Month 6 West London CCG Finance and Activity Performance Report

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1 Month 6 West London CCG Finance and Activity Performance Report 29-Oct-14 Cover

2 Contract Acronyms The following acronyms are used throughout this pack. ASP BLT C&W CLCH CNWL EHT ESH GOSH GSTT HRCH HUH HWP ICHT KCH KHT MEH NWLHT RBH RFT RMH RNOH RSC SGT SLAM SWL&StG THH UCLH WHH WLMH WMUH Acronym Full Provider Name Ashford And St Peter's Hospitals NHS Foundation Trust Barts Health NHS Trust Chelsea And Westminster Hospital NHS Foundation Trust Central London Community Healthcare NHS Trust Central And North West London MH NHS Foundation Trust Ealing Hospital NHS Trust Epsom And St Helier University Hospitals NHS Trust Great Ormond Street Hospital For Children NHS Foundation Trust Guys And St Thomas NHS Foundation Trust Hounslow And Richmond Community Healthcare NHS Trust Homerton University Hospital NHS Foundation Trust Heatherwood And Wexham Park Hosps NHS Foundation Trust Imperial College Healthcare NHS Trust Kings College Hospital NHS Foundation Trust Kingston Hospital NHS Trust Moorefield's Eye Hospital NHS Foundation Trust North West London Hospitals NHS Trust Royal Brompton And Harefield NHS Foundation Trust Royal Free London NHS Foundation Trust The Royal Marsden Hospital NHS Foundation Trust Royal National Orthopaedic Hospital NHS Trust Royal Surrey County NHS Foundation Trust St George's Healthcare NHS Trust South London And Maudsley NHS Foundation Trust South West London And St George's Mental Health NHS Trust The Hillingdon Hospital NHS Foundation Trust University College London NHS Foundation Trust The Whittington Hospital NHS Trust West London Mental Health NHS Trust West Middlesex University Hospital NHS Trust Glossary

Contents Executive summary Overall financial position Overall Overall financial financial position Contracts performance position Appendices Executive Summary 2 Surplus/deficit including running

3 Contents Executive summary Overall financial position Overall Overall financial financial position Contracts performance position Appendices Executive Summary 2 Surplus/deficit including running costs 7 Acute Contracts YTD Performance 16 Appendix 1.1: Revenue resource limit 26 CCG Finance dashboard 3 Breakdown of commissioning spend 8 Acute Provider Finance Performance - C&W 17 Appendix 2.1: RAG Rating Definitions 27 Risks & Opportunities 4 Breakdown of running cost spend 9 Acute Provider Finance Performance - ICHT 18 Appendix 3.1: CLCH Deep Dive 28 Underlying Position 5 Movements of Variances including Running Costs 10 Key issues and actions - C&W (i) 19 Appendix : Mental Health Breakdown of reserves 11 Key issues and actions - C&W (ii) 20 Appendix 5.1: ICHT Deep Dive Extract Investments 12 Key issues and actions - ICHT 21 QIPP 13 Progress on strategic priorities - ICHT 22 Capital, creditor payments and cash 14 Key issues and actions - Out of Area Trusts 23 Key issues and actions - Community Contract, CLCH 24 1

4 Executive summary Overall financial position Risks and Opportunities Contract performance In M6 the CCG is reporting a year-to-date favourable variance to plan of 230k and a full year outturn position on plan, which is in line with the NHSE control total. As at M6 the CCG is in a marginally unfavourable position with a likely net risk of 57k. In month the allocation for charged exempt overseas visitors was received and no longer a risk. A further SHSOP risk has been identified for redundancy with a likely estimated value of 350k and additonal risks related to contract performance and data issues have been identified with a likely estimated total value of 1,470k. This is mitigated by potential opportunities arising from investment slippage and unused contingency budget. At M6 acute contracts, including other acute services (e.g. non-contracted activity) are reporting a 653k YTD overspend (which translates to a 1,047k FOT overspend). The C&W contract is overspent by 689k at M6 ( 1,377k FOT). In month 6 the financial performance has remained consistent with month 5 when there was a signicant deterioration in performance. The contract is a partial block contract, with blocks on non-elective (excluding non-elective excess bed days) and outpatients, therefore, the overspend is being driven by PbR areas in A&E, critical care and direct access. The ICHT contract is under an Income Guarantee arrangement. A 'force back adjustment of ( 376k) has been applied to ensure the YTD charges match the agreed IG. Other significant overspends to date are 193k ( 386k FOT) at KCH mainly driven by complex cases within critical care and T&O, and 222k ( 402k FOT) at GSTT mainly driven by maternity and follow ups attendances. Status Green Green Amber QIPP delivery Investment & reserves QIPP plans are behind plan year-to-date ( 143k adverse variance) with a number of schemes under performing, driven by PPF, RSS, MSK and LTCs following a review of M5 data. Schemes are currently forecast behind plan ( 596k adverse variance) to deliver the full year QIPP targets, however, a number of actions are being taken to bring schemes back in line with plan, and additional outpatient and non-elective schemes are being launched over the summer, which are expected to impact towards the end of the year. The CCG's detailed investment plan is being reviewed and monitored by the Investment Task force. At M6, the FY investment pot is forecast to be fully spent and work is on-going to refine the plan and map against different funding sources. Amber Green Source: Team analysis 2

5 CCG finance dashboard On plan or better Take note Action required Key Indicator Target Actual Rating this month Financial position in month Break even/agreed surplus 2,258k 2,335k 3.4% variance from plan Financial position year to date Break even/agreed surplus 13,550k 13,781k 1.7% variance from plan Financial position forecast outturn Break even/agreed surplus 27,101k 27,101k 0.0% variance from plan Running costs forecast outturn Break even/agreed surplus 5,738k 5,738k 0.0% variance from plan QIPP year to date 3,099 2,955 (4.6%) variance from plan QIPP forecast outturn 9,893 9,297 (6.0%) variance from plan Investment plan 8,121k 7,872k 3.1% variance from plan Risks and opportunities 0k #REF! 1.0% (net risk) / opportunity outside reported position Creditors - Better Payment Practice Code 95.0% 82.7% (13.0%) of invoice value paid in 30 days Capital forecast outturn 2,500k 2,500k 0.0% forecast variance from allocation Cash 165,350k 156,009k (5.6%) year to date variance from cash limit Note Risk and opportunities reflect total likely risk identified in month 6 of 5,165k and total opportunity of 5,108k. Source: Financial ledger 3

6 Opps Risks Risks and opportunities As at M6 the CCG is in a marginal unfavourable position with a likely net risk of 57k Amount Likely Case Best Case Worst Case k Probability Value k Probability Value k Probability Value k Acute Services (1,400) 76% (1,070) 0% 0 100% (1,400) Continuing Healthcare (1,750) 84% (1,470) 27% (480) 100% (1,750) Mental Health Services (2,000) 75% (1,500) 25% (500) 100% (2,000) Property Services (725) 75% (544) 0% 0 100% (725) Performance Issues (1,163) 50% (582) 0% 0 100% (1,163) Total Risks (7,038) (5,165) (980) (7,038) Investment slippage / other uncommitted funds 4,762 34% 1, % 4,762 0% 0 Contingency not utilised 1, % 1, % 1, % 1,852 Property Services % % 330 0% 0 Acute Services 1,200 25% % 1,200 0% 0 Risk share agreements 1, % 1, % 1,000 0% 0 Total Opportunities 9,144 5,108 9,144 1,852 Net (Risks) & Opportunities 2,106 (57) 8,164 (5,186) 4 GB

7 Underlying Position The underlying financial position of the CCG shows the recurrent revenue less the recurrent expenditure and excludes all non-recurrent or one off items i.e. return of previous year surplus and spend on one off projects or investments such as the SystmOne roll out. Outturn at month 6 Revenue Expenditure Recurrent Non recurrent Total ( k) ( k) ( k) 316,880 30, , ,264 33, ,987 Surplus/(Deficit) 30,616 (3,515) 27,101 Underlying Position Total Total ( k) (%) Outturn Planned (per Bridge return June 14) 30, % 26, % Improvement / (worsening) 3,713 5

Contents Executive summary Overall financial position Over all finan cial posit ion Contracts performance Appendix Surplus/deficit including running costs 7 Breakdown of

8 Contents Executive summary Overall financial position Over all finan cial posit ion Contracts performance Appendix Surplus/deficit including running costs 7 Breakdown of commissioning spend 8 Breakdown of running cost spend 9 Movements of Variances including Running Costs 10 Breakdown of reserves 11 Investments 12 QIPP 13 Capital, creditor payments and cash 14 6

9 Surplus/deficit including running costs Key Messages At M6 the CCG is on track to delivery its surplus plan of 27,101k. Commissioned services are discussed further on page 8 and the key movements in variances are highlighted on page 10. CCG Budget Group Year to date ( k) Full year ( k) Budget Actual Variance Budget Outturn Variance Variance at M5 Further detail Allocation Resource Limit 172, , , , Page 26 Acute Services 70,392 71,045 (653) 144, ,197 (1,047) (1,115) Page 16 Expenditure on Programme Areas (Commissioned services) Community services 20,019 19, ,038 39, Mental health 31,465 31, ,875 63,185 (309) (804) Prescribing 11,847 11, ,777 23,795 (19) 2 Continuing Care 7,300 7, ,298 13, Primary Care Service 3,597 3,962 (364) 7,075 7,811 (736) (733) Other 11,518 11, ,036 21,476 1,561 2,245 Page 8 Running Costs Corporate costs 2,869 2, ,738 5, Page 9 Total Expenditure 159, , , ,987 (0) 0 Surplus/(Deficit) 13,550 13, ,101 27,101 (0) 0 7

10 Break-down of programme (commissioning ) spend The key overall commissioning pressures remain within acute, mental health and primary care services as shown in the table below. In acute, C&W is the main pressure with a 0.7m year to date overspend and a forecast outturn position of 1.4m overspend. In mental health, the key pressures are on Section 75 LD continuing care residential/home and day care and Section 256 MH placements with a forecast outturn overspend of 531k and 212k respectively. In addition, the C&NWL SLA contract was agreed above the budget envelope by 430k. These are partially offset by an underspend of 350k on MH continuing care, 318k on cost per case placements and 67k on NCAs. In primary care, local enhanced services are the key pressure as a result of 13/14 outturn being higher than predicted ( 809k FOT overspend against plan). C Commissioning Spend Breakdown Year to date ( k) Full year ( k) Budget Actual Variance Budget Outturn Variance Variance at M5 Acute NHS SLA Services (incl. CQUIN & Ambulance) 67,156 67,592 (436) 137, ,443 (764) (1,113) Other Acute Activity Services 3,235 3,453 (217) 6,471 6,754 (284) (2) Further detail Acute Services Sub Total 70,392 71,045 (653) 144, ,197 (1,047) (1,115) Page 16 Community Services 20,019 19, ,038 39, Mental Health Services 31,465 31, ,875 63,185 (309) (804) Prescribing 11,847 11, ,777 23,795 (19) 2 Commissioned services Continuing Care 7,300 7, ,298 13, Primary Care Service 3,597 3,962 (364) 7,075 7,811 (736) (733) Non Acute Sub Total 74,228 73, , ,576 (513) (1,130) Other Non Acute Services 1,818 1,917 (98) 3,637 3,732 (96) (66) Commissioning & Non Recurrent Reserves 5,810 4, ,633 10,138 1,496 2,125 Page 11 Other-Other Commissioned Services 3,890 4,456 (566) 7,766 7, Other Sub Total 11,518 11, ,036 21,476 1,561 2,245 TOTAL Commissioning spend 156, , , ,249 (0) 0 Source: Financial ledger 8

11 Break down of running cost spend Running costs is reporting a forecast outturn position on plan. Commissioning Spend Breakdown Year to date ( k) Full year ( k) Budget Actual Variance Budget Forecast Variance Variance at M5 Allocation Resource Limit 2,869 2, ,738 5, Pay Costs ,870 1, (118) Running costs CSU Costs 1,409 1, ,817 2, Other Non Pay Costs ,051 1,068 (17) 118 Surplus/deficit for running costs Source: Financial ledger 9

12 Movements of Variances including Running Costs Analysis of M6 Variance against M5 Initiative Month 6 Month 5 Movement Month 6 Month 5 Movement Further detail Acute NHS SLA Services (incl. CQUIN & Ambulance) Year to Date Variance Forecast Variance (436) (414) (22) (764) (1,113) 349 Based on M5 SLA monitoring data there has been an in month adverse FOT movement on Royal Brompton ( 100k) with favourable swings reported on UCLH ( 401k) and Royal Free ( 106k). Other providers are largely in line with the previous month. Acute risk reserve of 860k has been fully released to offset FOT overspend. Underdelivery on performance elements 1.2m assumed to be 100% achieved. Other Acute Activity Services (217) (1) (216) (284) (2) (281) In month adverse swing due to increased overseas charges from C&W. Community Services In month favourable swing due to a decrease in the NCA run rate. Mental Health Services 117 (115) 232 (309) (804) 495 Prescribing (19) 2 (21) In month favourable movement of 240k due to confirmation from NHSE of clients due to step down from MH Secure Service. Further favourable movements on spot placements 115k, CPC 78k and NCA 67k based on latest placement data and run rate. YTD practice prescribing underspend as per M4 IPP report. Full year forecast of breakeven until further month's monitoring data received. Continuing Care Primary Care Service (364) (300) (64) (736) (733) (4) Other Non Acute Services (98) (88) (10) (96) (66) (29) Commissioning Reserve ,496 2,125 (629) Reserves released to offset contract overspend. Other-Other Commissioned Services (566) (441) (125) (26) Running Costs (33) 0 0 (0) Total (0) 0 (0) Source: Financial ledger 10

13 Breakdown of reserves The table below shows the position of reserves at M6. This position is dependant upon a number of factors including successful delivery of QIPP schemes, roll out of investment schemes and risks and opportunities that will materialise during the course of the year. Year to date ( k) Full year ( k) Further detail Budget Actual Variance Budget Outturn Variance Reserve for Financial Strategy 2% Headroom Contingency QIPP Unidentified Other Reserve QIPP Reserves Investments Funding transferred to CL CCG ( 6.4m) and Harrow CCG ( 11.8m). Residual funding of 55k released % Headroom ( 8.3m) transferred to CL CCG (0) 1,852 1, (224) General reserves , ,416 Released to offset contract overspend 4,055 3, ,121 7, Page 12 TOTAL Reserves 5,810 4, ,633 10,138 1,496 Source: Financial ledger 11

14 Investments Investment plans identified to date for 14/15 total a maximum of 11.6m. Work is continuing to refine the investment plans, to identify any overlaps between schemes, and to risk assess the schemes for slippage. The investment plan will be monitored throughout the year by the Investment Task Force. It is important that the CCG spends its investment budget in 14/15 as this funding cannot be carried forward to future years. Year to date ( k) Full year ( k) Further detail Budget Actual Variance Budget Outturn Variance Primary Care investment ,000 2,000 0 QIPP investments ,810 1,810 0 Other Investments 2,153 2, ,311 4, Includes FYI of 2013/14 investments TOTAL Investments Within Reserves 4,055 3, ,121 7, Investments drawn down ,183 1,195 (12) TOTAL Investments 4,860 4, ,304 9,

QIPP A number of actions are being taken to bring underperforming schemes back in line with plan, and additional outpatient and non-elective schemes are being launched over the summer, which will

15 QIPP A number of actions are being taken to bring underperforming schemes back in line with plan, and additional outpatient and non-elective schemes are being launched over the summer, which will impact towards the end of the year. A review of budgets in M5 has identified savings to meet the 453k unidentified QIPP target. The position reported below is the underlying position based on actual activity, however, due to block contracts, all NEL and OP schemes have already been fully achieved in financial terms in 2014/15. Key initiatives (Net QIPP) Year to date ( k) Full year ( k) Initiative Plan Actual Var Plan Outturn Var Further detail Acute Services ,160 1,160 0 Mental Health Services Mental Health Placements Mental Health Psychiatric Liaison Community Services Specialist Housing Strategy for Older People: Care Services Procurement AQP TOP St Charles Hospital - financial efficiency through void space reduction Transforming Nursing and Care Home Contracting Small Contracts Efficiency Putting Patient First - Whole System Integrated Care (452) 2,371 1,919 (452) CIS Early Discharge Service (15) (15) UCC / A&E Referral Standardisation Scheme 225 (0) (225) (225) Scheme delivered well in M1-2 and underperformed in M3-4. Actions in place to recover scheme, but Imperial coding likely to be impacting performance Scheme underperforming against plan, but actions in place to recover position, including practice peer review meetings MSK Pathway 50 4 (46) (46) Primary Care Children Hub Primary Care Prescribing Long Term Conditions 90 (60) (150) (150) Scheme underperforming against plan, but actions in place to recover position, including CLS Plan target and practice peer review meetings Scheme underperforming against plan, but respiratory and diabetes services now live and cardiology to launch in October, so recovery expected Unidentified QIPP Savings identified in M5 which fully meet target QIPP risk reserve ,415 1,415 0 Mental Health 13/14 QIPP FYE Total 3,099 2,955 (143) 9,893 9,297 (596) Source: PMO QIPP report 13

16 Capital, creditor payments and cash Capital Creditor payments Cash NHSE has approved 14/15 capital plans of 2,500k: St Charles 1,450k; South Locality 1,050k. Invoice Count Invoice Count (Passed) % Passed BPPC Amount ( ) Invoice Amount (Passed) ( ) % Amount Passed NHS 1,938 1, % 129,870, ,026, % Non NHS 3,137 2, % 20,655,734 17,389, % Total 5,075 4, % 150,525, ,416, % The CCG has not met the Better Payment Practice Code (BPPC) target. This is mainly due to transitional issues. We are currently working with budget holders to ensure that invoices are coded and outstanding queries are dealt with promptly in order that invoices are paid within payment terms. We also work with SBS to make sure the correct payment terms are applied Maximum Cash Drawdown (MCD): 319,224k Drawn Down to Date: 156,009k (49%) Planned YTD draw down at Month 6: 165,350k Under Drawn: 9,341k Source: CCG analysis 14

Month 8 Hammersmith & Fulham CCG Finance Report. 9th January 2018

Month 8 Hammersmith & Fulham CCG Finance Report 9th January 2018 Contract Acronyms The following acronyms are used throughout this pack. Key message Acronym ASP BLT C&W CLCH CNWL EHT ESH GOSH GSTT HRCH