finance report period up to jan 2015 - wandsworth ccg · 2015-03-06 · finance report – period...
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Finance Report –Period up to Jan 2015
Presented by Finance
06/03/2015
Wandsworth Clinical Commissioning Group
Contents1. Month 10 Financial Position
2. Reserve Management
3. SWL Risk Pool
4. QIPP
5. Recommendations
06/03/2015 Board March 2015 2
Wandsworth Clinical Commissioning Group
Finance Scorecard up to January 2015
06/03/2015 Board March 2015
Financial Strategy Financial Performance
• NHSE issued planning guidance for 2015/16
• Minimal growth for Wandsworth CCG (1.94%)
• Guidance for 2015/16 requires CCG to increase
Mental Health spending by growth levels and support
system resilience schemes that were funded in
2014/15
• As a result WCCG has a net decrease in funding
• Draft of 2015/16 financial plan submitted to NHSE on
13 Jan – further submission made by 27 Feb
• The forecast surplus has increased from £8.5m to
£10m, due to non utilisation of SWL risk pool
• Full year acute overspend at St Georges of £3.8m
assumes full delivery of Out of Hospital QIPP schemes
• QIPP delivery is on track, but there are greater savings
anticipated in the final quarter
• Costs associated with the provision of continuing care
outstrip the budget available
Financial Governance Financial Risk
• Audit Committee considering implications of new
Conflicts of Interest guidance
• General overall positive Internal Audit reports received
to date
• Contingency Reserve in place
• Financial ledger system has limited capability
• Potential bad debt issue has been successfully
resolved
• Delivery of investments to generate savings
• Utilising all investment opportunities
• Agreeing year end positions with providers
3
Wandsworth Clinical Commissioning Group
Month 10 – Key Messages
• Due to the non utilisation of the SWL Risk Pool the surplus has been increased by £1.5m to
£10m. NHSE (London) have given an assurance that the additional £1.5m will be available for
drawdown in 15/16.
• Year to date position in line with the original plan.
• Forecasting a year end over spend against contracts for acute services of £4.8m. St George’s
Hospital is forecast to overperform by £3.8m which is less than the forecast last month.
• Continuing Care spend continues to be greater than plan – we are forecasting an overspend
of £1.3m
• Overspends are offset by existing reserves
• Quality Premium schemes are commencing.
• NHS Property Services have reviewed their charges to the CCG, and this will result in a full
year underspend of £273k.
• Expect to meet running cost target and QIPP
06/03/2015 Board March 2015 4
Wandsworth Clinical Commissioning Group
Month 10 – Revenue Resource Limit
06/03/2015 Board March 2015 5
The Resource Limit reflects the amount of money the CCG has available to commission services
(programme) and to run the CCG (admin). At Month 10, we have received funding for RTT tranche 2,
but we have had a reduction for Specialist Commissioning
Wandsworth Clinical Commissioning Group
Month 10 Financial Position
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Increase
in surplus
PERIODS TO DATE FULL YEAR
Budget Actual VarTotal
Budget Actual Var
£000s £000s £000s £ 000s £000s £000s
Resource Limit 339,318 339,318 0 409,111 409,111 0
EXPENDITURE
Acute Commissioning 177,571 181,036 -3,465 213,262 217,315 -4,053
Non Acute Commissioning 93,104 93,462 -358 112,421 112,740 -320
Primary Care 39,118 38,873 246 47,356 46,950 406
Corporate Costs 10,105 9,518 587 12,356 11,765 591
Estate Costs 732 531 201 878 605 273
Other 808 396 412 1,590 1,027 563
SWL Collaborative Commissioning 674 674 0 809 809 0
Reserves 11,061 8,684 2,378 13,066 7,887 5,179
Total Applications 333,173 333,173 0 401,738 399,099 2,638
Surplus/(Deficit) 6,144 6,144 0 7,373 10,012 -2,638
Wandsworth Clinical Commissioning Group
Month 10 Acute Analysis
06/03/2015 Board March 2015 7
• The YTD figures have been pro-rated up from the Month 9 SLAM reports. The FOT
overspend on the Acute SLAs is £4.8m, but this is partly offset by underspends on NCAs
and other Non-SLA budgets
Wandsworth Clinical Commissioning Group
POD Analysis
*All the Main Variance Drivers in green are underspending
(£1,500)
(£1,000)
(£500)
£0
£500
£1,000
YTD Variance £'000s
(£2,000)
(£1,500)
(£1,000)
(£500)
£0
£500
£1,000
£1,500FOT Variance £'000s
YTD
Variance
FOT
Variance
Main Variance
Drivers
£'000s £'000s
Elective -£1,128 -£1,553
SGH, &
Chelsea
Emergency -£321 -£565 SGH, KHT
Non-Elective -£839 -£1,498 SGH
Maternity Pathway -£109 -£50 Chelsea
A&E -£205 -£326
SGH, &
Chelsea
Out Patient 1st -£17 -£140 King's
Out Patient Follow Up £33 £73 KHT & MEH*
Out Patient Procedure -£725 -£946 SGH
Unbundled Diagnostics -£106 -£145
SGH, &
Chelsea
Critical Care £805 £1,081
CAW,KHT &
GSST*
Direct Access £19 £30 SGH*
Drugs & Devices -£773 -£1,020
MEH, SGH &
QMH
Other -£33 £136
Guy's &
Chelsea
PTS -£6 -£8 MEH
CQUIN £75 £94
Imperial &
CAW*
TOTAL - LOCAL ACUTE CONTRACTS -£3,332 -£4,836
WCCG
Board March 2015 06/03/20158
Wandsworth Clinical Commissioning Group
Month 10 Acute Commentary• Overall the YTD variance on Acute SLAs has improved by £765k compared to last month, and
the forecast variance has improved by £622k.
The main drivers of this movement are as follows:
• Chel West: There is a £200k favourable movement, largely because of challenges on
Outpatient activity and Non Elective Non-Emergency (Maternity) activity.
• Moorfields : There is a gain of £123k owing to High Costs Drug challenges as well as the
proposed Q2 Close Down Agreement.
• Queen Mary’s: There have been successful challenges for Audiology Services (£89k) and
Nuclear Medicine Scans (£44k).
• St George’s: There have been various technical challenges and claims mainly for High Cost
Drugs, Elective Care and uncoded Critical Care activity, resulting in an improvement of £150k.
06/03/2015 Board March 2015 9
Wandsworth Clinical Commissioning Group
Month 10 – Non Acute and Primary Care
• Overall there is no significant movement in the Non-Acute forecast compared to last month.
• Slippage on the Falls & Bone Health project, has led to a forecast underspend of £184k.
• However, this is largely offset by a rise in Home Care activity under Continuing Healthcare
(increase of £110k in the forecast) and an increase in spend on the Out of Hours GPs in the
St George’s Hospital Urgent Care Centre (£55k forecast).
• We are continuing to forecast overspends on the SWL&SGMHT SLA, Child & Adolescent
Mental Health placements and Learning Disability placements
• Based on the latest projection, we are forecasting an underspend of £415k on Prescribing
(the underspend was £310k last month)
06/03/2015 Board March 2015 10
Wandsworth Clinical Commissioning Group
Financial Risks
06/03/2015 Board March 2015 11
Risk Detail Mitigating Action
Risk
after
action
Acute Contracts
There is a risk of further overperformance on the
Acute contracts, over and above the amount
reported.
It is expected that reserves will be sufficient to
cover further over performance Medium
QIPP Delivery
While the CCG is currently on track to meet its
14/15 target, there remain two main areas of
concern: Evaluation of Out of Hospital targets due
to data quality, and attendances at St Georges
Hospital.
An action plan has been developed in
conjunction with providers to correct the data
quality issue. A further action plan has been
developed to address the activity issues at St
Georges
Low
Legacy provision
CCGs have been required to make a provision for
retrospective Continuing Health Care claims which
had not been planned as the former PCT had also
made a similar provision. Risk is the accounting
treatment may change resulting in a material
financial impact
Guidance is expected to clarify treatment.
NHSE is refunding £1.1m to WCCG in 14/15
against a provision of £1.5m, but this could still
be an issue in the future
Medium
Level of investment Not investing all funds in a timely manner
Majority of approved investment bids have been
actioned. A further £1.5m of investment has
been identified and is awaiting final approval.
CCG has increased surplus to mitigate risk of
non effective use of funds
Low
Financial Ledger
System misreports
position
National system has limited capability to report
detailed financial expenditure
No response received yet from national team
despite escalation.
Low
Internal and external audit review provided
sufficient assurance in 2013/14
Letter from WCCG Audit Chair has been sent to
NHSE Audit Chair to gain a response
Wandsworth Clinical Commissioning Group
Contents1. Month 10 Financial Position
2. Reserve Management
3. SWL Risk Pool
4. QIPP
5. Recommendations
06/03/2015 Board March 2015 12
Wandsworth Clinical Commissioning Group
Reserves ManagementMonth 10:
• Discussions with SGH and other providers
continue to reduce the risk around year end for
acute providers
• £2.3m of investments have been approved and
are currently being actioned
• Approximately £1.5m of investment has been
identified and requires final approval
• Investments have been made against the
achievement of the Quality Premium
06/03/2015 Board March 2015 13
Wandsworth Clinical Commissioning Group
Contents1. Month 10 Financial Position
2. Reserve Management
3. SWL Risk Pool
4. QIPP
5. Recommendations
06/03/2015 Board March 2015 14
Wandsworth Clinical Commissioning Group
SWL Risk Pool• Last month we reported that there was a risk that
CCGs in SWL may not require access to the risk pool
despite an earlier request
• NHSE (London) offered CCGs the potential to
increase their M10 surplus whilst guaranteeing the
return in 2015/16
• WCCG agreed to increase the surplus by £1.5m for
M10 to £10m
06/03/2015 Board March 2015 15
Wandsworth Clinical Commissioning Group
Contents1. Month 10 Financial Position
2. Reserve Management
3. SWL Risk Pool
4. QIPP
5. Recommendations
06/03/2015 Board March 2015 16
Wandsworth Clinical Commissioning Group
14-15 QIPP Totals at Month 9 by Project
17
Out of
Hospital
Programme
initiatives
.
06/03/2015 Board March 2015
Wandsworth Clinical Commissioning Group
QIPP - Out of Hospital Project Status (1)
18
Falls Programme - in its final year - is starting to show a plateau-ing effect
UCC / A&E - showing increased activity – although at the lowest tariff level.
Community Services Redesign & GP PACT LES - The GP PACT LES is delivering the expected
activity to date and the CAHS implementation is fully underway. Additional resource has also been
provided for rapid response social care and there are plans for additional social workers in PACT for
15-16. The number of non elective emergency admissions is showing a decrease which is in direct
contrast to the performance activity being reported from surrounding CCGs. So although there is no
direct link from the community services redesign and PACT LES to this decrease, it appears that the
schemes are having an impact.
Number of patients on the community ward remain at approximately 100, 50% of capacity.
However, 100% of patients have agreed goals on initial assessment with over 95% of those patients
meeting their goals at discharge and having an agreed ongoing care plan.
06/03/2015 Board March 2015
Wandsworth Clinical Commissioning Group
QIPP - Out of Hospital Project Status (2)
19
Out Patient Referral Management – Total out patient attendances have risen over April –
December compared to 13-14 activity leading to the Outpatient element of the out of hospital
programme delivering negative savings to QIPP. The coding issues with specialised commissioning
and QMH SUS uploads are now resolved for 14-15.
However, GP first referrals and attendances remain stable according to both SUS and MAR data.
Therefore, in the context of the objectives of the Referral Management Programme it is on track to
deliver. The overall Outpatient activity has increased by 4.9% over April – December period
comparing 13-14 to 14-15 while GP first attendances have decreased by 2.3%.
Other out of Hospital Initiatives – Slippage in three out-patient shift schemes (now to 16-17) and
two have been stopped as have proved infeasible.
Diagnostics – Slippage in programme and change in nature to programme – low uptake
Short Stay Admissions – New area in work up may deliver by Q4 but more likely to deliver in 15-16
06/03/2015 Board March 2015
Wandsworth Clinical Commissioning Group
QIPP - Out of Hospital Project Status (3)
20
Notes: The following adjustments have been made
• an adjustment has been made to attendances to account for the increases being at the lowest tariff level
• the navigator diversions which are included in activity but not being charged for have been removed.
06/03/2015 Board March 2015
Wandsworth Clinical Commissioning Group
QIPP - Risks & Mitigations (1)
Over 30% of the planned QIPP savings come from the out of hospital programme.
The plan was to monitor and evaluate the whole OOH programme at a top level and use
this evaluation to redirect efforts to patient cohorts rather than projects for 15-16.
Whilst the savings are being captured for the four savings areas, data issues have caused
a significant delay in the evaluation model.
An action plan was been developed with providers to correct the data issue.
Prototype of the evaluation was successfully demonstrated to the Delivery Group on
10th February
21 06/03/2015 Board March 2015
Wandsworth Clinical Commissioning Group
QIPP - Risk & Mitigations (2)
Current activity trends suggest a rise in attendances and a rise in the cost of activity. This will
have the effect of reducing the savings realised through the programme.
To mitigate against this the CCG is working with St George’s to understand both the rise in
activity and the rise in the proportion of higher tariff. Delivery Group requested an action plan
to address increase in activity. The action plan includes;
• An additional GP for the SGH UCC
• Additional GP at Brocklebank Walk in Centre
• Funds for a Battersea A&E Avoidance scheme for increased capacity of Out of
Hours NHS 111 bookable primary care clinics
22 06/03/2015 Board March 2015
Wandsworth Clinical Commissioning Group
Contents1. Month 10 Financial Position
2. Reserve Management
3. SWL Risk Pool
4. QIPP
5. Recommendations
06/03/2015 Board March 2015 23
Wandsworth Clinical Commissioning Group
Recommendations• CCG Board are asked to note the report and in
particular the increase in the forecast surplus
06/03/2015 Board March 2015 24