Kingston Hospital NHS Foundation Trust. Finance Report October 2018 (Month 07)

Original 0 0 0 ' s Var Kingston Hospital NHS Foundation Trust Finance Report October 2018 (Month 07)

CONTENTS EXECUTIVE SUMMARY........3 SECTION 1: OVERALL INCOME AND EXPENDITURE.......4 SECTION 2: DIVISIONAL POSITION.... 5 SECTION 3: FINANCIAL IMPROVEMENT PLAN......6 SECTION 4: STATEMENT OF FINANCIAL POSITION.........7 SECTION 5: CASH FLOW POSITION...........8 SECTION 6: FINANCE AND USE OF RESOURCES METRICS.......... 9 Contents

EXECUTIVE SUMMARY Headline In Month Performance Against Budget (Oct) Narrative I&E Position (control total basis - excluding PSF and donated asset adjustments) - The Trust reported a surplus in month of 0.4m, which is in line with plan. YTD deficit of 5.0m is on. The underlying position is in line with plan year to date and is forecast to be in line with plan to the end of the year. Provider Sustainability Funding (PSF) matches plan in month at 3.0m and YTD at 5.8m. Both the financial performance target and A&E access target have been reported as being met YTD at month 7. PSF is therefore accrued to plan. The in month accrued PSF is an increase of c. 2.4m. It is reflective of the adjustment to the control total to recognise the expected proceeds of sale of Land of 5m forecast in M12. Income (excluding PSF) is 1.6m favourable to plan in month and 4.0m favourable to plan YTD. Income from patient care activities is above plan by 1.1m in month, and by 3.3m YTD. Non-Elective is 0.2m above plan in month, and 2.3m above plan YTD. Daycase overperformed 0.1m in mth and 0.4m YTD. This was offset by underperformance in Outpatients, 0.1m in mth and 0.5m YTD. Other areas underperforming are YTD (ACU 0.2m, Acute Paed Medical 0.1m). Other income is favourable by 0.5m in month, of which 0.4m relates to donated asset income for the William Rouse Centre, and 0.7m YTD. Pay expenditure is 0.5m adverse to plan in month and 1.8m adverse YTD. Pay expenditure is 0.5m overspent in the month and 1.8m over year to date. Medical pay is 0.4m adverse to budget in month, with 0.1m in A&E and 0.3m in ned Care - due to vacancy in certain areas being covered by agency, including maternity leave covers and activity pressures. The YTD variance of 1.8m is above plan (of which A&E is 0.7m and 1.1m in ned Care). Non-pay expenditure is 0.6m adverse to plan in month and 1.3m adverse YTD (excl. high cost drugs). Non-pay expenditure is 0.8m overspent in the month ( 1.6m adverse YTD), including high cost drugs. Clinical expenditure is 0.2m adverse in month, relating to increased activity and General Supplies and Other costs 0.1m favourable, whilst PFI & Premise costs were 0.2m overspent in the month (contributing factors: increased maintenance costs and energy costs were greater than planned in October). FIP Delivery in month is 1.1m (incl. mitigations) increasing YTD delivery to 4.8m, which is 0.8m below YTD target of 5.6m. FIP delivery in month, including mitigations was broadly in line with the FIP plan submitted as part of the NHSI Operating plan. This included a 220k rephasing adjustment, of the underlying trust internal plan, to align it with the Operating plan. The MRET scheme was phased to start from M7, but it is recognised that it will not deliver. Capital expenditure YTD is 11.1m, which is 2.6m below plan The cash balance reported at the end of M7 was 1.6m. The YTD Capital spend of 11.1m is 2.6m below the YTD plan of 13.7m due to delays in spend of Medical Equipment, IMT and Estates Projects. The closing cash position for October was 1.6m which was 0.2m lower than the previous month but 0.4m above forecast. Significant receipts in month, including 2.6m for Q3 18/19 funding for HEE, has allowed improved management of payments to small and medium sized suppliers, thus improving the Better Payments Practice Code percentage of suppliers paid within term, from 89% to 97%. Financial performance In Month of 0.4m surplus, and YTD of 5.0m deficit is in line with the operating plan. The in month PSF of 3.0m was achieved. YTD PSF achieved was 5.8m. The PSF achievements are reflective of the 2 for 1 10m increase in PSF from the adjustment to the control total to recognise the expected proceeds of tha land sale ( 5m). The UOR score improved to 2 compared to a plan of 3. Pg3

SECTION 1: OVERALL INCOME AND EXPENDITURE Summary as at the end of Oct-18 IN MONTH YEAR TO DATE Income & Expenditure Budget v s Budget v s Annual Budget Budget Var Budget Var Income Patient Care Income 223,781 19,873 20,816 943 130,334 133,307 2,973 High Cost Drug Income 15,314 1,430 1,633 203 8,938 9,288 349 Other Income 27,777 2,058 2,554 496 14,697 15,421 724 Income 266,872 23,361 25,003 1,642 153,969 158,015 4,046 Expenditure Pay (166,406) (13,976) (14,455) (479) (96,891) (98,715) (1,824) Non Pay (77,308) (6,405) (6,999) (594) (45,149) (46,426) (1,278) High Cost Drugs (15,315) (1,430) (1,618) (188) (8,938) (9,283) (344) Expenditure (259,029) (21,811) (23,072) (1,261) (150,978) (154,423) (3,445) EBITDA 7,843 1,550 1,931 382 2,991 3,592 601 Depreciation and Amortisation (7,698) (651) (648) 3 (4,444) (4,593) (149) Investment Revenue 12 1 5 4 7 24 17 Finance Costs (3,881) (282) (313) (31) (2,169) (2,220) (51) Public Dividend Capital (2,456) (208) (189) 19 (1,476) (1,323) 153 Land Sale 5,000 I&E excl. PSF (1,181) 410 786 376 (5,091) (4,520) 571 Depreciation on donated assets 181 15 15 (0) 105 102 (3) Donated Asset Income 0 0 (389) (389) 0 (561) (561) Control Total - I&E excl. PSF and Impairments with donated asset adjs. (1,000) 425 413 (13) (4,986) (4,979) 7 Provide Sustainability Funding (PSF) 18,074 2,974 2,974 0 5,800 5,800 0 Impairments 0 0 0 0 0 0 0 Total Surplus/(Deficit) 16,893 3,384 3,760 376 709 1,280 571 Annual YTD EBITDA Margin 2.9% 6.6% 7.7% 1.9% 2.3% EBITDA Achieved 100.0% 100.0% 124.6% 100.0% 120.1% I&E Surplus Margin -0.4% 1.8% 3.1% -3.3% -2.9% 0.0-1.0 Cumulative Position Against 2018/19 (excl PSF) Apr May Jun Jul Aug Sep Oct Nov Dec Jan Feb Mar -2.0-3.0-4.0 m -5.0-6.0-7.0-8.0-9.0-10.0 s 2017/18 s 2018/19 2018/19 Forecast 2018/19 Pg4

SECTION 2: DIVISIONAL POSITIONS Overview Summary as at the end of Oct-18 Income & Expenditure Budget v s IN MONTH Variances Budget v s YEAR TO DATE Variances Annual Var Inc Pay Non Pay Total Var Inc Unplanned Care Division (5,386) (380) (393) (14) 235 91 (340) (14) (3,754) (5,254) (1,500) 379 (1,001) (878) (1,500) ned Care Division 38,528 3,908 4,130 222 991 (272) (497) 222 21,651 22,622 971 3,241 (833) (1,437) 971 Clinical Divisions 33,141 3,528 3,737 209 1,226 (181) (836) 209 17,897 17,368 (529) 3,620 (1,834) (2,315) (529) Strategy Director (2,630) (219) (228) (9) 0 (18) 9 (9) (1,537) (1,556) (19) 2 (54) 33 (19) Corporate Affairs (3,120) (261) (228) 33 5 6 21 33 (1,823) (1,769) 54 6 (9) 57 54 Finance (3,686) (308) (319) (12) (4) 11 (19) (12) (2,146) (2,220) (73) (23) 24 (74) (73) Human Resources (694) (50) (50) 0 41 (20) (21) 0 (423) (762) (339) 100 (216) (223) (339) Medical Director (5,396) (456) (405) 51 15 13 23 51 (3,128) (2,929) 199 49 86 64 199 Nursing Director (2,614) (216) (169) 46 38 5 3 46 (1,535) (1,453) 82 12 14 56 82 Operations (16,991) (1,466) (1,630) (164) (43) (7) (114) (164) (10,098) (10,432) (334) (155) 54 (232) (334) Directorates (35,130) (2,975) (3,031) (56) 52 (10) (98) (56) (20,691) (21,119) (429) (9) (99) (320) (429) Central Income 5,283 404 297 (107) (106) 0 (1) (107) 3,173 3,027 (146) (197) 0 51 (146) Other Central Budgets 9,549 593 928 335 470 (287) 153 335 2,612 4,316 1,704 633 110 962 1,704 EBITDA 12,843 1,550 1,931 382 1,642 (479) (782) 382 2,991 3,592 601 4,046 (1,824) (1,622) 601 Depreciation & Losses (7,698) (651) (648) 3 3 (4,444) (4,593) (149) (149) Finance Costs & Investment Revenue (3,869) (281) (308) (27) (27) (2,162) (2,196) (34) (34) PDC (2,456) (208) (189) 19 19 (1,476) (1,323) 153 153 Land Sale 5,000 0 0 0 Total I&E 3,819 410 786 376 376 (5,091) (4,520) 571 571 Income is 1.7m favourable to plan in month. This is driven by Patient care income is 0.9m, Other income is 0.5 and High Cost drugs is 0.2 favourable in month 7. Patient care income is 0.9m favourable which is being driven by increased non-elective, outpatient, daycase and other income in month. In Unplanned this is driven by A&E non-elective performance in month. In planned care this is driven by increased activity within T&O and Rheumatology, General Surgery, Ophthalmology and Gastro and Endoscopy. Other income is favourable in 0.5m in month which is driven by Donated asset income in relation to the Sir William Rouse re-development in month and BMI and provider to provider funding currently ahead of plan. Pay was 0.5m adverse to plan in month. Medical pay is 0.4m adverse to budget in month, and adverse YTD 1.9m (this includes a number of Consultant maternity covers, which are not budgeted, and payment of agency Consultants in a number of posts that have been hard to recruit to substantively). Admin and Clerical and Scientific and technical are 0.1m adverse to budget in month, which is driven by Radiology and Cardiology respectively. Non-pay was 0.8m adverse to budget in month. 0.2m relates to high costs drugs and 0.4 relating to activity driven costs of Clinical supplies and Drugs in month. Premises and Establishment costs across the trust make up the remaining total. Non-operating costs are on plan overall with an adverse variance on depreciation being offset by a favourable variance on finance costs and PDC. Pay Non Pay Total Pg5

SECTION 3: FINANCIAL IMPROVEMENT PROGRAMME Summary as at the end of Oct-18 FIP Allocation IN MONTH YEAR TO DATE Theme Annual Target Devolved Identification of Target Identified Unidentified Identified % In Month Mitigation Variance (inc. mitigations) Year to Date Mitigation Variance (inc. mitigations) In month achievement of 0.9m including 214k of mitigations is 12k below the in month plan of 1.1m. The YTD variance against plan is 767k adverse. Inpatient Flow 1,565 1,565 1,565 0 100% 134 134 0 0 523 487 0 (35) Theatre Productivity 1,059 1,059 1,059 0 100% 103 167 0 64 565 769 0 204 Outpatients & Patient Admin 500 500 500 0 100% 28 0 0 (28) 361 0 235 (126) Finance 1,000 1,000 1,000 0 100% 42 42 0 0 292 292 0 0 MRET 1,000 1,000 1,000 0 100% 167 0 0 (167) 167 0 0 (167) Partnerships 500 295 295 205 59% 53 22 0 (31) 236 125 0 (111) Collaboration 500 83 83 417 17% 65 2 0 (62) 176 11 0 (166) Corporate Schemes 2,000 2,000 2,000 0 100% 144 136 71 63 1,027 1,005 71 49 Unplanned Care Other Local 1,494 1,218 1,218 276 82% (64) 297 69 283 652 592 107 47 ned Care Other Local 2,382 2,122 2,122 260 89% 252 140 74 110 1,319 843 306 (170) Rephasing 220 0 (220) 292 0 0 (292) Total CIP 12,000 10,842 10,842 1,158 90% 1,144 940 214 12 5,610 4,124 719 (767) Type Annual Mitigation Variance YTD Mitigation Cost Reduction -6,428 296 492 69 266 2,666 2,579 255 167 In Month Variance The amount of FIP identified has increased by 0.5m to 10.3m, 81% of the target due to increase in emergency care local schemes. Underperformance on identified schemes in month was 0.2m. with an additional mitigation o 0.2m, leading to the In month FIP target to breakeven The 767k YTD adverse position on FIP is offset by favourable variances which have ensured the Trust is delivering it's control total YTD, including the net position on patient care income overperformance and contingency. % of 54% 167% 24% 97% 10% Income Generation -5,572 662 448 145 (69) 2,521 1,545 464 (512) % of 46% 68% 22% 61% 18% Total FIP -12,000 958 940 215 197 5,187 4,124 719 (344) % of 98% 22% 80% 14% Pg6

SECTION 4: STATEMENT OF FINANCIAL POSITION M7 Sep Oct m m NON CURRENT ASSETS: Property plant and equipment 123.7 125.5 Intangible assets 10.5 10.6 Other assets 0.9 1.0 TOTAL NON CURRENT ASSETS: 135.1 137.2 CURRENT ASSETS: Inventories 1.8 1.8 Trade and other receivables 25.6 33.4 Cash and cash equivalents 1.8 1.6 TOTAL CURRENT ASSETS 29.2 36.8 CURRENT LIABILITIES: Trade and other payables (30.8) (35.2) Current Borrowings (1.7) (1.7) Current Provisions (0.1) (0.1) TOTAL CURRENT LIABILITIES (32.6) (37.0) NET CURRENT ASSETS LESS CURRENT LIABILITIES (3.4) (0.2) TOTAL ASSETS LESS CURRENT LIABILITIES 131.8 137.0 NON CURRENT LIABILITIES: Borrowings (64.2) (65.5) Provisions (1.0) (1.0) Other liabilities 0.0 0.0 TOTAL ASSETS EMPLOYED 66.6 70.5 FINANCED BY TAXPAYERS EQUITY: Public Dividend Capital 60.5 60.6 Revaluation reserve 17.7 17.7 Income and Expenditure Reserve - Prior years (9.1) (9.1) Income and Expenditure Reserve - Current Year (2.5) 1.3 TOTAL TAXPAYERS EQUITY 66.6 70.5 Non - Current Assets There was a 2.1m increase in Non-Current Assets in October 2018 due to a 1.9m increase in Property, t and Equipment (capital expenditure including MES addition and fire exceeded depreciation in the month by this amount), 0.1m increase in Intangible Assets and 0.1m increase in Other Assets. Current Assets There was a 7.6m increase in Current Assets in September 2018 comprising of: 7.8m increase in Trade and Other and 0.2m decrease in Cash and Cash Equivalents. Current Liabilities There was a increase of 4.4m in Current Liabilities during the month due to an increase in Trade and Other Payables. Non-Current Liabilities Borrowings increased by 1.4m due to the MES addition completed by Siemens in October 2018. Pg7

SECTION 5: CASH FLOW STATEMENT Oct 2018 m Surplus/(deficit) after tax 3.7 Non-cash flows in operating surplus/(deficit) Depreciation and amortisation 0.7 PDC Dividend expense 0.2 Non-cash flows in operating surplus/(deficit) 0.9 Operating Cash flows before movements in working capital 4.6 Increase/(Decrease) in working capital Increase in Inventories 0.0 Increase in Trade and other receivables (7.8) Increase in Current Provisions 0.0 Decrease in Trade and Other payables 4.4 Increase/(Decrease) in working capital (3.4) '000's 12,000 11,000 10,000 9,000 8,000 7,000 6,000 5,000 4,000 3,000 2,000 1,000 0 Cashflow Chart 18/19 NHSI Forecast Net cash (outflow) from operating activities 1.2 Net cash inflow/(outflow) from investing activities Property t and Equipment (2.2) Intangible assets 0.0 Other assets 0.0 Net cash inflow/(outflow) from investing activities (2.2) Net cash inflow/(outflow) from financing activities PDC Drawdowns 0.0 PDC Dividend paid 0.0 Borrowings 1.4 Net cash inflow/(outflow) from financing activities 1.4 Net increase in cash 0.4 The closing cash position for October was 1.6m which was 0.2m lower than the previous month but 0.4m above forecast. Significant receipts in the month included 2.6m for Q3 18/19 funding from HEE, 0.8m from St George's, 0.5m from HMRC for the September VAT reclaim, 0.5m from KH Charity (including reimbursement of capital spend for the Sir William Rous project), 0.7m from Local Authorities for Q1 and Q2 GUM, and a total of 0.8m from CCGs for 18/19 over-performance (Kingston, Richmond, Wandsworth & NW Surrey). Payments to suppliers in the month were 0.9m higher than forecast as overdue creditors were paid following receipt of higher than forecast receipts in the month. This included 0.8m paid to St George's as a managed exchange to reduce receivables and payables balances. Availability of cash in the month allowed management actions in respect of payments to small and medium sized suppliers to be eased in the last two weeks of the month, improving the Trust's performance against the Better Payments Practice Code. Invoices totalling 1.5m were held for payment at month end. Opening cash 1.2 Closing cash 1.6 Pg8

Weight 1 2 3 4 Capital Servicing Capacity 20% 2.50 1.75 1.25 <1.25 SECTION 6: FINANCE AND USE OF RESOURCES METRICS Liquidity 20% - 7.00 - - 14.00 <-14 I&E Margin - Underlying performance 20% 1% 0% -1% <=-1 I&E Margin - Variance from plan 20% 0% -1% -2% <=-2 Agency 20% 0% 25% 50% >50% 100% 18/19 18/19 18/19 18/19 18/19 18/19 18/19 Heading M1 M2 M3 M4 M5 M6 M7 Capital Servicing Capacity 0.07 0.73 0.96 1.20 1.03 1.04 1.9 Liquidity (12.8) (14.9) (11.8) (7.9) (12.4) (7.7) (3.3) I&E Margin - Underlying performance (5%) (3%) (3%) (2%) (2%) (2%) 0% I&E Margin - Variance from plan (1%) (1%) 0% 0% 0% 0% 0% Agency (new metric) 1.4% (0.5%) (7.4%) (0.1%) (3.8%) (2.6%) (4.7%) 3.00 2.50 2.00 1.50 18/19 18/19 18/19 18/19 18/19 18/19 18/19 Heading M1 M2 M3 M4 M5 M6 M7 Capital Service Cover 4 4 4 4 4 4 2 Liquidity 3 4 3 3 2 3 2 I&E Margin - Underlying performance 4 4 4 4 4 4 2 I&E Margin - Variance from plan 2 2 1 1 1 1 2 Agency (new metric) 2 1 1 1 1 1 1 1.00 0.50 0.00 Apr-18 May-18 Jun-18 Jul-18 Aug-18 Sep-18 Oct-18 Average 3.00 3.00 3.00 2.60 2.40 2.60 1.80 Rounded Score 3.00 3.00 3.00 3.00 2.00 3.00 2.00 Capital Servicing Capacity I&E Margin Agency Liquid ratio I&E Margin Variance From Our current risk rating is 2.0, which is an improvement from prior months risk rating 3.0 Pg9