadership pledge, have changed the culture in North Yorkshire. This has led to significant improvements in partnership working, the quality of services and the outcomes achieved by children and young people.

The CCG is represented on the Board by the Designated Professionals (Dr Natalie Lyth and Elaine Wyllie) and also via an agreement with Carrie Wollerton, Lead Nurse for Scarborough and Ryedale CCG (which is the host CCG for the Designated Professionals team).

All three members are active in chairing various sub-groups of the LSCB and Elaine Wyllie was also appointed as Vice-Chair of the Board in 2014.

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“We’ve been delighted to work with North Yorkshire Police to get young people thinking about their health and how they can make a difference to their community. Well done to all the teams who

took part.”

Shirley Moses, HRW CCG Project Manager.

Partnership to commission services for children with special education needs and support for families

Partnership working to improve outcomes for vulnerable looked-after children

Mental health and dementia

Approximately £1 million extra has been invested in mental health services by HRW CCG during 2014/15 to support our strategy for enhancing local mental health care provision.

This has included the significant achievement of opening of a Section 136 Place of Safety at the Friarage Hospital, Northallerton. Liaison Psychiatry, which is running a five-day, 12 hour service with plans to move up to seven-days. This will be supported by the Crisis Team to create a 24/7 service. Additional funding to reduce waiting times in the Improving Access to Psychological Therapies (IAPT) service has been transferred to TEWV, which took over the service on 1 July 2014.

The CCG has also committed £90,000 to provide two, one-year positions to look at mental health care pathways, in particular dementia, and work is underway to improve diagnosis coding for patients who have dementia symptoms but no diagnosis. In addition, funding has been allocated to ensure people who are on ‘Out of Area’ placements can be brought back into the area as soon as possible if this is what the patient wants.

Place of Safety opens at the Friarage

A significant achievement as part of this investment was the opening of a Place of Safety assessment suite at the Friarage Hospital, Northallerton. This provides a place of safety for vulnerable adults detained by the police under Section 136 of the Mental Health Act.

The Place of Safety, run by Tees, Esk and Wear Valley NHS Foundation Trust, has been made possible through a partnership with HRW CCG (which funds the service), North Yorkshire Police and North Yorkshire County Council.

It helps people to recover from episodes of ill health, provide timely access to treatment and more rapid access to specialist care, and improved service user and carer experience in a safe environment and protecting them from avoidable harm.

A Place of Safety is somewhere a person can be detained for up to 72 hours if they are in mental health crisis and the police believe them to be in immediate need of care for the sake of their own, or another person’s safety. Until the opening of such Places of Safety the police had no option but to take these people to a custody suite, even though they may not have committed an offence.

Extended mental health liaison service

An expanded mental health service at the Friarage Hospital, Northallerton, is going from strength to strength in providing care and supporting hospital staff.

The Acute Liaison Service, commissioned by HRW CCG and provided by Tees, Esk and Wear Valleys NHS

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“The opening of the suite, coupled with the significant extra

investment we’ve made, underlines the CCG’s firm

commitment to mental health services in our part of North

Yorkshire.”

Dr George Campbell, Whitby GP and lead for mental health at

HRW CCG.

“As a local mental health charity, we welcome the fact that the CCG

is investing resources to assist people with their mental health issues. Mind continues to work

alongside its partners in order to ensure no one suffers mental ill-

health alone.”

Duncan Webster, Chair of the Board of Trustees, for

Scarborough, Whitby and

Foundation Trust (TEWV), aims to reduce the length of time patients with mental health needs in Northallerton spend in hospital.

The service began in September 2014 and now operates from 8am-8pm, seven days a week and provides care for people over 16 years old. Patients with a mental health need either on a hospital ward or attending A&E are assessed and given advice and recommended treatment plans. For those people who need to be admitted to hospital, ongoing advice and support is provided for individuals and the staff caring for them. The team also offers a service to the Lambert Memorial Hospital in Thirsk and the Friary Hospital in Richmond.

The team also carries out regular visits to acute care wards, providing advice and answering queries as well as reviewing known complex cases. They also help ward staff plan patient discharge plans, and liaise with GPs, community teams and the voluntary sector.

There is well-established evidence about the value of psychiatric liaison services. The prevalence of people in hospital for primarily a physical illness but who also have mental health issues is high. However, historically many of these issues typically go undiagnosed and untreated in the absence of effective mental health intervention.

Investing in dementia services

Needs Karen Bibbings info – got it! In emails

Working with South Tees Hospitals NHS Foundation Trust, the CCG has appointed a Dementia Champion at the Friarage Hospital. Working across the hospital and in the community with all groups of staff, the Dementia Champion has a number of roles. She trains and educates staff groups, with the focus being on enhancing patient-centred care on wards and in clinics. She also focuses on improving treatment, experience and support in the community.

She also works to improve signage and the overall environment, making sure that the hospital, care homes and GP practices are as dementia-friendly as they can be. The objective of training all staff is to make sure that dementia is a consideration for everyone, so they can spot the signs and react appropriately. This includes understanding how to care for patients with dementia, how to move them and knowing when they main be in pain.

Initial feedback has highlighted that staff have found it really useful, and have gained a greater understanding about dementia and hands-on practical tips to care for patients with dementia.

In addition, the CCG has also worked closely with North Yorkshire County Council and other CCGs to offer people living with dementia, their family and carers a dementia support worker who can help them link up with agencies and provide a wide range of information and advice. Evidence shows that people living with dementia and their families often do not get the information and support they need at the right time, particularly following a diagnosis of dementia. The County Council, as project leaders, has signed a contract with Dementia Forward and Making Space. The two voluntary organisations will work in different localities across North Yorkshire managing a service that will include dementia support workers. As well as providing advice, information and signposting to relevant services, the new service will work alongside other community organisations providing help for people with dementia and their carers. It will also provide learning programmes, so that people can better understand the condition.

Clinically appropriate planned care

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“As a local mental health charity, we welcome the fact that the CCG

is investing resources to assist people with their mental health issues. Mind continues to work

alongside its partners in order to ensure no one suffers mental ill-

health alone.”

Duncan Webster, Chair of the Board of Trustees, for

Scarborough, Whitby and

Improving access to IVF care Plans to improve access to assisted conception treatment including in-vitro fertilisation (IVF) were given the green light by HRW CCG. This means that women in the area under the age of 40 who are having difficulty conceiving can now be offered up to two cycles of IVF treatment.

Where a couple meet the specified criteria and a woman is under 40 years of age, the CCG will fund up to two full cycles of IVF, and where a woman is between 40 and 42, one full cycle.

HRW CCG inherited its commissioning policies from its predecessor, NHS North Yorkshire and York Primary Care Trust (PCT).This included a policy on IVF which was not routinely commissioned due to the financial position of the PCT.

Robot surgery enhances cancer care

Prostate cancer patients can now benefit from leading-edge robotic surgery as urologists at The James Cook University Hospital, Middlesbrough, now have a da Vinci robot to treat the illness.

Dr George Campbell, from HRW CCG, recognised the importance of robot surgery for patients with prostate cancer and was part of the implementation team that secured the high-tech kit.

The robot has revolutionised surgical treatment for prostate cancer by making it possible for surgeons to perform minimally-invasive surgery with greater precision and control than ever before.

It uses tiny instruments, controlled remotely by the surgeon sitting at a console. The surgeon has the benefits of 3D vision and hand and foot controls to control the micromanipulators, which have a greater range of movement than the human hand.

National NICE recommendations state that commissioners should consider robot surgery for patients with prostate cancer who are having a total prostatectomy for their treatment. The robot gives fewer side effects and better clearance of the cancer, and means local patients will have access to the most up-to-date technology and improved surgical treatment without the need to travel further afield.

Working to reduce unnecessary outpatient appointments

Over the past year the CCG has been working hard, in partnership with local NHS providers, to reduce unnecessary outpatient attendances and provide care closer to home when appropriate.

A plan has been developed which includes working collaboratively with providers to explore where face-to-face outpatient attendances could be replaced by a non-face-to-face attendance while still delivering appropriate care. This is supported by ongoing work looking at specialty disease registers which are compiled for conditions that are routinely reviewed in clinic alongside the number of reviews each condition would expect to have based upon best evidence where available.

Specific areas where this collaborative work has already been introduced are:

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“We understand the impact that infertility can have on people’s lives and IVF is something that we, as the leaders of the local

NHS, have been keen to introduce since we were

established.”

Dr George Campbell, local GP and lead for planned care at the

CCG.

“It’s a significant development and, over time, will be used not

only to treat patients with prostate cancer but also bladder cancer, kidney cancer, colorectal and gynaecological disease, head

and neck disease and thoracic surgery.”

Consultant urologist with South Tees Hospitals NHS Foundation

Trust David Chadwick.

Urology – monitoring of PSA (prostate-specific antigen) levels by GPs with protocols in place to refer back to specialists where necessary.

Gynaecology – re-fitting of ring pessaries. Neuro-oncology – nurse-led follow up telephone calls for benign results which has resulted

in about a 25 per cent reduction in time from investigation to communication of results to the patient.

Work currently underway includes:

Respiratory medicine – discussions ongoing to move five year follow-up appointments closer to home into GP practices.

Oral surgery – aiming to reduce the number of follow-ups for simple oral biopsy results which are normal with a letter-only follow-up. It is hoped that this may reduce outpatient attendances by 60 appointments per month.

Primary care productivity and development

Supporting local GP partnership working

Longer, more flexible opening hours for GP practices has been the highlight of a new GP alliance supported by HRW CCG.

The pilot scheme, known as ‘open for longer’, is being introduced by the Heartbeat Alliance, a newly formed group of local GPs who are working together to make improvements to local health services.

The Heartbeat Alliance came together after being awarded £2,481,000 from the Prime Minister’s Challenge Fund to start a project which will benefit over 140,000 patients. HRW CCG played a key role in helping GPs come together and bid for the money. The project aligns closely with the CCG’s aim of providing as much care as close to home as possible.

The vast majority of GP practices in the CCG’s area are taking part in the initiative, offering extra appointments on different evenings of the week. Weekend appointments are also available and provided from The Friarage Hospital or Harewood Medical Centre, 9am-1pm.

Expanding the number of treatments available at GP practices

Underlining the CCG’s commitment to providing care closer to home and improving convenience for patients, from April 2014 a number of medical services moved from local hospitals to GP practices within residents own locality.

Medical services now available for treatment and/or monitoring locally in 22 HRW CCG GP practices include:

• Deep vein thrombosis• Anti-coagulants• Minor injury services• Insulin initialisation• Complex wound care• Stable prostate cancer• Near patient monitoring• Management of benign prostatic hypertrophy presenting with acute urinary retention• Routine ring pessary fitting & replacement• Consultation for minor injuries

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“Having difficulty accessing GP appointments is an issue that is regularly flagged nationally, so it’s really positive that we have

the opportunity to do something about it in our local area.”

Duncan Rogers, local GP and chair of Heartbeat Alliance.

• GP in-hour triage

Access to these services at their local practice means patients can have a procedure or check-up undertaken by a familiar face. It also reduces transport costs, carbon emissions as well as saving on travel time for patients.

GP practices rated highly by patients

Local GP practice patients have given the thumbs up to their experience of GP surgeries, with overall experience rated as the best in the whole of England.

In the GP Patient Survey, 93 per cent of the 2,364 people surveyed in the CCG’s area said they were pleased with their overall experience of their GP surgery. This compares to a national average of 86 per cent.

When asked if their experience was ‘very good’, ‘fairly good’ or worse, 59 per cent of people said it was ‘very good’, five per cent higher than anywhere else in the country.

The GP Patient Survey is an independent survey run by Ipsos MORI on behalf of NHS England. This top rating is shared with NHS Bath and North East Somerset, which was also on 93% overall satisfaction.

Local GP practices were rated in the top five in the country in many categories, including:

• Confidence and trust in their GP

• Overall experience of making an appointment

• Rating of the time spent with their GP

• Rating of their GP listening to them

• Ease of getting through to someone on the phone at the GP practice

• Helpfulness of receptionists

• Satisfaction with opening hours

Encouraging better prescribing of medicines

One area which can provide savings without impacting on quality of care is the prescribing of medicines. HRW CCG offers an annual prescribing incentive scheme to its NHS GP practices to encourage and reward improvement to quality, safety and cost effectiveness in prescribing. It is one of many tools for successful implementation and delivery of benefits in-year and in subsequent years.

Although there can be significant variation in prescribing between practices, there are areas that the CCG seeks to address as a whole to ensure a prescribing incentive scheme offers greater value to the CCG and its population. Topics focused on in 2014/15 included:

All antibiotics: reduce total items prescribed. Quinolones and second and third generation cephalosporins: reduce total items prescribed.

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“Locally, our GPs are doing very well while under lots of pressure, as is the case across the country.

Our GPs are doing everything they can to respond to patient

need, and what this survey shows is that people are

generally very happy with their local service.”

Dr Vicky Pleydell, HRW CCG’s Clinical Chief Officer.

Fentanyl: reduce total spend. The CCG’s preference is for oral MR morphine or a low cost patch if necessary.

Oxycodone: reduce total spend. The CCG’s preference is for oral MR morphine. Morphine MR: increase the percentage of morphine MR items prescribed as low cost

products. Tramadol MR: reduce total spend. The CCG’s preference is for plain capsules or a low cost

brand if necessary.

The 2014/15 scheme is predicted to result in estimated savings of £142K in 2014/15 and an estimated £234K per annum (but reducing) in subsequent years.

Monthly audit of GP practice waiting times

Prescribing incentive scheme

Long-term conditions

Patients ask for care closer to home

Providing care closer to home in Hambleton and Richmondshire and responding to patients’ needs are the driving factors behind a successful new day hospice at The Friary Hospital in Richmond.

The pilot partnership between HRW CCG, which is funding the pilot, and St Teresa’s Hospice in Darlington, which operates the day hospice, means that patients who are too poorly to travel to the Hospice in Darlington can get care closer to home and more are now accessing services.

The £20,000 pilot day hospice was available over the winter for patients living in Hambleton and Richmondshire who have a life limiting or palliative illness and their carers. Appropriate referrals included cancer patients, neurological patients (motor neurone disease, multiple sclerosis, Parkinson’s), respiratory patients, heart failure patients and mild dementia patients.

It was set up following patient feedback. People said Darlington was too far to travel, especially at times when they were feeling particularly unwell. In addition, it was too far to travel in a car for respiratory patients, as they could not travel with oxygen cylinders switched on (unless in an ambulance).

Integrating health and social care

A health and social care team developed by HRW CCG, South Tees Hospitals NHS Trust and North Yorkshire County Council’s Health and Adult Services is now running 24/7 as it continues to improve care for older and vulnerable people in the area.

The Integrated Fast Response Team is designed to provide people who need some extra support with help and care in their own homes, for a period of up to six weeks. Its aim is to get people back on their feet and to prevent them being admitted to hospital unnecessarily.

It does this by:22

“The Hospice team is delighted to be working in partnership with

the CCG to help ensure our services can reach as many

people as possible in the district we serve. The feedback we have received to date from patients is

so positive.”

Jane Bradshaw, Chief Executive of St Teresa’s Hospice.

“Working together in this co-ordinated way allows us to put

patients’ needs at the heart of our services and ensures the right kinds of care are provided in a smooth and efficient manner.”

Mark Hodgson, Richmondshire GP and HRW CCG Governing

Body member.

providing short-term interventions (up to six weeks) of overnight care for people aged 18 and over living in Hambleton or Richmondshire;

supporting individuals in a crisis; and providing personal care, help with daily living activities and other practical tasks for a

period of up to six weeks for those people who may need it (known as reablement).

The beauty of the team is that it can respond quickly to patients in crisis, including patients in their own homes or in the A&E department at the Friarage Hospital, Northallerton. It also supports people who have recently been discharged from hospital, people with complex conditions and the frail elderly population.

The service is made up of health and social care professionals including registered general nurses, occupational therapists, healthcare assistants and social care workers. They are mainly contacted by local GPs when they recognise that their patients need some extra help.

A total of £422,000 per year for three years has been invested in the service, of which £165,000 is for health staff and £258,000 is social care staff.

Implementation of RAIDR jo and sam

Care planning by GP practices – top 2% of most at-risk of the population get care plans jo and sam

Commissioning health psychology services

The CCG has commissioned South Tees Hospitals NHS Foundation Trust to provide a Neuropsychology and Health Psychology Service for patients across the patch. It is designed to provide a highly specialised and good quality service to patients who are experiencing long-term health conditions. Objectives of the service include the management cognitive, emotional or behavioural problems arising from neurological illness/injury or psychogenic conditions which are non-neurological in origin, and the treatment of significant psychological problems arising from difficulties in adjusting to acute, chronic or terminal medical conditions. It is based at the Friarage Hospital, Northallerton, and a service is also provided to primary care.

Ill-health prevention

Helping people get active

We were very pleased to work closely with our colleagues at Hambleton District Council and Richmondshire District Council to launch brand new Lifestyle Management services to support residents who want to improve their health.

The councils were commissioned to provide, respectively, the holistic ‘Take that Step’ and ‘Step by Step’ services which aim to improve a range of health conditions including respiratory conditions, heart disease, muscular disorders, obesity, risk of falls, asthma, arthritis and osteoporosis, as well as supporting people who need to increase their physical activity.

The projects incorporate an existing GP exercise referral scheme and a new service for people who need extra support to improve their lifestyle. Anyone wishing to take part in the programmes would do so by visiting their GP for a referral.

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“The new referral service is all about encouraging and

supporting people to make small, achievable changes to their daily habits that will set them on the

road to reaching and maintaining a healthier lifestyle, along with all

the long term benefits that brings.”

Dr Vicky Pleydell, Clinical Chief Officer for HRW CCG.

In support of these schemes, the CCG commissioned an additional Weight Management Service from South Tees Hospitals NHS Foundation Trust. Starting in October 2014, the service provides a holistic, multi-disciplinary programme for patients aged over 16 years who meet specific pre-determined criteria.

Once a patient is accepted onto the programme, they work with clinicians to develop a bespoke weight management plan, with clear goals. These plans can last up to 12 months. Staff running the service includes a consultant metabolic physician/endocrinologist, a GP with a special interest in obesity management, specialist dietitians, a clinical psychologist, a physiotherapist and advanced health trainers. GPs are encouraged to review the caseloads and encourage appropriate patients to be referred into the service.

Supporting local services during Le Tour de France

Along with most people in Yorkshire, the CCG was delighted to welcome the Tour de France to our county in July 2014 for its Grand Depart.

We were part of a regional, multi-agency task force which has been working together to plan for the impact on all types of local services from the point that the announcement was made that the Tour de France Grand Depart would be coming to Yorkshire. The most significant issue was the potential increase in pressure on our healthcare services as we welcome up to an estimated 20,000 visitors from across the globe to our area.

In response, we drew up a comprehensive and robust plan of action that ensured our healthcare services had the extra capacity to cope throughout the weekend’s events. These included:

Additional nursing and additional doctor cover in A&E at James Cook University Hospital and The Friarage Hospital.

Increased ambulance cover across the CCG area, especially in Richmondshire where the race route passed through.

Additional air ambulance capacity – four air ambulances were on stand-by for the area as opposed to the usual two.

Doubled the amount of Fast Response Team cover for the care of vulnerable patients in the community. Vulnerable patients were identified and mapped and staff were on stand-by at home in order to respond to patients close to their home address.

A 25% increase in staff on call for out-of-hours cover. Signposted first aid points positioned at regular intervals along the race route.

Patients that were due to receive planned healthcare procedures over the weekend of Le Tour were re-scheduled. A communications campaign - which was shortlisted for a prestigious national award – heled to advise the public on how to prepare for their healthcare needs ahead of the race weekend and promoted tips for being a safe and healthy spectator.

Further positive achievements

Partner organisations endorse the CCG

An independent survey of major North Yorkshire organisations that work with HRW CCG overwhelmingly shows that they are pleased with how the NHS organisation works with them and takes on board their ideas and views.

The CCG 360 Degree Stakeholder Survey, conducted by NHS England, allows key people at organisations which work with the CCG to provide feedback on their

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“We work really hard to make sure we have a rounded picture of local needs to help us plan

health services. We’re very pleased with these results, which demonstrate that our approach to

engaging with and involving partner organisations is generally

high quality.”

Dr Vicky Pleydell, HRW CCG Clinical Chief Officer.

relationship. Organisations which fed back included North Yorkshire County Council, GP practices, Healthwatch North Yorkshire, other patient groups, NHS provider trusts including South Tees NHS Hospitals Trust, and the local Health & Wellbeing Board.

The survey also reveals that HRW CCG ranks significantly higher when compared to other CCGs in England in all but one category, placing it well above the national average scores.

Key findings include:

• Overall, to what extent, if at all, do you think there is clear and visible leadership of the CCG?92% said “strongly agree/tend to agree”

• Overall, to what extent, if at all, do you feel you have been engaged by the CCG?97% said “a great deal/a fair amount”

• How satisfied or dissatisfied are you with the way in which the CCG has engaged with you over the past 12 months?97% said “very satisfied/fairly satisfied”

The survey is a key part of ensuring strong working relationships are in place. CCGs need to have strong relationships with a range of health and care partners in order to be successful commissioners within the local system. These relationships provide CCGs with ongoing information, advice and knowledge to help them make commissioning decisions which have patients and the local population at the heart of them.

Awards recognising the CCG’s achievements

2014/15 saw HRW CCG and staff shortlisted for several awards, recognition of the high quality, patient-focused work being carried out.

The CGG was shortlisted for three awards in the national Health Service Journal Awards 2014; Improved Partnerships between Health and Local Government, Secondary Care Service Redesign category for the redesign of paediatric and maternity services at the Friarage Hospital, and Clinical Chief Officer Dr Vicky Pleydell was shortlisted in the Clinical Leader of the Year category.

The HSJ Awards recognise, on a national platform, the projects and initiatives that deliver healthcare excellence and innovation.

Imaginative approaches to considering health services from the viewpoint of patients has helped CCG Project Manager Shirley Moses NHS project manager win a prestigious Regional Emerging Leader of the Year Award.

Shirley won the award at the Yorkshire and the Humber Leadership Academy NHS Leadership Recognition Awards 2014. The award highlighted her ability to always think about and understand the patient viewpoint and how she is tenacious in championing change that makes the patient’s experience better every day.

The awards celebrate people at all levels and in all professions who have ultimately improved people’s health and the public’s experience of the NHS.

Finally, the work of the CCG in working together with other CCGs in North Yorkshire to develop and deliver a communications plan to promote health awareness messages during the Tour de France Grand Depart led to being shortlisted in the Comms2Point0 Unawards 2014 in the Best

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“We are really pleased to have been shortlisted for these

awards. Each is testament to the hard work of staff at the CCG –

and our partners – over the past year and our dedication to improving patient care.”

David Williams, HRW CCG Chair.

Collaboration category. This flexible, visually interesting campaign ran across the three North Yorkshire CCG areas that the race went through and was aimed at helping people understand how to look after themselves and where to get medical help if required.

Supporting the voluntary sector

Recognising the importance of the services and support the voluntary sector provides to some of the area’s most vulnerable people, during 2014/15 HRW CCG small grants totalling £181,000 to local projects across the patch.

The CCG looked to encourage innovative approaches to support its strategy and was particularly interested in bids which support the needs of carers, Support the needs of patients to help them to live independently, reduce loneliness and social isolation, support those with dementia or utilise new technologies.

The successful applications come from a wide range of organisations, including:

Whitby Age UK, £10,000 to assist older people access digital technologies, focusing on Skype and internet shopping. Aimed at reducing isolation, enhancing contact with family living away and independence.

Rural Action Yorkshire - £10,000 for their work to support community halls to become local hubs enabling communities to connect and reduce isolation.

The Cambridge Centre, Whitby, £1,400 for bereavement support for families affected by substance misuse.

Thirsk Community Centre - £4,104 to enable them to extend their ‘Food and Friendship’ programme reducing isolation and promoting independence.

Parents 4 Parents - £9,996 to provide emotional and social support to young parents. Horton Housing Association - £6,879 to create a wellbeing garden for a gypsy and traveller

site, to encourage mental and physical health. Hambleton and Richmondshire Citizens Advice - £9,660 for its Better Health Advisory

Service to signpost potential support services within GP surgeries, promoting health and wellbeing.

Our partners

We work closely with a range of partners on joint initiatives to help improve the health and wellbeing of people in our area. These organisations include:

Provider organisationsOver the year we have continued to work closely with our provider organisations to ensure the delivery of safe, sustainable care for local people. Key providers include South Tees Hospitals NHS Foundation Trust, York Teaching Hospital NHS Foundation Trust, Tees, Esk and Wear Valleys NHS Foundation Trust and Harrogate and District NHS Foundation Trust. We also work closely with charities and the voluntary sector as service providers. Our achievements are covered in greater detail on pages XX-XX.

North Yorkshire County Council’s Scrutiny of Health CommitteeThroughout the past twelve months we have continued to work hard to ensure that any commissioning decisions that are likely to have a significant impact on patients are presented to North Yorkshire County Council’s Scrutiny of Health Committee. We have kept the Committee up-

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“This grant allowed us to put in place an exciting new set-up

where we are able to work closely with GP practices to provide

advice and information to those members of the public who need

it and signpost to potential support services.”

Simon Fisher, Citizens Advice Benefits Adviser.

to-date with engagement activities and service proposals through attendance at their meetings and via our public newsletter. We value the committee’s interest in and contribution to our progress.

North Yorkshire Health and Wellbeing BoardWe are an active member of the Health and Wellbeing Board and participate in all areas of work including the delivery of the joint strategy, which our own strategic priorities are closely aligned to. Health and Wellbeing Boards ensure that services work together to respond to the needs and priorities of their communities. The Board involves people and community organisations, including elected representatives, in deciding what services the communities need and has helped us to understand which services our local people need.

North Yorkshire County CouncilNorth Yorkshire County Council commissions care and support services (including social care) and has a new responsibility to protect and improve health and wellbeing including taking responsibility for Public Health. The council uses its knowledge of our communities to tackle challenges such as smoking, alcohol and drug misuse and obesity. We have developed an effective working relationship with North Yorkshire County Council and will work together with health and care providers, community groups and other agencies, to prevent ill health by encouraging people to live healthier lives.

The Heartbeat Alliance The Alliance comprises 21 GP practices in Hambleton, Richmondshire and Whitby, stretching from Sedbergh in the west to Whitby on the east coast. We have been very pleased to work with them since their formation in 2014 to continue to enhance services in GP practices and local communities (read more on page XX).

Hambleton District Council, Richmondshire District Council & Scarborough Borough CouncilWe continue to work with our district & borough council partners to look for ways we can improve the health of our communities and engage with local people more effectively. We have attended various committee meetings to present the work we are doing and answer questions from councillors and members of the public.

Healthwatch North YorkshireWe are committed to involving our local communities and our patients in the work we do.One of the ways we will do this is by working closely with Healthwatch North Yorkshire, including working in partnership on innovate and interesting engagement campaigns. Healthwatch North Yorkshire is represented on the North Yorkshire Health and Wellbeing Board (see above), giving patients and communities a voice in decisions that affect them. Healthwatch North Yorkshire will feed back any views and concerns to Healthwatch England so that issues can also be raised at a national level.

Our commitment to engaging

We strive to involve patients, carers and members of the public in everything we do. Over the past 12 months we have continued to develop our public engagement approaches to ensure more than ever the public voice plays a vital and meaningful role in our business. Over the past year we have used a number of approaches to encourage people to have their say on the future of health services in our area.

By actively engaging with our communities, we are meeting the national objective to make sure that public, patient and carer voices are at the centre of our healthcare services from planning to delivery. Highlights include:

We have also embarked on a number of public engagement projects during 2014/15. Details of these projects can be found in the snapshot of our year section of this report.

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We continued to grow and develop our Health Engagement Network (HEN), capturing the views of local residents towards health related issues. Their views are gathered using a number of methods including surveys, focus groups and conversations. Members of the HEN can specify the level of involvement they would like – ranging from receiving occasional surveys to being invited to take part in focus groups looking at specific issues. We are also the only CCG in England to have elected a lay representative from each of the three localities onto the Governing Body.

Our Health Engagement Network representatives have played significant roles in the development of CCG projects. Their input and insight into the Whitby area out of hours and community services procurement project has been particularly valuable. The reps have been instrumental in the rural defibrillators project (see page XX), forging links between the CCG and local communities.

We held our Annual General Meeting at the Station, Richmond. We invited a range of partners and local voluntary sector organisations to join us in an information marketplace, which members of the public found very useful. We held the event at the Station to give us extra visibility, and attract visitors who were using other facilities at the location and who may not have been previously aware of our event.

We have held three Patient Congress events (one in each locality), which are a forum to bring together representatives from practice-based Patient Participation Groups and interested members of the public to discuss and debate key CCG topics.

Our Professional Engagement Network (PEN), which is similar to the HEN, provides a forum for us to engage with interested professionals and ensure local clinicians have the opportunity to influence commissioning decisions.

We increased the frequency of our stakeholder and GP practice newsletters, social media updates and media releases to keep people informed about the work of the CCG, and to help drive public participation.

We have continued to strengthen our links with the local charitable and voluntary sector organisations, as well as statutory organisations such as local councils and our partners in the NHS.

We hold our Governing Body meetings in public and actively encourage people to attend and submit questions.

We worked with Healthwatch North Yorkshire to develop Strictly Come Commissioning, an original, engaging desktop game aimed at members of the public exploring the challenges faced by CCGs when it comes to planning local health services.

We are further embedding patient engagement into our commissioning decisions, right from the beginning of projects.

We react and listen to what people tell us. We record our achievements on the You Said, We Did section on our website.

Our commitment to Quality Assurance

Ensuring that our patients receive high quality care is an inherently complex and fragile operation. Robust systems and processes to monitor, performance manage and regulate the quality of care provided to patients are therefore essential.

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However, the success of these systems and processes is almost entirely dependent on the values and behaviours of the staff working throughout the system. Strong leadership at every level is needed to ensure that values and behaviours that put patients first can prevail.

Routine quality monitoring considers all elements described here:

In order to monitor measure, benchmark and improve the quality of patient care, the CCG uses an evidence based Quality Assurance Framework to quality assure processes across the area.

These processes have been developed in partnership with other service commissioners, North Yorkshire County Council, providers, clinicians, service users and carers in order to:

Ensure that positive steps are be taken to protect patient safety Ensure commissioned services are evidence based, outcome focussed and aimed at

reducing clinical variation Monitor and improve the experience of patients accessing services

There are four stages of monitoring:

1) Routine Quality Assurance monitoring – this includes a wide range of metrics for the three domains of quality.

2) Routine Quality Assurance meetings3) Enhanced Quality

Surveillance measures 4) Enhanced Quality Review –

this process is used in situations when risk is increasing and assurance reducing and, dependant on the level of concern, can involve: Quality Review meetings, Single Item Quality Surveillance Group meetings, Rapid Response Reviews, Risk Summits.

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The CCG, via its Quality and Safety Committee further details on page XX), has used this process to identify areas for further investigation. Key examples over the past year include:

Heightened surveillance of South Tees Hospital Foundation Trust Care of the deteriorating patient at the Friarage Hospital, Northallerton Pressure ulcer care and management Discharge planning processes

Our commitment to the environment

We encourage our staff, visitors and the public to think lean and green when it comes to society and the environment. Wherever we can we are asking people to take opportunities to reduce waste and the use of utilities and minimise any negative impact on the environment.

We have taken a number of steps to help reduce our carbon footprint including:

Recycling and/or shredding as much of our waste paper and other consumables as possible. This achievement was certified by service provider Shred-it as having saved five trees during 2013.

Installation of video conferencing technology. When an upgrade is required, issuing senior staff with laptops with webcams. Installed a new, greener printer. The printer’s software means staff need to go to the printer

to print their job, cutting down on waste of items printed but not collected. Agreed a Flexible Working Policy. Recycling furniture wherever possible. Communicating with our Health Engagement Network via email wherever possible. Commissioning services close to people’s homes wherever possible.

We are committed to using local suppliers where possible for services such as graphic design and printing.

We share our office space with Hambleton District Council to ensure that we are supporting our local economy. However, this arrangement does mean we are unable to provide a Sustainability Report because the CCG’s usage statistics cannot be separated out from the Council’s.

Our commitment to equality and diversity

We take our responsibilities for equality and diversity very seriously. We consider what our local communities need and how their needs can best be met by the services we commission.We are determined to reduce health inequalities through understanding the health needs of local communities and making the services we commission inclusive and accessible.

Equality is for everyone and we strive to design services that are equally available, making sure that: services are open when they are needed and people understand the information they are given and know what to do when things don’t go well.

Our duties

To meet the Public Sector Equality Duty (PSED), we are required to ensure that equality, diversity and human rights are embedded into all our functions and activities. Specific duties require us to:

Publish information to demonstrate compliance with the Equality Duty, at least annually. Set equality objectives at least every four years.

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We are committed to making sure our objectives are meaningful and taken seriously by everyone in our organisation.

Our most significant achievement in 2014/15 has been the establishment of an Equality and Diversity Group. This group, made up of staff from across the CCG and partner organisations, carried out periodic critical reviews of its soon-to-be-approved Equality and Diversity Plan, ensuring appropriate relationships with both internal and external stakeholders is maintained. This Equality and Diversity Plan, which will be signed off in early 2015/16, outlines the CCG’s focus for the next few years. The CCG is also working to develop a standardised process for the completion of Equality Impact Assessments (EIA), and the creation of bespoke EIA templates which will be built in to the commissioning cycle. Equality and Diversity Champions will also be appointed, helping to ensure equality is embedded across the organisation.

We have also strengthened our links with Hambleton District Council in particular, exploring collaborative working and the two-way sharing of information.

Emergency Preparednes s

North Yorkshire and Humber Local Area Team has incident response plans in place, which are compliant with the NHS Commissioning Board Emergency Preparedness Framework 2013. To support this, the CCG has business continuity plans in place and supports other organisation with capacity and control plans for incidents. The CCG is assured that the North Yorkshire and Humber Local Area Team regularly reviews and makes improvements to its major incident plan and has a programme for regularly testing this plan locally.

In order for us to be assure that locally we are fully prepared in terms of urgent care, we chair the local Urgent Care Working Group (HRW UCWG).

The HRW UCWG is a multi-stakeholder body with membership from operational and strategic leads from all local health and social care organisations supported by lay membership, officers from the North Yorkshire & Humber Area Team and HRW CCG.

Member organisations of the HRW UCWG include Yorkshire Ambulance Service NHS Trust, South Tees Hospitals NHS Foundation Trust, Adult and Social Care Services and Public Health from North Yorkshire County Council, Tees, Esk and Wear Valleys NHS Foundation Trust and Harrogate and District Hospital NHS Foundation Trust’s Out of Hours service.

The CCG has, through the HRW UCWG, current assurance that all individual organisation plans in relation to emergency preparedness (and associated operational escalation plans such as on call arrangements) are in place for our population and have been appropriately shared across all HRW UCWG member organisations.

In addition, during 2014/15 the CCG developed and published a Business Continuity Plan. The plan is designed to enable the business to resume activities whether the situation is one of true disaster or whether there is simply partial loss of certain facilities. As such, it covers a broad spectrum of potential situations that may impact on the ability of the CCG to continue its normal business either short term or long term.

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

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Dr Vicky Pleydell Clinical Officer

How we learn from you

The key to ensuring that we continually review the quality of the services we commission is to learn from the feedback received from our patients, their families and carers.

We commission our Patient Relations service from Yorkshire and Humber Commissioning Support, who work with our partners in health and social care to resolve any issues and signpost people to the appropriate service for their needs.

The emphasis of complaints handling is focussed on resolving complaints at a local level and trying to come to a speedy resolution that clearly addresses the issues and concerns raised. Our commitment is to try to ensure that anyone making a complaint has their concerns fully investigated and receives a written response on the findings. When appropriate, this will include an apology and importantly associated learning as a result.

The total number of contacts received by the Patient Relations Team for the period 1 April 2014 to 31 March 2015 was 149. The table below shows the number and grade of contacts received by the Patient Relations Team (excluding contacts relating to independent contractors i.e. GPs, dentists, opticians and pharmacists).

Patient Advice & Liaison Service

Complaints Compliments Total

116 31 2 149

The majority of the calls to the Patient Advice and Liaison Service (PALS) were for signposting to another service such as a hospital or to a GP practice. There were also several contacts made regarding CCG commissioning decisions and for CCG contact information.

Out of the 31 complaints received, 21 were regarding Continuing Healthcare, four were regarding children’s services, three were regarding commissioning and two were regarding issues with the CCG’s commissioning policies. Three were recorded as ‘other’.

The compliments received were in regard to the good communication and good work undertaken by the CCG, including the publicising of meeting dates, and about the Partnership Commissioning Unit’s new Fast Track service.

The CCG welcomes feedback, positive or negative, about experiences of local NHS services as this helps us to improve services for patients. If you are unhappy with the treatment or service you have received from NHS services, you have the right to make a complaint, have it looked into and receive a response. You can also raise your concerns immediately by speaking with the staff involved. If you’re pleased with one of the services commissioned by the clinical commissioning group or wish to raise a concern or make a complaint, then please let us know by contacting us by phone, letter or email:

Email: HRWCCG.PatientRelations@nhs.net Phone: 0800 068 8000

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Address: Patient Relations, Health House, Grange Park Lane, Willerby, East Yorkshire, HU10 6DT.

Principles for Remedy

The CCG follows the Parliamentary and Health Service Ombudsman’s Principles for Remedy (published May 2010). This sets out six principles that represent best practice. This forms part of the CCG’s complaints handling procedure.

Information Governance

The CCG recognises the importance of having effective information governance controls in place to allow any and all personal confidential data held and processed to be adequately protected. In 2013/14 we developed an information governance framework that sets out the approach the CCG will take to the management of all information assets and to set a culture where information is protected and used appropriately. We have policies in place that detail to staff both the CCG’s and individual’s requirements to protect and use information in a lawful manner.

The development of these policies and framework has allowed us to achieve Level Two compliance with all relevant information governance toolkit standards. This has required that policies have been made available to staff and that every individual completing work on behalf of the CCG has completed Information Governance training. The implementation of these policies allows the CCG to fulfil its requirements under the Freedom of Information Act and Data Protection Act, relating to the protection, use and the processing of data requests. We have also implemented an incident reporting system that encompasses information governance incidents allowing staff a single point of reporting. There have been no reported information governance incidents during this year.

Freedom of Information

As a CCG, we are committed to being open and transparent with our communities. One of the ways we achieve this is by complying with the Freedom of Information Act (FOI). FOI gives members of the public the right to ask any public sector organisation for all the recorded information they have on any subject. Anyone can make a request for information – there are no restrictions on age, nationality or where a person lives.

During the period 1 April 2014 to 31 March 2015, the CCG processed the following requests for information under the Freedom of Information (FOI) Act 2000:

2014/2015

Number of FOI requests processed 252

Percentage of requests responded to within 20 working days 95.6%

Average time taken to respond to an FOI request 14.6

Eleven responses took longer than the statutory 20 working days to complete due to the complexity of the request.

In nine cases, no information was provided and in 29 cases, only part of the information was provided because an exemption was applied. Exemptions applied included information being accessible by other means, intended for future publication, the cost of providing the information

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exceeded the limits set by the FOI Act, the information requested was commercially sensitive or it was personal information.

Our publication scheme contains documents that are routinely published. This is available on our website at www.hambletonrichmondshireandwhitbyccg.nhs.uk/reports-and-publications/publication-scheme/

Our workforce

We have small team of 27 staff, directly employed by the CCG. We buy the majority of our support services, such as human resources, IT, communications and business intelligence support, from NHS Yorkshire and Humber Commissioning Support (formerly NHS North Yorkshire and Humber Commissioning Support Unit).

The number of persons of each sex who were on the Governing Body:

Male: 7Female: 5Transgender: 0

It is not possible to provide the number of persons of each sex who were on the Council of Members, as each GP practice has flexibility in who represents them at each Council meeting.

The number of other senior managers of each sex who were graded as ‘very senior managers’ (other than persons falling within the above disclosure):

Male: 0Female: 0Transgender: 0

The number of persons of each sex who were employees of the CCG:

Male: 8Female: 19Transgender: 0

We consult with our staff informally on a number of issues, through monthly full team meetings and one-to-ones. We also keep our staff and GP practices informed through a monthly newsletter and online resources website which we keep regularly updated.

2014/15 saw us establish a Health and Wellbeing Steering Group, which supports the CCG in achieving its aim of being an employer that demonstrates concern for the wellbeing of all staff, promotes healthy lifestyles and offers a healthy workplace. The Group consists of CCG staff members and colleagues from partner organisations who support the CCG with day-to-day management including human resources, business intelligence and communications.

The Group aims to enable staff to identify and implement improvements that matter to both individuals and the staff as a whole. So far, the CCG has undertaken a staff survey which identified both areas where our teams were happy with their working environment and also captured areas where people had suggestions for improvement.

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In addition, the CCG has teamed up with Hambleton District Council on its Dress Down Fridays to encourage more people to get together for lunch and socialise. On the last Friday of each month staff at the CCG are encouraged to bring in themed food. Staff then pay to take part and the money raised goes to charity. Charities we have supported include The British Legion, Children in Need, Friends of Chernobyl’s Children, Guide Dogs for the Blind, British Heart Foundation and Comic Relief.

There are currently no employees within the CCG who have declared a disability; however we actively encourage people with disabilities to apply for positions in the CCG. Applicants applying for roles at the CCG who declare a disability will be eligible for a guaranteed interview, providing they meet the minimum criteria within the person specification for the particular vacancy.

The CCG also supports staff and offers occupational health support and adjustments that may be required within the role in which they are employed.

Recognising the contribution we make to the local community, in March 2015 we agreed to pay all staff the Living Wage as a minimum. The Living Wage is based on research which asked people to list the items they felt an individual would need to live a minimum acceptable standard of living. The Living Wage is an informal figure that is not legally enforceable – unlike the compulsory minimum wage. The living wage is currently £7.85 per hour, compared to the national minimum wage of £6.50 per hour. This will be fully embedded during 2015/16.

Sickness absence data

HRW CCG has introduced the Policy for Management of Attendance and has systems and processes in place to record, monitor and manage absence with the support from the Workforce Team and Occupational Health. The average level of absence for the past 12 months for employees of the CCG is 1.41%, which is well below the national average. Absence continues to be proactively managed in accordance with the Policy.

Performance 2014/15

We are committed to securing high quality, safe and effective services for the population we represent. The CCG works closely with service providers to identify and support them improve service provision where this is below local or national standards or targets and this work continues into 2014/15.

The measures below cover aspects of patient experience, performance, quality and safety that the CCG is assessed against and we use these when managing the performance of our providers.

UPDATE TABLES AND LAY OUT MORE CLEARLY ONCE FINAL FIGURES ARE INReferral to treatment waiting times for non-urgent consultant-led treatment (up to February 2015)

Referral To Treatment waiting times for non-urgent consultant-led treatmentAdmitted patients to start treatment within a maximum of 18 weeks from referral 90% 93.9%Non-admitted patients to start treatment within a maximum of 18 weeks from referral 95% 97.9%Patients on incomplete non-emergency pathways (yet to start treatment) should have been waiting no more than 18 weeks from referral 92% 95.3%Number of patients waiting more than 52 weeks 0 4

Diagnostic test waiting times (up to February 2015)

Patients waiting for a diagnostic test should have been waiting less than 6 weeks from referral 1% 1.7%

A&E waits (full year)

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Patients should be admitted, transferred or discharged within 4 hours of their arrival at an A&E department 95% 94.1%

Cancer – two week waits (up to February 2015)

Maximum two-week wait for first outpatient appointment for patients referred urgently with suspected cancer by a GP 93% 92.1%Maximum two-week wait for first outpatient appointment for patients referred urgently with breast symptoms (where cancer was not initially suspected) 93% 89.1%

Cancer – 31 day waits (up to February 2015)

Maximum one month (31-day) wait from diagnosis to first definitive treatment for all cancers 96% 97.6%Maximum 31-day wait for subsequent treatment where that treatment is surgery 94% 97.8%Maximum 31-day wait for subsequent treatment where that treatment is an anti-cancer drug regimen 98% 99.3%Maximum 31-day wait for subsequent treatment where the treatment is a course of radiotherapy 94% 98.2%

Cancer – 62 day waits (up to February 2015)

Maximum two month (62-day) wait from urgent GP referral to first definitive treatment for cancer 85% 86.0%Maximum 62-day wait from referral from an NHS screening service to first definitive treatment for all cancers 90% 91.8%

Maximum 62-day wait for first definitive treatment following a consultant’s decision to upgrade the priority of the patient (all cancers)

No operational standard 92.9%

Ambulance response times – Category A calls (full year)

Category A calls resulting in an emergency response arriving within 8 minutes (Red 1) 75% 69.9%Category A calls resulting in an emergency response arriving within 8 minutes (Red 2) 75% 69.3%Category A calls resulting in an ambulance arriving at the scene within 19 minutes 95% 95.7%

Mixed sex accommodation breaches (full year)

Breaches of same sex accommodation 0 0

Cancelled operations (up to December 2014)

All patients who have operations cancelled, on or after the day of admission (including the day of surgery), for non-clinical reasons to be offered another binding date within 28 days, or the patient’s treatment to be funded at the time and hospital of the patient’s choice.

No operational standard 2.8%

Mental health (up to December 2014)Care Programme Approach (CPA): The proportion of people under adult mental illness specialties on CPA 95% 99.2%

Indicators not meeting requirements

Number of patients waiting more than 52 weeksJo Elsom, Abby Tebbs and Martin Short for this sectionThese breaches (need to check 4th) relate to unadjusted data reporting. Nationally reported data, obtained from a central reporting system operated by NHS England indicate 4 year to date 52 week breaches, all four are on completed admitted patient pathways and all at STHFT. All four patient pathways were fully reviewed by the Trust and in all four cases legitimate adjustments were identified which mean that following adjustment no patient breached the 52 week target. The CCG has discussed these with the Trust and is content with this position.

Diagnostic test waiting timesTo be provided

A&E waits

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Performance is monitored and reviewed through the System Resilience Group which will also monitor the successful operation of the plans agreed jointly by the CCG and Trust to support reduced admissions and the effective operation of the whole healthcare system through the winter months.

Cancer – two week waitsPatient choice continues to be a min driver of under achievement. The CCG is working with STHFT to review primary care information to ensure patients are aware of the referral pathway and 'willing and able' to accept an appointment within two weeks of referral.

Ambulance response times – Category A callsThe CCG has continued the performance enhancing initiatives that had such a positive impact in 2013/14 into 2014/15 and has also introduced further performance enhancing initiatives during 2014/15 that have had a significant and positive effect. Demand on the 999 service has increased in 2014/15 over and above 2013/14 levels. YAS implemented a service improvement action plan to rectify the performance deficit (commenced in the summer of 2014) including a revised Red performance trajectory. The impact of this recovery plan generated only a marginal improvement in the Red 1 call performance which remains below 2013/14 levels. When the Red 1 and Red 2 performance is combined the CCG position for 2014/15 is 66.6% which exceeds the locally agreed stretch target of 66%.

How are our main providers performing?

Short narrative to be provided with final figures.

Admitted (90%) Non Admitted (95%) Waiting (92%) MRSAC.difficile(Actual/Target) Continuity of Services Governance

South Tees Hospitals 93.3% 98.4% 96.0% 4 67/45 1 Subject to enforcement actionCounty Durham and Darlington NHS

91.3%98.2% 93.5% 5 16/34 3 No evident concerns

York Teaching Hospital 84.3% 96.0% 92.1% 0 54/54 4 No evident concernsHarrogate and District 94.1% 97.1% 97.1% 0 9/14 3 No evident concernsNewcastle upon Tyne Hospitals NHS

89.3%94.0% 92.6% 4 80/73 3 No evident concerns

Leeds Teaching Hospitals NHS

88.8%95.4% 93.2% 8 107/117

18 Week RTT HCAI Monitor Rating

Short narrative to be provided with final figures.

Friends and Family Test

This is a single question survey which asks patients whether they would recommend the NHS service they have received to friends and family who need similar treatment or care, it is initially for providers of NHS funded acute services for inpatients (including independent sector organisations that provide acute NHS services) and patients discharged from A&E (type 1 & 2). Providers have a target response rate of 15%. The response rate and test scores for our main local acute healthcare providers in March 2015 are:

Table to be included once clarity of information to be contained is provided.

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Our future plans, performance and objectives

In spring 2014, the CCG produced a five year Strategic Commissioning Plan 2014-19. This was built around seven strategic initiatives and underpinning themes of patient and stakeholder engagement, technology and quality assurance.

A year on, our Strategic Plan has not changed. However in the past year much has happened. As this report shows, we have made significant progress. We have also learned and developed our thinking in many areas based on both our successes and from obstacles encountered. We have therefore refreshed our Operational Plan for the year ahead (2015/16). The plan absolutely continues the breadth of projects initiated in 2014/15, building on successes, establishing clearer next steps where progress has not been as fast as intended, and adding in new projects where appropriate.

One of our over-arching aims is to transform the community system. In the Hambleton and Richmondshire area, the Fit 4 the Future programme is focusing on developing a beacon of rural health and care services. We serve a deeply rural community, who are passionate about local services. However, we recognise that the traditional way of organising and delivering services is not sustainable and together we want to radically reimagine how we provide care and support for our local population. We also believe that we should take a whole life and integrated approach, with the needs of the individual and the community at its heart. Using innovative and creative engagement techniques we believe we can establish a dialogue which will act as the precursor for co-creating a model of care. This model will be clinically and financially sustainable and enable us to keep the Friarage Hospital at the centre of healthcare for the people of Hambleton and Richmondshire for both elective and non-elective secondary care services.

In Whitby and surrounding area, our aim is to transform services to ensure they continue to be accessible to support the future needs of the local population including increasing levels of frailty. To ensure this we have commissioned Virgin Healthcare as the new provider of community and urgent care services and during the year ahead we will work with them to start the process of developing services. We would also like to work with North Yorkshire County Council and other local providers or health and social care to provide a vibrant and sustainable future for Whitby Hospital, including a health and wellbeing hub within the hospital which would provide both a physical space and virtual concept for preventing ill health.

As well as these over-arching transformational objectives, our Plan sets out a wide range of further projects and developments to address our priorities. We want to enable children and their families to have the best start in life, achieve improved health outcomes, and reduce health inequalities. We will enable GP practices to work more clearly and practically in partnership with social care and voluntary sector organisations so increasing numbers of patients with complex health issues are managed in or near home. For patients with mental health conditions or dementia, we want to establish accessible, multi-disciplinary services with clear pathways for all age service users to support both professionals and service users in managing care for individuals. We will ensure that care pathways and referrals across all specialities are as clinically efficient and effective as

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possible and, where possible, delivered close to home. Finally we will work with our partners in the local authority, district councils, Public Health and the voluntary sector to identify key groups who are at risk of ill health and provide preventative services that will reduce long term impact.

Financial Outlook

The financial plan for 2014/15 was set using the 2013/14 outturn as the starting point and applying national planning guidance. Funding for demographic growth and cost pressures was then added and a Quality, Innovation, Productivity and Prevention (QIPP) programme developed using local knowledge and business intelligence information from benchmarking. Since its inception on 1 April 2013 the CCG has moved from an underlying financial deficit and a requirement to repay legacy debt of £1.8m in 2013/14, to recurrent balance and a planned 1.0% surplus of £1.73m in 2014/15.

As part of the 2014/15 financial plan the CCG was required to set aside £0.67m to contribute to a national Continuing Health Care (CHC) Risk Pool, to settle CHC retrospective claims across England. During December 2014 NHS England reassessed the 2014/15 requirement and started to forecast an underspend across the country. This underspend was returned to CCGs on the basis that they would increase their surplus. The CCGs surplus therefore increased by £0.42m from £1.73m (1.0%) to £2.15m (1.2%).

For 2015/16 the CCG has developed its financial plan in much the same way. The CCG is planning to meet all of its statutory targets and maintain the surplus at £2.15m (1.2%).

Over the past year the CCG has been working with North Yorkshire County Council and other partners to develop a number of improvement initiatives aimed at reducing non-elective admissions by 4.5% (634 spells). These initiatives are a combination of home based and enhanced integrated community services. Non recurrent monies have been used during 2014/15 to pump prime some of these initiatives to deliver the QIPP and prepare the financial landscape for the introduction of the Better Care Fund (BCF) in 2015/16. The CCG is required to invest £6.3m of its own allocation in schemes to support the BCF and create a pooled budget with North Yorkshire County Council from 1 April 2015.

2015/16 is therefore another critical year for the CCG as it is essential that these initiatives move activity from acute to community settings and deliver the expected outcomes. There is a significant risk that funding is diverted to the BCF but the reductions in hospital activity are not enough to fund the transfer of resources. Partnership working across health and social care is essential to deliver the BCF ambitions and mitigate against the financial risk.

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Financial commentary

Financial targets performance

NHS Hambleton, Richmondshire and Whitby CCG has a duty to meet a number of financial targets during the year. The actual performance against these targets is summarised below.

Operating within the Resource Limit

The Resource Limit is NHS England approved funding for the year. The CCG receives two separate allocations. A Programme Allocation which covers expenditure which the CCG incurs to buy health services on behalf its local population, and a Running Cost Allocation to fund the management and clinical structure of the CCG and to pay for support services including those provided by the Yorkshire and Humber Commissioning Support Unit. Overall the CCG was required to achieve a surplus of £2.15m in 2014/15.

Programme Allocation

The programme allocation for 2014/15 was £175.5m, the CCG has achieved a £1.5m surplus against this allocation. Fig 1 provides a breakdown of where the funds were spent during 2014/15. Fig 2 analyses this spend further into different healthcare categories.

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Fig 2: 2014/15 Analyses spend into dif -ferent healthcare categories (2013/14)

Acute Commissioning 50.1% (50.7%)

Primary Care Services 16.3% (16.4%)

Community Health Services 12.0% (11.4%)

Mental Health 9.9% (9.2%)

Continuing Health Care 7.4% (8.0%)

Ambulance Services and Patient Transport 4.0% (3.8%)

Other Commissioning 0.4% (0.5%)

Running Costs

The running cost allocation for 2014/15 was £3,865k. £3,509k of this allocation relates to the running costs of the organisation and equates to £24.71 per head of population. £356k of this allocation relates to the CCGs achievement of the quality premium, the associated investment of this quality premium is recorded as expenditure against the programme allocation. The CCG has underspent by £645k against this allocation.

Cash Target

NHS Hambleton, Richmondshire and Whitby CCG operated within its maximum cash draw down limit of £177.3m.

Better Payments Practice Code

NHS England requires CCGs to pay all valid invoices within 30 days of receiving the goods or services, unless other payment terms have been agreed with the supplier. In 2014/15 96.5% of non NHS Invoices and 97.1% of NHS invoices were paid within 30 days. The CCG signed up to the prompt payment code in April 2014. This is a payment initiative developed by Government with the Institute of Credit Management (ICM) to “tackle the crucial issue of late payment and help small businesses”. Cost Allocation and Setting of Charges for Information

We certify that the clinical commissioning group has complied with HM Treasury’s guidance on cost allocation and the setting of charges for information.

Dr Vicky PleydellClinical Chief Officer

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Pay multiples

NHS Hambleton, Richmondshire and Whitby CCG is required to disclose the relationship between the remuneration of the highest-paid member of the Membership Body/Governing Body in their organisation and the median remuneration of the organisation’s workforce. The banded remuneration of the highest paid member of the Membership Body/Governing Body in the financial year 2014-15 was £185-£190 (2013-14, £185-£190) thousand.

This was 4.6 (2013-14, 3.5) times the median remuneration of the workforce, which was £41,531 (2013-14, £54,921). In 2014-15, zero (2013-14, zero) employees received remuneration in excess of the highest paid member of the Membership Body/Governing Body. Remuneration ranged from £10-£15 thousand to £185-£190 thousand.

The ratio of the highest paid officer to the median has changed from 3.5 times in 2013-14 to 4.6 times in 2014-15. The CCG has been carrying a number of vacancies since its inception on the 1st April 2013, as these posts have been filled the CCGs skill mix has changed and the median salary reduced.

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

Note: the full set of the 2014/15 Financial Accounts are available on the CCG’s website at www.hambletonrichmondshireandwhitbyccg.nhs.uk or call us on 01609 767600.

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Our Membership Body and Governing Body

Hambleton, Richmondshire and Whitby CCG’s Governing Body Register of Declarations of Interest 2014/15:

David Williams, Lay Chairman (Voting) 1 April 2014-PresentCommissioning representative on South Tees Hospitals Foundation Trust Council of Governors.Director of Wath Consulting & Development Ltd (property renovation).Trustee of Ripon Citizens Advice Bureau.Training to be a voluntary visitor at St Michael's Hospice

Dr George Campbell, Vice Chair and GP Governing Body Member (Voting)1 April 2012-Present PMS contract lead.Finance Lead at Whitby Group Practice.Heartbeat Alliance member.Whitby Group Practice is a research practice.Employed by York Foundation Trust as a GPSI & Hospital Practitioner in dermatology. Whitby Group Practice undertakes a numbers of roles at Whitby Hospital. Whitby Group Practice has an SPMS contract to provide out of hours GP services.

Dr Mark Hodgson, GP Governing Body Member (Voting)1 April 2012-Present GP Partner at Doctors Lane Surgery, Aldborough St John. Provides out of hours services for Harrogate & District Foundation Trust. Employed by South Tees Hospitals NHS Foundation Trust in the musculoskeletal clinic until 6 September 2014. Shareholder in Heartbeat Alliance Wife is an occupational therapist employed by South Tees Hospitals NHS Foundation Trust working at the Friary Community Hospital, Richmond.

Dr Charles Parker, GP Governing Body Member (Voting)1 April 2012-Present Senior partner at Topcliffe Surgery.Brother is a financial advisor providing advice to health care trusts and local authorities.Practice holds a share in the Heartbeat Alliance

Dr Vicky Pleydell, Clinical Chief Officer (Voting)1 April 2012-Present Partner Simon Kirk is on the consultancy list with Yorkshire and Humber Commissioning Support.

Debbie Newton, Chief Finance and Operating Officer (Voting)1 April 2012-PresentCommissioning Governor for North Yorkshire CCGs for Tees, Esk & Wear Valleys NHS Foundation Trust.Husband is IT manager at South Tees Hospitals NHS Foundation Trust.Son works for North Yorkshire County Council.

Jo Harding, Lead Nurse and Senior Delivery Manager (Voting)

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15 October 2012-Present No interests to declare

Sarah Ferguson, Senior Delivery Manager (Non-voting)1 November 2012-27 March 2015 No interests to declare

Abigail Tebbs, Acting Senior Delivery Manager (Non-voting)15 September 2014-Present No interests to declare

Alison Levin, Head of Finance, Governance and Business Support Services (Non-voting)1 April 2013-Present

Dr Jonathan James, Secondary care doctor (Voting)26 September 2013-PresentSon is a GP at Scorton Medical Centre, Richmondshire

Dr Katie Needham, Public Health Representative (Non-voting)1 April 2013-Present Consultant in public health, North Yorkshire County Council

Dr Duncan Rodgers, Local Medical Council (LMC) representative (Non-voting) 1 April 2013-12 August 2014 No interests to declare

Kenneth Readshaw, Lay Member with responsibility for Governance (Voting)1 September 2013-Present

Ken Elliott, Health Engagement Network representative (Hambleton) (Non-voting)1 September 2013-present No interests to declare

Linda Lloyd, Health Engagement Network representative (Whitby) (Non-voting)1 April 2013-presentShares through SEIS in REDX Pharma Ltd/Biobeck Pharmaceutical I.P – pre-clinical drug development & licensing company.Chairman of Rural Action Yorkshire.

Jane Ritchie MBE, Health Engagement Network representative (Richmondshire) (Non-voting)1 April 2013-present Honorary secretary of Upper Dales Healthwatch; Honorary secretary of Patient Consultative GroupChairman of Elm House Trust that supports community projects.Chairman of VOLT that owns The Work Place that rents space to County Durham and Darlington HealthWatch.Registered carer and attorney for two people in a North Yorkshire County Council extra care home.Chairman of Burton-Cum-Walden Parish Council. Member of Richmondshire District Council's Upper Dales Area Partnership.Voluntary Sector representative of North Yorkshire County Council’s Richmondshire Area Committee.All shares dealt with by stockbroker

The Governing Body is not aware of any relevant audit information that has been withheld from the CCG’s external auditors, and members of the Governing Body take all necessary steps to make

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themselves aware of relevant information and to ensure that this is passed to the external auditors where appropriate.

Committees of the Governing Body

The CCG’s Governing Body has appointed the following committees and sub-committees:

Audit and Integrated Governance Committee The Audit and Integrated Governance Committee, which is accountable to the CCG’s Governing Body, provides it with an independent and objective view of the CCG’s financial systems, financial information and compliance with laws, regulations and directions governing the group in so far as they relate to finance. The committee reviews the establishment and maintenance of an effective system of integrated governance, internal control and risk across the whole of the CCG’s activities that supports the achievement of its objectives.

The committee’s members were:

o The lay member on the Governing Body, with a lead role in overseeing key elements of governance (Chair).

o Membership will also include the following Governing Body members:o One GP Clinical Membero One registered nurseo A representative from one of the constituent practices, with a recognised finance

qualification

The Committee met four times during 2014/15. Attendance was:

Role Name 29 May 2014

4 September

2014

4 December 2014

5 March 2015

Governing Body Lay Member

Kenneth Readshaw

YES YES YES YES

GP Clinical Member

Dr George Campbell

YES YES YES YES

Lead Nurse Jo Harding YES YES YES YESConstituent

Practice representativ

e

Dr Stephen Brown

YES YES YES YES

Remuneration and Terms of Service Committee The Remuneration and Terms of Service Committee, which is accountable to the CCG’s Governing Body, makes recommendations to the Governing Body on determinations about the remuneration, fees and other allowances for employees and for people who provide services to the CCG, and on determinations about allowances under any pension scheme that the CCG may establish as an alternative to the NHS pension scheme.

The Committee was chaired by HRW CCG Lay Chair David Williams.

The Committee met three times during 2014/15. Attendance was:

Role Name 25 September 2014

18 December 2014

19 March 2015

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HRW CCG Lay Chair

David Williams YES YES YES

Governing Body Lay Member

Kenneth Readshaw

YES YES YES

Clinical Chief Officer

Dr Vicky Pleydell YES YES YES

Secondary Care Doctor

Dr Jon James NO YES YES

Chief Finance & Operating

Officer

Debbie Newton NO YES YES

HR Business Partner

Helen Darwin NO YES YES

Business Support Services Manager

Carol Johnston NO YES YES

No external support was provided.

Quality and Safety Committee The Quality and Safety Committee, which is accountable to the CCG’s Governing Body, provides the Governing Body with an independent and objective view on the quality of services commissioned, patients’ experiences, specific quality improvement initiatives and any serious failures in quality.

The committee’s members are:

The Governing Body’s Secondary Care Doctor (Chair) GP representative from a member GP practice Nurse representative from a member GP practice Senior Delivery Manager/Lead Nurse Quality and Safety Manager/ Deputy Lead Nurse Delivery Manager (Contracting) Lay Member/Audit and integrated Governance Lead CSU representation from Business Intelligence CSU representation from the Quality Team Adult Safeguarding Lead: Designated Professional Children’s Safeguarding Lead: Designated Nurse Partnership Commissioning (PCU) representative The LMC has an invitation to send a representative to each meeting Representation from NHS England Local Area Team Representative from the Local Authority Lay representative

The committee met five times during 2014/15. Attendance was as follows:

Role Name/s 19 May 2014

21 July 2014

27 October

2014

22 December

2014

23 February

2015Secondary Care Doctor

Jon James YES YES YES YES YES

Senior Delivery Manager/Lead Nurse

Jo Harding YES YES YES YES

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Governing Body Lay Member

Ken Readshaw YES YES YES YES

Delivery Manager (Team 1)

Abbigail Tebbs YES YES

Delivery Manager (Team 2)

John Darley YES YES

Quality & Safety Manager/Deputy Lead Nurse

Angela Edmunds YES YES YES YES YES

Delivery Support Manager

Kath Hume/Richard Kirby

YES YES YES YES

GP (HRW) Dr Bridget Laybourne

YES YES

Practice Nurse Lisa Kitson YES YESQuality Lead for NY & Humber CSU

Liz Vickerstaff YES YES YES YES

Business Intelligence (CSU)

Jo Elsom/Martin Short

YES YES YES YES

Designated Nurse for Safeguarding Children

Elaine Wyllie YES YES YES YES YES

Designated Professional for Safeguarding Adults (PCU)

John Keith/Stephen Wilcox

YES YES

Contracting Procurement & Quality (NYCC)

Janine Tranmer/Stephen Critchley/Hannah Bissett

YES YES YES

Deputy Director for Partnership Commissioning

Victoria Pilkington/Ursula Farringdon

YES YES YES

Remuneration report

Policy on Remuneration of Senior ManagersVery Senior Managers’ pay rates are set taking into account guidance received from NHS England and Yorkshire and Humber Commissioning Support. Other senior managers are paid in accordance with Agenda for Change Terms and Conditions of service.

The CCG continues to follow appropriate guidance on setting remuneration levels for Very Senior Managers and will take into account the prevailing financial position of the wider NHS and the need for pay restraint. Performance of Very Senior Managers will be monitored in line with the organisation’s objective setting and appraisals processes.

Senior Managers Performance Related Pay (not subject to audit)The Chief Operating and Finance Officer received performance related pay in 2014/15, relating to the previous financial year 2013/14.

Policy on Senior Managers Contracts (not subject to audit)47

Very Senior Managers are employed on substantive and permanent contracts. They are required to give and entitled to receive three months’ notice. Any termination payments will be made in line with the individual’s contract of employment and terms and conditions of service.

Senior Mangers Service Contracts (not subject to audit)No Very Senior Managers have been engaged under service contracts.

Payments to Past Senior Managers (not subject to audit)No payments have been made to past senior managers.

Payments for Loss of Office (not subject to audit)No payments have been made to senior managers for loss of office.Exit packages and severance payments. The figures to be disclosed here relate to exit packages agreed in year

Salaries and allowances (subject to audit)

2013/14 salaries and allowances (subject to audit)

Name and Title

Post(s) Salary & Fees (bands

of £5,000)

£000

Taxable Benefits

(rounded to the nearest

£00)

£00

Annual Performance

Related Bonuses (bands of

£5,000)

£000

Long-term Performance

Related Bonuses (bands of £5,000)

£000

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

£000

Total (bands of £5,000)

£000

Dr George Campbell

Vice Chair of CCG, GP Governing Body Member

65-70 0 0 0 450-452.5 540-545

Mr Henry Cronin

Lay Chairman of Governing Body

10-15 0 0 0 0 10-15

Mrs Sarah Ferguson

Senior Delivery Manager

65-70 0 0 0 17.5-20 105-110

Mrs Jo Harding

Lead Nurse/Senior Delivery Manager

70-75 0 0 0 25-27.5 115-120

Dr Mark Hodgson

GP Governing Body Member

55-60 0 0 0 107.5-110 180-185

Dr Jonathan James

Secondary Care Doctor, Governing Body (from Nov 13)

5-10 0 0 0 0 5-10

Mrs Alison Levin

Head of Finance, Governance and Support Services

45-50 0 0 0 95-97.5 150-155

Mrs Debbie Newton

Chief Operating and Finance Office

95-100 0 0 0 110-112.5 240-245

Dr Charles Parker

GP Governing Body Member

55-60 0 0 0 387.5-390 460-465

Dr Vicky Pleydell

Clinical Chief Officer

150-155 0 0 0 15-17.5 215-220

Prof Sue Proctor

Lay Member with Responsibility for Governance (Apr-Jun 13)

0-5 0 0 0 0 0-5

Mr Kenneth Readshaw

Lay Member with Responsibility

5-10 0 0 0 0 5-10

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for Governance (Apr-Jun 13)

2014/15 salaries and allowances (subject to audit)ALISON LEVIN

Name and Title

Post(s) Salary & Fees (bands

of £5,000)

£000

Taxable Benefits

(rounded to the nearest

£00)

£00

Annual Performance

Related Bonuses (bands of

£5,000)

£000

Long-term Performance

Related Bonuses (bands of £5,000)

£000

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

£000

Total (bands of £5,000)

£000

Pension liabilities

Pension entitlements of senior managers of Hambleton, Richmondshire and Whitby CCG:

Pension liabilities 12 months to 31 March 2014 (subject to audit)

Name and Title

Post(s) Real increase

in pension at age

60 (bands

of £2,500)

£000

Real increase

in pension

lump sum at

aged 60 (bands

of £2,500)

£000

Total accrued

pension at age 60 at 31 March

2014 (bands of £5,000)

£000

Lump sum at age 60 related to accrued

pension at 31 March

2014 (bands of £5,000)

£000

Cash Equivalent Transfer value at

31 March 2013

£000

Cash Equivalent Transfer

value at 31 March 2014

£000

Real increase in

Cash Equivalent Transfer

Value

£000

Employer’s Contribution

to stakeholder

pension

£000

Dr George Campbell

Vice Chair of CCG, GP Governing Body Member

17.5-20 57.5-60 30-35 100-105 197 508 311 0

Mrs Sarah Ferguson

Senior Delivery Manager

0-2.5 0-2.5 5-10 0-5 39 53 14 0

Mrs Jo Harding

Lead Nurse/Senior Delivery Manager

0-2.5 5-7.5 20-25 60-65 286 317 31 0

Dr Mark Hodgson

GP Governing Body Member

5-7.5 15-17.5 15-20 45-50 200 307 107 0

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Mrs Alison Levin

Head of Finance, Governance & Support Services

2.5-5 12.5-15 10-15 40-45 152 223 71 0

Mrs Debbie Newton

Chief Operating and Finance Officer

5-7.5 17.5-20 25-30 75-80 357 468 111 0

Dr Charles Parker

GP Governing Body Member

15-17.5 50-52.5 20-25 60-65 50 362 312 0

Dr Vicky Pleydell

Clinical Chief Officer

0-2.5 2.5-5 10-15 30-35 211 253 42 0

Pension liabilities 12 months to 31 March 2015 (subject to audit)ALISON LEVINName and

TitlePost(s) Real

increase in

pension at age

60 (bands

of £2,500)

£000

Real increase

in pension

lump sum at

aged 60 (bands

of £2,500)

£000

Total accrued

pension at age 60 at 31 March

2014 (bands of £5,000)

£000

Lump sum at age 60 related to accrued

pension at 31 March

2014 (bands of £5,000)

£000

Cash Equivalent Transfer

value at 31 March 2014

£000

Cash Equivalent Transfer

value at 31 March 2015

£000

Real increase in

Cash Equivalent Transfer

Value

£000

Employer’s Contribution

to stakeholder

pension

£000

Certain Members do not receive pensionable remuneration therefore there will be no entries in respect of pensions. For the CCG this relates to the posts of Vice Chair and the Lay Members.

A Cash Equivalent Transfer Value (CETV) is the actuarially assessed capital value of the pension scheme benefits accrued by a member at a particular point in time. The benefits valued are the member’s accrued benefits and any contingent spouse’s pension payable from the scheme. A CETV is a payment made by a pension scheme or arrangement to secure pension benefits in another pension scheme or arrangement when the member leaves a scheme and chooses to transfer the benefits accrued in their former scheme. The pension figures shown relate to the benefits that the individual has accrued as a consequence of their total membership of the pension scheme, not just their service in a senior capacity to which disclosure applies. The CETV figures and the other pension details include the value of any pension benefits in another scheme or arrangement which the individual has transferred to the NHS pension scheme. They also include any additional pension benefit accrued to the member as a result of their purchasing additional years of pension service in the scheme at their own cost. CETVs are calculated within the guidelines and framework prescribed by the Institute and Faculty of Actuaries.

Real Increase in CETVThis reflects the increase in CETV effectively funded by the employer. It takes account of the increase in accrued pension due to inflation, contributions paid by the employee (including the value of any benefits transferred from another scheme or arrangement) and uses common market valuation factors for the start and end of the period.

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Off-payroll engagementsFollowing the Review of Tax Arrangements of Public Sector Appointees published by the Chief Secretary to the Treasury on 23 May 2012 clinical commissioning groups must publish information on their highly paid and/or senior off-payroll engagements.

The CCG did not have any off-payroll engagements as of 31 March 2015, for more than £220 per day and that last longer than six months.

Statement of Accountable Officer’s Responsibilities

The National Health Service 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 Dr Vicky Pleydell to be the Accountable Officer of the Clinical Commissioning Group.

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

Under the National Health Service 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.

Dr Vicky PleydellClinical Chief Officer1 April 2015

Statement as to Disclosure to Auditors

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

So far as the member is aware, that there is no relevant audit information of which the clinical commissioning group’s external auditor is unaware; and that the member has taken all the steps that they ought to have taken as a member in order to make themself aware of any relevant audit information and to establish that the clinical commissioning group’s auditor is aware of that information.

Independent auditor’s report (to be included in final draft) ALISON LEVIN

How you can get involved

Get in touch – and tell us what you think! We’d really like to know what you think about our Annual Report.

Our contact details are:

Post: Hambleton Richmondshire and Whitby Clinical Commissioning Group, Civic Centre, Stone Cross, Northallerton, North Yorkshire, DL6 2UUTelephone: 01609 767600Web: www.hambletonrichmondshireandwhitbyccg.nhs.uk Email: HRWCCG.HRWCCGenquiries@nhs.net Twitter: @HRW_CCG Facebook: www.facebook.com/HRWCCG

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Why not join our Health Engagement Network?

We have set up a Health Engagement Network (HEN) for local people who care about the NHS.

This is your chance to influence local decision making, and be involved in decisions about new services.

You can choose how much to get involved. There will be opportunities to take part in surveys, focus groups and events. We will send all HEN members around four surveys a year. You could also volunteer to attend focus groups to discuss specific issues. We are always looking at new ways to help people have their say about health services and we’ll keep you updated about the ways in which you can be involved.

Please visit our website and click ‘get involved’ to join:

www.hambletonrichmondshireandwhitbyccg.nhs.uk

You can also directly contact your Health Engagement Network representatives:

Hambleton: Ken Elliott, hambleton.hen@nhs.net

Richmondshire: Jane Ritchie MBE richmondshire.hen@nhs.net

Whitby and the surrounding area: Linda Lloyd whitby.hen@nhs.net

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