NHS Wandsworth Finance Report. For the period April 2012 November 2012 & Interim Report up to December 2012

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Peter Arnold
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1 NHS Wandsworth Finance Report For the period April 2012 November 2012 & Interim Report up to December /02/2013 Produced by Finance 1

2 Finance Scorecard up to November 2012 Financial Strategy Work In Progress -CCG allocations for 13/14 published. 2.3% received in growth for all CCG s. -Business Intelligence Group up and running supports approval of business cases and QIPP and development of ongoing investment strategy -Dedicated resources to support development of Planning All Care Together initiative -Work underway to establish 13/14 QIPP and Investment Strategy Financial Performance - Forecast to meet control total of 10.5m as at Month 8. Recommended WPCT moves its control total to 15.2m. - Following risk analysis, non recurrent funding of 1.8m is proposed for non recurrent investment programmes. - Slippage of 1.1m against the Capital Resource Limit, work is underway to ensure the total allocation is appropriately spent. - Acute commissioning is forecast to over perform by 3.6m, this is mitigated by reserves. Financial Governance In Place Financial Risk - Managing Risk - CCG level reporting - Monthly finance reports are produced showing variances attributable to all future relevant bodies. - Board Sub Committees are in place and active. - Procurements at contract sign off stage - Out of Hours and 111 Service. - Active procurements : 1. Prison Drug and Alcohol Services Prison tender project board signing of recommendations paper on NHS Health Checks Procurement being led by Local Authority as start date of service will be AQP Podiatry Advert posted on Supply2Health on Key risks: 1.2m Continuing Care Retrospective Claims (30% success rate) 0.9m Winter pressures 0.5m Mental Health - Mitigating action all risks identified can be covered through the use of reserves - Other main risks are: Transition closing down accounts of a PCT and reassigning budgets. Establishing risk regarding property leases for WPCT. 06/02/2013 Produced by Finance 2

3 Key Messages 1. NHS Wandsworth (NHSW) is forecasting to meet its control total of 10.5m as at Month 8. It is proposed WPCT delivers a control total of 15.2m, this will put the CCG in a strong position in 13/ Following a detailed risk analysis, non recurrent funding of 1.8m is proposed for non recurrent investment programmes. 3. Acute commissioning is forecast to over perform by 3.6m. This was expected and is being mitigated by reserves. 4. Slippage of 1.1m against the Capital Resource Limit is reported, work is underway to ensure the total allocation is fully spent appropriately by the end of the year. 5. The Better Practice Payment Policy is currently below target as we aim to improve the rate at which invoices are processed and paid. 6. The cash drawn for the period to 30 November 2012 is lower than the year to date budget. This is owing to timing differences between expected receipts and payments, however the forecast is to stay within the cash resource limit. 7. All QIPP schemes are reported on target to deliver 10.9m. 8. Financial variances for the PCT are now illustrated by the various future attributable bodies. 06/02/2013 Produced by Finance 3

4 Contents Section 1 Financial Position Section 2 Financial Analysis Section 3 Financial Risks Section 4 Capital Section 5 - QIPP 06/02/2013 Produced by Finance 4

5 Section 1 Financial Position 06/02/2013 Produced by Finance 5

6 PCT Financial Position as at Month 8 (November) 06/02/2013 Produced by Finance 6

7 PCT Analysis split by future organisation (preliminary) 06/02/2013 Produced by Finance 7

8 Section 2 Financial Analysis 06/02/2013 Produced by Finance 8

9 Over spend Under spend Variance Analysis - Summary The year to date (YTD) position for the PCT is 6.9m surplus and the forecast year end position (FY) is 10.5m surplus which is in line with plan. Within the YTD and FY position there are a number of variances against plan and these are shown below: Year to Date Variance +ve Under spend Full Year Variance -ve Over spend 06/02/2013 Produced by Finance 9

10 Variance Analysis in Detail Acute YTD Variance FY Variance +ve -ve 0.1m Under spend 3.6m Over spend Overall minor YTD under spend of 0.1m. A big shift from previous month, largely expected as October is one of the longer months for working days. The largest YTD under spend in Acute SLAs is on Guy s and St Thomas SLA and Imperial College offset by YTD over spends at Kingston NHS Trust, Great Ormond St Hospital and The Royal Marsden Hospital Trust. FY over spend is 3.6m comprising of a 3.1m over spend on Acute SLAs and the remaining in other acute areas. The FY over spend reflects costs related to winter pressures and 18 weeks which are difficult to predict hence a prudent forecast is reported. Largest FY over spends are reported on Kingston, Queen Mary s SLA and Chelsea & Westminster. Main drivers of over performance are non elective work at Kingston, PbR outpatients at Queen Mary s and critical care at Chelsea & Westminster. The ACU have highlighted a risk that activity might have been moved from our reports into London Specialised Commissioning (LSCG) reports owing to the scale of the minimum take transfer from acute contracts to LSCG. The risk of in year under reporting should be noted until the exercise is concluded. 06/02/2013 Produced by Finance 10

11 Acute Activity Graphs Data source: ACU SLAM Reports Analysis 06/02/2013 Produced by Finance 11

12 Variance Analysis Acute Narrative on Activity Graphs Elective Activity and A&E Activity as expected has increased from Month 6 to Month 7 and is now closer to plan. Emergency Activity Increase in activity in Month 6 but decreasing trend from Month 6 to Month 7 and now closer to plan. The Acute Contracting Unit produce a monthly report explaining variances in greater detail. This is available if required. 06/02/2013 Produced by Finance 12

13 Variance analysis in Detail - Non Acute, Corporate, Estates and Other YTD Variance +ve 0.5m Under spend FY Variance -ve 1.2m Over spend Non Acute Minor YTD over spend, FY over spend of 0.6m. FY position has improved significantly from last month owing to discharges in CAMHS and Special Rehab placements. The FY over spend is mostly owing to forensic and continuing care placements. Corporate Minor YTD under spend of 0.2m, FY over spend of 0.3m is owing to recruitment of interim posts. Estates FY over spend of 0.3m on estates is owing to adjustments to depreciation and capital charges, these are being reviewed currently and likely to fluctuate. Other YTD under spend of 0.6m is due to delays in spending on premises. 06/02/2013 Produced by Finance 13

14 Over spend Under spend Variance Analysis in Detail Primary Care Year to Date Variance Full Year Variance -ve -ve 0.04m Over spend 0.7m Over spend GMS and PMS - over spend due to high growth in GP registered list sizes (2.2% from Jan 12 to Oct 12) offsetting the savings from last year s list cleansing programme. Enhanced Services under spend primarily owing to less than planned uptake of the Urgent Care LES. Out of Hours over spend due to a delay in the start of the new service and some additional costs owing to early start of new primary care clinics. 06/02/2013 Produced by Finance 14

Pharmacy - over spend owing to high level of prescriptions and a national increase in

15 Variance Analysis in Detail Pharmacy and Prescribing Pharmacy forecast based on six months data and seasonality trends observed in 10/11 and 11/12. Pharmacy - over spend owing to high level of prescriptions and a national increase in professional fees. Prescribing - under spend has been caused by price fluctuations. 06/02/2013 Produced by Finance 15

16 Over spend Under spend Over spend Under spend Variance Analysis in Detail - Public Health 06/02/2013 Produced by Finance 16

17 Variance Analysis in Detail Public Health Year to Date Variance Full Year Variance +ve +ve 1.0m Under spend 0.5m Under spend YTD under spend of 1m is primarily due to lifestyle non pay budgets owing to slippage in the commencement dates for some programmes such as sexual health and sickle cell pain management. Some of the under spend is also owing to vacancies, mainly in PH Adults and Lifestyles where new posts have been created but not recruited to. The FY forecast is 0.5m under spend owing to vacancies in PH adults, mental health, TB outreach and knowledge management. Also slippage on sexual health QIPP and sickle cell pain management programmes is reported. 06/02/2013 Produced by Finance 17

Contingency & Reserves Transition fund 2% - held by NHS London/NHS SWL Contingency can potentially be used to increase control total Acute over performance reserve

18 Contingency & Reserves Transition fund 2% - held by NHS London/NHS SWL Contingency can potentially be used to increase control total Acute over performance reserve has increased by 0.6m in Month 8 for cancer drugs funding reserve partially utilised Recommended reserve utilisation as per slide 20 06/02/2013 Produced by Finance 18

19 Section 3 Financial Risks 06/02/2013 Produced by Finance 19

20 Financial Risks NHSW can potentially deliver a control total of 15.2m and a non recurrent investment programme of 1.8m. Assumes: 1) Continuing Care provision based on 30% success rate 2) No cost for breaking leases 3) No impact from review of balance sheet balances 4) No requirement for contingency reserve for remainder of the year 5) A proportion of the revised surplus will be brought into WCCG in 2013/14. 06/02/2013 Produced by Finance 20

21 Section 4 Capital 06/02/2013 Produced by Finance 21

22 Capital spend programme Capital projects have been rag rated showing risk of delivery. A 1.1m under spend on capital is reported. A detailed review of all planned spend is being undertaken and opportunities to spend will be assessed through the business case approval process. 06/02/2013 Produced by Finance 22

23 Section 5 QIPP 06/02/2013 Produced by Finance 23

QIPP Full year net savings target is 10.9m and as at Month 7 (one month delay) it is forecast that this will be met. 1.7m of the target relates to red rated schemes, 0.

24 QIPP Full year net savings target is 10.9m and as at Month 7 (one month delay) it is forecast that this will be met. 1.7m of the target relates to red rated schemes, 0.5m of this relates to budget adjustments that did not materialize. Data has been received for the Falls and Alcohol projects. Alcohol is projecting delivery to plan and Falls is likely to deliver in excess of plan. The shortfall on some of the under achieving projects (GP Referrals, Community Services management cost savings and Out of Hours) is being met by over achievement on the medicines management project. 06/02/2013 Produced by Finance 24

25 Month 9 (April to December 2012) Interim Finance Report 25

26 Overall context PCT surpluses cannot be exceeded which for NHSW needs to be managed to allow the CCG to maximise all potential resources At Month 9 NHSW had anticipated an agreed increase in its control total, due to unused contingency reserve (not delegated to CCG s) and fortuitous gains. However plans are back to original control total of 10.5m surplus Alternative strategies are in the process of being developed to maximise available funds Year end agreements with St Georges and Epsom St Hellier have been reached 1.4m of non recurrent investments bids approved to date further bids in the process of being approved 26

27 Update Month 9 (December) Acute SLAs reporting over performance of 2.8m, this has reduced from Month 8 mostly owing to a reduction in over performance at QMH and University College London The cost pressure on non acute services has reduced by 0.2m owing to reduced costs in continuing care home care placements and prison bedwatch/escort services Further savings are also being seen on children placements - 0.3m under spending as at Month 9 Public Health now reporting a full year break even position 27

28 Update - Risks Developing appropriate strategy to utilise surplus funds Highest value risk continues to be continuing care Some further over performance might be seen on acute contracts over winter c 1.8m non recurrent investment plan needs to be spent by March Transition continues to be high risk 28

Finance Report March 2012

Finance Report March 2012 INTRODUCTION 1. This report presents the financial results for the eleven month period to 29 th February 2012 and the projected outturn for 2011/12. FINANCIAL OUTLOOK 2011/12 2. The forecast outturn assumes