Finance Report: 2014/15 Month 9. Maria Moore Deputy Chief Executive/Director of Finance TRUST BOARD 29 th January 2015

Transcription

1 Finance Report: 2014/15 Month 9 Maria Moore Deputy Chief Executive/Director of Finance TRUST BOARD 29 th January 2015

2 Summary as at 31 st December Actual YTD deficit of 4.48m m variance to plan 3. Income 6.00m above plan Current Month Year to Date Full Year Actual Variance Actual Variance Budget Actual Variance '000 '000 '000 '000 '000 '000 '000 Income 24, ,568 5, , ,456 7,456 Expenditure (23,878) (1,973) (212,243) (11,741) (266,091) (281,102) (15,012) EBITDA 665 (1,525) 13,325 (5,742) 25,910 18,354 (7,556) Depn/ Interest & PDC (2,043) 13 (17,809) 692 (24,714) (23,899) 815 Net Surplus / (Deficit) (1,378) (1,512) (4,484) (5,050) 1,196 (5,545) (6,741) 2. Expenditure 11.74m above plan 3. Annual Savings Target 12m 4. Cash balance is 7.3m which is 3.7m above plan. 5. Forecast outturn 5.6m Deficit 6. Continuity of Service Risk Rating of 1 AND a FRR of 2. EBITDA % Income 2.71% 5.91% 8.87% 6.13%

3 1.1 NHS Clinical Income Contractual income The table below reflects performance against the GWH Trust income plan, by contract. Total variance against the GWH income plan for commissioned contracts, Resilience & RTT income stands at 3.6M over performance at the end of month 9. This includes 2.5M of RTT income expected to be paid outside of CCG contracts. CQUIN - has been included at 85% achievement reflecting risk against delivery. Marginal rate credits equal 2.8M. This is the GWH view of MRET as the Trust is renegotiating baselines. A formal letter has been sent to Gloucestershire with whom the Trust is pushing for a 0.9M rebase. No response has yet been received. The trust is subject to c 1.5M credit for readmissions; this is included in the position but offset against Marginal rate as some would be already paid at a marginal rate. A pro rata amount of 1.5M income to cover additional costs incurred associated with resilience/winter planning/7 day working has been built in to the position. A summary of contractual penalties included in the position is on the next slide. An allowance for contractual challenges of 830K. The variance on the community contract reduced to 333K above plan. The additional income expected to cover the cost of escalation in Q1 has been removed ( 150K). Help to live at home and step up bed income is close to agreement for the remainder of the year.

4 1.2 NHS Financial Penalties

5 1.3 NHS Clinical Income ED Performance YTD Emergency department attendances are up on the same point in This is equivalent to 3,547 attendances or 6.2%. December 2014 has seen a large increase in attendances when compared to December 2013 an increase of 862 attendances or 14%. GWH ED Attendances December YTD GWH ED Attendances by Month / /14 14/ /13 13/14 14/ Apr May Jun Jul Aug Sep Oct Nov Dec Jan Feb Mar

6 1. 4 Elective & Day Case Activity Combined YTD Elective activity has increased by 4% compared to the same point last year. IP have reduced by 313 which is a 6% reduction DC have increased by 1,302 which is a 6% increase 30,000 GWH Elective & Day Case Spells December YTD GWH Elective & Day Case Spells by month 29,000 3,900 28,000 3,400 27,000 26,000 25,000 24,000 2,900 2,400 1, , ,400 Apr May Jun Jul Aug Sep Oct Nov Dec Jan Feb Mar

7 2. Trust Expenditure 2.1 Expenditure is 11.74m above plan year to date, 1.97m above plan in month. This includes:- 4,000 3,500 Expenditure April December ,600 6,550 6,500 Pay overspend of 5.30m year to date, Pay spend has increased in month by 0.13m, Non Pay '000 3,000 2,500 2,000 1,500 1,000 6,450 6,400 6,350 6,300 6,250 6,200 6,150 6,100 Pay ' m clinical supplies overspend year to date. In month overspend is 0.53m. Apr-13 May-13 Jun-13 Jul-13 Aug-13 Sep-13 Oct-13 Nov-13 Dec-13 Jan-14 Feb-14 Mar-14 Apr-14 May-14 Jun-14 Jul-14 Drugs Supplies Other Costs Pay Aug-14 Sep-14 Oct-14 Nov-14 Dec m overspend on drugs year to date. In month is an underspend of 0.16.

8 2.2 Pay Trend The pay bill increased by 0.135m in December compared to the previous month. 1,600k 1,400k Permanent, Bank, Agency & Locum April December ,000k 15,500k The use of agency staff increased in December by 0.11m; Nursing increased by 23% ( 0.08m) Medical increased by 19% ( 0.03m) AHPs increased by 17% ( 0.02m) Managers & admin reduced by 7% ( 0.01m) Bank. Agency & Locums 1,200k 1,000k 800k 600k 400k 200k 0k Apr May Jun Jul Aug Sep Oct Nov Dec Jan Feb Mar Apr May Jun Jul Aug Sep Oct Nov Dec Bank Locum Agency Permanent Total Linear (Agency) 15,000k 14,500k 14,000k 13,500k 13,000k 12,500k 12,000k Total Pay Bill Agency spend in December compared to November:- Medical increase included cover for the winter ward, Haematology & Oncology Nursing ward staff increased by 0.08m, this included increased spend on winter ward and resilience. Pharmacy increased by 0.02m Permanent & Total Pay Bill 16,000k 15,500k 15,000k 14,500k 14,000k 13,500k 13,000k 12,500k Permanent & Total Pay Bill April 2013 December ,000k Apr May Jun Jul Aug Sep Oct Nov Dec Jan Feb Mar Apr May Jun Jul Aug Sep Oct Nov Dec Permanent Total

9 2.2 Pay Trend The medical agency spend included 0.35m relating to additional initiatives. The nursing agency spend included 0.42m relating to additional initiatives. Other includes annual leave, sickness, training etc Analysis of Spend Total General Additional Services '000 '000 '000 Medical: Extra Work/ Posts Vacancy Cover Hold File Ophthalmology Other* Total Medical 1,591 1, Nursing: Escalation/ Step-up Acuity/ Close Support Vacancy Cover 1,716 1,716 RTT 8 8 Winter Pressures Other* Total Nursing 3,852 3, *Annual leave/ sick leave cover, training, supernumerary, etc.

10 2.2 Pay Trends Medical & Nursing Medical staff expenditure reduced by 0.01m in December. Agency costs increased by 0.03m and permanent reduced by 0.04m. Nursing staff expenditure increased in December by 0.11m. Permanent increased by 0.05m Bank reduced by 0.01m Agency increased by 0.07m ,900 3,700 3,500 3,300 3,100 2,900 2,700 2,500 Apr-13 May-13 Jun-13 Jul-13 Aug-13 Sep-13 Oct-13 Nov-13 Dec-13 Jan-14 Feb-14 Mar-14 Apr-14 May-14 Agency/ Locum '000 Jun-14 Jul-14 Aug-14 Sep-14 Oct-14 Nov-14 Dec-14 Total/ Perm. ' Medical April December 2014 Locum Agency Perm Total ,700 6,500 6,300 6,100 5,900 5,700 5,500 5,300 Apr-13 May-13 Jun-13 Jul-13 Aug-13 Sep-13 Oct-13 Nov-13 Dec-13 Jan-14 Feb-14 Mar-14 Apr-14 May-14 Bank/ Agency '000 Jun-14 Jul-14 Aug-14 Sep-14 Oct-14 Nov-14 Dec-14 Total/ Perm. '000 Nursing Pay April December 2014 Bank Agency Perm Total

11 2.3 Clinical & Non Clinical Supplies Supplies Spend April December m above plan year to date, due to increase spend on: Endoscopy 2,700 2,500 Audiology '000 2,300 Wheelchairs 2,100 MRI Pharmacy manufacturing 1,900 Pathology 1,700 Orthotics Cardiology 1,500 Apr May Jun Jul Aug Sep Oct Nov Dec Jan Actual Budget Actual Budget Feb Mar Emergency department Theatres consumables Drugs Spend April December , Drugs 1, m above plan year to date, due to: NICE 0.29m Immunoglobins 0.16m Combination therapy under plan by 0.05m '000 1,700 1,500 1,300 1, Other drugs over plan by 0.36m 700 Apr May Jun Jul Aug Sep Oct Nov Dec Jan Feb Mar Actual Budget Actual Budget

12 2.5 Potential Risks to Forecast Outturn Position 2014/15 Directorate have highlighted 1.86m risks to their forecast positions the main reasons for these risk include: Continued pressure of emergency activity and the use of additional clinical areas for escalation Further pressures on the delivery of RTT, due to cancelled operations. Additional 365k included in Planned Care. The reassessment of mitigations If these risks actually materialise the Trusts position would deteriorate by 1.9m to 7.4m. This assumes no additional mitigations There is also a risk of 3.4m on clinical income; relating to readmissions, marginal rates, elective activity and penalties. The Trust will continue to negotiate with the Commissioners to eliminate this risk

13 3. Cost Improvement Programme 3.1 Total target for the year is 12m. 4m agency spend cost avoidance 8m cash releasing efficiency savings 3.2 Overall variance YTD compared to 9/12ths of annual plan is a shortfall of 3.64m. CIP Performance Annual Plan YTD Plan YTD Actual YTD Variance to Plan Corporate 2,000 1, (944) Diagnos tics & Outpatients 2,120 1, (780) Integrated Com m unity Health 1, (169) Planned Care 2,483 1,954 1,202 (753) Unscheduled Care 2,000 1, (821) Wom en's & Children's 2,089 1,319 1,148 (171) Grand Total 12,068 8,946 5,308 (3,638) 3.3 The agency spend reduction delivery against target is a 2.06m shortfall to month 9. Excluding 0.76m spent on additional services reduces the shortfall to 1.30m. Agency Spend compared to Target Year to Date Target Spend Actual Variance '000 '000 '000 AHP, Prof & tech Admin 873 1, Medical & Dental 1,317 1, Nursing 2,927 3, Total 5,651 7,714 2,064 Exclude Additional Services Adjusted Total 5,651 6,954 1,303

14 4.1 The Trust had an additional 211 wte worked in December 2014 compared to December W orked (exc W iltshire Maternity) Ave Apr May Jun Jul Aug Sep Oct Nov Dec Jan Feb Mar 2013/14 4, , , , , , , , , , , , , /15 4, , , , , , , , , , Increase The number of contracted staff has increased by 371 wte since April Contracted W TE (exc W iltshire Maternity) Apr-13 Apr-14 May-14 Jun-14 Jul-14 Aug-14 Sep-14 Oct-14 Nov-14 Dec-14 Movement from Apr'13 Allied Health Prof & Scientific Medical & Dental Nursing 1, , , , , , , , , , Senior Managers & Admin , , , , , , , , , Total 4, , , , , , , , , , Increase/ (Decrease) in Month (23.26) (2.38) (6.92)

15 4.3 Analysis of worked WTE Agency usage increased from average of 116 wte in 2013/14 to 125 wte in 2014/15 The average ratio of temporary staff to permanent has reduced marginally. 2013/14 (exc Wiltshire Maternity) Apr May Jun Jul Aug Sep Oct Nov Dec Jan Feb Mar AVE Agency Bank Locum Perm 3, , , , , , , , , , , , , % temp 5.9% 5.9% 6.0% 6.0% 6.8% 6.7% 6.5% 6.4% 6.0% 6.3% 5.8% 5.8% 6.2% 2014/15 (exc Wiltshire Maternity) Apr May Jun Jul Aug Sep Oct Nov Dec Jan Feb Mar AVE Agency Bank Locum Perm 4, , , , , , , , , , % temp 5.9% 6.1% 6.0% 6.3% 6.4% 6.0% 5.4% 5.6% 5.9% 6.0%

16 5.Balance Sheet 5.1 Stock levels are 0.1m below plan. 5.2 Debtors above plan 8.4m. NHS Debtors are 5.3m above plan Other Debtors are 3.3m above plan Prepayments are 0.2m below plan. 5.3 Creditors is 17.5m above plan Trade Creditors above plan 11.3m Capital Creditors 0.1m below plan Other Creditors 3.6m above plan Accruals 2.3m above plan Balance sheet m As at 31 December 2014 Non-Current Assets Actual Plan Variance Intangible Assets Property, Plant and Equipment On balance sheet PFI assets (0.0) Total Non-Current Assets Current Assets Inventories (0.1) NHS Trade Receivables Non-NHS Trade Receivables Other Receivables Accrued Income (0.1) Prepayments (0.2) Cash Total Current Assets Total Assets Current Liabilities Deferred Income Trade Creditors Other Creditors Payment on Account Capital Creditors Provisions current Accruals Total Current Liabilities Non current Liabilities Deferred Income (0.0) Provisions non current PFI leases non-current (0.0) Total Non-Current Liabilities (0.0) Total Assets Employed (4.6) Taxpayer's and Others Equity PDC Retained Earnings (5.6) Revaluation Reserve Total Assets Employed (4.6)

17 6. Cash Position Cash is 7.3m which is 3.7m above plan As at 31 December 2014 Early receipt of Q4 PFI contract income from Wiltshire CCG ( 3.1m). Receipt of over performance income at end of December 0.6m Cashflow m Actual Plan Variance EBITDA (5.7) Debtors (4.7) (4.9) 0.2 Creditors Other change in WC Non cash I&E items (0.1) (0.1) (0.0) CF from operations Capital Expenditure (4.9) (5.4) 0.5 Asset sale Proceeds Net Interest (10.6) (10.9) 0.3 Dividends paid Movement in loans (0.6) (0.6) 0.0 PDC received / (repaid) Other (0.1) (0.5) 0.4 Net cash inflow/(outflow) 2.9 (0.8) 3.7 Opening Cash balance Closing Cash Balance

18 Recommendations / Decisions Required The Board is required to agree:- a) the Month 9 financial position is a deficit of 4.48m b) that the forecast year end Continuity of Service Risk Rating is a 1 c) that the current FRR is 2

19 Rolling Cash Flow Cashflow Forecast Dec-14 Jan-15 Feb-15 Mar-15 Apr-15 May-15 Jun-15 Jul-15 Aug-15 Sep-15 Oct-15 Nov-15 Dec m m m m m m m m m m m m m Opening cash balance Income NHS Income PCT PFI Payment RTA Income VAT Other income Total Income Expenditure Pay Tax & Pensions NHSLA Creditors PDC Dividend THC Capital expenditure Total Expenditure Net movement (5.252) (3.230) (0.036) (0.561) (0.286) (0.861) Closing cash balance

20 Continuity of Services Risk Rating (CoSRR) Scenarios The current CoSRR is 1. Weighting Metric Rating Rating Categories Capital Service Cover 50% <1.25 Liquidity 50% <-14 Continuity of Service Risk Rating 1 The forecast CoSRR for year end will be included within the recovery plan discussions

21 Financial Risk Rating The FRR at Month 2 is 2. Weight Rating Categories Financial Criteria (%) Metric to be Scored Metric Rating Achievement of plan 10% EBITDA achieved (%) 69.9% 2 100% 85% 70% 50% <50% Underlying 25% EBITDA margin (%) 5.9% 3 11% 9% 5% 1% <1% Financial efficiency (i) 20% Return Net after Financing -4.7% 2 3% 2% -1% -5% <-5% Financial efficiency (ii) 20% I&E surplus margin (%) -2.0% 2 3% 2% 1% -2% <-2% Liquidity 25% Liquidity ratio in days <10 Overall Financial Risk Rating 2