Month 2 Hammersmith & Fulham CCG Finance Report

12-July-16

Acronym Full Provider Name

ASP Ashford And St Peter's Hospitals NHS Foundation Trust

BLT Bart's Health NHS Trust

C&W Chelsea And Westminster Hospital NHS Foundation Trust

CLCH Central London Community Healthcare NHS Trust

CNWL Central And North West London MH NHS Foundation Trust

EHT Ealing Hospital NHS Trust

ESH Epsom And St Helier University Hospitals NHS Trust

GOSH Great Ormond Street Hospital For Children NHS Foundation Trust

GSTT Guys And St Thomas NHS Foundation Trust

HRCH Hounslow And Richmond Community Healthcare NHS Trust

HUH Homerton University Hospital NHS Foundation Trust

HWP Heatherwood And Wrexham Park Hosps NHS Foundation Trust

ICHT Imperial College Healthcare NHS Trust

KCH Kings College Hospital NHS Foundation Trust

KHT Kingston Hospital NHS Trust

MEH Moorefield's Eye Hospital NHS Foundation Trust

NWLHT North West London Hospitals NHS Trust

RBH Royal Brompton And Harefield NHS Foundation Trust

RMH The Royal Marsden Hospital NHS Foundation Trust

RNOH Royal National Orthopaedic Hospital NHS Trust

RSC Royal Surrey County NHS Foundation Trust

SGT St George's Healthcare NHS Trust

SLAM South London And Maudsley NHS Foundation Trust

SWL&StG South West London And St George's Mental Health NHS Trust

THH The Hillingdon Hospital NHS Foundation Trust

UCLH University College London NHS Foundation Trust

WHH The Whittington Hospital NHS Trust

WLMH West London Mental Health NHS Trust

WMUH West Middlesex University Hospital NHS Trust

Key message

The following acronyms are used throughout this pack.

Contract Acronyms

Acronyms

Executive summary Page Appendices Page

Executive summary 2 Appendix 1.1: Revenue resource limit 13

CCG finance dashboard 3

Risks and opportunities 4

Underlying position 5

Key issues and actions - financial position 6

Overall financial position Page

Surplus/deficit including running costs 7

Movement of variances including running costs 8

Reserves 9

Quality, Improvement, Productivity Plan 10

Capital, Creditor, Payments and Cash 11

Acute contracts: year to date performance 12

Contents

1

Status

Green

Risks and

opportunitiesGreen

Underlying

positionAmber

Contract

performanceGreen

QIPP Amber

Source: Team analysis

Reserves

Overall

financial

position

GreenThe CCG is holding reserves of £9.34m at month 2. These are largely committed eg to fund the NWL Strategy contribution, contingency and 1% uncommitted

required by NHSE. Those reserves available have been factored into the risks and opportunities assessment.

At month 2 the CCG is reporting a year to date surplus of £0.47m, which is slightly ahead of plan and is forecasting delivery of the planned £2.72m surplus.

Whilst it is early in the financial year, there are some emerging pressures to highlight:

(1) Continuing Healthcare Placement budgets are overspending by £0.12m at month 2 as both the average number of clients and average cost per client has

increased compared to 2015/16. A number of issues are causing this, specifically the weekly cap on St Vincent admissions and the proportion of H&F clients on

the highest RHND tariff.

(2) Community budgets are overspending by £0.15m year to date. This is mainly the waiting list initiative with Connect Health for the MSK backlog and is a

planned overspend. This is non recurrent and therefore not expected to affect the run rate.

(3) Acute contracts are underperforming by £0.17m year to date. This is based on activity data for only one month and so the position has not been extrapolated

into the forecast outturn which remains on plan. This will be reviewed next month.

The overspends that have emerged in the opening months of 2016/17 are currently being offset by underspends elsewhere in the position, and at this stage no

contingency funding has been required to balance the position.

The CCG has identified risks of £10.67m in the most likely case. Mitigations of £11.01m have been found locally. The CCG has an overall likely opportunity of

£0.34m and the range of risk is assessed to be an upside of £9.17m to a worsening in the forecast surplus of £8.88m.

The year to date contract position at month 2 is based on activity data received for month 1 extrapolated forward. Overall the acute contracts are

underperforming by £0.17m year to date. As this is only based on 1 month of data the forecast remains on plan but will be reviewed next month.

The forecast outturn reflects the QIPP position reported to NHS England which overall is below plan at month 2. The transformational schemes are showing

delivery of 69% in the year to date position. The QIPP forecast should be treated with caution as delivery relies on schemes yet to be identified, and non

recurrent measures of £2.69m.

Green

As the forecast outturn is on plan, there is no movement away from the planned underlying surplus of £6.29m. However, if we review the risk adjusted forecast

outturn this shows a significant worsening in the underlying position as the majority of risks faced are recurrent in nature and only managed in 2016/17 through

non recurrent mitigations. Action is required to manage the risks and strengthen the underlying position.

Executive summary

2

On plan

Take note

Action required

Indicator Target Actual

Rating this

month

Financial position year to date Agreed surplus £454k £475k 4.6%

Financial position forecast outturn Agreed surplus £2,722k £2,722k 0.0%

Running costs outturn £3,885k £3,885k 0.0%

Underlying position £6,293k £6,293k 0.0%

QIPP year to date £413k £327k (20.8%) variance from plan

QIPP forecast outturn £7,794k £7,794k 0.0% variance from plan

Risks and opportunities Risk/opportunity £0k £341k 0.0% net (risk) / opportunity outside reported position

Creditors - Better Payment Practice Code 95.0% 90.9% (4.3%) of invoice value paid in 30 days

Capital forecast outturn £850k £850k 0.0% subject to business case

Cash £42,700k £43,200k 1.2% variance from plan

Key

CCG Finance Dashboard

3

Key Message

Amount

£000s Probability £000s Probability £000s Probability £000s

Acute Commissioning Recurrent (3,961) 48% (1,884) -9% 338 100% (3,961)

Community Health Recurrent (1,832) 75% (1,376) 17% (320) 100% (1,832)

Community Health Non recurrent (150) 67% (100) 0% 0 100% (150)

Continuing Healthcare Recurrent (1,901) 68% (1,301) 53% (1,001) 100% (1,901)

Primary Care Non recurrent (645) 68% (439) 50% (323) 100% (645)

QIPP Recurrent (7,012) 76% (5,324) 70% (4,902) 100% (7,012)

Other Risks Non recurrent (500) 50% (250) 0% 0 100% (500)

Total (16,001) 67% (10,674) 39% (6,208) 100% (16,001)

Contingency Recurrent 1,408 100% 1,408 100% 1,408 100% 1,408

Non recurrent measures Non recurrent 5,991 74% 4,453 100% 5,991 49% 2,915

Other mitigations Recurrent 2,596 91% 2,353 100% 2,596 62% 1,598

Other mitigations Non recurrent 5,386 52% 2,800 100% 5,386 22% 1,200

Total 15,381 72% 11,014 100% 15,381 46% 7,121

Overall net (risk)/ opportunity (620) 341 9,173 (8,880)

This shows the potential risks and opportunities the CCG faces at M02 which are not yet reflected in the forecast outturn. Whilst the CCG is able to mitigate the

risks in year, the risks are largely recurrent with only non recurrent mitigations which will lead to a worsening of the underling position.

After the collaborative risk share there is a likely net opportunity of £0.34m.

Likely Case Best Case Worst Case

CCG Risks

CCG Opportunities

Recurrent / Non

recurrent

Risks and Opportunities

4.

Annual

BudgetFOT

Less Non

Recurrent

Items

Add Part

Year Effects

Underlying

PositionNon Recurrent / Part Year Items

Resource Allocation 272,209 272,209 (9,154) 0 263,055 Return of 15/16 surplus

Acute Contracts 136,743 136,743 0 0 136,743

Mental Health 34,501 34,501 (345) 0 34,156 £114k DPMS, £97k Perinatal uplift, £75k CAMHS OOH, £59k MST pilot

Community Health 32,005 32,005 (304) 0 31,701

Continuing Care 19,055 19,055 0 0 19,055

Prescribing 21,502 21,502 0 0 21,502

Primary Care 7,643 7,643 (527) 0 7,116 GP IT treated non recurrently

Other 14,153 14,153 (11,549) 0 2,604

Corporate Costs 3,885 3,885 0 0 3,885

Total Expenditure 269,487 269,487 (12,725) 0 256,762

Surplus/Deficit 2,722 2,722 3,571 0 6,293

Surplus/Deficit % 1.00% 1.00% N/A N/A 2.39%

Risk Adjusted Position

Impact

£'000s

Recurrent Net (risk) / opportunity (6,124)

Non recurrent Net (risk) / opportunity 6,464

Total net opportunity 340

Planned underlying surplus 16/17 6,293

Surplus after net recurrent risk 169

The underlying position shown below is the plan position, given at month 02 there has been no change in the forecast outturn for the CCG. The notes explain those items of spend which are planned to be non recurrent.

Key Messages

Expenditure

16/17 (£'000s)

£1361k contingency, £4206k NWLFS, £2677k 1% uncommited for NHSE

£236k Proactive care home pilot, £50k CIS mgt, £18k Homeless Health

However, if we consider the risks and opportunities identified on the previous slide it is clear that the risks are recurrent but the mitigations which will provide cover in 2016/17 are mainly non recurrent in nature.

Should these risks materialise it will have a significant impact on the undelying position, as shown below which reduces from £6.29m to £0.02m.

Underlying Position

5

Issue Key drivers Financial impact

YTD, £m

Action Owner Timeline

CHC

Overspend

Placements £0.11m adverse Review of the drivers of the variance and forecasting methodology Mary

Neckles /

Louise

Maile

July F&P

Acute over-

performance

LNWH and

OOA Trusts

£0.17m adverse The Operational Group have reviewed Acute performance at month 02 and

requested further information regarding the referrals being made to these Trusts

Shelley

Martin

July F&P

Act

ion

s

Key Issues and Actions Relating to Financial Position

6

5 6 8 9

Budget Actual Variance Budget Forecast Variance

Allocation Resource Limit 43,292 43,292 0 272,209 272,209 0 0 0

Acute Contracts 19,702 19,536 166 120,602 120,602 0 0 0

Other Acute Services 2,451 2,407 44 16,140 16,140 0 0 0

Total Acute Services 22,153 21,943 210 136,742 136,742 0 0 0

Continuing Care 3,176 3,290 (115) 19,055 19,055 0 0 0

Community Health 5,271 5,420 (149) 32,005 32,005 0 0 0

Mental Health 5,724 5,656 68 34,501 34,501 0 0 0

Prescribing 3,500 3,500 0 21,502 21,502 0 0 0

Primary Care 1,274 1,274 (0) 7,643 7,643 0 0 0

Total Non Acute Services 18,945 19,141 (196) 114,706 114,706 0 0 0

Commissioning Non Acute 107 110 (2) 644 644 0 0 0

Commissioning Reserves 0 0 0 4,919 4,919 0 0 0

Programme Projects 401 401 0 2,408 2,408 0 0 0

Other Commissioned Services 584 575 10 6,183 6,183 0 0 0

Total Other 1,093 1,086 7 14,154 14,154 0 0 0

Total Commissioning Spend 42,191 42,170 21 265,602 265,602 0 0 0

Running Costs Corporate Costs 648 648 0 3,885 3,885 0 0 0

Total Expenditure 42,838 42,817 21 269,487 269,487 0 0 0

Surplus/Deficit Position 454 475 21 2,722 2,722 0 0 0

Commissioned

Services

Key message

At month 2 the CCG is reporting a year to date surplus of £0.47m and is forecasting delivery of the planned £2.72m surplus.

Year to date (£'000s) Full year (£'000s) Forecast

Variance at

M1

Change in

FOT

Variance

Surplus/Deficit including Running Costs

7

Initiative Month 2 Month 1 Movement Month 2 Month 1 Movement Further detail

Acute Contracts 166 0 166 0 0 0 The acute contract position is based on Trust reported flex activity for April.

Acute Reserve 0 0 0 0 0 0

Other Acute Services 44 0 44 0 0 0 InHealth contract £48k underspent YTD

Continuing Care (115) 0 (115) 0 0 0 Data for M2 indicates YTD overspends on CHC Placements (£74k) and Phys Dis (£50k)

Community Health (149) 0 (149) 0 0 0 MSK YTD overspend - £138k non recurrent waiting list costs and £15k contract underfunded

Mental Health 68 0 68 0 0 0 Placements £49k underspend

Prescribing 0 0 0 0 0 0 To budget - annual phasing and April reports released in June

Primary Care (0) 0 (0) 0 0 0

Commissioning Non Acute (2) 0 (2) 0 0 0 Expert Patient Programme underfunded during budget setting

Commissioning Reserves 0 0 0 0 0 0

Programme Projects 0 0 0 0 0 0

Other Commissioned Services 10 0 10 0 0 0 Share of NHS 111 contract reduced in 16/17 due to reduction in population size

Corporate Costs 0 0 0 0 0 0

Total 21 (0) 21 0 (0) 0

Source: Financial ledger

Year to date variance (£'000s) Forecast outturn variance (£'000s)

Movement of Variances including Running Costs

8

Description

Reserve

16/17

£000

Recurrent

£000

Non-

Recurrent

£000

Comments

Contracts 1,699 1,699 0 Balance of contract settlement - final value tbc

Local reserve 1,127 513 614

Anticipated IATs (219) 0 (219) Resource transfer not yet actioned by NHSE

QIPP reserve (1,509) (4,199) 2,690

NWL Financial Strategy 4,206 0 4,206 Agreed contribution for 2016/17

General contingency 1,361 0 1,361 0.5% contingency held as per business rules

1% uncommitted reserve 2,677 0 2,677 1% held uncommitted as per NHSE guidance

Reserves Total 9,342 (1,987) 11,329

Reserves

Key Messages

The table below shows the reserves held by the CCG as at month 02, including the unidentified QIPP target. The reserves are largely committed, and where balances are

available these have been factored into the risks and opportunities assessment.

Reserves

9.

Area Plan Actual Variance Plan Actual Variance Comments

Acute Contracts 2 2 0 13 13 0

Mental Health 31 31 0 186 270 84

Community Health (6) 24 30 455 455 0

Total 27 57 30 654 738 84

Acute Contracts 67 38 (29) 407 407 0

Community Health 157 70 (87) 2,906 1,554 (1,352) Underdelivery of QIPP against CLCH contract

Prescribing 133 133 0 800 800 0

Other Commissioned Services 29 29 0 183 183 0

Total 386 270 (116) 4,296 2,944 (1,352)

Unidentified QIPP 0 0 0 2,844 1,422 (1,422) Assumes 50% will be identified

Non Recurrent Contingency 0 0 0 0 2,690 2,690 Release non recurrent QIPP contingency

Grand Total 413 327 (86) 7,794 7,794 0

Key Messages

The forecast outturn reflects the QIPP position reported to NHS England which overall is below plan at month 2. The transformational schemes are showing delivery of 69% in

the year to date position. The QIPP forecast should be treated with caution as delivery relies on schemes yet to be identified, and non recurrent measures of £2.69m.

YTD (£'000s) FOT (£'000s)

Transactional

Transformational

Quality, Improvement, Productivity plan (QIPP)

10

Capital • Grants with PID in progress: Parsons Green Health Centre £500k, Bridge House Centre for Health £250k, CCG IT Refresh £100k.

•

Invoice

Count

Invoice

Count

(Passed)

% Passed BPPC

Amount

Invoice

Amount

(Passed)

% Amount

Passed

NHS 472 439 93.0% 36,160 32,786 90.7%

Non NHS 1,591 1,498 94.2% 6,056 5,593 92.4%

Total 2,063 1,937 93.9% 42,216 38,379 90.9%

• Maximum Cash Drawdown Plan: £269.02m* Drawn Down to Date: £43.20m

Forecast Draw Down at Month 02: £42.70m Over Drawn: £0.5m

Source: team analysis

Key message

Cash

Creditor

payments

The CCG has not met the cumulative Better Payment Practice Code (BPPC) target for the invoice amount and invoice numbers. However the CCG has

met the NHS invoice number target. We are currently working with budget holders to ensure that invoices are coded and that outstanding queries are

dealt with promptly in order that invoices are paid within payment terms.

*The Maximum cash drawn (MCD) limit for 2016/17 is £269.02m as circulated by NHSE in the May 2016 cash report. This forecast is based on our planned net expenditure for

the year less any non cash expediture. The May 2016 cash report is showing a drawdown of £21.41m (£19.64m less drug prescribing). There was an over adverse variance

against planned cash drawn down year to date of £0.5m, this was due to extra cash requirement in oder that we settle outstanding prior year creditors. The forecast cash

drawdown is based on the Planned MCD of £269.02m.

Capital, Creditor Payments and Cash

80.0%

85.0%

90.0%

95.0%

100.0%

M01 M02

NHS Number

NHS Amount

Non NHS Number

Non NHS Amount

11

M1 SLAM

Provider Contract Status Actual (£k) Budget (£k) Actual (£k) Variance (£k) Budget (£k) Actual (£k) Variance (£k)

In Sector

Chelsea And Westminster Hospital NHS Foundation Trust CCG split TBC 2,835 5,647 5,499 148 34,387 34,387 0

Ealing Hospital NHS Trust Agreed 122 244 169 75 1,487 1,487 0

The Hillingdon Hospitals NHS Foundation Trust Agreed 49 98 89 9 588 588 0

Imperial College Healthcare NHS Trust Agreed 6,115 12,154 12,012 142 73,211 73,211 0

North West London Hospitals NHS Trust Agreed 59 117 160 (43) 721 721 0

Royal Brompton and Harefield NHS Foundation Trust Agreed 58 116 140 (24) 695 695 0

West Middlesex University Hospital NHS Trust CCG split TBC 36 73 87 (14) 443 443 0

Out of Sector

Guy's And St Thomas' NHS Foundation Trust Not agreed 106 211 260 (48) 1,417 1,417 0

King's College Hospital NHS Foundation Trust Not agreed 44 98 85 13 610 610 0

Moorfields Eye Hospital NHS Foundation Trust Agreed 57 114 136 (21) 684 684 0

Royal Free London NHS Foundation Trust Not agreed 32 66 72 (6) 414 414 0

St Georges University Hospitals Nhs Foundation Trust Not agreed 50 100 147 (47) 599 599 0

The Royal Marsden NHS Foundation Trust Not agreed 64 128 153 (25) 768 768 0

University College London Hospitals NHS Foundation Trust Not agreed 127 246 248 (2) 1,656 1,656 0

Other Out of Area Providers 82 289 278 12 1,736 1,736 0

Acute SLA Contract Total 9,836 19,702 19,536 166 119,416 119,416 0

Reserves

Acute SLA - Reserve 0 0 0 1,186 1,186 0

Grand Total 9,836 19,702 19,536 166 120,602 120,602 0

Key Messages

The year to date contract position at month 2 is based on activity data received for month 1 extrapolated forward.

Overall the acute contracts are underperforming by £0.17m YTD. As this is only based on 1 month of data the forecast remains on plan but will be reviewed next month.

The key in sector contracts have been agreed, however, the CCG split still needs to be finalised for C&W. Based on the current position below, the final contract values in aggregate have been settled

below envelope and enabled a reserve of £1.19m to be set to cover in year overperformance.

M2 YTD Position Full Year Outturn Position

Acute Contracts: Year to Date Performance

12.

Key Messages

Month Recurrent / non

recurrent

Allocation Confirmed

£'000s

Anticipated

£'000s

Total £'000s

Baseline Recurrent Initial CCG Programme Allocation 259,170 259,170

Baseline Non recurrent Return of Surplus/(Deficit) 9,154 9,154

Programme allocation total 268,324 0 268,324

Baseline Recurrent Initial CCG Running Cost Allocation 3,885 3,885

Running cost allocation 3,885 0 3,885

Total RRL 272,209 0 272,209

Source: Financial ledger

There was no change to the RRL in month 2.

Appendix 1.1: Revenue resource limit

13.