Kingston Hospital NHS Foundation Trust. Finance Report February 2016 (Month 11)

Transcription

1 Enc G Original ' s Var 's Kingston Hospital NHS Foundation Trust Finance Report February 6 (Month ) A revised annual plan of a 6.m deficit was submitted to Monitor in September. The analysis in this report is shown against this revised plan. For reference, the original budget is shown on page 4.

2 CONTENTS EXECUTIVE SUMMARY SECTION : OVERALL INCOME AND EXPENDITURE SECTION : DIVISIONAL POSITIONS SECTION 3: COST IMPROVEMENT PROGRAMME SECTION 4: INCOME SECTION 5: PAY COSTS SECTION 6: NON PAY COSTS SECTION 7: STATEMENT OF FINANCIAL POSITION SECTION 8: CASH FLOW STATMENT SECTION 9: DEBTORS SECTION : CREDITORS SECTION : CAPITAL SECTION : FINANCIAL SUSTAINABILITY RISK RATING (FSRR) Appendix - INCOME DETAIL Appendix - ACTIVITY DETAIL Appendix 3 - INCOME PENALTIES Contents

3 EXECUTIVE SUMMARY Headline Trend against Trend against Narrative (January) (February) At the end of M the Trust reported a year to date deficit of 6.5m, which is.7m adverse to the revised plan submitted to Monitor. The Trust reported an in month deficit of.4m. The underlying positive variance on patient care income is.m after removing the impact of high cost drugs (.m). Other income has improved in month due to additional LDA and research income. There is also nonrecurrent benefits from the release of GRNI and income risk reserves, together totalling.7m. The underlying clinical income favourable variance was.m of the reported.3m patient care income variance (.m of the reported position related to high cost drugs). The in-month income is above forecast by.3m which includes the benefit of.m of high cost drugs,which is a pass through cost. Pay and Non Pay Expenditure directly associated with the delivery of clinical services is over forecast by.m in M. Pay is.5m adverse in month while Non Pay is overspent by.5m. High agency usage due to escalations, specials and winter pressures are driving the pay increase. Non Pay variances are partly due to high cost drugs (.m) and partly to small clinical supplies overspends across a large number of service lines. Corporate Services pay and non pay were.m better than forecast in M The main driver for this is a reduction in agency usage compared to forecast CIP Delivery stands at 83% YTD and 88% in month. The CIP programme shortfall remains mainly due to Emergency service lines where only 56% of CIPs have been achieved YTD. All other divisions are forecasting over 9% achievement. The Trust is forecasting a deficit of 6.9m. This is.5m higher than the forecast presented to Monitor since Month 8. This movement is mainly due to the junior doctor strikes reducing activity and incurring additional costs. At the end of M, capital expenditure is below forecast. Capital YTD expenditure is 87% of the revised plan. Equipment and IT delays contribute to the slippage on capital, we expect this underspend to continue to 3st March 6 The cash balance reported at the end of M was.6m. The closing cash position for January was.6m which was a deterioration of.3m on the previous month's position. At the time of producing the report the cash balance was.6m. Pg3

4 m SECTION : OVERALL INCOME AND EXPENDITURE Version Summary as at the end of Feb-6 IN MONTH YEAR TO DATE Income & Expenditure v Actuals v Actuals Original 's plan 's Actual 's Var 's plan 's Actual 's Var 's Income Patient Care Income Other Income 3,36 4,56 4,63 4,74 Income 7,83 9,347 8,75 9, ,786,66,876 6,84,9 7,33, ,954,83 88,9 4,47,36,64 Expenditure Pay Non Pay (43,6) (77,64) (46,69) (73,549) (,79) (5,937) (,43) (5,899) (5) 38 (34,4) (67,549) (35,45) (7,5) (,9) (,566) Expenditure (,646) (,39) (8,6) (8,33) (4) (,97) (5,566) (3,595) EBITDA 7,76 9, ,85 7,96 (79) Depreciation and Amortisation Investment Revenue Finance Costs Public Dividend Capital (9,394) 6 (3,4) (3,3) (8,65) 4 (3,347) (3,8) Total I&E (8,845) (6,68) (746) (43) 35 (5,85) (6,53) (67) (7) (75) (69) (74) (75) (68) (39) () (7,658) (3,7) (,959) (7,59) (3,54) (,894) 66 () (83) 65 Original Actual Actual YTD EBITDA Margin EBITDA Achieved I&E Surplus Margin 3.%.% -3.9% 4.%.% -.6%.7%.% -4.% 4.4% 7.7% -.% 3.7%.% -.8% 3.3% 9.8% -3.%. Cumulative Position Against 5/6. Apr May Jun Jul Aug Sep Oct Nov Dec Jan Feb Mar Actuals 4/5 Actuals 5/6 Original 5/6 Forecast 5/6 \\lares\finance.grp\secure Department Folders\ning\5\Reporting\Monthly Position\M\M Finance Report V8 Pg4

5 SECTION : DIVISIONAL POSITIONS Overview Summary as at the end of Feb-6 Income & Expenditure 's (4,69) 4,698 5,496 v Actuals plan Actual Var 's 's 's IN MONTH Variances Inc Pay Non Pay Total v Actuals plan Actual Var 's 's 's YEAR TO DATE Variances Non Inc Pay Pay Total Clinical Support Services (,87) (,) (35) 8 (68) (85) (35) (,596) (3,78) (,) 74 (67) (769) (,) Emergency Care,4 46 (79) (9) (38) (9) (79) 3,343,559 (,784) (6) (,3) (,47) (,784) Specialist Services 4,4 3,88 (33) (9) (97) (6) (33) 46,84 45,8 (,5) (365) (5) (,6) (,5) Clinical Divisions 4,53 3,78,3 (,75) () (546) (5) (,75) 37,55 3,3 (5,48) (36) (,9) (3,) (5,48) Commercial Director Corporate Affairs Finance Human Resources Medical Director Nursing Director Operations (,7) (3,396) (4,) (,883) (45) (,75) (6,4) (77) (9) (34) (67) (5) (4) (,68) (4) (36) (79) (69) (53) (54) (,9) (3) () () (3) (4) () (9) 4 (6) (9) 4 (8) 6 (3) (7) (3) () () (,93) (3,5) (3,96) (,73) (376) (,94) (3,86) (,89) (,777) (3,97) (,79) (3) (,43) (3,3) 4 37 () (6) 66 (3) 658 () (53) (37) (7) (34) (433) (59) 4 37 () (6) 66 (3) 658 Directorates (4,3) (3,397) (3,) 76 (9) 377 (9) 76 (36,86) (35,933) (6) 98 Central Income Other Central Budgets 7, , ,53 3, , , ,945 EBITDA 9, (5) ,85 7,96 (79),876 (,9) (,566) (79) Depreciation & Losses Interest PDC (8,65) (3,33) (3,8) (7) (73) (69) (74) (74) (68) (39) () (39) () (7,658) (3,5) (,959) (7,594) (3,34) (,894) 63 (85) (85) 65 Total I&E (6,68) (746) (43) (5,85) (6,56) (675) (675) COMMENTARY Income has underperformed in month in Respiratory, T&O, AAU and Specialist outpatients mainly as a result of lower non elective activity. However this is offset by improved income on A&E, Gynaecology, General Surgery and Cardiology. Pay has been overspent within nursing due to escalations and winter pressures being funded through agency. Specials and locum usage in medical has also contributed to this overspend. Non Pay has been overspent in month due laboratory equipment in Pathology, Laproscopic consumables in Anaesthetics and additional consumable usage in A&E due to additional activity. Income in corporate areas has improved in both pay and non pay due partly to a faster reduction in agency spend than had been forecast. Central Income and Central Budgets includes additional LDA and NMET income recieved in monthof.m. It also includes the.5m release of GRNI accruals posted into the I&E as per the recovery plan. The income risk was also reassessed in month given the lower levels of activity and.3m was released into the position form central budgets. Both of these were unplanned resulting in a variance. Pg5

6 SECTION : DIVISIONAL POSITIONS Clinical Support Services Summary as at the end of Income & Expenditure Original 's Patient Care Activities Other 5,36 Feb-6 's 8,5 5,568 IN MONTH YEAR TO DATE IN MONTH YEAR TO DATE v Actuals v Actuals Service Lines plan v Actuals v Actuals plan Actual Var plan Actual Var plan Actual plan Actual 's 's 's 's 's 's 's 's 's Var 's 's 's Var 's, , () 6,93 5, 6,648 5,739 Income 5,36 4,69,89,9 8,3, Expenditure - Pay Medical & Dental Nursing & Midwifery Scientific,Professional & Tech Admin & Clerical Other (9,757) (7,977) (3,99) (,54) (9,9) (9,857) (7,834) (4,7) (,55) (9,43) (84) (653) (334) (6) (764) (84) (74) (343) () (75) (7) (5) (9) 6 3 (9,44) (7,8) (3,66) (,47) (8,86) (9,) (7,57) (3,737) (,46) (8,378) (55) 59 (77) (346) (77) (35) (9) Anaesthetics, Theatre and DSU Histopathology Imaging Intensive Care Unit Pathology Pharmacy Sterile Services Department Therapies (3,335) (,4) (9,388) (4,945) (,65) (,58) (,545) (4,9) (,) (89) (769) (47) (8) () (9) (36) (,3) () (8) (486) (853) (95) (9) (344) (3) (3) (33) (69) (5) 6 7 (,35) (,53) (8,69) (4,58) (9,83) (,94) (,45) (3,75) (,449) (,96) (8,84) (4,846) (,339) (,35) (,358) (3,84) (4) (44) () (37) (56) (58) 58 (73) (48,76) (3,979) (4,3) (5) (44,79) (46,5) (,396) Pay (3,75) (3,34) (,69) (,758) (68) (9,597) (3,4) (67) Service Lines In Month Variances Expenditure - Non Pay Inc Pay Non Pay YTD Variances Inc Pay Non Pay Clinical Supplies & Services Other Non Pay (3,64) (,838) (6,) (3,457) (3,) (6,457) (,58) (3) (,89) (,8) (55) (,373) (6) (4) (85) (,4) (,7) (5,) (,798) (3,84) (5,88) (398) (37) (769) Anaesthetics, Theatre and DSU Histopathology Imaging Intensive Care Unit 7 (9) (53) 4 3 (3) (63) (3) (5) (3) (6) 76 (47) (88) (55) (4) (84) (37) (73) (56) (38) (8) Expenditure (48,77) (48,76) (3,979) (4,3) (5) (44,79) (46,5) (,396) Pathology Pharmacy Sterile Services Department (8) 7 () (4) () (6) (4) 4 69 () (7) 45 (5) (354) (3) 63 Therapies 6 (9) 9 (46) (7) Income Less Direct Costs (4,97) (4,69) (,87) (,) (35) (,596) (3,78) (,) 8 (68) (85) 74 (67) (769) Income & Expenditure Commentary The month position is 35k adverse against the revised plan. Patient Care Income is 3k better than forecast and this is driven by the continued increase in activity in ICU in month which has resulted in an overperformance in income against forecast,. The acuity of patients and therefore the tariff received is still lower than had been planned (organ, and 3 supported),likely due to the success of the inreach and 4/7 sepsis initiatives. Other Income is k adverse against the plan in month driven by an adjustment to the invoices to Surbiton Hospital and Surbiton Health Centre as part of the Your Healthcare service contract. Pay is 68k adverse against the revised plan and this is mainly ICU, Radiographers and Radiologists and Pathology. In Imaging additional premium agency costs have been incurred due to the Gynae and thyroid lists being moved to theweekend and out of hours working to accommodate the breast work. Recruitment is underway to recruit permanently into the vacant consultant posts. In Pathology agency costs relating to chemical pathology are driving the adverse variance against forecast but these are chargeable to SWL Pathology and are reflected in other income. In ICU, agency usage to cover 9 wte vacancies is driving the overspend. Non Pay is 85k adverse against the revised plan. The adverse position largely lies within Pathology and Anaesthetics. The overspend in Pathology relates to lab equipment in chemical pathology and the SWL Pathology contract. These are chargeable to SWL Pathology and are reflected in other income. In Anaesthetics the overspend is due to laparoscopic consumables, wound closures, respiratory tubes and masks and medical and surgical equipment. CIP Commentary In month, the division achieved 83k (95%) of its target. The main shortfall relates to ceasing the Radiology SLA with St Georges for junior Doctors ( 63k YTD) Divisional Actions Actions were agreed within ICU, imaging and theatres to include: s to address recruitment to reduce agency spend Reviewing data on consultant productivity with action plans produced Review non pay spend within Imaging and understand the increase in the charge on the managed service contract. Develop plan to ring-fence slots for GPs Develop plan with theatres to ensure capacity available and wastage minimised Outsource out of hours reporting to expand in house capacity for routine work. Agree job plans for Imaging consultants and recruit into 3 vacant posts which will reduce agency usage from July 6 Pg6

7 SECTION : DIVISIONAL POSITIONS Emergency Care Summary as at the end of Income & Expenditure Patient Care Activities Original 's Other,347 Feb-6 plan 's 58,867,43 IN MONTH YEAR TO DATE IN MONTH YEAR TO DATE v Actuals v Actuals plan v Actuals v Actuals Service Lines plan Actual plan Actual Var plan Actual plan Actual 's 's Var 's 's 's 's 's 's 's Var 's 's 's Var 's Income,347 6,8 4,89 4,7 (9) 55,6 55, (6) Expenditure - Pay Medical & Dental Nursing & Midwifery Scientific,Professional & Tech Admin & Clerical Other (,557) (8,63) (8) (,38) (33) (,79) (,344) (89) (,9) (633) 4, (,54) (,68) (64) (8) (4) 4,75 (3) (,59) (,974) (68) (9) (46) 6 (4) (5) (356) (4) () (5) 53,897,39 53,93,7 34 (6) Accident and Emergency Acute Assessment Unit Cardiology Elderly Care Gastro and Endoscopy (44) Respiratory (75) Site management Pay (3,666) (36,56) (,959) (3,34) (38) (33,3) (34,55) (,3) Service Lines In Month Variances Expenditure - Non Pay Clinical Supplies & Services Other (3,3) (6,457) (,836) (6,59) (33) (54) (,5) (8,73) (746) (,9) (59) (,566) (9,48) Non Pay (9,479) (9,47) (746) (965) (9) (8,68) (9,97) (,47) Expenditure (4,45) (45,583) (3,75) (4,35) (6) (4,883) (44,44) (,558) (37) (648) (85) (34) (,64) (6,76) (789) (,9) (658) (3,5) (6,9) (43) () (66) (4) (85) Accident and Emergency Acute Assessment Unit Cardiology Elderly Care Gastro and Endoscopy Respiratory (9,73) (5,356) (8,9) (3,) (5,75) (3,39) (,59) (785) (4) (66) (,8) (4) (6) (87) (83) (5) (789) (,34) (494) (99) (87) (38) (89) (9) (3) (8) (39) (8,938) (4,934) (7,569) (,97) (4,663) (,879) (973) (9,735) (5,38) (8,4) (,346) (5,63) (,947) (989) (796) (4) (555) (49) (5) (45,583) (3,75) (4,35) (6) (4,883) (44,44) (,558) Inc Pay Non Pay 43 (64) (5) () (43) () (8) (8) (95) (56) (3) YTD Variances (67) (7) Inc Pay Non Pay Site management (3) () () 6 (3) Income Less Direct Costs (4,798) 4,698,4 46 (79) 3,343,559 (,784) (9) (38) (9) (6) (,3) (,47) (37) (9) () (8) (5) (8) 358 (6) 48 (34) (49) (3) (549) (78) 55 (367) (7) () (48) (7) (6) (5) (3) (58) Income & Expenditure Commentary The month position is 79k adverse against the revised plan. Patient Care Income is 6k better than the revised plan. A&E activity has been higher than forecast but this is offset by an underperformance in non elective income. Other income is 4k adverse and this is in elderly care where the commissioners will not be paying for the Geriatritian of the day service. (GOD Service) Pay is 38k adverse against plan. This is mainly within the nursing staff group. where escalations and winter pressures including Claremont have been funded through agency. Specials usage in Hardy ward along with the locum usage in medical staffing in Gastro is driving the pay overspend. Non pay is 9k adverse against the revised plan. This is partly due to high cost drugs ( 7k) which are offset by income within Cardiology. In A&E,the overspend is due to purchase of medical & surgical supplies reflecting higher activity. CIP Commentary The Emergency Services Division achieved 36% of its CIP target in month. Underachieving CIPs Sleep Apnoea ED Case mix / over-performance EDOU closure resulted in the loss of CIP's associated with it. Divisional Actions All ECIST steps are being factored into the transformation plan to minimise 4 hour breeches going forward. Pursue with recruiting into the consultant vacancies within the Gastro/Endo specialities Recruitment to vacant medical posts in progress. with success in the DD and CoE role will continue with locums in CoE, Stroke and ACPs while we continue to recruit. Matrons to lead on reducing the Specials expenditure through better management of substantive HCA establishment and improved assessment of patients. Discharge project will be working to reduce LoS along with employment of Locum CoE consultant against current vacancy. Working to ring fence AAU trollies to increase ambulatory care activity has not yet been successful Pg7

8 SECTION : DIVISIONAL POSITIONS Specialist Services Summary as at the end of Feb-6 Income & Expenditure Income Patient Care Activities Other Original 's,37 4,944 's 5,4 5,47 IN MONTH v Actuals plan Actual Var 's 's 's,38 49,8 553 (7) 44 YEAR TO DATE v Actuals plan Actual Var 's 's 's 4,474 4,648 3,76 5,3 Income 7,8 3,466,79,76 (9) 9, 8,757 (365) Expenditure - Pay Medical & Dental Nursing & Midwifery Scientific,Professional & Tech Admin & Clerical Other (,3) (5,35) (,63) (5,5) (,54) (,487) (5,55) (,597) (5,45) (,7) (,694) (,69) (4) (463) (95) (,796) (,8) (4) (43) () () (39) 49 (6) (8,793) (,9) (,457) (4,988) (,77) (9,445) (,593) (,46) (4,85) (,9) Pay (53,73) (53,76) (4,56) (4,659) (97) (49,5) (49,367) (5) Expenditure - Non Pay Clinical Supplies & Services Other (7,686) (6,6) (7,66) (7,593) (637) (,45) (77) (,54) (33) (7) (6,969) (6,34) (7,349) (6,759) Non Pay (3,947) (5,9) (,88) (,94) (6) (3,3) (4,8) (,6) Expenditure (77,67) (78,97) (6,649) (6,953) (33) (7,38) (73,476) (,57) Income Less Direct Costs 49,5 5,496 4,4 3,88 (33) 46,84 45,8 (,5) (748) 384 (65) (3) (38) (65) Service Lines GUM Gynaecology and Breast Maternity Ophthalmology Oral and ENT Paediatrics and NNU Specialist Outpatients plan 's (3,749) (5,8) (9,58) (7,75) (4,66) (,37) (,97) IN MONTH v Actuals plan Actual 's 's Var 's (3) (496) (,595) (638) (34) (89) (854) (346) (54) (,567) (7) (35) (97) (86) (5) (8) 8 (84) (9) (7) (7) YEAR TO DATE v Actuals plan Actual 's 's Var 's (3,48) (5,35) (7,563) (7,4) (3,75) (9,347) (9,43) (3,4) (5,5) (7,34) (7,457) (3,778) (9,39) (9,58) (344) (53) (43) (64) Total Specialist Services (6,878) (5,35) (5,68) (33) (55,76) (56,8) (357) General Surgery and Urology Trauma and Orthopaedics (8,658) (9,433) (75) (8) (833) (85) (8) (4) (7,969) (8,63) (8,5) (8,883) (54) (6) Total (78,97) (6,649) (6,953) (33) (7,38) (73,476) (,57) Service Lines GUM Gynaecology and Breast Maternity Ophthalmology Oral and ENT Paediatrics and NNU Specialist Outpatients In Month Variances Inc Pay Non Pay (6) (46) (9) 7 (8) (33) 3 (38) () (8) (5) YTD Variances Inc Pay Non Pay 48 5 () () 7 () 53 (3) (64) 66 (33) (7) (3) (37) Total Specialist Services 6 (5) (9) (644) General Surgery and Urology Trauma and Orthopaedics 6 (5) (8) () (47) (3) (3) (,7) (366) (73) (74) (87) Total (9) (97) (6) -365 (5) (,6) Income & Expenditure Commentary The month position is 33k adverse against the revised plan. Patient Care Income is 7k adverse against forecast. This is mainly within Trauma and Orthopaedics. Pay is 97k adverse against the revised plan. The overspend is mainly within medical staffing with agency usage in Paediatrics due to the shortage in middle grades. and in Ophthalmology. Non Pay is 6k adverse against the revised plan. 56k of this relates to clinical supplies mainly within Gynaecology, Surgery, Ophthalmology and Trauma and Orthopaedics. The purchases are activity driven and there is also an overspend in GUM relating to drugs within tariff. CIP Commentary The division has achieved.m of its target in month (87%). Schemes not delivering in month mainly relate to: T&O - coding of outpatient with procedures and non pay savings. Although procedure coding is being undertaken by the service this does not secure additional funding. Investigations are being undertaken between the coding, service and commissioning teams to understand this. Divisional Actions Understanding from the partnership board /Epsom Orthopaedics Centre the recovery of the current SWELOC position. A review of process in Gynaecology to ensure maximum utilisation of theatres and DSU has been undertaken. Consultants are signing off theatre lists now and this will drive better utilisation of theatres. DNA's are high in Gynae & Breast and the ser vice have developed an action plan to address the underlying causes. The service management are working collaboratively with theatres to address and resolve some of the under utilisation of theatres. Benefit of this is expected to be seen from March onwards. Job plans for Orthopaedics is being reviewed and will be undertaken by the new CD. Pg8

9 SECTION : DIVISIONAL POSITIONS Corporate Summary as at the end of Income & Expenditure Feb-6 IN MONTH YEAR TO DATE FORECAST OUTTURN IN MONTH YEAR TO DATE Original v Actuals v Actuals Budget v Forecast Service Lines v Actuals v Actuals Variances Actual Var Actual Forecast Actual Actual 's 's 's 's 's 's 's Var 's 's 's Var 's Inc Pay Non Pay Total 's 's 's Var 's 's 's Var 's Commercial Director (,7) (77) (4) 36 (,93) (,89) 4 Patient Care Activities,8, Corporate Affairs (3,396) (9) (36) 53 (3,5) (,777) 37 Other 5,938 5, (9) 5,439 5, Finance (4,) (34) (79) 5 (3,96) (3,97) () Income 7,8 6, (9) 6,373 6, Human Resources (,883) (67) (69) 98 (,73) (,79) (6) Expenditure - Pay Medical Director (45) (5) (53) (3) (376) (3) 66 Medical & Dental (,97) (,9) (8) (9) 88 (,848) (,79) 9 Nursing Director (,75) (4) (54) () (,94) (,43) (3) Nursing & Midwifery (,369) (,9) (6) (8) 5 (,85) (,45) 4 Operations (6,4) (,68) (,9) () (3,86) (3,3) 658 Scientific,Professional & Tech (567) (487) (36) (37) () (45) (56) (66) (4,3) (3,397) (3,) 76 (36,86) (35,933) 98 Admin & Clerical (8,659) (,56) (88) (76) (9,74) (9,375) 365 Other (8,69) (8,936) (89) (655) 54 (8,8) (7,6) 58 Pay (,76) (4,93) (,49) (,67) 377 (,5) (,75) 976 Expenditure - Non Pay Clinical Supplies & Services (439) (567) (5) (49) (55) (534) (9) Other (,49) (,33) (,856) (,95) (94) (,468) (,6) (593) Non Pay (,857) (,879) (,97) (,999) (9) (,983) (,595) (6) Expenditure (44,34) (47,7) (3,955) (3,67) 85 (43,34) (4,87) 364 Income Less Direct Costs (37,6) (4,3) (3,397) (3,) 76 (36,86) (35,933) 98 Service Lines Commercial Director Corporate Affairs Finance Human Resources Medical Director Nursing Director Operations In Month Variances Inc Pay Non Pay (3) (4) () (9) 4 (6) (9) 4 (8) 6 (3) (7) YTD Variances Inc Pay Non Pay () (53) (37) (7) (34) (433) (59) (9) 377 (9) (6) Income & Expenditure Commentary The month position is 76k favourable in month against the revised plan in month. The main areas are explained below: Income is ( 9k) adverse in month against plan. This is mainly due to reduced Nursery income received in month ( 38k) Pay is 377k favourable against plan in month. This is driven by Nursing, Commercial, HR, Operations and Finance. This is driven by a rationalisation of Agency use and accruals 57k, Substantive vacancies 93k, Medical staff recharges 4k. Non pay is adverse against the revised plan by ( 9k) in month. This continues to be driven by Overseas recruitment of Nurses will continue until the end of the year ( 56k) and Clinical Equipement and IT ( 56k); Estates department postage ( 73k) due to a billing backlog; offset by Corporate Affairs and others 37k. CIP Commentary The Corporate Directorate achieved 94% of its CIP target in month and 96% YTD. Underachieving CIPs Energy Rebate negotiations for 5k rebate are ongoing. Divisional Actions Recruiting to vacant posts. Finance has almost completed its recruitment drive which is resulting in a lower agency spend. PFI variation model is being developed to forecast seasonality. Pg9

10 SECTION 3: COST IMPROVEMENT PROGRAMME Division Annual 's IN MONTH Actual Variance 's 's 's YEAR TO DATE Actual Variance 's 's 's,44 Emergency Care,338 4 (7),7 685 (54) Specialist Services, (3),67,44 (3) Clinical Support Services, (5) (6) Commercial 7 () 96 (4) Corporate Affairs () 7 7 () Finance 8 5 (5) () HR () 5 5 () Medical () Nursing Operations (9) (4) Central (CNST),4,9,9 Total CIP 8, (4) 8, 7,53 (968) Type Summary as at the end of Annual 's Feb-6 In Month Actual Variance 's 's 's YTD Actual Variance 's 's 's COMMENTARY In month achievement is 83% of plan (YTD 88%). The CIP plan is in line with prior month projections and shortfalls continue in Emergency Services and T&O. All CIP shortfalls have been included in the Trust's forecast position. In Operations, we have been successful in securing an Energy rebate with our PFI provider amounting to.m but this is not yet reflected in the position. See divisional commentaries for further details of specific schemes and actions. Cost Reduction,54 4 (6),33,65 (65) 97% 97% Income Generation 6, (7) 5,89 4,988 (9) 78% 85% Total CIP 8, (4) 8, 7,53 (968) 83% 88% Pg

11 SECTION 4: INCOME Income Risk Summary 5/6 - Table COMMENTARY I&E YTD ( 86.m) Billed ( 8.8m) Accrued ( 3.3m) Paid ( 75.3m) Unpaid ( 7.5m) Low Risk( 3.m)* Medium Risk(.m)* Table Table shows income in 5/6 position and breaks it down into how much has not been received in cash terms. The Accrued income has increased from.6m to 3.3m. This Var primarily 's relates to.3m of NCA income,.m of over performance,.3m of GUM and the rest relates to Cancer, CQUIN and OSV reciprocal patients. 4/5 IMPACT IN 5/6 - Table Year End Accrual 7.m Billed 7.m Accrued.m Paid ( 6.6m) Unpaid (.4m) Low Risk( m)* Medium Risk(.m)* *Note: the risks have been estimated by the finance department. The 7.m unpaid invoices down from 9.m in the previous mounth, relates to 6.m of SLA overperformance invoices,.8m of NCA and.3 of GUM and IVF invoices Table Table shows the position on the 4/5 yearend income accrual and breaks it down into how much has not been received in cash terms. Further details of unrecovered items are shown on page 8. Pg

12 SECTION 5: PAY COSTS Costs 's In Month Var 's Actual 's Variance 's Year to Date 's Actual 's Variance 's Medical & Dental Nursing & Midwifery AHP Scientific, Professional & Tech Directors & Managers Admin & Clerical Support Staff (44,54) (55,53) (7,9) (6,9) (,5) (9,83) (,837) (3,74) (4,645) (67) (575) (884) (,594) (55) (3,788) (5,67) (679) (588) (78) (,435) (47) (46) (4) (9) (3) (4,8) (5,899) (7,38) (6,3) (9,68) (8,35) (,68) (4,86) (5,647) (7,45) (6,457) (8,7) (7,78) (,64) (,5) (748) (67) (45) Total Pay before Central Bud (46,598) (,66) (,43) (65) (34,344) (35,45) (,7) Reserves & CIP (9) (3) 3 (78) 78 Total Pay (46,69) (,79) (,43) (5) (34,4) (35,45) (,9) COMMENTARY The in-month pay is.m adverse against the revised plan. The majority of the nursing overspend is due to high usage of agency for escalations during the month with Claremont ward remaining open. The main adverse variances are in A&E, Elderly Care and AAU. Admin & Clerical and Managers have performed better as most of the agency posts have been recruited to or discontinued. The agency caps are also having a positive impact. Pg

13 SECTION 5: PAY COSTS Temporary Staffing analysis Qualified Nursing & Midwifery Medical & Dental Admin and Estates Staff Managers Other Grand Total 's Var 's Agency Bank Managers 34-6,37 8 Total Current Month, ,37 YTD Agency 7,34 3,949,4 85, ,54 Bank 4,634,7, ,38 Total YTD,957 6,9 3,733 98, ,886 Top 5 Agency users Commentary Total agency as a proportion of pay expenditure decreased from.% to.7% in month, whilst Bank staff expenditure has increased from 6.% to 6.5% of total pay. The additional staffing required for winter escalation is managed through agency, resulting in the agency spend not decreasing significantly. Monitor's cap of % applies for Q3 and Q4 and relates to nursing agency as a percentage of total nursing pay excluding HCA's. In January this percentage is 5.6%, up from 5.% in January. Current Month Year To Date Elderly Care Accident and Emergency Trauma and Orthopaedics Paediatrics and NNU Gastro and Endoscopy Other ,436,996, ,588 Total,37 6,54 Pg3

14 SECTION 5: PAY COSTS Costs Original 5 ' s Var 's 5/6 Bank and Agency Spend Admin and Estates Staff Allied Health Professionals Managers Medical And Dental Staff Qualified Nursing & Midwifery Other Grand Total Top 5 Agency and Bank Users Current Month Elderly Care 45 Accident and Emergency 8 General Surgery and Urology 39 Gastro and Endoscopy 33 Trauma and Orthopaedics 3 Others,9 Total,37 Year To Date Elderly Care 3,555 Accident and Emergency,93 General Surgery and Urology,36 Gastro and Endoscopy,37 Trauma and Orthopaedics,4 Others 4,56 Total 4,886 Pg4

15 SECTION 6: NON-PAY Non Pay 's In Month Actual Variance 's 's 's Year to Date Actual Variance 's 's 's Clinical Supplies & Services Drugs High Cost Drugs Transport Establishment General Supplies Other Premises PFI CNST (4,499) (4,877) (,837) (,479) (,993) (,96) (,76) (7,39) (,34) (4,757) (,98) (48) (,9) (4) (88) (45) (85) (595) (,3) (396) (,6) (,387) (,9) () (63) (6) (9) (67) (,34) (397) (8) (,39) (75) 9 (4) (76) (3) () (,58) (4,477) (,79) (,345) (,8) (,689) (,575) (6,55) (,3) (4,36) (3,743) (4,65) (,866) (,3) (,875) (,95) (3,69) (6,98) (,77) (4,367) (,35) 3 (,74) 5 (73) (36) (495) (43) 34 (6) Non Pay before Central Budgets (74,596) (6,) (7,66) (,56) (68,49) (7,5) (3,9) Reserves, , Total Non Pay (73,549) (5,937) (7,9) (,54) (67,549) (7,5) (,566) COMMENTARY Non Pay is overspent by.m in month or.6m after removing the impact of pathology recharges, high cost drugs and one off GRNI releases from the balance sheet. The clinical supplies and services overspend in the clinical divisions is driven by specialties such as Gynaecology, Ophthalmology, Cardiology and General Surgery and Urology where the activity has improved. In Anaesthetics, there is a continued overspend on laparoscopic consumables and other medical and surgical equipment. Pg5

16 SECTION 7: STATEMENT OF FINANCIAL POSITION 4/5 Audited m January m February m NON CURRENT ASSETS: Property plant and equipment Intangible assets Other assets TOTAL NON CURRENT ASSETS: CURRENT ASSETS: Inventories Trade and other receivables Cash and cash equivalents TOTAL CURRENT ASSETS CURRENT LIABILITIES: Trade and other payables Current Borrowings Current Provisions (9.) (.9) (.4) (33.) (.9) (.) (3.9) (.4) (.) TOTAL CURRENT LIABILITIES (3.5) (34.) (33.4) NET CURRENT ASSETS LESS CURRENT LIABILITIES (.8) (6.6) (7.) COMMENTARY Non - Current Assets There was a.5m decrease in February, comprising.m of additions and.7m depreciation. Current Assets There was a.8m decrease in Current Assets in February 6 comprising:.7m decrease in Cash and Cash Equivalents, as analysed in Section 8: Cash Flow Statement and a.m decrease in Inventories. Current Liabilities The decrease of.8m in Current Liabilities in February was largely due to a decrease in non-nhs Accruals which is analysed further in Section. TOTAL ASSETS LESS CURRENT LIABILITIES NON CURRENT LIABILITIES: Borrowings Provisions Other liabilities (9.6) (.3) (34.8) (.4) (34.) (.4) TOTAL ASSETS EMPLOYED FINANCED BY TAXPAYERS EQUITY: Public Dividend Capital Revaluation reserve Income and Expenditure Reserve - Prior years Income and Expenditure Reserve - Current year (6.) (6.5) TOTAL TAXPAYERS EQUITY Pg6

17 SECTION 8: CASH FLOW STATEMENT January 5 m Surplus/(deficit) after tax. Non-cash flows in operating surplus/(deficit) Depreciation and amortisation.7 PDC Dividend expense.3 Non-cash flows in operating surplus/(deficit). Var 's Operating Cash flows before movements in working capital. Increase/(Decrease) in working capital (Increase) in Inventories. (Increase) in Trade and other receivables (.) (Decrease) in Current Provisions (.) (Decrease) in Trade and Other payables (.5) Increase/(Decrease) in working capital (.5) Net cash (outflow) from operating activities (.4) Net cash inflow/(outflow) from investing activities Property t and Equipment (.) Intangible assets (.) Other assets. Net cash inflow/(outflow) from investing activities (.) Net cash inflow/(outflow) from financing activities PDC Drawdowns. PDC Dividend paid. Borrowings (.) Net cash inflow/(outflow) from financing activities (.) Net (decrease) in cash (.7) COMMENTARY The closing cash position for February was.6m which was.7m below the original month 5 forecast. The shortfall in the cash position was primarily attributable to unpaid overperformance invoices from commissioners for Q and Q totalling 3.m (Kingston, Richmond and Surrey Downs CCGs). Of this amount,.m has subsequently been paid by Surrey Downs in the first week of March. The impact of these unpaid amounts was offset in the month by slowing payments to trade creditors (.6m at the end of February). Lower than expected receipts from Royal Marsden (.m) and St Georges (.3m) were compensated by higher than forecast payments from Local Government organisations for GUM services (.m) and VAT reclaimed from HMRC (.m). Opening cash.3 Closing cash.6 Pg7

18 SECTION 9: DEBTORS Breakdown of Trade and Other Receivables (SoFP) in m: Months Mar-5 Apr-5 May-5 Jun-5 Jul-5 Aug-5 Sep-5 Oct-5 Nov-5 Dec-5 Jan-6 Feb-6 Income Accruals Aged Debtors (NHS and non NHS) Prepayments (mainly maintenance) Other* (.3) (.3)..4. Total Total Debt Outstanding As at 9th February 6 Up To 3 Da 3 To 6 Days to 9 DayOver 9 DayOverall Total Feb-6 Jan-6 Dec-5 Total Total debt at 9th February 6 9,64 748,39 4,6 5,493 6% 5% 9% 7% Total debt at 3st January 6 7,4 4,6 8 5,6 6,654 43% 4% % 3% Total debt at 3st December 5 8,36 98,4 4,655 4,354 58% % 7% 3% Commentary Trade and Other Receivables have increased by.m to 3.9m, the net effect of a.m increase in Income Accruals, a.9m decrease in Prepayments and a.9m decrease in Aged Debtors (NHS and non NHS) and a.m decrease in Other Debtors. Aged debtors decreased from 6.6m to 5.7m in month. Within this total, the current (<3 day) debt increased by.m, debt from 3-6 days decreased by 3.3m, 6-9 day debt increased by.m and debt over 9 days decreased by.m. Within these categories the significant movements were:- Invoices issued to CCGs at the end of January for the cumulative freeze position at Month 8 totalling.8m remain unpaid but remain in the -3 days bucket due to the short length of February Richmond CCG paid.5m for Q & Q 5/6 overperformance reducing 3-6 days debt Merton CCG paid.m over-performance invoices reducing 3-6 days debt Payments of.3m from Barking Havering & Redbridge NHST and.3m from BMI Healthcare both reduced over 9 days debt The increase of.m in income accruals relates mainly to month 9 overperformance. The.9m decrease in Prepayments was largely due to a.4m decrease in the CNST prepayment, a.m decreasein the AAH prepayment and a.m decrease in the Business Rates prepayment *Other includes the Provision of Irrecoverable Debts, Recoverable VAT and Other Debtors all due within one year. Pg8

19 SECTION : CREDITORS Description Aug-5 Sep-5 Oct-5 Nov-5 Dec-5 Jan-6 Feb-6 NHS Accruals (.3) (.4) (.6) (.5) (3.3) (3.) (3.4) Non NHS Accruals (4.) (3.) (.8) (.6) (.6) (.) (8.8) Capital Accruals (.7) (.4) (.6) (.) (.) (.4) (.) System GRNI Accruals (.9) (3.) (3.) (.5) (.8) (6.3) (.8) Deferred Income (3.6) (.6) (4.6) (3.6) (.6) (3.8) (3.) Trade Creditors (.7) (5.9) (.9) (3.) (6.) (6.3) (6.6) Income Tax and PDC Due Within Yr (4.4) (4.5) (4.5) (4.6) (4.6) (4.6) (4.7) Others including Provisions, PFI and Finance Leases (.8) (.) (.4) (.7) (.) (.4) (.9) Total (35.4) (35.) (3.7) (3.8) (33.3) (34.) (33.4) Commentary Outstanding creditors as at 9th February totalled 33.4m, a.8m decrease in month which comprised the net effect of:.3m increase in Trade Creditors which at the end of February, of which.m relates to an increase in slowed payments to suppliers at month end..3m decrease in Non NHS Accruals largely attributable to;.7m decrease in Trade Revenue accruals -.m decrease in Medical Pay accruals,.m decrease in General Surgery, Prime Care Solutions, Dalkia and Global Services..6m decrease in accrued JAC Pharmacy invoices.7m decrease in deferred income, due largely to; -.4m decrease in Q4 Madel deferred income -.m increase in Q4 Sift deferred income -.m increase in M 5-6 Winter Funding As in January, Trade Creditors in February remain comparatively high to previous months in the year. This is the combined impact of invoices being processed more quickly onto the financial system and constraints on the funds available resulting in payments being slowed as necessary. Pg9

20 SECTION : CREDITORS (BETTER PAYMENTS PRACTICE CODE) Commentary Original 's Var 's NHS Invoices paid within 3 days The value and number of NHS invoices paid within term both decreased in month. Invoice number remains below target. This is mainly attributable to 33 NHS Supply Chain invoices being paid late, accounting for 74% of all NHS out of term invoices. The drop in the invoice value was largely due to NHS Blood & Transplant invoices totalling 95k Non NHS Invoices paid within 3 days Both the value and number of NHS invoices paid within term decreased to 3% and 3% respectively in month. The value of invoices paid ontime fell below target in February due mainly to 336 ID Medical Group invoices and 6 Roche Diagnostics invoices totalling 645k being paid out of term. Overall, the percentages remain well below the target of 95% as the Trust manages its cash resources whilst awaiting payment of overperformance invoices from NHS commissioners. Pg

21 SECTION : CAPITAL 5/6 Capital Budget YTD YTD Spend YTD Variance Annual Updated Variance to ESTATES MAINTENANCE 3,3,659, ,3,77,358 5, , ,97 5, EQUIPMENT TOTAL IT TOTAL 3,57 3,34 3,3 3,57 3,53 37 Others TOTAL CAPITAL PROGRAMME 4,49,8,4,58 4,49,75,874 COMMENTARY Cumulative to Month, the Trust spent.m. This is.6m below the Trust s updated plan capital programme of.8m. Equipment spend is below updated plan by.49m. A&E & ITU monitoring machines ( 56k) scheduled for November have not arrived yet. IMT is.m underspent. Delays in commencement of SSD Track and Trace ( 3k), Server Replacement ( 34k) and PC and Mobile Replacement ( 4k) were the main reasons for this underspend. Estates Strategy is.5m underspent at M. Outpatients is 557k behind plan. The revised costs for 5/6 are currently been reviewed but some slippage into 6/7 is expected. Estates Maintenance is underspent by.m, due to delays in the commencement of Nurse Call Esher Wing ( k) and slippage in Pipework Replacement Phase II ( 73k) and Electrical Distribution Boards ( 56k). These slippages are expected to be corrected before year end. Others relates to Nursing Tech Fund and Charity Funded capital projects. Pg

22 SECTION : FINANCIAL SUSTAINABILITY RISK RATING (FSRR) Capital Servicing Capacity Liquidity I&E Margin - Underlying performance I&E Margin - Variance from plan Weight 5% 5% 5% 5% % % % % -% % -% <.5 <-4 <=- <=- 5/6 5/6 5/6 5/6 5/6 5/6 5/6 5/6 5/6 5/6 5/6 5/6 Heading M M M3 M4 M5 M6 M7 M8 M9 M M M Capital Servicing Capacity Liquidity I&E Margin - Underlying performance I&E Margin - Variance from plan.5 (5.) (4.5%).%.7 (6.4) (4.%).%.9 (8.) (3.%).%. (4.5) (.3%).%.7 (8.9) (4.%).%.8 (.5) (3.8%) (.%). (.3) (3.%).%. (8.7) (.9%) (.3%).8 (.) (3.6%) (.6%). (.) (3.%) (.5%).5 (.7) (.6%).% /4 3/4 3/4 3/4 3/4 3/4 3/4 3/4 3/4 3/5 3/6 3/7 Heading M M M3 M4 M5 M6 M7 M8 M9 M M M Capital Service Cover Liquidity I&E Margin - Underlying performance I&E Margin - Variance from plan Weighted average FSRR Rounded Weighted average COSR Capital Servicing Capacity I&E Margin Actual Liquid ratio I&E Margin Variance From COMMENTARY Our FSRR rating for month is a. This is driven by a variance from plan of % Pg

23 Appendix : INCOME DETAIL Income Summary Income 's In Month Actual 's Var 's Year to Date Actual Variance 's 's 's Patient Care Activities - CCG RTA\OSV Private Patients Other Patient Care Income, ,3 6, , (4) () () 84, ,7 86, ,5 Total Patient Care Income 4,63 6,84 7, ,954 88,9,36 Education BMI Provider to Provider Other 8,69,4 4,84, (4) ,46,97 3,94 9,496 8,63,93 4,67,9 Total Income 9,347 8,75 9, ,786,66,876,3 (55) (36) (37) 8 7 COMMENTARY Patient care income has improved due to the reassessment of income risk. Other income shows a favourable variance as additional LDA income recieved from HESL. Pg3

24 Appendix : ACTIVITY DETAIL Patient Care Activity Activity In Month Spells / Attendances Variance Year to Date Spells / Attendances Actual Variance Elective Day Cases Non Elective Out Patients A&E Critical Care Direct Access 3,964 3,953 6,8 364,44,44 9,6,858,356 33,996,69 3,369 9, ,96 33,5,35 34,45 9, ,373 9 (34) 3, (78) (8,84),973 7,965 9,5 73,38 83,568 6,9,43,767 3,59,535 4, ,48,35 8,964,64, ,57 5,473 95,93 8,747,5 46,847 Patient Care Income Income In Month Year to Date 's 's Actual 's Var 's 's Actual 's Variance 's Elective Day Cases Non Elective Non Elective Threshold Readmissions Out Patients A&E Critical Care Direct Access High Cost Drugs Non Elective - Maternity Pathway Out Patients - Maternity Pathway Other CQUIN 8,89 9,333 5,3 (,67) 46,48,63 9,4 8,5,87,39 8,58 3, ,686 4,59 (33) 4, ,5, SLA Income,45 6,634 6, ,93 86,34,3 7,646 3,958 (3) 3,84, ,9,, (59) (4) (3) (77) 66 6 () 4 () () 7,667 47,89 (,494) 4,8,58 8,76 7,5,769,369,36,3 3,69 7,83 7,385 46,99 (,59) 4,654,999 8,65 7,3,84,4,63 6,73 3,53 7,83 (8) (9) (35) (573) 47 () (),46 (7) (63) (5,589) (5) COMMENTARY The activity performance is detailed below: Non Electives and Critical care activity are below forecast. However A&E attenders are performing above plan. Pg4

25 Appendix 3 Income Penalties April May June July August September October November December January February YTD 8 week Breaches Mixed Sex Accomodation penalty Cancer Waits Cancelled Operations MRSA Penalty A&E Breaches Ambulance handovers OP New to Follow Up DCOP Readmissions , ,59 Commentary - The above table now shows all penalties that have been incurred by the Trust. A&E breaches penalties has increased in month. All other penalties remain in line with trend.