Initial Budgets and Financial Plan 2017/18

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Harrow CCG Agenda Item 8 Title of Meeting : Governing Body Date of meeting: 21 st March 2017 Paper No Attachment 8a Initial Budgets and Financial Plan 2017/18 Part 2 paper (private discussion): Y

1 Harrow CCG Agenda Item 8 Title of Meeting : Governing Body Date of meeting: 21 st March 2017 Paper No Attachment 8a Initial Budgets and Financial Plan 2017/18 Part 2 paper (private discussion): Y Purpose of the report The report provides a summary of the initial budget and financial plan for 2017/18 that was submitted to NHS England on the 27 February ACTION KEY Insert X as appropriate For Approval e.g. Strategies, plans, policies and minutes x For Discussion For Assurance For Noting For Information e.g. Challenging and forming opinions e.g. Evidence that we are meeting our obligations e.g. External reports and statutory requirements e.g. Internal reports and updates Executive Summary (to include outcome benefits) The latest iteration of the 17/18 financial plan was submitted to NHSE on the 27 February. Following feedback from NHSE the CCG has been requested to reduce the re-payment of support to Hillingdon and Brent CCGs in 17/18 by 2.5m. Key points are: The CCG plan shows an in-year deficit of 21.2m for 17/18; 1

2 In 17/18 the CCG is planning to deliver 17.5m of QIPP (net of the budget review). In order to deliver a recurrent surplus of 1% a further 21.3m of QIPP will be required in 18/19. Decision required: The Governing Body is asked to: Approve the initial budgets for 2017/18. Committee(s) / Group(s) Discussion Log Committee Name QIPP and Finance Committee Date of Issue(s) discussed Meeting 28/2/17 The initial draft budget and financial plan for 17/18 was discussed. Recommendations None. Relevance to Strategic Objective(s) 2016/17 Strategic Objective - Insert x to the objective your paper links to: SO1 Improve the health and wellbeing of people in Harrow by commissioning high quality and safe services SO2 Involve and empower the people of Harrow in shaping of local services SO3 Manage resources effectively ensuring best value and deliver financial balance SO4 Implement our Local Services Strategy primary care driving development and delivery of integrated care SO5 Develop robust and collaborative commissioning arrangements SO6 Improving performance in line with the NHS Constitution SO7 Empowering people of Harrow to keep well and have a positive experience of care when they require it Related Board Assurance Framework (BAF) and Corporate Risk Register (CRR) Risks: BAF Risk Reference: CRR Risk Reference: BAF No Summary descriptor: CRR No Summary descriptor: 3A Managing resources effectively. Mitigating Actions: BAF / CRR No 3A What are you, your team, CCG or Collaborative doing to control the risks? Development of QIPP recovery plan to ensure the CCG is financially sustainable. Equality and Diversity considerations and implications from which an Impact Assessment 2

3 might be made: N/A Resource implications: The paper sets out the initial budget for 2017/18. Quality impact assessment N/A Patient & Public Engagement Input to and/or Impact of this initiative N/A Safeguarding Implications: N/A Communications Strategy: N/A. Clinical Lead: Name: Dr Amol Kelshiker Job title: Chair, Harrow CCG Contact: Name: Neil Ferrelly Job title: Chief Finance Officer 3

4 Harrow CCG Initial Budgets and Financial Plan 2017/18 Governing Body March

5 2017/18 Position The latest iteration of the 17/18 financial plan was submitted to NHSE on the 27 February. Following feedback from NHSE the CCG has been requested to reduce the re-payment of support to Hillingdon and Brent CCGs in 17/18 by 2.5m. Key points are: The CCG plan shows an in-year deficit of 21.2m for 17/18; In 17/18 the CCG is planning to deliver 17.5m of QIPP (net of the budget review). In order to deliver a recurrent surplus of 1% a further 21.3m of QIPP will be required in 18/19. Business Rule Minimum cumulative underspend of 1% Contingency minimum 0.5% 0.5% of allocation held uncommitted at the start of the year Status No plan is for a deficit of 21.2m Achieved Achieved Management costs remain within allocation Budgets within allowance Mental Health Investment Standard Achieved Better Care Fund Contribution Minimum contribution exceeded GPFV 3 per head non-recurrent funding Planned spend in 2017/18 & 2018/19 2

6 2017/18 Position - Key Changes from December Submission The table on the following slide shows the key movements between the December Submission and the latest version of the plan. m Description 0.1 Planned Surplus in December Submission (3.5) Deterioration in underlying position currently forecasting a underlying deficit of 9.9m (0.2) Increase costs in 17/18 due to deteriorating position (14.7) Reduction in QIPP delivery December plan included unidentified QIPP to balance the plan to 0.1m surplus (3.9) Increase in repayment to Brent and Hillingdon 0.9 Decrease in non-recurrent costs (21.2) Planned Deficit in February Submission 3

7 2017/18 Position - Key Changes from December Submission The Finance Plan for 2017/18 shows the CCG with a deficit of 21.2m and an recurrent underlying 9.1m deficit. QIPP of 17.5m has been assumed in the plan including FYE of savings in Continuing Care and Prescribing Allocation 'm Current Plan (Deficit) / Surplus 'm Expend 'm Acute Mental Health Community Breakdown of Expenditure Continuing Care Primary Care Other Programme Running Costs Reserves 2016/17 Forecast Outturn (2.412) (1.757) Remove NR Bfwd Surplus (2.088) Remove NR Support (7.200) Remove NR other Allocation / Spend (1.943) (2.029) (1.286) (0.809) (0.174) NR Recovery plan within forecast (0.982) (0.982) FYE QIPP (2.773) (1.523) (1.250) Other FYE Remove LNW Risk Share Remove NWL Support & Expenditure (5.000) (5.000) (5.000) Additional Recurrent Allocation 1617 Opening Recurrent Position (9.926) (7.259) NWL Strategy previously funding 16/17 expenditure /17 opening recurrent position adjusted for NWL strategy (14.926) (2.259) BHH risk share repayments Position after repayment of BHH risk share (25.826) Allocation Uplift Assumed Net Tariff (0.1%) Activity Growth Demographic Activity Growth Non Demographic Contingency 0.5% Other Recurrent Costs Impact of Budget Review (4.261) (0.805) (0.108) (2.383) (0.965) Other Non recurrent costs (0.130) HRG4+ Allocation less costs Identification rules (0.680) (0.523) (0.523) Position before QIPP (35.860) NWL Recovery Plan (1.684) (1.684) QIPP Gross Savings - Finnamore Phase 1 (17.640) (15.099) (0.225) (0.231) (0.802) (1.165) (0.118) QIPP Investment - Finnamore Phase /18 In Year Position (21.159) Change in budget pre-qipp (7.759) (33.448) (0.122) (0.430) (0.597) /18 QIPP (14.701) (15.355) (0.150) (0.802) (0.865) (0.118) Change in budget post-qipp (4.965) (0.272) (1.232) (1.462)

8 2017/18 Risks 2017/18 Full Risk Value 15 Probability of risk Potential Risk Proportion of '000 being realised 15 Value 15 Total 15 % Risks % '000 Commentary 15 CCGs Acute SLAs 4, % 2, % Includes incomes recovery risk from LNWH (Harrow share 2m) Community SLAs % % Paediatrics community cost increase Mental Health SLAs 5, % 1, % Impact of CNWL rebasing exercise Continuing Care SLAs 2, % 1, % Growth continues at 16/17 rates QIPP Under-Delivery 20, % 8, % Plans not identified to meet unidentified QIPP plus risk around identified schemes Performance Issues - 0.0% Primary Care - 0.0% Prescribing 1, % % Growth higher than planned Running Costs - 0.0% BCF - 0.0% Other Risks - 0.0% TOTAL RISKS 33,150 40% 13, % Full Mitigation Value 15 '000 Mitigations Uncommitted Funds (Excl 0.5% uncommitted Headroom) Probability of success of mitigating action 15 % Expected Mitigation Value 15 '000 Proportion of Total 15 % Contingency Held 1, % 1, % Reserves 1, % 1, % 0.5% uncommitted reserve Investments Uncommitted - 0.0% Uncommitted Funds Sub-Total 3, % 3, % Actions to Implement Further QIPP Extensions - 0.0% Non-Recurrent Measures - 0.0% Delay/ Reduce Investment Plans - 0.0% Mitigations relying on potential funding % Complete in section below - row 41 Actions to Implement Sub-Total % Commentary15 TOTAL MITIGATION 3, % 3, % NET RISK / HEADROOM (30,150) 33.9% (10,225) BEST CASE IMPACT 3, % 3,000 No risks materialise and funds remain uncommitted. WORST CASE IMPACT (30,150) 33.9% (10,225) All risks occur and further actions all unsuccessful, uncommitted funds mitigate only. The CCG plan has reported a potential risk of 17.97m these include: Impact of LNW 7m Income recovery CIP Harrow share 2m CNWL Contract rebasing exercise Harrow CCG currently gross underpayment 5.4m QIPP potential under delivery 40% 5

9 2017/18 QIPP The 2017/18 QIPP plan is made up of three components: 1) Original CCG Schemes incorporating FYE of 16/17 schemes continuing health and medicines management; 2) Finnamore Stretch additional schemes/stretch identified by initial review; 3) NWL Recovery actions identified as part of the work across NWL. The values are shown in the table below.. Original Schemes Finnamore Stretch NWL Recovery Total Gross (15,455) (4,958) (1,684) (22,097) Investment 3,195 1,428 4,623 Net (12,260) (3,530) (1,684) (17,474) Breakdown of the budget review actions, which have been reflected in the plan before the calculation of the QIPP target, Finnamore Phase 1 schemes and NWL recovery actions are detailed on the following slides. 6

10 2017/18 QIPP Budget Review Harrow Budget Review Feb. '17 - Actions and Savings opportunity Value Savings identified '000 Review all specialites where Harrow is an outlier on planned care spend. TBC Review spend on BMI, Alliance and Spire TBC Pathology savings plan delivered through ICE and management cost savings (200) Remove Hillingdon Hospital high cost drugs budget (included in contract) (121) NCA work plan to establish savings scheme to release 10% of 16/17 costs (234) UCC remove budget in line with expected contract value (250) Remove mental health reserve relating to IAPT (98) Remove Alzheimer's budget (contract ended 16/17) (10) Reduce STARRs budget to 100k (326) Reduce QIPP reporvision costs by 200k (200) Remove Health Help App - costs to be covered by non-recurrent funding (35) Remove budget for Respiratory Nurse - budget no longer required (29) ENT budget not required (43) Terminate HHL arrangement for Gastro service (86) Confirm HHL working relationship with Moorfields TBC Total 200k saving on HHL contract (71) WSIC budget to reduce by 300k (300) Review small contracts TBC Remove spot placement budget (109) Review BCF spend along with other reablement spend TBC Remove miscellaneous spend (54) Non-recurrent costs - budget can be removed (15) Reduce system resilience spend by 76k (76) Reduce intermidiate care beds by 10 reducing spend by 1m (1,000) Reduce Optimise RX budget to contract value (39) Reduce Prescribing LIS budget by 200k (200) Remove Quality LIS budget - prevention work to be funded from GPFV (765) Reduce GPIT budget by 100k TBC Total (4,261) 7

11 2017/18 QIPP Finnamore Phase 1 8

12 2017/18 QIPP NWL Recovery Plan Actions NWL Financial Recovery Actions: '000 Out of Sector Contracts - claims & challenge 201 Choosing Wisely 154 CHC and other placements 0 Prescribing Waste 476 Biosimilars 273 PPWT 37 Urgent Care and LAS Demand Management 85 Addressing Variation in existing schemes 0 Operating Cost reduction 0 Challenging RTT assumptions 340 sub total 1,566 Other adjustments: HLP revised contribution 118 Net Benefit 1,684 9

Brent CCG INITIAL BUDGETS AND FINANCIAL PLAN 2017/18 & 2018/19. Governing Body Meeting 12 th April Neil Ferrelly Chief Finance Officer BHH CCGs

This image cannot currently be displayed. Brent CCG INITIAL BUDGETS AND FINANCIAL PLAN 2017/18 & 2018/19 Governing Body Meeting 12 th April 2017 Neil Ferrelly Chief Finance Officer BHH CCGs Contents Executive