1

 

Agenda Item No: 7.1

Date of Meeting: 28th January 2016

Governing Body Meeting in Public

Paper Title: Finance Report Month 8  2015/16

Decision Discussion Information Follow up from last meeting

Report author: Julie Williams, Senior Finance Manager 

Report signed off by: Alan Pond, Chief Finance Officer

Purpose of the paper: This paper provides details of the finance position at the end of 

November.   

Conflicts of Interest involved:

n/a

Recommendations to the Governing Body

To note the Month 8 position. 

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Finance Report 2015/16 CCG Governing Body Public Meeting 4th February 2016 

 

1  PURPOSE OF THE PAPER 

To provide the financial position of the CCG at the end of November 2015.   

2  APPENDICES 

Appendix 1 –Acute Commissioning 

 

3  TERMS/ACRONYMS USED IN THE REPORT  

Initials  In full 

B&CF  Barnet and Chase Farm Hospital Trust 

BEH  Barnet, Enfield and Haringey 

BPPC  Better payments practice code

BSA  Business Services Authority

CCG  Clinical Commissioning Group

CHC  Continuing healthcare

CUFT  Cambridge University Foundation Trust

ED  Emergency department 

FNC  Funded nursing care

FYE  Full year effect 

HCT  Hertfordshire Community Trust 

HPFT  Hertfordshire Partnership Foundation Trust 

MCD  Maximum cash drawdown 

MH  Mental health 

MVCC  Mount Vernon Cancer Centre 

NHSE  NHS England 

PAH  Princess Alexandra Hospital 

RTT  Referral  to treatment 

UCC  Urgent care centre

UCLH  University College London Hospitals

YTD  Year to date 

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4   LATEST SUMMARY POSITION    

     

  

             

Overall Position G 56 G 0

Acute contracts G (1,302) R (2,954)

Based on month 7 reports

GP Prescribed Drugs R (467) R (699)

Non acute commissioning and Primary Care R (194) R (717)

Transformation reserve and investments G 1,177 G 0

Running Costs G 841 G 900

% Utilised % UtilisedContingency G 0.00% G 0.00%

£ committed £ committedG 0 G 0

Value

Better Payments Practice Code (BPPC) NHS 89.2% 96.0%(Target is 95% of invoices by value and number are paid within 30 days) Non-NHS 97.2% 97.6%

Invoices

YTD

VARIANCE AGAINST PLANNOVEMBER 2015

FORECAST£'000

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5  EXPENDITURE REPORT   

5.1.1 CCG Allocation and Budgets  The CCG’s allocation has increased by £1,771k since last month, as shown in the table below.    

Month

8 £'000 Allocation prior month 685,058 New allocations: Liaison Psychiatry 116 Quality Premium 2014/15 849 Vanguard 806 Total notified allocation 686,829

   

5.1.2  CCG Overall Position  

The planned position is an underspend of £7,743k at year end.   The year to date position shows an underspend of £56k against plan.   The table below shows  further detail of the financial position by broad budget heading.    

    

DescriptionAnnual budget £'000

YTD budget £'000

YTD Actual £'000

YTD Variance

£'000

FOT Variance

£'000

Previous month

forecast variance

£'000

Forecast Movement

£'000

Allocation 686,829

Budget HeadingAcute Commissioning 374,999 249,947 251,249 (1,302) (2,954) (2,701) (253)Non Acute Commissioning 170,818 115,259 116,648 (1,389) (2,516) (2,828) 312GP Prescribed Drugs 76,901 51,239 51,706 (467) (699) (669) (31)Other Primary Care 18,724 11,921 10,726 1,195 1,799 940 860Running Costs 12,334 8,222 7,381 841 900 900Transformation reserve 9,839 3,340 2,163 1,177 3,470 4,160 (690)Recurrent investment fund 2,546Resilience funding 4,061 624 624 198 (198)MH investment fund 3,496Contingency reserve 3,358LD & CAMHS transformation funding 2,010Total 679,086 440,553 440,497 56 0 0 0

TOTAL UNDER/(OVER) SPEND 7,743 7,743 7,743 (0)

POSITION AS AT 30TH NOVEMBER 2015

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5.2  Locality Positions 

 5.2.1  Locality year to date position  

   5.3  Commissioning – Acute 

 5.3.1  Financial Performance 

   

DescriptionYTD

Allocation £'000

YTD Actual £'000

YTD Variance pre Contingency

£'000

Previous month

Variance extrapolated

£'000

Variance Movement

North Herts 83,994 83,955 39 181 (141)Lower Lea Valley 57,104 57,486 (383) (107) (276)Stevenage 68,269 69,416 (1,147) (1,161) 14Welhat 79,323 79,218 105 (5) 111Upper Lea Valley 81,910 81,900 9 (116) 126Stort Valley & Villages 40,443 40,625 (182) (311) 129Unattributable 18,656 19,413 (757) (559) (198)Running Costs 8,079 6,886 1,193 1,247 (54)Transformation reserve 3,340 2,163 1,177 1,170 7Contingency 0 0 0 0 0

Total 441,119 441,062 56 338 -282

TOTAL UNDER/(OVER) SPEND 7,743

FINANCE REPORT - LOCALITY SUMMARY POSITION AS AT 30TH NOVEMBER 2015

DescriptionAnnual budget £'000

YTD budget £'000

YTD Actual £'000

YTD Variance

£'000

FOT Variance

£'000

Previous month FOT

Variance £'000

East and North Herts Trust (incl MVCC) 196,564 130,936 133,028 (2,092) (3,887) (3,799)Princess Alexandra Hospital 54,348 36,232 36,679 (447) (671) (747)Royal Free FT 23,197 15,465 16,971 (1,506) (1,977) (1,569)Independent Sector 22,464 14,976 15,165 (189) (284) (232)Cambridge University Hospitals 11,068 7,379 7,367 12 13 13Other Acute 64,599 43,066 41,972 1,093 1,192 874Reserve for potential contract shortfalls 2,759 1,894 66 1,828 2,660 2,759

TOTAL 374,999 249,947 251,249 (1,302) (2,954) (2,701)

COMMISSIONING - ACUTE POSITION AS AT 30TH NOVEMBER 2015

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East and North Herts Trust  At Month 8, East  and North Herts NHS Trust  (ENHT)  is  showing  an over performance of £2,092k, including a £19k under performance at Mount Vernon Cancer Centre.  This includes the application of penalties totalling £1,380k.  The key services that continue to drive  the over performance against plan are non‐elective activity (£161k),  outpatients  (£345k),  maternity  (£168k),  adult  critical  care  (£970k)  and  high  cost  drugs (£950k). Elective activity at Month 8 was showing an under performance of £137k.  Non‐consultant led first appointments continue to account for the majority of the over performance within outpatients (£456k). Further  investigation has found that there was a number of anaesthetic pre‐operative  assessments  for  ophthalmology  and  orthopaedics  that  were  carried  out  in  the Clinicentre, which when transferred back to ENHT were not captured in the activity reports for 2014‐15.  It  is estimated  that  in 2014‐15  this amounted  to £486k of activity  that was not charged  to  the CCG, and which is now being reflected in the monthly finance outturn but is not reflected in the plan.  Further  discussions  around  the  current  over  performance  in  adult  critical  care  have  highlighted  a couple  of  areas  that  require  further  investigation.  The  number  of  critical  bed  days  attributed  to ENHCCG averaged 336 per month between M3 and Month 5. This has increased to an average of 475 per month between Month 6 and Month 8. This is driven by a combination of additional respiratory high  dependency  unit  activity  (new  this  year  following  the  accreditation  of  4  beds)  and  also  an increase in Lister critical care unit activity, which is likely due to the consolidation of services.  Figure 1: Adult Critical Care Costs by Commissioner  

  As indicated in Figure 1, NHS England have not been charged any critical care bed days during the last three  month  period,  compared  to  an  average  of  60  bed  days  per  month  prior  to  this  period. However, analysis shows that a number of critical care patients have been charged to the CCG which despite the value of these spells is to be confirmed by ENHT. These spells should have been charged to NHSE and these are being followed up with the Trust. 

0

100

200

300

400

500

600

1 2 3 4 5 6 7 8 9 10 11 12 1 2 3 4 5 6 7 8

2014/15 2015/16

E&NH Beds NHSE Others inc NCA

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 An audit of  readmissions at ENHT undertaken earlier  in 2015‐16,  suggests  that  there has been an improvement  in  the proportion of  avoidable  readmissions  attributable  to  ENHT;  a  reduction  from 23.8% to an estimated 14%. Although a final validation of the figures is currently being undertaken, it is estimated that at month 8 there will be an additional cost of £600k, which has been included in the figures. The high cost drugs spend at month 8  is £950K. A  full validation of the charges  is currently being undertaken by the CCG.      

Princess Alexandra Hospital (PAH)  At month 8, Princess Alexandra Hospital (PAH) is over‐performing by £447k (1%) against straight‐line plan.   This position  includes  the application of penalties capped at £872k  (2.5% of SLA value), and assumes £667k potential reinvestment of those penalties (£1m full year effect).  The Trust’s month 8 SLAM  report  (before penalties &  reinvestments)  showed  an over‐performance of £714k  (2%), but included charges for non‐chargeable scans, outpatient follow ups in excess of the agreed ratios, and MRET & re‐admissions at planned levels.  The key services driving the over‐performance are non‐elective (£494k), Outpatient First attendances (£368k, mainly  ophthalmology,  gynaecology,  cardiology &  anticoagulation),  Outpatient  Follow  Up (£120k),  Critical  Care  (£350k),  A&E  (£191k),  and  High  Cost  Drugs/Devices  (£280k  net  of  agreed challenges).  Elective activity is over plan by £441k, though this is offset by under‐performance in day‐case activity of £230k.    Other non‐elective spells continue to under‐perform against plan (£1,139k) bringing the overall non‐elective position to an under‐performance of £645k.    The month 8  report  includes Maternity Pathway  charges of £163k which have yet  to be validated against  data  from  ENHT.    There  has  also  been  a  significant  increase  in  Direct  Access  Cardiology charges from month 6 onwards which has been queried with the Trust.  The arbitration panel convened to mediate disputes between West Essex and PAH in December and found that: •  RTT and 52 week breach penalties should be applied •  Coding and Counting Changes ‐ no change of practice had been proven and the Trust should 

be reimbursed for properly coded and recorded activity •  Incorrect counting of non‐elective admissions (identified in the Re‐admissions audit) – further 

work to be done         

  

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Royal Free Foundation Trust  There is a Trust wide over performance of £1,506k at month 8.  The  Barnet  &  Chase  Farm  site  has  an  over  performance  of  £1,269k.  The  main  areas  of  over performance are Critical Care (£350) Non Elective (£312k), Direct Access (£257k) and Post Discharge Rehabilitation (£152k)  Critical Care  is 290 days over plan which  includes 3  long  length of stay patients previously reported with a combined cost of £274k. Non Elective is 226 episodes above plan mainly driven by A&E, T&O, General Medicine and Geriatric Medicine. Post Discharge Rehabilitation is over performing by £152k, which is mainly due to delayed transfers of care (DTOC) patients. A CCG investigation is underway in conjunction with the Royal Free. There have been no DTOC reported in the last month.   Direct Access  is  over  performing  by  £257k, mainly  in  Radiology  and Audiology.  The  Royal  Free  is currently  reviewing  the data  to ensure  that  there  is no duplicate activity  resulting  from  the  recent radiology systems.    The Royal Free site has an over performance of £237k which is predominately in Day Cases.  There has been a more complex case mix and an increase in Coronary Intervention Stents.    5.3.2 Activity  The following charts show activity from April 2013 to November 2015.   

  In month  8  there  has  been  an  increase  in Outpatient  First  attendances  particularly  in  Stevenage, Welwyn Hatfield and lower Lea Valley.  

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  The  elective  activity  continues  to  be  very  similar  to  previous  years.  The  CCG  has  seen  a  slight reduction in month 8 which is echoed in most localities.   

   Activity at the start of the year was at a much lower level than previous years. The increase in activity in July is mainly due to the closure of Spring House for walk in patients who were re‐directed to the new QEII Urgent Care Centre. Activity has  increased  in Stevenage, Welwyn Hatfield and Upper Lea Valley.   

10

  Emergency activity has been running above historic levels all year, however, in month 8 it fell more in line with  last year with a  large reduction  in particular  in Upper Lea Valley, Stort Valley and Villages and Welwyn Hatfield.   5.4  Commissioning – Non Acute  

The forecast overspend has reduced by £312k, most of which relates to Community Services where the underspend has increased by £206k. Quarter 2 saw a reduction in activity in some of our cost and volume contracts. Continuing healthcare spend continues to overspend but the rate of increase has started to level off.     

DescriptionAnnual budget £'000

YTD budget £'000

YTD Actual £'000

YTD Variance

£'000

FOT Variance

£'000

Previous month FOT

Variance £'000

MH/LD Contracts and NCAs 68,258 45,999 45,647 352 575 620IAPT 5,106 3,404 3,460 (56) (85) (85)Hertfordshire Community Trust 39,233 26,155 26,155 0 0 0Community Services excl HCT 5,001 3,334 3,297 37 208 2Continuing Healthcare & FNC 26,228 18,373 20,539 (2,166) (3,594) (3,481)Intermediate Care 2,718 1,812 2,027 (215) (289) (431)Better Care Fund 14,063 9,375 9,375 0 0 0Hospices 3,395 2,263 2,208 55 47 47NHS Property Services Ltd 1,886 1,257 1,257 0 0 0

0Other Non Acute 4,930 3,287 2,683 604 622 500

TOTAL 170,818 115,259 116,648 (1,389) (2,516) (2,828)

COMMISSIONING - NON ACUTE POSITION AS AT 30TH NOVEMBER 2015

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 5.5  Commissioning – Primary Care  

  The  prescribing  figures  are  based  on  the April  to October  figures  issued  by  the  Business  Services Authority. The forecast remains very much in line with last month.   The forecast movement for the £5 per head is due to a recent evaluation of Health checks which have been undertaken to date.  The numbers achieved so far suggest that, at best, only c70% of population will be achieved by April.    5.6  Transformation Reserve 

 The table below shows the  list of schemes which, at Month 8, are currently assumed to be  funded from the non‐recurrent transformation reserve.    

DescriptionAnnual budget £'000

YTD budget £'000

YTD Actual £'000

YTD Variance

£'000

FOT Variance

£'000

Previous month FOT

Variance £'000

GP Prescribed Drugs 76,901 51,239 51,706 (467) (699) (669)Central Drugs 2,159 1,443 1,458 (15) 0 0Oxygen 754 503 498 5 0 0Scriptswitch 245 163 166 (3) 0 0Local Enhanced Services 3,586 2,391 2,449 (58) (100) (100)Primary Care IT 1,495 997 997 0 0 0Out of Hours 4,545 3,030 3,030 0 (0) (0)

£5 and £1 per head 3,524 2,349 1,109 1,240 1,899 1,040

Acute in hours visiting service 1,567 1,045 1,019 26 0 0

Quality Premium 849

TOTAL 95,625 63,160 62,431 729 1,100 271

COMMISSIONING - PRIMARY CARE POSITION AS AT 30TH NOVEMBER 2015

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   A summary of all uncommitted funding is shown in the table below.  

  This  shows  that  there  is  currently headroom  of  £10.2m  to  offset  any  further  risks.    The  CCG  has already had initial discussions with NHSE around carrying this forward into 2016/17. 

 

Schemes funded from Transformation Funds AllocationIncluded in

Budgets Total £'000 £'000 £'000

Funds available1.5% of recurrent baseline 9,768 9,768 Brokerage return CCGs 6,000 6,000 Brokerage return NHSE 1,500 1,500 Continuing Healthcare national top-slice (2,664) 2,664 - Royal Free acquisition costs (700) 700 - Homefirst N Herts April - June (526) 526 - ENHT reduced waiting times (3,539) 3,539 - Total 9,839 7,429 17,268

Commitments: Map of medicine 82Isabel Hospice (Homefirst pilot) 70Leg ulcer project Upper Lea Valley 110CHC Retrospective team 300Integrated geriatric response vehicles (full year) 752Interface geriatricians ENHT 200In practice pharmacist roll out (part year est Jan 16 start) 70Get Healthy Get Active funding 50CARS service PAH 50Pharmacy HC420 scheme 25Isabel Hospice CHC bed 14Children's commissioner 12Childhood obesity 36Personal health budgets 17Royal College Psychiatric Review 20Comms re winter 56Diabetes telehealth 31Primary Care Nurse Tutors 131

Total spend committed 2,026 - -

Balance of funding available 7,813 -

£'000Forecast variance on allocated budgets (3,470)Uncommitted recurrent investments 2,546Uncommitted transformation fund 7,813Uncommitted contingency reserve 3,358

Total uncommitted 10,248

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6  BALANCE SHEET  6.1  Cash  The table below shows the total amount of cash utilised compared with the amount that would be expected  if  the annual amount,  referred  to as maximum cash drawdown  (MCD) was spent equally throughout  the  year.    The MCD  is  calculated  as  the  CCG’s  allocation  adjusted  for  non‐cash  items (depreciation), the planned underspend, and the opening cash bank balance.   

   This shows that £4.9m less cash was drawn down than 8/12 of the annual MCD.  This is because there has  been  less  than  proportionate  8/12  spend  on  the  transformation  fund,  investment  fund  and contingency reserves.   6.2  Balance sheet as at 30st November 2015  The table below shows the movement in the balance sheet between the end of March 2015 and end of November 2015.  

Cumulative year

to Date£ 000's

Cash Drawn from NHSE 389,500 CHC retrospective payment 2,664 Drugs recharges 51,626 Home oxygen recharges 490 Total cash drawings 444,279 Cash book position 266 Total cash utilised 444,546

Maximum cash annual drawdown 674,177 Cash PhasingEqual 1/12ths 449,451 Disproportionate Usage (4,905)( ) indicates less cash drawn than expected)

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  6.3  Debtors  The table below shows an analysis of the debtors figure in the balance sheet, by length of time since the raising of invoices.  

   Alan Pond Chief Finance Officer January 2016 

Opening 

balance 31 

March 2015

Closing 

balance end 

October 

2015

ytd 

movement

£'000 £'000 £'000

Non-current AssetsProperty, Plant & Equipment 906 897 (9)

Current AssetsTrade & Other Receivables 9,702 9,547 (154)

Cash & Cash Equivalents 167 (266) (433)

Total Assets 10,775 10,178 (597)

Current LiabilitiesTrade & Other Payables: (42,087) (37,708) 4,379

Provisions (984) (984) (0)

Total Current Liabilities (43,071) (38,692) 4,379

Total Assets Employed (32,296) (28,514) 3,783

Financed by Taxpayers’ Equity

General Fund 32,296 28,514 (3,783)of which:

Cash drawings & top-slice (444,279)

Expenditure 440,497

Total Taxpayers’ Equity 32,296 28,514 (3,783)

£000Current 2,348Overdue 1-30 days 71Overdue 31-60 days 0Overdue 61-90 days -23Overdue 91-120 days 0Overdue 121-180 days 0Overdue 181-360 days 0Overdue 361+ days 0

Total due amount 2,396

AR overdue 91+ amount 0

91+days % of total 0.0%

15

APPENDIX 1

EAST & NORTH HERTS CCGACUTE REPORT 2015-16 MONTH 8

DescriptionAnnual budget £'000

YTD budget £'000

Actual £'000 YTD

Variance £'000

Forecast Variance

£'000ContractsLocal Trusts

East & North Herts 196,564 130,936 133,028 (2,092) (3,887)

Princess Alexandra 54,348 36,232 36,679 (447) (671)

Royal Free 23,197 15,465 16,971 (1,506) (1,977)

Independent Sector 22,464 14,976 15,165 (189) (284)

Cambridge University Hospitals 11,068 7,379 7,367 12 13

West Herts Hospitals 2,705 1,803 1,747 57 85

Luton & Dunstable 1,190 793 646 147 221

Other Trusts

UCLH 7,594 5,063 4,778 285 294

North Middlesex 6,360 4,240 4,761 (521) (781)

Moorfields 3,949 2,633 2,462 170 256

Royal National Orthopaedic 3,103 2,069 2,293 (225) (337)

Barts Health 2,294 1,529 1,865 (336) (503)

Royal Brompton & Harefield 1,809 1,206 994 212 318

Papworth 1,361 907 826 82 122

Mid Essex 1,300 867 890 (23) (35)

Guys & St Thomas 1,077 718 924 (206) (310)

Imperial College 1,062 708 613 95 142

North West London 928 619 462 156 235

Great Ormond Street 856 571 597 (27) (40)

Basildon & Thurrock 1,033 689 509 179 269

Chelsea and Westminster 323 215 214 1 2

Kings 289 193 257 (64) (96)

Bedford 336 224 176 48 72

Whittington 291 194 164 30 44

The Royal Marsden 222 148 80 68 102

East of England Ambulance & PTS 19,391 12,927 12,672 255 383

Other Acute

Non Contract Activity (NCAs) 4,991 3,327 3,483 (155) (233)

IVF 1,131 754 688 66 99

Cheshunt MIU & ENHT UCC 757 505 549 (45) (67)

Services Outside Contracts 82 55 63 (8) (11)

IFRs 165 110 103 7 10

Winter Pressures

Reserves 2,759 1,894 66 1,828 2,660

Prior year balance (845) 845 951

TOTAL 374,999 249,947 251,249 (1,302) (2,954)

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APPENDIX 2 (page 1 of 2)

000's £000's 000's 000's

Summary Budget Actual Variance Budget Actual Variance Budget Actual Variance Budget Actual Variance

Year to Date

Year to Date

Year to Date

Year to Date

Year to Date

Year to Date

Year to Date

Year to Date

Year to Date

Year to Date

Year to Date

Year to Date

£000 £000 £000 £000 £000 £000 £000 £000 £000 £000 £000 £000Acute ServicesTariff related1st Outpatient attendances 2,581 2,537 44 1,721 1,703 17 2,339 2,176 163 2,618 2,496 122 Follow-up outpatient attendances 2,836 2,801 35 2,045 2,011 35 2,353 2,339 14 2,627 2,634 (6)Outpatient procedures 1,474 1,442 31 937 895 41 1,100 1,161 (61) 1,160 1,268 (108)Elective admissions 8,459 8,577 (118) 6,455 6,306 149 6,869 7,121 (252) 7,448 7,730 (283)Non-elective admissions 11,889 12,073 (184) 7,443 7,357 86 9,537 10,205 (668) 10,892 10,752 139 Non contract activity (NCAs) 562 611 (49) 485 501 (15) 440 461 (21) 668 770 (102)Discharge Summary Credit 0 0 0 0 0 0 0 0 0 0 0 0 A&E 2,329 2,068 261 1,291 1,415 (124) 2,315 2,078 236 2,648 2,215 433 Maternity 2,999 2,805 194 2,430 2,549 (119) 2,869 2,796 73 3,082 3,068 14 Urgent Care Centres 1 1 (0) 353 384 (31) 1 1 (0) 0 2 (2)Market Forces Factor (pro rata to pbr) 4,970 4,935 35 3,444 3,347 97 4,058 4,289 (231) 4,590 4,641 (51)Threshold (490) (463) (28) (119) (49) (71) (411) (403) (8) (458) (402) (57)Readmissions (486) (482) (4) (264) (266) 2 (397) (420) 23 (446) (442) (4)

Total tariff-related 37,123 36,905 217 26,220 26,152 67 31,072 31,805 (733) 34,828 34,732 95

Non tariff-related 9,096 8,988 107 6,262 7,173 (912) 7,835 7,764 72 8,653 9,240 (588)CQUIN 942 1,004 (63) 458 388 69 806 888 (83) 867 918 (51)Ambulance & Patient Transport 2,601 2,549 53 1,749 1,714 35 2,070 2,028 42 2,453 2,404 50 IVF 155 141 14 104 95 9 123 112 11 146 133 13 Reserves 160 14 146 135 9 126 121 11 111 885 13 873 Further savings required/ funding available 0 0 0 0 0 0 0 0 0 0 0 0 Sub-total Acute 50,076 49,601 475 34,928 35,532 (604) 42,027 42,608 (581) 47,832 47,440 392

Non-acute commissioningMH/LD Contracts and NCAs 9,445 9,373 72 6,351 6,303 48 7,514 7,456 57 8,908 8,840 68 IAPT and Counselling 638 609 29 356 354 3 668 747 (79) 638 696 (58)Community Services excl HCT* 538 422 116 552 434 118 379 350 29 476 416 60 HCT 6,115 6,115 (0) 3,911 3,766 144 4,182 4,252 (69) 4,950 4,947 4 NHS 111 213 212 1 143 143 1 169 169 1 201 200 1 Continuing Healthcare 3,408 3,853 (445) 2,292 2,591 (299) 2,711 3,065 (354) 3,214 3,633 (419)Intermediate Care 372 416 (44) 250 280 (30) 296 331 (35) 351 393 (42)Palliative care 46 0 46 31 0 31 37 0 37 44 0 44 Hospices 418 453 (35) 281 305 (24) 333 361 (28) 395 428 (33)AQP Vasectomy 12 17 (5) 7 7 (0) 12 11 1 14 19 (5)AQP Ophthalmology (was Herts Eye) 54 68 (15) 96 137 (41) 28 63 (35) 104 107 (3)Other Non Acute 53 14 39 103 0 103 45 14 31 58 14 44 Better Care Fund 0 0 0 0 0 0 0 0 0 0 0 0

Sub-total Non Acute 21,311 21,552 (241) 14,372 14,319 53 16,373 16,817 (444) 19,352 19,691 (339)

Primary Care CommissioningGP prescribed drugs 10,335 10,540 (205) 6,276 6,360 (84) 8,061 8,301 (240) 9,997 10,158 (161)Central Drugs 296 297 (1) 199 179 20 236 234 2 279 286 (7)Scriptswitch & Medicines Management 34 34 (1) 23 23 (0) 27 27 (0) 32 32 (1)Oxygen 103 120 (16) 69 69 1 82 85 (3) 97 80 17 Out of hours 622 622 (0) 418 418 (0) 495 495 (0) 587 587 (0)GP IT 0 0 0 0 0 0 0 0 0 0 0 0 Enhanced Services - incl Nursing Homes 491 656 (165) 330 236 94 391 411 (20) 463 425 38 Quality Premium 0 0 0 0 0 0 0 0 0 0 0 0 Acute In Hours Visiting 214 209 5 144 141 4 171 166 4 202 197 5 £5 per head > 75s 402 147 255 270 99 171 320 117 203 379 139 240 £1 per head 80 80 0 54 54 0 64 64 0 76 76 0

Sub-total Primary Care 12,578 12,706 (129) 7,784 7,579 205 9,846 9,900 (55) 12,112 11,980 132

Running Costs 29 95 (66) 20 56 (37) 23 90 (67) 28 107 (79)

Contingency / (further Savings Plans required) 0 0 0 0 0 0 0 0 0 0 0 0 Winter Pressures Funding 0 0 0 0 0 0 0 0 0 0 0 0 Transformation reserve 0 0 0 0 0 0 0 0 0 0 0 0 MH reserve 0 0 0 0 0 0 0 0 0 0 0 0 Investment Funding 0 0 0 0 0 0 0 0 0 0 0 0 Total Allocation - all items within the scope 83,994 83,955 39 57,104 57,486 (383) 68,269 69,416 (1,147) 79,323 79,218 105

This Month - October 2015 North Herts Lower Lea Valley Stevenage Welwyn Hatfield

17

APPENDIX 2 (page 2 of 2)

000's 000's 000's

Summary Budget Actual Variance Budget Actual Variance Budget Actual Variance Budget Actual Variance

Year to Date

Year to Date

Year to Date

Year to Date

Year to Date

Year to Date

Year to Date

Year to Date

Year to Date

Year to Date

Year to Date

Year to Date

£000 £000 £000 £000 £000 £000 £000 £000 £000 £000 £000 £000Acute ServicesTariff related1st Outpatient attendances 2,584 2,865 (282) 1,155 1,459 (304) 49 50 (1) 13,047 13,288 (241)Follow-up outpatient attendances 2,892 3,032 (141) 1,255 1,520 (265) 14 17 (3) 14,022 14,354 (332)Outpatient procedures 1,449 1,428 21 678 684 (7) 6 7 (2) 6,803 6,886 (84)Elective admissions 9,311 9,445 (134) 4,747 4,794 (47) 30 45 (15) 43,318 44,018 (700)Non-elective admissions 10,953 10,788 166 5,120 5,227 (106) 802 881 (79) 56,636 57,283 (646)Non contract activity (NCAs) 741 762 (21) 378 345 33 53 33 20 3,327 3,483 (155)Discharge Summary Credit 0 0 0 0 0 0 0 0 0 0 0 0 A&E 1,904 2,062 (157) 812 974 (162) 288 247 41 11,586 11,058 528 Maternity 3,413 3,325 87 1,715 1,653 62 21 42 (21) 16,529 16,238 291 Urgent Care Centres 127 139 (11) 2 2 (0) 10 10 (1) 493 539 (46)Market Forces Factor (pro rata to pbr) 5,002 4,980 22 2,389 2,436 (46) 185 194 (9) 24,638 24,821 (183)Threshold (364) (235) (129) (140) (50) (91) (33) (24) (9) (2,017) (1,625) (392)Readmissions (450) (443) (6) (214) (219) 5 (33) (30) (3) (2,290) (2,303) 13

Total tariff-related 37,562 38,148 (586) 17,896 18,824 (928) 1,391 1,472 (82) 186,092 188,039 (1,948)

Non tariff-related 8,550 7,967 583 3,454 3,130 324 221 1,287 (1,066) 44,069 45,549 (1,479)CQUIN 951 879 71 448 382 66 0 34 (34) 4,470 4,494 (24)Ambulance & Patient Transport 2,542 2,490 51 1,254 1,229 25 0 0 0 12,669 12,413 256 IVF 151 138 13 75 68 7 0 0 0 754 688 66 Reserves 175 13 162 196 7 190 221 0 221 1,894 66 1,828 Further savings required/ funding available 0 0 0 0 0 0 0 0 0 0 0 0 Sub-total Acute 49,930 49,636 295 23,322 23,639 (316) 1,833 2,793 (961) 249,948 251,249 (1,301)

Non-acute commissioningMH/LD Contracts and NCAs 9,228 9,157 71 4,554 4,519 35 0 0 0 45,999 45,647 352 IAPT and Counselling 736 772 (36) 368 283 86 0 0 0 3,404 3,460 (56)Community Services excl HCT* 743 489 254 646 550 96 0 0 0 3,334 2,661 673 HCT 4,439 4,533 (94) 2,558 2,543 15 0 0 0 26,155 26,155 0 NHS 111 208 207 1 103 102 0 0 0 0 1,037 1,033 4 Continuing Healthcare 3,329 3,764 (435) 1,643 1,857 (214) 1,776 1,776 0 18,373 20,539 (2,166)Intermediate Care 363 407 (43) 179 201 (21) 0 0 0 1,812 2,027 (215)Palliative care 45 0 45 22 0 22 0 0 0 226 0 226 Hospices 409 443 (34) 202 219 (17) 0 0 0 2,037 2,208 (171)AQP Vasectomy 18 17 2 7 7 1 0 0 0 70 77 (7)AQP Ophthalmology (was Herts Eye) 68 105 (37) 15 13 2 0 0 0 364 493 (129)Other Non Acute 38 0 38 36 17 19 2,742 2,915 (173) 3,073 2,973 100 Better Care Fund 0 0 0 0 0 0 9,375 9,375 0 9,375 9,375 0

0 0 0 0 Sub-total Non Acute 19,625 19,893 (268) 10,333 10,310 23 13,893 14,066 (173) 115,260 116,648 (1,388)

Primary Care CommissioningGP prescribed drugs 10,134 10,328 (194) 5,692 5,664 28 744 355 389 51,239 51,706 (467)Central Drugs 289 291 (2) 143 160 (17) 0 10 (10) 1,443 1,458 (15)Scriptswitch & Medicines Management 33 33 (1) 16 16 (0) 0 0 0 163 166 (3)Oxygen 101 98 3 50 46 4 0 1 (1) 503 498 5 Out of hours 608 608 (0) 300 300 (0) 0 0 0 3,030 3,030 (0)GP IT 0 0 0 0 0 0 997 997 (0) 997 997 (0)Enhanced Services - incl Nursing Homes 480 490 (11) 237 230 6 0 0 0 2,391 2,449 (58)Quality Premium 0 0 0 0 0 0 566 566 0 566 566 0 Acute In Hours Visiting 210 204 5 103 101 3 0 0 0 1,045 1,019 26 £5 per head > 75s 393 144 249 194 71 123 0 0 0 1,957 717 1,240 £1 per head 79 79 0 39 39 0 0 0 0 392 392 0

Sub-total Primary Care 12,325 12,275 50 6,774 6,627 147 2,307 1,929 378 63,725 62,997 728

Running Costs 29 96 (68) 14 50 (36) 8,079 6,886 1,193 8,222 7,381 841

Contingency / (further Savings Plans required) 0 0 0 0 0 0 0 0 0 0 0 0 Winter Pressures Funding 0 0 0 0 0 0 624 624 0 624 624 0 Transformation reserve 0 0 0 0 0 0 3,340 2,164 1,177 3,340 2,164 1,177 MH reserve 0 0 0 0 0 0 1,194 1,194 0 1,194 1,194 0 Investment Funding 0 0 0 0 0 0 0 1 (1) 0 1 (1)Total Allocation - all items within the scope 81,910 81,900 9 40,443 40,625 (182) 31,269 29,656 1,613 442,313 442,257 55

E&NCCG TotalThis Month - October 2015 Upper Lea ValleyStort Valley &

VillagesReserve &

Unattributable