Performance report€¦ · to underpin Ealing CCG’s 2015/16 investment plan. It is also important...

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


ScoredDiabetes Type 1 - Insulin Pump Initiation at

EHT/DICE Neha Unadkat 0 28 0 0 0 0 0 0 0

12


Scored Palliative care Neha Unadkat 0 32 0 0 0 0 0 0 0

13


Scored

London Ambulance Service Pathway Co-

ordinators(Ealing) Neha Unadkat 0 66 0 0 0 0 0 0 0

14


Scored

Diabetes - Education Programme - Right

Start Neha Unadkat 0 68 0 0 0 0 0 0 0

15


Scored Connecting Care for Children Neha Unadkat 0 100 0 0 0 0 0 0 0

16


Scored Diabetes - Psychologist Neha Unadkat 0 59 0 0 0 0 0 0 0

17


Scored

Enhanced Substance Misuse Hospital

Inreach Support Neha Unadkat 0 157 0 0 0 0 0 0 0

18


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


Scored Community musculoskeletal pain service Neha Unadkat 0 250 0 0 0 0 0 0 0

20


Scored Paediatrics - Atopic Conditions Neha Unadkat 0 330 0 0 0 0 0 0 0

21


Scored

UCC spec to common operating spec(i.e.

SaHF) Neha Unadkat 0 500 0 0 0 0 0 0 0

22


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


Scored

Imperial RTT & Opthamology - In-year

variations anticpated Neha Unadkat 0 1,736 0 0 0 0 0 0 0

23


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


Scored CSS Recharges for Non GPIT services 0 115

11


Scored OOH Training and Education 0 75

12


Scored OOH Equipment 0 152

13


Scored Carers Centre Project with Primary Care 0 95

14


Scored Strengthening Community Transport 0 11

15


Scored Paediatric Phlebotomy 0 75

16


Scored

Continuing Healthcare and Assessment

not inc CHS Contract 0 161

17


Scored

Continuing Healthcare and Assessment

CHS Contract 0 32

18


Scored

Outcome of the Establishment review -

reverse allcoation of Running Costs to

Programme costs which needs funding 0 200

19


Scored Non Contracted Activity (NCAs) 0 203

20


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)


acute footfall - NWP(£1,830) (£153) (£153)


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


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


Pulmonary Rehabilitation 15/16 Roll Over (£3)


acute footfall - HHT(£76) (£6) (£6)

Cardiology 15/16 New (£39)


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)


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)


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


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


Annual

Budgets

£000

YTD Budget

£000

YTD Actual

£000

Variance

Surplus /

(Deficit)

£000 FOT Actual £000


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


Annual

Budgets

£000

YTD Budget

£000

YTD Actual

£000

Variance

Surplus /

(Deficit)



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 -


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


Annual

Budgets

£000

YTD Budget

£000

YTD Actual

£000

Variance

Surplus /

(Deficit)


YTD Position

Appendix 1.17: Prescribing

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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

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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)

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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

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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.

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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).

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Appendix 1.23: Ealing CCG Cash flow

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Performance report€¦ · to underpin Ealing CCG’s 2015/16 investment plan. It is also important...

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