Transcript Service & Financial Performance October 2007

Finance Report
Month 12 2012-13
Governing Body 17/05/13
Jonathan Wise,
CFO, BEHH CCGs
NHS HILLINGDON M12 FINANCE REPORT 12/13 - CONTENTS
1. Summary [slides 3-10]
2. M12 Position [slides 11-44]
Appendices
Detailed finance schedules [slides 45-51]
Balance sheet analysis [slides 52 – 59]
Capital [slides 60 - 61]
NHS Hillingdon 2
SECTION 1 – SUMMARY
NHS Hillingdon 3
EXECUTIVE SUMMARY-MONTH 12
• At Month 12, QIPP schemes had delivered savings of £13.4m against an original
target of £18.1m- a shortfall of £4.7m against plan but £1m higher than the
recovery plan forecast at end of M6. The variance includes the slippage in the
planned property disposal of £1.4m. GP Prescribing is now £1.3m above target
• Overall the PCT has finished the 12/13 financial year with a surplus of £1.979m in
line with its revised control total . The final outturn was achieved with in-year
support of £21.8m and the return of Hillingdon’s share of the 2% topslice (£2.6m).
• Overspends in Acute budgets of (£15.5m) plus Corporate and Estates budgets
(£1.4m) are offset by use of contingency (£2.0m) plus underspend on Prescribing
(£2.3m) and other Primary Care budgets (£0.5m). The year-end position includes
a provision for retrospective Continuing Care claims of £10.6m.
• The PCT has now submitted its draft accounts for external audit.
• The overspend on CCG delegated budgets at month 12 is 11.6m (£8.7m at Month
11)
• On the basis of this outturn position, the CCG will carry forward its share of the
12/13 PCT outturn (a surplus of £1.4m) into the financial year 2013/14.
NHS Hillingdon 4
EXECUTIVE SUMMARY
Sources
Net Balance sheet Gains
£’000s
£’000s
2,098
Sub Total – balance sheet items
2,098
Allocations and Reserves
In-Year Support
•
•
•
•
Applications
£’000s
Continuing care retrospective cases
10,580
Early retirements / back to backs
Redundancies
21,823
Return of 2% Topslice
2,651
Contingency
2,053
Bad Debt Provision
Gross overspends on budgets
£’000s
1,259
830
1,012
12,965
26,646
Sub Total – allocations and reserves
26,527
Total
28,625
12/13 Surplus
1,979
28,625
Net Balance Sheet gain-This relates primarily to gains on reserve creditors accrued for at year end (11/12) but not
required in 12/13. The net gain of £2,098k compares to the anticipated loss of £4.3m from balance sheet
pressures identified in the PCT’s 12/13 recovery plan. This reflects the pro-active management of the balance
sheet since September.
Continuing Care-the estimate has been revised upwards to take account of the expected number of cases that are
likely to proceed and a 55% probability of success has been assumed. This provision also includes an allowance
for the second phase of the scheme for claims which were lodged by the end of March 2013.
The overall in-year overspend on budgets was £12.9m compared to the £14.4m FOT estimate in September. The
improvement relates primarily to greater than expected underspends in GP Prescribing and Dental.
Early retirements / back to backs relate to one-off payments to discharge future liabilities, primarily to NHS
Pensions, with a recurrent cost saving to the CCG. A bad debt provision of £1m has been made largely with
regards to section 106 funding.
FINANCIAL PERFORMANCE SUMMARY (1)

PCT Statutory duties
– Underspend against revenue resource
limit
– Achievement of capital resource limit
– Achievement of cash limit

Underlying recurrent position (PCT)

Achievement of public sector payment policy
(PCT)



YTD
FOT
G
G
G
G
G
G
R
R
R
R
Achievement of QIPP plan (PCT)
CCG Delegated Budgets
CCG Delegated QIPP
R
R
R
R
R
R
NHS Hillingdon 6
SUMMARY OF MONTH 12
The month 12 report includes performance against QIPP. The Month 12 variances have
been analysed between QIPP/non-QIPP as per the table below:- The Non-QIPP variance
against Other now includes the phasing into the position of the external financial support
confirmed in M10.
Year to date
QIPP variance*
£000s
Non-QIPP
£000s
Total
£000s
CCG Delegated
(2,937)
(5,360)
(8,297)
Other
(1,773)
12,049
10,276
Total
(4,710)
6,689
1,979
* QIPP variance relates to actual performance of schemes before the impact of block contracts. The impact of block
contracts is adjusted by the non-QIPP column.
NHS Hillingdon 7
UNDERLYING (RECURRENT) FINANCIAL POSITION
•In order to understand the financial position of the PCT, it is important to distinguish
between recurrent (underlying/run rate) and non-recurrent (one-off) income and
expenditure items. The recurrent position determines on-going financial sustainability.
• The recurrent position as per the FOT for 2012/13, adjusted for the major one-off
items, is set out below:
12/13 breakeven FOT
£m
1.9
- 12/13 Planned cluster support
- 12/13 In-Year Cluster Support
- Further NWL Contribution
+ Repay 2011/12 Support
+ 2% Non-Recurring Headroom
+ Repay Previous year debt
+ Non-Rec Spend
(4.4)
(21.8)
(2.6)
3.0
8.2
3.8
0.7
12/13 recurrent position (FOT)
(11.3)
NHS Hillingdon 8
PRACTICE BUDGETS IN 12/13-Month 10
Practice budgets of a total £323.3m have been issued to Practices,
Practice level reporting (including Access to Patient Level detail through the Portal) continues
to be developed
The M10 YTD position for Hillingdon Practice budgets was a deficit of £10.9m (4.1%) as shown in
Slide 10.
NHS Hillingdon 9
PRACTICE BUDGETS 2012/13- PERFORMANCE AT MONTH 10
Peer Group
Annual
Budget
Budget
YTD
Actual
YTD
Variance
At M10
Variance
At M9
Variance
At M10
Variance
At M9
£000s
£000s
£000s
£000s
£000s
%
%
Uxbridge and
West Drayton
94,021
77,854
82,052
(4,198)
(3,661)
(5.4%)
(5.2%)
North
Hillingdon
105,358
87,217
90,612
(3,396)
(3,295)
(3.9%)
(4.2%)
Hayes and
Harlington
82,157
68,028
69,924
(1,895)
(1,977)
(2.8%)
(3.2%)
Other
Delegated
Budgets not
held at
Practice
Level**
41,728
36,058
37,533
(1,475)
(1,832)
(4.1%)
(5.6%)
(10,766)
(4.1%)
(4.4%)
TOTAL
323,264
269,157 280,121 (10,964)
**Critical Care, Renal etc
NHS Hillingdon 10
SECTION 2 – MONTH 12 POSITION
NHS Hillingdon 11
OVERVIEW OF BUDGET POSITION AT MONTH 12
Month 11
£’000
Changes
£’000
Month 12
£’000
Issued budgets
Contingency & reserves
Planned surplus
422,228
25,269
(127)
(186)
422,101
25,083
Total allocation
447,497
(313)
447,184
Internal
transfers
£’000
Allocation
adjustments
£’000
Total
£’000
(173)
(286)
146
(173)
(286)
146
(313)
(313)
Impairment Funding
Cost of Capital adjustment
Other
Total allocation
)
0
NHS Hillingdon 12
SUMMARY OF VARIANCES - MONTH 12
£000s
M12
Total
M11
Total
M12*
QIPP
M11*
QIPP
-15,478
-12,948
-2,151
-2,042
Other Acute Commissioning
Joint Working Commissioning
Community
Prescribing
Sub-total:
Primary Care
Medical Contract
Primary Care Contracts
Dental Contract
Pharmacy Contract
Out of Hours
Ophthalmic
Sub-total:
Public Health
-998
1,335
196
2,227
-12,718
-322
853
88
2,256
-10,073
32
-163
-2,326
1,360
-3,249
27
-258
-1,933
1,286
-2,919
-587
-744
1,484
718
274
-681
1,428
624
312
0
0
0
92
0
0
0
-345
526
374
-292
1,353
229
-70
242
0
-64
28
0
Corporate & Estates Costs
TOTAL
Reserves and Contingency
Contingency
Investments/Reserves
Reserves Total:
TOTAL
-1,399
-13,216
-1,995
-10,486
-1,703
-4,710
-1,678
-4,569
2,053
13,142
15,195
1,979
1,882
8,604
10,486
0
0
0
0
0
0
-4,569
+ve = u/spend
-ve = o/spend
Commissioning of Healthcare
Acute Contracts
-4,710
*QIPP variance relates to actual performance of schemes before impact of block contracts.
* M12 performance includes the provision for retrospective Claims of £10.6m and bad debt provision of #1m
Explanations for the main variances are included on the following slides.
NHS Hillingdon 13
SUMMARY OF YEAR END VARIANCES (1)
Acute Commissioning
In Sector Contracts £12.1m unfavourable (£9.8m at Month 11) – The year-end variance shows the
agreed outturn position with THH of a £7.4m overperformance. The other SLAs show the expected outturn
based on the M11 SLAM position and an estimate for M12 performance.
Out of Sector Contracts £2.25m unfavourable (£2.0m at Month 11) - 11 ex 16 NHS OOS Acute
contracts ended the year with an overperformance. The most material variances were at West Herts 0.42m,
East & North Herts 0.42m and UCLH 0.3m.
Other Acute Commissioning £1.0m unfavourable - these budgets includes BMI, Spire, In Health,
London Specialist Commissioning Group (Acute), Other Specialist Commissioning for Acute, Cost per Case,
High Cost Drugs and Non Contracted Activities (NCAs). The most material variances are NCAs (£0.9m),
Private Providers (£1.2m).
Non Acute Commissioning
Joint Working- £1.3m favourable (£853k at Month 11) - comprises adult services and continuing care and
is detailed later.
Community Services -£0.2m favourable (£0.1m favourable at month 11)– community services include
CNWL, Urgent Care Centres, and other community services.
Prescribing £2.2m favourable (£2.2m at Month 11) – GP prescribing is showing £2.2m underspend
based on achievement of QIPP Plans.
NHS Hillingdon 14
SUMMARY OF YEAR END VARIANCES (2)
Primary Care £0.5m favourable (£1.3m at Month 11) – At the year end, Pharmacy contracts are
underspending by £0.7m , Dental contracts are £1.5m underspent and Ophthalmic £0.345m over.
Estates Costs £0.8m unfavourable (£1.17m at Month 11)– this largely relates to phasing in of
the budget for the planned Property disposal QIPP of £1.4m .
Corporate Costs £0.6m unfavourable (£0.8m at Month 11) –Recharges from Cluster are £0.6m
unfavourable due to increased costs not budgeted for. IT is £0.2m unfavourable due to increased
capital charges arising from last year’s Capital Programme.
Public Health £0.5m favourable (£0.3m at month 11)- this includes drugs & alcohol, LSG public
health, childhood immunisations, HIV and health promotion. There are under spends on Public
Health admin of £0.12m due to a number of vacancies and an underspend of £0.38m on PH
programmes.
General Reserve / Contingency £2.05m favourable
NHS Hillingdon 15
ACUTE CONTRACT POSITION – MONTH 12
The Analysis is based on Month 11 SLAM performance plus an estimate of M12 performance based on accrual information
provided by the NHS Trusts.
ACUTE CONTRACT POSITION – MONTH 11 key over performing providers
Provider
Hillingdon
Hospital FT
YTD Over
Performance
£6.1m
Position
Actions
Overview
A consistent run rate for the year to date is reflected in an actual
spend of £113.7m an adverse variance of £6.1m ,reduced to £5.4m
after mitigations. Except for non elective, (where acuity accounts for
most of the variance) over-performance is mainly driven by activity. At
month 11 the in month over performance is £926k as opposed to
£913k at M10.
• The CSU is working to support development and
Day cases An £1.96m over performance. At HRG chapter level MSK
trauma and non trauma procedures (£852k ) digestive system
disorders and procedures (£555k) account for the bulk of the over
performance
Non elective – Non elective over performance is £1.6m is driven by
acuity rather than volume . Mitigations are significant with NHS NWL
applying an emergency threshold adjustment of £1.6m, readmissions
credit of £2m and short stay admission adjustment credit of £141k.
First attendances - an adverse variance of £1.4m The top three over
performing specialties within outpatient first attendances in terms of
cost are General Surgery (£259k), Gastroenterology (£178k ) and T&O
(£166k)
•
•
delivery of the CCG QIPP, including commissioner
plans for MSK services
PPwT challenges have been adjusted in line with the
January audit findings giving a M11 risk adjusted
figures of £172k
The year-end position has been agreed with the
Trust reflecting an over-performance for the year of
£7.4m
ACUTE CONTRACT POSITION – MONTH 11 key over performing providers
Provider
YTD Over
Performance
Position
Actions
Royal
Brompton &
Harefield FT
£3.6m
Overview
NHS Hillingdon is over performing against plan by £3.6m an
adverse movement of £325k in month. Challenges are still
being calculated and further mitigations to this position with a
possible 111k.
•
Claims, challenges and mitigations are on-going,
•
Critical care network have carried out an audit on the
clinical coding of the activity to verify appropriateness
of HRG being charged. The critical care audit
concluded that the Trust are appropriately recording
HRG organ coding, and meet the criteria for HDU.
Electronic recording of patient activity at the bedside
commenced in February 2013. Credits are being
pursed where appropriate for individual spells
•
RBH to flag details of all on going high cost long stay
patients monthly, so future impact can be reported
and appropriate contingencies made
•
Monthly challenge review meetings will be scheduled
alongside implementation of a more robust
management and close down process
•
New to Follow up metric for 12/13 not implemented in
full until Q2 (M4).
•
Investigation into over performing elective areas to
determine whether the increase in activity is due to
over-intervention is on-going
Elective Inpatient activity is over performing by £557k due
to Cardiac and Respiratory activity . The NHS NWL review
highlighted that most ICD replacements are carried out in the
elective setting. The number of ICD patients have grown only
Imperial and RBH undertake this work.
Critical care over performance (£787k) is due to a
combination of factors; volume of activity, grouping into
higher HRGs than planned, and the complexity of the cases
continues to be high (organ 4, 5 & 6).
Other adverse variances - drugs and devices £879k, NEL
£348, NEL £325k & Daycase by £203k
West
Middlesex
University
Hospital
Trust
£157k
Overview
NHS Hillingdon is over performing against plan by £157k an
adverse movement of £20kfrom M10 to M11 as compared to
£37k adverse moevment in the previous month.
The area of overperformance is NEL IP (£125k) followed by
OP FA (£38k).
ACUTE CONTRACT POSITION – MONTH 11 key over performing providers
Provider
YTD Over
Performance
Position
Chelsea &
Westminster FT
£346k
At M11 NHS Hillingdon is over performing by £346k
against a contract plan of £1.6m a month in movement of
£39k.
HCD is over performing by £70k
Daycase is over performing by £56k
OPFU is over performing by £45k
North West
London Hospital
Trust (NWLHT)
£1.65m
NHS Hillingdon is over performing by £1.65m at M11, an
adverse movement in month of £105k.
NEL IP: variance of £405k, in month movement of £105k
EL IP: £379k variance, in month movement of £31k
DC : £227k over performance, in month movement of
£47k
As the contract operates as a block contract, NHS
Hillingdon will not pay for any over performance and will
pay under the block value if any penalties for national
breaches are applied or the Trust fails to deliver 100% of
the CQUINS.
The current estimate of the value of penalties for
national breaches (18 weeks ) is £20k .
Factoring the block agreement and exceptions to the
block agreement , the contract value payable is predicted
to between £135k - £69k below the contract sum.
Actions
ACUTE CONTRACT POSITION – MONTH 11 key under performing providers
YTD Month 11
Over/Under
Performance
Key areas of under performance
Actions
Imperial College
Healthcare NHS
Trust (-£887k)
The under performance on the ICHT contract is now -£887k below plan, an adverse
movement of £235k.
Cancer waits
The Trust is failing to achieve 2 of the 9 standards. An
agreed remedial plan has been put in place and is on
trajectory. The transfer to the Somerset PTL has been
delayed to mid March to ensure integrity of coding.
The system enables the tracking of patients more
prospectively to ensure they are treated in a timely
manner and performance levels sustained.
18wk RTT
ICHT has been notified that penalties are being
enforced for each specialty failing to achieve the 18
week target during periods 7, 8 &9; value £211k. The
same methodology will be used for months 10, 11
and 12.
A series of meeting are ongoing with the Trust. The
Trust is validating its data and action plans for each
specialty. With the exception of general surgery and
orthopaedics, plans were received on 1.3.13. The
outstanding plans will be received on 8.3.13.
Winter Pressures
In view of failure to meet A&E targets and 18 wk RTT
trajectories the CCGs are considering the withdrawal
of the additional winter pressure funding
The main changes are;
Elective in patient
Over performance of £295k (£2.26m YTD) compared to £161k M10. An in month adverse
movement of £120k
Critical Care
Underperformance in critical care in M11 is £867k, this compares to £869k at M10, an in
month movement of £2k, the lowest rate of underperformance since June 2012. However
activity remains 556 below plan with a YTD actual value of £1.3m. The Trust has confirmed
they have reduced critical care beds on general wards.
Day cases
Continued underachievement in activity to the value of £64k (YTD actual of £1.8m) an
adverse movement of £21k from M10. Activity is 144 below plan . This year’s plan was set at
2,325 above last year’s outturn.
Non elective admissions
Non elective admissions have shown a slight improvement of under performance from £506k
in M10 to £528k in M11YTD (incl NEL threshold), an in month movement of -£22k. YTD NEL
activity is under plan by 60.
For note:
The ICHT 2012-13 contract operates as a block contract. Any over performance
pre/post mitigations will not be payable or a business risk to commissioners. The
exception being CQUINS (traded at 50%) and national targets.
Out of cluster providers - position
by trust M11
Key areas of over performance
Variance
An over-performance of £1.9m (6.8% above plan), down from £2m at Month 10. This reflects an over-performance in 11 trusts
and under performance in 5
Royal National Orthopaedic Hospital NHS Trust
£2 m
£444k
In month movememnt of £94k. Elective IP variance increase from £289k in M10 to £345k in M11, Elective excess bed days
Have increase from £81k in M10 to £108k in M11.
West Hertfordshire Hospitals NHS Trust
£355k
Trust in month variance decreased from £413k to £355k. Main over performance is critical care with £256k with an in month movement of £21k, followed by
elective inpatients with a variance of £194k
UCLH
£523k
220k in high cost drugs, up from £195k in M10. Daycase are overperforming by £137k. Critical care is over performing by £101k a in month movement of -£38k.
£324k of critical care costs at UCLH relates to one high cost patient.
High cost drugs at UCLH are reviewed and validated by the NWL
ACUTE ACTIVITY ANALYSIS
• The following graphs compare monthly activity levels in 2012/13 with 2011/12 and
2010/11. There may be differences in the variances shown in slide 15 and the following
slides due to:
– Slide 15 is expressed in financial variances and the following slides are expressed in activity.
– Activity slides do not take into account case-mix and the impact of contract levers e.g. outpatient
follow-up ratios
– Non PbR spend areas such as Critical Care, Excluded Drugs & Devices, Direct Access, Renal
and Other Exclusions are not reflected in the Acute Activity Analysis graphs. Accident and
Emergency is also not reflected in the Acute Activity Analysis graphs.
– The following slides show actual activity changes year on year:
 Elective admissions (THH) increase of 5%;
 Elective admissions (Other) increase of 3%;
 Non-elective admissions (THH) decrease of 3%;
 Non-elective admissions (Other) increase of 3%;
 1st OP attendances GP referred (THH) increase of 1%;
 1st OP attendances GP referred (Other) decrease of 4%;
 1st OP attendances All referrals (THH) increase of 0%;
 1st OP attendances All referrals (Other) increase of 0%;
 FUP OP attendances GP referred (THH) decrease of 1%;
 FUP OP attendances GP referred (Other) increase of 1%;
 FUP OP attendances All referrals (THH) decrease of 1%;
 FUP OP attendances All referrals increase of 1%;
NHS Hillingdon 22
ACUTE ACTIVITY ANALYSIS (1) – ELECTIVE (THH)
Against the comparative period of April 2012- March 2013, there is an increase in activity
of 5%.
NHS Hillingdon 23
ACUTE ACTIVITY ANALYSIS (1) – ELECTIVE (OTHER)
Against the comparative period of April 2012 -March 2013, there is an increase in activity
of 3%.
NHS Hillingdon 24
ACUTE ACTIVITY ANALYSIS (1) – EMERGENCY (THH)
Against the comparative period of April 2012 - March 2013, there is an decrease in activity
of 3%.
NHS Hillingdon 25
ACUTE ACTIVITY ANALYSIS (1) – EMERGENCY (OTHER)
Against the comparative period of April 2012 –March 2013, there is an increase in activity
of 3%.
NHS Hillingdon 26
ACUTE ACTIVITY ANALYSIS (1) – GP REFERRED OUTPATIENTS (THH)
Against the comparative period of April 2012– March 2013, there is an increase in activity
of 1%.
NHS Hillingdon 27
ACUTE ACTIVITY ANALYSIS (1) – GP REFERRED OUTPATIENTS (OTHER)
Against the comparative period of April 2012–March 2013, there is an decrease in activity
of 4%.
NHS Hillingdon 28
ACUTE ACTIVITY ANALYSIS (1) – OUTPATIENTS (THH ALL REFERRALS)
Against the comparative period of April 2012– March 2013, there is an increase in activity
of 0.2%.
NHS Hillingdon 29
ACUTE ACTIVITY ANALYSIS (1) – OUTPATIENTS (ALL)
Against the comparative period of April 2012–March 2013, there is an increase in activity
of 0%.
NHS Hillingdon 30
ACUTE ACTIVITY ANALYSIS (1) – GP REFERRED FOLLOW-UP OP (THH)
Against the comparative period of April 2012–March 2013, there is an decrease in activity
of 1%.
NHS Hillingdon 31
ACUTE ACTIVITY ANALYSIS (1) – GP REFERRED FOLLOW-UP OP (OTHER)
Against the comparative period of April 2012– March 2013, there is an increase in activity
of 1%.
NHS Hillingdon 32
ACUTE ACTIVITY ANALYSIS (1) – FOLLOW-UP OP (THH)
Against the comparative period of April 2012– March 2013, there is an decrease in activity
of 1%.
NHS Hillingdon 33
ACUTE ACTIVITY ANALYSIS (1) –FOLLOW-UP OP (ALL)
Against the comparative period of April 2012– March 2013, there is an increase in activity
of 1%.
NHS Hillingdon 34
SPECIALIST COMMISSIONING – LSCG REPORT Outturn
•
The outturn position for Specialist Commissioning after risk share is an
underspend of £318k.
NHS Hillingdon 35
JOINT WORKING VARIANCES – MONTH 12
The year-end position for Joint Working Commissioning is reported as an
underspend of £1.3m. This compares to 853k underspend at month 11,
and is made up of the following : -
• MH SLAs (CNWL & WLMH) overspend of £1,057K YTD this includes £487k
shortfall on the Mental Health QIPP.
• Other Adult MH underspend of £919k . This includes Mental Health placements
with WLMH, CNWL & other private providers.
• Continuing Care Adults underspend of £900k (£801k at month 11).
• Franklyn House continuing care beds have been decommissioned 2012/13.
NHS Hillingdon 36
COMMUNITY SERVICES VARIANCES – MONTH 12
Community Services is showing an underspend of £196k at year end ( £88k at
month 11) and is made up of the following : -
• Community Services SLA (CNWL) showing an overspend of £193k.
• Urgent Care is under spending by £599k. Main contributing factors are the UCC
activity with Hillingdon Health Ltd below plan & 111 Non Emergency services
contract which is underspent by £70k due to credits received for lower than
contracted call volumes and other KPIs.
• Other Community Services is overspending by £211k, the main contributing
factors are the unbudgeted Intermediate Care service £150k and the Community
Equipment budget £70k,and Community Services NCAs £90k YTD.
NHS Hillingdon 37
PRIMARY CARE VARIANCES – MONTH 12
Prescribing £2.25m favourable (£2.2m at month 11) - GP prescribing is showing
£2.25m favourable based on April-January actuals. The position is also assisted
by a £205k credit relating to incorrect charges relating to 2011/12.
Dental Contract- £1.4m favourable (£1.4m at month 11). Continuation of previous
expenditure trend plus additional performance adjustment clawbacks of c£200k.
Pharmacy Contract- £718k favourable.(£624k at month 11).
Ophthalmic Contract- £345k unfavourable (£292k at month 11).
NHS Hillingdon 38
CORPORATE, ESTATES & PUBLIC HEALTH VARIANCES – MONTH 12
Estates (£0.777m) unfavourable (£1.171m at month 11)..The variance relates to the
the planned surplus on the property disposal which did not take place in 2012/13.
Corporate Services (£0.6m) unfavourable (£0.8m at month 11)
Public Health £0.374m favourable- this is due to underspends on NHS Health checks
and other Screening Programmes (£81k) and DAAT Expenditure (£71k).
NHS Hillingdon 39
BALANCE SHEET AT 31 MARCH 2013
Hillingdon PCT
Statement of Financial Position
NON-CURRENT ASSETS:
Property, Plant and Equipment
Intangible Assets
Other Financial Assets
TOTAL Non Current Assets
CURRENT ASSETS:
Inventories
Trade and Other Receivables
Cash and Cash Equivalents
Sub Total Current Assets
TOTAL Current Assets
TOTAL ASSETS
CURRENT LIABILITIES
Trade and Other Payables
Provisions
Total Current Liabilities
NET CURRENT ASSETS/(LIABILITIES)
TOTAL ASSETS LESS CURRENT LIABILITIES
NON-CURRENT LIABILITIES:
Trade and Other Payables
Provisions
Total Non-Current Liabilities
ASSETS LESS LIABILITIES (Total Assets
Employed)
TAXPAYERS EQUITY
General Fund
Revaluation Reserve
Total
B/Fwd
31.03.12
£000s
31.03.13
£000s
37,890
375
84
38,349
36,794
1,124
79
37,997
408
7,184
3
0
1,739
50
7,595
45,944
1,789
39,786
(28,596)
(725)
(29,321)
(21,726)
16,623
(26,578)
(11,004)
(37,582)
(35,793)
2,204
0
(1,968)
(1,968)
0
(504)
(504)
14,655
1,700
54
14,601
14,655
(13,009)
14,709
1,700
Further analysis of
balance sheet
movements is
contained in
appendix B
NHS Hillingdon 40
BETTER PAYMENT PRACTICE CODE (BPPC)
PCT Closedown
The organisations focus for the last six months has been to close down all outstanding issues and invoices. This
focus has been reflected in the increase in the number of invoices that have been paid in 2012/13 compared to
2011/12 (1965 additional invoices have been processed in 2012/13).
As a result of this drive to closedown historic issues, “the percentage of NHS trade invoices paid within target”
shows a decline compared to last year as the PCT is reporting a 92% performance against a target of 95% (prior
year 98%). Overall in terms of value and number of invoices being processed within the target timeframe, the PCT
has exceeded last years activity.
NHS Hillingdon 41
QIPP PROGRAMME M12 YTD SUMMARY (1)
The QIPP schemes for the year achieved total savings of £13.4m against an original plan target of £18.1
This equates to a shortfall of £4.7m or 26% of the original plan.
The Variance at month 11 was -£4,569k (-28%). The performance of £13.4m exceeded the forecast positio
Anticipated In the recovery plan by c£1m.
QIPP Scheme Variance
Explanation
HIL009
EstatesPremises
Disposal
-£1,403k • Property disposal did not take place in 2012/13.
PHHIL001
Productive
Community
Services
-£1,507k
• No reduction in expenditure from Community SLA . QIPP value offsetting planning
assumption around growth.
• Shortfall arising from delays in following schemes:-
P4HIL014
Mental Health
DAS
Challenge
P2HIL009
Referral
Facilitation
Service
-£487k
•
•
•
•
MH ICP acute hospital liaison service plan
Prescribing £150K antipsychotic prescribing
Joint Working across MH and CNWL
Offset by underspend on MH placements budget
• RFS scheme not progressed in 12/13.
-£774k
NHS Hillingdon 42
QIPP PROGRAMME M12 YTD SUMMARY (2)
QIPP Scheme Variance
P2HIL003
COPD/
Respiratory
-£400k
P3HIL009
UCC
-£647k
P1HIL002
Prescribing
+1,360k
Explanation
The project has emphasis on better coordination for this group of patients across the health
economy. Savings target based on reduction in non-elective admissions - but no Public
Health evidence to show (locally or nationally), that primary care interventions will reduce
non-elective activity/produce savings.


Delay in approval of UCC Business Case and Procurement now planned for October
2013.
Mitigating actions include credits from 111 contract and reduction in UCC activity

Additional Pharmacist resource in 12/13 to support GP reductions in drugs costs
NHS Hillingdon 43
QIPP PROGRAMME 2012/13- PERFORMANCE AT M12
NHS Hillingdon
QIPP SCHEMES
Outturn
RAG rating
HIL008- Continuing Care - Case Management
P4HIL013- Integrated Care Pathway Redesign
P3HIL009- UCC
P2HIL007- Diagnostics – Radiology and Pathology Direct Access Service Development
HI024- Ophthalmology Pathway Redesign
HI023- Gastroenterology Pathway Redesign
P2HIL005- Pain Management Pathway Development
P2HIL004- MSK Pathway Development
P2HIL009- Referral Facilitation Scheme
P1HIL001- Productive Community Services
P4HIL014- Mental Health Desirable Affordable Sustainable (DAS) Challenge
HI031- Reprovision of Adult Continuing Care Beds (Daniels Ward)
P2HIL003- COPD/Respiratory Pathway Development
P1HIL002- Primary Care Prescribing
P3HIL015- Collective - Acute Readmission Reduction Plans
P3HIL013- Non birth admission ratio
P3HIL016- Non-Elective Short-Stay Admissions Reduction
P2HIL010- PPwT Extended List
P6HIL006- PPwT Local Stretch
P2HIL008- Extend Outpatient Ratios
P6HIL007- Maternity Matters
P6HIL008- Acute Non-PbR
HIL010- Day case to outpatient ratio
HIL011- Non GP referral - first attendance & follow up
P6HIL001- Primary care Dentistry budget change
P6HIL002- Primary care Optoms budget change
HIL007- Primary Care LES
P6HIL004- Public health budget reduction
P6HIL003- Corporate budget reduction/efficiency
HIL009- Estates - premises disposals
P6HIL005- End of life care
NEW1- Ophthalmology Price Reduction
NEW2- A&E Attendences - GP Heralded
NEW3- Pulmonary Rehab
NEW4- Excess Bed Days
NEW5- Practice Commissioning Improvement Scheme
NEW6- Community Cardiology Service
Total
GREEN
RED
RED
GREEN
RED
RED
RED
RED
RED
RED
RED
GREEN
RED
GREEN
RED
RED
RED
RED
RED
GREEN
RED
RED
RED
GREEN
GREEN
RED
GREEN
GREEN
RED
RED
RED
GREEN
GREEN
RED
GREEN
GREEN
GREEN
2012/13
Gross QIPP
(£000)
Reprovision/Inv
estments
(£000)
Net
Planned
QIPP
savings
(£000)
0
(400)
YTD Plan
(400)
YTD Actuals
(400)
(724)
324
(376)
0
(376)
(376)
0
(376)
(930)
0
(930)
(930)
(283)
(647)
(155)
0
(155)
(155)
(187)
32
(536)
358
(178)
(178)
0
(178)
(194)
0
(194)
(194)
0
(194)
(221)
45
(176)
(176)
0
(176)
(443)
55
(388)
(388)
(250)
(138)
(1,274)
500
(774)
(774)
0
(774)
(1,507)
0
(1,507)
(1,507)
0
(1,507)
(2,000)
0
(2,000)
(2,000)
(1,513)
(487)
(175)
0
(175)
(175)
(175)
0
(400)
0
(400)
(400)
0
(400)
(2,323)
0
(2,323)
(2,323)
(3,683)
1,360
(2,033)
0
(2,033)
(2,033)
0
(2,033)
(387)
0
(387)
(387)
(163)
(224)
(4)
0
(4)
(4)
0
(4)
(319)
0
(319)
(319)
(169)
(150)
(139)
0
(139)
(139)
0
(139)
(224)
0
(224)
(224)
(2,923)
2,699
(690)
0
(690)
(690)
(345)
(345)
(600)
0
(600)
(600)
0
(600)
(426)
0
(426)
(426)
(234)
(192)
(300)
0
(300)
(300)
(537)
237
(280)
0
(280)
(280)
(280)
0
(70)
0
(70)
(70)
0
(70)
(500)
0
(500)
(500)
(812)
312
(200)
0
(200)
(200)
(200)
0
(300)
0
(300)
(300)
0
(300)
(1,403)
0
(1,403)
(1,403)
0
(1,403)
(252)
0
(252)
(252)
(80)
(172)
0
0
0
(0)
(500)
500
0
0
0
(0)
(66)
66
0
0
0
(0)
(0)
0
0
0
0
(0)
(87)
87
0
0
0
(0)
(183)
183
0
(19,061)
0
958
0
(18,103)
(0)
(18,103)
(0)
(13,393)
0
(4,710)
Variance
NHS Hillingdon 44
APPENDIX A – FINANCIAL SCHEDULES
NHS Hillingdon 45
SUMMARYMONTH 12
NHS Hillingdon
Annual
Budgets
(£000)
Changes
Presented to
April Board
Commissioning of Healthcare
Acute Contracts
Other Acute Commissioning
Joint Working Commissioning
Community
Prescribing
Sub-total:
Primary Care
Medical Contract
Primary Care Projects
Dental Contract
Pharmacy Contract
Out of Hours
Ophthalmic
Sub-total:
Public Health
Corporate & Estates Costs
TOTAL
Reserves and Contingency
Contingency
Investments / Reserves
RESERVES Total:
Total 2012-13 Initial Approved Budgets
PCT Planned Surplus
Total
Year to Date Position
Final
Budgets
(£000)
YTD Budget
(£000)
Forecast Outturn Position
Variance
Previous YTD QIPP
YTD Actual
Sur/(deficit) Month's YTD variance
(£000)
(£000)
Variance
(£000)
YTD CCG Deleg YTD CCG
Budgets Delegated
variance QIPP variance
(£000)
(£000)
FOT Variance FOT QIPP
FOT Actual
Sur/(deficit) Variance
(£000)
(£000)
(£000)
FOT CCG Deleg FOT CCG
Budgets Delegated
variance QIPP variance
(£000)
(£000)
202,126
36,139
43,525
32,967
34,155
348,912
(7,801)
9,091
1,201
1,506
(111)
3,886
194,325
45,230
44,726
34,473
34,044
352,798
194,325
45,230
44,726
34,473
34,044
352,798
209,803
46,228
43,391
34,277
31,818
365,517
(15,478)
(998)
1,335
196
2,227
(12,718)
(12,948)
(322)
853
88
2,256
(10,073)
(2,151)
32
(163)
(2,326)
1,360
(3,249)
(15,478)
(1,316)
1,335
196
2,227
(13,036)
(2,151)
32
(163)
(2,326)
1,360
(3,249)
209,803
46,228
43,391
34,277
31,818
365,517
(15,478)
(998)
1,335
196
2,227
(12,718)
(2,151)
32
(163)
(2,326)
1,360
(3,249)
(15,478)
(1,316)
1,335
196
2,227
(13,036)
(2,151)
32
(163)
(2,326)
1,360
(3,249)
33,882
(2,288)
2,124
17
(0)
0
0
(147)
94
3,117
6,951
31,594
2,124
8,954
8,212
0
2,247
53,131
4,595
11,576
422,101
31,594
2,124
8,954
8,212
0
2,247
53,131
4,595
11,576
422,101
32,181
2,868
7,470
7,494
0
2,592
52,605
4,221
12,975
435,318
(587)
(744)
1,484
718
0
(345)
526
374
(1,399)
(13,217)
274
(681)
1,428
624
0
(292)
1,353
229
(1,995)
(10,486)
312
0
0
0
0
(70)
242
0
(1,703)
(4,710)
(188)
0
0
0
0
0
(188)
0
0
(13,224)
312
0
0
0
0
0
312
0
0
(2,937)
32,181
2,868
7,470
7,494
0
2,592
52,605
4,221
12,975
435,318
(587)
(744)
1,484
718
0
(345)
526
374
(1,399)
(13,217)
312
0
0
0
0
(70)
242
0
(1,703)
(4,710)
(188)
0
0
0
0
0
(188)
0
0
(13,224)
312
0
0
0
0
0
312
0
0
(2,937)
2,053
0
23,030
23,030
2,053
23,030
25,083
2,053
23,030
25,083
0
9,887
9,887
2,053
13,143
15,196
1,882
8,604
10,486
0
0
0
1,642
0
1,642
0
0
0
0
9,887
9,887
2,053
13,143
15,196
0
0
0
1,642
0
1,642
0
0
0
417,203
29,981
447,184
447,184
445,205
1,979
0
(4,710)
(11,582)
(2,937)
445,205
1,979
(4,710)
(11,582)
(2,937)
0
0
417,203
29,981
447,184
447,184
445,205
1,979
0
(4,710)
(11,582)
(2,937)
445,205
1,979
(4,710)
(11,582)
(2,937)
8,937
8,212
2,247
53,278
4,501
8,459
415,150
2,053
NHS Hillingdon 46
ACUTE- MONTH 12
NHS Hillingdon
Year to Date Position
Forecast Outturn Position
Final
YTD
Budgets Budget
£000
£000
YTD
Actual
£000
Variance
Sur/(deficit)
£000
Previous
Month's
YTD
Variance
YTD QIPP
variance
£000
YTD CCG
Deleg
Budgets
variance
£000
Imperial
Ealing Hospital
Hillingdon Hospital
North West London Hospitals
Royal Brompton and Harefield
Chelsea And Westminster
West Middlesex
Sub Total - in Sector SLAs
Out of Sector SLAs
16,889
2,053
116,473
11,892
11,909
1,776
1,383
162,375
16,889
2,053
116,473
11,892
11,909
1,776
1,383
162,375
16,940
2,027
123,909
11,886
16,049
2,102
1,530
174,444
(51)
26
(7,436)
6
(4,140)
(326)
(147)
(12,069)
(0)
(0)
(5,658)
0
(3,633)
(337)
(151)
(9,779)
0
0
(2,151)
0
0
0
0
(2,151)
(51)
26
(7,436)
6
(4,140)
(326)
(147)
(12,069)
0
0
(2,151)
0
0
0
0
(2,151)
16,940
2,027
123,909
11,886
16,049
2,102
1,530
174,444
(51)
26
(7,436)
6
(4,140)
(326)
(147)
(12,069)
0
0
(2,151)
0
0
0
0
(2,151)
(51)
26
(7,436)
6
(4,140)
(326)
(147)
(12,069)
0
0
(2,151)
0
0
0
0
(2,151)
St Georges Healthcare
West Herts Hospitals
Whittington Hospital
East and North Herts Trust
Barts and the Royal London
Guys & St Thomas
The Homerton
Ashford & St Peter's
Heatherwood & Wexham Park
Kingston Hospital
Kings Healthcare
Moorfields Eye Hospital
The Royal Marsden
UCL Hospitals
Other Trusts
Pass through/hosted budgets
262
5,147
191
6,431
1,351
1,284
0
380
1,637
90
287
750
273
4,614
7,466
764
262
5,147
191
6,431
1,351
1,284
0
380
1,637
90
287
750
273
4,614
7,466
764
376
5,567
202
6,846
826
1,536
0
328
1,558
102
476
861
364
4,938
8,545
660
(114)
(420)
(11)
(415)
525
(252)
0
52
79
(12)
(189)
(111)
(91)
(324)
(1,079)
104
52
(454)
(17)
(299)
450
(217)
0
46
74
(30)
(63)
(77)
(84)
(640)
(850)
94
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
(114)
(420)
(11)
(415)
525
(252)
0
52
79
(12)
(189)
(111)
(91)
(324)
(1,079)
104
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
376
5,567
202
6,846
826
1,536
0
328
1,558
102
476
861
364
4,938
8,545
660
(114)
(420)
(11)
(415)
525
(252)
0
52
79
(12)
(189)
(111)
(91)
(324)
(1,079)
104
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
(114)
(420)
(11)
(415)
525
(252)
0
52
79
(12)
(189)
(111)
(91)
(324)
(1,079)
104
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
Sub-total - Others
Independent Sector Providers
30,927
1,022
0
1,022
0
0
194,325
22,861
7,489
9,788
2,484
2,608
45,230
239,555
30,927
1,022
0
1,022
0
0
194,325
22,861
7,489
9,788
2,484
2,608
45,230
239,555
33,185
2,174
0
2,174
0
0
209,803
22,542
8,319
9,719
3,283
2,365
46,228
256,031
(2,258)
(1,151)
0
(1,151)
0
0
(15,478)
318
(830)
70
(798)
243
(998)
(16,476)
(2,013)
(1,157)
0
(1,157)
0
0
(12,948)
350
139
9
(929)
109
(322)
(13,270)
0
0
0
0
0
0
(2,151)
0
0
0
0
32
32
(2,119)
(2,258)
(1,151)
0
(1,151)
0
0
(15,478)
0
(830)
70
(798)
243
(1,316)
(16,794)
0
0
0
0
0
0
(2,151)
0
0
0
0
32
32
(2,119)
33,185
2,174
0
2,174
0
0
209,803
22,542
8,319
9,719
3,283
2,365
46,228
256,031
(2,258)
(1,151)
0
(3,409)
0
0
(15,478)
318
(830)
70
(798)
243
(998)
(16,476)
0
0
0
0
0
0
(2,151)
0
0
0
0
32
32
(2,119)
(2,258)
(1,151)
0
(3,409)
0
0
(15,478)
0
(830)
70
(798)
243
(1,316)
(16,794)
0
0
0
0
0
0
(2,151)
0
0
0
0
32
32
(2,119)
Pass through /hosted budgets
Sub total
25% Readmission / In Year Risk Reserves
Readmission / In-year Risk Reserve
Sub Total - Acute SLAs
Specialist Consortia
High Cost Drugs
London Ambulance
NCAs / Acute Cost per Case
Other
Sub-total Other Commissioning
Total Acute
YTD CCG
Delegated
QIPP
variance
£000
FOT
FOT
QIPP
FOT Actual Variance
Variance
£000
Sur/(deficit)
£000
£000
FOT CCG
FOT CCG
Deleg Budgets Delegated
variance
QIPP variance
£000
£000
NHS Hillingdon 47
NON-ACUTE & PRIMARY CARE- MONTH 12
NHS Hillingdon
Year to Date Position
Final Budgets YTD Budget
£000
£000
Forecast Outturn Position
YTD Actual
£000
Variance
Sur/(deficit)
£000
Previous
Month's YTD
Variance
YTD QIPP
variance
£000
YTD CCG
YTD CCG
Delegated
Deleg Budgets QIPP variance
variance £000
£000
(1,057)
(487)
(28)
0
39
0
0
0
919
0
708
0
0
0
582
(487)
FOT Actual
£000
FOT Variance
Sur/(deficit)
£000
FOT QIPP
variance
£000
21,184
302
437
0
1,908
3,303
0
27,134
(1,057)
(28)
39
0
919
708
0
582
(487)
0
0
0
0
0
0
(487)
CNWL- MH
West London MH
Other MH SLA's
IAPT
Other Adult MH services
Re-ablement Social Care (Sec 256)
Joint Finance
Sub- total Adult Services
20,127
274
476
0
2,827
4,011
0
27,715
20,127
274
476
0
2,827
4,011
0
27,715
21,184
302
437
0
1,908
3,303
0
27,134
(1,057)
(28)
39
0
919
708
0
582
(969)
(26)
22
0
529
649
0
206
(487)
0
0
0
0
0
0
(487)
Continuing Care adults
Ombudsman approved Continuing care cases
Continuing Care children
Continuing Care
Children & Families
Children & Families
14,661
0
0
14,661
2,350
2,350
14,661
0
0
14,661
2,350
2,350
13,878
0
0
13,878
2,379
2,379
782
0
0
782
(29)
(29)
801
0
0
801
(154)
(154)
324
0
0
324
0
0
782
0
0
782
(29)
(29)
324
0
0
324
0
0
13,878
0
0
13,878
2,379
2,379
782
0
0
782
(29)
(29)
324
0
0
324
0
0
Total Joint Working
44,726
44,726
43,391
1,335
853
(163)
1,335
(163)
43,391
1,335
(163)
YTD Actual
£000
Variance
Sur/(deficit)
£000
Previous
Month's YTD
Variance
YTD QIPP
variance
£000
FOT Actual
£000
FOT Variance
Sur/(deficit)
£000
FOT QIPP
variance
£000
29,079
0
0
2,367
0
2,831
0
0
34,277
(193)
0
0
599
0
(211)
0
0
196
(1,679)
0
0
(647)
0
0
0
0
(2,326)
Final Budgets YTD Budget
£000
£000
CNWL - Community Services
Ealing ICO
Walk in Centres
Urgent Care Centres
STARRS
Other Community Services
Community Business Cases
YTD CCG
YTD CCG
Delegated
Deleg Budgets QIPP variance
variance £000
£000
(193)
(1,679)
0
0
0
0
599
(647)
0
0
(211)
0
0
0
0
0
196
(2,326)
FOT CCG
FOT CCG
Delegated
Deleg Budgets QIPP variance
variance £000
£000
(1,057)
(487)
(28)
0
39
0
0
0
919
0
708
0
0
0
582
(487)
782
0
0
782
(29)
(29)
0
1,335
324
0
0
324
0
0
(163)
FOT CCG
FOT CCG
Delegated
Deleg Budgets QIPP variance
variance £000
£000
(193)
(1,679)
0
0
0
0
599
(647)
0
0
(211)
0
0
0
0
0
196
(2,326)
Sub- total Community Services
28,887
0
0
2,966
0
2,620
0
0
34,473
28,887
0
0
2,966
0
2,620
0
0
34,473
29,079
0
0
2,367
0
2,831
0
0
34,277
(193)
0
0
599
0
(211)
0
0
196
(186)
0
0
458
0
(184)
0
0
88
(1,679)
0
0
(647)
0
0
0
0
(2,326)
GP Prescribing
Central Drug Costs
Other
Sub total Prescribing
34,044
0
0
34,044
34,044
0
0
34,044
31,818
0
0
31,818
2,227
0
0
2,227
2,256
0
0
2,256
1,360
0
0
1,360
2,227
0
0
2,227
1,360
0
0
1,360
31,818
0
0
31,818
2,227
0
0
2,227
1,360
0
0
1,360
2,227
0
0
2,227
1,360
0
0
1,360
GMS/PMS Baseline
Quality and Outcomes Framework
Pharmacy Contract
Opthalmic
Dental Contract
Out of Hours
DES Services
Local Enhanced Schemes
NES Services
Premises
Other Primary Care
21,264
4,931
8,212
2,247
8,954
0
1,708
1,400
0
2,291
2,124
21,264
4,931
8,212
2,247
8,954
0
1,708
1,400
0
2,291
2,124
20,888
5,449
7,494
2,592
7,470
0
2,077
1,588
0
2,179
2,868
375
(518)
718
(345)
1,484
0
(368)
(188)
0
112
(744)
484
(307)
624
(292)
1,428
0
138
(165)
0
124
(681)
0
0
0
(70)
0
0
0
312
0
0
0
0
0
0
0
0
0
0
(188)
0
0
(0)
0
0
0
(70)
0
0
0
312
0
0
0
20,888
5,449
7,494
2,592
7,470
0
2,077
1,588
0
2,179
2,868
375
(518)
718
(345)
1,484
0
(368)
(188)
0
112
(744)
0
0
0
(70)
0
0
0
312
0
0
0
0
0
0
0
0
0
0
(188)
0
0
(0)
0
0
0
(70)
0
0
0
312
0
0
0
Sub total Primary Care
53,131
53,131
52,605
526
1,353
242
(188)
242
52,605
526
242
(188)
242
NHS Hillingdon 48
PUBLIC HEALTH- MONTH 12
NHS Hillingdon
Year to Date Position
Final Budgets YTD Budget
£000
£000
YTD
Actual
£000
Forecast Outturn Position
YTD
Variance Previous
QIPP
Sur/(deficit) Month's YTD
variance
£000
Variance
£000
Sexual Health
DAAT/DIP-Expenditure
DAAT/DIP-Income
Children & Families - Sexual Health
Childhood Imms/Hib
Control of Infection
IUCD
MMR
Smoking Cessation
Immunisation
Improving Breast feeding rates
Increase Breast Screening
Breast Screening
Chlamydia Screening
Health Inequalities
Health Promotion
Improving Performance
Cancer Reform
Health Checks
WeLReN - income
WeLReN - expenditure
Other
496
64
(64)
593
0
0
0
0
428
0
0
0
0
487
424
0
0
0
310
0
0
1,857
496
64
(64)
593
0
0
0
0
428
0
0
0
0
487
424
0
0
0
310
0
0
1,857
457
0
(71)
557
0
0
0
0
401
0
0
0
0
443
417
0
0
0
273
0
0
1,745
39
64
7
37
0
0
0
0
27
0
0
0
0
44
7
0
0
0
37
0
0
112
(20)
58
7
31
0
0
0
0
6
0
0
0
0
41
8
0
0
0
53
0
0
47
Total Public Health
4,595
4,595
4,221
374
229
0
YTD LA
YTD LA
Delegated Delegated
Budgets
QIPP
variance variance
£000
£000
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
FOT Actual FOT Variance FOT QIPP
£000
Sur/(deficit) £000 variance £000
457
0
(71)
557
0
0
0
0
401
0
0
0
0
443
417
0
0
0
273
0
0
1,745
39
64
7
37
0
0
0
0
27
0
0
0
0
44
7
0
0
0
37
0
0
112
4,221
374
FOT LA
FOT LA Deleg
Delegated
Budgets
QIPP variance
variance £000
£000
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
NHS Hillingdon 49
ESTATES & CORPORATE – MONTH 12
NHS Hillingdon
Year to Date Position
Forecast Outturn Position
Final
YTD Budget
Budgets
£000
£000
YTD
Actual
£000
Variance
Sur/(deficit)
£000
Previous
Month's YTD
Variance
YTD QIPP
variance £000
FOT Actual
£000
FOT Variance
Sur/(deficit) £000
FOT QIPP
variance £000
Chief Executive
Strategy and QIPP
Finance and Information
ICT
Borough Directorate
Prescribing Team
Prescribing Team - Harrow
Continuing Healthcare
Family Health Services (FHS)
Public Health admin
Clinical Commissioning
Residual Costs
111 Project
Recharge - sector
Recharge - London wide
Recharge - NWL PCTs
Recharge - other Providers
Sub- total - Corporate services
Estates
Cost of Capital/depreciation
General Estates
Sub- total - Estates
0
0
3,631
1,024
1,468
0
0
485
359
973
822
0
0
1,003
(0)
680
0
10,446
1,131
0
0
1,131
0
0
3,631
1,024
1,468
0
0
485
359
973
822
0
0
1,003
(0)
680
0
10,446
1,131
0
0
1,131
0
0
2,943
1,331
2,308
0
0
313
599
851
588
0
0
1,652
(10)
493
0
11,067
1,908
0
0
1,908
0
0
688
(307)
(841)
0
0
173
(240)
122
234
0
0
(649)
10
188
0
(622)
(777)
0
0
(777)
0
0
342
(217)
(764)
0
0
219
(218)
114
(90)
0
0
(337)
(17)
142
0
(827)
(1,171)
0
0
(1,171)
0
0
0
0
0
0
0
0
0
0
0
0
0
(300)
0
0
0
(300)
(1,403)
0
0
(1,403)
0
0
2,943
1,331
2,308
0
0
313
599
851
588
0
0
1,652
(10)
493
0
11,067
1,908
0
0
1,908
0
0
688
(307)
(841)
0
0
173
(240)
122
234
0
0
(649)
10
188
0
(622)
(777)
0
0
(777)
0
0
0
0
0
0
0
0
0
0
0
0
0
(300)
0
0
0
(300)
(1,403)
0
0
(1,403)
Grand Total
11,576
11,576
12,975
(1,399)
(1,995)
(1,703)
12,975
(1,399)
(1,703)
NHS Hillingdon 50
CCG DELEGATED BUDGETS- MONTH 12
NHS Hillingdon
Year to Date Position
Forecast Outturn Position
Final Budgets
YTD
Budget(£000)
CCG list based responsibilities
Secondary and community care
Out-of-hours primary care
Prescribing costs
Contingency
Services currently commissioned through local enhanced
services (excluding public health)
Sub - total
CCG geographical responsibilities
Secondary care for prisoners
Unregistered populations
Charge exempt overseas visitors
Non-rechargeable services
Other Pass-Through type payments
Termination of pregnancy, sterilisation and vasectomy
Sub total - geographical responsibilities
Total - CCG Delegated Budgets
NHSCB direct commissioning
Specialised services
Secondary dental care
GP services excluding local enhanced services and out of hours
services
General Dental Services - contractor and salaried led (net of
patient charges)
General Ophthalmic Services
Pharmaceutical Services (net of patient charges)
Armed forces
Other Primary Care
Total rows 22-29
295,893
0
34,044
1,642
£000s
295,893
0
34,044
1,642
YTD Actual(£000)
£000s
311,177
0
31,818
Variance
Sur/(deficit)
£000
Previous
Month's YTD
Variance
£000s
(15,283)
0
2,227
1,642
£000s
(12,699)
0
2,256
1,506
YTD QIPP
variance £000
FOT Actual
£000
£000s
(4,609)
0
1,360
£000s
311,157
0
31,818
Corporate (exc PH)
Estates
Contingency
Admin
Sub total - Non-delegated Budgets
In-year support
TOTAL BUDGETS 2012/13
£000s
(15,263)
0
2,227
1,642
£000s
(4,609)
0
1,360
2,563
1,400
1,588
(188)
(165)
312
1,588
(188)
312
334,143
332,980
344,582
(11,602)
(9,102)
(2,937)
344,562
(11,582)
(2,937)
0
0
0
0
0
0
0
334,143
0
0
0
0
0
0
0
332,980
0
0
0
0
0
0
0
344,582
0
0
0
0
0
0
0
(11,602)
0
0
0
0
0
0
0
(9,102)
0
(2,937)
0
0
0
0
0
0
0
344,562
0
0
0
0
0
0
0
(11,582)
0
0
0
0
0
0
0
(2,937)
22,861
0
22,861
0
22,522
0
338
0
370
0
0
0
22,542
0
318
0
0
0
29,031
30,194
30,593
(399)
439
0
30,593
(399)
0
8,954
8,954
7,470
1,484
1,428
0
7,470
1,484
0
2,247
8,212
2,247
8,212
2,592
7,494
2,868
73,539
2,592
7,494
0
2,868
73,559
(345)
718
0
(744)
1,033
(70)
0
2,124
74,592
(292)
624
0
(681)
1,888
(70)
0
2,124
73,429
(345)
718
0
(744)
1,053
0
0
0
0
0
374
374
0
0
0
0
(622)
(777)
411
(988)
418
13,143
1,979
(300)
(1,403)
0
(70)
Public health system
LA responsibilities
Commissioned through NHSCB
PHE
Public Health Programme
Total
FOT Variance
FOT
QIPP
Sur/(deficit)
Variance £000
£000
4,595
4,595
4,595
4,595
4,221
4,221
374
374
229
229
0
0
0
0
4,221
4,221
10,446
1,131
411
11,987
90,011
23,030
447,184
10,446
1,131
411
11,987
91,174
23,030
447,184
11,067
1,908
(622)
(777)
411
(988)
438
13,143
1,979
(827)
(1,171)
376
(1,622)
496
8,604
(2)
(300)
(1,403)
11,067
1,908
(1,703)
(1,773)
12,975
90,756
9,887
445,205
12,975
90,736
9,887
445,205
(4,710)
0
(70)
(1,703)
(1,773)
(4,710)
NHS Hillingdon 51
APPENDIX B – BALANCE SHEET ANALYSIS
NHS Hillingdon 52
ANALYTICAL REVIEW 11/12 v M12 12/13
•Statement of Financial Position (ex Balance sheet)
, Plant and Equipment (fixed assets) – slide 54
– Trade and Other Receivables (debtors) – slide 55-56
– Trade and Other Payables (creditors) – slide 57-58
– Provisions– slide 59
– Property
NHS Hillingdon 53
PROPERTY, PLANT & EQUIPMENT
31/03/12
31/03/13
£000s
£000s
Tangible assets:
Balance (post IFRS)
Additions
Upward Valuation
Impairment
Depreciation
Disposals
Reclassification
38,311
1,766
121
(238)
(2,646)
0
576
37,890
889
476
(105)
(2,356)
0
0
Total
37,890
36,794
Intangible assets
Balance (post IFRS)
Additions
Depreciation
Reclassification
177
214
(74)
58
375
896
(147)
0
Total
375
1,124
The PCTs Land, Buildings and Dwellings have been valued by the District Value Office as at 31st March 2013. Land value
increased by £422k, along with nine dwellings totalling £54k. A total upward valuation movement of £476k.
Eleven health centre properties were impaired totalling £294k. Three buildings have a reversal of a prior year impairments
totalling £189k causing an overall impairment of £105k.
The £896k intangible assets relate to various IT projects completed in the year.
NHS Hillingdon54
54
TRADE & OTHER RECEIVABLES
31/03/2012
£000s
4,572
2,745
(133)
31/03/2013
£000s
1,320
1,431
(1,012)
Variance %
Total
7,184
1,739
-76%
Aged debtor analysis
0-30 days
31-60 days
61-90 days
Over 90 days
Sub Total
Less Bad debts Provision
£000s
18
4
176
1,100
1,298
(133)
£000s
123
0
12
1,015
1,150
(1,012)
Other Debtors / Prepayments
6,019
1,601
Total
7,184
1,739
NHS
Other debtors, prepayments etc.
Provision for irrecoverable debts
-71%
-48%
661%
NHS - There has been increased focus on recovering debts throughout the year as part of the PCT closedown project. This has resulted in a
much reduced debtors balance as at 31st March 2013.
Provision for irrecoverable debts - This relates to an invoice for £874k to London Borough of Hillingdon in relation to Section 106 funding, and
is the main component of the over 90 days debtors.
Other Debtors/ Prepayments includes £573k relating to current debtors, £113k rent prepayments, and £131k VAT.
NHS Hillingdon 55
Q4 AGREEMENT OF BALANCES
NHS Hillingdon sends a debtor statement up to the 14th March 2013, and a further accruals statement capturing all
invoices raised after this date relating to 2012/13 financial year including any income accruals. Debtors identify any
queries or disputes, along with the reason for the dispute, which we log. Where we can, we attempt to resolve disputes
before submission. For the purposes of submission there are two categories, agreed or disputed. If an invoice is agreed
the debtor is bound to pay it. Therefore if there is an outstanding query e.g. awaiting validation, for the purposes of the
submission it is disputed.
Table 1 shows the split of NHS
Debtors between disputed, and
agreed. N.B. excludes deminimus debtor balances but
includes credit notes.
ORG CODE
Table 2
contains an
analysis of
the disputed
invoices
Agreed
Disputed
Total
£993k
£327k
£1,320k
75%
25%
100%
CUSTOMER NAME
INVOICE DATE INVOICE NO:
INVOICE DESCRIPTION
OUTSTANDING BALANCE £
DISPUTED REASONS
RV3
Central And North West London MH NHS Foundation Trust
14/03/2013
B0001690 DEPN MONTH 1-6 PROVIDER SHARE BASED ON AGREED
51,577.72 AWAITING CODING AND VALIDATION
RV3
Central And North West London MH NHS Foundation Trust
14/03/2013
B0001691 EASTCOTE HEALTH CENTRE
161,059.62 AWAITING CODING AND VALIDATION
RV3
Central And North West London MH NHS Foundation Trust
14/03/2013
B0001685 RENT FEB-MARCH 2011 AS AGREED WITH CNWL
22,847.35 AWAITING CODING AND VALIDATION
RV3
Central And North West London MH NHS Foundation Trust
14/03/2013
B0001686 I.T COSTS AS AGREED WITH CNWL
16,736.22 AWAITING CODING AND VALIDATION
RV3
Central And North West London MH NHS Foundation Trust
14/03/2013
B0001687 HCH I.T RECHARGES AS AGREED WITH CNWL
8,296.75 AWAITING CODING AND VALIDATION
RV3
Central And North West London MH NHS Foundation Trust
14/03/2013
B0001688 LEASE CAR INVOICE
57,723.76 AWAITING CODING AND VALIDATION
RV3
Central And North West London MH NHS Foundation Trust
14/03/2013
B0001689 CRB APRIL 2011
9,122.47 AWAITING CODING AND VALIDATION
RV3
Central And North West London MH NHS Foundation Trust
21/12/2012
B0001297 COURSE FEES
240.00 AWAITING CODING AND VALIDATION
327,603.89
NHS Hillingdon 56
TRADE & OTHER PAYABLES
NHS
Non-NHS/trade creditors
Accruals and Deferred Income
Other (FHS,Social Security,Tax and Capital)
Total
31/03/12
£000s
31/03/13
£000s
Variance
%
11,357
2,647
1,055
13,537
28,596
8,694
1,413
2,170
14,301
26,578
-23
-47
106
6
-7
NHS and Non NHS – Due to an increased focus on clearing outstanding creditors the closing creditor
balance is much reduced compared to prior year.
Accruals and Deferred Income – This includes late invoices from London Borough of Hillingdon that are
still under review, and Urgent Care Winter Pressure and Children's placement costs.
Other – The increase mainly relates to FHS. There has been an increase in Quality Outcome Framework
(QOF) and Enhanced Services (LES).
NHS Hillingdon 57
Q4 AGREEMENT OF BALANCES – CREDITORS
Providers send creditor statements for invoices outstanding up to the 14th March 2013, and a further
accruals statement capturing all invoices they have raised after this date relating to 2012/13 financial
year and any expenditure accruals. We check whether invoices are on our ledger and identify any
queries or disputes with budget holders, along with the reason for the dispute, which we log. Where we
can, we attempt to resolve disputes before submission.
For the purposes of submission there are two categories, agreed or disputed. If we state an invoice is
agreed we are legally bound to pay it. Therefore if there is an outstanding query for the purposes of the
submission it is disputed.
Agreed
Disputed
Total
£4,235k
£4,459k
£8,694k
49%
52%
100%
Supplier Name
Croydon PCT
The Hillingdon Hospital NHS Foundation Trust
The Hillingdon Hospital NHS Foundation Trust
Croydon PCT
Croydon PCT
University College London NHS Foundation Trust
University College London NHS Foundation Trust
The Hillingdon Hospital NHS Foundation Trust
University College London NHS Foundation Trust
University College London NHS Foundation Trust
UP Their Reference
UP Invoice Description
Invoice Image
COMMENTS
23960978 Minimum take transfer to SCG from Imperial College HC NHST
894 Payment already included in 2012/13 SLA.
N0081084 WINTER FUNDING TRANCE 2; ;
788 Awaiting further information to confirm value.
N0080600 OVERPERFORMANCE 2012/2013 PAYMENT ON ACCOUNT; ;
423 Credit note issued - invoiced in error.
23960670 London SCG 2012/13 Annual Contribution
422 Invoice already paid.
23961236 London SCG 2012/13 Minimum Take services transferred from Hillingdon301 Awaiting support information to confirm value.
188139 Activity Billing
215 Ongoing dispute corresponding with Sandy Pearson - validation issues.
197340 Activity Billing November 12
154 Awaiting further information to confirm value.
N0081028 FEES FOR TESTS PERIOD: QTR 4, JANUARY - MARCH 12/13 ACTUAL FOR JANUARY
110 Awaiting
- FEBRUARY,
furtherESTIMATED
informationFOR
to confirm
MARCH;value.
;
173562 Activity Billing
98 Ongoing dispute corresponding with Sandy Pearson - validation issues.
191284 Activity Billing
80 Ongoing dispute corresponding with Sandy Pearson - validation issues.
3,485
The remaining £974k not included in the table above, relates to 273 invoices with various suppliers.
These have been disputed for a variety of reasons, such as waiting back up from the supplier and
awaiting budget holder validation.
The £4,459k has been fully accounted for and credits will only be included in I&E once disputes are
settled in the PCTs favour.
NHS Hillingdon58
58
PROVISIONS
31/03/12
Arising during the year
Utilised during the year
Reversed unused
Change in Discount Rate
Unwinding of discount
31/03/13
£000s
2,693
11,308
(3,751)
0
0
1,258
11,508
Comments
 The provisions balance largely relates to a provision for Continuing Care
Retrospective Claims of £10,630k. In addition there is a provision of £150k for
capital grants to GPs, £317k injury benefit claim, £411k for redundancies.
 The utilised figure mainly relates to the capitalisation of the early retirement
and back to back provisions of £3,395k.
 The unwinding of discount figure relates to the charge to I&E for capitalising
the early retirement and back to back provisions.
NHS Hillingdon 59
59
APPENDIX C – CAPITAL
NHS Hillingdon 60
CAPITAL PROGRAMME 12/13
Spend to M12
TITLE OF SCHEME
CONFIRM PCT LEAD DIRECTOR
FOR DELIVERY
2012/13
£'000
A
Health & Safety Compliance
- Estates
B
Fire Safety Compliance
C
Other Statutory Compliance
D
Backlog Maintenance
E
Major Schemes above £1m
F
Other Estates Projects
G
IT Projects
H
Capital Grants
I
Northwood and Pinner Sale
206
10
1,569
-
TOTAL EXPENDITURE
1,785
Estates
Estates
Estates
Estates
Estates
IT
actioned
Estates
The total spend for the year was £1,785k, against a Capital Resource Limit (CRL) of £1,914k.
Overall this resulted in an underspend against the CRL of £129k. The £1,569k spend on IT Projects
largely related to various GP IT schemes.
NHS Hillingdon 61