month 8 hammersmith & fulham ccg finance report … · status green risks and opportunities...
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Month 8 Hammersmith & Fulham CCG Finance Report
10-January-17
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 Contracts performance Page
Executive summary 2 Acute contracts: year to date performance 14
CCG finance dashboard 3 Acute provider finance performance - ICHT 15
Risks and opportunities 4 Acute provider finance performance - C&W 16
CWHHE Risk Share 5 Key issues and actions - C&W 17
Underlying position 6 Community Contract Performance - CLCH 18
Community YTD Service Line Performance - CLCH 19
Community YTD Service Line Performance vs 15/16 - CLCH 20
Overall financial position Page Appendices Page
Surplus/deficit including running costs - YTD 7 Appendix 1.1: Revenue resource limit 1.1
Surplus/deficit including running costs - FOT 8 Appendix 2.1: RAG rating definitions 2.1
Movement of variances including running costs 9 Appendix 3.1: Primary Medical Services - NW London 3.1
Corporate Expenditure 10 Appendix 3.2: Primary Medical Services - H&F 3.2
Reserves 11
Quality, Improvement, Productivity Plan 12
Capital, Creditor, Payments and Cash 13
Contents
1
Status
Green
Risks and
opportunitiesAmber
Underlying
positionRed
Contract
performanceAmber
QIPP Red
Source: Team analysis
Reserves
Overall
financial
position
At month 8 the CCG is reporting the year to date surplus on plan and is forecasting delivery of the planned £2.72m surplus. The key movements to highlight this
month are as follows:
GreenThe forecast position includes the full £4.19m QIPP gap for 2016/17. £2.51m reserves have been retained as they cover existing commitments. All other
available reserves have now been released to support delivery of the CCG planned surplus. £2.04m contingency has retained in the forecast to balance the
overall position.
(3) The estates budget has been adjusted this month to reflect the underspend on the CHP element of this budget. Additional budget had been included in the
position to fund the increased cost of rent relating to Parkview. CHP are now recovering these costs appropriately from tenants which has enabled the budget to
be released. This is a recurrent benefit of £0.64m and had previously been included in the risks and opportunities assessment.
In the most likely case the CCG has identified a net recurrent risk of £1.47m, mitigated by a net non recurrent opportunity of £0.57m. The CCG has a small
overall risk of £0.90m and the range is assessed to be an upside of £7.20m to a worsening in the forecast surplus of £5.55m.
The year to date contract position at month 8 is based on activity data received for month 7 extrapolated forward. Overall the acute contracts are overperforming
by £2.58m year to date with forecast overperformance of £4.95m. The largest YTD overspends are from C&W £1.13m, ICHT £0.59m and RBH £0.30m.
The YTD QIPP position is £1.14m below plan at month 8. The QIPP forecast of 32% underdelivery is after using non recurrent measures of £2.69m. A number
of the community schemes are showing underdelivery of savings in acute contracts.
Amber
The underlying position is a forecast surplus of £0.17m which is a worsening of £6.12m from the position in the operating plan and 5 year model. The movement
in acute and CHC has been offset by the improvement in property services, and is similar to the position reported at month 07.
(1) Acute contracts are overperforming by £2.58m year to date. This is based on activity data for April to October and there has been a deterioration of £0.62m
from the previous month. The acute reserve has been released pro rata to the YTD spend and this has reduced the overspend to £1.77m. The forecast outturn
is an overspend of £3.36m after mitigations.
(2) The community services forecast has worsened by £0.36m this month due to CIS and a pressure arising from the set up costs of the new service. In addition,
the value of the CLCH service provision which has now been decommissioned had been overstated in error. This has effectively reduced the funding available
for the new service and created an additional pressure of £0.08m. The pressure has been partially offset by a reduction in the forecast for the new community
cardio respiratory service of £0.26m based on activity to month 07.
(4) The YTD overspend across all areas is £5.32m and this has required the release of reserves and contingency to manage the position. Overall the forecast
has improved in month 8 by £1.42m including the benefit from the CHP budget and this has been offset by an increased contingency forecast.
Executive summary
2
On plan
Take note
Action required
Indicator Target Actual
Rating this
month
Financial position year to date Agreed surplus £1,815k £1,815k 0.0%
Financial position forecast outturn Agreed surplus £2,722k £2,722k 0.0%
Running costs outturn £3,841k £3,841k 0.0%
Underlying position £6,294k £174k (97.2%) variance from plan
QIPP year to date £4,216k £3,074k (27.1%) variance from plan
QIPP forecast outturn £7,795k £5,287k (32.2%) variance from plan
Risks and opportunities Risk/opportunity £0k (£898k) (5.0%) net (risk) / opportunity outside reported position
Creditors - Better Payment Practice Code 95.0% 94.4% (0.6%) of invoice value paid in 30 days
Capital forecast outturn £850k £850k 0.0% subject to business cases
Cash £179,690k £179,100k (0.3%) variance from plan
Key
CCG Finance Dashboard
3
Key Message
Amount
£000s Probability £000s Probability £000s Probability £000s
Recurrent
Acute Commissioning (5,632) 51% (2,878) 0% 0 100% (5,632)
Community Health (133) 50% (67) 0% 0 100% (133)
Continuing Healthcare (762) 30% (231) 5% (41) 61% (462)
Other risks (1,493) 62% (919) 0% 0 100% (1,493)
Subtotal Recurrent Risks (8,020) 51% (4,095) 1% (41) 96% (7,720)
Other mitigations 2,963 89% 2,626 100% 2,963 77% 2,288
Subtotal Recurrent Opportunities 2,963 89% 2,626 100% 2,963 77% 2,288
Net recurrent (risk) / opportunity (5,057) 29% (1,469) -58% 2,923 107% (5,432)
Non Recurrent
Community Health (895) 0% 0 0% 0 0% 0
Primary Care (117) 50% (59) 0% 0 100% (117)
Subtotal Non Recurrent Risks (1,012) 6% (59) 0% 0 12% (117)
Non recurrent measures 2,971 0% 0 100% 2,971 0% 0
Other mitigations 3,211 20% 629 41% 1,311 0% 0
Subtotal Non Recurrent Opportunities 6,182 10% 629 69% 4,282 0% 0
Net non recurrent (risk) / opportunity 5,170 11% 571 83% 4,282 -2% (117)
Overall net (risk) / opportunity 113 (898) 7,204 (5,549)
Risks
The review of risks and opportunities highlighted a potential favourable movement of £4.4m. Given this was a significant change from month 7 and the short timescale,
the decision was taken to review this in more detail and to hold the position at the previous month which was a net risk of £0.90m. The areas have been retained in the
analysis but with a 0% probability.
Area
Likely Case Best Case Worst Case
Opportunities
Risks
Opportunities
Risks and Opportunities
4GB
Month 8 Risk Share Enactment (included within forecast outturn)
Central London West LondonHammersmith and
FulhamHounslow Ealing CWHHE Total
Acute over performance above reserves 0 0 0 0 0 0
Support provided to balance FOT 0 0 0 0 0 0
Month 8 CWHHE R&O Summary
Central London West LondonHammersmith and
FulhamHounslow Ealing CWHHE Total
£000s £000s £000s £000s £000s Value
Acute over-performance (1,345) (389) (2,556) (1,439) (2,405) (8,134)
Other CCG risks (2,352) (9,520) (1,597) (4,358) (2,176) (20,003)
Total CCG level risks (3,697) (9,909) (4,153) (5,797) (4,581) (28,137)
Total CCG level opportunities 2,133 13,668 3,255 7,374 3,783 30,212
Net CCG (risk)/ opportunity (1,565) 3,758 (898) 1,578 (797) 2,076
Adjustments:
Acute over-performance Risk Share 0 0 0 0 0 0
Further SaHF commitments 0 0 0 0 0 0
Options for additional investment 0 0 0 0 0 0
Shared opportunities 0 0 0 0 0 0
Overall net (risk)/ opportunity (1,565) 3,758 (898) 1,578 (797) 2,076
Memo - acute over-performance in forecast out-turn (total)
£000 (5,717) (3,955) (4,741) (4,141) (11,612) (30,166)
Notes
No Risk share has been enacted in 2016-17
Notes
Please note this is based on potential risks and opportunities and has not been included in the actual financial forecast.
CCGs have a total net opportunity of £2.08m, with Central London, Hammersmith & Fulham and Ealing having a large net risk, offset by opportunities in the other 3 CCGs.
The memo above is included here to show acute over-performance has been reported in the actual forecast out-turn.
CWHHE - Risk Share
5
Annual
BudgetFOT
Less Non
Recurrent
Items
Add Part Year
Effects
Underlying
Position
Operating
Plan
Underlying
Position
Movement
Resource Allocation 266,970 266,970 (3,915) 0 263,055 263,055 0
Acute Contracts 135,997 138,124 (371) (700) 137,053 136,742 (311)
Continuing Care 19,055 21,131 (360) 569 21,340 19,055 (2,285)
Community Health 31,957 32,579 (1,386) 1,421 32,614 30,480 (2,134)
Mental Health 34,645 34,619 (598) 118 34,139 34,342 203
Prescribing 21,502 20,455 0 0 20,455 21,502 1,047
Primary Care 7,661 7,804 (128) 0 7,676 7,116 (559)
Other 9,590 5,694 25 0 5,719 3,639 (2,080)
Corporate Costs 3,841 3,841 44 0 3,885 3,885 0
Total Expenditure 264,248 264,248 (2,775) 1,407 262,881 256,761 (6,119)
Surplus/Deficit 2,722 2,722 (1,140) (1,407) 174 6,294 6,119
Surplus/Deficit % 1.02% 1.02% 0.07% 2.39%
(1,469)
(1,295)
Likely Net Recurrent Risk/Opportunity
Risk Adjusted Underlying Position
The underlying position is a forecast surplus of £0.17m which is a worsening of £6.12m from the position in the operating plan and 5 year model. The movement in acute and CHC has been offset by the improvement in property services, and is
similar to the position reported at month 07.
Key Messages
Expenditure
£3,033 recurrent QIPP gap still in position partly offset by uncommitted recurrent
investment reserve
£1,166k worsening due to increase in QIPP gap from CLCH SLA
Part year effect of QIPP investment ramp up throughout 16/17
Neuro Rehab overspend
16/17 (£'000s)
£3,359k worsening of SLA position after reserves
Part year effect of QIPP saving ramp up throughout 16/17
Recurrent underspends on InHealth & UCC
£527k GP IT previously treated as non recurrent
As per current forecast outturn
Envelope benefit
Worsening of placement position
Explanation of Movement
If we then consider the recurrent risk position identified on the previous slide, this would worsen the position by a further £1.47m, to a deficit of £1.29m.
Underlying Position
6
5 6 5 6 5 6
Variance Budget Actual Variance Budget Actual Variance Budget Actual Variance
Allocation Resource Limit 0 173,735 173,735 0 0 0 0 173,735 173,735 0
Acute Contracts (622) 79,742 82,325 (2,582) 817 0 817 80,559 82,325 (1,765)
Other Acute Services 150 9,507 8,927 580 0 0 0 9,507 8,927 580
Total Acute Services (471) 89,249 91,252 (2,003) 817 0 817 90,066 91,252 (1,186)
Continuing Care (66) 12,703 13,991 (1,288) 0 0 0 12,703 13,991 (1,288)
Community Health 121 20,596 21,086 (490) 189 0 189 20,785 21,086 (301)
Mental Health (66) 23,056 23,153 (97) 85 0 85 23,141 23,153 (12)
Prescribing 153 14,436 13,735 701 0 0 0 14,436 13,735 701
Primary Care 161 5,095 5,266 (171) 0 0 0 5,095 5,266 (171)
Total Non Acute Services 302 75,887 77,231 (1,344) 274 0 274 76,161 77,231 (1,071)
Other Commissioned Services 28 3,901 3,739 163 0 0 0 3,901 3,739 163
Commissioning Reserves (459) (2,138) 0 (2,138) 1,370 (2,862) 4,232 (768) (2,862) 2,093
Total Other (431) 1,763 3,739 (1,975) 1,370 (2,862) 4,232 3,133 877 2,256
Total Commissioning Spend (600) 166,899 172,221 (5,322) 2,461 (2,862) 5,322 169,360 169,360 (0)
Running Costs Corporate Costs (0) 2,561 2,561 0 0 0 0 2,561 2,561 0
Total Expenditure (600) 169,460 174,782 (5,322) 2,461 (2,862) 5,322 171,921 171,921 (0)
Surplus/Deficit Position (600) (5,322) 5,322 1,815 1,815 (0)
Note: All figures show in £'000s
Commissioned
Services
Key message
In-month
before
mitigations
Reported positionYear to date before mitigations Mitigations
The in-month position for month 8 is a worsening of £0.60m, and brings the YTD overspend to £5.32m. £2.14m is due to the unidentified QIPP being released into the YTD position as per the QIPP plan.
The mitigations brought into the position are highlighted below. The release of reserves and contingency has offset £2.46m of the overspend but leaves a balance of £2.86m. This has been managed through
the release of balance sheet gains, enabling the CCG to report on plan for month 8. The resulting forecast position is discussed on the next slide.
Surplus/Deficit including Running Costs - Year to Date
7
8 9
15/16
Outturn Budget Forecast Variance
Allocation Resource Limit 266,328 266,970 266,970 0 0 0
Acute Contracts 115,658 119,976 123,335 (3,359) (3,408) 49
Other Acute Services 16,806 16,021 14,789 1,232 749 483
Total Acute Services 132,464 135,997 138,124 (2,127) (2,658) 531
Continuing Care 18,812 19,055 21,131 (2,077) (2,030) (47)
Community Health 33,983 31,957 32,579 (622) (571) (51)
Mental Health 33,570 34,645 34,619 26 121 (95)
Prescribing 20,796 21,502 20,455 1,047 932 115
Primary Care 7,691 7,661 7,804 (143) (419) 277
Total Non Acute Services 114,852 114,820 116,588 (1,769) (1,967) 199
Other Commissioned Services 8,809 6,617 5,809 809 116 693
Commissioning Reserves (2,888) 2,972 (115) 3,087 4,510 (1,423)
Total Other 5,921 9,590 5,694 3,895 4,625 (730)
Total Commissioning Spend 253,238 260,407 260,407 0 0 (0)
Running Costs Corporate Costs 3,936 3,841 3,841 (0) (0) (0)
Total Expenditure 257,174 264,248 264,248 (0) 0 (0)
Surplus/Deficit Position 9,154 2,722 2,722 (0) (0) 0
Note: All figures show in £'000s
Commissioned
Services
Key message
The month 8 forecast assumes the overspends in acute and continuing care will worsen but these will be mitigated through the further release of contingency, reserves
and balance sheet gains. The detailed reserves position underpinning this forecast is shown on slide 9.
16/17 Full year Forecast
Variance at
M7
Change in
FOT Variance
Surplus/Deficit including Running Costs - Forecast Outturn
8
Initiative Month 8 Month 7 Movement Month 8 Month 7 Movement Further detail
Acute Contracts (2,582) (1,961) (622) (4,949) (5,008) 59See "Acute Contracts: Year to Date Performance" slide.
In month forecast improvements: Imperial £268k
Acute Reserve 817 610 207 1,590 1,600 (10) Released into YTD position in line with forecast overspend. Total figure changes on a monthly basis as contracts are finalised.
Other Acute Services 580 429 150 1,232 749 483£342k Overseas Visitors allocation received from NHSE, forecast value was already included in the position.
St Mary UCC forecast to underspend by £117k (£93k reduction in month) following receipt of M1-6 invoices.
Continuing Care (1,288) (1,223) (66) (2,077) (2,030) (47)Overspends: Placements £1,197k (£141k improvement), Phys Dis £826k (£210k deteriaration).
LBHF S75 Q2 report: LD placements £74k overspend, St Vin block £80k overspend, PD Equipment £133k underspend.
Community Health (301) (446) 145 (622) (571) (51)
CIS forecast increase: £249k CNWL cost pressure, £79k CLCH Voc Rehab, £34k CLCH final invoice.
Imperial community investment forecast reductions due to additional month of data: Cardio-Resp £281k, Ophthalmology £39k, Gynaecology
£7k
Mental Health (12) 36 (48) 26 121 (95) MH placement Priory client returning to care in M7 (£50k), IFR moved from MH NCA cost centre (£31k)
Prescribing 701 548 153 1,047 932 115 In month FOT reductions: Practice Prescribing based on latest info.
Primary Care (171) (331) 161 (143) (419) 277 OOH £269k decrease following M6 flex
Commissioning Reserves 2,093 2,202 (109) 3,087 4,510 (1,423) Increased contingency balancing figure
Other Commissioned Services 163 134 28 809 116 693£637k CHP budget reduction.
£61k reduction in voluntary sector grant as this was paid in 15/16.
Corporate Costs 0 0 (0) (0) 0 (0)
Total (0) (0) 0 (0) 0 (0)
Year to date variance (£'000s) Forecast outturn variance (£'000s)
Movement of Variances including Running Costs
9
YTD
Budget
YTD
Actual
YTD
Variance
Annual
BudgetForecast
Forecast
Variance
YTD
Budget
YTD
Actual
YTD
Variance
Annual
BudgetForecast
Forecast
Variance
CCG Pay - Permanent 646 522 124 969 822 147 546 502 44 819 775 44
CCG Pay - Interim 0 84 (84) 0 108 (108) 0 49 (49) 0 85 (85)
Board Costs 357 372 (15) 536 574 (38) 28 (0) 28 42 (0) 42
Non Pay 239 228 11 359 347 12 75 63 13 113 97 16
Local Total 1,242 1,206 37 1,864 1,850 13 649 614 35 974 957 17
CSS 709 687 21 1,063 1,053 10 410 394 16 615 603 11
Triborough - Adult, MH and Childrens 225 230 (5) 338 331 7 46 52 (6) 69 73 (3)
CWHHE - Collaborative Teams 647 634 13 971 950 21 531 497 34 796 798 (2)
Affordability Adjustment (263) (263) 0 (395) (395) 0 0 0 0 0 0 0
Balance 0 66 (66) 0 52 (52) 4 34 (29) 7 28 (22)
Pooled Total 1,318 1,355 (37) 1,977 1,991 (13) 991 976 15 1,487 1,502 (16)
Grand Total 2,561 2,561 0 3,841 3,841 0 1,640 1,590 50 2,461 2,459 2
Note: All figures show in £'000s
Local CCG
Budgets
Pooled
Budgets
Key message
Programme: Included in the forecast is a contingency of £0.03m offsetting the local & CSS underspends
Admin Programme
Overall the CCG is expected to achieve its Running Cost control total and underspend on corporate costs as a whole.
Admin: Included in the forecast is a contingency of £0.05m used to break even the position
Corporate Expenditure
10
Area Description
Budget
16/17
£000
YTD Plan
£000
YTD Actual
£000
YTD
Variance
£000
FOT
£000
FOT
Variance
£000
Comments
SLA Reserve 1,590 817 0 817 0 1,590 Remaining envelope after funding acute SLAs. Released into
YTD in line with forecast SLA overperformance.
LAS CQC 0 0 0 0 0 0 Budget moved to above line, now funded from resilience.
Community Health SLA Reserve 283 189 0 189 0 283 Remaining envelope after funding community SLAs, released in
12ths
Mental Health SLA/Placement Reserve 159 85 0 85 0 159 Remaining MH SLA envelope (released in 12ths) and MH
placement modelled growth not required (released in line with
placement overspend).
Healthy London Partnership 0 0 0 0 0 0 Resource transferred to Islington CCG in M3
PMS Review 200 0 0 0 0 200 Slipped into 17/18
Local Investment Reserve 313 0 0 0 0 313
Eating Disorders Anticipated IAT 0 0 0 0 0 0 Resource transferred from NHS England in M3
QIPP Unidentified - opening (3,033) (1,544) 0 (1,544) 0 (3,033) Phased as per QIPP plan
QIPP Unidentified - in year changes (1,166) (594) 0 (594) 0 (1,166) Increased due to reduced CLCH SLA QIPP
Recurrent Total (1,653) (1,048) 0 (1,048) 0 (1,653)
Local Investment Reserve 132 0 0 0 38 94 TCP LD scheme estimate included in FOT
QIPP Contingency 2,690 1,370 0 1,370 0 2,690 Phased in line with QIPP Unidentified
Home Oxygen Anticipated IAT (118) 0 0 0 (118) 0 Resource transfer not yet actioned
NWL Financial Strategy 0 0 0 0 0 0 Agreed contribution, transferred to Central London CCG
General Contingency 1,361 0 0 0 2,035 (674) Forecast figure to balance position after release of further prior
year accruals
1% Uncommitted Reserve 2,592 0 0 0 2,592 0 Budgeted as per NHS England guidance
Prior Year 0 0 (2,862) 2,862 (4,662) 4,662 15/16 performance estimates higher than finalised positions so
benefit in 16/17
Non Recurrent Total 6,658 1,370 (2,862) 4,232 (115) 6,772
Reserves Total 5,005 322 (2,862) 3,184 (115) 5,119
Note: All figures show in £'000s
Key Messages
The forecast position assumes the full £4.19m QIPP gap will remain for 2016/17 with no further schemes identified to deliver savings in the year. The highlighted lines show the reserves which have been retained as they cover
existing commitments. All other available reserves have now been released to support delivery of the CCG planned surplus.
Acute Contracts
Commissioning
ReservesNon Recurrent
Recurrent
Commissioning
Reserves
Reserves
11
Scheme Plan Actual Variance Plan Actual Variance Plan Actual Variance Plan Forecast Variance%
VarianceComments
Community Cardio-Respiratory Service 327 267 (176) 347 228 119 124 67 (58) 429 174 (255) -59%Revised forecast based on current data, planned acute
activity reduction too ambitious
Community Contract Efficiencies (CLCH) 520 203 (468) 0 0 0 700 232 (468) 1,700 348 (1,352) -80%
Community Gynaecology 219 67 (175) 61 14 47 189 61 (127) 287 82 (205) -71%Increased diagnostic tests (acute setting) which require a
follow up appointment
Community MSK Service 127 116 (31) 0 0 0 166 135 (31) 325 223 (102) -31%
Community Ophthalmology 445 97 (384) 107 0 107 401 124 (278) 620 230 (390) -63% Poor referral management/S1 use and high DNA rate
MH Placement Efficiencies 109 109 0 0 0 0 124 124 0 186 186 0 0%
Model of Care- Older Adults (A&E) 8 0 (9) 0 0 0 9 0 (9) 13 0 (13) -100%
Model of Care- Older Adults (NEL) 225 0 (257) 0 0 0 257 0 (257) 390 0 (390) -100%
Out of Hospital Services- Diabetes Level 2 33 37 (1) 0 0 0 38 37 (1) 57 57 0 0%
Out of Hospital Services- Ring Pessary 33 62 48 0 0 0 38 86 48 57 57 0 0%
Out of Hospital Services-ECG 33 37 11 0 0 0 37 48 11 57 57 0 0%
Out of Hospital Services-Near Patient Monitoring 7 12 8 0 0 0 8 16 8 12 16 4 39%
Primary Care prescribing 467 467 0 0 0 0 533 533 0 800 800 0 0%
St Mary's UCC 78 0 (21) 78 60 19 12 9 (3) 18 13 (4) -25%
In-Health Diagnostics 0 195 232 0 0 0 0 232 232 0 354 354 100% New scheme
Unidentified QIPP 1,580 0 (1,580) 0 0 0 1,580 0 (1,580) 2,844 0 (2,844) -100%
Non-Recurrent Contingencies 0 1,370 1,370 0 0 0 0 1,370 1,370 0 2,690 2,690 100%
Total 4,210 3,037 (1,433) 593 302 292 4,216 3,074 (1,143) 7,795 5,287 (2,507) -32%
Note: All figures show in £'000s
Net Position
Key Messages
The YTD QIPP position is £1.14m below plan at month 8. The QIPP forecast of 32% underdelivery is after using non recurrent measures of £2.69m. A number of the community schemes are showing underdelivery of savings in acute contracts.
Year to date Full year
Gross Savings Investments Net Position
Quality, Improvement, Productivity plan (QIPP)
12
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 2,397 2,280 95.1% 139,695 135,390 96.9%
Non NHS 7,022 6,807 96.9% 36,745 31,255 85.1%
Total 9,419 9,087 96.5% 176,440 166,645 94.4%
• Maximum Cash Drawdown Plan: £264.09m* Drawn Down to Date: £179.10m
Forecast Draw Down at Month 08: £179.69m Over Drawn: £0.59m
Key message
Cash
Creditor
payments
The CCG has met the cumulative Better Payment Practice Code (BPPC) target for the invoice numbers and not invoice amount overall. However the
CCG has met the NHS invoice number and amount and Non NHS invoice number. 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 £264.09m as circulated by NHSE in the November 2016 cash report. This forecast is based on our planned net
expenditure for the year less any non cash expenditure. The November 2016 cash report is showing a drawdown of £20.00m (£21.67m less drug prescribing). There was an
adverse variance against planned cash drawn down year to date of £0.06m, this was due to extra cash requirement in order to settle outstanding prior year creditors. The
forecast cash drawdown is based on the Planned MCD of £264.09m.
Capital, Creditor Payments and Cash
70.0%
75.0%
80.0%
85.0%
90.0%
95.0%
100.0%
M01 M02 M03 M04 M05 M06 M07 M08
NHS Number
NHS Amount
Non NHS Number
Non NHS Amount
13
Provider Plan Actual Mitigations Mitigated
Actual
Mitigated
Variance
Plan Mitigated
Actual
Mitigated
Variance
Plan Mitigated
Actual
Mitigated
Variance
In Sector
Chelsea And Westminster Hospital NHS Foundation Trust 20,032 20,843 (308) 20,535 (503) 22,821 23,947 (1,125) 33,881 35,311 (1,429)
The Hillingdon Hospitals NHS Foundation Trust 348 402 (3) 399 (51) 399 457 (58) 598 689 (91)
Imperial College Healthcare NHS Trust 43,218 44,143 (449) 43,694 (476) 49,375 49,961 (587) 73,211 75,541 (2,330)
London North West Healthcare NHS Trust 1,323 1,377 (69) 1,308 15 1,477 1,496 (20) 2,208 2,225 (18)
Royal Brompton and Harefield NHS Foundation Trust 406 669 (1) 668 (262) 464 764 (301) 695 1,142 (446)
Out of Sector
Guy's And St Thomas' NHS Foundation Trust 790 972 (3) 970 (180) 904 1,110 (206) 1,350 1,658 (308)
King's College Hospital NHS Foundation Trust 328 211 (1) 210 118 376 376 0 561 561 0
Moorfields Eye Hospital NHS Foundation Trust 399 475 (0) 475 (76) 456 544 (88) 684 806 (122)
Royal Free London NHS Foundation Trust 241 279 0 279 (37) 277 319 (43) 414 477 (63)
St Georges University Hospitals NHS Foundation Trust 349 399 (1) 398 (49) 399 456 (56) 599 667 (68)
The Royal Marsden NHS Foundation Trust 448 405 0 405 43 512 465 48 768 693 76
University College London Hospitals NHS Foundation Trust 969 1,008 (6) 1,002 (33) 1,110 1,148 (38) 1,656 1,713 (57)
Other Out of Area Providers 1,026 1,124 (3) 1,120 (94) 1,173 1,282 (109) 1,759 1,852 (93)
Acute SLA Contract Total 69,879 72,307 (844) 71,463 (1,584) 79,742 82,325 (2,582) 118,386 123,335 (4,949)
Reserves
Acute SLA - Reserve 817 0 817 1,590 0 1,590
Grand Total 69,879 72,307 (844) 71,463 (1,584) 80,559 82,325 (1,765) 119,976 123,335 (3,359)
Note: All figures show in £'000s
Key Messages
The year to date contract position at month 8 is based on the activity data received for month 7, less £0.84 mitigations and extrapolated forward.
Overall the acute contracts are overperforming by £2.58m YTD. This is partially offset by releasing uncommitted acute reserves to give a YTD overspend of £1.77m.
The forecast overperformance of £4.95m is offset by the £1.59m acute reserve to give an overall overspend of £3.36m.
M8 YTD Position Full Year Outturn PositionM7 YTD SLAM
Acute Contracts: Year to Date Performance
14
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
3 Non-Recurrent Eating Disorder Service 106 106
3 Non-Recurrent Latent TB Q1 22 22
3 Non-Recurrent HLP (389) (389)
3 Non-Recurrent Levies (85) (85)
3 Non-Recurrent Chel West MFF Impact (1,087) (1,087)
5 Non-Recurrent Safeguarding Children Named GPs 26 26
5 Non-Recurrent GP Development Programme - Reception and Clerical Training 18 18
6 Non-Recurrent Safeguarding Children Named GPs (26) (26)
6 Non-Recurrent NWL Financial Strategy - Part A (4,205) (4,205)
6 Non-Recurrent Latent TB Q2 22 22
7 Non-Recurrent CYP Local Transformation Mental Health 45 45
8 Non-Recurrent CYP Local Transformation Mental Health 16 16
8 Non-Recurrent Overseas Visitors 342 342
Programme allocation total 263,129 0 263,129
Baseline Recurrent Initial CCG Running Cost Allocation 3,885 3,885
3 Non-Recurrent Levies (44) (44)
Running cost allocation 3,841 0 3,841
Total RRL 266,970 0 266,970
Source: Financial ledger
In Month Transfers:
RRL Increase - CYP Transformation and Overseas visitors funding from NHS England
RRL Decrease -
Appendix 1.1: Revenue resource limit
1.1
The RAG rating definitions are as follows:
1. Financial position in month - Red is greater than or equal to 2%, Amber is less than 2% but greater than 0% and green is less than or
equal to 0%.
2. Financial position year to date - Red is greater than or equal to 1%, Amber is less than 1% but greater than 0% and green is less than or
equal to 0%.
3. Financial position forecast outturn - Red is greater than or equal to 0.5%, Amber is less than 0.5% but greater than 0% and green is less
than or equal to 0%.
4. Running costs forecast outturn - Red is greater than or equal to 0.5%, Amber is less than 0.5% but greater than 0% and green is less
than or equal to 0%.
5. QIPP year to date / QIPP forecast outturn / Investment plan - Red is greater than or equal to 20%, Amber is less than 20% but greater
than 5% and green is less than 5%.
6. Risks and opportunities - Red is greater than or equal to 0.5%, Amber is less than 0.5% but greater than 0% and green is less than 0%.
7. Creditors - Better Payment Practice Code - Red is less than or equal to 92.5%, Amber is less than 95% but greater than 92.5% and green
is greater than or equal to 95%.
8.Capital outturn -Red is greater than or equal to 10%, Amber is greater than 0.5% but less than 10% and green is less than 0.5%.
9. Cash drawn down to date - Red is less than or equal to 85%, Amber is less than 95% but greater than 85% and green is greater than or
equal to 95%.
Appendix 2.1: RAG rating definitions
2.1