Finance Report Period up to Jan 2015 - Wandsworth CCG · 2015-03-06 · Finance Report – Period...

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


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


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


Month 10 – Revenue Resource Limit

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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


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


Month 10 Acute Analysis

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• 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


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


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


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)

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Financial Risks

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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




3. SWL Risk Pool

4. QIPP

5. Recommendations

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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

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3. SWL Risk Pool

4. QIPP

5. Recommendations

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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

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3. SWL Risk Pool

4. QIPP

5. Recommendations

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14-15 QIPP Totals at Month 9 by Project

17

Out of

Hospital

Programme

initiatives

.

06/03/2015 Board March 2015


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.

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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

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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


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

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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

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3. SWL Risk Pool

4. QIPP

5. Recommendations

06/03/2015 Board March 2015 23


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

Finance Report Period up to Jan 2015 - Wandsworth CCG · 2015-03-06 · Finance Report – Period...

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