BOARD OF DIRECTORS COVER SHEET PART 1. DATE: 30 January Subject: CHARITABLE FUNDS EXPENDITURE OVER 25,000

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1 BOARD OF DIRECTORS COVER SHEET PART 1 DATE: 3 January 219 Agenda item: 11 Paper: F Subject: CHARITABLE FUNDS EXPENDITURE OVER 25, Prepared by: Presented by: Purpose of paper Background Key points for Board members Options and decisions required Mark Orchard, Director of Finance Mark Orchard, Director of Finance For approval. Following award decisions made by the Charitable Funds Committee, the Board of Directors are asked to support the receipt of charitable funds in each case. The Trust Board is asked to support the investment decisions considered by the Charitable Funds Committee on 22 January 219. The following awards require approval by the Board of Directors ahead of receipt: 1. Robert White Centre, Dorchester: up to 57,5 additional radiotherapy satellite centre equipment with no single item above 8,3 in value. A full schedule of items has been provided to members of the Charitable Funds Committee. 2. The 219/2 additional unfunded revenue costs of surgical robotics: 44,838 made up of: 153,319 additional marginal cost of robotic consumables over and above NHS commissioner funded treatment (i.e. 295,628 total cost, less 142,39 funded cost. Unfunded consumables comprise 1,975 gynae, 3,185 colorectal, 22,159 head and neck) 149,999 service and maintenance contract 11,52 sterilisation nil staffing Members should also note that the Committee received an update on the outstanding 869,676 donation pledged to support robotic surgery running costs for 217/18 and 218/19. Recommendations Next steps Members are asked to support the receipt of charitable funds in each of the two cases as listed. Where appropriate, benefits realisation reviews are undertaken on specific investments through the Investment Planning Group.

2 Links to Poole Hospital NHS Foundation Trust Strategic objectives, Board Assurance Framework, Corporate Risk Register Strategic Objective Ensure all resources are used efficiently, effectively and economically to deliver key operational standards BAF/ Corporate Risk Register AF4 CQC Reference Use of Resources Committees/Meetings at which the paper has been submitted: Date Charitable Funds Committee 22 January 219

3 FINANCIAL PERFORMANCE: 218/19 MONTH 9 (DECEMBER 218) INCOME AND EXPENDITURE (I&E) SUMMARY Month (December 218) Year to Date Full Year PAY EXPENDITURE Actual Plan Variance Actual Plan Variance Q3 Projection Plan ' ' ' ' ' ' ' ' NHS Dorset CCG 13,299 13, ,46 118,215 1, , ,622 NHS England (Wessex) 4,47 3, ,74 33,587 2,487 49,15 44,787 Pay Metrics Month Year to Date Full Year Sustainability and Transformation Fund (STF) ,981 5,94 (959) 4,981 9,142 Actual Actual Projection Plan Other Operating Income 3,192 2, ,867 26,517 1,35 35,78 33,643 Total pay costs as % of total operating income 68.5% 68.7% 69.6% 67.2% Total Operating Income 21,452 2, , ,259 4, , ,194 Agency expenditure as % of total pay 6.% 4.7% 4.7% 2.5% Charitable Income , ,571 1,24 Total Income 21,689 2, , ,163 4,97 25, ,398 Agency Staff Reliance Last Month This Month Year to Date ' ' ' Pay (14,7) (13,96) (74) (129,331) (125,77) (4,254) (173,47) (164,829) Nursing - 469k registered, 89k unregistered ,72 62% Non-Pay (6,68) (6,578) (12) (61,28) (59,239) (1,789) (81,715) (74,952) Medical - incl 114k juniors, 64k middle grades ,451 24% Total Operating Expenditure (21,38) (2,538) (842) (19,359) (184,316) (6,43) (255,122) (239,781) Other clinical Admin and clerical % 2% Finance Charges (839) (89) 51 (7,561) (8,) 439 (1,469) (1,67) Agency Staff Expenditure ,925 1% Surplus/ (Deficit) before adjustments below (53) (479) (51) (7,787) (7,153) (634) (14,835) (4,53) Agency expenditure ceiling ( 4.166m 218/19) Agency expenditure ceiling variance 347 (36) 349 (487) 3,125 (2,8) Note 1: Annual Financial Statements Impairment Reported Surplus/ (Deficit) (53) (479) (51) (7,787) (7,153) (634) (14,835) (4,53) Year to date agency staff cost ( ') Variance analysis: 6, 6.m 215/16 Sustainability and Transformation Fund (STF) (959) (4,161) Other (51) 325 (6,621) Note 2: Financial Control Total Donated capital adjustment 4 (55) (24) Control Total including STF income (526) (534) 8 (7,736) (6,898) (838) (14,638) (3,713) Less: STF Income (914) (914) (4,981) (5,94) 959 (4,981) (9,142) Control Total Surplus/ (Deficit) (1,44) (1,448) 8 (12,717) (12,838) 121 (19,619) (12,855) 3, DIRECTORATE REVENUE ANALYSIS Month (December 218) Year to Date Full Year 217/18 Actual Plan Variance Actual Plan Variance Q3 Projection Plan ' ' ' ' ' ' ' ' 2, General Medicine 2,985 2,828 (157) 25,143 24,696 (447) 33,58 33,397 Specialist Medicine ,3 9, ,94 11,87 216/17 215/16 Emergency and Ambulatory Care 1,217 1,156 (61) 1,475 1,241 (234) 13,635 13,454 Care Group: Medical 5,33 4,861 (172) 44,648 44,15 (633) 59,47 58,658 1, 218/19 Radiology and Therapies 1,454 1, ,87 12, ,397 17,427 Pharmacy and Pathology 1,8 1, ,55 1, ,557 13,64 Operational Support and Outpatients (3) 5,932 5,83 (129) 7,92 7,747 Apr May Jun Jul Aug Sep Oct Nov Dec Jan Feb Mar Care Group: Clinical and Operational Support 3,22 3, ,857 29, ,874 38,814 Critical Care 1,99 1,932 (58) 18,336 17,67 (666) 24,256 23,616 Surgery 1,128 1,49 (79) 9,846 9,392 (454) 12,88 12,543 Trauma and Orthopaedics (164) 7,645 6,736 (99) 9,885 9,4 Monthly cost ( ') Apr May Jun Jul Aug Sep Oct Nov Dec Jan Feb Mar Care Group: Surgical 4,37 3,736 (31) 35,827 33,798 (2,29) 46,949 45, /19: this year Oncology and Cancer Services 1,93 1, ,48 17, ,582 22,56 217/18: last year Women's Services 1,115 1, ,991 1, ,47 13, / Children's Services 1,14 1,14 (36) 9,855 9, ,199 13, / Care Group: Women, Children and Oncology 4,185 4,179 (6) 37,326 37, ,188 49,323 Clinical Directorates 16,476 16,25 (45) 146, ,517 (2,141) 193,58 191,958 Year to date cost ( ') Apr May Jun Jul Aug Sep Oct Nov Dec Jan Feb Mar 218/19: this year incl run-rate 53 1,67 1,65 2,322 2,968 3,628 4,382 5,89 5,925 8,175 Corporate Directorates 3,213 3, ,53 28, ,438 38, /18: last year ,44 1,56 1,996 2,535 3,5 3,341 3,756 4,49 4,465 5,53 Trust-wide: Income and Non-Directorate (2,219) (19,771) 448 (182,948) (18,589) 2,359 (245,331) (234,376) 216/ ,8 1,58 1,889 2,267 2,521 2,748 2,964 3,244 3,449 3,726 3,885 Reported Surplus/ (Deficit) (53) (479) (51) (7,787) (7,153) (634) (14,835) (4,53) 215/ ,95 1,588 2,112 2,482 2,938 3,396 3,851 4,32 4,884 5,41 5,996 5, 4, 4.% 5.1m 217/18 3.9m 216/17 1

4 SUSTAINABILITY & TRANSFORMATION FUND 7% 3% Full Year COST IMPROVEMENT PLAN (CIP) Month (December 218) Year to Date Full Year (STF) INCOME Financial A&E 4 Hour Q3 Projection Plan Actual Plan Variance Actual Plan Variance Q3 Projection Plan Control Performance ' ' ' ' ' ' ' ' By Quarter (accrued monthly) ' ' ' ' Medical (13) (25) Quarter 1 (15%) less 411k A&E STF Q ,371 Clinical and Operational Support (21) 1,279 1,489 (21) 1,875 2,135 Quarter 2 (2%) less 548k A&E STF Q2 1,279 1,279 1,828 Surgical (2) (11) Quarter 3 (3%) 1, ,743 2,743 Women, Children and Oncology 7 92 (22) 1,348 1,413 (65) 1,69 1,749 Quarter 4 (35%) less 96k A&E, 2,24k 3,2 Care Groups (58) 3,37 3,618 (311) 4,619 4,883 STF Core 6, ,982 9,142 Corporate Directorates (8) (48) STF Incentive/ Bonus Trust Wide Non-Directorate (147) ,24 1,291 STF General Distribution Sub-total (214) 4,672 4,85 (178) 6,591 6,911 Total STF Income 4,982 9,142 Unidentified (planning gap) 86 (86) 4,23 Total CIP (214) 4,672 4,936 (264) 6,591 1,934 CAPITAL EXPENDITURE YTD Full Year Expenditure Q3 Projection Plan ' ' ' Estates 1,186 3,36 2,74 Equipment 1,363 3,648 3,767 IT 1,43 1,41 1,267 Sub-total: Self-funded from depreciation 3,592 8,94 7,18 External funding sources: Radiotheraphy Modernisation Programme (PDC) 1,324 1,713 1,713 MRI Scanner (ITFF loan c/fwd from 217/18) 775 1,336 1,336 Charitable funds East Dorset Acute Reconfiguration (OBC design fees) 1,166 3,355 Guest Wifi (PDC) and UEC Ambulatory (PDC) 1, Total Capital Expenditure 7,33 12,849 14,139 4, 3, 2, 1, CIP delivery ( ') by month and year-to-date Apr May Jun Jul Aug Sep Oct Nov Dec Jan Feb Mar 1, 7,5 5, 2,5 PUBLIC SECTOR PAYMENT POLICY Plan for Month Actual for Month Plan for Year Actual Year-to-Date The Better Payment Practice Code requires the Trust to pay all valid non-nhs invoices by the due date or within 3 days of receipt of goods or a valid invoice, whichever is later. CASH BALANCE Better Payment Practice Code Month (December 218) Year to Date Number ' Number ' Non-NHS Invoices Total bills paid 5,43 13,34 47,964 67,414 Total bills paid within target 4,847 5,764 42,59 53,735 Percentage of bills paid within target 89.3% 43.2% 88.6% 79.7% NHS Invoices Total bills paid 284 2,373 1,989 9,715 Total bills paid within target 22 1,837 1,69 7,32 Percentage of bills paid within target 77.5% 77.4% 8.9% 75.2% 7, 6, 5, 4, 3, 2, 1, Cumulative month-end cash balance ( ') 218/19 Plan 218/19 Actual Apr May Jun Jul Aug Sep Oct Nov Dec Jan Feb Mar Total Cumulative cash balance ( ') Apr May Jun Jul Aug Sep Oct Nov Dec Jan Feb Mar Total bills paid 5,714 15,713 49,953 77, /19 Plan 1,58 1,249 1,249 4,44 4,27 2,141 1,78 1,729 1,53 1,387 2,37 1,249 Total bills paid within target 5,67 7,61 44,118 61,37 218/19 Actual 3,152 1,335 1,347 4,114 3,38 3,233 3,98 6,351 6,67 Percentage of bills paid within target 88.7% 48.4% 88.3% 79.1% Of which, Uncommitted Term Loan 1,61 2,8 7 8,121 2

BOARD OF DIRECTORS PART 1 COVER SHEET DATE: 3 January 219 Agenda item: 16 Paper: J Subject: Financial Performance: Month 9 (December 218) Prepared by: Presented by: Purpose of paper Andrew Goodwin,

5 BOARD OF DIRECTORS PART 1 COVER SHEET DATE: 3 January 219 Agenda item: 16 Paper: J Subject: Financial Performance: Month 9 (December 218) Prepared by: Presented by: Purpose of paper Andrew Goodwin, Deputy Director of Finance Mark Orchard, Director of Finance For information and scrutiny: Month 9 financial performance 218/19 financial forecast deterioration Background The Trust accepted a planned 218/19 financial control total expenditure over income deficit of 12.8m, within the context of the Dorset NHS group overarching plan. At planning stage 4m CIP was recognised as being either unidentified or high risk, and unless mitigated internally would require a compensating Dorset NHS group in-year financial delivery offset. Key points for members Month 9 (December 218) Circa 3m further overspend continues to be projected, mainly attributable to an increasing agency reliance runrate. The Trust s full year financial risk against the planned control total was assessed as being 6.8m at the end of Quarter 2 and remains unchanged at the end of Quarter 3, despite action to support an improvement by March 219: Overseas nurse recruitment Actions arising from the external nurse agency review by PA Consulting Mobilisation of work programmes in response to the external financial review by PwC During the first nine months, the Trust has incurred 7.8m more cost than income received. Whilst the Trust has an authorised deficit plan, this actual level of deficit is 634k above that planned for the year to date. After adjusting for A&E performance related income not earnt ( 959k from the national Sustainability and Transformation Fund for Quarters 1 and 2), less 24k donated capital, performance against the financial control total is 121k favourable at the end of Quarter 3.

6 Specific points worthy of note include: Pay overspend remains the most significant underlying financial concern at 4.3m above plan for the first nine months. Two care groups are significantly overspent on their delegated operating budgets, namely surgical 2m and medical.6m. Agency reliance increased again significantly to 836k for the month of December 218 (total 5.9m for the first nine months compared to 3.3m for the prior year). Nursing agency accounts for 558k or 62% of the total agency bill which includes 89k unregistered nursing for the month. The Trust earnt the 823k A&E STF performance related income in full for Quarter 3, in addition to 1.9m for achieving the year-to-date financial control total. However, the Trust is not expecting to achieve the Quarter 4 financial plan requirements thereby forgoing 3.2m in income ( 2.2m financial control total gateway plus 96k A&E). The 4m original planning gap is fully phased into the month of March 219. The agency run-rate overspend for the first nine months has been partly offset by nonrecurrent offsets and earlier than planned delivery of non-recurrent CIP e.g. 44k new Main Entrance (South) income planned for March 219 but received in October 218, and 265k unplanned additional CNST Maternity Incentive scheme income received in November 218 (in addition to the planned 512k reimbursement received in July 218). That is, the underlying position without these two income receipts is behind plan. Two cases for consultancy expenditure above 5k in value remain outstanding for approval with NHS Improvement (external theatres productivity review and external PMO/ CIP development support). The Trust has agreed to contribute 5% towards the non-recurrent cost of transitioning to a joint chair and chief executive model from January 219. The year-to-date cash position is favourable to plan but includes income received ahead of plan and on account. Trust plans to draw further external cash support from the Department of Health and Social Care s Uncommitted Interim Revenue Support Facility during Quarter 4 (up to a further 8m, in addition to 5m already drawn to date). Further detail is provided within the report to Finance & Investment Committee.

7 Options and decisions required Recommendations Next steps No specific additional decisions are required at this point. For information and scrutiny. Actions will continue to support an improvement in the Trust s run-rate position both in terms of exiting 218/19 and planning for 219/2: 1. Impact quantification of overseas nurse recruitment (and associated reduction in nurse agency reliance run-rate). The Quarter 3 financial forecast continues to assume 753k in-year cost against an assumed 42 whole-time equivalent registered nurse recruits (with a further 1,36k investment being considered for 219/2 against 5 overseas i.e. total potential investment 1.8m for a return of 92 additional nurses recruited). 2. Actionable interventions arising from the PwC financial review for both 218/19 and 219/ /2 operational planning to ensure sustainable and safe delivery alongside organisational merger and the East Dorset acute services estate redevelopment and transformation plan. Links to Poole Hospital NHS Foundation Trust Strategic objectives, Board Assurance Framework, Corporate Risk Register Strategic Objective Ensure all resources are used efficiently, effectively and economically to deliver key operational standards BAF/ Corporate Risk Register AF4 CQC Reference Use of Resources Committees/Meetings at which the paper has been submitted: Date Council of Governors 31 January 219 Board of Directors 3 January 219 Finance & Investment Committee 28 January 219 Hospital Executive Group 25 January 219

Kingston Hospital NHS Foundation Trust. Finance Report October 2018 (Month 07)

Original 0 0 0 ' s Var Kingston Hospital NHS Foundation Trust Finance Report October 2018 (Month 07) CONTENTS EXECUTIVE SUMMARY........3 SECTION 1: OVERALL INCOME AND EXPENDITURE.......4 SECTION 2: DIVISIONAL