Chief Finance Officer. The CCG reports a surplus of 79k for the year after holding a projected a surplus of 32k for the last three months.

Size: px

Start display at page:

Download "Chief Finance Officer. The CCG reports a surplus of 79k for the year after holding a projected a surplus of 32k for the last three months."

Patience Webb
5 years ago
Views:

1 Agenda item 8 TITLE PRESENTED BY LEAD MANAGER PURPOSE OF PAPER RECOMMENDATION EQUALITY & DIVERSITY IMPACT FINANCE REPORT Stephen Schofield Chief Finance Officer Stephen Schofield Chief Finance Officer To provide an overview of the financial position for the period to 31st March 2013 and the final outturn for 2012/13. The Board is asked to Note this report Financial governance impacts the CCG s ability to deliver services in an equitable manner that reflects the diverse needs of the population. Executive Summary The CCG reports a surplus of 79k for the year after holding a projected a surplus of 32k for the last three months. Appendix A summarises the position for the services that the CCG is responsible for and Appendix B shows the finally agreed acute provider positions. 1. Financial Position In achieving this result the CCG: has not be able to deploy 1.6m of the 2% Transformation Fund; has used the full 4.3m Contingency; and not distributed 0.9m for Winter Pressures Resource as a non-recurrent investment. Acute over performance is the main variance at 6.9m above budget. Acute Luton & Dunstable Hospital The activity levels at the Luton and Dunstable remained high during March. The contract was agreed at 110.0m, which was a final over-performance of 4.2m, but this was against an increased budget following receipt of an additional resource of 2m. Over-performance of urgent care remained the main contributing factor, emergency admissions over-performed by 2.9m, an 11.8% increase on last year. A&E showed high levels of activity creating a 618k over spend, a 3.6% increase on last year. Outpatients were also higher than plan by 902k and high cost drugs by 674k. Data for January and February has shown that A&E attendances and the more expensive corresponding admissions have decreased during this time. March data is not yet available. 1

2 Royal Free Royal Free has under-spent by 92k in the month which has reduced the deficit to 348k. This has resulted from an earlier long stay critical care patient at a cost of 435k. West Hertfordshire Hospital West Hertfordshire Hospital has again improved in month by a modest 1k reducing the year to date adverse variance to 117k. The main reason for the over-performance is due to the discharge of a high cost patient from critical care at a cost of 85k. This contract also over-performed in elective orthopaedic activity generating an over-spend of 59k. Cambridge University Hospital (Addenbrookes) Cambridge University Hospital reports an adverse movement of 15k in the month which has increased the over-spend to 252k. This is mainly due to two cases of aneurysm coil devices being required at a cost of 146k and over-performance in elective activity largely accounts for the remainder. Community (CCS) and Mental Health (SEPT) Community Services reports a surplus of 250k, this is due to the costs for Gynae Services being 112k lower than the budget and also a credit received in relation to Falls for 107k, due to the service not being up and running in 2012/13. Other Community Other Community contracts have reported an over-spend of 841k. In Children s CHC services there was an increase in activity over 2011/12 levels by 265k and also a greater uptake in community MSK service, which has meant an overperformance of 280k. In relation to both CHC ABI and Rehab ABI there has been a slight increase in activity but due to the high cost of some of the packages, this has meant an over-spend across the two areas of 294k. Mental Health placements report higher activity and as a result has come in at a 730k over-spend. This includes an over-spend of 142k due to an increase in NCA patients. This over-performance has been offset by the delayed start to the IAPT service which has reduced costs by 284k. Intermediate care beds are reporting an adverse variance of 320k, reflecting the full year effect of additional beds which were block purchased part way through last year and not fully budgeted for in 2012/13. Urgent Care (Primary Care) The Urgent Care directorate incorporates the Urgent Care Centre (UCC), GP Out of Hours Service (OOH) and Call Handling and Triaging Service (111) and reports a final year end underspend position of 508k. 2

3 The underspend position relates mainly to the UCC. The service is provided as a block contract therefore actual costs are in line with planned expenditure. As previously reported the surplus position has been generated due to overstating the planned budget which accounted for non-recurrent set up costs incurred in the previous year. This has subsequently created an overall year end benefit of 200k. In addition to this, out of area patients utilising the UCC can be recharged under the responsible commissioner guidelines, therefore external recharges for out of area patients has created a further year end benefit of 197k. Thus creating an overall year end under-spend of 397k for the UCC. The OOH service is also a block contract and is therefore largely in line with planned expenditure showing a final under-spend of 8k. The 111 budget has also contributed to the overall under-spend within the Urgent Care directorate. As previously reported, service costs are largely in line with plan so there are no significant variances to report. The under-spend position has been generated following a provision in the budget for re-procurement costs which were lower than planned creating a final year end surplus of 103k. Medicines Management Medicines Management completed the year with an under-spend of 771k which was largely due the over performance of QIPP plans. This was 55k worse than the last forecast and reflected the revised PPA forecast. The underspend is due to lower than expected costs due to a revised impact of benefits derived from price changes to category M drugs as well as higher than expected QIPP savings in 2012/13. It should be noted prescribing data is received two months in arrears, with January being the latest. Corporate Services The Prior Approvals process continued to operate, in order to apply a brake on expenditure, and has enabled the final position to be settled with a favourable variance of 35k. 2. QIPP The table below shows the full year QIPP performance for the entire PCT. 3

4 Workstreams Annual Plan YTD Plan YTD Actual Variance Planned Care 1,362 1, (1,226) LTC (274) Urgent Care 2,201 2, (1,938) Paediatrics (137) Prescribing ,716 1,776 Maternity (350) Prevention (126) Primary Care (100) Other 2,999 2,999 2,343 (656) Total for Workstreams 8,584 8,584 5,554 (3,030) Add. Financial Challenge Acute 2,400 2,400 0 (2,400) Medicines Management (500) Grand Total 11,484 11,484 5,554 (5,930) The targeted PCT QIPP savings was 11.5m and comprised the initial QIPP challenge of 8.6m together with 2.9m additional objectives [Acute ( 2.4m) and Medicines Management ( 0.5m)], which have been reported previously. The shortfall against the planned savings programme has increased again, by 65k from last month, and is finalised at 5.9m below Plan a 52% shortfall. 3. Risks There are no specific risks to the CCG result in that the position reported is the full year result. The transfer arrangement for relevant and appropriate Balance Sheet balances to the CCG has not yet been resolved in detail nationally and any risk implications to this cannot be seen at the moment, but the intention has been for the PCT to properly accrue for all known costs. A provision for the historical Continuing Healthcare retrospective claims catch-up, following the introduction of Government deadlines for submission of claims, has been provided by the PCT at 575k and a Contingent Liability of c 500k will also be reported in the Annual Accounts. Therefore the CCG is not therefore expected to have any residual on-going liability for such historical claims. 4. Recommendation The Board is asked to Note this report. 5. Glossary ABI Acquired Brain Injury CAMHS Children and Adolescent Mental Health Services CCC Clinical Commissioning Committee CCG Clinical Commissioning Group CCS Cambridge Community Services CHC Continuing Health Care 4

5 CQUIN Commissioning for Quality and Innovation DH Department of Health HA Pharmaceutical Health Authority Pharmaceutical, contains medicines waste management costs. IAPT Improving Access to Pychological Therapies L&D Luton and Dunstable NHS Foundation Trust MSK - Musculoskeletal NCA Non Contracted Activity OOH Out of Hours PPA Prescribing Pricing Authority QIPP Quality Innovation Productivity Prevention RRL Revenue Resource Limit SBS Shared Business Services SCG Specialist Commissioning Group UCC Urgent Care Centre 5

Report. Chris Ford Joint Chief Finance Officer

Report. Chris Ford Joint Chief Finance Officer Governing Body Meeting held in public Report Date of Meeting: 8 November 2018 Agenda Item: 15.0 Report Title Finance Report as at 30 th September 2018 (Month 6) Report Author Presented By Responsible Director