N H S H I G H L A N D B O A R D

F I N A N C E R E P O R T M O N T H 9 D E C E M B E R 2 0 1 9 / 2 0

N H S H I G H L A N D B O A R D

2 8 T H T J A N U A R Y 2 0 2 0

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Director of Finance narrative – Dec 2019

Headlines:

The month nine position shows an adverse YTD position of £10.6 m. >£8.5m YTD of planned deficit (£11.4m) >(£0.1)m savings >£2.2m cost pressures As summary YTD position highlights our major problem when looked at operationally is

Raigmore with a £3.1m adverse YTD position. This is partly linked to both the premium cost interim and agency, increased prescribing issues along with clinical supplies, short stay ward and medical rota gaps.

Premium pay costs are still a major pressure with locums spending £13.5m to month 9

and other staff groups £18m - see slides 12 and 13 for more detail. Projected position remains at £11.4m.

Month 9 position is showing £13.9m potential overspend at year end leaving a challenge

of £2.5m to deliver the AoP target

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Director of Finance narrative – Dec 2019

The £13.9m projection is an improvement of £9.7m on the previous reported projections (see slide 8 for more info). £3.7m AoP planned non recurrent savings for central slippage was realised and actioned in month 9, this along with cost pressure mitigation has improved the projections

Following month 8 a mitigation plan to reduce cost pressures was implemented, with targets of £4.9m and £1.9m identified (£6.8m). In month 9 £4.8m has been identified and brought into the projected position for current and future months forecast.

Challenge of £2,5m to reach £11.4m target – not including discussions around the GG&C contract.

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Funding 2019-20

SG funding for 2019/20 assumes £820.3m

This includes baseline funding uplifted by 2.56% for 2019/20

Allocations received to date

FHS allocation

Anticipated funding for non Discretionary FHS, and other expected allocations

Funding to and from The Highland Council for Adult and Children’s services bring total expected funding to £910.1m

Current

Summary Funding & Expenditure 2019/20 Plan

£m

SGHSCD -Baseline Funding 644.8

- Recurring Supplemental Allocations 22.6

- Non Recurring Supplemental Allocations 0.5

- FHS GMS Allocation 67.7

Sub total - SGHSCD Core RRL 735.7

- Non Core Funding 46

SGHSCD Funding at month 9 781.8

Anticipated funding

- FHS Non Discretionary 34.3

- Recurring Pending allocations 0.6

- Non Recurring Pending allocations 3.6

- Non Core Pending allocations 0.0

TOTAL SGHSCD Funding 820.3

Add- Adult Social Care Quantum Funding 100.6

Less - THC Childrens services Transfer (10.8)

Funding 910.1

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Summary YTD position by unit- December 2019

Month 9 overspend of £10.6m made up of;

£8.6m of planned ‘gap’ (9 months of the AOP £11.4m)

Saving delivery phasing of £0.1m

Operational pressures of £2.2m

Broken down as follows;

Operational units

Raigmore £3.1m operational overspend (see slide 7 for more info)

North & West £0.2m overspend

Support Services

Facilities £0.6m overspend (national waste contract)

Tertiary – out of area £0.5m overspend

Offset with underspends in South & Mid, ASC central and income, Corporate and Argyll & Bute

Plan Actual Var

Expenditure to

Month 9 - December to Date to Date to Date

Planned

Deficit

Savings

delivery

Operational

Variance

£m £m £m £m £m £m

South & Mid Division 168.8 168.7 0.1 0.0 (0.4) 0.5

Raigmore Division 144.4 148.4 (4.1) 0.0 (0.9) (3.1)

North & West Division 114.7 115.9 (1.1) 0.0 (0.9) (0.2)

Sub Total NH Op Units 427.9 433.1 (5.1) 0.0 (2.3) (2.9)

ASC - Central 3.1 2.4 0.7 0.0 0.3 0.4

Facilities 17.7 18.5 (0.8) 0.0 (0.1) (0.6)

e health 6.5 6.5 0.0 0.0 0.0 0.0

Tertiary 16.4 17.2 (0.8) 0.0 (0.3) (0.5)

Central services 29.2 25.9 3.3 0.0 3.5 (0.2)

ASC Income (9.9) (10.2) 0.3 0.0 0.0 0.3

HSCP Corp Support 0.8 0.8 0.0 0.0 0.0 0.0

TOTAL H&SCP 491.9 494.2 (2.3) 0.0 1.1 (3.5)

Corporate Services 17.1 16.9 0.2 0.0 (0.1) 0.3

Argyll & Bute 154.6 154.5 0.1 0.0 (0.9) 1.0

Planned Defcit (8.6) (8.6) (8.6) 0.0

Total Expenditure 655.0 665.6 (10.6) (8.6) 0.1 (2.2)

Components of Variance

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Monthly Outturn Comparison

YTD position at month 9 is £10.6m overspend

0

2

4

6

8

10

12

14

16

18

20

May June July Aug Sept Oct Nov Dec Jan Feb March

£m

's

YTD position comparison

17-18 YTD 18-19 YTD 19-20 YTD

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Raigmore Cost pressures

Raigmore cost pressures YTD Full year

£000's £000's

Medical pay pressures including locuma 1,072 1,042

Nursing pressures including worforce tool 1,120 1,069

Short stay ward - medical & nursing 275 367

Non Pay Theatres & endoscopy 528 593

Drugs - Ophthalmolgy 585 480

Cancer 634 690

Medical & Surgical 626 403

Radiology 355 492

Other 134 0

5,329 5,136

Offsetting underspends (2,212) (2,760)

Operational pressures 3,117 2,376

Improvement from month 8 of £0.6m

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Forecast movement

Forecast movements month 8 - 9 £m's

Non Recurrent AoP planned savings 3.7

Mitigation plan(incl £0.5m Raigmore 4.8

Raigmore savings 0.7

Central Inc ASC Centralcost reduction 0.3

Facilities 0.2

Total Movement 9.7

Planning slippage not required, Allocation slippage (to be reinstated in 20/21

Prof fees, year end flexibility, Raigmore and Corporate housekeeping eHealth programme slippage, other agreed programme slippage

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Forecast position as at month 9

Operational forecast at month 9 is £13.9m overspend.- positive movement in month of £9.75m

Planned deficit as per AOP of £11.4m £3.0m of savings yet to be actioned £0.5m of overall operational

underspend S&M unit forecast a small

underspend excluding savings Raigmore have a forecasted

overspend of £2.4m (excluding workstream savings) due to drugs and locums and clinical supplies (see slide 7)

N&W have an overspend after savings of £0.2m mainly due to locums

Facilities have £1.1m pressure made up of the new national waste contract and energy costs

Annual

Summary Funding &

Expenditure Forecast

Plan Outturn Variance

Planned

Deficit

Workstream

& unit

savings

Operational

Variance

£m £m £m £m £m £m

South & Mid Division 225.2 226.7 (1.5) (1.6) 0.03

Raigmore Division 191.4 196.6 (5.2) (2.9) (2.4)

North & West Division 153.5 156.0 (2.5) (2.3) (0.2)

Sub Total NH Op Units 570.0 579.3 (9.2) 0.0 (6.7) (2.5)

Adult Social Care - Central 4.7 3.5 1.2 0.6 0.7

Facilities 23.3 24.8 (1.4) (0.3) (1.1)

e health 8.8 8.7 0.0 0.0 0.0

Tertiary 21.3 22.6 (1.3) (0.6) (0.7)

Central services 72.9 64.9 8.0 4.5 3.5

ASC Income (13.2) (13.3) 0.1 0.0 0.1

HSCP Corporate Support 1.9 1.8 0.0 0.0 0.0

TOTAL H&SCP 689.7 692.3 (2.6) 0.0 (2.5) (0.0)

Corporate Services 24.1 24.0 0.1 (0.2) 0.2

Argyll & Bute 207.7 207.7 (0.0) (0.3) 0.3

Unplanned Savings (11.4) 0.0 (11.4) (11.4) 0.0

Total Expenditure 910.1 924.0 (13.9) (11.4) (3.0) 0.5

Forecast Components of Variance

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Summary position by subjective spend

Shown by subjective spend

Medical pay has an overspend of £4.6m YTD overspend , other staff groups are bringing the total to £2.3m YTD overspend- £2.5m year end projection

In non pay Clinical costs are the main driver with drugs and equipment being the main issues with a £2m projected overspend.

Savings show £8.5m (9 months of £11.4)of savings outstanding YTD and £14.1m Forecast (£11.4m unplanned deficit and balance of delivery and workstreams)

Over recovery of operational income of £2.8m

YTD YTD YTD Annual Forecast Year End

Subjective Spend Budget Actuals Variance Plan Out-Turn Variance

£m £m's £m's £m £m £m

PAY

Medical & Dental 62.5 67.1 (4.6) 83.1 88.0 (4.9)

Medical & Dental Support 4.3 4.1 0.3 5.8 5.4 0.3

Nursing & Midwifery 111.0 111.0 (0.1) 148.9 148.5 0.4

Allied Health Professionals20.9 19.8 1.1 27.9 26.8 1.1

Healthcare Sciences 9.7 9.5 0.3 13.0 12.7 0.3

Other Therapeutic 9.8 8.9 0.9 13.3 12.2 1.1

Support Services 22.0 21.6 0.3 29.1 29.2 (0.1)

Admin & Clerical 40.6 40.1 0.5 54.6 54.1 0.4

Senior Managers 2.3 2.1 0.1 3.0 2.8 0.2

Social Care 28.3 27.7 0.6 37.7 37.1 0.6

Commtments/Pay Savings(2.2) (0.4) (1.8) (2.2) (0.2) (2.0)

Pay - Total 309.2 311.5 (2.3) 414.1 416.6 (2.5)

Drugs 73.8 74.4 (0.6) 97.5 98.0 (0.4)

Property 32.2 32.5 (0.3) 43.0 43.6 (0.6)

Non Pay 27.5 27.6 (0.1) 38.0 36.7 1.3

Clinical non pay 29.5 31.4 (1.9) 39.2 41.2 (2.0)

Health care OOA 45.1 45.5 (0.4) 56.0 56.7 (0.7)

GG&C SLA 48.9 48.9 0.0 65.2 65.2 0.0

Social Care ISC 75.6 75.8 (0.2) 101.1 101.9 (0.8)

FHS 71.9 71.5 0.5 96.8 96.2 0.6

Commitments 0.3 0.0 0.3 40.4 37.0 3.4

Savings (8.5) 0.0 (8.5) (15.0) (0.9) (14.1)

Operational Income (50.6) (53.5) 2.8 (66.2) (68.3) 2.1

Total 655.0 665.6 (10.6) 910.1 924.0 (13.9)

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Savings Delivery

Savings forecast to PMO £000's

Recurrent savings delivered and forecast 16,692

Non Rec savings delivered and forecast 8,451

Savings delivery at month 9 25,143

Target 28,000

Balance to achieve 2,857

Savings delivered as above 25,143

Savings delivered and forecast as per PMO 26,045

Difference -902

Difference is due to cost avoidance/reduction shown within PMO savings - but as not budget savings are recognised in the forecast figures within actual costs

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Locum spend

Spend of £13.5m to month 9 19-20 compared to £11.36m in 18-19 to month 9

2019-20 break down

Raigmore £4.6m S&M £1.1m N&W £4.5m A&B £3.2m

Month 9 costs decreased by £374k

800

900

1,000

1,100

1,200

1,300

1,400

1,500

1,600

1,700

1,800

Mth 1 Mth 2 Mth 3 Mth 4 Mth 5 Mth 6 Mth 7 Mth 8 Mth 9 Mth 10 Mth 11 Mth 12

£0

00

's

Locums 2016-17 to 2019-20

2019/20 2018/19 2017/18 2016/17

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Supplementary staffing spend

2019/20 M9 costs of £1.98m - cumulative £18.16m 2018/19 M9 costs of £1.89m -cumulative £16.7m

1.600

1.700

1.800

1.900

2.000

2.100

2.200

Month 1 Month 2 Month 3 Month 4 Month 5 Month 6 Month 7 Month 8 Month 9 Month 10 Month 11 Month 12

Supplementary staffing

SS Spend 2017/18 SS Spend 2018/19 SS Spend 2019/20

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NHS Highland APPENDIX 1

Adult Social Care Financial Statement at Month 09 2019-20

Annual YTD YTD YTD Forecast Forecast

Services Category Budget Budget Actual Variance Outturn Variance

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

Older People - Residential/Non Residential Care

Older People - Care Homes (In House) 11,004 8,220 8,481 (260) 11,459 (455)Older People - Care Homes - (ISC/SDS) 28,688 21,501 22,842 (1,341) 30,677 (1,989)Older People - Other non-residential Care (in House) 916 707 701 6 954 (38)Older People - Other non-residential Care (ISC) 1,390 1,042 1,088 (46) 1,477 (87)

Total Older People - Residential/Non Residential Care 41,998 31,471 33,112 (1,641) 44,567 (2,568)

Older People - Care at Home

Older People - Care at Home (in House) 14,155 10,360 9,763 597 13,737 418Older People - Care at home (ISC/SDS) 13,810 11,008 9,472 1,536 12,916 894

Total Older People - Care at Home 27,965 21,369 19,236 2,133 26,653 1,313

People with a Learning Disability

People with a Learning Disability (In House) 3,953 2,965 2,721 244 3,731 223People with a Learning Disability (ISC/SDS) 27,151 20,393 21,494 (1,101) 28,981 (1,830)

Total People with a Learning Disability 31,105 23,357 24,215 (858) 32,712 (1,607)

People with a Mental Illness

People with a Mental Illness (In House) 357 268 187 81 266 91People with a Mental Illness (ISC/SDS) 6,417 4,811 5,052 (240) 6,832 (415)

Total People with a Mental Illness 6,774 5,079 5,239 (159) 7,099 (325)

People with a Physical Disability

People with a Physical Disability (In House) 655 495 393 102 538 117People with a Physical Disability (ISC/SDS) 6,364 4,793 4,780 13 6,450 (87)

Total People with a Physical Disability 7,018 5,288 5,173 116 6,988 30

Other Community Care

Community Care Teams 6,803 5,150 4,790 360 6,446 357People Misusing Drugs and Alcohol (ISC) 44 33 17 16 22 21Housing Support 5,610 4,175 4,305 (130) 5,767 (157)Telecare 949 600 487 113 791 157

Total Other Community Care 13,405 9,959 9,599 359 13,027 379

Support Services

Business Support 1,390 969 929 40 1,325 65Management and Planning 3,017 1,382 206 1,176 (276) 3,293

Total Support Services 4,406 2,351 1,134 1,216 1,049 3,357

Total Adult Social Care Services 132,672 98,874 97,707 1,167 132,094 579

ASC services now integrated within health codes 3,565 2,674 2,674 0 3,565 0

Total Integrated AdultSocial Care Services 136,237 101,547 100,381 1,167 0 135,659 579

Three Care categories account for 77% of total spend on ASC

Older People accounts for the largest proportion of the Forecast Overspend.

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