KCCG Finance Report September Yarlini Roberts Local Director of Finance

Transcription

1 KCCG Finance Report September 2017 Yarlini Roberts Local Director of Finance Produced by Finance September

2 Contents 1. Finance Scorecard 2. Key Indicators 3. Summary Financial Position 4. Run Rate Analysis 5. Acute Commissioning 6. Non-Acute Commissioning 7. Primary Care 8. Running Costs 9. Underlying Position 10. Quality, Innovation, Productivity and Prevention programme (QIPP) 11. Financial Statements 12. Appendices Produced by Finance September

3 1 Finance Scorecard Financial Strategy - Better Care Fund (BCF) plans were submitted to NHS England on 11 th September. - Kingston Medical Services contracts will bring all GP practices onto equivalent contracts with a suite of KPI s. A phased approach to equalisation of GMS and PMS prices has been agreed at PCCC. - Work continues to share information and to progress medium term plans, assessing financial sustainability CCG s are engaged with acute and community providers and work continues to collaboratively produce joint QIPP and CIP plans for future years. Financial Performance - At month 6, the CCG is on target to achieve its business rules for 2017/18 - The CCG is forecast to meet its planned in year 0.5% surplus of 1,151k and cumulative surplus of 4,713k (approx. 4%) - Reserves have been used to enable delivery of the surplus - Better Payment Practice Code (BPPC) & Cash targets were achieved at month 6 - QIPP savings are forecast to under-achieve against plan, due to delays in some QIPP schemes. Financial Governance - The CCG constitution and scheme of delegation were approved at the September meeting of the Governing Body. - Scheme of delegation and other financial polices are aligned with LDU and alliance CCG s - The financial plan was approved by Governing Body in September Financial Risk - Reserves have been fully utilised to cover the acute over performance seen in month 6, with the exception of half of the 1% on recurrent reserves which is to remain uncommitted as per NHS England guidance. - Non-recurrent benefits have been used to allow financial balance at month 6. This presents a risk for future years, if recurrent savings are not found. Produced by Finance September

4 2 Key Indicators Expenditure YTD variance '000 YTD Variance % YTD RAG RATING Annual Variance '000 Annual Variance % Acute Contracts (2,975) -4.9% (5,831) -4.8% Continuing Care (74) -1.6% (619) -6.7% Prescribing (125) -1.2% (441) -2.1% In-Year Surplus 0 0.1% 0 0.0% Forecast RAG RATING Kingston CCG expects to deliver against key financial targets. Overspends in acute, continuing care, and Prescribing are covered by mitigations (reserves etc.) as at month 6. Risk & Mitigations Worst Case Outturn N/A N/A N/A 0 0.0% Best Case Outturn N/A N/A N/A 0 0.0% Underlying position Closing 2017/18 underlying position N/A N/A N/A 0 0.0% Opening 2018/19 underlying position N/A N/A N/A 0 0.0% QIPP Plan vs Outturn (200) -4.8% (1,623) -16.4% The risk in delivery of the 17/18 QIPP target has been mitigated by reserves and non-recurrent measures. Planned savings are weighted towards the last 6 months of the year. Produced by Finance September

5 3 Month 6 Summary The CCG expects to meet its planned in year 0.5% surplus of 1,151k. Cash and Better Payment Practice Code (BPPC) targets were met in month 6 Non-recurrent allocation of 30k has been received in month 6 for quarter 2 payment to Kingston Hospital to deliver the Faster Diagnosis standard. The cost impact of Identification Rules (IR) is excluded from the acute position. Analysis work is being carried out with NHSE specialised and it is anticipated that funding will be received to cover the shortfall. QIPP savings are forecast to under-achieve against plan, due to delays in starting some QIPP schemes. Action plans are in development to improve performance. The CCG is using non-recurrent support to manage the forecast position, enabling delivery of the planned in-year surplus of 0.5%. Produced by Finance September

6 3 Summary Financial Position Year To Date Full Year Forecast Outturn Budget Actual Variance Budget Actual Variance 000's 000's 000's 000's 000's 000's In Year Revenue Resource Limit 128, , , ,576 0 EXPENDITURE Acute Commissioning 63,869 66,616 (2,747) 127, ,892 (3,154) Non Acute Commissioning 29,956 30,241 (285) 59,912 61,031 (1,119) Primary Care 26,076 25, ,154 52,344 (190) Corporate Costs 2,662 2, ,325 5, Estate Costs Reserves 4,745 2,204 2,540 10,606 6,252 4,354 This report shows the in-year position only. The resource limit of 257,576k does not include brought forward surplus of 3,562k Total Applications 127, ,653 (0) 256, ,425 0 In Year Surplus ,151 1,151 (0) Historic Surplus 1,781 1, ,562 3,562 0 Cumulative Surplus 2,356 2, ,713 4,713 (0) As per NHS England guidance, half of the 1% non recurrent reserves are fully uncommitted until further notice is received. This is the surplus that will be reported in the annual accounts. Produced by Finance September

7 4 Run Rate Analysis Run rate for expenditure, plan and allocation is increasing due to non-recurrent allocations each month. Nonrecurrent allocations in September were lower than in previous months. Produced by Finance September

8 4 Run Rate Analysis In M1-2, acute spend was reported at planned values. Acute spend rose significantly in June and increases are seen in all subsequent months until September, when acute spend decreased due to a change in reporting of IR impact. CHC has decreased significantly in September. Reserves and non-recurrent benefits are sufficient to offset overspends as at month 6. Produced by Finance September

9 5 Acute Commissioning ISSUE Kingston Hospital s reported forecast position has worsened slightly by 260k since month 5 largely due to seasonality adjustment. Large variances are remain in the following areas, A&E, emergency, other and outpatient procedures. The largest variance exists in emergency showing 1.5m over plan year to date (YTD). The 16/17 Kingston Hospital contract which rolled over in 17/18 states that 20% of the Urgent Care Centre (UCC) activity should be charged at the local tariff of 59 however Kingston hospital are disputing this and continue to charge all UCC activity at the higher tariff of 100. St Georges reported forecast position does not include the Identification Rules (IR) impact of the 17/18 tariffs. ACTION There has been some progress on outstanding issues with the Indicative Activity Plan (IAP). The 1617 part year effect of the activity relating to the Clinical Decision Unit (CDU), will be removed from the 1718 plan for M6 SLAM. The arbitration modelling for the 1718 plan regarding adult spells and associated AE attendances is expected to be resolved for M6 SLAM. The EEG/EMG business case has been produced by KHFT. It is currently under review by NELCSU ahead of KCCG sign off. NELCSU will continue to work with Kingston Hospital to resolve the remaining issues. Kingston Hospital have requested a clinical review to take place on 23 rd December. CCG to share with CSU the UCC tariff structure for benchmarking purposes so we can negotiate a local price with Kingston Hospital and resolve the issue. Analysis work is being carried out with NHS E specialised and therefore KCCG is anticipating that funding will be received to cover the shortfall. Produced by Finance September

10 5 Acute Commissioning Year To Date Full Year Forecast Outturn Budget Actual Variance Variance Budget Actual Variance Variance 000's 000's 000's % 000's 000's 000's % Foundation Trust SLAs Ashford & St Peters NHS FT (16) (12%) (32) (12%) Chelsea & Westminster Hospital NHS FT (including West Middlesex University Hospital) (69) (16%) 869 1,008 (139) (16%) GOSH NHS FT % % Guys & St Thomas NHS FT % 1,960 1, % Kings College Hospital NHS FT (56) (32%) (123) (36%) Kingston Hospital NHS FT 42,162 43,819 (1,656) (4%) 84,325 88,463 (4,138) (5%) Moorfields Eye Hospital NHS FT % % Royal Brompton & Harefield NHS FT (38) (14%) (76) (14%) Royal Free Hampstead NHS FT % % The Royal Marsden NHS FT 1, % 2,266 1, % Royal Surrey County NHS FT % % University College London Hospital NHS FT % % St Georges Hospital NHS FT 6,588 7,739 (1,151) (17%) 13,176 14,163 (987) (7%) Other Acute SLAs Barts & the London NHS T % % Epsom & St Helier NHS T 4,364 4,369 (5) (0%) 8,729 9,061 (332) (4%) Imperial College NHS T (96) (26%) (192) (26%) NW London Hospital NHS T (88) (91%) (176) (91%) Royal National Orthopaedic Hospital NHS T (112) (189%) (161) (136%) Ashtead Hospital (40) (67%) (39) (33%) London Ambulance NHS T 2,874 2,919 (45) (2%) 5,749 5,838 (89) (2%) Total Acute SLAs 60,943 63,918 (2,975) (5%) 121, ,716 (5,831) (5%) Other Acute (59) (57) NCA's 1,214 1, ,429 2, Total Other Acute 1,676 1, ,352 3, Out of Hospital Schemes ,029 1, Systems Resilience Overseas patients Other Non SLA Acute (1,934) 2,411 Total Non SLA Acute 1,250 1, , ,456 Total Acute Commissioning 63,869 66,616 (2,747) 127, ,892 (3,154) Produced by Finance September 2017 The CCG has utilised some non-recurrent benefits to support the position, enabling delivery of the planned in year surplus of 0.5%. 10

11 5 Acute Commissioning - Activity The table above shows the year to date activity up to August 2017 against the Operating Plan, with areas greater than 2% shown as either Amber or Red. Produced by Finance September

12 5 Acute Commissioning - Activity Non-Elective Admissions The variation year to date in August 2017 has increased to 11.8% from 10.6% in July 2017.The two main reasons for variation are detailed below: 1. The main QIPP programme to reduce Non-Elective Admissions through integrated teams as part of Kingston Co-ordinated Care was planned to demonstrate a reduction within in quarter The first of the locality teams is due to start later than planned, with a pilot in New Malden due to complete soon. 2. There has been an increased level of admissions as a result of the newly opened Clinical Decisions Unit (CDU) at Kingston Hospital, which was planned on the basis that activity levels would not increase. There have been c150 Kingston patients admitted into the CDU per month, all of which stay in hospital less than a day. An Activity Query notice has been issued by the CCG to Kingston Hospital. Work is continuing to set up locality teams with the Kingston Coordinated Care provider alliance. Issues with the CDU will be worked through as part of the regular contract meetings with Kingston Hospital. Produced by Finance September

13 6 Non Acute Commissioning ISSUE The continuing healthcare (CHC) position has improved since month 5 by 105k, with a forecast overspend of 619k by year end. The improvement is due to the net number of clients receiving CHC reducing by 14 in the month. The average weekly fee continues to increase due to a shortage of AQP placements at 859 per week. Children s forecast has worsened by 141k since month 5, now expected to overspend by 508k. This is due to 6 new continuing healthcare children who have started in 2017/18. ACTION The CHC team continue to seek out AQP beds wherever possible and will update the CCG finance team with the outcome of appeals. CHC clients will be reviewed regularly to ensure they still meet the CHC criteria. Reviews of high cost placements have been requested from the provider and the position will be monitored closely. Mental Health budgets meet the 2.67% Mental Health Investment Standard (MHIS) requirement. Investment funds will be fully committed by year end. Mental Health Placements forecast underspend has reduced to 144k in Sept due to a Personality Disorder patient leaving an acute ward and an additional forensic patient in locked rehabilitation. Uncertainty still remains over joint funded RBK placements and a number of NHS England specialised and Transforming Care Partnerships (TCP) placements. Risk therefore remains on this budget, however if risks do not materialise, the underspend will be reinvested. MHIS will be monitored throughout the year to ensure the required investment into mental health services is achieved. Regular meetings with Royal Borough of Kingston to monitor and progress. Routine updates received from commissioners for any changes in NHS commissioning. Produced by Finance September

14 6 Non Acute Commissioning Year To Date Full Year Forecast Outturn Budget Actual Variance Budget Actual Variance 000's 000's 000's 000's 000's 000's Mental Health Contracts 6,828 6,828 (0) 13,656 13,656 (0) IAPT ,793 1,794 (1) Mental Health Placements 1,898 1, ,796 3, Collaborative Commissioning MH NCA's Other Mental Health Mental Health Investment Standard (293) 1,188 1,409 (221) Child and Adolescent Mental Health Total Mental Health 10,823 10,823 (0) 21,645 21,658 (13) Continuing Care & YPD 4,634 4,708 (74) 9,267 9,886 (619) CHC Assessment & Support Funded Nursing Care 1,497 1,560 (63) 2,995 3,108 (113) Total Continuing Care 6,478 6,609 (131) 12,956 13,622 (666) Children with disabilities 1,162 1,353 (191) 2,324 2,832 (508) Collaborative Commissioning (Moor Lane) (0) 1,260 1,260 0 Total Children with Disabilities 1,792 1,983 (191) 3,584 4,092 (508) Community Services (YHC & HRCH) 9,884 9, ,767 19,767 1 Property Services Capital Charges (0) Learning Difficulties Hospices Other Non-Acute Total Community Services 11,208 11, ,417 22, Total Non Acute Commissioning 30,301 30,569 (267) 60,603 61,687 (1,084) Produced by Finance September

15 7 Primary Care ISSUE Prescribing reports to July were available at the time of reporting. Prescribing costs in the first four months compared to the same period in 16/17 are 305k higher, contributing to a forecast overspend of 424k for the year. Since reporting, further data has been published about costs of generic drugs, and costs have increased since July. This cost pressure has not been reflected in reported figures and could be significant. Primary Care Development budget overspend of 228k relates to the additional cost of extended access above the 17/18 NHS England allocation of 619k which is shown within the GP Forward View budget. Delegated Commissioning reports a small underspend of 18k. Mandatory reserves are largely committed. Savings 510k from the closure of Gosbury Hill and other practices have been used to fund KPI s for GMS practices as part of the equalisation of GMS and PMS contracts. Cost of GMS KPI s, the first stage of the Kingston Medical Services (KMS) contract, are shown under the Primary Care investment budget. The KMS contract start date has been delayed until Apr-18. PMS practices will not perform the new KPI s until this date. ACTION Prescribing team will continue to monitor GP prescribing. Further investigation into drivers of increased prescribing costs is required. Work is being carried out to close the gap of 228k. Savings and/or benefits from changes to rates have not yet been quantified. NHSE continue to work to assess the impact. Performance of KPI s is monitored. A process is in development to manage KPI s that do not deliver expected outcomes. Produced by Finance September

16 7 Primary Care Year To Date Full Year Forecast Outturn Budget Actual Variance Budget Actual Variance 000's 000's 000's 000's 000's 000's Prescribing 9,906 10,031 (125) 19,811 20,252 (441) Prescribing Incentives Central Drugs Home Oxygen (18) (36) Total Prescribing Services 10,525 10,647 (122) 21,050 21,506 (456) Local Enhanced Services ,469 1,469 (0) Churchill Drugs Out of Hours ,107 1, NHS GP IT (17) (8) GP Fees (0) (1) Primary Care Developments (107) (228) Primary Care Investments GP Forward View Primary Care Delegated Commissioning: PMS Essential and Additional Services 5,031 4, ,063 9, GMS Global Sum & MPIG 3,944 3, ,888 7,888 0 Enhanced Services Quality and Outcomes Framework (QOF) (39) 1,819 1,898 (79) Premises Payment 1,520 1,522 (2) 3,041 3,038 3 Seniority (19) (38) Other Administered Funds (Maternity etc) Personally Administered Drugs Other Medical Services , KPI'S (255) (510) 16/17 Prior Year 0 26 (26) 0 26 (26) Total Primary Care Delegated 12,616 12, ,233 25, Total Primary Care 15,552 15, ,105 30, Total Primary Care & Prescribing 26,076 25, ,154 52,344 (190) Produced by Finance September

17 8 Running Costs ISSUE Running Costs budgets currently reflect the new structure working under the Local Delivery Unit (LDU). A vacant information officer post is causing a 44k underspend on the Business Informatics budget. Three vacant posts in Commissioning are causing an underspend of 47k in 2017/18. Admin Projects is underspent by 50k due to a post being vacant for half the year and a staff member being seconded to Richmond CCG. There is a small Running Costs contingency as at month 5. ACTION In future months the structure/establishment of the CCG may change and this will be reflected in the reported position. After a second round of interviews a suitable candidate has accepted the post and is estimated to start mid December Plans are being made to recruit later in the year. A project manager has commenced in October 2017 on a fixed term contract. The Head of Primary Care commenced employment in September This contingency is expected to be fully spent by year end. Produced by Finance September

18 8 Running Costs Year To Date Full Year Forecast Outturn Budget Actual Variance Budget Actual Variance 000's 000's 000's 000's 000's 000's Administration & Business Support (13) Business Informatics CEO/ Board Office Chair And Non Execs Commissioning Contract Management (6) 1,455 1,467 (12) Corporate Costs & Services Corporate Governance Education And Training (1) Finance Patient, Public Involvement (0) Quality Assurance (3) (6) Strategy & Development (183) Admin Projects Total Running Costs 2,143 1, ,286 4,286 0 Medicines Management Clinical Leads (14) As at Month 6, the running cost allocation is forecast to be fully spent in 2017/18. Produced by Finance September

19 NR Allocations & Matched Expenditure NR QIPP Benefit 0.5% Risk Reserve Other NR Spend / Income QIPP Other 9 Underlying Position Forecast Net Expenditure Remove Non Recurrent Items Part/Full Year Effects CCG UNDERLYING POSITION Plan Actual Variance Variance 2017/18 Underlying Position m m m % m m m m m m m REVENUE RESOURCE LIMIT (IN YEAR) (1.9) Acute Services (5.5) (4.3%) (0.2) (1.3) Mental Health Services (0.0) (0.0%) (0.1) Community Health Services % (0.7) Continuing Care Services (1.2) (7.7%) Primary Care Services (0.3) (1.0%) (0.8) Primary Care Co-Commissioning % Other Programme Services % (0.1) 0.0 (1.1) 5.3 Commissioning Services Total % (1.9) 0.0 (1.1) 2.4 (1.3) Running Costs % TOTAL CCG NET EXPENDITURE % (1.9) 0.0 (1.1) 2.4 (1.3) IN YEAR UNDERSPEND / (DEFICIT) (0.0) (0.0%) Underlying Underspend / (Deficit] 1.2 KCCG s underlying position at month 6 is 1.2m surplus (0.5%). Non-recurrent benefits of 2.4m are included in the reported position, worsening the underlying position. However, this is offset by the non-recurrent risk reserve and full year effect of QIPP schemes that started later this year. % RRL 0.5 % Produced by Finance September

20 10 QIPP Performance 2017/18 August 2017/18 Year to Date TOTAL QIPP Forecast CCG EFFICIENCY PLANS Transactional / Transformational Plan Actual Variance % Achieved Plan Actual Variance % Achieved m m m % m m m % Acute KPI Contractual challenges Transactional % % Acute KPI Contractual challenges Transactional % % Demand and growth management Transactional % % Demand and growth management Transactional % % Prescribing growth management Transactional % % CHC - enhanced review process Transactional % % Financial management Transactional % % Financial management Transactional % % Kingston Coordinated Care (KCC) Locality Teams Transformational (0.24) 0.0 % (0.31) 56.6 % Community crisis and ICT / Rapid response (STP) Transformational 0.18 (0.19) (0.37) (107.6%) 0.53 (0.28) (0.81) (52.9%) POLCE/ ECI procedures Transformational % % Better Bones Service Transformational 0.00 (0.03) (0.04) (705.8%) 0.01 (0.11) (0.12) (1224.5%) End of life care Transformational % % Frequent Attenders in A&E (Risk Stratification project) Transformational (0.04) 0.0 % (0.04) 58.3 % Kinesis & outpatient referral support (11% target) Transformational % % Kingston Care Record (ICR) Transformational (0.01) 0.0 % 0.02 (0.02) (0.04) (72.7%) LAS Admissions avoidance (A&E Delivery Board) Transformational (0.05) 0.0 % (0.12) 9.8 % Neurology community shifts Transformational % % Ophthalmology increased community provision Transformational % (0.05) 75.6 % Paediatric same day appt's (FYE of 1617 scheme) Transformational 0.23 (0.00) (0.23) (2.1%) 0.46 (0.01) (0.47) (2.1%) Planned Care Transformation (STP) Transformational % % Primary Care Access Standards (STP) Transformational (0.17) 8.9 % (0.36) 6.3 % Primary Care Weekend Services (x3) inc SHC Transformational (0.13) 5.3 % (0.25) 5.3 % Reduction in outpatient follow-up rates Transformational % % Respiratory KPI Transformational % (0.15) 41.6 % Balance of Schemes under ( 0.5m) Mental Health Transactional (0.10) % (0.10) % Optimising the Use of Medicines Transformational % % TOTAL Unidentified % % TOTAL CCG EFFICIENCIES (0.30) 95.2 % (1.50) 83.6 % Produced by Finance September

21 10 QIPP Performance 2017/18 August 2017/18 The table on p22 reflects the forecasted Quality, Innovation, Productivity and Prevention (QIPP) position based on M1-5 data for all QIPP schemes. The overall QIPP forecast shows an expected under achievement of 1.5m based on savings seen year to date. 11 QIPP schemes are RAG rated red and forecast to under-achieve significantly against plan. Action plans are in development for all schemes that are expected to under-achieve against savings target. Kingston Coordinated Care (KCC) Locality Teams is forecast to achieve 56.6% of its planned target due to a delay in project roll out. The pilot phase is now complete and awaiting evaluation. The team are establishing commissioner provider meetings and as part of this will identify KPIs. Community crisis and ICT / Rapid response (STP) has not seen any savings, and is forecast to cost the CCG 0.28m. The poor performance was discussed at last contract review meeting. It was agreed to review emergency admissions and provide an updated plan to address the under achievement in this scheme Produced by Finance September

22 11 Statement of Financial Position 2018 SEP-17 AUG-17 JUL-17 Intangible Assets 30,651 29,157 37,541 Property, Plant And Equipment 609, , ,470 Non-current Assets Total 640, , ,010 Cash And Cash Equivalents -67, ,575 30,088 Current Trade And Other Receivables 1,596, ,095 2,396,010 Current Assets Total 1,528, ,521 2,426,098 Current Other Liabilities -4,924,298-3,986,921-2,410,039 Current Trade And Other Payables -26,971,391-27,506,634-28,678,336 Provisions -467, , ,675 Current Liabilities Total -32,362,690-32,007,230-31,602,049 NC Provisions Non-Current Liabilities: Total Grand Total -30,193,164-30,740,911-28,537,941 The cash balance as at 30 th September 2017 of - 68k is due to timing between the cashbooks and the ledger. The actual bank balance at the end of September 2017 was 71k. KCCG met the cash target in M6. Closing Balance Closing Balance Closing Balance 2018 SEP-17 AUG-17 JUL-17 General Fund 30,193,164 30,740,963 28,537,941 Financed by Taxpayers Equity: Total 30,193,164 30,740,963 28,537,941 Grand Total Total Produced by Finance September

23 11 Cash Drawdown Cash Resource Limit 000s Cash Report September 2017 MCD Cash limit 256,178 Less Capital & CHC Risk Pool 0 Other Central / BSA payments 19,845 The Maximum Cash Drawdown (MCD) is based on the Annual Cash Forecast (ACF) to NHS England in March with in year adjustments. The current MCD is 256.2m. 19.6m cash was drawn down in September. The target for cash remaining at end of September was achieved with a balance of 71k (inside the 1.25% required by NHS England). Remaining Cash limit 236,333 Month Forecast Monthly Main Draw dow n Draw dow n 000s 000s Additional Draw dow n 000s Difference betw een Forecast and Actual 000s Cumulative Draw dow n 000s Proportion of Annual Cash Resource Limit KPI 1.25% of main draw dow n 000s Actual month end cash balance 000s KPI achievem ent Apr-17 19,694 16, ,344 17, % % May-17 19,694 18,000 3,900 2,206 39, % % Jun-17 19,694 16,300 2, , % % Jul-17 19,694 16, ,544 75, % % Aug-17 19,694 17, ,074 92, % % Sep-17 19,694 17,600 2, , % % Oct-17 19,694 18, , , % 229 Nov-17 19,694 Dec-17 19,694 Jan-18 19,694 Feb-18 19,694 Mar-18 19,699 Annual Total 236, ,370 10,450-7,038 Produced by Finance September

24 11 Cash Flow Statement JUL-17 AUG-17 SEP Subjective Code Mapping Movement Movement Movement (Increase) decrease in trade and other receivables -556,137 1,572, ,308 Depreciation and amortisation 22,212 22,212 22,212 Impairments and reversals Increase (decrease) in provisions Increase (decrease) in trade and other payables 3,213, , ,081 Net operating costs for the financial year -21,508,822-21,516,407-20,823,066 Provisions utilised ,673 1.Cash Flows from Operating Activities: Total -18,828,872-19,516,047-21,218,754 (Payments) for intangible assets 9, ,877 (Payments) for property, plant and equipment 31, ,171 Proceeds from disposal of assets held for sale: property, plant and equipm Cash Flows from Investing Activities Total 41, ,048 Net parliamentary funding received 18,844,588 19,313,384 21,370, Cash Flows from Financing Activities Total 18,844,588 19,313,384 21,370,866 Grand Total 56, , ,064 JUL-17 AUG-17 SEP Movement 62, , ,064 Opening Amount -32,675 30, ,575 Closing Amount 30, ,575-67,511 Cash balance is within the required limit of 1.25% of monthly drawdown Produced by Finance September

25 11 Better Payment Practice Code (BPPC) BETTER PAYMENT PRACTICE CODE NUMBERS FOR THE MONTH Sep-17 NHS NON-NHS TOTAL Total number of invoices paid in the month Number of invoices paid w ithin target Numbers % for the month 99.17% 99.83% 99.64% VALUES FOR THE MONTH ( 000s) Total value of invoices paid in the month 12,832 6,447 19,279 Value of invoices paid w ithin target 12,832 6,447 19,279 Value % for the month % % % CUMULATIVE NUMBERS TO THE MONTH Total number of invoices paid YTD 1,341 4,391 5,732 Number of invoices paid w ithin target 1,317 4,369 5,686 Numbers % Cumulative 98.21% 99.50% 99.20% The BPPC target is to pay 95% of invoices within the required payment terms. These targets have been met in month 6. The finance team will continue to monitor the invoice workflows and send out reminders to budget holders on a fortnightly basis. Annual Budget Holder training was held in September. Another training session was held in October for those who were unable to attend in September. KCCG will ensure all budget holders receive the training and plan to roll out oracle training later in the year. CUMULATIVE VALUES TO THE MTH ( 000s) Total value of invoices paid YTD 74,769 42, ,687 Value of invoices paid w ithin target 74,835 42, ,704 Value % Cumulative % 99.89% % Produced by Finance September

26 Appendix 1 KCCG Operating Plan Activity This graph shows that there was a decrease in elective inpatient cases in April 2013, however this has begun to increase again since August Produced by Finance September

27 Appendix 1 KCCG Operating Plan Activity This graph shows that the number of non-elective cases have seen a sharp increase in Feb 2015 and again in August 16. The increase in August 16 can be explained by the new Clinical Decision Unit (CDU) that opened in November Produced by Finance September

28 Appendix 1 KCCG Operating Plan Activity This graph shows that in April 2015 outpatients first and follow-ups saw a significant increase. The increase in outpatients first is due to diagnostic imaging activity being sent via Secondary Uses Service (SUS) for the first time since April Produced by Finance September

29 Appendix 1 KCCG Operating Plan Activity Referrals declined in April 2017 but started to increase again, there has been a small decline since June Produced by Finance September

30 Appendix 2 Acute Commissioning Analysis by POD All SL CCGs Annual Budget YTD Variance Against Plan (Adverse)/Favourable Elective Non-Elective Maternity Pathway A&E Out Patient Other TOTAL S/L FOT S/L FOT Variance (Adverse)/ Favourable FOT FOT Variance (Adverse)/ Favourable '000s '000s '000s '000s '000s '000s '000s '000s '000s '000s '000s '000s Kingston Hospital 84, , ,656 87,638-3,313 88,463-4,138 St George's Healthcare 11, ,280 14,078-2,554 12,608-1,084 Epsom and St Helier University Hospitals 5, , , South West London Elective Orthopaedic Centre 3, , , The Royal Marsden 2, , , London Ambulance 5, , , Other Contracts 9, , , TOTAL ACUTE CONTRACTS 121, , ,293-2, ,882-5, ,716-5,824 The table above shows the position against the agreed acute contract values (or CCG envelope where not finalised), with the YTD position split at a summary Point of Delivery (POD) level. The other POD category includes unbundled diagnostics, critical care, direct access, drugs & devices, patient transport, CQUIN and others. The reported variance reflects the likely position from the month 5 activity SLAM data received. The straight line forecast (FOT) variance shows the worst case scenario if the contracts were to continue at the rate seen in the first 5 months of this financial year. The reported FOT is 166k better than the straight-line position. Produced by Finance September