Vicki Taylor, Deputy Chief Finance Officer. Vicki Taylor 16/03/2018. No Commissioning, Finance and Performance Committee

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1 Agenda item: 3.6 Paper No: 11 Committee: Governing Body Venue: Board Room, Dominion House, Guildford Date: 27/03/2018 Status: FOR REVIEW AND NOTE Title of Report Presented by Author Finance Lead sign off Conflict of Interest Governance and reporting- at which other meeting has this paper been discussed Monthly Finance Board Report Summary M11 (at 28 th February 2018) Karen McDowell, Chief Finance Officer, Surrey Heartlands CCGs Vicki Taylor, Deputy Chief Finance Officer Vicki Taylor 16/03/2018 No Commissioning, Finance and Performance Committee 20 March 2018 Executive Summary: The purpose of this paper is to update the Governing Body on the Month 11 (up to 28 th February 2018) financial position, risks and actions for Guildford & Waverley CCG. The Month 11 financial position for Guildford & Waverley CCG is a 10.4m deficit year to date against the plan of 7.7m resulting in in 2.8m adverse variance. Based on the information available and assumptions contained within the report, a year-end position of 11.7m is reported, which is 3.3m adverse against the plan. Risks are accounted for in the reported financial position year to date and forecast at Month 11. Implications: Health/ CCG strategic objectives Financial/ Resource Legal/ Compliance Equality Analysis Patient and Public Engagement Risk (including reputational) and rating We will manage the health economy within our available budget None specific to this report The CCG has a statutory duty not to exceed its financial allocation. None specific to this report None specific to this report R0003 If the CCG does not achieve financial balance then it will not comply with its statutory duty (current score 25) Recommendation(s): TO REVIEW AND NOTE the financial position for Month 11 and the assumptions and risks reported Next Steps: To note the financial performance for 2017/18 and key risks to the CCG as noted. Monthly Finance Board Report/March 2018 Governing Body 1

2 MONTH 11 FINANCE REPORT 1. Overview of Month 11 Financial Position 1.1. The purpose of this paper is to update the Finance Committee and Governing Body on the Month 11 (up to 28 th of February) financial position, risks and actions for Guildford & Waverley CCG The key financial performance indicators are shown below: 1.3. The financial position as reported to NHS England is a year to date deficit of 10.4m and a forecast deficit of 11.7m for the full year 2017/18. The forecast is a 3.3m adverse variance against the plan. The year to date position represents a significant adverse variance of 2.8m against a year to date planned deficit of 7.7m The main driver of the year to date variance is over performance within the main acute provider contract of 6.9m. This overspend is forecast to be 7.6m at year end. The over spend on the RSCH contract includes a combination of over performance, particularly within Non Elective areas of activity, as well as slippage against the QIPP programme The CCG and Trust have been working closely together to close the financial gap and deliver against joint targets which has not materialised, resulting in further pressures to the CCG The Month 11 financial position includes the full benefit of the agreed risk share with the Trust (2.75m Trust full year contribution and 1.25m CCG full year contribution), equating to 3.7m at Month 11 and 4m forecast for the year. Monthly Finance Board Report Summary M11 (at 28 th February 2018) Page 1

3 1.7. The forecast outturn position of 11.7m deficit is a 3.3m adverse variance against the plan. It includes a forecast over spend of 7.6m on the RSCH contract partially offset through under spending on other areas of CCG budgets and the release of contingency as part of the risk sharing agreement The forecast outturn position of 11.7m deficit includes an adjustment made as planned to offset reductions earlier in the year for Specialist Commissioning in year issues Risks are accounted for in the reported financial position year to date and forecast at Month The risk in relation to Medicines Management and the issue with No Cheaper Stock Obtainable (NCSO) is included within the financial position both year to date at Month 11 ( 1.0m) and forecast ( 1.1m). This is noted in more detail in section 2 below. Key Assumptions and Risks The data used from providers to inform reporting at Month 11 is based on Month 10 SLAM reports Prescribing data from the Practice Prescribing Authority (PPA) is received two months in arrears so the year to date and forecast positions within this report are based on December data Collaborative arrangements for Mental Health, Children s and Continuing Healthcare budgets have used Month 10 data to inform the year to date and forecast positions As previously notified to the committee and Governing Body, there has been a transfer of activity from specialist commissioning to CCGs and a change in tariff to HRG4+ in 2017/18. The CCG received additional allocations for this transfer but an issue across the system resulted in a reduction in CCG allocation at Month 5 which has now been resolved The CCG financial plan for the year includes 8.6m of QIPP. Although there has been some positive performance against many of the schemes, there has been slippage in the year to date position with delivery of 73% reported YTD ( 5.7m). It is expected that further positive impact will be delivered by year end in order to meet the reported forecast of 6.3m (73%) Prescribing pressures arising from No Cheaper Stock Obtainable (NCSO) have been accounted for in the year to date and forecast position at Month 11. This accounts for 1.0m of YTD pressure and 1.1m forecast. This is the full reported level of risk and is within the position. The NCSO issue has created a significant financial pressure against the medicines management budget in year and significantly limited the delivery of mitigations against the QIPP programme. In comparison to the previous financial year, this issue has resulted in an additional new pressure of c. 1m in year. Monthly Finance Board Report Summary M11 (at 28 th February 2018) Page 2

4 1.17. Contingencies have been released in part at Month 11 and in full into the forecast position to deliver the reported forecast position. This is the CCG contribution to the risk share agreement in place with the main acute provider In addition, there are a number of other under spending budgets which are contributing to mitigating the full financial risk of acute over performance The CCG is required to set a 1% non-recurrent reserve in 2017/18 to the value of 2.4m of which 0.5% ( 1.2m) cannot be committed. The CCG has accounted for the full utilisation of the 0.5% balance as required by NHS England. Monthly Finance Board Report Summary M11 (at 28 th February 2018) Page 3

5 Finance Committee and Governing Body Finance Report Month Introduction 1.1. The report details the financial position for Guildford & Waverley CCG for 2017/18 at the end of Month 11 (28 th February 2018). 2. Allocations 2.1. At the start of 2017/18, NHS England moved to monitoring CCGs financial performance against in-year allocations. As at Month 11, the in-year Revenue Resource Limit (RRL) of the CCG was 265m During the year, the CCG has received a number of adjustments to the resource limit which are shown in the table below: Guildford & Waverley CCG Total Budget CONFIRMED OPENING RESOURCE LIMIT /18 255,368 Epsom and St Helier (contract variation) 10 Named GP for Safeguarding 33 PMS Review Premium Release from 2016/2017 recurrent 53 Tier 3 high cost drugs correction -32 Looked After Nurse funding 55 Repayment of systems risk support from 16/ PMS Premium Release Reception and clerical training - (Training Care Navigators and Medical Assistants) 38 NHS WiFi 101 Market rents adjustment 337 Paramedic Rebanding Additional Funding HSCN - funding 63 CYPT IAPT Trainee staff support costs 49 Infrastructure funding for STPs 220 Payment for the Q1-2 to Surrey Heartlands STP in their role as Early Adopters 265 Cancer 62d wait support - Royal Surrey County Hospital NHS Foundation Trust 80 Cancer 62d pathway co-ordinator - Royal Surrey County Hospital NHS Foundation Trust 30 IR Changes -4,340 Mental Health New Care Models support funding 2017/ Transformation Programme Funding 9,167 Cancer 62 day wait tranche 3 South funding 72 CYP IAPT Trainee staff support costs 49 Early Adopter funding for Quarter Charge Exempt Overseas Visitor (CEOV) Adjustment 141 STP Comms and Engagement 364 Online consultations 231 Additional Winter Funding - Mental Health bids 348 Additional Winter Funding - GP Winter Access Bid 129 Mth10 IR Changes 24 Backfill staff for backlog of Learning Disability Mortality Review Programme 8 ICS Insight Pilots Project 24 Rightcare CROC phase STG - Surrey H Primary Care Development funding 505 Additional month 11 IR Changes 1, /18 REVENUE RESOURCE LIMIT 264,976 Deficit carry forward - outside of 2017/18 allocation -5,011 RESOURCE LIMIT AFTER THE DEFICIT CARRY FORWARD 259,965 Monthly Finance Board Report Summary M11 (at 28 th February 2018) Page 4

6 3. Financial Performance to 28 th February The financial position for the first 11 months of the year shows a year to date deficit of 10.4m which is an adverse variance to plan of 2.8m, and the forecast outturn shows a deficit of 11.7m which is 3.3m adverse variance on the plan. The CCG had a notified control total at the start of the year of 3.965m which it was unable to achieve and submitted a plan to NHS England resulting in a deficit of 8.4m which it now reports against as agreed by NHS England The financial positions against each area for the year to date Month 11 and full year forecast are summarised below. *variance key: Budget Year to date M11 Actual Negative underspend; positive - overspend Variance Year End Forecast Allocation Forecast Variance Resource Limit 241, , , ,976 0 Expenditure Acute Commissioning 128, ,312 5, , ,353 5,775 Mental Health Services 21,859 21, ,846 23, Community Health Services 16,096 16, ,559 17, Continuing Care Services 17,131 16, ,688 18, Primary Care Services 4,976 4, ,428 5, Better Care Fund 10,790 10, ,771 11, Prescribing 27,038 28,148 1,110 29,496 30,765 1,269 Voluntary Sector Grants / Services 1,737 1, ,895 1,902 7 Other Corporate Costs (Non-Running Costs) 13,913 13, ,178 14, Corporate Running Costs 4,503 3, ,913 4, Reserves: 2,526 1,355-1,171 3,988 2,711-1, % Contingency 1, ,171 1, ,277 National Non Recurrent Reserve ,233 1,233 0 General Reserve 1,355 1, ,478 1,478 - Total Expenditure 249, ,221 2, , ,640 3,300 Deficit 2017/18-7,668-10,443-2,775-8,365-11,665-3,300 Deficit carried forward from 2016/17-5,026 Monthly Finance Board Report Summary M11 (at 28 th February 2018) Page 5

7 4. Acute Provider Position 4.1. The table below summarises the Month 11 year to date position for acute services and is based on Month 10 SLAM data. The financial summary shows a year to date overspend of 5.4m and forecast over spend of 5.8m. The main contributing elements to the year to date overspend are Royal Surrey County 7m, Frimley 1.0m, Ashford and St Peters 0.4m and St Georges 0.3m. The main movement between month 10 and 11 on the acute position is the increasing over spend at Guy s and St Thomas s due to a high cost critical care patient at M10. The acute reserve movement is due to the additional funding received for Specialist Commissioning as planned at M The financial positions against each area are summarised below: Provider YTD Plan YTD Actual YTD Variance Annual FOT Budget FOT Move on last Variance month Royal Surrey County Hospital 96, ,263 6, , ,650 7,590 0 Frimley Park Hospital 4,648 5,680 1,032 5,071 6,158 1, Ashford & St Peters Hospitals 2,422 2, ,643 3, Epsom & St Helier Hospitals 1,034 1, ,128 1, Other Acute and Tertiary SLAs 6,102 6, ,656 6, and PTS 6,986 7, ,621 7, Winter Pressures 1, ,012 1, , Other Acute Costs 2,188 2, ,387 2, Acute Reserve 213-2,145-2, ,439-2,671 1,882 Acute-SLAs-Other Providers 5,652 5, ,150 5, Acute - NCAs / High Cost Drugs 3,121 3, ,404 3, Total Acute Services 130, ,667 5, , ,831 5,775 1,697 The prior year benefit for agreed 2016/17 outturn was released and is as follows: Provider Released from 16/17 Great Ormond Street Hospital Foundation Trust -8 Guy's and St Thomas's Foundation Trust -19 Imperial College Healthcare NHS Trust 1 Portsmouth Hospitals NHS Trust 21 Queen Victoria Foundation Trust -14 Royal Brompton and Harefield NHS Trust -18 Royal National Orthopaedic Hospital NHS Trust -7 St George's University Hospitals Foundation Trust -164 Surrey & Sussex NHS Trust -0 Royal Marsden Foundation Trust 11 University College London Foundation Trust -53 Western Sussex Hospital Foundation Trust -12 Total Although the 2016/17 position above released a number of benefits, there were also a number of cost pressures from the close down of 2016/17, in particular RSCH ( 1.5m), Frimley Health ( 290k), Ashford and St Peters ( 32k), and Moorfields ( 45k). These had to be funded from 2017/18 allocation. Monthly Finance Board Report Summary M11 (at 28 th February 2018) Page 6

8 4.4. The acute position for 2017/18 can be further broken down into more detail by provider as shown below: Provider YTD Plan YTD Actual YTD Annual Variance Budget FOT FOT Variance against budget Move on last month Royal Surrey County Hospital Foundation Trust 96, ,263 6, , ,650 7,590 0 Ashford & St Peters Foundation Trust 2,504 2, ,732 3, Epsom & St Helier NHS Trust 1,034 1, ,128 1, Frimley Health Foundation Trust 5,219 5, ,693 6, St George's University Hospitals Foundation Trust 1,788 2, ,950 2, BMI Mount Alvernia 1,291 1, ,408 1, Great Ormond Street Hospital Foundation Trust Guy's and St Thomas's Foundation Trust , Imperial College Healthcare NHS Trust Moorfields Eye Hospital Foundation Trust Portsmouth Hospitals NHS Trust Queen Victoria Foundation Trust Royal Brompton and Harefield NHS Trust Royal National Orthopaedic Hospital NHS Trust Surrey & Sussex NHS Trust Royal Marsden Foundation Trust University College London Foundation Trust Western Sussex Hospital Foundation Trust TOTAL 112, ,253 8, , ,189 9, Royal Surrey County Hospital At Month 11 there is a year to date overspend of 6.7m against the contract with the Royal Surrey, this has increased from Month 10 which was 5.7m, an increase of 1m. The forecast outturn is 7.6m and is consistent with the previous month. The adverse position with the Trust reflects the agreed position with the provider as both organisations continued to work together to address this financial gap but further mitigations did not materialise resulting in a worsening of the CCG forecast outturn at Month 10. There is a further financial risk to the CCG which is associated with further increases in acute over performance in the last couple of months particularly within Non Elective and also with Elective activity as a result of potential APAS coding issues at the Trust. This position is being closely monitored with the trust and mitigations must be sought to ensure delivery of the financial forecast. RSCH s plan remains at the level of the signed contract in December 2016 ( 108.4m) with no adjustment for contract variations in year or recognition of QIPP. As a result, a comparison against the same period in 2016/17 is more meaningful to understand areas of significant change in cost and activity. The key areas of increased costs comparing to YTD M10 (Flex) 2016/17 are as follows: Non-elective activity is 1,573 spells (10%) higher than in prior year, costing the CCG an additional 4m. Decrease in A&E attendances, which are 466 (1%) attendances lower than in the same period last year, indicating an increase in conversion rate from A&E to NEL admission as the reason for the significant over spend in NEL admissions. However, A&E attendances are also costing an additional 314k due to tariff increase in 2017/18 and a richer case mix within coding. Monthly Finance Board Report Summary M11 (at 28 th February 2018) Page 7

9 Under spend in Outpatient follow up activity of 738k and Non Elective Excess bed days of 686k Frimley Park Hospital The majority of the over spend at Frimley Park Hospital relates to Non Elective activity which is 350 (106%) activities higher and 780k (77%) higher than in the same period in 2016/17. Of this over-performance of 423k (175 activities) are within Stroke Medicine. However, this is as expected due to the implementation of the new Stroke pathway. Cardiology is the second highest over-performing specialty for non-elective activity with 26 spells (36%) and 115k (54%) higher than the same period in 2016/17. Coronary Angioplasty is the HRG with the highest variance against same period last year. There was a high cost critical care episode at M7 costing 102k for 2 patients - staying 30 days also contributing to the over spending position. There has been an adverse financial movement in the Freeze data at M7 due to agreement by the Lead Commissioner to revise the Marginal Rate Threshold by 2%, resulting in additional cost of 93k for M1-5. This agreement is in line with contract but it was not correctly notified to allow for a provision to be made in the earlier months. Frimley is continuing base billing to CCGs and NHSE on the 2016/17 IR rules. There has been a proposal put to the CCG that rather than re-running the IR rules for 2017/18 at this point in the year, which is quite a complex exercise, that the CCGs pay the provider the allocation adjustment that they received at the beginning of the year. This potentially may be less than re-running the activity through the 2017/18 rules. The full year impact of this is 128k increase in spend. This is now reflected in M11 reported position Ashford & St Peters The CCG has agreed a final year end settlement with Ashford and St Peter s at 3,050k. This is reflected in the position reported at M11. Monthly Finance Board Report Summary M11 (at 28 th February 2018) Page 8

10 4.8. Acute Challenges The tables below provide information on contractual challenges for Acute Providers at M9 Flex (not cumulative) These automated challenges are run by North East London CSU on CCG's behalf: Total Challenged Rejected with reason Still investigating / Accepted % Accepted Provider Activity 's Activity 's Activity 's Activity 's Ashford and St Peter's Hospitals NHS Foundation Trust 90 10, , % Chelsea and Westminster Hospital NHS Foundation Trust % Epsom and St Helier University Hospitals NHS Trust 19 3, , % Imperial College Healthcare NHS Trust % Moorfields Eye Hospital NHS Foundation Trust 10 1, ,197 0% Royal Brompton & Harefield NHS Foundation Trust 23 8, ,188 0% Royal National Orthopaedic Hospital NHS Trust % St George's University Hospitals NHS Foundation Trust 6 4, ,861 0% Surrey and Sussex Healthcare NHS Trust % The Royal Marsden NHS Foundation Trust 1 1, ,959 0% University College London Hospitals NHS Foundation Trust 19 2, , % Western Sussex Hospitals NHS Foundation Trust % Royal Surrey County Hospital NHS Foundation Trust , ,453 99% Total , , ,517 39% These drug challenges are run by Surrey Downs CCG on GWCCG's behalf: Total Challenged Rejected with reason Still investigating / No response Accepted % Accepted Provider 's 's 's 's Royal Surrey County Hospital NHS Foundation Trust - High Cost Drug challenge 20,248 15, ,765 24% Total 20,248 15, ,765 Monthly Finance Board Report Summary M11 (at 28 th February 2018) Page 9

11 5. Non-Acute Provider Position 5.1. The table below summarises the Month 11 year to date position for non-acute services and is based on the latest received information Provider / Service YTD Plan YTD Actual 5.2. South East Coast Ambulance YTD Variance Annual Budget FOT FOT Variance Move on last month SaBP - Mental Health Services - Adult 12,507 12, ,644 13, SaBP - Delegated Commissioning - Adult 1,033 1, ,127 1, SABP - Learning Disability Serv. 1,507 1, ,644 1, SABP - CAMHS 1,327 1, ,448 1, Local Authority / Joint Services - CAMHS IAPT Service 1,393 1, ,520 1, Healthy Children & Families - children 2,160 2, ,357 2, South East Coast Ambulance Service - A&E 6,113 6, ,669 6, South Central Ambulance Service - PTS South East Coast Ambulance Service Continuing Care Services (All Care Groups) 11,969 12, ,057 13, Funded Nursing Care 4,896 4, ,341 5, Virgin Care - adults 12,697 12, ,851 14, Better Care Fund 10,790 10, ,771 11, Enhanced Services 2,186 2, ,384 2, Primary Care Investments Frailty Initiative Out of Hours 1,375 1, ,500 1, Additional stroke transport costs following the pathway changes are causing an over spend of 300k for the year included within the position reported above. There has been a final year end agreement with SECAmb for the 2017/18 financial year which is reflected in the table above. Monthly Finance Board Report Summary M11 (at 28 th February 2018) Page 10

12 6. Prescribing 6.1. The Practice Prescribing Authority (PPA) data is received two months in arrears so this report is based upon December data. There is an over spend of 1.0m year to date and forecast over spend of 1.1m in relation to the pressure associated with No Cheaper Stock Obtainable (NCSO) A QIPP plan of 2.5m has been set for Medicines Management. Performance against the programme is below plan mainly as a result of lower than planned performance against the repeat prescribing programme It should be noted that the pressure of NCSO described above has been absorbed into the medicines management position resulting in additional costs of 1.1m forecast for the year. This has significantly reduced the ability of the team to mitigate pressures of other over spending areas and lower performance on QIPP. 7. Mental Health 7.1. The Surrey & Borders Partnership Foundation Trust (SABPT) Mental Health and Learning Disability SLAs are agreed block contract values Both contracts have a QIPP requirement, which collectively total 0.1m and needs to be achieved in order for the planned block values to be delivered /17 CQUIN achievement has been agreed on the Adult and Learning Disability contract. This has released a benefit of 0.1m into the year to date and forecast positions Improving Access to Psychological Therapy (IAPT) budgets are locally managed. Year to date there is an under spend of 130k; with a 147k under spend in the forecast position to reflect the increasing patient numbers accessing this service. 8. Continuing Healthcare and Free Nursing Care 8.1. The host commissioner, Surrey Downs CCG, have advised that CHC and FNC is forecast to meet the budget for the financial year. An agreed overspend on CHC team costs is being offset by an under spend on clinical costs The CCG is required to make a provision for retrospective claims from patients who may be eligible for continuing healthcare. Based upon information received from Surrey Downs for M11, this provision has increased by 3k in the year to date and 3k in the forecast position. This is adverse movement in forecast of 60k compared to numbers previously reported During the budget setting process the CCG included a risk adjustment to the CHC budget of 290k in addition to the budget advised by Surrey Downs CCG. This has been released in both the year to date and forecast outturn as it is no longer required as a contribution to the national risk pool. Monthly Finance Board Report Summary M11 (at 28 th February 2018) Page 11

13 9. Better Care Fund 9.1. Guildford & Waverley CCG is required to contribute 11.7m into the Better Care Fund, a pooled budget hosted by Surrey County Council. Any over or under spends are shared equally between each partner or can be carried forward the decision lies with the Local Joint Commissioning Group Of this fund, 11.7m is transferred to Surrey County Council of which 4.8m is returned to the CCG. Of this 4.8m, 3.2m are allocated against the existing community contract and 1.6m against other schemes including psychiatric liaison, virtual wards and the non- elective activity metric As in previous years, 227k of contingency within the fund has been allocated against non-elective activity at the Royal Surrey County Hospital and is released into the financial position The table below details the breakdown of this fund and forecast outturn: Information in this table is at Month 10 - January 2017 BCF Summary Category Care Act Revenue Carers Health Commissioned Services Continuing Investment in Health and Social Care - CCG managed Schemes Continuing Investment in Health and Social Care - SCC Protection of Adult Social Care BCF Plan Submission Total Disabled Facilities Grant Improved BCF and Spring Funding Carry Forward and Adjustments Grand Total Annual Plan 000 Forecast at M Forecast at M10 variance to Annual Plan 000 Move on last month ,281 3, ,547 1, ,696 1, ,342 4, ,754 11, ,310 1, ,095 13, There has been an agreement with the Surrey County Council that 50% of the total underspend of the Joint Schemes, will be retained by the CCG (in line with Section 75). 10. Running Costs At Month 11 running costs are delivering an under spend in both the year to date ( 0.84m) and forecast outturn positions ( 0.84m). This supports the corporate element of the CCG QIPP programme. Monthly Finance Board Report Summary M11 (at 28 th February 2018) Page 12

14 11. New Investments, Reserves and Contingencies In order to achieve the Month 11 position and reflect the agreed risk share arrangement with the main acute provider, contingency funds of 1.2m have been released. This represents an even profile of the annual budget The CCG is required to set a non-recurrent reserve in 2017/18 to the value of 2.4m of which 0.5% ( 1.2m) cannot be committed. No commitments or assumed use of this 0.5% reserve have been made and the forecast accounts for this being returned to NHS E and not impacting on the CCG bottom line. 12. Quality Innovation Productivity and Performance (QIPP) In order to deliver a balanced position the CCG base budget for 2017/18 included a QIPP savings requirement of 8.6m The plan includes a requirement to deliver 5.1m QIPP savings against the RSCH contract. A Joint Programme of work has been in place however there has been slippage against the programme year to date. Many of the schemes are now in place but have been implemented later than was originally planned and have not delivered benefits at the scale and pace of change required During the year, the CCG has been subject to a joint NHS England and NHS Improvement approach for achieving system balance Local Envelope System Approach. This has involved assessing all options to reduce expenditure across the System The Month 11 full year forecast for QIPP is 6.3m representing delivery of 73% Reported QIPP delivery at Month 11 is 5.7m against a plan of 7.9m, achievement of 73%. The detail is shown in the table below. Monthly Finance Board Report Summary M11 (at 28 th February 2018) Page 13

15 13. Risks and Mitigation The key financial risks faced by the CCG at Month 11 are: Acute activity over performance There is potential for the risk of further acute over performance in the last month of the year which presents a risk to the CCG forecast. The position will continue to be monitored and ensuring monthly rigorous performance management of contracts. Negotiations to cap a number of acute provider contracts also provide mitigation to the risk of further over performance. This is rated as a Medium risk. QIPP Delivery in the last quarter is required to deliver against the reported forecast which presents a risk if performance is lower than planned. This is rated Medium risk as most of the slippage is within the reported forecast. Continuing Healthcare placement costs Continued risk of increasing cost of placements or higher levels of activity. This is rated as a Medium risk Monthly Finance Board Report Summary M11 (at 28 th February 2018) Page 14

16 14. Cash Position The CCG draws down cash at the beginning of the month from NHS England to ensure that creditors can be paid on time At 28 th February 2018, the CCG has drawn down 244m (88.1%) of the anticipated 2017/18 net annual cash resource of 276.9m. This level of drawdown is below current target of 91.67% Cash KPI for February was met. Actual cash balance at 28 th February 2018 was 250k at 1.22% of main drawdown of 20,5m (target is below 1.25%) Statement of Cashflow as at 28 th February 2018: Actual Cash Flows from Operating Activities 000s Net Operating Cost Before Interest (252,221) Depreciation and Amortisation 18 Impairments and Reversals 0 (Increase)/Decrease in Trade and Other Receivables (494) (Increase)/Decrease in Other Current Assets 0 Increase/(Decrease) in Trade and Other Payables 8,889 (Increase)/Decrease in Other Current Liabilities 0 Provisions Utilised (11) Increase/(Decrease) in movement in non cash Provisions (53) Net Cash Inflow/(Outflow) from Operating Activities (243,871) CASH FLOWS FROM INVESTING ACTIVITIES Year to Date (Payments) for Property, Plant and Equipment 0 Net Cash Inflow/(Outflow) from Investing Activities 0 NET CASH INFLOW/(OUTFLOW) BEFORE FINANCING (243,871) CASH FLOWS FROM FINANCING ACTIVITIES Net Parliamentary Funding 243,986 Cash Transferred (to)/from Other NHS Bodies (free text note required) 0 Net Cash Inflow/(Outflow) from Financing Activities 243,986 NET INCREASE/(DECREASE) IN CASH AND CASH EQUIVALENTS 114 Cash and Cash Equivalents ( and Bank Overdraft) at Beginning of the Period 35 Cash and Cash Equivalents (and Bank Overdraft) at YTD Better Payment Practice Code The Better Payments Practice Code measures the number of CCG invoices paid within 30 days as a % of the total invoices paid The Target is 95% and the CCG s performance YTD to February 2018 is above this target at 97.54% on volume of invoices paid. The value target is also met and performance is significantly higher than target at 99.37% A weekly report is sent to Budget holders to remind them to clear their SBS workflows to aid achievement of this target. Monthly Finance Board Report Summary M11 (at 28 th February 2018) Page 15

17 16. Statement of Financial Position The Statement of Financial Position shows the CCG's balance sheet (assets and liabilities) as at 28 th February 2018 in comparison to 31 st January 2018 Balance Sheet Balance Sheet Movement As At As At From last month 28 February January s 000s 000s Fixed Assets Property Plant & Equipment Current Assets Debtors 6,247 6,333 (85) Cash at Bank and in hand 149 (731) 880 6,396 5, Total Assets 6,449 5, Current Liabilities Trade and Other Payables (32,788) (30,622) (2,166) Provisions (201) (197) (3) Other (32,989) (30,820) (2,169) Net Current Assets/(Liabilites) (26,592) (25,218) (1,375) Total Assets Less Current Liabilities (26,540) (25,165) (1,374) Non-Current Liabilities Assets Less Liabilities (26,540) (25,165) (1,374) Financed By: Taxpayers' Equity General Fund 26,540 25,165 1,374 Revaluation Reserves Total Taxpayers' Equity 26,540 25,165 1, Conclusion The Month 11 financial position for Guildford & Waverley CCG is a 10.4m deficit year to date against the plan of 7.7m resulting in in 2.8m adverse variance Based on the information available and assumptions contained within the report, a year end position of 11.7m deficit, 3.3m adverse variance on the 8.4m deficit plan has been reported with noted additional risks. Monthly Finance Board Report Summary M11 (at 28 th February 2018) Page 16

18 APPENDIX A Budget to date Cumulative Position Actual to date Variance to date Forecast Outturn Annual Plan Year End Variance Forecast Forecast Resource Limit 241, , , ,976 0 Operational Financial Balance Acute Commissioning Acute-SLAs-NHS (Includes Ambulance Services) 120, ,629 5, , ,904 5,879 Acute-SLAs-Other Providers (Non-NHS, incl. VS) 5,652 5,484 (167) 6,150 5,941 (208) Acute - High Cost Drugs (60) (65) Acute - NCAs 2,983 3, ,254 3, Sub-Total Acute Services 128, ,312 5, , ,353 5,775 Non Acute Commissioning Mental Health Services 21,859 21,406 (452) 23,846 23,381 (465) Community Health Services 16,096 16,028 (68) 17,559 17,493 (67) Continuing Healthcare Services 17,131 16,822 (309) 18,688 18,397 (291) Primary Care Services 4,976 4,962 (14) 5,428 5,417 (12) Better Care Fund 10,790 10,582 (208) 11,771 11,544 (227) Sub-Total Non Acute Services 70,851 69,801 (1,050) 77,292 76,231 (1,061) Prescribing 27,038 28,148 1,110 29,496 30,765 1,269 Voluntary Sector Grants / Services 1,737 1,718 (19) 1,895 1,902 7 Other Corporate Costs (Non-Running Costs) Clinical Costs 13,200 12,610 (590) 14,400 13,937 (462) NHS Property Services re-charge (98) (107) Sub-Total Other Corporate Costs 13,913 13,225 (688) 15,178 14,609 (569) Corporate Running Costs 4,503 3,661 (842) 4,913 4,069 (843) Total Before Reserves (5,142) (9,088) 3,945 (4,377) (8,953) 4,577 Operating Plan Requirements and Reserves 0.5% Contingency 1,171 0 (1,171) 1,277 0 (1,277) 1% Non Recurrent Reserve ,233 1,233 0 General Reserve 1,355 1, ,478 1,478 0 Surplus / (Deficit) (7,668) (10,443) 2,775 (8,365) (11,665) 3,300 Monthly Finance Board Report Summary M11 (at 28 th February 2018) Page 17