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Paper: 11b
Date Wednesday, 15 July 2015
Presenter Dr Breac MacLeod
Author Dr Breac MacLeod
Responsible Director
David Tomlinson
Clinical Lead N/A
Confidential Yes ☐ No Items are only confidential if it is in the public interest for them to be so
The Governing Body is asked to: Agree: the M2 2015/16 outturn and forecast position presented in the attached 2015/16 M2 Finance and Activity Performance report
Agree the following proposed actions in response to the M2 report:
1. Perform a full establishment review to provide analysis of and the explanation for theRunning Cost over-performance identified at M2 F&A, to report in M3 and develop aremedial action plan for delivery in M4 focussing on implementing enhanced interimcontrols.
2. Use the Governing body seminar on 8th July to agree the remaining investments tobe prioritised for delivery by Ealing CCG using the £8.2m quantum of funds proposedfor certain commitment after:• securing additional services in the main 2015/16 acute contract settlements;• securing the investment needed to deliver the QIPP projects; and• setting aside sufficient reserve to cover the full year risks identified at M2.
3. Develop a further list of further priority investments that can rapidly be brought on lineif the risks that emerge after M2 do not materialise to the level that the conservativeestimate at M2 predicts.
Agree: that the Finance and Activity committee will work with Ealing’s Finance team to develop a series of additional slides for M4 onwards to provide additional information around the CCG financial performance to assist the Governing boards on-going review and stewardship.
Title of paper Ealing CCG – 2015/16 M2 Finance and Activity (F&A) Performance report
1
Paper: 11b
Summary of purpose and scope of report
As at M2 - £14.5m of possible risks of additional expenditure not captured in the M2 accounts were identified which were assessed as having a likelihood of materialisation at a level of £9.1m. Planning to manage this risk Ealing CCG has identified thlikely need to dedicate - as yet uncommitted funds (which are drawn from the Reserves, balance sheet gains, RTT backlog adjustments and Acute under-performance) at £9.4m leaving net headroom of £0.3m.
Review at M2 identified that £0.22m of that headroom might also need to be called upon under the CWHHE risk reserve arrangements - leaving the remaining unutilised reserves for to underpin Ealing CCG’s 2015/16 investment plan. It is also important to note that since M2 close 1 further 100% likely risk have emerged - NHSE changed the Recharge arrangements for Overseas visitor in 2015/16 putting a cost pressure of £0.2m which would need to funded from reserves.
Finally looking at the worst case risks which amount to £14.7m (including Overseas visitors) if Ealing were to offset these risks with all the available reserves, contingency, balance sheet gains at £1m, QIPP delivery at £7.5m against an original target of £12.1m , the CCG would be left with £22.9m - £14.7m = £8.2m of available funds to deliver on the planned £5.5m new investments and £2.7m on mental health parity (in addition to that already funded in the main WLMHT etc. contracts).
Quality & Safety/ Patient Engagement/ Impact on patient services:
• None identified
Finance, resources and QIPP • No specific issues
Equality / Human Rights / Privacy impact analysis
None relevant
Risk Mitigating actions
1. Running Cost over-performanceidentified at M2 F&A
1. A full establishment review is to beundertaken in M3 to provide analysis ofand the explanation for the Running Costover-performance identified at M2 F&A,to report in M3 and develop a remedialaction plan for delivery in M3 and 4
2
Paper: 11b
2. Further clarity is needed to identify theremaining investments to be prioritisedand delivered by Ealing CCG using thefunds available after setting asidesufficient reserve to cover the full yearrisks identified at M2.
focussing on implementing enhanced interim controls.
2. A Governing body seminar was held on8th July 2015 to agree the investments tobe prioritised for delivery by Ealing CCGusing the funds available after settingaside sufficient reserve to cover the fullyear risks identified at M2. Noting that aprudent assessment of the fundsavailable has to be taken at M2 and asthe year progress identify a list of furtherpriority investments that can rapidly bebrought on line if the forecast risks do notmaterialise.
Supporting documents
• Attached paper
Governance and reporting
Committee name Date discussed Outcome
Finance and Performance 01/07/15 Noted
Additional commentary for Governing Body paper: None
3
09-Jul-2015
Month 2 2015/16 Ealing CCG Finance and Activity Performance
Finance Report Pages Appendices Page
Provider Acronyms 2 Appendix 1: Financial Schedules 20-33
Rag rating definitions 3
Executive Summary 4a, 4b
CCG Finance dashboard 5
Risk and Opportunities Key Issues & Table 6
Underlying Recurrent position 7
Key issues and actions relating to financial position 8
2015/16 Provider Contract: Deep-dive timetable and contents 9
Surplus/deficit including running costs 10
Budget Movements including running costs 11
Break down of running cost spend 12
Breakdown of Reserves / Opportunities 13
Better Care Fund (1) 14
Better Care Fund (2) 15
Plans to use the 2015/16 budgeted reserves: Investments etc 16a, 16b
QIPP Outturn Summary 17
QIPP Schemes 18a, 18b
Capital, creditor payments and cash 19
Contents
1
Acronym Full Provider Name
ASP Ashford And St Peter's Hospitals NHS Foundation Trust
BLT Barts Health NHS TrustC&W Chelsea And Westminster Hospital NHS Foundation Trust
CLCH Central London Community Healthcare NHS Trust
CNWL Central And North West London MH NHS Foundation Trust
EHT Ealing Hospital NHS Trust
ESH Epsom And St Helier University Hospitals NHS Trust
GOSH Great Ormond Street Hospital For Children NHS Foundation Trust
GSTT Guys And St Thomas NHS Foundation Trust
HRCH Hounslow And Richmond Community Healthcare NHS Trust
HUH Homerton University Hospital NHS Foundation Trust
HWP Heatherwood And Wexham Park Hospitals NHS Foundation Trust
ICHT Imperial College Healthcare NHS Trust
KCH Kings College Hospital NHS Foundation Trust
KHT Kingston Hospital NHS Trust
MEH Moorfields Eye Hospital NHS Foundation Trust
NWLHT North West London Hospitals NHS Trust
RBH Royal Brompton And Harefield NHS Foundation Trust
RFT Royal Free London NHS Foundation Trust
RMH The Royal Marsden Hospital NHS Foundation Trust
RNOH Royal National Orthopaedic Hospital NHS Trust
RSC Royal Surrey County NHS Foundation Trust
SGT St George's Healthcare NHS Trust
SLAM South London And Maudsley NHS Foundation Trust
SWL&StG South West London And St George's Mental Health NHS Trust
THH The Hillingdon Hospital NHS Foundation Trust
UCLH University College London NHS Foundation Trust
WHH The Whittington Hospital NHS Trust
WLMH West London Mental Health NHS Trust
WMUH West Middlesex University Hospital NHS Trust
Key message
The following acronyms are used throughout this pack.
Provider Acronyms
2
Source: CWHHE Central Finance
The RAG rating definitions are as follows:
1. Financial position in month - Red is greater than or equal to 2%, Amber is less than 2% but greater than 0% and green is less than
or equal to 0%.
2. Financial position year to date - Red is greater than or equal to 1%, Amber is less than 1% but greater than 0% and green is less
than or equal to 0%.
3. Financial position forecast outturn - Red is greater than or equal to 0.5%, Amber is less than 0.5% but greater than 0% and green
is less than or equal to 0%.
4. Running costs forecast outturn - Red is greater than or equal to 0.5%, Amber is less than 0.5% but greater than 0% and green is
less than or equal to 0%.
5. QIPP year to date / QIPP forecast outturn / Investment plan - Red is greater than or equal to 20%, Amber is less than 20% but
greater than 5% and green is less than 5%.
6. Risks and opportunities - Red is greater than or equal to 0.5%, Amber is less than 0.5% but greater than 0% and green is less than
0%.
7. Creditors - Better Payment Practice Code - Red is less than or equal to 92.5%, Amber is less than 95% but greater than 92.5% and
green is greater than or equal to 95%.
8.Capital outturn -Red is greater than or equal to 10%, Amber is greater than 0.5% but less than 10% and green is less than 0.5%.
9. Cash drawn down to date - Red is less than or equal to 85%, Amber is less than 95% but greater than 85% and green is greater
than or equal to 95%.
RAG Rating Definitions - Slide ii
3
Status
Overall
financial
position
Green
Contract
PerformanceGreen
As at Month 2 the total budget is £479m for 2015-16. The individual budgets at Month 2 (M2) reflect the plan agreed at the Governing Body on the 10th June 2015. The
Governing Body agreed that all future budget changes will be managed under the CWHHE budget virements policy and will be subjected to 1st review at the 8 July 2015
Governing body seminar. The seminar will clarify:
1) The amount of reserves available in 2015/16
2) The risks and cost pressures on the Underlying budgets as a call on reserves
3) the Priority of 15/16 investments for delivery
At Month 2 the CCG's planned surplus of £4.9m is still forecast to be achieved but necessitated the release of £0.9m to M2 to cover Programme overspend (predominantly
from Acute contracts) and the release of £0.24m to M2 to cover the overspend on Running costs against a running cost reserve of £0.33m.
Programme Pressures/variances to M2 are predominantly from:-
- Acute Contracts £0.8m ; with material contributions from Imperial (£0.17m), West Middx (£0.26m), Chelsea and Westminster (£0.28m), UCLH (£0.066m), Guys and St.
Thomas' (£0. 049m)
NB Ealing Hospital have a capped Block contract in 15/16. In M2 the CCG reported spend to block but will need to closely monitor to reflect impact if the 1.5% cap /
threshold nears breach levels in future months.
- Other Acute £0.2m; Planned Care associated with Phlebotomy and Spirometry pressures
NB £2.4m of Reserve was needed to be released to M12 in order to maintain the profiled £4.9m annual surplus
Running cost Pressures / Variances to M2 are driven by:-
- The attribution of CCG staff cost spend between Programme and admin categories needing to be refined: and
- the recording and use of CCG interims needing to be tightened
The Ealing Senior team are performing a full establishment review in M3, alongside the development of the resource/ staffing plan for implementing Ealing's QIPP and
Investment schemes to bring the Running cost expenditure back into profile for 2015/16 and will report back findings at the M3 F&P.
The over-performance to M2 on the CSS workforce element of Running costs is lacking transparency currently and the Ealing senior team is working with the CSS team in
M3 and M4 to gain greater clarity and assurance about where spend can be pulled back within budget whilst minimising impact to Ealing's CSS services. The CSS team
are to circulate a Running cost paper to CWHHE F&Ps in July 2015 as a start of this exercise.
Full Year Forecast Outturn (FOT): Analysis at M2 (only the 1st month of the Acute contracts SLAM data was available and history shows that this tends to be unreliable
and therefore needing cautious consideration) demonstrated that:
a) The Imperial M2 overspend is likely to be turned around to a Forecast Outturn (FOT) of £0m because Direct access pathology will only impact for 3 months and will be
offset by countervailing underspends. But this will need further investigation to confirm in M3.
b) UCLH and Guys and St. Thomas' are likely to have a FOT of £0.28k and £0.33m respectively as the M2 spend profile presented similarly to 2014/15 but the 2015/16
contracts were agreed lower by these values.
c) West Midd and C&W are likely to yield FOTs of £1.3k and £0.7m respectively as analysis of the M2 spend profile showed that this was actual overspend against plan for
maternity and NEL. This will need further investigation to confirm FOT in M3
NB £2.4m of Acute reserve was needed to be released to cover overspend to FOT and maintain the profiled £4.9m annual surplus
Executive Summary (a)
4a
Status
QIPP Green
Risks and
Opportunities
Green
Investment and
ReservesGreen
The CCG has a 2015/16 plan to deliver gross QIPP savings of £12.2m, offset by a dedicated QIPP reserve to fund Reprovision costs and underpin QIPP
under delivery of £4.4m. Full application of this reserve to QIPP would yield an overall net QIPP saving delivery of £7.8m . A significant proportion of the
planned net QIPP savings are reflected as a £4.4m block with Ealing Hospital.
The Ealing senior team is reviewing the progress on QIPP planning and forecast delivery in M3 to determine how much of the £4.4m needs is likely to need
committing to cover Reprovision costs and under-delivery in 2015/16. The outcome will be reported to the M3 F&P committee.
At Month 2 there is a worst case £14.7m additional risk facing the delivery of the £4.9m surplus. This translates to LIKELY level of risk identified of £9.4m
which this report shows can be mitigated by opportunities / use of reserves of £9.5m - resulting in a net opportunity of £0.083m - see Slide 5.
The impact of Risks and Opportunities are not reflected in the forecast outturn position but are items (both adverse and favourable) which if they were to
occur, would impact on the Final financial position. Both risk and opportunities are subject to uncertainty as to value and timing, so as and when these
uncertainties crystallise they will need to be reflected in forecast outturn, or be removed from the Risks and Opportunities table.
The Opportunities are a reflection of how the reserves that have been set aside by Ealing CCG is 2015/16 might be committed by the Governing body to
manage a wide range of investments needed to deliver on its operating plan and surplus and the cost pressure and risks that it faces that were not fully
identified at the time of agreeing the 2015/16 budget in June 2015.
The opportunities held by Ealing result from setting up budgets of £21.9m of reserves and £1.0m 2014/15 Accrual reversal from unmaterialising accruals to
fund investments and manage emerging risks in 2015/16. The £21.9m of reserves consist of:
1) The Contingency fund has been set at £4.7m and amounts to approximately 1% of the CCG allocation at Month 2.
2) The Other Reserve of £2.1m has been set to fund Ealing CCG's commitment to delivering Mental Health Parity.
3) The Investment reserve amounts of £5.5m to be committed against ECCG strategic priorities in 2015/16.
4) The QIPP Risk reserve of £4.4m funds reprovision costs and underpins under delivery.
5) The Non Demographic, Acute, Mental Health and Community Reserves retain funds of £4.7m to offset emerging cost pressures in 2015/16 with the
balance available for supplementing ECCG's investment plans. As at M2 it is anticipated that £2.4m will need to be released to cover the material cost
pressures on Programme spend - predominantly acute contracts - that have been identified. This leaves a balance of £2.3m for consideration for
investment or covering other cost pressures.
In addition, Ealing CCG has committed £13.3m as its contribution towards the NWL Financial Strategy Part A.
Executive Summary (b)
4b
Indicator Target Actual
Rating this
month
Programme Financial position YTD Agreed surplus £815k £814k (0.1%) variance from planned position
Programme Financial position forecast outturn Agreed surplus £4,889k £4,889k 0.0% variance from planned position
Running Costs Financial position YTD Expenditure £1,562k £1,562k 0.0% variance from planned position
Running costs forecast outturn Expenditure £8,262k £8,262k 0.0% variance from planned position
QIPP year to date Savings £1,334k £1,520k (12.2%)
QIPP outturn Savings £7,778k £9,250k (15.9%)
Risks and opportunities Risk/opportunity £9,381k £9,463k 0.9%(net risk) / opportunity outside reported position (likely
case)
Payables - Better Payment Practice Code Payments 95.0% 96.9% 96.9% Invoices paid within 30 days target
Cash Cash flow £79,009k £67,198k 14.9% As per maximum cash draw down
Note
The CCG is on course to achieve its key financial targets.
variance from plan - CWHHE agreed to Plan submission with
no QIPP reserve phased in
variance from plan - CWHHE agreed to Plan submission with
no QIPP reserve phased in
CCG Finance Dashboard
5
M2 - Underlying Recurrent Position
6
Key message
As at M2 - £14.5m of risks but as yet not committed spend were identified but not reflected in the M2 accounts. This was because the likelihood of materialisation of these risks still needs to assessed and
reviewed on a monthly basis. In order to manage / cover this risk if it materialises, ECCG is retaining, as yet, uncommitted funds (which are drawn from the Reserves, balance sheet gains, RTT backlog
adjustments and Acute under-performance). The table below shows how these Reserves could be committed at £9.4m to cover the "Likely" risks whilst still leaving a net headroom of £0.3m. Under the M2
review by CWHHE they identified that £0.22m of that headroom might also need to be called upon under the CWHHE risk reserve arrangements - leaving the remaining unutilised reserves to underpin
ECCG 2015/16 investment plan. It is also important to note that since M2 close, one new risk has emerged from NHSE changing the recharge arrangements for Overseas visitor in 2015/16 presenting the
CCG with a cost pressure of £0.2m which would need to funded from reserves. NB The CCG has a capped Block 15/16 contract with Ealing Hospital. Up to M2, performance has been reported to
budgeted block value, but this contract will need close monitoring in future months to reflect the additional spend impact if the 1.5% threshold proves to be at risk of being breached.
Looking at the worst case risks at m2 - which amount to £14.7m (including Overseas visitors) - if Ealing were to offset these risks with all the available reserves, contingency, balance sheet gains at £1m,
and delivery QIPP saving at £7.5m against an original target of £12.1m, then the CCG would be left with £22.9m - £14.7m = £8.2m of available funds to deliver on the planned £5.5m priority new
investments and £2.7m on mental health parity investments - in addition to that already funded in the main WLMHT etc. contracts. The CCG is focussing on the delivery of the prioritised projects in Slide
16a up to this amount under review with GB at the seminar on 8th July.
Risks and Opportunities (Reserves and Balance sheet gains)
Range Likely Best Worst
CCG level risks £000s % £000s % £000s % £000s Commentary
Other QIPP Achievement 4,552 75% 3,414 0% 0 100% 4,552 £12.1m in 2015/16 operating plan with £4.552m risk reserve set up
Acute over-performance 5,469 56% 3,085 0% 0 100% 5,469 Intelligence from across CWHHE Contracting and Contract Finance divisions
Mental health/Community Cost
and Volume
65 50% 32 0% 0 100% 65 Upper range of high cost patient impact that can emerge beyond average budgets
Further IR/NHSE 920 50% 460 0% 0 100% 920 Risk of internally generated and specialised commissioning referrals being passed back to Ealing CCG after
others' challengeContinuing care 1,000 25% 250 0% 0 100% 1,000 Upper range of high cost patient impact that can emerge beyond average budgets
RHN Pressure 283 100% 283 50% 142 100% 283 Royal Hospital for Neuro-Disabilities are attempting to negotiate Tariff change will all London CCGs
Out of Hospital Costs 500 50% 250 0% 0 100% 500 Upper range of high cost patient impact that can emerge beyond average budgets
NHS Property Services and
CHP
169 80% 135 0% 0 100% 169 Value under dispute for Estate costs
Prescribing 500 50% 250 0% 0 100% 500 Allows for emerging NICE approved drug costs and price changes
Unforeseen risks 1,000 100% 1,000 0% 0 100% 1,000 Intelligence from across CWHHE
Total 14,457 63% 9,159 1% 142 100% 14,457
CCG level opportunities £000s % £000s % £000s % £000s Commentary
Investment slippage 5,545 10% 555 50% 2,773 0% 0 Funding set aside to fund 2015/16 priority CCG Investments identified in the outline Operating planning for work
up and final costing and approval during the year.
Balance sheet gains 1,000 20% 200 0% 0 100% 1,000 Amounting of accruals set aside by CCG in 2014/15 after the Agreement of Balances (and other) exercises which
are settled on average in Ealing's favour and offer Non recurrent benefit
Contingency not utilised 4,738 100% 4,738 0% 0 100% 4,738 NHSE mandate the retention of 1% contingency to cover (inc £2.1m Parity of esteem)
Other acute reserves not
utilised
11,622 22% 2,506 0% 0 86% 10,022 Acute, Community, mental health, QIPP reserve and Parity of esteem reserves set aside
RTT backlog included in FOT 1,484 25% 371 95% 1,409 10% 148 RTT at risk of being initially reported by Trusts but recoup under CWHHE wide initiative
Acute under performance 2,838 39% 1,095 0% 0 86% 2,437 Intelligence from across CWHHE
Total 27,227 35% 9,463 44% 4,182 439% 18,345
Net CCG (risk)/ opportunity 12,770 305 4,041 3,888
CWHHE risk share Commentary
Acute over-performance (222) (222) (222) (222) Balancing risk and opportunity across all CWHHE CCGs. The Ealing Senior team is working with the central
Total (222) 0 (222) 0 (222) 0 (222) team to understand the rules for the potential activation of the Risk share each month throughout the year.
Overall net (risk)/ 83 3,819 3,6667
Issue Key drivers
Financial
impact
YTD, £m Action Owner
Chelsea And Westminster -£0.3
The main reasons for overspend at Month 2 are Day Cases (£0.1m) and Electives
(£0.1m). Under - investigation in liaison with CWHHE Trust contract and Finance
managers to develop FOT impact assessment for M3.
Breac
MacLeod
West Middlesex -£0.3
The main reasons for overspend at Month 2 are Maternity (£0.2m) and Non
Electives (£0.2m). Under - investigation in liaison with CWHHE Trust contract and
Finance managers to develop FOT impact assessment for M3.
Breac
MacLeod
Imperial -£0.2
The main reasons for overspend at Month 2 is Daycases and Direct pathology.
Under - investigation in liaison with CWHHE Trust contract and Finance managers
to develop FOT impact assessment for M3.
Breac
MacLeod
Total -£0.7
Total -£1.4
GP IT BAU -£0.2The variance shown is due to no allocation being notified for 2015-16 as yet. It is
expected that an allocation for GPIT will be notified for Month 3 Reporting.
Neetika
Mahan
Total -£0.2
CO
NT
RA
CT
S
Key issues and actions relating to Financial Position - (a)
8
Key Provider Critical
Care
NEL
Admission
QIPP
Details
etc etc etc etc
1 West Middlesex M3 M6 M12
2 Imperial M3 M6 M9
3 Ashford and St Peter M6
4 Hounslow and Richmond Community
Healthcare M6 M12
5 Moorfields M3 M9
6 Ealing M6 M12
Source: M2 F&P
ContentsDeep Dive Presented to F&P
2015/16 Provider Contract: Deep-dive timetable and contents
9
.
Key message
2 3 5 6 8 9
Budget Actual Variance Budget Outturn Variance
Allocation Resource limit 73,987 73,987 0 478,942 478,942 0
Acute Contracts 35,270 36,112 (843) 215,356 217,312 (1,957)
Acute In Year Risk Reserve 0 0 0 0 0 0
Other Acute Commissioning 4,104 4,131 (28) 24,622 24,812 (190)
Mental Health Commissioning 8,155 8,155 (0) 49,510 49,514 (4)
Continuing Care 2,770 2,770 0 19,480 19,480 0
Community 9,352 9,352 (0) 55,747 55,747 0
Prescribing 6,913 6,916 (4) 42,796 42,796 0
Primary Care 2,942 2,920 22 17,652 17,652 0
Other 2,105 1,253 852 40,629 38,478 2,151
Running Costs Corporate Costs 1,562 1,562 (0) 8,262 8,262 0
Net Expenditure 73,172 73,172 (0) 474,053 474,053 0
Surplus/(Deficit) 815 814 1 4,889 4,889 0
The main pressures on Acute Contracts are highlighted on Slide 8a and in the Executive Summary.
The "Other" category includes corporate non running costs, reserves and contingency.
The planned surplus for Ealing CCG is £4.9m. At Month 2 the CCG are forecasting to achieve the planned surplus.
Year to date (£k) Full year (£k)
Commissioned
services
Surplus/(Deficit) including Running Costs
10
Key message
Summary
Initiative Month 1
Budget
Changes
Classification
Changes Month 2 Further detail
£k £k £k £k
Programme 427,382 0 3,204 430,586 Please see detail below
Programme - Contingency and Reserves 42,910 (4,501) (3,204) 35,205 Reduction in RRL of £4.5m relating to NWL Strategy
Running Costs 8,262 0 0 8,262
Planned Surplus/Deficit 4,798 91 0 4,889 Increase in RRL of 0.1m relating to DTR/ETO
Total Allocation 483,352 (4,410) 0 478,942
Detail
Acute 237,291 3,506 (820) 239,978Acute Contract Adjustments £3.5m from Reserves. Movement of LPS Income Budget from WLMHT to LNW Ealing Hospital
(£0.8m).
Mental Health 49,844 (1,154) 820 49,510Reduction in MH In Year Risk Reserve (£0.2m) to reserves. Mental Health Contract Adjustments (£0.9m) to reserves. Movement
of LPS Income Budget from WLMHT to LNW Ealing Hospital £0.8m.
Continuing Care 19,480 0 0 19,480 0
Community ( Inc. LES) 38,732 1,066 15,949 55,747Reduction in Community In Year Risk Reserve (£0.2m) to Reserves. Community Contract Adjustments £1.7m from Reserves.
Reclassification of BCF to Community from Corporate £15.9m. Reduction in ICE BCF Funding (£0.5m) moved to reserves.
Prescribing 42,796 0 0 42,796 0
Primary Care 16,806 846 0 17,652 Increase in Budget for OOH LIS £0.9m from Reserves. Reduction in NHS 111 Budget (£0.1m) moved to Reserves
Corporate and Estates 22,434 (1,061) (15,949) 5,424Reduction of Property Services Budget (£1.1m) moved to reserves. Reclassification of BCF to Community from Corporate
(£15.9m)
Reserves and Contingency 42,910 (7,705) 0 35,205
Reduction of RRL NWL Strategy (£4.5m). Acute Contract Adjustments (£3.5m) from Reserves. Reduction in MH In Year Risk
Reserve £0.2m to reserves. Mental Health Contract Adjustments £0.9m to reserves.Reduction in ICE BCF Funding £0.5m moved
to Reserves. Reduction in Community In Year Risk Reserve £0.2m to Reserves. Community Contract Adjustments (£1.7m) from
Reserves. Reduction of Property Services Budget £1.1m moved to reserves. Increase in Budget for OOH LIS (£0.9m) from
Reserves. Reduction in NHS 111 Budget £0.1m moved to Reserves
Running Costs 8,262 0 0 8,262 0
Planned Surplus/Deficit 4,798 91 0 4,889 Increase in RRL of 0.1m relating to DTR/ETO
Total 483,352 (4,410) 0 478,942
Please see detail below
Budget Movements including Running Costs - Draft M1 to M2 agreed at June Governing Board
11
Key message
Commissioning
Spend Budget Actual Variance Budget Actual Variance
Allocation Resource Limit 1,562 1,562 0 8,262 8,262 0
Borough Costs 995 1,171 (176) 5,971 5,971 0
CSS Costs 311 153 158 1,866 1,866 0
Other Recharges 16 236 (221) 94 94 0
Reserves 240 1 239 332 332 0Surplus/deficit
for running costs 0 (0) (0) 0 0 0
£0.24m of the £0.33m Running cost reserve had to be released to M2 to cover the overspend on Running costs. If a similar trend prevailed
for the remaining months of 2015/16 then there is a risk that this budget would be ovr-spent. Consequently the June F&P agreed that Ealing
CCG would carry out a full Establishment review and develop an action plan to quash the risk of such an overspend.
Early analysis shows that the Running cost Pressures / Variances to M2 are driven by:-
- The attribution of staff cost spend between Programme and admin categories needing to be refined: and
- the recording and use of interims needing to be tightened
The Ealing Senior team will perform the establishment review in M3, alongside the development of the resource/ staffing plan for
implementing Ealing's QIPP and Investment schemes to bring the Running cost expenditure back into profile for 2015/16 and will report
back findings at the M3 F&P.
Year to date (£k) Full year (£k)
Running
costs
Break down of Running Cost Spend
12
Key message
Budget Actual Variance Budget Outturn Variance
• Contingency 0 0 0 4,738 4,738 0
A Contingency reserve of £4.7m at Month 2 which amounts to approximately 1% of
the CCG overall budget at Month 2. At Month 2 the forecast is that the £4.7m will be
fully utilised.
• Other Reserve 0 0 0 2,080 2,080 0The other reserve is to cover Mental Health parity pressures and amounts to £2.1m.
At Month 2 the forecast is that the £2.1m will be fully utilised.
• Investment Reserve 0 0 0 5,545 5,545 0The investment reserve amounts to £5.5m and is to be used against agreed
investment by the CCG. At Month 2 the forecast is that the £5.5m will be fully utilised.
• QIPP Risk Reserve 0 0 0 4,882 4,882 0The QIPP Risk Reserve of £4.9m is to be used against any pressures on the QIPP
plan for the CCG. At Month 2 the forecast is that the £4.9m will be fully utilised.
• Non-Demographic Reserve - Mental Health 0 0 0 408 408 0
The Non Demographic Reserve Mental Health is to be used against any pressures
on Mental Health related budgets. At Month 2 the forecast is that the £0.4m will be
fully utilised.
• Non-Demographic Reserve - Acute 1,201 289 912 3,444 1,013 2,431
The Non Demographic Reserve Acute is to be used against any pressures on Acute
related budgets. At Month 2 the forecast is that the £1.0m will be utilised by year end.
The balance of £2.4m is available to offset forecasted pressure in other areas.
Non-Demographic Reserve - Community 0 0 0 809 809 0
The Non Demographic Reserve Community is to be used against any pressures on
Community related budgets. At Month 2 the forecast is that the £0.8m will be fully
utilised.
2014/15 Balance Sheet Gains 0 0 0 1,000 1,000 0By M4 Ealing CCG's Finance will evaluate the amount of prior year accruals that
have been unutilised and can support non-recurrent investment. @M2=£0
Total Available Reserve to cover Risk and
Investment1,201 289 912 22,905 20,474 2,431
In £21.9m is available for covering the emerging risk in 2015/16 and delivering
the Investments needed to underpin Ealing CCG's Operating plan
• NWL Financial Strategy Part A 0 0 0 13,300 13,300 0The NWL Financial Strategy Reserve has been set to use against Part A contribution
and is forecasted to be fully utilised at Month 2.
TOTAL 2015/16 Reserves1,201 289 912 36,205 33,774 2,431
NB Excluding the NWL Financial Strategy Part A contribution of £13.3m leaves £21.9m of available 2015/16 reserves and the opportunity to utilise the likely
balance sheet gains from the non-materialisation of 2014/16 actuals at a value of around £1m - totalling £22.9m.
By M4 Ealing CCG's Finance will evaluate the amount of balance sheet gains that can been unutilised and support non-recurrent investment in 2015/16. @
M2 = £0
Year to date (£k) Full year Forecast (£k) Further detail
Breakdown of Reserves / Opportunities
13
Key message
Under development for Governing Body Discussion
Better Care Fund - (1) Under Development
Key message
Under development for Governing Body Discussion
Better Care Fund (2) - Under development
Key message
Allocated Ref Category Service Supplier Lead Manager
Total
Budget
2015/16
Full Year
Plan
2015/16 Recurrent Non Recurrent YTD Plan
YTD
Actual
YTD
Variance FOT
FOT
Variance
£000 £000 £000 £000 £000 £000 £000 £000 £000
1
Investment Reserve -
F&P Approved
01/06/15Paediatric Physiotherapy Services (part of
Childrens' services) LB of Ealing
Allison
Bennett 44 44 0 44 0 0 0 0 0
2
Investment Reserve -
F&P Approved
01/06/15 Maternity Ante-Natal - New (Out of starting Imperial
Delia
O'Rourke 212 212 0 212 0 0 0 0
3
Investment reserve -
ScoredEaling Integrated Intermediate Care(EIIC) Healthy
@ Home/ICE 2 Ealing Hospital Neha Unadkat 800 800 0 0 0 0 0 0 0
Total 1,056 1,056 0 256 0 0 0 0 0
11
Investment reserve -
ScoredDiabetes Type 1 - Insulin Pump Initiation at
EHT/DICE Neha Unadkat 0 28 0 0 0 0 0 0 0
12
Investment reserve -
Scored Palliative care Neha Unadkat 0 32 0 0 0 0 0 0 0
13
Investment reserve -
Scored
London Ambulance Service Pathway Co-
ordinators(Ealing) Neha Unadkat 0 66 0 0 0 0 0 0 0
14
Investment reserve -
Scored
Diabetes - Education Programme - Right
Start Neha Unadkat 0 68 0 0 0 0 0 0 0
15
Investment reserve -
Scored Connecting Care for Children Neha Unadkat 0 100 0 0 0 0 0 0 0
16
Investment reserve -
Scored Diabetes - Psychologist Neha Unadkat 0 59 0 0 0 0 0 0 0
17
Investment reserve -
Scored
Enhanced Substance Misuse Hospital
Inreach Support Neha Unadkat 0 157 0 0 0 0 0 0 0
18
Investment reserve -
Scored
Early Start Ealing - an integrated health
and family support service for families
with pre school children Neha Unadkat 0 122 0 0 0 0 0 0 0
19
Investment reserve -
Scored Community musculoskeletal pain service Neha Unadkat 0 250 0 0 0 0 0 0 0
20
Investment reserve -
Scored Paediatrics - Atopic Conditions Neha Unadkat 0 330 0 0 0 0 0 0 0
21
Investment reserve -
Scored
UCC spec to common operating spec(i.e.
SaHF) Neha Unadkat 0 500 0 0 0 0 0 0 0
22
Investment reserve -
Scored
Specialist child health services (Less £44k
for Paediatric Physiotherapy Services
agreed F&P 01/07) Neha Unadkat 0 534 0 0 0 0 0 0 0
23
Investment reserve -
Scored
Imperial RTT & Opthamology - In-year
variations anticpated Neha Unadkat 0 1,736 0 0 0 0 0 0 0
23
Investment reserve -
Scored Remaining Reserve
Governing
Body 0 506 0 0 0 0 0 0 0
Remaining Investment
reserve to be VIRED0 4,489 0 0 0 0 0 0 0
2015/16 Investment reserve -
Total Budgeted1,056 5,545 0 256 0 0 0 0 0
1 Mental health Parity IAPT Cath Attlee 0 140 0 0 0 0 0 0 0
2 Mental health Parity Primary MH Workers - SSOC Cath Attlee 0 220 0 0 0 0 0 0 0
3 Mental health Parity
1 WTE Social Worker for Winterbourne
(non=rec) +Additional Community Staff Cath Attlee 0 280 0 0 0 0 0 0 0
4 Mental health Parity Cognitive Impairment & Dementia Service Cath Attlee 0 335 0 0 0 0 0 0 0
5 Mental health Parity Perinatal Mental Health Cath Attlee 0 501 0 0 0 0 0 0 0
6 Mental health Parity Urgent Care Cath Attlee 0 848 0 0 0 0 0 0 0
7 Mental health Parity
Increase in pricing for OOH Severe mental
Illness Cath Attlee 0 200 0 0 0 0 0 0 0
8 Mental health Parity CAMHS out of hours service Cath Attlee 0 158 0 0 0 0 0 0 0
9 Mental health Parity SSOC user engagement and MH pathways Cath Attlee 0 60 0 0 0 0 0 0 0
10 Mental health Parity Remaining Reserve Cath Attlee 0 (87) 0 0 0 0 0 0 0
Mental Health Parity of Esteem
Reserve 0 2,655 0 0 0 0 0 0 0
Total Committed Reserves 1,056 8,200 0 256 0 0 0 0 0
Remaining Reserves to Cover Risks
including Cost pressures0 14,700 0 0 0 0 0 0 0
2015/16 Reserves and Investments
Grand Total1,056 22,900 0 256 0 0 0 0 0
Other Scored and Prioritised
2015/16 Investments -
Slated against the
Invetsment Reserve
To retain £14.7m Risk reserve to cover the worst case identified in the Risks and opportunities analysis on Page 5, Ealing CGG is left with freely committable reserves of £2.7m for mental health parity of esteem and £5.545m for Other prioritised
Investments. The Mental health investments are in addition to the £1,050m already committed to WLMHT for Limes extension and Dementia services in 2015/16 Contract which totals £3.75m additional investment of mental health parity of esteem
investment in 2015/16. These investments are presented below in the current order of priority for the Governing Body to confirm their approval and re-prioritisation in light of the Unscored investments and Cost pressures already identified for Ealing CCG
which are presented on page 14(a).
Moved into the agreed
2015/16 Budget - from
Investment Reserve
Other Scored and Prioritised
2015/16 Investments slated
against the Mental Health
Parity of Esteem Reserve
Plans to use the 2015/16 budgeted reserves on Mental Health parity schemes and Ealing Priority Investments
16a
Key message
Allocated Ref Category Service Supplier Lead Manager
Total
Budget
2015/16
Full Year
Plan 2015/16 Recurrent Non Recurrent YTD Plan
YTD
Actual
YTD
Variance FOT
FOT
Variance
£000 £000 £000 £000 £000 £000 £000 £000 £000
1 CMC funding for practices 0 125
2 OOH - extended hours 0 990
3 Community Transport Funding 0 250
4 Planned care gynaecology 0 250
5 Planned care respiratory 0 100
6
London Ambulance Service - anticipated
cost pressure a c 7.5% contract value 0 750
7 Older People - frailty service 0 250
8 Additional funding for winter/resilience 0 500
9
Remaining needed for Mental Health
and priority Investments 0 (419)
Additional release of
reserves needed 2,796
10
Investment reserve -
Scored CSS Recharges for Non GPIT services 0 115
11
Investment reserve -
Scored OOH Training and Education 0 75
12
Investment reserve -
Scored OOH Equipment 0 152
13
Investment reserve -
Scored Carers Centre Project with Primary Care 0 95
14
Investment reserve -
Scored Strengthening Community Transport 0 11
15
Investment reserve -
Scored Paediatric Phlebotomy 0 75
16
Investment reserve -
Scored
Continuing Healthcare and Assessment
not inc CHS Contract 0 161
17
Investment reserve -
Scored
Continuing Healthcare and Assessment
CHS Contract 0 32
18
Investment reserve -
Scored
Outcome of the Establishment review -
reverse allcoation of Running Costs to
Programme costs which needs funding 0 200
19
Investment reserve -
Scored Non Contracted Activity (NCAs) 0 203
20
Investment reserve -
Scored Adult Phlebotomy 0 57
Cost Pressure Total 0 1,177
QIPP Re-provision / under-
delivery Reserve0 4,882
Remaining Risk cover Acute Over-performance, Prescribing, RHN tariff increase etc. 0 5,845
0 14,700
The £14.7m Risk reserve proposed to be set aside by the Governing Body of Ealing to cover the worst case identified in the Risks and opportunities analysis recognises a range pressures including the £977k of
cost pressures that have been identified at M2.
This seminar presents the Governing body the opportunity to look at the Unscored as yet unprioritised investments which may be interchanged with the other investments present on the Previous page whilst
agreeing how much funding should be set aside to cover the other risks such as Acute over-performance, prescribing over-performance etc.
It is suggest that the Governing body via the F&P would review this commitment on a monthly basis and rebalance as the year progress and some of the uncertainties become clarified with time. M2 represent s the
start point for this process of monthly review.
Cost Pressures emerging at M2 -
Unforeseen Risks
UnScored or As yet "unPrioritised"
2015/16 Investments
Total Uncommitted Reserve
Plans to use the 2015/16 budgeted reserves on As yet "UnPrioritised" Investments, emerging cost pressures, QIPP under-delivery and the remaining risks facing Ealing CCG
16b
Key message
Source:PMO QIPP report
high quality support to commissioners to improve health and wellbeing
M P I W
The gross QIPP plan before reprovision investment and under-delivery risk cover amounts to £12.2m. The planned reprovision costs amount to £4.4m. This gives a net QIPP Plan for 2015-16 of £7.8m. No QIPP reprovison reserve was released
in Month 2.
QIPP Outturn Summary
QIPP CCGs
Previous
Month In Month Actual - Month 02 YTD
£m% of
Allocation
Actual
£m
Forecast
£m
Plan
£m
Actual
£m
Var
£m% of Plan RAG
Plan
£m
Actual
£m
Var
£m% of Plan RAG
Actual
£m
Var
£m% of Plan RAG
Headings APlan A%OfAllo PrevMthYTDPrevMthFCOT MthPlan MthAct MthVar Mth%PlanMth_RAG YTDPlan YTDAct YTDVar YTD%PlanYTD_RAG FCOTAct FCOTVar FCOT%PlanFCOT_RAG
Transactional QIPP
Acute services 0.00 0.0% 0.00 0.00 0.00 0.00 0.00 0.00 0.00
Mental Health Services 0.00 0.0% 0.00 0.00 0.00 0.00 0.00 0.00 0.00
Community Health Services 0.00 0.0% 0.00 0.00 0.00 0.00 0.00 0.00 0.00
Continuing Care Services 0.00 0.0% 0.00 0.00 0.00 0.00 0.00 0.00 0.00
Primary Care services 0.00 0.0% 0.00 0.00 0.00 0.00 0.00 0.00 0.00
Other Programme Services 0.00 0.0% 0.00 0.00 0.00 0.00 0.00 0.00 0.00
Commissioning Services Total 0.00 0.0% 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00
Running Costs 0.00 0.0% 0.00 0.00 0.00 0.00 0.00 0.00 0.00
Transactional QIPP TOTAL 0.00 0.0% 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00
Transformational QIPP
Acute services 10.04 2.1% 0.66 0.00 0.49 0.66 0.17 135.1% G 0.98 1.32 0.34 135.1% G 8.02 (2.02) 79.9% A
Mental Health Services .04 0.0% 0.00 0.00 0.00 0.00 (0.00) 0.0% R 0.01 0.00 (0.01) 0.0% R 0.03 (0.01) 85.7% A
Community Health Services .56 0.1% 0.04 0.00 0.05 0.04 (0.01) 85.7% A 0.09 0.08 (0.01) 85.7% A 0.45 (0.11) 80.4% A
Continuing Care Services 0.00 0.0% 0.00 0.00 0.00 0.00 0.00 0.00 0.00
Primary Care services .75 0.2% 0.06 0.00 0.06 0.06 (0.00) 96.0% G 0.13 0.12 (0.01) 96.0% G 0.75 0.00 100.0% G
Other Programme Services (3.61) -0.8% 0.00 0.07 (0.07) 0.0% R 0.13 0.00 (0.13) 0.0% R 3.61 0.0% R
Commissioning services Total 7.78 1.6% 0.76 0.00 0.67 0.76 0.09 113.9% G 1.33 1.52 0.19 113.9% G 9.25 1.47 118.9% G
Running Costs 0.00 0.0% 0.00 0.00 0.00 0.00 0.00 0.00 0.00
Transformational QIPP TOTAL 7.78 1.6% 0.76 0.00 0.67 0.76 0.09 113.9% G 1.33 1.52 0.19 113.9% G 9.25 1.47 118.9% G
Unidentified QIPP 0.00 0.0% 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00
TOTAL QIPP 7.78 1.6% .76 0.00 .67 .76 .09 113.9% G 1.33 1.52 .19 113.9% G 9.25 1.47 118.9% G
15/16 Target Forecast
17
Key Messages
The CCG has a 2015/16 plan to deliver gross QIPP savings of £12.2m, offset by a dedicated reserve to fund Reprovision costs and underpin QIPP under delivery of £4.4m. Full
application of this reserve to QIPP would yield an overall net QIPP saving delivery of £7.8m . The significant proportion of the net savings are reflected in contracts, including a £4.4m
block with Ealing Hospital.
QIPP Scheme Delivery - (1)
Provider / Scheme Scheme NamesRoll over
/ New
Cost
Reduction
Investment
required
Financial Plan (Gross
no Investment)M1 M2
Service redesign to reduce
acute footfall - EHT(£4,745) (£373) (£373)
Cardiology 15/16 New (£517) £632
Dermatology 14/15 Roll Over (£118)
Dermatology 15/16 New £74
DTOCs 15/16 New (£25)
EIICS 15/16 New (£376)
ICE 14/15 Roll over
MSK 15/16 New (£313) £101
MSK 14/15 Roll over
Nursing Home Services 15/16 New (£425)
Nursing Home Services 14/15 Roll over
Out Of Hospital 15/16 New (£817)
Paediatrics 15/16 New (£46) £58
Pulmonary Rehabilitation 15/16 Roll over (£210)
Service redesign to reduce
acute footfall - NWP(£1,830) (£153) (£153)
Service redesign to reduce
acute footfall- IMP(£3,039) (£74) (£74)
Cardiology 15/16 New (215)
Dermatology 14/15 Roll Over (47)
Dermatology 15/16 New
EIICS 15/16 New (339)
ICE 14/15 Roll over
MSK 15/16 New (95)
MSK 14/15 Roll over
Nursing Home Services 15/16 New (56)
Nursing Home Services 14/15 Roll over
Out Of Hospital 15/16 New (273)
Paediatrics 15/16 New (26)
Pulmonary Rehabilitation 15/16 Roll over (33)
Key Messages
The CCG has a 2015/16 plan to deliver gross QIPP savings of £12.2m, offset by a dedicated reserve to fund Reprovision costs and underpin QIPP under delivery of £4.4m. Full
application of this reserve to QIPP would yield an overall net QIPP saving delivery of £7.8m . The significant proportion of the net savings are reflected in contracts, including a £4.4m
block with Ealing Hospital.
The Ealing senior team is reviewing the progress on QIPP planning and forecast delivery in M3 to determine how much of the £4.4m needs to be uncommitted to cover Reprovision
costs and under-delivery. The outcome will be reported to the M3 F&P committee.
QIPP Scheme Delivery - (2)
Provider / Scheme Scheme NamesRoll over
/ New
Cost
Reduction
Investment
required
Financial Plan (Gross
no Investment)M1 M2
Service redesign to reduce
acute footfall- WMH(£272) (£23) (£23)
Cardiology 15/16 New (£11)
Dermatology 14/15 Roll Over (£2)
Dermatology 15/16 New
DTOCs 15/16 New £0
EIICS 15/16 New (£64)
ICE 14/15 Roll Over
Nursing Home Services 15/16 New (£33)
Nursing Home Services 14/15 Roll Over
Out Of Hospital 15/16 New (£4)
Pulmonary Rehabilitation 15/16 Roll Over (£3)
Service redesign to reduce
acute footfall - HHT(£76) (£6) (£6)
Cardiology 15/16 New (£39)
Out Of Hospital 15/16 New (£37)
Procurement savings (£401) (£33) (£33)
Work with GPs to impove
EEE(£750) (£63) (£63)
Reduced DToCs (£35) (£3) (£3)
Improved service delivery £0 £0 £0
Reduction in costs - reduced
use of contract staff65 (£250) £0 £0
Outsourcing of services (£145) (£12) (£12)
Cost effectiveness review (£560) (£25) (£25)
Activity reduction (£73) (£6) (£6)
Service redesign to reduce
acute footfall -c&W(£5) (£0) (£0)
Total 930 (£12,181) (£771) (£771)
Nett QIPP (£11,251)
Key message
Invoice
Count
Invoice
Count
(Passed)
% Passed Invoice
Amount
Invoice
Amount
(Passed)
% Amount
Passed
£ £
NHS 557 515 92.5% 52,560,363 51,974,709 98.9%
Non NHS 2,353 2,147 91.2% 7,642,489 6,379,592 83.5%
Total 2,910 2,662 91.5% 60,202,851 58,354,301 96.9%
Planned Cash Limit: 474,055£ Drawn Down to Date
(Including PPA): 67,198£
Planned Draw Down at Month Eleven: 79,009£ Under Drawn: 11,811£
Creditor
payments
•
Cash
•
•
Capital The CCGs financial plan has indicated that we require central funding for GPIT of £727k. We are currently awaiting final approval from NHS England.
We are currently working with budget holders to ensure that invoices are coded and outstanding queries are dealt with promptly in order that invoices are
paid within payment terms.
Capital, Creditor Payments and Cash Capital, Creditor Payments and Cash
19
Appendix 1: RAG Rating Definitions 35
Appendix 2: Financial Schedules 36-49
Appendix 3: Underlying Recurrent Position 50
Appendix 5: Imperial Hospital Detail Schedules 51-70
Appendix 6: Royal Brompton & Harefield Hospital Detail Schedules 71-74
Appendix 7: Out of Sector Contracts 75-86
Appendix 8: Community Contracts 87-88
Appendix 9: Mental Health Contracts
Appendix
20
Key message
Total Programme Running Costs
£k £k £kRecurrent Initial Budgets 483,352 475,090 8,262
In year allocations (notified)
Subtotal Notified Allocation as at Month 1 483,352 475,090 8,262
NWL FS (4,500) (4,500)
DTR/ETO 91 91
Rounding (1) (1)
Subtotal Notified Allocation Current Month (4,410) (4,410) 0
Total Notified Allocation 478,942 470,680 8,262
Variance 0 0 0
Appendix 1.11: Revenue Resource Limit
21
Commissioning of Healthcare
Acute Contracts 215,356 35,270 36,112 (843) 217,312 (1,957)
Acute In Year Risk Reserve 0 0 0 0 0 0
Other Acute Commissioning 24,622 4,104 4,131 (28) 24,812 (190)
Mental Health Commissioning 49,510 8,155 8,155 (0) 49,514 (4)
Continuing Care 19,480 2,770 2,770 0 19,480 0
Community 55,747 9,352 9,352 (0) 55,747 0
Prescribing 42,796 6,913 6,916 (4) 42,796 0
Primary Care 17,652 2,942 2,920 22 17,652 0
Sub-total: 425,162 69,505 70,357 (852) 427,313 (2,151)
Corporate & Other 5,424 904 964 (60) 5,704 (280)
TOTAL 430,586 70,409 71,321 (912) 433,017 (2,430)
Reserves and Contingency
Contingency 4,738 0 0 0 4,738 0
Other Reserve 2,080 0 0 0 2,080 0
Investment Reserve 5,545 0 0 0 5,545 0
QIPP Risk Reserve 4,882 0 0 0 4,882 0
Non-Demographic Reserve - Mental Health 408 0 0 0 408 0
Non-Demographic Reserve - Acute 3,444 1,201 289 912 1,013 2,431
Non-Demographic Reserve - Community 809 0 0 0 809 0
NWL Financial Strategy Part A 13,300 0 0 0 13,300 0
2014-15 Reserve 0 0 0 0 0 0
RESERVES Total: 35,205 1,201 289 912 32,774 2,431
Total Programme Budgets 465,791 71,610 71,610 (0) 465,791 0
Total Admin Budgets 8,262 1,562 1,562 (0) 8,262 0
Planned Expenditure 474,053 73,172 73,172 (0) 474,053 0
CCG Planned Surplus 4,889 815 0 815 0 4,889
Total 478,942 73,987 73,172 814 474,053 4,889
Revised Annual
Budgets £000
YTD Budget
£000 YTD Actual £000
Variance
Surplus /
(Deficit) £000
Forecast Outturn PositionYear to Date Position
FOT Actual £000
FOT Variance
Surplus / (Deficit)
£000
Appendix 1.12 : Financial Summary
22
CCGNAME- Ealing CCG
Imperial 62,184 10,030 10,196 (166) 61,769 415
Ealing Hospital 82,693 13,782 13,782 0 82,693 0
Hillingdon Hospital 12,154 1,946 1,946 (0) 12,154 0
North West London Hospitals 22,776 3,652 3,652 0 22,776 0
Royal Brompton and Harefield 2,010 314 314 (0) 2,010 0
Chelsea And Westminster 5,680 897 1,175 (278) 6,389 (709)
West Middlesex 8,120 1,310 1,570 (259) 9,418 (1,298)
Sub Total - in Sector SLAs 195,617 31,931 32,634 (703) 197,209 (1,592)
Out of Sector SLAs
St.Georges Healthcare 387 64 36 28 218 169
Whittington Hospital 195 33 33 0 195 0
East and North Herts Trust 205 34 24 10 188 17
Barts and the Royal London 567 94 181 (87) 567 0
Guys & St.Thomas 1,386 231 280 (49) 1,669 (283)
The Homerton 76 13 13 (0) 76 0
Kingston Hospital 168 27 25 2 156 12
Kings Healthcare 700 151 151 0 700 0
Moorfields Eye Hospital 8,190 1,365 1,365 0 8,190 0
The Royal Marsden 376 63 63 (0) 376 0
UCL Hospitals 2,286 381 447 (66) 2,613 (327)
Barnet Chase Farm 105 18 26 (8) 155 (50)
Great Ormond Street 558 91 103 (13) 620 (62)
Rnoh 1,661 294 226 68 1,355 306
The Royal Free 1,148 192 219 (27) 1,314 (165)
Frimley Health - Heatherwood & Wexham Pk 547 91 105 (14) 633 (86)
Ashford and St Peters 290 48 48 0 290 0
Sub-total - Others 18,845 3,190 3,346 (156) 19,315 (469)
BMI 278 46 30 16 173 105
In Health 615 102 102 0 615 0
Sub total 893 149 133 16 788 105
Acute In Year Risk Reserve 0 0 0 0 0 0
In-year Risk Reserve 0 0 0 0 0 0
Sub Total - Acute SLAs 215,356 35,270 36,112 (843) 217,312 (1,957)
High Cost Drugs 96 16 16 0 96 0
London Ambulance Service 10,961 1,827 1,827 0 10,961 0
NCAs / Acute Cost per Case 2,429 405 405 0 2,429 0
Critical Care Network 0 0 (0) 0 0 0
Urgent Care Centre 6,316 1,053 1,053 0 6,316 0
Resilience Funding 2,313 386 386 0 2,313 0
Sub-total Other Commissioning 24,622 4,104 4,131 (28) 24,812 (190)
Total Acute 239,978 39,374 40,244 (870) 242,125 (2,147)
239,978 39,374 40,244 870- 242,125 2,147-
Annual Budgets
£000
YTD Budget
£000
YTD Actual
£000
Variance
Surplus /
(Deficit) £000
Year to Date Position
FOT Actual £000
FOT Variance
Surplus / (Deficit)
£000
Forecast Outturn Position
Appendix 1.13: Acute
23
CCGNAME- Ealing CCG
C & NW London NHSF Trust 1,292 215 215 0 1,293 (1)
W London MH Trust 38,404 6,401 6,401 0 38,404 0
Tavistock & Portman MH Trust 99 17 17 0 102 (3)
Voluntary Sector- SLA's 478 80 80 (0) 478 0
Total Mental Health Contracts 40,273 6,712 6,712 (0) 40,277 (4)
Child & Adolescent Mental Health 114 19 19 0 114 0
Learning Difficulties 4,767 795 795 0 4,767 0
Mental Capacity Act 215 36 36 0 215 0
Mental Health Treatment & Care 2,678 446 446 0 2,678 0
Mental Health Block Others 578 96 96 0 578 0
Mental Health services - Not Contracted Activity 306 51 51 0 306 0
Mental Health services - Overseas Visitors 0 0 0 0 0 0
Mental Health In Year Risk Reserve 579 0 0 0 579 0
Mental Health Other 9,237 1,443 1,443 0 9,237 0
Sub total Mental Health Services 49,510 8,155 8,155 (0) 49,514 (4)
49,510 8,155 8,155 0- 49,514 4-
FOT Variance
Surplus / (Deficit)
£000
Forecast Outturn Position
Annual
Budgets
£000
YTD Budget
£000
YTD Actual
£000
Variance
Surplus /
(Deficit)
£000 FOT Actual £000
Year to Date Position
Appendix 1.14: Mental Health
24
CCGNAME- Ealing CCG
CHC Adult Fully Funded 12,042 2,007 2,007 0 12,042 0
CHC Adult Joint Funded 0 0 0 0 0 0
CHC Children 1,460 243 243 0 1,460 0
Funded Nursing Care 3,120 520 520 0 3,120 0
CHC Risk Pool 2,858 0 0 0 2,858 0
Sub total Continuing care 19,480 2,770 2,770 0 19,480 0
19,480 2,770 2,770 - 19,480 -
FOT Variance Surplus /
(Deficit) £000
Forecast Outturn Position
Annual
Budgets
£000
YTD Budget
£000
YTD Actual
£000
Variance
Surplus /
(Deficit)
£000 FOT Actual £000
Year to Date Position
Appendix 1.15: Continuing Care
25
CCGNAME- Ealing CCG
Ealing ICO 31,883 5,374 5,374 0 31,883 0
CLCH - Barnet Community Services 315 52 53 (0) 315 0
CNWL - Hillingdon Community Services 250 42 41 0 250 0
St Georges HC Trust 28 5 5 0 28 0
Hounslow & Richmond Community Services 300 50 50 0 300 0
Reablement 2,067 345 345 0 2,067 0
Other Community Services 280 47 47 0 280 0
Community Services 35,122 5,914 5,914 0 35,122 0
Better Care Fund 15,499 2,583 2,583 (0) 15,499 0
Community Rehabilitation 2,875 479 479 0 2,875 0
Rehab Engineering 35 6 6 0 35 0
Patient Transport 19 3 3 0 19 0
Referral Facilitation Service 753 126 126 0 753 0
Palliative Care 283 47 47 0 283 0
Community Equipment 1,160 193 193 0 1,160 0
Community In year risk reserve (0) 0 0 0 (0) 0
Waiting List Initiative - MSK 0 0 0 0 0 0
Community services other contracts 20,625 3,437 3,438 (0) 20,625 0
Sub total Community Services 55,747 9,352 9,352 (0) 55,747 0
55,747 9,352 9,352 0- 55,747 -
Forecast Outturn Position
Annual
Budgets £000
YTD Budget
£000
YTD Actual
£000
Variance
Surplus /
(Deficit)
£000
YTD Position
FOT Actual £000
FOT Variance Surplus /
(Deficit) £000
Appendix 1.16: Community Services
26
CCGNAME- Ealing CCG
GP Prescribing 41,146 6,645 6,645 (0) 41,146 0
Central Drug Costs 1,109 179 179 0 1,109 0
Oxygen 347 56 60 (4) 347 0
Other Prescribing Costs (Scriptswitch, Pharmacy Schemes and
Invest to Save) 194 32 32 0 194 0
Sub total Prescribing 42,796 6,913 6,916 (4) 42,796 0
42,796 6,913 6,916 4- 42,796 -
FOT Variance
Surplus / (Deficit)
£000
Forecast Outturn Position
Annual
Budgets
£000
YTD Budget
£000
YTD Actual
£000
Variance
Surplus /
(Deficit)
£000 FOT Actual £000
YTD Position
Appendix 1.17: Prescribing
27
CCGNAME- Ealing CCG
Local Incentive Scheme 6,651 1,109 1,109 0 6,651 0
Care Planning 1,675 279 279 0 1,675 0
Pathology 5,287 881 881 0 5,287 0
Nursing Home Service 688 115 115 0 688 0
Out of Hours 1,494 249 249 0 1,494 0
NHS 111 667 111 89 22 667 0
Interpreting Services 119 20 20 0 119 0
Care Navigators 1,071 179 179 0 1,071 0
Sub total Primary Care 17,652 2,942 2,920 22 17,652 0
17,652 2,942 2,920 22 17,652 -
YTD Position Forecast Outturn Position
FOT Variance
Surplus / (Deficit)
£000
Annual
Budgets £000
YTD Budget
£000
YTD Actual
£000
Variance
Surplus /
(Deficit) £000 FOT Actual £000
Appendix 1.18: Primary Care
28
CCGNAME- Ealing CCG
Medicine Management 626 104 78 26 626 0
Continuing Healthcare Assessment & Support 1,037 173 176 (4) 1,069 (32)
Safeguarding 237 39 39 0 237 0
Service Redesign and Integration 1,770 295 225 70 1,770 0
Strengthening Community Transport 214 36 36 0 214 0
Recharges for Property Services 562 94 94 0 562 0
London Health Contribution 679 113 113 0 679 0
GP IT BAU 0 0 153 (153) 248 (248)
ICP 300 50 50 0 300 0
Sub- total - Corporate services & Other 5,424 904 964 (60) 5,704 (280)
YTD Position Forecast Outturn Position
FOT Variance
Surplus / (Deficit)
£000
Annual
Budgets
£000
YTD Budget
£000
YTD Actual
£000
Variance
Surplus /
(Deficit) £000 FOT Actual £000
Appendix 1.19: Corporate (Non Running Costs)
29
Ealing CCG
Chair and Lay Members 574 96 88 7 0 574
Clinical Support 0 0 19 (19) 0 0
Commissioning & COO 1,700 283 383 (99) 0 1,700
Communication & Public Relations 0 0 12 (12) 0 0
Corporate Costs & Services 3,437 573 605 (32) 0 3,437
Continuing Care 128 21 33 (12) 0 128
Estates & Facilities 132 22 22 (0) 0 132
Premises Development 0 0 9 (9) 0 0
Borough Costs Total 5,971 995 1,171 (176) 0 5,971
Finance 122 20 103 (83) 0 122
Business Informatics 107 18 10 8 0 107
Contract Management 312 52 40 12 0 312
CSU/CSS Recharges 1,325 221 0 221 0 1,325
Shared Costs 1,866 311 153 158 0 1,866
CWHHE Recharges 0 0 221 (221) 0 0
Ealing ICO (IT) 0 0 0 0 0 0
NHS Lambeth Recharges 94 16 16 0 0 94
Non Recurrent Cost 0 0 0 0 0 0
Reserves 332 240 0 240 8,262 (7,930)
Reserves 2014-15 0 0 1 (1) 0 0
Sub- total -Running Costs 8,262 1,562 1,562 (0) 8,262 0
FOT Variance
Surplus / (Deficit)
£000FOT Actual £000
Forecast Outturn (FOT) PositionYear to Date Position
Annual
Budgets £000
YTD Budget
£000
YTD Actual
£000
Variance
Surplus /
(Deficit) £000
Appendix 1.20: Running Costs
30
Appendix 1.21: Ealing CCG Balance Sheet
Statement of Financial Position M12 M2 Movement
£000s £000s £000s
NON-CURRENT ASSETS:
Property, Plant and Equipment 0 0 0
Intangible Assets 0 0 0
Other Financial Assets 0 0 0
Trade and Other Receivables 0 0 0
TOTAL Non Current Assets 0 0 0
CURRENT ASSETS:
Inventories 0 0 0
Trade and Other Receivables 4,765 5,438 673
Cash and Cash Equivalents 155 30 (125)
Sub Total Current Assets 4,920 5,468 548
TOTAL Current Assets 4,920 5,468 548
TOTAL ASSETS 4,920 5,468 548
CURRENT LIABILITIES
Trade and Other Payables (55,505) (62,028) (6,523)
Provisions (52) (52) 0
Borrowings 0 0 0
Total Current Liabilities (55,557) (62,080) (6,523)
NET CURRENT ASSETS/(LIABILITIES) (50,637) (56,612) (5,975)
TOTAL ASSETS LESS CURRENT LIABILITIES (50,637) (56,612) (5,975)
NON-CURRENT LIABILITIES:
Trade and Other Payables 0 0 0
Provisions 0 0 0
Borrowings 0 0 0
Total Non-Current Liabilities 0 0 0
ASSETS LESS LIABILITIES (Total Assets Employed) (50,637) (56,612) (5,975)
TAXPAYERS EQUITY
General Fund (50,637) (56,612) (5,975)
Revaluation Reserve 0 0 0
Total (50,637) (56,612) (5,975)
N.B. We are not required to report Month 1, hence for a meaningful comparison month 2 is compared with month 12 of 2014/15.
It is not unusual in commissioning organisations for Payables to exceed Receivables.
Trade and Other Receivables - Includes £4.84m invoices to NHS & Non NHS Debtors, £1.23m of Maternity WIP treated as a
prepayment, £0.09m Accruals, (£0.77m) provision for Irrecoverable Debts, £0.01m CHC Legacy monies awaiting reimbursement
from NHSE and £0.03m of VAT.
Cash - The cash balance at the end of May 2015 was within the limit of 1.25% of May's drawdown, the limit set by NHS England.
Trade & Other Payables - This balance includes £18m outstanding invoices, £1.5m of 14/15 WIP, £1.4m PMS & GMS Accruals,
£0.30m Payroll & Deferred Income and £40.8m accruals.
31
Appendix 1.22: Ealing CCG Cash flow
Ealing CCG
Monthly Cash flow April May June July August September October November December January February March Total
£'000 £'000 £'000 £'000 £'000 £'000 £'000 £'000 £'000 £'000 £'000 £'000 £'000
Original Cash Plan 39,505 39,505 39,505 39,505 39,505 39,505 39,505 39,505 39,505 39,505 39,505 39,500 474,055
Forecast
Maximum Cash Drawdown (MCD) 39,505 39,505 39,505 39,505 39,505 39,505 39,505 39,505 39,505 39,505 39,505 39,500 474,055
Less Forecast PPA/HOT Topslices (3,216) (3,482) (3,590) (3,590) (3,590) (3,590) (3,590) (3,590) (3,590) (3,590) (3,590) (3,594) (42,602)
Anticipated Adjustments 0
Forecast Monthly Drawdown 36,289 36,023 35,915 35,915 35,915 35,915 35,915 35,915 35,915 35,915 35,915 35,906 431,453
Updated Cash Plan 39,505 39,505 39,505 39,505 39,505 39,505 39,505 39,505 39,505 39,505 39,505 39,500 474,055
ACTUALS
Actual Cash Draw Down 29,000 31,500 60,500
CHC Risk Pool Contribution 0
PPA / HOT Topslice 3,216 3,482 6,698
TOTAL 32,216 34,982 0 0 0 0 0 0 0 0 0 0 67,198
15/16 Cash Utilisation % of Total Funding 7% 7% 0% 0% 0% 0% 0% 0% 0% 0% 0% 0% 14.2%
Balance B/fwd. from 14/15 154
Cash Payments (net of misc. receipts) 29,883 30,741 60,624
Closing Bank Balances c/f -729 30
Average Bank Balance -729 -350
Cumulative Monthly Cash flow April May June July August September October November December January February March
£'000 £'000 £'000 £'000 £'000 £'000 £'000 £'000 £'000 £'000 £'000 £'000
Bank Balance Brought Forward 154 154
Cumulative Cash Draw Down 29,000 60,500
Net Cash (Payments less misc. receipts) 29,883 60,624
Closing Bank Balances c/f -729 30 0 0 0 0 0 0 0 0 0 0
COMMENTS
The Maximum Cash Drawdown has not yet been set for 15/16 and so the target we are currenlty working to is based on the latest Operating Plan figures.
The cash target for May 15 was achieved with a closing cash balance of £30k (<1.25% of May's drawdown).
32
Appendix 1.23: Ealing CCG Cash flow
33