Mersey Care NHS Foundation Trust Care at a Glance Report · ** CQC Community Mental Health Survey results published in November 2017. The trust has been reported as better than expected

Mersey Care NHS Foundation Trust Care at a Glance Report

Report Area

Regulatory Position (Internal Reporting)

Regulation – Overview

Regulation – Quality of Care

Regulation – Finance and Use of Resources

Regulation – Leadership and Improvement

Regulation – Operational Performance

Strategy

Strategic Wheel – Overview

Our Services Top Lines reviewed at QAC

Our People Top Lines reviewed at PIFC

Our Resources Top Lines reviewed at PIFC

Our Future Top Lines reviewed at PIFC

Operational Transformation

Transformation - Overview

Transformation - Local

Transformation - Secure

Transformation - Specialist LD

Transformation - Community

Appendices

Safe Staffing Report - Trust

Our Services KPIs - Local

Our People KPIs - Local

Our Future KPIs - Local

Our Services KPIs - Secure

Our People KPIs - Secure

Our Future KPIs - Secure

Our Services KPIs - SpLD

Our People KPIs - SpLD

Our Future KPIs - SpLD

Finance Report

Contents

EC: B2

TB: C2 1

Regulation - Single Oversight Framework / CQC

CQC Rating

3 3 3 3

1 1

2

0

1

2

3

4

Apr-

17

May-1

7

Jun-1

7

Jul-17

Aug

-17

Sep

-17

Oct-

17

NHSi Finance & Use of Resources Score

2 2 2 2 2 2 2

0

1

2

3

4

Ap

r-1

7

May

-17

Jun

-17

Jul-

17

Au

g-17

Sep

-17

Oct

-17

NHSi Segment Score

EC: B2

TB: C2 2

Regulation - Quality of Care

(Internal Reporting)

Measure TypeData

FrequencyThreshold Q4 16/17 Q1 17/18 Q2 17/18 Q3 17/18 Q4 17/18

Written

Complaints -

rate

Caring Quarterly TBC 34.4 29.1 *

Staff FFT %

recommended

- care

Caring Quarterly TBC 68.63% 67.41% 71.13%

* Local data not available.

Trend Source

NHS Digitial

NHS England

National Data

Measure TypeData

FrequencyThreshold Apr-17 May-17 Jun-17 Jul-17 Aug-17 Sep-17 Oct-17 Nov-17 Dec-17 Jan-18 Feb-18 Mar-18 Source

Occurrence of

Never EventSafe

Monthly (six

monthly

rolling)

Green - 0,

Red - 1 or

more

0 0 0 0 0 0 0MCFT Internal

Reporting

Patient Safety

Alerts not

completed by

deadline

Safe Monthly

Green - 0,

Red - 1 or

more

0 0 0 0 0 0 0

NHS

Improvement

(publicly

available)

Admissions to

adult facilities of

patients under 16

years old

Safe Monthly

Green - 0,

Red - 1 or

more

0 0 0 0 0 0 0MCFT Internal

Reporting

Mental health

scores from FFT -

% positive

Caring Monthly 86.67% 86.91% 88.26% 89.99% 85.53% 93.32% 88.51%MCFT Internal

Reporting

Community

scores from

Friends and

Family Test - %

positive

Caring Monthly TBC 100% 100% * NHS England

Mixed Sex

Accommodation

Breaches

Caring MonthlyNational

Median 30 0 0 0 0 0 0

MCFT Internal

Reporting

CQC Community

Mental Health

Survey

Organisational

HealthAnnual 8.91 ***

Care Quality

Commission

Aggressive Cost

Reduction Plans

Organisational

HealthMonthly

National

Median

4.1%

2.83% 2.83% 2.83% 2.83% 2.83% 2.83% 2.83%MCFT Internal

Reporting

Care Programme

approach follow

up within 7 days

Effective Monthly 95% 92.00% 93.72% 94.67% 94.07% 95.56% 95.05% 92.73%MCFT Internal

Reporting

% clients in

settled

accomodation

Effective Monthly

National

Median

64%

63.00% 62.00% 62.00% 61.00% *** *** ***NHS Digital

via MHSDS

% clients in

employmentEffective Monthly

National

Median

9%

3.00% 4.00% 4.00% 4.00% *** *** ***NHS Digital

via MHSDS

** CQC Community Mental Health Survey results published in November 2017. The trust has been reported as better than expected. Details to follow.

*** Data not reported on locally, data is reported on via NHS Digital.

* October 2017 data not available

Trend

EC: B2

TB: C2 3

Regulation - Finance & Use of Resources


Financial Risk Measure Apr-17 May-17 Jun-17 Jul-17 Aug-17 Sep-17 Oct-17 Nov-17 Dec-17 Jan-18 Feb-18 Mar-18

Days 28 22 21 24 22 21 20

Risk Score 1 1 1 1 1 1 1

RAG Green Green Green Green Green Green Green

Rating 3 3 3 3 3 3 2

Risk Score 1 1 1 1 1 1 2

RAG Green Green Green Green Green Green Yellow

Rating 3.03% 2.71% 2.80% 3.00% 2.80% 2.22%

Risk Score 1 1 1 1 1 1 1

RAG Green Green Green Green Green Green Green

Rating 0.12% 0.10% (0.10%) 0.00% 0.04% 0.02%

Risk Score 1 1 2 1 1 1 1

RAG Green Green Yellow Green Green Green Green

Rating 56.0% 52.3% 50.9% 57.3% 42.8% 42.7% 44.00%

Risk Score 4 4 4 4 3 3 3

RAG Red Red Red Red Amber Amber Amber

3 3 3 3 1 1 2

Amber Amber Amber Amber Green Green YellowOverall Financial Sustainability RAG

Liquidity days

Capital services capacity

I&E Margin

I&E Margin Variance (based on

original plan)

Agency Spend

Finance Score

EC: B2

TB: C2 4

Regulation - Operational Performance (Internal Reporting)

MeasureData

FrequencyThreshold Apr-17 May-17 Jun-17 Jul-17 Aug-17 Sep-17 Oct-17 Nov-17 Dec-17 Jan-18 Feb-18 Mar-18 Source

People with a first episode of

psychosis begin treatment

with a NICE recommended

care package within 2 weeks

of referral.

Quarterly

(three

month

rolling)

50% 62.79% 66.67% 72.97% 82.05% 75.47% 70.77% 63.83% Unify Return

Accommodation Status Monthly 85% 80.50% 80.20% 81.07% 80.06% 79.67% 78.80% 81.73%MCFT Internal

Reporting

Commissioner Org Code Monthly 95% 99.98% 99.99% 99.99% 99.99% 99.99% 99.99% *MCFT Internal

Reporting

Date of Birth Monthly 95% 100% 100% 100% 100% 100% 100% *MCFT Internal

Reporting

Employment Status (adults) Monthly 85% 83.62% 82.45% 78.04% 82.45% 82.06% 81.20% 83.97%MCFT Internal

Reporting

Ethnicity Monthly 85% 82.00% 82.26% 82.17% 83.31% 82.88% 82.88% 82.85%MCFT Internal

Reporting

Current gender Monthly 95% 100% 100% 100% 100% 100% 100% *MCFT Internal

Reporting

Registered GP Org Code Monthly 95% 98.41% 98.12% 98.08% 98.36% 98.32% 98.05% *MCFT Internal

Reporting

NHS Number Monthly 95% 98.82% 98.50% 98.74% 99.08% 99.09% 98.70% *MCFT Internal

Reporting

Postcode Monthly 95% 99.73% 99.72% 99.73% 99.72% 99.72% 99.71% *MCFT Internal

Reporting

Patients requiring acute care

who received best practice

gatekeeping assessment

Monthly 95% 97.62% 88.78% 88.16% 98.21% 95.85% 92.86% 93.98%MCFT Internal

Reporting

IAPT - proportion of people

completing treatment who

move to recovery (from IAPT

minimum dataset)

3-month

rolling

>=50%

green;

<50% red

85.10% 89.48% 94.64% 96.06% 96.21% 95.50% 95.62%MCFT Internal

Reporting

IAPT – waiting time to begin

treatment (from IAPT minimum

data set) within six weeks

3-month

rolling

>=75%

green;

<75% red

98.27% 98.78% 99.41% 99.91% 100% 100% 100%MCFT Internal

Reporting

Trend

* Local data not available due to submission due on Wednesday 22.11.2017.

MeasureData

FrequencyThreshold Q4 16/17 Q1 17/18 Q2 17/18 Q3 17/18 Q4 17/18

IAPT - proportion of people completing

treatment who move to recovery (from

IAPT minimum dataset)

Quarterly >=50% green;

<50% red30.50% 31.59% 33.78%

Ensure that cardio-metabolic

assessment and treatment for people

with psychosis is delivered routinely in

inpatient wards

Annual>=90% green;

<90% red66.00%




early intervention in psychosis services

Annual>=90% green;

<90% red

Not

Applicable




early intervention in community mental

health services (people on CPA)

Annual>=65% green;

<65% red8.00%

CQUIN - to be

reported on in

Q4 2017/18

Trend Source

MCFT Internal

Reporting

CQUIN - to be

reported on in

Q4 2017/18

CQUIN - to be

reported on in

Q4 2017/18

EC: B2

TB: C2 5

Regulation - Leadership & Improvement


MeasureData

FrequencyThreshold Mar-17 Apr-17 May-17 Jun-17 Jul-17 Aug-17 Sep-17 Oct-17 Nov-17 Dec-17 Jan-18 Feb-18 Mar-18 Source

NHS Staff Survey Annual 3.68 3.63 NHS England

Proportion of Temporary Staff Monthly

National

Median

4.60%

5.57% 5.57% 5.13% 5.01% 5.13% 4.66% 4.91% 4.93%MCFT Internal

Reporting

Staff sickness Monthly

National

Median

4.46%

6.93% 6.36% 6.47% 6.76% 6.70% 6.54% 7.22%MCFT Internal

Reporting

Turnover Monthly

Internal -

Between

8% and

12%

15.66% 15.75% 15.22% 14.49% 14.13% 13.73% 13.53%MCFT Internal

Reporting

Trend

EC: B2

TB: C2 6

RAG Kitemark RAG Kitemark

RAG Kitemark RAG KitemarkTrend line

Risks associated with Contracts from Board

Assurance Framework

No of Restrictive Practice Incidents

Win Rate

Self-harm incidents (Project wards Arnold,

Dee, Harrington and Poplar)

Assaults on staff

Plan Surplus v Actual

Patient Experience Friends and Family

Plan Cashflow v Actual

Estate Category B (Metric under review)

Trend lineMetric

Delayed Discharges

Detention of BME under MHA

Safe Staffing Levels

Physical Health for new admissions (local

division only)

Strategic Priorities 2017/18 - Summary

Metric Trend line Metric

No of STEIS Incidents

Trend line

No of Actual and Potential Suicides

Metric

Sickness Absence

Vacancies Vs Budgeted Establishment

Globlar Digital Exemplar - Delivery against milestone plan to

attract the external funding

Substantive leader in place for 3 months or

more (Self Assessment)

Completion of Core Statutory Training

Involved in the development of your care

plan

Turnover Rate

EC: B2

TB: C2 7

Trust Level Strategic Priorities - Our Services - Key Performance Indicators

% BME Detained within last 12 months under the Mental

Health Act

% of shifts filled by nurses against planned establishment

(NHS England Fill rate measure) / CHPPD

Equitable - Detention Under MHA by BME

Service Users

Effective - Physical Health Screening for New

Admissions

Safe - STEIS Incidents

No of STEIS Incidents

Patient Centred - Friends & Family

% likely to recommend our service to friends and family

% of new admissions who have had physical health screening

completed (NAS Standard) (Local Division Only)

Timely - Delayed Discharge

Deyaled Transfers of Care (Step Change Nov 2016)

Efficient - Safe Staffing Levels

40.00%

50.00%

60.00%

70.00%

80.00%

90.00%

100.00%

110.00%

Mean Average Upper control limit Lower control limit Target

5.00%

10.00%

15.00%

20.00%

25.00%

30.00%

35.00%

40.00%


0

5

10

15

20

25

30

35

Mean Average Upper control limit Lower control limit

0.00%

10.00%

20.00%

30.00%

40.00%

50.00%

60.00%

70.00%

80.00%

90.00%

100.00%


90.00%

95.00%

100.00%

105.00%

110.00%

115.00%

120.00%


EC: B2

TB: C2 8

Trust Level Strategic Priorities - Our People - Key Performance Indicators

A productive, skilled workforce

Sickness Absence

Vacancy Rate % Involved in the development of your care plan

Side by side with service users and carers

Substantive leader in place for 3 months or more (Self

Assessment)

Great managers and teams A productive, skilled workforce


Great managers and teams A productive, skilled workforce

Turnover % (Step Change March 2017)

70.00%

75.00%

80.00%

85.00%

90.00%

95.00%

100.00%


0.00%

2.00%

4.00%

6.00%

8.00%

10.00%

12.00%


0.00%

1.00%

2.00%

3.00%

4.00%

5.00%

6.00%

7.00%

8.00%

9.00%


89.00%

90.00%

91.00%

92.00%

93.00%

94.00%

95.00%

96.00%

97.00%

98.00%


30.00%

40.00%

50.00%

60.00%

70.00%

80.00%

90.00%

100.00%


EC: B2

TB: C2 9

Current Rating

Delivery against milestone plan to attract the

external funding

Trust Level Strategic Priorities - Our Resources - Key Performance Indicators

Estate category B Global Digital Exemplar

Buildings that work for us Technology that helps us provide better care

Finance

Plan Surplus v Actual

Finance

Plan Cashflow v Actual

-619

-290

-715

-1,011

-445

-160-223

-£1,200

-£1,000

-£800

-£600

-£400

-£200

£0

Apr-

17

Ma

y-1

7

Jun-1

7

Jul-17

Aug-1

7

Sep-1

7

Oct-

17

No

v-1

7

De

c-1

7

Jan-1

8

Fe

b-1

8

Ma

r-1

8

Surplus (£000) Excluding I&E impairments

Actual surplus Planned surplus

20,711 21,15722,749

26,594 27,41729,055

27,595

£0

£5,000

£10,000

£15,000

£20,000

£25,000

£30,000

£35,000

Apr-

17

Ma

y-1

7

Jun-1

7

Jul-17

Aug-1

7

Sep-1

7

Oct-

17

No

v-1

7

De

c-1

7

Jan-1

8

Fe

b-1

8

Ma

r-1

8

Cash Balance (£000)

Actual cash balance Planned cash balance

A1.02%

B69.39%

C29.59%

as at April 2015

New metric in development

EC: B2

TB: C2 10

Trust Level Strategic Priorities - Our Future - Key Performance Indicators

Research and innovation Research and innovation Grow our service

Actual & Potential Suicide count - Community Team Caseload

(rolling 12 months) Physical restraint reduction Win Rate

Research and innovation Research and innovation Effective partnerships

Self-harm incidents (Project wards only Arnold, Dee,

Harrington and Poplar)Assaults on Staff (Step Change Nov 2016) Risks associated with Contracts from Board Assurance Framework

If the Trust continues

to fail to achieve the

appropriate levels of

compliance with

Safeguarding training,

then a performance

notice may be issued

from CCG resulting in

financial and

reputational damage

for the Trust.

16 316

Initial Risk

RatingTarget Score

Current Risk

RatingTitle

0%

10%

20%

30%

40%

50%

60%

70%

80%

90%

100%

0

1

2

3

4

5

6

7

8

9

No

of

Bid

s Y

TD

Bids YTD Win Rate % Target

50

100

150

200

250

300

350


commencement of intervention

10

15

20

25

30

35

40


EC: B2

TB: C2 11

Metric

Apr-17 May-17 Jun-17 Jul-17 Aug-17 Sep-17 Oct-17 Nov-17 Dec-17 Jan-18 Feb-18 Mar-18

Plan 925 965 956 993 926 963 1036 991 868 1029 1014 1038

Actual 935 1163 1092 1112 1068 1020 1137

Plan 30.00 30.00 30.00 30.00 30.00 30.00 30.00 30.00 30.00 30.00 30.00 30.00

Actual 26.66 27.04 26.89 26.96 25.92 19.61

Plan 16.70% 16.70% 16.70% 16.70% 16.70% 16.70% 16.70% 16.70% 16.70% 16.70% 16.70% 16.70%

Actual 25.59% 23.63% 25.53% 25.59% 25.00% 20.97% 21.23%

Plan 3.83% 3.83% 3.83% 3.83% 3.83% 3.83% 3.83% 3.83% 3.83% 3.83% 3.83% 3.83%

Actual 5.73% 5.81% 5.83% 5.83% 6.00% 5.95% 6.92%

Plan 85.00% 85.00% 85.00% 85.00% 85.00% 85.00% 85.00% 85.00% 85.00% 85.00% 85.00% 85.00%

Actual 94.57% 95.54% 94.59% 95.50% 94.87% 93.72% 95.53%

Plan 33.4 33.4 33.4 33.4 33.4 33.4 33.4 33.4 33.4 33.4 33.4 33.4

Actual 32.0 42.0 31.0 33.0 46.0 34.0 39.0

Plan 7.50% 7.50% 7.50% 7.50% 7.50% 7.50% 7.50% 7.50% 7.50% 7.50% 7.50% 7.50%

Actual 7.26% 6.55% 5.93% 6.69% 6.92% 6.67% 8.15%

Plan 0 0 0 0 0 0 0 0 0 0 0 0

Actual 11 8 3 4 9 3 4

Plan 17.26% 17.26% 17.26% 17.26% 17.26% 17.26% 17.26% 17.26% 17.26% 17.26% 17.26% 17.26%

Actual 8.86% 7.73% 15.42% 14.66% 15.13% 13.61% 12.02%

Plan 4.80% 6.00% 6.00% 6.00% 6.00% 6.00% 6.00% 6.00% 6.00% 6.00% 6.00% 6.00%

Actual 7.09% 6.42% 6.60% 7.56% 7.12% 6.69% 6.60%

Plan 95.00% 95.00% 95.00% 95.00% 95.00% 95.00% 95.00% 95.00% 95.00% 95.00% 95.00% 95.00%

Actual 96.39% 92.52% 95.49% 94.47% 96.74% 93.81% 93.82%

Plan 5.00% 5.00% 5.00% 5.00% 5.00% 5.00% 5.00% 5.00% 5.00% 5.00% 5.00% 5.00%

Actual 9.24% 10.62% 10.39% 11.39% 11.59% 12.06% 10.73%

Plan £6,875 £5,357 £6,150 £6,467 £6,235 £6,255 £5,997

Actual £7,004 £5,247 £6,050 £5,997 £6,072 £6,170 £6,153

Plan £1,062 £170 £170 £170 £170 £170 £199 £199 £199 £199 £199 £199

Actual £913 £42 £87 £22 £4 £62 £86

149 128 83 148 166 108 113

GOVERNANCE

The operational lead is Donna Robinson

The Accountable Director is Mark Hindle

Assurance is provided to the Performance Investment and Finance Committee

* Reported with a month timelag to allow service users to be assessed who were referrered at the end of September 2017.

** In October 2017, out of the eight wards within Adult Mental Health, six wards are achieving better than the NHS Benchmark 2015-16 Discharged Patients LOS.

INPATIENTS - Number of unplanned Adult Acute Out

of Area Placements (Count of Service Users)

INPATIENTS - AMH Discharged Patients LOS (in-

month) achieving better than the NHS benchmark 2015-

16 Discharged Patients LOS (mean average).

% Incidents that result in harm

% Vacancies against budget

CIP's £000

Budget £000

Absence rate

COMMUNITY - Average Days between Referral date to

the First Seen in Assessment Service's*

COMMUNITY - AMH DNA Rate for 1st appointments

only

INPATIENTS - AMH Delayed Discharges

INPATIENTS - AMH Bed Occupancy (excluding leave)


Local Transformation Plan

12 Month Trend

Line

COMMUNITY - New referrals from GP practice

Local Division

2017/18

COMMUNITY/INPATIENTS - % Caseload on Clusters

1, 2 and 3

EC: B2

TB: C2 12

Metric


Plan 16521 16521 16521 16521 16521 16521 16521 16521 16521 16521 16521 16521

Actual 20652 18387 18576 18732 18960 18057 18340

Plan 7.50% 7.50% 7.50% 7.50% 7.50% 7.50% 7.50% 7.50% 7.50% 7.50% 7.50% 7.50%

Actual 3.30% 3.17% 3.18% 3.63% 3.64% 3.51% 2.89%

Plan

Actual N/A 46.69 27.56 18.97 21.62 46.53 10.44

Plan 7.42% 7.42% 7.42% 7.42% 7.42% 7.42% 7.42% 7.42% 7.42% 7.42% 7.42% 7.42%

Actual 6.77% 4.22% 6.49% 4.83% 3.70% 4.55% 5.79%

Plan 4.80% 6.00% 6.00% 6.00% 6.00% 6.00% 6.00% 6.00% 6.00% 6.00% 6.00% 6.00%

Actual 6.95% 6.79% 6.82% 7.39% 7.04% 7.47% 8.55%

Plan 95.00% 95.00% 95.00% 95.00% 95.00% 95.00% 95.00% 95.00% 95.00% 95.00% 95.00% 95.00%

Actual 73.45% 81.44% 77.57% 69.64% 84.62% 78.43% 75.25%

Plan 5.00% 5.00% 5.00% 5.00% 5.00% 5.00% 5.00% 5.00% 5.00% 5.00% 5.00% 5.00%

Actual 5.66% 5.35% 5.76% 5.80% 6.36% 6.07% 6.34%

Plan £4,536 £3,881 £4,087 £4,016 £4,070 £4,044 £4,027

Actual £4,526 £3,935 £4,057 £3,996 £4,065 £4,019 £3,993

Plan £166 £166 £166 £166 £166 £166 £166 £166 £166 £166 £166 £166

Actual £166 £166 £166 £166 £166 £166 £166£0.00 £0.00 £0.00 £0.00 £0.00 £0.00 £0.00

GOVERNANCE

The operational lead is Des Johnson



Reduction in time spent in long term

segregation (days)*

Delayed discharges


Reduction in LOS in Low Secure based on

discharged patients (months)**

Plan to be confirmed

Secure Transformation Plan

Secure Division

12 Month Trend

Line

2017/18


Absence rate

* Data has been reported for this indicator, however, this is still in the 'sense check' stage. The figures reported show the total cumulative segregation in days. In line with the

Reducing Long-term Segregation: A Zero Approach, the plan has been aligned to the outcome: To Reduce Long-term Segregation by 20%. The baseline used is April 2017.

**Based on discharged patients in the period. Where it states N/A this represents that there were no discharges within that month. Plan to be confirmed by the division.


Budget £000

CIP's £000

EC: B2

TB: C2 13

Metric


Plan 5 4 10 8 7 12 8 9 9 12 1 24

Actual 3 2 1 1 2 5 2

Plan 143 143 143 143 143 143 143 143 143 143 143 143

Actual 134 133 133 132 130 129 128

Plan

Actual

Plan 19.93% 19.93% 19.93% 19.93% 19.93% 19.93% 19.93% 19.93% 19.93% 19.93% 19.93% 19.93%

Actual 4.48% 4.95% 1.65% 9.66% 9.73% 6.89% 2.85%

Plan 4.80% 6.00% 6.00% 6.00% 6.00% 6.00% 6.00% 6.00% 6.00% 6.00% 6.00% 6.00%

Actual 10.74% 9.40% 9.48% 8.40% 8.92% 8.36% 10.31%

Plan 95.00% 95.00% 95.00% 95.00% 95.00% 95.00% 95.00% 95.00% 95.00% 95.00% 95.00% 95.00%

Actual 81.44% 76.47%

Plan 5.00% 5.00% 5.00% 5.00% 5.00% 5.00% 5.00% 5.00% 5.00% 5.00% 5.00% 5.00%

Actual 4.48% 19.56% 20.76% 19.19% 19.41% 17.31% 20.83%

Plan £2,224 £1,818 £1,882 £1,908 £1,891 £2,007 £2,129

Actual £2,239 £2,017 £1,850 £1,978 £2,006 £2,001 £2,033

Plan

Actual

GOVERNANCE

The operational lead is Lee Taylor



*The Friends and Family Test in the Specialist LD Division is asked as part of the quarterly patient experience survey. The Division’s survey is different to the Trust-wide patient

experience survey and is completed quarterly until the data systems can be aligned in an easy-read format.

SpLD Transformation Plan

Specialist Learning Disabilities Division

12 Month Trend

Line

No of service users discharged

No of service users

Absence rate


2017/18

CIP's £000

% of workforce in posts within the new

clinical model

Patient Experience Friends and Family *

No CIP's for SpLD

Metric in development

Budget £000


EC: B2

TB: C2 14

Metric


Plan 1 1 1 1 1 1 1 1 1 1Actual 1 1 3 2 1

Plan 0 0 0 0 0 0 0 0 0 0Actual 0 0 0 0 0

Plan 95.00% 95.00% 95.00% 95.00% 95.00% 95.00% 95.00% 95.00% 95.00% 95.00%

Actual 89.40% 89.30% 92.80% 92.87% 94.40%

Plan 95.00% 95.00% 95.00% 95.00% 95.00% 95.00% 95.00% 95.00% 95.00% 95.00%

Actual 91.30% 92.10% 93.20% 94.45% 93.79%

Plan 7.50% 7.50% 7.50% 7.50% 7.50% 7.50% 7.50% 7.50% 7.50% 7.50%

Actual 15.80% 20.86% 18.77% 11.85% 9.97%

Plan 36.65% 36.65% 36.65% 36.65% 36.65% 36.65% 36.65% 36.65% 36.65% 36.65%

Actual 37.50% 28.96% 34.46% 29.60% 36.67%

Plan 6.00% 6.00% 6.00% 6.00% 6.00% 6.00% 6.00% 6.00% 6.00% 6.00%

Actual 6.81% 6.98% 8.29% 7.62% 9.43%

Plan 95.00% 95.00% 95.00% 95.00% 95.00% 95.00% 95.00% 95.00% 95.00% 95.00%

Actual 98.18% 100.00% 100.00% 100.00% 100.00%

Plan 5.00% 5.00% 5.00% 5.00% 5.00% 5.00% 5.00% 5.00% 5.00% 5.00%

Actual 6.07% 6.35% 8.01% 7.94% 10.76%

Plan £1,986 £2,001 £1,999 £2,003 £2,000

Actual £1,986 £2,001 £2,008 £2,006 £1,985

Plan

Actual

GOVERNANCE

The operational lead is Judith Malkin

The Accountable Director is Trish Bennett


• Delayed transfers of care has been added as metric to replace the % of urgent care referrals

District Nurse Falls Risk Assessment Tool

completionDistrict Nurse Malnutrition Universal

Screening Tool completion


Budget £000

CIP's £000


Absence rate

No CIP's for SSCD


Pressure Ulcers: Number of Grade 3 CAA

Pressure Ulcers: Number of Grade 4 CAA

Ward 35: Delayed Discharges

2017/18

South Sefton Community Transformation Plan

South Sefton Community Division

3 Month Trend

Line

EC: B2

TB: C2 15

Please note the following appendices are provided for information

Safe Sustainable Staffing Trust Level

Our Services

The operational lead for Our Services is Steve Morgan , The Accountable Director is Ray Walker, Performance is reviewed by the Executive CommitteeAssurance is through the Quality Assurance Committee

Our People

The operational lead for Our People is Claire Almond, The Accountable Director is Amanda Oates, Performance is reviewed by the Executive CommitteeAssurance is through the Performance and Investment Committee

Our Future

The Accountable Director is Louise Edwards, Performance is reviewed by the Executive CommitteeAssurance is through the Performance and Investment Committee

Finance Dashboard

Appendices

EC: B2

TB: C2 16

Safe Sustainable Staffing Dashboard

Fill rate reported as over 100% mainly due to the need to support observation levels. Recruitment to vacancies continues to be challenging across the

divisions. Local division report ongoing delay for staff awaiting start dates and have escalated to head of HR to address. Secure division have recruited

to posts but also awaiting start dates. SLDD vacancy at 17% due to site retraction.

Mandatory training rates are being monitored with an aim for 100%. A significant decrease in incidents is reported with a corresponding increase in

patient experience .

EC: B2

TB: C2 17

Local Division Strategic Priorities - Our Services - KPI's

Safe - STEIS Incidents Timely - Delayed Discharge


Admissions

No of STEIS Incidents Delayed Transfers of Care - April 2016 to October 2017% of new admissions who have had physical health screening

completed (NAS Standard) (Local Division only)


Service Users

Efficient - Safe Staffing Levels Patient Centred - Friends & Family


Health Act



Step Change Sept 2016


0.00%

1.00%

2.00%

3.00%

4.00%

5.00%

6.00%

7.00%

8.00%

9.00%


75.00%

80.00%

85.00%

90.00%

95.00%

100.00%

105.00%


0.00%

5.00%

10.00%

15.00%

20.00%

25.00%

30.00%

35.00%

40.00%


0

5

10

15

20

25

Mean Average Upper control limit

0.00%

10.00%

20.00%

30.00%

40.00%

50.00%

60.00%

70.00%

80.00%

90.00%

100.00%


EC: B2

TB: C2 18

Local Division Strategic Priorities - Our People - KPIs


Turnover

Great managers and teams A productive, skilled workforce A productive, skilled workforce


Assessment)


(Step Change Feb 2017)Sickness Absence



Great managers and teams

0.00%

1.00%

2.00%

3.00%

4.00%

5.00%

6.00%

7.00%

8.00%

9.00%


4.00%

6.00%

8.00%

10.00%

12.00%

14.00%

16.00%


0.00%

2.00%

4.00%

6.00%

8.00%

10.00%

12.00%

14.00%


50.00%

60.00%

70.00%

80.00%

90.00%

100.00%

110.00%


0.00%

20.00%

40.00%

60.00%

80.00%

100.00%

120.00%


EC: B2

TB: C2 19

Local Division Strategic Priorities - Our Future - KPI's

Research and innovation Research and innovation


(rolling 12 months)Physical restraint reduction

TitleInitial

Risk

Current Risk

RatingTarget Score




compliance with

Safeguarding

training, then a

performance notice

may be issued from

CCG resulting in

financial and

reputational damage

for the Trust.

16 16 3


Self-harm incidents (Project wards Dee & Harrington)

Assaults on staff rolling 12 months (assaults on staff resulting

in harm for inpatient wards only per 1000 staff headcount)

Step Change Jan 2017

Risks associated with Contracts from Board Assurance Framework

0

20

40

60

80

100

120

140


0

5

10

15

20

25

30

35

40


0

10

20

30

40

50

60

70

80

90

100

Self Harm Mean Average Upper Natural Process Limit Lower Natural Process Limit

EC: B2

TB: C2 20

Secure Division Strategic Priorities - Our Services - KPI's



Admissions

No of STEIS Incidents Deyaled Transfers of Care (Step Change Oct 2016)% of new admissions who have had physical health screening

completed (NAS Standard)

Data not yet available


Service Users



Health Act




(Step Change Feb 2017)

94.00%

96.00%

98.00%

100.00%

102.00%

104.00%

106.00%

108.00%

110.00%

112.00%

Upper control limit Lower control limit Target

0.00%

10.00%

20.00%

30.00%

40.00%

50.00%

60.00%

70.00%

80.00%

90.00%

100.00%


0

5

10

15

20

25


EC: B2

TB: C2 21

Secure Division Strategic Priorities - Our People - KPI's


Turnover



Assessment)


(Step Change Feb 2017)Sickness Absence




0.00%

1.00%

2.00%

3.00%

4.00%

5.00%

6.00%

7.00%

8.00%

9.00%


4.00%

6.00%

8.00%

10.00%

12.00%

14.00%

16.00%


0.00%

2.00%

4.00%

6.00%

8.00%

10.00%

12.00%

14.00%


50.00%

60.00%

70.00%

80.00%

90.00%

100.00%

110.00%


0.00%

20.00%

40.00%

60.00%

80.00%

100.00%

120.00%


EC: B2

TB: C2 22

Secure Division Strategic Priorities - Our Future - KPI's


Self-harm incidents (Project wards Arnold & Poplar)Assaults on staff rolling 12 months (assaults on staff resulting


Risks associated with Contracts from Board Assurance

Framework




TitleInitial

Risk

Current Risk

RatingTarget Score




compliance with

Safeguarding

training, then a

performance notice

may be issued from

CCG resulting in

financial and

reputational damage

for the Trust.

16 16 3

0

10

20

30

40

50

60

70

80


0

1

2

3

4

5

Mean Average Target

0

10

20

30

40

50

60

70

Self Harm Secure Mean Average Upper Natural Process Limit

EC: B2

TB: C2 23

SpLD Division Strategic Priorities - Our Services - KPI's



Admissions

No of STEIS IncidentsDelayed Transfers of Care - April 2016 to October 2017 (Step

Change Feb 2017)

% of new admissions who have had physical health screening

completed (NAS Standard)

Data not currently available at Divisional level


Service Users



Health Act



Data unavailable until alignment of systems for

SpLDD

60.00%

70.00%

80.00%

90.00%

100.00%

110.00%

120.00%

130.00%

140.00%


0

1

2

3

4

5

6

7


0.00%

2.00%

4.00%

6.00%

8.00%

10.00%

12.00%

14.00%

16.00%

18.00%

20.00%

Mean Average Upper control limit Target

EC: B2

TB: C2 24

SpLD Division Strategic Priorities - Our People - KPI's

Data unavailable until alignment of systems

for SpLDD


Turnover (Step Change Jan 2017)



Assessment)Completion of Core Statutory Training Sickness Absence




0.00%

2.00%

4.00%

6.00%

8.00%

10.00%

12.00%


0.00%

20.00%

40.00%

60.00%

80.00%

100.00%

120.00%


0.00%

5.00%

10.00%

15.00%

20.00%

25.00%


0.00%

20.00%

40.00%

60.00%

80.00%

100.00%

120.00%

140.00%


EC: B2

TB: C2 25

SpLD Divisions Strategic Priorities - Our Future - KPI's

No Risks to report associated with Contracts

from Board Assurance Framework

Effective partnerships

Self-harm incidents (Project wards only Arnold, Dee,

Harrington and Poplar)

Assaults on staff rolling 12 months (assaults on staff resulting


Risks associated with Contracts from Board Assurance

Framework




Data not currently available at Divisional level

No Suicides to report within last 12 months

rolling period


0

20

40

60

80

100

120

140

160

180


0

100

200

300

400

500

600

700

800

900

Mean Average Upper control limit Lower control limit

EC: B2

TB: C2 26

Finance Dashboard 2017/18 - Month 7

Finance and Use of Resources Metrics Weight M7 Plan M7 ActualYear End

Plan

Year End

Forecast

Capital Service Capacity 20% 2 2 2 2

Liquidity 20% 1 1 1 1

I&E Margin 20% 1 1 1 1

Distance from financial plan 20% 1 1

Agency Spend 20% 2 3 2 3

Overall Score (after overrides) 100% 2 2 2 2

Agenda Item No: B2

MERSEY CARE NHS FOUNDATION TRUST

Month 7 Financial Performance

OVERALL FINANICAL PERFORMANCE 1. The trust is reporting a surplus of £3.463m at Month 7. It is forecast to achieve the

control total of £5.162m at the year end. A summary of the financial position is provided in Table 1.0 and detailed in Appendix A. Table 1.0 – Summary Financial Position – Month 7

2. From Table 1.0 it can be seen divisional pressures, in month 7, are being supported by the local, secure and corporate divisions. A more detailed analysis is provided in Appendix B. Key areas to note:

a) The local division underspend at month 7 of £0.837m is due to non recurrent funding in the division. This will reduce in future months as vacant posts are recruited to. Currently overspends within out of Area Treatments (OATs), Talk Liverpool, radiology and nuclear medicine alongside CIP underachievement of £1.2m. The forecast outturn for 2017/18 is breakeven and includes additional growth funding of £0.385m and £0.428m CQUIN. The forecast is assumes: non-delivery of £1.2m CIP; a high level of OATs activity; overspends in Talk Liverpool, agency spend for Supported Living Services (SLS) and an increase in costs as newly funded posts are recruited to. It is also anticipated back pay will be paid to SLS staff amounting to £0.463m. The STAR Unit transferred to the Specialised LD division in month 7, however the year to date overspend of £0.327m has been retained within the Local Division.

b) The secure division is underspent by £0.100m as a consequence of vacancies, offset in part by non pay cost pressures. The division is forecast to breakeven. CIP savings of £1.256m have been delivered to month 7 and the plan of £2.200m is forecast to be delivered. However £0.263m is being delivered non-recurrently, therefore recurrent plans need to be developed for 2018/19.

c) The Specialist LD division is £0.449m overspent at month 7. The overspend is related to the operational requirement for additional staffing required to deliver

YTD

BudgetYTD Actual

YTD

Variance

Annual

Budget

Forecast

OutturnVariance

£000 £000 £000 £000 £000 £000

Income 153,415 153,318 (97) 265,200 265,138 (62)

Total Income 153,415 153,318 (97) 265,200 265,138 (62)

Expenditure

Local Division (41,810) (40,973) 837 (72,586) (72,586) 0

Secure Division (28,662) (28,562) 100 (49,519) (49,519) 0

Specialist Learning Disabilities (15,394) (15,844) (449) (26,333) (27,077) (744)

Sefton Community Division (9,989) (9,985) 4 (20,203) (20,360) (156)

Corporate Division (Excl. Medical Services & LCH) (26,333) (25,844) 490 (46,148) (45,698) 450

LCH (182) (346) (163) (230) (1,230) (1,000)

Medical Services (12,316) (13,088) (773) (20,971) (21,821) (850)

Informatics Merseyside (IM) (6,008) (6,008) (0) (10,461) (10,461) 0

Sub Total - Divisional Expenditure (140,693) (140,649) 44 (246,450) (248,750) (2,300)

Reserves & Other Budgets (5,659) (9,206) (3,547) (9,988) (10,376) (388)

Revaluation Reserve (3,600) 3,600 (3,600) (850) 2,750

Other Budgets & Reserves (9,259) (9,206) 53 (13,588) (11,226) 2,362

I&E Surplus/(Deficit) 3,463 3,463 0 5,162 5,162 0

Division

Agenda Item No: B2

increased levels of clinical observations, especially in low secure services. The transfer of the STAR unit from the local division has generated an in month overspend of £0.034m due to agency usage associated with patient acuity. The division has spent £0.928m on agency and £2.108m on bank staff to month 7. Additional staffing costs linked to unplanned care continue to be closely monitored by the management team. The forecast position has been amended to reflect delays in patient discharges from a breakeven position to £0.500m overspent In addition, the transfer of the STAR unit has increased the forecast by £0.244m to £0.744m overspent.

d) Sefton community services division is breakeven at month 7, mainly due to vacancies in clinical areas, which are non-recurrently supporting the CIP position. The forecast outturn for 2017/18 is £0.150m overspent due to additional posts of £0.282m, which have been approved to stabilise the Division’s services and meet winter pressures. The division is currently undertaking a number of clinical service reviews, there is a risk this may identify further cost pressures. The impact of service reviews will be monitored regularly and the forecast outturn position will be updated accordingly.

e) The corporate division is under-spending across executive nursing, finance, estates, corporate governance and workforce, offsetting overspends within IPI, perfect care and costs associated with the LCH bid.

f) Medical services are overspending as a result of senior medical staffing costs within the local division. These are currently being offset by underspends within the specialist learning disabilities medical staff and vacancies across junior medical staff areas. A plan has been developed by the Medical Director, to reduce spend by £1.5m in 2018/19. This is currently being verified by the finance.

COST IMPROVEMENT PLANS (CIP) 3. The target CIP for 2017/18 is £6.210m. At month 7, the target is £3.801m of which

£2.740m has been delivered. The areas of underachievement are within the local and corporate divisions.

a) The local division have a month 7 CIP target of £2.109m and have achieved £1.217m. Schemes that are under achieving include the community services redesign and income generation. The forecast for the division indicates a recurrent underachievement against the CIP of £1.2m in 2017/18. Delivery of the recurrent CIP target is critical to the trusts ability to meet its control total for 2018/19. The division is currently developing alternative schemes.

b) The corporate division have a year to date CIP target of £0.533m of which

£0.365m has been achieved. The underachieving schemes relate to the pharmacy drugs review and executive nurse patient safety review. Alternative schemes have been requested from the relevant executive directors.

4. It is essential recurrent replacement schemes for the above are required to be presented

to the Quality Assurance Committee in during quarter four by the respective director.

FINANICAL RISKS 5. The Trust is currently planning to meet the control total of £5.162m. However there are

financial risks of circa £2.750m for 2017/18. The key areas are summarised below:

Agenda Item No: B2

a) Medical services - The medical services budget is forecast to overspend by £0.850m.

b) Specialist LD division - The division has a £0.744m overspend. Delays in discharges are becoming more likely as availability of client placements outside the trust becomes more difficult. This could result in an over spend of up to £0.500m, in addition to £0.244m relating to the transfer of Local services in month 7.

c) Sefton community services division – The division is forecasting a £0.156m overspend position. This reflects the need to stabilise the new service.

d) New business developments – The trust will incur additional costs associated with being selected as the preferred provider for the Liverpool Community Health Service. These are currently estimated at £1.000m.

6. Remedial action plans for the areas identified above should be presented and monitored

through the Performance, Investment and Finance Committee in December by the relevant Chief Operating Officer or Executive Lead.

7. As part of the financial planning for 2018/19 work has been undertaken to assess the

financial risks. In total these amount to £4.970m and include:

a) Medical Services (£1.0m) – Overspend to continue into 2018/19 whilst case load review is undertaken and recruitment takes place.

b) Local Division (1.470m) – This includes cost pressures for SLS (£0.100m), OATS (£0.500m), YMCA (£0.250m) and IAPT services (£0.620m)

c) Specialist LD division (£0.500m) – A similar financial position to 2017/18 is anticipated resulting in an overspend.

d) Corporate CIP Under achievement (£1.0m) – At present there are insufficient plans to meet the £4.0m corporate CIP target.

e) LCH Support (£1.0m) – The financial envelope associated with LCH services included the requirement to achieve £1.0m in efficiencies. There are currently no robust plans to meet this target.

8. Unless these issues are resolved there will be long term financial implications for the trust.

9. A paper will be presented to the Executive Committee and the Performance, Investment and Finance Committee detailing the proposed financial plan and associated risks for 2018/19 in December 2017.

NHS IMPROVEMENT RISK RATING 10. The overall ‘use of resources’ risk rating is currently at level 2, which is on plan.

11. Capital services capacity measures how well the Trust can meet fixed payments

associated with capital financing (e.g. lease interest payments, public dividend capital). The trust is able to cover the payments 2.39 times.

12. Liquidity measures the availability of liquid (cash) resources to be able to meet liabilities

as they fall due. The Trust is currently at 20 days, which is rated as 1.

13. The I&E margin metric measures the percentage of financial performance surplus compared to operating income. This is currently at 2.22% and is rated at 1.

Agenda Item No: B2

14. The I&E margin distance from plan, compares the planned I&E metric to actual performance. The trust is on plan and is rated at 1.

15. The agency rating measures agency spend against the ceiling applied by NHS Improvement. At month 7, agency spend totals £5.734m, which is 44% above national target levels and this metric is rated at 3, compared to a plan of 2. An analysis of agency costs is provided in Appendix C. Divisions have developed remedial action plans from all divisions to identify areas where agency spends will reduce.

CAPITAL EXPENDITURE 16. At the end of October capital costs of £9.162m have been incurred. This is £6.056m

below plan as a result of slippage against the following schemes: Liverpool & Southport inpatient facilities, pharmacy relocation, Kevin White Unit redevelopment and the Trust decant facility.

17. A review of the 2017/18 capital programme has been undertaken and submitted to NHSi. The forecast outturn has reduced by £8.888m to £28.930m due to slippage in the Medium Secure Unit (MSU), Local Secure Unit (LSU) and Southport Inpatient Facility.

18. Southport Inpatient Facility is underspent by £1.668m due to delays with planning permission. The trust is forecasting £2.250m will be spent in 2017/18.

19. The business case for the MSU (£60.700m) is currently with the Department of Health (DH) awaiting Ministerial, then Treasury, approval.

CASH POSITION 20. At the end of October the cash balance is £27.595m, which is £7.791m above plan. This

is driven by a combination of slippage on capital investment and favourable working capital movements. A detailed analysis is provided in Appendix D.

21. The statutory duty to pay 95% of suppliers within 30 days has been achieved in September at 97.7%. (NHS suppliers are 98.5% and Non NHS suppliers are 97.7%).

22. The trust has requested a loan of £60.700m to finance the MSU. Once Treasury approval for the scheme has been received, the trust will develop an accurate draw down profile for the funds. It is anticipated that the first receipt will be in January 2018 (£6.370m) and will continue until 2019/20. This can be seen in the cash flow statement in Appendix D.

23. Treasury approval for the MSU was expected in November but is subject to DH and ministerial approval which is yet to be granted. Delays at this stage may impact on the draw down profile.

24. During 2018/19, planned expenditure on the Southport Inpatient Facility will reduce the trust’s cash balance to £5.000m which equates to 10 days working capital.

FORWARD LOOK 25. The revaluation reserve of £3.600m is currently being held to support forecast

overspends of £2.399m in 2017/18. It is proposed the remaining balance of £0.850m is

Agenda Item No: B2

utilised non-recurrently to support transformation schemes within the trust. Options will be evaluated by the executive team and will be included in the December finance paper.

RECOMMENDATIONS 26. The Board is asked to:

a) Note the current financial position and planned achievement of the control

total.

b) Agree and monitor the recommendation for replacement CIP schemes to be

presented to the Quality Assurance Committee in January by the Chief

Operating Officer of the local division, the Medical Director and Executive

Nurse Director.

c) Note the risks associated with the 2017/18 financial position and require the

following to be presented at the December Performance, Investment and

Finance Committee:

o Chief Operating Officer to provide assurance of the financial position

for Local and specialist learning disabilities division

o Medical Director to provide a recovery plan for the local medical

staffing budget.

d) Note the financial risk of £4.970m associated with 2018/19.

e) Proposed plans for the remaining revaluation reserves funding of £0.850m to

be agreed by the executive team and included in the December finance

paper.

Neil Smith Executive Director of Finance November 2017

Plan Actual Variance Plan Actual Variance

Contract Income 144,641 144,120 (521) 252,503 249,982 (2,521)

Sustainability & Transformation Funding (STF) 582 582 (0) 1,294 1,294 0

Informatics Merseyside Income 4,688 4,698 10 7,966 7,966 0

Operational Income 6,052 6,563 510 10,354 9,334 (1,020)

Total Income 155,964 155,963 (1) 272,116 268,576 (3,540)

Employee Expenses (119,511) (115,461) 4,050 (210,250) (200,667) 9,583

Non Pay Expenses (25,527) (29,312) (3,785) (43,798) (49,421) (5,623)

EBITDA (Earnings before interest, tax, depreciation and amortisation) 10,926 11,190 264 18,069 18,488 419

EBITDA Margin % 7.01% 7.17% 0.17% 7% 7% 0%

Capital Charges (3,201) (3,305) (104) (5,491) (5,734) (243)

Public Dividend Capital (2,830) (2,830) 0 (4,930) (4,930) (0)

Provisions unwinding of discount (53) (53) 0 (53) (53) 0

Interest Payable (1,345) (1,410) (65) (2,375) (2,491) (116)

Interest Receivable 63 32 (31) 108 43 (65)

Carbon Credits (97) (161) (64) (166) (161) 5

I&E Surplus 3,463 3,463 (0) 5,162 5,162 0

I&E Surplus Margin % 2% 2% 0% 2% 2% 0%

Capital Impairment 0 0 0 (8,435) (2,755) 5,680

Net I&E Surplus 3,463 3,463 (0) (3,273) 2,407 5,680

FoTYTDStatement of Comprehensive Income (SoCI)

Appendix A

Statement of Comprehensive Income (SOCI)

Budget

£000

Actual

£000

Variance

£000

265,680 Income 153,415 153,318 (98)

265,680 Total Income 153,415 153,318 (98)

EXPENDITURE

Local Division

(42,025) Liverpool (24,475) (22,776) 1,699

(8,911) Management (4,719) (4,899) (179)

(21,650) Sefton & Kirby (12,615) (13,298) (683)

(72,586) Sub-Total Local Division (41,810) (40,973) 837

Secure Division

(36,301) High Secure (21,053) (20,720) 333

(13,126) Medium & Low Secure (7,609) (7,842) (233)

(49,427) Sub-Total Secure Division (28,662) (28,562) 100

Specialist LD Division

(399) Divisional Services (388) (1,064) (676)

(926) Management (535) (477) 58

(21,380) Forensic & High Support (12,497) (12,315) 182

(497) Forensic Support Service (290) (269) 21

(2,890) Local LD Services (1,684) (1,718) (34)

(26,093) Sub-Total Specialist LD Division (15,394) (15,844) (449)

Corporate Division

(3,020) Board (1,783) (1,795) (12)

(3,893) Executive Nurse (2,202) (1,981) 222

(2,939) Finance (1,662) (1,626) 37

(14,937) Estates & Facilities (8,802) (8,392) 410

(3,189) Corporate Govn & Business Dev (1,775) (1,667) 108

(7,403) Informatics & Performance Impr (3,663) (3,693) (30)

(182) LCH Bid (182) (347) (164)

(23,514) Medical Services (13,781) (14,544) (764)

(2,242) Perfect Care (1,526) (1,782) (255)

0 Calderstones Transition (86) (86) (0)

(5,782) Workforce (3,368) (3,365) 3

(67,102) Sub-Total Specialist LD Division (38,831) (39,278) (447)

Sefton Division

(2,521) Sefton Corporate Services (1,216) (1,202) 14

(17,683) Sefton Cross Divisional Services (8,773) (8,783) (10)

(20,203) Sub-Total Sefton Division (9,989) (9,985) 4

(10,311) Informatics Merseyside (IM) (6,008) (6,008) (0)

(14,797) Other Budgets & Earmarked Reserves (9,259) (9,206) 53

(260,518) Total Expenditure (149,952) (149,855) 98

5,162 Net Surplus/(Deficit) before technical adjustments 3,463 3,463 (0)

Divisions

Month 7 2017/18Annual

Budget

£000Year to Date

Appendix B

Financial Position by Division

01,0002,0003,0004,0005,0006,0007,0008,000

Apr

May Jun Jul

Aug

Sept

Oct

Nov Dec Jan

Feb

Mar

£'0

00

Agency Spend - Trust WideActual Agency Spend Agency Cap

0100200300400500600700800900

Apr

May Jun Jul

Aug

Sept

Oct

Nov Dec Jan

Feb

Mar

£'0

00

Agency Spend - Corporate DivisionActual Agency Spend Agency Cap

0

50

100

150

200

250

Apr

May Jun Jul

Aug

Sept

Oct

Nov Dec Jan

Feb

Mar

£'0

00

Agency Spend - Secure DivisionActual Agency Spend Agency Cap

0200400600800

1,0001,2001,4001,6001,800

Apr

May Jun Jul

Aug

Sept

Oct

Nov Dec Jan

Feb

Mar

£'0

00

Agency Spend - Local DivisionActual Agency Spend Agency Cap

0100200300400500600700800900

Apr

May Jun Jul

Aug

Sept

Oct

Nov Dec Jan

Feb

Mar

£'0

00

Agency Spend - iMerseyside (IM)Actual Agency Spend Agency Cap

0200400600800

1,0001,2001,4001,6001,800

Apr

May Jun Jul

Aug

Sept

Oct

Nov Dec Jan

Feb

Mar

£'0

00

Agency Spend - Specialist LD DivisionActual Agency Spend Agency Cap

Agency spend within the corporate division to month 7 is £0.513m, compared to a ceiling of £0.455m. An option being considered by the Executive team as part of the recovery plan is to cease all corporate agency spend.

At £5.734m, the Trust is 44.0% above its agency ceiling as at October 2017. This equates to a risk score of 3. The main areas of high agency usage continue to be the local division and medical staff. Action plans have been requested from all areas operating above the ceiling to reduce the forecast outturn.

The local division agency spend as at month 7 is £1.529m, which is £0.909m above the ceiling of £0.621m. The overspend relates largely to agency nursing costs covering vacancies and sickness. The division has started to address agency use as part of a key action in the divisions recovery plan.

Agency usage within the secure division remains at a minimum

Specialist learning disability division's agency spend at month 7 is £1.073m which is above the ceiling by £0.098m. Remedial action plans continue in place and further reductions are expected as the service retracts.

As at end of October, IM's agency spend is £0.676m compared with its agency ceiling of £0.457m. Temporary staff are used to resource change notices on SLA's and to fill vacancies that require specialist skill sets. However the main driver of agency spending has been resourcing the Liverpool Community Health SLA due to the uncertainty of the future direction of the organisation. Plans to recruit to posts have been developed and the level of spend should reduce to within the ceiling by March 2018.

Appendix C

Cumulative Agency Spend by Division

0

100

200

300

400

500

600

700

Ap

r

May Jun Jul

Au

g

Sep

t

Oct

No

v

Dec Jan

Feb

Mar

£'0

00

Agency Spend - LCH South Sefton DivisionActual Agency Spend Agency Cap

The south sefton division transferred to Mersey Care on 1st June. The agency spend to October is £0.328m, which is slightly above the ceiling of £0.292m. The spend is mainly within district nursing, discharge planning and intermediate care.

0200400600800

1,0001,2001,4001,6001,8002,000

Ap

r

May Jun Jul

Au

g

Sep

t

Oct

No

v

Dec Jan

Feb

Mar

£'0

00

Agency Spend - MedicsActual Agency Spend Agency Cap

As at end of October, medical agency/locum spend is £1.595m, compared to a ceiling of £1.064m. This is mainly due to senior medical staffing costs within the local division, offset in part by vacancies across junior medical staff and senior medical staff within Specialist LD. A recovery plan has been developed by the Medical Director and the level of spend will reduce slightly in 2017/18, but the full year effect of the saving is £1.5m.

Cumulative Agency Expenditure by Division - October 2017

Statement of Cash Flows (CF)

April May June July August September October November December January February March

£000s £000s £000s £000s £000s £000s £000s £000s £000s £000s £000s £000s

CASH FLOWS FROM OPERATING ACTIVITIES

Operating Surplus/(Deficit) 1,262 997 1,325 1,402 1,043 868 989 851 527 694 1,208 (996)

Depreciation and Amortisation 446 447 461 490 490 490 480 463 493 494 490 490

Impairments and Reversals 0 0 0 0 0 0 0 0 400 0 0 2,355

Interest Paid (160) (196) (198) (198) (197) (254) (207) (209) (212) (211) (208) (255)

Dividend Paid 0 0 0 0 0 (1,609) 0 0 0 0 0 (3,291)

Losses 0 0 0 0 0 0 0 0 0 0 0 0

(Increase)/Decrease in Inventories 18 (22) (12) 15 (41) 18 42 (6) (6) (6) 0 0

(Increase)/Decrease in Trade and Other Receivables (1,106) 3,712 (2,629) 2,706 1,084 (290) 267 (1,267) (1,267) (1,265) 0 0

Increase/(Decrease) in Trade and Other Payables 637 (937) 3,266 264 (269) 3,153 (902) 881 882 881 (137) (5,104)

Increase/(Decrease) in Other Current Liabilities 0 0 0 0 0 0 0 0 0 0 0 0

Increase/(Decrease) in Provisions (526) (19) 383 (274) (331) 317 (839) 334 333 (16) (6) 252

Net Cash Inflow/(Outflow) from Operating Activities 571 3,982 2,596 4,405 1,779 2,693 (170) 1,047 1,150 571 1,347 (6,549)

CASH FLOWS FROM INVESTING ACTIVITIES

Interest received 4 4 7 3 4 6 4 0 0 1 5 5

(Payments) for Property, Plant and Equipment (1,383) (3,507) (979) (530) (884) (1,030) (1,130) (1,985) (3,033) (3,608) (4,873) (5,417)

(Payments) for Intangible Assets 0 0 0 0 0 0 0 0 0 0 0 0

Proceeds of disposal of assets held for sale (PPE) 0 0 0 0 0 0 0 0 0 0 0 0

Net Cash Inflow/(Outflow)from Investing Activities (1,379) (3,503) (972) (527) (880) (1,024) (1,126) (1,985) (3,033) (3,607) (4,868) (5,412)

NET CASH INFLOW/(OUTFLOW) BEFORE FINANCING (808) 479 1,624 3,878 899 1,669 (1,296) (938) (1,883) (3,036) (3,521) (11,961)

CASH FLOWS FROM FINANCING ACTIVITIES

New Public Dividend Capital 0 0 0 0 0 0 0 1,250 0 0 0 500

Loans received from DH - New Capital Investment Loans 0 0 0 0 0 0 0 0 0 6,370 0 0

Public Dividend Capital repaid in year 0 0 0 0 0 0 0 0 0 0 0 0

Other Capital Receipts 0 0 0 0 0 0 0 0 0 0 0 0

Loans repaid to DH - Capital Investment Loans Repayment of Principal 0 0 0 0 0 0 0 0 0 0 0 (64)

Capital Element of Finance Leases and PFI (33) (34) (32) (33) (74) (33) (164) (50) (55) (54) (60) (63)

Net Cash Inflow/(Outflow)from Financing (33) (34) (32) (33) (74) (33) (164) 1,200 (55) 6,316 (60) 373

Net Increase/(Decrease) in Cash (841) 445 1,592 3,845 825 1,636 (1,460) 262 (1,938) 3,280 (3,581) (11,588)

Cash at the Beginning of the Period 21,553 20,712 21,157 22,749 26,594 27,419 29,055 27,595 27,857 25,919 29,199 25,618

Cash at the End of the Financial Period 20,712 21,157 22,749 26,594 27,419 29,055 27,595 27,857 25,919 29,199 25,618 14,030

ForecastActual

Appendix D

Statement of Cash Flow

Documents

Mersey Care NHS Foundation Trust Care at a Glance Report · ** CQC Community Mental Health Survey results published in November 2017. The trust has been reported as better than expected