Finance and Performance Committee Report to the Board. Mark Bryant, Non-Executive Director. Mark Bryant, Non-Executive Director

Transcription

1 Front Sheet Title of Meeting Trust Board Date 29 th March 2018 Title of Paper: Author: Executive Director: Finance and Performance Committee Report to the Board Mark Bryant, Non-Executive Director Mark Bryant, Non-Executive Director Purpose: the paper is for: Delete as applicable Noting: An item of business for which the Board is required to give due regard to but for which there is not expected to be discussion Recommendation: The committee/meeting are asked to: Summary of Key Issues: No more than five bullet points The Board is asked to note the following: 1. The Trust reported a deficit of 0.1m in M11, bringing the deficit YTD to 2.7m in line with plan, against a control total of 2.8m deficit for the year. P&L, cash and capital expenditure were in line with expectations. 2. FPC continues to scrutinise the implementation of the Community Single Operating Model and allocated/unallocated caseloads. Details below. 3. FY18/19 contract negotiations have progressed - the Trust is making reasonable and timely progress with CCG colleagues against deadlines. 4. The Committee recommends Board approval of the proposal to out-source building maintenance functions to the preferred provider from the market test result. 5. The Committee agreed to award the linen and laundry contract to the highest scoring tender. 6. FPC recommends that the Board notes the progress to date with the strategy of disposing of surplus accommodation in order to generate receipts for reinvestment in making patient environments safer for both patients and the workforce, and confirm its continuing support for this approach. 7. FPC previously reported to the Board (January 2018) support for the executive recommendation for the disposal of St Martins West in FY18/19. The decision to dispose of St Martins West in FY 18/19 is important in triggering the process to deconsecrate the Chapel on site, which needs to be done before disposal of the site. FPC recommends the Board note that decision such that the process to deconsecrate can begin. FPC Board Report

2 8. FPC approved BC256 and CRF189 - WAN Facing Data Centre Firewall Replacement to protect the Trust from a much broader range of threats. The Trust s bid for 294k to replace the firewalls and a small number of network switches was approved by NHS Digital. 9. FPC is pleased to note that arrangements are in place for an experienced and senior doctor attendance at M11 and all future FPC meetings, ensuring a strong independent clinical voice and insight. Report History: None. Strategic Objectives: Select as applicable Deliver outstanding quality of care across all of our domains Are an attractive place to work promoting employee recruitment, retention and development Deliver and embed continuous improvement in all we do Promote and deliver an internationally based research programmes Maximise the use of digital technology to improve service access and quality Optimise our estate to deliver integrated physical and mental health services across all communities in Kent and Medway Deliver financial balance and organisational sustainability Develop our core business and enter new markets through increased partnership working. Implications / Impact: Patient Safety: N/A Identified Risks and Risk Management Action: Links to BAF 5216, 3164, 3163 Resource and Financial Implications: The Trust must hit a revenue deficit of 2.8m in 2017/18 to avoid regulatory intervention. Legal/ Regulatory: None. Engagement and Consultation: N/A Equality: N/A FPC Board Report

3 Quality Impact Assessment Form Completed: Yes/ No FPC addressed the following agenda: 1. Financials including: a. M11 Financial report b. Financial forecast c. Risk mitigations Cash analysis a. Contracts update b. Financial risks c. Capital plan d. Estates report 2. ICT report 3. Integrated Quality and Performance Report (IQPR) 4. Proposed New Integrated Quality and Performance Report (IQPR) 5. PD Strategy update 6. Two year service development plan discussion 7. Single Point of Access Tactical and Strategic approach 8. Trust Bed Strategy update 9. New Car Models (Forensics) update 1. FINANCE - Highlights for M11: Overall For month 11 the Trust reported in line with plan, a deficit of 0.1m and is 60k favourable year to date with a cumulative deficit of 2.7m. Agency Agency spend remains below the cap by 58k year to date which saw a small improvement from 55k in January. The Trust is continuing to forecast an underspend by the end of the financial year. Capital Capital expenditure is underspent at the end of month 11 by 1.9m year to date due to the phasing of the main strategic scheme. FPC Board Report

4 Cash Cash balance at the end of the month was 6.0m which was 3.6m better than plan. The Trust remains within its 1.1m obligation for minimum cash holdings. CIP The Trust was adverse to plan in month by 0.15m, and year to date the programme is under achieving against plan by 1.25m, with total savings delivered of 4.9m compared to a planned 6.1m. The total programme for this year is 7.0m. The forecast position for delivery of savings against plan is a gap of 1.4m based on a review of scheme details which is no change from January. CQUINS The risks identified last month for Q4 remain relevant. Current risk reflects worst case scenario for CQUIN failure. Financial Forecast and Risk Mitigations (1) Executive Summary The Trust is required to deliver a deficit of 2.8m for the year ending 31 st March 2018 to meet the control total target set by NHS Improvement. As part of the review of the plan known risks have been identified together with mitigating actions. Worst Case 5.1m deficit, 2.2m off plan Likely Case 2.8m deficit, deliver plan Best Case Breakeven, 2.8m better than plan (2) Issues and pressures identified The key issues affecting the financial position not included in the plan for 2017/18 are detailed below. Some are included within Care Group forecasts and where robust assumptions cannot be made they are identified separately. Various income challenges 2.5m Risk of CQUIN failure 1.2m Open Dialogue staff no budget transferred 0.3m Increased costs to deliver Place of Safety (s136) 1m Loss of income for the cost per case activity at the Frank Lloyd Unit. 1.2m Loss of income for the cost per case activity at the Littlestone Unit 0.3m Cost of delivering EIP NICE compliance 0.5m Settlement and further risks on prior year debt 1m FPC Board Report

5 Risk share, Support services and the Forensic Care Group continue to forecast underspends therefore some of these costs are being mitigated. The total risk to achieving plan is 2.2m, which would result in a deficit of 5.1m, the worst case scenario, if management actions do not deliver. (3) Key Actions to hit financial plan The following actions are being taken to ensure that the financial plan is hit and address the key risks and issues identified:- Negotiate settlements to contract challenges, 0.64m CQUIN increased management and scrutiny including at PMMs to deliver (at no extra cost) thus achieve income 0.55m. Negotiate settlement of CHC Dispute 0.55m Review provisions 0.38m Redeploy staff to mitigate redundancy 0.17m These key actions reduce the worst case scenario and enable the Trust to deliver the planned deficit of 2.8m as required by NHSI. (4) Actions to progress to Best Case The following actions would be required to deliver the best case scenario of breakeven in 2017/18: Further CIP delivery in addition to the 7.1m plan 0.75m Deliver all CQUIN 0.69m Negotiate no loss of Liaison and incentivisation funding 0.61m Retain the underspend on MIMHS services 0.40m Negotiate a 25% settlement for CHC, 0.28m (5) Contingency The Trust 948k contingency/reserve has been fully utilised. It is overcommitted which is an additional pressure requiring mitigation in order to achieve plan. (6) Risk Share The Trust plan assumed 3m of the risk share funding to mitigate the additional investments the Trust implemented to manage private placements e.g. discharge team and additional CRHT staff. A further 2.2m is being forecast to support mitigation of the cost pressures identified in section 2 and thus deliver plan. Trust Financial Risks FPC Board Report

6 There were no amendments to the risks this month. The largest strategic risk is 5216 which covers the risk of missing the financial plan for 2017/18 including associated cash risks. Estates Report Sale completion of the Homeopathic Hospital is scheduled for 29 March. Discussion with Homes England and the Department of Health about the possible transfer sale of St Martins West is ongoing. The Committee recommended that the Board notes the progress to date with the strategy of disposing of surplus accommodation in order to generate receipts for reinvestment in making patient environments safer for both patients and the workforce, and confirm its continuing support for this approach. The Committee recommended Board approval of the proposal to out-source building maintenance functions to the preferred provider from the market test result. The project to market test catering functions across the Trust is underway and a full description of this project will be available for discussion in April. The Committee agreed to award the linen and laundry contract to the highest scoring tender. ICT Report Additional funding from West Kent, DGS and Sussex CCGs has been obtained to invest in additional capabilities for RiO. The Committee approved BC256 and CRF189 - WAN Facing Data Centre Firewall Replacement to protect the Trust from a much broader range of threats. The Trust s bid for 294k to replace the firewalls and a small number of network switches was approved by NHS Digital. ICT Business Continuity was tested during the snow and freezing conditions and proved robust with increased staff working from home connecting to the cloud desktop. As the 600-user threshold was approached additional cloud servers were started to keep capacity ahead of rising demand. 2. PERFORMANCE Highlights for M11: Integrated Quality and Performance Report The Trust achieved 6 of the 8 regulatory targets in February. The unachieved regulatory targets were: CPA patients receiving formal 12 month review 151 patients out of a total of 2,412 did not receive a formal 12 month review within the February reported position. All patients are part of the Community care group and FPC Board Report

7 the reasons for, along with plans to correct, will be discussed with the team at the forthcoming performance meetings. CPA patients receiving follow-up within 7 days of discharge 7 patients out of a total of 118 were not followed up within the 7 day target, 6 within the Community care group and 1 within Forensics. FPC noted a further 96 patients had been discharged who were not on CPA and that of these 19 had no record of follow up on RIO. Following discussion, executives will report back on (1) the definition of follow up, given there is no national standard, (2) policy criteria on who is discharged on CPA and not on CPA, adherence to the policy, assurance testing that RIO is accurate e.g. using sampled checks. At M11, in summary, the Trust has 9554 referrals of which 7567 have been seen and allocated a pathway. This leaves 1987 patients (up from 1679 patients in M10) who have been referred but not yet been assigned pathway - of whom 738 have been waiting less than 28 days. FPC noted positive progress in relation to the monthly plan for 12 month formal reviews for CPA patients. This is significantly improved showing more realistic volumes each month. Furthermore, the number of overdue patients is on a clear reducing trend as is the total number of patients to be seen FPC also noted that a deep dive had done on each referred patient shown waiting 99+ days. FPC also noted that the implementation of the revised DNA Policy will impact this group, discharging to GP and enabling rapid re-referral if still required. Caseloads by team were scrutinised. All teams show an average caseload below 40. FPC requested analysis of specific staff with more than 40 cases, given the discussion highlighted that averages are only one metric and do not reflect the overall situation or cases known (and being addressed) by Operations. The number of patients not on a pathway increased to 1987 from 1679 in M10 (+290/17%). The performance team are drilling down into this group using our reporting technologies to help improve this situation. Executives recognise that considerable further work remains to be done, both in reducing the number of patients who are waiting to be seen and in improving our ability to report on the quality of patient contacts and documentation. New IQPR The Committee discussed the new proposed IQPR as a first step to improving the information reporting to the Trust Board and FPC. The proposed IQPR is set out to focus on the five CQC domains and report over a 100 indicators by the CQC domains. This is intended to enable the Trust Board to triangulate metrics and remain focussed on the quality of the services offered. FPC noted that this will take some time to bed down. FPC Board Report

8 3. CARE GROUPS/OTHER FPC noted updates on a range of matters including Clinical Pathways, 2 Year Service Development Plan, PD Model Strategy, Single Point of Access, New Care Models (Forensics) and the Trust s Bed strategy. FPC Board Report

9 Front Sheet Title of Meeting Trust Board Date 29 th March 2018 Title of Paper: Financial Performance Report for February 2018 (Month 11) Author: Executive Director: Ada Foreman, Deputy Director of Finance Sheila Stenson, Executive Director of Finance Recommendation: the paper is for: Delete as applicable Consideration: A report containing a positional statement relating to the delivery of the Trust s functions for which the Board has a corporate responsibility but is not explicitly required to make a decision Purpose of the Report: The purpose of the report is to set out the financial position for month 10 (January 2018). This is consistent with the position submitted to NHS Improvement in the Key Data Return. Summary of Key Issues: For month 11 the Trust reported in line with plan, a deficit of 0.1m and is 60k favourable year to date with a cumulative deficit of 2.7m. Agency spend in month was below the cap set by NHS Improvement and remains below year to date. The cash balance at the end of February was 6m which is ahead of plan mainly due to 1.5m received twice in error which is being recovered in March and the reprofiling of the capital programme. Capital programme was underspent as at end of February and is expected to recover by the end of the financial year. PDC has been received in March for cybersecurity thus the total programme will increase by this new funding. The Trust is still forecasting to deliver its 2.8m deficit control total for 2017/18 and all its other statutory targets. Report History: None Finance Performance Report M11 Front Sheet

10 Strategic Objectives: Please click on appropriate objective Deliver outstanding quality of care across all of our domains Are an attractive place to work promoting employee recruitment, retention and development Deliver and embed continuous improvement in all we do Promote and deliver an internationally based research programmes Maximise the use of digital technology to improve service access and quality Optimise our estate to deliver integrated physical and mental health services across all communities in Kent and Medway Deliver financial balance and organisational sustainability Develop our core business and enter new markets through increased partnership working. Implications / Impact: Patient Safety: None Identified Risks and Risk Management Action: Control total of 2.8m set for 2017/18 CRL and EFL limits set that can be under shot but not over shot. Resource and Financial Implications: Loss of Q4 STF funding if the control total is not delivered Legal/ Regulatory: Matches report provided to NHS Improvement in the Key Data return Delivery of statutory targets Engagement and Consultation: None Equality: None Quality Impact Assessment Form Completed: Yes/ No/NA Finance Performance Report M11 Front Sheet

11 Trust Board Financial Performance Report February

12 Contents Executive Summary 3 Page Statement of Comprehensive Income - Statement of Comprehensive Income - Trust 4 - Performance by Care Group 5 - Patient Care Income 8 - CQUIN 9 - Cost Improvement Programme 10 - Forecast 11 Statement of Financial Position - Summary month cashflow 13 - Capital Programme 14 Risks - Risk Schedule 15 2

13 Executive Summary RAG ratings are based on assessment of the risks around delivery of the forecast outturn for each measure. Executive Summary for February 2017 G A R Income and Expenditure G The Trust has a reported deficit of 2.7m year to date at the end of month 11, this continues to be in line with plan. The Trust is forecasting to deliver its control total of 2.8m deficit for 2017/18. This is despite overspends in two key care groups (Acute and Older People), which are being mitigated by underspends in most Support Services and Forensic Care Group. Non recurrent funding for private placements is supporting the unfunded cost of alternative provision. Agency spend remains below the cap by 58k year to date which is small improvement from 55k in January; the Trust is continuing to forecast an underspend by the end of the financial year. The cash balance at the end of the month was 6.0m which was 3.6m better than plan. The Trust has a requirement to hold a minimum of 1.1m at any one time as a result of the revenue support loan in place, which it is forecasting to achieve all year. The Trust's risk rating for February remains as a score of 3. This is due to an override rule that results in a maximum score of 3 if any one metric is rated 4. The scale is 1 to 4, with 1 being best performing and 4 being akin to special measures. Single Oversight Framework Metric Capital Service Capacity Liquidity (days) Definition Degree to which the provider's generated income covers its financial obligations Days of operating costs held in cash or cash-equivalent forms, including wholly committed lines of credit available for drawdown YTD Plan YTD Annual Plan In February the Trust reported a loss of 0.1m in month, bringing the year to date position to a deficit of 2.7m which is in line with plan. This continues to be mostly due to benefits from non recurrent funding in private placements where spend is below expected levels, which is offsetting the service investment incurred to deliver this. There are risks within this position totalling 5.3m, mitigations have been identified to ensure the Trust still delivers its required plan. Cash A The cash balance at the end of February was 6.0m, which was 3.6m favourable to plan. This is due to a duplicate payment received from Canterbury & Coastal CCG for 1.5m, this will be recovered in March. The Trust remains within its 1.1m obligation for minimum cash holdings. There are some risks non currently in the position relating to the with-holding of cash by East Kent CCGs, this is under discussion with the CFOs. It is likely the Homeopathic Hospital disposal will not complete until the 29th March therefore requiring additional cash control measures. Capital Programme G The capital expenditure is underspent at the end of month 11 by 1.9m year to date due to the phasing of the main strategic scheme. The Homeopathic Hospital with a net book value of 1.6m is due to complete at the end of March. I&E Margin I&E surplus or deficit as a proportion of total revenue Cost Improvement Programme A Distance from financial plan Year to date I&E surplus/deficit compared to year to date The Trust was adverse to plan in month by 0.15m, and year to date the plan programme is under acheiving against plan by 1.25m, with total savings Agency spend Distance from provider's cap delivered of 4.9m compared to a planned 6.1m. Rating for Use of Financial Resources The total programme for this year is 7.0m. The forecast position for delivery of savings against plan is a gap of 1.4m based on a review of scheme details which NOTE: The Single Oversight Framework is in place from April Above are the finance metrics included within this. Despite achieving an average score of 2.4, the Trust can only report a score of 3, denoting cause for concern, due to an is no change from January. override rule from achieving a score of 4 in one of the metrics. 3

14 Monthly (Deficit) / Surplus 000 Statement of Comprehensive Income - Trust Comparison to Budget Income Current Month - February 2018 Prior Year Prior Year Annual Year to Date In Month YTD NHSI Plan Plan Variance Plan Variance Plan Income from Activities (13,991) (14,199) (208) (13,599) (154,841) (154,764) 77 (154,949) (168,837) Other Operating Income (857) (879) (22) (1,899) (8,990) (9,639) (649) (12,506) (9,848) Total Income (14,848) (15,078) (230) (15,498) (163,831) (164,403) (572) (167,455) (178,685) Substantive 10,017 9,858 (159) 9, , ,930 (3,076) 107, ,025 Bank (14) 898 9,812 10, ,949 10,705 Locum Agency (2) 650 6,383 6,325 (58) 8,765 6,951 Total Pay 11,459 11,360 (99) 11, , ,205 (1,996) 127, ,681 Clinical supplies ,323 1, ,891 1,443 Drugs ,238 2, ,529 2,441 Other non pay 2,102 2, ,977 24,566 26,223 1,656 28,550 26,644 Total Non Pay 2,425 2, ,291 28,127 30,647 2,520 32,970 30,528 Total Expenditure 13,884 14, , , , , ,209 EBITDA (964) (959) 5 (781) (8,503) (8,552) (49) (7,404) (9,476) Post EBITDA Depreciation (25) 561 5,988 5,819 (169) 6,149 6,536 Interest (Receivable)/Payable PDC Dividend ,916 3, ,960 4,272 (Profit)/Loss on disposal and contingent rent ,032 1,023 (9) 1,019 11,342 11,331 (11) 11,497 12,376 Net (Profit) / Loss (3) 238 2,839 2,780 (59) 4,093 2,900 Donated Depreciation (6) (6) 0 (117) (60) (61) (1) (1,391) (66) NHSI Control Total (Profit) / Loss (3) 121 2,779 2,719 (60) 2,702 2, In month performance against budget Apr May Jun Jul Aug Sep Oct Nov Dec Jan Feb Mar Budget Income and Expenditure Commentary The Trust reported a 0.1m loss for February, this is in line with plan. Income: Income from Activities was favourable in month, this is due to Winter Pressure funding received 256k. The Other Operating Income has improved due to seconded staff recharges. Pay: Overall pay spend is favourable in month, this has decreased from last month as the January position included adjustments for actual invoices received from other NHS Trusts for junior doctors. The Trust continues to carry vacancies in the substantive workforce. Agency spend has decreased compared to January and overall the total spend is forecast to remain below cap for the rest of the year. Non Pay: Clinical supplies is overspent in month reporting a deficit year to date due to higher spend in the limbs service. Drugs are overspent in Community Recovery teams and Acute wards. Other non pay includes the contingency of 1.4m and an underspend in private placements following lower activity than plan as a result of alternative services provided. Post EBITDA: Depreciation is lower than plan due to timing delays on schemes. 4

15 Performance by Care Group 1,500 1,300 1, Forensic & Specialist Services Apr May Jun Jul Aug Sep Oct Nov Dec Jan Feb Mar Budget Community Recovery and Primary Care Psychology Therapy Services Comments Month on month YTD VARIANCE ( 865k) Comments Month on month YTD VARIANCE 219k The month 11 position is an in month under spend of 20k bringing the year to date under spend to 865k. The main reasons for this position are as follows: 1. Vacancies - slippage year to date has reached 3,024k. This is offsetting year to date spend of 1,923k on temporary staff, creating a net under spend on pay of 964k year to date. These values exclude the new MIMHS development. 2. Disablement Services - The over spend is currently at 143k year to date. This is due to limbs 475k which has been partly offset by over achievement on income of 188k and under spends on pay of 104k. 3. Addiction Services - is over spent by 95k which is an improvement of 4k on M10. This is due to over spends of 80k on pay, 14k on non pay and an under achievement of 1k on income. Actions are being taken to increase the income and reduce spend in order to make some recovery of this position prior to year end. The month 11 position is an in month under spend of 1k, resulting in a year to date over spend of 219k. The main drivers behind this are as follows: 1. Vacancies - the net under spend has reduced to 156k year to date. This includes year to date slippage of 2,403k which is offsetting temporary staffing costs of 2,247k. 2. Income - is showing an over achievement of 309k due to income received for PCPTS from Month 4 which was not budgeted. The service has now ceased with an over spend position of 25k. These under spends are offset by: 3. Drugs - the year to date over spend on drugs and FP10s is 470k. 4. Single Point of Access - is over spent by 339k year to date, mainly due to agency costs but also including a 6k over spend against non pay. 5. Community Recovery Management - is over spent by 47k. This is due to pay 41k from seconded posts related to the patient flow project and unfunded Band 8, 6 and 5 posts, and 13k on non pay. 6. AMHP Service - is over spent by 96k mainly due to patient transport costs 82k and pay 11k. 3,000 2,500 2,000 1,500 1, Apr May Jun Jul Aug Sep Oct Nov Dec Jan Feb Mar Budget 5

16 Performance by Care Group 3,000 Acute Older People Mental Health Services 2,500 2,500 2,000 1,500 1,000 Budget 2,000 1,500 1,000 Budget 500 Apr May Jun Jul Aug Sep Oct Nov Dec Jan Feb Mar 500 Apr May Jun Jul Aug Sep Oct Nov Dec Jan Feb Mar Comments Month on month YTD VARIANCE 1,191k Comments Month on month YTD VARIANCE 750k The month 11 position is an in month overspend of 253k and a year to date The month 11 position is an underspend of 227k and the year to date position position of 1,191k overspend. This position is due to the following key areas: of 750k overspend. The over spend is due to the following: 1. Ward Nursing overspend 733k relates to high observation levels particularly in North Kent. The Willow Suite became a male only unit in month which is expected to result in a reduction in spend. EK wards continue to under spend partially offsetting WK and NK wards. 2. Place of Safety is causing a significant cost pressure of 928k year to date. Previously this was delivered within CRHT establishments but this year the Care Group have set up separate rosters to deliver the service, which is being provided by agency staff. 3. Open Dialogue 209k adverse year to date. 4. Other services underspend of 663k due to vacancies. 1. Continuing Healthcare - The in month position for CHC income was an under achievement of 176k, bringing the year to date underachivement to 1,834k. Littlestone has now closed and the Littlestone cost per case funding to be transferred to a block from October to ensure Frank Lloyd Unit cosyts are fully covered; this is still under negotiation with commissioners and will be resolved by the end of the financial year. This under achievement of income is offset by: 2. Underspends on non pay 222k and pay 744k year to date. Excluding CHC income, the underlying position would be a year to date under spend of 119k which is due to vacancy slippage within community areas of 482k, staffing pressures within Inpatients 799k, non pay under spends of 73k and over achievement against other income areas of 389k. 6

17 000 Performance by Care Group 3,500 3,000 2,500 2,000 1,500 Corporate Services Budget Chief Executive and Board YTD VARIANCE ( 280k) The CEO services has a year to date underspend of 280k as at Month 11. This is due to vacancies within Information Rights 90k, Executive Assistants 110k. Communications is underspent by 68k. Operations YTD VARIANCE ( 32k) The Operations has a year to date underspend of 32k as at month 11, mainly due to the Chief Operating Officer vacancy slippage. 1, Apr May Jun Jul Aug Sep Oct Nov Dec Jan Feb Mar HR & Training YTD VARIANCE ( 364k) HR & Training has a year to date underspend of 364k as at Month 11, which is mainly due to vacancies within Workforce 141k and Training Management 129k. Overall there are 9.32 WTE vacancies. Finance and Resources YTD VARIANCE ( 247k) The Finance department has a year to date underspend of 152k due to slippage in recruiting to posts in Financial Management and Payroll. Corporate has an underspend of 378k, mainly due to higher than expected OATS income. The Capital Planning, Estates & Facilities department has a year to date overspend of 538k as at Month 11. This is mainly due to overspends on Minor Works and Building contracts 829k, telephone installation 103k, Utilities 196k, Clinical Waste 91k, Grounds & Security 111k, which are offset by Pay underspends of 745k. Executive Nursing YTD VARIANCE ( 62k) Executive Nursing and Governance has a year to date underspend of 62k as at Month 11. This is due to vacancies across the service, that are currently being recruited to. The position includes, an increased provision for higher future costs in legal claims and legal costs. Medical Directorate YTD VARIANCE ( 686k) Medical has a year to date underspend of 686k as at month 11. The position is mainly driven by higher PGME income and underspending on this budget. Transformation and IM&T YTD VARIANCE ( 91k) Transformation and IM&T has a year to date underspend of 91k as at Month 11. This includes a staffing vacancies underspend of 93k within the systems Support Team. Risk Share YTD VARIANCE ( 2,001k) Perfomance YTD VARIANCE ( 255k) Risk Share Placements budgets have a year to date underspend of 162k in Performance has a year to date underspend of 255k as at Month 11 due to month and 2,001k year to date despite the reduction in bed numbers due to vacancies in Contracting 56k, Performance 105k and Information Management the decant of Chartwell Ward. 88k. 7

18 Monthly income ( 000) Monthly income ( 000) Monthly income ( 000) Monthly income ( 000) Patient Care Income Patient Care Income by Type In month Prior Year to date Annual Budget* Variance Month Budget* Variance Budget NHS Ashford CCG (831) (831) 0 (826) (9,154) (9,154) 0 (9,984) NSH Canterbury & Coastal CCG (1,603) (1,603) 0 (1,592) (17,736) (17,736) 0 (19,339) NHS South Kent Coast CCG (1,597) (1,661) (64) (1,588) (17,655) (17,784) (128) (19,252) NHS Thanet CCG (1,398) (1,401) (3) (1,357) (15,422) (15,078) 344 (16,820) NHS Medway CCG (1,715) (1,761) (46) (1,754) (18,926) (18,625) 300 (20,641) NHS Swale CCG (718) (717) 1 (714) (7,801) (7,798) 3 (8,519) NHS Dartford, Gravesham & Swanley CCG (1,382) (1,382) (0) (1,373) (14,910) (14,905) 5 (16,292) NHS West Kent CCG (2,667) (2,774) (107) (2,742) (29,011) (29,907) (896) (31,679) Block Contract - Other (1,710) (1,735) (25) (1,673) (18,812) (18,947) (135) (20,523) Total Fixed Value Contracts (13,620) (13,864) (244) (13,620) (149,428) (149,935) (507) (163,048) Clinical Partnerships providing mandatory services (including S75 agreements) (194) (96) 98 (89) (2,136) (1,055) 1,080 (2,330) Short term episodic treatment - Cost and Volume Contract Revenue (149) (76) 73 (83) (2,749) (1,584) 1,165 (2,898) Other - Cost and Volume Contract Revenue (135) (164) (29) (223) (1,705) (2,189) (484) (1,840) Total Cost Per Case (284) (241) 44 (306) (4,454) (3,773) 681 (4,739) Total Patient Care Income (14,099) (14,201) (102) (14,014) (156,018) (154,763) 1,255 (170,116) Fixed value contracts YTD variance 507k favourable. This reflects: (a) Assumed return of unspend MIMS project funding 403k adv. (b) Alliance contract paid by West Kent 996k fav. (c) Continuation of second Forensic aftercare contract. 61k Fav (d) High Weald Liaison services 55k fav. (e) Prior year adjustments West 133k adv, North 160k adv and Medway FT 28k adv. (f) Return of EDS transformation funding to North CCGs 49k adv. (g) Additional Liaison support provided in Medway 49k fav. (h) Thanet Street Triage pilot CV 59k fav. (i) Pump Priming for new MBU from NHSE 44k fav. (j) Winter Pressures funding 256k fav. (k) Return of Core24 Liaison funding; Medway 241k adv. Clinical Partnerships YTD variance 1,080k adverse. This reflects: TGU 71k adv. Alliance contract paid by West Kent 996k adv. Detox services 13k adv. Short term episodic treatment YTD variance 1,165k adverse. This reflects: Brookfield 233k fav. Bridge House 12k fav. Frank Lloyd & Littlestone 1,410k adv. *NOTE: The Budget used here is the ledger budget. This is to reflect in year changes and will differ from the Annual Plan values used in other areas of this report Top 4 Commissioning areas against Budget 5,000 4,000 3,000 2,000 1, ,000 2,500 2,000 1,500 1, North Kent CCGs Apr May Jun Jul Aug Sep Oct Nov Dec Jan Feb Mar West Kent CCGs Apr May Jun Jul Aug Sep Oct Nov Dec Jan Feb Mar Budget Budget 6,000 5,000 4,000 3,000 2,000 1, ,000 1,500 1, Other - Cost and Volume Contracts YTD 484k favourable. This reflects: OATS 314k fav, Overseas 182k fav, PCPTS 261k fav, CAMHS k fav, external beds/risk share arrangements 39k fav. East Kent CCGs Apr May Jun Jul Aug Sep Oct Nov Dec Jan Feb Mar NHS England Apr May Jun Jul Aug Sep Oct Nov Dec Jan Feb Mar Budget Budget 8

19 CQUIN Position CQUIN Summary 2017/18 Quarter 1 Quarter 2 Quarter 3 Quarter 4 Total RAG RATING Length of Stay G 1a Staff Health and Wellbeing A 1b Healthy Food G 1c Flu vaccine A 3a Cardio metabolic assessment A 3b Collaboration with primary care A 4 MH in A&E A 5 Transition from CAMHS G 9a Tobacco screening A 9b Tobacco advice A 9c Tobacco referral A 9d Alcohol screening A 9e Alcohol advice and/or referral A STP Engagement G Financial Balance Control Total G Total 1, ,889 3,788 Annual Plan Total CQUIN at Risk (Worst Risk Adjusted CQUIN Risk Further Mitigated Risk Total Annual plan (above) 3,788 3,788 Less Length of stay CQUIN (225) (113) 0 (113) CQUIN 1a Staff Health & Wellbeing (133) (133) 0 (133) FLU CQUIN 1c (133) (67) 0 (67) CQUIN 3A cardiometabolic Assessment (224) (112) 0 (112) CQUIN 3b Collaboration with primary care (64) (64) 0 (64) CQUIN 4 MH In A&E (160) (80) 80 0 CQUIN 9 Alcohol & Tobacco Screening (300) (200) 0 (200) Total Forecast 3,788 (1,241) (769) 80 3,099 Comments: Quarter 1 - The Trust has had confirmation from all Commissioners that the Quarter one CQUIN milestones have been achieved. Quarter 2 - The Trust has received comments from all commissioners relating to the evidence presented for Quarter 2. It has successfully secured the West Kent CCG Q2 funding, East Kent and North Kent CCG's have queried elements of CQUIN 4, 5 and 9 requesting additional information. The contract team are providing this information and are confident that CQUIN 4 and 5 evidence will be accepted by the commissioners. There is a risk that the Trust has not met the milestones for CQUIN 9. This value is reported within the finance risk and mitigation position ( 100k) Quarter 3 - All commissioners have provided KMPT with a response to the Q3 queries and the Trust is arranging to meet with all localities to discuss the items identified. The risks identified here reflect the CCG queries to date. Year end forecast - The Risks identified last month for Q4 remain relevant and are identified within the table. 9

20 Monthly Achievement 000 Cost Improvement Programme In Month Year to Date Forecast Commentary Care Group Plan Variance Plan Variance Plan Variance ( 000) ( 000) ( 000) ( 000) ( 000) ( 000) ( 000) ( 000) ( 000) ASCG 9 - (9) (55) (64) OPCG (36) (149) (185) FSCG (30) (361) (391) CRCG (50) 1, (592) 1,723 1,082 (641) Facilities (0) (0) (0) IMT (0) (1) (1) Finance Central 11 - (11) (119) (130) Workforce (20) (4) Risk Share ,538 2, ,038 3,038 0 Total (156) 6,149 4,889 (1,260) 7,041 5,625 (1,416) Recurrent (156) 3,611 2,351 (1,261) 4,003 2,588 (1,416) Non Recurrent ,538 2, ,038 3, , Monthly profile Apr May Jun Jul Aug Sep Oct Nov Dec Jan Feb Mar R A G Forecast In February the Trust reported 156k worse than plan, with the overall programme now under acheiving against plan year to date by 1,260k. The Forensic and Specialist Care Group variance ( 361k adverse) is as a result of the limbs service. This is only partly being met currently however the forecast has been updated to reflect this. The Community Recovery year to date variance is due to delays in the savings materialising from the CMHT transformation, underachievement against rehab service changes and an overspend on drugs. The Risk Share savings are on plan for the year to date and are forecast to achieve their full target of 3,038k. The forecast has been calculated by scheme, using plans in place as a guide. This suggests that with no further action the programme will have a gap of 1.4m, this is no change to the reported forecast in January. 10

21 Forecast Monthly Profile Forecast Apr-17 May-17 Jun-17 Jul-17 Aug-17 Sep-17 Oct-17 Nov-17 Dec-17 Jan-18 Feb-18 Mar-18 Forecast Outturn Plan Variance Income Clinical income (13,909) (14,129) (13,741) (14,186) (14,413) (13,627) (14,017) (14,220) (14,202) (14,120) (14,199) (12,259) (167,023) (168,837) 1,814 Other Operating Income (796) (849) (1,164) (711) (797) (770) (811) (922) (938) (1,003) (879) (839) (10,479) (9,848) (631) Total Income (14,705) (14,978) (14,905) (14,897) (15,210) (14,396) (14,828) (15,142) (15,140) (15,123) (15,078) (13,098) (177,501) (178,685) 1,184 Expenditure Substantive 9,801 9,951 9,895 9,824 9,848 9,811 9,786 9,762 9,759 9,634 9,858 10, , ,025 (3,077) Bank ,136 1, ,974 10, Locum Agency ,936 6,951 (15) Total Pay 11,283 11,418 11,400 11,571 11,586 11,350 11,254 11,462 11,359 11,163 11,360 11, , ,681 (1,903) Clinical supplies ,758 1, Drugs ,031 2, Other non pay 2,475 2,632 2,444 2,229 2,451 1,578 2,274 2,330 2,787 2,665 2, ,807 26, Total Non Pay 2,863 3,048 2,828 2,637 2,849 2,021 2,711 2,748 3,155 3,031 2, ,596 30,528 1,068 14,146 14,466 14,228 14,208 14,435 13,371 13,965 14,210 14,514 14,194 14,119 12, , ,209 (835) EBITDA (559) (512) (677) (689) (775) (1,025) (863) (933) (627) (930) (959) (579) (9,127) (9,476) 349 Post EBITDA 1,017 1,018 1,056 1,014 1,025 1,175 1,029 1, ,083 1, ,023 12,376 (353) Net (Profit) / Loss ,895 2,900 (5) Donated Depreciation 0 (11) (5) (5) (5) (5) (5) (5) (5) (5) (5) (5) (61) (66) 5 Adjusted Net (Profit) / Loss ,834 2,834 0 Commentary: The Trust is currently forecasting to deliver its plan by the end of March The current forecast shows that the Trust will deliver its agency cap for the year. Care groups and Support Services have been set revised control totals as at month 6. Community Recovery, Older Adult and Forensic Services have improved against this mainly as a result of vacancy controls. Support Services have also improved. However these improvements have been utilised by income risks that have emerged since month 6. This forecast is not without risk of delivery and is discussed separately at the Finance and Performance Committee. 11

22 Statement of Financial Position - Summary February 2018 Opening Movement Year End Plan '000 '000 '000 Non-current assets 7000 Property Plant and Equipment 149, ,260 3, , Intangible Assets 1, Other non-current receivables Total non-current assets 152, ,782 4, , Current Assets 5000 Trade and other receivables 8,038 5,958 2,080 8, Cash and cash equivalents 1,484 5,979 (4,495) 1, Total current assets 9,522 11,937 (2,415) 9, Current Liabilities Trade and other payables (12,268) (14,560) 2,292 (13,328) Provisions (696) (662) (34) (346) -346 Borrowings (788) (829) 41 (832) -832 DH Capital Loan (800) (800) 0 (800) Total current liabilities (14,552) (16,851) 2,299 (15,306) NET CURRENT ASSETS (5,030) (4,914) (116) (6,119) Total non-current liabilities (19,201) (17,842) (1,359) (18,062) TOTAL NET ASSETS 127, ,026 2, , TOTAL TAXPAYERS EQUITY (127,800) (125,026) (2,774) (125,607) Aged Debt Analysis > 90 Days Days Days < 30 Days Current Statement of Financial Position Commentary Over 90 Day Debt Creditor payments We carefully review each payment run and majority of outstanding invoices are paid on time. The variance in February is mainly due to the timing of payment processing. External Financing The Trust is not planning to draw any loans in 2017/18. The Trust currently has two outstanding loans. The explanation of the variances to plan for Property, Plant and Equipment are detailed on page 12 of this report. Please refer to page 11 to see the detailed explanation in regards to movement in Cash and Cash Equivalents. The target for over 90 day debt for the Trust is that over 90 day debt must be less than 5% of overall debt. This target has not been achieved in February 2018 for NHS debt by 33%, but was achieved by 3% for non NHS debt respectively. 13/14 Total 541k 14/15 Total 60k 15/16 Total 275k 16/17 Total 214k - 478k EK QIPP - 60k High Weald - 93k Medway Overseas - 77k MFT - Payment in M12-46k EK Section k High Weald - 18k Medway Overseas - 17k High Weald - 125k NHSE - 119k High Weald 12

23 000's 12 Month Cashflow Cashflow as at February 2018 Annual Cash Flow Apr-17 May-17 Jun-17 Jul-17 Aug-17 Sep-17 Oct-17 Nov-17 Dec-17 Jan-18 Feb-18 Mar-18 Forecast 000's 000's 000's 000's 000's 000's 000's 000's 000's 000's 000's 000's TOTAL CASH B/FWD 1,484 2,435 2,253 2,134 4,027 4,239 2,246 3,904 3,731 3,622 5,403 5,979 Revenue Receipts 15,751 14,788 14,755 15,794 14,978 15,205 16,708 15,015 14,005 16,676 14,757 11,372 STP Funding , Capital Receipts , ,030 TOTAL RECEIPTS 15,751 14,788 14,755 16,832 14,978 15,370 16,708 15,015 15,476 16,676 14,757 13,402 Pay (9,928) (10,013) (10,057) (10,018) (9,980) (9,999) (9,962) (9,972) (9,987) (9,884) (9,961) (10,030) Non-Pay (4,383) (4,591) (4,225) (4,858) (4,624) (4,955) (4,626) (4,606) (4,965) (4,804) (3,795) (4,417) Capital (489) 48 (592) (64) (161) (356) (462) (197) (634) (207) (425) (1,621) Loan repayment 0 (414) (412) Dividend payment (2,054) (2,136) Comments: The actual ledger cash position as at February 2018 (Month 11) is 5.97m which is 3.6m higher than planned cash of 2.4m. The variance is mainly due to: 1.1m payment of aged debt from East Kent CCGs in October Receipt of STF of 0.8m in July, as a result of Trust delivering the agreed financial control total in 2016/17 Lower than planned cash payments relating to Non-pay, primarily due to reduced external bed usage. The cash increase brought forward from January is due to duplicate payment the Trust received from Canterbury and Coastal CCG of 1.5m, this payment will be rectified in March. Offset by: The withholding by East Kent CCGs of the block contract income of 662k in relation to growth and incentivisation monies from April TOTAL PAYMENTS (14,801) (14,970) (14,873) (14,940) (14,766) (17,363) (15,050) (15,187) (15,585) (14,894) (14,182) (18,205) Net Cash Inflow/Outflow 951 (182) (118) 1, (1,993) 1,658 (173) (110) 1, (4,802) Achievement of Plan The Trust is managing its Cash resources within the set External Financing Limit (EFL). PDC Financing Transactions TOTAL CASH & CASH EQUIVALENT 2,435 2,253 2,134 4,027 4,239 2,246 3,904 3,731 3,622 5,403 5,979 1,831 Opening cash 2017/18 1,484 Closing cash 2017/18 (1,831) NHSI Annual Plan Forecast 1,467 1,383 2,407 2,439 2,521 2,171 2,203 2,169 2,289 2,271 2,361 1,180 Cash reduction (347) VARIANCE (273) 1,588 1, ,701 1,562 1,333 3,132 3, Items not included in EFL (935) EFL required (1,282) 6,500 6,000 5,500 5,000 4,500 4,000 3,500 3,000 2,500 2,000 1,500 1, Progress against the Cash Plan Mar Apr May Jun Jul Aug Sep Oct Nov Dec Jan Feb Mar Plan Forecast Min Cash Bal Initial Allocation (1,233) Adjustments agreed by NHSI: 1,214 Forecast EFL (19) Forecast Undershoot (1,263) This undershoot is as a result of the 700k deferred capital to 18/19 and EFL adjustment for 560k improvement in working capital not required. 13

24 Capital Programme Capital Resource Limit Funded by: Plan CRL Limit 2,096 Own resources - Depreciation 5,795 Adjustments: - STP 560 Adjustments: - STP 560 Adjustments: - MBU (PDC) 150 Adjustments: - MBU 150 Adjustment for PFI Lifecycle Costs 71 Adjustments: - Wireless 210 Adjustments: - Wireless (PDC) 210 Adjustments: - Disposal Receipt 1,640 New adjustments: - Disposal Receipt 1,640 Adjustments: - Cybersecurity 294 Loan payment (800) Confirmed CRL 4,727 Net cash movement (2,828) New adjustments: - Cybersecurity (PDC) 294 Available Resources: 5,021 NBV sale of assets 1,091 Forecast CRL 5,021 Forecast gross capital spend 6,112 Capital Expenditure 2017/18 The capital expenditure forecast below assumes the sale proceeds of both Homeopathic and Mulberry. This is a variance to the NHSI return which requires the Trust to remove the spend to be financed from the proceeds until they are realised. Year to Date Annual Revised Plan Plan Variance Forecast Expenditure: Strategic Schemes 3,520 3,050 1,987 (1,063) 3,916 Operational capital 826 1, (755) 491 IM&T (62) 1,005 NHSI Plan 4,941 4,620 2,739 (1,881) 5,412 Asset Disposals: Sale of Assets - Homeopathic (1,670) (1,628) 0 1,628 (1,628) Sale of Assets - Mulberry (1,104) (1,091) (1,091) 0 (1,091) NHSI Plan (2,774) (2,719) (1,091) 1,628 (2,719) 2,167 1,901 1,648 (253) 2,693 CRL 5,021 Undershoot 2,328 Comments The Trust is underspent on capital at the end of month 11 by 1,881m. In the programme strategic schemes mainly relate to the Boughton and Chartwell (Phase 2 Modernising Acute Inpatient Programme), and operational capital schemes include elements to address backlog maintenance which is recommended by the Estates Department, proposed by the care groups and approved by the Trust Capital Group. The current forecast is an underspend against CRL of 2,328k which is 700k due to schemes deferred to 2018/19 and the expectation the the final disposla will occur thus negated the CRL adjustment recently received. Meeting the Trust Capital Resource Limit (CRL) The main risks in meeting the CRL, are: the completion of the Homeopathic disposal which is currently forecast to complete by the end of March challenges to the delivery of the externally funded projects, with the commencement of the Mother and Baby Unit and the IT projects (wireless and cybersecurity) where there are risks to the achievement of the CRL if the projects are not completed this financial year Cumulative Capital Spend against Plan The CRL Undershoot is as a result of 700k deferred to 18/19 and CRL adjustment for the sale of Homeopathic not required. Plan Forecast 14

25 Risk Schedule 2017/18 Risk Schedule Risk Description Current Risk ( 000) Previous Risk ( 000) Change in Risk (-ve = Reduced Risk) Mitigation INCOME AND EXPENDITURE 15/16 Risk Share debt CCG's are querying the methodology of Risk Share agreements This debt has now been paid CRES (5216) PCPTS (3753/4221) Use of private beds (TBC) NHS debts CQUIN (4863) / KPI Penalties Loss of income from CHC (4891/5133) Managing within available resources and delivery of CIP. All schemes to be delivered whilst maintaining safety and quality and avoiding unfunded restructuring costs. IF unable to attract sufficient income to meet its expenditure under the Any Qualified Provider Contract service will need to be ceased. I&E loss increased by any redundancy cost. Remaining investment for private placement costs after funding converted to cover the additional investment in Trust services to enable delivering within Trust bed base. Prior year NHS debts that have yet to be resolved. Settlement may result in credit notes being raised. All disputes assumed to be paid in full (risk share risk identified separately) Managing delivery of CQUIN goals within available resources + delivery of key SLA targets and avoiding KPI penalties 10 SPOT FLU beds ceased and reduced bed numbers in Littlestone resulting is a loss of income. 1,416 1, ,233 2, ,001 1,001 0 Non recurrent benefits from Risk Share and Support Services underspend. Risk now reflects the forecast CIP gap Close and regular scrutiny at senior and service line level. This reflects the overspend operational risk only. No costs for closue in December have been assumed. The level of use of private beds kept to the minimum so funding available to cover additional costs incurred in delivery of no private beds and to support other cost pressures. Remaining unpaid 16/17 and prior debt excluding risk share. For local CCGs recovery being escalated via the formal contract performance meetings. Will refer to arbitration is resolution cannot be obtained Current risk reflects worst case scenario for CQUIN failure This risk has crystalised. The new model of care implemented in October 2017 and CV expected for baseline move. Bills raised to CCGs. Revenue implication of Revenue implication of the strategic scheme for Maidstone Acute Ward Capital scheme improvements Mitigated in full by no use of out of area beds. Sub Total Income & Expenditure Risks 5,376 5,376 0 Mitigations Deliver CRES (1,416) (1,416) 0 Obtain payment from the CCGs for prior year disputes (1,001) (1,001) 0 Additional cost controls (2,959) (2,959) 0 OUTTURN Other Risks Cash (4762) achieve EFL statutory target Capital Programme (3164) If the over spend and debtor risks are not mitigated there will be insufficient cash to meet our liabilities. 1,000 1,000 0 Managing additional capital commitments within existing resources Close monitoring of payment runs. Detailed report to FPC. Monthly senior team meeting to review debt and monthly reporting to contract meetings. Prioritisation of schemes undertaken by the Trust Capital Group. Monthly monitoring by FPC. Strategic scheme utilises most of the available resource. Proposal to be approved to incresse CRL from excess cash achieved at year end. 15