Hambleton, Richmondshire and Whitby
Clinical Commissioning Group
Annual Report 2014/15
Draft, version 2
13 May 2015
1
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
2
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
Lay Chair
Dr Vicky Pleydell
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.
3
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.
4
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, cocommissioning 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 Campbell
GP Lead for Whitby
Dr Mark Hodgson
GP Lead for Richmondshire
Dr Charles Parker
GP Lead for Hambleton
5
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 Pleydell
Clinical Chief Officer
6
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:
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Planned hospital care
Urgent and emergency care
Rehabilitation care
Community health services
Mental health and learning disability services
Other functions we undertake include:
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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
Collaboration
Courage
Focus
We have four core strategic aims which will help us to deliver our mission:
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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
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.
7
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
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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
Egton Surgery, Egton
Danby Surgery, Danby
8
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.
“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
The £6 million a year contract was out for tender because
Operating and Finance Officer.
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
• Rapid assessment for frail and elderly to help community
teams manage patients in their own home for as long as
9
“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.
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.
“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
South Tees Hospitals NHS Foundation Trust is now
and Finance Officer at HRW CCG.
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
10
“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:
Red (combined)
Red 1 calls
Red 2 calls
2013/14
64/3% of calls reached within
eight minutes
68.4%
64.0%
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.
2014/15
66.6%
67.9%
66.5%
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.”
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
11
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.
“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.
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
“We are a village of people who
defibrillators in their communities.
are getting older, and a
defibrillator
would be useful.
When they got married, they thought it would be nice to
Hopefully
it
never
gets used, but
give something back to the community and asked their
it’s
right
here
if
we
need it. It’s
guests for money for charity instead of gifts. The
here for the whole community.”
12
David Humphreys, landlord of
The Stiddy pub, Lythe.
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 redesign 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 redesign of children’s and maternity
services at the hospital which would
ensure they would be clinically safe and
sustainable for the future.
“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.”
Our robust, comprehensive and
transparent engagement process
included nine formal public engagement
Dr Vicky Pleydell, HRW CCG Clinical Chief Officer.
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
14
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.
“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.
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
15
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.
“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.
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 eightminute 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.
16
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 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.
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.
“As a local mental health charity,
we welcome the fact that the CCG
Extended mental health liaison service
is investing resources to assist
people with their mental health
An expanded mental health service at the Friarage
issues.
Mind continues to work
Hospital, Northallerton, is going from strength to strength in
providing care and supporting hospital staff.
alongside its partners in order to
ensure no one suffers mental illThe Acute Liaison Service, commissioned by HRW CCG
health alone.”
and provided by Tees, Esk and Wear Valleys NHS
Foundation Trust (TEWV), aims to reduce the length of
Duncan Webster, Chair of the
17
Board of Trustees, for
Scarborough, Whitby and
Ryedale Mind.
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
Improving access to IVF care
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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.
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.
“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.
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:


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.
19

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.
“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.
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
GP in-hour triage
20
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.
“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.
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.
Fentanyl: reduce total spend. The CCG’s preference is for oral MR morphine or a low cost
patch if necessary.
21



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 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.
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
“Working together in this coordinated 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 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.
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.
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
23
holistic, multi-disciplinary programme for patients aged over 16 years who meet specific predetermined 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
relationship. Organisations which fed back included North
24
“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.
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, patientfocused work being carried out.
“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.”
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
David Williams, HRW CCG Chair.
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
Collaboration category. This flexible, visually interesting campaign ran across the three North
25
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.
“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.
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 organisations
Over 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 Committee
Throughout 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 upto-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.
26
North Yorkshire Health and Wellbeing Board
We 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 Council
North 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
Council
We 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 Yorkshire
We 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.
27

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.
28
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 meetings
3) 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.
29
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.
30
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 Preparedness
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.
31
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
116
Complaints
Compliments
Total
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
32
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
33
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-andpublications/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: 7
Female: 5
Transgender: 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: 0
Female: 0
Transgender: 0
The number of persons of each sex who were employees of the CCG:
Male: 8
Female: 19
Transgender: 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.
34
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 IN
Referral to treatment waiting times for non-urgent consultant-led treatment (up to February
2015)
Referral To Treatment waiting times for non-urgent consultant-led treatment
Admitted patients to start treatment within a maximum of 18 weeks from referral
Non-admitted patients to start treatment within a maximum of 18 weeks from referral
Patients on incomplete non-emergency pathways (yet to start treatment) should have been waiting no more
than 18 weeks from referral
Number of patients waiting more than 52 weeks
90%
95%
93.9%
97.9%
92%
0
95.3%
4
1%
1.7%
Diagnostic test waiting times (up to February 2015)
Patients waiting for a diagnostic test should have been waiting less than 6 weeks from referral
A&E waits (full year)
35
Patients should be admitted, transferred or discharged within 4 hours of their arrival at an A&E department
95%
94.1%
93%
92.1%
93%
89.1%
96%
94%
98%
94%
97.6%
97.8%
99.3%
98.2%
85%
90%
86.0%
91.8%
No operational
standard
92.9%
75%
75%
95%
69.9%
69.3%
95.7%
0
0
No operational
standard
2.8%
95%
99.2%
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
Maximum two-week wait for first outpatient appointment for patients referred urgently with breast symptoms
(where cancer was not initially suspected)
Cancer – 31 day waits (up to February 2015)
Maximum one month (31-day) wait from diagnosis to first definitive treatment for all cancers
Maximum 31-day wait for subsequent treatment where that treatment is surgery
Maximum 31-day wait for subsequent treatment where that treatment is an anti-cancer drug regimen
Maximum 31-day wait for subsequent treatment where the treatment is a course of radiotherapy
Cancer – 62 day waits (up to February 2015)
Maximum two month (62-day) wait from urgent GP referral to first definitive treatment for cancer
Maximum 62-day wait from referral from an NHS screening service to first definitive treatment for all cancers
Maximum 62-day wait for first definitive treatment following a consultant’s decision to upgrade the priority of
the patient (all cancers)
Ambulance response times – Category A calls (full year)
Category A calls resulting in an emergency response arriving within 8 minutes (Red 1)
Category A calls resulting in an emergency response arriving within 8 minutes (Red 2)
Category A calls resulting in an ambulance arriving at the scene within 19 minutes
Mixed sex accommodation breaches (full year)
Breaches of same sex accommodation
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.
Mental health (up to December 2014)
Care Programme Approach (CPA): The proportion of people under adult mental illness specialties on CPA
Indicators not meeting requirements
Number of patients waiting more than 52 weeks
Jo Elsom, Abby Tebbs and Martin Short for this section
These 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 times
To be provided
A&E waits
36
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 waits
Patient 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 calls
The 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.
18 Week RTT
South Tees Hospitals
County Durham and
Darlington NHS
York Teaching Hospital
Harrogate and District
Newcastle upon Tyne
Hospitals NHS
Leeds Teaching
Hospitals NHS
Admitted (90%) Non Admitted (95%) Waiting (92%)
93.3%
98.4%
96.0%
91.3%
98.2%
93.5%
84.3%
96.0%
92.1%
94.1%
97.1%
97.1%
89.3%
94.0%
92.6%
88.8%
95.4%
93.2%
MRSA
4
HCAI
Monitor Rating
C.difficile
(Actual/Target) Continuity of Services Governance
67/45
1
Subject to enforcement action
5
0
0
16/34
54/54
9/14
3
4
3
No evident concerns
No evident concerns
No evident concerns
4
80/73
3
No evident concerns
8
107/117
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.
37
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
38
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.
39
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.
40
Fig 2: 2014/15 Analyses spend into
different healthcare categories
(2013/14)
Acute Commissioning
50.1% (50.7%)
Primary Care Services
16.3% (16.4%)
Community Health
Services 12.0% (11.4%)
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 Pleydell
Clinical Chief Officer
41
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.
42
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-Present
Commissioning 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-Present
Commissioning 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.
43
Jo Harding, Lead Nurse and Senior Delivery Manager (Voting)
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-Present
Son 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-present
Shares 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) (Nonvoting)
1 April 2013-present
Honorary secretary of Upper Dales Healthwatch; Honorary secretary of Patient Consultative Group
Chairman 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
44
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
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
o
The lay member on the Governing Body, with a lead role in overseeing key elements of
governance (Chair).
Membership will also include the following Governing Body members:
o One GP Clinical Member
o One registered nurse
o 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 December
2014
5 March
2015
YES
4
September
2014
YES
Governing
Body Lay
Member
GP Clinical
Member
Lead Nurse
Constituent
Practice
representative
Kenneth
Readshaw
YES
YES
Dr George
Campbell
Jo Harding
Dr Stephen
Brown
YES
YES
YES
YES
YES
YES
YES
YES
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
45
18 December
2014
19 March 2015
HRW CCG
Lay Chair
Governing
Body Lay
Member
Clinical Chief
Officer
Secondary
Care Doctor
Chief Finance
& Operating
Officer
HR Business
Partner
Business
Support
Services
Manager
David Williams
YES
YES
YES
Kenneth
Readshaw
YES
YES
YES
Dr Vicky Pleydell
YES
YES
YES
Dr Jon James
NO
YES
YES
Debbie Newton
NO
YES
YES
Helen Darwin
NO
YES
YES
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
Secondary Care
Doctor
Senior Delivery
Manager/Lead
Name/s
19 May
2014
21 July
2014
Jon James
YES
Jo Harding
YES
46
YES
27
October
2014
YES
22
December
2014
YES
YES
YES
YES
23
February
2015
YES
Nurse
Governing Body
Lay Member
Delivery
Manager (Team
1)
Delivery
Manager (Team
2)
Quality & Safety
Manager/Deputy
Lead Nurse
Delivery Support
Manager
GP (HRW)
Practice Nurse
Quality Lead for
NY & Humber
CSU
Business
Intelligence
(CSU)
Designated
Nurse for
Safeguarding
Children
Designated
Professional for
Safeguarding
Adults (PCU)
Contracting
Procurement &
Quality (NYCC)
Deputy Director
for Partnership
Commissioning
Ken Readshaw
YES
Abbigail Tebbs
YES
YES
YES
YES
John Darley
YES
YES
Angela Edmunds
YES
YES
YES
YES
Kath
Hume/Richard
Kirby
Dr Bridget
Laybourne
Lisa Kitson
Liz Vickerstaff
YES
YES
YES
YES
YES
YES
Jo Elsom/Martin
Short
YES
YES
Elaine Wyllie
YES
YES
YES
YES
YES
John
Keith/Stephen
Wilcox
Janine
Tranmer/Stephen
Critchley/Hannah
Bissett
Victoria
Pilkington/Ursula
Farringdon
YES
YES
YES
YES
YES
YES
YES
YES
YES
YES
YES
YES
YES
YES
YES
YES
YES
YES
Remuneration report
Policy on Remuneration of Senior Managers
Very 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.
47
Policy on Senior Managers Contracts (not subject to audit)
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
Dr George
Campbell
Mr Henry
Cronin
Mrs Sarah
Ferguson
Mrs Jo
Harding
Dr Mark
Hodgson
Dr Jonathan
James
Mrs Alison
Levin
Mrs Debbie
Newton
Dr Charles
Parker
Dr Vicky
Pleydell
Prof Sue
Proctor
Mr Kenneth
Post(s)
Vice Chair of
CCG, GP
Governing
Body Member
Lay Chairman
of Governing
Body
Senior
Delivery
Manager
Lead
Nurse/Senior
Delivery
Manager
GP Governing
Body Member
Secondary
Care Doctor,
Governing
Body (from
Nov 13)
Head of
Finance,
Governance
and Support
Services
Chief
Operating and
Finance
Office
GP Governing
Body Member
Clinical Chief
Officer
Lay Member
with
Responsibility
for
Governance
(Apr-Jun 13)
Lay Member
Salary &
Fees (bands
of £5,000)
Taxable
Benefits
(rounded to
the nearest
£00)
£000
£00
Annual
Performance
Related
Bonuses
(bands of
£5,000)
Long-term
Performance
Related
Bonuses
(bands of
£5,000)
£000
0
All Pension
Related
Benefits
(bands of
£2,500)
Total (bands
of £5,000)
£000
£000
450-452.5
540-545
65-70
0
£000
0
10-15
0
0
0
0
10-15
65-70
0
0
0
17.5-20
105-110
70-75
0
0
0
25-27.5
115-120
55-60
0
0
0
107.5-110
180-185
5-10
0
0
0
0
5-10
45-50
0
0
0
95-97.5
150-155
95-100
0
0
0
110-112.5
240-245
55-60
0
0
0
387.5-390
460-465
150-155
0
0
0
15-17.5
215-220
0-5
0
0
0
0
0-5
5-10
0
0
0
0
5-10
48
Readshaw
with
Responsibility
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)
Taxable
Benefits
(rounded to
the nearest
£00)
£000
£00
Annual
Performance
Related
Bonuses
(bands of
£5,000)
Long-term
Performance
Related
Bonuses
(bands of
£5,000)
£000
£000
All Pension
Related
Benefits
(bands of
£2,500)
Total (bands
of £5,000)
£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)
Real
increase
in
pension
lump
sum at
aged 60
(bands
of
£2,500)
Total
accrued
pension at
age 60 at
31 March
2014
(bands of
£5,000)
£000
£000
Lump sum
at age 60
related to
accrued
pension at
31 March
2014
(bands of
£5,000)
Cash
Equivalent
Transfer
value at
31 March
2013
Cash
Equivalent
Transfer
value at 31
March 2014
£000
£000
Real
increase in
Cash
Equivalent
Transfer
Value
Employer’s
Contribution
to
stakeholder
pension
£000
Dr George
Campbell
Mrs Sarah
Ferguson
Mrs Jo
Harding
Dr Mark
Hodgson
Vice Chair
of CCG,
GP
Governing
Body
Member
Senior
Delivery
Manager
Lead
Nurse/Sen
ior
Delivery
Manager
GP
Governing
£000
17.5-20
57.5-60
30-35
100-105
197
0-2.5
0-2.5
5-10
0-5
0-2.5
5-7.5
20-25
5-7.5
15-17.5
15-20
49
£000
508
£000
311
0
39
53
14
0
60-65
286
317
31
0
45-50
200
307
107
0
Mrs Alison
Levin
Mrs Debbie
Newton
Dr Charles
Parker
Dr Vicky
Pleydell
Body
Member
Head of
Finance,
Governan
ce &
Support
Services
Chief
Operating
and
Finance
Officer
GP
Governing
Body
Member
Clinical
Chief
Officer
2.5-5
12.5-15
10-15
40-45
152
223
71
0
5-7.5
17.5-20
25-30
75-80
357
468
111
0
15-17.5
50-52.5
20-25
60-65
50
362
312
0
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 LEVIN
Name and
Title
Post(s)
Real
increase
in
pension
at age
60
(bands
of
£2,500)
Real
increase
in
pension
lump
sum at
aged 60
(bands
of
£2,500)
Total
accrued
pension at
age 60 at
31 March
2014
(bands of
£5,000)
Lump sum
at age 60
related to
accrued
pension at
31 March
2014
(bands of
£5,000)
Cash
Equivalent
Transfer
value at 31
March 2014
Cash
Equivalent
Transfer
value at 31
March 2015
Real
increase in
Cash
Equivalent
Transfer
Value
Employer’s
Contribution
to
stakeholder
pension
£000
£000
£000
£000
£000
£000
£000
£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 CETV
This reflects the increase in CETV effectively funded by the employer. It takes account of the
increase in accrued pension due to inflation, contributions paid by the employee (including the
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value of any benefits transferred from another scheme or arrangement) and uses common market
valuation factors for the start and end of the period.
Off-payroll engagements
Following 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 Pleydell
Clinical Chief Officer
1 April 2015
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Statement as to Disclosure to Auditors
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 2UU
Telephone: 01609 767600
Web: 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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