Transcript Slide 1

Report to the Public Trust Board
Financial Performance Report
Month 8
Chris Tidman – Director of Resources
/ Deputy Chief Executive
1
Summary Points
The Trusts run rate has deteriorated to a £0.4m deficit in month. This is
now £0.8m away from plan. The key reason has been the impact of
Norovirus on the Trust’s income and cost base.
Pages 3 & 4
Income has been affected by outbreaks of Norovirus. Whilst this has
resulted in an average activity month, November is usually one of the
highest months and had the second highest plan of the year.
Pages 6 to 8
Expenditure has remained stable for November, although the additional
costs of Norovirus have offset what would have been a reduction. This
has also hindered the realisation of Length of Stay savings.
Pages 9 to 10
Internal QIPP savings for the month were £1.2m, £0.1m above plan. The
year to date achievement is £6.3m against a plan of £6.5m. The Trust is
forecasting to achieve £12m QIPP by the year end which equates to 4%
of turnover.
A £12m Revenue Support Loan has been agreed by the DH and is
available on the 17th Dec. This will allow the Trust to significantly reduce
the outstanding creditors
Page 5
Pages 11 - 13
2
Trustwide Position
Income & Expenditure
Current Month
Year to Date
Annual
Plan
Actual
Var
Plan
Actual
Var
Plan
£000s
£000s
£000s
£000s
£000s
£000s
£000s
Operating Revenue & Income
Pati ent Care Revenue
Other Operati ng Income
Total Operating Revenue
27,296
27,728
432
203,831
211,209
7,378
2,351
2,672
321
19,453
20,440
986
305,613
29,005
29,647
30,400
753
223,284
231,649
8,364
334,618
(17,291)
(17,802)
(511)
(137,121)
(140,887)
(3,766)
(201,052)
(9,738)
(11,008)
(1,271)
(70,366)
(76,686)
(6,320)
(106,691)
(27,029)
(28,810)
(1,782)
(207,487)
(217,573)
(10,086)
(307,743)
2,619
1,590
(1,029)
15,797
14,076
(1,721)
26,875
8.8%
5.2%
7.1%
6.1%
Operating Expenses
Pay
Non Pay
Total Operating Expenses
EBITDA *
EBITDA %
Depreci ati on
Net Interes t & Di vi dends
Excepti onal s (i ncl i mpai rments )
Reported Total Surplus / (Deficit)
(874)
(853)
21
(7,004)
(6,833)
171
(10,675)
(1,241)
(1,204)
37
(9,943)
(9,808)
135
(15,083)
0
0
0
0
0
0
0
504
(467)
(971)
(1,150)
(2,565)
(1,415)
1,117
0
0
0
0
32
40
8
255
317
62
383
536
(427)
(963)
(895)
(2,248)
(1,353)
1,500
1.8%
-1.4%
-0.4%
-1.0%
Les s i mpai rment i nc. Above
Les s IFRS Techni cal Adj 't i ncl above
Surplus / (Deficit) against Control Total
Surpl us / (Defi ci t) %
8.0%
• The overall position at month 8 is a deficit of £2.2m, £0.4m worse than Month 7.
0.4%
This compares to a planned
£1.4m deficit.
• This adverse movement is due mainly to the Norovirus outbreak.
• £0.5m on reduced Healthcare Income
• £0.3m on increased one off costs to manage the outbreak and the lost opportunities on QIPP
• As a result the Trust is now forecasting a break-even position at year end.
3
Run Rate & FRP
Run Rate
Run Rate 2012/13
£m
1.0
0.0
Apr
May
Jun
Jul
Aug
Sep
Oct
Nov
Dec
Jan
Feb
Mar
• Worsened in Month 8
• £0.4m in month
• £0.9m behind
plan
-1.0
-2.0
-3.0
-4.0
Planned Run rate
Actual Run rate
Planned Cumulative
Likely case
Actual Cumulative
Forecast
• Forecast outturn has been revised to break-even. This assumes:
• No contractual penalties are applied
• Reasonable settlement with commissioners over the costs of meeting stepped 12% increase
Emergency Demand – Discussions continuing
• £12m QIPP delivery
• Additional £2m Financial savings package agreed at November Board including cessation of WLI , use
of nurse agency staffing and closure of TAU
4
Internal QIPP
•Improved QIPP Performance
• Month 8 savings £1.2m
• Key scheme performance
• Newton schemes
• CQUIN from over
performance
• Procurement
• Forecast performance based on
assessment at individual scheme
level.
• Current forecast achievement
£11.6m
• Additional measures will ensure
£12m achievement reached
Division
ALEX
WRH/KTC
Core
Corporate
Total
Target
£4,411,000
£8,289,000
£1,400,000
£900,000
£15,000,000
PYE
£3,677,222
£6,685,449
£1,419,377
£834,772
£12,616,821
FYE
£4,242,083
£6,835,004
£1,534,975
£749,767
£13,361,830
In Year
2012/2013 %
Surplus/Shortfall
of Target
£733,778
83.36%
£1,603,551
80.65%
-£19,377
101.38%
£65,228
92.75%
£2,383,179
84.11%
5
Income - Summary
Plan
Elective
Daycase
Non Elective - Emergency
Non Elective - Other
Total Inpatients
Outpatients New
Outpatients F Up
Outpatients Procedure
Total Outpatients
A&E
Other Contract Income
Non Contract Income
Phasing Adj
In Month
Actual
Var
£'000
£'000
2,640
2,538
7,217
1,486
13,880
1,886
1,945
803
4,634
1,096
5,830
1,775
(919)
26,296
2,320
2,802
7,259
1,472
13,853
1,903
1,941
746
4,590
1,071
6,357
1,775
(919)
26,728
£'000
(320)
264
43
(14)
(27)
18
(4)
(58)
(44)
(25)
527
0
0
432
%
Plan
£'000
£'000
(12%)
19,820
10%
18,217
1%
55,433
(1%)
11,411
(%) 104,881
1%
14,110
(%)
14,552
(7%)
6,011
(1%)
34,674
(2%)
9,349
9%
44,043
%
10,196
%
(313)
2% 202,831
Year To Date
Actual
Var
£'000
19,546
18,936
59,299
12,172
109,953
14,674
14,453
5,965
35,092
9,094
46,186
10,196
(313)
210,209
£'000
(274)
718
3,866
761
5,072
564
(99)
(47)
419
(255)
2,143
0
0
7,378
%
£'000
(1%)
4%
7%
7%
5%
4%
(1%)
(1%)
1%
(3%)
5%
%
%
4%
• YTD patient care income is £210.2m representing £7.4m over performance against the internal plan
• Income for November lower than expected as a result of the Norovirus outbreak plus plateauing of
emergency admissions increase. November is usually a productive month
• The Trust lost 1,320 bed days in November as a result of bed closures attributed to Norovirus
6
Income - Inpatient
• Daycase activity is higher than plan in month
8.
• Elective activity is under plan as a result of
cancellations to surgery and bed/ward
closures due to the Norovirus outbreak.
• Emergency admissions remain 12% higher
than 2012/13 plan and also above last
financial year levels.
• However, Emergency demand in November
now appears to be following the prior year
trends.
• It is forecast that the admission avoidance
schemes should begin to have a positive
impact on admissions in the last quarter.
7
Outpatient & A&E
• New and Follow up Outpatient attendances
are broadly in line with plan in month 8,
while Outpatient procedures are slightly
underperforming.
•The introduction of EZ notes at
Kidderminster has resulted in some reduction
in outpatient booking at Kidderminster to
enable staff access the notes.
• The small under performance in Month is
consistent with previous months.
• This would suggest that commissioner plans
to offer alternatives to A&E for less complex
patients are having an impact.
• This masks the fact that blue light ambulance
attendances have increased as a % of total
attendances
8
Pay
£m
Medics Pay Costs £m's
5.8
5.6
5.4
5.2
5.0
4.8
4.6
4.4
4.2
4.0
Susbtantive
Temporary
Medics Control Total
Nursing Pay Costs £m's
• Temporary nursing has
increased due to Norovirus &
winter pressures capacity
( Highfield)
• Substantive staffing now
equal to total staffing at start
of 11/12
7.4
7.2
7.0
£m
•Substantive medical costs have
been relatively stable since Aug 12
• Agency usage remains high
• Double running of
Anaesthetics Jnrs
• Improving flow of medical
patients
• Cover for sickness and
absence
• COO & CMO to review agency
staffing plans
6.8
6.6
6.4
6.2
6.0
Susbtantive
Temporary
Highfield
Nursing Control Total
9
Waiting List Initiatives
Trust wide WLI spend £000's
WLI
350
300
250
200
150
100
50
0
Apr
May
Jun
Jul
Aug
Sep
2011/12
2012/13
Oct
Nov
Dec
20% price reduction
Top 10 Directorates for (YTD) WLI Spend 2012/13 vs 2011/12
400
Jan
Feb
Mar
• WLI have fallen for last 3
months and are only
below 11/12 levels for the
same period due to the
20% pay rate change
• Operational plans in
place to cease reliance on
WLI from January, noting
that this may temporarily
affect 18 week
performance whilst new
arrangements bed in.
350
£000's
300
250
200
150
100
50
-
2011/12 YTD
2012/13 YTD
10
Balance Sheet
Balance Sheet
ASSETS, NON CURRENT
Line
# Property, Pl ant and Equi pment and i ntangi bl e as s ets , Net
# Property, pl ant & equi pment (PFI)
Balance At
YTD Balance At
Movement
31st Oct 2012
30th Nov 2012
In Month
£000s
£000s
£000s
139,963
139,945
(18)
93,640
93,435
(205)
# Other As s ets , Non-Current
1,259
1,259
# Assets, Non-Current, Total
234,862
234,639
4,306
4,935
18,878
19,041
1,730
59
0
(223)
ASSETS, CURRENT
# Inventori es
Debtors
2.1a
# Cas h and Cas h Equi val ents
Assets, Current, Total
ASSETS, TOTAL
629
163
(1,671)
24,914
24,035
(879)
259,776
258,674
(1,102)
LIABILITIES, CURRENT
690
552
(138)
Credi tors < 1 Year
4.4a
33,341
32,823
(518)
# Liabilities, Current, Total
34,031
33,375
(656)
# Net Current Assets/(Liabilities)
(9,117)
(9,340)
(223)
4 PFI l eas es , Current
LIABILITIES, NON CURRENT
(19)
5,689
5,670
79,561
79,561
# Other Li abi l i ti es , Non-Current
0
0
# Liabilities, Non-Current, Total
85,250
85,231
(19)
140,495
140,068
(427)
Credi tors > 1 Year
5.5a
# PFI l eas es , Non-Current
# TOTAL ASSETS EMPLOYED
FINANCED BY :- PUBLIC EQUITY
0
£000s
£000s
£000s
0
139,878
139,878
0
59,732
59,732
0
# Donated As s et res erve
0
0
0
# Government Grant Res erve
0
0
0
Publ i c Di vi dend Capi tal
# Reval uati on res erve
# Other res erves
# Income and expendi ture res erve
TOTAL PUBLIC EQUITY
0
(861)
(861)
(58,254)
(58,681)
(427)
140,495
140,068
(427)
11
Cash & Debtors
Debt Position As At 30/11/12
In terms
NHS Non-NHS Total
£'000 £'000
£'000
Last Month
£'000
953
200
1,153
1,891
1-30 Days Overdue
3,760
233
3,993
4,630
31-60 Days Overdue
4,164
137
4,301
901
61-90 Days Overdue
400
91
491
393
91-180 Days Overdue
32
292
324
142
555
963
1,518
1,692
1,916 11,780
9,649
In Excess of 6 Months Overdue
Total
9,864
BPPC Performance
Nov Oct Sep Aug Av
2012 2012 2012 2012 YTD
Target: 95%
Paid Within Target Number
Paid Within Target Value
Cash
•
Debt > 90 Days Overdue
3500
3000
2500
£12m Revenue Support Loan
agreed
• Available on 17th Dec
2012
• A number of outstanding
creditors to be paid
2000
1500
Debtors
1000
•
500
Nov-12
Oct-12
Sep-12
Aug-12
Jul-12
Jun-12
May-12
0
Apr-12
£'000
37% 37% 40% 42% 36%
62% 49% 58% 49% 49%
•
Total debt position includes the
£3.5m balance of transitional
support and £2.5m Emergency
demand invoice
Aged Debt Profile Improving
Month
12
Capital
0
•
•
Capital schemes are back-loaded and will
increase through the remainder of the year
Financial recovery plan includes delaying non
essential capital spend on all three sites
Capital Expenditure Profile
2,500
2,000
Spend to Save
1,500
Estates/Buildings
1,000
ICT
500
Equipment
Mar-13
0
Feb-13
1,949
1,691
162
747
231
52
0
4,832
Jan-13
216
900
13,302
4,916
3,906
1,037
1,241
973
300
929
13,302
Capital
Dec-12
Startpoint CRL
Radiotherapy Car Park Loan
IFRS Adjustment
Current CRL
Expected Changes to CRL;
Capital Receipts
220 Newtown Road
Expected CRL
Pre-Commitments
Clinical Strategy
Replacement Equipment
ICT
Estate/Buildings
Spend to Save
Other Commitments/Flexibility
Planned Expenditure
(Under)/Over Commitment
against CRL
Annual Budget Expenditure
2012/13
2012/13
£'000
£'000
9,016
2,000
1,170
12,186
£'000
Capital Programme to 30th
November 2012
Clinical Strategy
Pre Commitments
Month
13
Summary
• Financial Position has moved adversely to £2.2m deficit due to impact of
Norovirus
• Forecast outturn now revised to breakeven at year end. This position
is based on the following main assumptions.
• QIPP schemes continue to deliver as planned
• Reasonable settlement with commissioners re funding for the
stepped increase in emergency demand
• Any contractual penalties levied for A & E / C-Diff are reinvested
• Winter Pressures capacity (Highfield Ward) is funded
• Additional £2m financial savings package is delivered through revised
operational planning, noting the potential risks to performance targets
• Weekly Financial recovery meetings will continue until the financial position
improves
14