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Finance Report at Month 9 Governing Body Update

Item 2 1 February 2018

1. Executive Summary Key Duties Year to

date Forecast Key Issues

Deliver £13.2m Surplus (£9.9m) (£13.2m) The surplus brought forward from 2016/17 was (CCG’s Control Total) Under Under £11.6m. In 2017/18, the CCG has to make against Commissioning Spend Spend progress towards a 1% surplus as part of an Revenue Resource Limit overall control total for South Yorkshire and (RRL) + RCA combined Bassetlaw CCGs and has agreed an in year

surplus of £1.6m with NHS England to take the overall planned surplus to £13.2m. We continue to forecast achievement of this planned surplus, but there remain a range of pressures and risks to be managed during the last quarter of the year if this is to be achieved.

a) Achieve a surplus (£8.5m) (£11.3m) A number of risks and challenges need to be against the Under Under managed (see sections 2 & 3). Substantial financial Programme Spend Spend pressures continue in terms of acute activity, partly Allocation due to delivery against some QIPP schemes being

well below plan. We have previously agreed a number of mitigating actions which, based on the information available, appear sufficient to manage the current assessment level of financial risk. However, there remains a level of volatility in the range of estimates of spend in the final 3 months of the financial year which will need to be managed if we are to deliver our financial plan.

b) Remain within (£1.4m) (£1.9m) At the plan stage, we agreed £0.3m of our surplus Running Cost Under Under should come from the RCA. Subsequently QIPP Allowance (RCA) of Spend Spend underspends from vacancies and release of running £12.72m. cost reserves have been identified, increasing the

projected surplus to £1.9m.

Remain within Cash Limit £0.3m Breakeven The CCG’s maximum draw down for 2017/18 (i.e. Maximum draw closing notified in December is £848.6m. To remain within down set by NHS balance this limit, which requires the revenue position to be England) brought in on plan, cash payments will need to be

managed to meet this target.

Hold 0.5% of CCG resources as a reserve to be released only with agreement of NHSE

£3.4m £3.4m

The CCG continues to hold a 0.5% reserve, which demonstrates compliance with this requirement.

Key: Significant risk of non-delivery. Additional actions need to be urgently pursued. Red

Amber Medium risk of non-delivery requires additional management effort. Green Low risk of non-delivery – current management effort should deliver success.

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2.0 Summary of the reported position

The overall position is summarised in table 1 below.

Table 1: Summary Position at 30 November 2017

Annual Budget

£’000s

Year to Date

Variance £’000s

Forecast Variance

£’000s

Forecast Variance

%

Acute Hospital Care Mental Health & Learning Disabilities Primary & Community Services (Incl. CHC) Prescribing Collaborative Working

397,506 84,230

233,593 96,778

1,877

12,100 1,275 (577) (141) (189)

14,174 2,468

(1,030) 208

(142)

3.6% 2.9%

-0.5% 0.2%

-7.6% Reserves including planned surplus 39,506 (20,960) (26,983)

Programme Costs Running Costs (analysis in section 2.1.12)

853,490 12,722

(8,492) (1,428)

(11,305) (1,899)

-1.3% -14.9%

Year to date and Year end Surplus 866,212 (9,920) (13,203) -1.5%

Figures are subject to roundings.

Further detail can be found at Appendix A (at summary level) and a more detailed position by programme category is then provided in Appendix B.

Overall the forecast position at month 9 is in line with that reported at month 8. Forecast increases in spend on prescribing (+£0.2m) are broadly counterbalanced by a forecast decrease in spend in Continuing Healthcare. At month 9 we have incorporated a range of slippage on acute healthcare QIPP schemes (+£2m) into the reported position, rather than holding as potential risks. We have counterbalanced this by reflecting the agreement reached with Sheffield Teaching Hospitals on financial rebates expected in relation to contractual challenges, expected performance against CQUIN indicators and agreed contributions into ACP wide initiatives for 2017/18 together totalling c£2.8m.

We are reporting a £9.9m year-to-date (YTD) surplus broadly in line with our plan for this stage of the year but this is only being achieved by releasing £11.5m of general contingency and commissioning reserves.

At Month 8 we reported “un-covered” risk of £2m – that is risk which has a good probability of materialising and for which we have no confirmed contingency actions or reserves in place to manage. At month 9, given the stability of the in month position and the progress we have made in terms of finalising a number of actions, we have assessed that, on balance, we have sufficient mitigating actions to manage the remaining level of financial risk. As a result, net level of uncovered risk has been reduced to zero. However, it should be noted that there is a broad confidence interval around the predicted forecast spend for the final three months of the financial year. The quantified risks to the current forecast position ranges from a best case of -£3.4m to a worse case of +£4.8m (+/- circa 0.5% of the total budget).

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3 Further Information on Key Budgets

Acute Hospital Activity: Sheffield Teaching Hospitals (STH) is by far the most significant contract in value terms as it is planned to account for £383m (including the MSK and Walk in Centre contracts).

Year to date: At month 9, the budget for the contract overall is £12.1m (4.2%) overspent. This is a slight worsening of the position, as the contract was 3.8% overspent at month 8 – this movement chiefly relates to QIPP non delivery against the plan for December.

A breakdown of the key variances by activity and price is shown in the table below.

Contract Position for the period ending December 2017

Activity Variance

Cost variance

Variance (£000's)

Volume of

activity (£000's)

Pricing element (£000's)

Planned Inpatients ↑ 9.0% ↑ 7.4% £ 2,559 £ 3,113 (£ 553)

Outpatient Firsts ↑ 4.5% ↑ 3.3% £ 481 £ 652 (£ 171)

Outpatient Follow-Ups ↑ 6.8% ↑ 11.5% £ 1,813 £ 1,081 £ 733

Urgent Inpatients ↑ 4.8% ↑ 6.6% £ 5,370 £ 3,899 £ 1,471

A&E ↑ 0.3% ↑ 1.3% £ 207 £ 31 £ 176

Sub Total £ 10,432 £ 8,776 £ 1,656

High Cost Drugs £ 911

All other areas £ 780

Total £ 12,123

The planned impact of QIPP schemes on the STHFT contract for the full year is c£12m with c£7m phased in to date. We have assessed that £3m has been delivered to date and this shortfall in the achievement of QIPP schemes clearly contributes to the overspend variance shown in the table above.

The levels of activity which has not been fully coded within the contract data remain similar to the last few months at 0.5% of total activity. An estimate of just over £2m for the cost of this activity has been included in the year to date position.

Monitoring information indicates the outpatient queue at the end of December has increased 1% above the March levels (last month up 2.1%); whilst the inpatient waiting list has reduced by 1.1% since March (1.1% up last month).

Forecast Outturn The forecast variance reflects the updated position in terms of QIPP delivery. There is a risk of further slippage on a small number of schemes which could lead to a further deterioration of up to £1.3m.

We are concluding an agreement with the Trust in respect of the in-year contractual challenges, together with a forecast in terms of achievement of the CQUIN indicators within the contract. We have agreed with the Trust that we will agree an overall fixed rebate, based on latest estimates, to ensure stability for both parties. The overall rebate expected is in the region of c£2m. In addition the Trust has agreed to contribute c£0.8m towards system wide initiatives designed to reduce both hospital admissions and delayed transfers of care, which reduces both our expected spend with the trust and contributes to CCG expenditure on intermediate care.

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Month 9 data from Sheffield Children’s (SCH) shows a small reduction in activity overall resulting in a year end forecast over performance of £0.5m. The majority of this pressure continues to be due to QIPP under delivery (£0.4m).

Continuing Health Care (CHC) and Funded Nursing Care (FNC): Adults CHC has a year to date underspend of £0.9m with an expected underspend of £1.2m by year end based on our latest assessment of known packages of care and what may happen for the rest of the year in terms of potential net “run rate” of new patients and average package costs. There has been a small changes in forecast spend on Children’s continuing care and FNC reflecting current packages costs.

Primary Care: Full details of the primary care position can be found in the Financial Report presented to the Primary Care Commissioning Committee Meeting on 25th

January. There are no major changes compared to the position reported at Month 8, except for the release of the £0.4m general contingency reserve increasing the overall forecast position at month 9 to an underspend of £1.4m made up of:

£0.4m underspend on Delegated budgets, having made some assumptions around list-size increases and additional expenditure on premises and locums; and

£1m forecast underspend for the CCG Commissioned budgets, mainly due to £0.7m slippage on the budget provided for Practice Transformational Support as approved by Committee last month.

Prescribing: Prescribing data is available for April - November, with a local estimate, based on sample data, available for December. Actual November volume was lower than the original local estimate due to a reduction in items prescribed however excluding the impact of No Cheaper Stock Obtainable (NCSO) the average price per item increased by 11p. The value of NCSO items reduced in November as it was expected to do. Future months have been forecasted to include the reduction in average growth across the year, the latest increased average price and the latest average impact of NCSO. On this basis the forecast spend has increased slightly by £0.2m to an overspend of £0.2m.

As detailed in previous papers there is still the possibility for large variability in price, items prescribed and the NCSO cost pressure. A sensitivity analysis of these variables show the forecast spend could yet increases or decrease by up to £1m either way.

The price reductions for certain drugs (Category M) came into effect from August 2017 but this financial benefit will be transferred back to NHS England to ensure an appropriate level of national contingency reserves. The amount continues at a similar level resulting in £1m transfer for Sheffield which is incorporated into our forecast.

Quality Innovation, Productivity & Prevention (QIPP): A separate QIPP report is available from the Director of Commissioning and Performance. The forecast delivery remains in line with the position reported at M8, at c£10.5m of the original £21.6m target.

Section 75 Framework Partnership Agreement (Better Care Fund): Appendix E shows the citywide positon in relation to the Better Care Fund. Overall, with a forecast overspend of £10.1m. Of this, £3m relates to SCC services within the BCF which is a small improvement of £0.5m compared to the previous month’s forecast, mainly as a result of reduced forecast expenditure on minor works grants.

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Information reported on the CCG expenditure within the Better Care Fund (BCF) is included within the overall CCG reported positon in appendix A to D. Forecast spend on CCG budgets within the scope of the BCF is in line with that reported in previous months.

0.5% Non-Recurrent Reserve: NHS England business rules require that all CCGs plan on retaining 0.5% (£4.1m including £0.4m relating to primary care) uncommitted to support the overall NHS financial position. Despite our locally challenged financial position, we continue to comply with this requirement. We expect to receive guidance from NHS England on how to treat this reserve before the end of the financial year.

Running Costs: The forecast spend against the £12.7m running cost allocation is summarised in the table below. At the planning stage Governing Body approved a planned underspend of £0.3m towards delivery of the overall surplus. Various QIPP schemes were then identified, totalling £250k, which increased this figure to £0.55m. At month 9, further slippage is reported in relation to uncommitted reserves, on recruitment to vacant posts and minimising spend on consultancy and agency staff.

Category Annual Budget £’000s

YTD Variance £’000s

Forecast Variance £’000s

Pay Non Pay Income Running Costs Reserve Running Costs Planned Surplus

8,930 4,165

(1,477) 554 550

(198) (551) (216)

(50) (413)

(326) (264) (328) (431) (550)

Running Cost Budget 12,722 (1,428) (1,899)

Additional Income: Under the Financial Management principles approved by Governing Body we are seeking to maximise additional income, over and above the CCG’s core allocation, to be able to support delivery of our commissioning intentions. A table summarising the additional allocations secured to date is attached at Appendix F. Any known slippage from this income is now factored into the 2017/18 forecast.

4. Delivery of Cash Position

The CCG was notified of a maximum cash drawdown limit of £848.6m at month 9. The total cash used to the end of December was £574.8m against a requested cash drawdown of £567.3m, other income of £7.7m and a brought forward balance of £141k. The cash balance at bank at the end of the month was £0.3m. A minimal cash balance at bank is planned for the year end.

5. Better Payment Practice Code

The Better Payment Practice Code requires the clinical commissioning group to pay all valid invoices by the due date or within 30 days of receipt of a valid invoice, whichever is later. A summary of the position to the end of December is reported in the table below:

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Measure of compliance 12 months to

Dec-17 12 months to

Dec-17 Number £'000

Non-NHS Payables Total Non-NHS Trade invoices paid in the year 15,863 196,526

Percentage of Non-NHS Trade invoices paid within target 98.49% 99.73%

Total Non-NHS Trade Invoices paid within target 15,623 195,997

NHS Payables Total NHS Trade invoices paid in the year 4,745 575,967

Percentage of NHS Trade invoices paid within target 99.58% 99.88%

Total NHS Trade invoices paid within target 4,725 575,291

Recommendations

Governing Body is asked to note the risk assessment and existing mitigations to manage the risks to deliver the CCG’s year end control total of a £13.2m surplus.

Paper prepared by: Jackie Mills, Deputy Director of Finance, Chris Cotton, Senior Finance Manager and Pat Lunness, Senior Finance Manager

On behalf of: Julia Newton, Director of Finance

January 2018

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Appendix A

NHS Sheffield Clinical Commisisoning Group Finance Report 2017/18 - Financial Position for Period Ending 31 December 2017

Budget Expenditure Budget Forecast

£'000s £'000s £'000s % £'000s £'000s £'000s % £'000s

PROGRAMME COSTS Revenue Resource Limit 632,728 632,728 0 0.0% 853,490 853,490 0 0.0% 0

EXPENDITURE Acute Hospital Care

Elective 115,472 119,924 4,452 3.9% 153,406 159,994 6,589 4.3% 5,351 Urgent care 109,917 115,305 5,387 4.9% 144,088 150,754 6,666 4.6% 6,991 Other Acute Care / Ambulance Services 74,499 76,759 2,260 3.0% 100,013 100,931 918 0.9% 2,731

299,888 311,987 12,100 4.0% 397,506 411,679 14,173 3.6% 15,073

Mental Health & Learning Disabilities Mental Health & Learning Disabilities 62,952 64,227 1,275 2.0% 84,230 86,699 2,468 2.9% 1,598

Community Services Elective Community Care 24,334 24,153 (181) -0.7% 29,455 29,207 (248) -0.8% (227) Urgent Community Care 3,793 3,806 13 0.3% 5,039 5,056 17 0.3% 17 Intermediate Care & Reablement 33,836 34,469 633 1.9% 44,983 45,956 973 2.2% 982 Long Term Care and End of Life 46,374 45,413 (961) -2.1% 62,125 60,879 (1,245) -2.0% (950) Prescribing 72,477 72,336 (141) -0.2% 96,778 96,987 208 0.2% (14) Other Commissioning 2,523 2,895 373 14.8% 3,365 3,886 521 15.5% 295

183,337 183,072 (265) -0.1% 241,746 241,971 225 0.1% 101

Primary Care Primary Care Co-commissioning 51,762 51,630 (132) -0.3% 71,102 71,012 (90) -0.1% (90) Locally Commissioned Primary Care Services 12,263 11,942 (321) -2.6% 17,523 16,567 (956) -5.5% (948)

64,025 63,572 (453) -0.7% 88,625 87,579 (1,046) -1.2% (1,038)

Collaborative Working Collaborative Working 1,566 1,378 (189) -12.1% 1,877 1,735 (142) -7.6% (146)

1,566 1,378 (189) -12.1% 1,877 1,735 (142) -7.6% (146)

Reserves Reserves 20,960 0 (20,960) -100.0% 39,506 12,523 (26,983) -68.3% (27,121)

TOTAL EXPENDITURE - PROGRAMME COSTS 632,728 624,236 (8,492) -1.3% 853,490 842,185 (11,305) -1.3% (11,387)

(UNDER)/OVER SPEND - Programme Costs 0 (8,492) (8,492) 0 (11,305) (11,305) (11,387)

Forecast Variance @

Month 8

Year to Date: December Year End Forecast Out-turn

Variance Variance Change from prev

month*

Over (+)/ Under(- ) Over (+)/ Under(- )

RUNNING COSTS ALLOWANCE Running Cost Funding 9,146 Total Running Cost Expenditure 9,146

9,146 0 0.0% 7,717 (1,428) -15.6%

12,722 12,722 0 0.0% 0 12,722 10,823 (1,899) -14.9% (1,816)

(UNDER)/OVER SPEND - Running Costs 0 (1,428) (1,428) 0 (1,899) (1,899) (1,816)

TOTAL Revenue Resource Limit 641,874 641,874 0 0.0% 866,212 866,212 0 0.0% 0

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Appendix A (cont)

RESOURCE LIMIT ALLOCATIONS

Programme Costs

Initial CCG Programme Allocation

Primary Care Co-Commissioning

CHIS funding currently in Sheffield Children's Hospital

PMS Premium - Co Commissioning

PYE transfer of One Health

PYE transfer of Claremont

Budget re suspended doctors transferred with other Co-Comm in error

PMCF - GP Access Fund and TA Improving Access Allocations

IR changes

HRG4+ changes

Planned surplus carry forward from 2016/17

Surplus/Deficit Carry Forward - 1617 Final Outturn

Reception and clerical training

Diabetes Treatment and Care Transformation Fund

NHS WiFi

Market rents adjustment

Paramedic Rebanding Additional Funding 2017-18

TB allocations Qtr 1

Cancer Alliance Running Cost FY 2017/18

Cancer Phase 1 Early Diagnosis Q1/Q2/Q3 2017/18

£176,961 - HSCN - GP funding , £59,917 - HSCN - CCG funding

CYPT IAPT Trainee staff support costs

Adult IAPT Wave 2

Acute hospital urgent & emergency liaison mental health services

Transfer NHCN - CCG funding from programme to running costs

Infrastructure funding for STPs

Adult IAPT Wave 2

STP comms and egagement

Cancer Phase 1 LWBC South Yorks

Additional month5 IR Changes - agreed by J Stalker Booth

Structured Education: Diabetes Treatment and Care Transformation Fund

Treatment Targets: Diabetes Treatment and Care Transformation Fund

MDFT: Diabetes Treatment and Care Transformation Fund

DISN: Diabetes Treatment and Care Transformation Fund

CYP IPC Personal Health Programme

South Yorkshire & Bassetlaw ACS Transformation Funds

UEC Transformation Funding – SYB STP

CCG LTBI Q2 funding - TB reserve

Living with and beyond cancer funding

Cancer 62 day wait tranche 3 North funding

CYP IAPT Trainee staff support costs

Early Implementers Wave 2 Third payment

Occupational Health for Dentists

Cancer Nursing Specialist Delivery Models, Patient Experience

CYP IPC Personal Health Programme

CYP Crisis Acceleration Funding

Charge Exempt Overseas Visitor (CEOV) Adjustment

SCH Amber services

ACS funding for STP sites

STP Comms and Engagement

Q3 2017/18 LTBI allocations

Quality Premium 16/17 stage one payment

DISN: Diabetes Transformation Fund

Additional Winter Funding - (GP Winter Access Bid etc. )

Month 9 Programme Costs Resource Limit

Running Costs

Initial Running Costs allocation

Market rents - Admin adjustment

Transfer NHCN - CCG funding from programme to running costs

Month 8 Running Cost Resource Limit

CLOSING LIMITS (B)

Revenue

Recurrent Non Rec Total

£'000s £'000s £'000s

748,941 748,941

76,122 76,122

(249) (249)

362 362

87 87

336 336

(94) (94)

3,496 3,496

(306) (306)

(2,190) (2,190)

11,620 11,620

4 4

101 101

143 143

222 222

(580) (580)

179 179

17 17

275 275

2,418 2,415

237 237

7 7

453 453

401 401

(60) (60)

281 281

453 453

175 175

132 132

(6) (6)

35 35

82 82

56 56

56 56

70 70

7,333 7,333

312 312

17 17

66 66

114 114

7 7

716 716

(132) (132)

78 78

40 40

78 78

(159) (159)

717 717

150 150

32 32

20 20

573 573

55 55

200 200

828,869 24,621 853,490

12,634 12,634

28 28

60 60

12,634 88 12,722

841,503 24,709 866,212

Maximum Cash Drawdown incl Capital

Confirmed Anticipated

£'000s £'000s

Total

£'000s

848,597 848,597

848,597 0

848,597 0

848,597

848,597

Memo Table: Planned Surplus £'000

Historic Surplus b/f 3,500 Plus release of 1% reserve in 2016/17 added to surplus b/f 8,124 Cumulative surplus carried forward from 2016/17 11,624 Planned increase to surplus in 2017/18 1,579

Total planned surplus for 2017/18 13,203

Balance of surplus required to be 'drawn up' in future years (to meet business rules) 2,608

Memo Table: Forecast In Year Financial Performance

Total Allocation 17/18 from the above table 866,212 Less cumulative surplus carried forward from 2016/17 ‐11,624 In Year Allocation 854,588

Expenditure: Forecast Expenditure (Programme Spend plus Running Costs) 853,009 Forecast under/(over)‐spend against in year allocation 1,579

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Appendix B



£'000s £'000s £'000s % £'000s £'000s £'000s % £'000s

PROGRAMME COSTS

Revenue Resource Limit 632,728 632,728 0 0% 853,490 853,490 0 0% 0

EXPENDITURE Acute Hospital Care Planned Care Sheffield Teaching Hospitals NHS FT 101,976 106,863 4,887 5% 135,399 142,613 7,214 5% 5,749 Sheffield Children's NHS FT 8,493 8,331 (162) -2% 11,425 11,202 (223) -2% (190) Other NHS Trusts 2,548 2,579 31 1% 3,386 3,456 70 2% 8 ISTC & Extended Choice 2,453 2,151 (302) -12% 3,195 2,724 (472) -15% (216) Planned Care 115,472 119,924 4,452 4% 153,406 159,994 6,589 4% 5,351

Urgent Care Sheffield Teaching Hospitals NHS FT 96,414 101,821 5,407 6% 126,059 132,786 6,727 5% 7,183 Sheffield Children's NHS FT 8,930 8,923 (8) 0% 11,907 11,818 (89) -1% 58 Other NHS Trusts 4,573 4,561 (12) 0% 6,121 6,150 29 0% (250) Urgent Care 109,917 115,305 5,387 5% 144,088 150,754 6,666 5% 6,991

Other Acute Care / Ambulance Services Sheffield Teaching Hospitals NHS FT 50,157 51,568 1,411 3% 66,917 67,389 472 1% 1,503 Sheffield Children's NHS FT 1,270 1,819 549 43% 2,419 2,513 94 4% 746 Other NHS Trusts 1,400 1,260 (140) -10% 1,860 1,606 (254) -14% (133) ISTC & Extended Choice 23 23 0 0% 54 54 0 0% 0 Ambulance Services 17,890 18,123 233 1% 23,727 23,966 239 1% 249 Other Acute Services 3,758 3,966 207 6% 5,037 5,403 367 7% 366 Other Acute Care 74,499 76,759 2,260 3% 100,013 100,931 918 1% 2,731

Mental Health & Learning Disabilities Sheffield Health and Social Care NHS FT 57,090 57,886 796 1% 75,707 76,626 919 1% 919 Sheffield Children's NHS FT 3,688 3,675 (13) 0% 4,917 5,622 704 14% (69) Local Authority 1,478 1,491 12 1% 2,673 2,698 25 1% 0 Other Mental Health Services 695 1,176 480 69% 933 1,753 820 88% 748 Mental Health & Learning Disabilities 62,952 64,227 1,275 2% 84,230 86,699 2,468 3% 1,598

Community Services Planned Care Sheffield Teaching Hospitals NHS FT 6,171 6,171 0 0% 8,229 8,229 0 0% 0 Sheffield Children's NHS FT 3,019 3,019 0 4,026 4,026 0 0% 0 Local Authority 14,039 13,978 (61) 0% 15,719 15,638 (81) -1% (60) Development Nurses 328 196 (132) -40% 438 261 (176) -40% (176) Other Community Services 776 788 12 2% 1,044 1,053 9 1% 9 Planned Community Care 24,334 24,153 (181) -1% 29,455 29,207 (248) -1% (227)

Urgent Care 111 987 1,000 13 1% 1,297 1,314 17 1% 17 Out of Hours 2,807 2,807 0 0% 3,742 3,742 0 0% 0 Urgent Community Care 3,793 3,806 13 0% 5,039 5,056 17 0% 17

Intermediate Care & Reablement Sheffield Teaching Hospitals NHS FT 31,029 31,382 353 1% 41,241 41,841 600 1% 600 Local Authority 1,363 1,363 0 0% 1,817 1,817 0 0% 0 Community Equipment 1,444 1,723 280 19% 1,925 2,298 373 19% 382 Intermediate Care 33,836 34,469 633 2% 44,983 45,956 973 2% 982

Long Term Care and End of Life Continuing Care 35,401 34,640 (761) -2% 47,467 46,436 (1,031) -2% (636) Continuing Healthcare Assessments 1,826 1,558 (268) -15% 2,462 2,166 (296) -12% (297) Continuing Care - IFRs 51 46 (5) -10% 67 51 (16) -24% (7) Funded Nursing Care 5,749 5,765 15 0% 7,666 7,687 21 0% (45) St Lukes Hospice 1,751 1,743 (8) 0% 2,335 2,325 (10) 0% (13) Sheffield Teaching Hospitals NHS FT 1,596 1,661 65 4% 2,128 2,215 87 4% 48 Long Term Care 46,374 45,413 (961) -2% 62,125 60,879 (1,245) -2% (950)

GP Prescribing Prescribing 71,264 71,160 (105) 0% 95,153 95,397 244 0% 22 Medicines Management Team 1,212 1,176 (36) -3% 1,625 1,590 (35) -2% (36) Prescribing 72,477 72,336 (141) 0% 96,778 96,987 208 0% (14)

Other Commissioning 2,523 2,895 373 15% 3,365 3,886 521 15% 440 Other Commissioning 2,523 2,895 373 15% 3,365 3,886 521 15% 440

Primary Care

Co-Commissioning

Core Contract 37,278 37,284 6 0% 49,704 49,704 0 0% 0

Premises 7,234 7,208 (26) 0% 9,669 9,698 29 0% 29 QoF 4,195 4,195 1 0% 7,574 7,574 0 0% 0 Enhanced Services 1,080 858 (223) -21% 1,521 1,235 (287) -19% (287) Primary Care Other 1,975 2,085 110 6% 2,634 2,801 167 6% 167 Primary Care Reserve 0 0 0 0 0 0 0

Locally Commissioned Primary Care Services 12,263 11,942 (321) -3% 17,523 16,567 (956) -5% (948)

Primary Care 64,025 63,572 (453) 88,625 87,579 (1,046) -1% (1,038)

Forecast Variance @

Month 8

Year to Date: December Forecast Out-turn

Variance Variance


9


£'000s £'000s £'000s % £'000s £'000s £'000s % £'000s

Forecast Variance @

Month 8

Year to Date: December Forecast Out-turn

Variance Variance


Collaborative Working

Accountable Care Partnership (3) (2) 1 -38% 50 24 (26) -52% (29)

Accountable Care System 1,230 1,230 0 0% 1,375 1,375 0 0% 0

Commissioners Working Together 187 3 (184) -98% 250 142 (108) -43% (108)

Better Care Fund 152 146 (6) -4% 202 194 (8) -4% (8)

Collaborative Working 1,566 1,378 (189) 1,877 1,735 (142) (146)

Reserves Commissioning Reserves 1,593 0 (1,593) -100% 12,776 8,414 (4,362) -34% (3,147) General Contingency Reserve 9,606 0 (9,606) 9,606 0 (9,606) -100% (11,321) Primary Care 272 0 (272) 726 363 (363) 0 0.5% Non Recurrent Reserve 0 0 0 3,746 3,746 0 0% 0 Planned Surplus 9,489 0 (9,489) -100% 12,653 0 (12,653) -100% (12,653) Reserves 20,960 0 (20,960) -100% 39,506 12,523 (26,983) -68% (27,121)

TOTAL EXPENDITURE - PROGRAMME COSTS 632,728 624,236 (8,492) -1% 853,490 842,185 (11,305) -1% (11,388)

(UNDER)/OVER SPEND - Programme Costs 0 (8,492) (8,492) 0 (11,305) (11,305) (11,388)

RUNNING COSTS ALLOWANCE RUNNING COST ALLOCATION 9,146 9,146 0 0% 12,722 12,722 0 0% 0 EXPENDITURE Accountable Officer 1,494 1,463 (32) -2% 1,991 1,961 (31) -2% (32) Commissioning & Performance 2,209 2,011 (198) -9% 2,936 2,755 (182) -6% (162) Finance & Facilities 2,302 1,848 (454) -20% 3,121 2,721 (399) -13% (340) Nursing,Quality & Workforce 2,021 1,848 (173) -9% 2,694 2,504 (190) -7% (179) Transformation & Delivery 656 547 (109) -17% 875 759 (116) -13% (120) Running Cost Reserve 50 0 (50) 554 123 (431) -78% (434) Running Cost Planned surplus 413 0 (413) -100% 550 0 (550) -100% (550) TOTAL EXPENDITURE - RUNNING COSTS 9,146 7,717 (1,428) -16% 12,722 10,823 (1,899) -15% (1,816)

(UNDER)/OVER SPEND - Running Costs 0 (1,428) (1,428) 0 (1,899) (1,899) (1,816)

TOTAL (UNDER)/OVER SPEND 0 (9,920) (9,920) - 0 (13,203) (13,203) - (13,203)

10

Appendix C


Main Provider Contracts

Year to Date: December Budget Expenditure Variance

Over (+)/ Under(- ) £'000 £'000 £'000 %

Year End Forecast Out-turn Budget Forecast Variance

Over (+)/ Under(- ) £'000 £'000 £'000 %

EXPENDITURE

Sheffield Teaching Hospitals NHS FT

Planned Care - STH

Urgent Care - STH

Community Care - STH

Other Acute - STH

High Cost Drugs - STH

Maternity Services

Primary Care - Out of Hours

Intermediate Care & Reablement

End of Life Care

Sheffield Children's NHS FT

Planned Care - SCH

Urgent Care - SCH

Community Care - SCH

Mental Health Services - SCH

Other Acute - SCH

High Cost Drugs - SCH

Safeguarding

Sheffield Health and Social Care NHS FT Mental Health & Learning Disabilities

Sub Total

Sub Total

Sub Total

101,976

96,414

6,171

31,527

9,772

8,858

2,807

31,029

1,596

106,863

101,821

6,171

32,200

10,683

8,684

2,807

31,382

1,661

4,887

5,407

0

674

912

(175)

0

353

65

4.8%

5.6%

0.0%

2.1%

9.3%

-2.0%

0.0%

1.1%

4.1%

290,150

8,493

8,930

2,751

3,688

832

439

268

302,273

8,331

8,923

2,751

3,675

1,267

552

268

12,123

(162)

(8)

0

(13)

436

113

0

4.2%

-1.9%

-0.1%

0.0%

-0.4%

52.4%

25.8%

0.0%

25,402

57,090

25,768

57,886

366

796

1.4%

1.4%

57,090 57,886 796 1.4%

372,643 385,927 13,284 3.6%

135,399

126,059

8,229

42,036

13,070

11,811

3,742

41,241

2,128

142,613

132,786

8,229

41,442

14,369

11,578

3,742

41,841

2,215

7,214

6,727

0

(593)

1,298

(233)

0

600

87

5.3%

5.3%

0.0%

-1.4%

9.9%

-2.0%

0.0%

1.5%

4.1%

383,715

11,425

11,907

3,668

4,917

1,834

585

358

398,814

11,202

11,818

3,668

5,622

1,777

736

358

15,099

(223)

(89)

0

704

(57)

151

0

3.9%

-1.9%

-0.7%

0.0%

14.3%

-3.1%

25.8%

0.0%

34,694

75,707

35,181

76,626

487

919

1.4%

1.2%

75,707 76,626 919 1.2%

494,116 510,621 16,505 3.3%

11

Appendix D

Sheffield CCG Commissioned Activity and Costs - December 2017

Sheffield Teaching Hospitals NHS FT

‐2.0%

0.0%

2.0%

4.0%

6.0%

8.0%

10.0%

Variance in Actual vs Target Activity

Outpatient Firsts

Outpatient Followups

Outpatient Unbundled Imaging

Electives

Electives ‐ Excess Beddays

Non Electives

Non Electives ‐ Excess Beddays

CDU Outpatients

Accident and Emergency

‐50.0%

‐40.0%

‐30.0%

‐20.0%

‐10.0%

0.0%

10.0%

20.0%

Variance in Actual vs Target (inc. QIPP) Cost

Outpatient Firsts



Electives

Electives ‐ Excess Beddays

Non Electives

Non Electives ‐ Excess Beddays

CDU Outpatients


Point of Delivery

Year to Date Activity Plan

Year to Date Actual Activity

Variance

Activity %

Outpatient Firsts



Electives

Electives - Excess Beddays

Non Electives

Non Electives - Excess Beddays

CDU Outpatients


85,916

204,301

40,697

38,852

25,151

98,408

89,750

218,272

44,352

40,725

24,805

98,657

3,834

13,971

3,655

1,873

-346

249

4.5%

6.8%

9.0%

4.8%

-1.4%

0.3%

Total

Year to Date Budget

Actual Expenditure Variance

£'000s £'000s £'000s %

14,616

15,802

2,929

34,192

469

76,077

4,824

1,218

12,264

15,097

17,614

2,886

37,008

290

82,318

3,954

1,047

12,471

481

1,813

-43

2,815

-179

6,240

-870

-171

207

3.3%

11.5%

-1.5%

8.2%

-38.2%

8.2%

-18.0%

-14.0%

1.7%

162,392 172,686 10,294 6.3%

MFF Uplift Applied to Contract Monitoring Costings at 2.9422% for PbR Activity Only Includes PbR and Non-Pbr Activity (and CDU (A&E) activity) Includes Financial Adjustments and QIPP

A&E does not include Primary Care Access Centre activity or costs

There are some minor differences between the finance report and the BI version due to financial adjustments which are not reflected in BI data

12

Appendix E


Memorandum: Section 75 - Better Care Fund

Theme

Citywide Position People Keeping Well in their local community Active Support & Recovery Independent Living Solutions Ongoing Care Emergency Medical Admissions - STH Mental Health Capital Grants TOTAL EXPENDITURE

Year to Date: December

Budget Expenditure Variance Over (+)/ Under(- )

£'000s £'000s £'000s %

6,666 5,365 (1,300) -19.5% 38,577 38,026 (550) -1.4% 2,827 3,709 881 31.2%

101,865 109,411 7,546 7.4% 43,832 48,286 4,454 10.2% 78,774 78,647 (127) -0.2% 1,857 1,631 (226) -12.1%

274,398 285,075 10,677 3.9%

NHS Sheffield CCG People Keeping Well in their local community Active Support & Recovery Independent Living Solutions Ongoing Care Emergency Medical Admissions - STH Mental Health Capital Grants CCG Total

1,439 1,154 (285) -19.8% 32,392 32,745 353 1.1% 1,444 1,723 280 19.4%

35,848 35,561 (287) -0.8% 43,832 48,286 4,454 10.2% 71,850 72,517 667 0.9%

0 0 0 0.0% 186,805 191,987 5,182 2.77%

Sheffield City Council (SCC) People Keeping Well in their local community Active Support & Recovery Independent Living Solutions Ongoing Care Emergency Medical Admissions - STH Mental Health Capital Grants SCC Total

Notes:

Key elements of each theme are summarised below:

5,227 4,211 (1,016) -19.4% 6,185 5,281 (903) -14.6% 1,384 1,985 602 43.5%

66,017 73,850 7,833 11.9% 0 0 0 0.0%

6,924 6,130 (794) -11.5% 1,857 1,631 (226) -12.1%

87,593 93,089 5,496 6.3%

Year End Forecast Out-turn

Budget Forecast Variance Over (+)/ Under(- )

£'000s £'000s £'000s %

8,608 7,647 (962) -11.2% 51,444 51,463 19 0.0% 3,744 4,271 527 14.1%

132,713 139,341 6,628 5.0% 56,750 62,553 5,803 10.2%

105,120 106,124 1,004 1.0% 5,687 2,738 (2,949) -51.9%

364,067 374,138 10,071 2.8%

1,959 1,603 (355) -18.1% 43,057 43,657 600 1.4%

1,925 2,298 373 19.4% 45,279 44,881 (398) -0.9% 56,750 62,553 5,803 10.2% 95,888 96,984 1,096 1.1%

0 0 0 0.0% 244,858 251,976 7,119 2.9%

6,650 6,043 (606) -9.1% 8,387 7,805 (581) -6.9% 1,819 1,973 154 8.5%

87,434 94,461 7,026 8.0% 0 0 0 0.0%

9,232 9,140 (92) -1.0% 5,687 2,738 (2,949) -51.9%

119,209 122,161 2,952 2.5%

(334) 601 382

(340) 5,663 1,178

0 7,149

(540) (537)

162 7,322

0 (52)

(2,812) 3,542

Forecast Variance @

Month 8

£'000s

(874) 63

544 6,982 5,663 1,126

(2,812) 10,691

Includes Care Planning, Health trainers/ Community Support Workers, Community Grants and

People Keeping Well in their local community Support to VCF sector, Public Health, Housing related support to Older People and other support

services

Active Support & Recovery Includes community nursing, Intermediate Care Beds, CICs, Transfer of Care Teams, STIT, Intermediate Care Assessment teams

Independent Living Solutions Includes community equipment and adaptations

Ongoing Care Includes CHC& FNC, Learning Disabilities, Adult Social Care. From April 2017, this excludes spend on mental health which is now included in the mental health theme.

Emergency Medical Admissions - STH Includes Adult Inpatient Medical Emergency Admissions (excluding gastroenterology)

Mental Health Includes all adult mental health services as commissioned by the CCG, with those for under 65 years purchased by SCC in 2017/18.

13

Additional Funding via CCG into Sheffield System 2017/18 ‐ Status as at December 2017 Appendix F

There are opportunities to bid for additional resources being held centrally and being released via STP / FYFV and other workstreams. To date we have been successful in securing the following:

Funding Name Source Provider Description Recurrent? Funding £'000

Mental Health Liaison NHSE through A&E Delivery Board

SHSC Ensure Liaison service in STH meets Core 24 standard ‐ additional A&E , ward, and medical liasion staffing

Non‐ Recurrent 536

IAPT NHSE through STP SHSC

Additional IAPT services covering Cardiology, NCCP, COPD, MSK, Cancer, Diabetes, CFS/ME, Irritable Bowel, Medically Unexplained Symptoms & Health Anxiety

Non‐ Recurrent 1,812

Integrated Personalised Commissioning

NHSE Mainly CCG Costs Project to increase integrated Personalised Commissioning and number of personal health budgets


CYP IPC Project NHSE Mainly CCG Costs

Integrated Personal Commissioning for Looked After Children and Young People with Mental Health Support Needs Project


Diabetes Prevention NHSE Various practices Diabetes Prevention Non‐ Recurrent 45

Diabetes Treatment & Care

NHSE STH Structural Education, Multi‐Discplinary Foot Team, Specialist Nursing Non‐ Recurrent (expect

some funding in 18/19)

405

NHSE CCG Internal Currently determining plan for remainder

165

Digital inclusion Good Things Foundation TBC Upskill patients with the use of healthcare technology to promote self‐care

Non‐ Recurrent 50

Latent TB Initiative NHSE STH/Primary Care Latent TB screening programme Non‐ Recurrent 68 CYPT IAPT Trainee staff support costs

NHSE SCH Non‐ Recurrent 7

Health Led Employment Trial

City Region CCG CCG leading on Health Led Employment Trial Procurement

Non‐ Recurrent 50

Additional Winter Funding

NHSE Primary Care GP Winter Access Bid Non‐ Recurrent 200

3,648

In addition the CCG is in receipt of certain earmarked allocations linked to the Primary Care FYFV as follows:

Training Care Navigators and Practice Staff

NHSE TBC

Part of GPFYFV, also £102k available in 18/19. Training staff to be able to signpost patients to other available services and help to free up GP resource

Non‐Recurrent 101

GP Extended Access NHSE PCS

Initial continuation of 4 primary care hubs, with view to exploring possible future options. £3,535k available in 18/19

Non‐Recurrent 3,479

On‐Line Consultation Systems

NHSE TBC

Part of GPFYFV, also £203k available in 18/19. For practices to purchase on‐line consultation systems improving access and making full use of clinicians' time

Non‐Recurrent 153

HSCN 177

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