Finance Report Month 9 2011-12. Jonathan Wise, Director of Finance & Performance. NHS HARROW FINANCE REPORT 11/12 - CONTENTS. Summary [Slides 3-7] M9 Position [Slides 8-36] Forecast outturn position [slides 37-41] Appendices Detailed finance schedules [Slides 42-53]. SECTION 1 – SUMMARY.
Director of Finance & Performance
Explanations for the main variances are included on the following slide.
Acute Commissioning £1.8m unfavourable - Currently 10 out of the 23 NHS acute contracts are showing over-performance at month 8 (of greater than £50k). These are at North West London Hospitals (£3.5m), RNOH (£0.7m), Royal Brompton & Harefield (£0.8m), Chelsea & Westminster (£0.4m), Guys & St Thomas’ (£0.2m), Imperial (£0.4m), Royal Free (£0.6m), Moorfields (£0.2m), UCLH (£0.2m), Royal Marsden (£0.1).In addition there is over-performance at BMI (£0.3m) and a shortfall on acute QIPP stretch target (£0.9m) and underperformance at Hillingdon £0.1m and Whittington £0.1m. The overspend has been reduced to (£1.8m) after factoring in £6.4m of the annual in-year risk reserve of £6.9m.
Other Acute Commissioning £0.5m 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 material overspends are in High Cost Drugs (£0.2m) NCAs (£0.2m) and Cost per Case (£0.2m).
Joint Working Commissioning - £1m favourable - This relates to under spending on various services, which are detailed later.
Community Commissioning £1.2m 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 9 the favourable position is due to under spending on various services, which are detailed later.
Prescribing (£0.3m) unfavourable - Unfavourable position at month 9 relating to April to October 2011 data. Expenditure relating to month 8 and 9 is estimated based on PPA forecast expenditure for those months.
Primary Care (£0.1m) Unfavourable – Medical contracts are under spending by £0.1m due to savings from list reductions, seniority payments 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 0.3m due to higher payments for community pharmacists as per Community Pharmacy Contractual funding changes for 11/12. Ophthalmic contracts are over spending by £0.2m due to increased activity and QIPP target not being met.
Estates Costs (£0.07m) unfavourable - This includes the various sites including Alexandra Avenue, depreciation and cost of capital. The overall budget is over spent due to due to increased service costs, maintenance contracts and telephone costs across a number of sites including Alexandra Avenue, Kenmore, Waverley, Wealdstone and Pinn Medical.
Corporate Costs (£0.08m) favourable - This includes the share of sub-cluster costs, turnaround support and Clinical Commissioning. The under spend is due to additional budget added to the Turnaround support.
Public Health (£0.1m) 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 £0.06m, LSG Public Health of £0.02m, Public Health Performance of £0.03m and HIV of £0.03m.
General Reserve / Contingency (£0.4m) favourable - £0.4m of the £1.8m contingency budget has been factored into the year-to-date position.
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 8 Performance Reports for each Trust forecasted to Month 8. A commentary on material over performance at the month 8 position reported by Trusts is on the following slide.
The following tables reflect the latest available contract data from Trusts which is month 8
- outpatients 4.5% increase (excluding CAS services)
Against the comparative period of April-November 2010/11, there is an increase in activity of 4.5%. This excludes community outpatients activity seen by the CAS services which is currently unreported on SUS.
Against the comparative period of April – November 2010/11, there is an increase in activity of 9.7%.
Against the comparative period of April – November 2010/11 , there is an increase in activity of 2.1%.
Against the comparative period of April – November 2010/11, there is a decrease in activity of 2.5%
LSG Report is unavailable for Month 8 therefore the figures reported are based on Month 7
LSG Report depicts a favourable variance of £767k at month 7
Main areas of underperformance are Forensic MH, Haemophilia and Adult BMT however, Spinal is over-performing
Forensic MH is showing an underspend of £117k, Haemophilia £165k, and Adult BMT £127k, offset by an overspend of £64k on Spinal
FOT position at month 7, after risk share agreement is applied, is £146k favourable
N.B. Figures reflect Month 7 data
Joint Working Commissioning is showing a £1m under spending, and is made up of the following areas: –
- Continuing Care Adults is showing a £0.6m under spending. This is due principally to changes in spending in Nursing Care, Adult Mental Illness, Elderly and people with Physical Disabilities.
- Continuing Care Children is showing a £0.1m over spending. This is due principally to increased pressure on care packages.
- Intermediate Care is showing a £0.5m under spending. This is due principally to lack of use of spot placements for such care £0.2m, an under spending of £0.2m on Harrow Joint Finance and under spending of £0.1m on Minor Budgets.
- End of Life is showing an under spending of £0.04m in month 9.
- Mental Health Providers is showing an over spending of £0.07m in month 9.
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)
The following slides provide a scheme-by-scheme analysis of the QIPP programme
Explanations for the main variances are included on the following slide.
Acute Contracts £1.2m unfavourable – The FOT is shown as £1.2m unfavourable after extrapolating the in-year positions, adjusting for NWLHT challenges, contract caps and the partial utilisation (£4.5m out of £6.9m) of the acute contract in-year risk reserve.
Other Acute Commissioning £0.7m unfavourable – The most material variances projected are a £0.2m overspend relating to High Cost Drugs, a £0.3m overspend relating to Cost per Case Acute and an underspend of £0.2m on NCAs.
Joint Working Commissioning £0.8m favourable – The FOT is set at £0.8m favourable due to a projected under spending on Continuing Care (Adults) at £0.7m,a projected under spending of £0.2m on Intermediate Care (Spot Placements), a projected under spending of £0.2m on Minor Budgets and a projected under spending of £0.06 on End of Life. Mental Health SLA`s is showing a projected over spending of £0.2m, and Continuing Care (Children) is showing a projected over spending of £0.1m. Other budget headings are projected to break even.
Community Commissioning £0.7m favourable. – Community Services contract - The FOT is showing a projection of £0.7m 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, CLCH/Barnet Community Services shows a projected under spending of £0.1m,similar to the under spending on Non Commissioned Activity (NCA`s) An unfavourable variance of £0.4m is projected for the Ealing/ICO Harrow QIPP target, and unfavourable variance of £0.2m shown for Hillingdon Wheelchair Service.
Prescribing (£0.3m) Unfavourable – Forecasted £0.1m unfavourable from information
provided by PPA for October as per their forecast outturn and also over spend £0.2m from central drugs and other prescribing.
Primary Care Primary Medical Service – Breakeven – 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. 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 (£0.6m)Unfavourable – Based on DH prediction tool and as per Community Pharmacy Contractual funding changes for 11/12.
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 from 10/11.
Estates (£0.9m) Unfavourable – This is due to overspends across the sites including Alexandra Avenue, Kenmore Lane, Wealdstone, Waverley and Pinn Medical Centre due to a number of reasons including increased utility costs.
Corporate Costs Breakeven - The FOT is expected to be breakeven
Public Health (£0.15m) Favourable – This is due to Childhood Imms, Public Health Performance and LSG Public Health underperforming at this stage.
Reserves/Investments £0.4m favourable – £0.4m of the £2.5m contingency, investment and reserves budget has been factored into the forecast outturn position.