BOARD PAPER - NHS ENGLAND
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1 BOARD PAPER - NHS ENGLAND Paper: PB /09 Title: Consolidated Month /17 Financial Report Lead Director: Paul Baumann, Chief Financial Officer Purpose of Paper: To update the Board on the financial position for month /17, the forecast for the year and the associated risks of delivery Key Points: NHS England is on track to meet its financial targets to balance its budget, while generating an 800m managed underspend to contribute to offsetting trust deficits. The Board is invited to: Note the financial position for month 11 1
2 PURPOSE CONSOLIDATED MONTH /17 FINANCIAL REPORT 1. This paper summarises the year to date and forecast position at month 11, 2016/17. CONTEXT 2. The commissioning system is planning to spend a total RDEL allocation of 105.8bn, which includes 250m of prior year drawdown, plus a further 651m for AME/ Technical items1 giving a total in-year allocation of 106.5bn. This excludes any historical underspends that are not available to be spent in 2016/ The commissioning expenditure for the year includes a reserve for non-recurrent investment expenditure of 1 of allocations (ca. 800m), which is uncommitted and will be used to offset overspends across the health system to ensure the delivery of overall financial balance. The creation of this reserve has placed significant pressure on the commissioning system, which is reflected in an increase in the level of savings that commissioners need to deliver, from an average of 2.2 of allocations in 2015/16 to 3.0 of allocations in 2016/17 plans. The challenge in delivering a higher level of savings has been reflected in commissioner risks from the start of the year and is increasingly crystallising in individual CCG forecasts. 4. The figures in this report are derived from the consolidated financial reports of clinical commissioning groups (CCGs) and direct commissioning units, which have been reviewed and assured by local offices and the regional teams, and from the monthly financial reports on central budgets. ANALYSIS Overall Financial Position 5. Table 1 summarises the year to date and full year forecast expenditure for NHS England as at month 11: Table 1 Net Expenditure Year to Date Outturn Actual Under/(over) spend FOT Under/(over) spend CCGs 69, ,950.7 (584.1) (0.8) 76, ,232.7 (550.4) (0.7) Direct Commissioning 23, , , , NHSE Running & central programme costs (excl. depreciation) 2, , , , Other including technical and ringfenced adjustments (95.7) (42.7) (53.0) Total non-ringfenced RDEL under/(over) spend 94, , , , The NHS England mandate includes two technical financial targets; 300m Annually Managed Expenditure (AME) limit for provision movements and other impairments and 351m Technical accounting limit (e.g. for capital grants). These limits are ringfenced and cannot be used to support core patient services, which comprise our Revenue Departmental Expenditure Limit (RDEL) limit. 2
3 6. Overall at month 11, NHS England is reporting a year to date underspend of 21m (0.0). A 0.8 overspend on CCGs (see para 8) is offset by underspends on other areas of direct commissioning and NHS England central budgets. 7. The full year forecast shows a bottom line position in line with plan. This excludes any release of the commissioners risk reserve and is made up of a forecast overspend in CCGs ( 550m, 0.7) offset by forecast underspends on direct commissioning ( 125m, 0.5) and NHS England central budgets ( 479m, 13.9). The forecast also reflects greater pressure than expected from the impact of the technical and ringfenced adjustments relating to provision movements and depreciation, though the position has improved slightly compared to month 10. The total forecast variance of 53m in these areas is the result provision movements ( 35m) and lower than expected depreciation charges ( 18m), both of which are adjusted for when reporting against the core non-ringfenced RDEL measure. 8. There are 79 CCGs forecasting a year end overspend, of which 37 are forecasting unplanned cumulative deficit positions. All CCGs facing potential overspends are fully engaged in mitigating actions, with additional intervention where necessary by NHS England regional teams. CCGs are currently forecasting an overall 584m (0.8) overspend which is offset by a 34m forecast underspend on the quality premium budget for the year. There is a 34 forecast increase in the value of commissioner savings compared to 2015/16. At month 11, commissioners are forecasting that 2.5bn of their savings plans will be delivered. Further detail on commissioner efficiency performance can be found in Appendix D. 9. Further detail on the overall financial position can be found in the appendices, including a detailed summary of year to date and forecast expenditure (Appendix A), a breakdown of running costs (Appendix B) and of programme costs (Appendix C). Detailed financial performance information is also published on the NHS England website on a quarterly basis ( Risks and Mitigations 10. Alongside the forecast, NHS England monitors financial risks and available mitigations. A higher level of risk than in previous years was identified during planning, predominantly reflecting the higher level of ambition with regard to efficiency gains, and this has been reported to the board since the start of the year. As expected and planned for, risk has crystallised into forecasts as the year has progressed, but the aggregate of forecast overspend and net risk has reduced steadily in recent months, as mitigating actions have taken effect. At Month 11 the outstanding net risk has been reduced to 34m. 11. This net risk assessment excludes the 800m non-recurrent investment funding which is being held uncommitted by CCGs and NHS England Commissioning Teams. This funding will be required to offset overspends across the wider health system, and so will be released into the CCG positions in month Including this reserve, the current forecast and risk assessment show that CCGs and NHS England are on course to balance their combined budget for 2016/17 as a whole, while contributing an 800m managed underspend. 3
4 RECOMMENDATION 13. The Board is asked to note the financial position for month 11. Author: Paul Baumann, Chief Financial Officer Date: March
5 Summary of Year to Date and Expenditure by Area of Commissioning APPENDIX A Local Net Expenditure Actual 5 North 21, ,532.3 (175.0) (0.8) 23, ,788.2 (174.6) (0.7) Midlands & East 20, ,358.1 (144.0) (0.7) 22, ,436.1 (116.0) (0.5) London 10, ,811.5 (44.1) (0.4) 11, ,992.4 (60.5) (0.5) South 17, ,248.8 (221.0) (1.3) 18, ,016.0 (232.8) (1.2) Quality Premium Total Local Net Expenditure 69, ,950.7 (584.1) (0.8) 76, ,232.7 (550.4) (0.7) Direct Commissioning Specialised Commissioning 14, ,106.9 (23.3) (0.2) 15, , Armed Forces Health & Justice Primary Care & Secondary Dental 7, , , , Public Health Total Direct Commissioning Expenditure 23, , , , NHS England Other (excluding depreciation & technical) NHS England Running Costs (excl. depreciation) NHS England Central Programme Costs (excl. depreciation) CSUs net margin 5.6 (8.2) Other Central Budgets (including provider STF) 2 1, , , Total NHS England Other (excluding depreciation & technical) Year to Date Net Expenditure Net Expenditure 2, , , , NHS England depreciation charges Remove ringfenced under/(over) spend (depreciation and impairments) (166.0) (89.5) (76.5) Remove AME/Technical items (52.6) (17.8) (34.8) Total non-ringfenced RDEL under/(over) spend 94, , , , Note 1 - Quality Premium is added to the planned expenditure (and income) of CCGs in the lines above w hen earned. This line show s the element of annual quality premium budget w hich has not been earned. Note 2 - Expenditure relating to aw ards under the provider element of the Sustainability and Transformation Fund is assumed to be in line w ith the full allocation of 1.8bn. The related income for trusts is fully accounted for in the provider position reported by NHS Improvement either w ithin individual organisations results and forecasts or as a separate line to the extent that it is either not yet allocated or not earned under the relevant aw ard criteria.
6 Summary of Year to Date and NHS England Running Costs Expenditure APPENDIX B ' ' Year to Date Net Expenditure Actual Net Expenditure Medical Nursing Operations and Information Specialised Commissioning Finance (0.4) (0.9) Commissioning Strategy Transformation & Corp Operations PCS (0.6) (1.0) Chair & Chief Executive Group Contingency/other 8.2 (13.7) (9.1) TOTAL excl Depreciation
7 Summary of Year to Date and NHS England Programme Costs Expenditure APPENDIX C ' ' Year to Date Net Expenditure Actual Net Expenditure Medical Nursing Operations and Information Specialised Commissioning Finance Commissioning Strategy Transformation & Corp Operations Clinical Excellence Aw ards Provider Support Other Programmes Rates and fraud recovery income 0.0 (90.9) (93.6) NHS England contribution to legacy CHC claims Contingency 15.1 (39.6) (44.2) TOTAL excl Depreciation
8 APPENDIX D Summary of Year to Date and Commissioner Efficiency Performance by Area of Commissioning Year to Date Commissioner Efficiency Commissioner Efficiency 2015/16 Actual Achieved As of Allocation As of Allocation Achieved Outturn As of Allocation Local North (139.2) (163.9) Midlands and East (90.1) (68.4) London (38.2) (45.7) South (187.1) (182.0) Total Local 2, ,718.7 (454.6) , , (460.0) , Direct Commissioning 0.0 Percentage Increase Specialised (112.9) (94.8) Health & Justice (0.0) Armed Forces (0.0) (100.0) (100.0) Primary Care and Secondary Dental (70.6) (73.0) Public Health Total DC (182.3) (167.8) TOTAL 2, ,110.6 (636.9) , , (627.8) , ned Of w hich transformational 1, (243.0) , (201.2)
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