Budget Paper 2015/16

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1 Budget Paper 2015/16 1. Introduction The CCG constitution requires that the Chief Finance Officer will, on behalf of the accountable officer, prepare and submit budgets for approval by the governing body. This paper sets out the proposed budget for 2015/16 and should be considered alongside the financial planning section of the 15/16 Commissioning plan which has been shared with the Governing Body. That plan sets out the financial framework for the 2nd year of the 2 year commissioning plan previously agreed by the CCG. 2. The section below sets out a summary of the budget changes and the changes to the financial framework A change to the previously notified CCG allocation for 15/16 which means an increase of 10.1m 4.2% and which is 5.2m 2.1% greater than previously notified (see section 4 below) Seasonal resilience funds included in the CCG allocation 1.275m. Expectation that parity of esteem for Mental Health will be equivalent to CCG growth in allocation 0.8m Movement from an adverse 2014/15 underlying recurrent forecast outturn position to a 1% underlying recurrent surplus Contribution to Better Care Fund 12.7m of which 8.6m is from the CCGs existing programme allocation. Creation of a 1% non-recurrent reserve 1% surplus increasing from the FOT 14/15 surplus of 0.7% Demographic growth & historical growth on 14/15 recurrent forecast spend areas QIPP target of 4% Movement from acute services to community services The budgets assume if providers opt for the Enhanced Tariff Option (ETO), this consists of 0.334m lower efficiency in the deflator and NHSE have issued guidance to show this as unmitigated risk in the plan submission. We are showing this as assumed central funding in the budget proposals so would become an additional saving requirement if not funded or a reduction in the surplus if additional savings are not deliverable. Risks & mitigations particularly around the tariff impact. Unmitigated risk of 1.8m impact of Marginal Rate Emergency Tariff change from 30% to 70% which is an increased risk if QIPP does not deliver the activity reductions in acute. Page 1 of 9

2 Financial Position Revenue Resource Limit /15 blank12015/16 Recurrent 240, ,672 Non-Recurrent 4,205 1,771 Total 244, ,443 Income and Expenditure Acute 131, ,030 Mental Health 19,727 20,556 Community 18,716 17,826 Continuing Care 20,038 20,931 Primary Care 35,418 35,756 Other Programme 11,925 23,644 Total Programme Costs 236, ,742 Running Costs 4,368 4,868 Contingency 1,202 1,277 Total Costs 242, , / /16 Surplus/(Deficit) In-Year Movement 1, Surplus/(Deficit) Cumulative 1,771 2,555 Surplus/(Deficit) % 0.7% 1.0% Surplus (RAG) AMBER GREEN Net Risk/Headroom - Risk Adjusted Surplus/(Deficit) Cumulative 2,555 Risk Adjusted Surplus/(Deficit) % 1.0% Risk Adjusted Surplus/(Deficit) (RAG) GREEN Underlying position - Surplus/ (Deficit) Cumulative 1,016 2,897 Underlying position - Surplus/ (Deficit) % 0.4% 1.1% Underlying position (RAG) AMBER AMBER Contingency 1,202 1,277 Contingency % 0.5% 0.5% Contingency (RAG) GREEN Notified Running Cost Allocation 5,526 4,971 Running Cost 4,368 4,868 Under / (Overspend) 1, Running Costs (RAG) GREEN GREEN Population Size (000) Spend per head ( ) Page 2 of 9

3 The pie charts below show the proposed changes by care setting. The Better Care Fund has been broken out from other programme in the 2015/16 pie chart and acute & community services reflect the change in funding streams. The MSK service is shown within Acute Services for consistency across 2014/15 and 2015/16. Mental Health services is the same % of total funds reflecting the 4.2% increase through parity of esteem (ie MH spend increases by 4.2% in line with the allocation growth) 3. General financial duties Appendix 1 sets out the General Financial Duties of the CCG which are included under section 5.3 of the CCG constitution. Prime Financial Policies included in Appendix E of the Constitution set out the group s control environment for managing the organisation s financial affairs. 4. Allocation The table below shows the movement from the 14/15 programme baseline allocation to the 15/16 allocation including projected registered population change Allocation 2015/16 Additional Information 2015/16 Opening distance from target -1.66% Programme growth 4.31% Total Programme allocation Programme Closing Target Closing distance from target -1.92% Seasonal resilience included in recurrent allocation 1275 BCF funding from CCGs not included in programme allocation 4108 Running cost allowances 4971 Estimated registered population Estimated registered population The key points to note from the programme allocation notified are Page 3 of 9

4 HMS CCG received programme growth of 4.31% (the minimum level is 1.94%) as it is under the fair shares target HMS projected population increase in the NHSE CCGs allocation is less than 1% for 15/16 The CCG has raised the above issue with NHSE in 14/15 and has received the following response o The estimated population growth is from ONS. NHSE have taken the estimates from a credible national source. With precedent now set that allocations follow population, this will self correct in subsequent years. o Adjustments to allocations will be linked to population growth as and when they are recognised by the increase in GP lists. There is no other credible source nationally to use other than ONS for future projections 5. Programme Budget Summary The financial framework incorporated in this budget in line with the national guidance to deliver for the first time the full business rules: 1% surplus. NB the surplus will be returned to the CCG in the following financial year 0.5% contingency 1% non-recurrent headroom. (National framework guidance is 1% nonrecurrent ) The key assumptions are The baseline for 15/16 is the forecast outturn for 14/15 adjusted for nonrecurrent items The assumptions are set out in the table below Key Planning Assumptions 2015/16 Notified Allocation Change ( '000) 9,560 Notified Allocation Change (%) 4.0% Tariff Change - Acute (%) -0.6% Tariff Change - Non Acute (%) -0.5% Demographic Growth (%) 1.5% Non Demographic Growth - Acute (%) 0.6% Non Demographic Growth - Cont.Care(%) 1.1% Non Demographic Growth - Prescribing (%) 3.5% Non Demographic Growth - Other Non Acute (%) 0.3% The QIPP target for HMS CCG in 2014/15 is a net target after investments 10.6m (4.1%). There is a separate section on QIPP in the Q&D plan which with the finance template submission provides the delivery assurance framework, along with the profiling of QIPP. Appendix 2 shows the Table of the QIPP schemes. Page 4 of 9

5 The waterfall analysis over the 2015/16 financial year with the delivery of 1% surplus and 1% nonrecurrent is shown in Appendix 3. The table below provides further analysis of these movements by major spend headings: Grand Total Acute Services Mental Health Community Health Continuing Care Primary Care Better Care Fund Other Programme Contingency M9 Forecast Outturn 238,070, ,044,504 19,727,049 18,716,450 20,038,098 35,417,654-11,924,711 1,202,000 Less Non Recurrent (2,647,341) (2,284,341) (363,000) - Add back NELTH 1,797,945 2,605, (807,482) - Add Back Readmissions 575,277 1,004, (429,378) - Other Adjustment 431,705 1,008, (577,000) FYE QIPP (-) (1,242,000) (1,242,000) /16 Opening Net Baseline Budgets (Rec) 236,986, ,136,949 19,727,049 18,716,450 20,038,098 34,840,654-10,324,851 1,202,000 Net Tariff Deflation / Inflation (+/-) 1,310,643 (792,822) (33,536) (31,818) 667,269 1,160, ,356 - Activity Growth (Demog) (+) 4,729,153 3,211, , , , , ,176 - Activity Growth (Non-Demog) (+) 2,239, ,822 67,072 63, ,404 1,068,310-34,853 - Better Care Fund (+/-) 11,516, (1,196,000) ,712, Reserves Update (Recurrent) (+) 2,555, ,480,511 75,215 QIPP (Recurrent) (-) (9,352,000) (6,985,000) (263,000) - (280,000) (1,824,000) Investment (Recurrent) (+) 768, , Savings (Non Recurrent) (-) (2,400,000) (1,800,000) (600,000) - Additional Central Funding - Tariff (-) (334,000) (334,000) A Total /16 Plan 248,019, ,029,756 20,555,585 17,826,464 20,931,328 35,755,573 10,912,000 12,731,748 1,277, % B Programme Allocation 250,471,510 C: B - A Surplus/(Deficit) from Programme 2,451,841 D Running Costs 2015/16 Plan 4,867,534 E Running Costs Allocation 4,971,000 F: E - D Surplus/(Deficit) from Running Costs 103,466 G: C + F Overall Surplus/(Deficit) 2,555,308 H: F/(B+E) % Surplus 1.0% Budget line analysis The analysis of individual budget lines supporting the summary above has been shared separately with the Governing body but as contract negotiations are ongoing may be subject to subsequent budget virements as contracts are agreed. Profiling of budget spend & QIPP profile The budget is profiled according to working days, seasonal adjustment & QIPP profiling. Risk/ mitigations The section below sets out the key financial risks identified in the setting of these budgets and the available mitigation. The wider system financial risks are covered in the operating plan. The budgets assume financial support ( 150m nationally) from NHSE as a result of the option to use the Enhanced Tariff Option (ETO). Without this support the QIPP target will increase by 0.334m. In the event that the providers opt for the Default Tariff Rollover (DTR) the CCG will expect to negotiate the delivery of CQINs at no additional cost. The budgets supporting this paper include the financial envelopes for contracts shared with providers, however as contract negotiations are ongoing there is a risk that budget virements will be required as and when contracts are agreed. Page 5 of 9

6 There is a risk that the growth assumptions for demand will be lower than actuals. The mitigation is to agree capacity plans (bed and workforce numbers) with providers and this work is on-going through urgent care boards. There is a QIPP delivery risk that is higher in 15/16 due to the Better Care Fund (BCF) contributions. This BCF risk is mitigated through the risk sharing arrangements in the BCF and the CCGs delivery assurance framework that programmes work within. The BCF funds will not be created unless activity is diverted from the acute sector. 6. Running Cost Allocation (RCA) The Running cost allowance notified is 4.971m which is a reduction of 9% as expected (10% running cost reduction & 1% population increase) The budget proposal for running costs is 4.868m. Increases to the running cost budget up to the allowance will reduce the surplus contribution from running costs and require an equivalent increased contribution to the surplus from the programme allocation 7. Capital CCG Capital allocations for 15/16 have not yet been notified by the NHSE. The CCG has limited assets (IT equipment) that would be eligible for capitalisation under the current NHS capital accounting regime. The CCG is the co-sponsor (but will not own the assets) to a number of Project Initiation Documents (PIDs) with NHSE/ practices around primary care premises development and & NHS Property Services around capital developments on sites owned by NHSPS in the CCG area. These include MSK estates at Horsham Hospital. 8. Statement of Financial Position (SOFP)/ Balance Sheet & cash The SOFP is reported quarterly to the audit committee and is not part of the budget proposal. An annual cash limit is set by the NHSE(based on the revenue resource limit or allocation adjusted for any non-cash items) and the CCG will draw down the monthly cash required to pay employees via payroll and creditors in line with the Better Payment Practice Code (BPPC). The CCG is required not to draw down cash in advance of its need and not to exceed the annual cash limit. The CCG is not permitted to invest surplus cash. 9. Recommendations During the month of March, issues such as which tariff option providers have opted for and the agreement of contracts by 31 March 2015 will be progressed. Providing these are within the financial framework and proposed budgets presented to the Governing Body in this paper, the Governing body are requested to approve the Programme budgets set out in section 5 The running cost allowance proposal in section 6 Confirm that the Accountable Officer will sign contracts within this financial framework and budgets, as set out in the Operational Scheme of Delegation and that any affordable virements to these proposed budgets can be agreed through the Chairs action in agreement with the Accountable Officer and Chief Finance Officer and reported to the Governing Body as an update to the budgets. Page 6 of 9

7 Appendix 1 General Financial Duties the CCG will perform its functions so as to: Ensure its expenditure does not exceed the aggregate of its allotments for the financial year i by a) Delegating responsibility to its governing body for the discharge of this duty. b) Monitoring of progress through performance reporting and general reporting mechanisms Ensure its use of resources (both its capital resource use and revenue resource use) does not exceed the amount specified by the NHS Commissioning Board for the financial year ii by a) Delegating responsibility to its governing body for the discharge of this duty. b) Monitoring of progress through performance reporting and general reporting mechanisms Take account of any directions issued by the NHS Commissioning Board, in respect of specified types of resource use in a financial year, to ensure the CCG does not exceed an amount specified by the NHS Commissioning Board iii by a) Delegating responsibility to its governing body for the discharge of this duty. b) Monitoring of progress through performance reporting and general reporting mechanisms Publish an explanation of how the CCG spent any payment in respect of quality made to it by the NHS Commissioning Board iv by a) Delegating responsibility to its governing body for the discharge of this duty. b) Monitoring of progress through performance reporting and general reporting mechanisms. i ii Act iii iv See section 223H(1) of the 2006 Act, inserted by section 27 of the 2012 Act See sections 223I(2) and 223I(3) of the 2006 Act, inserted by section 27 of the 2012 See section 223J of the 2006 Act, inserted by section 27 of the 2012 Act See section 223K(7) of the 2006 Act, inserted by section 27 of the 2012 Act Page 7 of 9

8 Investment from Better Care Fund Appendix 2 Surrey & Sussex Healthcare Brighton & Sussex University Hospitals Others Investment Total QIPP QIPP Plan Title 000s 000s 000s 000s 000s BCF QIPP MDT (Proactive Care) ,269 Long Term Conditions Programme Managing the front door of PRH Integrated Discharge Team Admissions Avoidance Sub Acute Ward/Enhancing Community Beds ,007 Care Homes Dementia Managing the front door of Crawley Hospital Integrated Health & Social Care 1,321 1,321 Continuing Healthcare Total BCF QIPP 2,294 2,763 1,601-6,658 Other QIPP MSK QIPP 1,882 6,873 3,469-10,982 1,242 Medicines Management 1,793 1,793 High Cost Drugs Mental Health Savings from Running Cost Investment in Town Planning Total Other QIPP Total QIPP 1,882 6,873 6,163-10,982 3,936 4,176 9,636 7,764-10,982 10,594 Page 8 of 9

9 Appendix 3 Page 9 of 9

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