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Agenda Item 09 Enclosure CKWCB/12/58

Report To:

Cluster Board Meeting – 6 March 2012

Title of Report:

Financial Report

FOI Exemption Category: Open

Responsible Director:

Jonathan Molyneux, Director of Finance and Efficiency

Report Author and Job Title:

Jonathan Molyneux, Director of Finance and Efficiency

Executive Summary: Finance/Resource Implications: Risk Assessment:

This report summarises the month 10 financial position for NHS Calderdale, NHS Kirklees and NHS Wakefield District. As detailed within the report.

As detailed within the report.

Legal Implications:

Not applicable.

Health Benefits:

Not applicable.

Staffing/Workforce Implications:

Not applicable.

Outcome of Equality Impact Assessment:

Not applicable. Finance and Performance Group – NHS Calderdale

Sub Group/Committee:

Finance and Performance Group – NHS Kirklees Finance and Performance Group – NHS Wakefield District

Recommendation (s):

Cluster Board members are asked to note the content of the report.

1


Calderdale, Kirklees and Wakefield District Cluster Board Cluster Board Meeting 6 March 2012 1

Introduction Separate monthly finance reports are produced for each of the three statutory Primary Care Trusts (PCTs) and these are reviewed at the Finance and Performance Group for each PCT. These reports are available if required. This report summarises the financial position for the year to date, up to 31st January 2012 (Month 10). In addition to reporting the actual figures for the year to date it includes a forecast of the annual position. This report is the summarised report for the Cluster Board at month 10 and contains a forecast outturn position based on this.

2

Summary

The three PCTs are forecasting that they will all meet their key financial targets, including the income and expenditure surplus, by the year end. A summary of the relevant figures for the cluster and the individual PCTs is set out on the next page. The actual income and expenditure surplus at Month 10 is ÂŁ13M for the cluster, against a budget of ÂŁ12.3M and the forecast annual surplus is ÂŁ15M in line with the original budget.

The forecast is subject to a number of risks, only two of which at this stage may be critical to the achievement of these targets. The critical risks are;

financial challenges at Mid Yorkshire Hospitals Trust which could impact on PCT expenditure delivery of QIPP savings; Other risks are:activity performances against contract values prescribing costs variance to budget pressures on the pharmacy contract service pressures on continuing care costs delivery of running cost targets 2


Financial Summary at Month 10 - 2011/12 Income and Expenditure Month 10 Actual - Year to date Total £000

Calderdale £000

Kirklees £000

Wakefield District £000

Month 10 - year to date Income (RRL) Expenditure Surplus

1,408,910 1,395,895 13,015

296,650 293,662 2,988

570,926 563,768 7,158

541,334 538,465 2,869

12,313 (702)

2,988 0

6,917 (241)

2,408 (461)

Income and Expenditure - Annual Forecast Income (RRL) 1,694,675 356,027 Expenditure 1,679,675 352,427 Surplus 15,000 3,600

686,493 678,193 8,300

652,155 649,055 3,100

Budget surplus to date Variance (Favourable)

Budget surplus Variance (Favourable)

Annual Capital Expenditure Forecast Budget Variance (Favourable)

15,000 0

3,600 0

8,300 0

3,100 0

3,192 3,427 235

613 613 0

2,081 2,179 98

498 635 137

1,700,913 1,700,913 0

364,056 364,056 0

681,981 681,981 0

654,876 654,876 0

Annual Cash Allocation Forecast Budget Variance (Favourable)

Month 10 - Year to date Public Sector Payment Policy (by value) Non NHS creditors % % Actual 100.00 93.90 Target 95.00 95.00 Variance (Unfavourable) 5.00 (1.10)

3

% 97.07 95.00 2.07


3

Key Issues and Risks at Primary Care Trust

NHS Calderdale The Primary Care Trust is forecasting to achieve its target surplus as agreed with the Strategic Health Authority of £3.6M. The forecast position assumes that the contingency fund is fully utilised by the year-end and a spending plan is now in place to ensure that this happens The year to date position shows a surplus of £3M against a plan of £3M. Risks relate to:the potential for overtrading on acute contracts, although the majority of this risk is mitigated by the contract arrangements in place delivery of recurrent QIPP targets potential for prescribing costs to exceed budget NHS Kirklees The Primary Care Trust is forecasting to achieve its target surplus as agreed with the Strategic Health Authority of £8.3M. The year to date position shows an underspend of £241K after achieving the year to date target surplus of £6.9M. Risks relate to:the under achievement of QIPP plans in acute services potential overtrading on acute contracts evidenced by the forecast outturn at month 10 NHS Wakefield District The Primary Care Trust is forecasting to achieve its target surplus as agreed with the Strategic Health Authority of £3.1M. The year to date position shows an underspend of £461K after achieving the year to date target surplus of £2,408K. Risks relate to:as lead commissioner for Mid Yorkshire NHS Trust the Primary Care Trust is leading on discussions with the Trust and Strategic Health Authority regarding the Trust’s income assumptions and underlying financial position. Work to establish the total risk to the health economy is being finalised. Forecast outturn between the Trust and the Primary Care Trust’s differ at this stage but is expected to be agreed following current negotiations. the potential for over performance on acute contracts although mitigating action and contingency reserves are in place; 4


prescribing costs variance to budget; under achievement of QIPP targets; the pharmacy contract exceeding budget provided; the potential for continuing care costs to exceed budget provided; and utilisation of contingency reserves In summary, both NHS Kirklees and NHS Calderdale have moved to cover risks identified from agreed contingency reserves. NHS Wakefield District had previously reflected some of the risk in the opening budget position. Mitigation strategies are being put in place to offset the risk. It should be noted that the Strategic Health Authority has agreed the plans to utilise the non-recurrent 2% transformational funding. All 2% non-recurrent funding has now been returned to PCTs by the Strategic Health Authority. 4

Financial Position The following table details the summary financial position at month 10 and forecast outturn positions for each budget heading. The summarised financial position of each individual Primary Care Trust showing the financial performance against the key budget headings recognised by each individual Primary Care Trust is attached at Appendix 1. Calderdale, Kirklees and Wakefield District Cluster Board Month 10 Financial Position 2011/12

Commissioned Services Prescribing Pharmacy Contract Primary Medical Services Dental Services Opthalmic Services Headquarters Services Commissioning Intentions Specific Reserves Uncommitted reserve Non recurrent reserve Kirklees Community Health Services QIPP efficiencies - Calderdale QIPP efficiencies - Kirklees QIPP efficiencies - Wakefield Strategic Investment Fund (SIF) - Wake Management costs savings target CHFT contract risk sub total expenditure Surplus Total

Annual Budget to Expend to Variance to Budget date Date Date £000 £000 £000 £000 1,218,305 1,013,210 1,015,028 1,818 168,041 139,431 137,143 (2,288) 33,828 28,175 28,358 183 141,313 117,666 116,869 (797) 45,792 38,269 39,338 1,069 9,383 7,819 7,830 11 71,405 60,124 55,033 (5,091) 1,869 683 683 0 16,317 14,741 14,821 80 4,907 4,090 4,090 0 4,070 1,766 1,650 (116) (2) 1 139 138 (4,140) (3,450) (3,562) (112) (11,957) (8,718) (8,054) 664 (10,431) (9,138) (9,146) (8) (4,000) (4,000) (4,000) 0 (5,025) (4,072) (4,275) (203) 0 0 3,950 3,950 1,679,675 1,396,597 1,395,895 (702) 15,000 12,313 12,313 0 1,694,675 1,408,910 1,408,208 (702)

5

Forecast year-end variance £000 1,619 (2,004) 421 271 1,149 333 (3,016) 0 1,506 (1,647) (139) 2 0 1,229 161 0 115 0 0 0 0

Forecast year-end variance % 0.00 (0.01) 0.01 0.00 0.03 0.04 (0.04) 0.00 0.09 (0.34) (0.03) 0.00 0.00 (0.10) (0.02) 0.00 (0.02) 0.00 (0) 0.00 0


5

QIPP The table below summarises the total of the QIPP schemes across the CKW cluster. The detail of the individual Primary Care Trusts’ QIPP plans are attached at Appendix 2. NHS Calderdale is showing a forecast year-end position of breakeven against its QIPP plans. NHS Kirklees is forecasting to achieve its QIPP target at the year-end by identifying a number of additional areas where efficiencies can be made and are working towards achieving further savings in year to help manage the financial risk. NHS Wakefield is forecasting an under-achievement of £161K at the year-end on its QIPP plans mainly on primary care projects. This under-achievement is planned to be funded from contingency reserve within the month 10 position and therefore does not present a financial risk. The plans to achieve the running costs target are being met across the Cluster. Calderdale, Kirklees and Wakefield District Cluster Board Efficiencies at Month 10

QIPP Projects

Forecast year-end variance £000

Primary Care Projects

9,012

6,970

6,911

59

507

Community Care Projects

5,805

4,929

5,303

(374)

68

Acute Care Projects

9,362

7,538

6,279

1,259

1,215

Corporate HQ projects

2,216

1,868

2,268

(400)

(400)

133

0

0

0

0

Mitigations - Kirklees

0

0

0

(664)

(1,229)

Total QIPP Projects

26,528

21,305

20,761

(120)

161

Specialised commissioning Group

Running costs

Savings Running costs total

6

Target Target to Savings Variance savings date to date to Date £000 £000 £000 £'000

Target Target to Savings Variance savings date to date to Date £000 £000 £000 £'000 5,025 5,025

4,072 4,072

Statement of Financial Position (SOFP) 6

4,275 4,275

(203) (203)

Forecast year-end variance £000 0 0


Appendix 3 details the SOFPs of the three PCTs and movement in working balances from 1 April 2011 to 31 March 2012. 6

Recommendation The Cluster Board is asked to note: the content of the report; and the financial risks identified.

Jonathan Molyneux Director of Finance and Efficiency Calderdale, Kirklees and Wakefield District Cluster Board

7


Appendix 1 NHS Calderdale Annual Budget £000 Commissioned Services Prescribing Pharmacy Contract Primary Medical Services Dental Services Opthalmic Services Headquarters Services Specific Reserves Non recurrent reserve QIPP efficiencies Management costs savings target CHFT contract risk sub-total expenditure Surplus Total

259,325 34,425 6,480 28,375 9,673 1,891 15,159 3,000 139 (4,140) (1,900) 0 352,427 3,600 356,027

Budget to date £000 216,080 28,687 5,400 23,645 8,060 1,576 12,631 2500 116 (3,450) (1,583) 0 293,662 2988 296,650

Expend to Date £000 216,370 28,576 5,636 22,517 8,783 1,609 11,569 0 0 (3,562) (1,786) 3,950 293,662 2988 296,650

Variance to Date £000 290 (111) 236 (1,128) 723 33 (1,062) (2,500) (116) (112) (203) 3,950 0 0 0

Forecast year-end variance £000 144 (120) 307 (121) 814 33 560 (1,593) (139) 0 115 0 0 0 0

Forecast year-end variance %

0.06 (0.35) 4.74 (0.43) 8.42 1.75 3.69 (53.10) (100.00) 0.00 (6.05) 0.00 0.00 0.00 0.00

NHS Kirklees Annual Budget £000 Commissioned Services Prescribing Pharmacy Contract Primary Medical Services Dental Services Opthalmic Services Headquarters Services Specific Reserves Uncommitted reserve Kirklees Community Health Services QIPP efficiencies Management costs savings target sub-total expenditure Surplus Total

487,653 69,629 14,028 54,731 19,179 3,890 30,482 7,033 4,907 (2) (11,957) (1,380) 678,193 8,300 686,493

Budget to date £000 404,356 57,397 11,690 45,515 16,008 3,242 25,422 6,041 4,090 1 (8,718) (1,035) 564,009 6,917 570,926

Expend to Date £000 406,740 56,166 11,593 45,757 16,239 3,169 22,923 6,041 4,090 139 (8,054) (1,035) 563,768 6,917 570,685

Variance to Date £000 2,384 (1,231) (97) 242 231 (73) (2,499) 0 0 138 664 0 (241) 0 (241)

Forecast year-end variance £000 2,528 (884) (6) 286 198 300 (2,006) 0 (1,647) 2 1,229 0 0 0 0

Forecast year-end variance %

0.52 (1.27) (0.04) 0.52 1.03 7.71 (6.58) 0.00 (33.56) 0.00 (10.28) 0.00 0.00 0.00 0.00

NHS Wakefield

Commissioned Services Prescribing Pharmacy Contract Primary Medical Services Dental Services Opthalmic Services Headquarters Services Health and Social care Commissioning Intentions Specific Reserves Non recurrent reserve QIPP efficiencies Management costs savings target sub-total expenditure Surplus Total

Forecast Forecast Annual Budget to Expend to Variance to year-end year-end Budget date Date Date variance variance £000 £000 £000 £000 £000 % 471,327 392,774 391,918 (856) (1,053) (0.22) 63,987 53,347 52,401 (946) (1,000) (1.56) 13,320 11,085 11,129 44 120 0.90 58,207 48,506 48,595 89 106 0.18 16,940 14,201 14,316 115 137 0.81 3,602 3,001 3,052 51 0 0.00 25,764 22,071 20,541 (1,530) (1,570) (6.09) 0 0 0 0 0 0.00 1,869 683 683 0 0 0.00 6,284 6200 8,780 2,580 3,099 49.32 3,931 1650 1650 0 0 0.00 (14,431) (13,138) (13,146) (8) 161 (1.12) (1,745) (1,454) (1,454) 0 0 0.00 649,055 538,926 538,465 (461) 0 0.00 3,100 2,408 2,408 0 0 0.00 652,155 541,334 540,873 (461) 0 0.00

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Appendix 2

Calderdale

QIPP Projects

Target savings £'000

Target to Savings to Variance to date date Date £000 £000 £000

Forecast year-end variance £000

Primary Care Projects Medicines management

640

533

462

71

0

Community Care Projects Mental Health Continuing Care Procurement contract savingsa

400 500 100

333 417 83

192 758 100

141 (341) (17)

0 0 0

Non elective activity Elective activity High cost drug expenditure

1,000 1,000 500

833 833 417

833 833 383

0 0 34

0 0 0

Total QIPP Projects

4,140

3,449

3,561

(112)

0

Acute Care Projects

Running costs

Corporate contribution Running costs total

Target savings £'000

Target to Savings to Variance to date date Date £000 £000 £000

1,900 1,900

1,583 1,583

9

1,786 1,786

(203) (203)

Forecast year-end variance £000 0 0


Kirklees

QIPP Projects

Target savings £'000

Target to Savings to Variance to date date Date £000 £000 £000

Forecast year-end variance £000

Primary Care Projects Contracts

462

362

362

0

0

Dental

150

150

150

0

0

Medicines Management

3,200

2,039

2,353

(314)

(116)

Total Primary Care

3,812

2,551

2,865

(314)

(116)

Community Care Projects Mental Health Other and Provider services Public Health Total Community Care

1,400 1,691 96 3,187

1,044 1,338 96 2,478

1,139 1,338 96 2,573

(95) 0 0 (95)

130 0 0 130

1,389

690

0

690

1,389

IFRs

300

225

0

225

300

Evidence based protocols Minor Hand surgery

440 360

290 270

198 171

92 99

176 132

COPD & Heart Failure

232

180

180

0

0

PCI

199

144

144

0

0

Oxygen

105

72

0

72

105

22

16

0

16

0

Case Managers

300

225

75

150

150

Vunerable People

315

315

315

0

0

Falls & Bone Health

400

297

66

231

231

WheelChair

450

225

0

225

450

Walk in Patients

250

189

0

189

0

Paediatric usage

280

207

99

108

82

(1,800)

(1,024)

0

(1,024)

(1,800)

Acute total

3,242

2,321

1,248

1,073

1,215

Corporate HQ Projects

1,716

1,368

1,368

0

0

0

0

0

(664)

(1,229)

11,957

8,718

8,054

0

0

Acute Care Projects Clinical stop list

Chronic Pain

Other

Mitigations Total QIPP Projects

Running costs

Corporate contribution Running costs total

Target savings £'000 1,380 1,380

Target to Savings to Variance to date date Date £000 £000 £000 1,035 1,035

10

1,035 1,035

0 0

Forecast year-end variance £000 0 0


Wakefield

QIPP Projects

Target savings £'000

Target to Savings to Variance to date date Date £000 £000 £000

Forecast year-end variance £000

Primary Care Projects Extended prescribing

2,520

2,187

2,187

0

0

Total Primary Care

590 1,450 4,560

491 1,208 3,886

397 1,000 3,584

94 208 302

173 450 623

Community Care Projects Mental Health Interagency value Community Services Public Health Total Community Care

500 0 435 683 1,618

500 0 435 683 1,618

500 0 497 683 1,680

0 0 (62) 0 (62)

0 0 (62) 0 (62)

500 960 1,752 200 208 3,620

500 800 1,460 166 208 3,134

1,455 340 876 103 208 2,982

(955) 460 584 63 0 152

(1,356) 480 876 0 0 0

Corporate HQ Projects

500

500

900

(400)

(400)

Specialised commissioning Group

133

0

0

0

0

10,431

9,138

9,146

(8)

161

Enhanced service review Primary care

Acute Care Projects Admission and discharge criteria Incentivising primary care access Admission avoidance in primary care Negotiating lower prices Planned procedures not carried out

Acute Total

Additional £4M efficiency Total QIPP Projects

0

Running costs

Corporate contribution Running costs total

Target savings £'000

Target to Savings to Variance to date date Date £000 £000 £000

1,745 1,745

1,454 1,454

11

1,454 1,454

0 0

Forecast year-end variance £000 0 0


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