MERTON CLINICAL COMMISSIONING GROUP GOVERNING BODY

Transcription

1 MERTON CLINICAL COMMISSIONING GROUP GOVERNING BODY Date of Meeting: 30 th November 2017 Agenda No: 9.2 Attachment: 11 Title of Document: Finance Report Month 7 Report Author: Robert Kirton Purpose of Report: To inform the Governing Body of the financial position for Merton CCG at the end of October and the forecast outturn position for the full year. Lead Director: Neil McDowell Executive Summary: Merton CCG is reporting that it is in a breakeven position at the end of October (M7) and forecasts to breakeven for the financial year. There are a number of risks and mitigations which may impact on this decision which are outlined in this report. Key sections for particular note (paragraph/page), areas of concern etc: The section regarding Acute Commissioning details the financial pressures in this area. The section on QIPP delivery addresses the risks to delivery in the year. Recommendation(s): The Governing Body is asked to NOTE this report. Committees which have previously discussed/agreed the report: The Finance Committee in Common considered a fuller version of this report which incorporated the financial position for Wandsworth CCG on November 21 st. Financial Implications: The financial position and future risks are outlined in this report. Implications for CCG Governing Body: The Governing Body must seek assurance that the CCG can achieve its financial responsibilities. How has the Patient voice been considered in development of this paper: The financial position of the CCG is discussed at public GB meetings and papers posted to the CCGs website. The public is consulted when major QIPP initiatives are proposed. Other Implications: N/A Equality Assessment: N/A Information Privacy Issues: None Communication Plan: All documents appearing on Part 1 of the Governing Body meeting will be accessible via the CCG s website. 1

2 Merton CCG Finance Report October 2017 (Month 7)

3 Contents 1. Finance Scorecard and Key Indicators 2. Month 7 Financial Position 3. Risks and Mitigations 4. Acute Commissioning 5. Non-Acute Commissioning 6. Primary Care 7. Running Costs and Corporate 8. QIPP 9. Financial Statements Statement of Financial Position Statement of Cash Flows Cash Drawdown to Month 7 Analysis of Aged Debt Month 7 Better Payment Practice Code 10. Appendices Month 7 RRL 29 November 2017 Merton CCG Governing Body 2

4 1. Finance Scorecard and Key Indicators 23 November FRC - November 2017

5 1.1 LDU Finance Scorecard October 2017 Financial Strategy Programme management office for the system transformation plan has been established to support SWL CCG s to deliver the vision. Local Transformation Board, with Finance and Activity subcommittee, has been established to deliver the strategy for Wandsworth and Merton LDU 2017/18 is year 2 of the 5 year notification of allocations. Years 4 and 5 are soft allocations. 0.5% non recurrent reserve cannot be committed in 2017/18 Contracts have been agreed but with significant QIPP outside of these plans. SWL commissioner control totals have been issued of which Merton s contribution is to break even. Financial Governance Annual internal audit plan for 2017/18 has been agreed Corporate objectives now agreed with Board Assurance Framework to follow. With the formation of the Merton & Wandsworth Local Delivery Unit a review of meetings and governance has been undertaken. Financial Recovery Group (CCG wide focus) and Savings & Delivery Group (focus on QIPP) have merged into Financial Recovery Oversight Group, which meets across Wandsworth and Merton CCG. Financial Performance MCCG forecast to achieve the in-year target break-even position. Original QIPP plan not forecast to be met but mitigated by stretching existing schemes or bringing forward new schemes as well as other one off measures such as holding budget underspends. Significant levels of acute over-performance are being seen at month 7. The cost of specialised activity transferring from NHSE to the CCG has to date been in excess of the allocation transfer. MCCG is forecasting to meet the running cost target. MCCG have achieved the Better Payment Practice Code (BPPC) of paying 95% of invoices in total within 30 days. Financial Risk Financial ledger system has limited capability to do detailed analysis. Further issues may emerge around acute contracting which may impact on our ability to achieve our target. Further mitigations have been developed to ensure that flexibility is built into the position. 2017/18 QIPP delivery represents a significant risk due to size of the programme, and the lack of reserves left to offset any further non-delivery. Currently, the QIPP programme is reporting largely to plan at Month 7. However, with savings back-weighted into the second half of the year, there is still a significant risk of underperformance. 29 November 2017 Merton CCG Governing Body 4

6 1.2 Key Indicators October 2017 YTD 000 YTD RAG FOT 000 Acute 81, ,703 Continuing Care 7,261 11,945 Mental Health 14,230 24,391 Prescribing 13,740 24,069 Surplus 0 0 QIPP 5,386 11,240 FOT RAG 29 November 2017 Merton CCG Governing Body 5

7 2. Month 7 Financial Position 23 November FRC - November 2017

8 2.1 Month 7 Financial Position overview October 2017 October 2017 The Merton CCG forecast outturn is break-even as planned. There is a risk that QIPP will not deliver the full level of savings ( 11.2m) planned, but at this point we believe that we can make up any shortfall with reserves and other non recurrent measures. The mitigations include an assessment of any slippage on the investments, but through the Financial Recovery & Oversight Group (FROG) all opportunities are being explored to identify additional QIPP and stretch existing schemes which are performing well. Acute contracts remain the main area of pressure, predominantly driven by the change in the identification rules for specialised commissioned activity, but also non-achievement and slippage of ambitious transformational QIPP plans in-year, underlying activity growth and case mix changes Pressures are predominantly at St George s ( 3.9m) and Kingston ( 1.4m). Continuing healthcare remains stable and is still forecast to underperform against budget ( 2.3m). There remains further opportunity to reduce expenditure in 2018/19. Although we are expecting to achieve the Prescribing QIPP and additional savings, these are offset by a pressure caused by stock shortages leading to higher prices, and NHS England holding back Category M savings. Overall primary care budgets are showing an underspend of 0.2m. Investments are in place to meet the mental health investment standard. The CCG plans to meet the running costs target. The 0.5% non-recurrent reserve remains uncommitted, as per NHSE requirements. 29 November 2017 Merton CCG Governing Body 7

9 2.2 Summary Financial Position October 2017 October 2017 PERIODS TO DATE FULL YEAR Budget Actual Var Total Budget Actual Var 000s 000s 000s 000s 000s 000s Resource Limit 163, , , ,698 0 EXPENDITURE Acute Commissioning 78,339 81,766-3, , ,703-6,504 Non Acute Commissioning 41,518 40,125 1,393 71,174 68,298 2,876 Primary Care & Prescribing 33,209 32, ,786 57, Running CSU (Excluding Costs Running 2,596 2, ,451 4, Costs) ,021 1, Estate Costs 1,591 1, ,728 2,728 0 Other 2,434 2, ,172 4, Reserves 2, ,862 6,167 2,476 3,691 Total Applications 163, , , ,698 0 Surplus/(Deficit) November 2017 Merton CCG Governing Body 8

10 3. Risks and Mitigations 23 November FRC - November 2017

11 3.1 Risks and Mitigations October 2017 October 2017 TABLE 1 CURRENT REPORTED POSITION MERTON CCG POTENTIAL UNMITIGATED RISKS '000 '000 '000 '000 Risks Further Risks Acute commissioning Acute SLAs - QIPP non-achievement (2,606) - QIPP under delivery (not in contracts) (3,000) - Performance (3,899) - Performance (1,000) Corporate (314) - Specialised commissioning Issue (1,200) LD Continuing care (400) Other system pressures (500) Prescribing (535) Total Risks (6,819) Total Further Risks to Mitigate (6,635) Mitigations Further Mitigations Continuing Care & FNC QIPP 1,626 Release all investments 1,000 Mental Health & LD 976 Acute challenges (including non contracted activity) 585 Community and other non acute 273 Receive allocation for specialised commissioning issue 1,200 NHS 111/OOH 182 Balance sheet flexibility 350 Prescribing & Other primary care 70 Corporate savings 150 Reserves, contingency etc 3,691 Stretch/Additional QIPP - Continuing healthcare Practice variation Other initiatives 500 Total Mitigations 6,818 Total Further Mitigations 4,635 Total Reported Position (1) Potential Surplus/(Deficit) to mitigate (2,000) 29 November 2017 Merton CCG Governing Body 10

12 4. Acute Commissioning 23 November FRC - November 2017

13 4.1 Acute Commissioning October 2017 October 2017 Year to Date The YTD position for Total Acute Commissioning at Month 7 is an overspend of 3,426, driven by overspends at St George s ( 2,404) and Kingston ( 734k). The YTD overspend at St George s is principally due to Critical Care ( 911k), Emergency ( 470k), Maternity Pathway ( 415k), Outpatients ( 341k) and Electives ( 213k). The YTD overspend at Kingston as at month 7 is being driven by increases in emergency and maternity activity. Forecast Outturn The FOT position is an overspend of 6,505k due to overspends at St George s ( 3,940k) and Kingston ( 1,436k). The FOT position at St George s is an overspend of 3,940k which is due to a continuation of trends in electives and non-electives with an extrapolated effect on critical care of 1.6m. In addition, the FOT assumes a shortfall in QIPP contracted activity, more expenditure on births of 1m and a readmission challenge of 300k. The FOT overspend position at Kingston of 1,436k is an extrapolation of the year to date position plus some seasonality built in for the second half of the year. 29 November 2017 Merton CCG Governing Body 12

14 4.2 Acute Commissioning October 2017 October 2017 Full Year Budget Budget to Date Actual to Date Variance to Date Forecast Actual Forecast Variance % Var ACUTE COMMISSIONING 000s 000s 000s 000s 000s 000s ST GEORGE'S HEALTHCARE TRUST 62,413 36,467 38,871-2,404 66,353-3,940-6% EPSOM & ST. HELIER UNIVERSITY HOSPITALS NHS TRUST - ACUTE 32,459 18,934 18, , % KINGSTON NHS TRUST 10,261 5,986 6, ,697-1,436-14% LAS - EMERGENCY SERVICE CONTRACT 6,616 3,859 3, , % EPSOM & ST. HELIER UNIVERSITY HOSPITALS NHS TRUST 4,102 2,393 2, , % MOORFIELDS EYE HOSPITAL 4,083 2,382 2, , % GUYS & ST THOMAS' HOSPITAL TRUST 2,948 1,720 1, , % CROYDON UNIVERSITY HOSPITAL NHS TRUST 1,968 1,148 1, , % THE ROYAL MARSDEN HOSPITAL TRUST 1, , % CHELSEA & WESTMINSTER HEALTHCARE TRUST 1, , % QUEEN MARYS ROEHAMPTON 1, , % Other Contracts < 1m 4,867 2,839 2, , % ACUTE CONTRACT RESERVE -3,052-1, , ,252 74% NON CONTRACTED ACTIVITY (net of QIPP) 2,199 1, , % Other Acute Non-SLA Services % Total Acute Commissioning 134,199 78,339 81,766-3, ,703-6,505-5% 29 November 2017 Merton CCG Governing Body 13

15 5. Non-Acute Commissioning 23 November FRC - November 2017

16 5.1 Non-Acute Commissioning October 2017 October 2017 Non-Acute Commissioning is showing an underspend of 1,394k at Month 7 along with a forecast year-end underspend of 2,875k. Forecast underspends are principally in the Learning Difficulties budget on Continuing Care ( 766k) and Continuing Care placements ( 2,385k). Small underspends have arisen in the carers support and dementia budgets as a result of these costs now being met as part of the Better Care Fund (BCF) although still included in the Mental Health Budget. 29 November 2017 Merton CCG Governing Body 15

17 5.2 Non-Acute Commissioning October 2017 October 2017 Year to Date Full Year Forecast Outturn Budget Actual Variance Budget Actual Variance 000s 000s 000s 000s 000s 000s Mental Health Contracts 9,970 9, ,092 17,090 2 Dementia IAPT ,513 1,513 0 Mental Health Placements 2,917 2, ,000 4, MH NCAs Bereavement Service Other Mental Health Child and Adolescent Mental Health Total Mental Health 14,380 14, ,651 24, Continuing Care 6,717 5,632 1,085 11,513 9,128 2,385 Funded Nursing Care 1,200 1, ,057 2, Total Continuing Care - Adults 7,917 7, ,570 11,944 1,626 Continuing Care - Children ,119 1,119 0 Total Continuing Care - Children ,119 1,119 0 Community Services (SGUH etc) 12,489 12, ,410 21, MCP (Multi-Specialty Community Provider) Learning Disabilities 1,572 1, ,696 1, Hospices / Other EOLC Other Non-Acute (e.g. BCF, AQP) 4,096 4, ,022 7, Total Community Services 18,569 17, ,833 30,799 1,034 Total Non-Acute Commissioning 41,519 40,125 1,394 71,173 68,298 2, November 2017 Merton CCG Governing Body 16

18 6. Primary Care 23 November FRC - November 2017

19 6.1 Primary Care October 2017 October 2017 The forecast underspend in Primary Care is 252k which is principally due to the NHS 111 contract. This assumes that activity levels remain in line with current levels. Prescribing is forecast at 65k underspent but there is some risk around the prescribing outcome in respect of Category M savings. Primary care delegated commissioning is showing a year to date over spend but this is expected to move to plan by year end. Within the first 7 months of the year we have seen commitments against a caretaker contract and a shortfall in a 16/17 accrual come through higher than plan. The run rate moving into the second half of the year will be lower and this will offset the overspend seen year to date. 29 November 2017 Merton CCG Governing Body 18

20 6.2 Primary Care - Merton October 2017 October 2017 Description Annual Budget YTD Budget YTD Actual Expenditure YTD Variance Forecast Outturn Forecast Variance 000's 000's 000's 000's 000's 000's Essential and Additional Services 20,546 11,915 11, , QIPP Savings Enhanced Services Quality and Outcomes Framework (QOF) 2,170 1,266 1, , Premises Payment 4,477 2,451 2, ,477 0 Seniority Other Administered Funds (Maternity etc) Personally Administered Drugs Other Medical Services Prior Year Accruals Sub-total: Primary Care Delegated Budgets 28,595 16,450 16, ,595 0 Prescribing (incl central costs) 24,134 14,078 13, , Other Primary Care Budgets 5,058 2,681 2, , Total 57,786 33,209 32, , November 2017 Merton CCG Governing Body 19

21 7. Running Costs and Corporate 23 November FRC - November 2017

22 7.1 Running Costs and Corporate October 2017 October 2017 Running costs are expected to be met Pressures on other corporate costs relate to investment in our QIPP programme as well as an increase in the budgeted cost of CSU services 29 November 2017 Merton CCG Governing Body 21

23 8. QIPP 23 November FRC - November 2017

24 8.1 QIPP October 2017 Merton CCG has under-delivered by 8.0m against the original 11.2m QIPP programme plan, and have removed 5.4m of schemes which were planned but are not being delivered or not showing any benefits at M7. The refreshed plan, which is forecast to deliver in full, largely consists of transactional items which are one-off in nature. There is a detailed, scheme-level breakdown on the following page. 29 November 2017 Merton CCG Governing Body 23

25 8.2 QIPP FOT October 2017 October 2017 Category Scheme Net target Net FOT FOT var '000's '000's '000's Transformational Acute Ambulatory Care Queen Marys Rhmtpn Primary Care Primary Care mitigations Co-comissioning mitigations Other Programme Other programme mitigations Discontinued 4,430-4,430 Sub-Total - Transformational 4,850 2,210-2,640 Transactional Acute Clinical Thresholds Independent Sector Counting & Coding Contract Efficiencies Contract Review Mitigations 1,353 1,353 Mental Health Placements Community Mitigations Wheelchair Service Continuing Care FNC CHC Review 700 1,107 1,407 Primary Care Medicines Management 1, Mitigations Other Programme Corporate Efficiencies Financial Policies Mitigations 1,331 1,331 Discontinued 1,850-1,850 Sub-Total Transactional 6,390 9,030 2,640 Grand Total 11,240 11, November 2017 Merton CCG Governing Body 24

26 9. Financial Statements 23 November FRC - November 2017

27 9.1 Statement of Financial Position October 2017 STATEMENT OF FINANCIAL POSITION Oct-17 Sep-17 ADJ Property, Plant And Equipment Non-current Assets Total Cash And Cash Equivalents (1,284) (744) 17 Current Trade And Other Receivables 2,157 2,520 4,959 Current Assets Total 873 1,776 4,976 Current Other Liabilities (587) (540) (2,706) Current Trade And Other Payables (25,747) (24,797) (18,456) Current Liabilities Total (26,334) (25,337) (21,162) Grand Total 559 (22,986) (15,515) General Fund 24,902 22,986 15,515 Financed by Taxpayers Equity: Total 24,902 22,986 15,515 Grand Total The CCG s available working capital has decreased by 6.3m over the seven months, mostly due to an increase in creditors November 2017 Merton CCG Governing Body 26

28 9.2 Statement of Cash Flows October 2017 STATEMENT OF CASH FLOWS Qtr 1 Qtr 2 Oct-17 Total (Increase) decrease in trade and other receivables 1, ,802 Depreciation and amortisation Increase (decrease) in trade and other payables (454) 4, ,172 Net operating costs for the financial year (69,376) (70,128) (23,580) (163,085) (Payments) for property, plant and equipment 0 (3) (1) (4) 1.Cash Flows from Operating Activities: Total (67,926) (64,869) (22,203) (154,998) Net parliamentary funding received 67,879 64,155 21, , Cash Flows from Financing Activities Total 67,879 64,155 21, ,698 Grand Total (47) (714) (539) (1,301) Movement (47) (714) (539) (1,301) Opening Amount 17 (30) (744) 17 Closing Amount (30) (744) (1,284) (1,284) 29 November 2017 Merton CCG Governing Body 27

29 9.3 Cash Drawdown to Month 7 October 2017 Monthly Drawdown 000s Proportion of Annual Cash Resource Limit CumulativeDra Cash Balance Cash drawdown wdown 000s 000s KPI % Apr-17 21,505 21,505 8% % May-17 21,505 43,010 17% % Jun-17 21,505 64,515 25% % Jul-17 21,505 86,020 33% % Aug-17 21, ,525 42% % Sep-17 21, ,030 50% % Oct-17 21, ,535 58% % Nov-17 21, ,040 Dec-17 21, ,545 Jan-18 21, ,050 Feb-18 21, ,555 Mar-18 21, ,061 TOTAL 258,061 We have met the cash target set which is to ensure we are within 0.5% of the cash drawdown at the beginning of the month. 29 November 2017 Merton CCG Governing Body 28

30 9.4 Analysis of Aged Debt Month 7 October 2017 Org. 08R Fiscal Period OCT-17 Customer Account Group Total AR O/S Amt AR Ageing 1-30 Amt AR Ageing Amt AR Ageing Amt AR Ageing Amt AR Ageing Amount AR Ageing Amount NHS 536, , ,974 NON-NHS 242,704 8, ,660 Grand Total 779,112 8, , , November 2017 Merton CCG Governing Body 29

31 9.5 Better Payment Practice Code (BPPC) October 2017 Oct-17 NHS NON-NHS TOTAL NUMBERS FOR THE MONTH Total number of invoices paid in the month Number of invoices paid within target Numbers % for the month 96.15% 98.03% 97.60% VALUES FOR THE MONTH ( 000s) Total value of invoices paid in the month 15,361 4,902 20,263 Value of invoices paid within target 14,997 4,603 19,600 Value % for the month 97.63% 93.90% 96.73% CUMULATIVE NUMBERS TO THE MONTH Total number of invoices paid YTD 1,605 5,839 7,444 Number of invoices paid within target 1,559 5,709 7,268 Numbers % Cumulative 97.13% 97.77% 97.64% CUMULATIVE VALUES TO THE MONTH ( 000s) Total value of invoices paid YTD 106,394 36, ,912 Value of invoices paid within target 105,773 34, ,483 Value % Cumulative 99.42% 95.05% 98.30% The target is 95% 29 November 2017 Merton CCG Governing Body 30

32 10. Appendix 1 - RRL 23 November FRC - November 2017

33 10.1 Appendix 1 - Month 7 Revenue Resource Limit October s 000s 000s Programme Admin Total Initial Allocation 237, ,592 Growth 5,717 5,717 Running cost 4,421 4,421 Sub-total 243,309 4, ,730 Adjustments PRIMARY CARE ALLOCATION 28,595 28,595 CHEMOTHERAPY DELIVERY EPSOM & ST HELIER CYTOKINE IDENTIFICATION RULES CHANGES HRG4+ CHANGES 1,608 1,608 FOETAL MEDICINE EPSOM & ST HELIER CYTOKINE LIAISON AND DIVERSIONS - CYP TRAINING CARE NAVIGATORS AND MEDICAL ASSISTANTS NHS WIFI MARKET RENTS 1,473 1,473 MARKET RENTS - RUNNING COSTS PARAMEDIC REBANDING TUBERCOLOSIS HEALTH AND SOCIAL CARE NETWORK - N3 ACCESS HEALTH AND SOCIAL CARE NETWORK - N3 ACCESS - RUNNING COSTS 2 2 GPFV extended access 17/ Additional month5 IR Changes - agreed by J Stalker Booth (8) -8 contribution to london Levies 17/18 (396) -396 Sub-total 33, ,968 Position as at Month 7 277,277 4, ,698 There have been no notifications of changes to the RRL received in October.. 29 November 2017 Merton CCG Governing Body 32