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Finance Report Month 11 2011-12 Master v0.1

Finance Report Month 11 2011-12 Master v0.1. Jonathan Wise, Director of Finance & Performance . NHS HARROW FINANCE REPORT 11/12 - CONTENTS. Summary [Slides 3-7] M11 Position [Slides 8-36] Forecast outturn position [slides 37-41] Appendices Detailed finance schedules [Slides 42-53].

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Finance Report Month 11 2011-12 Master v0.1

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  1. Finance ReportMonth 11 2011-12Master v0.1 Jonathan Wise, Director of Finance & Performance

  2. NHS HARROW FINANCE REPORT 11/12 - CONTENTS • Summary [Slides 3-7] • M11 Position [Slides 8-36] • Forecast outturn position [slides 37-41] • Appendices • Detailed finance schedules [Slides 42-53]

  3. SECTION 1 – SUMMARY

  4. EXECUTIVE SUMMARY • The month 11 report includes performance against QIPP. The Month 11 and forecast outturn (FOT) variances have been analysed between QIPP/non-QIPP as per the table below: • The QIPP position is shown in detail on slides 33-36 • Overall at month 11 the position is break-even against plan. The forecast outturn at month 11 is also breakeven. • At month 11 the acute contract position has improved by £2.8m, primarily due to the release of in-year risk reserves no longer required. This is offset by a £2.6m pressure as a result of the provision for the Heights lease offset by accruals no longer required together with net pressures of £0.2m on other budgets.

  5. FINANCIAL PERFORMANCE SUMMARY (1) YTD FOT • Statutory duties • Underspend against revenue resource limit • Achievement of capital resource limit • Achievement of cash limit • Underlying recurrent position • Achievement of overall financial plan • Achievement of public sector payment policy • Achievement of 11/12 QIPP plan • CCB delegated budgets G G G G G G R R G G A A G G G G

  6. SUMMARY OF MONTH 11 AND FORECAST OUTTURN • Year to Date position • The year to date position at month 11 is breakeven, made up of overspends of £0.1m on acute commissioning, £0.3m on prescribing and £2.5m on reserves offset by underspends on community services of £1.3m, joint working of £1.2m, primary care of £0.2m and estates of £0.2m. • Forecast outturn position • The forecast outturn position is breakeven. This is made up of forecast overspends of £0.3m on prescribing and £2.6m on reserves offset by forecast underspends of £0.3m on primary care, £0.2m on acute commissioning, £1.1m on joint working, £1.2m on community services and £0.1m on estates. • CCB Delegated budgets • At month 11 the CCB delegated budgets are underspent by £0.3m. This is made up of underspends of £0.2m on direct access and a £0.2m on contingency offset by an overspend of £0.1m on prescribing.

  7. UNDERLYING (RECURRENT) FINANCIAL POSITION • In order to understand the financial position of the PCT, it is important to distinguish between recurrent (underlying/run rate) and non-recurrent (one-off) income and expenditure items as it is the recurrent position that is core determinant of on-going financial sustainability; • The year-end outturn, adjusted for the major one-off items is set out below: • £m • Year-end outturn 0 • Adjusted for Sector support (20.2) • Return of 2% funding (5.3) • 10/11 Surplus c/f (0.7) • Other non-recurrent items 1.2 • Underlying financial surplus/(deficit) (25.0) • The movement in the underlying position between M10 and M11 is as follows: • - Month 10 Underlying financial deficit (27.1) • - increase in recurrent allocation 0.4 • - decrease in recurrent spend 1.7 • - M11 Underlying financial deficit (25.0)

  8. SECTION 2 – MONTH 11 POSITION

  9. OVERVIEW OF BUDGET POSITION AT MONTH 11 • Budget changes are shown below:

  10. DELEGATED GP BUDGETS – MONTH 11 • The Year to Date position reflects Month 9 Expenditure projected to Month 11 • The Annual Budgets reflect the revised Annual Budgets as at Month 9

  11. SUMMARY OF YEAR TO DATE VARIANCES - MONTH 11 Explanations for the main variances are included on the following slide.

  12. SUMMARY OF YEAR TO DATE VARIANCES (1) Acute Commissioning (£0.05m) unfavourable - Currently 8 out of the 21 NHS acute contracts are showing over-performance at month 11 (of greater than £50k). These are at RNOH (£0.6m), Royal Brompton & Harefield (£1.2m), Chelsea & Westminster (£0.5m), Guys & St Thomas’ (£0.4m), Royal Free (£0.4m), Moorfields (£0.2m), UCLH (£0.5m), Royal Marsden (£0.1). In addition there is over-performance at In Health (£0.1m) and a shortfall on acute QIPP stretch target (£1.0m). There are underspends at West Herts, Barts, Whittington and Hillingdon of £0.3m in total. The overspend has been reduced to (£0.05m) after factoring in £4.6m of the annual in-year risk reserve of £5.9m. NWLHT and Imperial are shown as breakeven due to the impact of the cap. Other Acute Commissioning (£0.1m) unfavourable - This includes London Specialist Commissioning Group (Acute), Other Specialist Commissioning for Acute, Cost per Case, High Cost Drugs and Non Contracted Activities. At month 11 the most material overspends are in High Cost Drugs (£0.3m) and Cost per Case (£0.2m) offset by underspends of £0.4m on specialist consortia. Joint Working Commissioning - £1.2m favourable - This relates to under spending on various services, which are detailed later. Community Commissioning £1.3m favourable- This includes the various Community services plus UCC, NCA and Hillingdon Wheelchair Services and the Primary Commissioning Services which includes Physiotherapy, CAS, SPA and the referral management centre. At month 11 the favourable position is due to under spending on various services, which are detailed later. Prescribing (£0.3m) unfavourable - Unfavourable position at month 11 relating to over spend in GP Prescribing, central drugs and other prescribing.

  13. SUMMARY OF YEAR TO DATE VARIANCES (2) Primary Care (£0.15m) Favourable – Medical contracts are under spending by £0.2m due to savings from list reductions, seniority payments, savings from the termination of SLA with Harmoni (out of Hours Provider) and greater than budgeted income collection from primary care walk-in-centres. Dental contracts also under spending by £0.2m due recovery of under performance from 10/11 . Pharmacy contracts are over spending by 0.15m due to higher payments for community pharmacists as per Community Pharmacy Contractual funding changes for 11/12. Ophthalmic contracts are over spending by £0.1m due to increased activity and QIPP target not being met. Estates Costs (£0.2m) favourable - This includes the various sites including Alexandra Avenue, depreciation and cost of capital. Community Estates is under spent due to surplus depreciation budget not now required. This is netted off against overspends in other lines due to increased service costs, maintenance contracts and telephone costs across a number of sites including Alexandra Avenue, Community Estates, Kenmore, Elmwood Ave , Waverley, Wealdstone and Pinn Medical. Corporate Costs (£0.05m) favourable – There are in-year under spends on Turnaround support and recharge from Brent. Public Health (£0.04m) favourable - This includes drugs & alcohol, LSG Public Health, Childhood Immunisation, Termination of Pregnancy, HIV and Health Promotion. There are under spends on Childhood Immunisation of £0.05m, Public Health Performance of £0.1m. LSG Public Health of £0.04m, HIV of £0.03m and other budgets £0.03m. There are over spends on ToP of £0.06m, Breast Screening of £0.03m and Retinal Screening of £0.05m and public health projects £0.07m. General Reserve / Contingency (£2.5m) unfavourable – The net pressure has been created by the cost of the Heights (£3.9m) net of release of prior year accruals of £1.4m. This net pressure is offset by net underspends on issued budgets.

  14. ACUTE CONTRACT POSITION – MONTH 11 • Figures used have been based on Month 10 Trust reports as reported by the ACV • Year to date reported Trust figures exclude ACV Challenges which have not yet been incorporated or accepted by the Trusts and the impact of any agreements (“caps”) connected with non recurrent support for NWLHT and Imperial • Out of Sector contracts - reflects latest position from ACV for contracts and Trust reported figures for actual values. • Total YTD performance: £3.7m overspend on acute NHS contracts. In addition a Stretched QIPP under achievement of £1.0m. With £4.6m of the acute in-year-risk reserve factored in the overall position is £0.05m overspent. • Forecast Outturn (FOT) position: Projecting the YTD position to year-end (including ACV challenges and the impact of contract caps) gives an overspend of (£4.2m) (2.6%) on NHS Acute contracts. In addition, projecting the YTD overspend position to year-end on Stretched QIPP (£1.1m) gives an overspend of £5.3m. After factoring in the £5.9m of the acute contract in-year risk reserve the FOT position is £0.6m underspent.

  15. ACUTE CONTRACT POSITION – MONTH 11 The Year to Date Analysis is based on Month 10 Performance Reports for each Trust forecasted to Month 11.

  16. ACUTE CONTRACT POSITION – MONTH 11 Analysis of (Over)/Under Performance by Point of Delivery (POD) (£’000) The above table analyses £’000s under/(over) performance by POD by Trust. Over performance in excess of £20k has been highlighted in yellow. The Year to Date Analysis is based on Month 10 Performance Reports for each Trust forecasted to Month 11 on a straight line basis. . A commentary on material over performance at the month 10 position reported by Trusts is on the following slide.

  17. ACUTE CONTRACT POSITION – M10 TRUST REPORTS (1) The following tables reflect the latest available contract data from Trusts which is month 10

  18. ACUTE CONTRACT POSITION – M10 TRUST REPORTS (2)

  19. ACUTE CONTRACT POSITION – M10 TRUST REPORTS (3)

  20. ACUTE ACTIVITY ANALYSIS - MONTH 11 • The following graphs compare monthly activity levels in 2011/12 with 2009/10 and 2010/11. There may be differences in the variances shown in slide 16 and the following slides due to: • Non PbR spend areas such as Critical Care, Excluded Drugs & Devices, Direct Access, Renal and Other Exclusions are not reflected in the Acute Activity Analysis graphs. Also Accident and Emergency activity is not reflected in the Acute Activity Analysis graphs; • The following slides show actual activity changes year on year: - outpatients 7.0% increase (excluding CAS services) • - elective admissions have increased by 11.2% • - non-elective admissions have increased by 2.5% • - births have decreased by 1.7%

  21. ACUTE ACTIVITY ANALYSIS (1) - OUTPATIENTS Against the comparative period of April-January 2010/11, there is an increase in activity of 7.0%. This excludes community outpatients activity seen by the CAS services which is currently unreported on SUS.

  22. ACUTE ACTIVITY ANALYSIS (2) - ELECTIVE Against the comparative period of April – January 2010/11, there is an increase in activity of 11.2%.

  23. ACUTE ACTIVITY ANALYSIS (3) – NON-ELECTIVE Against the comparative period of April – January 2010/11 , there is an increase in activity of 2.5%.

  24. ACUTE ACTIVITY ANALYSIS (4) – BIRTHS Against the comparative period of April – January 2010/11, there is a decrease in activity of 1.7%

  25. SPECIALIST COMMISSIONING – LSG REPORT M9 LSG Report is unavailable for Month 10 therefore the figures reported are based on Month 9 LSG Report depicts a favourable variance of £280k at month 9 Main areas of overperformance at Month 9 are NICU, PICU and Spinal and main areas of underspend are Adult BMT, Forensic MH – WLMHT, Haemophilia and Neuro Rehabilitation At Month 9 Adult BMT is showing an underspend of £196k, Forensic MH £146k, Paediatric BMT £88k, Haemophilia £155k and Neuro Rehabilitation £132k, offset by overspends of £286k in NICU, £185k in PICU, and £72k in Spinal FOT position at month 9, after risk share agreement is applied, is £123k favourable

  26. SPECIALIST COMMISSIONING – LSG REPORT M9 N.B. Figures reflect Month 9 data

  27. JOINT WORKING VARIANCES – MONTH 11 Joint Working Commissioning is showing a £1.2m under spending, and is made up of the following areas: – - Continuing Care Adults is showing a £0.4m under spending. This is due principally to spending in Nursing Care, Adult Mental Illness, Elderly and people with Physical Disabilities. - Continuing Care Children is showing a £0.09m over spending. This is due principally to increased pressure on care packages. - Intermediate Care is showing a £0.6m under spending. This is due principally to lack of use of spot placements for such care at £0.3m, an under spending of £0.2m on Harrow Joint Finance and under spending of £0.09m on Minor Budgets. - End of Life is showing an under spending of £0.07m in month 11. - Mental Health Providers is showing an under spending of £0.2m in month 11. This is due to an under spending of £0.15m on Other Mental Health providers and an under spending £0.05m on Mental Health Specialised Commissioning.

  28. COMMUNITY SERVICES VARIANCES – MONTH 11 • Community Services Contracts £0.7m favourable. The principal reasons for the under spending are the Urgent Care Centres (Ealing) being £1m under spent and the CNWL/Hillingdon Community Services being £0.2m under spent. However, the Ealing ICO/Harrow QIPP target is showing and adverse balance of £0.3m, and the Hillingdon Wheelchair Service is showing a similar adverse balance of £0.3m. Other budget headings in Community Commissioning show variances that are not considered significant but contribute to the total under spending. • Primary Commissioning Services £0.7m favourable – This is due to under spends in CAS cost of projects £0.2m and Referral Management Centre £0.4m and an overspend in Physiotherapy Direct Access of £0.1m.

  29. PRIMARY CARE VARIANCES - MONTH 11 • Prescribing (£0.3m) Unfavourable - GP Prescribing is over spending by £0.1m. Central drugs are over spending by £0.1m and other prescribing overspending by £0.1m. • Primary Medical Service (£0.2m) Favourable - due to over achievement of Walk in centre income, savings from baseline payments due to list reduction and also savings from the termination of SLA with the Out of Hours provider. • Dental Contract (£0.2m) Favourable – This is due to the recovery of income from 10/11 under performance. • Pharmacy Contract (£0.15m) Unfavourable – Pharmacy contracts are over spending by £0.3m due to higher payments for community pharmacists as per DOH guidance. • Ophthalmic Contract (£0.1m) Unfavourable – April to January payments were more than the budget and the anticipated QIPP savings not being achieved.

  30. CORPORATE, ESTATES & PUBLIC HEALTH VARIANCES – MONTH 11 • Estates (£0.2m) Favourable – The Estates are showing a favourable position due to an under spend on Depreciation. • Corporate Service (£0.05m) Favourable – Turnaround Support and recharge from Brent are showing under spends in month. • Public Health (£0.04m) Favourable – Predominantly due to Public Health Performance under spend by £0.1m.

  31. BALANCE SHEET AT 29 FEBRUARY

  32. BETTER PAYMENT PRACTICE CODE (BPPC) PSPP is being achieved in two out of four categories. Note: Figures include performance on commissioning (plus Harrow provider services invoices relating to 10/11)

  33. QIPP PROGRAMME SUMMARY • The Bottom-line QIPP position is shown as follows: The following slides provide a scheme-by-scheme analysis of the QIPP programme

  34. QIPP PROGRAMME (1)

  35. QIPP PROGRAMME (2)

  36. QIPP PROGRAMME SUMMARY FOT • Full year plan = £14.0m • Current FOT including benefit of non recurrent contract caps of £2.6m = £14.5m • Improved QIPP performance from month 5 to month 7 with a slight decrease in month 8. • A slight decrease from month 10 in QIPP performance due to decreased savings in Mental Health repatriation, Prescribing and ACV project • There would be an under achievement on plan of £2.0m if there were no contract caps in place • Total FYE of 11/12 performance = £16.7m including FYE impact of £4.7m

  37. SECTION 3 - FORECAST OUTTURN

  38. SUMMARY OF FORECAST OUTTURN VARIANCES Explanations for the main variances are included on the following slide.

  39. SUMMARY OF FOT VARIANCES (1) Acute Contracts £0.6m favourable – The FOT is shown as £0.6m favourable after extrapolating the in-year positions, adjusting for NWLHT challenges, contract caps and the utilisation of the acute contract in-year risk reserve (£5.9m). Other Acute Commissioning £0.4m unfavourable – The most material variances projected are a £0.4m overspend relating to High Cost Drugs, a £0.2m overspend relating to Cost per Case Acute and an overspend of £0.2m in NCAs offset by an underspend of £0.4m on specialist consortia. Joint Working Commissioning £1.1m favourable – The FOT is set at £1.1m favourable due to a projected under spending on Continuing Care (Adults) at £0.4m,a projected under spending of £0.3m on Intermediate Care (Spot Placements), a projected under spending of £0.1m on Minor Budgets, a projected under spending of £0.1m on Joint Finance, a projected under spending of £0.2m on Mental Health SLA`s and a projected under spending of £0.07 on End of Life. Continuing Care (Children) is showing a projected over spending of £0.1m. Other budget headings are projected to break even. Community Commissioning £0.5m favourable – Community Services contract - The FOT is showing a projection of £0.5m favourable due principally to the projected under spending on the Urgent Care Centres of £1m, CNWL/Hillingdon Community Services shows a projected under spending of £0.2m and CLCH/Barnet Community Services shows a projected under spending of £0.1m. An unfavourable variance of £0.4m is projected for the Ealing/ICO Harrow QIPP target, an unfavourable variance of £0.3m shown for Hillingdon Wheelchair Service, and a £0.1m unfavourable variance for Non Contract Activity (NCAs). Primary Commissioned Services £0.7m unfavourable – Due to CAS £0.2m and Referral Management Centre £0.5m. Prescribing (£0.3m) Unfavourable – GP Prescribing budget is forecasted to over spend by £0.2m and Central drugs are forecasted to over spend by £0.1m.

  40. SUMMARY OF FOT VARIANCES (2) Primary Care Primary Medical Service (£0.2m) Favourable – This is predominantly due to savings from baseline payments due to list reduction and also due to decreased payments than budgeted in areas such as seniority and parental leave payments. There is also savings from termination of SLA with Out of Hours provider. These savings are offset by non achievement of QIPP in walk in centre redesigning & PBC LIS. Dental Contract (£0.4m) Favourable– This is due to the contract claw back for non achievement of dental targets for 10/11. Pharmacy Contract (£0.2m)Unfavourable – As per Community Pharmacy Contractual funding changes for 11/12 and expenditure trend for April to December. Ophthalmic Contract (£0.2m) Unfavourable – This is due to QIPP targets not expected to be met and also due to increase in the activity related payments. Estates (£0.2m) Favourable – This position is due to surplus depreciation budget in Community Estates which is now not required. This is balanced by FOT over spends across sites including Alexandra Avenue, Kenmore Lane, Elmwood Ave, Wealdstone, Waverley and Pinn Medical Centre due to a number of reasons including increased utility costs. Corporate Costs (£0.04m) Favourable - The Recharge from Brent is expected to be under spent. Public Health (£0.06m) Favourable – There are expected under spends in HIV, childhood Imms, LSG Public Health and Health Checks. Contingency / Reserves £2.6m unfavourable – Net pressure of the Heights offset by release of prior year accruals.

  41. CAPITAL FORECAST OUTTURN • The capital programme of £475k, as approved by the sub-Cluster capital and estates group, is forecast to be breakeven. The following budgets are expected to be fully utilised. • Boiler Room Replacement Carol Thomas £54.5k • Boiler Room Replacement Belmont £54.5k • GP Computer Replacement Programme £126k • The Heights computers £20k • Capital Grant to EACH £45k • Capital Grant to COMPASS £175k

  42. APPENDIX A – FINANCIAL SCHEDULES

  43. NHS HARROW SUMMARY - MONTH 11

  44. ACUTE - MONTH 11

  45. JOINT WORKING - MONTH 11

  46. PRIMARY CARE - MONTH 11

  47. PRESCRIBING – MONTH 11

  48. COMMUNITY SERVICES - MONTH 11

  49. PUBLIC HEALTH – MONTH 11

  50. ESTATES – MONTH 11

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