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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 BRENT FINANCE REPORT 11/12 - CONTENTS. Summary [Slides 3-7] M11 Position [Slides 8-37] Forecast outturn position [slides 38-41] 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 BRENT FINANCE REPORT 11/12 - CONTENTS • Summary [Slides 3-7] • M11 Position [Slides 8-37] • Forecast outturn position [slides 38-41] • 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 34-37. Brent is now forecasting an over-achievement of £0.2m 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 11 the position is £9.2m surplus against plan. The forecast outturn at month 11 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 position is unchanged since M10. However since month 10 the forecast position on issued budgets has improved by £1.2m due to the release of accruals in acute of £0.3m and primary care of £0.7m and £0.2m of other improvements. This has been offset by a reduction in reserves of £1.2m due to a revenue to capital transfer of £0.9m and issued budgets of £0.3m.

  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 • GPCE Delegated Budgets G G G G G G G G 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 £9.2m underspend, made up of underspends of £1.9m on joint working, £1.2m on prescribing, £2.4m on primary care, £2.0m on corporate budgets, £1.3m on public health, £0.2m on estates and £1.8m on reserves offset by overspends of £1.0m on community budgets and £0.6m 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, £2.6m on primary care, £1.7m on corporate budgets, £0.3m on public health, £0.2m on estates and £3.7m on reserves offset by overspends of £0.9m on community budgets and £1.2m on acute commissioning. • GPCE Delegated budgets • At month 11 the GPCE delegated budgets are £0.4m underspent, made up of overspends on PbR outpatients of £0.8m and Harness elective inpatients of £0.9m and Community services of £0.5m offset by underspends on prescribing of £1.6m, direct access of £0.5m and contingency of £0.5m.

  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 21.6 • 10/11 surplus carried forward (17.4) • Non-recurrent allocation items 5.4 • Non-recurrent expenditure 4.1 • 13.7 • The movement of the underlying position from M10 to M11 is set out below: • -M10 underlying position 13.5 • - movement in recurrent position 0.2 • - M11 underlying position 13.7

  8. SECTION 2 – MONTH 11 POSITION

  9. OVERVIEW OF BUDGET POSITION AT MONTH 11 • The net budget movement from M10 to M11 is analysed 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 slides.

  12. SUMMARY OF YEAR TO DATE VARIANCES (1) Acute Commissioning (£0.1m) unfavourable - Currently 11 out of the 24 NHS acute contracts are showing overspends at month 11. The most material variances are over-performance reported at RNOH (£0.6m), Royal Brompton & Harefield (£1.0m), East & North Herts (£0.1m), Guys & St Thomas’ (£0.3m), Great Ormond Street (£0.5m), University College London (£0.8m), Chelsea & Westminster (£0.4m), Royal Marsden (£0.1m), Royal Free (£1.0m), Independent providers (£1.1m), Hillingdon (£0.2m), Ealing (£0.1m) and underperformances at Barnet & Chase Farm (£0.6m), St Georges (£0.2m), North Middlesex (£0.1m), Whittington (£0.1m) and Kings (£0.1m). This gives a net £5.1m overspend against which £0.3m of prior year accruals and £4.7m of the acute contract in-year risk reserve has been released resulting in a £0.1m overspend. NWLHT and Imperial are shown as breakeven due to the impact of the cap. 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 11 the most significant variances are over performance in NCAs (£0.7m) and in Cost per Case (£0.3m). Joint Working Commissioning (£1.9m) favourable – The principal under spending at month 11 are on:Continuing Care Children - £0.6m,Continuing Care Adult - £0.2m, Brent Carers £0.3m, End of Life £0.3m, Rehabilitation - £0.1m,Peel Road re-provision £0.1m and other Mental Health slas’- £0.3m. Community Services (£1m) unfavourable - Community Services include community services, walk-in centres, STARRS and UCC-Care UK services. The £1m unfavourable position is due principally to the Ealing ICO/Brent Community Services QIPP which shows a £0.5m unfavourable position. There is also an overspending of £0.2m on the UCC Rental Recharge to Care UK, an overspending of £0.2m on TPN costs and £0.1m overspending on Walk-in Centres services. Other budget headings are exhibiting variances which are not considered significant.

  13. SUMMARY OF YEAR TO DATE VARIANCES (2) Prescribing (£1.2m) favourable - Favourable position at month 11 relating to April to December 2011 data. Expenditure relating to month 10 and 11 is estimated based on PPA forecasts. Primary Care (£2.4m) favourable – Medical contracts are under spending by £1.3m mainly due to list validation QIPP, from Out of Hours budget and also due to write backs of accruals done in the previous years for QOF. Out of Hours cost commissioned with Care UK is less than budgeted for in 11/12. Dental contracts are under spending by £0.7m 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 £0.05m. Pharmacy contracts are over spending by 0.2m due to higher payments for community pharmacists as per Pharmacy Contractual funding changes for 11/12. There is an under spend of £0.5m on primary care projects. 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 £0.07m due to the cost of the service charge. There are overspends on Hillside (£0.03m) and Monks Park (£0.03m) due to increased rates as these properties were re-valued this year and increased service charge. There are underspends on Chalkhill (£0.02m), Peel Road (£0.02m) and cost of capital and depreciation of £0.09m due to actual depreciation charge being lower than budget. The General Estates is under spent (£0.2m) due to the release of prior year accruals. Corporate Costs (£2.0m) favourable - This includes all the corporate cost centres, public health and the recharge costs from the Cluster and London-wide. There are under spends across the services due to vacancies and a lag in non pay spends across a range of headings. The London wide recharge was over-budgeted for by £0.5m. There are underspends on Chief Executives of £0.4m, ICT of £0.5m and other budgets of a net £0.6m. Public Health (£1.2m) favourable – This includes public health commissioned services including Sexual health, Drugs and Alcohol Treatment and Smoking Cessation. There are underspends on DAAT (£0.2m), Children & Family (£0.1m), Immunisation (£0.1m), Chlamydia Screening (£0.2m), Health Checks (£0.1m) Smoking Cessation (£0.2m), HIV TC Consortium (£0.1m) and WeLRen (£0.4m) offset by overspends on Childhood Imms (£0.1m) and sexual health (£0.1m). Contingency / Reserves (£1.8m) favourable-£1.8m of the £3.7m contingency/reserves has been released.

  14. ACUTE CONTRACT MONTH 11 Figures used are based on Month 10 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: £4.0m overspend on acute NHS contracts plus £1.1m overspend on independent sector contracts giving an overspend of £5.1m. With £4.7m of the acute in-year-risk reserve factored in the overall position and release of £0.3m of prior year accruals is £0.1m overspent. Forecast Outturn (FOT) position: Projecting the YTD position to year-end (including ACV challenges) gives an overspend of (£4.7m) (1.3%) on NHS Acute contracts. In addition, projecting the YTD overspend position to year-end on independent sector contracts (£1.3m) gives an overspend of £6.0m. After factoring in the £5.1m of the acute contract in-year risk reserve and £0.3m of prior year accruals 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 on a straight line basis.

  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 slides.

  17. ACUTE CONTRACT POSITION – MONTH 10 The following tables reflect the latest available contract data from Trusts which is month 10.

  18. ACUTE CONTRACT POSITION – MONTH 10

  19. ACUTE CONTRACT POSITION – MONTH 10

  20. ACUTE CONTRACT POSITION – MONTH 10

  21. ACUTE CONTRACT POSITION - 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: • Slide 16 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 1.3% increase; • elective admissions increase of 3.3%; • non-elective admissions decrease of 4.0%; • births decrease of 3.3%.

  22. ACUTE ACTIVITY ANALYSIS (1) - OUTPATIENTS Against the comparative period of April- January 2010/11 , there is an increase in activity of 1.3%.

  23. ACUTE ACTIVITY ANALYSIS (2) - ELECTIVE Against the comparative period of April – January 2010/11, there is an increase in activity of 3.3%.

  24. ACUTE ACTIVITY ANALYSIS (3) – NON-ELECTIVE Against the comparative period of April – January 2010/11, there is a decrease in activity of 4.0%.

  25. ACUTE ACTIVITY ANALYSIS (4) – BIRTHS Against the comparative period of April – January 2010/11, there is a decrease in activity of 3.3%

  26. SPECIALIST COMMISSIONING – LSG REPORT M9 LSG Report is unavailable for Month 10 therefore the figures reported are based on Month 9 LSG Report depicts the YTD unfavourable position of £551k at Month 9 Main areas of risk as at month 9 are NICU, PICU and Forensic Mental Health – WLMHT At Month 9 Forensic Mental Health WLMHT is showing an overspend of £615k, Burns £247k, NICU £477k, and PICU £545k offset by underspends in CAMHS – Priory £213k, Haemophilia £114k, Neuro Rehabilitation £194k, SCBU £275k, Child & Adolescent £132k, HIV £133k, MH for the Deaf £97k and Spinal £329k FOT position as at month 9, after risk share agreement is applied, is £551k favourable

  27. SPECIALIST COMMISSIONING – LSG REPORT SUMMARY N.B. Figures represent Month 9 data

  28. JOINT WORKING VARIANCES – MONTH 11 Joint Working Commissioning is showing a £1.9m under spending, and is made up of the following areas: – Continuing Care Children (£0.6m) favourable – Favourable variance due to high number of transition to adulthood thereby reducing cost significantly and no new client intake. Continuing Care Adult (£0.2m) 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. End of Life – Favourable variance of £0.3m – The favourable variance of £0.4m is due to the late start of the Business Case Project (£0.2m) and underspends with Palliative Care Voluntary Sector Services (0.2m). Peel Road Re-provision/Social care (£0.1m) – Favourable variance of £0.1m due to lower spend in reprovision. Other Mental Health SLAs (£0.3m) – Favourable variance of £0.14m in specialist commission after risk share and £0.16m in cost per case due to low activity.

  29. PRIMARY CARE VARIANCES – MONTH 11 Prescribing (£1.2m) Favourable - Under spend relates to April to December 2011 GP prescribing and non GP Prescribing area such as prescribing support. Primary Medical Service(£1.4m)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 in 11/12. There is also under spend in the PCO managed services such as sickness& maternity payments. Under spend is also due to the write back of accruals which was not required in prior years. Primary Care Projects(£0.5m) Favourable – Majority of expenditure will be in the last 1 month of the year. Dental Contract (£0.8m) 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 (£0.1m) Unfavourable – April to January activity was more than budgeted for and the month eleven payments are estimated as per the trend.

  30. CORPORATE COSTS VARIANCES - MONTH 11 • Corporate Services (£2.0m) Favourable – this variance reflects the vacancies within the structure of £0.6m, underspends on non-pay budgets of £1.4m. • COMMUNITY SERVICES VARIANCES - MONTH 11 • Community Services (£1m) unfavourable The £1m unfavourable position is due principally to the Ealing ICO/Brent Community Services QIPP which shows a £0.5m unfavourable position. There is also an overspending of £0.1m on Walk in Centres due to higher activities and overspending of £0.2m on TPN costs. UCC Rental Charge exhibits an unfavourable variance of £0.2m.

  31. PUBLIC HEALTH VARIANCES – MONTH 11 ESTATES VARIANCES - MONTH 11 • Estates (£0.2m) Favourable - There are underspends on Peel Road (£0.01m), Chalkhill (£0.02m) and General Estates (£0.3m) due to surplus accruals.There are overspend on, Hillside (£0.03m), Monks Park (£0.03m) Willesden (£0.07m) due to rates being higher than budget as the properties were revalued. Public Health Services (£1.2m) Favourable – there are underspends on Chlamydia Screening (£0.2m), Health Checks (£0.1m) due to a lag in activity in the first half of the year. There is an underspend on Children & Families –sexual health (£0.1m) due to reduced activity to achieve the QIPP target. There is an under spend on Drug and Alcohol (£0.2m) due to surplus pay budgets. There are also underspends on other areas such as WeLRen (£0.4m) and Smoking Cessation (£0.2m).

  32. BALANCE SHEET AT 29 FEBRUARY

  33. 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.

  34. QIPP PROGRAMME SUMMARY • Total QIPP performance is as follows: • The following slides provide a scheme-by-scheme analysis of the QIPP programme

  35. QIPP PROGRAMME (1)

  36. QIPP PROGRAMME (2)

  37. QIPP PROGRAMME SUMMARY FOT • Full year plan = £13.9m • Current FOT = £14.0m • Main reasons for increase in Month 7 are due to the impact of PPwT and CMH UCC. • Total FYE of 11/12 performance = £15.9m including FYE impact of £1.9m • A slight decrease in QIPP performance in month 9 due to UCC CMH, STARRS (A&E) and End of Life projects. • A small decrease in QIPP performance in month 10 due to Community contract and End of Life projects. • A slight decrease from month 10 in QIPP performance due to decreased savings in LD repatriation and ACV projects.

  38. SECTION 3 - FORECAST OUTTURN

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

  40. SUMMARY OF FOT VARIANCES (1) Acute Contracts (£0.6m) unfavourable – The FOT represents a £4.7m forecast outturn overspend on NHS acute contracts, £1.3m overspend on Independent Sector contracts offset by £5.1m released from acute contract in-year risk reserve and £0.3m from prior year accruals. Other Acute Commissioning (£0.7m) unfavourable– The main areas of variance are overspends Cost per Case (£0.4m) and NCAs (£0.8m) offset by an underspend on specialist consortia of £0.5m Joint Working Commissioning FOT position (£1.9m) favourable – The FOT variance is due to a £1.2m favourable variance in Adult Services (Brent Carers £0.3m, End of Life £0.3m,Peel Road re-provision £0.1m, Rehabilitation £0.2m, Other Mental Health Slas’ £0.3m),a favourable variance of £0.8m in Continuing Care and unfavourable variance of £0.1m in Children & Families services. Community Services FOT position (£0.9m) unfavourable - The £0.9m FOT unfavourable position is due principally to the Ealing ICO/Brent Community Services QIPP which shows a £0.5m unfavourable projected position, and Walk in Centres showing an unfavourable projected position of £0.3m.Other budget headings - £0.1m contribute to the position but the projections are very minimal due to the net effect of the favourable and unfavourable variances. Prescribing (£1.7m) favourable - Forecasted favourable variance of £1.7m based upon information provided by PPA for December GP Prescribing

  41. SUMMARY OF FOT VARIANCES (2) Primary Medical Service– (£1.7m) Favourable – Adverse QIPP variance of £0.1m is offset by list validation savings of £0.4m.There is expected net under spend in PCO Administration of £0.1m from non recurrent PBC incentive budget. Favourable variances are expected from Walk in Centre income collection of £0.2m and Out of Hours services of £0.4m. Under spend is also due to the write back of accruals of £734k which was not required in prior years. Dental Contract - (£0.8m) 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 – (£0.3m) Unfavourable - As per Community Pharmacy Contractual funding changes for 11/12 and expenditure trend for April to December. Ophthalmic Contracts – (£0.06m) Unfavourable – This position is due to increased activity related expenditure for sight test fees and supply of specs vouchers Primary Care Projects – (£0.5m) Favourable – This is due to underspend on the primary care business case. Estates – (£0.2m) favourable – This position is due to underspends due to the release of surplus accruals and surplus budget in Cost of Capital/depreciation. Corporate Costs – (£1.7m) 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 and an underspend on London Wide Recharge. Public Health Breakeven- (£0.3m) Favourable– This position is largely due to underspends on HIV TC Consortium of £0.1m, Health Checks of £0.8m,Children & Families – sexual health of £0.1m and Chlamydia of £0.2m. Contingency / Reserves – (£3.8m) Favourable – £3.8m is the remaining contingency / reserve budget which is forecast to be unutilised. 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 fully spent at year-end.

  42. APPENDIX A – FINANCIAL SCHEDULES

  43. NHS BRENT 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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