paper k month 2 finance report - nhs sheffield ccg us/ccg...scft and shsct), with further detail in...

Month 2 Finance Report

Governing Body meeting K 5 July 2018

Author(s) Jackie Mills, Deputy Director of Finance Chris Cotton, Senior Finance Manager Pat Lunness, Senior Finance Manager Julia Newton, Director of Finance

Sponsor Director Julia Newton, Director of Finance Purpose of Paper

This report provides information on the financial position at Month 2 (May 2018), together with an assessment of the risks and existing mitigations available to deliver the CCG’s control total of in year break even (which also equates to a cumulative year end surplus of £18m).

Key Issues

We are reporting an overall year-to-date (YTD) surplus of £3.2m, which is in line with our planned YTD surplus of £3.0m. At this early point in the financial year, it is difficult to accurately forecast the year end position, given the numerous factors that will come into play and the limited data which is available to date. Whilst there remain a number of key risks and issues that need to be managed we are, however, forecasting delivery of our planned surplus.

Is your report for Approval / Consideration / Noting

Consideration of the risk assessment and existing mitigations to manage the risks to deliver the CCG’s year end control total of a £18.0m outlined in section 2.

Approval of the budget movements noted in section 6.

Noting of the requirement to submit the Financial Control, Planning and Governance Self-Assessment, following sign off by the Accountable Officer and Audit Chair.

Recommendations / Action Required by Governing Body

Governing Body is asked to: Consider the risk assessment and existing mitigations to manage the risks to

deliver the CCG’s year end control total of a £18.0m surplus as outlined in section 2.

Approve the budget movements noted in section 6. Note the requirement to submit the Financial Control, Planning and Governance

Self-Assessment, following sign off by the Accountable Officer and Audit Chair.

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Governing Body Assurance Framework

Which of the CCG’s objectives does this paper support? Strategic Objective - To ensure there is a sustainable, affordable healthcare system in Sheffield. It supports management of the CCG’s principal risks 3.1, 4.1, 4.2 and 4.3 in the Assurance Framework.

Are there any Resource Implications (including Financial, Staffing etc)?

Not specifically

Please attach if completed. Please explain if not, why not Not applicable

Have you involved patients, carers and the public in the preparation of the report?

Not applicable

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Finance Report at Month 2

Governing Body Meeting

5 July 2018

1. Executive Summary

Deliver £18.0m Surplus (CCG’s Control Total) against Commissioning Revenue Resource Limit (RRL) + RCA combined

Key Duties

a) Achieve a surplus against the Programme Allocation

b) Remain within Running Cost Allowance (RCA) of £12.66m.

Remain within Cash Limit (i.e. Maximum draw down set by NHS England)

Key: Red Significant risk of non-delivery. Additional actions need to be urgently pursued. Amber Medium risk of non-delivery requires additional management effort. Green Low risk of non-delivery – current management effort should deliver success.

(£3.2m) Under Spend

Year to date




budgets.

£1.4m closing balance

Breakeven The CCG’s maximum draw down for 2018/19 notified in May was £857.6m. To remain within this limit, which requires the revenue position to be

managed to meet this target.


Forecast Key Issues


At this early stage of the financial year, there are a number of risks and challenges that need to be managed (see section 2). In particular, there are significant risks associated with full delivery of

The surplus brought forward from 2017/18 was £18.0m. For 2018/19, the CCG has been set an in-year breakeven control total by NHS England, i.e. we are required to maintain our brought forward cumulative surplus. We are forecasting achievement of this surplus but there remain a range of pressures and risks to be managed throughout the year.

the QIPP plan of £18.5m, with £2.4m of schemes still to be identified. Hence a RAG rating of amber indicating the need for additional actions which are being progressed.

At the plan stage, we agreed £0.3m of our surplus should come from the RCA. Subsequently an additional £100k was identified from non pay

brought in on plan, cash payments will need to be

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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 31 May 2018 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

414,960 86,783

240,912 96,356

536

7 42

(272) (388)

661

(121) 80

(381) (594)

0

0.0% 0.1%

-0.2% -0.6% 0.0%

Reserves including planned surplus 24,770 (2,934) (16,568)

Programme Costs Running Costs (analysis in section 2.1.12)

864,317 12,661

(2884) (272)

(17,584) (420)

-2.0% -3.3%

Year to date and Year end Surplus 876,978 (3,156) (18,004) -2.0% Figures are subject to rounding

We are reporting an overall year-to-date (YTD) surplus of £3.2m, which is in line with our planned YTD surplus of £3.0m. At this early point in the financial year, it is difficult to accurately forecast the year end position, given the numerous factors that will come into play. Whilst there remain a number of key risks and issues that need to be managed we are currently forecasting delivery of our planned surplus. Further detail of spend in different areas can be found at Appendix A (at summary level) and a more detailed position by programme category is then provided in Appendix B. Appendix C provides a summary of the financial position for our main contracts with Sheffield providers (STHFT, SCFT and SHSCT), with further detail in Appendix D on the activity and spend for STHFT. Appendix E summarises the overall position for budgets within the scope of the BCF arrangement with Sheffield City Council.

The largest area of risk to delivery of the overall financial position identified to date relates to QIPP delivery. Information on the current available data in relation to QIPP is provided separately in the Director of Commissioning’s QIPP report. As noted in the Executive Summary, there are currently no agreed plans in place to deliver £2.4m of the total £18.5m plan, which is a significant risk. In addition, there are differential risks associated with the remaining schemes and so it is imperative that we maintain the focus on the delivery of all the schemes.

Our assessment using the information available to date is a risk range of £4m upside to £7m downside which is fairly normal for this stage in the financial year. Based on known risks at Month 2, we have assessed that we should have sufficient mitigating actions to manage our risks. However, there are likely to be new risks emerge over the coming months, and so intense scrutiny and early identification of potential issues remains key.

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 £401m (including the MSK and Walk in Centre contracts). At month 2, we are reporting a £0.2m (0.2%) overspend for the contract overall.

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It is important to note that the phasing of QIPP savings means that £0.9m of the £9.2m attributed to the STH contract is phased into the first 2 months. The delivery of the agreed QIPP plan is vital to the delivery of the financial position.

There have been several issues relating to activity data provided by STHFT in relation to the M2 reported position. Due to changes to the code which assigns commissioner to the Lorenzo (patient) system, STHFT identified an error in the initial data provided. This resulted in a review by STHFT and subsequent correction, meaning that the CCG received contract monitoring information a week late, making turnaround for Governing Body reporting extremely challenging for both Information and Finance teams. It is possible that some records remain assigned to the wrong commissioner and we will be working closely with STHFT to understand any remaining issues. We will also ensure a full and robust reconciliation of Quarter 1 contract monitoring.

As a result of the problems we are unable to report accurately on the Outpatient Queue; Inpatient Waiting list or referrals data at Month 2.

The ongoing problems with uncoded spells continues and within the M2 monitoring received from STHFT there are 1,266 Elective and 2,933 Non-Elective spells for Sheffield CCG patients which incomplete coded records at the time when reporting was provided. This is a marked deterioration when compared with 17/18 M2 numbers (which were 251 and 928 respectively). The uncoded spells account for approx. £8m of the £28m spent on inpatients in the first two months. Whilst our experience in 2017/18 was that the agreed methodology for estimating the cost of uncoded spells was relatively accurate, the level of uncoded activity at month 2 is a particular concern. We are aware that there are national issues with the availability of trained clinical coders. STHFT have indicated that they have a plan to address the clinical coding problems but that this may not be resolved in the short-term.

Due to the limited data from only 2 months it is not felt that it is appropriate to extrapolate the overspend to a full year, this approach has been used in most areas of spend within this report. As a result a forecast breakeven position on this budget has been reported.

Month 2 data from Sheffield Children’s (SCH) shows an under performance against plan by £64k. Planned care services are over plan whilst urgent care services are below, due to the variability in urgent care activity the current forecast for the year is a break even position against plan.

Other Secondary Care shows small variances for Independent sector contracts and individual funding requests but with limited charges to date, especially with non contract activity, the overall position is roughly on plan.

Continuing Health Care (CHC) and Funded Nursing Care (FNC): Adults CHC has a year to date underspend of £0.2m with an expected underspend of £0.3m by year end. The year to date underspend is due to a lower number of patients in receipt of CHC packages than budgeted for. We budgeted for a small net increase in patients each month and to date we have had a small net decrease. As CHC patient numbers and spend can be volatile the forecast is based on the planned growth in patient numbers for the remainder of the year. FNC is also underspent year to date due to the announced national weekly payment rate being slightly less than planned for and lower number of patients. For the year end forecast we have assumed patient numbers will increase back to plan. Children’s continuing care is around breakeven.

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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 21 June 2018. Given that we are still awaiting the final outcome of national negotiations re GP core contracts, it is difficult to assess the likely pressures that may appear in relation to delegated budgets. At this early stage of the year we have forecast spend to match budget across both delegated and locally commissioned primary care services.

Prescribing: Prescribing data is available for April. The average price per item remained at the same level as March at £6.58; items prescribed were at a lower level than planned. Using April’s costs as an estimate for May the year to date underspend £0.4m. The cost pressure caused by No Cheaper Stock Obtainable (NCSO) in quarters 2 and 3 of 2017/18 did return to historical levels in Q4 last year and this has continued in April in line with national guidance. It is expected that the price for certain drugs (Category M) will increase from July when the current national pricing agreement comes to an end, resulting in an increase in the average item price. The budget has been phased to take account of this expected change in price and the forecast currently is that spend will be on plan from July, this has resulted in a reported year end underspend of £0.6m. Each of these are assumptions which have a significant degree of risk attached to them and until we have July information (in September) it will be difficult to give an informed view of forecast out-turn. Prescribing QIPP plans are progressing well.

Collaborative Working: For 2018/19 we have set up a separate section on Appendix A so that we can report spend on our collaborative working with partners, particularly as Sheffield CCG is the host organisation for both the SY&BL Integrated Care System (ICS) (incorporating the previous commissioner working together arrangements) and the Sheffield Accountable Care Partnership. This will capture in summary level the spend against the allocations from eg NHS England which the CCG receives on behalf of the ICS and the contributions from Sheffield CCG. The CCG will be collecting in income from all partner organisations to contribute to ICS and ACP costs and this income will be offset against relevant expenditure and so only the net position is reported on Appendix A. In this regard, it is important to note that separate financial reporting will occur to the public sessions of both ICS and Sheffield ACP boards during 2018/19 and so it is not the intention that detailed reporting occurs in this CCG financial report.

The year to date position shows a significant overspend of £661k on the ICS budget because spend is being incurred on a range of transformation work and at M2 we have not yet had the allocations for either the ICS or Cancer Alliance work and so can not show in our budgets at this time. Thus the overspend is a timing issue regarding the receipt of these previously notified allocations and hence why we are reporting breakeven by year end.

Section 75 Framework Partnership Agreement (Better Care Fund): Appendix E shows the citywide positon in relation to the Better Care Fund. The year to date position shows an overspend of £0.1m in relation to CCG budgets, and an underspend of £2m in relation to council budgets, mainly in relation to People Keeping Well, Active Support & Recovery (STIT) and Ongoing Care (Adult social care purchasing).

As reported elsewhere in this report, the majority of budgets managed by the CCG are currently forecast to breakeven, given we are at an early point of the financial year, with the exception of CHC which is showing a small forecast underspend. However, Sheffield City Council are reporting that they expect that some slippage currently reported will be utilised later in the financial year and/or there are additional activity pressures, particularly

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in adult social care purchasing, that will materialise later in the financial year. As a result, a forecast overspend of £8m is reported, offset by slippage of £3m on capital grants, leaving a net overspend of £5m.

0.5% Non-Recurrent Reserve: The 2017/18 business rule requiring CCGs to set aside 1% of their allocation (0.5% of which was available for CCGs to use) is no longer applicable. However, due to a range of non recurrent pressures in 2018/19 the CCG will continue to hold the 0.5% reserve for such costs. This reserve is £3.2m at M2 and it is expected this will be fully committed.

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. Subsequently additional QIPP schemes were identified, totalling £100k, which increased this figure to £0.4m. At month 2, further slippage is reported, mainly in relation to recruitment to vacant posts.

Category Annual Budget £’000s

YTD Variance £’000s

Forecast Variance £’000s

Pay Non Pay Income Running Costs Reserve Running Costs Planned Surplus

9,405 4,118

(1,325) 63

400

(135) (46) (24)

0 (67)

55 (1)

(114) 0

(360) Running Cost Budget 12,661 (272) (420)

Additional Income: Under the Financial Management principles previously 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. We are still working to establish the likely additional funding that will be available in 2018/19, as we are still awaiting confirmation from NHS England and/or the sICS in a number of cases. We are also still awaiting confirmation of how the additional funding committed by the treasury to fund the recently agreed Agenda for Change pay increases will flow to the local system, and whether this will leave the CCG with any net risk.

The recent government announcement of a new multi-year funding plan for the NHS is unlikely to provide any additional funding for 2018/19 but is clearly welcome in terms of longer term plans. Again, there is a great deal of uncertainty as to how this funding will be allocated between different NHS funding streams or what additional requirements will come in relation to how it can be spent, although there are some early indications of some of the key priorities including: delivering agreed performance standards, transforming cancer care; better access to mental health services; better integration of health and social care; and prevention of ill-health.

4. Delivery of Cash Position

The CCG was notified of a maximum cash drawdown limit of £857.6m at month 2. The total cash used to the end of May was £132.5m against a requested cash drawdown of £132.4m, other income of £1.3m and a brought forward balance of £181k. The cash balance at bank at the end of the month was £1.4m. A minimal cash balance at bank is planned for the year end.

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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 for the 12 month period to the end of May is reported in the table below:

Measure of compliance 12 months to

May-18 12 months to

May-18 Number £'000

Non-NHS Payables Total Non-NHS Trade invoices paid in the year 15,982 191,272 Total Non-NHS Trade Invoices paid within target 15,752 190,671 Percentage of Non-NHS Trade invoices paid within target 98.56% 99.69%

NHS Payables Total NHS Trade invoices paid in the year 4,321 591,682 Total NHS Trade invoices paid within target 4,296 590,790 Percentage of NHS Trade invoices paid within target 99.42% 99.85%

6. Key Budget Movements

In line with the Scheme of Budgetary Delegation, the Governing Body is required to sign off all budget movements over £2m. There have been no budget movements over £2m since the beginning of the financial year.

In addition, in line with the section 75 agreement with Sheffield City Council (SCC), any proposed changes to Better Care Fund budgets in excess of £1m are required to be approved by the Governing Body (as well as by SCC). At month 2, the CCG has re-analysed its final budget splits between BCF and non BCF lines. This has resulted in the following budget changes: +£2.1m re BCF urgent care (from urgent care specialties outside the BCF), +£1.9m re mental health within the scope of the BCF.

7. Financial Control, Planning and Governance Self-Assessment

NHS England has recently published a new Financial Control, Planning and Governance Self-Assessment that all CCGs are required to submit by 29th June. The purpose of the template is to provide ‘early warning signs’ of CCGs in financial distress and to provide assurance that there are adequately-designed and effective financial controls and governance processes in place to manage risk. The self-assessment is required to be signed off by the Accountable Officer or Audit Chair before submission. The outcome of the assessment will be used as an indicator of risk to the local office, among the other metrics the local office uses, as part of the CCG assurance process.

At the time of writing this report, the final agreed submission is not complete. Our expectation is that we can demonstrate compliance with the majority of indicators, and where there are exceptions these are not considered material to the overall assessment of the CCGs financial controls and governance processes. A verbal update on the final submission will be provided to the meeting.

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Recommendations

Governing Body is asked to: Consider the risk assessment and existing mitigations to manage the risks to

deliver the CCG’s year end control total of a £18.0m surplus as outlined in section 2.

Approve the budget movements noted in section 6. Note the requirement to submit the Financial Control, Planning and Governance

Self-Assessment, following sign off by the Accountable Officer or Audit Chair.

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

June 2018

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Appendix A

NHS Sheffield Clinical Commisisoning Group Finance Report 2018/19 - Financial Position for Period Ending 31 May 2018

Budget Expenditure Budget Forecast

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

PROGRAMME COSTS Revenue Resource Limit 142,443 142,443 0 0.0% 864,317 864,317 0 0.0% 0

EXPENDITURE Acute Hospital Care

Elective 26,402 26,691 289 1.1% 159,143 159,100 (43) 0.0% 0 Urgent care 26,380 26,184 (196) -0.7% 154,060 153,995 (65) 0.0% 0 Other Acute Care / Ambulance Services 17,077 16,992 (86) -0.5% 101,756 101,743 (13) 0.0% 0

69,859 69,866 7 0.0% 414,960 414,839 (121) 0.0% 0

Mental Health & Learning Disabilities Mental Health & Learning Disabilities 14,464 14,506 42 0.3% 86,783 86,863 80 0.1% 0

Community Services Elective Community Care 12,389 12,450 60 0.5% 32,429 32,365 (64) -0.2% 0 Urgent Community Care 864 864 0 0.0% 5,185 5,185 0 0.0% 0 Intermediate Care & Reablement 669 689 20 3.0% 45,646 45,765 119 0.3% 0 Long Term Care and End of Life 10,618 10,265 (353) -3.3% 63,724 63,287 (436) -0.7% 0 Prescribing 15,611 15,222 (389) -2.5% 96,356 95,762 (594) -0.6% 0 Other Commissioning 149 155 6 4.0% 2,374 2,374 (0) 0.0% 0

40,300 39,644 (656) -1.6% 245,713 244,738 (975) -0.4% 0

Primary Care Primary Care Co-commissioning 12,147 12,158 11 0.1% 72,830 72,830 0 0.0% 0 Locally Commissioned Primary Care Services 2,650 2,635 (16) -0.6% 18,725 18,725 0 0.0% 0

14,797 14,792 (5) 0.0% 91,555 91,555 0 0.0% 0

Collaborative Working Collaborative Working 89 750 661 743.4% 536 536 (0) 0.0% 0

89 750 661 743.4% 536 536 (0) 0.0% 0

Reserves Reserves 2,934 0 (2,934) -100.0% 24,770 8,202 (16,568) -66.9% (17,604)

TOTAL EXPENDITURE - PROGRAMME COSTS 142,443 139,558 (2,884) -2.0% 864,317 846,734 (17,584) -2.0% (17,604)

(UNDER)/OVER SPEND - Programme Costs 0 (2,884) (2,884) 0 (17,583) (17,584) (17,604)

Year to Date: May Year End Forecast Out-turn Forecast Variance @

Month 1 Variance Variance Change

from prev month*

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

RUNNING COSTS ALLOWANCE Running Cost Funding 2,076 Total Running Cost Expenditure 2,076

2,076 0 0.0% 1,804 (272) -13.1%

12,661 12,661 0 0.0% 0 12,661 12,241 (420) -3.3% (400)

(UNDER)/OVER SPEND - Running Costs 0 (272) (272) 0 (420) (420) (400)

TOTAL Revenue Resource Limit Expenditure TOTAL (A)

144,518 144,518 0 0.0% 144,519 141,363 (3,156) -2.2%

0 (3,156) (3,156)

876,978 876,978 0 0.0% 0 876,978 858,974 (18,004) -2.1% (18,004)

(18,004)0 (18,004) (18,004)

* ↑ = deterioration, ↓ = improvement, = no change.

Memo Table: Forecast In Year Financial Performance Total Allocation 18/19 from the above table Less cumulative surplus carried forward from 2017/18 In Year Allocation

876,978 ‐18,004

858,974

876,978 -18,004 858,974

Expenditure: Forecast Expenditure (Programme Spend plus Running Costs) Forecast under/(over)‐spend against in year allocation

858,974 0

858,974 0

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Appendix A (cont)

RESOURCE LIMIT ALLOCATIONS

Programme Costs

18/19 Opening CCG Recurrent Allocation

18/19 Opening Position - Primary Care Co Commissioning - Delegated

18/19 Opening Position - Recurrent Change - Primary Care Access

18/19 Opening Position Transfer from specialised services 18/19 Opening Position Child Health Information System responsibility to NHSE

18/19 Opening Position HRG 4 deduction made recurrent

18/19 Opening Position IR deduction made recurrent

Opening Position - Market Rent deduction made recurrent

2018-19 Additional Cash Uplift announced January 2018

2017/18 Brought Forward Surplus/Deficit Position at Financial Plan Stage

18/19 Paramedic Allocations

HSCN

Month 2 Programme Costs Resource Limit

Running Costs

Initial Running Costs allocation

Market rents

HSCN

Month 2 Running Cost Resource Limit

CLOSING LIMITS (B)

Revenue

Recurrent Non Rec Total

£'000s £'000s £'000s

761,852 761,852

77,727 77,727

3,496 3,496

423 423 (249) (249)

(2,225) (2,225)

(314) (314)

(580) (580)

5,867 5,867

18,004 18,004 845,997 18,004 864,001

147 147

169 169

0

0

0

0

845,997 18,320 864,317

12,612 12,612

28 28

21 21

12,612 49 12,661

858,609 18,369 876,978

Maximum Cash Drawdown incl Capital

Confirmed Anticipated

£'000s £'000s

Total

£'000s

857,551 857,551

857,551 0 857,551

857,551 0 857,551

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Appendix B


Forecast Variance @

Month 1 Budget Expenditure Budget Forecast

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

PROGRAMME COSTS

Revenue Resource Limit 142,443 142,443 0 0% 864,317 864,317 0 0% 0

EXPENDITURE Acute Hospital Care Planned Care Sheffield Teaching Hospitals NHS FT 23,379 23,640 260 1% 140,912 140,912 0 0% 0 Sheffield Children's NHS FT 2,019 2,085 67 3% 12,113 12,113 0 0% 0 Other NHS Trusts 606 618 13 2% 3,618 3,627 8 0% 0 ISTC & Extended Choice 398 347 (51) -13% 2,499 2,448 (51) -2% 0 Planned Care 26,402 26,691 289 1% 159,143 159,100 (43) 0% 0

Urgent Care Sheffield Teaching Hospitals NHS FT 23,309 23,295 (13) 0% 136,037 136,037 0 0% 0 Sheffield Children's NHS FT 1,984 1,861 (122) -6% 11,902 11,902 0 0% 0 Other NHS Trusts 1,087 1,027 (60) -6% 6,121 6,056 (65) -1% 0 ISTC & Extended Choice 0 0 0 #DIV/0! 0 0 0 #DIV/0! 0 Urgent Care 26,380 26,184 (196) -1% 154,060 153,995 (65) 0% 0

Other Acute Care / Ambulance Services Sheffield Teaching Hospitals NHS FT 11,275 11,175 (100) -1% 67,161 67,161 0 0% 0 Sheffield Children's NHS FT 447 440 (8) -2% 2,683 2,683 (0) 0% 0 Other NHS Trusts 333 385 52 16% 1,860 1,917 57 3% 0 ISTC & Extended Choice 23 23 0 0% 54 54 0 0% 0 Ambulance Services 4,088 4,082 (6) 0% 24,528 24,528 0 0% 0 Other Acute Services 912 887 (25) -3% 5,470 5,400 (70) -1% 0 Other Acute Care 17,077 16,992 (86) -1% 101,756 101,743 (13) 0% 0

Mental Health & Learning Disabilities Sheffield Health and Social Care NHS FT 13,082 13,082 0 0% 78,491 78,491 0 0% 0 Sheffield Children's NHS FT 820 824 5 1% 4,919 4,919 0 0% 0 Local Authority 176 176 0 0% 1,058 1,058 0 0% 0 Other Mental Health Services 386 423 37 10% 2,316 2,395 80 3% 0 Mental Health & Learning Disabilities 14,464 14,506 42 0% 86,783 86,863 80 0% 0

Community Services Planned Care Sheffield Teaching Hospitals NHS FT 8,345 8,429 84 1% 8,185 8,185 0 0% 0 Sheffield Children's NHS FT 666 658 (8) 3,996 3,996 0 0% 0 Local Authority 3,126 3,120 (6) 0% 18,755 18,718 (37) 0% 0 Development Nurses 74 63 (10) -14% 443 416 (27) -6% 0 Other Community Services 180 180 0 0% 1,050 1,050 (0) 0% 0 Planned Community Care 12,389 12,450 60 0% 32,429 32,365 (64) 0% 0

Urgent Care 111 234 234 0 0% 1,407 1,407 0 0% 0 Out of Hours 630 630 0 0% 3,778 3,778 0 0% 0 Urgent Community Care 864 864 0 0% 5,185 5,185 0 0% 0

Intermediate Care & Reablement Sheffield Teaching Hospitals NHS FT 0 0 0 #DIV/0! 41,633 41,633 0 0% 0 Local Authority 303 303 0 0% 1,817 1,817 0 0% 0 Community Equipment 366 386 20 5% 2,196 2,315 119 5% 0 Intermediate Care 669 689 20 3% 45,646 45,765 119 0% 0

Long Term Care and End of Life Continuing Care 7,978 7,753 (225) -3% 47,868 47,544 (324) -1% 0 Continuing Healthcare Assessments 410 435 25 6% 2,477 2,476 (1) 0% 0 Continuing Care - IFRs 10 4 (7) -65% 63 56 (7) -11% 0 Funded Nursing Care 1,304 1,235 (69) -5% 7,825 7,721 (104) -1% 0 St Lukes Hospice 393 393 (0) 0% 2,360 2,360 0 0% 0 Sheffield Teaching Hospitals NHS FT 522 445 (77) -15% 3,131 3,131 0 0% 0 Long Term Care 10,618 10,265 (353) -3% 63,724 63,287 (436) -1% 0

GP Prescribing Prescribing 15,334 14,954 (380) -2% 94,684 94,094 (590) -1% 0 Medicines Management Team 276 268 (8) -3% 1,672 1,668 (4) 0% 0 Prescribing 15,611 15,222 (389) -2% 96,356 95,762 (594) -1% 0

Other Commissioning 149 155 6 4% 2,374 2,374 (0) 0% 0 Other Commissioning 149 155 6 4% 2,374 2,374 (0) 0% 0

Primary Care

Co-Commissioning

Core Contract 8,471 8,471 (0) 0% 50,828 50,828 0 0% 0

Premises 1,690 1,690 (0) 0% 10,139 10,139 0 0% 0 QoF 1,272 1,272 0 0% 7,635 7,635 0 0% 0 Enhanced Services 288 298 10 3% 1,731 1,731 0 0% 0 Primary Care Other 425 426 1 0% 2,498 2,498 0 0% 0 Primary Care Reserve 0 0 0 0 0 0 0

Locally Commissioned Primary Care Services 2,650 2,635 (16) -1% 18,725 18,725 0 0% 0

Primary Care 14,797 14,792 (5) 91,555 91,555 0 0% 0

Year to Date: May Forecast Out-turn

Variance Variance


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Forecast Variance @

Month 1 Budget Expenditure Budget Forecast

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

Year to Date: May Forecast Out-turn

Variance Variance


Collaborative Working

Accountable Care Partnership 10 16 7 67% 59 59 0 0% 0

Integrated Care System 33 676 642 1927% 200 200 0 0% 0

Better Care Fund 33 53 20 62% 200 200 (0) 0% 0

Other Collaborative Working 13 5 (8) -65% 77 77 0 0% 0

Collaborative Working 89 750 661 536 536 (0) 0

Reserves Commissioning Reserves 0 0 0 1,404 1,404 (0) 0% 0 General Contingency Reserve 0 0 0 3,856 4,892 1,036 -35% 0 Primary Care 0 0 0 1,110 1,110 0 0 Unidentified QIPP 0 0 0 (2,390) (2,390) 0 0 0.5% Non Recurrent Reserve 0 0 0 3,186 3,186 0 0% 0 Planned Surplus 2,934 0 (2,934) -100% 17,604 0 (17,604) -100% (17,604) Reserves 2,934 0 (2,934) -100% 24,770 8,202 (16,568) -67% (17,604)

TOTAL EXPENDITURE - PROGRAMME COSTS 142,443 139,558 (2,884) -2% 864,317 846,734 (17,584) -2% (17,604)

(UNDER)/OVER SPEND - Programme Costs 0 (2,884) (2,884) 0 (17,583) (17,584) (17,604)

RUNNING COSTS ALLOWANCE Funding net of £1.5m transfer to commissioning budgets 2,076 2,076 0 0% 12,661 12,661 0 0% 0 EXPENDITURE Accountable Officer 326 296 (30) -9% 2,004 2,001 (2) 0% 0 Commissioning & Performance 504 440 (64) -13% 3,043 3,030 (13) 0% 0 Finance & Facilities 519 523 4 1% 3,167 3,151 (16) 0% 0 Nursing,Quality & Workforce 496 421 (76) -15% 2,996 2,971 (25) -1% 0 Transformation & Delivery 164 124 (40) -24% 989 985 (5) 0% 0 Running Cost Reserve 0 0 0 63 63 0 0% 0 Running Cost Planned surplus 67 0 (67) -100% 400 40 (360) -90% (400) TOTAL EXPENDITURE - RUNNING COSTS 2,076 1,804 (272) -13% 12,661 12,241 (420) -3% 0

(UNDER)/OVER SPEND - Running Costs 0 (272) (272) 0 (420) (420) (400)

TOTAL (UNDER)/OVER SPEND 0 (3,156) (3,156) - 0 (18,004) (18,004) - (18,004)

13

Appendix C


Main Provider Contracts

Year to Date: May 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

23,379

23,309

8,345

6,848

2,562

1,864

630

0

522

23,640

23,295

8,429

6,899

2,579

1,697

630

0

445

260

(13)

84

51

17

(168)

0

0

(77)

1.1%

-0.1%

1.0%

0.7%

0.7%

-9.0%

0.0%

-14.8%

67,459

2,019

1,984

599

820

322

125

67

67,613

2,085

1,861

591

824

327

113

67

154

67

(122)

(8)

5

5

(12)

0

0.2%

3.3%

-6.2%

-1.3%

0.6%

1.5%

-9.8%

0.0%

5,935

13,082

5,869

13,082

(66)

0

-1.1%

0.0%

13,082 13,082 0 0.0%

86,476 86,563 88 0.1%

140,912

136,037

8,185

40,604

15,371

11,186

3,778

41,633

3,131

140,912

136,037

8,185

40,604

15,371

11,186

3,778

41,633

3,131

0

0

0

0

0

0

0

0

0

0.0%

0.0%

0.0%

0.0%

0.0%

0.0%

0.0%

0.0%

0.0%

400,837

12,113

11,902

3,592

4,919

1,934

749

404

400,837

12,113

11,902

3,592

4,919

1,934

749

404

0

0

0

(0)

0

(0)

0

0

0.0%

0.0%

0.0%

0.0%

0.0%

0.0%

0.0%

0.0%

35,613

78,491

35,613

78,491

(0)

0

0.0%

0.0%

78,491 78,491 0 0.0%

514,941 514,941 0 0.0%

14

Appendix D

Sheffield CCG Commissioned Activity and Costs - May 2018

Sheffield Teaching Hospitals NHS FT

‐4.0%

‐3.0%

‐2.0%

‐1.0%

0.0%

1.0%

2.0%

3.0%

4.0%

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

‐25.0%

‐20.0%

‐15.0%

‐10.0%

‐5.0%

0.0%

5.0%

10.0%

15.0%

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


19,447

46,980

9,490

9,142

5,491

23,621

19,802

48,209

9,753

9,311

5,301

23,049

355

1,229

263

169

-190

-572

1.8%

2.6%

2.8%

1.8%

-3.5%

-2.4%

Total

Year to Date Budget

Actual Expenditure Variance

£'000s £'000s £'000s %

3,356

3,833

647

7,818

59

18,695

841

264

3,046

3,428

3,982

744

7,761

59

19,007

654

255

2,931

72

149

97

-57

0

312

-187

-9

-115

2.1%

3.9%

15.0%

-0.7%

0.0%

1.7%

-22.2%

-3.4%

-3.8%

38,559 38,821 262 0.7%

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

Note - This appendix now excludes the MSK contract activity

15

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: May

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

£'000s £'000s £'000s %

1,572 1,187 (384) -24.4% 9,382 8,819 (564) -6.0%

673 836 163 24.2% 24,766 24,020 (745) -3.0% 10,751 11,016 265 2.5% 17,903 17,833 (70) -0.4%

836 295 (541) -64.7% 65,882 64,007 (1,875) -2.8%

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

302 296 (6) -2.0% 7,242 7,326 84 1.2%

366 386 20 5.4% 7,795 7,618 (177) -2.3%

10,751 11,016 265 2.5% 16,661 16,580 (81) -0.5%

0 0 0 0.0% 43,115 43,221 106 0.25%

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:

1,270 892 (378) -29.8% 2,141 1,493 (648) -30.3%

307 451 143 46.6% 16,971 16,402 (568) -3.3%

0 0 0 0.0% 1,242 1,253 11 0.9%

836 295 (541) -64.7% 22,767 20,786 (1,981) -8.7%

Year End Forecast Out-turn

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

£'000s £'000s £'000s %

8,272 8,241 (31) -0.4% 52,712 52,615 (97) -0.2% 3,966 4,329 363 9.2%

139,110 145,822 6,712 4.8% 64,505 64,505 (0) 0.0%

107,416 108,322 906 0.8% 5,678 2,600 (3,078) -54.2%

381,660 386,435 4,775 1.3%

1,811 1,774 (37) -2.0% 43,449 43,449 0 0.0%

2,196 2,315 119 5.4% 46,768 46,508 (261) -0.6% 64,505 64,505 (0) 0.0% 99,964 99,870 (94) -0.1%

0 0 0 0.0% 258,694 258,421 (273) -0.1%

6,462 6,467 6 0.1% 9,263 9,166 (97) -1.0% 1,770 2,014 244 13.8%

92,341 99,314 6,973 7.6% 0 0 0 0.0%

7,452 8,453 1,000 13.4% 5,678 2,600 (3,078) -54.2%

122,966 128,014 5,048 4.1%

0 0 0 0 0 0 0 0

0 0 0 0 0 0 0 0

Forecast Variance @

Month 1

£'000s

0 0 0 0 0 0 0 0

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.

16

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