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Paper 17

Ayrshire and Arran NHS Board Monday 25 March 2019

Financial Management Report for the 11 months to 28 February 2019 Author: Rob Whiteford, Assistant Director of Finance – Operational Services Bob Brown - Assistant Director of Finance – Shared Services and Governance

Sponsoring Director: Derek Lindsay, Director of Finance

Date: 19 March 2019

Recommendation

The Board is asked to:

note the financial position for the first eleven months of the financial year;

note the progress on delivering on transformation, cost avoidance and cash releasing efficiency savings; and

note the projected outturn of £20.0 million deficit for the year.

Key Messages:

The Board delivered a deficit of £0.8million for month 11. This reflects improvements made during the year and one off benefits. The cumulative deficit is £19.2 million.

The draft Annual Operating Plan submitted to Scottish Government in March 2018 indicated that the deficit in 2018/2019 would be £20 million. The 2018/2019 revenue plan submitted to Board for approval in June 2018 set out a Financial Control Schedule with a deficit of £22.4 million following detailed review. Mid-year saw a national agreement for holiday pay for regular overtime which added a further recurring financial challenge of £1.4 million. Our forecast outturn is £20.0 million.

Acute Services overspent by £0.4 million in February 2019. Cumulatively they are £8.6 million overspent.

Health and Social Care Partnerships are £0.9 million underspent as at February 2019.

The charge from reserves in Month 11 was £0.4 million. The charge arising from the underlying recurring deficit is partially offset by one off benefits in 2018/2019.

£27.3 million of interventions and efficiencies are planned for the year. Forecast achievement is updated on an ongoing basis. Forecast achievement is £23.9 million.

Glossary of Terms CRES Est TAVI WTE YTD

Cash releasing efficiency savings Establishment Transcatheter aortic valve implantation procedures Whole time equivalent Year to date

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1. Background 1.1 Scrutiny of all resource plans (revenue and capital) and the associated financial

monitoring is considered by the Corporate Management Team, the Performance Governance Committee, and the Board. This report summarises the revenue position at 28 February 2019.

2. Revenue resource limit 2.1 NHS Ayrshire & Arran is £19.2 million overspent for the eleven months ended 28

February 2019. The overall position is shown in more detail at Appendix 1.

2.2

The revenue budget for the year is £851.5 million. This comprises £778.1 million of allocations received (Appendix 4), £26.8 million of non-core funding received and £46.6 million of anticipated allocations.

2.3

Allocations received in February were £234,734 for distinction awards for NHS Consultants (which are funded by Scottish Government), £107,079 for cyber security software and two adjusting allocations:

- £148,183 being our share of underspend by national services and risk shares for which there was a £2.76 million allocation reduction in July (letter 73).

- £29,828 top up to the £929,297 received in September (letter 671) for the vaccine cost of Zostavax, Rotavirus and flu.

2.4 Hospital, Community and Family Health Services (Appendix 1, section 1) is overspent by £9.3 million. Support Services (Appendix 1/Section 2) excluding corporate projects, are underspent by £1.1 million.

3.1

Acute Services

3.1.1 The annual budget for Acute Services is £324.7 million. The directorate is reporting an overspend of £8.6 million after 11 months. (Appendix 2).

Annual

Budget

YTD

Budget

YTD

Actual YTD Var

Month

Budget

Month

Actual

Month

Var

All Acute £000 £000 £000 £000 £000 £000 £000

Pay 224,683 205,045 209,522 (4,477) 19,173 19,327 (155)

Supplies 69,483 61,402 61,960 (558) 5,509 5,472 37

Purchase of Healthcare 59,562 54,442 55,089 (647) 4,959 5,069 (110)

Provision of Healthcare (24,634) (22,618) (22,630) 11 (2,478) (2,494) 16

Operating Income (840) (777) (1,101) 324 (69) (164) 95

Unallocated Savings (3,532) (3,238) 0 (3,238) (294) 0 (294)

Total 324,723 294,256 302,840 (8,585) 26,798 27,209 (411) 3.1.2 The month 11 overspend was £0.4 million, against an average of £0.8 million in the

year to date.

The in month position benefitted from £0.1 million of costs being charged to Waiting List Initiatives.

Ward 4D was allocated £0.15 million of additional non recurring funding

High Cost Low Volume drugs improved by £0.1 million

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3.1.3 A waiting times allocation of £600,000 has been received from Scottish Government. This is to fund 15 transition beds in ward 5B over winter thereby protecting elective capacity. The budget has been phased in over the last four months of the year, therefore giving a £150,000 benefit to acute nursing pay budgets in month 11.

3.1.4

The Nursing Pay overspend is £6.1 million after 11 months. The overspend was £0.3 million in month 11.

Annual

Budget

YTD

Budget

YTD

Actual YTD Var

Mth

Budget

Mth

Actual Mth Var

Nursing Pay £000 £000 £000 £000 £000 £000 £000

Acute Medicine - Crosshouse 6,665 5,910 8,381 (2,471) 760 781 (21)

Gen Medicine - Crosshouse 18,349 16,828 18,524 (1,696) 1,534 1,651 (117)

Gen Surgery - Crosshouse 4,052 3,717 4,014 (298) 340 372 (32)

Crosshouse Nursing Pool 0 0 115 (115) 0 0 0

Orthopaedics - Crosshouse 3,519 3,227 3,411 (183) 295 325 (30)

Anaesthesia - Crosshouse 7,994 7,332 7,283 49 670 655 15

Cancer Svs - Crosshouse 2,148 1,969 2,102 (132) 179 192 (12)

Acute Nursing Maternity Pay 1,013 929 988 (59) 84 73 11

Crosshouse Access - Orthopaedics 0 0 59 (59) 0 0 (0)

Rainbow House Nursing 219 201 258 (57) 18 41 (23)

Other Crosshouse Overspends 5,887 5,364 5,613 (249) 544 539 5

Crosshouse Underspends 21,384 19,598 19,392 206 1,796 1,812 (16)

Subtotal Crosshouse 71,230 65,075 70,140 (5,064) 6,220 6,441 (221)

Gen Medicine - Ayr 7,421 6,804 7,418 (614) 628 703 (75)

Ayr Nursing Pool 0 0 106 (106) 0 0 0

Cancer Svs - Ayr 903 828 954 (126) 76 85 (9)

A+E - Ayr 2,523 2,314 2,398 (85) 211 213 (2)

Ophthalmology - Ayr 813 745 784 (39) 68 76 (9)

Urology - Ayr 1,507 1,382 1,444 (62) 126 135 (9)

Acute Medicine - Ayr 4,680 4,289 4,372 (83) 394 410 (15)

Mgt Surgical Gm - Ayr 158 145 148 (3) 13 12 1

Other Ayr Overspends 1,984 1,820 2,001 (181) 166 188 (22)

Ayr Underspends 11,687 10,707 10,734 (27) 988 993 (5)

Subtotal Ayr 31,676 29,034 30,359 (1,325) 2,670 2,815 (144)

Cross Site Services 4,119 3,759 3,476 283 360 328 32

Total Nursing Overspend 107,025 97,868 103,975 (6,107) 9,250 9,584 (334)

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Est Average Current

Est less

Current

Nursing Pay WTE WTE WTE WTE

Acute Medicine - Crosshouse 176 238 236 (59)

Gen Medicine - Crosshouse 465 515 494 (29)

Gen Surgery - Crosshouse 102 108 105 (3)

Crosshouse Nursing Pool 0 4 0 0

Orthopaedics - Crosshouse 91 95 95 (4)

Anaesthesia - Crosshouse 196 194 189 7

Cancer Svs - Crosshouse 49 56 54 (4)

Acute Nursing Maternity Pay 25 31 25 (0)

Crosshouse Access - Orthopaedics 0 1 0 (0)

Rainbow House Nursing 5 7 6 (1)

Other Crosshouse Overspends 144 145 149 (4)

Crosshouse Underspends 480 476 487 (7)

Subtotal Crosshouse 1,735 1,870 1,840 (106)

Gen Medicine - Ayr 192 209 210 (18)

Ayr Nursing Pool 0 4 0 0

Cancer Svs - Ayr 23 25 25 (2)

A+E - Ayr 58 58 57 1

Ophthalmology - Ayr 22 24 25 (2)

Urology - Ayr 36 38 39 (3)

Acute Medicine - Ayr 124 128 127 (3)

Mgt Surgical Gm - Ayr 2 2 2 (0)

Other Ayr Overspends 49 53 53 (4)

Ayr Underspends 307 303 305 2

Subtotal Ayr 813 843 842 (29)

Cross Site Services 78 69 76 2

Total 2,625 2,782 2,758 (133) 3.1.5 Redesign and change in acute bed provision.

The teams within University Hospital Crosshouse and University Hospital Ayr have redesigned services and 40 unfunded beds were successfully closed at University Hospital Ayr. While 30 beds in ward 5E at University Hospital Crosshouse have closed a reassessment of the core general medicine bed compliment at University Hospital Crosshouse indicates that ward 4D at University Hospital Crosshouse (which was originally opened as a winter pressures ward a few years ago) will require to be retained with 30 beds covering infectious disease and endocrine specialties. The risks around winter pressures informed a decision to keep open a further 15 transition beds in ward 5B over winter, whilst intermediate care and rehabilitation services develop. In February, 30 beds were open in ward 5b due to winter pressures and delayed discharges. These 15 beds closed in March 2019. Scottish Government has agreed £0.6 million of funding for the 15 transition beds as this will protect planned care achievement, and this is included in the budget for ward 5b. The 30 beds in Ward 4D will be a cost pressure in 2019/2020.

3.1.6 Unachieved cash releasing efficiency savings (CRES)

While £3.7 million of acute cash releasing efficiency savings are on track to be delivered, another £3.5 million of carry forward cash releasing efficiency savings do not have robust plans at this stage. The year to date overspend against these is £3.2 million.

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3.1.7

The spend on nursing agency was successfully reduced from £3.1 million in 2016/2017 to £1.9 million in 2017/2018. In the eleven months to date agency nursing spend in acute services was £0.579 million, representing an improvement on 2017/2018. Whilst it may not be possible to completely eradicate the use of agency nurses a further £1.0 million reduction is on target to be achieved in 2018/2019.

00.05

0.10.15

0.20.25

0.30.35

0.40.45

0.5

£ m

illio

n

Nursing Agency Spend

2015/16

2016/17

2017/18

2018/19

3.2 Health and Social Care Partnerships

3.2.1

The total health budgets for the three Health and Social Care Partnerships are £400.0 million.

3.2.2 South Partnership is overspent by £0.1 million, East is underspent by £0.4 million, and North is underspent by £0.6 million. In aggregate the underspend is £0.9 million at month 11. The East Partnership position has improved due to additional costs in Dental and medical out of hours cover being less than expected over the winter period, together with slippage on the Intermediate Care Fund.

3.2.3 The Board approved investment of £2.5 million in Intermediate Care and Rehabilitation. £1.0 million was made available to partnerships in month 8 as new staff came into post. £0.2 million has been returned to reserves as a result of slippage.

3.3 Other Clinical Services

3.3.1

The total budget for Other Clinical services is £15.6 million and is overspent by £1.6 million in the year to date. This is a deterioration of £0.2 million in Month 11.

3.3.2 The main overspend is within the New Medicines Fund which reports an adverse variance of £1.4 million in the year to date. This budget also includes unplanned activity outwith Ayrshire which is £0.8 million overspent. Expenditure on transcatheter aortic valve implantations (TAVI) has been increased significantly from last year. This has been discussed at national and regional groups and referrals have been in

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accordance with criteria. Local discussions will continue to understand any further changes. An increased number of referrals to the brain injuries rehabilitation service also contribute to the year to date overspend. These overspends are partially offset by underspends in the Pharmacy teams.

3.4 Clinical and Non-Clinical Support Services

3.4.1 Support service departments have annual budgets totalling £115.0 million, with a £1.1

million underspend after eleven months. This arises as a result of several small underspends aggregated in corporate departments, and represents a consistent trend to date.

3.5 Corporate Resource and Reserves

3.5.1 Reserves are £11.1 million over committed after eleven months. This is largely due to the £13.2 million deficit budget set in 2016/2017. There was a further requirement to plan for £1.4 million of “pay as if at work” liability; however some non-recurring mitigation in the year and lower than anticipated primary care prescribing price increases has helped alleviate this pressure.

4. Cash releasing efficiency savings (CRES)

4.1 The target for cash releasing savings in the 2018/2019 revenue plan is £15.8 million. In addition, £8.0 million of unachieved or non-recurringly achieved CRES from previous years is carried forward bringing the target to £23.8 million. This does not include cost avoidance interventions such as closing unfunded beds.

New

2018/2019

CRES

Carry-

forward from

2016/2017

and

2017/2018

Total

including

carry-

forward

Unidentified/

(Over

Identified)

Removed

from

Budget

Achievement

included in

Month 11

position

High Medium Low

£000 £000 £000 £000 £000 £000 £000 Y/N £000

Chief Executive 9 0 9 0 0 9 Y 8

Acute (including hospital prescribing

and SLA)3,691 3,559 7,250 1,000 0 3,691 2,559

Y3,383

East 400 1,272 1,672 0 400 1,272 0 Y 1,533

North 690 2,527 3,217 0 1,000 690 1,527 Y 1,549

South 390 501 891 0 891 0 Y 817

Primary Care Prescribing 2,744 0 2,744 0 0 4,044 (1,300) Y 3,707

Medical Director

(including pharmacy)70 95 165 0 165 0 0

Y151

Nurse Director 44 59 103 0 103 0 0 Y 94

Finance Director 34 0 34 0 0 34 0 Y 31

Director for OHRD 44 0 44 0 0 44 0 Y 40

Corporate Support Services 440 0 440 0 0 440 0 Y 403

Public Health 30 0 30 0 0 30 0 Y 28

Transformation and sustainability 9 0 9 0 0 9 0 Y 8

National services 100 0 100 0 0 100 0 Y 92

Estates rationalisation 150 0 150 0 150 0 0 Y 138

Workforce costs 3,000 0 3,000 0 0 3,000 0 Y 2,750

Procurement 600 0 600 0 100 100 400 Y 183

Realistic medicine thresholds 500 0 500 0 0 0 500 N 0

New Medicines Fund 1,500 0 1,500 0 108 0 1,392 Y 99

Supplies inflation 1,032 0 1,032 0 0 1,032 0 Y 946

Energy 200 0 200 0 0 200 0 Y 183

CAU Cleaning 115 0 115 0 0 0 115 N 0

TOTAL 15,792 8,013 23,805 1,000 2,026 15,586 5,193 16,143

Risk regarding achievement

4.2 In the first eleven months, £16.1 million of CRES has been achieved, but none in

relation to £0.5 million target for the Realistic medicines thresholds. It is expected that of the £8.0 million CRES carried forward from previous years, around £5.2 million will be carried into 2019/2020. This is £3.6 million for acute and £1.6 million for North

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Partnership. In addition, unachieved CRES in relation to Realistic Medicine (£0.5 million) and procurement (£0.4 million) will be a pressure in 2019/2020.

5. Workforce

5.1 Against a funded establishment for the whole organisation of 9,552 whole time equivalents (WTE), hours worked in February 2019 amounted to 9,469. Appendix 3 shows the increase in staff costs by professional grouping.

5.2 The table below compares the average monthly position in the two preceding years with the eleven months to February. A contributory factor to the cost increase in 2018/2019 will be pay inflation.

2016-17 2017-18 2018-19 2016-17 2017-18 2018-19

£000 £000 £000 Average WTE Average WTE Average WTE

Contracted Hrs 30,637 31,723 32,810 8,709 8,878 8,872

Waiting List (Access) 229 254 220

Excess Part Time Hrs 491 538 446 278 299 281

Overtime 320 340 312 93 95 88

Bank Staff 337 453 551 121 170 191

Agency Staff 1,135 933 780 84 71 53

Total 33,150 34,241 35,120 9,285 9,512 9,486 5.3 Nursing, as the largest component of our workforce (approximately 48%), utilises the

highest volume of supplemental staffing in order to maintain the 24/7 service they provide. Supplemental staffing should be utilised for short term, unpredicted short term absence or unavoidable peaks in activity e.g. enhanced observations for mental health inpatients. Senior charge nurses and clinical nurse managers proactively fill vacancies and recruit staff to cover long term sickness absence and maternity, which would not be suitably covered by supplemental solutions in the long term.

5.4 The graph and table below show nurse staff utilised in February were 64 WTE above funded levels. We are now running at consistently low numbers of agency staff. This reflects the closure of unfunded beds and redeployment of these nurses to funded posts.

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5.5 The graph below shows the equivalent information for medical staffing. We utilised

807 WTE against a budget of 816 WTE.

5.6 All NHS Boards formally report consultant vacancies on a quarterly basis. The chart

below illustrates the significant growth in the volume of consultant vacancies within NHS Ayrshire & Arran over the last six years, which is in line with all Health Boards in Scotland:

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8.8

15.0

27.6

41.4

50.1

45.4

0.0

10.0

20.0

30.0

40.0

50.0

60.0

March 2013 March 2014 March 2015 March 2016 March 2017 March 2018

Head

coun

t of v

acan

cies

ISD Vacancy Census Quarterly report period

Consultant Vacancies

5.7 As at December 2018, there were 42.90 WTE consultant vacancies of which 37.90 WTE were unfilled and 5.00 WTE had appointments but the successful candidate had not yet commenced in post.

5.8

Medical Agency expenditure has been a major focus of attention and a £1.0 million reduction target was included in the 2018/2019 financial plan. The graph below charts our medical agency expenditure over recent years.

Medical Agency spend is at its lowest level since 2015/2016, and we are on target for the planned reduction of £1.0 million on 2017/2018 spend. We incurred £0.6 million of medical agency expenditure in Month 11.

5.9

Staff sickness absence from work has organisational impact beyond the individual staff member, affecting other staff, service delivery, productivity and cost, where backfill arrangements have to be put in place.

5.10 Driven by the Board’s People Strategy, the Health, Safety & Wellbeing Improvement Plan identifies the programme of work being undertaken to improve staff health and wellbeing and, through the Promoting Attendance Policy, to have a clear process for appropriately managing staff sickness absence.

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5.11 Sickness levels within the Board have reduced over the last few years, from 6% average in 2012/13 to 5% average in 2017/18. A national standard for sickness absence of 4% exists across NHS Scotland. The performance metrics are:

5.12 Absence has fluctuated above and below 5%. Each year, between November and

February, the trend shows higher seasonal absence levels; with the highest spike in recorded absence occurring in January 2018, identified as seasonal ‘flu and respiratory problems. All Boards saw a significant increase at that time and the average January absence level for Scotland was 6.7%. Last year, 52% of NHS Ayrshire and Arran staff received the ‘flu vaccination and this year we have set a target of 65%.

5.13 Going into 2018/2019, target reductions of 0.5% were agreed for the next two years with expected year end absence of 4.76% and 4.26% by March 2019 and March 2020 respectively, supported by a range of interventions and actions. To enable delivery of this, each Directorate / Health & Social Care Partnership has set their own target, supported by a clear local action plan. Monthly and rolling yearly absence rates since April 2015, against both national and local targets, are shown below.

Monthly and rolling year rates – since April 2015 (against national and local targets)

3.50%

4.00%

4.50%

5.00%

5.50%

6.00%

6.50%

7.00%

Apr

-15

May

-15

Jun-

15Ju

l-15

Aug

-15

Sep-

15O

ct-1

5N

ov-1

5D

ec-1

5Ja

n-16

Feb-

16M

ar-1

6A

pr-1

6M

ay-1

6Ju

n-16

Jul-1

6A

ug-1

6Se

p-16

Oct

-16

Nov

-16

Dec

-16

Jan-

17Fe

b-17

Mar

-17

Apr

-17

May

-17

Jun-

17Ju

l-17

Aug

-17

Sep-

17O

ct-1

7N

ov-1

7D

ec-1

7Ja

n-18

Feb-

18M

ar-1

8A

pr-1

8M

ay-1

8Ju

n-18

Jul-1

8A

ug-1

8Se

p-18

Oct

-18

Nov

-18

Dec

-18

Jan-

19Fe

b-19

monthly rates rolling years national target (4.00%) local target (4.76%)

5.14 Robust performance management arrangements exist within the Board, locally

through management teams and corporately through the Health, Safety & Wellbeing Committee, Area Partnership forum, Corporate Management Team and Staff Governance Committee.

Headline sickness r ates Monthly rates – this year and last 2 years Month of February 2019 sickness rate …

- short term - long term

… a dec rease on the previous month rat e …

- short term - long term

Y ear 201 8 /1 9 accumulative position ….

- short term - long term

… and similar to 20 1 7 /1 8 p osition …

- short term - long term

5 . 4 % 2 . 2 % 3 . 2 % 6 . 1 % 2 . 4 % 3 . 7 % 5 . 3 % 1. 8 % 3 . 5 % 5 . 3 % 1 . 9 % 3 . 4 %

3.5%

4.5%

5.5%

6.5%

7.5%

Apr May Jun Jul

Aug Sep Oct Nov Dec Jan

Feb Mar

year 2016/17 year 2017/18 year 2018/19 national target

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6. Risk assessment and mitigation

6.1 The Strategic Risk Register has set out a risk for financial performance as high. The Board has taken a number of steps to mitigate this position and is focused on delivering the actions in the Financial Control Schedule for 2018/2019 and preparing a Three year revenue plan for 2019/2020 to 2021/2022.

6.2 The Board is working with an Improvement Director to enable transformation combined with an improvement in operational “grip”.

6.3

Financial provision has been made for the liability related to pay as if at work for holiday for part time staff. This is an additional £1.4 million for the whole year.

7. Conclusion

7.1 The revenue plan was approved by the Board on the 25 June 2018. This was a deficit of £22.4 million. Since then an additional £1.4 million has been recognised for Pay as if at Work pressures. However Scottish Government are currently planning on £20.0 million of brokerage.

7.2 An overspend of £19.2 million after eleven months is reported. This reflects the deficit brought forward, the overspend in acute services, and recognises that cost savings from a number of planned efficiency savings are yet to be realised.

7.3 Our recent run rate demonstrates significant improvement.

7.3 Our forecast position at March 2019 is a deficit of £20.0 million.

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Appendix 1

Month11

Projected

Outurn M11

Budget Expenditure Variance Budget Expenditure Variance Budget Expenditure Variance

FOT

£000 £000 £000 £000 £000 £000 £000 £000 £000 £000 £000 £000 £000

Ayr £59,023 £54,103 £55,272 (£1,169) £10,637 £9,693 £10,032 (£338) £69,660 £63,796 £65,304 (£1,508) (£1,285)

Crosshouse £148,206 £135,523 £139,419 (£3,896) £26,112 £21,887 £26,826 (£4,939) £174,318 £157,409 £166,245 (£8,835) (£9,502)

Other Acute £17,455 £15,420 £14,831 £589 £63,290 £57,630 £56,461 £1,169 £80,745 £73,050 £71,292 £1,758 £1,787

Acute Total (Appendix 2) £224,683 £205,045 £209,522 (£4,477) £100,040 £89,211 £93,318 (£4,108) £324,723 £294,256 £302,840 (£8,585) (£9,000)

East Hscp £42,213 £37,938 £38,064 (£125) £129,081 £117,095 £116,578 £516 £171,295 £155,033 £154,642 £391 £668

North Hscp £63,457 £58,117 £56,304 £1,813 £79,179 £72,252 £73,494 (£1,242) £142,636 £130,370 £129,799 £571 £250

South Hscp £24,490 £22,311 £22,711 (£401) £61,562 £56,064 £55,737 £327 £86,052 £78,375 £78,449 (£74) £0

HSCP Total £130,161 £118,366 £117,079 £1,287 £269,822 £245,411 £245,810 (£399) £399,983 £363,777 £362,889 £888 £918

Other Clinical Services £8,651 £7,931 £7,361 £570 £6,976 £6,394 £8,535 (£2,141) £15,627 £14,325 £15,896 (£1,571) (£1,875)

Hospital Community and Family

Health Services (section 1) £363,495 £331,342 £333,962 (£2,620) £376,838 £341,016 £347,663 (£6,648) £740,333 £672,358 £681,626 (£9,268) (£9,957)

Chief Executive £1,934 £1,771 £1,624 £147 £725 £616 £670 (£53) £2,659 £2,388 £2,294 £94 £120

Director Public Health £4,680 £4,286 £4,093 £193 £754 £684 £476 £208 £5,435 £4,970 £4,569 £401 £380

Medical Director £3,531 £3,219 £3,040 £179 (£2,701) (£2,688) (£2,565) (£124) £829 £531 £475 £56 £83

Nursing Director £4,514 £4,044 £3,896 £147 £136 £167 £20 £148 £4,651 £4,211 £3,916 £295 £322

Corporate Support Services £35,315 £32,262 £32,179 £83 £56,746 £47,928 £47,974 (£47) £92,061 £80,190 £80,154 £36 £0

Finance £3,937 £3,613 £3,484 £129 (£504) (£497) (£478) (£19) £3,433 £3,117 £3,007 £110 £120

ORG and HR Development £4,163 £3,812 £3,737 £75 £307 £217 £162 £55 £4,469 £4,029 £3,899 £130 £137

West Of Scotland Region Ce £1,501 £564 £561 £4 £0 £0 £4 (£4) £1,501 £564 £564 £0 £0

Clinical and Non Clinical Support

Services (Section 2) £59,575 £53,572 £52,614 £958 £55,463 £46,427 £46,263 £164 £115,038 £100,000 £98,877 £1,123 £1,162

Corporate Income (non RRL) £1,700 £0 £0 £0 £3,995 £288 £484 (£196) £5,695 £288 £484 (£196) (£559)

Corporate Reserves £585 £0 £0 £0 (£10,109) (£10,894) £0 (£10,894) (£9,524) (£10,894) £0 (£10,894) (£10,673)

Corporate Resource and Reserves £2,285 £0 £0 £0 (£6,114) (£10,606) £484 (£11,090) (£3,829) (£10,606) £484 (£11,091) (£11,232)

NHS A&A Total £425,355 £384,915 £386,577 (£1,662) £426,187 £376,836 £394,410 (£17,574) £851,542 £761,751 £780,987 (£19,236) (£20,027)

Annual

Budget

Year to Date

Income and Expenditure Summary for Health Services : Financial Year 2018

Salaries Supplies Total

Annual

Budget

Year to Date

Annual

Budget

Year to Date

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Appendix 2

Budget Expenditure Variance Budget Expenditure Variance Budget Expenditure Variance

£000 £000 £000 £000 £000 £000 £000 £000 £000 £000 £000 £000

Surgical - Ayr £31,669 £29,055 £29,340 (£284) £8,304 £7,605 £7,606 (£1) £39,972 £36,661 £36,946 (£285)

Medical - Ayr £27,354 £25,047 £25,826 (£779) £2,334 £2,088 £2,426 (£338) £29,688 £27,135 £28,252 (£1,117)

Ayr Nursing Pool £0 £0 £106 (£106) £0 £0 £0 £0 £0 £0 £106 (£106)

Total Ayr 59,023 54,103 55,272 (1,169) 10,637 9,693 10,032 (338) 69,660 63,796 65,304 (1,508)

Surgical - Chouse £42,609 £39,010 £40,077 (£1,067) £7,964 £5,357 £5,888 (£531) £50,572 £44,367 £45,965 (£1,598)

Medical - Chouse £48,563 £44,239 £48,694 (£4,455) £9,799 £9,003 £11,669 (£2,666) £58,362 £53,242 £60,363 (£7,121)

Women + Childrens £30,821 £28,254 £27,964 £290 £2,352 £2,015 £2,744 (£729) £33,173 £30,269 £30,708 (£439)

Diagnostic Svs £26,213 £24,019 £22,569 £1,450 £5,998 £5,512 £6,525 (£1,012) £32,211 £29,531 £29,094 £437

Chouse Nursing Pool £0 £0 £115 (£115) £0 £0 £0 £0 £0 £0 £115 (£115)

Total Crosshouse 148,206 135,523 139,419 (3,896) 26,112 21,887 26,826 (4,939) 174,318 157,409 166,245 (8,835)

Other £11,021 £9,522 £9,154 £369 £63,303 £57,645 £56,315 £1,330 £74,324 £67,168 £65,469 £1,699

Acute Access £6,434 £5,898 £5,678 £220 (£13) (£15) £146 (£161) £6,421 £5,883 £5,823 £59

Acute £224,683 £205,045 £209,522 (£4,477) £100,040 £89,211 £93,318 (£4,108) £324,723 £294,256 £302,840 (£8,585)

Annual

Budget

Year to Date

Income and Expenditure Summary for Health Services Financial Year 2018 Period 11

Salaries Supplies Total

Annual

Budget

Year to Date

Annual

Budget

Year to Date

Appendix 3

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Staff costs (including agency)

Staff costs (including agency)

Nurses

Medical

and dental

Other Total

£000 £000 £000 £000

2013/2014 156,886 74,133 127,803 358,822

2014/2015 159,671 77,167 130,425 367,263

2015/2016 (1% superan increase)

163,375 81,775 132,216 377,366

2016/2017 (NI increase of 2%)

174,399 86,504 136,023 396,926

2017/2018 (0.5% apprenticeship levy)

181,632 89,746 140,359 411,737

% increase since 2013/2014

15.77% 21.07% 9.82% 14.75%

Pay restraint over the last four years might have meant an inflationary 1% increase per annum, which would therefore explain a 4% increase. Increases in employer superannuation contributions, national insurance changes, and introduction of the apprenticeship levy would explain a further 3.5% increase, therefore 7.5% increase could be attributed to these inflationary factors. Further increases are likely to be related to increased headcount.

Agency spend is included in the above figures. From 2013/2014 to 2017/2018, allied health professionals agency increased from £138,565 to £432,705, nursing agency increased from £1.3 million to £1.9 million and medical agency more than doubled from £4 million to £8.6 million. These account for part of the above increases, but the rest is about increase in numbers of staff employed.

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Appendix 4

Ref Description

Baseline

recurring

£

Earmarked

recurring

£

Non-

recurring

£

Total

£

3 Initial baseline including uplift 694,904,000 694,904,000

4 Adjustment for 2017-2018 recurring allocations 387,000 387,000

6 Outcomes Framework 2018-2019 4,072,927 4,072,927

21 Waiting Times - Long Waits 1st Tranche 1,852,000 1,852,000

23 Woodland Review - Unitary Charge 4,265,014 4,265,014

30 GP Out of Hours (OOH) Fund 2018/2019 370,457 370,457

31 Primary Care Improvement Fund - Tranche 1 1,974,270 1,974,270

34 Action 15 of the Mental Health Strategy 2017/2027 570,504 570,504

37 Improvement Director Funding 120,000 120,000

38 SLA Children's Hospices Across Scotland (Year 2 / 5) (444,549) (444,549)

47 Additional funding for insulin pumps for adults and

CGMs178,844 178,844

51 Additional 500 Health Visitors 1,770,000 1,770,000

60 Family Nurse Partnership Programme Funding 838,547 838,547

73 NSD Risk Share (2,758,543) (2,758,543)

74 Public Dental Service in NHS Board area 2,049,000 2,049,000

100 Supporting FASD improvement activity 190,000 190,000

111 Improvement funding to support the four hour A&E

target444,549 444,549

119 Veterans 385,714 385,714

125 eHealth Strategic Fund 1,475,777 1,475,777

338 CSO - research infrastructure 740,000 740,000

349 AST - Trauma & Orthopaedics 250,000 250,000

361 £20m tariff reduction to global sum (1,391,389) (1,391,389)

365 Disestablishment of 4 year GPST programmes 406,467 406,467

377 Carry forward of 2017-18 core revenue surplus 173,000 173,000

382 Additional ADP funding 1,259,555 1,259,555

401 Combat Stress Specialist Mental Health Services

Contract1,424,090 1,424,090

419 Pre-registration Pharmacists Scheme (122,061) (122,061)

420 New Medicines Fund 3,271,139 3,271,139

422 eHealth IPACC 591,200 591,200

428 NDC Top Slice (986,790) (986,790)

492 AST Waiting Times - Long Waits 2nd Tranche 1,852,000 1,852,000

503 National Cancer Strategy 110,321 110,321

508 AST - Endoscopy Waiting Times 476,095 476,095

509 Cancer Waiting Times 445,348 445,348

547 Contribution to pharmacy global sum (205,603) (205,603)

576 NHS Boards Pay Awards 6,288,000 6,288,000

587 Primary Care Improvement Fund - Tranche 1 1,974,270 1,974,270

588 Primary Care Improvement Fund - Tranche 1 (1,974,270) (1,974,270)

591 Implementation of type 2 diabetes prevention

framework173,000 173,000

596 Non-core expenditure - depreciation (13,880,000) (13,880,000)

622 Veterans First Point Services 102,894 102,894

624 Primary Medical Services 54,032,000 54,032,000

625 Primary Medical Services Bundle 2018-2019 1,988,992 1,988,992

636 AST - Winter Pressures 696,460 696,460

640 TEC Programme Funding to support scale up 102,000 102,000

644 Golden Jubilee Foundation top slice 2018-2019 Board

SLAs(1,145,035) (1,145,035)

671 Zostavax, Rotavirus, Seasonal Flu and Childhood Flu

2018929,297 929,297

720 Reallocation of the Cancer Waiting Times funding (222,157) (222,157)

730 CSO - Support for Health Innovation 250,000 250,000

739 NSS - AfC Top-slice 109,665 109,665

742 Risk and Quality Improvement Team Ayrshire maternity

unit478,720 478,720

826 NSS - AfC Top-slice correction (218,483) (218,483)

838 Mental Health Outcomes Framework 1,492,428 1,492,428

1,020 Infrastructure Support 1,426,000 1,426,000

1,022 Waiting Times Improvement 1,988,000 1,988,000

1,049 Improvement Dircetor Funding 185,400 185,400

1,061 WoS Transformation Funding Correction 1,501,144 1,501,144

1,070 Unscheduled Care Allocation 300,000 300,000

1,072 ScotSTAR 2018/19 (341,462) (341,462)

1,099 PET Scans (509,619) (509,619)

1,126 Distinction Awards 234,734 234,734

1,134 NSD Rebate 148183 148,183

1,138 NHSS Cyber Security Project A/V 107079 107,079

1,151 Seasonal and Childhood Flu (Quad) 29828 29,828

Other Small Allocations (26,099) 7,002 969,945 950,848

703,708,615 12,318,475 62,109,709 778,136,799

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Monitoring Form

Policy/Strategy Implications

Overspending areas in acute services could adversely impact the delivery of the strategic direction for the Board in moving investment towards community based.

Workforce Implications

Informs the forward workforce plan.

Financial Implications

Corrective action required for the Board to be operating in line with the statutory target to operate within the revenue and capital resource limits.

Consultation (including Professional Committees)

Directorates receive monthly financial reports. Financial reports are received at Corporate Management Team and Performance Governance Committee.

Risk Assessment

The risk tolerance agreed for investment is “medium” which includes “prepared to accept possibility of some limited financial loss, but value for money is still the primary concern.

Best Value - Vision and leadership

Confirms ongoing, effective use of resources and management in year of risks and issues in relation to achieving agreed financial performance targets.

- Effective partnerships

- Governance and accountability

- Use of resources

- Performance management

Compliance with Corporate Objectives

Delivery of efficient and effective services within budget and to develop a culture of continuous improvement.

Single Outcome Agreement (SOA)

Not applicable.

Impact Assessment This report is a monitoring report therefore does not require an equality and diversity impact assessment (EDIA).