Nicola Greenfield, Deputy Director of Finance. Approve Adopt Receive for information. Finance Revenue & Capital X Equality & Diversity

Transcription

1 Board of Directors Agenda Item Date: 26 th September 2013 Title of Report Monitor s revised Risk Assessment Framework for 2013/14 Purpose of the report and the key issues for consideration / decision Presented by: Name & Title Prepared by: Name & Title Action Required (please X) Strategic / Corporate Objective(s) supported by this paper Is this on the Trust s risk register? Which Standards apply to this report? This paper summarises some of the key issues within the new Risk Assessment Framework (RAF) which takes effect on the 1 st October It also gives an initial view of our expected performance within it. Bill Gregory, Director of Finance Nicola Greenfield, Deputy Director of Finance Approve Adopt Receive for information Financial position Governance No X Yes CQC NHSLA BAF Objectives 13/14 X If Yes, Score X Have all implications related to this report been considered? Finance Revenue & Capital X Equality & Diversity National Policy / Legislation Patient Experience NHS Contract Governance & Risk Management Human Resources Terms of Authorisation Consultation / Communication Human Rights Other: Carbon Reduction Previous Meetings Please insert the date the paper was presented to the relevant Committee: Audit Committee Clinical Quality & Safety Committee Provider Efficiency Board ET Remuneration Committee Assurance & Risk Committee Other Your Health. Our Priority Page 1 of 16

2 Board of Directors Thursday, 26 th September, 2013 Agenda Item No. 1.0 Introduction Monitor s revised Risk Assessment Framework for 2013/ Monitor published its revised Risk Assessment Framework on the 27 th August This document outlines its approach to overseeing NHS foundation trusts compliance with the governance and continuity of services requirements of their provider licence. It replaces the Compliance Framework from the 1 st October This paper summarises some of the key issues within the Risk Assessment Framework (RAF) to the Board of Directors and gives an initial view of our expected performance within it. 2.0 The Risk Assessment Framework (RAF) 2.1 The RAF is Monitor s approach for overseeing the health sector under the new rules. It comes into force for Foundation Trusts on 1st October 2013, but on the 1st April 2014 will be expanded, along with the licence system, to cover all providers of NHS services. 2.2 It explains how Monitor will use the framework to assess individual NHS foundation trusts compliance with two specific elements of their work detailed in their provider licences: the continuity of services; and governance conditions. and to highlight when there is: a significant risk to the financial sustainability of a provider which endangers the continuity of provision of those services; and / or poor governance. 2.3 These two elements will be assessed separately and each Foundation Trust will be assigned a separate rating for each element. 2.4 The ratings will indicate when there is a cause for concern at a provider, but they will not automatically indicate a breach of its licence or trigger regulatory action. They will prompt Monitor to consider whether a more detailed investigation is necessary to establish the scale and scope of any risk. The Risk Assessment Framework publication gives further details about the investigation process. Monitor s view of their review process is detailed in the diagram below: Your Health. Our Priority Page 2 of 16

3 Source: Monitor s Risk Assessment Framework, published 27 th August 2013, page Continuity of Services (CoS) Rating 3.1 One of Monitor s statutory roles is to ensure the continued provision of key NHS services, identified by commissioners as Commissioner Required Services (CRS). 3.2 The Continuity of Services (CoS or CoSRR) risk rating states Monitor s view of the risk facing a provider of key NHS services. There are four rating categories ranging from 1, which represents the most serious risk, to 4, representing the least risk to incur a breach of the provider s licence. 3.3 The new CoS risk rating is not calculated and used in the same way as the financial risk rating (FRR) that was applied through Monitor s Compliance Framework. Whereas the FRR was intended to identify breaches of terms of authorisation on financial grounds, the CoS risk rating identifies the level of risk to the on-going availability of key services. 3.4 The CoS risk rating incorporates two common measures of financial robustness: a) liquidity: days of operating costs held in cash or cash-equivalent forms, including wholly committed lines of credit available for drawdown (such as agreed Public Dividend Capital (PDC) allocations, but excluding the current working capital facility); and Your Health. Our Priority Page 3 of 16

4 b) capital servicing capacity: the degree to which the organisation s generated income covers its financing obligations (i.e interest, dividend and loan repayments). 3.5 These are given the following weightings and thresholds: Source: Monitor s Risk Assessment Framework, published 27 th August 2013, page A worked example of the new CoS risk rating calculation is included at paragraph 5.6 below. 3.7 These are then used to calculate the overall CoS risk rating defined as below. Board members will note the addition of a new rating 2*. For an organisation causing concern and moving down the risk ratings gives Monitor time to consider the merits of whether to investigate without triggering it. For an organisation moving up the risk ratings, it means that Monitor can keep a closer eye on things for longer. Source: Monitor s Risk Assessment Framework, published 27 th August 2013, page The regulatory implications of the CoS risk rating are detailed below: Your Health. Our Priority Page 4 of 16

5 Source: Monitor s Risk Assessment Framework, published 27 th August 2013, page Monitor also request exception reporting on material in-year changes, for example, the loss of a contract. In these circumstances it may apply over-riding rules, and decide to take further action such as request a re-forecast or further information If a provider looks likely to fail financially, Monitor may take steps to reconfigure services to ensure they continue to be available to local patients. This may take place either by agreement with other parties in the local health economy or under the guidance of a Trust Special Administrator. 4.0 Governance Rating 4.1 Monitor believes that all Foundation Trusts should be well-governed, including how they oversee care for patients, deliver national standards and remain efficient, effective and economic. 4.2 They will use a governance rating to describe their view of the governance of a Foundation trust. This rating will be generated by considering the following information regarding the Foundation Trust and whether it is indicative of a potential breach of the governance condition: 1. performance against selected national access and outcomes standards (Appendices 1 and 2) and we expect that this data will continue to be collected quarterly or more regularly if issues arise with achievement; 2. CQC judgments on the quality of care provided; 3. relevant information from third parties (see diagram below in paragraph 4.4 for examples); 4. a selection of information chosen to reflect quality governance at the organisation, which will specifically include the results of staff and Your Health. Our Priority Page 5 of 16

6 patient surveys (see diagram below in paragraph 4.4 for further examples); 5. the degree of risk to continuity of services and other aspects of risk relating to financial governance; and 6. any other relevant information. 4.3 Further detail on each of these is given in the Risk Assessment Framework publication. This is a much more extensive list than previously considered under the Compliance Framework and not definitive therefore the scope of governance scrutiny is expanded and provides Monitor more scope to respond to specific issues. However, there is much less clarity and specificity as to how it will work in practice. 4.4 Monitor will use the information gathered under the categories outlined in paragraph 4.2 above (alongside any other relevant information, exception reporting as identified on page 21 in the publication and that identified in paragraph 4.9) to assess the strength of governance at an NHS foundation trust. The diagram below outlines what could give Monitor cause for governance concerns. However, Monitor also state that information that comes to light from other areas of their governance oversight (e.g. board statements, reviews of plans and governance reviews) may lead to overrides in the governance rating. Source: Monitor s Risk Assessment Framework, published 27 th August 2013, page 39 Your Health. Our Priority Page 6 of 16

7 4.5 The governance rating assigned to a Foundation Trust reflects Monitor s views of its governance. There are three categories to the new governance rating: a green rating will be awarded if no governance concern is evident; where potential material causes for concern with the trust s governance in one or more of the categories (requiring further information or formal investigation) are identified, the Foundation Trust s green rating will be replaced with a description of the issue and the steps (formal or informal) Monitor are taking to address it; or a red rating will be assigned if regulatory action is instigated (s.105, s.106, s.111) etc. 4.6 In determining the rating, Monitor will take into account: The seriousness of the issue; information they already have concerning the situation; their perception of the effectiveness of the trust s initial response to the issue; and the time-critical nature of the situation. 4.7 Monitor may require additional information from the Foundation Trust. They may decide to investigate formally and / or address the issue through their enforcement powers outlined in the Enforcement Guidance. 4.8 This is summarised in the diagram below: Source: Monitor s Risk Assessment Framework, published 27 th August 2013, page 40 Your Health. Our Priority Page 7 of 16

8 4.9 Monitor will also review other required information to inform their governance rating, and may also use these as an over-ride. These include: the Corporate Governance Statement (CGS) (see paragraphs ); which replaces the current annual plan declarations the Annual Governance Statement (AGS), currently produced as part of the Annual Report; Foundation Trust forward plans, submitted on the 31 st May each year, although we have received feedback that this may be required earlier this year; regular governance reviews To comply with the governance conditions of their licence, Foundation Trusts are required to provide a statement (the Corporate Governance Statement) setting out: a) any risks to compliance with the governance condition; and b) actions taken or being taken to maintain future compliance The statement replaces the Board Statements that Foundation Trusts were previously required to submit with their annual plans under the Compliance Framework This is attached in Appendix 3 for information In the Risk Assessment Framework publication Monitor requires Foundation Trusts to carry out periodic in-depth and independent reviews of their governance, ideally every three years. They state this is to ensure a consistently effective level of governance assurance at Foundation Trusts. However, where reviews identify material governance concerns, Monitor will consider the Trust s response to the review and whether it needs to take action Foundation Trusts are free to set the overall scope of the reviews they carry out, however there is also a minimum required scope by Monitor identified. It is expected that these will take a similar form to the work we have recently completed with KPMG 4.15 Foundation Trusts are required to report the findings of these reviews, and any response, to Monitor within 60 days of their submission to Board of Directors. However, if Monitor are aware of findings earlier and they are such that they consider it necessary to take action, they may do so sooner Further guidance will be issued in late Forecast assessment of the CoS rating and Governance 5.1 Attached at Appendix 4 is a letter received from Monitor on the 17 th September 2013 explaining the process of transition to the new ratings and the expected dates of publication. Your Health. Our Priority Page 8 of 16

9 5.2 We have undertaken an exercise to consider our current governance and financial position, and the ratings that this may give rise to. 5.3 With respect to the Governance Rating that we expect to be issued with on the 1 st October 2013, given that we have accepted Enforcement Undertakings under s.106 of Monitor s licence conditions we would expect to be issued with a Red Governance Rating. For the foreseeable future due to our continuing A&E issues, we expect at least be of concern but more probably Red. 5.4 The finance team have reviewed the future CoS rating and in order to understand the sensitivities of variables within it have prepared a number of scenarios which are presented below. 5.5 It must be emphasised that Monitor have not yet issued the formal calculations and therefore the following Risk Ratings are based on the finance team s assumptions of what will be included. 5.6 A worked example to derive the CoS risk rating, based on the Month 5 Year-to- Date position is presented below: Continuity of Service (CoS) Risk Rating Worked example based on Month 5 position Metric Weight Aim of metric Definition Liquidity Ratio (days) 50% Can immediate cash requirements be met? Calculation Rating Categories Working Capital Balance x x 150 (33.0) days < = Annual Operating Expenses (114.9) Working Capital Balance: m Working capital facility 21.0 Current assets 58.2 Current liabilities (30.4) Stock (2.5) Sub-total cash for liquidity purposes 46.3 less: Working Capital facility (21.0) Cash for CoS liquidity purposes 25.3 Operating expenses within EBITDA from SoCI (114.9) Days within cumulative accounting period 150 Metric Weight Aim of metric Definition Capital Servicing Capacity (times) 50% Canmedium-term financing requirements be met? Calculation Rating Categories Revenue available for capital service 4.2 = 1.8 times < Annual Debt Service 2.3 Your Health. Our Priority Page 9 of 16

10 Revenue available for capital service: m Surplus / (Deficit) (0.5) Less: Depreciation and amortisation (2.9) Interest expense (0.4) PDC dividend (1.4) Total Revenue Available for Debt Service 4.2 Annual Debt Service: m PDC Dividend Expense (1.4) Interest expense on non-commercial borrowings (0.4) Repayment of non-commercial loans (0.5) Total Annual Debt Service (2.3) In summary: Metric Weighted Weighting Rating Calculation Liquidity Ratio (days) 50% 4 2 Capital Servicing Capacity (times) 50% Unrounded CoS Rating Rounded CoS Rating Due to the weightings of the metrics, the Trust s current favourable cash position is important in delivering the CoS rating. A series of scenarios is presented below, which illustrates the sensitivity of both metrics, and degree to which decision-making may be influenced by them. The caveat at paragraph 5.5 must be remembered in considering these scenarios. Continuity of Services Risk Rating Modelling Summary of Scenarios Scenario A B C D E F M05 YTD Year End M05 Year End M m CRP Year End M05 + D Block Baseline Annual Plan ( 21m CRP) Adjusted Annual Plan: D Block + 18m CRP Capital Service Capacity: Capital Service Capacity metric (x) Caital Service Capacity rating Liquidity: Liquidity metric (days) Liquidity rating Continuity of Services Risk Rating Note: balance sheet calculated using forecast year end balance sheet. Cash flow and I&E items are as per annual plan. 5.8 The scenarios are: a) Month 5 year-to-date position: which very marginally affords us a CoSRR of 4; b) Year-end-forecast: due to a lower forecast Capital Service Capacity ratio, the CoSSRR is 3; Your Health. Our Priority Page 10 of 16

11 c) Year-end forecast plus additional delivery of 1.6m CRP, which secures a CoSRR of a 4; d) Year-end forecast plus D-block; which whilst secures a CoSRR of a 3, is marginal as it reduces liquidity down to 5 days; e) 2014/15 Annual Plan (2013/14 submission), which secures a CoSRR of a 4; f) 2014/15 Annual Plan plus D block development, plus the CRP target required to deliver a CoSRR of a 4: this crudely indicates that a CRP of 18m would deliver a CoSRR however, liquidity is then at 0 days. 5.9 From this we would conclude that the modelling above broadly supports our previous FRR modelling suggesting a 21m CRP requirement for 2014/15. We will model the requirement in more detail as part of our planning work for next year This scenario modelling demonstrates the importance to the Trust s future financial viability of the successful delivery of Cost Reduction Programmes (CRP), and illustrates how quickly cash dwindles without this, which would threaten the Going Concern assumption Due to the reduction in the number of financial metrics and the importance of the liquidity rating in our overall rating, the Board of Directors will need to be even more mindful of the impact of the non-achievement of the Cost Reduction Programme on the cash position, and the impact of utilising cash to increase the capital allocation above the base depreciation value for schemes such as D Block. Bill Gregory Director of Finance 20 th September 2013 Your Health. Our Priority Page 11 of 16

12 Appendix 1 Your Health. Our Priority Page 12 of 16

13 Appendix 2 Your Health. Our Priority Page 13 of 16

14 Appendix 3 Your Health. Our Priority Page 14 of 16

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16 Appendix 4 Your Health. Our Priority Page 16 of 16