Mid Essex Clinical Commissioning Group

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Mid Essex Clinical

Commissioning Group

Annual Report:

April 2022 – June 2022

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Contents

Chair’s Foreword ........................................................................................................ 4

PERFORMANCE REPORT ....................................................................................... 5

Accountable Officer’s Introduction .............................................................................. 5

What Mid Essex CCG does ....................................................................................... 6

Mid and South Essex Health and Care Partnership ................................................... 8

Local Achievements ................................................................................................. 10

How we have performed .......................................................................................... 10

Key issues and risk .................................................................................................. 13

Performance analysis ............................................................................................... 14

Introduction .............................................................................................................. 14

Performance summary ............................................................................................. 14

Improve Quality ........................................................................................................ 18

Reducing Health Inequality ...................................................................................... 20

Engaging People and Communities ......................................................................... 20

Health and Wellbeing Strategy ................................................................................. 24

Financial Review ...................................................................................................... 24

Risks ........................................................................................................................ 24

Sustainable Development ........................................................................................ 28

ACCOUNTABILITY REPORT .................................................................................. 31

Corporate Governance Report ................................................................................. 31

Members Report ...................................................................................................... 31

Governance Statement ............................................................................................ 37

REMUNERATION AND STAFF REPORT ............................................................... 54

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

Staff Report .............................................................................................................. 64

PARLIAMENTARY ACCOUNTABILITY AND AUDIT REPORT ............................... 71

ANNUAL ACCOUNTS .............................................................................................. 72

Accountable Officer’s Foreword

This annual report covers the period between 1 April 2022 and 30 June 2022. It will be

our last report as a Clinical Commissioning Group, with our move to being an Integrated

Care System.

During this time period, we have continued to widen collaboration with our local

authorities, service providers and voluntary organisations so we are all working together

for better lives. I’m hugely proud of all my NHS colleagues – health and care

professionals and non-clinical staff alike – for the efforts they continue to make for local

residents.

We do recognise that many people have had challenges accessing healthcare in recent

months. The “digital first” approach that NHS England and NHS Improvement asked all

CCGs to follow has made accessing services easier for some people, but many people

have also found such significant and rapid change a challenge. The CCG has continued

to listen to our communities and work with them to develop models of care that meet

everyone’s needs. This work will carry on as we begin the next chapter as an

Integrated Care System.

As we move into the new financial year, a robust plan is also being developed within

national guidelines to significantly reduce the number people waiting for operations and

treatments. Momentum on this programme will build as we move into our new

partnership for local working.

Finally, I was to pass on my heartfelt thanks to our local workforce without whom none

of this would be possible. I look forward to pushing forward together as an alliance with

our local authority, trusts, community providers and wider community and voluntary

sector.

Anthony McKeever

Accountable Officer

26 June 2023

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PERFORMANCE REPORT

Performance Overview

The purpose of the performance report is to provide information on the CCG’s

objectives for the 2022/23 financial year, the principal risks to their achievement and

how the CCG performed against these objectives. This section provides a precis of the

rest of the annual report and accounts.

Accountable Officer’s Introduction

Across the mid and south Essex system all services continue to be under extreme

pressure with demand higher than capacity. We need to work with our partners to

ensure that services are able to safely support our residents with long term conditions

and respond to their health needs in a timely manner. Across acute, community and

mental health partners the increase in the acuity of people presenting to their services

is impacting on length of stay and the ability to meet demand and release

capacity. Work continues with wider System partners including local authority and

voluntary sector who work collaboratively to enable discharge and care out of hospital

enabling people to return to their usual place of residence with the right package of

care.

Public services depend on trust. Every time the question of trusted professionals is

raised, doctors and nurses are near the top of the list. This shows the mutual

confidence our residents and healthcare professionals have in one another and is

evident across the public services we all rely upon. During difficult times collaboration

and confidence helps us work effectively and support one another.

Our transition to an “integrated care system” (ICS) on 1

July 2022 – will promote

confidence and enhance collaborative working. Over the first quarter of 2022/23 we

have been preparing the new ICS to build on the legacy of the five clinical

commissioning groups to show that people’s best interests and improved health

outcomes are at the heart of everything we do. Now and in the future. This document

reflects the seriousness with which we take our responsibilities as part of an ICS.

Anthony McKeever

Accountable Officer

26 June 2023

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What Mid Essex CCG does

Our Purpose

NHS Mid Essex CCG is a clinically led organisation, established on 1 April 2013, that

decides how to spend the NHS budget on the majority of health services for people

living in the mid Essex area.

This includes the care and treatment you receive in hospital, maternity services,

community, and mental health services. The CCG also assumes full responsibility for

commissioning of GP services (since 1 April 2021).

Our role is to specify outcomes that we want to achieve for our population, and then

contract with Providers to provide care to achieve those outcomes. We’re committed to

ensuring the provision of local, high-quality services that meet the specific needs of our

population.

We’ve a statutory obligation to achieve our financial targets and ensure that we live

within our means, whilst assuring all centrally set performance targets are met.

Established under the Health and Social Care Act 2012 as a statutory body, every GP

from the mid Essex GP practices is a member of NHS Mid Essex CCG. As a CCG, we

work hard to understand the needs of people living in mid Essex to commission the

right services for the those that live there.

To do this, the vast majority of decisions about how we use public money is made by

local clinicians who are closest to the people they look after. We work in partnership

with health and social care partners (e.g., local hospitals, local authorities, the

community, and voluntary sector). Our governing body is made up of 4 representatives

of general practice (GPs) from across mid Essex along with a Joint Accountable Officer,

Joint Chief Finance Officer, Executive Director of Nursing, NHS Alliance Director,

secondary care (hospital) specialist and three Lay Members that are part of a joint

management team across mid and south Essex.

The key providers from which the CCG buys health services for the residents of mid

Essex are:

• Mid and South Essex NHS Foundation Trust (MSEFT) is the main provider of

acute hospital services from its sites at Basildon, Southend, and Broomfield.

• Essex Partnership University NHS Foundation Trust (EPUT) is the main provider

of mental health services.

• Provide Community Interest Company are our main providers of community

services.

• Emergency health services and transport are provided by the East of England

Ambulance Service NHS Trust and urgent care services by IC24.

In addition, the CCG has a range of contracts with other providers of services such as

palliative care and end of life services, specialist health services for fertility and

termination of pregnancy and community elective care services. We also buy services

from a number of Independent Sector providers.

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GP Practices within our CCG have formed 39 Primary Care Networks (PCNs) to

develop local primary care services to meet the needs of our residents.

A formal document, called a constitution, sets out the arrangements the CCG has made

to ensure it meets its responsibilities for commissioning high quality services for the

people of mid Essex.

It describes the governing principles, rules and procedures which will ensure integrity,

honesty, and accountability. Also, it commits the CCG to taking decisions in an open

and transparent way and places the interests of patients and public at its heart. We last

refreshed our constitution in March 2021 to reflect joint working arrangements with the

mid and south Essex CCGs.

Our constitution can be requested by emailing icb.enquiries@nhs.net.

NHS Mid Essex CCG – facts and figures

CCG Headquarters

Wren House, Hedgerows Business Park,

Colchester Road, Chelmsford, Essex, CM2 5PF

Communities Covered

Chelmsford, Braintree and Maldon Districts.

Population (registered with a

GP) at 1 April 2022

Total Mid Essex GP registered population is

405,344

Number of member GP

practices at 31 March 2022

39 (with about 250 GPs between them)

Number of CCG employees

212 staff, 187.02 whole time equivalent (WTE)

Total health funding and

running costs expenditure

(Q1 2022/23)

£197.8m

Our Strategy

The MSE Health & Care Partnership developed its five-year strategy in December

2019. The strategy outlines 4 key ambitions, with the overarching aim to reduce health

inequalities. The strategy outlines that we would achieve this through:

• Creating opportunity for our residents – supporting education, employment,

and socio-economic improvements for our residents. We have developed this

ambition further - for example, extending the successful work led by MSEFT on

hospitals as Anchor institutions, and starting work to implement our agreement to

a system-wide Anchor Charter in 2021.

• Supporting health and wellbeing – including continuing our focus on

prevention, self-care, lifestyle support. We have undertaken much work in this

area continuing to work in partnership to target prevention opportunities and we

have been working with public health colleagues to focus particularly on healthy

weight as well as through schemes such as BP at Home.

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• Bringing Care Closer to Home – where this is safe and possible. We have

been progressing with a number of developments through PCNs and Alliances to

bring services closer to home.

• Improving and Transforming our Services – we know that our services are

under considerable pressure, and we are not providing the level or quality of

service that we would like. There are several transformation programmes

progressing, underpinned by system working on workforce, digital, and finance to

bring improvements in primary care, cancer care, elective recovery, urgent care,

community diagnostics, flow through the system and care arrangements. Our

Stewardship programme has started to develop and will continue to be key in our

future approach to service improvement and transformation.

We will take the five-year strategy into the new ICS and use the early period of the

Integrated Care Partnership (ICP) formation to begin work to develop the Integrated

Care Strategy – taking our three upper tier local authority Joint Strategic Needs

Assessments (JSNAs)

and health and wellbeing strategies to develop a single strategy

for Mid & South Essex.

As a partner in the provision of health and care services to the population PCNs are

starting to participate and help shape, where appropriate, in the production of these

needs assessments.

We have been clear that we want the hallmarks of our ICS to be:

• Evidence and data driven.

• Have a true partnership with our communities and use their lived experience and

insight to help us shape our work.

• Ensure clinical and care professionals are leading strategy formation and

supporting decision-making.

NHS Mid and South Essex

Key activities in quarter 1 of 2022/23

During 2022/23 the system completed the establishment of the ICS by:

A joint strategic needs assessment (JSNA) looks at the current and future health and care needs of

local populations to inform planning and commissioning of health, well-being and social care

services. They are often, but not always, led by the local authority(ies) of an area but do require

participation from all appropriate partners to:

1) Collect, analyse and interpret health and care needs information.

2) Participate in engagement work between partners or with the population.

3) Follow up and implement recommendations.

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• Successfully navigating assurance processes to establish the Mid and South

Essex Integrated Care Board (ICB) on 1July 2022.

• Developing Partnership and governance structures to enable the new Integrated

Care Partnership to meet its statutory obligations and continue our collaborative

working with partnership organisations as we become established.

• Developing our strategies, policies and processes to support our working as an

Integrated Care System.

• Supporting our four Alliances to further develop their partnership working with

local authority colleagues, Healthwatch and community and voluntary sector

organisations to further develop delivery plans for their local population.

• Undergoing a staffing re-structure to reflect the change from CCGs to the ICB,

supporting our staff through this complex process.

• Completing the closure of the five mid and south Essex CCGs and ensuring

responsibilities are appropriately transferred to the new ICB.

• Preparing to take on new responsibilities from NHS England as part of our

establishment as an ICB.

• Beginning to embed our Population Health Management (PHM) programme

working in collaboration with our PCNs.

• Publishing our engagement strategy that defines how we will gain and use

insight from our communities in the work that we do.

• Developing and agreeing a system wide quality strategy, bringing together all

aspects of the health system.

• Further developing our system finance approach through the System Finance

Leaders Group.

• Embedding joint accountability and assurance through our System Oversight and

Assurance Committee, co-chaired by the Accountable Officer and the NHSE

Regional Director for Strategy and Transformation – and further developing our

embedded assurance model with NHSE colleagues so as to reduce traditional

transactional assurance processes between the system and NHSE.

• Developing our approach to clinical and professional leadership, including how

the clinical and multi-professional congress supports the ICS and our

Stewardship programme to ensure the expertise of clinicians and care

professionals is at the heart of our work.

• Developing the work of MSE Partners as a means to supporting innovation and

improvement.

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Integrated Care Board

The ICB will take on all of the functions of the CCGs and, over time, some

commissioning functions from NHSE. It will be responsible for the system’s entire NHS

finance allocation and will take responsibility for workforce, digital, data and

engagement.

Anthony McKeever has been appointed as the Chief Executive Officer (CEO) designate

of the new ICB and Professor Michael Thorne CBE, has been appointed as Chair

designate of the ICB. Non-executive members for the new ICB Board have been

appointed and remaining appointments to the executive team have now been finalised.

NHS England confirmed the creation of the ICB and ICS on 1

July 2022.

Integrated Care Partnership

The ICP has been established as a joint and equal partnership between the NHS and

our upper tier local authorities. Together, we have agreed that the ICP will be chaired

by Professor Thorne so as to ensure consistency and coherence across the ICS, with

the three health and wellbeing board chairs of our upper tier local authorities acting as

vice chairs for the ICP. We have agreed membership of the ICP and started to develop

its work programme. The first task of the ICP is underway whereby we are beginning to

develop a new Integrated Care Strategy for the ICS, and for the population of Mid &

South Essex.

Local Achievements

Covid Vaccinations

During 21/22 there were multiple vaccination sites across mid Essex, run by a mix of

General Practices and Pharmacists. The table below shows the number and

percentage of people vaccinated across mid Essex last year split by first dose, second

dose and booster, this work continued during Q1 2022/23.

Respiratory Virtual Clinics

Following a successful pilot with 2 Mid Essex Primary Care Networks (PCNs), Mid

Essex commissioned MDT Respiratory Virtual Clinics for all Mid Essex PCNs. Across

the clinics, 8 different respiratory education topics have been discussed, delivered by a

respiratory consultant and respiratory specialist, and 83 individual complex patient

cases have been discussed collaboratively, with clear actions agreed for each patient.

Preliminary outcomes demonstrate strong findings of improved patient care and

collaboration across profession, with 74% primary care attendees in agreement that the

clinic improved confidence, knowledge, and attitudes regarding the management of

complex respiratory patients in primary care. 31% of patients discussed were

recommended a change to their diagnosis, and 58% were recommended a change to

their treatment (e.g., referral to mental health services or pulmonary rehabilitation, for

example). A full 12-month evaluation will be produced imminently, including follow-up

interviews of attendees. This project has been published as best practice by NHSE.

Prevention and early intervention- Freshwell low carbohydrate programme

To expand the success of the Freshwell low carb programme, the service has been

upscaled across the Colne Valley PCN, delivered by the PCN Health and Wellbeing

coaches (funded by the Additional Roles Reimbursement Scheme).

The service, originally delivered as a tier 2 weight management style of service (12-

week behaviour change), has organically evolved to further engage and involve the

local community. Examples include: weekly drop-in information sessions at GP

Practices throughout the PCN (delivered by volunteers); community groups that meet to

discuss the lifestyle (organised by volunteers), enjoy social activities, and attend

parkrun each week. The outcomes of the programme continue to demonstrate clinically

significant weight loss (maintained at 12-months), remission of Type 2 Diabetes in

some cases, reduced prescribing of medication for many patients with Type 2 Diabetes

(evidenced by significant prescribing cost savings for the Practices, in reverse of the

national trends), and improved self-assessment of wellbeing, and life satisfaction for the

majority of patients. The service leads have also engaged with the University of Essex

to explore further evaluation work.

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To increase accessibility of the programme, from March 22, the PCN will be working

with the MSE ICB to produce extra meal planners, tailored to specific groups at risk of

health inequality.

Physical Health Checks for individuals with Serious Mental Illness (SMI)

With the launch of our Integrated Primary Care Community (IPCC) programme to

deliver mental health services more holistically without organisational barriers between

primary care, secondary care, and the voluntary sector the way we deliver health

checks for people with SMI is improving. As part of the IPCC programme a Physical

Health Team pilot begun with Healthcare Assistants recruited to provide physical health

checks that are compliant with QOF indicators for mental health.

The national target for completed health checks is 60%, since the IPCC programme

and launch of the service in Oct 2021 performance has improved from 15.7% (Mar 21)

to 44% (Mar 22). The next stage is to expand the service to ensure a Health Care

Assistant is integrated into all 9 PCNs in Mid Essex and incorporate the additional

support and guidance for; nutrition, exercise, sexual health and promotion of

vaccinations programmes and public health screening programmes, as well as starting

to work with system partners to look at a more holistic approach to supporting this

cohort by looking at the wider determinants of health, their impact and support that can

be offered.

PCN Development

In 21/22, two PCNs (Chelmsford West PCN and Dengie and South Woodham Ferrers

PCN) across Mid Essex bid for Accelerator status and are subsequently being

supported with local initiatives driven primarily by population health data.

21/22 saw the forging of a working relationship with Writtle University College. The

launch of the Colleges Sports and Health Hub lends itself to collaborative working and

joined up pathways, most notably with Chelmsford West PCN, whose geographical

footprint they fall within.

The “PCN Livewell Garden” based at Tennyson House Surgery continues to be

successful as a social prescribing and volunteering space and is successfully overseen

by the Chelmsford CVS. This initiative is now being replicated at the Writtle GP surgery.

South Woodham Ferrers & Dengie PCN have been working up a model for a virtual

PCN, that will integrate teams from across health and care to support those with

complex frail needs, using data to identify those people most at risk and implement

proactive care and interventions to support them. The aim over time is to reduce

repeated, reactive, urgent demand on teams and services as capacity becomes united

and efficiently coordinated ensuring local residents get the right support, by the right

team, at the right place and time for them.

Asset Based Community Development

In May 2021, Community360, Chelmsford CVS and Maldon & District CVS were

commissioned by the mid Essex Alliance to deliver a Mid Essex Mapping exercise, the

outcome of which provided a comprehensive analysis of existing community assets and

the strengths and opportunities for growth in the voluntary and community sector across

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Mid Essex. This is the first time this information has been readily available to system

partners and is being used to support further development and growth of community

assets, as well as realising where gaps are that we need to fill to support with the

priority to reduce health inequalities and create preventative and self-care approaches

to health and wellbeing for our communities.

How we have performed

The CCG monitors health outcomes against a range of NHS Constitutional Standards’

that are set nationally

. Performance across the system has generally been below the

set standards due to capacity pressures throughout the health and care system.

The CCG has been working with local providers of services and NHS

England/Improvement (which is the regulatory organisation for the CCG and providers

of services) to agree the system transformation required to support improvements in

care for patients.

As seen nationally, performance against the standards has been directly impacted by

the Covid-19 pandemic. A key issue experienced nationally is the increased waiting list

and backlog sizes for planned elective care during the COVID19 pandemic. As directed

from national guidance whilst capacity was reduced, non-urgent diagnostic tests

together with elective planned appointments and procedures were paused to prioritise

emergency, urgent and cancer work.

A key risk affecting the delivery of performance and recovery is ensuring workforce is in

place to meet the delivery of the increased capacity required to recover and meet

demand.

Key issues and risk

The Covid-19 pandemic had a significant impact upon the operation of NHS services

across the country, which brought with it several associated risks, firstly in relation to

the effects of the virus itself and secondly in relation to the effects that management of

the pandemic has had on core services and the achievement of constitutional

standards.

The former has been managed well during the year, which is reflected in the lowering of

risk in relation to the effects of the virus as a result of the success of the Covid-19

vaccination programme and greater understanding of how to care for patients with the

virus. The Mid and South Essex CCGs continue to manage the impact of risks on core

services, focusing on restoring performance back to pre-Covid levels.

Further information on the CCG’s key risks and risk profile is provided in the Risks

section of the Performance Analysis report.

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Performance Analysis

Introduction

Measuring our performance against a range of indicators, including nationally agreed

quality standards, is important for our patients and the public as they relate to key areas

such as access, treatment times and quality of care. Performance against these targets,

and the plans we have to improve them, is overseen by the Finance and Performance

Committee.

2022/23 has, as outlined within this report, provided challenges to delivery and recovery

of performance standards. The below summary shows the performance as reported in

June 2022, this is the most up to date information at time of writing this report.

Mid and South Essex continues to work collaboratively with our provider partners to

support recovery of performance standards and outcomes for our population. This work

is ongoing and continues in the work of the ICB.

Performance summary

The following is an overview of how the system has performed against the constitutional

standards.

• NHS Constitution – Urgent and Emergency Care (UEC)

The UEC Strategic Board oversees performance and planning for all UEC services

(East of England Ambulance Service (EEAST), NHS111, A&E, Urgent Community

Response Team (UCRT), Mental Health Emergency Department (ED) and has

members from both health and social care.

Daily operational calls (Daily Tactical Care call) are in place with system partners,

ensuring plans are in place or reviewed to mitigate presenting pressures across the

system.

Organisations across the system are working collaboratively to improve ambulance

offload times (for conveyed patients) and the flow through ED. For example, community

providers have an Urgent Community Response Team (UCRT) team working with

EEAST to, where appropriate, provide an alternative to conveying patients to acute

hospital. The Virtual Wards work is continuing to be developed to support admission

and reduce the need for conveyance of frail elderly patients where more appropriate.

The EEAST Hospital Ambulance Liaison Officer (HALO) are working within Mid and

South Essex Foundation Trust (MSEFT) ED to facilitate the triaging and handover of

patients arriving via ambulance to release EEAST staff. To facilitate optimal flow

through the hospital, Local Authorities ensure continued support for timely discharges

from the acute.

The key issues for the UEC programme include the following where performance is

below standards:

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Ambulance Response Times

Standards:

• Respond to Category 1 calls in 7 minutes on average, and respond to 90% of

Category 1 calls in 15 minutes

• Respond to Category 2 calls in 18 minutes on average, and respond to 90%

of Category 2 calls in 40 minutes

• Respond to 90% of Category 3 calls in 120 minutes

• Respond to 90% of Category 4 calls in 180 minutes

The ambulance response times remain below the NHS constitutional standards.

The following table shows the range of 90

centile and mean response times across

Mid Essex CCG for each of the four categories of calls and respective standards.

Emergency Department – waiting times.

Standard:

• 95% of patients have a maximum 4-hour wait in A&E from arrival to

admission, transfer, or discharge

Within MSEFT A&E (Type 1), the 95% four-hour performance is below the constitutional

standard as per following table.

• Elective Care

Key issues for the Elective programme include waiting time performance being below

standards for Diagnostics, Cancer and RTT (Referral To Treatment).

Diagnostics Waiting Times

Standard:

• The constitutional standard is no more than 1% of patients waiting 6 weeks

or more for a diagnostic test and no patients waiting 13+ weeks.

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As seen nationally during the COVID-19 pandemic, waiting times for diagnostic tests or

procedures has increased significantly with a large increase in the number of patients

waiting over six weeks and 13 weeks.

The waiting times for diagnostic tests remain below the NHS constitutional standards.

During Quarter one 2022/23, 75% of patients waited less than six weeks (below standard

of >= 99%) with circa 6% of patients waiting over 13 weeks (below standard of zero) at

Mid Essex CCG.

The System Diagnostic Board oversees performance and planning for diagnostics

across MSE supported by sub-groups including assurance.

A significant acute challenge lies in non-obstetric ultrasound. An identified issue

includes workforce capacity regarding Sonographers.

Cancer Waiting Times

Standards: For people with suspected cancer:

• To see a specialist within 14 days of being urgently referred by their GP or a

screening programme.

• To not wait more than 28 days from referral to getting a cancer diagnosis or

having cancer ruled out.

• To receive first definitive treatment within 31 days from decision to treat

• To start drug, radiotherapy, and surgery subsequent treatments within 31 days

• To receive their first definitive treatment for cancer within 62 days of receipt of

urgent referral.

The waiting times for patients on a cancer pathway remain below the NHS

constitutional standards.

The following table shows the Quarter one 2022/23 position for Mid Essex CCG for

each of the waiting time standards.

The MSE HCP Cancer, Palliative & End of Life Care Board oversees cancer assurance

and transformation supported by sub-groups including the Cancer Programme Delivery

Group (for assurance and focus on national, regional, and local commitments and

deliverables); Quality Cancer meeting; and the Palliative Care Delivery group.

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The wider system is working with MSEFT and Cancer Alliance through plans to

transform the diagnosis, treatment, and care for cancer patients to recover performance

for the local population.

Referral to Treatment (RTT) Waiting Times

Standards:

• The constitutional standard is starting consultant-led treatment within a

maximum of 18 weeks from referral for non-urgent conditions. Since the

significant increase in waiting times following the global COVID pandemic, the

NHS is working to achieve the following 2022/23 planning round asks:

• eliminate waits of over 104 weeks as a priority by July 2022 and maintain

this position through 2022/23 (except where patients choose to wait

longer)

• Reduce the number of patients waiting 78+ weeks on an RTT pathway to

zero by March 2023

• Reduce the number of patients waiting 52+ weeks on an RTT pathway to

zero by March 2025

As of Quarter one 2022/23, there were 5 patients waiting 104+ weeks, 193 patients

waiting 78+ weeks and 1,963 patients waiting 52+ weeks on an RTT pathway for Mid

Essex CCG.

The Elective Board oversees RTT assurance.

Mid and South Essex system through collaborative working between partner

organisations including MSEFT, Independent Sector Providers, Community Providers

and primary care are working together to ease pressure at the acute trust, ensuring

patients with 2ww or urgent referral are prioritised, and available capacity is maximised

across the system.

Community providers are working with MSEFT to, where appropriate, provide an

alternative place for treatment to waiting and being treated at MSEFT. Local

Independent Sector providers are providing additional system capacity for patients

waiting at MSEFT facilitated by commissioners and MSEFT. Primary care is supporting

with demand management/referral diversion plans.

• Mental Health

A key issue for the mental health work programme is workforce capacity and

constraints with recruitment to mitigate against workforce vacancies. In terms of

governance, performance is overseen at the Mental Health Partnership Board.

Improving access to psychology therapies (IAPT)

Standards include:

• 75% of people referred to the improving access to psychology therapies

(IAPT) programme should begin treatment within 6 weeks of referral and 95%

of people referred to the IAPT programme should begin treatment within 18

weeks of referral

The six and 18-week waiting time standards for people referred to the IAPT programme

to start treatment is being sustainably achieved across Mid Essex CCG.

A priority is to increase IAPT in terms of number of people accessing the programme.

Early Intervention in Psychosis (EIP) access

Standard:

• more than 50% of people experiencing first episode psychosis commence a

National Institute for Health and Care Excellence (NICE)- recommended

package of care within two weeks of referral.

The EIP access standard is being sustainably met for Mid Essex CCG.

Improve Quality

Q1 2022/23 has continued to bring challenges and demands on our services, during

which time colleagues from all sectors have worked hard to ensure we continue to

maintain quality care to thousands of patients across our system.

Mid and South Essex CCGs (MSE) have continued to maintain core quality functions,

such as serious incident monitoring and investigation, safeguarding, quality assurance

and infection prevention and control. At times having to prioritise our work to flex with

the needs of the system working towards the transformation of services and processes

in readiness for transition to the ICB.

Care Quality Commission (CQC)

The ratings of our primary providers remain as:

• Provide Community Interest Company - Outstanding

• Essex Partnership University Trust (EPUT) Community - Good

• Mid and South Essex Foundation Trust (MSEFT) – Requires Improvement

• EPUT Mental Health Services – Requires Improvement

• North East London Foundation Trust Community Services – Required

Improvement

• East of England Ambulance service – Requires Improvement

Following a review of Maternity services, the CQC gave an overall rating of - Requires

Improvement. This represents an improvement and acknowledges the hard work being

undertaken as part of the MSE wide Maternity Improvement Programme. The CQC

Section 31 notice for Maternity remains in place, with ongoing support provided through

the NHSE/I Maternity Safety Support Programme. The Maternity Improvement

Programme has been updated to reflect CQC’s most recent recommendations and

strengthened to include learning from the Ockenden Report, both will support and

further improve the transformation of Maternity services across MSE.

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System Quality

The establishment of the Mid and South Essex System Quality Group has significantly

strengthened the quality surveyance, oversight and wider system learning from all key

providers and partners. This group has been instrumental in developing system

strategy leading into the Integrated Care Board and Partnership.

Patient Safety Specialist meetings continued as one of the elements from the National

Patient Safety Strategy. These meetings aim to share knowledge and learning across

our system through the collaboration of all acute and community partners.

MSE Quality Teams have also supported MSEFT to undertake deep dive harm reviews

on all patients whose care pathways breached cancer standards and those breaching

referral to treatment standards. This has enabled the Trust to identify where harm has

occurred and for learning to be used to change pathways and processes moving

forward.

Mental Health Quality Teams have continued to work closely with Essex Partnership

University NHS Foundation Trust (EPUT), the newly formed Mental Health Provider

Collaborative and other local providers to ensure robust oversight of the quality and

safety of care provided.

Special Educational Needs and Disability (SEND)

Essex - The Ofsted & CQC revisit took place between 17 and 19 May 2022. The area

was found to have made sufficient progress in addressing all three of the significant

weaknesses identified at the initial inspection. They noted that:

• Area leaders had worked diligently to establish structures for strategic

oversight and governance that involve all partners

• There has been a palpable change in the culture among partners to joint

working

• Processes are in place to quality assure health and care partners’

contributions to EHC plans resulting in better quality plans. Partners from

health, social care and education are now contributing meaningfully to the

production of plans.

Infection Prevention and Control

The Infection Prevention and Control team have remained busy with continued

oversight of the Covid-19 response as well as healthcare associated infections such as

Methicillin resistant Staphylococcus aureus bacteraemia (MRSAB) and Clostridioides

difficile infection (CDI) cases. The team continue to support all providers across the Mid

and South Essex locality

Patient Experience

The Quality Teams have continued to ensure the voice of the patient is heard for

example through the programme of patient stories which capture authentic lived

experiences. This, in turn, is shared with Commissioners and has directly influenced

commissioning decisions. Furthermore, co-production with patients and services users

was a key focus of stakeholder development of the MSE Quality Strategy.

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Care Sector

The Quality team continued to support the provision of Enhanced Care in Care Homes.

This has furthered the support provided to homes during the Covid-19 pandemic with

continued training and new technology to support remote and daily hub calls to enable

rapid responses to our homes.

Reducing Health Inequality

Duty to reduce inequality

Health inequalities are the preventable, unfair, and unjust differences in health status

between groups, populations or individuals that arise from the unequal distribution of

social, environmental, and economic conditions within societies. This in turn can

determine the risk of people getting ill, their ability to prevent sickness, or opportunities

to act and access treatment when ill health occurs.

Addressing health inequalities is a core strategic ambition of the MSE Health & Care

Partnership (HCP). The significant increase in collaborative working accelerated by the

Covid pandemic has enabled us to tackle these issues across the HCP. The MSE ICS

five-year HCP strategy outlines our commitment through working with our partners to

reduce inequalities. We aim to achieve this by:

(1) Creating opportunities through education, employment, housing, and growth

(2) Supporting health and wellbeing

(3) Bringing care closer to home and

(4) Transforming and improving health and care services.

The Health Inequalities Oversight Group (HIOG) was established to provide an

enhanced focus and ensure the delivery of requirements to reduce inequalities. The

HIOG group has cross organisational representation from NHS Providers, Local

Authority Community and Voluntary Services, Public Health, Primary Care, and other

NHS organisations. This group reports into the System Leadership Executive and MSE

Healthcare Partnership Board.

The work to reduce health inequalities is driven by a maturing network of equity

leadership. All system providers have a named Inequalities Senior Responsible Officer

(SRO), and each Alliance has named inequalities leads who will support the Primary

Care Networks (PCN’s).

Progress in health inequalities improvement is established through the use of the

System Outcomes Framework which are health inequalities indicative metrics aligned to

system ambitions. System and Place-based inequalities plans are focused on the

amalgamation of Prevention, Population Health Management, Personalised Care, Self-

Care and strengthening our community-based approach. A place-based approach to

addressing inequalities is being delivered with our four Alliances which sees NHS

organisations, Primary Care, Health and Wellbeing Boards, Local Authority Public

Health, Social Care and children’s services, voluntary sector organisations working

collaboratively through a single, shared “place plan” to address agreed key priorities.

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Addressing the wider determinants of inequalities, particularly in our most deprived

areas, is crucial in reducing inequality gaps. With an explicit focus on the social

determinants of health - at system and place level - partnership working is embedded in

our approach to inequalities improvement. This can be seen in areas such as Better

Start Southend, which delivers targeted provision to children aged 4 and under in the

most deprived wards in Southend, and the Mid and South Essex Foundation Trust

(MSEFT) Anchor Programme initiatives that are targeting employment opportunities to

young people and adults in the most deprived wards.

To realise our ambition to reduce inequalities, we have identified community asset

engagement as a core principle within our engagement strategy - which is driven by our

aim to ensure local voices are heard, improved local confidence and to be unified to

creating changes. Embedding co-production into the equalities workstream has been a

key part of the MSE equalities approach. Following a co-design initiative for people with

Learning Disabilities accessing hospital services in 2021-22, MSEFT began to

implement a detailed action plan to improve access for people with Learning Disabilities

across hospital sites. We are also working with providers in other parts of Essex to

jointly take actions for the benefit of our population.

The Core20PLUS5 approach to tackle health inequalities was also introduced in 2021.

This approach outlines a framework to accelerate health inequalities improvement

through focused approaches targeted at the Core20 (the most deprived 20% of the

population) PLUS (other inclusion groups) and 5 (clinical areas of focus which are

Cardiovascular disease, Maternity, Cancer, Respiratory and Mental Health). This

Core20PLUS5 framework has been adopted across the system and health inequalities

improvement plans at system and place have been refined to reflect the Core20PLUS 5

approach.

The work across the health partners within Mid and South Essex continues to be

focused on:

• Restoring NHS services inclusively which incorporated analysing the waiting lists

by ethnicity and deprivation to support local action plan to reduce the barriers to

accessing service for certain groups

• Mitigating against digital exclusion by maintaining access to face-to-face

consultations to ensure digital access does not disadvantage some patients

• Ensuring datasets are complete and timely by improving data collection on

ethnicity across all healthcare settings

• Accelerating preventive programmes that proactively engage those at greatest

risk of poor health outcomes which includes ensuring high level of vaccination

uptake across all areas of the population, health checks are undertaken for

people with Learning Disabilities or Serious Mental Illness, and a focus on the

five clinical areas within the Core20 plus 5 framework.

Within Primary Care, the Tackling Neighborhood Inequalities Directed Enhanced

Service (DES) has called for a coordinated approach to tackling inequalities within

Primary Care. All PCNs are required to nominate a health inequalities lead will be to act

as a focal point and champion for this work. PCNs will also work with commissioners

and PHM teams to design and deliver inequalities improvement intervention(s) for a

selected population group experiencing inequality.

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We have also begun the development of an overarching ICS Health Inequalities

Strategy.

Engaging People and Communities

We put patients and the public at the heart of our CCG. Working in partnership with

patients, carers, families, and local people within their own communities brings a

different perspective to our understanding and can challenge our view of how we think

services are received and should be delivered in the future. Service provision can be

improved if we can learn more about the views, experiences and concerns of patients,

service users, carers, and our wider communities. We believe that better decisions are

made when patients and professionals work together. We strive to make sure we get

the community involved at the very beginning of a project and build things around local

need rather than organisations.

Our legal duties and principles of engagement

The CCG has a duty, under Section 14Z2 of the NHS Act 2006, to involve the public in

commissioning. Here we provide an overview of the engagement activities that have

taken place in this reporting period (April – June 2022).

We know from experience that engagement with patients, carers and our local

communities can result in:

• Better outcomes and patient experience

• Improved services

• Reduced demand

• Deliver change

Engagement from Mid Essex CCG within the Mid and South Essex Health and

Care Partnership

Collectively the CCGs and partner organisations across mid and south Essex have

benefitted from sharing best practice. So, we have been expanding the ways we work

with local people and to join the conversation in a way that suits them:

• The Mid Essex Patient and Community Representatives Group held every two

months with invitees including delegates Healthwatch Essex, GP patient

participation groups, charities and local authorities.

• Attending CCG meetings and Governing Body meetings held in public.

• Seeking involvement with Primary Care Networks (PCNs) as they begin to

deliver on their obligation to engage with their residents.

• Joining ad hoc meetings to inform our work – for example, we hosted gatherings

of patient representatives who helped us to design recent communications

campaigns on GP pressures and other key topics.

• Being part of our Citizen Panel, called Virtual Views, that can be found here.

In 2022 we asked for their views on; GP access and shared decision making.

Following and interacting with the CCG on social media or visiting our website or

subscribing to one of our newsletters.

• Contacting the CCG with specific ideas, questions, or concerns.

Partnerships across the health and care system

We actively worked and collaborated with our local Healthwatch and voluntary,

community and faith sector colleagues.

Following the successful work undertaken by the Essex Vax Van which enabled a new

model of outreach and ensured a culturally sensitive approach for communities not

engaging in the national Covid-19 vaccination programme, was then used for

spirometry testing into the community.

We listened to feedback on a local weight management clinical pathway which has

informed a new model and covers the whole of mid and south Essex.

Improving accessibility to healthcare information

The CCGs have continued to improve accessibility to healthcare information working

closely with the Council for Voluntary Services (CVS). Work includes providing

information in a number of formats; easy read, information in different languages or

through for learning disabilities and videos produced by the CCG with subtitles and

where possible a British Sign Language interpreter on the screen.

Children’s Health Matters: we worked with parents and carers of children aged 0-5

living in mid and south Essex to co-design a useful guide to better manage childhood

Illnesses. It provided an opportunity for them to influence local communications and

behaviour interventions and support our campaign. This has led to the delivery of

regular electronic newsletters to the right audiences, with the right messages, that

parents and carers have supported.

Social media and digital marketing

The CCG has also presented appealing, insights-driven digital communications in line

with priorities, offer opportunities for engagement and are viewed as a trusted source of

information.

Our digital communications channels including social media, website and e-publications

have been used to:

 Explain and showcase CCG work to residents of mid and south Essex, health

and social care colleagues and beyond.

 To encourage residents to engage with the CCG via its digital channels,

motivate those individuals to take action that will help them stay well and use

health and care resources appropriately, and support them to lead their best

lives.

 To build the CCGs online presence.

 To analyse digital engagement data to build insight-driven campaigns that are

supported, shaped, and shared by organisations across the Partnership, and to

measure and evaluate the effectiveness of those campaigns.

Our ambition

Our ambition is to place engagement at the forefront of all we do in mid and south

Essex, creating healthier communities that people recognise and feel a part of.

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Together we will aim to co-design and deliver new models of care and different ways of

working that make a real difference to people and their local communities. We will work

collaboratively across local authority, health, and voluntary sector to understand and

build our communities, maximising the collective impact we can have on the health of

our population.

Health and Wellbeing Strategy

The MSE Health & Care Partnership’s 5-year strategy is built upon the priorities agreed

through the three upper tier Health and Wellbeing Boards which continues to underpin

the work we do together.

Through the ICS and our four Alliances we have been involved with and contributed to

the development of refreshed joint Health and Well Being strategies and will continue to

ensure our plans are supportive of delivering the aims of these strategies at system,

Alliance and PCN level.

Senior leaders from the CCGs have engaged with all three upper tier local authority

Health and Wellbeing (HWB) Boards, as well as district, borough, and city fora. CCG

leaders are core members of the HWB Boards and have proactively participated in

attending meetings, workshops, and events, contributing to the refresh of joint health

and wellbeing strategies and co-producing Alliance plans. Across the three Upper Tier

Local Authorities (UTLAs) we have continued work on a joint mental health strategy, as

well as a children’s partnership plan.

The chairs of the three UTLA HWB Boards sit on the MSE Health & Care Partnership

Board, as do senior officers, including Directors of Adult Social Care and Directors of

Public Health.

Financial Review

Financial overview

Our full statutory financial accounts are included from page 72 onwards. This section

provides a summary of our 2022/23 financial position from 1 April 2022 to the cessation

of the CCG on 30 June 2022. Our Head of Internal Audit offers an opinion on Financial

Systems Key Controls and other matters which can be found on page 52. whilst our

overall financial management arrangements and financial statements were subject to

audit review and opinion by our external auditors, KPMG, as part of their annual review

of our accounts (see page 100 for their full audit opinion).

CCG funding

During the period 1 April 2022 to 30 June 2022 (Q1) the CCG has continued to operate

under the financial regime and allocation methodology that was put in place at the

beginning of 2020/21 to support the ongoing response to the Covid pandemic this has

been subject to a few modifications.

Firstly, arrangements for healthcare have been considered to be in a period of post

pandemic recovery resulting in a cessation of funding for the Hospital Discharge

Programme (HDP) to support discharges from Hospital once patients have been

medically optimised to allow for recovery of the Elective backlog and secondly the

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transition from CCGs to Integrated Care Boards that has been agreed nationally and

became effective from 1 July 2022.

This has led to funding changes for the final CCG reporting period where the final CCG

allocation has been matched to equal CCG costs incurred with any under or over

expenditure compared to the anticipated allocation being adjusted in the remaining

allocation for the successor body the Integrated Care Board.

Mid Essex CCG has continued as the nominated lead CCG for receiving and managing

the distribution of most non-organisational specific system allocations. As a CCG we

received and managed funds across and on behalf of our CCG partners in Thurrock,

Southend, Castle Point and Rochford and Basildon and Brentwood.

In Q1 2022/23, our in year total healthcare funding including system funding was

£192.02m. CCG expenditure for Q1 was £192.02m, resulting in a net breakeven

position.

NHS planning guidance requires CCGs to meet the ‘Mental Health Investment

Standard’ (MHIS). This requires CCGs to demonstrate that expenditure on mental

health services has grown year on year. In 2022/23 the MHIS was set for the whole

financial year and was achieved.

How your money was spent

The following chart shows the areas of expenditure we have made for healthcare

(including CCG running costs). (Core GP-led services (primary care) are commissioned

by NHS England and are not accounted for in the CCGs accounts).

Expenditure April to June 2022

Acute Services £127.4m

Mental Health Services £12m

Community Health Services

£14.1m

Continuing Care Services

£7m

Primary Care Services

£13.6m

Primary Care Co-

Commissioning £14.6m

Other Programme Services

£1.6m

Running Costs £1.7m

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Capital spending

We did not require a CCG capital allocation for Q1 2022/23, but the Mid and South

Essex Health and Care Partnership footprint was awarded Estates and Technology

Transformation Funding (ETTF) towards primary care estates projects and GP IT. ETTF

expenditure is accounted for by NHSEI.

Paying our suppliers and providers

National rules mean we must aim to pay all valid invoices by the due date or within 30

days of receiving them, whichever is the latter. The NHS aims to pay at least 95% of

invoices within 30 days of receipt, or within agreed contract terms. In Q1 2022/23 we

met all four targets (based on invoice numbers and value of expenditure) for NHS and

non-NHS invoices – see Note 6 of the Financial Statements for details.

We are also an approved signatory of the Prompt Payment Code. The government

designed this initiative with the Chartered Institute of Credit Management to tackle the

crucial issue of late payment and to help small businesses. Suppliers can have

confidence that any organisation signed up to the code will pay them within clearly

defined terms and that proper processes are in place to deal with any disputed

payments. Approved signatories have committed to:

• Paying suppliers on time

• Giving clear guidance to suppliers and resolving disputes as quickly as possible

• Encouraging suppliers and customers to sign up to the code.

The national measures for payment performance do not include any delays in payment

during the time that an invoice is on hold.

2022/23 financial plans and looking to the future

The unprecedented impact of the Covid pandemic has inevitably delayed the return to

normal financial arrangements. CCGs ceased to exist on 30 June 2022 and on 1 July

2022 the 5 CCGs became Mid and South Essex Integrated Care Board.

Published allocations for 2022/23 have been split between CCGs and the Mid and

South Essex Integrated Care Board although performance will be monitored on a full

year basis. Following the demise of the CCGs on 30 June 2022 the Mid and South

Essex Integrated Care Board manage and oversee the balance of £1.891bn healthcare

funding and investment on behalf of the healthcare system and will report following

closure of its first period of accounts running from 1 July 2022 to 31 March 2023.

Risks

The CCG’s risk profile as of 30 June 2022 is detailed in the table below:

Workstream

RAG Rating

Total No of

Risks

Green

Amber

Red

Cancer and End of Life

Children and Young People

Community

Workstream

RAG Rating

Total No of

Risks

Green

Amber

Red

Digital and Business

Intelligence

Estates

Finance

Health Inequalities

Integrated Care System

Maternity

Medicines Optimisation

Mental Health and Learning

Disability

People

Planned Care

Population Health

Management

Primary Care

Stewardship

Urgent Emergency Care

Vaccination

Total as of 30 June 2022

Total as of 31 March 2022

During Q1 of 2022/23 the MSE CCGs’ risk profile has seen the total number of risks

reduce by 1 (from 68 as of 31 March 2022 to 67), although the number of red rated

risks remains static.

As of 30 June 2022, there were 8 red-rated risks, which related to the following 4 areas

of the CCG’s business:

Referral to Treatment (RTT) standard, cancer, access to service and capacity

The MSE CCGs continue to work with the Mid and South Essex NHS Foundation Trust

(MSEFT) to address Licence Undertakings. Arrangements are in place to ensure

oversight of the required actions to address RTT poor performance. There has been a

significant impact on performance as a direct result of the Covid-19 pandemic. Delayed

discharges and capacity out of hospital, both within health and social care, have also

impacted upon performance. In partnership with NHS England, plans, oversight groups

and reporting processes have been established to oversee restoration.

The System Quality section of this report provides an overview of action taken by the

MSE Quality teams to support MSEFT to undertake deep dive harm reviews on all

patients whose care pathways breached cancer and RTT standards.

Maternity services

Arrangements are in place (as part of the MSEFT Licence Undertakings) to address

significant concerns relating to maternity services, particularly those identified in the

Care Quality Commission report for Basildon Hospital. The Mid and South Essex

Local Maternity and Neonatal System (LMNS) are working with MSEFT to support

workforce recruitment and retention measures and the Maternity Improvement Plan,

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including a review of the findings set out in Donna Ockenden’s reports following an

independent review of maternity services to assur

e the system and identify any further

action required. Further information on maternity services is provided under the Care

Quality Commission section of this report.

Mental Health and Learning Disability Services

The Essex Mental Health Independent Inquiry is investigating matters surrounding the

deaths of mental health inpatients across NHS Trusts in Essex between 2000 and

2020. The Inquiry is in Phase 2 and will hear evidence from families, carers, and

friends of those who died; others with experience of mental health inpatient care in

Essex during the 21-year period; as well as staff, former-staff, relevant professionals,

and organisations. The Inquiry is independent of government and the health care

system. The Inquiry is planned to be concluded and to publish its report in Spring

2023.

The quality assurance of Autism Spectrum Disorder (ASD) services was added to the

risk register in May 2022 due to a significant number of individuals waiting over 12

months for assessment and diagnosis.

An impact of this is primarily due to an overall increase of referrals which has meant

patients dealing with longer waiting times, and large referral backlogs across the ICB.

Having to wait a long time for an ASD diagnosis can have a negative impact on the

person’s daily life, their physical and mental health, social functioning, and

employment.

Workforce

Workforce vacancy levels persist across MSE particularly in nursing and midwifery

areas. Ongoing international and domestic recruitment initiatives are in place with a

targeted retention strategy running in parallel. The MSE system has recently trialled a

large in-person recruitment event for entry level roles, which resulted in 170 plus offers

being made in one day. Similar initiatives will be rolled out across the system during

2022/2023. The system will begin a one workforce approach through a Health

Education England funded academy for Health Care Support Workers. The aim is to

develop a sustainable pipeline by onboarding and developing our unqualified workforce

through associate and apprenticeship roles.

Sustainable Development

As an NHS organisation, and as a spender of public funds, we have an obligation to

work in a way that has a positive effect on the communities for which we commission

and procure healthcare services. Sustainability means spending public money well,

the smart and efficient use of natural resources and building healthy, resilient

communities. By making the most of social, environmental, and economic assets we

can improve health both in the immediate and long term even in the context of rising

cost of natural resources. Spending money well and considering the social and

environmental impacts is enshrined in the Public Services (Social Value) Act (2012).

We acknowledge this responsibility to our patients, local communities, and the

environment by working hard to minimise our carbon footprint.

In October 2020, the Greener NHS National Programme published its new strategy,

Delivering a Net Zero National Health Service. This report highlighted that left unabated

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climate change will disrupt care, with poor environmental health contributing to major

diseases, including cardiac problems, asthma, and cancer. The report set out

trajectories and actions for the entire NHS to reach net zero carbon emissions by 2040

for the emissions it controls directly, and 2045 for those it can influence (such as the

supply chain). As part of the NHS, public health, and social care system, it is our duty to

contribute towards the targets set out in this document.

As a commissioner of services, the CCG sets out a commitment to sustainable

procurement in its Procurement Policy. The CCG has taken measures to encourage

greater awareness among staff. In November 2019, the Governance Committee

recommended adoption of the NHS England pledge to eliminate single use plastics. In

December 2019, the Staff Engagement Group supported an initiative for staff to make a

“Green Pledge”.

An ICS Green Plan has been in development and sets out actions to achieve Net Zero

Carbon across the ICS. The CCG is fundamental to the delivery of this plan.

Sustainability will become business as usual across all service areas.

Modelled Carbon Footprint

In England, the NHS is estimated to account for 5.4% of the country’s greenhouse gas

emissions. The health and social care system reduced its carbon footprint by an

estimated 62% between 1990-2020, however, drastic action is now required.

Figures 1 and 2 below illustrate the key areas of focus that the NHS must deliver on to

reduce its carbon footprint and meet the Greener NHS targets of being a net carbon

zero health care service by 2045.

igure 1: Greenhouse Gas Protocol (GHGP) scopes in the context of the NHS

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Figure 2: Sources of carbon emissions by proportion of NHS Carbon Footprint Plus

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ACCOUNTABILITY REPORT

Corporate Governance Report

Members Report

Member Profiles

CCGs are clinically led membership organisations made up of general practices. As of

30 June 2022, the following 39 NHS practices are members of Mid Essex CCG:

Practice

Area served

Primary Care

Network

Baddow Village Surgery

Great Baddow

Chelmsford City

Health

Beacon Health Group

Chelmsford and

Danbury

Aegros

Beauchamp House Surgery

Chelmsford

Chelmsford City

Health

Blackwater Medical Centre

Maldon

Witham and Maldon

Blandford Medical Centre

Braintree

Blyth’s Meadow Surgery

Braintree

Burnham Surgery

Burnham-on-Crouch

Dengie and SWF

Chelmer Medical Partnership

Western Chelmsford

Chelmsford West

Chelmer Village Surgery

Chelmsford

Chelmer

Church Lane Surgery

Braintree

Coggeshall Surgery

Coggeshall

Colne Valley

Collingwood Road Surgery

Witham

Witham and Maldon

Dengie Medical Partnership

Tillingham, the

Maylands

Dengie and SWF

Dickens Place Surgery

Chelmsford

Chelmsford West

Douglas Grove Surgery

Witham

Aegros

Elizabeth Courtauld Surgery

Halstead

Colne Valley

Fern House Surgery

Witham

Witham and Maldon

Freshford Practice

Finchingfield

Colne Valley

Greenwood Surgery

South Woodham

Ferrers

Dengie and SWF

Hedingham Medical Centre

Castle Hedingham,

Sible Hedingham,

Yeldham

Colne Valley

Kelvedon and Feering Health

Centre

Kelvedon

Colne Valley

Kingsway Surgery

South Woodham

Ferrers

Dengie and SWF

Little Waltham and Great Notley

Surgeries

Little Waltham and

Great Notley

Aegros

Longfield Medical Centre

Maldon

Phoenix (Mid Essex)

Mount Chambers Surgery

Braintree

Practice

Area served

Primary Care

Network

North Chelmsford Healthcare

Centre

Chelmsford

Chelmer

Pump House Surgery

Earls Colne

Colne Valley

Rivermead Gate Medical Centre

Chelmsford

Chelmer

Sidney House & The Laurels

Surgeries

Hatfield Peverel,

Boreham

Aegros

Silver End Surgery

Witham

Braintree

Stock Surgery

Stock

Chelmsford City

Health

Sutherland Lodge Surgery

Chelmsford

Chelmer

Tollesbury Surgery

Tollesbury

Phoenix (Mid Essex)

Trinity Medical Practice

The Maylands

Dengie and SWF

Whitley House Surgery

Chelmsford

Chelmsford City

Health

William Fisher Medical Centre

Southminster

Dengie and SWF

Witham Health Centre

Witham

Witham and Maldon

Writtle Surgery

Writtle

Chelmsford West

Wyncroft Surgery

Bicknacre, East

Hanningfield

Dengie and SWF

Composition of Governing Body

The CCGs Governing Body is the accountable body for the performance of the CCG. It

has four GP members elected by their fellow GPs to lead the organisation alongside the

Executive membership. One of these elected GPs, Dr Anna Davey, chairs the

Governing Body meeting.

The Governing Body also has three lay members. Their roles include ensuring views

and suggestions from patients and the public are properly considered by the CCG,

providing independent judgement and sound commercial knowledge, and helping to

ensure the CCG is well run and uses public funds properly. In addition, the role of the

secondary care member ensures that the views of secondary care providers, which

includes acute and mental health services, are considered by the Governing Body.

The Governing Body also comprises of the Accountable Officer, Chief Finance Officer,

Executive Director of Nursing, NHS Alliance Director. Representatives from the Local

Authority and other CCG Executive Directors are regular attendees.

As of 30 June 2022, the board consisted of 12 members. Of these, 7 are female and 5

are male.

The main function of the Governing Body is to ensure that the group has appropriate

arrangements in place to exercise its functions effectively, efficiently, and economically

and in accordance with the group’s principles of good governance. The other key

functions are outlined in the CCGs constitution.

In February 2022, the Governing Bodies of Basildon and Brentwood, Castle Point and

Rochford, Mid Essex, Southend, and Thurrock CCG, collectively referred to as Mid and

South Essex (MSE) CCGs, agreed to ‘meet in common’ until establishment of the MSE

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Integrated Care Board on 1 July 2022. This meant that each Board met in the same

place (virtually via MS Teams), at the same time, although they still made decisions as

separate bodies. These arrangements enabled decisions affecting the whole MSE

population to be made collectively.

The following people have been CCG Board Members during 2022/23:

• Dr Anna Davey, Elected GP, and Chair

Dr Anna Davey qualified from the Guy’s and St. Thomas’ Medical School in

1999, going on to train at The Ipswich Hospital NHS Trust and Colchester

Hospital University NHS Trust in junior doctor posts.

Anna worked as a GP in Halstead for 12 years before moving to Coggeshall

Surgery in 2017. She became a clinical lead for out-of-hospital care at Mid Essex

CCG in 2016 and became Chair in October 2018. Her clinical interests are

women’s health, dermatology, and the complex care of frail elderly patients.

• An

thony (Mac) McKeever,

Accountable Officer, Mid and South Essex

CCGs and Executive Lead, Mid and South Essex Health and Care

Partnership

Anthony, known to all as Mac, has more than 40 years’ experience in the NHS

and other healthcare organisations. Before joining the mid and south Essex

CCGs he served as Director General for Health and Community Services for the

States of Jersey.

Originally a “fast stream” civil servant, Mac joined the NHS in 1987, operating for

25 years as a CEO, helping to turn around performance at several hospitals and

commissioning organisations. Having established his own business, he served

on the Future Forum in 2010, and returned to work in the NHS in 2015.

Mac was appointed Interim Joint Accountable Officer for the Mid and South

Essex CCGs from 1 March 2020.

Mac has since been appointed Chief Executive Officer Designate for the Mid and

South Essex Integrated Care Board and System.

• Mark Barker, Chief Finance Officer

Prior to joining the NHS over 20 years ago, Mark was a Senior Manager at

KPMG, Director of Finance in various housing associations and business

controller at Transport for London. Mark has worked in a number of NHS

organisations, most recently as the Chief Finance Officer for Castle Point and

Rochford and Southend CCGs and, from 1 January 2021, he was appointed as

Joint Chief Finance Officer for the five mid and south Essex CCGs.

• Rachel Hearn, Executive Director of Nursing and Quality

Rachel is a Registered Nurse and Executive Director of Nursing and Quality

across the five Mid and South Essex CCGs. Rachel has over 20 years’ clinical

experience as a nurse within the NHS. Having worked predominantly in

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emergency and general medicine, Rachel has clinically led work on the changing

face of emergency care. Rachel’s role in commissioning focuses on quality

improvement, safeguarding adults and children and continuing health care

provision.

• Dan Doherty, Alliance Director for Mid Essex and Deputy Accountable

Officer for Mid and South Essex CCGs

Dan was previously Director of Clinical Commissioning and from 15 January

2018 was appointed Director of Clinical Transformation and Deputy Accountable

Officer. In March 2016 Dan was seconded to the Mid and South Essex Success

Regime (Locality Health and Care) for 18 months, working on system

transformation with a particular focus on innovation in health and care. Dan was

appointed as the Alliance Director for Mid Essex on 2 November 2020 and also

acts as Deputy Accountable Officer for the mid and south Essex CCGs.

Dan is a practising physiotherapist who previously worked at St Peter's Hospital

in Maldon.

• John Gilham, Lay Board Member (Governance) and Deputy Chair

John Gilham was appointed as Lay Member for Governance in July 2018. He

was formerly chief executive of two NHS hospital trusts in Essex covering a

period of almost nine years.

John has over 35 years’ management experience across a range of functions in

the NHS. Prior to joining Mid Essex CCG, he served as a public sector non-

executive director with the NHS, including undertaking the role as Chair of the

Risk and Quality Committee at East and North Hertfordshire NHS Trust.

John also has experience of working with the private sector over the last nine

years as a management consultant, focusing on how their services can best be

matched to the needs of the NHS and to give patients an improved service

experience.

• Nathalie Wright, Lay Member (Patient and Public Engagement)

Nathalie joined the CCG in 2018 as Lay Member for Patient and Public

Engagement.

Following a career in Senior Management within Financial Services Nathalie

joined the NHS within the Oncology Services team for Mid Anglia Cancer

Network.

Nathalie has experience in both the private and public sector and is a qualified

counsellor. Since 2016 Nathalie has undertaken voluntary roles working as a

mental health therapist in local education settings and is a Young Minds

ambassador.

• Pauline Stratford, Third Lay Member

Before joining the NHS, Pauline was a senior commissioner for social care

mental health services. Prior to that Pauline was a human resources and

change manager with a lead in equalities in central government. Pauline also

serves as the Lay Member for Primary Care of the Castle Point and Rochford

and Southend CCGs.

• Dr Julia Hale, Secondary Care Specialist from 1 August 2021

Dr Hale has been a consultant paediatrician for 21 years, specialising in neuro-

disability, safeguarding and adoption. She has an MSc in Community Child

Health and was a member of the CoramBAAF Health Advisory Committee for 7

years. She has experience in clinical governance, patient experience and

service reconfiguration in community services. Dr Hale also serves as the

Secondary Care Specialist member of Basildon and Brentwood CCG.

•

Dr Julie McGeachy, Elected GP and Clinical Vice Chair

Dr Julie McGeachy qualified from Nottingham University medical school in 1987

and trained as a GP in Derby. She has been a GP at the Tillingham Medical

Centre for more than 20 years.

Julie also spent five years experiencing primary care in different settlings – New

Zealand and the South Pacific – and has an interest in change and innovation in

a challenging NHS environment.

Julie completed the Future Clinical Commissioning Leadership course run by the

NHS Leadership Academy in 2018. Her clinical interests are dermatology, care

of the elderly and mental health.

•

Dr Fatai Salau, Elected GP

Dr Fatai Salau qualified from the College of Medicine, University of Lagos,

Nigeria in 1992 and has been a GP at the Douglas Grove Surgery in Witham

since 2006.

Fatai is a member of the Royal College of Physicians and has been involved with

developing changes to primary care in the Witham area. His clinical interests are

acute medicine and gastroenterology.

• Dr Elizabeth Towers, Elected GP

Dr Liz Towers was a GP at Whitley House Surgery for more than 30 years,

having spent three years as a junior doctor in the Chelmsford area. Her interests

were particularly cancer and end of life care. Liz became a Macmillan GP in

Committees, including Audit Committee

A full list of the committees supporting the Board, including the Audit Committee, and

membership of those committees is provided within the Governance Statement from

page 38 onwards.

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At all formal meetings of the board and its committees, members must declare if they

have an interest in any agenda items under discussion.

The CCG maintains a register of interests declared by board members. The register of

board members’ interests is regularly updated and included within the papers for

publicly held board meetings. This is available upon request by contacting

mseicb.enquiries@nhs.net.

Modern Slavery Act

The CCG fully supports the Government’s objectives to eradicate modern slavery and

human trafficking. The Modern Slavery Act statement of the MSE CCGs has been

adopted by the MSE ICB and is published on the website at Modern Slavery Act

Statement (hyperlinks)

Complaints to Parliamentary and Health Service Ombudsman

The CCG receives complaints from patients, carers, family members and Members of

Parliament. Where the complaint relates directly to a provider the permission of the

individual is sought to refer to the relevant provider. The CCG will analyse any trends and

themes arising from complaints and works with providers to address these. Complaints

relating to primary care services are managed by NHS England.

During Q1 2022/23, there were 74 complaints opened and 55 complaints closed, with 19

complaints still under investigation at the year end. Themes and trends included difficulty

accessing face to face GP appointments, Covid vaccination queries and funding

requests, including funding for ADHD referrals and IVF.

No complaints were referred to the Parliamentary and Health Service Ombudsman

(PHSO) in 2022/23.

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 Anthony McKeever to be the Accountable Officer of Mid Essex CCG.

The responsibilities of an Accountable Officer are set out under the National Health

Service Act 2006 (as amended), Managing Public Money and in the Clinical

Commissioning Group Accountable Officer Appointment Letter. They include

responsibilities for:

• The propriety and regularity of the public finances for which the Accountable

Officer is answerable,

• For keeping proper accounting records (which disclose with reasonable accuracy

at any time the financial position of the Clinical Commissioning Group and

enable them to ensure that the accounts comply with the requirements of the

Accounts Direction),

• For safeguarding the Clinical Commissioning Group’s assets (and hence for

taking reasonable steps for the prevention and detection of fraud and other

irregularities),

• The relevant responsibilities of accounting officers under Managing Public

Money,

• Ensuring the CCG exercises its functions effectively, efficiently, and economically

(in accordance with Section 14Q of the National Health Service Act 2006 (as

amended)) and with a view to securing continuous improvement in the quality of

services (in accordance with Section14R of the National Health Service Act 2006

(as amended)),

• Ensuring that the CCG complies with its financial duties under Sections 223H to

223J of the National Health Service Act 2006 (as amended).

Under the National Health Service Act 2006 (as amended), NHS England has directed

each Clinical Commissioning Group to prepare for each financial year a statement of

accounts in the form and on the basis set out in the Accounts Direction. The accounts

are prepared on an accruals basis and must give a true and fair view of the state of

affairs of the Clinical Commissioning Group and of its income and expenditure,

Statement of Financial Position, and cash flows for the financial year.

In preparing the accounts, the Accountable Officer is required to comply with the

requirements of the Government Financial Reporting Manual 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 Government

Financial Reporting Manual have been followed, and disclose and explain any

material departures in the accounts; and

• Prepare the accounts on a going concern basis; and

• Confirm that the Annual Report and Accounts as a whole is fair, balanced, and

understandable and take personal responsibility for the Annual Report and

Accounts and the judgements required for determining that it is fair, balanced,

and understandable.

As the Accountable Officer, I have taken all the steps that I ought to have taken to make

myself aware of any relevant audit information and to establish that Mid Essex CCG’s

auditors are aware of that information. So far as I am aware, there is no relevant audit

information of which the auditors are unaware.

Anthony McKeever

Accountable Officer

26 June 2023

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Governance Statement

Introduction and Context

Mid Essex CCG (the CCG) is a body corporate established by NHS England on 1 April

2013 under the National Health Service Act 2006 (as amended).

The CCG’s statutory functions are set out under the National Health Service Act 2006

(as amended). The CCG’s general function is arranging the provision of services for

persons for the purposes of the health service in England. In particular, the CCG is

required to arrange for the provision of certain health services to such extent as it

considers necessary to meet the reasonable requirements of its local population.

As at 1 April 2022, the CCG is not subject to any directions from NHS England issued

under Section 14Z21 of the National Health Service Act 2006.

The CCG is part of the Mid and South Essex Health and Care Partnership (the HCP)

covering the geographic areas of Mid Essex, Basildon and Brentwood, Castle Point and

Rochford, Southend, and Thurrock CCGs (the MSE CCGs). The HCP has been

created to bring local health and care leaders together to plan for the long-term needs

of local communities.

In July 2017, the five MSE CCGs formally established a CCG Joint Committee (JC) to

act collectively in the planning, securing, and monitoring of services to meet the needs

of their 1.2 million population, as well as representing the HCP footprint for services

commissioned over a larger area. As outlined within the CCG’s 2021/22 Annual

Report, due to business continuity arrangements implemented by the CCGs from mid-

December 2021 to the end of February 2022, all business delegated to the JC was

conducted by the CCG Boards meeting in common and consequently the JC did not

meet again.

All other decisions about healthcare continued to be taken locally by the relevant CCG.

Scope of responsibility

As Accountable Officer, I have responsibility for maintaining a sound system of internal

control that supports the achievement of the CCG’s policies, aims and objectives, whilst

safeguarding the public funds and assets for which I am personally responsible, in

accordance with the responsibilities assigned to me in Managing Public Money. I also

acknowledge my responsibilities as set out under the National Health Service Act 2006

(as amended) and in my Clinical Commissioning Group Accountable Officer

Appointment Letter.

I am responsible for ensuring that the CCG is administered prudently and economically

and that resources are applied efficiently and effectively, safeguarding financial

propriety and regularity. I also have responsibility for reviewing the effectiveness of the

system of internal control within the CCG as set out in this governance statement.

Governance arrangements and effectiveness

The main function of the governing body (the Board) is to ensure that the group has

made appropriate arrangements for ensuring that it exercises its functions effectively,

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efficiently, and economically and complies with such generally accepted principles of

good governance as are relevant to it.

CCGs are clinically led membership organisations made up of general practices. The

members of the CCG have determined the governing arrangements for the CCG as

set out in its constitution, which was based on the Model Constitution Framework for

CCGs. The CCG undertook a thorough review of its constitution, in line with the NHS

CCG New Model Constitution, to enable the CCG to take on fully delegated primary

care commissioning with effect from 1 April 2021 and to align its constitution with the

other mid and south Essex CCGs in preparation for the development of an Integrated

Care System.

The revised constitution was approved by the Board at its meeting on 25 March 2021.

There are 39 member practices within Mid Essex CCG, serving a registered population

of 405,344 patients as of 1 April 2022. The practices were formed into nine Primary

Care Networks (PCNs) across mid Essex from 1 July 2019. Details of the PCNs are

shown in the table below:

Primary Care Network Number of

Practices

Registered Patient

Population as at

1 April 2022

Braintree

56,436

Colne Valley

55,015

Aegros

37,514

Witham and Maldon

37,496

Phoenix

45,895

Dengie and South Woodham Ferrers

48,951

Chelmer

40,504

Chelmsford West

41,082

Chelmsford City

42,451

Practices work together within their PCNs to collaborate on the effective provision of

primary care in their local areas and to engage in the commissioning of services on

behalf of their populations.

In some PCNs these working together arrangements are facilitated through the sharing

of workforce, sharing back-office functions, and collaborative working in certain

chosen clinical areas. Practices are gradually working towards developing

standardised policies, processes and agreed governance structures.

Governing Body (the Board)

The CCG’s constitution sets out the governance arrangements, roles and

responsibilities of the Board and its membership.

In February 2022 the CCG Board met in common with the other MSE CCG Boards and

agreed that they would continue to meet in common until the MSE Integrated Care

Board (ICB) was established. The Boards met in common on one occasion during

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Quarter 1 (Q1) of 2022/23 on 26 May 2022. The Boards also approved the MSE

System Financial Plan for submission to NHS England in June 2022 via an Emergency

Powers decision.

The Board meeting was broadcast via ‘MS Teams’ which enabled members of the

public to listen to discussions held and submit questions.

The decisions of the CCG Board were quorate whereby any member who was not

present at the meeting confirmed their support for the recommendations made.

Membership of the Board is set out on page 32 of the Members Report.

The Board undertakes an annual review of its effectiveness. The 2021/22 review

determined that it fulfilled its role effectively either all or most of the time and that there

is good engagement of members.

To support the Board in carrying out its duties effectively, committees reporting to the

Board are formally established. The current committee structure is set out below.

During Q1 of 2022/23 the five MSE CCGs held their main committee meetings in

common, these being Audit; Finance & Performance; Patient Safety & Quality (or

equivalent); Primary Care Commissioning; and Remuneration.

The Mid and South Essex Health and Care Partnership Board, which includes

representation from the CCG, local authorities, Healthwatch Essex, the voluntary

sector, Anglian Ruskin University and the MSE CCGs’ main providers, met in private

during Q1 of 2022/23.

In principle, each main committee submits its approved minutes to the Board

. The

main committees providing assurance to the Board are set out below.

Audit Committee

This Committee provides the CCG Board with an independent and objective view of the

CCG’s financial systems, financial information and compliance with laws, regulations

and directions governing the CCG insofar as they relate to finance, good corporate

governance, information governance, cyber-security, emergency planning, resilience

and response (EPRR), business continuity management (BCM) and the CCG’s

responsibility to act effectively, efficiently and economically.

The Audit Committee is chaired by the Lay Member (Governance) and Deputy Chair of

the CCG, John Gilham. As of 30 June 2022, the Committee’s other members were

Dr Elizabeth Towers, elected GP Board member, and Nathalie Wright, Lay Member

(Patient and Public Engagement).

During Quarter 1 of 2022/23, the Committee met in common with the other MSE CCG

Audit Committees on 2 occasions, plus 1 extraordinary meeting to review draft policies

where minutes had not been approved in time to submit to the final meeting of the CCG Boards, they

were submitted to the relevant committee of the Integrated Care Board.

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developed for the MSE ICB. Decisions were quorate in line with its Terms of Reference

(minimum of two core members) on all occasions. Where any member was not present

at the meeting their support for the recommendations made were submitted virtually.

During Q1 of 2022/23 the Audit Committee continued to focus upon ensuring the review

of the systems, policies, procedures, and processes fundamental to the governance of

the organisation. The committee also undertook a review of policies being developed

for the MSE ICB relating to areas within the committee’s remit and had oversight of the

governance of transition to the ICB.

The Committee has received assurance from internal audit of key systems and

processes and, in addition to routine reporting, has received updates on counter-fraud

initiatives and investigations and implementation of audit recommendations. The

Committee reviewed the CCG’s draft accounts and approved the final accounts and

management response to the auditor for 2021/22 on behalf of the Board.

The Committee also reviews the CCG’s risk register/Board Assurance Framework

(BAF) and associated risk management processes and procedures.

The Committee also received the minutes of the Primary Care Commissioning

Committee, the Patient Safety and Quality and the Finance & Performance Committee

meetings held in common with the other M&SE CCG committees.

In line with NHS England guidance on the management of Conflicts of Interest, the

Chair of the Audit Committee acts as the CCG’s Conflicts of Interest Guardian.

The Audit Committee Chair received assurance that the CCG was adhering to NHS

England mandatory guidance on the management of conflicts of interest via the annual

internal audit of conflicts of interest for 2021/22 which identified ‘reasonable’ assurance.

The requirement to submit quarterly returns to NHS England regarding the CCG’s

adherence to the mandatory guidance continued to be suspended during Q1 of

2022/23.

Remuneration Committee

The Remuneration and Terms of Service Committee is a committee of the CCG Board

with delegated responsibility for making recommendations to the Board on all aspects

of remuneration and terms of service of employees, including the Accountable Officer,

Directors, and Lay Members.

In addition, the Committee is responsible for making recommendations to the Board

concerning the remuneration and terms of service for Elected GP members and other

people who provide services to the CCG (all of whom are not employees of the CCG),

taking in to account any national or local guidance as appropriate, to ensure that

individuals are fairly rewarded for their contribution to the CCG.

As of 30 June 2022, the membership of the Remuneration Committee comprised of

three lay members. The committee is chaired by the Lay Member (Patient and Public

Engagement).

The Remuneration Committee met in common with the other MSE CCG Remuneration

Committees on 2 occasions. Decisions were quorate in line with its Terms of

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Reference (minimum of two core members) on all occasions. Where any member was

not present at the meeting their support for the recommendations made were submitted

virtually.

Patient Safety and Quality Committee

The Committee provides assurance regarding the safety and quality of services directly

commissioned by the CCG, i.e., acute, community, learning disability and mental health

services, as well as the quality of services within primary care and the care home

sector.

The committee also maintains oversight of safeguarding (adults and children) and

medicines optimisation.

The Committee was chaired by the Lay Member for Patient and Public Engagement

and its core decision making membership comprised a GP Representative (Vice Chair),

Director of Nursing and Quality and the NHS Alliance Director for Mid Essex.

Committee meetings were also attended by other senior managers with specific

responsibility for areas within the remit of the committee.

The committee met in common with the other MSE CCG Patient Safety and Quality

Committee’s on one occasion during Q1 of 2022/23 in May 2022, with a further ‘virtual’

meeting held in June 2022 to approve the CCG’s responses to the Quality Accounts of

its main providers.

The Committees meeting in common focused on arrangements to provide care for

patients diagnosed with COVID-19 within acute, community and care home settings,

the safety of staff and workforce capacity issues, and the effect that the pandemic was

having on patients requiring routine and elective care.

Other key areas discussed included arrangements for monitoring the quality of provider

contracts; review of NHS Patient Safety Updates; review of the Quality Accounts

2021/22 from the main Providers of services commissioned by the CCG; and agreeing

the CCGs’ responses to the Quality Accounts; serious incidents and never events;

review of arrangements for the implementation of the Patient Safety Incident Response

Framework; update on Special Educational Needs and Disabilities services; updates on

Learning Disabilities Mortality Review (LeDeR) Programme; System Quality Strategy;

Infection Prevention and Control Strategy; approval of policies; all age continuing care;

personal health budgets; review of patient safety and quality risks; quality and equality

impact assessments; complaints and a review of any virtual decisions taken since the

last committee meeting.

Decisions were quorate in line with its Terms of Reference on all occasions. Where any

member was not present at the meeting their support for the recommendations made

were submitted virtually.

Finance and Performance Committee

This Committee scrutinises and provides the CCG Board with assurance on the delivery

of the CCG’s remit in respect of the CCG’s overall financial position (including running

costs) and for service performance for commissioned services not delegated to the JC.

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The Committee also maintains local oversight of information management and

technology, estates developments and the Savings Programme Board’s scrutiny and

challenge role to ensure the delivery of the CCG’s programme of financial savings. The

Committee acts as a point of approval for major changes to existing projects and plans,

where these are based on considerations related to the achievement of financial or

other benefits. The Committee also assesses whether there is continued business

justification for existing projects and programmes where the financial or other benefits

have changed.

At the start of the year the Committee was chaired by the Lay Member (Governance)

and its core membership comprised a GP Representative (Vice Chair), Executive Chief

Finance Officer, NHS Alliance Director for Mid Essex (or nominated deputy), and

Executive Director of Nursing and Quality (or nominated deputy nurse).

During Q1 of 2022/23 it met on two occasions in common with the other MSE CCG

Finance & Performance Committees to review finance and performance issues across

all health care services, including those ordinarily within the remit of the Mid and South

Essex STP CCG Joint Commissioning Committee (JC).

The quoracy arrangements for meetings held in common with the other CCG

committees, mirrored those described under the ‘Patient Safety and Quality Committee’

section.

During Q1 of 2022/23 the Committee particularly focused upon review of finance and

performance risks, receipt of monthly finance reports, Joint Committee finance

reports, Elective Recovery Framework updates, Hospital Discharge Programme,

contract planning, awards and procurement decisions, performance reports from

System Oversight and Assurance Group (SOAG), Adult Mental Health

Transformation Plan contracts, system financial sustainability, 2022/23 Business Plan

and CCG budgets, approval of terms of reference/frequency of meetings, receipt of

System Finance Leaders Group (SFLG) minutes.

Mid Essex Alliance

The aim of the Mid Essex Alliance is to bring all key partners from across mid Essex

together to provide the localism needed within the Mid and South Essex system to

create opportunities for people to live well in mid Essex.

Its membership comprises Director level representation from the ICB mid Essex place

team, PCN Clinical Directors, the Clinical Alliance Director, Essex County Council and

Braintree, Chelmsford and Maldon District Councils, Provide Community Interest

Company, Essex Partnership University NHSFT, North East London NHSFT, Mid and

South Essex Foundation Trust, Farleigh Hospice, Chelmsford and Maldon CVS,

Community 360 and Virgin Healthcare.

The Alliance meets monthly with good representation from all partners.

The Alliance has been involved in a three month Place Development Programme, led

by NHS England, to support the development of priorities and plans, governance and

the Alliance approach to population health management for 2022/23 and beyond. This

was a successful programme which has helped to develop a number of actions that the

Alliance now needs to take forwards.

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Primary Care Commissioning Committee

This Committee is chaired by the Lay Member for Patient and Public Engagement.

During Q1 of 2022/23 two meetings were held in common with the other MSE CCGs

Primary Care Commissioning Committees.

The Committee focused on contractual updates/breaches/requests for contractual

changes from general practices; local contract decisions; GP primary care quality and

safety reports; budget reports; information technology and digital updates; estates

issues; primary care workforce; and review of primary care risks.

Better Care Fund (including Improved Better Care Fund) Governance

A Better Care Fund (BCF) Partnership Board meets to fulfil the governance

requirements with Essex County Council.

In line with the terms of the Section 75 Better Care Fund Agreement, decision-

making relating to the BCF is delegated to two nominated representatives of the

CCG and two representatives of Essex County Council. As national guidance had

not been received in relation to the 2022/23 BCF utilisation of the BCF funds was in

line with the latest Section 75 Agreement and reporting for the period focused upon

expenditure on the approved services and monitoring against previously agreed

performance targets.

UK Corporate Governance Code

The CCG is not required to comply with the UK Code of Corporate Governance.

However, we have reported on our Corporate Governance arrangements by drawing

upon best practice available, including those aspects of the UK Corporate Governance

Code we consider to be relevant to the CCG and best practice.

As part of its annual review of effectiveness for 2021/22 the CCG Board undertook an

assessment which encompassed the relevant principles of the UK Corporate

Governance Code.

The Board concluded from this assessment that it was generally following best practice

in relation to providing effective leadership, having an appropriate balance of skills,

experience, independence, and knowledge to enable Board members to discharge their

duties and responsibilities effectively, presenting a balanced and understandable

assessment of the CCG’s position in its financial and other reporting and ensuring that

remuneration is set appropriately.

A review of Board effectiveness was not undertaken during Q1 of 2022/23 as the CCG

was dis-established on 30 June 2022.

Discharge of Statutory Functions

In light of the recommendations of the 2013 Harris Review, the clinical commissioning

group has reviewed all of the statutory duties and powers conferred on it by the

National Health Service Act 2006 (as amended) and other associated legislative and

regulations. As a result, I can confirm that the clinical commissioning group is clear

about the legislative requirements associated with each of the statutory functions for

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which it is responsible, including any restrictions on delegation of those functions. The

CCG’s current Scheme of Reservation and Delegation (SoRD) was approved by the

Board in March 2021. The CCG worked with the other MSE CCGs to develop a new

SoRD for the MSE ICB.

Risk management arrangements and effectiveness

The CCG is committed to ensuring that risk management forms an integral part of its

philosophy, practices and business plans, rather than viewed or practised as a separate

programme, and that responsibility for implementation is accepted at all levels of the

CCG.

An aligned MSE CCG Risk Management Policy, which encompasses both clinical and

non-clinical risks and the CCGs’ agreed risk appetite statement, was approved by all

MSE CCGs in November 2021. The Policy is based on the Australia/New Zealand risk

management model and sets out the risk management system, supporting processes

and reporting arrangements which aim to protect patients, the public, staff and the

CCG’s assets and reputation.

The overarching M&SE Board Assurance Framework (BAF) originally implemented in

June 2020, has been further developed. Risks are mapped against the MSE CCGs

common strategic objectives and key workstreams, these being:

• Cancer and End of Life

• Children and Young People

• Community

• Digital and Business Intelligence

• Estates

• Finance

• Health Inequalities

• Integrated Care System

• Maternity

• Medicines Optimisation

• Mental Health and Learning Disability

• People

• Planned Care

• Population Health Management

• Primary Care

• Stewardship

• Urgent Emergency Care

• Vaccination

The risk appetite statement assists managers to identify when risk levels are tolerable

or where further action is required to reduce risk ratings to an acceptable level. The

BAF is reviewed at each Part I Board meeting.

Capacity to Handle Risk

During Q1 of 2022/2 the CCG had the following arrangements in place:

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• Clear ownership of risks, with responsible Directors and lead officers identified,

with escalation arrangements in place to the Board.

• A Board Assurance Framework within which the latest updates from lead officers

were recorded and reported to relevant committees and the Board.

• Recording and investigation processes for incidents, including identification of

learning.

• Triangulation of learning from incidents, complaints, and claims (should they

arise) as a standing item on the agenda of the Patient Safety and Quality

Committee.

• Monitoring of completion of Equality and Health Inequality Impact Assessments,

Quality Impact Assessments and Privacy Impact Assessments

• Regular review of anti-fraud, bribery, and security arrangements by the Audit

Committee.

• Emergency Planning, Resilience and Response and Business Continuity

Management Policies and Procedures.

The CCG’s Whistleblowing Policy and arrangements, including the appointment of a

Freedom To Speak Up Guardian, also support risk management by providing a

framework for employees to raise concerns, in line with the Public Interest Disclosure

Act 1998, without the perception of being disloyal to colleagues, managers or the

organisation.

The CCG is committed to identifying the underlying or root causes of incidents, claims

and complaints, and the principal objective is to identify ‘system failures’, rather than

focusing on individual failures.

Stakeholders, including staff, patients and the public have been involved in the risk

management process, for example by ensuring that relevant staff were identified to

input into any risk assessments in their function or area of work; that CCG staff and

contractors were made aware of agreed risk reporting procedures including risks

associated with COVID-19; that contracts clearly stated the responsibilities of

contracted personnel with regard to risk identification, reduction, mitigation and

reporting; that feedback on risk issues was encouraged via the CCG’s complaints and

enquiries services and through its public engagement and consultation mechanisms,

e.g. patient stories at Board meetings, engagement with the public and other

stakeholders on future plans for services.

The effectiveness of these risk management arrangements is summarised under the

‘Review of the Effectiveness of Governance, Risk Management and Internal Control’

section, which includes the monitoring, review and management of the Assurance

Framework by the Audit Committee and Board.

Prevention of Risk

The application of this framework enables the prevention of risk through:

• Commitment to identifying the underlying or root causes of incidents,

complaints, and claims (should they arise)

• Promoting an open, just, and non-punitive culture

• Driving an ongoing information and education programme which empowers

and supports Board members and staff in the risk management process

generally and in relation to specific areas of risk

• All staff being familiar with the Anti-fraud, Anti-bribery and Security policies’

terms through promotion and training and the issuing of fraud alerts, with the

help of counter-fraud services

• All staff being familiar with the terms of the Conflicts of Interest, Gifts and

Hospitality and Standards of Conduct Policies.

• Registers of Interests being produced for Board and Committee meetings and

those Sub-committees with decision-making powers, or capacity to influence

decisions made by the CCG, so that the relevant Chair can ensure that potential

conflicts are managed appropriately.

Other sources of assurance

Internal Control Framework

A system of internal control is the set of processes and procedures in place in the

CCG to ensure it delivers its policies, aims and objectives. It is designed to identify

and prioritise the risks, to evaluate the likelihood of those risks being realised and the

impact should they be realised, and to manage them efficiently, effectively, and

economically.

The system of internal control allows risk to be managed to a reasonable level

rather than eliminating all risk; it can therefore only provide reasonable and not

absolute assurance of effectiveness.

The system of control in place is set out within the Board, Committee and Risk

Management sections of this statement.

Financial Arrangements

The CCG’s key financial systems are operated by third party providers. The CCG

Finance team oversee the operation of internal financial control arrangements and the

dissemination of good financial management and professional standards. The CCG’s

financial arrangements are assessed annually by external parties as part of the internal

and external audit functions.

The Finance and Performance Committee, which met in common with the other M&SE

CCGs during Q1 of 2022/23, exercises the Board’s functions in respect of the oversight

of financial control.

Risk Assessment

Risk assessments have been carried for each workstream identified on page 45 above.

Each risk recorded on the BAF is scored on the basis of inherent and residual risk.

Continued efforts are made to strengthen controls where residual risk scores remain

above the CCG’s Risk Appetite.

The CCG also undertakes other risk assessments, for example, health and safety/fire

workplace risk assessment of its premises and COVID-19 risk assessment to ensure

that its premises are COVID-19 secure. These risk assessments have associated

Page 47 of 72

action plans, policies, and procedures to ensure that risks identified are managed on an

ongoing basis.

Annual Audit of Conflicts of Interest Management

The revised statutory guidance on managing conflicts of interest for CCGs (published

June 2017) requires CCGs to undertake an annual internal audit of conflicts of interest

management.

To support CCGs to undertake this task, NHS England has published a template audit

framework. The annual internal audit of conflicts of interest 2021/22, which was

undertaken as part of the wider audit of the CCG’s risk management and governance

arrangements, identified ‘reasonable’ assurance.

Data Quality

In 2020/21 and 2021/22, when the annual contracting round coincided with peak

periods of the pandemic, the requirement for signed contracts with NHS Trusts and

NHS Foundation Trusts was relaxed. However, in 2022/23, as we revert to more normal

working arrangements, it is important, from a governance perspective, that properly

documented contracts are put in place in all cases.

The NHS Standard Contract (SC28) includes a specific requirement for the provider to

use all reasonable endeavours to optimise its performance under NHS Digital’s Data

Quality Maturity Index (DQMI), where applicable, demonstrating its progress through

implementation of a DQIP or other appropriate mean. The DQMI currently covers the

national datasets for admitted patient care, A&E, community services, diagnostic

imaging, IAPT, mental health, maternity, and outpatients.

Data Quality Improvement Plans (DQIPs) allow the commissioner and the provider to

agree a local plan to improve the capture, quality, and flow of data to meet the

requirements of the Information Schedule (6A) and to support both the commissioning

and contract management processes, generally targeting areas of particular concern, or

in relation to new data capture as a result of service transformation. Completion of a

DQIP is not mandatory for each contract, however in 2022/23 there are a number of

recommended DQIPs depending on the nature of the service provided. These include

providers of maternity services (to improve the accuracy and completeness of maternity

services data), providers of mental health and LD services (focussing on mental health

clinically led review of standards), providers of inpatient services (to record diagnoses

of LD and autism), and providers of community services (to improve the accuracy and

completeness of Community Dataset submissions).

Commissioners are able to use DQIPs (where agreed) to address data quality issues

highlighted through direct reporting or through the nationally available NHS Digital’s

Data Quality Maturity Index (DQMI).

Information Governance

The NHS Information Governance (IG) Framework sets the processes and procedures

by which the NHS handles information about patients and employees, in particular,

personal identifiable information. The NHS Information Governance Framework is

supported by a data security and protection toolkit and the annual submission process

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provides assurances to the CCG, other organisations and to individuals that personal

information is dealt with legally, securely, efficiently, and effectively.

We place high importance on ensuring there are robust information governance

systems and processes in place to help protect patient and corporate information. We

have established an information governance management framework and have

developed information governance processes and procedures in line with the Data

Security and Protection Toolkit. We have ensured all staff undertake annual information

governance training and have implemented a staff information governance handbook to

ensure members of staff are aware of their information governance roles and

responsibilities, and how to access information or assistance.

There are processes in place for incident reporting and investigation of serious

incidents. No serious incidents requiring investigation involving personal data were

reported to the Information Commissioner in Q1 of 2022/23.

The CCG has nominated information asset owners who have completed the new data

flow mapping and information asset registers to ensure compliance with the General

Data Protection Regulations (GDPR). This was undertaken with support from the IG

Team to ensure consistency of approach.

The CCG submitted a “Standards Met” Data Security and Protection Toolkit for 2021/22

on 22 June 2022.

Business Critical Models

The CCG supports the principles of the Macpherson Report and is committed to

embedding best practice in relation to quality assuring our prioritised business critical

models and other functions.

The Essex CCGs each have a Business Continuity Plan supported by an overarching

Essex-wide Business Continuity Policy, all of which have been approved by the CCGs'

Audit Committee. The documents are updated when a material change occurs, and

usually a comprehensive annual review takes place each year, although during the last

two years events have curtailed this process.

A memorandum of understanding has been signed by the Essex CCGs which sets out

the intentions of the CCGs to provide mutual aid and assistance to each other during a

business continuity incident which cannot be managed internally within each CCG’s

own business continuity arrangements, and which involves one or more of the following:

critical loss of key staff, temporary loss of premises or loss of a significant amount of IT

hardware. The CCGs have worked jointly since March 2020 on the response to the

Covid-19 pandemic.

Since March 2020, the CCGs have reviewed, tested, and updated their internal

business continuity arrangements as a result of the COVID-19 pandemic and continued

to update these throughout Q1 of 2022/23 in line with operational and Government

requirements and have developed new policies and procedures for the MSE ICB.

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Third party assurances

The CCG relies on a number of third-party providers which are listed below, together

with information on how assurance is received from each provider, the effectiveness of

these arrangements and whether any improvements are planned in the future.

The CCG relies on a third-party provider for payroll and pension services. This service

is provided by Whittington Health NHS Trust which is based in North London. The CCG

continues in a positive relationship with Whittington Health and regular virtual MS

Teams meetings are held between Whittington and the HR Managers at the CCG.

Human Resources transactional, recruitment and workforce services are now provided

in house directly by the CCG. From 1 July 2021, Occupational Health support has been

provided by Optima Health.

The CCG retains the services of a procurement expert company (Attain) to ensure

probity during procurement processes. The Finance & Performance Committee

receives procurement reports at each meeting and a register of procurement decisions,

which is published on the CCG’s public-facing website, is reviewed by the Audit

Committee to ensure rigour is being applied.

The MSE CCGs hold a monthly contract review meeting with Arden and Greater East

Midlands (AGEM) Central Support Unit (CSU) to monitor all aspects of the contract and

review performance against service level agreements and key performance indicators.

This includes extended services such as back-ups and business continuity planning.

Exceptions or escalations are reported to the Primary Care Digital Board. The CCGs

receive copies of all NHS Digital CareCert alerts and confirmation when AGEM has

updated against them.

Control Issues

EPUT have developed a Quality Strategy ‘Safety First, Safety Always’ which aims to

ensure that EPUT provide safe and high-quality care. The Essex mental health system

is one of the first areas in the country to roll out the new Patient Safety Incident

Response Framework. The CCG continues to monitor safety via the CQRG

mechanism. In September 2020 the CCGs began a joint pan Essex review (known as

the Taskforce) of the systems and processes within CCGs for the commissioning of

mental health services as provided by Essex Partnership University NHS Trust. The

Mental Health Taskforce has completed its review and the final report has been

produced. The ongoing work to fully deliver the taskforce recommendations are being

taken forward and overseen by the Mental Health Partnership Board to ensure that

delivery and progress is maintained going forward.

Review of economy, efficiency & effectiveness of the use of resources

As described in the Financial Overview section, many of the amendments made to the

financial regime during 2021/22 remained in place during Q1 2022/23 in response to

the ongoing challenges of the Covid-19 pandemic. The CCG reported a breakeven

position at the end of Q1 2022/23.

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The MSE CCGs’ Finance and Performance Committees in common (F&P CiC) and the

Board have each received regular financial reporting and had the opportunity for

detailed review of the CCG’s position.

The F&P CiC continued to monitor the CCG’s procurement and planning arrangements

in order to ensure value for money from commissioned services.

The CCG’s Q1 2022/23 running (management) costs were within nationally permitted

expenditure limits.

The Internal Auditor has reviewed the CCG’s financial systems and processes,

including the arrangements for financial reporting, and confirmed that the CCG has

reasonable arrangements in place. The external auditor’s comments on our

arrangements for securing economy, efficiency, and effectiveness in use of resources

in Q1 2022/23 are included in their report immediately preceding the Annual Accounts

(see page 100 onwards).

Delegation of functions

Acute services are commissioned by a central Mid and South Essex Acute

Commissioning Team, which is hosted by Mid Essex CCG.

Acute adult and older adult mental health services are commissioned by a central

mental health commissioning team hosted for Mid and South Essex by Thurrock CCG.

The individual placements team, which commissions placements for individuals with

Section 117 after-care rights as well as specialist placements for children and for adults

requiring tertiary care, is hosted by North East Essex CCG, which provides this function

on a pan-Essex basis.

Early intervention (Tier 2- Local Authority) and Specialist Community Mental Health

Services (Tier 3- CCGs) for Children is known as Southend, Essex and Thurrock

Children and Adolescent Mental Health Services (SET CAMHS). This has been

procured on a pan-Essex basis with a Commissioning Collaborative Agreement in place

for all 10 partner organisations. West Essex CCG is the Host commissioner for this

service. Children’s in-patient services continue to be commissioned by NHS England

and managed through the establishment of the Provider Collaborative for Children’s

Mental Health.

Learning Disability (LD) services are commissioned by Essex County Council, with

Castle Point and Rochford and Southend CCGs leading on this for health for Mid and

South Essex.

In common with other CCGs, the Executive Director of Nursing and Quality Chief Nurse

was a member of the Quality Surveillance Group which allows quality intelligence to be

shared across Essex with other commissioners and with the CQC.

No adverse information has been received from third party assurance reports relating to

West Essex’s host commissioner role for EWMHS or North East Essex CCG’s host

commissioner role for section 117 services.

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Counter fraud arrangements

An accredited Local Counter Fraud Specialist (LCFS), who is an employee of the

CCG’s internal auditors, is contracted to undertake counter fraud work proportionate to

identified risks. The Audit Committee receives an update from the LCFS regarding any

counter-fraud initiatives or investigations at each meeting and reports progress and

outcomes against each of the Government Counter Fraud Functional Standards

GovS 013.

There is executive support and direction from the Chief Finance Officer for a

proportionate proactive work plan to address identified risks. The Chief Finance Officer

is the identified member of the executive team named within the Anti-Fraud, Bribery and

Corruption Policy who is proactively and demonstrably responsible for tackling fraud,

bribery and corruption.

The CCG is committed to robustly investigating all reports of fraud, bribery and

corruption and will seek to recover lost NHS funds where proportionate and necessary.

At the end of the financial year, the CCG submits a self-assessment to the NHS

Counter Fraud Authority against the Government Counter Fraud Functional Standards.

The Chief Finance Officer and Chair of the Audit Committee authorise the assessment

prior to submission.

Head of Internal Audit Opinion

Following completion of the planned audit work for the financial year for the clinical

commissioning group, the Head of Internal Audit issued an independent and objective

opinion on the adequacy and effectiveness of the clinical commissioning group’s

system of risk management, governance, and internal control.

During 2022/23 Internal Audit issued the following audit reports:

Assignment Assurance Opinion

Review to confirm that governance processes

continued to operate during Q1 of 2022/23

Reasonable

Part 1 - Review of ‘due diligence’ processes

established in preparedness for transition to the

ICB

Reasonable

Part 2 - Review of ‘due diligence’ processes

established in preparedness for transition to the

ICB

Reasonable

Action plans have been established to address all recommendations made in internal

audit reports. Regular updates on progress are submitted to Audit Committee.

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

My review of the effectiveness of the system of internal control is informed by the work

of the internal auditors, executive managers and clinical leads within the clinical

commissioning group and the Acute Commissioning Team who have responsibility for

the development and maintenance of the internal control framework. I have drawn on

performance information available to me. My review is also informed by comments

made by the external auditors in their annual audit letter and other reports.

Our assurance framework provides me with evidence that the effectiveness of controls

that manage risks to the clinical commissioning group achieving its principal objectives

have been reviewed.

I have been advised on the implications of the result of this review by:

• The Board

• Audit Committee

• Remuneration Committee

• Quality and Governance Committee

• Finance and Performance Committee

• Primary Care Commissioning Committee

• The Joint Committee

• Internal audit

• Other explicit review/assurance mechanisms.

Conclusion

I concur with the Head of Internal Audit Opinion that during Q1 2022/23 there has been

a generally sound system of internal control, designed to meet the organisation’s

objectives, and that controls have been generally applied consistently.

Action plans to implement any outstanding recommendations from audits are in place

and will continue to be monitored during the 2022/23 financial year.

I confirm that there are no risks which may affect the CCG’s Licence or serious lapses

in control.

Anthony McKeever

Accountable Officer

26 June 2023

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REMUNERATION AND STAFF REPORT

Remuneration Report

For 2022/23 the membership of the Remuneration Committee was as follows:

• Nathalie Wright, Lay Member (Patient and Public Involvement) - Chair

• John Gilham, Lay Member (Governance)

• Pauline Stratford – Third Lay Member

This committee met in common with the other 4 MSE CCGs on 2 occasions during Q1

2022/23 both meetings were quorate.

HR and remuneration advice was provided by Human Resources and the committee

was informed by local and national guidance on remuneration matters.

Policy on remuneration of senior managers

Senior managers are subject to Agenda for Change terms and conditions, with the

exception of those roles which are subject to the VSM (Very Senior Managers)

framework. The salaries of governing body members are determined by remuneration

committee with national and local guidance (provided by the Chief Finance Officer and

Interim Director of Human Resources) being considered in all decisions.

Remuneration of Very Senior Managers

The Accountable Officer/CEO salary is set within national salary boundaries for the

AO/CEO of a CCG/ICB. The determination within this broad salary boundary is set with

NHS England and the CCG Remuneration Committee.

Senior Manager’s Performance Related Pay

The performance of all staff (including the Accountable Officer, directors, and senior

managers) is monitored and assessed through the use of a robust appraisal system. A

formal appraisal review is undertaken at least annually.

Agenda for Change contracts do not contain provision for performance-related

remuneration beyond the element introduced in 2018 for bands 8c, 8d and 9.

Specifically, in the year after an employee has reached the top of any of those bands,

subject to performance the employee will retain their basic salary, or their salary will be

reduced by five per cent or 10 per cent. The employee will be able to restore their

salary at the end of the following year by achieving agreed levels of performance.

Under the VSM pay framework, there is the potential for performance-related pay under

the terms and conditions of the contract. No proportion of remuneration for any staff

member has been subject to performance conditions at the CCG during the accounting

period.

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Senior manager remuneration (including salary and pension entitlements)

CCG Remuneration Reports 2022/23 (April 22 to June 22)

This Clinical Commissioning Group Remuneration Report for 2022-23 is shown in two

sections, representing the Salary and Allowances and Pension entitlements of the

senior leadership of the CCG.

CCG Salaries and Allowances Table:

This includes the Clinical Commissioning Group specific Remuneration Report table of

directors and senior managers.

CCG Pension Table:

This includes the Clinical Commissioning Group specific Pension entitlements of

directors and senior manager.

For the April 22 to June 22 period the CCGs operated a Board Meeting in Common and

did not operate the Joint Committee.

Page 56 of 72

Salaries and allowances (SUBJECT TO AUDIT)

Name and Title

Note

Date served

2022/23 (April 22 to June 22) 2021/22

Commenced Ceased

Salary

(bands

£5,000)

Expense

Payments

(taxable)

(total to

nearest

£100)

Other

Remunerati

on (bands

of £5,000)

All Pension

Benefits

(bands of

£2,500)

Total

(bands of

£5,000)

Salary

(bands of

£5,000)

Expense

Payments

(taxable)

(total to

nearest

£100)

Other

Remuner

ation

(bands of

£5,000)

All Pension

Benefits

(bands of

£2,500)

Total

(bands of

£5,000)

£000

Anthony McKeever

Joint Accountable

Officer – Joint

Executive Team

2 03-Oct-20 30-Jun-22 0 0 0 0 0 50-55 0 0 7.5-10 60-65

Mark Barker

Joint Chief Finance

Officer - Joint

Executive Team

2 & 8 01-Jan-21 30-Jun-22 0 0 0 0 0 40-45 0 0 0 40-45

Rachel Hearn

Executive Director of

Nursing and Quality -

Joint Executive Team

2 02-Nov-20 30-Jun-22 30-35 0 0 25-27.5 55-60 40-45 0 0 62.5-65 105-110

Daniel Doherty

NHS Alliance Director,

Mid Essex - Joint

Executive Team and

Deputy Accountable

Officer

3 02-Nov-20 30-Jun-22 30-35 0 0 10-12.5 40-45 125-130 0 0 72.5-75 195-200

John Gilham

Lay Member,

Governance and Audit

Chair

01-Jul-18 30-Jun-22 0-5 0 0 0 0-5 15-20 0 0 0 15-20

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Nathalie Wright

Lay Member, Patient &

Public Participation

01-Apr-18 30-Jun-22 0-5 0 0 0 0-5 10-15 0 0 0 10-15

Pauline Stratford

Lay Member

6 01-Aug-21 30-Jun-22 0 0 0 0 0 0-5 0 0 0 0-5

Dr Anna Davey

Elected GP –

Governing Body

Member and

CCG Chair (Clinical)

5 01-Apr-18

01-Oct-18

30-Jun-22

15-20 0 0 0 15-20 65-70 0 0 0 65-70

Dr Elizabeth Towers

Elected GP -

Governing Body

Member

4 01-Apr-15 30-Jun-22 15-20 0 0 15-20 65-70 0 0 0 65-70

Dr Julie McGeachy

Elected GP –

Governing Body

Member

5 01-Apr-18 30-Jun-22 0-5 0 0 0 0-5 10-15 0 0 0 10-15

Dr Fatai Salau

Elected GP –

Governing Body

Member

5 01-Apr-18 30-Jun-22 0-5 0 0 0 0-5 10-15 0 0 0 10-15

Dr Julia Hale

Secondary Care

Consultant

7 01-Aug-21 30-Jun-22 0 0 0 0 0 0-5 0 0 0 0-5

Notes:

1 The pension-related benefit figures do not represent cash payments made to an individual's pension provider. The quoted figures

provided by NHS Pensions Agency are an estimate of the increase in the accrued pension over their estimated pensionable life.

Each organisation reports a disclosure value appropriate to the length of time the senior manager was employed by their

organisation.

2 Anthony McKeever, employed by Basildon and Brentwood CCG, Mark Barker, employed by Castle Point & Rochford CCG, and

Rachel Hearn, employed by Mid Essex CCG are members of the Joint Executive Team, a single executive body covering the five

CCGs in mid and south Essex. Their remuneration is shared across the five CCGs, and our share is shown in the table above.

The total remuneration (inclusive of pension benefits and taxable expense payments) for Rachel Hearn, was in the range £30k-

£35k, for Mark Barker in the range £35k-£40k, and for Anthony McKeever in the range £65k-£70k.

3 Daniel Doherty is a member of the Joint Executive Team, as an NHS Alliance Director supporting the mid Essex locality and

leading on Community services across the five CCGs in mid and south Essex. Daniel Doherty’s total remuneration is shown in

the Salaries and Allowances table above.

4 The Salary Band for Elizabeth Towers includes work undertaken for the CCG under separate contracts. These are: Macmillan

GP Facilitator and Clinical Lead - Rapid Diagnostic Centre initiative. The Macmillan GP Facilitator role is partly funded by

Macmillan Cancer Support, with the Clinical Lead – Rapid Diagnostic Centre being funded by NHS England. The remuneration

band for this additional work was £15k-£20k.

5 Drs Anna Davey, Julie McGeachy and Fatai Salau, GP Elected members of the Governing Body, are employed as ‘Off Payroll

Workers’ but processed through the CCG’s payroll to ensure the statutory HMRC deductions are made. The salary disclosure

includes employer pension contributions (where applicable). They are not reported in the ‘Off-Payroll’ section of the

Remuneration Report.

6 Pauline Stratford, Lay Member is also a member of NHS Southend CCG, NHS Castle Point & Rochford CCG and NHS Thurrock

CCG Boards. Her salary was not recharged to Mid Essex CCG in the period. Her total remuneration, paid by Castle Point &

Rochford CCG, was in the range £0k-£5k.

7 Dr Julia Hale, Secondary Care Specialist, is also a member of NHS Basildon and Brentwood CCG Board. The remuneration

shown above is the total remuneration as none was recharged to NHS Basildon & Brentwood CCG in the period.

8 The pension figures for staff who are also included in CCG remuneration reports are shown in full in their employing CCG's

remuneration report and have not been apportioned to more than one organisation.

Dr Maggie Pacini, Consultant in Public Health and Councillor Mike Steel attend the board in a non-voting capacity as Essex County

Council representatives. No remuneration is paid to Essex County Council, and they are therefore not included in the above table.

Performance pay and bonuses, and Long-Term performance pay and bonuses, are not paid by the CCG.

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Pension benefits as at 30 June 2022 (SUBJECT TO AUDIT)

Name and

Title

(a)

Real

increase

pension

age

(bands of

£2,500)

(b)

Real

increase in

pension

lump sum

at pension

age

(bands of

£2,500)

(c)

Total

accrued

pension at

pension

age at 30

June 2022

(bands of

£5,000)

(d)

Lump sum

at pension

age related

to accrued

pension at

30 June

2022

(bands of

£5,000)

(e)

Cash

Equivalent

Transfer

Value at 1

April 2021

(f)

eal

Increase in

Cash

Equivalent

Transfer

Value

(g)

ash

Equivalen

t Transfer

Value at

30 June

2022

(h)

Employers

Contribution to

partnership pension

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

Rachel Hearn

Executive Director

of Nursing and

Quality – Joint

Executive Team

0-2.5 0 35-40 65-70 553 19 594 0

Daniel Doherty

NHS Alliance

Director, Mid

Essex – Joint

Executive Team

and

Deputy

Accountable

Officer

0-2.5 0 35-40 60-65 524 6 551 0

As non-executive directors do not receive pensionable remuneration, there will be no

entries in respect of pensions for their non-executive director’s role.

Cash equivalent transfer values

CETV figures are calculated using the guidance on discount rates for calculating

unfunded public service pension contribution rates that was extant at 31 March 2023.

HM Treasury published updated guidance on 27 April 2023; this guidance will be used

in the calculation of 2023 to 24 CETV figures.

A Cash Equivalent Transfer Value (CETV) is the actuarially assessed capital value of

the pension scheme benefits accrued by a member at a particular point in time.

The benefits valued are the member’s accrued benefits and any contingent spouse’s (or

other allowable beneficiary’s) pension payable from the scheme. CETVs are calculated

in accordance with SI 2008 No.1050 Occupational Pension Schemes (Transfer Values)

Regulations 2008.

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. 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 is required. 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.

Real increase in CETV

This reflects the increase in CETV effectively funded by the employer.

It does not include the increase in accrued pension due to inflation or contributions paid

by the employee (including the value of any benefits transferred from another pension

scheme or arrangement)

The pension-related benefit figures quoted do not represent cash payments made to an

individual's pension provider. The quoted figures provided by NHS Pensions Agency

are an estimation of the increase in the accrued pension over their estimated

pensionable life. Where an individual joins the pension fund after a significant gap, this

can result in a higher estimate than would normally be expected. However, the pension

benefit figures are expected to return to normal levels in the second year of disclosure.

NHS Pensions are using pension and lump sum data from their systems without any

adjustment for a potential future legal remedy required as a result of the McCloud

judgement. (This is a legal case concerning age discrimination over the manner in

which UK public service pension schemes introduced a CARE benefit design in 2015

for all but the oldest members who retained a Final Salary design). We believe this

approach is appropriate given that there is still considerable uncertainty on how the

affected benefits within the new NHS 2015 Scheme would be adjusted in future as a

result of these legal proceedings.

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Compensation on early retirement or for loss of office

There have been 0 compensation payments on early retirement or for loss of office.

Payments to past directors

There have been 0 payments to past directors.

Fair Pay Disclosure (SUBJECT TO AUDIT)

Percentage Change in Remuneration of Highest Paid Director

% Change from previous

financial year in Salary

and Allowances

% Change from previous

financial year in

Performance Pay and

Bonuses

The percentage change

from the previous financial

year in respect of the

highest paid director

+4.1% N/A*

The average percentage

change from the previous

financial year in respect of

employees of the entity,

taken as a whole.

+6.3% N/A*

*No Performance Pay and Bonus payments are made by the CCG.

Pay Ratio Information

Reporting bodies are required to disclose the relationship between the remuneration of

the highest-paid director / member in their organisation against the 25th percentile,

median and 75th percentile of remuneration of the organisation’s workforce. Total

remuneration is further broken down to show the relationship between the highest paid

director's salary component of their total remuneration against the 25th percentile,

median and 75th percentile of salary components of the organisation’s workforce.

The banded remuneration of the highest paid director/member in Mid Essex CCG in the

financial period April to June 2022 was £125k-130k (+4% against 2021-22: £120k-125k)

and the relationship to the remuneration of the organisation's workforce is disclosed in

the below table.

Pay Ratio information table

2022-23 25th percentile Median 75th percentile

Total remuneration (£) £27,361 £42,446 £56,625

*Salary component of total

remuneration (£)

£27,361 £42,446 £56,625

Pay ratio information 4.7:1 3.0:1 2.3:1

2021-22

Total remuneration (£) £26,721 £41,890 £54,904

*Salary component of total

remuneration (£)

£26,721 £41,890 £54,904

Pay ratio information 4.8:1 3.0:1 2.3:1

*No Performance Pay and Bonus Payments are paid by the CCG, therefore both Salary

component and Total Remuneration are the same.

In the period April – June 2022, 1 (2021/22, 0) employee received remuneration in

excess of the highest-paid director/member.

As at 30 June 2022, remuneration ranged from £5k to £140k (2021/22: £3k to 125k)

based on annualised, full-time equivalent remuneration of all staff (including temporary

and agency staff)

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age 63 of 72

Policy on the duration of contracts, notice periods and termination payments

The duration of contracts is determined by the duration of the roles and responsibilities

to be undertaken. The contracts of the Accountable Officer, directors and other CCG

staff are permanent unless applicable to a time-limited project or funding, in which case

contracts will be offered on a fixed-term.

The notice period applying to the Joint Accountable Officer is six months. For directors

and other senior managers, the notice period is three months. Any termination

payments would be in accordance with relevant contractual, legislative and HMRC

requirements.

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Staff Report

Number of senior managers

In 2022/23, the CCG had 31 senior managers.

Staff numbers and costs

Pay Band 2 3 4 5 6 7 8a 8b 8c 8d 9 Other Grand Total

Senior Managers

Female 14 21 17 27 27 23 15 10 9 2 7 172

Male 1 1 3 3 2 7 2 7 5 5 4 40

Grand Total 1 15 24 20 29 34 25 22 15 9 7 11 212

Staff composition

EMPLOYED STAFF

Employee category Headcount WTE

Permanent 178 162.64

Fixed-term 28 24.38

TOTAL 206 187.02

AGENCY & INTERIM

TOTAL 6 0.00

GRAND TOTAL 212 187.02

Sickness absence data

Average FTE for

2022

Average Annual

Sick Days per FTE

Sum of FTE

Days Sick

Sum of FTE

Days

Available

Months

177

6.8

648

21,524

Sickness absence data can be found here: https://digital.nhs.uk/data-and-

information/publications/statistical/nhs-sickness-absence-rates

Staff turnover percentages

Staff Engagement

For the first year, all of the 5 CCGs in Mid and South Essex have participated in the

NHS Staff Survey on a combined basis and the results have been presented across

joint Directorates and teams.

The CCGs had an excellent response rate of 78%. Key themes have been shared with

the CCGs Executive Team and they have been asked to work with their teams to write

action plans in response to the staff survey results. In addition to this, the 5 CCGs

formed a staff engagement group in January 2022 and this group is also developing an

organisational action plan to look at key themes such as health and wellbeing, and

diversity and inclusion. This group has representation of staff from across the 5 CCGs

and will be tasked with feeding into the organisational development work required as

the CCGs transition into an ICB.

There are regular all-staff briefings across the 5 CCGs to communicate key messages

around organisational change, as well as operational updates and regular updates on

system priorities.

There are also opportunities for staff to meet at a more local level through Alliance

briefings as well as team briefings and regular one-to-one meetings with their

manager.

Page 65 of 72

Staff policies

The CCG has given full and fair consideration to applications for employment made by

disabled persons, having regard to their particular aptitudes and abilities.

The CCG has continued the employment of and arranged appropriate training for

employees who have become disabled persons during their period of employment.

It is the policy of the CCG to ensure that any member of the CCG Board, its staff and its

member practices are able to raise concerns about unlawful conduct, financial

malpractice/fraud and risks to the environment and to patient care in line with legislation

and good practice. This is covered under our whistleblowing policy.

Equality, Diversity, and Inclusion

The CCGs are committed to providing equal opportunities and to avoiding unlawful

discrimination and the Recruitment and Selection Policy is designed to assist the CCGs

in putting this commitment into practice. The policy is compliant with the Equality Act

2010 and sets out specific actions undertaken by the CCGs, in the context of

employment and people management, in order to fulfil its Public Sector Equality Duty.

All CCG staff were offered further equality, diversity, and inclusion training as part of the

transition into the ICB - the offering included unconscious bias training, awareness of

protected characteristics, allyship and also a complete review of policies, procedures

and practices to eliminate bias. This was offered in line with the recommendations of

the No More Tick boxes report.

The CCGs also worked with the Mid and South Essex Health and Care Partnership to

develop an organisational and system response to the regional Anti-Racism Strategy,

being implemented through the Equality, Diversity and Inclusion Subgroup that is

accountable to the Mid and South Essex People Board. In addition, an EDI dashboard

is also in development for the MSE Partnerships, which the CCGs will feed into.

The CCGs also participated in the MSE reciprocal mentoring programme through the

NHS Leadership academy, a commitment that has been made by the Executive teams

from across the system.

Trade Union Facility Time Reporting Requirements

There was no Trade Union Facility Time in the accounting period.

Health and Wellbeing

The CCGs have benefitted from a comprehensive staff health and wellbeing offer

through the Live Life Connected programme, which offers a vast array of health and

wellbeing interventions, such as online talks around health topics, online exercise

classes, mindfulness, and gratitude practice.

In addition, there is also an employee assistance programme available to all staff which

provides a telephone support line and counselling, as well as a comprehensive

occupational health provision.

Page 66 of 72

Page 67 of 72

During the Covid pandemic, there have also been enhanced national, regional and local

offers available to staff, including the regional mental health hubs and the Here For You

service is available to all CCG employees and has continued this year.

The CCGs also have a trained network of mental health first aiders and have also

provided bespoke Change and Resilience workshops for staff, as well as benefitting

from ICS offers such as Kindness masterclasses.

The CCGs are committed to supporting disabled colleagues within the workplace

through making reasonable adjustments as well as the use of regular risk assessments

and also supporting colleagues’ mental health through the use of stress risk

assessments and other support tools.

Health and Safety

The CCG’s Health and Safety Policy sets out our responsibilities and those of

employees under the Health and Safety Work Act 1974. Health and safety, fire safety

and manual handling are included in the mandatory training programme for all CCG

staff.

Risk assessment and inspections identify health and safety issues to enable

appropriate action to be taken to reduce risks to staff and other users of CCG premises.

Although CCG staff have worked from home since the beginning of the pandemic,

regular health, and safety inspections, building system tests and maintenance

continued throughout the year.

Expenditure on consultancy

Page 68 of 72

Page 69 of 72

Page 70 of 72

Losses and Special Payments

In the accounting period, the total number of NHS clinical commissioning group losses

and special payments cases were nil (2021/22: nil).

Exit packages, including special (non-contractual) payments

In the accounting period, the total number of NHS clinical commissioning group exit

packages were nil (2021/22: nil)

Page 71 of 72

PARLIAMENTARY ACCOUNTABILITY AND

AUDIT REPORT

The CCG is not required to produce a Parliamentary Accountability and Audit Report

but has opted to include disclosures on remote contingent liabilities, losses and special

payments, gifts, and fees and charges in this Accountability Report at page 70. An audit

certificate and report is also included in this Annual Report.

Page 72 of 72

ANNUAL ACCOUNTS

I confirm that the annual accounts adhere to the reporting framework.

Anthony McKeever

Accountable Officer

26 June 2023

Entity name:

NHS Mid Essex CCG

Statutory Accounts

This period

1-Apr-22 to 30-Jun-22

Last year 2021-22

This period ended

30-Jun-22

Last year ended 31-Mar-22

This period commencing:

1-Apr-22

Last year commencing:

1-Apr-21

Page 1 of 32

NHS Mid Essex CCG - Statutory Accounts - 1-Apr-22 to 30-Jun-22

Page

Number

The Primary Statements:

Statement of Comprehensive Net Expenditure for the period ended 30-Jun-22 3

Statement of Financial Position as at 30-Jun-22 4

Statement of Changes in Taxpayers' Equity for the period ended 30-Jun-22 5

Statement of Cash Flows for the period ended 30-Jun-22 6

Notes to the Accounts

Accounting Policies 7-10

Operating Revenue 11

Employee Benefits, Staff Numbers and Pension Costs 12-13

Operating Expenses 14

Better Payment Practice Code 15

Finance Costs 15

Leases 16-17

Trade and Other Receivables 18

Cash and Cash Equivalents 19

Trade and Other Payables 19

Provisions 20

Financial Instruments 21-22

Operating Segments 23

Joint Arrangements - Interests in Joint Operations 23

Related Party Transactions 24

Events After the End of the Reporting Period 25

Financial Performance Targets 25

CONTENTS

Page 2 of 32

NHS Mid Essex CCG - Statutory Accounts - 1-Apr-22 to 30-Jun-22

Statement of Comprehensive Net Expenditure for the period ended

30-Jun-22

1-Apr-22 to

30-Jun-22

2021-22

Note £'000 £'000

Income from sale of goods and services

2 (177) (720)

Total operating income

(177) (720)

Staff costs

4 3,064 9,443

Purchase of goods and services

5 189,036 917,926

Depreciation and impairment charges

5 47 -

Provision expense

5 - 973

Other operating expenditure

5 55 675

Total operating expenditure

192,202 929,017

Net operating expenditure

192,025 928,297

Finance costs

7 0 -

Comprehensive expenditure for the period

192,025 928,297

The notes on pages 7 to 25 form part of this statement

Page 3 of 32

NHS Mid Essex CCG - Statutory Accounts - 1-Apr-22 to 30-Jun-22

Statement of Financial Position as at

30 Jun 22

30-Jun-22

31-Mar-22

Note £'000 £'000

Non-current assets:

Right-of-use assets 8 175 -

Total non-current assets 175 -

Current assets:

Trade and other receivables 9 4,428 1,653

Cash and cash equivalents 10 0 0

Total current assets 4,428 1,653

Total assets 4,603 1,653

Current liabilities

Trade and other payables 11 (21,501) (46,420)

Lease liabilities 8 (185) -

Borrowings (2,588) (4,300)

Provisions 12 (2,093) (1,568)

Total current liabilities (26,367) (52,288)

Non-current assets plus/less net current assets/liabilities (21,764) (50,635)

Non-current liabilities

Provisions 12 (2,549) (2,549)

Total non-current liabilities (2,549) (2,549)

Assets less Liabilities (24,313) (53,184)

Financed by taxpayers’ equity

General fund (24,314) (53,184)

Total taxpayers' equity: (24,314) (53,184)

The notes on pages 7 to 25 form part of this statement

Chief Accountable Officer

Anthony McKeever

The financial statements on pages 3 to 6 were approved by the governing body on 26 June 23 and signed

on its behalf by:

Page 4 of 32

NHS Mid Essex CCG - Statutory Accounts - 1-Apr-22 to 30-Jun-22

Statement of Changes In Taxpayers Equity for the period ended

30-Jun-22

General fund

Total

reserves

£'000 £'000

Changes in taxpayers’ equity for 1-Apr-22 to 30-Jun-22

Balance at 1-Apr-22 (53,184) (53,184)

Adjusted NHS clinical commissioning group balance at 31-Mar-22 (53,184) (53,184)

Changes in NHS clinical commissioning group taxpayers’ equity for 1-Apr-

22 to 30-Jun-22

Net operating expenditure for the financial period (192,025)

(192,025)

Net recognised NHS clinical commissioning group expenditure for the

financial period

(192,025) (192,025)

Net funding 220,895

220,895

Balance at 30-Jun-22 (24,314) (24,314)

General fund Total reserves

£'000 £'000

Changes in taxpayers’ equity for 2021-22

Balance at 1-Apr-21

(38,528) (38,528)

Adjusted NHS Clinical Commissioning Group balance at 31-Mar-21 (38,528) (38,528)

Changes in NHS clinical commissioning group taxpayers’ equity for 2021-22

Net operating expenditure for the financial year (928,297)

(928,297)

Net recognised NHS clinical commissioning group expenditure for the

financial year

(928,297) (928,297)

Net funding 913,641

913,641

Balance at 31-Mar-22 (53,184) (53,184)

The notes on pages 7 to 25 form part of this statement

Page 5 of 32

NHS Mid Essex CCG - Statutory Accounts - 1-Apr-22 to 30-Jun-22

Statement of Cash Flows for the period ended

30-Jun-22

1-Apr-22 to

30-Jun-22

2021-22

Note

£'000 £'000

Cash flows from operating activities

Net operating expenditure for the financial period (192,025) (928,297)

Depreciation 5 47 0

(Increase)/decrease in trade & other receivables 9 (2,774) 7,071

(Decrease)/Increase in trade & other payables 11 (24,919) 2,971

Provisions utilised 12 525 (110)

Increase in provisions 12 0 973

Net cash (outflow) from operating activities (219,147) (917,392)

Net cash (outflow) before financing (219,147) (917,392)

Cash flows from financing activities

Grant in aid funding received 220,895 913,641

Repayment of lease liabilities (37) 0

Net cash inflow (outflow) from financing activities 220,858 913,641

Net increase/(decrease) in cash & cash equivalents 10 1,711 (3,752)

Cash & cash equivalents at the beginning of the financial period (4,299) (548)

Cash & cash equivalents at the end of the financial period (2,588) (4,300)

The notes on pages 7 to 25 form part of this statement

Page 6 of 32

NHS Mid Essex CCG - Statutory Accounts - 1-Apr-22 to 30-Jun-22

Notes to the financial statements

Accounting Policies

NHS England has directed that the financial statements of NHS clinical commissioning groups shall meet the accounting

requirements of the Group Accounting Manual issued by the Department of Health and Social Care. Consequently, the

following financial statements have been prepared in accordance with the Group Accounting Manual 2022-23 issued by the

Department of Health and Social Care. The accounting policies contained in the Group Accounting Manual follow International

Financial Reporting Standards to the extent that they are meaningful and appropriate to clinical commissioning groups, as

determined by HM Treasury, which is advised by the Financial Reporting Advisory Board. Where the Group Accounting Manual

permits a choice of accounting policy, the accounting policy which is judged to be most appropriate to the particular

circumstances of the clinical commissioning group for the purpose of giving a true and fair view has been selected. The

particular policies adopted by the clinical commissioning group are described below. They have been applied consistently in

dealing with items considered material in relation to the accounts.

1.1

Going Concern

These accounts have been prepared on a going concern basis.

Public sector bodies are assumed to be going concerns where the continuation of the provision of a service in the future is

anticipated, as evidenced by inclusion of financial provision for that service in published documents.

Where an NHS clinical commissioning group ceases to exist, it considers whether or not its services will continue to be

provided (using the same assets, by another public sector entity) in determining whether to use the concept of going concern

for the final set of financial statements. If services will continue to be provided the financial statements are prepared on the

going concern basis. The statement of financial position has therefore been drawn up at 30 June 22 on a going concern basis.

Following the approval of the Health and Care Bill on 28 April 2022 the NHS Basildon and Brentwood Clinical Commissioning

Group (the CCG) was dissolved on 30 June 22. Whilst the CCG as an entity ceased to exist on that date, the activities

undertaken by the CCG continued to be undertaken by the Mid and South Essex Integrated Health and Care Board. In

accordance with the Department of Health and Social Care Group Accounting Manual, the continuation of the provision of

services within the public sector means that the accounts of the CCG should be and have been prepared on a going concern

basis.

1.2

Accounting Convention

These accounts have been prepared under the historical cost convention modified to account for the revaluation of property,

plant and equipment, intangible assets, inventories and certain financial assets and financial liabilities.

1.3

Movement of Assets within the Department of Health and Social Care Group

As Public Sector Bodies are deemed to operate under common control, business reconfigurations within the Department of

Health and Social Care Group are outside the scope of IFRS 3 Business Combinations. Where functions transfer between two

public sector bodies, the Department of Health and Social Care GAM requires the application of absorption accounting.

Absorption accounting requires that entities account for their transactions in the period in which they took place, with no

restatement of performance required when functions transfer within the public sector. Where assets and liabilities transfer, the

Other transfers of assets and liabilities within the Department of Health and Social Care Group are accounted for in line with

IAS 20 and similarly give rise to income and expenditure entries.

1.4

Joint Arrangements

The NHS clinical commissioning group has not been part of any pooled budget arrangements in 2022-23. The NHS

commissioning group and Essex County Council have continued to operate a Better Care Fund during 2022-23 under a

Section 75 agreement. The arrangements under which the Better Care Fund operated in 2022-23 do not constitute a pooled

budget as the risks of each scheme have remained with the respective commissioners. See Note 15 for further information.

1.5

Operating Segments

Income and expenditure are analysed in the Operating Segments note and are reported in line with management information

used within the clinical commissioning group.

Page 7 of 32

NHS Mid Essex CCG - Statutory Accounts - 1-Apr-22 to 30-Jun-22

Notes to the financial statements

1.6

Revenue

In the application of IFRS 15 a number of practical expedients offered in the Standard have been employed. These are as

follows:

• As per paragraph 121 of the Standard the clinical commissioning group will not disclose information regarding performance

obligations part of a contract that has an original expected duration of one year or less,

• The NHS clinical commissioning group is to similarly not disclose information where revenue is recognised in line with the

practical expedient offered in paragraph B16 of the Standard where the right to consideration corresponds directly with value of

the performance completed to date.

• The FReM has mandated the exercise of the practical expedient offered in C7(a) of the Standard that requires the NHS

clinical commissioning group to reflect the aggregate effect of all contracts modified before the date of initial application.

The main source of funding for the NHS clinical commissioning group is from NHS England. This is drawn down and credited to

the general fund. Funding is recognised in the period in which it is received.

Revenue in respect of services provided is recognised when (or as) performance obligations are satisfied by transferring

promised services to the customer, and is measured at the amount of the transaction price allocated to that performance

obligation.

Where income is received for a specific performance obligation that is to be satisfied in the following year, that income is

deferred.

Payment terms are standard reflecting cross government principles.

The value of the benefit received when the NHS clinical commissioning group accesses funds from the Government’s

apprenticeship service are recognised as income in accordance with IAS 20, Accounting for Government Grants. Where these

funds are paid directly to an accredited training provider, non-cash income and a corresponding non-cash training expense are

recognised, both equal to the cost of the training funded.

1.7

Employee Benefits

1.7.1

Short-term Employee Benefits

Salaries, wages and employment-related payments, including payments arising from the apprenticeship levy, are recognised in

the period in which the service is received from employees, including bonuses earned but not yet taken.

The cost of leave earned but not taken by employees at the end of the period is recognised in the financial statements to the

extent that employees are permitted to carry forward leave into the following period.

1.7.2

Retirement Benefit Costs

Past and present employees are covered by the provisions of the NHS pensions schemes. These schemes are unfunded,

defined benefit schemes that cover NHS employers, General Practices and other bodies allowed under the direction of the

Secretary of State in England and Wales. The schemes are not designed to be run in a way that would enable NHS bodies to

identify their share of the underlying scheme assets and liabilities. Therefore, the schemes are accounted for as if they were a

defined contribution scheme; the cost recognised in these accounts represents the contributions payable for the period. Details

of the benefits payable under these provisions can be found on the NHS Pensions website at www.nhsbsa.nhs.uk/pensions.

For early retirements other than those due to ill health the additional pension liabilities are not funded by the scheme. The full

amount of the liability for the additional costs is charged to expenditure at the time the clinical commissioning group commits

itself to the retirement, regardless of the method of payment.

The schemes are subject to a full actuarial valuation every four years and an accounting valuation every year.

1.8

Other Expenses

Other operating expenses are recognised when, and to the extent that, the goods or services have been received. They are

measured at the fair value of the consideration payable.

1.9

Leases

A lease is a contract, or part of a contract, that conveys the right to control the use of an asset for a period of time in exchange

for consideration. The NHS clinical commissioning group assesses whether a contract is or contains a lease, at inception of the

contract.

Page 8 of 32

NHS Mid Essex CCG - Statutory Accounts - 1-Apr-22 to 30-Jun-22

Notes to the financial statements

1.9.1

The NHS Clinical Commissioning Group as Lessee

A right-of-use asset and a corresponding lease liability are recognised at commencement of the lease.

The lease liability is initially measured at the present value of the future lease payments, discounted by using the rate implicit in

the lease. If this rate cannot be readily determined, the prescribed HM Treasury discount rates are used as the incremental

borrowing rate to discount future lease payments.

The HM Treasury incremental borrowing rate of 0.95% is applied for leases commencing, transitioning or being remeasured in

the 2022 calendar year under IFRS 16.

Lease payments included in the measurement of the lease liability comprise

-Fixed payments;

-Variable lease payments dependent on an index or rate, initially measured using the index or rate at commencement;

-The amount expected to be payable under residual value guarantees;

-The exercise price of purchase options, if it is reasonably certain the option will be exercised; and

-Payments of penalties for terminating the lease, if the lease term reflects the exercise of an option to terminate the lease.

Variable rents that do not depend on an index or rate are not included in the measurement the lease liability and are recognised

as an expense in the period in which the event or condition that triggers those payments occurs.

The lease liability is subsequently measured by increasing the carrying amount for interest incurred using the effective interest

method and decreasing the carrying amount to reflect the lease payments made. The lease liability is remeasured, with a

corresponding adjustment to the right-of-use asset, to reflect any reassessment of or modification made to the lease.

The right-of-use asset is initially measured at an amount equal to the initial lease liability adjusted for any lease prepayments or

incentives, initial direct costs or an estimate of any dismantling, removal or restoring costs relating to either restoring the

location of the asset or restoring the underlying asset itself, unless costs are incurred to produce inventories.

The subsequent measurement of the right-of-use asset is consistent with the principles for subsequent measurement of

property, plant and equipment. Accordingly, right-of-use assets, that are held for their service potential and are in use, are

subsequently measured at their current value in existing use.

Right-of-use assets for leases that are low value or short term and for which current value in use is not expected to fluctuate

significantly due to changes in market prices and conditions are valued at depreciated historical cost as a proxy for current

value in existing use.

Other than leases for assets under construction and investment property, the right-of-use asset is subsequently depreciated on

a straight-line basis over the shorter of the lease term or the useful life of the underlying asset. The right-of-use asset is tested

for impairment if there are any indicators of impairment and impairment losses are accounted for as described in the

‘Depreciation, amortisation and impairments’ policy.

Peppercorn leases are defined as leases for which the consideration paid is nil or nominal (that is, significantly below market

value). Peppercorn leases are in the scope of IFRS 16 if they meet the definition of a lease in all aspects apart from containing

consideration.

For peppercorn leases a right-of-use asset is recognised and initially measured at current value in existing use. The lease

liability is measured in accordance with the above policy. Any difference between the carrying amount of the right-of-use asset

and the lease liability is recognised as income as required by IAS 20 as interpreted by the FReM.

Leases of low value assets (value when new less than £5,000) and short-term leases of 12 months or less are recognised as

an expense on a straight-line basis over the term of the lease.

1.10

Cash & Cash Equivalents

Cash is cash in hand and deposits with any financial institution repayable without penalty on notice of not more than 24 hours.

Cash equivalents are investments that mature in 3 months or less from the date of acquisition and that are readily convertible to

known amounts of cash with insignificant risk of change in value.

In the Statement of Cash Flows, cash and cash equivalents are shown net of bank overdrafts that are repayable on demand

and that form an integral part of the clinical commissioning group’s cash management.

Page 9 of 32

NHS Mid Essex CCG - Statutory Accounts - 1-Apr-22 to 30-Jun-22

Notes to the financial statements

1.11

Provisions

Provisions are recognised when the NHS clinical commissioning group has a present legal or constructive obligation as a result

of a past event, it is probable that the NHS clinical commissioning group will be required to settle the obligation, and a reliable

estimate can be made of the amount of the obligation. The amount recognised as a provision is the best estimate of the

expenditure required to settle the obligation at the end of the reporting period, taking into account the risks and uncertainties.

Where a provision is measured using the cash flows estimated to settle the obligation, its carrying amount is the present value

of those cash flows using HM Treasury’s discount rate as follows:

When some or all of the economic benefits required to settle a provision are expected to be recovered from a third party, the

receivable is recognised as an asset if it is virtually certain that reimbursements will be received and the amount of the

receivable can be measured reliably.

A restructuring provision is recognised when the NHS clinical commissioning group has developed a detailed formal plan for

the restructuring and has raised a valid expectation in those affected that it will carry out the restructuring by starting to

implement the plan or announcing its main features to those affected by it. The measurement of a restructuring provision

includes only the direct expenditures arising from the restructuring, which are those amounts that are both necessarily entailed

by the restructuring and not associated with on-going activities of the entity.

1.12

Clinical Negligence Costs

NHS Resolution operates a risk pooling scheme under which the NHS clinical commissioning group pays an annual

contribution to NHS Resolution, which in return settles all clinical negligence claims. The contribution is charged to expenditure.

Although NHS Resolution is administratively responsible for all clinical negligence cases, the legal liability remains with the

NHS clinical commissioning group.

1.13

Non-Clinical Risk Pooling

The NHS clinical commissioning group participates in the Property Expenses Scheme and the Liabilities to Third Parties

Scheme. Both are risk pooling schemes under which the NHS clinical commissioning group pays an annual contribution to NHS

Resolution and, in return, receives assistance with the costs of claims arising. The annual membership contributions, and any

excesses payable in respect of particular claims, are charged to operating expenses as and when they become due.

1.14

Contingent Liabilities and Contingent Assets

A contingent liability is a possible obligation that arises from past events, and whose existence will be confirmed only by the

occurrence, or non-occurrence of one or more uncertain future events not wholly within the control of the NHS clinical

commissioning group, or a present obligation that is not recognised, because it is not probable that a payment will be required

to settle the obligation, or the amount of the obligation cannot be measured sufficiently reliably. A contingent liability is disclosed

unless the possibility of a payment is remote.

A contingent asset is a possible asset that arises from past events, and whose existence will be confirmed by the occurrence,

or non-occurrence of one or more uncertain future events not wholly within the control of the NHS clinical commissioning group.

A contingent asset is disclosed where an inflow of economic benefits is probable.

Where the time value of money is material, contingent liabilities and contingent assets are disclosed at their present value.

1.15

Financial Assets

Financial assets are recognised when the clinical commissioning group becomes party to the financial instrument contract or, in

the case of trade receivables, when the goods or services have been delivered. Financial assets are derecognised when the

contractual rights have expired or the asset has been transferred.

Financial assets are classified into the following categories:

· Financial assets at amortised cost;

· Financial assets at fair value through other comprehensive income and ;

· Financial assets at fair value through profit and loss.

The classification is determined by the cash flow and business model characteristics of the financial assets, as set out in IFRS

9, and is determined at the time of initial recognition.

1.15.1

Financial Assets at Amortised cost

Financial assets measured at amortised cost are those held within a business model whose objective is achieved by collecting

contractual cash flows and where the cash flows are solely payments of principal and interest. This includes most trade

receivables and other simple debt instruments. After initial recognition these financial assets are measured at amortised cost

using the effective interest method less any impairment. The effective interest rate is the rate that exactly discounts estimated

future cash receipts through the life of the financial asset to the gross carrying amount of the financial asset.

Page 10 of 32

NHS Mid Essex CCG - Statutory Accounts - 1-Apr-22 to 30-Jun-22

Notes to the financial statements

1.15.2

Financial Assets at Fair Value Through Other Comprehensive Income

Financial assets held at fair value through other comprehensive income are those held within a business model, whose

objective is achieved by both collecting contractual cash flows and selling financial assets, and where the cash flows are solely

payments of principal and interest.

1.15.3

Financial Assets at Fair Value Through Profit and Loss

Financial assets measure at fair value through profit and loss are those that are not otherwise measured at amortised cost or

fair value through other comprehensive income. This includes derivatives and financial assets acquired principally for the

purpose of selling in the short term.

1.16

Financial Liabilities

Financial liabilities are recognised on the statement of financial position when the NHS clinical commissioning group becomes

party to the contractual provisions of the financial instrument or, in the case of trade payables, when the goods or services have

been received. Financial liabilities are de-recognised when the liability has been discharged, that is, the liability has been paid

or has expired.

1.16.1

Other Financial Liabilities

After initial recognition, all other financial liabilities are measured at amortised cost using the effective interest method, except

for loans from Department of Health and Social Care, which are carried at historic cost. The effective interest rate is the rate

that exactly discounts estimated future cash payments through the life of the asset, to the net carrying amount of the financial

liability. Interest is recognised using the effective interest method.

1.17

Value Added Tax

Most of the activities of the NHS clinical commissioning group are outside the scope of VAT and, in general, output tax does not

apply and input tax on purchases is not recoverable. Irrecoverable VAT is charged to the relevant expenditure category or

included in the capitalised purchase cost of fixed assets. Where output tax is charged or input VAT is recoverable, the amounts

are stated net of VAT.

1.18

Foreign Currencies

The NHS clinical commissioning group’s functional currency and presentational currency is pounds sterling and amounts are

presented in thousands of pounds unless expressly stated otherwise. Transactions denominated in a foreign currency are

translated into sterling at the exchange rate ruling on the dates of the transactions. At the end of the reporting period, monetary

items denominated in foreign currencies are retranslated at the spot exchange rate on 30 June 2022. Resulting exchange gains

and losses for either of these are recognised in the NHS clinical commissioning group’s surplus in the period in which they

arise.

1.19

Critical Accounting Judgements and Key Sources of Estimation Uncertainty

In the application of the NHS clinical commissioning group's accounting policies, management is required to make various

judgements, estimates and assumptions. These are regularly reviewed.

1.19.1

Critical Accounting Judgements in Applying Accounting Policies

The following are the judgements, apart from those involving estimations, that management has made in the process of

applying the clinical commissioning group's accounting policies and that have the most significant effect on the amounts

recognised in the financial statements.

The NHS clinical Commissioning group has operated a Better Care Fund with Essex County Council during 2022-23, under a

section 75 agreement. This arrangement has been reviewed and all parties have agreed that it does not constitute a pooled

budget, as the risks of each scheme have remained with the respective commissioner. See Note 15 for furthur information.

1.19.2

Sources of Estimation Uncertainty

The following are assumptions about the future and other major sources of estimation uncertainty that have a significant risk of

resulting in a material adjustment to the carrying amounts of assets and liabilities within the next financial year.

The CCG does not consider there to be any assumptions about the future and other major sources of estimation uncertainty

that have a significant risk of resulting in a material adjustment to the carrying amounts of assets and liabilities within the next

financial year.

1.20

Adoption of New Standards

On 1 April 2022, the NHS clinical commissioning group adopted IFRS 16 ‘Leases’. The new standard introduces a single, on

statement of financial position lease accounting model for lessees and removes the distinction between operating and finance

leases.

Under IFRS 16 the NHS clinical commissioning group recognise a right-of-use asset representing the NHS clinical

commissioning group’s right to use the underlying asset, and a lease liability representing its obligation to make lease payments

for any operating leases assessed to fall under IFRS 16. There are recognition exemptions for short term leases and leases of

low value items.

In addition, the group will no longer charge provisions for operating leases that it assesses to be onerous to the statement of

comprehensive net expenditure. Instead, the group will include the payments due under the lease with any appropriate

assessment for impairments in the right-of-use asset.

Page 11 of 32

NHS Mid Essex CCG - Statutory Accounts - 1-Apr-22 to 30-Jun-22

Notes to the financial statements

1.20.1

Impact Assessment

The NHS clinical commissioning group has applied the modified retrospective approach, and recognise the cumulative effect of

adopting the standard at the date of initial application, as an adjustment to the opening retained earnings with no restatement of

comparative balances.

IFRS 16 does not require entities to reassess whether a contract is, or contains, a lease at the date of initial application. HM

Treasury has interpreted this to mandate this practical expedient and, therefore, the group has applied IFRS 16 to contracts

identified as a lease under IAS 17 or IFRIC 4 at 1 April 2022.

The NHS clinical commissioning group has utilised three further practical expedients under the transition approach adopted:

a) The election to not make an adjustment for leases for which the underlying asset is of low value.

b) The election to not make an adjustment to leases where the lease terms ends within 12 months of the date of application.

c) The election to use hindsight in determining the lease term if the contract contains options to extend or terminate the lease.

The most significant impact of the adoption of IFRS 16 has been the need to recognise right-of-use assets and lease liabilities

for any buildings previously treated as operating leases that meet the recognition criteria in IFRS 16. Expenditure on operating

leases has been replaced by interest on lease liabilities and depreciation on right-of-use assets in the statement of

comprehensive net expenditure.

As of 1 April 2022, the group recognised £221k of right-of-use assets and lease liabilities of £221k. The weighted average

incremental borrowing rate applied at 1 April 2022 is 0.95% and on adoption of IFRS 16 there was an [£Xm] impact to tax

payers’ equity.

The NHS clinical commissioning group has assessed that there is no significant impact on its current finance leases due to the

immaterial value on the statement of financial position, and no significant impact on the limited transactions it undertakes as a

lessor because IFRS 16 has not substantially changed the accounting arrangements for lessors.

The following table reconciles the group’s operating lease obligations at 31 March 2022, disclosed in the group’s 2021/22

financial statements, to the lease liabilities recognised on initial application of IFRS 16 at 1 April 2022.

Total

£000

Operating lease commitments at 31 Mar 22 1,089

Impact of discounting at 1 Apr 22 using the weighted average incremental borrowing rate of 0.95% 10

Operating lease commitments discounted used weighted average IBR 1,079

Less: Low value leases 858-

Lease liability at 1 Apr 22 221

1.21

New and revised IFRS Standards in issue but not yet effective

● IFRS 17 Insurance Contracts – Application required for accounting periods beginning on or after 1 January 21. Standard is

not yet adopted by the FReM which is expected to be April 23: early adoption is not therefore permitted.

The NHS clinical commissioning group does not anticipate any significant impact from Standards that have not yet been

adopted.

Page 12 of 32

NHS Mid Essex CCG - Statutory Accounts - 1-Apr-22 to 30-Jun-22

2 Operating Revenue

1-Apr-22 to

30-Jun-22

2021-22

Total Total

£'000 £'000

Income from sale of goods and services

Non-patient care services to other bodies

177 710

Other contract income

0 10

Total Income from sale of goods and services 177 720

Total operating income 177 720

3 Disaggregation of Income - Income from sale of good and services

Non-patient care

services to other

bodies

£'000

Source of Revenue

NHS

Non NHS

105

Total

177

Non-patient care

services to other

bodies

£'000

Timing of Revenue

Point in time

Over time

177

Total

177

Page 13 of 32

NHS Mid Essex CCG - Statutory Accounts - 1-Apr-22 to 30-Jun-22

4. Employee Benefits and Staff Numbers

4.1.1 Employee benefits / Staff costs

Permanent

employees

Other Total

£'000 £'000 £'000

Employee benefits

Salaries and wages 2,321 51 2,372

Social security costs 268 (0) 268

Employer contributions to NHS pension scheme 403 - 403

Other pension costs 13 - 13

Apprenticeship levy 8 - 8

Gross employee benefits expenditure 3,013 51 3,064

Net employee benefits 3,013 51 3,064

No Exit Packages were paid in 1-Apr-22 to 30-Jun-22 or 2021-22

4.1.1 Employee benefits / Staff costs

Permanent

employees

Other Total

£'000 £'000 £'000

Employee benefits

Salaries and wages 6,669 800 7,469

Social security costs 722 2 724

Employer contributions to NHS pension scheme 1,213 - 1,213

Other pension costs 9 - 9

Apprenticeship levy 28 - 28

Gross employee benefits expenditure

8,641 802 9,443

Net employee benefits 8,641 802 9,443

4.2 Average number of people employed (WTE)

Permanently

employed

Other Total

Number Number Number

Total number of people employed (WTE) 185.4 1.7 187.0

Permanently

employed

Other Total

Number Number Number

Total number of people employed (WTE) 136.09 7.39 143.48

1-Apr-22 to 30-Jun-22

2021-22

1-Apr-22 to 30-Jun-22

2021-22

Page 14 of 32

NHS Mid Essex CCG - Statutory Accounts - 1-Apr-22 to 30-Jun-22

4.3 Pension Costs

Past and present employees are covered by the provisions of the two NHS Pension Schemes. Details of the benefits

payable and rules of the Schemes can be found on the NHS Pensions website at www.nhsbsa.nhs.uk/pensions. Both

are unfunded defined benefit schemes that cover NHS employers, GP practices and other bodies, allowed under the

direction of the Secretary of State for Health and Social Care in England and Wales. They are not designed to be run in

a way that would enable NHS bodies to identify their share of the underlying scheme assets and liabilities. Therefore,

each scheme is accounted for as if it were a defined contribution scheme: the cost to the NHS body of participating in

each scheme is taken as equal to the contributions payable to that scheme for the accounting period.  

In order that the defined benefit obligations recognised in the financial statements do not differ materially from those that

would be determined at the reporting date by a formal actuarial valuation, the FReM requires that “the period between

formal valuations shall be four years, with approximate assessments in intervening years”. An outline of these follows:

4.3.1 Accounting valuation

A valuation of scheme liability is carried out annually by the scheme actuary (currently the Government Actuary’s

Department) as at the end of the reporting period. This utilises an actuarial assessment for the previous accounting

period in conjunction with updated membership and financial data for the current reporting period, and is accepted as

providing suitably robust figures for financial reporting purposes. The valuation of the scheme liability as at 31 March 22,

is based on valuation data as 31 March 21, updated to 31 March 22 with summary global member and accounting data.

In undertaking this actuarial assessment, the methodology prescribed in IAS 19, relevant FReM interpretations, and the

discount rate prescribed by HM Treasury have also been used.

The latest assessment of the liabilities of the scheme is contained in the report of the scheme actuary, which forms part

of the annual NHS Pension Scheme Accounts. These accounts can be viewed on the NHS Pensions website and are

published annually. Copies can also be obtained from The Stationery Office.

4.3.2 Full actuarial (funding) valuation

The purpose of this valuation is to assess the level of liability in respect of the benefits due under the schemes (taking

into account recent demographic experience), and to recommend contribution rates payable by employees and

employers.

The latest actuarial valuation undertaken for the NHS Pension Scheme was completed as at 31 March 2016. The

results of this valuation set the employer contribution rate payable from April 2019 to 20.6% of pensionable pay.

The 2016 funding valuation also tested the cost of the Scheme relative to the employer cost cap that was set following

the 2012 valuation. There was initially a pause to the cost control element of the 2016 valuations, due to the uncertainty

around member benefits caused by the discrimination ruling relating to the McCloud case.

HMT published valuation directions dated 7 October 2021 (see Amending Directions 2021) that set out the technical

detail of how the costs of remedy are included in the 2016 valuation process. Following these directions, the scheme

actuary has completed the cost control element of the 2016 valuation for the NHS Pension Scheme, which concludes no

changes to benefits or member contributions are required. The 2016 valuation reports can be found on the NHS

Pensions website at https://www.nhsbsa.nhs.uk/nhs-pension-scheme-accounts-and-valuation-reports.

Page 15 of 32

NHS Mid Essex CCG - Statutory Accounts - 1-Apr-22 to 30-Jun-22

5 Operating expenses

1-Apr-22 to 30-

Jun-22

2021-22

Total Total

£'000 £'000

Purchase of goods and services

Services from other CCGs and NHS England 620 1,686

Services from foundation trusts 132,995 605,211

Services from other NHS trusts 7,058 25,771

Services from other WGA bodies - 1

Purchase of healthcare from non-NHS bodies 21,862 152,882

Prescribing costs 13,638 58,098

General Ophthalmic services 1 8

GPMS/APMS and PCTMS 13,097 64,395

Supplies and services – clinical 7 30

Supplies and services – general (1,780) 3,836

Consultancy services 79 542

Establishment 280 836

Transport 812 2,864

Premises 191 1,368

Audit fees 71 78

Other professional fees 43 239

Legal fees 5 56

Education, training and conferences 57 25

Total purchase of goods and services 189,036 917,926

Depreciation and impairment charges

Depreciation 47 -

Total depreciation and impairment charges 47 -

Provision expense

Provisions - 973

Total provision expense - 973

Other operating expenditure

Chair and non-executive members 40 104

Grants to Other bodies 14 566

Expected credit loss on receivables 1 -

Other expenditure (0) 5

Total other operating expenditure 55 675

Total operating expenditure 189,138 919,574

There were no Losses or special payments in 1-Apr-22 to 30-Jun-22 or 2021-22

Page 16 of 32

NHS Mid Essex CCG - Statutory Accounts - 1-Apr-22 to 30-Jun-22

8 Leases

8.1 Right-of-use assets

1-Apr-22 to 30-Jun-22

Buildings

excluding

dwellings

Total

£'000 £'000

Cost/valuation at 1-Apr-22 - -

IFRS 16 transition adjustment 222 222

Cost/valuation at 30-Jun-22 222 222

Depreciation 1-Apr-22 - -

Charged during the period 47 47

Depreciation at 30-Jun-22 47 47

Net book value at 30-Jun-22 175 175

8.2 Lease liabilities

1-Apr-22 to 30-Jun-22

1-Apr-22 to

30-Jun-22

£'000

Lease liabilities at 1-Apr-22

IFRS 16 transition adjustment 221

Repayment of lease liabilities (including interest) (37)

Lease liabilities at 30-Jun-22 184

8.3 Lease liabilities - maturity analysis of undiscounted future lease payments

1-Apr-22 to

30-Jun-22

£'000

Within one year (148)

Between one and five years (37)

Balance at 30-Jun-22 (185)

Effect of discounting

(0)

Included in:

Current lease liabilities (185)

Balance at 30-Jun-22 (185)

Page 17 of 32

NHS Mid Essex CCG - Statutory Accounts - 1-Apr-22 to 30-Jun-22

6 Better Payment Practice Code

Measure of compliance

1-Apr-22 to

30-Jun-22

1-Apr-22 to

30-Jun-22

2021-22 2021-22

Number £'000 Number £'000

Non-NHS payables

Total non-NHS trade invoices paid in the period 4,068 58,672 12,247 229,306

Total non-NHS trade Invoices paid within target 4,000 57,806 11,747 222,252

Percentage of non-NHS trade invoices paid within target 98.33% 98.52% 95.92% 96.92%

NHS payables

Total NHS trade invoices paid in the period 160 110,881 668 662,643

Total NHS trade invoices paid within target 143 106,360 642 657,668

Percentage of NHS trade Invoices paid within target 89.38% 95.92% 96.11% 99.25%

7 Finance Costs

1-Apr-22 to

30-Jun-22

2021-22

£'000

Interest

Interest on lease liabilities 0 -

Total interest 0 -

Total finance costs 0 -

Page 18 of 32

NHS Mid Essex CCG - Statutory Accounts - 1-Apr-22 to 30-Jun-22

8 Leases continued

8.4 Amounts recognised in statement of comprehensive net expenditure

1-Apr-22 to

30-Jun-22

2021-22

£'000

Depreciation expense on right-of-use assets 47 -

Interest expense on lease liabilities 0 -

8.5 Amounts recognised in statement of cash flows

1-Apr-22 to

30-Jun-22

2021-22

£'000

Total cash outflow on leases under IFRS 16 (37) -

8.6 Leases narrative

We receive an annual charging schedule from NHS Property Services in relation to the costs.

The leasing activities falling under IFRS 16 relate to the administration premises at Hedgerows

Business Park, Chelmsford for the NHS clinical commissioning group.

Page 19 of 32

NHS Mid Essex CCG - Statutory Accounts - 1-Apr-22 to 30-Jun-22

9 Trade and other receivables

30-Jun-22 31-Mar-22

£'000 £'000

NHS receivables: revenue

141 191

NHS/WGA accrued income

30 739

Non-NHS and other WGA receivables:

revenue

36 380

Non-NHS and other WGA prepayments

266 255

Non-NHS and other WGA accrued income

3,365 40

VAT

590 48

Total trade & other receivables - current 4,428 1,653

9.1 Receivables past their due date but not impaired

30-Jun-22 30-Jun-22 31-Mar-22 31-Mar-22

DHSC group

bodies

Non DHSC

group bodies

DHSC group

bodies

Non DHSC

group bodies

£'000 £'000

By up to three months

124 26 18 159

By three to six months

- - 21 -

By more than six months

17 - - -

Total 141 26 39 159

Page 20 of 32

NHS Mid Essex CCG - Statutory Accounts - 1-Apr-22 to 30-Jun-22

10 Cash and cash equivalents

1-Apr-22 to

30-Jun-22

2021-22

£'000

Opening Balance (4,299) (548)

Net change in period 1,711 (3,752)

Closing Balance (2,588) (4,300)

Made up of:

Cash with the government banking service 0 -

Cash in hand - 0

Cash and cash equivalents as in Statement of Financial Position 0 0

Bank overdraft: Government Banking Service (2,588) (4,300)

Closing Balance (2,588) (4,300)

11 Trade and other payables

30-Jun-22 31-Mar-22

£'000 £'000

NHS payables: revenue 298 4,318

NHS accruals 2,724 1,650

Non-NHS and other WGA payables: revenue 2,116 2,148

Non-NHS and other WGA accruals 15,316 37,120

Non-NHS and Other WGA deferred income 38 75

Social security costs 162 149

Tax 127 132

Other payables and accruals 720 828

Total trade & other payables - current 21,501 46,420

Other payables include £335k outstanding pension contributions at 30-Jun-22 (31-Mar-22 £394k)

The NHS clinical commissioning group's cash position is reported in the financial statements as a negative

balance of £2,588k at 30 Jun 22, due to outstanding payments due to clear after year-end. As at 30 Jun 22,

the NHS clinical commissioning group had a net positive balance deposited in its Government Banking

Service bank account of £110k.

Page 21 of 32

NHS Mid Essex CCG - Statutory Accounts - 1-Apr-22 to 30-Jun-22

12 Provisions

Current Non-current Current Non-current

30-Jun-22 30-Jun-22 31-Mar-22 31-Mar-22

£'000 £'000 £'000 £'000

Restructuring 919 - 919 -

Continuing care 1,030 2,351 494 2,351

Other 144 198 155 198

Total provisions 2,093 2,549 1,568 2,549

Total current and non-current 4,642 4,117

Restructuring

Continuing

Care

Other Total

£'000 £'000 £'000 £'000

Balance at 1-Apr-22 919 2,844 354 4,117

Utilised during the period - 536 (11)

525

Balance at 30-Jun-22 919 3,380 343 4,642

Expected timing of cash flows:

Within one year 919 1,030 144

2,093

Between one and five years - 2,350 199

2,549

Balance at 30-Jun-22 919 3,380 343 4,642

Restructuring provision

CHC (Continuing Care) provision

Other provision

A restructuring provision has been calculated across all CCGs and shared proportionately to the size of each CCG. The provision

has been made as the CCGs are in the process of restructuring resources for transition. Engagement on the restructure began

during March 22, with the information available the CCG has estimated potential one-off costs which could come to bear, throughout

2022-23 as a result of decisions made during 2021-22. These costs are associated with displacement of staff, retraining or

redeployment on the basis of the new organisational form.

This provision is to cover the cost of reimbursing residents for CHC amenity top ups back to 2012 as per the national CHC guidance.

The provision has been calculated based on a full years anticipated cost extrapolated back to 2012.

This provision which covered dilapidation costs; based on 7.5% of the annual lease value, from the commencement of the lease,

has been released following the council relocating the CCG to a new part of the building, as part of changes to the council building.

Page 22 of 32

NHS Mid Essex CCG - Statutory Accounts - 1-Apr-22 to 30-Jun-22

13 Financial Instruments

13.1 Financial risk management

13.1.1 Currency risk

13.1.2 Interest rate risk

13.1.3 Credit risk

13.1.4 Liquidity risk

13.1.5 Financial Instruments

As the cash requirements of NHS England are met through the estimate process, financial instruments play a more limited role in

creating and managing risk than would apply to a non-public sector body. The majority of financial instruments relate to contracts to buy

non-financial items in line with NHS England's expected purchase and usage requirements and NHS England is therefore exposed to

little credit, liquidity or market risk.

The NHS clinical commissioning group borrows from government for capital expenditure, subject to affordability as confirmed by NHS

England. The borrowings are for 1 to 25 years, in line with the life of the associated assets, and interest is charged at the National Loans

Fund rate, fixed for the life of the loan. The clinical commissioning group therefore has low exposure to interest rate fluctuations.

Because the majority of the NHS clinical commissioning group and revenue comes parliamentary funding, NHS clinical commissioning

group has low exposure to credit risk. The maximum exposures as at the end of the financial year are in receivables from customers, as

disclosed in the trade and other receivables note.

NHS clinical commissioning group is required to operate within revenue and capital resource limits, which are financed from resources

voted annually by Parliament. The NHS clinical commissioning group draws down cash to cover expenditure, as the need arises. The

NHS clinical commissioning group is not, therefore, exposed to significant liquidity risks.

Financial reporting standard IFRS 7 requires disclosure of the role that financial instruments have had during the period in creating or

changing the risks a body faces in undertaking its activities.

Because NHS clinical commissioning group is financed through parliamentary funding, it is not exposed to the degree of financial risk

faced by business entities. Also, financial instruments play a much more limited role in creating or changing risk than would be typical of

listed companies, to which the financial reporting standards mainly apply. The clinical commissioning group has limited powers to borrow

or invest surplus funds and financial assets and liabilities are generated by day-to-day operational activities rather than being held to

change the risks facing the clinical commissioning group in undertaking its activities.

Treasury management operations are carried out by the finance department, within parameters defined formally within the NHS clinical

commissioning group standing financial instructions and policies agreed by the governing body. Treasury activity is subject to review by

the NHS clinical commissioning group and internal auditors.

The NHS clinical commissioning group is principally a domestic organisation with the great majority of transactions, assets and liabilities

being in the UK and sterling based. The NHS clinical commissioning group has no overseas operations. The NHS clinical commissioning

group and therefore has low exposure to currency rate fluctuations.

Page 23 of 32

NHS Mid Essex CCG - Statutory Accounts - 1-Apr-22 to 30-Jun-22

13 Financial instruments continued.

13.2 Financial assets

Financial assets

measured at

amortised cost

Total

30-Jun-22 30-Jun-22

£'000 £'000

Trade and other receivables with NHSE bodies 154 154

Trade and other receivables with other DHSC / WGA group bodies 3,382 3,382

Trade and other receivables with external bodies 36 36

Cash and cash equivalents 0 0

Total at 30-Jun-22 3,572 3,572

13.3 Financial liabilities

Financial liabilities

measured at

amortised cost

Total

30-Jun-22 30-Jun-22

£'000

Loans with external bodies 2,588

2,588

Trade and other payables with NHSE bodies 100

100

Trade and other payables with other DHSC group bodies 3,308

3,308

Trade and other payables with external bodies (Incl. IFRS 16 Lease Liability). 17,950

17,950

Total at 30-Jun-22 23,946 23,946

Page 24 of 32

NHS Mid Essex CCG - Statutory Accounts - 1-Apr-22 to 30-Jun-22

14 Operating Segments

15 Joint Arrangements - Interests in Joint Operations

1-Apr-22 to

30-Jun-22

2021-22

£'000 £'000

Income 6,722 26,888

Expenditure (6,722) (26,888)

There are five NHS clinical commissioning group (CCGs), within Essex Better Care Fund:

NHS Basildon and Brentwood Clinical Commissioning Group (BBCCG)

NHS Castle Point and Rochford Clinical Commissioning Group (CPRCCG)

NHS Mid Essex Clinical Commissioning Group (MECCG)

NHS North East Essex Clinical Commissioning Group (NECCG)

NHS West Essex Clinical Commissioning Group (WECCG)

The NHS clinical commissioning group has only one segment, commissioning of healthcare services (2021-22 one

segment).

The s75 agreement sets out the terms on which the partners have agreed to collaborate and to establish a framework

through which the partners can secure the future position of health and social care services through lead

commissioning arrangements. It is also the means through which the partners pool funds and align budgets as agreed

between the partners.

The Essex Better Care Fund therefore comprises five pooled funds (i.e. one for each CCG), each governed by a

Section 75 Agreement, with an overarching collaboration agreement signed by Essex County Council and each of the

CCGs.

The NHS clinical commissioning group shares of the income and expenditure handled by the Better Care Fund in the

financial period were:

Page 25 of 32

NHS Mid Essex CCG - Statutory Accounts - 1-Apr-22 to 30-Jun-22

16 Related Party Transactions

Details of related party transactions are as follows:

Payments

to Related

Party

Receipts

from

Party

Amounts

owed to

Party

Amounts

due from

Party

£'000 £'000 £'000 £'000

Part one - Transactions with board members and those with significant influence over the CCG

Part two - Transactions in relation to interests declared by Governing Board Members

Nursing for NHS Thurrock CCG - Rachel Hearn (Executive Director of Nursing), Anthony

McKeever (Joint Accountable Officer), Mark Barker (Joint Chief Finance Officer)

18 - - -

Dr Julie McGeachy (GP Board Member) - spouse is employed as Chief Medical Officer at

Provide

9,742 - 994 -

Part Three - Transactions in relation to practices where the GP has served during the period of the Governing Body

Dr Julie McGeachy (GP Board Member) - a GP partner at Dengie Medical Partnership 429 - 26 -

Dr Fatai Salau (GP Board Member) - Douglas Grove Surgery partner 459 - 28 -

Dr Anna Davey (Chair of Mid Essex CCG and Partner at Coggeshall Surgery) 467 - 33 -

Part Four - Material transactions in relation to Department of Health and Social Care Bodies

Cambridge University Hospitals NHS Foundation Trust

East of England Ambulance Service NHS Trust

East Suffolk and North Essex NHS Foundation Trust

Essex Partnership University NHS Foundation Trust

Hertfordshire Partnership University NHS Foundation Trust

Mid and South Essex NHS Foundation Trust

NHS Arden & GEM Commissioning Support Unit

NHS Business Services Authority

North East London NHS Foundation Trust

Princess Alexandra Hospital NHS Trust

Specialist acute London hospitals

Part Five - Department of Health and Social Care

The individuals and entities that the Department of Health and Social Care identifies as meeting the definition of Related Parties set out in IAS 24

(Related Party Transactions) are also deemed to be related parties of entities within the Departmental Group. We have reviewed the list of individuals

and entities and the CCG does not have any material disclosable transaction with any of the entities.

In addition, the NHS clinical commissioning group has had a number of material transactions with other government departments and other central

and local government bodies. Most of these transactions have been with Essex County Council (ECC).

Transactions with the chair, chief executive or members of the board of directors are shown in the remuneration report.

There are no other individuals who are considered to meet the definition of related parties under IAS24 as interpreted by the GAM 2022-23.

The Department of Health and Social Care is regarded as a related party. During the period the NHS clinical commissioning group has had a

significant number of material transactions with entities for which the Department is regarded as the parent Department:

The NHS clinical commissioning group has had a number of joint working arrangements and transactions with Essex clinical commissioning groups

such as Basildon and Brentwood CCG, Castle Point and Rochford CCG, Thurrock CCG, Southend CCG, North East Essex CCG and West Essex

CCG.

Page 26 of 32

NHS Mid Essex CCG - Statutory Accounts - 1-Apr-22 to 30-Jun-22

17 Events After the End of the Reporting Period

18 Financial Performance Targets

NHS clinical commissioning group have a number of financial duties under the NHS Act 2006 (as amended).

NHS clinical commissioning group performance against those duties was as follows:

1-Apr-22 to

30-Jun-22

1-Apr-22 to 30-

Jun-22

1-Apr-22 to

30-Jun-22

Target Performance Duty

£'000 £'000 achieved?

Expenditure not to exceed income 192,203 192,202 Yes

Revenue resource use does not exceed the amount specified in

Directions

192,026 192,025 Yes

Revenue administration resource use does not exceed the amount

specified in Directions

924 923 Yes

2021-22 2021-22 2021-22

Target Performance Duty

£'000 £'000 achieved?

Expenditure not to exceed income 929,272 929,017 Yes

Revenue resource use does not exceed the amount specified in

Directions

928,552 928,297 Yes

Revenue administration resource use does not exceed the amount

specified in Directions

7,808 7,789 Yes

The Health and Care Bill, as approved by Parliament on 28 April 22, approved the formation of Integrated Care

Boards and for them to take over the functions of Clinical Commissioning Groups. As a result, NHS Mid Essex CCG

dissolved on 30 June 22 and the Mid and South Essex Integrated Health and Care Board was formed from the

following day. In line with the provisions of the Group Accounting Manual the assets and liabilities of the CCG

transfered to the newly formed Integrated Care Board at book value. Further details are provided in the annual report

and in the accounting policies.

Page 27 of 32

INDEPENDENT AUDITOR’S REPORT TO THE MEMBERS OF THE

BOARD OF NHS MID & SOUTH ESSEX INTEGRATED CARE BOARD IN

RESPECT OF NHS MID ESSEX CLINICAL COMMISSIONING GROUP

REPORT ON THE AUDIT OF THE FINANCIAL STATEMENTS

Opinion

We have audited the financial statements of NHS Mid Essex Clinical Commissioning Group

(“the CCG”) for the three month period ended 30 June 2022 which comprise the Statement of

Comprehensive Net Expenditure, Statement of Financial Position, Statement of Changes in

Taxpayers’ Equity and Statement of Cash Flows, and the related notes, including the

accounting policies in note 1.

In our opinion the financial statements:

• give a true and fair view of the state of the CCG’s affairs as at 30 June 2022 and of its

income and expenditure for the three month period then ended; and

• have been properly prepared in accordance with the accounting policies directed by NHS

England with the consent of the Secretary of State on 22 June 2022 as being relevant to

CCGs in England and included in the Department of Health and Social Care Group

Accounting Manual 2022/23; and

• have been prepared in accordance with the requirements of the National Health Service

Act 2006 (as amended).

Basis for opinion

We conducted our audit in accordance with International Standards on Auditing (UK) (“ISAs

(UK)”) and applicable law. Our responsibilities are described below. We have fulfilled our

ethical responsibilities under and are independent of the CCG and NHS Mid & South Essex

Integrated Care Board (“the ICB”) in accordance with, UK ethical requirements including the

FRC Ethical Standard. We believe that the audit evidence we have obtained is a sufficient

and appropriate basis for our opinion.

Emphasis of matter – going concern

We draw attention to the disclosure made in note 1.1 to the financial statements which

explains that on 1 July 2022, NHS Mid Essex CCG was dissolved, and its services

transferred to NHS

Mid & South Essex Integrated Care Board. Under the continuation of

service principle the financial statements of the CCG have been prepared on a going concern

basis because its services will continue to be provided by the successor public sector entity.

Our opinion is not modified in respect of this matter.

Going concern

The Accountable Officer of the ICB (“the Accountable Officer”) has prepared the financial

statements on the going concern basis as the CCG has been dissolved and its services

transferred to another public sector entity, the ICB, and the Accountable Officer has not been

informed by the relevant national body of the intention to cease the services previously

provided by the CCG. They have also concluded that there are no material uncertainties that

could have cast significant doubt over its ability to continue as a going concern for at least a

year from the date of approval of the financial statements (“the going concern period”).

In our evaluation of the Accountable Officer’s conclusions, we considered the inherent risks

associated with the continuity of services provided by the CCG and transferred to the ICB

over the going concern period.

Our conclusions based on this work:

• we consider that the Accountable Officer’s use of the going concern basis of accounting

in the preparation of the financial statements is appropriate; and

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• we have not identified and concur with the Accountable Officer’s assessment that there is

not, a material uncertainty related to events or conditions that, individually or collectively,

may cast significant doubt on the CCG’s ability to continue as a going concern for the

going concern period.

However, as we cannot predict all future events or conditions and as subsequent events may

result in outcomes that are inconsistent with judgements that were reasonable at the time

they were made, the above conclusions are not a guarantee that the services provided by the

CCG will continue to be provided by the successor body.

Fraud a

nd breaches of laws and regulations – ability to detect

Identifying and responding to risks of material misstatement due to fraud

To identify risks of material misstatement due to fraud (“fraud risks”) we assessed events or

conditions that could indicate an incentive or pressure to commit fraud or provide an

opportunity to commit fraud. Our risk assessment procedures included:

• Enquiring of management, the Audit Committee of the successor ICB and internal audit

as to the CCG’s high-level policies and procedures to prevent and detect fraud, including

the internal audit function, , as well as whether they have knowledge of any actual,

suspected or alleged fraud.

• Reading Governing Body and Audit Committee minutes of the CCG.

• Using analytical procedures to identify any unusual or unexpected relationships.

We communicated identified fraud risks throughout the audit team and remained alert to any

indications of fraud throughout the audit.

As required by auditing standards, we performed procedures to address the risk of

management override of controls, in particular the risk that CCG management may be in a

position to make inappropriate accounting entries.

On this audit we did not identify a fraud risk related to revenue recognition because of the

nature of funding provided to the CCG, which is transferred from NHS England and

recognised through the Statement of Changes in Taxpayers’ Equity.

We did not i

dentify any additional fraud risks.

We performed procedures including:

• Identifying journal entries and other adjustments to test based on risk criteria and

comparing the identified entries to supporting documentation. These included unusual

doubl

e entries where one side included either Cash & Borrowings, or Revenue

Ident

ifying and responding to risks of material misstatement related to compliance with laws

and regulations

We identified areas of laws and regulations that could reasonably be expected to have a

material effect on the financial statements from our general sector experience and through

discussion with the Board of the CCG and ICB (as required by auditing standards), and from

inspection of the CCG’s regulatory and legal correspondence and discussed with the directors

and other management the policies and procedures regarding compliance with laws and

regulations.

We communic

ated identified laws and regulations throughout our team and remained alert to

any indications of non-compliance throughout the audit.

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The potential effect of these laws and regulations on the financial statements varies

considerably.

First

ly, the CCG is subject to laws and regulations that directly affect the financial statements

including the financial reporting aspects of NHS legislation We assessed the extent of

compliance with these laws and regulations as part of our procedures on the related financial

statement items.

Secondly, the CCG is subject to many other laws and regulations where the consequences of

non-compliance could have a material effect on amounts or disclosures in the financial

statements, for instance through the imposition of fines or litigation. We identified the

following areas as those most likely to have such an effect: health and safety, data protection

laws, anti-bribery, employment law recognising the regulated nature of the CCG’s activities.

Auditing standards limit the required audit procedures to identify non-compliance with these

laws and regulations to enquiry of the directors and inspection of regulatory and legal

correspondence, if any.

Therefore, if a breach of operational regulations is not disclosed to us

or evident from relevant correspondence, an audit will not detect that breach.

Context

of the ability of the audit to detect fraud or breaches of law or regulation

Owing to the inherent limitations of an audit, there is an unavoidable risk that we may not

have detected some material misstatements in the financial statements, even though we have

properly planned and performed our audit in accordance with auditing standards. For

example, the further removed non-compliance with laws and regulations is from the events

and transactions reflected in the financial statements, the less likely the inherently limited

procedures required by auditing standards would identify it.

In addition, as with any audit, there remained a higher risk of non-detection of fraud, as these

may involve collusion, forgery, intentional omissions, misrepresentations, or the override of

internal controls. Our audit procedures are designed to detect material misstatement. We are

not responsible for preventing non-compliance or fraud and cannot be expected to detect

non-compliance with all laws and regulations.

Other information in the Annual Report

The Accountable Officer is responsible for the other information, which comprises the

information included in the Annual Report, other than the financial statements and our

auditor’s report thereon. Our opinion on the financial statements does not cover the other

information and, accordingly, we do not express an audit opinion or, except as explicitly

stated below, any form of assurance conclusion thereon.

Our responsibility is to read the other information and, in doing so, consider whether, based

on our financial statements audit work, the information therein is materially misstated or

inconsistent with the financial statements or our audit knowledge. Based solely on that work:

• we have not identified material misstatements in the other information; and

• in our opinion the other information included in the Annual Report for the financial year is

consistent with the financial statements.

Annual Governance Statement

We are r

equired by the Code of Audit Practice published by the National Audit Office in April

2020 on behalf of the Comptroller and Auditor General (the “Code of Audit Practice”) to report

to you if the Annual Governance Statement has not been prepared in accordance with the

requirements of the Department of Health and Social Care Group Accounting Manual

2022/23. We have nothing to report in this respect.

Remuneration and Staff Reports

In our opinion the parts of the Remuneration and Staff Reports subject to audit have been

properly prepared, in all material respects, in accordance with the Department of Health and

Social Care Group Accounting Manual 2022/23.

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Accountable Officer’s responsibilities

As explained more fully in the statement set out on page 36, the Accountable Officer of the

ICB is responsible for the preparation of financial statements that give a true and fair view.

They are also responsible for such internal control as they determine is necessary to enable

the preparation of financial statements that are free from material misstatement, whether due

to fraud or error; assessing the CCG’s ability to continue as a going concern, disclosing, as

applicable, matters related to going concern; and using the going concern basis of accounting

unless they have been informed by the relevant national body of the intention to either cease

the services provided by the CCG or dissolve the CCG without the transfer of its services to

another public sector entity.

Auditor’s responsibilities

Our objectives are to obtain reasonable assurance about whether the financial statements as

a whole are free from material misstatement, whether due to fraud or error, and to issue our

opinion in an auditor’s report. Reasonable assurance is a high level of assurance, but does

not guarantee that an audit conducted in accordance with ISAs (UK) will always detect a

material misstatement when it exists. Misstatements can arise from fraud or error and are

considered material if, individually or in aggregate, they could reasonably be expected to

influence the economic decisions of users taken on the basis of the financial statements.

A fuller description of our responsibilities is provided on the FRC’s website at

www.frc.org.uk/auditorsresponsibilities

REPORT ON OTHER LEGAL AND REGULATORY MATTERS

Opinion on regularity

We are required to report on the following matters under Section 21(4) and (5) of the Local

Audit and Accountability Act 2014.

In our opinion, in all material respects, the expenditure and income recorded in the financial

statements have been applied to the purposes intended by Parliament and the financial

transactions conform to the authorities which govern them.

Report on the CCG’s arrangements for securing economy, efficiency and effectiveness

in its use of resources

Under the Code of Audit Practice, we are required to report if we identify any significant

weaknesses in the arrangements that have been made by the CCG to secure economy,

efficiency and effectiveness in its use of resources.

We have nothing to report in this respect.

Respective responsibilities in respect of our review of arrangements for securing

economy, efficiency and effectiveness in the use of resources

As explained more fully in the statement set out on page 36, the Accountable Officer is

responsible for ensuring that the CCG exercises its functions effectively, efficiently and

economically. We are required under section 21(1)(c) of the Local Audit and Accountability

Act 2014 to be satisfied that the CCG has made proper arrangements for securing economy,

efficiency and effectiveness in its use of resources.

We are not required to consider, nor have we considered, whether all aspects of the CCG’s

arrangements for securing economy, efficiency and effectiveness in the use of resources are

operating effectively.

We planned our work and undertook our review in accordance with the Code of Audit Practice

and related statutory guidance, having regard to whether the CCG had proper arrangements

in place to ensure financial sustainability, proper governance and to use information about

costs and performance to improve the way it manages and delivers its services. Based on our

risk assessment, we undertook such work as we considered necessary.

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Statutory reporting matters

We are required by Schedule 2 to the Code of Audit Practice to report to you if we refer a

matter to the Secretary of State and NHS England under section 30 of the Local Audit and

Accountability Act 2014 because we have reason to believe that the CCG, or an officer of the

CCG, is about to make, or has made, a decision which involves or would involve the body

incurring unlawful expenditure, or is about to take, or has begun to take a course of action

which, if followed to its conclusion, would be unlawful and likely to cause a loss or deficiency.

We have nothing to report in this respect.

THE PURPOSE OF OUR AUDIT WORK AND TO WHOM WE OWE OUR

RESPONSIBILITIES

This report is made solely to the Members of the Board of NHS Mid and South Essex

Integrated Care Board in respect of NHS Mid Essex CCG, as a body, in accordance with Part

5 of the Local Audit and Accountability Act 2014. Our audit work has been undertaken so

that we might state to the Members of the Board of the ICB, as a body, those matters we are

required to state to them in an auditor’s report and for no other purpose. To the fullest extent

permitted by law, we do not accept or assume responsibility to anyone other than the

Members of the Board of the ICB, as a body, for our audit work, for this report or for the

opinions we have formed.

CERTIFICATE OF COMPLETION OF THE AUDIT

We certify that we have completed the audit of the accounts of NHS Mid Essex CCG for the

three month period ended 30 June 2022 in accordance with the requirements of the Local

Audit and Accountability Act 2014 and the Code of Audit Practice.

Emma Larcombe

for and on behalf of KPMG LLP

Chartered Accountants

Dragonfly House

2 Gilders Way

Norwich

NR3 1UB

28 June 2023

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