Ealing CCG Annual Report 2013/14

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Ealing CCG

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Foreword

We are focused on improving health and on improving health services.

Our first year as a fully authorised clinical commissioning group (CCG) has been one of

development and change. We want to build on the achievements of Ealing Primary Care Trust and also move to develop our identity, vision and way of working. We were determined to keep our focus on improving health outcomes and on improving health services. We have made some good progress in delivering our commissioning intentions that we set out to achieve in 2013/14. Along with our CCG partners across North West London we have made major progress in our ambitious programme to transform and modernise health services across the region.

CCGs are new organisations. In 2012/13 we started to develop in shadow form. We had to create our organisation from scratch, elect our GP members to our governing body and recruit our lay members. We had to develop all our policies and plans and prove to NHS England that we were up to the task of commissioning, monitoring high quality services on behalf of local people and making sure that providers were delivering to the right clinical standards. We were successful: on 1 April 2013 we were authorised with no conditions and became a statutory organisation

shouldering all our roles and responsibilities. This was a tremendous achievement of which all those involved should be rightly proud.

This annual report says who we are, what we do and what we have delivered for local people this year. Of equal importance is what we intend to do in the future. The annual report details what we want to do over the next one and two years and also what strategically we wish to deliver at the end of five years through the Shaping a Healthier Future programme.

We aspire to deliver healthcare using the ‘right care, right time, right place’ approach, which underpins our out of hospital strategy. We believe that the right care should be provided at the right care setting for the individual and the quality of the care should be maintained irrespective of the care setting. There are times when we use hospitals to provide care for patients when that care could be provided closer to their home and in the community. Developing the right care delivered to the right quality standards outside hospital is a key part of how we will continue to maintain the provision of quality and cost effective care for the residents of Ealing.

Our vision is to ensure that our health care system keeps patients well at home and, when patients do become unwell, provides cost-effective, evidence-based and timely care at the place most appropriate to their needs. As demand rises with increasing health needs and the

development of new treatments, we need to respond to these challenges while still delivering the highest quality of care.

A key element to our future plans is the integration of health and social care and we are working with Ealing Council and our partners in the NHS to deliver this. We have developed excellent relationships with Healthwatch and with our colleagues in the local authority and have extended social services to cover weekends and evenings to provide emergency packages of care to prevent people going into hospital and to support people who need to be discharged.

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You will see that this year we have had some successes. A major achievement this year has been the approval of the Shaping a Healthier Future plans by the Secretary of State. This followed a detailed review by the Independent Reconfiguration Panel which concluded that the “programme provides the way forward for the future and that the proposals for change will enable the

provision of safe, sustainable and accessible services.”

We recognise that there is some strong local opposition to these plans, but the changes put forward by clinicians have always been about putting patients first. The improvements are needed to modernise the delivery of health care, fit for the 21st century, to deliver much needed care at home and in the community and to concentrate specialised services to provide higher quality teams.

We started the year working as part of the Brent, Ealing, Harrow and Hillingdon federation of CCGs, but on 1 December 2013, we joined Central London, West London, Hammersmith and Fulham and Hounslow CCGs to form the CWHHE Collaborative.

Ealing sits in the middle of North West London and our patients currently use all the acute hospitals in the area. As we implement Shaping a Healthier Future, our patient flows will alter, with the majority using acute providers in the areas covered by Central London, West London, Hammersmith and Fulham and Hounslow CCGs. We felt that we could best fulfil our

responsibilities to commission care for our patients if we were part of the CWHHE collaborative, which best reflects the future of our patient flows. It also felt right as we commission care from the same mental health provider as Hammersmith and Fulham and Hounslow CCGs.

We take pride in the high level of public engagement that our CCG carries out. During our first operational year, we regularly scrutinised patient and public feedback and considered how this information should shape its commissioning intentions. You can find out more about how we engaged with local people over the last year on page 20.

We would like to end by paying tribute to and thanking all those who have worked so hard to provide a high level of services to patients in the past year. So often you only hear about the poor care that someone received or the fact that they could not get the care that they wanted when they wanted it. The reality is that our GP practices, hospitals, community and mental health services see thousands of patients every day and successfully provide them with excellent treatment and care in difficult circumstances.

That is not to say that we should not seek to improve services and the care that patients receive. It is the job of the CCG to help deliver this and in the year ahead we will be dedicating ourselves to achieving this.

Dr Mohini Parmar, Chair, Ealing CCG Daniel Elkeles,

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Member practice introduction

The member practices of Ealing Clinical Commissioning Group have worked closely with our governing body over the course of the year to improve the services provided to our patients in the borough.

Throughout 2013/14, we have worked hard to transform the health system itself – how the different parts of the NHS in North West London work together, and integrate these services better with the social care services provided by our partner organisations. We have started to implement our out of hospital strategy and the Shaping a Healthier Future Programme, working with patients and providers to transform a number of individual care pathways, so that more services are provided in a community setting, making it easier for patients to access them and receive the care they need. More information about this can be found later in this annual report. Having direct contact with patients means we can ensure that the feedback we hear can directly influence the decisions made by the CCG. This means we can commission services for the

residents of Ealing that better meet their needs, and provide support and care at an early stage to avoid them getting seriously ill. This has also been an important factor as we undertook contract negotiations with providers. Another important driver for us is to ensure that services are provided as efficiently as possible, so that we make best use of our financial resources. There are 79 GP practices in Ealing, organised into seven networks which are arranged on a geographical basis across the borough. We regularly meet as GP commissioners in our networks to collectively commission new services and share best practice. This has been particularly important as new care pathways for patients have been introduced, and for sharing ideas on how best we can manage our budgets.

Ealing CCG also holds a regular Council of Members meeting, which is attended by all 79 GP practices, where we discuss progress against commissioning intentions; agree issues relating to our constitutional obligations and discuss any areas of common concern.

Evaluation of how we work together is very important, so that collectively we make decisions that will result in better health outcomes for our patients. For example, the 360 degree stakeholder survey commissioned by NHS England will provide us with useful insights into how we can work better both as an organisation and with our provider organisations to commission and manage services for our patients.

This has been our first year of operation as the body responsible for commissioning health services for residents in Ealing. Having GPs working together with patients, providers and our neighbouring CCGs in North West London has enabled us to make significant progress towards our vision of providing high quality, modern, sustainable, needs-led and cost effective care within our financial budget.

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Strategic report

Who we are and what we do

NHS Ealing Clinical Commissioning Group (CCG) is the GP-led organisation responsible for planning and buying (commissioning) health services for the people living in the borough of Ealing.

Established on 1 April 2013, our vision is to develop, commission and deliver high-quality, cost-effective clinical services for the local population through patient-centred commissioning and by working in partnership. Ealing CCG is made up of 79 GP member practices that serve a registered patient population of 338,000. We are committed to improving the care provided to patients, reducing health inequalities and raising the quality and standards of GP practices whilst achieving a financial balance.

How the CCG works

CCGs put local GP clinicians at the heart of deciding what health services local people need and receive so it is important to understand how they work. The governing body is made up of GP members who work in local practices. GP practices elect the GP representatives and those representatives elect the Chair. Other representatives on the governing body include a practice nurse, practice manager, lay members and CCG officers. You can find out more about the

governing body representatives on page 44. It is the governing body that oversees the day to day running of the CCG, supported by an administrative office. You can find out more about the CCG and how it works at www.ealingccg.nhs.uk.

We work with clinicians, patients and carers to make sure your health and social care services are effective and coordinated. With an annual budget of £426million we buy a range of services including:

 Planned surgery (elective hospital care)

 Rehabilitation care

 Urgent care and emergency care

 Most community health services

 Mental health and learning disability services

Our aim is to ensure the highest quality of care is delivered by those organisations best qualified to do so for the diverse needs of our patients, carers and the public, and at the best value for money so that we spend public money wisely.

Working in partnership

At Ealing CCG we work in a partnership with neighbouring clinical commissioning groups. This partnership includes Central London CCG, West London CCG, Hammersmith and Fulham CCG and Hounslow CCG.

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Working in a collaborative means we have a stronger influence, which leads to better outcomes for our patients. It also allows us to provide greater scrutiny and influence on any decision that affects our area.

Improving patient safety and the quality of services at our hospitals and other providers are just two areas where we have more impact when we work together. For example, we have a collaborative safeguarding team which works across all five CCG areas to protect children and other vulnerable patients.

Alongside Ealing CCG’s dedicated team, we also share a larger collaborative team, which includes our chief officer, Daniel Elkeles, and our chief financial officer, Clare Parker. The collaborative is not an organisation or legal entity; the individual CCGs are the statutory organisations responsible for commissioning healthcare in their areas.

We also work closely with Brent, Harrow and Hillingdon CCGs, on areas that affect all eight CCGs in North West London, such as the Shaping a Healthier Future programme and the associated

implementation work. The eight CCGs in North West London have appointed Thirza Sawtell as the director of strategy to help us work together on those important strategic projects such as Shaping a Healthier Future to ensure the work we do is fully coordinated and aligned.

We work in partnership with a wide range of organisations to ensure that Ealing residents receive the health and social care services that they need. These organisations include:

 Ealing Council

 Ealing Hospital

 Ealing Integrated Care Organisation (ICO)

 Voluntary/community organisations

 London Borough of Ealing

Of crucial importance is the Ealing health and wellbeing board which we sit on. The board was established as part of the Government's changes to the health and social care system and became a statutory committee on 1 April 2013. It is made up of local authority, NHS and voluntary sector representatives. It is the place for key partners to work together to improve the health and wellbeing of our population. This new partnership drives innovation around the chosen priority areas of the health and wellbeing strategy. More details of the priority areas can be found in the ‘our performance section’ of this report.

From 1 April 2013, Ealing Council was given a new duty to improve the health of people in Ealing. The single public health team that was previously based in Ealing Primary Care Trust moved over to the local authority. However, we continue to work closely with them on health and wellbeing issues and call on their expertise when needed. Public Health England is the overseeing body that has a duty to reduce national health inequalities and improve the nation’s health and wellbeing.

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Principal risks and uncertainties

The CCG has assessed its principal risks and uncertainties. A workshop was carried out and the outcomes formed the basis of the board assurance framework. This document sets out the principal risks to delivering the strategic objectives. Risks are scored according to the 5x5 matrix described in the risk management strategy and policy.

The highest scoring risks for Ealing CCG as at March 2014 were:

 Capacity of local primary care to support delivery of CCG's Commissioning Strategy;

 Risk to patients of Ealing Maternity Services if activity drops below a safe and sustainable level;

 Reliance on interims and changing personnel. Significant issues around performance of service specification;

 Member practices find it increasingly difficult to separate their commissioning and provider functions; and

 Process to establish effective working networks (x 7) in Ealing is not embraced by member practices.

For each risk, controls were implemented and assurances were received by the governing body as to the effectiveness of the controls.

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About the borough

Ealing has the third largest resident population in London with a population of 338,000 (2011 Census). The borough’s Joint Strategic Needs Assessment (JSNA) states that this is expected to increase to 372,000 by 2020, with most of the increase due to a 14.8% rise in the number of people between 0 and 14 years old. There will be a 19. 5% rise in the numbers of over 65 years of age, whereas the number of over 85s is expected to rise by 48%.

The population registered with Ealing GPs is in the region of 380,000, reflecting the fact that many patients who live in neighbouring boroughs may choose to have a GP in Ealing.

According to the Greater London Authority’s 2010-round ethnic group population projections, black and minority ethnic (BME) communities, including individuals of mixed ethnicity, make 46% of the Ealing’s total population in 2012. This compares to approximately 35% of Greater London’s population.

Ealing is considered to be a relatively prosperous London borough. It has an overall employment rate of 70%, which is slightly higher than the London average. However, Ealing also has areas of concentrated worklessness, with significant income inequalities.

Ealing has a number of specific health challenges. The main causes of death in the borough are cardiovascular disease (31% of all deaths), cancers (30%) and respiratory disease (14%). There are high rates of emergency admissions for heart attacks, strokes, and mental health problems and a high prevalence of diabetes at 20,000 diagnosed patients, with this figure set to double in the next ten years.

In Ealing, 22.2% of year 6 children are classified as obese, which is significantly worse than the England average of 19.2%. In Ealing it is estimated that treating diseases related to overweight and obesity will cost the NHS in the region of £98.8 million by 2015.

At present, access to care and the quality of care are variable across the borough. For example, too often our care is fragmented and we have an over-reliance on hospital care. Many hospital admissions could be prevented or treated in a community setting that is better for patients. People can end up staying in hospital longer than they need or wish to, due to a lack of adequate supported discharge. We need to have more planned care and earlier interventions outside of hospital, and access to and quality of care that people receive can be variable.

Developing and investing in out of hospital care will help us meet the changing requirements of Ealing’s population and enable them to access the care they need in the most appropriate setting.

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The year in focus

This has been a year of change and improvement. Our focus has been on developing ourselves as an organisation, delivering real and immediate service improvements for local residents and putting in place the building blocks needed to deliver substantial improvement and change over the next five years.

We have made good progress in delivering our out of hospital strategy, ‘Better Care, Closer to Home’, which aims to deliver care as close to home as possible. Our out of hospital initiatives will be inclusive, which we will achieve by involving patients and the public in our proposals;

integrated, working with all our stakeholders in primary care, community services, social care, nursing homes and voluntary groups; and sustainable.

Our out of hospital strategy underpins the delivery of the Shaping a Healthier Future programme, so the Secretary of State’s approval of the plans in October 2012, following an independent review by the Independent Reconfiguration Panel, was a significant achievement.

Under the proposals, Ealing Hospital will become a local hospital with a 24/7 A&E and will provide immediate access to specialist consultant opinion, a wide range of diagnostic services and the ability to admit people for assessment, treatment and rehabilitation.

In the past year we have been and working through the various challenges and issues posed and with our hospital partners developing the business plans which will lead to fundamental changes to hospital services in the years ahead. We are committed to engaging with our patients as these plans are developed and the changes are implemented.

Care for nursing home residents

This year, Ealing CCG commissioned a new service for nursing home residents. This service is an enhanced primary care service offering proactive case management, seven days a week from 8am to 8pm.

Ealing commissioned this service to respond to the growing level of complexity and associated need of patients living in nursing homes. The analysis of emergency admissions to Accident and Emergency departments from patients living in nursing homes revealed that many of these could have been avoided had an enhanced level of primary care been available.

The Argyle Care Home Service is in the process of making contact with local nursing homes and other stakeholders as part of the mobilisation of The Argyle Care Home Service.

Since going live in July 2013 more than 800 nursing home residents have chosen to register with this scheme.

Improving Diabetes Care

Diabetic patients can now access clinics close to home and no longer have to go to the hospital for their outpatient treatment.

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We established six community clinics, which are fully operational across the borough, and supported the development of the workforce to ensure these clinics are run by a combination of hospital and community clinical staff. To date, 244 patients have been seen in the new community clinics.

Patient education and self-management programmes for type 2 diabetic patients have been established and well received by patients.

A new single point of access process for diabetes referrals to see a clinician has been established and shared with providers.

Pulmonary rehabilitation service

Our pulmonary rehabilitation service, provided by Ealing ICO, has been in operation for over a year now. In its first year of operation, over 400 patients with lung disease have been helped by the new Pulmonary Rehabilitation Service. People with lung disease often have difficulties breathing, and frequent chest infections resulting in frequent unplanned hospital admissions. Pulmonary Rehabilitation is a 6 week programme of exercise, education about COPD and its causes plus advice on how to manage the condition at home. At the end of the programme over 75% of patients have shown a measurable physical improvement and patient feedback is very positive. Investing in additional winter services

Ealing CCG has overseen an Investment of over £400k in Primary Care Services to strengthen our local system for the busy winter periods, including extended hours for additional GP appointments and duty clinicians to allow earlier home visits if required.

Over £1m was also invested in creating 25 extra community general short term rehabilitation beds on the Jasmin Ward at Claypond’s Hospital. The service provides patients with the intensive support they need to get them back on their feet so they can leave hospital and return home. We have worked with Ealing Council to extend seven day social services working to cover weekends and evenings to provide emergency packages of care to prevent people going into hospital and support people who need to be discharged.

Urgent/unplanned care – Intermediate Care Ealing

Ealing’s Integrated Care Service covers both health and social care and aims to help keep people in their homes or in the community preventing unnecessary emergency hospital attendances and admissions. Working with patients’ GPs it provides rapid assessment and response, and short term rehabilitation in the community.

GPs and other healthcare professionals can refer to the service and uptake of the service

continues to improve. We believe that this service has enabled us to make great progress with the delivery of our Out of Hospital strategy and has prevented more than 1,000 hospital admissions in the short time it has been in operation.

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Musculoskeletal services

We have invested in MSK services, which has improved quality, reduced waiting times for patients and lowered the requirement for hospital based care. This service now has waiting times of four weeks and we are seeking to expand it further.

GP networks

GP practices across Ealing have been structured into seven health networks covering populations between 50,000 and 70,000 each. By working in health networks we will be able to offer a wide range of out of hospital services in each area. Services will be delivered in a GP practice or within a local hub, increasing access to primary care.

Pioneer for integration

In 2013, the NHS in North West London was selected as one of only 14 NHS areas in the country to be awarded the chance to be a ‘pioneer’ to support the delivery of new and ambitious plans to deliver local health and social care services for local people.

The announcement means that Ealing will receive specially tailored support from the Department of Health to enable more joined-up, user-centred care. This means people in Ealing will benefit from much closer working between all parts of the health and social care system, and will have more say over their care and when, where and how they receive it. They will also find it easier to navigate their way through the care system.

We will continue to invest in areas where opportunities to progress our out of hospital ambitions present themselves.

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The year ahead

Ealing CCG’s staff will continue to work collaboratively with Central London, West London, Hammersmith and Fulham and Hounslow CCGs to achieve the strategic goals that we all share. Our commissioning priorities for 2014/15 will enable us to implement Shaping a Healthier Future, and the out of hospital strategy that it supports. Our strong partnerships with the local authority, our providers, community organisations and the voluntary sector will help us to develop ‘whole systems’ working to deliver more integrated care across health and social services.

Shaping a Healthier Future

In 2011, local clinicians began the development of a set of proposed changes to reshape acute and out-of-hospital health and care services across North West London – the Shaping a Healthier Future (SaHF) programme. North West London has a growing and ageing population, and at

present, specialist care is too thinly spread over too many sites and some facilities are inadequate. The proposed changes went out to public consultation in the summer of 2012. Some 17,022 responses were received during the 14 week consultation period, marking it as one of the most debated ever held within the NHS. On 19 February 2013, the Joint Committee of the then eight primary care trusts approved the recommendations.

On 1 April 2013 the eight CCGs in North West London, including Ealing, took over leadership of the SaHF programme and, in 2013/14, they continued to build on the work of the previous year. This work is being carried out over the next five years and is now led by the clinicians who have seen first-hand the health inequalities and changing needs in the area.

On 10 October 2013 the High Court rejected the case brought by Ealing Council to seek to halt the SaHF programme and on 30 October 2013, the Secretary of State for Health, Jeremy Hunt,

accepted advice ‘in full’ from the Independent Reconfiguration Panel’s recent SaHF review and agreed that changes to NHS services in North West London should proceed as quickly as practicable.

In order to deliver these changes the plans are to make significant steps in implementation during 2014, including the transition of A&E services from Hammersmith Hospital and Central Middlesex Hospital and opening a new A&E department at Northwick Park Hospital. Detailed transition plans for these improvements are currently being developed.

The SaHF clinical board is managing clinical safety and risk during this period, supported by clinical implementation groups. A priority for the urgent care clinical implementation group is to

understand the implications of the recent Keogh Review for the programme. Summary of the proposals

A key principle that underpins SaHF is the centralisation of the most specialist services (such as A&E, maternity, paediatrics, emergency and non-elective care), as this will lead to better clinical outcomes and safer services for patients.

To this end the existing nine hospitals will be transformed into five major acute hospitals, including West Middlesex Hospital. On the remaining sites there will be further investment in local hospitals

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at Ealing and Charing Cross, developed in conjunction with patients and stakeholders; there will be a specialist hospital at Hammersmith; and there will be a local and elective hospital at Central Middlesex. The benefits associated with each hospital site are summarised below:

Major hospitals will be:

 Saving at least 130 lives per year by having more specialist consultants on duty at all major hospitals at the weekend.

 Centres of excellence in emergency care, which copy the way stroke and trauma has been centralised across London: something which was controversial at the time and now acclaimed by clinicians and politicians alike proving to save hundreds of lives every year.

 Hitting 4-hour A&E waiting time targets consistently, at all major hospitals across North West London, throughout the year.

 Providing more critical care consultants on duty 24/7 (168 hours per week), so that seriously ill patients always get the best expert care.

 Providing more obstetric consultants on duty 24/7 in labour wards (168 hours per week), reducing the number of serious, sometimes fatal, complications during birth, and one to one midwifery care for women during established labour.

 Providing more consultants in other specialties such as paediatrics on duty between 12-16 hours per day, seven days per week, providing much more cover than at present.

 Providing more trained and experienced emergency doctors on site 24/7 in A&E departments ensuring patients are seen by senior specialist staff early in their treatment.

 Providing more investment in mental health so that psychiatric liaison services can better co-ordinate 24/7 care for vulnerable, mentally ill people.

 A brand new 21st century hospital delivering world class trauma and acute care at St Mary’s, Paddington.

GPs and local hospitals

 Access to GP services seven days a week, across North West London.

 All nine key hospitals across North West London will have an Urgent Care Centre open 24/7 to see 70% of existing A&E activity, with a guaranteed waiting time of no more than four hours.

 GPs working much more closely with hospitals, local authorities, and other NHS partners to provide more joined-up care across organisational and geographical boundaries.

 Every patient with long-term needs will have a care plan, developed with them, to ensure they get the best treatment delivered in the way they want it. This will mean for diabetic patients, for example, less risk of renal failure, fewer hospital admissions and fewer lower limb

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built to deliver the specific services most needed in those local communities.

 Some £190m spent recurrently, every year, on GP and other local services by 2017-2018. Elective hospitals

 Safe, clean and modern facilities for planned operations like hip replacements and other orthopaedic surgery and pre-planned procedures.

 Zero cancellations of planned operations due to facilities no longer having to be shared with potential emergency cases.

 Zero infection levels due to better, more modern buildings and no risk of cross-contamination from unplanned emergency cases.

Outline business cases for the hospital sites are currently in development. These cases describe the detailed services changes at each site, and how they can be delivered and the capital required by the programme to make these changes. They also explain how the changes will improve quality, the workforce implications and the plans for making these changes over the coming years. The Department of Health is expecting to review these cases during the second half of 2014. To find out more about SaHF visit www.healthiernorthwestlondon.nhs.uk.

Planned care pathways

We aspire to increase the proportion of care that is planned. We aim to simplify existing pathways, with more diagnostics and decision making carried out in primary and community settings.

Dermatology: We are in the process of commissioning a new teledermatology service for Ealing patients. The new service will remotely assess a wide range of skin conditions and provide GPs with a treatment plan to manage patients in primary care, or recommend referral to secondary care. Patients will be seen closer to home, and diagnosed and treated more quickly.

Cardiology: We plan to mobilise the service redesign work begun in 2013/14. This redesign is in line with our Out of Hospital strategy, and focuses on the development of community services and improving clinical quality outcomes across the Borough.

We recognise the value of specialist nurses caring for patients with heart failure. It is our intention to increase the number of heart failure nurses working in the borough. There is good evidence that care by heart failure nurses improves the quality of life for patients and reduces the number of unplanned admissions for patients under their care.

Cardiac rehabilitation services have traditionally been focused on patients who have been admitted to hospital. We are looking at ways of widening access to rehabilitation services for patients with chronic cardiac conditions with the intention of preventing future admissions. Anticoagulation: Over the last five years more and more GP practices have been offering patients on warfarin their regular routine blood tests as an alternative to patients attending a hospital clinic. This service has been shown to be safe and popular with patients. We are now looking at ways to

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improve anticoagulation monitoring of housebound patients and redefine the threshold for hospital care, so more patients can be seen in the community.

Caring for older people

We will continue the roll-out of the enhanced primary care service for nursing home residents, which includes minimum commitments by GPs to time spent at nursing homes caring for patients, and a 24/7 on-call rapid response by GPs. We will have in place robust medical cover

arrangements for all nursing homes and care homes in Ealing to ensure that residents are not inappropriately admitted to hospital for needs that can be met by an enhanced level of primary care.

Primary care

Ealing CCG is not responsible for the commissioning of primary care services, but we are committed to improving access to primary care so it meets patients’ expectations. Improving access will mean opening at convenient times, offering a wider-range of services and being located in the right places. We also want to improve quality which means ensuring that care is being delivered to the right clinical standards, in good facilities.

High quality, financially sustainable primary care is vital to the strategic direction of all the CCGs. Current levels of expenditure across the five CWHHE CCGs will be at least maintained, and investment will be made in some areas.

We aim to support patients to self-manage as much as possible. We know that a significant proportion of service users would value an increased role in the management of their own care, but that the current system does not provide patients with the information, advice and support they need to self-manage.

Practices remain the centre for most routine primary care. GPs will act as the named point of contact for co-ordinating care for their patients.

Every practice will continue to offer core primary care services, as well as working with other practices in their care network to provide additional services. GP practices will also continue to have access to and provide the diagnostics and tests that they do currently such as blood tests. In line with national expectations and work taking place across North West London, we are

working to identify ways of delivering services more flexibly and innovatively with extended hours, seven days a week.

Future models of primary care are currently being developed. All CCGs are currently exploring ways of working across networks of practices to best provide care for their patients, and this is likely to lead to many services that are currently provided through local enhanced services being provided in future by a network of practices providing services to their own patients or on behalf of other practices within the network. We see this model as key to the delivery of whole systems integrated care and we will therefore identify a number of services where primary care is most capable and ‘best able’ to deliver those services.

North West London Integrated Care Pilot

A key enabler of health and social care integration (in which we are already fully engaged) is the North West London Integrated Care Pilot (ICP). The ICP brings together GPs, social services,

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community nursing teams, mental health specialists, and hospital consultants to discuss patients and agree interventions to improve their care.

The aims of the ICP are to empower patients to self-manage, make joint decisions, and receive appropriate screening and early interventions. It also sets out to create a culture of re-ablement and prevent dependency, resulting in proactive rather than reactive health and social care provision.

We intend to use the learning from our engagement with the ICP to develop a more ambitious approach to health and social care integration across Ealing. This will be facilitated by our work on the Better Care Fund (BCF) with Ealing Council and our partners. The BCF is funding to help enable older people and people living with long term health conditions to stay healthy and independent at home.

Ealing health and social care integration: local authority and partner engagement The health and wellbeing board in Ealing has agreed a shared commitment to implement integrated care at scale and pace, building on existing partnerships.

We have agreed our integrated governance arrangements in partnership with ourselves, Ealing Council, providers, voluntary Sector, Healthwatch and the health and wellbeing board. The Ealing Executive Group (EEG) acting as the integration steering group will oversee whole system

integration across Ealing.

Our approach to health and social care integration is based on the registered GP list, organised around the seven GP Networks based in three localities. We expect to focus on patients with complex health and social care needs, such as the frail elderly, patients with long term conditions and frequent users of health and social care services.

We will work across organisational and professional boundaries to ensure that we deliver health and social care interventions in a coordinated patient-centred way to the most vulnerable patients in our communities.

More information about our plans can be found in our commissioning intentions 2014/15 at

www.ealingccg.nhs.uk.

Risks and challenges for 2014/15

There are a number of key issues that could have an impact on the work of Ealing CCG for the future. These are set out below, with an outline of the actions the CCG is taking to mitigate the associated risks. Details on the financial pressures facing Ealing CCG are set out in section on progress against financial targets.

Reconfiguration of hospital services across North West London: The Shaping a Healthier Future programme will result in significant changes to the location of hospital services across North West London. It is important that these changes are delivered in a programmed way, with no disruption to existing services. Ealing CCG will continue to work closely with the other seven CCGs in North West London, as well as providers, partner organisations and the public and patients to ensure all parties can contribute their views on the changes and their implementation. We are also taking

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forward our out of hospital plans to provide more services in a community setting, which will enable hospitals to focus on providing specialist care.

Working with partner organisations: all organisations in the public sector face pressure on resources because of the tight economic climate we are operating in. This could mean

organisations want to prioritise their own core business, at a time when working in partnership to achieve shared goals is the best way to deliver efficient and effective services. Ealing CCG will continue to be an active partner in the Ealing health and wellbeing board, which agrees joint strategies and plans to support the health and wellbeing needs of the community. We will also continue to develop our plans for whole systems integrated commissioning with Ealing Council to deliver patient centred joined up health and social care services, utilising the Government’s new Better Care Fund.

Ealing CCG has a board assurance framework which sets out the strategic risks to the CCG, the measures in place to manage these risks, and an overall risk rating. The assurance framework is presented to the governing body every quarter so members can review the risks and mitigations, and record any actions or events which mean the score for each risk is amended accordingly. Further details on risk are included in the governance statement.

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Ealing CCG’s performance information against priorities

Ealing CCG produces a monthly integrated performance report which provides a monthly update on the performance of the CCG. This is based on the latest performance information available from our providers, and reports on the actions being taken to address any performance issues with progress to date.

The content of the report are defined by the CCG’s priorities which are informed by nationally defined objectives for commissioners - the NHS Constitution, Everyone Counts Guidance for 2013-14 (operating framework) and the NHS Mandated Outcomes Framework.

Results where Ealing CCG met the standard are as follows:

 18 weeks referral to treatment (RTT) - non-admitted performance within 18 weeks

 18 weeks RTT - incomplete pathways performance within 18 weeks

 Patients waiting more than 6 weeks for a diagnostic test

 Clostridium difficile: reducing the number of outbreaks

 Total time spent in A & E < 4 hours (all activity types)

 Cancelled Operations

 Urgent operations cancelled for a second time

 Cancer 2 Week Waits: Percentage of patients seen within two weeks of an urgent GP referral for suspected cancer

 Cancer 2 Week Waits: Percentage of patients seen within two weeks of an urgent referral for breast symptoms where cancer is not initially suspected

 Cancer 31 Day Waits: Percentage of patients receiving first definitive treatment within one month of a cancer diagnosis

 Cancer 31 Day Waits: Percentage of patients receiving subsequent treatment for cancer within 31-days where that treatment is Surgery

 Cancer 31 Day Waits: Percentage of patients receiving subsequent treatment for cancer within 31-days where that treatment is an Anti- Cancer Drug Regime

 Cancer 31 Day Waits: Percentage of patients receiving subsequent treatment for cancer within 31-days where that treatment is a Radiotherapy Treatment Course

 Cancer 62 Day Waits: Percentage of patients receiving first definitive treatment for cancer within 62-days of an urgent GP referral for suspected cancer

 Cancer 62 Day Waits: Percentage of patients receiving first definitive treatment for cancer within 62-days of referral from an NHS Cancer Screening Service

 Cancer 62 Day Waits: Percentage of patients receiving first definitive treatment for cancer within 62-days of a consultant decision to upgrade their priority status

 Mental Health – IAPT: Proportion of people with depression and/or anxiety disorders referred for and receiving psychological therapies

 Mental Health - CPA 7 day follow up: The proportion of patients on Care Programme Approach (CPA) discharged from inpatient care who are followed up within 7 days

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Ealing CCG did not fully meet the following performance standards in 2013/14:

 18 weeks RTT - admitted performance within 18 weeks

 Number of 52 week RTT pathways - admitted

 Number of 52 week RTT pathways - non-admitted

 Number of 52 week RTT pathways - incomplete pathways

 Mixed Sex Accommodation (MSA) breaches

 Mixed Sex Accommodation (MSA) breach rate

 MRSA

 Patients who have waited over 12 hours in A&E from decision to admit to admission

 Number of LAS arrival to handover greater than 30mins

 Number of LAS arrival to handover greater than 60mins

 Mental Health – IAPT: Proportion of people with depression and/or anxiety disorders receiving psychological therapies who are moving to recovery

By comparison, in 2012/13 NHS Ealing PCT met the following national indicators:

 Methicillin-resistant Staphylococcus aureus bacteraemia: reducing the number of outbreaks

 Clostridium difficile: reducing the number of outbreaks

 Ambulance response times: category A response within 8 minutes

 Ambulance response times: category A response within 19 minutes

 18 weeks referral to treatment: non-admitted performance within 18 weeks

 18 weeks referral to treatment: incomplete pathways performance within 18 weeks

 Cancer two week wait: percentage seen within two weeks of an urgent GP referral for suspected cancer.

NHS Ealing PCT did not fully meet the following national indicators:

 18 weeks RTT – admitted performance within 18 weeks: 89.6 per cent against a target of 90 per cent.

 Cancer 62 day wait percentage treated in 62 days from urgent GP referral for suspected cancer: 80.0 per cent against a target of 85 per cent

 Childhood immunisation levels continued to be a challenge for all PCT’s with performance slipping from 2011/12 levels. Action plans were agreed with providers and best practice shared across all of North West London PCTs

In 2014/15 Ealing CCG will continue to work with its GP members and the providers it commissions services from in order to meet its national targets.

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Where we spend our money

The chart below gives a breakdown of how we spent the £426m of public money for which we were responsible during 2013/14.

Through the innovative redesign of local services, we made both significant improvements in quality and efficiency savings over the year. The CCG’s 2013/14 financial plan was to breakeven, and this target was surpassed.

1. GP prescribing and out of hours care. NHS England holds the budget for GP contracts

2. This fits within the £25 per head allocation that NHS England set for each CCG

Statutory financial duties

All clinical commissioning groups have a number of financial duties under the National Health Service Act 2006 (as amended) regarding the use of it resources. NHS Ealing CCG’s performance against each is summarised below:

 Expenditure not to exceed its income: in 2013/14 Ealing CCG recorded a surplus of £6.9m.

Acute services, £240m

Mental health services,

£47m

Community health services,

£44m

Continuing and free nursing care, £15m

1. Primary care services, £12m

Prescribing, £41m Programme

administration and estates costs, £10m

Surplus, £7m 2. Running costs,

£9m

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22 | P a g e  Revenue resource use not to exceed the amount specified in directions: In 2013/14 Ealing

CCG’s net revenue expenditure totalled £418.7m, against a revenue resource limit of £425.6m.

 Capital resource use not to exceed the amount specified in directions: In 2013/14 Ealing CCG did not have a capital allocation.

In addition the NHS Commissioning Board placed the following additional controls on a Clinical Commissioning Groups use of resources:

 Revenue resource use on specified matters not to exceed the amount specified in directions (relates to programme cost): In 2013/14 Ealing CCG had a surplus of £6.8m.

 Revenue administration resource use not to exceed the amount specified in directions (relates to running cost): In 2013/14 Ealing CCG had a surplus of £0.1m.

 Capital resource use on specified matters not to exceed the amount specified in directions: In 2013/14 Ealing CCG did not have a capital allocation.

Other financial commentary

The surplus noted above resulted from the following performance components: Underspends:

 £11.9m: Unspent reserves

 £1.0m: Corporate & Estates

 £0.7m: Mental Health Commissioning

 £0.3m : Other acute commissioning

These underspends are offset by the following overspends:

 £2.6m: Community relating to joint projects with London Borough of Ealing.

 £2.3m: Prescribing relating mainly to GP prescribing and central drugs costs.

 £1.3m: Acute contracts (£7.2m of over performance offset by risk reserve of £5.9m).

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Patient and public engagement

Ealing CCG has made an on-going commitment to fully involving patients and the public in its work and to capturing public feedback and patient experiences.

In its first twelve months of delivery, Ealing CCG dedicated significant time and staff resource to developing its patient and public engagement (PPE) workstream in line with its corporate PPE strategy.

This included four geographically-focused stakeholder engagement events; regular links with the partnership boards, voluntary sector forums, user-led groups and the four community networks in the borough; relationship-building with the voluntary and community sector; the identification of the CCG’s top twenty community stakeholders and strengthening links with the well-established patient participation groups.

Patient and public engagement and involvement in 2013/14

Our PPE workstream has had three main areas of focus so far:

 Gathering patient experiences, feedback and comments via local voluntary organisations, GP service alerts, self-help and patient-led groups, complaints and public queries. This feedback has been collated as a tool to shape commissioning intentions and inform decision-making.

 Communicating key messages to patients via public events and presentations, information stalls, community stakeholders, PPGs, our website and quarterly patient newsletter. By identifying and developing relationships with key community stakeholders, we now have communication conduits, through which we can easily cascade information to our local population. We have used these conduits to brief patients about specific changes to local services, such as new diabetes clinics, local hospital developments, local hubs, cardiology service re-design and shifting settings of care for mental health patients.

 Making the CCG accountable and open to public scrutiny. Our quarterly PPE reports are shared with local stakeholders and on the website. We have developed four-year equality objectives, which are scrutinised by a multi-agency reference group, chaired by Ealing Community Network. We also have organisational processes to respond to public queries and complaints, and to enable public scrutiny and questions at Governing Board meetings.

Patient involvement in procurement

Ealing CCG ensures that patients and the public are engaged in procurement processes. Patient representatives sit on our procurement panels, working alongside NHS procurement staff and commissioners to ensure that the best possible services are procured for the residents of Ealing.

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Engagement priorities for 2014/15

 We will be carrying out work in partnership with the Shaping a Healthier Future team to capture feedback about and engage local people on the issues of the local hospital development in Ealing. We are already working together to target older people, women and families, who are the cohorts most likely to be impacted by the closure of A&E and maternity services at Ealing Hospital.

 Further work will be done to engage with hard to reach communities including refugees, young carers and local travellers.

 Ealing CCG is jointly procuring a GP out of hour’s service with West London CCG. We have established a patient and public subgroup to look at the various issues involved with this. The aim is for the service in place by October 2014.

Sustainability

Ealing CCG leases premises from NHS Property Services Ltd, which is required to provide

information on the management of these properties for inclusion in this annual report. However, they are unable to do so for 2013/14, and the intention is that they will provide the necessary data in 2014/15.

Equality and diversity

Ealing CCG serves a diverse population and it is committed to addressing equality and diversity issues. As an employer and commissioner of services, it is important that the CCG remains committed to promoting diversity and equality by eliminating discrimination and complying fully with the statutory duties under the single equality scheme.

The CCG, together with its partners in the CWHHE Collaborative, employs a senior manager to bring a coordinated approach and focus to these issues. Samira Ben Omar, our assistant director of patient experience and equalities, was announced as a winner in the Health Service Journal (HSJ) inaugural edition of BME Pioneers, which is supported by the British Medical Association (BMA), NHS Employers, and the NHS Leadership Academy. This was a fantastic achievement and reflects Samira’s passionate advocacy of the equality and diversity agenda.

Composition of Ealing Clinical Commissioning Group

As part of the annual reporting process, it is a requirement for the annual report to contain the following information about the composition of the organisation:

 The number of persons of each sex who are on the governing body: female – 7; male – 13.

 The number of other senior managers of each sex who were at very senior manager (VSM) grade (other than persons falling within the above disclosure): female – 0; male – 0.

 The number of persons of each sex who were employees of the CCG (including the governing body): female – 42; male – 14.

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Young carers

Ealing CCG has come together with CWHHE Collaborative CCGs to commission a home based-family support service to support young carers. The project aims to address issues that can impact on the health and wellbeing of young carers and their family members, such as:

 Poor diet and non-attendance at medical appointments

 Poor attendance at school

 Unrecognised or poorly managed mental health or substance misuse issues

 Safeguarding concerns

Governing body equality seminars

Ealing CCG will be holding an equality seminar for its staff and governing body with the purpose of developing a greater awareness of the Equalities and Human Rights Act. More specifically this was to provide a better understanding amongst governing body members on the issue of ‘Conscious and Unconscious bias’ and how this affects decisions relating to staff recruitment and promotion well as commissioning decisions.

Engagement to develop a patient experience strategy

We have been working with patients and wider stakeholders through a series of meetings and workshops to develop a shared and inclusive definition of patient experience. Key themes have been identified, which will be used to help develop a strategy for CCGs to embed within the commissioning process to ensure good patient experience is used to ensure care that is commissioned is person-centred, compassionate, safe and effective.

Equality objectives

Equality objectives were set in October 2013 and we are now working towards achieving them. The equality objectives can be found at www.ealingccg.nhs.uk.

Ealing CCG set up project group to produce the objectives, chaired by its Governing Board Equality Lead and including representatives of Healthwatch, Ealing Council, Public Health, Human

Resources and Shaping a Healthier Future.

Ealing CCG actively sought input on the objectives from a range of local community stakeholders, including voluntary sector forums and organisations, community networks, local authority partnership boards and forums, service users and carers, and other partner organisations.

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Signed……….. Daniel Elkeles

Chief officer

Date………..

Self-certification by the accountable officer

I certify that the clinical commissioning group has complied with the statutory duties laid down in the National Health Service Act 2006 (as amended).

Daniel Elkeles Chief officer

Ealing Clinical Commissioning Group April 2014

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Members’ report

Ealing CCG’s member practices

:

 Acton Health Centre

 Acton Lane Medical Centre

 Acton Town Medical Centre

 Allenby Clinic

 Allendale Road

 The Argyle Surgery

 Barnabas Medical Centre

 The Bedford Park Surgery

 Belmont Medical Centre

 Boileau Road Surgery

 Broadmead Surgery

 Brunswick Road Medical Centre

 The Burlington Gardens Surgery

 Chepstow Gardens Medical Centre

 Chiswick Family Practice (Dr Webber)

 Chiswick Family Practice (Dr Bhatt)

 Churchfield Surgery

 Cloister Road Surgery

 Corfton Road Surgery

 Cuckoo Lane Surgery

 Crown St Surgery

 Dormers Wells Medical Centre

 Dr K K Gyi & Partner

 Ealing Park Health Centre

 Eastmead Surgery

 Elmbank surgery

 Elm Trees Surgery

 Elthorne Park Surgery

 Featherstone Road Health Centre (Bondcare)

 The Florence Road Surgery

 Goodcare Practice

 Gordon House Surgery

 Greenford Avenue Family Health Practice

 Greenford Road Medical Centre

 Grosvenor House Surgery

 The Grove Medical Practice

 Guru Nanak Medical Centre

 Hammond Road Surgery

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28 | P a g e  Hanwell Health Centre (Dr R Naish)

 Hillcrest surgery

 Hillview Surgery

 Horn Lane Surgery

 Islip Manor Medical Centre

 Jubilee Gardens Medical Centre

 K S Medical Centre

 Lady Margarat Road Medical Centre

 Lynwood Surgery

 Mandeville Medical Centre

 Mansell Rd Practice

 Meadow View Surgery

 Medical Centre (Mangat)

 The Medical Centre (Balachandran) (Doncaster Drive Medical Centre)

 Mill Hill Surgery

 The MWH Practice

 The Northcote Avenue Practice

 Northfields Surgery

 Northolt Family Practice

 Oldfield Family Practice

 Perivale Medical Clinic

 Pitshanger family practice

 Queen Walk Practice

 Ribchester Medical Centre

 Saluja Clinic

 Somerset Family Health Practice

 Somerset Medical Centre

 Southall Medical Centre - main branch

 St George's Medical Centre

 Sunrise Medical Centre

 The Surgery

 The Town Surgery

 The Vale Surgery

 Waterside Medical Centre

 The Welcome Practice

 West End Surgery

 Western Avenue Surgery

 Westseven GP

 Woodbridge Medical Centre

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Membership of Ealing CCG’s governing body

The membership of Ealing CCG’s governing body is:

 Dr Mohini Parmar, chair

 Dr Raj Chandok, vice chair

 Dr Arjun Dhillon, GP member

 Dr Mohammad Alzarrad, GP member

 Dr Robert McLaren, GP member

 Dr Vijay Tailor, GP member

 Dr Zaheer Nasir, GP member

 Carmel Cahill, associate governing body member

 Sally Armstrong, practice nurse member

 Philip Portwood, lay member

 Philip Young, lay member

 Fionnuala O’donnell, practice manager member

 Daniel Elkeles, chief officer and accountable officer*

 Clare Parker, chief financial officer*

 Kathryn Magson, managing director#

 Dr John Riordan, secondary care consultant

 Jonathan Webster, secondary care nurse member, director of nursing, quality and safety*

*Please note Daniel Elkeles, Clare Parker and Jonathan Webster succeeding Robert Larkman, Jonathan Wise and Ursula Gallagher on 1 December 2013.

#Please note Kathryn Magson succeeded Jo Murfitt on 2 June 2013.

Full biographical details of the members are within the remuneration report. Ealing CCG also keeps a record of the declarations of interests of governing body members, and these are published on the CCG website.

The governing body is not aware of any relevant audit information that has been withheld from Ealing CCG’s external auditors, and members of the governing body take all necessary steps to make themselves aware of relevant information and to ensure that this is passes to the external auditors where appropriate.

Ealing CCG Committees

Ealing CCG has an audit committee and a remuneration committee. These meet jointly with the other CWHHE CCGs’ committees (from 1 December 2013 onwards).

The CCG also has a finance and performance committee, a quality and safety committee, an executive management and innovation committee, and an IM&T committee.

The CWHHE collaborative has an investment committee, quality and patient safety committee, performance committee and an information strategy and information governance committee.

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The audit committee is responsible for scrutinising the CCG’s arrangements for risk management and internal control and supporting the maintenance of an appropriate relationship between the CCG and the auditors.

The audit committee meets in common with those of the other CCGs in the collaborative. The attendance records for Ealing CCG audit committee from 1 December 2013 to 31 March 2014 is as follows:

Philip Young (chair) 6 of 6

John Riordan (secondary care consultant, Ealing) 2 of 2 This is a meeting in common with the audit committees of the other CCGs in the CWHHE collaborative. Other attendees are:

Alastair Gilchrist (lay member) 1 of 2

Michael Morton (lay member) 0 of 2

Rohan Hewavisenti (lay member) 0 of 2

Trevor Woolley (lay member) 2 of 2

Alan Hakim (secondary care consultant, CWHH CCGs) 2 of 2 Jonathan Munday (governing body member) 2 of 2

Ealing CCG had an audit committee held jointly with Brent, Harrow and Hillingdon CCGs, 1 April 2013 to 30 November 2013. The attendance record is as follows:

Dr Zaheer Nasir (GP governing body member) 4 of 4

Philip Young (lay member) 3 of 4

Details of the remuneration committee can be found in the remuneration report. Further information on the governing body and other committees are set out in Ealing CCG’s annual governance statement. Biographical details and arrangements on the management of any potential conflicts of interest are contained at the end of this annual report.

Governance statement

Ealing CCG has produced a governance statement and this can be found on our website

www.ealingccg.nhs.uk.

Pension liabilities

The CCG has no pension liabilities due in future years under arrangements to buy out the liability for early retirement over 5 years.

The accounts include a balance of £48k in other payables relating to outstanding pension contributions at 31 March 2014.

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A total of 102 working days were lost for Ealing CCG due to sickness absence during the year 2013/14. Ealing CCG is working to reduce sickness absence through management of short term and long term sickness absence in line with the Absence Management Policy. Staff are also supported to return to work and advice is sought from Occupational Health as required. Staff sickness absence 2013/14

Total days lost 102

Total staff years 38

Average working days lost 3

Staff sickness absence figures are provided by Department of Health and cover the calendar year.

External audit

External audit services during 2013/14 were provided to Ealing CCG by Deloitte.

Audit fees paid to the organisation’s external auditors amounted to £105,000 plus VAT in respect of the following services:

Audit Services (the statutory audit and related services) - £105,000.

Serious incidents relating to breaches of confidential information

In 2013/2014 there were no serious incidents relating to breaches of confidential information.

Cost allocation and setting of charges for information

Ealing CCG certifies that the clinical commissioning group has complied with HM Treasury’s guidance on setting charges for information.

Better payments practice code

The Better Payment Practice Code requires the clinical commissioning group to aim to pay all valid invoices by the due date or within 30 days of receipt of a valid invoice, whichever is later.

The NHS aims to pay at least 95% of invoices within 30 days of receipt, or within agreed contract terms.

Details of compliance with the code are given in the notes to the financial statements.

Complaints and principles for remedy

The NHS believes complaints are a valuable source of feedback, which help to shed light on the quality of local health services. A national complaints process applies to all NHS organisations and seeks to provide complainants with explanation and, where appropriate, an apology, and the correction for an error or other remedial action. The NHS also seeks to learn from complaints and improve procedures to prevent problems being repeated. The NHS complaints procedure adheres

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to the revised Principles for Remedy published by the Parliamentary and Health Service Ombudsman.

From 1 April 2013 to 31 March 2014 the CCG received a total of 28 complaints. 13 of these related to the commissioning decisions taken by the CCG and were investigated and responded to under the NHS Complaints Procedure. 10 complaints were about primary care contractors and were forwarded to NHS England for investigation and response. 5 complaints were about other providers and were forwarded to the appropriate organisations for investigation and response. Where appropriate, the CCG requests a copy of the final response for monitoring purposes. Of the complaints investigated and responded to by the CCG, 6 related to the individual funding request process; 7 related to NHS funded continuing healthcare; 15 related to other

commissioning decisions.

Who to contact to make a complaint

From 1 April 2013 commissioning of primary care services, which includes GPs, dentists,

pharmacists and opticians moved to NHS England. Therefore any complaints about these services that cannot be resolved locally with the practice manager should be directed to NHS England at [email protected] or on 0300 311 2233.

Any comments or complaints about hospitals, mental health trusts or community trusts should be directed to the organisation involved.

If you have comments or complaints about any other local health service, please contact the CCG

at [email protected] or call 020 3350 4567.

Our staff and employee consultations

For our staff in Ealing CCG, 2013/14 has been a year of consolidation and growth and the forging of new relationships with CCG colleagues across the CWHHE Collaborative and other important partners in Ealing Council, the NHS, local voluntary and community sector and, of course, our patients and patient groups.

Ealing CCG holds regular meetings where staff can share with each other their work priorities and strategically plan ahead. At a CWHHE collaborative level, two all-staff events were held where we discussed how we could work better together and introduced a monthly bulletin from the five CCG Chairs and Chief Officer, which update staff on the current priorities and issues.

Ealing CCG engaged with staff as a matter of good management but has not carried out any statutory consultations.

Disabled employees

Ealing CCG is committed to equality of opportunity for all employees and is committed to employment practices, policies and procedures which ensure that no employee, or potential employee, receives less favourable treatment on the grounds of disability. Diversity is viewed positively and, in recognising that everyone is different, the unique contribution that each individual’s experience, knowledge and skills can make is valued equally. Ealing CCG works with