FINANCE REPORT. April 2014 to December 2014

Transcription

1 FINANCE REPORT April 2014 to December 2014 This report summarises the financial position of Rushcliffe CCG for the 9 months ending 31 December The table below summarises the statutory financial duties and targets. Statutory Duties Date Risk Rating Comments Remain within the Revenue Resource Limit and produce the required surplus. * This excludes the adjustment noted in section 2.1 continuing care risk pool. (690)k (surplus) / deficit* (1,395)k (surplus) / deficit* Remain within Running Costs Target 1,980k 3,027k Amber The CCG is forecasting that the planned surplus of 1,395k will be delivered, however, drawdown of reserves continues to achieve this position. The CCG is expected to remain within the allowance limit of 3,027k Cash Balance at end of period 694k 50k The CCG will work within the given Maximum Cash Drawdown (MCD). Better Payments Practice Code Date % Target % Risk Rating Comments By number Non NHS By number NHS 98.6% 95.0% 98.3% 95.0% By value Non NHS 98.0% 95.0% The CCG has achieved all BPPC targets. By value NHS 99.4% 95.0% Amber Red Indicates that the organisation is forecasting to achieve its target by the financial year-end Indicates that there is some cause for concern and the organisation may not achieve its target unless action is taken Indicates that the organisation will not achieve its target by the financial year-end without immediate intervention 1

2 1. date financial position 1.1. The Revenue Resource Limit has changed in month. Non-recurrent funding of 76k has been received in relation to 2013/14 quality premium awards. Recurrent Non Recurrent TOTAL Opening Revenue Resource Limit as per Financial Plan 128,108 2, ,535 Month 9 Adjustments Month 9 Revenue Resource Limit 128,108 2, , Surplus position: date planned (surplus) / deficit: (690)k date actual (surplus) / deficit: (690)k 1.3. To deliver the planned surplus the CCG continues to call down risk reserves. For the year to date 1,454k of reserves have been drawn down. This is an additional 429k drawn down from reserves compared to the previous month. The year to date level of usage continues to give concern and puts the CCG at risk of not achieving the planned surplus. 2. Key Variances, Risks and Potential Gains 2.1. As indicated in paragraph 1.3 the CCG did achieve the overall required surplus for the period with the use of reserves. The main factors influencing the CCGs performance are: NUH Current overspend of 729k (1.9%) over plan. As in previous months, there are pressures on non-elective and elective admissions, with outpatient attendances also showing adverse variance. Nottingham Treatment Centre (Circle) is showing a 806k overspend (12.5%) against plan. Key over performing areas are first and follow up attendance outpatient procedures (48% of the overspend), mainly gynaecology and 2

3 dermatology and drugs expenditure (19% of the overspend), in particular cytokine inhibiter drugs. Continuing Care & Funded Nursing Care (FNC) overspend of 397k (6.2%). The overspend has increased by 130k. Fast track cases recorded have increased, being the main reason for the higher overspend. There exists a national continuing care risk pool, and all CCGs have been allocated a rebate in December. The rebate is 302k for this CCG. The CCG has been asked to show this amount in the forecast outturn, increasing the actual surplus delivery accordingly. The planned surplus remains at 1%, with the actual surplus having to increase. The rebate will therefore not produce a financial benefit for the CCG. The CCGs forecasts in Appendix One have been adjusted accordingly. County Health Partnerships (CHP) The CCG is due a rebate of 35k for the year, due to proposed initiatives slipping in terms of implementation. A proportionate value for the period equalling 26k is included in the current position. The services that have slipped relates to the alcohol worker initiative. Prescribing - Primary Care prescribing is showing an underspend of 201k. There is an additional risk for prescribing going forward due to the replacement of Warfarin with Dabigatran and Rivaroxaban. Estates risk still remains around estates charging, with final charging schedules from NHS PS and CHP property companies still awaited. 3. QIPP 3.1. Current QIPP is forecast to be in line with planned levels. The table and graph below show a summary by scheme headings, the delivery to date and the forecast against plan. 3

4 Apr-14 May-14 Jun-14 Jul-14 Aug-14 Sep-14 Oct-14 Nov-14 Dec-14 Jan-15 Feb-15 Mar-15 Workstream Planned Savings Actual/ Variance YTD Outturn Date Date Financial RAG Rating on Outturn Continuing Care (240) (180) R Community Services (100) (57) R Contracting 1,503 1, (564) (472) A Elective Care (703) (547) R Mental Health G Non Elective Care 1, , (142) (64) A OOH G Other (56) (41) R Prescribing G Reserves (863) (567) ,605 1,193 R Running Costs G Total 3,779 2,837 3,779 2, G 4,000,000 3,500,000 3,000,000 2,500,000 Rushcliffe CCG QIPP Performance ,000,000 1,500,000 1,000, ,000 Delivered Planned Actual/ The table and graph above show that the CCG is on track to deliver the QIPP target of 3,779. The forecast QIPP position is supported by 626k of non-recurrent reserves. 4

5 3.3. Savings on mental health are mainly due to the success of a scheme surrounding MHSOP Beds being moved from the Ashfield site and Dementia Intensive Care Unit (DICU) beds being set up Work is being undertaken on underperforming areas to monitor the schemes in place, to review their viability and to enhance the savings that can be made in these areas. 4. Running Costs 4.1. The CCG has spent 1,980k on running costs for the period April 2014 to December 2014, against a budget of 2,045k for the period The CCG running costs are expected to be within the 3,027k running cost allowance for the full year. 5. Statement of Financial Position and Cash 5.1. The Statement of Financial Position can be found in Appendix The movements within the Statement of Financial Position are in line with the planned movement in working balances For December 2014 the CCG drew down cash of 13,650k against a plan of 8,598k. This is 5,052k over the plan for the month, 5.4. For the period April 2014 to December ,100k has been drawn down against a plan of 84,490k. This is 7,390k below the plan for the period. This is due to the CCG receiving income from the other CCGs for the Continuing Care spend, but having only paid months 1-7 to the Council for payment of Continuing Care The Maximum Cash Drawdown has recently been issued. This has been set based on the Resource Limit as at Month 7, which has been adjusted for the planned surplus and any non-cash items, e.g. depreciation. The CCG will have the opportunity to update the MCD in January, to allow for any additional resources The new Cash Management regime requires the CCG to have a balance at the end of the month, of not more than 1.25% of that months drawdown. This equates to 171k for December. The Cash balance at the bank at the end of December is 694k, which exceeds that limit due to the timing of payments. 5

6 16000 Cash Drawdown Against Plan () Cash Draw Down Plan Cumulative Cash Drawdown Against Plan () Cash Draw Down Plan 6. Better Payments Practice Code 6.1. NHS Organisations have a target of paying 95% of invoices within 30 days. The CCG is currently on track to achieve the 95% BPPC targets. 7. Non-Recurrent Funds 7.1. The NHS planning guidance Everyone Counts requires CCGs to spend 2.5% of the resource allocation non-recurrently. For the CCG this totals 3,120k. Given the pressure on the overall CCG financial position the review of all non-recurrent expenditure continues and it is recommended that any uncommitted discretionary expenditure remains paused. 6

7 8. Key Messages 8.1. The CCG has kept expenditure within the Revenue Resource Limit for the period April 2014 to December The current rate of CCG expenditure is placing the CCG at financial risk, and will need to be reduced The CCG is recommended to cease any uncommitted discretionary expenditure, including investments that do not deliver a satisfactory payback The CCG is forecasting to deliver the annual QIPP plan by year end The CCG is on target to be within the running cost allowance 8.6. Whilst forecasting to achieve the required surplus, there are still a number of risks that the CCG faces in delivering this financial requirement. These include: Increasing activity pressures at NUHT, Circle and other providers. Continuing Care pressures Delivery of the QIPP target for the year 9. Recommendations 9.1. The CCG Governing Body is asked to: NOTE the financial position of the CCG for April 2014 to December 2014 and the risks faced in delivering 2014/15 planned surplus. APPROVE the continued restriction on using non recurrent funds. APPROVE the Finance Report for April 2014 to December Jonathan Bemrose Chief Finance Officer 13 January