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Paper 15

Ayrshire and Arran NHS Board Monday 2 December 2019

Financial Management Report for the seven months ended 31 October 2019 Author: Rob Whiteford, Assistant Director of Finance – Operational Services Bob Brown - Assistant Director of Finance – Shared Services and Governance

Sponsoring Director: Derek Lindsay, Director of Finance

Date: 21 November 2019

Recommendation

Board members are asked to note:

the financial position for the year to date;

the progress on delivering cost avoidance and cash releasing efficiency savings;

the adverse impact caused by delayed discharges; and

the positive impact in the month caused by non-recurring benefits

Key Messages:

The Annual Plan is a deficit of £14.75 million.

NHS Ayrshire & Arran is £11.2 million overspent for the year so far.

The average monthly run rate to month 6 was an overspend of £1.65 million.

NHS Ayrshire & Arran was £1.3 million overspent in month seven.

Benefits brought in through reserves was the main reason the position was better than the average for the year so far as acute overspend was £1.3 million in month 7 (average year to date was £1.1 million).

£23.1 million of interventions and efficiencies were planned for the year. Achievement to date is £9.15 million, and NHS Ayrshire & Arran forecast achievement of £16.4 million.

In order to achieve the planned deficit NHS Ayrshire & Arran must deliver against the £23.1 million transformation and efficiency plan or find alternative funding sources to substitute for savings shortfall.

Glossary of Terms

CAR-T CRES TAVI Var WTE YTD PET

Chimeric antigen reception T-cell Cash releasing efficiency savings Transcatheter aortic valve implantation Variance Whole time equivalent Year to date Positron Emission Therapy

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1. Background 1.1 Scrutiny of all resource plans (revenue and capital) and the associated financial

monitoring is considered by the Corporate Management Team, the Performance Governance Committee, and the Board. This report summarises the revenue position for the seven months ended 31 October 2019.

2. Revenue resource limit and overall financial position 2.1

The revenue budget for the year is £900 million. This comprises £830.0 million of allocations received (Appendix 3) and anticipated allocations of £70 million.

2.2

Funding allocations in October (listed on Appendix 3) included £0.7 million for Winter funding, £0.7 million to improve waiting list performance and £1.2 million previously agreed with Scottish Government for the Voluntary Redundancy Scheme. £0.6 million was removed as anticipated to pay for Positron Emission Tomography (PET) scans.

2.3 Acute Services continued to overspend but at a £0.2 million more than the average rate from months 1 to 6. Primary Care Prescribing was £2.0 million overspent after 7 months, with the year-end forecast reducing by £0.2 million to £3.4 million in light of August information. There was no charge from reserves in month 7 compared with a normal monthly charge of £0.55 million. This recognises the benefit of additional Non-Core Departmental Expenditure Limit (DEL) and confirmed rates refunds.

3.1 Acute Services

3.1.1 The annual budget for Acute Services is £335.2 million. The directorate is overspent by £7.8 million for the year to date. (Appendix 2).

3.1.2 The in-month overspend was £1.3 million. The average overspend in the first six

months was £1.1 million per month. The deterioration in Month 7 was due to Station 1 remaining open (it was non recurrently funded for the first part of the financial year), higher than average non pay spend and higher than average spend on drugs, particularly for Multiple Sclerosis. The year to date overspend is a result of:

£8.9 million of unallocated annual savings which are £5.1 million overspent after 7 months;

£1.6 million overspend on nursing pay (of which £0.3 million was in month 7);

£1.5 million overspend on non-pay including drugs (of which £0.5 million was in month 7);

£0.4 million overspend on externals.

Table 1 Annual Budget

YTD

Budget YTD Actual YTD Var

Acute Services Division £000 £000 £000 £000

Pay 241,044 139,820 140,793 (972)

Non Pay 64,943 35,873 37,368 (1,495)

Other Operating Income (849) (512) (747) 235

Unallocated Savings (8,872) (5,124) 0 (5,124)

Healthcare Provided to Others (24,773) (14,506) (14,553) 46

Purchase Of Healthcare 63,729 36,967 37,408 (441)

335,221 192,519 200,270 (7,751)

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3.1.3 Unallocated Savings

The £8.9 million unallocated savings are £3.5 million brought forward from 2018/2019, £0.8 million of unachieved historic redesign savings plus additional savings targets in 2019/2020. This will cause an adverse variance of £0.75 million per month until savings are found.

3.1.4

Nursing Pay

The main components of the £1.6 million nursing pay overspend are £1.0 million in Crosshouse Medical Wards and £0.4 million in Ayr Medical Wards. At Crosshouse the most material overspent areas are Ward 5d (£0.240 million), and the Combined Assessment Unit (£0.158 million).

At Ayr Station 1 is £0.256 million overspent on nursing, whilst Station 16, Station 14 and the Discharge Lounge together account for a further £0.154 million. Station 1 overspent by £0.084 million in Month 7.

3.1.5 The 2019/2020 budget anticipated that all acute hospital beds were funded. However it has been necessary to open additional beds in response to demand and the number of delayed discharges. In Ayr Station 1, about 20 beds have been open for most of the financial year, due to delays in discharge of South Ayrshire residents. On average 19 beds were open during October.

3.1.6 £0.275 million was issued non recurringly to the Station 1 nursing budget at month 5. Similarly £44,000 was issued to “Crosshouse Winter Pressures” in order to fund additional capacity. This funding was phased into the first half of the financial year.

Annual Budget

YTD

Budget YTD Actual YTD Var

Crosshouse Medical Ward

Nursing Pay £000 £000 £000 £000

Chouse Ward 5d Ger Asst Nrs 1,412 823 1,063 (240)

Chouse Winter Pressures 44 44 73 (29)

Chouse Ward 3d Medicine Nrs 1,345 785 862 (78)

Chouse Ward 2f Medicine Nrs 1,312 766 821 (55)

Chouse Anps - Acute Med 60 35 68 (33)

Chouse Ward 4d 1,532 894 913 (20)

Cardiac Rehab Nrs 165 96 117 (21)

Chouse Gen Mgr Medical 207 123 164 (41)

Chouse Ward 3f A/Med Nrs 1,510 881 934 (53)

Chouse Combined Asst Unit Nrs 5,147 3,003 3,161 (158)

Chouse Ward 3b Medicine Nrs 1,474 860 915 (55)

Chouse A + E Dept Nrs 2,575 1,502 1,547 (44)

Chouse Discharge Lounge Nrs 204 119 161 (42)

Chouse Ward 4e Medicine Nrs 1,379 804 875 (71)

Chouse Ward 4f Medicine Nrs 1,294 755 799 (44)

Other smaller variances 10,536 6,155 6,129 26

30,196 17,645 18,603 (957)

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3.1.7 Acute Medical Agency

Medical Agency usage has decreased compared with last year. After removing the effect of VAT charged up to the 7 October 2019 we are on track to achieve £0.811 million of the £1.0 million targeted reduction. VAT on medical agency is now able to be reclaimed with effect from the 7 October.

3.1.8 Non Pay

Non Pay budgets were £0.465 million overspent in Month 7 in the following areas:

Drugs - £0.1 million in month overspend on Multiple Sclerosis drugs. The pharmacy and medical teams are engaging with the clinicians.

Medica contract for radiology is showing a year to date supplies overspend of £0.4 million (with a matching salaries underspend in relation to vacant consultant radiologist posts). The month 7 overspend was £70,000.

Laboratory Supplies - £0.1 million overspend in the month. The average overspend was £0.054 million in months 1 to 6, but rose to £0.086 million in month 7. Cumulative laboratory overspend is £0.41 million due to double testing and other costs associated with ISO standard, as well as increasing demand.

Orthopaedic supplies in Ayr Theatres. Year to date overspend of £228,000 and month 7 overspend of £50,000 due to new consultant doing more complex procedures with more expensive supplies, but mainly related to additional activity being done to reduce waiting times.

One off costs were also incurred in the month on:

Cancer Services Crosshouse - £0.020 million. The cost of a new computer system and associated software were incurred in the month.

Haemodialysis cabins to allow home dialysis - £0.019 million

Purchase of insulin pumps - £0.014 million.

3.1.9

Purchase of Healthcare

Externals are overspent by £0.4 million in the year to date. An increase in the number of paediatric bone marrow transplants previously has caused exclusions from Glasgow service level agreements (which are paid on a cost per case basis) to overspend by £0.3 million. Externals were on budget in Month 7.

3.2 Health and Social Care Partnerships

3.2.1 The total health budgets for the three Health and Social Care Partnerships are £419.3 million.

3.2.2 Combined partnership health budget overspends are £1.2 million overspent including the prescribing overspend of £2.0 million referred to in section 2.3 above. The Health Board is responsible for funding prescribing. When this is done the overall partnership position is an underspend of £0.8 million.

3.2.3 On an underlying basis North Partnership are £0.182 million underspent, East £0.921 million underspent and South £0.330 million overspent. South are overspent on Biggart Hospital and District Nursing. East are underspent on Mental Health Services, Allied Health Professionals and Hospital and Community Care whilst North are underspent on Specialist Mental Health Services.

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3.3 Other Clinical Services

3.3.1 The total budget for Other Clinical services is £25.0 million and it is underspent by £0.4 million. This area includes the budgets for the Pharmacy teams, the New Medicines Fund and activity such as brain injuries and transcatheter aortic valve implantation (TAVI) replacements. The underspend is mostly as a result of vacancies in the central pharmacy team. The New Medicines Fund continues to operate in line with budget. £1.05 million has been funded non-recurrently to address expected additional spend on Chimeric antigen reception T-cell (CAR-T) patients.

3.4 Clinical and Non-Clinical Support Services

3.4.1 Support service departments have annual budgets totalling £119.3 million, with a £0.7 million underspend for the year to date. This average monthly underspend of £0.1 million has been a consistent trend since April.

3.5 Corporate Resource and Reserves

3.5.1 Reserves are £3.2 million overspent for the seven months to October. This is largely as a result of the underlying deficit being held centrally offset by one off benefits. The was no charge from reserves in month 7, as benefits from rates reductions and non-core Departmental Expenditure Limit (DEL) have been recognised.

4. Efficiency and Transformation Programme

4.1 The target for cash releasing savings in the 2019/2020 revenue plan is £23.1 million. We have achieved £9.2 million (40%) by the end of month 7. Appendix 4 forecasts achievement of £16.4 million. Ensuring delivery of the remaining target is key to achieving our financial targets in 2019/2020.

4.2 The main schemes which are behind plan are Acute Operational CRES, adhering to the Nursing Budget and Intermediate Care and Rehabilitation. An evaluation of Intermediate Care and Rehabilitation indicates that it has prevented some emergency admissions however no cash releasing savings have been achieved as no hospital beds have closed due to high numbers of delayed transfer of care.

5. Workforce

5.1 Against a funded establishment for the whole organisation of 9,544 whole time equivalent staff, hours worked in October 2019 amounted to 9,495.

5.2 The table below shows the WTE staff used in each month from April to October 2019. The average is then compared with the average from April to October 2018. This shows an overall reduction of 18 WTE staff.

Apr-19 May-19 Jun-19 Jul-19 Aug-19 Sep-19 Oct-19

Apr -

Oct

2019

average

Apr -

Oct

2018

average

WTE WTE WTE WTE WTE WTE WTE WTE WTE

Contracted Hours 8,795 8,849 8,747 8,808 8,853 8,765 8,812 8,804 8,884

Excess Part Time Hours 349 216 332 258 272 336 254 288 288

Overtime 122 85 91 94 90 92 93 95 92

Bank Staff 192 211 218 244 257 268 281 239 184

Agency Staff 51 59 47 67 54 52 55 55 52

Total WTE 9,509 9,420 9,435 9,471 9,526 9,513 9,495 9,481 9,499

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5.3 The graph below shows the trend for nursing staff. We were 27 over establishment in month 7.

5.4 The year to date nursing agency spend of just over £0.6 million is above 2018/2019

levels. We spent £0.14 million in month 7. The trend has been increasing since June but reduced in October.

5.5 We used 822 WTE medical staff, including locums and agency, which is 4 above the

establishment. The increase in contractual hours for doctors reflects a lower junior doctor vacancies than seen in previous years.

3,800

3,900

4,000

4,100

4,200

4,300

4,400

4,500

4,600

4,700

Nov-18 Dec-18 Jan-19 Feb-19 Mar-19 Apr-19May-19 Jun-19 Jul-19 Aug-19 Sep-19 Oct-19

Nu

rsin

g W

TE

Nov-18 Dec-18 Jan-19 Feb-19Mar-

19Apr-19

May-19

Jun-19 Jul-19 Aug-19 Sep-19 Oct-19

Agency Staff 6 6 11 14 19 12 12 8 14 17 20 17

Bank Staff 205 192 213 202 209 192 211 218 244 257 268 281

Overtime 52 51 42 49 67 77 54 56 56 56 56 59

Excess Part Time Hrs 74 114 67 95 116 129 53 150 71 69 146 65

Contracted Hrs 4,257 4,200 4,213 4,217 4,228 4,177 4,216 4,118 4,187 4,181 4,095 4,177

Establishment 4,481 4,509 4,513 4,513 4,516 4,467 4,481 4,506 4,539 4,551 4,588 4,572

00.05

0.10.15

0.20.25

0.30.35

0.40.45

0.5

£ m

illio

n

Nursing Agency Spend

2015/16

2016/17

2017/18

2018/19

2019/20

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5.6

The graph shows medical agency spend, which was £0.559 million in September, rose to £0.653 million in October. The spend up to and including the 7 October 2019 includes VAT which was not reclaimable. Subsequent agency spend is VAT recoverable.

5.7 All NHS Boards formally report consultant vacancies. Consultant vacancies are a main

driver for medical agency expenditure. The chart below illustrates the trend of consultant vacancies within NHS Ayrshire & Arran over the last seven years.

700

720

740

760

780

800

820

840

Me

dic

al W

TE

Nov-18

Dec-18

Jan-19 Feb-19Mar-

19Apr-19

May-19

Jun-19 Jul-19Aug-19

Sep-19 Oct-19

Agency Staff 34 29 42 38 34 32 39 35 42 31 27 31

NHS Locum 16 10 14 17 11 13 22 13 17 17 11 14

Excess Part Time Hrs 2 1 2 2 2 2 2 1 3 1 1 1

Contracted Hrs 759 751 755 750 751 748 744 750 746 752 771 776

Establishment 815 817 817 816 812 808 807 808 810 822 816 818

0

0.2

0.4

0.6

0.8

1

1.2

£ m

illio

n

Medical Agency Spend

2015/16

2016/17

2017/18

2018/19

2019/20

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5.8 Staff sickness absence from work has organisational impact beyond the individual staff

member, affecting other staff, service delivery, productivity and cost, where backfill arrangements have to be put in place.

5.9 Driven by the Board’s People Strategy, the Health, Safety & Wellbeing Improvement Plan identifies the programme of work being undertaken to improve staff health and wellbeing and, through the Promoting Attendance Policy, to have a clear process for appropriately managing staff sickness absence.

5.10 A national standard for sickness absence of 4% exists across NHS Scotland. The graph below shows our performance against this target. We have averaged 4.72% in the year so far.

8.8

15

27.6

41.4

50.1

45.4 45.7

0

10

20

30

40

50

60

Mar-13 Mar-14 Mar-15 Mar-16 Mar-17 Mar-18 Mar-19

Who

le ti

me

equi

vale

nts

(WTE

s)

Consultant Vacancies (from ISD quarterly census)

4.67 4.68 4.88 4.68 4.65 4.62

0

1

2

3

4

5

6

% S

ickn

ess

abse

nce

rat

e

Monthly organisational absence rate (data from eESS)

NHSA&A rate National standard

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6. Risk assessment and mitigation

6.1 The Strategic Risk Register has set out a risk for financial performance as very high. The Board has taken a number of steps to mitigate this position.

6.2 £5.0 million of 2019/2020 acute CRES is very unlikely to be achieved. This is in addition to £2.5 million of previous year CRES which was not expected to be achieved. Mitigating actions in relation to this are outlined in the conclusion.

6.3 A new cost pressure emerged following the rise in delayed discharges. In August 2019 we had 61% higher occupied bed days by delayed discharge patients than in August 2018. This equated in August 2019 to 178 hospital beds being occupied by people who did not need hospital care. This resulted in not living within nursing budget as additional beds require to be staffed. This pressure was evident at both main hospitals and continued during the whole of the second quarter. It remains a pressure in October.

6.4 The Chief Executive previously agreed to fund 34 care home places at a cost of £0.4 million to improve patient flow and unblock delayed discharges at Ayr and Biggart Hospitals. This funding is non recurrent and on a specific patient basis. This funding has been used to place patients in Care Homes who were previously in Ayr and Biggart Hospitals.

6.5 Based on the first five months of Primary Care prescribing data there is a risk of an annual overspend of £3.3 million. Volume growth has averaged 3.7% whilst 0.8% was provided for in budgets. Preliminary September volume information suggests the 3.7% will be applicable for that month also.

7. Conclusion

7.1 The revenue plan approved by the Board was a deficit of £14.75 million.

7.2 At the end of the first half of the financial year the Board is £11.2 million overspent. The £11.2 million includes partnership underspends of £1.1 million which do not belong to NHS Ayrshire and Arran, without which the overspend would be £12.3 million.

7.3 Additional beds resulting from operational pressure and delayed discharges, combined with high primary care prescribing costs and shortfall in CRES delivery (see paragraph 6.2 above) are the main reasons for the overspend being higher than expected. This has been offset in part by non-recurring benefits.

7.4 A paper entitled “mid-year review and outturn projection” went to a meeting of the Performance Governance Committee on 5 November 2019, along with the month six financial management report. This outlined measures to mitigate a projected deficit of £19.8 million which was £5 million worse than the £14.75 million agreed with Scottish Government at the beginning of the year.

7.5 In terms of expenditure reduction, some areas of opportunity had been identified at a Corporate Management Team on 23 October 2019, however these were described at Performance Governance Committee as more of a “housekeeping” nature and are unlikely to significantly reduce the £5 million gap. The Performance Governance Committee therefore considered and supported the following funding proposals:-

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£1.2 million capital to revenue transfer;

request a further £1.6 million of non-core DEL funding from Scottish Government;

request flexibility from East Ayrshire Integration Joint Board to retain about £0.8 million projected underspend in 2019/2020 and repay it in 2020/2021.

7.6 The above funding options contain risks and are not guaranteed, however have been reflected in the reserves outturn on Appendix 1. The remaining gap of over £1 million has not a level of confidence to reflect in reserves the following:

a VAT tribunal in June 2019 related to prison medical services which, if successful, has a benefit of £0.6 million;

a national risk share introduced for chimeric antigen reception T-cell therapy (new treatment where three Ayrshire patients are treated at a cost of over £1 million). If all patients covered then the refund may be £0.5 million.

7.7 The above measures are proposed to give the Board a reasonable prospect of achieving the required £14.75 million deficit outturn.

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Appendix 1

FOT M7

Budget Expenditure Variance Budget Expenditure Variance Budget Expenditure Variance

£000 £000 £000 £000 £000 £000 £000 £000 £000 £000 £000 £000 £000

Acute £241,044 £139,820 £140,793 (£972) £94,178 £52,698 £59,477 (£6,779) £335,221 £192,519 £200,270 (£7,751) (£11,200)

East Hscp £44,685 £25,086 £26,057 (£971) £138,035 £79,405 £78,144 £1,262 £182,720 £104,491 £104,201 £291 £0

North Hscp £70,762 £41,441 £41,078 £363 £78,634 £45,649 £46,572 (£923) £149,396 £87,090 £87,650 (£560) (£1,441)

South Hscp £25,225 £14,784 £15,268 (£484) £61,978 £36,103 £36,540 (£436) £87,203 £50,887 £51,807 (£920) (£1,651)

Other Clinical Services £9,285 £5,412 £4,899 £513 £15,682 £8,382 £8,489 (£108) £24,967 £13,794 £13,388 £406 £446

Hospital Community and Family Health Services (section 1) £391,001 £226,543 £228,094 (£1,551) £388,507 £222,238 £229,222 (£6,984) £779,508 £448,781 £457,316 (£8,535) (£13,846)

Chief Executive £1,114 £650 £619 £31 £79 £25 £38 (£13) £1,193 £675 £657 £18 £32

Director Public Health £5,059 £2,957 £2,825 £132 £855 £511 £459 £51 £5,914 £3,468 £3,285 £183 £210

Medical Director £3,786 £2,256 £2,090 £166 (£2,755) (£1,883) (£1,758) (£126) £1,032 £372 £332 £40 £189

Nursing Director £4,873 £2,791 £2,616 £175 £135 £93 £139 (£46) £5,009 £2,883 £2,755 £128 £100

Corporate Support Services £37,443 £21,619 £21,544 £75 £57,648 £28,233 £28,315 (£81) £95,091 £49,852 £49,858 (£6) £0

Finance £4,169 £2,432 £2,293 £139 (£680) (£413) (£358) (£55) £3,489 £2,018 £1,935 £83 £92

ORG and HR Development £4,536 £2,625 £2,545 £80 £255 £176 £177 (£1) £4,791 £2,801 £2,722 £79 £144

West Of Scotland Region Ce £0 £0 £141 (£141) £1,316 £146 £5 £141 £1,316 £146 £146 £0 £0

Transformation+sustainability £1,405 £808 £611 £197 £100 £28 £28 (£1) £1,505 £836 £640 £196 £300

Clinical and Non Clinical Support Services (Section 2) £62,386 £36,137 £35,284 £853 £56,954 £26,915 £27,046 (£132) £119,340 £63,052 £62,331 £721 £1,067

Corporate Income (non RRL) £459 £459 £459 £0 £3,679 (£75) £83 (£157) £4,139 £385 £542 (£157) (£202)

Corporate Reserves £504 £167 £0 £167 (£3,387) (£3,352) £0 (£3,352) (£2,884) (£3,185) £0 (£3,185) (£2,928)

Corporate Resource and Reserves £963 £626 £459 £167 £292 (£3,427) £83 (£3,509) £1,255 (£2,800) £542 (£3,342) (£3,130)

NHS A&A Total £454,350 £263,307 £263,838 (£531) £445,753 £245,726 £256,351 (£10,625) £900,102 £509,033 £520,188 (£11,156) (£15,909)

Salaries Supplies Total

Annual

Budget

Year to Date

Annual Budget

Year to Date

Annual

Budget

Year to Date

Variance

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Appendix 2

Budget Expenditure Variance Budget Expenditure Variance Budget Expenditure Variance

£000 £000 £000 £000 £000 £000 £000 £000 £000 £000 £000 £000

Surgical - Ayr £34,567 £20,215 £20,059 £157 £11,640 £6,816 £7,236 (£420) £46,208 £27,031 £27,295 (£264)

Medical - Ayr £29,336 £17,328 £17,765 (£437) £2,312 £1,405 £1,924 (£519) £31,648 £18,733 £19,689 (£956)

Surgical - Chouse £46,284 £26,999 £27,189 (£190) £8,355 £3,554 £4,125 (£571) £54,639 £30,554 £31,314 (£760)

Medical - Chouse £49,368 £28,914 £30,376 (£1,461) £10,659 £6,268 £7,373 (£1,105) £60,027 £35,182 £37,749 (£2,567)

Women + Childrens £33,347 £19,450 £19,464 (£15) £2,559 £1,251 £1,819 (£568) £35,906 £20,701 £21,283 (£582)

Diagnostic Svs £27,840 £16,218 £15,401 £817 £5,783 £3,264 £4,065 (£801) £33,624 £19,482 £19,466 £16

Other £13,363 £6,649 £6,651 (£2) £52,982 £30,202 £32,822 (£2,620) £66,345 £36,851 £39,473 (£2,622)

Acute Medical Records £6,938 £4,047 £3,889 £158 (£113) (£62) £112 (£174) £6,824 £3,985 £4,001 (£16)

Acute £241,044 £139,820 £140,793 (£972) £94,178 £52,698 £59,477 (£6,779) £335,221 £192,519 £200,270 (£7,751)

Salaries Supplies Total

Annual

Budget

Year to Date

Annual

Budget

Year to Date

Annual

Budget

Year to Date

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Appendix 3

Description

Baseline

recurring

£

Earmarked

recurring

£

Non-

recurring

£

Total

£

Initial baseline including uplift 719,959,000 719,959,000

Adjustment for 2018-2019 recurring allocations 2,167,948 2,167,948

SLA Children’s Hospices Across Scotland (Year 3 / 5) (443,595) (443,595)

S28 Carers (Scotland) Act 2016 - tests of

change/evaluation75,972 75,972

Elective activity as per AOPs 4,153,340 4,153,340

To implement recommendations in Best Start 387,116 387,116

6EA -Unscheduled Care 550,000 550,000

Open University Nursing Students Q3 & 4 75,000 75,000

Implementation of type 2 diabetes prevention 289,000 289,000

Outcomes Framework 2019-20 3,869,280 3,869,280

Employer Pension Contributions 17,680,000 17,680,000

General Dental Services element of the Public Dental

Service1,950,000 1,950,000

Implementation - Child Weight Management Services

Standards83,000 83,000

FASD Project 192,084 192,084

Family Nurse Partnership programme 770,759 770,759

Breastfeeding PfG year 2 project funding 194,500 194,500

Transforming NHS Services 1,050,000 1,050,000

Excellence in Care 70,000 70,000

Embedding advice services in health settings 62,500 62,500

Cancer and diagnostics activity in 2019/20 394,000 394,000

Mental Health Strategy Action 15 Workforce - First

Tranche639,798 639,798

£20m (2018-19) tariff reduction to global sum (1,391,389) (1,391,389)

£20m (2019-20) tariff reduction to global sum (1,550,290) (1,550,290)

Disestablishment of 4 year GPST programmes 475,566 475,566

Additional funding for elective activity as per AOPs 60,000 60,000

eHealth Strategic Fund 1,401,988 1,401,988

Integrated Primary and Community Care 591,200 591,200

Employer Pension Contributions - second instalment 427,000 427,000

Alcohol & Drug Partnership - Local Improvement Fund 1,108,932 1,108,932

Woodhill Unitary Charge 4,271,861 4,271,861

Draw down of 2018/19 carry forward 494,000 494,000

NDC Top slice (966,687) (966,687)

Primary Care Improvement Fund 2019-20 Tranche 1 2,026,931 2,026,931

Draw down of 2018/19 carry forward 1,032,500 1,032,500

GP Out of Hours (OOH) Fund 369,663 369,663

Contribution to Pharmacy Global Sum (203,200) (203,200)

CSO - support for research infrastructure 661,000 661,000

Elective activity as per AOPs 600,000 600,000

Flow Variability Programme 70,000 70,000

Combat Stress Specialist Mental Health Services 1,424,090 1,424,090

Veterans First Point Service 103,923 103,923

Supporting improvements in primary care digital 249,605 249,605

Salary cost for JC - Sept - March 52,800 52,800

Primary Medical Services - provision and support 60,196,490 60,196,490

Supporting improvements to GP premises 221,798 221,798

TEC funding to support local scale up 58,000 58,000

Supporting better value healthcare in Boards 77,864 77,864

Paid as if at work 600,000 600,000

National Cancer Strategy 110,321 110,321

Shingles, Rotavirus, Seasonal Flu 1,043,923 1,043,923

Open University Nursing Students 1st & 2nd Quarter 110,000 110,000

Pre-Registration Pharmacist Scheme (170,740) (170,740)

Positron Emission Tomography (PET) Scans - (587,547) (587,547)

Winter funding 709,728 709,728

AOP funding for elective activity 676,680 676,680

Voluntary Redundancy Funding 1,200,000 1,200,000

Other Smaller Allocations (45,204) (4,379) 295,179 245,596

Total 740,188,744 70,946,494 18,836,070 829,971,308

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Appendix 4

Plan v Forecast £000 £000 £000 £000 £000

Plan Area Plan Forecast M7 Variance YTD Savings M7-M6 Change

Acute Operational 4,500 482 (4,018) 202 0

Reduce Medical Agency 1,000 811 (189) 543 (179)

External SLAs 2,000 2,000 0 1,167 0

Corporate Support Services 1,360 1,360 0 739 0

Intermediate care and rehab 1,000 - (1,000) - 0

Close Unfunded Beds 1,300 1,300 0 758 0

Corporate Dept CRES 880 820 (60) 478 0

Outpatient Paperlite 100 90 (10) 40 0

Cardiac ward reconfiguration 450 412 (38) 233 0

Energy 100 100 0 58 0

Estate Rationalisation 200 200 0 117 0

Adherence to Nursing Budget 2,300 526 (1,774) 100 1

Stop Nurse pool 200 200 0 200 0

Redeployment Pool 400 690 290 345 0

Primary Care Prescribing 2,773 2,773 0 1,633 0

Acute Prescribing 3,000 3,000 (0) 1,750 0

Mental Health Legacy CRES 1,600 1,600 0 792 0

Total 23,163 16,364 (6,799) 9,154 (178)

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Monitoring Form

Policy/Strategy Implications

Overspending areas in acute services could adversely impact the delivery of the strategic direction for the Board in moving investment towards community based.

Workforce Implications

Informs the forward workforce plan.

Financial Implications

Corrective action required for the Board to be operating in line with the statutory target to operate within the revenue and capital resource limits.

Consultation (including Professional Committees)

Directorates receive monthly financial reports. Financial reports are received at Corporate Management Team and Performance Governance Committee.

Risk Assessment

The risk tolerance agreed for investment is “medium” which includes “prepared to accept possibility of some limited financial loss, but value for money is still the primary concern.

Best Value

Vision and leadership

Effective partnerships

Governance and accountability

Use of resources

Performance management

Confirms ongoing, effective use of resources and management in year of risks and issues in relation to achieving agreed financial performance targets.

Compliance with Corporate Objectives

Delivery of efficient and effective services within budget and to develop a culture of continuous improvement.

Single Outcome Agreement (SOA)

Not applicable.

Impact Assessment This report is a monitoring report therefore does not require an equality and diversity impact assessment (EDIA).