kingston hospital nhs foundation trust finance report ... · pdf fileenc g original plan...

Enc G

Original Plan

£

0

0

0

'

s Var £000's

Kingston Hospital NHS Foundation Trust

Finance Report

February 2016 (Month 11)

A revised annual plan of a £6.1m deficit was submitted to Monitor in September. The analysis in this report is shown against this revised plan. For reference,

the original budget is shown on page 4.

CONTENTS

EXECUTIVE SUMMARY…………………...………………………………………………………………………..………………......3

SECTION 1: OVERALL INCOME AND EXPENDITURE……….…………..……………………………….………….…….…….4

SECTION 2: DIVISIONAL POSITIONS……………....………………………………………….……………………………………5

SECTION 3: COST IMPROVEMENT PROGRAMME ………..…………….……………….……………………………………..10

SECTION 4: INCOME………………………………………...…………………………….…………………………………………..11

SECTION 5: PAY COSTS……....……………………………………………………………………………………….……………..12

SECTION 6: NON PAY COSTS……..……………………………………………….………………………………….…………….15

SECTION 7: STATEMENT OF FINANCIAL POSITION …………..…….…..……………………………………………………..16

SECTION 8: CASH FLOW STATMENT.……..…..…………………………………………………………………………………..17

SECTION 9: DEBTORS………..…………………………….…..……………….…………………………………………..……….18

SECTION 10: CREDITORS…..…………....………………….….……………….…………………………………………..……….19

SECTION 11: CAPITAL …………...……..…………………………………………………………………………………………......21

SECTION 12: FINANCIAL SUSTAINABILITY RISK RATING (FSRR) … …….……………...……………………………..……22

Appendix 1 - INCOME DETAIL ….………………………....………………………..………………..………..……….…………….23

Appendix 2 - ACTIVITY DETAIL …..……..….…………………….……………………………………………..…………….……..24

Appendix 3 - INCOME PENALTIES ………... …….…..….……...…………………….………………………..…………….……..25

Contents

Pg3

EXECUTIVE SUMMARY

Headline

Trend

against

Revised

Plan

Trend

against

Revised

Plan

Narrative

(January) (February)

At the end of M11 the Trust reported a year to date deficit of

£6.5m, which is £0.7m adverse to the revised plan submitted to

Monitor.

The Trust reported an in month deficit of £0.4m. The underlying positive variance on patient care income is £0.1m after removing the

impact of high cost drugs (£0.2m). Other income has improved in month due to additional LDA and research income. There is also non-

recurrent benefits from the release of GRNI and income risk reserves, together totalling £0.7m.

The underlying clinical income favourable variance was £0.1m

of the reported £0.3m patient care income variance (£0.2m of

the reported position related to high cost drugs).

The in-month income is above forecast by £0.3m which includes the benefit of £0.2m of high cost drugs,which is a pass through cost.

Pay and Non Pay Expenditure directly associated with the

delivery of clinical services is over forecast by £1.1m in M11.

Pay is £0.5m adverse in month while Non Pay is overspent by £0.5m. High agency usage due to escalations, specials and winter

pressures are driving the pay increase. Non Pay variances are partly due to high cost drugs (£0.2m) and partly to small clinical supplies

overspends across a large number of service lines.

Corporate Services pay and non pay were £0.2m better than

forecast in M11

The main driver for this is a reduction in agency usage compared to forecast

CIP Delivery stands at 83% YTD and 88% in month.

The CIP programme shortfall remains mainly due to Emergency service lines where only 56% of CIPs have been achieved YTD. All other

divisions are forecasting over 90% achievement.

The Trust is forecasting a deficit of £6.9m.

This is £0.5m higher than the forecast presented to Monitor since Month 8. This movement is mainly due to the junior doctor strikes

reducing activity and incurring additional costs.

At the end of M11, capital expenditure is below forecast.

Capital YTD expenditure is 87% of the revised plan. Equipment and IT delays contribute to the slippage on capital, we expect this

underspend to continue to 31st March 2016

The cash balance reported at the end of M11 was £1.6m.

The closing cash position for January was £1.6m which was a deterioration of £0.3m on the previous month's position. At the time of

producing the report the cash balance was £12.6m.

\\lares\FINANCE.grp\Secure Department Folders\Planning\2015\Reporting\Monthly Position\M11\M11 Finance Report V8 Pg4

£m

SECTION 1: OVERALL INCOME AND EXPENDITURE Version 1

Summary as at the end of Feb-16

IN MONTH YEAR TO DATE

Income & Expenditure

Original Plan

£000's

Revised Plan

Revised Plan v Actuals

Revised plan

£000's Actual £000's Var £000's


Revised plan

£000's Actual £000's Var £000's

Income Patient Care Income

Other Income

203,316

24,506

204,623

24,724

16,814

1,901

17,133

2,049

319

148

186,954

22,832

188,191

24,472

1,236

1,640

Income 227,823 229,347 18,715 19,182 467 209,786 212,662 2,876

Expenditure Pay

Non Pay

(143,006)

(77,641)

(146,690)

(73,549)

(12,279)

(5,937)

(12,431)

(5,899)

(152)

38

(134,422)

(67,549)

(135,451)

(70,115)

(1,029)

(2,566)

Expenditure (220,646) (220,239) (18,216) (18,330) (114) (201,971) (205,566) (3,595)

EBITDA 7,176 9,108 499 852 353 7,815 7,096 (719)

Depreciation and Amortisation

Investment Revenue

Finance Costs

Public Dividend Capital

(9,394)

16

(3,411)

(3,232)

(8,625)

24

(3,347)

(3,228)

(702)

2

(275)

(269)

(741)

1

(275)

(268)

(39)

(1)

1

2

(7,658)

22

(3,071)

(2,959)

(7,591)

20

(3,154)

(2,894)

66

(2)

(83)

65

Total I&E (8,845) (6,068) (746) (431) 315 (5,851) (6,523) (672)

Original Plan

Revised Plan

Plan

Actual

Plan

Actual YTD

EBITDA Margin

EBITDA Achieved

I&E Surplus Margin

3.1%

100.0%

-3.9%

4.0%

100.0%

-2.6%

2.7%

100.0%

-4.0%

4.4%

170.7%

-2.2%

3.7%

100.0%

-2.8%

3.3%

90.8%

-3.1%

2.0

Cumulative Position Against Plan 2015/16

0.0

-2.0

Apr May Jun Jul Aug Sep Oct Nov Dec Jan Feb Mar

-4.0

-6.0

-8.0

-10.0

Actuals 2014/15 Actuals 2015/16 Original Plan 2015/16 Forecast 2015/16

Pg5

SECTION 2: DIVISIONAL POSITIONS

Overview



Income & Expenditure

Revised

Plan

£000's


Revised

plan Actual Var

£000's £000's £000's

Variances

Inc Pay Non Pay Total


Revised

plan Actual Var

£000's £000's £000's

Variances

Non

Inc Pay Pay Total

Clinical Support Services

Emergency Care Specialist Services

(24,692)

14,698 51,496

(2,087)

1,124 4,140

(2,221)

416 3,808

(135)

(709) (332)

18

(109) (29)

(68)

(381) (97)

(85)

(219) (206)

(135)

(709) (332)

(22,596)

13,343 46,804

(23,718)

10,559 45,282

(1,122)

(2,784) (1,522)

274

(226) (365)

(627)

(1,312) (152)

(769)

(1,247) (1,006)

(1,122)

(2,784) (1,522)

Clinical Divisions 41,503 3,178 2,003 (1,175) (120) (546) (510) (1,175) 37,551 32,123 (5,428) (316) (2,091) (3,022) (5,428)

Commercial Director

Corporate Affairs

Finance

Human Resources

Medical Director

Nursing Director

Operations

(2,107)

(3,396)

(4,220)

(1,883)

(425)

(2,175)

(26,024)

(177)

(290)

(304)

(167)

(50)

(242)

(2,168)

(140)

(136)

(279)

(69)

(53)

(254)

(2,190)

36

153

25

98

(3)

(11)

(22)

(3)

12

(4)

(22)

(9)

24 (6)

69

38

57

58

5

96 55

(29)

104

(28)

62

0

(131)

(71)

36

153

25

98

(3)

(11)

(22)

(1,930)

(3,105)

(3,916)

(1,732)

(376)

(1,940)

(23,862)

(1,890)

(2,777)

(3,917)

(1,792)

(310)

(2,043)

(23,203)

40

327

(1)

(60)

66

(103) 658

(10)

62

7

27

38

136 305

88

243

64

(53)

26

194 413

(37)

22

(71)

(34)

2

(433)

(59)

40

327

(1)

(60)

66

(103) 658

Directorates (40,231) (3,397) (3,121) 276 (9) 377 (92) 276 (36,861) (35,933) 928 564 976 (612) 928

Central Income

Other Central Budgets 7,001

836

592

126

971

999

380

872 0

128

468

3

13

249

392

380

872

6,417

709

7,253

3,653

836

2,945 0

399

2,228

11

75

426

642

836

2,945 0

EBITDA 9,108 499 852 353 467 (152) 38 353 7,815 7,096 (719) 2,876 (1,029) (2,566) (719)

Depreciation & Losses

Interest

PDC

(8,625)

(3,323)

(3,228)

(702)

(273)

(269)

(741)

(274)

(268)

(39)

(0)

2

(39)

(0)

2

(7,658)

(3,050)

(2,959)

(7,594)

(3,134)

(2,894)

63

(85)

65

63

(85)

65

Total I&E (6,068) (746) (431) 315 315 (5,851) (6,526) (675) (675)

COMMENTARY

• Income has underperformed in month in Respiratory, T&O, AAU and Specialist outpatients mainly as a result of lower non elective activity. However this is offset by improved income on A&E, Gynaecology, General Surgery and Cardiology. Pay has been overspent within nursing due to escalations and winter pressures being funded through agency. Specials and locum usage in medical has also contributed to this overspend. Non Pay has been overspent in month due laboratory equipment in Pathology, Laproscopic consumables in Anaesthetics and additional consumable usage in A&E due to additional activity.

• Income in corporate areas has improved in both pay and non pay due partly to a faster reduction in agency spend than had been forecast.

• Central Income and Central Budgets includes additional LDA and NMET income recieved in monthof £0.2m. It also includes the £0.5m release of GRNI accruals posted into the I&E as

per the recovery plan. The income risk was also reassessed in month given the lower levels of activity and £0.3m was released into the position form central budgets. Both of these were unplanned resulting in a variance.

Pg6


Clinical Support Services Summary as at the end of Feb-16



Income & Expenditure Original

Plan

£000's

Revised

Plan

£000's


Revised

plan Actual Var

£000's £000's £000's


Revised

plan Actual Var

£000's £000's £000's

Service Lines Revised

plan

£000's


Revised

plan Actual

£000's £000's Var £000's


Revised

plan Actual

£000's £000's Var £000's

Patient Care Activ ities

Other

5,360

18,501

5,568

1,534

358

1,564

346

30

(12)

16,903

5,210

16,648

5,739

(255)

529

Anaesthetics, Theatre and DSU

Histopathology

Imaging

Intensive Care Unit

Pathology

Pharmacy

Sterile Services Department

Therapies

(13,335)

(2,242)

(9,388)

(4,945)

(10,615)

(2,582)

(1,545)

(4,109)

(1,100)

(189)

(769)

(417)

(802)

(211)

(129)

(361)

(1,130)

(202)

(802)

(486)

(853)

(195)

(119)

(344)

(30)

(13)

(33)

(69)

(50)

16

10

17

(12,235)

(2,053)

(8,619)

(4,528)

(9,813)

(2,294)

(1,415)

(3,752)

(12,449)

(2,096)

(8,842)

(4,846)

(10,339)

(2,351)

(1,358)

(3,824)

(214)

(44)

(222)

(317)

(526)

(58)

58

(73)

Income 5,360 24,069 1,892 1,910 18 22,113 22,387 274

Expenditure - Pay

Medical & Dental

Nursing & Midwifery

Scientific,Professional & Tech

Admin & Clerical

Other

(9,757)

(7,977)

(3,929)

(1,504)

(9,109)

(9,857)

(7,834)

(4,017)

(1,552)

(9,043)

(814)

(653)

(334)

(126)

(764)

(840)

(704)

(343)

(120)

(750)

(27)

(51)

(9)

6

13

(9,044)

(7,181)

(3,660)

(1,427)

(8,286)

(9,121)

(7,527)

(3,737)

(1,462)

(8,378)

(77)

(346)

(77)

(35)

(92) (48,761) (3,979) (4,131) (152) (44,709) (46,105) (1,396)

Pay (32,275) (32,304) (2,690) (2,758) (68) (29,597) (30,224) (627) Service Lines In Month Variances

Inc Pay Non Pay

YTD Variances

Inc Pay Non Pay Expenditure - Non Pay

Clinical Supplies & Services

Other

(13,164)

(2,838)

(13,457)

(3,000)

(1,058)

(230)

(1,118)

(255)

(60)

(24)

(12,400)

(2,712)

(12,798)

(3,084)

(398)

(371)

Anaesthetics, Theatre and DSU

Histopathology

Imaging

Intensive Care Unit

Pathology

Pharmacy

Sterile Services Department

Therapies

27

(9)

(53)

42

(8)

7

(0)

11

1

3

(30)

(63)

(24)

20

(1)

26

(31)

(15)

(3)

(6)

(26)

(4)

11

(9)

176

(47)

(288)

(155)

402

169

(1)

19

(42)

12

(184)

(237)

(172)

45

(5)

(46)

(173)

(56)

(38)

(81)

(354)

(103)

63

(27)

Non Pay (16,002) (16,457) (1,289) (1,373) (85) (15,112) (15,881) (769)

Expenditure (48,277) (48,761) (3,979) (4,131) (152) (44,709) (46,105) (1,396)

Income Less Direct Costs (42,917) (24,692) (2,087) (2,221) (135) (22,596) (23,718) (1,122)

18 (68) (85) 274 (627) (769)

Income & Expenditure Commentary

• The month 11 position is £135k adverse against the revised plan.

• Patient Care Income is £30k better than forecast and this is driven by the continued increase in activity in ICU in month which has resulted in an overperformance in income against forecast ,. The acuity of patients and therefore the tariff received is still lower than had been planned (organ 1, 2 and 3 supported) ,likely due to the success of the inreach and 24/7 sepsis initiatives.

• Other Income is £12k adverse against the plan in month driven by an adjustment to the invoices to Surbiton Hospital and Surbiton Health Centre as part of the Your

Healthcare service contract.

• Pay is £68k adverse against the revised plan and this is mainly ICU, Radiographers and Radiologists and Pathology. In Imaging additional premium agency costs have been incurred due to the Gynae and thyroid lists being moved to theweekend and out of hours working to accommodate the breast work. Recruitment is underway to recruit permanently into the vacant consultant posts. In Pathology agency costs relating to chemical pathology are driving the adverse variance against forecast but these are chargeable to SWL Pathology and are reflected in other income. In ICU, agency usage to cover 9 wte vacancies is driving the overspend.

• Non Pay is £85k adverse against the revised plan. The adverse position largely lies within Pathology and Anaesthetics . The overspend in Pathology relates to lab equipment

in chemical pathology and the SWL Pathology contract. These are chargeable to SWL Pathology and are reflected in other income. In Anaesthetics the overspend is due to laparoscopic consumables, wound closures, respiratory tubes and masks and medical and surgical equipment .

CIP Commentary • In month, the division achieved £83k (95%) of its

target.

• The main shortfall relates to ceasing the Radiology

SLA with St Georges for junior Doctors (£63k YTD)

Divisional Actions Actions were agreed within ICU, imaging and theatres to include: • Plans to address recruitment to reduce agency

spend

• Reviewing data on consultant productivity with action plans produced

• Review non pay spend within Imaging and

understand the increase in the charge on the managed service contract.

• Develop plan to ring-fence slots for GPs

• Develop plan with theatres to ensure capacity

available and wastage minimised

• Outsource out of hours reporting to expand in house capacity for routine work.

• Agree job plans for Imaging consultants and

recruit into 3 vacant posts which will reduce agency usage from July 2016

Pg7


Emergency Care Summary as at the end of Feb-16




Plan

£000's

Revised plan

£000's


Revised

plan Actual

£000's £000's Var £000's


Revised plan Actual Var

£000's £000's £000's

Service Lines

Revised

plan

£000's


Revised

plan Actual

£000's £000's Var £000's


Revised

plan Actual

£000's £000's Var £000's

Patient Care Activ ities

Other

1,347

58,867

1,413

4,745

84

4,751

(31)

6

(114)

53,897

1,329

53,931

1,070

34

(260)

Accident and Emergency

Acute Assessment Unit

Cardiology

Elderly Care

Gastro and Endoscopy

Respiratory

Site management

(9,723)

(5,356)

(8,229)

(13,002)

(5,075)

(3,139)

(1,059)

(785)

(421)

(660)

(1,081)

(412)

(260)

(87)

(823)

(510)

(789)

(1,304)

(494)

(299)

(87)

(38)

(89)

(129)

(223)

(82)

(39)

0

(8,938)

(4,934)

(7,569)

(11,927)

(4,663)

(2,879)

(973)

(9,735)

(5,138)

(8,124)

(12,346)

(5,163)

(2,947)

(989)

(796)

(204)

(555)

(419)

(500)

(67)

(17)

Income 1,347 60,281 4,829 4,720 (109) 55,226 55,000 (226)

Expenditure - Pay

Medical & Dental

Nursing & Midwifery


Admin & Clerical

Other

(10,557)

(18,603)

(810)

(2,382)

(313)

(12,179)

(20,344)

(809)

(2,191)

(633)

(1,054)

(1,618)

(64)

(182)

(41)

(1,059)

(1,974)

(68)

(192)

(46)

(5)

(356)

(4)

(10)

(5)

(11,125)

(18,732)

(746)

(2,009)

(592)

(11,566)

(19,482)

(789)

(2,019)

(658)

(441)

(750)

(43)

(10)

(66)

(45,583) (3,705) (4,305) (600) (41,883) (44,442) (2,558)

Pay (32,666) (36,156) (2,959) (3,340) (381) (33,203) (34,515) (1,312) Service Lines In Month Variances

Inc Pay Non Pay

YTD Variances

Inc Pay Non Pay Expenditure - Non Pay


Other

(3,023)

(6,457)

(2,836)

(6,591)

(233)

(514)

(317)

(648)

(85)

(134)

(2,604)

(6,076)

(3,025)

(6,902)

(421)

(825)


Acute Assessment Unit

Cardiology

Elderly Care


Respiratory

Site management

143

(64)

122

(150)

(12)

(143)

(3)

(1)

(80)

(18)

(195)

(56)

(31)

0

(37)

(9)

(111)

(28)

(25)

(8)

(0)

358

(226)

148

(234)

(49)

(203)

(20)

(549)

(178)

55

(367)

(270)

(10)

6

(248)

(27)

(610)

(52)

(230)

(58)

(23)

Non Pay (9,479) (9,427) (746) (965) (219) (8,680) (9,927) (1,247)

Expenditure (42,145) (45,583) (3,705) (4,305) (600) (41,883) (44,442) (2,558) Income Less Direct Costs (40,798) 14,698 1,124 416 (709) 13,343 10,559 (2,784)

(109) (381) (219) (226) (1,312) (1,247)



• �Patient Care Income is £6k better than the revised plan. A&E activity has been higher than forecast but this is offset by an underperformance in non elective income. Other

income is £114k adverse and this is in elderly care where the commissioners will not be paying for the Geriatritian of the day service. (GOD Service)

• Pay is £381k adverse against plan. This is mainly within the nursing staff group. where escalations and winter pressures including Claremont have been funded through

agency. Specials usage in Hardy ward along with the locum usage in medical staffing in Gastro is driving the pay overspend.

• �Non pay is £219k adverse against the revised plan. This is partly due to high cost drugs (£71k) which are offset by income within Cardiology . In A&E ,the overspend is due

to purchase of medical & surgical supplies reflecting higher activity.

CIP Commentary

The Emergency Services Division achieved 36% of its CIP

target in month.

Underachieving CIPs

• Sleep Apnoea

• ED Case mix / over-performance

• EDOU closure resulted in the loss of CIP's associated

with it.

Divisional Actions

• All ECIST steps are being factored into the transformation plan to

minimise 4 hour breeches going forward.

• Pursue with recruiting into the consultant vacancies within the

Gastro/Endo specialities

• Recruitment to vacant medical posts in progress. with success in

the DD and CoE role will continue with locums in CoE , Stroke and

ACPs while we continue to recruit.

• Matrons to lead on reducing the Specials expenditure through

better management of substantive HCA establishment and

improved assessment of patients.

• Discharge project will be working to reduce LoS along with

employment of Locum CoE consultant against current vacancy.

• Working to ring fence AAU trollies to increase ambulatory care

activity has not yet been successful


Service Lines Revised

plan

£000's


Revised

plan Actual

£000's £000's Var £000's


Revised

plan Actual

£000's £000's Var £000's

GUM

Gynaecology and Breast

Maternity

Ophthalmology

Oral and ENT

Paediatrics and NNU

Specialist Outpatients

(3,749)

(5,820)

(19,158)

(7,751)

(4,066)

(10,237)

(10,097)

(321)

(496)

(1,595)

(638)

(341)

(890)

(854)

(346)

(514)

(1,567)

(722)

(350)

(907)

(862)

(25)

(18)

28

(84)

(9)

(17)

(7)

(3,428)

(5,305)

(17,563)

(7,114)

(3,725)

(9,347)

(9,243)

(3,410)

(5,215)

(17,324)

(7,457)

(3,778)

(9,390)

(9,508)

17

90

239

(344)

(53)

(43)

(264)

Total Specialist Services (60,878) (5,135) (5,268) (133) (55,726) (56,082) (357)

General Surgery and Urology

Trauma and Orthopaedics

(8,658)

(9,433)

(705)

(810)

(833)

(852)

(128)

(42)

(7,969)

(8,623)

(8,510)

(8,883)

(541)

(260)

Total (78,970) (6,649) (6,953) (303) (72,318) (73,476) (1,157)

Service Lines In Month Variances Inc Pay Non Pay

YTD Variances Inc Pay Non Pay

GUM

Gynaecology and Breast

Maternity

Ophthalmology

Oral and ENT

Paediatrics and NNU

Specialist Outpatients

21

72

18

19

50

41

(60)

3

14

25

(46)

0

(9)

7

(28)

(33)

3

(38)

(10)

(8)

(15)

48

50

(210)

187

228

38

454

20

154

174

(111)

17

(20)

53

(3)

(64)

66

(233)

(70)

(23)

(317)

Total Specialist Services 161 (5) (129) 794 288 (644)



62

(252)

(82)

(11)

(47)

(31)

(131)

(1,027)

(366)

(73)

(174)

(187)

Total (29) (97) (206) -365 (152) (1,006)


Specialist Services Summary as at the end of Feb-16



Plan

£000's

Revised

Plan

£000's


Revised plan Actual Var

£000's £000's £000's


Revised

plan Actual Var

£000's £000's £000's

Income

Patient Care Activities

Other

122,237

4,944

125,420

5,047

10,381

409

10,208

553

0

(172)

144

114,474

4,648

113,726

5,031

(748)

384

Income 127,180 130,466 10,790 10,761 (29) 119,122 118,757 (365)

Expenditure - Pay

Medical & Dental

Nursing & Midwifery


Admin & Clerical

Other

(20,203)

(25,235)

(1,630)

(5,501)

(1,154)

(20,487)

(25,055)

(1,597)

(5,450)

(1,172)

(1,694)

(2,169)

(141)

(463)

(95)

(1,796)

(2,208)

(140)

(413)

(102)

(102)

(39)

1

49

(6)

(18,793)

(22,902)

(1,457)

(4,988)

(1,077)

(19,445)

(22,593)

(1,416)

(4,805)

(1,109)

(652)

308

41

183

(32)

Pay (53,723) (53,761) (4,561) (4,659) (97) (49,215) (49,367) (152)

Expenditure - Non Pay


Other

(7,686)

(16,262)

(7,616)

(17,593)

(637)

(1,451)

(770)

(1,524)

(133)

(72)

(6,969)

(16,134)

(7,349)

(16,759)

(380)

(625)

Non Pay (23,947) (25,209) (2,088) (2,294) (206) (23,103) (24,108) (1,006)

Expenditure (77,670) (78,970) (6,649) (6,953) (303) (72,318) (73,476) (1,157)

Income Less Direct Costs 49,510 51,496 4,140 3,808 (332) 46,804 45,282 (1,522)



• Patient Care Income is £172k adverse against forecast. This is mainly within Trauma and Orthopaedics.

• Pay is £97k adverse against the revised plan. The overspend is mainly within medical staffing with agency usage in Paediatrics due to the shortage in middle grades. and in Ophthalmology.

• Non Pay is £206k adverse against the revised plan. £156k of this relates to clinical supplies mainly within Gynaecology, Surgery , Ophthalmology and Trauma and Orthopaedics. The purchases

are activity driven and there is also an overspend in GUM relating to drugs within tariff.

CIP Commentary

• The division has achieved £0.2m of its target in month

(87%). Schemes not delivering in month mainly relate to:

• T&O - coding of outpatient with procedures and non

pay savings. Although procedure coding is being undertaken by the service this does not secure additional funding. Investigations are being undertaken between the coding, service and commissioning teams to understand this.

Divisional Actions • Understanding from the partnership board

/Epsom Orthopaedics Centre the recovery of the current SWELOC position.

• A review of process in Gynaecology to ensure

maximum utilisation of theatres and DSU has been undertaken. Consultants are signing off theatre lists now and this will drive better utilisation of theatres.

• DNA's are high in Gynae & Breast and the ser vice

have developed an action plan to address the underlying causes .

• The service management are working

collaboratively with theatres to address and resolve some of the under utilisation of theatres. Benefit of this is expected to be seen from March onwards.

• Job plans for Orthopaedics is being reviewed and

will be undertaken by the new CD.

Pg8

Service Lines In Month Variances

Inc Pay Non Pay

YTD Variances

Inc Pay Non Pay

Commercial Director

Corporate Affairs

Finance

Human Resources

Medical Director

Nursing Director

Operations

(3)

12

(4)

(22)

(9)

24

(6)

69

38

57

58

5

96

55

(29)

104

(28)

62

0

(131)

(71)

(10)

62

7

27

38

136

305

88

243

64

(53)

26

194

413

(37)

22

(71)

(34)

2

(433)

(59)

(9) 377 (92) 564 976 (612)


Corporate Summary as at the end of Feb-16


FORECAST OUTTURN



Plan

Revised

Plan Revised Plan v Actuals Revised Plan v Actuals Budget v Forecast

Variances Service Lines

Revised Plan Revised Plan v Actuals Revised Plan v Actuals

Revised

Plan Actual Var

Revised

Plan Actual Plan Forecast

Revised

Plan Actual

Revised

Plan Actual

£000's £000's £000's £000's £000's £000's £000's Var £000's £000's £000's Var £000's Inc Pay Non Pay Total £000's £000's £000's Var £000's £000's £000's Var £000's

Commercial Director (2,107) (177) (140) 36 (1,930) (1,890) 40

Patient Care Activities 1,080 1,019 85 85 0 935 955 21 Corporate Affairs (3,396) (290) (136) 153 (3,105) (2,777) 327

Other 5,938 5,921 474 465 (9) 5,439 5,982 544 Finance (4,220) (304) (279) 25 (3,916) (3,917) (1)

Income 7,018 6,940 558 549 (9) 6,373 6,937 564 Human Resources (1,883) (167) (69) 98 (1,732) (1,792) (60)

Expenditure - Pay Medical Director (425) (50) (53) (3) (376) (310) 66

Medical & Dental (1,972) (2,019) (180) (92) 88 (1,848) (1,729) 119 Nursing Director (2,175) (242) (254) (11) (1,940) (2,043) (103)

Nursing & Midwifery (2,369) (2,291) (206) (181) 25 (2,085) (2,045) 40 Operations (26,024) (2,168) (2,190) (22) (23,862) (23,203) 658

Scientific,Professional & Tech (567) (487) (36) (37) (1) (450) (516) (66) (40,231) (3,397) (3,121) 276 (36,861) (35,933) 928

Admin & Clerical (8,659) (10,560) (818) (706) 111 (9,740) (9,375) 365

Other (8,609) (8,936) (809) (655) 154 (8,128) (7,610) 518

Pay (22,176) (24,293) (2,049) (1,671) 377 (22,251) (21,275) 976

Expenditure - Non Pay

Clinical Supplies & Services (439) (567) (51) (49) 1 (515) (534) (19)

Other (21,419) (22,313) (1,856) (1,950) (94) (20,468) (21,061) (593)

Non Pay (21,857) (22,879) (1,907) (1,999) (92) (20,983) (21,595) (612)

Expenditure (44,034) (47,172) (3,955) (3,670) 285 (43,234) (42,870) 364

Income Less Direct Costs (37,016) (40,231) (3,397) (3,121) 276 (36,861) (35,933) 928


The month 11 position is £276k favourable in month against the revised plan in month. The main areas are explained below:

• Income is (£9k) adverse in month against plan. This is mainly due to reduced Nursery income received in month (£38k)

• Pay is £377k favourable against plan in month. This is driven by Nursing, Commercial, HR, Operations and Finance . This is driven by a rationalisation of Agency use and accruals £157k, Substantive vacancies £193k, Medical staff recharges £24k.

• Non pay is adverse against the revised plan by (£92k) in month. This continues to be driven by Overseas recruitment of Nurses will continue until the end of the year (£56k) and Clinical Equipement and IT (£56k); Estates department postage (£73k) due to a billing backlog;

offset by Corporate Affairs and others £37k.

CIP Commentary

The Corporate Directorate achieved 94% of its CIP

target in month and 96% YTD.

Underachieving CIPs

• Energy Rebate negotiations for £150k rebate are

ongoing.

Divisional Actions

• �Recruiting to vacant posts.

• Finance has almost completed its recruitment drive

which is resulting in a lower agency spend.

• PFI variation model is being developed to forecast

seasonality.

Pg9

Pg10


Division Annual

Plan £000's

Plan Actual Variance

£000's £000's £000's


£000's £000's £000's

Emergency Care

Specialist Services

Clinical Support Services

Commercial

Corporate Affairs

Finance

HR

Medical

Nursing

Operations

Central (CNST)

1,338

2,898

1,004

110

191

108

56

19

50

760

2,421

111 41 (70)

229 199 (30)

88 83 (5)

10 7 (2)

19 17 (1)

10 5 (5)

5 4 (0)

2 2 0

4 4 0

58 49 (9)

202 202 0

2,441

1,227 685 (541)

2,672 2,441 (231)

916 854 (62)

100 96 (4)

172 170 (2)

98 95 (2)

51 50 (1)

18 18 (0)

46 46 0

702 579 (124)

2,219 2,219 0

Total CIP 8,954 737 613 (124) 8,221 7,253 (968)

Type Annual

Plan £000's

In Month Plan Actual Variance

£000's £000's £000's

YTD Plan Actual Variance

£000's £000's £000's

Cost Reduction 2,541 211 204 (6) 2,330 2,265 (65)

97% 97%

Income Generation 6,413 526 409 (117) 5,891 4,988 (902)

78% 85%

Total CIP 8,954 737 613 (124) 8,221 7,253 (968)

83% 88%

SECTION 3: COST IMPROVEMENT PROGRAMME


COMMENTARY

• In month achievement is 83% of plan (YTD 88%).

• The CIP plan is in line with prior month projections

and shortfalls continue in Emergency Services and

T&O.

• All CIP shortfalls have been included in the Trust's

forecast position.

• In Operations , we have been successful in securing

an Energy rebate with our PFI provider amounting

to £0.1m but this is not yet reflected in the position.

• See divisional commentaries for further details of

specific schemes and actions.

Pg11

Var £000's

I&E YTD (£186.1m)

Billed (£182.8m)

Paid (£175.3m)

Unpaid (£7.5m)

Low Risk(£3.2m)*

Medium Risk(£0.1m)*

Year End Accrual

Billed £7.1m

Paid (£6.6m)

£7.2m Unpaid (£0.4m)

Accrued £0.1m Low Risk(£0m)*

Medium Risk(£0.1m)*

SECTION 4: INCOME

Income Risk Summary 2015/16 - Table 1

Accrued (£3.3m)

COMMENTARY

Table 1

• Table 1 shows income in 2015/16 position and breaks it down into how much has not been received in cash terms.

• The Accrued income has increased from £1.6m to

£3.3m. This primarily relates to £0.3m of NCA income, £2.2m of over performance, £0.3m of GUM and the rest relates to Cancer, CQUIN and OSV reciprocal patients.

2014/15 IMPACT IN 2015/16 - Table 2

*Note: the risks have been estimated by the finance department.

• The £7.2m unpaid invoices down from £9.2m in the previous mounth, relates to £6.1m of SLA overperformance invoices, £0.8m of NCA and £0.3 of GUM and IVF invoices

Table 2

• �Table 2 shows the position on the 2014/15 year-

end income accrual and breaks it down into how much has not been received in cash terms.

• Further details of unrecovered items are shown

on page 18.

Pg12

SECTION 5: PAY COSTS

Costs

Revised Plan

£000's

In Month

Var £000's Actual £000's Variance £000's

Revised Year to Date Plan

£000's Actual £000's Variance £000's

Medical & Dental

Nursing & Midwifery

AHP

Scientific, Professional & Tech

Directors & Managers

Admin & Clerical

Support Staff

(44,542)

(55,523)

(7,902)

(6,910)

(10,052)

(19,832)

(1,837)

(3,742)

(4,645)

(670)

(575)

(884)

(1,594)

(155)

0

(3,788)

(5,067)

(679)

(588)

(728)

(1,435)

(147)

(46)

(422)

(9)

(13)

156

159

9

(40,810)

(50,899)

(7,238)

(6,312)

(9,168)

(18,235)

(1,681)

(41,861)

(51,647)

(7,405)

(6,457)

(8,711)

(17,728)

(1,641)

(1,052)

(748)

(167)

(145)

457

507

41

Total Pay before Central Bud (146,598) (12,266) (12,431) (165) (134,344) (135,451) (1,107)

Reserves & CIP (92) (13) 0 13 (78) 0 78

Total Pay (146,690) (12,279) (12,431) (152) (134,422) (135,451) (1,029)

COMMENTARY

The in-month pay is £0.2m adverse against the revised plan.

The majority of the nursing overspend is due to high usage of agency for escalations during the month with Claremont ward remaining open.

The main adverse variances are in A&E, Elderly Care and AAU.

Admin & Clerical and Managers have performed better as most of the agency posts have been recruited to or discontinued. The agency caps

are also having a positive impact.

Pg13

Qualified

Nursing &

Midwifery

Medical & Dental

Admin and

Estates Staff

Managers

Other

Grand Total

£000's £000 £000 £000 Var £000's £000 £000 £000

Agency

Bank

770

498

396

184

9

103

56

16

Managers

34

-

61

10

1,327

810

Total Current Month 1,268 580 112 72 34 71 2,137

YTD

Agency

Bank

7,324

4,634

3,949

2,170

2,421

1,312

852

129

1,154

- 0

804

137

16,504

8,382

Total YTD 11,957 6,119 3,733 982 1,154 942 24,886

Current

Month

Year To Date

£000 £000

Elderly Care



Paediatrics and NNU


Other

299

178

90

86

78

596

2,436

1,996

1,071

585

828

9,588

Total 1,327 16,504


Temporary Staffing analysis

Commentary

Total agency as a proportion of pay expenditure

decreased from 11.2% to 10.7% in month, whilst

Bank staff expenditure has increased from 6.0%

to 6.5% of total pay.

Top 5 Agency users

The additional staffing required for winter

escalation is managed through agency, resulting

in the agency spend not decreasing significantly.

Monitor's cap of 10% applies for Q3 and Q4 and

relates to nursing agency as a percentage of

total nursing pay excluding HCA's. In January

this percentage is 15.6%, up from 15.0% in

January.

Pg14

Original Plan

£

0

0

0

'

s Var £000's

Year To Date £000

Elderly Care





Others

3,555

2,932

1,236

1,237

1,400

14,526

Total 24,886

£0

00


Costs

2500

2015/16 Bank and Agency Spend

2000

1500

1000

500

0

-500

Admin and Estates Staff Allied Health Professionals Managers Medical And Dental Staff

Qualified Nursing & Midwifery Other Grand Total

Top 5 Agency and Bank Users

Current Month £000

Elderly Care





Others

415

208

139

133

132

1,109

Total 2,137

Pg15

SECTION 6: NON-PAY

Non Pay

Revised Plan

£000's

In Month Revised


£000's £000's £000's

Year to Date Revised


£000's £000's £000's


Drugs

High Cost Drugs

Transport

Establishment

General Supplies

Other

Premises

PFI

CNST

(24,499)

(4,877)

(12,837)

(1,479)

(1,993)

(1,916)

(2,760)

(7,139)

(12,340)

(4,757)

(1,980)

(248)

(1,192)

(140)

(188)

(145)

(185)

(595)

(1,030)

(396)

(2,262)

(1,387)

(1,192)

(121)

(263)

(126)

(209)

(671)

(1,034)

(397)

(282)

(1,139)

0

20

(75)

19

(24)

(76)

(3)

(1)

(22,508)

(4,477)

(11,792)

(1,345)

(1,801)

(1,689)

(2,575)

(6,550)

(11,310)

(4,361)

(23,743)

(4,165)

(12,866)

(1,230)

(1,875)

(1,925)

(3,069)

(6,982)

(11,277)

(4,367)

(1,235)

312

(1,074)

115

(73)

(236)

(495)

(432)

34

(6)

Non Pay before Central Budgets (74,596) (6,101) (7,662) (1,561) (68,409) (71,500) (3,091)

Reserves 1,047 163 571 408 861 1,385 524

Total Non Pay (73,549) (5,937) (7,091) (1,154) (67,549) (70,115) (2,566)

COMMENTARY

Non Pay is overspent by £1.2m in month or £0.6m after removing the impact of pathology recharges, high cost drugs and one

off GRNI releases from the balance sheet.

The clinical supplies and services overspend in the clinical divisions is driven by specialties such as Gynaecology,

Ophthalmology, Cardiology and General Surgery and Urology where the activity has improved. In Anaesthetics, there is a

continued overspend on laparoscopic consumables and other medical and surgical equipment.

Pg16

2014/15

Audited

£m

January

£m

February

£m

NON CURRENT ASSETS: Property plant and equipment

Intangible assets

Other assets

127.2

6.9

0.2

129.4

7.9

0.3

128.9

7.9

0.3

TOTAL NON CURRENT ASSETS: 134.3 137.6 137.1

CURRENT ASSETS:

Inventories

Trade and other receivables Cash and cash equivalents

0.9

20.4

6.4

0.9

24.3

2.3

0.8

23.9

1.6

TOTAL CURRENT ASSETS 27.7 27.6 26.3

CURRENT LIABILITIES:

Trade and other payables Current Borrowings

Current Provisions

(29.2)

(0.9)

(0.4)

(33.2)

(0.9)

(0.1)

(31.9)

(1.4)

(0.1)

TOTAL CURRENT LIABILITIES (30.5) (34.2) (33.4)

NET CURRENT ASSETS LESS CURRENT

LIABILITIES

(2.8)

(6.6)

(7.1)

TOTAL ASSETS LESS CURRENT LIABILITIES

131.5

131.0

130.0

NON CURRENT LIABILITIES:

Borrowings Provisions Other liabilities

(29.6)

(1.3)

(34.8)

(1.4)

(34.2)

(1.4)

TOTAL ASSETS EMPLOYED 100.6 94.8 94.4

FINANCED BY

TAXPAYERS EQUITY:

Public Dividend Capital

Revaluation reserve

Income and Expenditure Reserve - Prior years Income and Expenditure Reserve - Current year

58.7

25.9

16.0

59.0

25.9

16.0

(6.1)

59.0

25.9

16.0

(6.5)

TOTAL TAXPAYERS EQUITY 100.6 94.8 94.4

SECTION 7: STATEMENT OF FINANCIAL POSITION

COMMENTARY

Non - Current Assets There was a £0.5m decrease in February, comprising £0.2m of additions and £0.7m depreciation.

Current Assets There was a £0.8m decrease in Current Assets in February 2016 comprising: £0.7m decrease in Cash and Cash Equivalents, as analysed in Section 8: Cash Flow Statement and a £0.1m decrease in Inventories.

Current Liabilities The decrease of £0.8m in Current Liabilities in February was largely due to a decrease in non-NHS Accruals which is analysed further in Section 10.

Pg17

January 2015 £m

Surplus/(deficit) after tax 0.1

Non-cash flows in operating surplus/(deficit)

Depreciation and amortisation 0.7

PDC Dividend expense 0.3

Non-cash flows in operating surplus/(deficit) 1.0

Operating Cash flows before movements in working capital 1.1

Increase/(Decrease) in working capital

(Increase) in Inventories 0.1

(Increase) in Trade and other receivables (0.0)

(Decrease) in Current Provisions (0.0)

(Decrease) in Trade and Other payables (1.5)

Increase/(Decrease) in working capital (1.5)

Net cash (outflow) from operating activities (0.4)

Net cash inflow/(outflow) from investing activities

Property Plant and Equipment (0.2)

Intangible assets (0.1)

Other assets 0.0

Net cash inflow/(outflow) from investing activities (0.2)

Net cash inflow/(outflow) from financing activities

PDC Drawdowns 0.0

PDC Dividend paid 0.0

Borrowings (0.1)

Net cash inflow/(outflow) from financing activities (0.1)

Net (decrease) in cash (0.7)

Opening cash 2.3

Closing cash 1.6

SECTION 8: CASH FLOW STATEMENT

Var £000's

COMMENTARY

The closing cash position for February was £1.6m which was £1.7m below the original month 5 forecast. The shortfall in the cash position was primarily attributable to unpaid overperformance invoices from commissioners for Q1 and Q2 totalling £3.0m (Kingston, Richmond and Surrey Downs CCGs). Of this amount, £1.2m has subsequently been paid by Surrey Downs in the first week of March.

The impact of these unpaid amounts was offset in the month by slowing payments to trade creditors (£1.6m at the end of February). Lower than expected receipts from Royal Marsden (£0.2m) and St Georges (£0.3m) were compensated by higher than forecast payments from Local Government organisations for GUM services (£0.2m) and VAT reclaimed from HMRC (£0.2m).

Pg18

SECTION 9: DEBTORS Breakdown of Trade and Other Receivables (SoFP) in £m:

Months Mar-15 Apr-15 May-15 Jun-15 Jul-15 Aug-15 Sep-15 Oct-15 Nov-15 Dec-15 Jan-16 Feb-16

Income Accruals 10.3 10.7 10.1 8.4 9.1 6.5 8.1 10.4 8.2 6.9 5.0 7.1

Aged Debtors (NHS and non NHS) 8.9 10.9 10.2 15.6 13.7 11.0 10.0 9.4 12.8 14.4 16.6 15.7

Prepayments (mainly maintenance) 0.7 1.5 1.4 1.6 1.6 1.7 1.7 2.4 2.3 2.4 1.8 0.9

Other* 0.5 -0.3 0.5 0.1 0.6 -0.2 0.1 (0.3) (0.3) 0.1 0.4 0.2

Total 20.4 22.8 22.2 25.7 25.0 19.0 19.9 21.9 23.0 23.7 23.8 23.9

Total Debt Outstanding

As at 29th February 2016 Up To 30 Da 31 To 60 Days 1 to 90 DayOver 90 DayOverall Total

Feb-16 Jan-16 Dec-15 Total

Total debt at 29th February 2016 9,264 748 1,319 4,162 15,493

60% 5% 9% 27%

Total debt at 31st January 2016 7,214 4,060 218 5,162 16,654

43% 24% 1% 31%

Total debt at 31st December 2015 8,361 298 1,041 4,655 14,354

58% 2% 7% 32%

Commentary

Trade and Other Receivables have increased by £0.1m to £23.9m, the net effect of a £2.1m increase in Income Accruals, a £0.9m decrease in Prepayments and a £0.9m decrease in

Aged Debtors (NHS and non NHS) and a £0.2m decrease in Other Debtors.

Aged debtors decreased from £16.6m to £15.7m in month. Within this total, the current (<30 day) debt increased by £2.1m, debt from 31-60 days decreased by £3.3m, 61-90 day

debt increased by £1.1m and debt over 90 days decreased by £1.0m. Within these categories the significant movements were:-

• Invoices issued to CCGs at the end of January for the cumulative freeze position at Month 8 totalling £1.8m remain unpaid but remain in the 0-30 days bucket due to the short

length of February

• Richmond CCG paid £0.5m for Q1 & Q2 2015/16 overperformance reducing 31-60 days debt

• Merton CCG paid £0.2m over-performance invoices reducing 31-60 days debt

• Payments of £0.3m from Barking Havering & Redbridge NHST and £0.3m from BMI Healthcare both reduced over 90 days debt

The increase of £2.1m in income accruals relates mainly to month 9 overperformance. The £0.9m decrease in Prepayments was largely due to a £0.4m decrease in the CNST

prepayment, a £0.2m decreasein the AAH prepayment and a £0.1m decrease in the Business Rates prepayment

*Other includes the Provision of Irrecoverable Debts, Recoverable VAT and Other Debtors all due within one year.

Pg19

SECTION 10: CREDITORS

Description Aug-15 Sep-15 Oct-15 Nov-15 Dec-15 Jan-16 Feb-16

NHS Accruals (2.3) (2.4) (2.6) (2.5) (3.3) (3.1) (3.4)

Non NHS Accruals (14.0) (13.0) (11.8) (12.6) (10.6) (10.1) (8.8)

Capital Accruals (2.7) (2.4) (2.6) (2.2) (2.2) (2.4) (2.1)

System GRNI Accruals (2.9) (3.2) (3.2) (2.5) (1.8) (6.3) (1.8)

Deferred Income (3.6) (2.6) (4.6) (3.6) (2.6) (3.8) (3.1)

Trade Creditors (2.7) (5.9) (1.9) (3.1) (6.1) (6.3) (6.6)

Income Tax and PDC Due Within 1 Yr (4.4) (4.5) (4.5) (4.6) (4.6) (4.6) (4.7)

Others including Provisions, PFI and Finance Leases (2.8) (1.2) (1.4) (1.7) (2.1) (2.4) (2.9)

Total (35.4) (35.2) (32.7) (32.8) (33.3) (34.2) (33.4)

Commentary

Outstanding creditors as at 29th February totalled £33.4m, a £0.8m decrease in month which comprised the net effect of:

• £0.3m increase in Trade Creditors which at the end of February, of which £0.2m relates to an increase in slowed payments to suppliers at month end. • £1.3m decrease in Non NHS Accruals largely attributable to; • £0.7m decrease in Trade Revenue accruals - £0.2m decrease in Medical Pay accruals, £0.1m decrease in General Surgery, Prime Care Solutions, Dalkia and

Global Services. • £0.6m decrease in accrued JAC Pharmacy invoices • £0.7m decrease in deferred income, due largely to;

- £0.4m decrease in Q4 Madel deferred income - £0.1m increase in Q4 Sift deferred income - £0.1m increase in M11 15-16 Winter Funding

As in January, Trade Creditors in February remain comparatively high to previous months in the year . This is the combined impact of invoices being processed more quickly onto the financial system and constraints on the funds available resulting in payments being slowed as necessary.

Pg20

SECTION 10: CREDITORS (BETTER PAYMENTS PRACTICE CODE)

Original Plan

£000's Var £000's

Commentary

NHS Invoices paid within 30 days

• The value and number of NHS invoices paid within term both

decreased in month.

• Invoice number remains below target. This is mainly attributable

to 323 NHS Supply Chain invoices being paid late, accounting for

74% of all NHS out of term invoices.

• The drop in the invoice value was largely due to NHS Blood &

Transplant invoices totalling £95k

Non NHS Invoices paid within 30 days

• Both the value and number of NHS invoices paid within term

decreased to 30% and 3% respectively in month.

• The value of invoices paid ontime fell below target in February

due mainly to 336 ID Medical Group invoices and 6 Roche Diagnostics invoices totalling £645k being paid out of term.

• Overall, the percentages remain well below the target of 95% as

the Trust manages its cash resources whilst awaiting payment of

overperformance invoices from NHS commissioners.

Pg21

2015/16

Capital

Budget

£000

YTD

Revised

Plan

£000

YTD Spend

£000

YTD

Variance

£000

Annual Plan

£000

Updated

Plan

£000

Variance to

Revised

Plan

£000

ESTATES MAINTENANCE 3,130 1,659 1,453 206 3,130 1,772 1,358

5,972 971 5,133 538 5,972 5,773 199

EQUIPMENT TOTAL 927 971 490 481 927 927 -

IT TOTAL 3,570 3,234 3,113 121 3,570 3,253 317

Others 550 286 51 235 550 550 -

TOTAL CAPITAL PROGRAMME 14,149 11,821 10,240 1,581 14,149 12,275 1,874

SECTION 11: CAPITAL

COMMENTARY

•Cumulative to Month 11, the Trust spent £10.2m. This is

£1.6m below the Trust’s updated plan capital programme of £11.8m.

• Equipment spend is below updated plan by £0.49m. A&E

& ITU monitoring machines (£560k) scheduled for November have not arrived yet.

• IMT is £0.1m underspent. Delays in commencement of

SSD Track and Trace (£130k), Server Replacement (£134k) and PC and Mobile Replacement (£41k) were the main reasons for this underspend .

• Estates Strategy is £0.5m underspent at M11 .

Outpatients is £557k behind plan. The revised costs for 2015/16 are currently been reviewed but some slippage into 2016/17 is expected.

• Estates Maintenance is underspent by £0.2m, due to

delays in the commencement of Nurse Call Esher Wing (£22k) and slippage in Pipework Replacement Phase II (£73k) and Electrical Distribution Boards (£56k). These slippages are expected to be corrected before year end.

• Others relates to Nursing Tech Fund and Charity Funded

capital projects.

Weight

25%

25%

25%

25%

4

2.50

-

1%

0%

3

1.75

- 7.00

0%

-1%

2

1.25

- 14.00

-1%

-2%

1

<1.25

<-14

<=-1

<=-2

100%

15/16 15/16 15/16 15/16 15/16 15/16 15/16 15/16 15/16 15/16 15/16 15/16

Heading M1 M2 M3 M4 M5 M6 M7 M8 M9 M10 M11 M12

Capital Servicing Capacity

Liquidity

I&E Margin - Underlying performance

I&E Margin - Variance from plan

0.5

(5.1)

(4.5%)

0.0%

0.7

(6.4)

(4.0%)

0.0%

0.9

(8.0)

(3.1%)

0.0%

1.2

(4.5)

(2.3%)

0.0%

0.7

(8.9)

(4.0%)

0.0%

0.8

(11.5)

(3.8%)

(0.0%)

1.0

(11.3)

(3.1%)

0.0%

1.0

(8.7)

(2.9%)

(0.3%)

0.8

(12.2)

(3.6%)

(0.6%)

1.0

(12.1)

(3.1%)

(0.5%)

1.5

(12.7)

(1.6%)

1.2%

13/14 13/14 13/14 13/14 13/14 13/14 13/14 13/14 13/14 13/15 13/16 13/17

Heading M1 M2 M3 M4 M5 M6 M7 M8 M9 M10 M11 M12

Capital Service Cover

Liquidity



1

3

1

4

1

3

1

4

1

2

1

4

1

3

1

4

1

2

1

4

1

2

1

3

1

2

1

4

1

2

1

3

1

2

1

3

1

2

1

3

2

2

1

4

Capital Servicing Capacity

SECTION 12: FINANCIAL SUSTAINABILITY RISK RATING (FSRR) Liquidity



2.50

2.00

1.50

1.00

0.50

0.00

Capital Servicing Capacity Liquid ratio

I&E Margin Actual I&E Margin Variance From Plan

Weighted average FSRR 2.25 2.25 2.00 2.25 2.00 1.75 2.00 1.75 1.75 1.75 2.25 0.00 Rounded Weighted average COSR 2.00 2.00 2.00 2.00 2.00 2.00 2.00 2.00 2.00 2.00 2.00 0.00

COMMENTARY

Our FSRR rating for month 11 is a 2. This is driven by a variance from plan of 1%

Pg22

Pg23

Appendix 1: INCOME DETAIL

Income Summary

Income

Revised Plan

£000's

Revised In Month

Actual Var

£000's £000's

Revised Year to Date


£000's £000's £000's

Patient Care Activities - CCG

RTA\OSV

Private Patients

Other Patient Care Income

202,405

645

460

1,113

16,634

54

40

86

16,988

30

28

86

355

(24)

(12)

(0)

184,931

592

405

1,027

186,134

537

369

1,151

1,203

(55)

(36)

124

Total Patient Care Income 204,623 16,814 17,133 319 186,954 188,191 1,236

Education

BMI

Provider to Provider

Other

8,069

2,142

4,284

10,228

653

172

344

731

692

168

441

749

39

(4)

97

17

7,426

1,970

3,940

9,496

8,263

1,932

4,067

10,209

837

(37)

128

712

Total Income 229,347 18,715 19,182 467 209,786 212,662 2,876

COMMENTARY

Patient care income has improved due to the reassessment of income risk.

Other income shows a favourable variance as additional LDA income recieved from HESL.

Pg24

Appendix 2: ACTIVITY DETAIL

Patient Care Activity

Activity

Revised Plan

In Month Spells / Attendances

Revised Plan Variance

Year to Date Spells / Attendances

Revised Plan Actual Variance

Elective Day

Cases Non

Elective Out

Patients A&E

Critical Care

Direct Access

3,964

23,953

26,028

364,424

111,424

9,216

2,858,356

330

1,996

2,169

30,369

9,285

768

238,196

332

2,005

2,135

34,045

9,368

690

229,373

2

9

(34)

3,676

83

(78)

(8,824)

2,973

17,965

19,521

273,318

83,568

6,912

2,143,767

3,519

21,535

24,994

369,248

102,315

8,964

2,604,615

546

3,570

5,473

95,930

18,747

2,052

460,847

Patient Care Income

Income Revised

Plan £000's

Revised In Month

Plan £000's Actual £000's Var £000's

Revised Year to Date

Plan £000's Actual £000's Variance £000's

Elective Day

Cases Non

Elective

Non Elective Threshold

Readmissions

Out Patients

A&E

Critical Care

Direct Access

High Cost Drugs

Non Elective - Maternity Pathway

Out Patients - Maternity Pathway

Other

CQUIN

8,892

19,333

52,300

0

(1,627)

46,408

12,632

9,014

8,250

12,817

12,391

18,058

3,937

779

1,686

4,259

0

(133)

4,018

923

682

684

1,050

1,033

962

362

328

720

1,646

3,958

0

(132)

3,842

1,089

708

683

1,192

1,012

1,002

951

318

(59)

(40)

(301)

0

0

(177)

166

26

(1)

142

(21)

40

589

(10)

17,667

47,829

0

(1,494)

42,228

11,528

8,276

7,522

11,769

12,369

11,326

12,302

3,609

7,803

17,385

46,909

0

(1,529)

41,654

11,999

8,165

7,312

12,814

12,242

11,163

6,713

3,503

7,803

(282)

(920)

0

(35)

(573)

471

(112)

(210)

1,046

(127)

(163)

(5,589)

(105)

SLA Income 202,405 16,634 16,988 355 184,931 186,134 1,203

COMMENTARY

The activity performance is detailed below:

Non Electives and Critical care activity are below forecast. However A&E attenders are performing above plan.

Appendix 3

Income Penalties

April

May

June

July

August

September

October

November

December

January

February

YTD

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

18 week Breaches

Mixed Sex Accomodation penalty

Cancer Waits

Cancelled Operations

MRSA Penalty

A&E Breaches

Ambulance handovers

OP New to Follow Up

DC2OP

Readmissions

1

0

0

0

0

55

14

18

9

137

0

1

0

1

0

47

8

1

9

141

0

0

0

0

0

80

12

7

10

137

0

0

1

0

0

21

1

8

12

141

0

0

0

0

0

0

1

5

17

141

0

0

0

0

10

38

1

-2

13

137

0

0

0

2

0

9

1

-3

11

142

0

0

1

2

0

16

1

5

14

137

0

0

0

1

0

9

1

4

15

141

0

0

0

0

0

37

1

10

16

141

0

0

0

0

0

47

1

10

13

132

1

1

2

7

10

358

42

63

136

1,529

234 208 245 185 164 197 161 176 171 205 203 2,150

Commentary - The above table now shows all penalties that have been incurred by the Trust. A&E breaches penalties has increased in month. All other penalties remain in line with trend.

kingston hospital nhs foundation trust finance report ... · pdf fileenc g original plan...

Documents