Transcript Slide 1

Page 1
Key Finance Overview
July Financial Position
• The in month position was a negative variance of £206k; the year to date underperformance against plan is now £1,014k. The actual
position is a surplus of £2,697k, although this includes income relating to Macmillan of £2,055k. The Trust’s underlying position
excluding Macmillan is therefore a surplus of £642k year to date.
• The Trust-wide waterfall diagram is shown on page 4 of this report.
• The Commissioner Income position shows an overtrade on the acute activity of £914k year to date. The movement of £378k in month is
made up of improvements in previous months’ reported income positions, relating to clarity being reached on Specialist Commissioning
activity together with achievement of the July plan. The income plan for July is one of the highest in-month plans across the year and it
should be acknowledged that the Directorates have worked very hard to ensure delivery.
• Referral levels continue above plan and outpatient activity is on plan. This implies that the improvement in income in June and July can
be sustained, and the activity in August is currently around planned levels.
• The continuing key issue is the level of expenditure across the Trust, with an overspend against budgets of £445k. There is continued
expenditure on locums to cover vacancies and sickness in medical staffing in several specialties, including the Emergency Department,
Neurology, Cardiology, Trauma & Orthopaedics and Obstetrics & Gynaecology. The ward expenditure has reduced, however there are
continuing overspends on one-to-one nursing and non-pay.
• Further CIPs have been identified and actioned during July which has also contributed to the reduction in overspends. Further work is
still required to fully identify CIP recurrently for 2013/14. There has been a further reduction in expenditure with Estates and the
maintenance budget is in balance in July.
• There has been significant management input to manage the levels of expenditure down, Directorates have met with Directors on a
number of occasions to describe the key actions which are now being taken to reduce expenditure. It is recognised that Directorate
management are focused on delivering their financial plans and that the Operational Directors in particular are to be commended on
their input and drive in relation to improving the financial position.
• A straight-line forecast of the position is shown on page 6, with key actions to improve the overspend trend on pages 7 and 8. These
actions do not fully recover the financial position (in particular, the impact of Month 1 and Month 2) and therefore work is continuing with
Directorates to ensure improved delivery of the outstanding CIP targets.
• As the Integrated Care Directorate is seen as the Directorate with the most financial risk at present, the detailed actions relating to the
medical staffing issues are included within this report on page 12.
• Significant time has been taken at sessions such as Team Brief, SMT, Q,F&P meetings, Performance meetings and ward manager
meetings to go through the financial position and the importance of taking actions to manage within our resources.
• The Finance Committee has met to discuss and understand the financial position and the actions being taken to improve the forecast
outturn. This paper reflects that discussion, in particular the detail relating to the cash position.
Page 2
Key Finance Overview (continued)
Significant cost pressures
• There are two significant discrete areas of cost the increased scale of which have come to light since the planning process was
completed. These are:
• £145,000 + VAT for a survey of the Trust site to identify where asbestos remains in the fabric of the building, expected to
commence imminently.
• In the region of £45,000 for Board recruitment, expected to be incurred by December 2013.
• These costs will need to be managed within the resources available and an update will be provided when they are incurred.
Cash
• The cash balance at the end of July was £5.6m, which was lower than in planned (£6.0m) due to additional creditor payments being
released. Cash is being very tightly managed and negotiations with the HaRD CCG resulted in an additional payment on account of
£1m in July. In addition, the CCG has agreed to ‘frontload’ the contract payments so the Trust receives a proportion of cash upfront
once the contract is agreed.
• A more detailed explanation of the cash position and actions to manage this is shown on Page 16.
Financial Risk Rating
• The FRR at the end of July remains a 3.
Annual Plan Review
• The Trust has received confirmation from Monitor that they will not be taking the Trust’s Annual Plan Review process forward to Stage
2. This is a reflection of the good standard of the plan submitted, in terms of risk and scope.
Page 3
Trust waterfall diagram
6,000.0
5,000.0
£'Thousands'
4,000.0
3,000.0
2,000.0
1,000.0
0.0
Page 4
Overview Income & Expenditure Position
2012/13
Actual
£000
Budget
Annual
Proportion
Budget
To Date
£000
£000
2013/14
Plan
£000
154,686
1,456
580
15,826
527
173,075
INCOME
NHS Clinical Income (Commissioners)
159,339
NHS Clinical Income - Acute
NHS Clinical Income - Community
Non NHS Clinical Income
1,580
Private Patient& Amenity Bed Income
544
Other Non-Protected Clinical Income (RTA)
Other Income
914
216
1,981
544
653
181
566
151
(87)
(31)
10,582
70
5,614
3,729
70
2,052
3,862
70
2,055
133
0
3
181,015
60,838
61,986
1,148
(120,835)
(41,092)
(41,822)
(730)
(5,194)
(15,431)
(16,157)
(3,228)
(5,337)
(5,466)
(3,374)
(5,519)
(6,328)
(147)
(182)
(862)
Reserves :
(860)
0
(4,505)
(4,511)
559
(18)
(110)
0
0
155
0
169
(6)
(110)
0
0
100
0
0
(14)
(110)
0
0
(55)
0
(169)
(8)
(1)
(162,904) TOTAL COSTS
(167,060)
(54,914)
(57,067)
(2,154)
13,965 EBITDA
13,955
5,924
4,918
(1,006)
0
(4,186)
(40)
34
(2,456)
0
(4,186)
(40)
44
(2,456)
0
(1,395)
(13)
15
(819)
0
(1,395)
(12)
7
(820)
0
(0)
1
(8)
(1)
7,316
3,711
2,697
(1,014)
(1,400)
0
0
0
5,916
3,711
2,697
(1,014)
9,792
0
5,614
(11)
0
3
0
0
(19)
(299)
(2,845)
0
(12,719)
(6,401)
3,959
(18)
0
0
612
Non Clinical Income
Hosted Services
Donated Asset Income
176,869 TOTAL INCOME
(2,922)
(14,371)
(14,186)
1,120
£000
41,920
13,362
(9,716)
(16,476)
(19,207)
0
(4,124)
0
62
(2,360)
£000
41,006
13,146
(113,401)
7,543
Cumulative
Variance
123,412
38,811
(119,807)
(165,533)
Actual
To Date
EXPENSES
Pay
Pay Expenditure
Non Pay
Drugs
Clinical Services & Supplies
Other Costs
Pay
Pay savings targets
Other Reserves
High Cost Drugs
Non Pay savings targets
Other Finance Costs
Hosted Services
Profit / (Loss) on disposal of assets
Depreciation
Interest Payable
Interest Receivable
Dividend Payable
7,316 Net Surplus/(Deficit) before impairments
(1,400)
Impairments re Donated assets
5,916 Net Surplus/(Deficit)
Negative sign under variance indicates an UNDER-recovery of forecast income, or an OVER-spending against budget
Page 5
Overview Total Directorate Position
2012/13
Actual
£000
Opening
Budget
£000
Annual
Budget
£000
1,442
(30,589)
(7,014)
(36,160)
1,249
(31,527)
(3,121)
(33,399)
Non-Comissioner Income
Pay
Non-Pay
Total Integrated Care Directorate
1,613
(35,167)
(4,773)
(38,327)
2,763
(34,143)
(12,752)
(44,132)
1,832
(29,955)
(7,926)
(36,049)
Non-Comissioner Income
Pay
Non-Pay
Total Acute & Cancer Care Services Directorate
2,178
(30,343)
(9,072) .
(37,237)
1,322
(38,997)
(12,228)
(49,903)
1,403
(36,471)
(8,488)
(43,557)
Non-Comissioner Income
Pay
Non-Pay
Total Elective Care Directorate
1,567
(38,995)
(10,195)
(47,624)
(14,938)
(18,000) Corporate (Clinical)
(145,134)
(131,005) Total Clinical Spend
Workforce
Budget
Actual
wte
wte
In Month
Actual
£000
Budget
£000
Variance
£000
Cumulative
Budget
Actual
£000
£000
Variance
(o.s)/u.s
£000
153
(2,996)
(471)
(3,315)
186
(3,022)
(520)
(3,356)
33
(26)
(49)
(41)
644
(11,913)
(2,445)
(13,714)
680
(12,228)
(2,681)
(14,228)
37
(315)
(235)
(513)
210
(2,564)
(960)
(3,314)
204
(2,619)
(1,017)
(3,432)
(7)
(55)
(56)
(118)
784
(10,330)
(3,646)
(13,192)
845
(10,511)
(4,033)
(13,698)
62
(181)
(387)
(507)
845.18
128
(3,397)
(992)
(4,261)
78
(3,438)
(1,079)
(4,439)
(49)
(41)
(87)
(178)
513
(13,380)
(3,800)
(16,667)
418
(13,595)
(3,982)
(17,159)
(95)
(215)
(182)
(492)
392.11
392.11
(1,636)
(1,646)
(10)
(6,308)
(6,634)
(326)
(142,142)
2862.02
2725.36
(12,526)
(12,873)
(347)
(49,880)
(51,719)
(1,839)
939.85
886.53
939.85
886.53
654.13
601.54
654.13
601.54
875.93
845.18
875.93
(18,954)
(11,584)
(7,619) Corporate (inc. CNST)
(7,502)
139.50
140.30
(615)
(656)
(41)
(2,389)
(2,441)
(52)
(26,522)
(25,619) Total Corporate Position
(26,457)
531.61
532.41
(2,251)
(2,302)
(51)
(8,697)
(9,074)
(378)
154,686
159,339 Commissioner Income
162,223
14,337
14,618
280
54,152
55,282
1,129
(19,014) Central
(10,876)
(50)
(149)
(98)
(224)
(480)
(256)
5,614
462
462
0
2,052
2,055
3
(1,400)
0
0
0
0
0
0
1,608
1,402
(206)
3,711
2,645
5,614 Donations for Capital Expenditure
(1,400) Impairments on Donated assets
612
5,916
5,916
2.71
3,004.23
2.80
2,868.46
2,697
(1,014)
Page 6
Staffing Expenditure Analysis
Staffing Group
Jul-13
Budget
Medical Staff:
- Contracted Pay
- Contracted GP Pay
- Waiting List Initiative
- Agency
- Locum GP Pay
- Locum
Total Medical Staff
Nursing:
- Contracted Pay
- Overtime
- Bank
- Agency
Total Nursing
Other Clinical Staff:
- Contracted Pay
- Overtime
- Bank
- Agency
Total Other Clinical Staff
Non-Clinical Staff:
- Contracted Pay
- Overtime
- Bank
- Agency
- Locum
Total Non-Clinical Staff
Vacancy Factor/Reserves
TOTAL
Jun-13
Actual
Variance
Budget
YEAR TO DATE
Actual
Change in Actual Apr
less May
Budget
Actual
Variance
WTE
£'000
Actual
WTE
£'000
WTE
£'000
WTE
£'000
Actual
WTE
£'000
WTE
£'000
WTE
£'000
Average
WTE
£'000
Average
WTE
£'000
299.04
27.33
2,447
312
271.42
18.65
2,225
267
27.62
8.68
222
46
0
296.40
27.33
2,381
296
271.90
17.09
2,232
243
0.48
(1.56)
0.00
6
(24)
0
1188.69
109.32
9,618
1,199
0
1094.84
69.31
9,012
982
93.85
40.01
0.00
607
217
0
0.00
2.30
328.67
41
193
41
3,035
6.30
296.37
349
99
167
3,108
0.00
0.00
(4.00)
32.30
(308)
94
(126)
(72)
0.00
0.00
2.30
326.03
11
128
34
2,850
0.00
0.00
6.91
295.90
417
139
140
3,170
0.00
0.00
0.61
(0.47)
67
41
(28)
63
0.00
0.00
9.20
1307.21
28
576
151
11,573
0.00
0.00
21.42
1,185.57
1,300
624
559
12,476
0.00
0.00
(12.22)
121.64
(1,272)
(47)
(409)
(903)
1164.99
3,513
1100.21
3,348
64.78
0.00
166
0
1162.66
3,514
1119.58
3,411
19.37
0.00
63
0
4635.95
13,989
4466.34
13,511
169.61
0.00
478
0
0.61
7.81
(7.20)
0.00
57.58
(101)
(22)
42
1163.27
9
-23
3,500
9.29
1108.02
108
25
3,481
0.61
1165.60
7
3
3,523
1128.87
96
(23)
3,485
1.48
0.00
20.85
(12)
(48)
3
2.77
5.28
4644.00
31
4
14,023
97.01
27.88
4,591.23
403
90
14,004
(94.24)
(22.60)
52.77
(372)
(87)
19
644.41
1,932
616.26
1,893
28.15
0.00
40
0
644.58
1,927
611.45
1,880
(4.81)
0.00
(13)
0
2577.86
7,719
2437.83
7,469
140.03
0.00
250
0
2.91
644.41
4
9
1,945
619.17
8
17
1,917
(2.91)
0.00
25.24
(4)
(8)
28
0.00
0.00
644.58
4
1
1,932
2.90
0.00
614.35
7
9
1,896
(0.01)
0.00
(4.82)
(1)
(7)
-21
0.00
0.00
2577.86
16
21
7,755
11.67
0.00
2,449.50
29
46
7,544
(11.67)
0.00
128.36
(13)
(26)
211
865.58
1,938
827.87
1,940
37.71
0.00
(2)
0
863.95
1,916
816.81
1,861
(11.06)
0.00
(78)
0
3460.40
7,717
3254.66
7,524
205.74
0.00
194
0
7
39
17.03
(15)
44
(17.03)
0.00
23
(6)
0.00
0.00
7
37
16.07
0.00
34
56
26
150
95.74
0.00
137
180
1,984
844.90
1,969
20.68
15
863.95
1,960
832.88
1,951
49
12
0
(17)
0.00
0.00
865.58
(0.96)
0.00
0.00
(12.02)
3460.40
7,893
3,350.40
7,841
(95.74)
0.00
0.00
110.00
(111)
(31)
0
52
-0.03
(142)
(142)
0
-3.03
12
0.00
0
-10.72
-110
0.00
0
(10.72)
(110)
3004.23
10,346
(128)
2994.80
10,253
3.54
28
11989.47
41,134
11576.70
41,865
412.77
(730)
2868.46
10,474
135.80
2872.00
10,502
Page 7
Notes
• “Vacancy factor” is a negative budget line which reduces the overall staffing budget to take into account the expected slippage between staff leaving and being replaced
• The overspend on GP’s relates to the GP OOH service which is being funded by the North Yorkshire CCGs
Year end forecast range
Trust Variance Position and Forecast
2,000
0
Month 3 straight line
variance forecast
£3.2m
Commissioner income
delivery to plan
£0.0m
Improvement in expenditure
forecast
£0.2m
Month 4 straight line
variance forecast
£3.0m
-2,000
-4,000
•
-6,000
-8,000
•
-10,000
In month variance
Straight line forecast
The following two pages detail
the key actions identified by
Directorates to improve
delivery against the financial
plan.
In addition, delivery against the
CIP targets must be further
improved in order to fully
deliver the plan.
Page 8
Key Actions to deliver the Financial Plan
A number of actions are being pursued by Directorates and details have been shared both through Q,F & P meetings and meetings
with the Director of Finance.
Directorate
Integrated Care
Action
Impact: Improvement on Trend
Q2
Q3
Q4
Total
Q2
delivery
to date
9 detailed ward staffing actions
£110k
£120k
£120k
£0.35m
£85k
13 specific medical posts targeted in
relation to recruitment and reductions
in PAs being covered where possible
£300k
£200k
£100k
£0.60m
£300k
£15k
£15k
£0.03m
£0k
Additional CIP schemes identified
Acute & Cancer
Care
Continued on Page 9
Quotas for wheelchair and equipment
in-month spend
£56k
£56k
£56k
£0.17m
-£49k
Radiology Department expenditure
reduction
£29k
£27k
£27k
£0.08m
£15k
Therapy CIP delivery
£50k
£75k
£75k
£0.2m
£0k
Page 9
Key Actions Continued
Directorate
Elective
Corporate
Trustwide
Action
Impact: Improvement on Trend
Total
Q2
Delivery
to date
£80k
£0.19m
£73k
£60k
£60k
£0.18m
£28k
£30k
£30k
£30k
£0.09m
-£24k
£30k
£30k
£30k
£0.09m
£0k
Q2
Q3
Q4
Woodlands ward establishment review to
manage winter and summer appropriately
£50k
£60k
Inpatient ward actions (number of actions
already in place and implemented)
£60k
Medical staffing locum management
Other various actions
Estate maintenance reduction (non-urgent jobs)
£20k
£20k
£20k
£0.06m
£8k
Energy reduction (including assessment of
usage across the year and energy reduction
schemes)
£30k
£60k
£60k
£0.15m
£117k
Senior posts
£10k
£30k
£30k
£0.07m
£0k
Use of Magnum and medical records review of
expenditure
£15k
£15k
£15k
£0.05m
£5k
Improve delivery of CIP
£200k
£300k
£400k
£0.9m
£50k
£1.0m
£1.1m
£1.1m
£3.2m
£645k
Total impact of identified actions
Page 10
Integrated Care Directorate Finance Overview as at 31st July 2013
Directorate Income & Expenditure (£'000)
In Month Variance to Plan
(41)
Key Financial Drivers
YTD Variance to Plan
Variance to plan
(513)
Total Income:
Private Patient Income
Other Income
£'000's
In Month Financial Position
3700
3600
3500
3400
3300
3200
3100
3000
2900
2800
2700
2600
2500
YTD £'000
37
(24)
61
Previous
Month YTD
(£'000)
3
(25)
28
Plan (£'000)
Actual
(£'000)
Total Expenditure
Pay:
Nursing
Medical Staff
Other Pay
(550)
39
(294)
(60)
(476)
21
(248)
(62)
Drugs
Clinical Supplies
Other Non Pay
(46)
0
(190)
(33)
21
(174)
Net Position
(513)
(472)
Performance Against CIP 2013/14
Actions Agreed:
Medium risk,
£27
High risk and
unfound, £466
Actioned & Low
risk, £2,262
* Recruitment to vacant Consultant posts, with business cases agreed to proceed to
advertisement.
* Assessment of position in respect of specialing costs and how this can be delivered
more cost effectively.
* Delivery of outstanding actions on the CIP action plan
* Management of Junior doctor vacancies more cost effectively.
* Review options to generate further income through growth into new areas.
Cumulative CIP Target to Date (£'000)
Cumulative CIP Achieved to Date (£'000)
Over-achievement/Shortfall (£'000)
Comments:
930
788
(142)
The Integrated Care Directorate overspend was £41k for the month of July,
which is a significant improvement compared to previous months.
* Ward budgets were 23k overspent, which was an improvement in trend
following the reduction in estimates for outstanding Ensign accruals. The
underlying position was a 38k overspend, with 17k of this incurred on pay
(largely drug costs).
* Medical staffing continues to be a cost pressure from vacancies at consultant
level, however one off benefits totalling 38k were seen this month, thus the
overspend in month was lower than trend at 45k.
* Further CIP was actioned this month, reducing the unmet/ high risk element
phased into the position.
* Action plan for reducing non pay overspends across the wards.
Progress on Actions Agreed:
* One consultant Neurology vacancy recruited to on an NHS locum basis, commenced in
May. The Elderly consultant posts have been recruited to, with start dates in September
and October. An appointment to the 2nd Neurology vacancy has been made from
September which will further reduce agency costs.
* Vacancy control is in place to assess all posts that arise for replacement, through an
authorisation process via the Directorate. Further review of non clinical vacancies.
* Assessment criteria for in place for patients requiring 1 -1 attention on the wards, to
reduce bank and agency costs. Coupled with initiatives for wards to work jointly to utilise
resources flexibly where possible.
* Business cases have been compiled for the remaining consultant vacancies, with cases
relating to Cardiology and CAT nearing completion.
* Review of current agency commitments to regularly reassess case of need and
opportunities for reducing cost
Page 11
Integrated Care Medical Staffing Actions
Vacancy
Date vacant Description of cover
Cons agency Neuro
Vacancy 1 = Assumed filled by NHS locum
Feb-12 (Neuro/Stroke) from Madrid then substantive post.
Cons agency Neuro
Vacancy 2 = Interviews end of Feb, assumed
appointment from August from Consultant time from
Nov-12 another organisation ( PAs).
Cons agency Derm
Need for
Require Business case to appoint substantively
agency from (assume Sept start date). Infrastructure funding from
Sep '12
April
Cons agency Cardio
Cons agency CAT
Need for
agency from
Jan -12
Agency from
May '12
Cons agency Elderly
Cons agency Elderly
CT1 - Gen Med
Neuro rehab
consultant
cover
Extra F2 post
Other
Subtotal Medical staff
Require Business case to appoint substantively
(assume July start date). Infrastructure funding from
April.
Require Business case to appoint substantively
(assume July start date)
Advertised (Feb) interview dates TBC. Assume Jun
Jan-12 start date
Comments / Actions
Locum commenced mid May
Advert out on NHS jobs, Medical resourcing
processing start date for Leeds retiring
consultant (5 or 6 PAs) to commence beg.
Sept. No locum anticipated other than to
cover any capacity pressures. 8PA agency
for July & Aug.
Interview date delayed from 31st July to 9th
Sept following a lack of applicants and
indications that 2 may apply in this second
round of advertising. Of these two potential
applicants, it is unlikely that either could
start until at least December.
Bus case partially complete, however review
of specialty doctor job plan and oncall
commitments which may change the
capacity requirements detailed in the case.
RL returned to BC on 26/04/13. 11/06/13
with J Crewe
Appointments made- latest update on start
dates are 16th Sept and 1st October. RW
stated that 4 day working not possible for
July and August for the agency locum.
Additional unfunded post in place for April & May
Ceased end of May
Ensure that any gaps on the August rota are
first filled by this post before recruiting
Extra ACCS post unfunded, not covering vacant oncalls agency. Or utilise to fill some of the Twilight
on a separate rota.
shifts / vacant F2 oncalls from August.
Original NHS locum option fell through. Until August - BC agreed with agency cover in interim for
Dr Loizou on 10 PAs, From August - locum agency on 8 only 8 PAs rather than 10. Renegotiating a
PAs
rate with the existing locum to reduce cost.
May Jun
Jul Aug
Sep
Oct Nov Dec Jan
Feb Mar
-7
-15
-15
-12
-12
-16
-16
0
-10
0
-3
-10
-10
-2
0
0
-2
-2
-19
-13
-16
-19
-9
-5
-5
-5
-5
-39
-13
-10
-10
-16 -15.5 -15.5 -16 -16 -16
-10 -10 -10 -10
-10
-10
-2
-2
-2
-2
-2
-2
-5
-5
-5
-5
-5
-5
-10 -10 -10 -10
-10
-10
-2.1 -2.08 -2.08 -2.1 -2.1 -2.1 -2.08
-2.1
-20
-5
Full time post to cover part time vacancy
-9
-102
5
-82
8
-41
Page 12
-75
-53
-44 -44 -44 -44
-28
-28
Acute & Cancer Care Directorate 31st July 2013
Directorate Income & Expenditure (£'000)
In Month Variance to Plan
(118)
Key Financial Drivers
YTD Variance to Plan
(507)
Variance to plan
Total Income:
Private Patient Income
Other Income
Monthly Financial Position
YTD £'000
62
33
28
Previous Month
YTD (£'000)
68
13
55
3500
Value £'000
3450
3400
3350
Total Expenditure
(568)
(457)
Pay:
44
(573)
348
37
(440)
279
(74)
(56)
Clinical Supplies
Other Non Pay
(195)
(119)
(134)
(142)
Net Position
(507)
(389)
3300
3250
Nursing
Medical Staff
Other Pay
Drugs
3200
Actual (£'000)
Med Risk CIP
4%
Plan (£'000)
CIP Target 13/14
ACTIONS AGREED
High Risk and
unfound CIP
9%
Actioned & Low
risk CIP
87%
Cumulative CIP Target to Date (£'000)
Cumulative CIP Achieved to Date (£'000)
1,088
976
Over-achievement/(Shortfall) (£'000)
(112)
Comments:
The Acute & Cancer Care Directorate reported an in-month over spend
against total budget of £118k. Of the overspend, pressures occurred in
the following areas:
* ED Medical Staff- £40k overspend. The driver for the position this
month continues to be the 3 middle grade posts requiring agency cover
for the tier 3 rota, in addition there has been some short term
Consultant sickness.
* Radiology Medical staff £11k overspend due to additional payments to
Consultants due to high activity levels and to meet reporting deadlines.
* Therapy Services - non-recurrent impact of actioning CIP £33k
* Medical Devices - increased spend on call-outs £20k
* Community Equipment increase in rental and equipment purchase
£25k
12.14 CIP TARGET
Work is underway to ensure that the actions identified to meet the CIP
target are met in full. The unmet CIP stood at 13% in May decreased to
5% in June, and is now down to 2% actions are required for the
remaining £70k of CIP. departments across the Directorate have been
set individual targets to meet this shortfall. Directorates have identified
76% of the Therapy CIP target.
Emergency Department
The directorate are continuing to report monthly on the medical staffing
rota costs within the emergency department. Significant agency locum
input has been required following high sickness levels, and during 13/14
this area will continue to be a pressure due to vacant middle grade
posts. Adverts have been placed for GP's to fill some of the gaps on the
rota following expressions of interest from GPs, if successful this will
reduce the cost of filling the gaps. In addition there has been a period of
Consultant sickness which stopped in mid-July. The potential gap in the
Middle Grade rota in rotational SpR from 1st August has been filled by
the deanery
Radiology Deapartment
Interviews for the new Consultant Radiologist were held at the end of
June, the successful applicant has a fellowship abroad for a year and so
willl not be in post until July 2014. It is anticipated that the additional
payments being paid to Radiologists for reporting backlogs and
additional activity will continue throughout the summer. Following a
review of the payments made by the Clinical Lead there has been a
reduction in payments in July.
In addition the radiology management
team have been tasked with finding more cost effective alternatives to
ensure time reporting of scans
Page 13
Elective Services Directorate Finance Overview as at 31st July 2013
Directorate Income & Expenditure (£'000)
In Month Variance to Plan
Key Financial Drivers
YTD Variance to Plan
(178)
(492)
Monthly Financial Position
Variance to plan
Total Income:
Private Patient Income
Other Income
YTD £'000
(95)
(96)
0
Previous Month
YTD (£'000)
(46)
(54)
8
Total Expenditure
Pay:
Nursing
Medical Staff
Other Pay
(397)
(37)
(127)
(50)
(269)
(55)
(96)
(23)
Drugs
Clinical Supplies
Other Non Pay
(39)
23
(167)
(27)
47
(116)
Net Position
(492)
(315)
4,550
4,450
Value £'000
4,350
4,250
4,150
4,050
3,950
3,850
3,750
Plan (£'000)
Ac tual (£'000)
Actions Agreed:
Performance Against CIP 2013/14
Unachieved/
High Risk, £176,
6%
Medium risk,
£117, 4%
* Set meetings with clinical leads to discuss both short term and long terms
approaches to current and potential up coming vacancies
* New finance and HR reporting structure for all areas linking HR issues such
as sickness against bank and agency spend
* On going work to close remaining gap on CIP and action all items currently
identified on plan
* Provide flexibility to clinicians to allow for scheduling of PP's
Actioned & Low
risk, £2,764,
90%
Cumulative CIP Target to Date (£'000)
Cumulative CIP Achieved to Date (£'000)
Over-achievement/Shortfall (£'000)
956
881
(75)
Comments:
* The elective directorate had an overspend of £178k in the financial month of July
2013/14. The main reasons for the movement were:
1) Private Patient Income - PP income was down £41k against plan in July. This was
mainly down in Orthopaedics and Urology. Year to date income is down £86k
against plan (25%)
2) Medical Staffing - Although a significant amount of work is ongoing to reduce the
costs of vacancies there has been some short term sickness causing pressures in
O&G (£13k) and General Surgery (£3k) along with a long term Orthopaedics middle
grade vacancy (£15k) which has been recruited to from September. Overall medical
staffing was £31k overspent in month.
3) CIP - £20k was phased in month to account for the unachieved/ high risk CIP
target
4) Theatres - there was a significant increase in activity in July reflected in an
increase in theatre consumables (£42k over in month)
* Work on going to move over establishments into vacant posts
Progress on Actions Agreed:
* Agency and locum spend down in a number of specialities however work
still on going with O&G and Paediatrics
* Majority of CIP action plan now actioned with only 9% remaining
unactioned and plans for achievement of £2.928m
* Sickness levels have reduced significantly in first quarter with
corresponding reductions in bank and agency spend
* New third DSU open and operational with new theatre schedule to
maximise throughput
* Activity levels have picked up significantly in July including Leeds Yeadon
activity
* Other items identified against CIP including non recurrent savings on
scope maintenance in 13/14 now actioned
Page 14
Corporate Directorate Finance Overview July 2013
Directorate Income & Expenditure (£'000)
In Month Variance to Plan
Key Financial Drivers
YTD Variance to Plan
(51)
C
u
m
u
l
a
t
i
v
(378)
Monthly Financial Position
Value £'000
2,200
2,000
1,800
1,600
S
p
e
1,400
1,200
Plan (£'000)
Actual (£'000)
Performance Against CIP 2012/13
High-Risk,
£352
Med-Risk , £0
Actioned &
low Risk ,
£1,418
VarinceYto
ActualYeroD
PlanYertoDMgiRs
Specialty£0
ENT 1,9230
GenralSugy 1,370492
Gynaecolg 2,8061(9)
Obsteric 6,408 192
Ophtalmogy 5,31749(2)
Oral&MxiofcSugey951,083
Orthopaedics 17,4052
Urolgy 4,321 0
Total50,683(2)
YTD £'000
(14)
Previous Month
YTD (£'000)
0
Total Expenditure
Pay:
Clinical Corporate
Non Clinical Corporate
(364)
(23)
3
(327)
(8)
(5)
Non Pay:
(319)
(25)
(324)
10
(378)
(327)
Total Income:
£'000's
2,400
Variance to plan
Clinical Corporate
Non Clinical Corporate
Net Position
Actions Agreed:
* Senior Management have agreed to look at prioritising the minor works
schedule within Estates with a view to reducing materials costs.
* All vacancies have to be brought before the Weekly Vacancy Control Group
Meeting, with a freeze in place for non-clinical posts.
* Continued reinforcement of the message to budget holders of the need to
strictly manage non pay budgets
* On going series of meetings with senior management and budget holders
individually regarding the CIP plan and high risk schemes.
* Meeting with Leads for Domestic services to review rotas
Progress on Actions Agreed:
Cumulative CIP Target to Date (£'000)
663
Cumulative CIP Achieved to Date (£'000)
544
Over-achievement/Shortfall (£'000)
(119)
Comments:
Corporate Services have over spent against budget in month by £51k.
*£37k relates to information services: £18k phones/data lines and £20k
software/hardware purchases.
*£32k is a year to date correction of CNST contributions, variance is nil.
*£17k within human resources relates to training costs.
*£32k in Hotel services relates to cleaning and catering over spends.
*£21k patient access relates to medical records magnum/Hornbeam cost
These over spends are offset in month by an improvement in the Estates
budgetary performance.
* The minor works over spend run rate has reduced further in Month 04 and
is break even against budget in month.
* 13/14 CIP has been fully identified apart from 2% (£40k). However, there
has been slippage on identified schemes and a number of schemes remain
high risk. Work is continuing to look at additional non-recurrent schemes to
compensate the high overspend within the directorate.
* Actual meter readings are to be communicated to suppliers for month 05 so
that the energy spend figures can be verified within the ledger.
Page 15
Cash Position
Cash is managed proactively on a daily basis. Due to the new commissioning arrangements and the current performance against
the Trust’s financial plan, there are a number of actions being taken to ensure cash balances remain at an appropriate level. The
table below identifies the factors which have impacted on the cash position.
31 July Cash balance
£5.6m
31 July cash plan
£6.0m
Monitor 10-day de minimis level
£4.6m
Factors:
Impact on cash
Final settlement of 2012/13 performance
-£1.6m
I&E performance
-£1.0m
Income above plan included in I&E performance without cash
receipt
-£1.1m
Commissioner payments below Trust plan
-£1.3m
Commissioner cash payment reductions due to changes of
responsible commissioners and shifts from monthly payment to
payment in arrears where monthly values were expected to be
too low for contracts to be set up.
-£1.6m
Cash advance from HaRD CCG in July
£1.0m
Subtotal: In-year Commissioner income impact
-£3.0m
Total Cash impact to 31 July
-£5.6m
Position managed through working capital actions (particularly
creditors) to £0.4m behind plan
£5.2m
This level increased by £1m as a result of the
increased turnover when the Trust took on
Community Services
Now agreed and cash received in August.
Timing is in line with national contractual
arrangements
Year to date impact, no scope to realistically
significantly increase
Page 16
Cash Position (continued)
The table below identifies actions to be taken to improve the cash position.
Action
Full year Impact
Timescale
Notes
2012/13 settlement
£1.6m
August
Increase commissioner payments
through contract signature
£2.5m
September
Estimate of contract values
Increase commissioner payments by
agreeing to invoice in 1/12th
£1.4m
September
Estimate of ability to agree with
commissioners
Improvement in expenditure trend
£1.0m
Ongoing
Reduction in expenditure trend seen in July
continues for full year.
Capital programme slippage
£1.0m
Ongoing
Expected natural slippage. Further scope
available if needed later in the year.
Note: the loan for the MRI capital scheme is available for drawdown in September to facilitate this element of the capital
programme.
Page 17
Cash Flow – Receipts & Payments
Opening cash balance
APRIL
MAY
JUN
Actual
Actual
Actual
Plan
Actual
Plan
Plan
Plan
Plan
Plan
Plan
Plan
Plan
£000
£000
£000
£000
£000
£000
£000
£000
£000
£000
£000
£000
£000
7,371
4,706
JUL
2,524
5,860
AUG
5,860
SEP
5,554
OCT
5,497
NOV
5,443
DEC
5,444
JAN
5,526
FEB
5,490
TOTAL FOR
YEAR
MAR
5,505
£000
5,524
7,371
Receipts
New public Dividend Capital draw
0
0
0
0
0
0
0
0
0
0
0
0
0
0
NHS patient care - HARD CCG
6,951
6,951
6,991
7,670
7,964
7,670
7,670
7,670
7,670
7,670
7,670
7,670
7,670
90,217
NHS patient care
5,268
5,129
4,831
5,110
5,435
5,110
5,110
5,110
5,110
5,110
5,110
5,110
5,110
61,543
Other income
2,303
2,752
1,883
1,642
2,021
1,642
1,642
1,642
1,642
1,642
1,642
1,642
1,642
22,095
1
2
2
1
2
1
1
1
1
1
1
1
1
15
158
163
930
608
0
752
631
553
517
335
0
0
0
4,039
0
0
0
0
0
0
0
0
0
1,500
0
0
0
1,500
14,681
14,997
14,637
15,031
15,422
15,175
15,054
14,976
14,940
16,258
14,423
14,423
14,423
179,409
Cash spend - payroll
(5,782)
(5,844)
(5,862)
(5,832)
(5,768)
(5,832)
(5,832)
(5,832)
(5,832)
(5,832)
(5,832)
(5,832)
(5,832)
(69,912)
PAYE & Pensions
(3,837)
(4,117)
(3,988)
(4,117)
(4,041)
(4,117)
(4,117)
(4,117)
(4,117)
(4,117)
(4,117)
(4,117)
(4,117)
(48,919)
Cash spend - non-pay
(6,881)
(5,816)
(1,388)
(3,474)
(4,503)
(4,266)
(2,869)
(3,982)
(3,552)
(5,653)
(3,731)
(2,851)
(2,526)
(48,018)
(733)
(1,402)
(63)
(1,464)
(1,416)
(1,017)
(1,106)
(1,044)
(1,357)
(692)
(728)
(1,604)
(671)
(11,833)
0
0
0
0
0
0
(1,117)
0
0
0
0
0
(1,228)
(2,345)
(113)
0
0
0
0
0
(67)
0
0
0
0
0
0
(180)
(17,346) (17,179) (11,301) (14,887) (15,728) (15,232) (15,108) (14,975) (14,858) (16,294) (14,408) (14,404) (14,374)
(181,207)
Investment interest
Macmillan Contribution
Loan finance
Total cash receipts
Payments
Cash spend - non-pay - Capital
Dividend paid
Restructuring costs
Total cash spend
Closing cash balance
4,706
2,524
5,860
6,004
5,554
5,497
5,443
5,444
5,526
5,490
5,505
5,524
5,573
Monitor plan month-end cash balance
5,672
4,870
4,948
5,092
5,092
5,035
4,981
4,982
5,064
5,028
5,043
5,062
5,111
Closing cash balance required to
equal 10 days Operating Exp.
4,568
4,568
4,568
4,603
4,603
4,603
4,603
4,597
4,597
4,597
4,640
4,640
4,640
Page 18
5,573
Debtors Report
Outstanding Accounts Receivable Debts - JULY 2013
NHS Debts
Insurance Companies
Other
Totals
0 to 30
Days
31 to 60 Days
61 to 90
Days
Over 91 Days
Total
£000
£000
£000
£000
£000
767
72
811
1,896
37
106
2,309
43
12
1,549
25
49
6,521
177
978
1,650
2,039
2,364
1,623
7,676
Note:- Excludes RTA's, Accruals & Prepayments.
Outstanding Inv oices Ov er 61 Days & £10,000 - JULY 2013
Debtor Name
Invoice
Number
Invoice Description
NHS North Yorkshire & York
H156706 HIV Drugs Jan & Feb 2013
71
NHS North Yorkshire & York
H156707 Rheumatology Drugs Jan & Feb 2013
24
NHS North Yorkshire & York
H156708 Factor 8 Blood Products January 2013
NHS North Yorkshire & York
H156898 Community Services 2012/13
279
NHS Harrogate District Rural CCG
H156900 April Service Agreement-(shortfall)
141
NHS North Yorkshire & York
H157098 Call To Action Funding 2012/13
120
NHS North Yorkshire & York
H157315 Factor 8
11
BMI Duchy
H157353 Clinical Services Charge
20
NHS North Yorkshire & York
H157393 HIV Drugs March 2013
NHS Harrogate District Rural CCG
H157666 May Service Agreement-(shortfall)
NHS Airedale W harfedale & Craven H157760 Community Services May 2013
*
*
*
11
31
141
29
NHS North Yorkshire & York
H158652 Interim invoice against additional overtrade
NHS Harrogate District Rural CCG
H158795 Comm Service Block Contract Apr-June-shortfall
63
NHS Hambleton,Richmondshire
H158797 Comm Service Block Contract Apr-June-shortfall
97
North Yorkshire & Humber
H158810 Catch Up SLA
NHS Harrogate District Rural CCG
H158811 June Service Agreement-shortfall
NHS North East Lincolnshire
H159109 NCA April 2013
14
NHS Scarborough & Ryedale
H159113 NCA April 2013
24
York Teaching Hospitals
H159332
HIV Drugs Recharge April 2013
60
Private patient
H159548 Private Patient
32
Total
*
Total
£000
Now paid
1,600
12
141
2,921
Balance outstanding on 22.8.13
2,851