GOVERNING BODY FINANCE REPORT MONTH 9

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Mariah Booker
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1 LEAD: Neil Ferrelly, Chief Finance Officer REPORT AUTHOR: Jenny Sinnott, Head of Finance GOVERNING BODY ATTACHMENT: AGENDA ITEM: 9 H RECOMMENDATION: The Governing Body is asked to note the points raised in the report below. GOVERNING BODY MEETING DATE: 4th March 2014 FINANCE REPORT MONTH 9 EXECUTIVE SUMMARY: 1. The CCG reports a forecast 2.01m surplus for the year in line with the financial plan. 2. The 0.5% contingency reserve is assumed to be fully utilised during the year. 3. QIPP is reporting an estimated full year underachievement of 131k. 4. The running costs budget has been reported to break even at the year end. 5. The CCG made a bid against the SWL Risk pool for the unforeseen in respect of specialist commissioning and NETA, which has been approved and the full initial contribution of 984k by the CCG has been returned. 6. There remains a risk of 1.1m in respect of duplicating various property and accommodation charges that is still to be mitigated. KEY SECTIONS FOR PARTICULAR NOTE: See above RECOMMENDATIONS: To note the attached report RISKS IDENTIFIED: Risks are detailed in the attached report FINANCIAL IMPLICATIONS: Financial implications are detailed in the attached report Version: Final H - 1

2 GOVERNING BODY OBJECTIVES for 2013/14: Please indicate below all the domains which the paper provides evidence for: Domain One: A strong clinical focus and multi professional focus which brings real added value Domain Two: Meaningful engagement with patients, carers and their communities Domain Three: Clear and credible plans which continue to deliver the QIPP challenge within financial resources, in line with national requirements (including outcomes) and the local joint health and wellbeing strategy Domain Four: Proper constitutional and governance arrangements, with the capacity and capability to deliver all their duties and responsibilities, including financial control, as well as effectively commission all the services for which they are responsible. Domain Five: Collaborative arrangements for commissioning with other CCGs, local authorities and NHS England as well as the appropriate external commissioning support Domain Six: Great leaders who individually and collectively can make a real difference EQUALITY IMPACT ASSESSMENT: PRIVACY IMPACT ASSESSMENT: Please indicate whether any engagement has been carried out regarding this service change. (tick appropriate box) Yes No If no, please state reason: Version: Final H - 2

3 Kingston Clinical Commissioning Group Board Objectives for 2013/14 Set out below are a set of objectives for the CCG Board. The format is based on the 6 authorisation domains. Within each domain there are a small number of mission critical key objectives where the Board should collectively focus the majority of its attention. Domain one: a strong clinical and multi-professional focus which brings real added value. Continued development of the role and function of the Council of Members. Clinicians leading service change. Domain two: meaningful engagement with patients, carers and their communities. Genuinely involve patients in service design and evolution. Engagement with Healthwatch. Domain three: clear and credible plans which continue to deliver the QIPP challenge within financial resources, in line with national requirements (including outcomes) and the local joint health and wellbeing strategy. Delivery of the 2013/14 financial and service plans. Delivery of the National Outcomes Framework. Innovation. Domain four: proper constitutional and governance arrangements, with the capacity and capability to deliver all their duties and responsibilities, including financial control, as well as effectively commission all the services for which they are responsible. Effective arrangements for oversight of the quality and safety of commissioned services. Compliance with statutory duties. Domain five: collaborative arrangements for commissioning with other CCGs, local authorities and the NHS England as well as the appropriate external commissioning support. Integrated commissioning of services with RBK. Effective discharge of our lead commissioning arrangements with Kingston Hospital NHS Trust, South West London and ST Georges NHS trust and Your Healthcare CIC. Primary Care development. Better Services, Better Value Domain six: great leaders who individually and collectively can make a real difference. Board development. Commissioning staff development. Version: Final H - 3

4 KINGSTON CCG MISSION & VALUES We are passionate about your health, compassionate about your care Our task is to: become unwell, and for those services to be safe, effective and provide the good experience you deserve o the health and wellbeing of people in Kingston o the support that s available to help people look after themselves o the quality of local health services We value: ton being able to say, I m heard, I m healthier, I m cared for We plan to achieve this by: available and accessible in a timely way We will measure how well we do by: n the health gap between affluent and more disadvantaged areas and people Version: Final H - 4

5 Finance Report Period 9 December Financial Position 2013/14 Kingston CCG s financial plan is to maintain a surplus of 2,012k, which is 1% of total revenue resources. The CCG is also required to maintain an additional 0.5% contingency fund. The financial position at month 9 is shown in Appendix 1. Kingston CCG reports delivery of a 1,511k YTD surplus, which is in line with achievement of the planned 1% surplus at year end. Key Points to note:- 1. The CCG reports a forecast 2.01m surplus for the year in line with the financial plan. 2. The 0.5% contingency reserve is assumed to be fully utilised during the year. 3. QIPP is reporting an estimated full year underachievement of 131k. 4. The running costs budget has been reported to break even at the year end. 5. The CCG made a bid against the SWL Risk pool for the unforeseen in respect of specialist commissioning and NETA, which has been approved and the full initial contribution of 984k by the CCG has been returned. 6. There remains a risk of 1.1m in respect of duplicating various property and accommodation charges that is still to be mitigated. 2. Key Financial Risks Impact of Risks on Achievement of Surplus The reported surplus position in Appendix 1 excludes the following uncertain costs:- 1. NHS Property Services have nationally advised CCG s that premises and accommodation charges will be made based on estimated costs prepared in 2012/13 rather than actual 2013/14 costs. This has created an additional risk of 1.1m as the CCG is funding Property Services for costs that are already paid through SLA s with other parties following property sales. Further discussions are being undertaken with the NHS Property national and local team to mitigate this risk. This risk has resulted in the CCG reporting an amber RAG rating on the assurance framework. Version: Final H - 5

6 3. NHS ENGLAND CCG Balance Scorecard Quarter 3 No Indicator Primary / Supportin g Indicator Start RAG rating RAG Description 1 Underlying recurrent surplus on exit of 2013/14 Primary Q2 G >= 2% 2 Plan - year to date (variance to plan as % of YTD allocation) Primary Q1 G Variance <= 0.1% 3 Plan - full year (forecast variance to plan as % of allocation) Primary Q1 G Variance <= 0.1% 4 Management of 2% NR funds w ithin agreed processes Supporting Q1 G Yes 5 QIPP ** - year to date delivery Primary Q1 G >= 95% of plan 6 QIPP ** - full year forecast Primary Q1 G >= 95% of plan 7 Activity trends - year to date Supporting Q3 < 101% of plan 8 Activity trends - full year forecast Supporting Q3 < 101% of plan 9 Running costs Primary Q1 G <= RCA 10 Clear identification of risks against financial delivery and mitigations Primary Q1 AR Risks not fully mitigated and, if they w ere to materialise, the CCG w ould be in deficit up to 1% of allocation 4. Commissioned Services Acute Services (Appendix 2) Acute financial performance at month 9 is reported in Appendix 2. As at month 9, the latest acute information available is month 8. Fig 1. Total Acute Trust Point of delivery (over)/under spend YTD ( 000 s) Kingston Hospital is above plan by 2.3m M8 YTD and this is mitigated to an over performance of 1.1m after challenges, with a forecast annual overperformance of 1.7m. Non elective work is the main driver of the YTD position. General Medicine contributes 1.1m of the over performance, and this is in the main due to thoracic procedures and disorders ( 0.4m), digestive system procedures and disorders ( 0.2m), and immunology infectious diseases et al ( 0.2m). Version: Final H - 6

7 St George s Hospital is performing close to plan YTD after the application of mitigations. A forecast outturn overspend of 0.1m is the most likely position based on activity and challenges experienced M8 YTD. Adult critical care continues to over perform at M8, but the Trust has not reported any long stay patients. The non-elective activity overspend is driven by Trauma & Orthopaedics, Vascular Surgery, General Medicine and also Oncology. Epsom & St Helier Acute is under spending by 0.4m after the application of challenges. This challenge amount covers items such as Ophthalmology out-patient attendances incorrectly charged as outpatient procedures, erroneous over spends on the anti-coagulation service and also reductions to income based on CQUIN non achievement. The underspend is offset by a 0.2m overspend on SWLEOC, driven by reconstructive procedures. Non-Acute Services (Appendix 3) Mental Health is forecast to overspend by 7k by year end. This is due to a 693k overspend on the SWLMHT contract caused by the delayed closure of Fuchsias ward, which had been anticipated to occur during the year. This is largely offset by an underspend on placements. Continuing Care is showing a forecast outturn overspend of 1.8m. The over spend is driven by increases in admissions in earlier months, particularly for palliative and physically frail patients. The forecast assumes a steady state to the end of the year and an additional 1.5% is built into the forecast to incorporate any sudden growth in admissions due to their unpredictable nature. Fig 2. Continuing Care admissions net of discharges 2012/13 Q1 2012/13 Q2 2012/13 Q3 2012/13 Q4 2013/14 Q1 2013/14 Q2 2013/14 Q3 EMI Others Palliative Physically frail YPD Total Graphs describing continuing care trends in price and activity are shown in Appendix 7. Children with Disabilities spend is forecast to overspend by 725k, which is a 36% overspend. This is due to an increase in complexity of care and the hours of care required per child. A new contract was negotiated with the main supplier with the aim of increasing quality and the reviewed care packages are more costly. Primary Care Services (Appendix 4) Prescribing budgets are forecast to overspend by 3k at year end. The position also includes an amount of 194k of income for the recharge of drugs relating to services transferred to the local authority in April. The local authority have yet to agree to this recharge and there is a risk that the full income will not be retrieved. 5. QIPP Kingston CCG has reported to NHS England in month 9 that it expects to under achieve on its QIPP target by 131k. There are under-achievements on a number of projects i.e. 239k under achievement on Angina Modelling due to a delayed start and 151k on Telehealth & Risk Stratification due to low uptake. Admissions avoidance data shows achievement of higher than target savings offsetting some of the underachievements on other projects. QIPP projects are detailed in Appendix 5. Version: Final H - 7

8 6. Legacy Balances Transfer from PCT s Work is continuing to transfer the balances remaining on the PCT accounts to the receiving organisations. It has been confirmed that all CCG balances will transfer to NHS England, with the exception of those associated with fixed assets. The CCG will not benefit from any PCT balances and these balances have not previously been included in the reported financial position. Version: Final H - 8

9 Appendix 1 Finance Report at Month 9 Version: Final H - 9

10 Appendix 2 Acute Commissioning Version: Final H - 10

11 Appendix 3 Non Acute Commissioning Appendix 4 Primary Care Services Version: Final H - 11

12 Appendix 5 QIPP Position at Month 9 Version: Final H - 12

13 Appendix 6 Revenue Resource Limit at Month 9 Version: Final H - 13

14 Appendix 7 - Continuing Care Activity Trends Average Weekly Rate Cost Profile Net Admissions/Discharges per quarter Monthly trend of increasing admissions and decreasing discharges Total patients in Continuing Care Version: Final H - 14

Finance Report Period 6 September 2013

1. Financial Position 2013/14 Finance Report Period 6 September 2013 Kingston CC s financial plan is to maintain a surplus of 2,012k, which is 1% of total revenue resources. The CC is also required to