item 6.1 nov 09 finance and workforce report

1p1 November 09

Title slide

NOVEMBER 2009NOVEMBER 2009

Linda Potter, Director of FinanceLinda Potter, Director of Finance

FINANCE & WORKFORCE REPORTFINANCE & WORKFORCE REPORT

2p2 November 09

• Executive Summary

• Financial Risk Rating

• Income and Expenditure (Trust)

• Performance Summaries

• CIP Summary

• Service Line Report (October 09 summary)

• Balance Sheet

• Cash Flow

• Capital Report

CONTENTS

3p3 November 09

EXECUTIVE SUMMARYFINANCIAL PERFORMANCE REPORT

EIGHT MONTHS TO END NOVEMBER 2009

FINANCIAL PERFORMANCE SUMMARY

All monetary figures stated in £ millions

CurrentActual 4.7

Financial Budget 4.5

PositionVariance Favourable

/ (Adverse) 0.2

EBITDA £ 9.4 Operational surplus is above budget by1.4% due to the better than budget income position.

% 9.5% YTD Target: 9.6%

CIP Target 2.7(savings)

Actual 3.4

I&E Forecast Outturn Recurrent 6.0 Current projected forecast outturn based on November financial position (November contract income estimated).

Retained 6.0 No significant non-recurrent financial activities are expected.

Capital Plan FY 5.3 The annual capital plan forecasts capital expenditure increasing during the remainder of the financial year.

Actual Ytd 2.3 Expenditure on clinical equipment, maintenance and IM&T; further capital spend phased for the remainder of the year.

CashCurrent Balance 11.0

F'cast y/e Balance 11.5 Current lower creditor balance expected to be achieved by year-end, capital expenditure re-profiled.

Working Capital/ LiquidityDebtors 5.2

Creditors 15.4 Small decrease on October (£15.9m); creditor value will vary linked to timing of creditor payment runs and accrual levels

Liquidity 40 days

Overall Financial Risk RatingFRR score 5

Key Budget Highlights

Risks & Opportunities

Savings targets are proactively monitored through Directorate Performance Reviews and as part of Transformation programme to ensure CIP targets are met.

Reforecasting exercise for activity and contract income has been completed and is subject to agreement with NHS Suffolk before being included in future forecast.

Ahead of planned savings driven by higher than planned achievement in pay savings both recurrent and non-recurrent. Surgery underperformance on CIPs linked to extra sessional payments and costs of completing work by external bodies.

Surplus. The cumulative financial position reflects an adjustment for NCA income made in November, resulting in the Trust effectively breaking even in the month. Contract income for November has been estimated pending the publication of November priced activity. Income is 2.6% above budget, operational costs are 2.8% over budget.

Budget surplus.

Income above both plan and current forecast have improved the performance against budget. Pay costs and clinical supplies costs continue to exceed budget reflecting both recruitment difficulties and activity above plan levels. Total pay costs are £64.1m (1.3% over budget) and include £1.68m of agency costs. (£1.56m Oct)

Improved position October balance (£6.1m). Timing of invoicing and cash receipts will affect balances month to month

Creditors continue to be paid promptly - 10 day payment performance is 65%; current low spend on capital contributing to high cash balance.

High variable costs of activity (sessional payments, o/time, etc) and continued agency costs are driving pay costs above budget, though income is also above plan offsetting the impact of these higher costs. Recruitment plans being actively managed to minimise agency costs.

Improved cash and debtor position has increased the Trusts ability to cover immediate liabilities.

Peformance monitoring will be key to maintaining income and minimising contract penalties, regular SLA reviews are held with Suffolk PCT.

Strong performance in all rating measures for the 8 months to November. The forecast outturn rating remains at 4.

The November postion reflects continued agency cost and clinical consumables cost pressures, and additional expenditure on replacement MSE. Income reflects an adjustment for NCA income for the first six months of the year which had been overstated.

The high-cost drugs budgets now include adjustments for over-performance.

4p4 November 09

FINANCIAL RISK RATING (FRR – SHA model)

To move the Underlying Performance rating for full year outturn forecast from amber to green (from 3 to 4) the Trust would need to reduce operational costs or increase income by approximately £450k. This would have the effect of increasing the forecast outturn surplus from £6.0m to £6.4m.

Financial Risk Ratings Month Nov-09

Criteria Metric Weight 5 4 3 2 1

Annual Plan rating

09/10Score09/10

Risk ratings09/10

Score09/10

Risk ratings09/10

Underlying performance EBITDA margin % 25% 11 9 5 1 <1

3 9.5% 4 8.7% 3

Achievement of plan EBITDA achieved % 10% 100 85 # 70 50 <50

5 155.1% 5 123.2% 5

Financial efficiency Return on assets % 20% 6 5 3 2 <-2

5 11.8% 5 11.8% 5

I&E surplus margin % 20% 3 2 1 -2 <-25 4.8% 5 4.0% 5

Liquidity Liquid ratio days 25% 60 25 15 10 <105 39.9 4 39.9 4

Average4.50 4.50 4.25

Overriding rules Overriding rules

0 0 0

Overall rating Overall rating5 5 4

At least one criteria on Plan 1 or 2

Actual YTD Full year outturn

forecast

5p5 November 09

£000's Full Year Actual Budget Variance

Previous Month

Variance Full Year

Contract Income 133,370 89,014 87,904 1,110 1,524 133,503Other Patient related income 2,140 2,076 1,427 648 440 2,781

Income From Patient Activities 135,510 91,090 89,332 1,758 1,964 136,284

Other Operating Income 11,314 8,355 7,588 768 664 12,374

TOTAL INCOME 146,824 99,445 96,919 2,526 2,628 148,658

Pay expenses 95,248 64,076 63,256 (820) (586) 97,190Drugs 10,392 7,287 7,258 (29) 13 10,812

Supplies 11,360 8,046 7,562 (484) (313) 12,301Other Expenses 17,594 10,593 9,491 (1,103) (1,193) 15,381

TOTAL OPERATING EXPENSES 134,593 90,003 87,567 (2,435) (2,079) 135,684

EBITDA 12,230 9,442 9,352 91 549 12,974EBITDA margin 8.3% 9.5% 9.6% -0.2% 8.7%

Depreciation 4,237 2,674 2,825 151 126 3,986Finance Costs (PDC Dividend & Interest) 2,993 2,007 1,995 (12) (13) 2,986

Gain/(Loss) on Disposal 0 (2) 0 (2) (2) (2)

SURPLUS/(DEFICIT) 5,000 4,760 4,532 228 660 6,000

INCOME AND EXPENDITURE ACCOUNT EIGHT MONTHS TO END NOVEMBER 2009

YEAR TO DATEBUDGET FORECAST

COMMENTS ON YEAR-TO-DATE VARIANCES:▪Contract income for November has been estimated.The SLA income budget has been phased on the basis of last year actual profile. October actual income was £0.16m below estimate forecast and an adjustment for NCA income has led to to lower cumulative variance on contract income. The final agreement with Suffolk PCT on Qtr 1 contract position is still outstanding and carries a potential risk of £100k. ▪ Pay costs overall are 1.3% above budget. Agency and locum costs continue to be incurred to cover vacancies, absence and activity demands both in medical and non-medical staff groups. • The movement on the supplies variance is due to further purchases of new minor clinical equipment during November. ▪ The adverse variance on Other Expenses includes central costs for consultancy and expenditure on ward furnture and equipment. • The forecast outturn includes the assumption that approx. £0.3m costs will be funded from reserves over the remaining months of the year.

6p6 November 09

• The following schedules show the financial and workforce performance for the whole Trust and each of the directorates.• Activity relates to the period to October 09 and variances are based on an estimated profile.• Contract income for November has been estimated.• The Trust currently forecasts to achieve a surplus of £6m.

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

•The Trust has generated a surplus of £4.8 m, £0.2m above the revised, phased budget. Pay costs remain at just over 1% above budget, and include £1.68m of agency costs. Non-pay costs are generally on or below budget, which includes costs for new clinical and medical equipment purchased across the Trust. •Overall nursing staff costs are 1.5% below budget. Medical staff costs (incl. agency) are 5.6% over budget.•The Trust currently employs 2214.6 WTE staff an increase of 14 wte since October.•There are currently 72.23 WTE (91 headcount) employees on maternity leave, compared to 48.08 WTE (60 headcount) for the same period last year. There are several areas of the hospital where the high level of maternity leave could impact on service delivery and are therefore back filled through temporary staffing.• Sickness rate for the month is 4.15%. The cumulative sickness rate for the year is 3.78%

PERFORMANCE SUMMARIES

TRUST

TRUST

November 2009 £000 Current Variance to

BudgetVariance

%

Last month

Variance %

Same period

Last year variance

%

Oct 2009 £000Actual to date Variance %

Last month

Variance %

Same period Last

year variance %

November 2009 £000Actual to date

Last month

Same period

Last yearIncome 2,526 2.6% 3.1% -13.8% SLA Activity (No.) 1,466,884 3.3% 2.9% 31% Employed WTE 2214.6 2199.1 2220.2

Pay (820) -1.3% -1.1% -2.2% Sickness Rates (Oct only) 4.2% 3.8% 3.9%Non-Pay (1,477) -5.1% -5.5% -53.9% SLA Income (£000) 75,414 4.7% 5.7% 5% Mat Leave 3.2% 3.3% 1.9%Net Total 228 5.0% 15.9% 2.0% Vacancy level (wte) 199.38 212.71 175.85

Temp Staff % of Total Pay 7.6% 7.5% 6.4%CIPs 714 26.1% 25.9% 15.6% Agency Staff (£000's) 1,681 1,557 1,310

NHS Locum/Bank Staff (£000's) 3,184 2,643 2,632

FULL YEAR 2009/10 £000Forecast outturn Budget Variance

Variance %


Variance %

Net Total (Surplus)/Deficit (6,000) (5,000) 1,000 20.0% SLA Activity (No.) 2,470,115 2,400,134 69,981 2.9%

CIPs 4,676 3,982 694 17.4% SLA Income (£000) 134,102 132,000 2,102 1.6%

Financial Performance Contract Performance Workforce Performance

7p7 November 09

MEDICINE DIRECTORATE

• Month 7 (October) activity showed a Directorate over performance in the region of 5,400 actual activity, and £900k in value. November activity not available at the time of writing this report.• The Directorate was over spent £94k in the month.• Income was £39k better than budget - the majority of this was due to recovery of consultant staff costs (£16k - Oncology and Neurology), Nurses (£7k), R & D income (5k), alcohol awareness (£4k) and £6k funding for equipment for the Stroke service - much of this income is matched by additional cost.• Covering consultant vacancies in Accident & Emergency and Cardiology added significantly to costs: A&E £40k in the month, Cardiology incurred £35k in additional sessions and a further £5k of locum costs. Other than Cardiology, additional sessional costs were less than previous months. Further locum costs were incurred to cover consultant maternity leave in Haematology.• Nursing costs were £41k above budget. Agency costs reduced to £3k in the month, bank costs remained high. £15k referred to posts funded by income detailed above, £19k for posts that have been approved, via business cases, with no additional funding (Medical Day Treatment Unit and Discharge Unit). The remainder was concentrated on a number of wards with high levels of maternity leave and/or sickness in order to maintain clinical standards.• Non pay costs were underspent, including a reduction in charges for Mobile Angiography - contract based on number of patients seen.

MEDICINE


BudgetVariance

%

Last month

Variance %

Same period

Last year variance

%


Last month

Variance %

Same period Last

year variance %


Last month

Same period

Last yearIncome 237 12.1% 11.5% -37.3% SLA Activity (No.) 81,701 7.1% 8.3% 8% Employed WTE 662.2 659.4 628.5

Pay (754) -4.1% -3.8% -4.2% Sickness Rates (Oct only) 5.1% 4.7% 4.2%Non-Pay (128) -2.0% -2.4% -5.6% SLA Income (£000) 24,214 4.0% 7.2% 5% Mat Leave 2.5% 2.7% 2.6%Net Total (645) -2.8% -2.8% -3.5% Vacancy level (wte) 45.11 48.09 54.23

Temp Staff % of Total Pay 9.8% 9.9% 9.8%CIPs 281 37% 33.5% -10.8% Agency Staff (£000's) 705 662 718

NHS Locum/Bank Staff (£000's) 1,155 972 976


Variance %


Variance %

Net Total Expenditure 35,399 33,840 (1,559) -4.6% SLA Activity (No.) tbc tbc #VALUE! #VALUE!

CIPs 1,547 1,116 431 38.6% SLA Income (£000) tbc tbc #VALUE! #VALUE!


8p8 November 09

There has been little change since last month’s report. Activity remains above plan by approx 12% along with the associated income. Outpatient demand continues to require additional sessions to manage demand in General Surgery, (particularly 2 week wait rapid access colo-rectal), T&O, ENT, Ophthalmology and Oral Surgery. The PCT are attempting to provide a GDP solution for minor oral surgery which, once implemented, will reduce demand in Oral (no time frame yet). New to follow up ratios are satisfactory. Discussions also taking place with Addenbrookes over additional permanent sessions for vascular and plastics.

Income for the month was better than budget due to invoices for the use of medical staff £104k, SLA Income £12k and Private Patients of £38k. Pay was more than budget primarily as a result of medical staff £514k, due to extra session payments, Prof. & Tech agency cost £109k, and nursing bank £278k but partially offset by £230k from staff vacancies. Non-Pay exceeds the budget £187k for contracted work – plastics, ENT, and dental. MSE was over by £276k due to equipment replacements and general supplies in theatres. Cost of appliances and other supplies were £96k over.

Sickness/absence and maternity leave rates have improved on the inpatients wards but the levels still necessitate backfill by bank staff.The use of agency staff was £271k for junior medical staff (Urology, T&O, ENT) and £104k for consultants (Anaesthetics). A further £109k for non-medical agency includes cover for Audiologist (£54k) and the Plaster Orderly (£55k) in the Fracture Clinic (this position has now been recruited to), plus £11k nursing. Locum cost were £355k, primarily in Anaesthetics for consultant cover and bank usage was £278k for nurses and £65k for medical secretaries to cover sickness, maternity leave and vacancies.

SURGERY DIRECTORATESURGERY


BudgetVariance

%

Last month

Variance %

Same period

Last year variance

%


Last month

Variance %

Same period Last

year variance %


Last month

Same period

Last yearIncome 163 11.7% 13.5% -10.1% SLA Activity (No.) 80,974 11.6% 12.0% 14% Employed WTE 545.8 540.0 529.7

Pay (682) -3.9% -3.6% -6.4% Sickness Rates (Oct only) 4.1% 4.0% 4.4%Non-Pay (569) -10.2% -8.2% -13.6% SLA Income (£000) 29,152 15.3% 15.7% 2% Mat Leave 4.0% 3.9% 3.6%Net Total (1,087) -5.0% -4.2% -7.9% Vacancy level (wte) 55.4 61.3 35.2

Temp Staff % of Total Pay 6.5% 6.5% 4.7%CIPs (347) -53.3% -52.4% -46.7% Agency Staff (£000's) 496 473 227

NHS Locum/Bank Staff (£000's) 698 557 570


Variance %


Variance %

Net Total Expenditure 34,681 32,806 (1,874) -5.7% SLA Activity (No.) tbc tbc #VALUE! #VALUE!

CIPs 389 976 (587) -60.2% SLA Income (£000) tbc tbc #VALUE! #VALUE!

Workforce PerformanceContract PerformanceFinancial Performance

9p9 November 09

• The favourable variance to budget is driven mainly by £128.4k in vacant positions, £15.6k in lower drug cost, £13.2k lower rent costs for community midwifery clinic space, £22.2k in transport cost due to last year credits received, Lower SLA charges £0.9k, additional USAF income of £378.8k and £116.5k from EWTD funds. These savings were partially offset by extra session payments of £55.8k and £84.8k for the wards’ bank usage and £44.7k in MSE and other supply cost

• Activity data reflects a significant increase in gynaecology referrals over last year and recorded activity is 30.9% up year-on-year through October. Paediatric referrals are up 6.3% but recorded activity is down by 3.8% primarily due to no longer having the gastroenterology patients. Activity vs the SLA through October is down mainly in midwifery and obstetrics due to over-commissioned levels by the PCT. This will be now be subject to a contract variation.

• Sickness rates have improved from the October position but maternity leave has increased. Use of bank staff (£305.3k) reflects vacancy cover, maternity leave and long term sick cover. Paediatrics have used agency staff to support the service. Locum staff (£173.9k) are being used to cover the vacancies for the hybrid consultants in Paediatrics although part of this cost is offset by additional EWTD income (£116.5k). Non-NHS Agency cost is primarily due to Junior Doctor coverage in Paediatrics.

WOMAN & CHILD DIRECTORATEWOMAN & CHILD


BudgetVariance

%

Last month

Variance %

Same period

Last year variance

%


Last month

Variance %

Same period Last

year variance %


Last month

Same period

Last yearIncome 494 80.1% 53.1% -107.7% SLA Activity (No.) 22,180 -13.9% -13.9% 22% Employed WTE 217.3 214.4 208.5

Pay (12) -0.2% 0.2% 1.3% Sickness Rates (Oct only) 2.2% 2.5% 4.3%Non-Pay 7 1.0% 6.6% -13.4% SLA Income (£000) 10,403 -19.6% -19.7% 10% Mat Leave 5.5% 4.4% 3.0%Net Total 489 7.1% 5.6% 5.4% Vacancy level (wte) 18.50 21.38 15.95

Temp Staff % of Total Pay 8.1% 7.7% 5.1%CIPs 129 59.3% 44.7% 123.0% Agency Staff (£000's) 72 65 37



Variance %


Variance %

Net Total Expenditure 9,927 10,415 (488) 4.7% SLA Activity (No.) tbc tbc #VALUE! #VALUE!

CIPs 396 304 92 -30.3% SLA Income (£000) tbc tbc #VALUE! #VALUE!


10p10 November 09

CLINICAL SUPPORT DIRECTORATE

• The Directorate was over spent this month by £81k.• Income was greater than budgeted due to the continued support for the Early Intervention Team and running the Newmarket

hospital pharmacy service on an interim basis.• Radiology Consultants were successful in an appeal regarding on call duties and received an increase of one Programmed

Activity back dated to May 09. This is not included within budgets (net cost £25k year to date).• Consultant vacancies meant expenditure on locums in Chemistry (£4k) and Histopathology (£9k), with the latter also incurring

a further £11k in referred work. A locum Radiologist is working above their established hours to manage current departmental workload with additional sessions also being required.

• Vacancies in other professions are also being addressed, with Pharmacy now at establishment. There is still some agency staff to cover rehabilitation and Microbiology, which has several vacancies at the moment.

• Medical and Surgical equipment and Pathology equipment were above budget (£6k and £19k respectively), in part to cover activity levels, though there is some increase in analyser stocks with the new contract in chemistry about to start.

• The National Blood service contract was over spent by £19k this month, despite receiving a credit (national contingency savings) of £15k for the first six months, with more expected in January. Costs are being reviewed in light of the higher cost in the month.

CLINICAL SUPPORT


BudgetVariance

%

Last month

Variance %

Same period

Last year variance

%


Last month

Variance %

Same period Last

year variance %


Last month

Same period

Last yearIncome 119 10.6% 11.2% -5.5% SLA Activity (No.) 1,280,357 3.0% 2.4% 35% Employed WTE 443.3 439.7 422.7

Pay 231 2.1% 2.8% 3.6% Sickness Rates (Oct only) 3.5% 3.0% 3.3%Non-Pay (202) -5.3% -4.4% -10.8% SLA Income (£000) 9,686 18.6% 16.6% 20% Mat Leave 4.0% 3.8% 2.1%Net Total 147 1.1% 1.9% 0.4% Vacancy level (wte) 31.02 34.28 37.78




Variance %


Variance %

Net Total Expenditure 20,370 20,452 82 0.4% SLA Activity (No.) tbc tbc #VALUE! #VALUE!

CIPs 1,141 876 265 30.3% SLA Income (£000) tbc tbc #VALUE! #VALUE!


11p11 November 09

IncomeContinues to improve.PaySSD – underspend as a result of vacancy.Estates – underspend as a result of vacancies.Facilities Admin – underspend due to vacancy.Non Pay underspend has reduced this month. Utilities continue to underspend due to lower tariffs.Central Med & Surg – overspend forecast on mattresses has been removed to central fund.WorkforceThe majority of short term sickness is within the Trust target of 3.5%. It was hoped that the Long Term sickness would reduce in October as some staff were on a phased return to work. Regular analysis of the sickness will highlight the variance.

FACILITIES DIRECTORATEFACILITIES


BudgetVariance

%

Last month

Variance %

Same period

Last year variance

%


Last month

Variance %

Same period Last

year variance %


Last month

Same period

Last yearIncome 97 5.5% 4.2% -6.9% SLA Activity (No.) Employed WTE 264.3 264.9 259.64

Pay 84 1.8% 1.3% -3.5% Sickness Rates (Oct only) 5.0% 4.9% 3.8%Non-Pay 249 6.0% 8.8% -13.8% SLA Income (£000) Mat Leave 0.9% 0.2% 2.3%Net Total 430 6.0% 7.0% -8.4% Vacancy level (wte) 19.66 19.07 21.47

Temp Staff % of Total Pay 9.0% 9.1% 8.1%CIPs 233 94.8% 86.6% -12.6% Agency Staff (£000's) 28 23 104



Variance %


Variance %

Net Total Expenditure 10,506 10,773 (267) 2.5% SLA Activity (No.)

CIPs 635 351 284 80.8% SLA Income (£000)


12p12 November 09

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

• The overall pay variance remains favourable. Agency and bank staff are still being used in Finance to support FT work, IT and payroll. The cost of bank nurses on mandatory training are included in these Corporate numbers.

• The Income variance is favourable due mainly to RTA (£204k variance) income and some funding which has associated unbudgeted costs, for example: Pandemic Flu, IT support contracts and Research.

• The Overheads budget includes a CIP for Collaborative Hub led savings, but these savings actually arise elsewhere throughout the Trust, contributing to the adverse variance. The non-pay variance also includes provisions for unbudgeted consultancy work associated with Transformation and Foundation Trust and other projects, creating the high adverse variance.

•The Maternity and sickness rates are below the overall Trust rate.

CORPORATE DIRECTORATECORPORATE


BudgetVariance

%

Last month

Variance %

Same period

Last year variance

%


Last month

Variance %

Same period Last

year variance %


Last month

Same period

Last yearIncome 307 14.1% 14.7% -3.9% SLA Activity (No.) Employed WTE 173.7 172.7 171.2

Pay 313 6.3% 5.9% 3.5% Sickness Rates (Oct only) 3.3% 1.9% 0.6%Non-Pay (752) -21.0% -21.0% 44.8% SLA Income (£000) Mat Leave 0.5% 1.0% 0.3%Net Total (132) -1.2% -1.3% -0.6% Vacancy level (wte) 29.65 28.64 13.99




Variance %


Variance %

Net Total Expenditure 16,358 16,496 (138) 0.8% SLA Activity (No.)

CIPs 569 359 209 58.3% SLA Income (£000)


13p13 November 09

On the basis of the level of surgical activity delivered during the year the Performance Review Group has recognised that the original CIP target for Surgery will not be met, and despite Surgery seeking alternative CIPs, this will not be deliverable in year.

2009/10 CIP REPORT as at 30th November 2009

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

Directorate £000 Target Actual Variance%

VarianceOriginal target

Projected Variance%

Variance Woman and Child 217 345 129 59% 304 396 92 30% Surgery 651 304 (347) -53% 976 389 (587) -60% Facilities 245 478 233 95% 351 635 284 81% Finance and Information 87 143 56 64% 115 185 70 61% HR and Communications 14 31 17 126% 18 38 19 106% Nursing and Governance 7 25 17 241% 7 31 24 331% Medical Director 5 9 4 72% 8 13 6 78% Trust Office 30 111 81 274% 34 119 85 246% Overheads 107 107 - 0% 160 160 - 0% Operations 16 19 3 20% 17 22 5 32% Clinical Support 605 846 241 40% 876 1,141 265 30% Medicine 755 1,036 281 37% 1,116 1,547 431 39%

TOTAL 2,738 3,452 714 26% 3,982 4,676 694 17%

SUMMARISED CIP TYPE COST SAVINGS ACHIEVED - To dateTOTAL COST SAVINGS

Projected - Full year (£'000s)Projection Recurrent Non-recurrent Recurrent Non-recurrent

Target Actual Target Actual Target Actual Target Actual PAY 1,103 1,231 631 1,004 1,666 1,834 842 1,240 AGENCY/BANK 109 38 10 10 163 59 15 15 DRUGS 67 80 - - 101 112 - - CLINICAL SUPPLIES 81 35 - - 122 52 - - OTHER NON-PAY 598 783 131 272 896 1,039 166 324 IT COSTS 8 1 - - 12 2 - -

TOTAL 1,966 2,167 772 1,285 2,960 3,097 1,022 1,579

14p14 November 09

The above table shows financial performance by main specialty lines for the period to October 09. This summary now reflects the changes to the income budget made to the September financial reports. In addition, the October financial position now reflects the actual income position for the first quarter SLA contract. The current Obstetric performance reflects over-commissioned activity by NHS Suffolk

The SLR above reflects the published October financial information.

Summary Service Line Report for October 2009

Total Income to cover Specialty

Costs

Total Expenditure after CRES

Surplus / DeficitTotal Income to cover Specialty

Costs


Surplus / DeficitTotal Income to cover Specialty

Costs


Surplus / Deficit

Surgical Directorate Surgical Directorate Surgical Directorate

General Surgery 7,258,203 7,604,850 ( 346,647 ) General Surgery 6,617,587 7,492,705 ( 875,118 ) General Surgery 640,616 112,145 528,471 Urology 2,779,650 2,920,345 ( 140,695 ) Urology 2,420,299 2,810,922 ( 390,623 ) Urology 359,351 109,423 249,929 Trauma & Orthopaedics 10,960,108 9,209,569 1,750,539 Trauma & Orthopaedics 11,086,136 9,010,303 2,075,833 Trauma & Orthopaedics ( 126,028 ) 199,266 ( 325,294 )Ear, Nose & Throat 3,082,795 1,970,314 1,112,481 Ear, Nose & Throat 2,498,066 1,781,038 717,028 Ear, Nose & Throat 584,729 189,276 395,453 Ophthalmology 4,903,915 3,244,350 1,659,565 Ophthalmology 4,074,368 3,154,457 919,910 Ophthalmology 829,548 89,893 739,655 Dental Surgery 706,008 584,910 121,097 Dental Surgery 569,974 564,210 5,764 Dental Surgery 136,034 20,701 115,333 Plastic Surgery 646,463 510,450 136,014 Plastic Surgery 500,844 404,741 96,103 Plastic Surgery 145,620 105,709 39,911 Thoracic Surgery 9,799 7,537 2,262 Thoracic Surgery 9,691 7,707 1,983 Thoracic Surgery 108 ( 171 ) 279

Total Surgical Directorate 30,346,942 26,052,325 4,294,617 Total Surgical Directorate 27,776,964 25,226,084 2,550,880 Total Surgical Directorate 2,569,978 826,241 1,743,737

Medical Directorate Medical Directorate Medical Directorate

General Medicine 9,483,696 8,054,818 1,428,878 General Medicine 9,175,709 7,900,054 1,275,655 General Medicine 307,987 154,764 153,223 Geriatric Medicine 6,490,628 7,692,790 ( 1,202,162 ) Geriatric Medicine 6,887,165 7,649,284 ( 762,119 ) Geriatric Medicine ( 396,537 ) 43,506 ( 440,043 )Cardiology 1,715,260 1,459,499 255,761 Cardiology 863,149 1,424,625 ( 561,476 ) Cardiology 852,111 34,875 817,236 Coronary CU 27,184 523,552 ( 496,368 ) Coronary CU 4,179 505,634 ( 501,455 ) Coronary CU 23,005 17,918 5,087 Thoracic Medicine 987,322 1,399,706 ( 412,384 ) Thoracic Medicine 962,523 1,462,689 ( 500,166 ) Thoracic Medicine 24,800 ( 62,983 ) 87,783 A&E 2,486,505 4,208,514 ( 1,722,009 ) A&E 2,445,734 3,989,969 ( 1,544,235 ) A&E 40,771 218,545 ( 177,774 )Clinical Haematology 1,753,081 1,533,141 219,940 Clinical Haematology 1,391,402 1,524,943 ( 133,541 ) Clinical Haematology 361,680 8,198 353,482 Dermatology 1,121,704 981,729 139,974 Dermatology 1,384,880 948,594 436,286 Dermatology ( 263,177 ) 33,135 ( 296,311 )GU Medicine 521,398 474,943 46,454 GU Medicine 418,226 484,106 ( 65,880 ) GU Medicine 103,172 ( 9,162 ) 112,334 Neurology 410,486 397,703 12,783 Neurology 389,732 407,654 ( 17,922 ) Neurology 20,754 ( 9,951 ) 30,705 Rheum 1,515,094 1,700,695 ( 185,602 ) Rheum 1,672,698 1,665,571 7,127 Rheum ( 157,605 ) 35,124 ( 192,729 )Clinical Oncology 1,951,612 2,165,834 ( 214,222 ) Clinical Oncology 1,659,275 2,160,304 ( 501,029 ) Clinical Oncology 292,337 5,530 286,807 Pain 326,581 319,111 7,470 Pain 367,280 354,247 13,033 Pain ( 40,699 ) ( 35,136 ) ( 5,563 )

Total Medical Directorate 28,790,550 30,912,035 ( 2,121,485 ) Total Medical Directorate 27,621,951 30,477,674 ( 2,855,723 ) Total Medical Directorate 1,168,599 434,361 734,237

Woman & Child Woman & Child Woman & Child

Maternity Services Maternity Services Maternity ServicesObstetrics 2,236,273 1,766,049 470,224 Obstetrics 3,986,987 1,743,568 2,243,419 Obstetrics ( 1,750,714 ) 22,481 ( 1,773,195 )Midwifery 1,644,489 1,947,183 ( 302,694 ) Midwifery 2,273,194 1,969,103 304,092 Midwifery ( 628,705 ) ( 21,920 ) ( 606,785 )Community Midwifery 799,128 1,126,556 ( 327,428 ) Community Midwifery 806,088 1,144,312 ( 338,225 ) Community Midwifery ( 6,959 ) ( 17,756 ) 10,797 Ante Natal 56,224 626,980 ( 570,756 ) Ante Natal 57,151 648,842 ( 591,691 ) Ante Natal ( 927 ) ( 21,862 ) 20,935 Total 4,736,114 5,466,768 ( 730,654 ) Total 7,123,420 5,505,825 1,617,595 Total ( 2,387,306 ) ( 39,058 ) ( 2,348,249 )

Children's Services Children's Services Children's ServicesPaediatrics 2,475,578 1,929,801 545,777 Paediatrics 2,401,937 1,970,170 431,768 Paediatrics 73,641 ( 40,368 ) 114,009 SCBU 1,105,195 1,096,655 8,539 SCBU 1,078,613 1,102,341 ( 23,728 ) SCBU 26,582 ( 5,685 ) 32,267 Total 3,580,773 3,026,457 554,316 Total 3,480,550 3,072,510 408,040 Total 100,223 ( 46,054 ) 146,276

Gynaecology 2,571,933 2,284,085 287,848 Gynaecology 2,342,367 2,220,991 121,376 Gynaecology 229,566 63,094 166,472

Total Woman & Child 10,888,820 10,777,310 111,510 Total Woman & Child 12,946,338 10,799,327 2,147,011 Total Woman & Child ( 2,057,518 ) ( 22,017 ) ( 2,035,501 )

Other Support Services, incl Radiography, Critical Care, Direct Access and Block.

7,819,378 5,303,797 2,515,581 Other Support Services, incl Radiography, Critical Care, Direct Access and Block.

7,682,083 5,384,290 2,297,793 Other Support Services, incl Radiography, Critical Care, Direct Access and Block.

137,295 ( 80,493 ) 217,788

Trust Total 77,845,690 73,045,467 4,800,223 Trust Total 76,027,336 71,887,375 4,139,961 Trust Total 1,818,354 1,158,092 660,262

Specialty Summary Report

Actual

Specialty Summary Report Specialty Summary Report

Budget VariancePeriod to 31st October 2009 Period to 31st October 2009 Period to 31st October 2009

15p15 November 09

£000

's£0

00's

£000

's£0

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£000

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316

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732

740

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r im

pairm

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f deb

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(96)

(96)

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paym

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687

561

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147

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72,4

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in 1

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incl

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with

in N

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ese

have

now

bee

n re

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nd re

flect

a m

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norm

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mai

n co

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tent

with

the

star

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he y

ear.

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w

ithin

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ther

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a to

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rela

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men

t Hub

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urin

g N

ovem

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tota

l of £

57k

was

invo

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a

tota

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181k

was

col

lect

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the

mon

th.

It sh

ould

als

o be

not

ed th

at ti

ghte

r cre

dit c

ontro

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resu

lted

in a

redu

ctio

n in

non

NH

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ebto

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ys.

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h an

d ba

nk -

The

leve

l of c

ash

rem

ains

hig

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d w

ill c

ontin

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t thi

s le

vel.

The

mai

n re

ason

for t

his

is th

e re

ciep

t of

unde

rper

form

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the

incr

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in n

on tr

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cred

itors

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apita

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ave

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eref

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invo

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are

like

ly to

be

accr

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at th

e ye

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nd).

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fore

cast

refle

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the

curr

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&E

fore

cast

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redi

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and

loan

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s no

ted

abov

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pita

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dito

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ill b

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gh a

t the

yea

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. Th

e le

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f loa

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ill d

ecre

ase

refle

ctin

g th

e ag

reed

re

paym

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ched

ule.

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line

with

Gov

ernm

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eque

st th

e Tr

ust i

s pa

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SM

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with

in 1

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here

pos

sibl

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targ

et o

f 60%

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ow b

eing

ach

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here

are

a n

umbe

r of r

even

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redi

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in re

latio

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the

CP

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ese

are

rela

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all.

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e re

serv

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rela

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to th

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sur

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ncom

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xpen

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re to

talli

ng £

1,23

7K is

hel

d w

ithin

oth

er c

redi

tors

BA

LAN

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SH

EE

T A

S A

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NO

VE

MB

ER

200

9

The

bala

nce

shee

t ref

lect

s th

e po

sitio

n of

the

Trus

t as

at 3

0 N

ovem

ber 2

009

and

the

fore

cast

as

at 3

1 M

arch

201

0. T

he fo

rmat

refle

cts

the

mov

e to

IFR

S re

porti

ng.

The

mai

n ar

eas

for c

onsi

dera

tion

are:

-Fi

xed

asse

ts -

The

mov

emen

ts re

flect

the

valu

e of

the

capi

tal p

rogr

amm

e le

ss th

e de

prec

iatio

n ch

arge

. N

o in

dexa

tion

of fi

xed

asse

ts h

as

been

ass

umed

as

ther

e is

insu

ffici

ent g

uida

nce

to d

eter

min

e w

hat t

he li

kely

cha

nge

in v

alue

s w

ill b

e. T

he T

rust

is c

urre

ntly

in th

e pr

oces

s of

reva

luin

g its

land

and

bui

ldin

gs u

sing

the

Dis

trict

Val

uatio

n S

ervi

ce. T

he fi

gure

s ab

ove

have

not

bee

n am

ende

d to

take

acc

ount

of t

he

reva

luat

ion.

The

ass

ets

held

for r

esal

e ha

ve b

een

anal

ysed

sep

arat

ely.

Mar

ch 2

009

Nov

embe

r 20

09Fo

reca

st M

arch

201

0

16p16 November 09

West Suffolk Hospitals - Rolling cash forecast to 31 March 2011

£000QTR to JUNE

2009QTR to SEPT

2009 OCT NOV DECQTR to DEC

2009 JAN FEB MARQTR to MAR

2010FULL YEAR

2009/10

INCOME

BAL B/FWD 5,858 10,417 10,013 11,058 10,963 10,013 11,347 11,576 11,991 11,347 5,858

NHS Clinical Income 34,570 34,278 11,256 11,457 10,942 33,655 10,777 10,777 12,251 33,805 136,308

Other NHS Income 3,403 2,171 1,184 750 685 2,619 700 685 685 2,070 10,263

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

Income Generation 292 294 109 111 93 313 93 93 93 279 1,178

RTA 150 76 17 40 21 78 21 21 21 63 367

Interest 2 9 3 3 3 9 3 3 3 9 29

Misc Other 1,865 1,526 431 443 376 1,250 376 376 376 1,128 5,769

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

TOTAL INCOME 40,282 38,354 13,000 12,804 12,120 37,924 11,970 11,955 13,429 37,354 153,914

EXPENDITURE

Pay Costs 14,127 14,269 4,739 4,940 4,820 14,499 4,820 4,920 4,810 14,550 57,445

Tax/Pension 9,409 9,469 3,179 3,183 3,115 9,477 3,115 3,115 3,115 9,345 37,700

Creditors 7,714 7,726 2,363 2,491 2,221 7,075 2,221 2,168 2,168 6,557 29,072

Drugs/Stores/NHS Litigation 4,027 4,111 1,411 1,667 1,180 4,258 1,180 937 941 3,058 15,454

PDC Payments 0 1,400 0 0 0 0 0 0 1,372 1,372 2,772

Interest on loans 0 124 0 0 0 0 0 0 102 102 226

Capital expenditure 446 834 263 618 400 1,281 405 400 600 1,405 3,966

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

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

TOTAL EXPENDITURE 35,723 38,758 11,955 12,899 11,736 36,590 11,741 11,540 13,933 37,214 148,285

BALANCE C/fwd 10,417 10,013 11,058 10,963 11,347 11,347 11,576 11,991 11,487 11,487 11,487

FORECAST

The cash flow forecast reflects the actual cash position as at 30 November 2009. The model takes account of the Department of Health loan including its repayment schedule and interest charges. The Trust is required to report against EFL however relaxation of rules allow for Trust's hold cash balances above it's EFL target. The figure for April includes the receipt of overperfomance on contracts up to the end of the financial year. The lower cash balance in September is a result of the repayment of loans and associated interest and the half yearly payment of Public Capital Dividend. The forecast at the year end reflects the current view on the surplus for the year.

ACTUAL

17p17 November 09

Wes

t Suf

folk

Hos

pita

l NH

S Tr

ust C

apita

l Pro

gram

me

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9-20

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evis

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lSc

hem

eB

udge

tEx

pend

iture

Fore

cast

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as a

t 30

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Expe

nditu

re

Pre-

Com

mitm

ents

(inc

08/

09 C

ontr

actu

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omm

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Phar

mac

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nit/R

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1,42

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The

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as a

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% o

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k, F

acilit

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ely

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The

unde

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note

d ab

ove

have

the

effe

ct o

f for

ecas

ting

an o

vera

ll und

ersp

end

of £

88k

item 6.1 nov 09 finance and workforce report

Documents