Integrated Performance Report

Transcription

1 M Executive Summary Risk ratings Continuity of Service Risk Rating: 13/14 Plan: FY Performance: 4 4 Current 4 Previous Mth 4 Summary Performance: A ytd surplus of 11.5m has been recorded, resulting li in a CoSRR of 4 The New Monitor Framework Continuity of Service Risk Rating has now been implemented The main drivers of current performance are over performance on commissioning income, under spends on pay and over spends on non pay Cash has increased by 10m in month and to date is 67m ahead of plan Financial performance Clinical Directorates are 1.8m underspent Total CIPs are 0.7m (1%) above plan CoSRR of 4 is reported against a plan of 4 The pay bill increased by 0.6m and remains above the monthly average Commissioning income over performance increased by 12.6m in month to 33.5m Cash position remains healthy and the increase is due to the receipt of Project Diamond funding Summary Income & Cash Flow vs Plan m 2013/14 M11 Previous Month Plan Actual Actual Operating Income for EBITDA 1, , Employee Expenses (620.4) (611.4) 8.9 (554.7) 8.3 All other operating expenses (402.6) (424.6) (22.0) (381.6) (14.6) EBITDA Surplus/(Deficit) pre exceptionals Net Surplus/(Deficit) EBITDA % 94.8% 117.6% 22.8% 107.9% 13.1% Capital Expenditure 1 (126.9) (94.5) 32.4 (86.0) 25.6 Net Cash Flow 1 (67.9) (0.4) 67.5 (10.5) 47.9 Cash & Cash Equivalents CoSRR Liquidity Days CIP Performance % 100.0% 101.0% 1.0% 99.1% (0.9%) Net Current Assets Borrowings 1 (82.2) (99.4) (17.2) (99.4) (20.8) 1. Plan is set Quarterly with Monitor Monthly plan is extrapolated Key risks Action taken / committed Gaps and residual concerns The Fit For the Future the future programme (FFF) is developing further programmes to achieve the break even plan The Trust holds monthly performance review meeting with all clinical directorates to ensure progress towards targets are on track and actions are in place to close any shortfalls Directorates not meeting their financial targets are being tasked with identifying in year recovery plans Directorates projecting to exceed their financial targets have agreed to deliver projected favourable variances Stretch targets for the FFF programmes are being agreed and plans identified to support performance against CIP plans Significant in month deterioration in the due to high levels of invoices remaining unpaid Negotiations continue with the relevant organisations to secure commissioning income. Project Diamond income has now been resolved. A shortfall in the current year recurrent CIPs will increase financial challenges in subsequent years, or impact the availability of capital 1

2 M Monitor Risk Rating Area of review Key Highlights Continuity of Service Risk Rating (CoSRR) Month 11 Month 11 Plan Month 10 OVERALL Continuity of Service Risk Rating (CoSRR) The new Monitor framework has now been implemented and we are reporting under the Continuity of Service Risk Rating Framework. An overall CoSRR of 4.0 has been achieved at Month 11 for both the and projection with both Risk Ratings scoring a four Under the previous assessment criteria (FRR) a rating of 3.2, against a plan of 2.4 would have been achieved; this rating is rounded to a 3. Current performance days, a rating of four has been achieved, which is Liquid Ratio (50%) inline with the planned rating of four Debt Service Cover (50%) Current performance of 3.27 times, results in a rating of four being achieved, which is ahead of the plan of 3.00 times

3 M Directorate 14 Performance 14,000 Performance against Plan ( '000s) 12,000 10,000 8,000 6,000 4,000 2,000 0 ( 2,000) ( 4,000) ( 6,000) ( 8,000) ( 10,000) ( 12,000) Year to Date Financial Performance: 11.5m Surplus The Trust has recorded a surplus of 11.5m for the eleven months to February 2014 against a plan of Breakeven. This chart records the performance of each directorate t against tits agreed target. t The performance will comprise the directorates performance against its CIP programme as well as in year variances to plan associated with its service delivery. A more detailed analysis of the underlying causes is provided to the Finance and Investment Committee and Trust Management Executive for their consideration through the monthly finance report The performance of clinical directorates is reviewed on a monthly basis with the COO, and seniorrepresentatives representatives fromfinance Finance, the Chief Nurse, the Medical Director and Workforce. Any required actions are discussed and agreed at those meetings The performance of corporate directorates is reviewed on a quarterly basis with the Executive Directors. 3

4 M Directorate 14 Commentary Abdominal Med. & Surgery Month 11 Month 10 ( 581) ( 912) : Within total income underperformance CCG/NHSE income is 782k behind plan; primarily driven by Urology at 1.7M and is offset by Surgery at 943k. Cross directorate cost under-spends of 1.7m continue to be reported across nursing, pathology and drugs. Unmet pay CIPs of 2.2m are driving the pay overspend but are partly offset by vacancies. Actions: Coding improvements have been identified in Urology & Gastro following Maxwell Stanley guidance. Acute Medicine ( 2,937) ( 2,905) : The pay over spend of 994k includes 893k of unidentified CIPs. Significant over spends in A&E clinical staffing are currently being off-set by vacancies in other specialties. The over spend on internal recharges is primarily due to the use of Howard ward (offset by nursing pay) and an unachieved ward closure CIP of 817k. Non-pay over spends are driven by CIP slippage across the directorate and activity related expenditure primarily in General Medicine, as well as R&D grant funded expenditure. Actions: The directorate are committed to improving their financial position and are taking steps to reduce bank and agency expenditure across the directorate and improve coding, particularly in A&E. They are also developing and implementing a number of savings initiatives to ensure delivery in Cardio-vascular ( 2,249) ( 2,197) : A key driver is income underperformance of 3.4m; Cardiology 2.9m adv (ICDs with CRT and day cases), Cardiac Surgery 1.4m adv (elective), Vascular 1.2mk fav (emergency & HDU). Increased activity in January has stopped underperformance increasing this month. Pay is 246k under spent with nurse overspends ( 473k) on specialing in Vascular and increased temporary staffing in Cardiac Surgery being offset by vacant Medical PAs and junior doctor vacancies. Vascular non-pay is overspent on emergency and HDU activity ( 550k) partly offset by Cardiac Surgery.Actions: Reducing cancellations in Cardiac Surgery, reintroducing the weekly theatre scheduling meetings and improving theatre efficiency in the Cath Labs. Focus on maintaining the increased New OP activity for the rest of the year. Good progress is being achieved with more accurate and efficient stock management. CLIMP ( 12) ( 191) : Favourable \ (Adverse) :A small reduction in activity for diagnostic tests, CIP slippage and agency costs are the main drivers of the small adverse variance. A favourable adjustment was made to vascular recharge mix of 46k in month. Nuclear Medicine's adverse pay position has been partly offset by increased activity in Peptide Therapy. The non pay overspends in nuclear medicine and medical physics are due to CIP slippage, prior year invoices and increased supplies (due in part to supplies for the peptide therapy) and are offset by increased income. Payments for the PET centre are contributing to the non-pay overspend but are fully offset by income. Actions: Bank and agency spend is being reviewed with a focus on specialist staffing groups. 4

5 M Directorate 14 Commentary Month 11 Month 10 Dental Services Evelina Children's Hosp. 3,283 2,046 : Slippage in the recruitment of new positions approved through the business planning round accounts for the majority of the pay under spend of 1.5m and has enabled delivery of the directorate's full-year vacancy factor CIP target of 341k. The adverse position reported against income relates to the directorate plan to secure additional education income from the Dental SiFT levy. 3.4m is planned for the year ( 3.1m ) with 1.1m of income currently reported. Commissioning income is 1.3m ahead of plan across the board and this has helped mitigate the overall directorate position. : NHS income is over performing by 3.8m and can be split between increased activity of 2.8m across various Specialties and improvements in coding/case-mix of 1.0m mainly in Orthopaedics/Spinal. The Directorate have seen recent benefits from a better bed planning process and improved utilisation of resources. Other income is underperforming by 480k driven by R&D/Charity (offset by pay). Pay is 615k under spent driven by low nursing spend in prior months and R&D/Charity. Non-pay is overspent by 716k driven by increased spend on clinical supplies ( 340k), which is in line with activity, and pass-through drugs costs ( 280k). GRIDA ( 283) ( 591) : Pathology costs are overspent by 791K, driven by Genetics, GUM and Dermatology activities. Overall Pay is 157K under spent of which 398K is due to vacancies within research projects, offset by research income. 32% of the 324K Vacancy Factor saving has therefore been delivered to date. The non pay overspend of 2.1m is focused around drugs ( 1.2m), clinical supplies ( 670K) and planning gap ( 175K). The HIV drugs budget is under spent by 224K but other specialities are overspent relating to CCG activity. Action: Improved resource planning to see improved CCG activity. ty Coding reviews e to improve capture and income. Close monitoring of income and actions are being undertaken to ensure the levels remain high. Inpatient Services Medical Specialties : significant levels of pay vacancies have to date mitigated the remaining unidentified CIPs. : The pay over spend of 486k is mainly attributable to unidentified pay CIPs of 1.1M ( 976K ), this has been partly off-set byvacancies. The non payover spend of 1.2m is connected to the Drugs and Medical supplies due to higher service demand and of which 616k is directly recovered as pass-through. Actions: Review of Internal Recharges spending in order to identify efficiencies related to miscodes from other areas and rationalisation of current demand, focusing on both Theatres and CLIMP charges. Additionally, income recovery related to Ophthalmology DMO procedure is now under control, removing 200k of financial risk from the CIP plans and the directorate's financial projection. Nuffield House : Favourable \ (Adverse) : reduction in internal recharges following the transfer of premises to clinical i lservices is driving i the under spend. Where the facility is used by clinical services to undertake NHS activity those individual services now provide their own staff to undertake this work 5

6 M Directorate 14 Commentary Onc, Haem & Cell Path Month 11 Month 10 ( 1,330) ( 1,618) : Non-PbR drug income is over performing by 5.5m and is offset in Non-pay. Commissioning income is underperforming by 1.1m within Thoracic Surgery and 325k in ENT. SLR recharges are overspending due to unachieved CIP and increased costs in theatres ( 157k), Therapies, ( 213k) and Imaging ( 96k) associated with additional lists to achieve activity targets. Actions: The Directorate are looking at coding opportunities, particularly in ENT, as well as actively seeking available theatre lists and escalating issues as per the Directorate policy. Weekend clinics are taking place in both ENT and Thoracic to help recover the position. Pathology 1,549 1,769 : The non-pay overspend is caused by 214k of prior year costs and in-year clinical supplies costs, primarily driven by additional Pathology activity, as well as additional costs associated with the new price per test model. The favourable variances on income relate to Commissioning income as well as prior year 3rd parties and GSTS salary recharges. Blood is also under spent year to date by 357k. Internal Recharges are over performing as Pathology use, compared to plan, is up across the Trust; this is offset by the non-pay charge from GSTS Pathology for this work. PCCP Pharmacy 1,408 1,389 Surgery ( 552) ( 635) : Vacancies among critical care consultants and non recurrent benefits from prior year are the main drivers of the pay under spend. Non pay overspends include 1.8m in relation to clinical supplies of which 800k is due to CIPs not being realised with the rest activity related. Other non-pay costs contributing to the non-pay overspend includes legal fees, HR case, bed hire charges and drug costs. These costs are offset by the over performance on private patient income of 500K which is driven by ECMO activity. Commissioning income is 2.1m ahead of plan due to ECMO and usage of Nuffield theatres in Pain Management. : Pay vacancies of 1.2M are greater than the level planned by the Directorate, this is because of delays in recruitment to winter pressure posts and delays to the 7 day working consultation. Additional funding associated with activity growth has been agreed and allocated to the directorate and has been phased in line with the recruitment plan, coming on line during quarter four. A bad debt provision of 140k was made in Month 10 relating to an unpaid invoice for 2012/13, this is being actively pursued. : There was a favourable movement of 83k in the month primarily caused by 60k of non-recurrent benefit from research income. The overspend of ( 552k) is primarily driven by under performance on CCG activity in Orthopaedics of c.( 1.57m) offset by over performance in Plastics of 0.7m. Actions: Work is ongoing within Plastics with regard to coding improvements and plans to deliver additional Orthopaedic activity through increased Saturday theatre lists are in the recovery plan. Therapies : Favourable \ (Adverse) : Both Internal and commissioning income streams are over-performing by 56k and 105k respectively. 6

7 M Directorate 14 Commentary Women's Services Month 11 Month 10 ( 294) ( 647) Community 1,975 1,423 : Private patient t income is underperforming by 2.4m, which h is split across ACU ( 1.2m) & Westminster t Maternity Unit ( 1.3m) and is being partly offset by over performance on Overseas Patient income of 579k. ACU income includes 372k of credit notes issued for prior years work. CCG/NHSE Income is ahead of plan, with Maternity over performing by 2.0m & Gynaecology under performing by 36k. Actions: Further review of ACU processes with regards to invoicing for private work, as well as the recording of NHS patient episodes and the monitoring of private income performance. : The under spend is mainly due to pay under spends of 1.9m. At Month 11, there are 257 WTE substantive vacancies (a decrease of 33 WTE's in the month, mainly due to new starters on NMET ). A non-recurrent solution to Newborn Hearing Screening funding has been resolved this month, income relating to internal GSTT activity contributed 229k towards the fav position. Cancer Strategy Chief Executive Chief Nurse : significant non pay expenditure has been incurred in relation to charity grants and is off-set by additional income; against the main strategy budget the favourable position is due to vacancies and low levels of non pay expenditure to date around consultancy costs. : in month improvements relates to slippage on the costs of the KHP FBC (GSTT share only), this had been included in the previous months projection; position also includes the recognition of an under spend on the GSTT contribution toward the Integrated Care Pathway (ICP) project. : the over spend on non pay is driven by various initiatives and projects which have external income to fund them; vacancies across a number of teams have driven the current favourable position; these have mitigated the small remaining planning gap ( 115K FYE), not formally addressed through the identification of CIPs. Chief Operating Officer : funding has been allocated in relation to the additional agency and external consultancy costs to support improved coding; substantive staff are currently on secondment to clinical directorates to help support their coding activities and these posts are being back-filled. : Favourable \ (Adverse) 7

8 M Directorate 14 Commentary Director of Essentia Month 11 Month 10 ( 1,159) ( 1,236) : The position i is being driven primarily il by additional i costs for the increased Hercules House Rent ( 200k), Great Dover St ( 343k), Staff shuttle bus ( 300k), Provision for historic staffing costs ( 100k), non-pay costs relating to engineering ( 372k).The contains the bad debt being recognised against the KCL invoice for the integrated Cancer Centre ORIS project of 712k. New income streams and pay under spends are partly offsetting these along with higher than anticipated E&U income. 50k of winter pressure funding is within the position. The overall CIP target has been identified with the new CIPs being monitored by the Essentia Streamlining MAP group. Director of Finance 1,120 1,023 : in month improvement due to continued vacancies; vacancies across a number finance functions have resulted in a significant under spend against pay budgets, the CIPs targeted a recovery of prior period VAT charges and balance sheet gains and this is currently 131K ahead of plan. Medical Director ( 91) ( 127) : unidentified CIPs of 354K ( 316K) which has arisen in part due to the need to fund additional PAs associated with undergraduate education; the purchase of IT software and legal \ litigation fees are the other main areas of over spend, partly mitigated by income from the simulation centre and undergraduate education. Commercial Director Director of Workforce 5,690 4, : the directorate is exceeding its planned contribution levels due to positive contractual performance, slippage in incurring planned expenditure or some prior year benefits. These additional contributions are associated with new developments, additional private patient activity and benefits derived from on-going contracts. Invoices with a value in excess of 400K in respect of shops and aerials are still to be raised (but have been accrued) due to prolonged contract negotiations. : the favourable position is due to under spends within training of 832K across schemes associated with continual professional development, individual learning accounts and leadership; service design budgets are under spent by 258K; to date there has been slippage against planned CIPs associated with HR transactional savings, these will increase the longer the projects implementation is delayed. : Favourable \ (Adverse) 8

9 M Bridge Analysis 36.0m 32.0m 28.0m 24.0m 20.0m 16.0m 11.5m 12.0m 8.0m 4.0m Bridge Analysis of 0.0m Pay Income ITDA Non Pay & Recharges Bridge Analysis The trust has recorded a surplus of 11.5m for the eleven months to February 2014 Pay 8.9m under spent: This includes slippage on agreed CIP programmes. This has been offset by vacancies and slippage on hosted projects of 3.3m. 3 Income 23.8m Above plan: Commissioning and Education income are 33.5m and 1.5m ahead of plan respectively. Areas where income is less than planned include R&D and charity but these are offset by expenditure under spends. Planned growth in Private Patient activity has not been fully achieved. ITDA 0.7m under spent: This relates to the Deprecation charge and Public Dividend Capital payment both being below plan by 0.4m and 0.3m respectively. Non Pay 22.0m over spent: The main drivers are Clinical supplies, Drugs, Blood and transport costs which will be related to the income over performance. Provisions for non payment of invoice are currently 10.6m which reflects the high number of unpaid invoices 9 and commissioner challenges; this is a 6.8m increase from last month.

10 M CIP Performance 10,000 CIP Monthly Performance ( '000s) 9,000 8,000 7,000 6,000 5,000 4,000 3,000 2,000 1,000 0 CIP Plan CIP Delivered CIP Projected Apr 13 May 13 Jun 13 Jul 13 Aug 13 Sep 13 Oct 13 Nov 13 Dec 13 Jan 14 Feb 14 Mar 14 CIP Performance The Trust is monitoring CIPs with a value of 78.9m, with an average monthly run rate of 6.6m Progress by the end of February has resulted in delivery of 72.6m of CIP across the trust. This is 0.7m greater than had been planned and reflects overachievements within a number of CIP programs which offset underachievement in others. CIP delivery has increased from last month. The monthly performance review meetings (PRMs) with the clinical directorates review the CIP programme, identify blockages and agree actions required to recover any slippage. The current projection will achieve 80.6m and is a 1.7m over performance of the CIP plan. The stretch targets allocated to the FFF work streams along with further mitigating actions agreed at PRMs are expected to offset the shortfall in the current projection and aid the delivery of the trust stretch plan. 10

11 M FFF CIP Delivery Year to Date CIPs CIPs CIPs Required Delivered By Theme: Annual Plan CIPs CIPs Projected Required Total CIPs Projection VAR 4,787 7,852 3,065 Clinical coding 5,204 8,691 3,487 1, ( 720) Surgical Productivity 1, ( 773) 2,298 2,114 ( 184) Outpatients 2,507 2,346 ( 162) ( 443) ( 357) 86 Outpatients - Cost of growth ( 483) ( 392) 91 1, ( 1,179) Length of stay 1, ( 1,239) 1,979 2, Medical productivity 2,141 3, ,802 33,656 ( 3,146) GP and Tertiary pathways 40,291 37,466 ( 2,825) ( 19,292) ( 15,733) 3,558 Increase mkt share - GPs - Cost of growth ( 21,056) ( 17,411) 3,645 5,102 4,199 ( 903) Reduce pay costs in non-clinical departments 5,570 4,601 ( 969) 628 1, Reduce cost of process & beaureaucracy 685 1, Maximise benefits from capital expenditure ( 0) 1,668 1, Reduce costs associated with space 1,847 1, ,956 2,303 ( 654) Nursing and AHP productivity 3,256 2,656 ( 600) 9,956 9,136 ( 820) Large scale procurement / non pay 10,885 10,269 ( 616) 1,764 1,403 ( 361) Pathology expenditure 1,960 1,582 ( 377) 1,471 2, Medicine management 1,607 2,632 1,024 2,434 2, SLR / M 2,655 3, ,024 1,468 ( 556) Private Patients 2,289 1,666 ( 623) Delivering safe cover 24/ ( 132) Imaging ( 139) 13,994 14, Other Categories 15,563 15,482 ( 82) 71,831 72, Total All Themes 78,902 80,595 1,694 11

12 M Employee Expenses 60.0 Monthly Employee Expenses and Budget ( m) Actual Budget Monthly Employee Expenses The Trust pay bill for February was 56.8m which is an increase of 0.6m and is above the monthly average. Pay is under spending by 8.9m against the budget which is partly due to 3.3m under spend on specific projects and R&D schemes (offset by income) across the trust. Vacancies across the trust are also contributing to the under spend and offsetting CIP slippage Areas of over spend include AMS, Acute Medicine, Med Specialities and Workforce due to either CIP slippage or operational pressures. Work to monitor the pay CIPs and vacancy levels across the trust has realised further benefit as seen within the CIP run rate. Workforce are working with Directorates and attending the monthly performance reviews in order to monitor and develop any action plans around performance that may be required. 12

13 M Other Operating Expenses Monthly Other Operating Expenses and Budget ( m) Actual Budget Monthly Other Operating Expenses Other Operating Expenses for February were 43.0m, which is 7.0m higher than plan and represents the highest level of monthly expenditure seen this year The main drivers of the in month increase in Operating Expenses are the bad debt provisions. The significant in month deterioration in the bad debt position is due to the high levels of invoices remaining unpaid and due to some challenges having been received from commissioners. In line with previous months further reserves, have been released which were required for their intended purpose Other Operating Expenses are over spent by 22.0m which is due to drugs ( 4.9m), clinical supplies ( 6.6m) and transport ( 1.3m) being over spent. These are caused by high activity and are offset by income. Bad debt provisions are greater than plan by 10.6m. Work is ongoing to support directorates in identifying further CIPs, focusing on Procurement, Pharmacy and Pathology costs under the FFF programme. 13

14 M Cash Flow Cash Actual Cash vs Plan and Prior Year ( m) Prior Year Actual 13/14 Plan 13/14 Apr May Jun Jul Aug Sep Oct Nov Dec Jan Feb Mar Cash Flow The graph above shows the actual cash and cash equivalents held by the trust. The plan is set Quarterly with Monitor. The cash balance has increased in month by 10.1m due to receipt of the Project Diamond funding and increased Private Patient payments. Cash is above plan but has been impacted by non payment or shortfalls in payments of contracts by CCG's and NHS England Cash is expected to increase next month as we receive settlement on debt before the year end. The finance team monitor the cash balances on a daily basis and on a weekly basis the payment of supplies, also liaising with capital projects to identify when large contractual payments are due. 14

15 M Capital Expenditure Actual 13/14 Plan 13/14 Capital Cumulative Spend Monitor Plan ( m) Apr May Jun Jul Aug Sep Oct Nov Dec Jan Feb Mar Capital Expenditure The trust currently has 142m of funding available for capital projects for the year 2013/14 The current capital spend is 94.5m which is 32.4m below plan. Within the current capital schemes overspends on a number of schemes have now been approved at IPB with the sterile services project still under review. The capital schemes in the trust are monitored monthly by the IPB who also review additional capital schemes. A 5 year capital plan has been submitted to Monitor laying out plans and aspirations for the trusts capital expenditure and development of the trusts estate. 15