item 6.1 - may 09 finance and workforce board report

WEST SUFFOLK HOSPITAL NHS TRUST

FINANCE & WORKFORCE REPORT MAY 2009

Linda Potter, Director of Finance

Agenda item 6.1

2

West Suffolk Hospitals NHS Trust Finance & Workforce Report May 2009

Contents:

Executive Summary Income and Expenditure (Trust) Income and Expenditure (Directorate) Directorate Performance Summaries Balance Sheet Cash Flow CIP Summary Capital Report Appendix 1: Agency cost analysis

3


EXECUTIVE SUMMARYFINANCIAL PERFORMANCE REPORT

TWO MONTHS TO END MAY 2009

FINANCIAL PERFORMANCE SUMMARY

Current Actual 694K

Financial Position Budget 410K

Variance Favourable /

(Adverse)284K

CIP Target 782(savings) Actual 798

I&E Forecast Outturn Recurrent 3.0m as budget surplus

Retained 3.0m

Capital Plan FY 5.3m A major capital expenditure review is current being undetaken linked to the recent 6 facet survey on the Trust estate

Actual Ytd 232k Ependiture on clinical equipment and IM&T

Cash Current Balance 9.5m Creditors being paid promptly; all appropriate historic creditors now cleared, contract over-performance to March 09 paid by SPCT.

Forecast Balance 9.0m Subject to review following confirmation of SLA contract value

Working Capital/ Liquidity Debtors 5.1m Reduced from March due to settlement of PCT invoices

Creditors 17.2m Small increase on March position

Liquidity 17 Estimated days cover

Overall Financial Risk RatingFRR est 3

Key Budget Highlights

Risks & Opportunities

Savings targets are proactively monitored through F&PRG to ensure CIP targets are met.

Surplus. The actual financial position reflects highrer than anticipated income from the first two months contract income. Operational costs are on track with budget.

Budget surplus.

Contract income for May has been assumed to be similar to April pending the publication of May priced activity. Drug costs YTD are still high, although May drug costs were on budget. High cost drugs over and above the SLA value are recoverable via the SLA contract. Pay costs on budget, but include an increase in bank nurse costs in the month.

Slightly ahead of planned savings.

Peformance monitoring will be key to maintaining income and minimising contract penalties, regular review with PCT at SLA meeting.

The high cost drugs budgets (currently overspending) will be adjusted for over-performance following the completion of joint work between Finance and Pharmacy.

Pending updated model from SHA. However with an I&E surplus above plan, debtor/creditor positions similar to March 2009 and estimated liquidity days of 17 would indicate a rating of at least 3

The contract income includes provision for contract penalties, which at this early stage of the contract can only be an estimate.

The May postion reflects provisions for costs associated with Transformation and Foundation Trust project work

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INCOME AND EXPENDITURE ACCOUNT TWO MONTHS TO END MAY 2009

£000's Full Year Actual Budget Variance

Health AuthoritiesPrimary Care Trusts (126,804) (21,798) (20,497) 1,301

Other Patient related income (1,248) (260) (208) 52Income From Patient Activities (128,052) (22,058) (20,705) 1,353

Other Operating Income (11,606) (2,117) (1,945) 172

TOTAL INCOME (139,658) (24,175) (22,650) 1,525#REF! #REF! #REF!

NHS Staff 95,135 15,371 15,597 226Agency Staff 210 291 61 (229)

Total Pay 95,345 15,662 15,658 (4)

Drugs 9,852 1,764 1,637 (127)Supplies 11,346 1,787 1,864 77

Other Expenses 12,884 3,054 1,876 (1,178)Depreciation 4,237 706 706 0

Total Non Pay 38,320 7,311 6,083 (1,228)

TOTAL OPERATING EXPENSES 133,665 22,973 21,741 (1,232)

Finance Costs (PDC Dividend & Interest) 2,993 508 499 (9)

IN-YEAR SURPLUS/(DEFICIT) 3,000 694 410 284

Non Recurring Items 0 0 0 0

RETAINED SURPLUS/(DEFICIT) 3,000 694 410 284

YEAR TO DATEBUDGET

COMMENTS ON YEAR-TO-DATE VARIANCES:▪Contract income for May is estimated to be similar to April contract income value - the SLA income budget has been phased on the basis of last year actual profile. The high favourable variance is due to the prudent approach taken in setting the contract income budget.▪ Pay costs overall are on budget, though agency costs continue to be incurred to cover vacancies and absence both in medical and non-medical staff groups. ▪ Allocation of budget for high cost drugs, ambulance contract wil be completed when the SLA position is confirmed and May priced activity is available .▪ Total drug costs for May were just below budget at £0.8m, the cost of any additional high-cost drugs being recoverable through PCT contracts. ▪ The adverse variance on Other Expenses is due to the inclusion of provisions and the phasing of reserves budgets. This will also be reviewed on confirmation of SLA contract value.

I NCOME

EXPENDITUR

E

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DIRECTORATE INCOME AND EXPENDITURE ACCOUNTTWO MONTHS ENDING 31 MAY 2009

£000's Full Year Actual Variance Variance

Central Income (LDP/DoH) (126,193) (21,672) 1,276 (19)

Medical Services Directorate (3,036) (604) 83 66Clinical Support Directorate (1,675) (310) 29 12Surgical Services Directorate (2,154) (401) 56 12Facilities Directorate (2,636) (440) 1 8Woman and Child Services (912) (198) 46 (3)Operations Directorate (44) 0 (7) (4)Operational Directorates Total (10,457) (1,953) 208 91

Medical Director (311) (50) (2) (1)Finance and Information (133) (23) 1 0HR (84) (17) 2 5Nursing & Governance (123) (29) 1 (0)Trust Office (25) (4) 0 0Overheads (2,331) (428) 39 86Corporate Directorates Total (3,008) (551) 41 89

TOTAL INCOME (139,658) (24,175) 1,525 161

Medical Services Directorate 36,670 6,292 (210) (96)Clinical Support Directorate 22,125 3,664 14 28Surgical Services Directorate 34,656 5,715 (30) (51)Facilities Directorate 13,120 2,024 121 61Woman and Child Services 11,334 1,815 36 17Operations Directorate 827 127 6 7Operational Directorates Total 118,733 19,636 (63) (35)

Medical Director. 799 120 12 7Finance and Information 3,442 506 15 (0)HR 1,050 166 2 2Nursing & Governance 1,522 244 15 (3)Trust Office 1,470 199 17 13Overheads 9,643 2,609 (1,239) (196)Corporate Directorates Total 17,925 3,845 (1,178) (178)

TOTAL EXPENDITURE 136,658 23,481 (1,241) (213)

Current Year Surplus/ (Deficit) 3,000 694 284 (52)

Non Recurring Costs 0 0 0 0Profit and Loss on Disposal 0 0 0 0Repayment of Historical Deficit 0 0 0 0

Retained Surplus/(Deficit) 3,000 694 284 (52)

BUDGET YEAR TO DATE PREVIOUS MONTH

I NCOME

EXPEND I TURE

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PERFORMANCE SUMMARIES The following schedules show the financial and workforce performance for the whole Trust and each of the directorates. Activity variances are based on an estimated profile. Forecast outturn is assumed to match full year budget A detailed forecast will be available after the 1st quarter financial results and included in the July Finance Report The Budget adjustments for additional high cost drugs costs above the SLA value is not reflected in the month

variance stated, pending the completion of a project between Finance and Pharmacy.

Trust

The Trust has generated a surplus of £694K, £284K above budget. Pay costs on budget. Non-pay costs are generally on or below budget, except drugs and services from other Trusts.

Overall nursing costs are 0.6% below budget.

The Trust currently employs 2250.1 WTE staff, an increase of 9.0 WTE on last month.

There are currently 70.25 WTE (84 headcount) employees on maternity leave, compared to 42.95 WTE (54 headcount) for the same period last year.. There are several areas of the hospital where the high level of maternity leave could impact on service delivery and are therefore back filled through temporary staffing.

Green Variance at >0%Amber Variance at 0% >< -2%Red Variance at > -2%

TRUST Income PayNonPay Total

CIPS(Note)

SLA Income £000

SLAActivityNo.

EmployedWTE

SicknessRates (cuml.)

MatLeave

Vacancylevel (No.)

TempStaff %of Total Pay

Agency Staff(£000's)

NHS Loc/BankStaff (£000's)

Totalbudget£000

Forecast CIPs

ForecastSLA £000

ForecastActivityNo.

Cumulative £000's 1,525 (4) (1,237) 284 16 11,181 206,273 2250.1 3.5% 3.1% 209.75 5.8% 291 614 3,000 3,997 126,961 2,400,134 % Variance 7% 0% -16% 69% 2% 8.3% 5.7% -35% 0.0% 0.0% 0.0%% Variance Last month 1% 1% -8% -20% N/A N/A 2241.1 3.7% 3.0% 216.36 5.2% 145 260% Variance Last year(actual to actual) -13% 9% 31% #DIV/0! 16% N/A N/A 2183.4 4.3% 2.0% 122.18 6.3% 316 589 4,600 4,717 105,050 2,089,963

YTD Variance to plan SLA Income Workforce Full Year 0910

7


Surgery

• Income for the month was better than budget due to increased charges for medical staff to other Trusts of £27k and USAF (Tricare) income of £30k. Pay was £72k more than budget primarily as a result of medical agency staff £60K, Prof. & Tech agency cost £16k, but partially offset by £5k from vacancies. Non-Pay was £42k under budget due to drug savings £15k, hearing aids £26k, orthopaedic appliances £12k and £3k professional fees but an unplanned medical staff recruitment fee of £15k partially offset these savings.

•The Directorate continues to experience high levels of GP referrals necessitating additional outpatient sessions to manage demand, particularly within ENT and Oral Surgery. Referrals in other areas have reached a plateau but remain higher than capacity. New to follow up ratios are within acceptable limits. The majority of additional activity is within outpatients based on activity data.

•Sickness rates on the inpatients wards have improved but maternity leave continues to increase resulting in more backfill from bank staff to meet the current level of elective and emergency activity.

•The use of agency staff was £48k for junior medical staff (Gen. Surgery, Urology, T&O, ENT) and £12k for consultants (Anaesthetics). A further £15k was for the plaster orderly in the Fracture Clinic (long term sick and subsequent retirement) and £5K Admin cover. Locum cost were £50k, primarily in Anaesthetics and Plastics for consultant cover and bank usage was £56k for nurses and medical secretaries to cover sickness, maternity leave, bank holidays, and vacancies.

SURGERYOther Income Pay

NonPay Total

CIPS(Note)

SLA Income £000

SLAActivityNo.

EmployedWTE


MatLeave

Vacancylevel (No.)




Totalbudget£000

Forecast CIPs

ForecastSLA £000

ForecastActivityNo.

Cumulative £000's 56 (72) 42 26 0 4,002 13,616 526.1 2.6% 3.2% 49.47 4.2% 80 106 32,502 976 42,784 134,163 % Variance 16% -2% 3% 0% 0% 15.1% 24.8% 6% 0.0% 0.0% 0.0%% Variance Last month 26% -2% 0% -1% N/A N/A 527.1 3.7% 3.1% 48.52 4.7% 57 48% Variance Last year(actual to actual) -302% 5% 4% -1% 63% N/A N/A 541.8 4.8% N/A 23.16 4.2% 27 150 30,542 565 39,150 122,625

YTD Variance to plan WorkforceSLA Income Full Year 0910

8


Medicine

• The Directorate was overspent by £96k in May 2009. • Directorate activity for the current financial year has not yet been published, therefore it is difficult to ascertain if some of this is due to over performance.• ‘Other Income’ was over recovered by £18k, due to increased charges out for consultants reflecting the Medical staff pay award – made in May and backdated to April. There were also unbudgeted charges to the PCT for staff involved in the Rapid Response Team.• Staffing costs were the biggest contributor to the overspend. Consultant vacancies in Gastroenterology, Oncology, Dermatology, Stroke and A & E have been covered by a combination of additional sessions, locum cover and agency costs. The continued increased demand for Rheumatology outpatients has necessitated additional outpatient sessions.• Agency expenditure was concentrated on filling Medical vacancies. The main areas using non-NHS staff were Accident and Emergency and junior on-take medical staff.• Nurse costs net of bank expenditure were underspent.• Non pay expenditure was overspent by £15k in the month – the costs of drugs exceeded budget by £8k primarily in Oncology and Haematology and Neurology, the majority of which can be reclaimed from the PCT as part of the high costs drugs excluded from tariff.• The Directorate incurred a one off cost of £6k related to advertising. Normally this is funded via HR, but local nursing staff were targeted as part of a successful recruitment drive.• Increased rental costs for the Mobile Angiography unit (reflecting a new, more resilient unit) have meant expenditure above budget. Income, will exceed the expenditure, is recorded centrally and therefore does not offset the costs to the directorate.

MEDICINEOther Income Pay

NonPay Total

CIPS(Note)

SLA Income £000

SLAActivityNo.

EmployedWTE


MatLeave

Vacancylevel (No.)




Totalbudget£000

Forecast CIPs

ForecastSLA £000

ForecastActivityNo.

Cumulative £000's 83 (70) (140) (127) 0 4,140 14,260 645.4 3.9% 4.5% 68.30 7.5% 93 256 33,635 1,116 53,325 143,139 % Variance 16% -2% -9% -2% 0% -4.5% 22.5% 19% 0.0% 0.0% 0.0%% Variance Last month 44% 1% -17% -1% N/A N/A 645.1 4.2% 4.4% 68.90 6.4% 34 110% Variance Last year(actual to actual) -181% 10% 18% 5% 42% N/A N/A 625.0 2.7% N/A 54.06 9.6% 200 205 28,331 782 37,447 125,359


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Clinical Support

• The directorate underspent this month by £3k: pay costs and income underspent, whilst nonpay overspent.• Income exceeded budget due to the continued support to EIT in A&E: involving both Physiotherapy and Occupational Therapy staff. • A consultant vacancy in Microbiology has been offset by additional PAs worked by the existing consultants and locum cover. New consultant due to take up post in September. Additional sessions in Radiology have meant net costs on consultants exceeded budget.• Vacancies in Physiotherapy, Occupational Therapy, Radiology and Pharmacy have meant significant pay underspends. Departments are having to resort to temporary agency cover as a measure to ensure continued service delivery pending appointments and students qualifying over the summer.• A drug overspend of £18k in the month, mainly in pharmacy is to be investigated.• Medical & Surgical costs exceeded budget by £17k, mainly in Endoscopy. A review of the expenditure has identified this is due to an increase in activity and the purchase a patient monitor. ( £4k )• Pathology equipment and materials were underspent by £19k, this was due to investigations into April 2009 expenditure. Subsequent adjustments have been made to contracts for blood products and the coagulation analyser.• Workload demand in Histopathology has meant that an increasing amount of work has had to be referred to an outside agency. In May this amounted to £10k. A new consultant recently approved by TEG, will address this longer term. • Services received continue to overspend. Addenbrookes charges in Radiology are expected to be settled immanently, addressing the current budget allowances which have been made to reflect this historical overspend. Additional provision has also been made for Speech and Language Therapy, anticipating additional costs for the Stroke/Thrombolysis service started in April.

CLINICAL SUPPORTOther Income Pay

NonPay Total

CIPS(Note)

SLA Income £000

SLAActivityNo.

EmployedWTE


MatLeave

Vacancylevel (No.)




Totalbudget£000

Forecast CIPs

ForecastSLA £000

ForecastActivityNo.

Cumulative £000's 29 119 (105) 43 0 756 173,420 426.8 3.8% 3.4% 44.44 5.0% 67 64 20,451 876 10,115 2,079,505 % Variance 10% 4% -11% 1% 0% -8.3% 2.6% 11% 0.0% N/A N/A% Variance Last month 9% 5% -9% 2% N/A N/A 419.7 3.7% 3.0% 49.91 5.4% 34 36% Variance Last year(actual to actual) -25% 11% 16% 11% -26% N/A N/A 406.6 4.8% N/A 52.81 4.7% 15 96 18,504 1,149 10,060 1,806,371


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Woman & Child

•The favourable variance to budget is driven mainly by £38.1k in vacant positions, 11.9k in lower drug cost, £3.3k less rent of clinic space, £9.8k in transport cost due to last year credits received, additional USAF income of £26.2k and £20.3k from EWTD funds. These savings were partially offset by extra session payments of £8.8k and £18.8k in bank usage.

•Sickness rates are improving but maternity leave remains high. Use of bank staff (£56.8k) reflects the four bank holidays in the period. Paediatrics have used agency staff to support the service. Locum staff (£27.6k) are being used to cover the vacancies for the hybrid consultants in Paediatrics although part of this cost is offset by additional EWTD income (£20.3k).

WOMAN & CHILDOther Income Pay

NonPay Total

CIPS(Note)

SLA Income £000

SLAActivityNo.

EmployedWTE


MatLeave

Vacancylevel (No.)




Totalbudget£000

Forecast CIPs

ForecastSLA £000

ForecastActivityNo.

Cumulative £000's 46 10 26 83 0 1,694 4,812 215.1 3.1% 3.6% 8.76 6.0% 10 89 10,422 304 20,736 43,326 % Variance 30% 1% 15% 5% 0% 0.5% 36.6% 4% 0.0% 0.0% 0.0%% Variance Last month -13% 1% 8% 2% N/A N/A 215.9 3.5% 3.6% 7.89 4.1% 4 31% Variance Last year(actual to actual) -542% 7% -7% -4% 76% N/A N/A 191.9 5.1% N/A 32.56 5.8% 17 73 10,006 1,422 14,157 35,633


11


Facilities

Income has evened out from April and is now on budget.

PaySSD (£6k) – vacancy on hold.Housekeeping (£45k) – additional bank & agency staff for continuation of enhanced clean.Facilities Admin (£11k) – phasing of vacancy for Director post.

Non Pay is generally under spending across the directorate as some non essential spend is being held until July as requested. Some key areas of under spend are as follows:Estates (£50k), HRS (£5k), EBME (£34k), SSD (£5k) & Purchasing (£5k) - service contracts, phasing of budget in line with timing of contracts is required.Utilities (£10k), lower tariffs & operation of CHP.Portering (£7k) – has incorrect credit, to be corrected.Switchboard (£5k) – telephone calls reduced by installation of GSM gateway (fixed calls to mobiles)

WorkforceSickness monitoring & return to work interview process is now established across the directorate and continues to reduce sickness/absence.

FACILITIESOther Income Pay

NonPay Total

CIPS(Note)

SLA Income £000

SLAActivityNo.

EmployedWTE


MatLeave

Vacancylevel (No.)




Totalbudget£000

Forecast CIPs

ForecastSLA £000

ForecastActivityNo.

Cumulative £000's 1 (29) 151 122 0 262.8 4.1% 0.7% 16.81 8.1% 5 87 10,485 367% Variance 0% -3% 15% 7% 0% 22% 0.0%% Variance Last month 4% -1% 12% 8% 260.2 4.0% 0.7% 20.36 5.4% 0 30% Variance Last year(actual to actual) -2% 1% 5% 2% -15% 255.26 3.4% N/A 25.85 7.5% 30 55 8,610 427


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Corporate

• Corporate report is a consolidation of Finance and Information, Human Resources and Communications, Medical Director, Nursing and Governance, Trust Office and Overhead Directorates. Reserves are excluded from this report.

• Agency and bank staff are being used in Finance, HR and the Nursing Directorate, but the overall pay variance is favourable.

• Both Income and Non Pay variances are favourable overall. Overheads have some unbudgeted non pay costs which are offset by additional income.

•The sickness and maternity rates remain below the overall Trust rates.

CORPORATEOther Income Pay

NonPay Total

CIPS(Note)

SLA Income £000

SLAActivityNo.

EmployedWTE


MatLeave

Vacancylevel (No.)




Totalbudget£000

Forecast CIPs

ForecastSLA £000

ForecastActivityNo.

Cumulative £000's 41 35 29 105 16 159.2 1.8% 0.3% 21.44 2.7% 16 12 15,912 343% Variance 9% 3% 4% 4% 15% 172% 0.0%% Variance Last month 14% 2% 14% 14% 158.4 0.4% 0.3% 20.25 2.2% 7 5% Variance Last year(actual to actual) 44% 14% 17% 44% 56% 148.3 1.7% N/A 12.81 3.9% 27 9 5,852 346


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£000 MARCH 2009 May 2009

Forecast March 2010

FIXED ASSETS:Tangible assets 77,989 77,466 78,261TOTAL FIXED ASSETS 77,989 77,466 78,261

CURRENT ASSETS:Stocks 2,157 2,209 2,137Debtors 5,882 5,123 5,632Cash (incl petty cash) 5,862 9,468 9,161TOTAL CURRENT ASSETS 13,901 16,800 16,930

CREDITORS:Amounts falling due within one year (15,544) (17,216) (17,812)

NET CURRENT ASSETS/(LIABILITIES) (1,643) (416) (882)TOTAL ASSETS LESS CURRENT LIABILITIES 76,346 77,050 77,379

CREDITORS:Amounts falling due after more than one year (3,500) (3,500) (1,850)Provision for Liabilities and charges (393) (404) (379)

TOTAL ASSETS EMPLOYED 72,453 73,146 75,150

FINANCED BY:Public dividend capital 58,250 58,250 58,250Revaluation reserve 15,874 15,874 15,874Donated asset reserve 3,665 3,665 3,362Income and expenditure reserve (5,336) (4,643) (2,336)

TOTAL TAXPAYERS EQUITY 72,453 73,146 75,150Last Year Apr-09 May-09

Trade debtor days - NHS 3.7 3.9 6.0Trade debtor days - Non NHS 121.1 70.4 77.6Trade creditor days 12.8 16.7 5.1Non NHS invoices paid within 10 days (%) 2.8 46.1 42.8

KPI LY YTD FYDebtors as % of turnover 4.8% 7.8% 4.3%Creditors as % of operational expenses 13.3% 27.6% 14.2%Liquidity (days) 0 17 17

BALANCE SHEET AS AT 31 MAY 2009

The balance sheet reflects the position of the Trust as at 31 Mayl 2009. In line with Government request the Trust is paying SMEs within 10 days where possible. The current high level of cash reflects the receipt of overperformance invoices. No indexation of fixed assest has been assumed as there is insufficient guidance to determine what the likely change in values will be. The Trust will undertake a revaluation exercise during the year. This will be undertaken by professional valuers and is scheduled to be complete by July 2009

The decrease in the month represents the excess of depreciation over the additions in the month. The forecast does not allow for any revaluation of assets.

Stocks are in line with expectations. The stock value shows a slight increase in the month and this was mainly within pharmacy stock. Debtors have reduced since the year end as a result of the payment of some overperformance invoices.

The current high level of cash reflects the receipt of overperformance invoices in previous months. The level of surplus has enabled the Trust to pay creditors within 10 days without impacting on the level of cash..

Creditors are in line with expectations. Principal creditors are Trade £3.6m, Tax/NI/Pension £3.1, Vinci income £2.1m other deferred income £2.1m,loans £1.7m and accruals £4.6m

The balance at the year end represents the value of the new DoH loan that is outstanding after 1 year. The original loan is now all repayable within 1 year

The revaluation reserve has not moved. The Trust will be undertaking a revaluation of estate exercise during the year in accordance with guidance.

The movement in the year represents the forecast surplus for the year.

Debtor and creditor days are calculated on the basis of the balances on the debtor and purchase ledgers and comparing to the invoices raised in the month. They exclude any prepayments and accruals. Non NHS trade debtor days include USAF invoices that can take up to 120 days to resolve. The increase in the NHS debtor day figure is due to the CPH invoicing during May.

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West Suffolk Hospitals - Rolling cash forecast to 31 March 2011

£000

APRIL MAY JUNEQTR to JUNE

2009QTR to SEPT

2009QTR to DEC

2009QTR to MAR

2010FULL YEAR

2009/10 QTR to JUNE QTR to SEPT QTR to DEC QTR to MARFULL YEAR

2010/11

INCOME

BAL B/FWD 5,858 7,737 9,468 5,858 9,603 9,162 9,792 5,858 9,161 10,013 10,131 9,592 9,161

NHS Clinical Income 11,693 11,350 10,100 33,143 30,300 30,300 30,300 124,043 31,050 31,050 31,050 31,050 124,200

Other NHS Income 1,309 801 685 2,795 2,070 2,070 2,070 9,005 2,125 2,130 2,130 2,130 8,515

Loan/PDC advance 0 0 0 0 0 0 0 0 0 0 0 0 0

Income Generation 97 91 93 281 279 279 279 1,118 294 294 294 294 1,176

RTA 19 70 21 110 63 63 63 299 63 63 63 63 252

Interest 0 2 15 17 45 45 45 152 45 45 45 45 180

Misc Other 554 359 322 1,235 968 968 968 4,139 1,023 1,018 1,018 1,018 4,077

Disposal of Property 0 0 0 0 0 0 0 0 0 0 0 0 0

TOTAL INCOME 13,672 12,673 11,236 37,581 33,725 33,725 33,725 138,756 34,600 34,600 34,600 34,600 138,400

EXPENDITURE

Pay Costs 4,677 4,745 4,475 13,897 13,425 13,425 13,425 54,172 13,545 13,545 13,545 13,545 54,180

Tax/Pension 3,089 3,132 3,031 9,252 9,093 9,093 9,093 36,531 9,229 9,297 9,297 9,297 37,120

Creditors 2,555 1,632 1,923 6,110 5,769 5,769 5,663 23,311 5,448 5,448 5,448 5,338 21,682

Drugs/Stores/NHS Litigation 1,236 1,367 1,075 3,678 3,225 3,225 2,949 13,077 3,549 3,549 3,549 3,267 13,914

PDC Payments 0 0 0 0 1,372 0 1,372 2,744 0 1,364 0 1,364 2,728

Interest on loans 0 0 0 0 124 0 102 226 0 83 0 70 153

Capital expenditure 236 66 597 899 333 1,583 927 3,742 1,977 696 3,300 1,848 7,821

Misc 0 0 0 0 0 0 0 0 0 0 0 0 0

Repayment of loans 0 0 0 0 825 0 825 1,650 0 500 0 500 1,000

TOTAL EXPENDITURE 11,793 10,942 11,101 33,836 34,166 33,095 34,356 135,453 33,748 34,482 35,139 35,229 138,598

BALANCE C/fwd 7,737 9,468 9,603 9,603 9,162 9,792 9,161 9,161 10,013 10,131 9,592 8,963 8,963

FORECAST FORECAST

The cash flow forecast reflects the actual cash position as at 31 May 2009. The model takes account of the Department of Health loan including its repayment schedule and interest charges. The Trust is required to report against EFL however relaxation of rules allow for Trust's hold cash balances above it's EFL target. The figure for April includes the receipt of overperfomance on contracts up to the end of the financial year. Creditor payments were fairly low as the previous month figure was high as a result of moving to paying creditors quicker. May represents a more typical level of payments. Debtor payments were lower than the prevoius months.

ACTUAL FORECAST

15


2009/10 CIP REPORT as at 31st May 2009

COST SAVINGS ACHIEVED - To date TOTAL COST SAVINGS - Full year

Directorate £000 Target Actual Variance%

VarianceOriginal target

Projected Variance%

Variance Woman and Child 72 72 - 0% 304 304 - 0% Surgery 163 163 - 0% 976 976 - 0% Facilities 56 56 - 0% 367 367 - 0% Finance and Information 41 46 5 13% 115 115 - 0% HR and Communications 6 6 0 4% 18 18 - 0% Nursing and Governance 7 9 1 18% 7 7 - 0% Medical Director 1 1 0 17% 8 8 - 0% Trust Office 22 31 8 38% 34 34 - 0% Overheads 27 27 - 0% 160 160 - 0% Operations 12 12 0 1% 17 17 - 0% Clinical Support 186 186 - 0% 876 876 - 0% Medicine 189 189 - 0% 1,116 1,116 - 0%

TOTAL 782 798 16 2% 3,997 3,997 - 0%

SUMMARISED CIP TYPE COST SAVINGS ACHIEVED - To dateTOTAL COST SAVINGS -Target -

Full year (£'000s)

Projection

RecurrentNon-

recurrentRecurrent

Non-recurrent

Total

Target Actual Target Actual PAY 231 231 262 265 1,463 874 2,337 AGENCY/BANK 27 27 2 2 163 15 178 DRUGS 17 17 - - 101 - 101 CLINICAL SUPPLIES 21 21 - - 123 - 123 OTHER NON-PAY 186 194 34 34 1,114 133 1,247 IT COSTS 2 7 - - 12 - 12

TOTAL 483 497 299 301 2,975 1,022 3,997

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17


Appendix 1

AGENCY COSTS ANALYSIS (based on costs as at May 2009)

The following graphs illustrate the breakdown of agency expenditure incurred during the two months to May 2009

The analysis has focused on the Medical Agency costs as this is the largest area of agency expenditure incurred by the Trust.

The graphical information analyses the expenditure by the staff type, the location (department) and by the reason (type) for the agency expenditure

The Trust, as part of it’s budget setting process, does not generally set budgets for agency expenditure, unless there is a specific and long-term need for agency expenditure required.

The Trust to date is maintaining total pay costs to budget. The majority of agency costs is linked to covering vacant posts, with low agency cost associated with staff

absence.

18


Total pay is currently in line with total budget Total pay analysis show agency costs are currently 1.86% of total pay costs There are no agency nursing costs incurred by the Trust to date

Total Pay Analysis

10

11

12

13

14

15

16

Actual Budget

Mill

ions

Pay

cos

ts £

m Agency

NHS Staff

Agency Costs Analysis

0

50

100

150

200

250

300

350

Actual Budget

Thou

sand

sAg

ency

cos

t £k Other staff

Nursing staff

Medical staff

Graph 1 Graph 2

19


Graph 3 illustrates the majority of the budget is linked to substantive posts Locum costs are costs paid at NHS pay rates and are therefore not included as agency costs Graphs 3 and 4 illustrate only a small proportion of agency cost is planned

Medical staff cost breakdown

4,200

4,300

4,400

4,500

4,600

4,700

4,800

4,900

Actual Budget

Thou

sand

s£k

Agency

Locum

Substantive

Medical Agency Costs

0

50

100

150

200

250

Actual Budget

Thou

sand

s£k

Other Medics

Junior Drs

Consultants

Graph 3 Graph 4

20


Graph 5 indicates that consultant substantive and locum budget covers the costs of substantive locum and agency expenditure Graph 6 illustrates that almost all the consultant agency cost relates to covering vacant consultant posts Graph 7 indicates only several areas were expecting to have to fund agency costs; vacant posts are driving the remaining agency cost

Anal

ysis

of C

onsu

ltant

Cos

ts

2,20

0

2,30

0

2,40

0

2,50

0

2,60

0

2,70

0

2,80

0

2,90

0

3,00

0

3,10

0

Actu

al

Budg

et

Thousands

£k

CONS

ULTA

NTS

ADDI

TION

AL W

ORK

AGEN

CY C

ONS

VACA

NCY

COVE

RAG

ENCY

CON

SSI

CK L

EAVE

AGEN

CY C

ONS

STUD

Y LE

AVE

AGEN

CY C

ONS

EXTR

A CO

VER

AGEN

CY C

ONS

ANNU

AL L

EAVE

LOCU

MCO

NSUL

TANT

CONS

ULTA

NTS

Co

ns

ult

an

t A

ge

nc

y C

os

ts b

y L

oc

ati

on

0

20

,00

0

40

,00

0

60

,00

0

80

,00

0

10

0,0

00

12

0,0

00

Ac

tua

l B

ud

ge

t

£

An

ae

sth

eti

cs

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rob

iolo

gy

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ok

e

A&

E

Me

dic

ine

o

n-t

ak

e

GU

M

Ha

em

ato

log

y

Rh

eu

ma

tolo

gy

Co

nsu

ltan

t Ag

ency

co

sts

by

typ

e

0

20,0

00

40,0

00

60,0

00

80,0

00

100,

000

120,

000

Act

ual

Bud

get

£

annu

al le

ave

stud

y le

ave

sick

leav

eex

tra

cove

rst

aff v

acan

cy

Ove

rspe

nd

£90k

Graph 5 Graph 6 Graph 7

21


Graphs 8 and 9 illustrates that there is significant pressure on junior doctor costs with a large number of vacancies at junior doctor level.

Ana

lysi

s of

Jun

ior D

octo

r Cos

ts

1,25

0

1,30

0

1,35

0

1,40

0

1,45

0

1,50

0

1,55

0

Act

ual

Bud

get

Thousands

£k

Age

ncy

Jnr D

rE

xtra

Sic

k Le

ave

Age

ncy

Jnr D

rE

xtra

Stu

dyLe

ave

Age

ncy

Jnr D

rE

xtra

A/L

Age

ncy

Jnr D

rE

xtra

cov

er

Age

ncy

Jnr D

rV

acan

cy C

over

Locu

m J

nrD

octo

rs

Jnr D

octo

rs

Ove

rspe

nd £

68k

Jun

ior

Dr

Ag

ency

co

sts

by

loca

tion

0

20406080

100

120

Act

ual

Bud

get

Thousands

Uro

logy

EN

T

Gen

Sur

gery

T&O

Obs

tetr

ics

Pae

diat

rics

A&

E

Med

icin

e on

-tak

e

Jun

ior

Dr

Ag

ency

co

sts

by

typ

e

0

20,0

00

40,0

00

60,0

00

80,0

00

100,

000

120,

000

Act

ual

Bud

get

£

annu

al le

ave

stud

y le

ave

sick

leav

e

extr

a co

ver

staf

f vac

ancy

Graph 8 Graph 9 Graph 10

item 6.1 - may 09 finance and workforce board report

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