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Finance Report Month 9 2011-12. Jonathan Wise, Director of Finance & Performance. NHS BRENT FINANCE REPORT 11/12 - CONTENTS. Summary [Slides 3-7] M9 Position [Slides 8-37] Forecast outturn position [slides 38-41] Appendices Detailed finance schedules [Slides 42-53]. SECTION 1 – SUMMARY.
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Finance ReportMonth 9 2011-12 Jonathan Wise, Director of Finance & Performance
NHS BRENT FINANCE REPORT 11/12 - CONTENTS • Summary [Slides 3-7] • M9 Position [Slides 8-37] • Forecast outturn position [slides 38-41] • Appendices • Detailed finance schedules [Slides 42-53]
EXECUTIVE SUMMARY • The month 9 report includes performance against QIPP. The Month 9 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 34-37. Brent is now forecasting an over-achievement of £0.7m largely as a result of out of cluster acute contract savings, Planned Procedures with Thresholds and the UCC at Central Middlesex exceeding targets. • Overall at month 9 the position is £7.5m surplus against plan. The forecast outturn at month 9 is £10m surplus against the plan of £11.6m surplus (i.e. £21.6m in total). The additional £10m surplus will be carried forward and be used to meet Brent’s 12/13 Challenged Trust Board contribution. • The forecast assumes that currently uncommitted amounts of £2.1m within general contingency/reserves will be fully utilised in Q4. Potential commitments against the £2.1m include further investments in QIPP delivery, performance delivery and other priority investments. The forecast also assumes budget outturns as per current forecasts which are in the process of being validated and that no further unplanned allocations are received. Discussions are also on-going with the Cluster regarding the forecast outturn, in the context of the Cluster-wide position.
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 • GPCE Delegated Budgets G G G G G G G G G G A A G G G G
SUMMARY OF MONTH 9 AND FORECAST OUTTURN • Year to Date Position • The year-to-date position at month 9 is £7.5m underspend, made up of underspends of £1.7m on joint working, £1.0m on prescribing, £0.9m on primary care, £0.9m on corporate budgets, £0.5m on public health, £0.2m on estates and £3.8m on reserves offset by overspends of £0.6m on community budgets and £0.9m on acute commissioning. • Forecast Outturn Position • The forecast outturn position is a £10m underspend against plan. This is made up of underspends of £1.9m on joint working budgets, £1.7m on prescribing, £1.3m on primary care, £0.6m on corporate budgets, £0.1m on estates, £0.3m on public health, £5.0m on contingency for Harrow offset by overspends on £0.7m on community budgets and £0.2m on acute commissioning. • GPCE Delegated budgets • At month 9 the GPCE delegated budgets are £0.7m underspent, made up of overspends on PbR outpatients of £0.9m and Harness elective inpatients of £0.4m and Community services of £0.2m offset by underspends on prescribing of £1.4m, direct access of £0.4m and contingency of £0.4m.
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 21.6 • 10/11 surplus carried forward (17.4) • Non-recurrent allocation items 2.3 • Non-recurrent expenditure 6.0 • 12.5 • The movement of the underlying position from M8 to M9 is set out below: • - M8 underlying position 13.4 • - increase in non-recurrent budget relating to dental 0.1 • - increase in benefit of cap on Imperial (1.0) • - M9 underlying position 12.5
OVERVIEW OF BUDGET POSITION AT MONTH 9 • The net budget increase of £0.3m from M8 to M9 is analysed below:
GP DELEGATED BUDGETS – MONTH 9 • The Year to Date position reflects Month 7 Expenditure projected to Month 9 • The Annual Budgets reflect the revised Annual Budgets as at Month 7
SUMMARY OF YEAR TO DATE VARIANCES - MONTH 9 Explanations for the main variances are included on the following slides.
SUMMARY OF YEAR TO DATE VARIANCES (1) Acute Commissioning (£0.6m) unfavourable - Currently 15 out of the 22 acute contracts are showing overspends at month 9. The most material variances are over-performance reported at Imperial (£1.2m), NWLHT (£0.8m), RNOH (£0.5m), Royal Brompton & Harefield (£0.9m), East & North Herts (£0.2m), Guys & St Thomas’ (£0.3m), Great Ormond Street (£0.3m), University College London (£0.7m), Chelsea & Westminster (£0.5m), Royal Marsden (£0.2m), Royal Free (£0.8m), Independent providers (£1.0m), Hillingdon (£0.1m), Ealing (£0.1m) and underperformances at Barnet & Chase Farm (£0.5m), St Georges (£0.1m), Whittington (£0.1m) and Kings (£0.1m). This gives a net £6.8m overspend against which £6.2m of the acute contract in-year risk reserve has been released resulting in a £0.6m overspend. Other Acute Commissioning £0.3m 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 9 the most significant variance is over performance in NCAs (£0.3m). Joint Working Commissioning (£1.7m) favourable – The principal under spending at month 9 are on:Continuing Care Children - £0.4m,Continuing Care Adult - £0.5m, Brent Carers £0.2m, End of Life £0.3m, Rehabilitation - £0.1m and Peel Road re-provision £0.2m Community Services (£0.6m) unfavourable - Community Services include community services, walk-in centres, STARRS and UCC-Care UK services. The £0.6m unfavourable position is due principally to the Ealing ICO/Brent Community Services QIPP which shows a £0.4m unfavourable position. There is also an overspending of £0.2m on the Walk in Centres, an overspending of £0.1m on STARRS and an overspending of £0.07m on TPN costs. UCC Care UK exhibits a favourable variance of £0.1m. Other budget headings are exhibiting variances which are not considered significant.
SUMMARY OF YEAR TO DATE VARIANCES (2) Prescribing (£1.0m) favourable - Favourable position at month 9 relating to April to October 2011 data. Expenditure relating to month 8 and 9 is estimated based on PPA forecasts. Primary Care (£0.8m) favourable – Medical contracts are under spending by £0.4m mainly due to list validation QIPP and also from Out of Hours budget. Out of Hours cost commissioned with Care UK is less than budgeted for inn 11/12. Dental contracts are under spending by £0.6m due to the claw back for non achievement of dental targets for 10/11 and higher than expected patient charge revenue collection. Ophthalmic contracts are over spending by £0.06m. Pharmacy contracts are over spending by 0.2m due to higher payments for community pharmacists as per Pharmacy Contractual funding changes for 11/12. Estates (£0.2m) favourable - This includes the cost of all the sites including depreciation and the cost of capital. There is an overspend on Willesden of £0.04m due to the cost of the service charge. Hillside is over by £0.02m and Chalkhill is over by £0.02m due to increased rates as these properties were re-valued this year and increased service charge. There are underspends on Monks Park of £0.01m, Sudbury of £0.01m and General Estates of £0.09m due to staff vacancies and the underspend on cost of capital and depreciation of £0.1m due to actual depreciation charge being lower than budget. Corporate Costs (£0.9m) favourable - This includes all the corporate cost centres, public health and the recharge costs from the Cluster and London-wide. There are underspends across the services due to vacancies and a lag in non pay spends across a range of headings plus £0.1m on London wide recharge. There is an overspend on Residual costs of £0.2m. Public Health (£0.5m) favourable – This includes public health commissioned services including Sexual health, Drugs and Alcohol Treatment and Smoking Cessation. Childhood imms/Hib is £0.06m overspend. Underspends exist on DAAT (£0.2m), Children & Family (£0.08m), Chlamydia Screening (£0.05m), Improving Breast feeding rates (£0.03m), Health Checks (£0.4m) and Health Promotion (£0.03m) due to a lag in the activity in the first half of the year. Overall the WeLRen service is underspent (£0.2m). Contingency for Harrow (£3.8m) favourable - £3.8m of the £5m contingency held for Harrow PCT has been released.
ACUTE CONTRACT MONTH 9 • Figures used are based on Month 8 Trust reports as reported by the ACV • 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 – budgets reflects latest position and advice from Acute Commissioning Vehicle for contract values and Trust reported figures for actuals. • Total YTD performance: £5,805k overspend on acute NHS contracts plus £985k overspend on independent sector contracts giving an overspend of £6,790k. With £6,176k of the acute in-year-risk reserve factored in the overall position is £614k overspent. • Forecast Outturn (FOT) position: Projecting the YTD position to year-end (including ACV challenges) gives an overspend of (£5.4m) (2.2%) on NHS Acute contracts. In addition, projecting the YTD overspend position to year-end on independent sector contracts (£1.2m) gives and overspend of £6.6m. After factoring in the £6.7m of the acute contract in-year risk reserve the FOT position is £0.1m underspent.
ACUTE CONTRACT POSITION – MONTH 9 The Year to Date Analysis is based on Month 8 Performance Reports for each Trust forecasted to Month 9 on a straight line basis. There are two Out-of Sector 11/12 contracts which have not yet been agreed, which are UCLH and Royal Marsden, as the lead commissioners have yet to agree a contract with these providers. Where the contract value is not yet available the month 9 position is based upon estimated values.
ACUTE CONTRACT POSITION – MONTH 8 The following tables reflect the latest available contract data from Trusts which is month 8.
ACUTE CONTRACT POSITION – MONTH 9 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 8 Performance Reports for each Trust forecasted to Month 9 on a straight line basis.
ACUTE CONTRACT POSITION - MONTH 9 • 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 20 and the following slides due to: • Slide 20 is expressed in financial variances and the following slides are expressed in activity. • Activity slides do not take into account case-mix and the impact of contract levers e.g. outpatient follow-up ratios • 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. Accident and Emergency is also not reflected in the Acute Activity Analysis graphs. • The following slides show actual activity changes year on year: • - outpatients 0.3% increase; • - elective admissions increase of 2.8%; • - non-elective admissions decrease of 4.2%; • - births decrease of 7.4%.
ACUTE ACTIVITY ANALYSIS (1) - OUTPATIENTS Against the comparative period of April- November 2010/11 , there is an increase in activity of 0.3%.
ACUTE ACTIVITY ANALYSIS (2) - ELECTIVE Against the comparative period of April – November 2010/11, there is an increase in activity of 2.8%.
ACUTE ACTIVITY ANALYSIS (3) – NON-ELECTIVE Against the comparative period of April – October 2010/11, there is a decrease in activity of 4.2%.
ACUTE ACTIVITY ANALYSIS (4) – BIRTHS Against the comparative period of April – November 2010/11, there is a decrease in activity of 7.4%
SPECIALIST COMMISSIONING – LSG REPORT M7 LSG Report is unavailable for Month 8 therefore the figures reported are based on Month 7 LSG Report depicts the YTD favourable position of £6k at Month 7 Main areas of risk as at month 7 are NICU, PICU and Forensic Mental Health – WLMHT Forensic Mental Health WLMHT is showing an overspend of £546k, NICU £360k, and PICU £361k FOT position as at month 7, after risk share agreement is applied, is £281k favourable
SPECIALIST COMMISSIONING – LSG REPORT SUMMARY N.B. Figures represent Month 7 data
JOINT WORKING VARIANCES – MONTH 9 Joint Working Commissioning is showing a £1.7m under spending, and is made up of the following areas: – Continuing Care Children (£0.5m) favourable – Favourable variance due to high number of transition to adulthood thereby reducing cost significantly and no new client intake Continuing Care Adult (£0.4m) favourable – Favourable variance due to low uptake in free nursing care and net decrease in care episodes in Adult Mental Health and Older Adults over 65 years of age Brent Carers – Favourable variance of £0.3m is due to lower spending and commitments in the service than budgeted End of Life (£0.3m) Favourable– Favourable variance of £0.3m is due to the late start of the Business Case Project (£0.2m) and underspends with Palliative Care Voluntary Sector Services (0.1m) Peel Road Re-provision/Social care – Favourable variance of £0.2m due to lower spend in reprovision
PRIMARY CARE VARIANCES – MONTH 9 • Prescribing (£1m) Favourable - Under spend relates to April to October 2011 GP prescribing and non GP Prescribing area such as prescribing support. • Primary Medical Service(£0.42m)Favourable - due to list validation QIPP and also from Out of Hours budget. Out of Hours cost commissioned with Care UK is less than budgeted for inn 11/12 • Primary Care Projects(£0.09m) Favourable – Majority of expenditure will be in the last quarter of the year. • Dental Contract (£0.60m) Favourable – due to the claw back for non achievement of dental targets for 10/11 and higher than expected patient charge revenue collection. • Pharmacy Contract (£0.2m) Unfavourable – Pharmacy contracts are over spending by 0.2m due to higher payments for community pharmacists as per Pharmacy Contractual funding changes for 11/12. • Ophthalmic Contract (£0.06m) Unfavourable – April to November activity was more than budgeted for and the month nine payments are estimated as per the trend.
CORPORATE COSTS VARIANCES - MONTH 9 • Corporate Services (£0.9m) Favourable – this variance reflects the vacancies within the structure of £0.4m, underspends on the non-pay budgets of £0.3m and higher than budgeted levels of income e.g. training of £0.02m. The Residual costs are showing an overspend of £0.2m, and London wide recharge is £0.1m underspent. • COMMUNITY SERVICES VARIANCES - MONTH 9 • Community Services (£0.6m) unfavourable The £0.6m unfavourable position is due principally to the Ealing ICO/Brent Community Services QIPP which shows a £0.4m unfavourable position. There is also an overspending of £0.2m on Walk in Centres, an overspending of £0.1m on STARRS and an overspending of £0.07m on TPN costs. UCC Care UK exhibits a favourable variance of £0.1m. Other budget headings are exhibiting variances including: Ealing/ICO Harrow Community Services being £0.06m under spent, UCC Rental Charge from NWLHT exhibiting a £0.04 over spending and Kilburn MSK £0.02m under spent.
PUBLIC HEALTH VARIANCES – MONTH 9 ESTATES VARIANCES - MONTH 9 • Estates (£0.2m) Favourable - There are underspends on General Estates (£0.1m) due to underspends on pay (£0.07m) and Cost of Capital (£0.1m) due to depreciation being lower than budget. There are overspend on, Hillside (£0.02m), Chalkhill (£0.02m) and Willesden (£0.04m) due to rates being higher than budget as the properties were revalued. • Public Health Services (£0.5m) Favourable – there are underspends on Improving Breast Feeding rates (£0.03m), Chlamydia Screening (£0.05m), Health Promotion (£0.03m) and Health Checks (£0.04m) due to a lag in activity in the first half of the year. There is an underspend on Children & Families –sexual health (£0.08m) due to reduced activity to achieve the QIPP target. There is an underspend on Drug and Alcohol (£0.2m) due to slippage on project spend. There is an overspend on Childhood Imms/Hib (£0.09m) due to better performance than budgeted. The overall WeLRen service is underspent (£0.2m).
BETTER PAYMENT PRACTICE CODE (BPPC) The PSPP target is being achieved in 1 out of 4 categories. The BCS figures relate to invoices processed in 11/12 relating to the 10/11 financial year.
QIPP PROGRAMME SUMMARY • . Total QIPP performance is as follows: • . The following slides provide a scheme-by-scheme analysis of the QIPP programme
QIPP PROGRAMME SUMMARY FOT • Full year plan = £13.9m • Current FOT = £14.5m • Main reasons for increase in Month 7 were due to the impact of PPwT and CMH UCC. • Total FYE of 11/12 performance = £15.8m including FYE impact of £1.3m • A slight decrease in QIPP performance in month 9 due to UCC CMH, STARRS (A&E) and End of Life projects.
SUMMARY OF FORECAST OUTTURN VARIANCES Explanations for the main variances are included on the following slide.
SUMMARY OF FOT VARIANCES (1) Acute Contracts Breakeven (£0.1m) favourable – The FOT represents a £5.4m forecast outturn overspend on NHS acute contracts, £1.2m overspend on Independent Sector contracts offset by £6.7m released from acute contract in-year risk reserve. Other Acute Commissioning (£0.5m) unfavourable– The main areas of variance are overspends High Cost Drugs (£0.1m) and NCAs (£0.4m). Joint Working Commissioning FOT position (£1.9m) favourable – The FOT variance is due to a £1.0m favourable variance in Adult Services (Brent Carers £0.3m, End of Life £0.3m,Peel Road re-provision £0.3m, Rehabilitation £0.1m), and a favourable variance of £0.9 in Continuing Care. Community Services FOT position (£0.7m) unfavourable - The £0.7m FOT unfavourable position is due principally to the Ealing ICO/Brent Community Services QIPP which shows a £0.4m unfavourable projected position and Walk in Centres showing an unfavourable projected position of £0.3m.Other budget headings contribute to the position but the projections are not considered significant. Prescribing (£1.8m) favourable - Forecasted favourable variance of £1.8m based upon information provided by PPA for November GP Prescribing
SUMMARY OF FOT VARIANCES (2) Primary Medical Service– (£0.8m) Favourable – Adverse QIPP variance of £137k is offset by list validation savings of £342k and Homeless QIPP savings of £41k.There is expected over spend in PCO Administration due to GP suspension, interpreting costs, parental leave payments and increased expenditure on Oxygen services. Favourable variances are expected from Walk in Centre income collection and Out of Hours services. Dental Contract - (£0.9m) Favourable - due to the claw back for non achievement of dental targets for 10/11 and also from higher than expected patient charge revenue collection. Pharmacy Contract – (£0.4m) Unfavourable - Based on 11/12 DH prediction tool and as per Community Pharmacy Contractual funding changes for 11/12. Ophthalmic Contracts – (£0.03m) Unfavourable – This position is due to increased activity related expenditure for sight test fees and supply of specs vouchers Estates – (£0.1m) favourable – This position is due to underspends against budget in general estates on both pay and non-pay. Corporate Costs – (£0.6m) Favourable–This position is due to underspends across the cost centres on pay due to vacancies to date and a lag in non-pay expenditure. Public Health Breakeven- (£0.3m) Favourable– This position is largely due to underspends on Drug and Alcohol of £0.2m due to surplus pay budget, Health Checks of £0.08m, Chlamydia Screening of £0.07m and Children & Families – sexual health of £0.09m against budget set. Contingency / Reserves – (£5.0m) Favourable – Made up of the £5m contingency held for Harrow. Capital - Break-even – There are two capital schemes; Wembley statutory and mandatory works for £1,076k, approved by NHS London, and Stag Lane statutory and mandatory works for £55k approved by the sub-Cluster capital and estates group. Both schemes are forecast to be breakeven at year-end.
