Finance Report M4 2016/17

Transcription

1 Finance Report M4 2016/17 Summary The Trust is reporting an underlying deficit (excluding STF income) of 1.2m against a planned surplus of 0.3m at the end of July. The Trust is reporting an FSR rating of '3' in line with its financial plan. Financial Sustainability Risk Rating G Control Total (exc STF) Surplus k A Agency Ceiling k G Plan Actual / Forecast Plan Actual / Forecast Plan Actual/Forecast Year to Date 3 3 Year to Date k 318 (1,218) Year to Date k 8,040 6,362 Year End Forecast 4 4 Year End Forecast k 3,234 3,234 Year End Forecast k 17,249 17,249 The Trust is reporting a Financial Sustainability Risk Rating (FSRR) of '3' at the end of July, in line with its financial plan. The Trust is reporting an adverse position against plan in M4. Income has underperformed in month due to reduced activity levels in outpatients and elective inpatients which has not been offset by non-elective overperformance. Pay is overspent as the Trust has had more beds open than planned for July. At the end of July the Trust is 1.68m below the agency ceiling and expenditure for the month. Expenditure in July was consistent with June as reductions in nurse agency expenditure were offset by increases in medical and other clinical agency. Income k A Operating Costs k A Agency Expenditure A Expenditure as % of Total Paybill (monthly) 2014/ / /17 Plan Actual / Forecast Plan Actual / Forecast Medical 13.8% 15.9% 6.8% Year to Date k 144, ,372 Year to Date k (131,573) (133,263) Nursing 1.2% 7.5% 8.3% Year End Forecast 434, ,914 Year End Forecast k (392,956) (392,956) Other Staff Groups 3.1% 4.0% 3.5% At the end of July income is 0.4m below plan. Although income from activities remains above plan, this was reduced in month due to underperformance in elective inpatients and outpatients. Private patient income continues to underperform. Pay is above plan in July across all Clinical staff groups. Non pay is above plan, with the largest drivers remaining PbR excluded drugs and clinical supplies. All Agency 5.6% 8.8% 6.2% Although nurse agency has reduced, it remains above the ceiling level and further reductions are need to deliver a sustainable level of spend. Cash k A Capital k A Efficiency and Transformation Programme k G Plan Actual Plan Actual / Forecast Plan Actual / Forecast Year to Date k 2,202 6,895 Year to Date k 6,718 1,210 Year to Date k 6,208 6,187 Year End Forecast k 12,931 12,931 Year End Forecast k 16,812 16,812 Year End Forecast k 18,902 18,509 The cash position is ahead of plan due to the impact of slippage on the capital programme. The capital programme is under-spent by 5.1m due to later start dates on some programmes. A number of schemes have been approved to start and so it is expected that the programme will move closer to plan during Q2. At the end of July, the Efficiency Programme delivered cumulative savings of 6.1m against a plan of 6.2m (99.7%). Key Risks: 1. Ability to exit premium rate workforce arrangements. Vacancies and long-term sickness in key staff groups are driving agency expenditure. The Workforce Transformation Group is overseeing action plans to increase recruitment, redesign workforce roles and manage sickness, rostering and retention issues. Opportunities to move to framework agency and reduce rates paid per shift are also being explored. A weekly review of tactical actions to manage pay expenditure is taking place. 2. Management of patient flow to ensure that activity is able to be delivered within funded capacity and that numbers of patients medically fit for discharge are minimised and elective throughput is maximised. The Trust is working closely with health economy partners to ensure that the levels of fit for discharge patients and community bed capacity is managed. 3. Delivery of commissioner QIPP plans and impact on affordability for commissioners if plans do not deliver in full. The Trust is working in partnership with the CCG to agree implementation plans and monitoring arrangements. 4. Achievement of financial control on a quarterly basis and delivery of access trajectories to secure access to the Sustainability and Transformation Funds. The Trust needs to deliver further improvements in the remainder of the quarter to be eleigible for 3.3m of STF funds at the end of Q2.

2 Finance Report M4 2016/17 G The Trust is reporting a Financial Sustainability Risk Rating (FSRR) of '3'. The liquidity metric has improved to a 3, with the metric improving due to slippage on the capital programme. However, the the variance in I&E margin has deteriorated between June and July due to the adverse position in July. Financial Sustainability Risk Rating Plan Plan Actual Actual YTD Metric Rating Metric Rating Liquidity Ratio (10.5) 2 (5.7) 3 Capital Servicing Capacity Ratio Income and Expenditure Margin 3.7% 4 2.3% 4 Variance in I&E margin as a % of income (1.8%) 2 (1.4%) 2 Financial Sustainability Rating 3 3 Financial Criteria SFP Weight Metric to be Definition Rating categories Liquidity Ratio 25% Liquidity ratio (days) Working capital balance x (7.0) (14.0) <(14.0) Annual operating expenses Revenue available for capital service Capital Servicing Capacity Ratio 25% Capital servicing capacity (times) Annual debt service 2.5x 1.75x 1.25x <1.25x Income and Expenditure Margin 25% I&E Margin (%) Total Operating and Non Op Income Surplus/(Deficit) before exceptional items 1% 0% (1.0%) <(1.0%) Variance in I&E margin as a % of Actual Surplus/(Deficit) - Planned Surplus/(Deficit) 0% (1.0%) (2.0%) <(2.0%) I&E Plan Variance 25% income Operating Income

3 Finance Report M4 2016/17 Surplus A At the end of July the Trust is reporting a 1.2m deficit (exluding STF),against a planned surplus of 0.3m. The slippage against the plan in July will need to be recovered to enable access to the STF funding for Q2. The Trust is currently forecasting that it will deliver its financial plan in Q2 and has therefore recognised the proportion of STF income relating to July. Year Forecast Plan Actual Variance Plan Forecast Variance (Surplus) Deficit including STF 4,718 3,182 (1,536) (Surplus) Deficit 16,434 16,434 - less Sustainability and Transformation Fund (4,400) (4,400) - less Sustainability and Transformation Fund (13,200) (13,200) - Underlying Performance against Control Total excluding STF 318 (1,218) (1,536) Underlying Performance against Control Total excluding STF 3,234 3,234 - Income from activities remains above plan at the end of July with high activity within Non Elective admissions, A&E and Day cases. PbR drugs and devices remain above plan and remain the key driver within Non pay. Pay is above plan in month and has increased compared to expenditure in June as the Trust has more beds opened than planned which has caused an overspend on nursing costs. Additional WLI and medical locum costs have also been incurred in lieu of medical agency expenditure. Year to Date Full Year Prev Yr Actual Plan Actual Variance Plan Forecast Variance k Income 99, , ,372 (426) Income 434, ,914 - Pay (65,709) (92,543) (93,493) (949) Pay (274,546) (274,546) - Non-Pay (tariff) (29,757) (29,257) (29,529) (271) Non-Pay (tariff) (92,095) (92,095) - Non-Pay (PbR exc) (9,577) (9,772) (10,242) (470) Non-Pay (PbR exc) (26,316) (26,316) - EBITDA * (6,030) 13,225 11,108 (2,117) EBITDA * 41,958 41,958 - Profit / Loss on Disposal of Fixed Assets Profit / Loss on Disposal of Fixed Assets Interest Payable (221) (305) (283) 21 Interest Payable (914) (914) - Interest Receivable Interest Receivable Depreciation (3,542) (5,087) (4,933) 154 Depreciation (15,263) (15,263) - Impairments Impairments Public Dividend Capital Dividend (1,879) (2,520) (2,520) 0 Public Dividend Capital Dividend (7,559) (7,559) - Net Surplus / (Deficit) (983) 5,324 3,389 (1,935) Net Surplus / (Deficit) 18,254 18,253 - less: Impairment less: Impairment Retained Surplus/(Deficit) (983) 5,324 3,389 (1,935) Retained Surplus/(Deficit) 18,254 18,253 - Donated Assets (195) (877) (613) 263 Donated Assets (2,630) (2,630) - Donated Asset Depreciation and Amortisation Donated Asset Depreciation and Amortisation Control Total including STF (967) 4,718 3,182 (1,536) Underlying Operational Performance 16,434 16,434 - less Sustainability and Transformation Fund - (4,400) (4,400) - less Sustainability and Transformation Fund (13,200) (13,200) - Underlying Performance against Control Total excluding STF (967) 318 (1,218) (1,536) Performance against Control Total 3,234 3,234 - * EBITDA Earnings before Interest Taxation Depreciation and Amortisation Control Total by Month Cumulative Control Total by Month 3,500 18,000 3,000 16,000 2,500 14,000 12,000 2,000 1,500 Budget Actual 10,000 8,000 Budget Actual 1,000 6,000 4, ,000 0 Apr May Jun Jul Aug Sep Oct Nov Dec Jan Feb Mar 0 Apr May Jun Jul Aug Sep Oct Nov Dec Jan Feb Mar

4 Finance Report M4 2016/17 Sustainability and Transformation Fund A At the end of Q2 the Trust needs to a deliver a cumulative surplus of 159k. This requires delivery of a suplus of 885k or better in Q2. The financial plan for M4 was challenging due to the phasing of the income plan and expected impact of pay savings schemes. High levels of A&E and Non-Elective activity has impacted on both delivery of the activity plan and has caused beds to be opened above plan. In M4 the Trust is reporting an underlying deficit of 1.2m and will therefore need to deliver a surplus of 1.4m in aggregate in August and September in order to be eligible for STF funding. The Trust has achieved or exceed STF access trajectories for RTT and Cancer in M4, however, A&E performance in July was 93.4% against a target of 95%. The STF criteria include the ability to earn back lost months and so the Trust will be able to achieve the full A&E value if aggregate performance is 95% at the end of Q2 and the financial trajectory is delivered. Actual Actual Forecast Forecast Q1 Jul-16 Aug-16 Sep-16 Q2 Q3 Q4 2016/17 Financial Control Total (exc STF) Plan (753) ,534 3,234 3,234 Actual (726) 3,182 Eligible for STF Funding Yes No STF Income Available 3,300 3,300 3,300 3,300 13,200 Delivery of Financial Control Total A&E Waiting Times RTT Cancer Diagnostic Waiting Times Achieved? Yes No Income 70.0% 2,310 Achieved? Yes No Income 12.5% 413 Achieved? Yes Yes Income 12.5% 413 Achieved? Yes Yes Income 5.0% 165 Achieved? Yes Yes Income 0.0% 0 Total STF Income Achieved () 3,300

5 Apr May Jun Jul Aug Sep Oct Nov Dec Jan Feb Mar Finance Report M4 2016/17 Income A At the end of July income is 0.4m below plan. Although income from activities remains above plan, this was reduced in month due to underperformance in elective inpatients and outpatients. Private patient income continues to underperform. Year End Forecast Prev Yr. Actual Plan Actual Variance Plan Forecast Variance k Total Income 134, , ,372 (426) Total Income 434, ,914 0 At the end of July income from activities is 0.4m ahead of the Trust operational plan. Activity and income was above plan in month for Non-elective admissions, A&E attendances, and Daycases, however, Outpatient and Elective activity was below plan. PbR excluded drugs cumulatively are ahead of plan by 0.5m. The reported income position includes 668k of seasonal resilience monies to reflect the initiatives agreed for M1 - M4 with the CCG and 4,400k of income from the Strategic Transformation Fund. Fewer NHS patients utilised beds within the Private Patients wards in July, resulting in a small increase on income compared to June. Overall income remains below plan. Year to Date Full Year Prev Yr Actual Plan Actual Variance Plan Forecast Variance Income k k k k Income k k k Clinical Commissioning Groups 100, , , Clinical Commissioning Groups 310, ,804 0 Specialist LAT 16,043 16,049 16, Specialist LAT 48,196 48,196 0 WSCC - Sexual Health 2,104 2,038 1,681 (357) WSCC - Sexual Health 5,973 5,973 0 NCA 2,829 3,019 2,461 (558) NCA 9,067 9,067 0 Other Trust Income 0 5,315 5,260 (55) Other Trust Income 16,762 16,762 0 Income From Activities 121, , , Income From Activities 390, ,801 0 Private Patients 1,947 2,646 2,142 (504) Private Patients 7,537 7,537 0 Education, Training and Research 3,390 4,500 4, Education, Training and Research 13,492 13,492 0 Donated Asset / Grant Income (263) Donated Asset Income 2,630 2,630 0 Other Income 7,514 6,640 6,357 (283) Other Income 20,455 20,455 0 Other Operating Income 13,051 14,663 13,806 (857) Other Operating Income 44,113 44,113 0 Total Income 134, , ,372 (426) Total Income 434, ,914 0 of which : PbR Drugs/Devices 9,577 9,772 10, ,000 37,500 37,000 36,500 36,000 Monthly Income 38,000 37,000 36,000 35,000 34,000 Monthly Income Yearly Comparison 35,500 33,000 35,000 32,000 34,500 31,000 34,000 33,500 Apr May Jun Jul Aug Sep Oct Nov Dec Jan Feb Mar 30,000 29,000 Budget Actual

6 Finance Report M4 2016/17 Contract Performance G The Trust reports income based on the contract monitoring position for prior months and an estimate of income for the current month based on priced and coded activity in the month as available. An estimate is made for the value of uncoded spells and missing days and included within the reported income position. 1) Context The main contract with Coastal West Sussex CCG and associate CCGs was signed in early June. The financial reconciliation process for M1 has started with the CCG but has not yet been concluded. This is expected to be completed by the beginning of September. The reconciliation process with NHSE has not yet started and has been escalated within NHSE. 2) YTD Report Trust internal monitoring information shows overperformance against the internal plan for NHSE and for the main CCG contract. A&E and non-elective activity has been high in July compared to the planned level but has been offset by elective underperformance. It is important to note that the performance indicated is compared to the Trust's plan and does not reflect the over-performance against commissioner contracts. Table 1. Total Financial Values by Contract Table 2. Activity and Income by Point of Delivery Estimated Values for YTD July 2016 (incl CQUIN) '000 Activity Volumes Point of Delivery YTD Plan YTD Actual YTD Var YTD Plan YTD Actual YTD Var FYE Plan YTD Plan YTD Actual YTD Var Daycases 20,423 21,933 1,510 13,133 13, Coastal West Sussex (and associate CCGs) 310, , , Elective Spells 2,890 2,675 (215) 9,241 8,659 (583) NHS England 48,196 16,049 16, Elective Excess Bed days (21) Integrated Sexual Health Services 5,973 2,038 1,681 (357) Non Elective Spells 18,377 18, ,345 35,530 1,185 Non Contract Activity 9,067 3,019 2,480 (540) Non Elective short-stay 3,673 4, ,042 3, Non Elective Excess Bed days 8,750 9, ,926 2, Total 374, , , Outpatients 204, ,836 (8,269) 21,814 21,508 (306) A&E 46,779 48,239 1,460 5,282 5, NB: Variances are reported against Western Sussex Hospitals Planned Income Levels PbR exclusions 9,772 10, Critical Care 4,747 4, Maternity Pathway 3,857 3,560 (297) OP Diagnostic Imaging 2,857 3, Sexual Health 1,699 1,642 (57) Direct Access Pathology 2,488 2, Other Direct Access (Imaging and Dietetics) Breast Screening 1,120 1,120 - Other 5,728 3,760 (1,967) CQUIN 2,750 2,747 (2) Total 124, , '000 Table 3. - Reconciliation to Income Reporting Table 4. Contract Income by CCG and NHS England FYE Plan YTD Plan YTD Actual SUSSEX CCGs and NHS ENGLAND Contract Monitoring Performance 365, , ,578 YTD Plan YTD Actual YTD Var CQUIN 2.25% 8,410 2,750 2,747 NHS COASTAL WEST SUSSEX CCG 97,685 98, NHS HORSHAM AND MID SUSSEX CCG 1,561 1,558 (3) Total Contracted Income 374, , ,325 NHS BRIGHTON AND HOVE CCG 1,641 1, NHS HIGH WEALD LEWES HAVENS CCG Income Recharged non-contract NHS CRAWLEY CCG (113) Strategic Transformation Fund 13,200 4,400 4,400 NHS EASTBOURNE, HAILSHAM AND SEAFORD CCG Seasonal Resilience funding 3, NHS HASTINGS AND ROTHER CCG (21) Horsham Older People's service NHS SOUTH EASTERN HAMPSHIRE CCG 1,968 2, Maternity pathway payment (19) NHS PORTSMOUTH CCG Cystic Fibrosis NHS FAREHAM AND GOSPORT CCG NCA credit notes (55) NHS GUILDFORD AND WAVERLEY CCG (57) Subtotal CCG Acute Contracts 103, , Total Income from Activities 390, , ,566 NHS England 16,049 16, Total 119, ,163 1,401 '000 This table represents the Trusts assessment of the performance against commissioners only with whom a Contract SLA has been agreed. There are some differences between the Trust's income plan and the agreed contract values due to QIPP assumptions Page 6

7 Finance Report M4 2016/17 Operating Costs A Pay is above plan as the Trust has more beds opened than planned and has incurred increased costs in supporting these beds. Overall agency expenditure is lower than the ceiling level although Nurse agency remains above ceiling target. Medical agency is below ceiling but has been offset by increased WLI and medical locum costs. Year Forecast Prev Yr Actual Plan Actual Variance Plan Forecast Variance Pay (87,970) (92,543) (93,493) (949) Pay (274,546) (274,546) - Non Pay (39,334) (39,029) (39,771) (741) Non Pay (118,411) (118,411) - Operational Costs (127,304) (131,573) (133,263) (1,691) Operational Costs (392,956) (392,956) - Pay: The impact of additional wards remaining open above plan is reflected in the Nursing pay. The numbers of patients requiring specialist Mental Health Nursing have decreased in month but are higher than the same period last year. Other Healthcare staff continue to high agency and WLI costs as there are a number of susbtantive posts still vacant. Exit strategies are in place which are expected to deliver benefits in Q3 & Q4. Medical agency is above plan this month, due increased locum and WLI expenditure. Vacancies within Management & Admin staff are partially offsetting pressures being experienced in the Clinical areas. Non Pay: PbR excluded drugs remain the key driver of Non Pay expenditure being above plan. Non Elective activity remains high and cost of additional consumables costs are being incurred. High pacemaker usage, increase blood product charges and high volumes of pathology tests are all impacting on the high clinical supplies and services expenditure. Year to Date Full Year Prev Yr Actual Plan Actual Variance Plan Forecast Variance k Pay Pay Management & Admin (12,139) (13,110) (12,744) 366 Management & Admin (39,806) (39,806) - Medical and Dental Staff (25,199) (25,902) (25,984) (82) Medical and Dental Staff (76,983) (76,983) - Nursing & Midwifery (33,098) (35,035) (35,874) (840) Nursing & Midwifery (102,567) (102,567) - Other Healthcare (12,124) (12,967) (13,401) (434) Other Healthcare (38,724) (38,724) - Estates (5,410) (5,449) (5,489) (41) Estates (16,012) (16,012) - Other Staff - (81) - 81 Other Staff (454) (454) - Total Pay (87,970) (92,543) (93,493) (949) Total Pay (274,546) (274,546) - Non-Pay Non-Pay Services from Other NHS Bodies (1,199) (1,146) (1,293) (147) Services from Other NHS Bodies (3,448) (3,448) - Purchase of Healthcare from Non NHS Bodies (1,446) (1,167) (861) 307 Purchase of Healthcare from Non NHS Bodies (3,006) (3,006) - Drugs & Medical Gases - tariff (4,048) (4,158) (3,790) 368 Drugs & Medical Gases 10,627 10,627 - Drugs & Medical Gases - PbR excluded (8,364) (7,312) (8,195) (883) Drugs & Medical Gases - PbR excluded (20,456) (20,456) - Drugs & Medical Gases - Cancer Drug Fund (1,440) (1,051) 389 Drugs & Medical Gases - Cancer Drug Fund (2,801) (2,801) - Supplies and Services - Clinical (11,789) (11,068) (11,666) (598) Supplies and Services - Clinical (30,541) (30,541) - Supplies and Services - Clinical PbR Excluded (1,213) (1,020) (996) 24 Supplies and Services - Clinical Pbr Excluded (3,060) (3,060) - Supplies and Services - General (1,443) (1,409) (1,428) (19) Supplies and Services - General (4,222) (4,222) - Establishment Expenses (2,491) (1,815) (1,791) 24 Establishment Expenses (5,393) (5,393) - Premises (5,173) (5,030) (5,202) (172) Premises (14,927) (14,927) - Education and Training - (434) (288) 146 Education and Training (1,198) (1,198) - Clinical Negligence Premium (441) (2,420) (2,420) 0 Clinical Negligence Premium (7,261) (7,261) - Other Non-Pay (1,727) (609) (789) (180) Other Non-Pay (32,726) (32,726) - Total Non-Pay (39,334) (39,029) (39,771) (741) Total Non-Pay (118,411) (118,411) - Total Expenditure (127,304) (131,573) (133,263) (1,691) Total Expenditure (392,956) (392,956) - 24,000 23,500 23,000 22,500 22,000 Monthly Pay Apr May Jun Jul Aug Sep Oct Nov Dec Jan Feb Mar Budget Actual 11,000 10,500 10,000 9,500 9,000 8,500 Monthly Non Pay Apr May Jun Jul Aug Sep Oct Nov Dec Jan Feb Mar Budget Actual Monthly Operating Costs Monthly Pay Yearly Comparison 34,500 34,000 33,500 33,000 32,500 32,000 31,500 Apr May Jun Jul Aug Sep Oct Nov Dec Jan Feb Mar 24,000 23,500 23,000 22,500 22,000 21,500 21,000 20,500 Apr May Jun Jul Aug Sep Oct Nov Dec Jan Feb Mar Budget Actual

8 Apr May Jun Jul Aug Sep Oct Nov Dec Jan Feb Mar Finance Report M4 2016/17 Payroll & Agency Costs A Agency 2014/ /16 Ceiling Actual Variance Compliance with Agency Cap Rates Proportion of Shifts Complying with Capped Rates k k k k k Target Actual Medical and Dental Staff (3,020) (2,892) (3,648) (1,765) 1,883 Medical and Dental Staff 45% 50% Nursing & Midwifery (1,227) (2,216) (3,056) (3,388) (332) Nursing & Midwifery 0% 0% Other Healthcare (577) (677) (1,014) (901) 114 Other Healthcare 68% 84% Management & Admin (94) (127) (167) (151) 17 Management & Admin 100% 80% Estates (217) (154) (154) (158) (3) Estates 100% 80% - - (5,135) (6,065) (8,040) (6,362) 1,678 Agency Expenditure Comparison Agency Type Comparison 3,000 2,500 2,000 1,500 1, ,500 3,000 2,500 2,000 1,500 1, Ceiling 0 Medical and Dental Staff Nursing & Midwifery Other Healthcare Management & Admin Estates Payroll Staff in post incl Bank Prev Yr Actual Plan Actual Variance Prev Yr Actual Plan Actual Variance k k k k WTE WTE WTE WTE Medical and Dental Staff (22,306) (23,494) (24,220) (725) (57) Nursing & Midwifery (30,883) (32,066) (32,486) (421) 2,491 2,749 2,641 (146) Other Healthcare (11,447) (12,827) (12,500) ,101 1,003 (70) Management & Admin (12,013) (13,088) (12,593) 495 1,221 1,281 1,269 (25) Estates (5,256) (5,339) (5,331) (76) Other Staff - (81) (15) - 1 (81,905) (86,895) (87,131) (236) 5,989 6,577 6,290 (372)

9 Finance Report M4 2016/17 Divisional Performance A Surgery: In July, Elective and Day Case activity was low within Trauma and Orthopaedics due to a number of sickness issues. Overall income remains above plans as Ophthalmology day case and General Surgery elective activity are delivering above plan. Non Elective and Critical Care activity both remain above plan. Pay expenditure continues above plan with theatres pay being the key driver of the adverse position despite agency nursing usage decreasing. PbR excluded drugs are the predominant driver of the Non Pay variance, however clinical supplies expenditure is above plan and work remains ongoing through efficiency programmes to reduce costs in the latter half of the year. Medicine: Non Elective activity has remained high in July and is still performing significantly ahead of plan. This has resulted in the inability to close beds as planned on the Worthing site and to flex the planned number of bays on the St Richard s site, which has meant the Division has not achieved the planned efficiency savings in month. The impact is largely seen in nursing costs however drugs and other clinical supplies expenditure have also been impacted. Further reductions in nursing agency spend for specialling have been achieved in month, however total nurse agency usage still remains in excess of the levels incurred during the same period in 2015/16. Core: Activity from Pathology, Physiotherapy and Radiology Direct Access continues to be high and income is performing above plan. Ongoing recruitment issues within Radiology are the main reason for the adverse pay position. An agency exit strategy alongside recruitment plans has been developed. Expenditure reductions are planned in Q3. Non pay is adverse with high blood product charges incurred in July as well as continuing increased pathology testing impacting on consumables costs. PY Actual Plan Actual Variance RAG PY Actual Plan Actual Variance RAG PY Actual Plan Actual Variance RAG Contract Income 36,205 37,122 37, G Contract Income 54,333 50,077 51,965 1,887 G Contract Income 9,304 13,487 13, G Other Income A Other Income 1, A Other Income 3,778 3,984 3,981 (3) R Total Income 36,947 37,841 38, G Total Income 55,353 51,010 52,911 1,902 G Total Income 13,082 17,471 17, G Pay (20,922) (20,770) (21,365) (594) R Pay (26,576) (28,395) (28,858) (464) R Pay (16,100) (18,167) (18,508) (341) R Non Pay (7,691) (7,149) (7,499) (351) R Non Pay (10,957) (10,804) (11,437) (633) R Non Pay (7,789) (7,951) (7,984) (32) R Total Expenditure (28,613) (27,919) (28,864) (945) R Total Expenditure (37,533) (39,199) (40,295) (1,096) R Total Expenditure (23,889) (26,118) (26,491) (373) R EBITDA Surplus/(Deficit) 8,334 9,922 9,432 (490) R EBITDA Surplus/(Deficit) 17,820 11,811 12, G EBITDA Surplus/(Deficit) (10,807) (8,647) (8,596) 51 G Women & Children: Divisional activity remains adverse to plan. Vacancies within Paediatrics have resulted in a number of Registrar and nurse led clinics not running in July. Additional locum hours and longer term agency doctors have been engaged on both sites, with this additional resource being prioritised towards providing safe cover for the wards. This has resulted in an increase to pay costs in month, for both payroll locums and medical agency, but there has not been a corresponding increase in income. Additional clinics have been planned for August within Paediatrics, as part of a longer term plan to recover activity by the end of the year. Underperformance in maternity services is currently being investigated with the Division. Facilities & Estates: Pay is at a similar level to last month reflecting continuing high use of the Housekeeping, Portering and Catering teams. Within this, the level of agency staff has reduced as substantive posts are recruited to. Agency expenditure remains on course to cease by September. Non-pay expenditure is overspent with additional postage and utility charges incurred. For the year to date, income remains ahead of plan as a result of higher catering receipts. Corporate: Private patient income has risen this month despite a drop in patient numbers, due to a richer case mix. The level of NHS patients in the private patient suites is slightly lower than last month. Admin and managerial vacancies are contributing to pay underspends. Non-pay remains favourable with controls in place over areas of discretionary expenditure. PY Actual Plan Actual Variance RAG PY Actual Plan Actual Variance RAG PY Actual Plan Actual Variance RAG Contract Income 20,080 20,662 19,517 (1,146) R Contract Income Contract Income 0 (0) (0) Other Income (5) A Other Income 1,813 1,715 1, G Other Income 4,731 5,402 4,676 (727) R Total Income 20,395 20,937 19,786 (1,151) R Total Income 1,813 1,715 1, G Total Income 4,731 5,403 4,676 (727) R Pay (10,275) (10,457) (10,363) 93 G Pay (5,512) (5,457) (5,593) (137) R Pay (8,577) (8,871) (8,641) 230 G Non Pay (3,305) (3,604) (3,629) (24) R Non Pay (5,085) (4,743) (4,890) (146) R Non Pay (4,623) (4,843) (4,671) 173 G Total Expenditure (13,580) (14,061) (13,992) 69 G Total Expenditure (10,597) (10,200) (10,483) (283) R Total Expenditure (13,200) (13,714) (13,312) 403 G EBITDA Surplus/(Deficit) 6,815 6,876 5,794 (1,082) R EBITDA Surplus/(Deficit) (8,784) (8,485) (8,711) (226) R EBITDA Surplus/(Deficit) (8,470) (8,312) (8,636) (324) R

10 Finance Report M4 2016/17 Statement of Financial Position The Trust Balance Sheet is produced on a monthly basis, and reflects changes in the asset values, as well as movement in liabilities. Plan Actual Variance Notes Plan Forecast Variance Notes Property, Plant and Equipment 276, ,832 2,026 1 Property, Plant and Equipment 276, ,197 7,020 1 Intangible Assets Intangible Assets Other Assets Other Assets Non Current Assets 277, ,260 2,175 Non Current Assets 276, ,476 7,020 Inventories 5,894 6, Inventories 6,161 6,161 - Trade and Other Receivables 33,471 30,826 (2,645) 2 Trade and Other Receivables 34,587 34,587-2 Cash and Cash Equivalents 2,202 6,895 4,693 Cash and Cash Equivalents 12,931 12,931 - Non Current Assets Held for Sale Non Current Assets Held for Sale Current Assets 41,567 44,056 2,489 Current Assets 53,679 53,679 - Trade and Other Payables (40,140) (41,369) (1,229) 3 Trade and Other Payables (40,354) (40,354) - 3 Borrowings (2,224) (2,274) (50) Borrowings (2,114) (2,114) - Other Financial Liabilities Other Financial Liabilities Provisions (698) (459) 239 Provisions (901) (901) - Other Liabilities Other Liabilities Current Liabilities (43,062) (44,102) (1,040) Current Liabilities (43,369) (43,369) - Borrowings (24,479) (24,429) 50 Borrowings (22,964) (22,964) - Trade and Other Payables Trade and Other Payables Provisions (2,940) (2,861) 79 Provisions (2,704) (2,704) - TOTAL ASSETS EMPLOYED 248, ,924 3,753 Financed by: TOTAL ASSETS EMPLOYED Financed by: 261, ,118 7,020 Public Dividend Capital 239, ,191 0 Public Dividend Capital 239, ,191 - Retained Earnings (33,785) (40,784) (6,999) Retained Earnings (20,858) (24,589) (3,731) Surplus/(Deficit) for Year (Surplus)/Deficit for Year Revaluation Reserve 42,765 53,516 10,751 Revaluation Reserve 42,765 53,516 10,751 TOTAL TAXPAYERS EQUITY Year to Date 248, ,924 3,752 TOTAL TAXPAYERS EQUITY Full Year 261, ,118 7, The variance on Property, Plant and Equipment is due to the plan being set prior to the impact of the Trust's year end valuation, this has been reflected in the forecast position. 2. Within trade and other receivables, there has been a 2.6m decrease versus the plan due to a lower out-turn debtor position in 2015/16 than the original expectation in the 2016/17 plan. 3. Trade and other payables are higher than plan, which is due to the continued extended payment timescales.

11 Finance Report M4 2016/17 Cash A The cash position is ahead of plan, however, this is largely due to slippage on capital expenditure, which is contributing 6.0m to the cash position. The underlying operational performance has had a adverse impact of 2.1m on the cash position. Full Year Plan Actual Variance Plan Forecast Variance Cash Balance 2,202 6,895 4,694 12,931 12,931 - Year to Date Full Year Plan Actual Variance Plan Forecast Variance EBITDA 13,207 11,126 (2,081) EBITDA 41,902 41,902 - Movement in Working Capital (9,915) (9,311) 604 Movement in Working Capital (7,306) (7,306) - Provisions (101) Provisions (304) (304) - Cashflow from Operations 3,191 1,893 (1,298) Cashflow from Operations 34,292 34,292 - Capital Expenditure (7,164) (1,047) 6,117 Capital Expenditure (16,673) (16,673) - Cash receipt from asset sales Cash receipt from asset sales Cashflow before financing (3,973) 846 4,819 Cashflow before financing 17,619 17,619 - PDC Received PDC Received PDC Repaid PDC Repaid Dividends Paid Dividends Paid (8,649) (8,649) - Interest on Loans and leases (288) (274) 14 Interest on Loans and leases (864) (864) - Interest received Interest received Donations received in cash Donations received in cash Drawdown on debt Drawdown on debt Repayment of debt (500) (500) (0) Repayment of debt (2,158) (2,158) - Cashflow from financing (778) (762) 16 Cashflow from financing (11,641) (11,641) - Net Cash Inflow / (Outflow) (4,751) 84 4,835 Net Cash Inflow / (Outflow) 5,978 5,978 - Opening Cash Balance 6,953 6, Opening Cash Balance 6,953 6,953 - Closing Cash Balance 2,202 7,070 4,868 Closing Cash Balance 12,931 12,931 -

12 Finance Report M4 2016/17 Aged Debtors The Trust debtors are a mixture of invoiced debtors, accrued income and prepayments as set out in the table below. The Trust has outstanding debtors of 31 days or more of 7.5m, this is an increase since June of 0.9m predominantly in the days category, 0.6m of which relates to Foundation Trusts. The most significant component of outstanding debtors greater than 90 days also relates to NHS foundation trusts income of 1.6m, relating to service level agreements for drugs costs and staff recharges. NHS debt has decreased by 4.1m between June and July due to payments received from Health Education England for medical training for Q2 and invoices related to the differences between the interim values used to invoice in 2016/17 and the agreed contract values. Non NHS debt has decreased by 0.8m in the month, in part due to the payment from West Sussex County Council. Invoiced Debtors Overdue Within Total Terms days > 90 days days days CCG's 377 1, ,146 4,733 NHS England (in Health Education England) NHS Trusts Foundation Trusts ,595 3,042 Other NHS Non-NHS ,410 Total 818 2,165 1, ,074 10,487 8% 21% 11% 2% 58% 6,074k Debtors 2,165k 1,203k 1-30 days days days > 90 days Provision for Bad Debts (including RTA Provision) (929) Accrued Income (including Work in Progress) 11,984 Prepayments 4,312 Other Debtors 4,970 Total Trade & Other Receivables 30, k Other debtors consists of 2.0m of RTA debtors, 1.2m of Private Patients and 0.9m relates to Charity (this is made up of 0.4m from the League of Friends and 0.5m from LYH) and 0.8m of VAT refunds relating to the capital programme as advised by the Trust's VAT advisers. 0.3m of the balance from LYH is due to be paid in August. Accrued income consists of 6.3m of commissioner income, 0.6m of provider to provider income, 0.8m of medical training income, non-contracted activity 0.3m, drugs/pharmacy 0.5m, private patients 0.2m, work-in-progress 2.7m and 0.5m of other income recharges including radiology, catering and clinical excellence awards.

13 Finance Report M4 2016/17 Capital A The capital programme is under-spent by 5.5m. This is due to slippage against the Southlands Ophthalmology project which has a revised monthly forecast in terms of expenditure but which is still forecast to be completed within the year; and slippage within Estates and Facilities schemes which are due to move closer to plan by quarter 2 following the approval of business cases. Medical equipment priorities have been agreed and orders are being placed for approved items, the majority of this expenditure is expected to be spent by the end of Q2. Year End Forecast Plan Actual Variance Plan Forecast Variance Total Capital 6,718 1,210 5,508 Total Capital 16,812 16,812 - Capital Year to Date Full Year Budget Actual Variance Plan Forecast Variance Source of Funds k k k Source of Funds k k k Depreciation (net of IFRIC 12) 5,087 4,933 (154) Depreciation (net of IFRIC 12) 15,340 14,870 (470) Loan Repayments (500) (500) - Loan Repayments (1,158) (1,158) - Charitable Funds Charitable Funds 1,104 1, Donation/Grants Donation/Grants 1,526 1,526 - Application of Funds 4,587 4,433 (154) 16,812 16,427 (385) Application of Funds Endoscopy Endoscopy 1,066 1,066 - Southlands Ophthalmology 2, ,559 Southlands Ophthalmology 6,550 6,550 - MSK MSK Equipment Replacement - Imaging Equipment Replacement - Imaging 1,000 1,000 - Other Service Developments Other Service Developments 1,166 1,166 - Medical Equipment 1, Medical Equipment 1,655 1,655 - Facilities & Estates 2, ,910 Facilities & Estates 5,290 5,290 - Information Technology 1, Information Technology 3,683 3,683 - Miscellaneous - (584) 584 Miscellaneous Overprogramming (1,366) 0 (1,366) Overprogramming (4,098) (4,098) - Total Expenditure 6,718 1,210 5,508 Total Expenditure 16,812 16,812 -

14 Finance Report M4 2016/17 Efficiency and Transformation Programme A At the end of July, the Efficiency Programme has delivered savings of 6.1m against a plan of 6.2m (99.7%). Slippage on Phase 1 bed configuration and Commercial schemes have been mitigated in part by over-delivery within the Back Office, Core & Procurement work-streams and delivery of agency exit and rate reduction schemes. Year to Date Forecast Out-turn Workstream Plan Actual Variance Plan Forecast Variance FYE 15/16 2,333 2,039 (294) 3,525 3,140 (385) Back Office & Corporate Support Commercial Opportunities (66) 2,226 2,219 (7) Core Estates & Facilities Medicine (18) (9) Medicines Management (12) Procurement ,023 2,023 (0) Surgery (25) Women & Children Workforce 1,271 1, ,820 4, Medical Workforce (8) 1,899 1,899 - Nursing Workforce 7 3 (4) (25) Transformation ,027 1,027 - Efficiency Plan Total 6,208 6,187 (21) 18,902 18,509 (393) Month 4 Cumulative (July) Plan vs Actual 2,500 2,000 1,500 1,000 Plan Actual FYE 15/16 Back Office & Corporate Support Commercial Opportunities Core Estates & Facilities Medicine Medicines Management Procurement Surgery Women & Children Workforce Medical Workforce Nursing Workforce