DATE OF MEETING: 27 September 2012
Paper Title: Financial Report
Agenda Item: 09 Enclosure: CKWCB/12/184 Category of Paper Tick() Decision and Approval Position statement
Responsible Director: Ian Currell, Director of Finance and Efficiency
Discussion
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Information
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Paper Author: Ian Currell, Director of Finance and Efficiency
FOI Status: Open
Executive Summary:
This report summarises the month 5 financial position for NHS Calderdale, NHS Kirklees and NHS Wakefield District.
Outcome of Equality Impact Assessment: Sub Group/Committee:
Not applicable. Finance and Performance Group – NHS Calderdale 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.
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Calderdale, Kirklees and Wakefield District Cluster Board Cluster Board Meeting 27 September 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 August 2012 (Month 5). 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 5 and contains a forecast outturn position based on this.
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Forecast Year-end position Each PCT is forecasting that it will meet its surplus control total by the year end. A more detailed review of the year end position for each PCT has been completed during September and these positions are being reported through each Clinical Commissioning Executive (CCE) and Finance & Performance Committee. It is important that each PCTs control total is met in full and is not either under or over achieved. Any flexibility in meeting the year end control target must be proactively managed by the relevant CCE. I have written to each of the shadow Accountable Officers and Chief Finance Officers asking for detailed plans showing how any in year flexibility will be used. 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 5 is £7.6M for the cluster, against a budget of £5.5M and the forecast annual surplus is £13.3M in line with the original budget. The forecast is subject to a number of risks, the significant ones which may be critical to the achievement of these targets at this stage in the financial year are list below; •
delivery of QIPP savings;
•
delivery of running cost targets;
•
financial challenges at Mid Yorkshire Hospitals Trust.
Other in-year risks are:•
activity performances against contract values;
•
the volatility in prescribing costs;
•
pressures on the pharmacy contract; and 2
•
service pressures on continuing care costs
Financial Summary at Month 5 - 2012/13 Income and Expenditure Month 5 Actual - Year to date Total £000
Calderdale £000
Kirklees £000
Wakefield District £000
Month 5 - year to date Income (RRL) Expenditure Surplus
713,478 705,867 7,611
151,677 150,177 1,500
293,407 289,253 4,154
268,394 266,437 1,957
5,540 (2,071)
1,500 0
2,750 (1,404)
1,290 (667)
Income and Expenditure - Annual Forecast Income (RRL) 1,726,484 364,028 Expenditure 1,713,184 360,428 Surplus 13,300 3,600
704,653 698,053 6,600
657,803 654,703 3,100
Budget surplus to date Variance (Favourable)
Budget surplus Variance (Favourable)
13,300 0
3,600 0
6,600 0
3,100 0
2,400 3,300 900
170 170 0
1,280 1,280 0
950 1850 900
1,715,534 1,715,714 0
361,792 361,972 0
697,889 697,889 0
655,853 655,853 0
Month 5 - Year to date Public Sector Payment Policy (by value) Non NHS creditors % % Actual 99.58 87.40 Target 95.00 95.00 Variance (Unfavourable) 4.58 (7.60)
% 91.13 95.00 (3.87)
Annual Capital Expenditure Forecast Budget Variance (Favourable)
Annual Cash Allocation Forecast Budget Variance (Favourable)
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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 year to date position shows a surplus of £1.5M against a plan of £1.5M.
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
•
The ability to fully utilise contingent and investment funds
NHS Kirklees •
The Primary Care Trust is forecasting to achieve its target surplus as agreed with the Strategic Health Authority of £6.6M. The year to date position shows an underspend of £1,404K after achieving the year to date target surplus of £2.8M.
Risks relate to:•
the under achievement of QIPP plans in acute services
•
Overtrading on acute contracts during the year. This has been mitigated to a large extent through contractual agreements with CHFT, MYHT and Leeds
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 £667K after achieving the year to date target surplus of £1,290K.
Risks relate to:• Financial challenges at Mid Yorkshire NHS Trust. The PCT has mitigated the financial risk through 2012/13 contract negotiations. •
the potential for over performance on acute contracts although mitigating action and contingency reserves are in place;
•
prescribing costs variance to budget;
•
under achievement of QIPP targets;
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Financial Position The following table details the summary financial position at month 5 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 5 Financial Position 2012/13
Commissioned Services Prescribing Pharmacy Contract Primary Medical Services Dental Services Opthalmic Services Headquarters Services Commissioning Intentions Contingency Specific Reserves Uncommitted Reserves Non recurrent Reserves Kirklees Community Health Services Total Expenditure Surplus TOTAL
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Annual Budget £000 1,235,882 165,042 35,427 138,201 46,398 9,788 56,200 854 5,973 7,172 5,388 6,859 0 1,713,184 13,300 1,726,484
Budget to Expend to Variance Date to Date Date £000 £000 £000 514,968 512,890 (2,078) 68,526 66,515 (2,011) 14,710 15,471 761 57,581 56,516 (1,065) 19,312 19,392 80 4,078 3,813 (265) 22,820 21,141 (1,679) 0 0 0 0 0 0 2,756 2,756 0 2,245 6,952 4,707 942 0 (942) 0 421 421 707,938 705,867 (2,071) 5,540 5,540 0 713,478 711,407 (2,071)
Forecast year-end variance £000 (2,810) (3,251) 1,143 (1,771) (58) 25 (1,032) 0 867 0 6,887 0 0 0 0 0
QIPP The table below summarises the total of the QIPP schemes across the CKW cluster. The detail of the individual Primary Care Trust’s QIPP plans are attached at Appendix 2. NHS Calderdale is forecasting achievement of £4.6m of its QIPP plans this year, an overall shortfall of £1m. There is currently a shortfall of £1.5m in confirmed plans relating to elective and non elective schemes. The shortfall does not pose any risk to the overall financial position this year. Additional savings are being forecast for two of the schemes, mental health and procurement and latest activity data suggests that the low secure contract will ensure savings of approximately £500k over plan. These additional savings will help offset the underperforming areas. It is also expected that continuing care will deliver further savings. 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 achievement of its QIPP plans at the year-end. Within the overall QIPP schemes further work is being undertaken on the Primary Care Transformation scheme to better understand achievement by practice. There has been a 3 month review of practice achievement against KPIs and practice plans resulting in support meetings taking place with underperforming practices. The plans to achieve the running costs target are being met across the Cluster.
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Calderdale, Kirklees and Wakefield District QIPP Efficiencies at Month 5
QIPP Projects Calderdale Kirklees Wakefield Total QIPP Projects
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Forecast Target Target to Savings Variance year-end savings date to date to date variance £000 £000 £000 £000 £000 5,600 1,909 1,338 571 981 9,575 3,990 3,990 0 0 12,567 3,898 3,981 (83) 0 27,742 9,797 9,309 488 981
Capital NHS Wakefield has received an allocation for the development of Stanley health centre which will not be spent by the end of March 2013. Conversations have been held between the PCT, HPM and the SHA around the potential usage of the funding. It is currently showing as an underspend against the capital allocation of £900K. NHS Calderdale and NHS Kirklees are forecasting breakeven against their capital resource limits.
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Statement of Financial Position (SOFP) Appendix 3 details the SOFPs of the three PCTs and movement in working balances from 1 April 2011 to 31 August 2012.
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Annual Audit Letters The 2011/12 Annual Audit letters for each PCT have been received and are attached at Appendix 4 for Board members information. The letters have already been presented to the Cluster Audit Committee on 18 September 2012.
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CSS Development Budget At the July meeting the Board noted the request for a development budget of £1.1m by West Yorkshire Commissioning Support Service. It was agreed that this was a decision for each Clinical Commissioning Executive (CCE) and I can now confirm that each CCE has agreed to fund their relevant share.
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Recommendation The Cluster Board is asked to note: •
the content of the report; and
•
the financial risks identified.
Ian Currell Director of Finance and Efficiency Calderdale, Kirklees and Wakefield District Cluster Board
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Appendix 1 Expenditure at Month 5
Calderdale Commissioned Services Prescribing Pharmacy Contract Primary Medical Services Dental Services Opthalmic Services Headquarters Services Commissioning Intentions Specific Reserves Uncommitted Reserves Non recurrent Reserves Total Expenditure Surplus TOTAL
Kirklees Commissioned Services Prescribing Pharmacy Contract Primary Medical Services Dental Services Opthalmic Services Headquarters Services Commissioning Intentions Specific Reserves Uncommitted Reserves Non recurrent Reserves Kirklees Community Health services Total Expenditure Surplus TOTAL
Wakefield Commissioned Services Prescribing Pharmacy Contract Primary Medical Services Dental Services Opthalmic Services Headquarters Services Commissioning Intentions Contingency Specific Reserves Uncommitted Reserves Non recurrent Reserves Total Expenditure Surplus TOTAL
Annual Budget to Expend Variance Budget Date to Date to Date £000 £000 £000 £000 260,219 108,424 106,170 (2,254) 34,834 14,514 14,280 (234) 7,133 2,972 3,242 270 28,564 11,901 10,175 (1,726) 10,786 4,494 4,705 211 1,923 801 809 8 11,710 4,879 4,839 (40) 0 0 0 0 0 0 0 0 3,000 1,250 5,957 4,707 2,259 942 0 (942) 360,428 150,177 150,177 0 3,600 1,500 1,500 0 364,028 151,677 151,677 0
Forecast year-end variance £000 (5,129) (498) 312 (2,009) 36 25 494 0 0 6,769 0 0 0 0
Annual Budget to Expend Variance Budget Date to Date to Date £000 £000 £000 £000 501,782 209,094 208,348 (746) 67,859 28,275 27,625 (650) 15,010 6,254 6,461 207 54,884 22,866 23,553 687 19,246 8,019 7,982 (37) 4,209 1,754 1,447 (307) 26,060 10,644 9,665 (979) 0 0 0 0 6,615 2,756 2,756 0 2,388 995 995 0 0 0 0 0 0 0 421 421 698,053 290,657 289,253 (1,404) 6,600 2,750 2,750 0 704,653 293,407 292,003 (1,404)
Forecast year-end variance £000 110 (22) 144 300 0 0 (650) 0 0 118 0 0 0 0 0
Annual Budget to Expend Variance Budget Date to Date to Date £000 £000 £000 £000 473,881 197,450 198,372 922 62,349 25,737 24,610 (1,127) 13,284 5,484 5,768 284 54,753 22,814 22,788 (26) 16,366 6,799 6,705 (94) 3,656 1,523 1,557 34 18,430 7,297 6,637 (660) 854 0 0 0 5,973 0 0 0 557 0 0 0 0 0 0 0 4,600 0 0 0 654,703 267,104 266,437 (667) 3,100 1,290 1,290 0 657,803 268,394 267,727 (667)
Forecast year-end variance £000 2,209 (2,731) 687 (62) (94) 0 (876) 0 867 0 0 0 0 0 0
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Appendix 2
NHS Calderdale Achievement against planned efficiencies Month 5
QIPP Projects
Target Target to Savings to Variance savings date date to Date £000 £000 £000 £'000
Forecast year-end variance £000
Primary Care Projects Medicines management
500
167
167
0
0
Community Care Projects Mental Health Continuing Care Procurement contract savings
500 500 100
209 167 33
264 109 67
(55) 58 (34)
(400) 0 (100)
Non elective activity Elective activity
1,500 1,500
500 500
199 307
579 902
Running costs projects
1,000
333
225
301 193 0 108
Total QIPP Projects
5,600
1,909
1,338
571
981
Acute Care Projects
0
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NHS Kirklees Achievement against planned efficiencies
QIPP Projects
Target savings £'000
Target to date £000
Savings to date £000
Variance to Forecast yearend variance Date £000 £000
Primary Care Projects Contracts Medicines Management Total Primary Care
715 1,400 2,115
298 583 881
0 583 583
298 0 298
715 0 715
Community Care Projects Mental Health Other and Provider services Public Health Total Community Care
1,280 65 83 1,428
533 27 35 595
533 27 35 595
0 0 0 0
320 0 0 320
755 200 763 400 390
315 83 318 167 163
315 0 0 167 163
0 83 318 0 0
0 200 763 0 195
1,285
535
535
0
0
Acute total
40 104 20 125 280 50 120 4,532
17 43 8 52 117 21 50 1,889
8 22 4 26 58 10 25 1,333
9 21 4 26 59 11 25 556
20 52 10 63 140 25 60 1,528
Running costs
1,500
625
625
0
0
0
0
854
(854)
(2,563)
9,575
3,990
3,990
0
0
Acute Care Projects Contractual Challenges CHFT Orthopaedics Others TBI Contractual Challenges CHFT Trans Childrens Admissions avoidance CHFT & MYHT Oxygen Therapy Diabetes CIP Palliative Care Social Workers CIP Generic Workers CIP Early Supported Discharge CIP Intermediate Care Social Workers CIP PCI
Mitigations Total QIPP Projects
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NHS Wakefield Achievement against planned efficiencies As at 31/8/2012
QIPP Projects
Target savings £'000
Target to Savings to date date £000 £000
Variance to Forecast yearDate end variance £000 £000
Transformational Schemes Commissioning Primary Care Transformation Scheme Planned Care Clinical thresholds Oral surgery Trauma & Orthopaedics Ophthalmology SCG Contract Dermatology Sub-total Transformational Schemes
2,984 1,442 477 141 293 85 8 5,430
0 326 15 141 163 16 8 669
0 204 15 246 163 16 108 752
0 122 0 (105) 0 0 (100) (83)
1 607 432 (597) (196) 69 (316) 0
Transactional Schemes Commissioning Planned care contract stances Midwifery Contract reductions
1,711 477
713 199
713 199
0 0
0 0
Planned Procedures not carried out Maternity non delivery CAU tariff Alcohol Liaison Nurse Failsafe Beds Patient Choice Breasfeeding support service sub-total Commissioning
209 140 360 245 1,000 200 50 4,392
87 58 150 102 417 200 50 1,976
87 58 150 102 417 200 50 1,976
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
Primary Care Enhanced service Audits Angel Lodge Oxygen Services Prescribing sub-total Primary Care
50 136 100 1,000 1,286
50 136 42 417 645
50 136 42 417 645
0 0 0 0 0
0 0 0 0 0
Running costs
1,459
608
608
0
0
12,567
3,898
3,981
(83)
0
Total QIPP Projects
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Statement of Financial Position
Appendix 3
The Table below shows the cluster PCTs opening Statement of Financial Position, the position at the end of August and the forecast year-end balances.
NHS Calderdale Balance 01/04/2012 £k NON CURRENT ASSETS Property, Plant and Equipment Intangible Assets Trade and Other Receivables TOTAL Non Current Assets CURRENT ASSETS Inventories Trade and Other Receivables Cash and Cash Equivalents Sub Total Current Assets Non-Current Assets Held for Sale TOTAL Current Assets TOTAL ASSETS CURRENT LIABILITIES Trade and Other Payables
Balance 31/08/2012 £k
NHS Kirklees Forecast 31/03/2013 £k
Balance 01/04/2012 £k
Balance 31/08/2012 £k
NHS Wakefield District Forecast 31/03/2013 £k
Balance 01/04/2012 £k
Balance 31/08/2012 £k
Forecast 31/03/2013 £k
5,741 0 0
5,411 0 0
5,300 0 0
33,500 0 0
33,531 13 0
33,000 13 0
11,841 0 0
11,841 0 0
12,441 0 0
5,741
5,411
5,300
33,500
33,544
33,013
11,841
11,841
12,441
0 5,328 2
0 4,680 91
0 2,500 2
258 3,000 1
258 9,946 1,695
258 4,500 1
0 3,254 5
0 4,104 24
0 3,254 5
5,330 0
4,771 0
2,502 0
3,259 801
11,899 801
4,759 0
3,259 120
4,128 120
3,259 0
5,330 11,071
4,771 10,182
2,502 7,802
4,060 37,560
12,700 46,244
4,759 37,772
3,379 15,220
4,248 16,089
3,259 15,700
(25,901)
(27,365)
(22,652)
(40,555)
(50,362)
(46,541)
(40,679)
(39,784)
(38,679)
Provisions
0
0
0
(5,170)
(5,134)
(204)
(4,192)
(4,083)
(4,192)
Borrowings
0
0
0
(712)
(712)
(712)
0
0
0
(25,901) (20,571) (14,830)
(27,365) (22,594) (17,183)
(22,652) (20,150) (14,850)
(46,437) (42,377) (8,877)
(56,208) (43,508) (9,964)
(47,457) (42,698) (9,685)
(44,871) (41,492) (29,651)
(43,867) (39,619) (27,778)
(42,871) (39,612) (27,171)
0 (4,141) 0
0 (3,997) 0
0 (4,111) 0
0 (1,066) (24,815)
0 (994) (24,475)
0 (873) (24,000)
0 0 0
0 0 0
0 0 0
Total Non-Current Liabilities ASSETS LESS LIABILITIES (Total Assets Employed)
(4,141) (18,971)
(3,997) (21,180)
(4,111) (18,961)
(25,881) (34,758)
(25,469) (35,433)
(24,873) (34,558)
0 (29,651)
0 (27,778)
0 (27,171)
TAXPAYERS EQUITY General Fund Revaluation Reserve Total
(19,809) 838 (18,971)
(22,019) 839 (21,180)
(19,800) 839 (18,961)
(37,289) 2,531 (34,758)
(37,942) 2,509 (35,433)
(37,067) 2,509 (34,558)
(34,262) 4,611 (29,651)
(32,389) 4,611 (27,778)
(31,782) 4,611 (27,171)
Total Current Liabilities NET CURRENT ASSETS/(LIABILITIES) TOTAL ASSETS LESS CURRENT LIABILITIES NON-CURRENT LIABILITIES Trade and Other Payables Provisions Borrowings
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