Finance Report Month 3 2011-12. Jonathan Wise, Director of Finance & Performance. NHS HARROW FINANCE REPORT 11/12 - CONTENTS. Summary [Slides 3-7] M3 Position [Slides 8-25] Forecast outturn position [slides 26-29] Appendices Detailed finance schedules [Slides 30-40]. 2.
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Finance ReportMonth 3 2011-12
Director of Finance & Performance
OVERVIEW OF BUDGET POSITION AT MONTH 3
There has been a net reduction in the resource limit due to PCT contribution towards London Health Programmes and other levies net of allocations received for which budgets have already been created.
There has been a transfer of from issued budgets into Reserves as a result of contract finalisation.
SUMMARY OF YEAR TO DATE VARIANCES - MONTH 3
Explanations for the main variances are included on the following slide.
Acute Commissioning(£1.5m)unfavourable - Currently 8 out of the 23 acute contracts are showing overspends at month 3. The most material variances are overperformance reported at North West London Hospitals (£1.4m), Imperial (£0.2m), UCLH (£0.4m), Chelsea & Westminster £0.2m and underperformance at Barnet & Chase Farm £0.1m, Royal Free £0.1m, RHOH £0.1m, West Herts £0.1m, Great Ormond Street £0.1m, Hillingdon £0.1m and Royal Brompton £0.1m.
Other Acute Commissioning breakeven - This includes London Specialist Commissioning Group (Acute & Mental Health), Other Specialist Commissioning for Acute and Mental Health, Cost per Case, High Cost Drugs and Non Contracted Activities. At month 3 there is a breakeven position reflected.
Joint Working Commissioning(£0.1m) unfavourable - This relates to a Continuing care overspend of £0.1m.
Community Commissioning breakeven- 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.
Prescribing (£0.1m) unfavourable Unfavourable position at month 3 based upon April 2011 data.
Primary Care (£0.04m) unfavourable – Medical contracts are under spending by £0.1m. Dental contracts are overspending by £0.1m as the patient charge revenue collected is less than the month 3 target.
Estates Costs breakeven - This includes the various sites including Alexander Centre, The Heights and depreciation and cost of capital.
Corporate Costs breakeven - This includes the share of sub-cluster costs and turnaround support.
Public Health (£0.02m) favourable - This includes drugs & alcohol, LSG Public Health, Childhood Immunisation, Termination of Pregnancy, HIV and Health Promotion. The Childhood Immunisation is £0.02m under spent.
Analysis of (Over)/Under Performance by Point of Delivery (POD) (£’000)
The above table analyses 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 2 Performance Reports for each Trust forecasted to Month 3. A commentary on the month 2 position reported by Trusts is on the following slide.
Actions in the above table are due for review by the end of August or are ongoing.
Against the comparative period of April- May 11 , there is a decrease in activity of 7.4%. This excludes activity seen by the CAS services which is currently unreported on national returns.
Against the comparative period of April – May 11, there is an increase in activity of 5.6%.
Against the comparative period of April - May 11 , there is an decrease in activity of 0.4%. This excludes activity seen by the CAU services which is currently unreported on national returns.
Against the comparative period of April - May 11, there is an decrease in activity of 4.6%
The ACV undertakes a number of contract challenges each month including attribution checks, rule based checks such as Non-Paediatric Outpatients coded as Paediatrics, OP Attendances during period of admission etc. and clinical checks such as A&E re-attendance within 2 hours, multiple day cases on same day.
There will also be challenges relating to the 11/12 contract levers such as testing that the outpatient ratios and day-case to outpatient ratios have been calculated correctly, Planned Procedures with Thresholds charged correctly, emergency marginal rate adjustments calculated correctly, emergency re-admissions treated correctly.
In addition the ACV will measure the quality metrics included in acute contracts and apply the financial consequences of breaches where these have been agreed in the 11/12 contract.
At the time of this report there is no data yet available from the ACV on all the challenges they have raised relating to 11/12. However, for example, the expected yield from challenges raised to NWLHT for April 11 is £179k.
The PCT also undertakes attribution checks on non-contracted activity, high cost drugs and cost per case invoices.
N.B. Figures reflect month 2 data from providers
BETTER PAYMENT PRACTICE CODE (BPPC)
PSPP is being achieved in three out of four categories and very nearly achieved in the fourth.
Note: Figures include performance on commissioning (plus Harrow provider services invoices relating to 10/11)
SUMMARY OF FORECAST OUTTURN VARIANCES
Explanations for the main variances are included on the following slide.
Acute Commissioning (£0.8m) unfavourable – The FOT is shown as £0.8m overspent after adjusting for NWLHT challenges and contract adjustments and being offset by acute contract in-year risk acute reserves.
Other Acute Commissioning Breakeven– The FOT position is shown as breakeven.
Joint Working Commissioning (£0.5m) un/favourable – Due to part non-achievement of Mental Health repatriation QIPP scheme.
Community Commissioning Breakeven – Community Services contract - The FOT is also showing a breakeven position.
Primary Commissioning Services Breakeven The FOT is set at £0.2m favourable due to the effect of the achievement of QIPP savings (Referral Management Centre).
Prescribing (£1.04m) Unfavourable – Due to QIPP savings forecasted not to achieve.
Primary Care Primary Medical Service – (0.1m) Favourable – This is due tot the review of Out of Hours contract with Harmoni and issue of termination notice for the last 6 months.
Dental Contract Break Even – Based on 10/11 outturn and expenditure profile for Month 1 to Month 3.
Pharmacy Contract Break Even– Based on 10/11 outturn.
Ophthalmic Contract(£0.02m) Unfavourable – Based on 10/11 outturn, forecasted to have an unfavourable variance of £15k.
Estates Break-even - The most likely FOT is a breakeven position.
Corporate Costs Breakeven - The FOT is expected to be breakeven
Public Health Breakeven - The FOT variance is expected to be breakeven.
Reserves/Investments (£2.04) favourable – there is a forecast underspend on in-year investment to balance the overspends above.
Based upon the above analysis the worst case is for an overspend of between £1m-£2.5m. The potential best case reflects the non-utilisation of the risk reserve for Harrow held at Brent plus any further underspends on budgets and reserves.
NHS HARROW SUMMARY - MONTH 3
ACUTE - MONTH 3
PRIMARY CARE - MONTH 3
PRESCRIBING – MONTH 3
COMMUNITY SERVICES - MONTH 3
PUBLIC HEALTH – MONTH 3
ESTATES – MONTH 3
CORPORATE – MONTH 3
CONTINGENCY / RESERVES – MONTH 3