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20082009 FINANCE AND PERFORMANCE REPORT - Month 7 .ppt

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20082009 FINANCE AND PERFORMANCE REPORT - Month 7 .ppt Powered By Docstoc
					  2008/2009
  FINANCE AND PERFORMANCE
  REPORT - Month 9
  BOARD – 29th January 2009



Jonathan Wise,
Director of Finance & Performance   The Strategic Health Authority for London
Contents
  Part 1 – Finance report (slides 3-19)
  Part 2 – Investment report (slides 20-22)
  Part 3 – Acute commissioning and PBC report
           (slides 23-29)
  Part 4 – Performance report (slides 30-49)

  Finance Appendices: (slides 50-62)
  1. Summary Operating Cost Statement and
     variances by budget heading
  2. Balance sheet
  3. Capital
  4. Cash flow
  5. Debtors & PSPP
  6. Overview of Allocation 08-09
                                                2
PART 1: – FINANCE REPORT

             Financial position - Summary

       Statutory duties
       – Forecast underspend against revenue resource limit
       – Achievement of capital resource limit
       – Forecast underspend against cash limit

      Achievement of public sector payment policy

      Budget holder responsibilities / training

      Achievement of Operating plan surplus
       within SHA defined tolerances

      Improvement in ALE assessment

      Provider Arm full cost recovery                        3
Overview of Budget Position at Month 9
Initial budgets agreed by Board at March 08 meeting updated

  £000s                       Initial       Changes    Month 8    Changes    Month 9
  Issued budgets                418,054        4,025   422,079      2,593    424,672
  Contingency                      4,200     (1,737)     2,463        (93)     2,370
  Investment Programme             9,500     (2,102)     7,398     (1,251)     6,147
  Investment Slippage                   -       736        736           -       736
  Reserves                              -    (1,099)    (1,099)        65     (1,034)
  Total                         431,754        (176)   431,578      1,314    432,892
  Surplus for Investment          12,446           -    12,446           -    12,446
  Total                         444,200        (176)   444,024      1,314    445,338


  • Access to Contingency as agreed by CE

  • Investment Programme as agreed by Investment Panel

  • Reserves adjustments reflect new allocations

  • Negative £1m reserves largely as a result of unplanned 06/07 adjustment
  actioned by DH/NHS London
                                                                                        4
SUMMARY OF YEAR TO DATE VARIANCES to MONTH 9


£000s                                                           Current     Movement
+ve = u/spend
                                   M6        M7        M8       Month 9     M8 to M9
–ve = o/spend

Acute Commissioning               (3,427)   (4,440)   (5,576)     (5,799)       (223)
Joint Working                      1,081     1,432     1,719       1,884         165
Primary Care                       1,115     2,100     2,938       2,979          41
PCT Management                       148       (44)      (47)         59         106
Provider Services                  (572)     (498)     (518)        (460)         58
Sub Total                         (1,655)   (1,450)   (1,484)     (1,337)        147
Programmes / Reserves / Surplus   11,196    11,061    11,786      12,507         721
Total Actual                       9,541     9,611    10,302      11,170         868
Plan Comparison                   10,001    10,961    11,261      11,559         298
Under / (Over) Plan                (460)    (1,350)    (959)        (389)        570


• At month 9 the adverse variance against plan has fallen to £0.39m


                                                                                        5
Acute Commissioning (1)
Variances
Based on month 8 data (where available) and extrapolated with specific assumptions to 9 months.
Net of assumed gain from challenges.
North West London Hospitals £2,376k over

   PBR non-elective including short stay and excess bed days £1,171k over
   PBR first outpatient appointments £593k over and outpatient follow ups £782k over
   A&E over by £664k
   Offset by underspend on critical care.

Imperial Hospitals Trust £1,707k over

 Electives and Day cases over by £663k
 OP first attendances over by £273k, follow ups over by £560k
 Renal (all modes) £363k over

Royal National Orthopaedic Hospital £908k over

 Non-PbR Overspends - Critical care, excluded drugs, electives, non-electives.

UCLH £567k over

• PBR day case and electives, non PBR day case and electives.
Great Ormond Street Hospital £254k over

Royal Free Hospital £213k over

•Trust report data problems and project over spend based on 1/4/08 - 13/6/08 period only
                                                                                                  6
Acute Commissioning (2)
Actions

• Continue to review in detail in-patient and out-patient overspend at NWL,
Imperial and UCLH

• Develop further analysis of non PBR activity/cost particularly NWLH & Imperial

• Agree outstanding Q1 and Q2 challenges around multiple attendances and
follow up ratios (NWLH /Imperial)

• PBC producing recovery plan




                                                                                   7
Joint Commissioning
Variances

Long Term Care – £749k under due to lower take-up of registered free nursing
care.

Mental Health - £725k under due to low cost per case activity. Current information
on consortia indicates an under spend.

Children and Families – £197k under due to lower cost per case activity. Current
information on consortia indicates an underspend.

Substance Misuse - £90k under due to vacant posts and training.

Learning Disabilities – £95k under due to lower cost per case activity.

Actions

Maintain close contact with joint commissioning managers to ensure that any
possible change in the variances is communicated speedily and accurately.


                                                                                     8
Primary & Community Commissioning
Variances

Medical Contracts £1,246k under
  Under spends due to list validation savings in advance of budget profile
  Slippage on enhanced services

Dental Contracts £179k under
  Dental development funding received and schemes not yet commenced
  Additional revenue spend to cover £161k dental premises improvements.

Pharmacy Contracts £163k over
  Pharmacy practice payment prices increased from October 08

Prescribing £1,741k under
  Under spend for April – December based on October 08 PPA actual data.

Actions

  Continue to implement enhanced schemes
  Implement dental development schemes



                                                                              9
PCT Provider Services

Variances
Income
    NWL Hospitals for use of Willesden - £276k shortfall
    Catering - £69k shortfall
    Workforce Confederation – £61k shortfall
    Reduction in Harrow PCT SLA – £36k
Expenditure
    Costs associated with LD outreach staff £60k over
    LD bank and agency staff at Peel Road £121k over
    Utilities £152k over
    Interim management £294k over
    Community Nursing – bank/agency £77k over
    Vacancies held in all areas £150k under
Actions
  Recovery actions on income and cost reductions continuing
  Maintain tighter threshold for use of agency/bank staff
  Review potential to meet one-off costs with internal budget management and
   reserves review


                                                                                10
PCT Management Costs

Variances

Total underspend of £59k is due to vacancies plus slippage in recruiting to
new posts funded from 08-09 investment funds.

Actions

Confirm with Directors forecast outturn in context of work plans January -
March




                                                                              11
Balance Sheet, Cash and Capital

Balance Sheet

  2008/09 indexation of £2.181m applied to fixed assets and added to
   revaluation reserve on 1 April 2008 per DH guidance
  Debtors down by £3.7m to date mainly relating to Sure Start funding
   received

Cash

  Drawings are 4.5% below plan mainly due to investment slippage and
   additional receipts
  Achievement of revised planned under drawing of £27m requires further
   reduction of creditors by March 09
  Cash at bank of £418k

Capital

  Capital spend to December of £702k (26.2% of total budget)
                                                                           12
Public Sector Payment Policy (PSPP)

Issues

• During the 2007-08 external audit of the year end accounts, it was
discovered that the PCT’s method of recording whether invoices had been
paid within the 30 day requirement, laid down by the above policy, was
flawed.

• The PCT is now recording this information correctly and is achieving the
95% target in value for non- NHS and NHS bills paid but only achieving the
required standard for the number of non-NHS bills paid.

• An action plan has been developed to improve performance and agreed by
EMT

ACTIONS

• Implement the action plan

                                                                             13
Forecast Outturn 08-09 – Objectives & Methodology
Objectives

 Provide an updated assessment on a monthly basis of the forecast outturn
 for 08/09 from the Operating Plan/budgets

 Identify actions required as a result of the analysis

Methodology

 Assessed the best/mid/worst case for each budget area, taking into account
 all known factors, including where relevant:
 - trends
 - seasonality

 Explicitly set out key assumptions / variables / constraints

 Incorporation of best practice advice from NHS London

 Discussed and agreed the key factors influencing the forecast with
 Directors and EMT
                                                                             14
Forecast Outturn 08-09 Context - NHS London
Control Ranges
 The PCT planned to achieve a surplus of £12,446k in 08-09. NHS London has
  now set a range for the level of surplus it expects the PCT to achieve at year
  end:

  Lower limit £11,391k
  Upper limit £12,683k

 The ranges have been derived from the DH targets for the NHS in London for
  financial performance and will be used in determining PCT performance for risk
  rating purposes.

 The control range for each organisation may be subject to change during the
year if there is a case for it. This will be in agreement with the SHA and will be on
an ‘exception’ basis. There are no guarantees that requests will be agreed, and
organisations must therefore ensure that they take robust corrective action where
required to achieve an outturn within their allocated range.

 The SHA is unable to guarantee RAB carry forward into 2009/10 in excess of the
upper limit of PCT control ranges.

                                                                                        15
SUMMARY FORECAST OUTTURN
£000s                                         Month 7       Month 8    Month 9    Movement
                                                                                   M8 to M9
Acute Commissioning                             (7,734)      (7,774)    (8,027)        (253)
Joint Commissioning                               2,458        2,482      2,395         (87)
Primary Care                                      2,743        3,073      3,323         250
PCT Management                                        340       287        310           23
Provider Services                               (1,151)        (963)      (677)         286
Sub Total                                       (3,344)      (2,895)    (2,676)         219
Programmes / Reserves / Surplus                 14,745        14,517     14,721         204
Total Actual                                    11,401        11,622     12,045         423

Plan Comparison                                 12,446        12,446     12,446            -
Under / (Over) Plan                             (1,045)        (824)      (401)         423

• Provider Services improvement due to budget savings

• Primary Care improvement due to continued prescribing underspend and slippage
  on enhanced services

• Overall forecast remains within SHA control total
                                                                                               16
Key Variables / Risks Affecting Forecast Outturn
 Acute commissioning assumes a 40% (20% Imperial) success rate for
  challenges not yet accepted by Trusts.

 Joint commissioning shows little cost per case activity to date.The general
  assumption is spend will continue at current rate across all care groups.

• Primary Care GP – prescribing based on M7 data, and forecast outturn provided
 by PPA. Non achievement of PBC incentive scheme.

 Provider – continued implementation of recovery plan.

• Headquarters assumes current vacancies profiled forward with the
 current level of interim cover.

 PCT will fully utilise the remaining contingency (£2.4m) – largest element
  assumed Market Forces Factor (MFF) for acute over-performance pressure to be
  confirmed in Feb 09.

 Balance sheet – benefits assumed to offset pressures


                                                                                  17
M9 Summary & Outturn Forecast to Plan (1)
£000s                                             Year to Date             Forecast
+ve = u/spend
                                                     Variance              Variance
–ve = o/spend

Acute Commissioning                                     (5,799)               (8,027)
Joint Working                                            1,884                 2,395
Primary Care                                             2,979                 3,323
PCT Management                                             (47)                  310
Provider Services                                        (460)                 (677)
Sub Total                                               (1,337)               (2,676)
Programmes / Reserves / Surplus                         12,507                14,721
Total Actual                                            11,170                12,045
Plan Comparison                                         11,559                12,446
Under / (Over) Plan                                      (389)                 (401)

• PCT management FOT assumes current levels of vacancies and use of interim support
remains static for rest of year

• Programme / reserves / surplus includes offset against £6m of NWLH overperformance
(estimated at £3.2m)
                                                                                        18
 Summary M9 & Forecast Outturn Position (2)

 £000’s                                     Year to Date                     Forecast Outturn

                                  Plan         Actual      Variance   Plan        Actual        Variance


 Revenue Resource Limit            11,559       11,170        (389)   12,445      12,045           (401)

 Capital Resource Limit               998           701        297     2,096       1,600            496

 Cash Limit                        18,944       33,336      14,392    22,351      27,000          4,649


• The revenue resource variance to plan at M9 is due to pressures in acute commissioning and the
provider arm offset by favourable variances in primary care and management / HQ.

• Capital plan represents the latest notified resource limit from the SHA.Some schemes are expected
to slip, resulting in an underspend of £500k (approx).

• Cash plan reflects planned underspends and prior year revenue deficit repayments. The cash
underspend to date is ahead of plan due to the phasing of new investments and the deferral of cash
payments for over-performance until reconciliation dates.The PCT has generated excess cash this
year by reducing its debtors by £3.6m – this cash will not be need during 2008-09.



                                                                                                           19
PART 2: – INVESTMENT REPORT

Phase 2 Investment
 A review of the Phase 2 Investment Programme of £9.5m has been undertaken
  and potential slippage of £6m has been identified.

 Slippage is offset by a non-recurrent performance/transition fund of up to £6m
  with NW London Hospitals which would:

    Cover forecast over-performance of PCT activity in NWLH
    Generate momentum for a sustainable strategic solution for the Trust
    Incentivise the Trust to exceed key targets
    Eliminate uncertainty about end of year outturn at the Trust
    Help ensure the delivery of the PCT’s plan
    Be consistent with PbR, the NHS Performance Regime and WCC ‘system
    management’

 Formal agreement at November Board subject to further work and report back
  on the terms and conditions.


                                                                                   20
Investment Programme – Phase 2 Schemes
                                                              08/09          Recurrent /       FYE
                                                              £000s         Non-Recurrent     £000s
 Approved at May Board
 HPV Immunisation                                                      88         R                   273
 PBC Exec                                                             100        N/R
 Primary Care Strategy                                                 65        N/R
 HCAI                                                                  57        N/R
 Health Visiting                                                      145      R & N/R                117
 Programme Costs                                                      216        N/R

 Approved at July Board
 World Class Commissioning                                            647        N/R
 Childhood Obesity                                                    112      R & N/R                   94
 BAME Management Development                                           17       TBC

 Agreed by Investment Panel (Aug / Sept)
 HPV Extension                                                        138       N/R         inc. above
 Support for Children & Families                                       64       N/R
 Nurse staffing levels Willesden (approved September Board)           153        R                    614
 Phlebotomy                                                            44       N/R
 MMR catch up / measles awareness                                      97       N/R
 Project costs early intervention                                      37       N/R
 PBC Exec                                                              16       N/R
 Primary Care Strategy                                                120       N/R


                                                                                                          21
Investment Programme – Phase 2 Schemes
                                               08/09           Recurrent /     FYE
                                               £000s          Non-Recurrent   £000s
 Agreed by Investment Panel (Oct / Nov)
 GP IM&T                                               113          R                 165
 Immunisation                                          111       R & N/R               76
 Intermediate Care (approved November Board)           413       R & N/R              226
 World Class Commissioning                               34        N/R
 PBC Cluster administration                              29        N/R
 Smoking – tobacco control                              -           R                 44
 09-10 operating plan                                    76        N/R
 Provider services management information                32        N/R
 GP led Health Centre                                  104         N/R
 HCAI                                                   -           R                 297

 Investment Panel (December)
 GP led Healthcentre                                    99         N/R
 Breast Screening                                       37       R & N/R              22
 Chlamydia                                              27          R                 35
 QOF                                                    33         N/R
 Provider 18 weeks                                     118       R & N/R              97
 Immunisation                                           11         N/R

 Sub-total                                         3,353                          2,060

 NWLH Performance / Transition Fund                6,000
 (approved November Board)

 Balance available                                     147

 Plan                                              9,500

                                                                                            22
PART 3: – ACUTE COMMISSIONING & PBC

                         Variance Summary by Provider

                                                    £000s          %

    North West London                               (2,376)        (3.9%)
    Imperial College                                (1,707)       (5.0%)
    Royal Free                                        (214)       (3.1%)
    UCLH                                              (567)      (13.8%)
    RNOH                                              (907)      (80.5%)
    Other                                               49
    Acute total                                     (5,820)       (4.7%)


    • based on month 8 data from 16/22 providers and months 3,5,6 and 7
    data from 6/22 providers.

    • extrapolated to 9 months on a linear basis and adjusted for specific
    assumptions at some Trusts.

    • net of £1.188m assumed successful challenges on month 8 data.


                                                                             23
                     Validation and Challenges

The PCT has identified acute contract data validation challenges with Trusts for
month 9 (cumulative) of:
                                                                    £k
Patients incorrectly attributed to Brent PCT                       134
OP Follow-up ratio                                               1,354
OP multiple First Attendances in same specialty                    324
OP multiple First Attendances                                      397
Cancelled Operations (S22) charged                                 167
N12 ( Obstetrics non-delivery day episodes)                        139
Other                                                             748

Total                                                            3,263

• The month 9 position assumes that 40% of the above challenges pro rata to
month 8 are successful.




                                                                                   24
NORTH WEST LONDON HOSPITALS




                              25
                                        IMPERIAL HEALTHCARE
non PBR other                                                                     Imperial M08 Variance ex Challenges
                                                non PBR Exc Drug
                            non PBR DA
                                                                                                      non PBR CC-ITU
                                                                              non PBR RDA
                                   non PBR OP
                                                 non PBR Inpatient
                                                High Cost (A&E)
                                                                                                                            Standard (A&E)
POD




                    Minors (A&E)
                                           GUM Follow up attends
                                                   GUM First attends
                                                                                          Outpatient Procedures
            Follow Up attends
                                         First Attends
                                                                            NE, non Emergency
                                                                            Emergency
                       Elective
                       Daycase


-600,000             -400,000              -200,000                    0                  200,000                 400,000                600,000
                                                                           Variance £££


                                                                                                                                             26
Practice Based Commissioning
                           Budget and Reporting Process

                                                                         £m
Annual budget for Acute SLAs                                             163.1
less: A&E/GUM                                                            (10.3)
      Non PbR                                                            (54.7)
PbR Budget assigned to PBC                                                98.1

• 70/71 practices have signed up to budgets

• Cluster plans now agreed

• Month 8 budget reports and validation queries issued to Clusters and Practices

• PCT is working with Dr Foster to develop PBC budget reporting system

• Detail available to clusters from Dr. Foster and from ad-hoc reports




                                                                                   27
                                PBC Position by Cluster
                               Month 8 Budget Summary

£000s                                                Budget         Actual      Variance      %

Harness                                               12,968        14,529        (1,561)         12

Independent                                            2,482         2,682          (200)          8

Kilburn                                               15,071        16,434        (1,363)          9

Kingsbury                                             11,713        12,839        (1,126)         10

Unattributed                                           1,433         2,736        (1,303)         91

Wembley                                               10,449        11,854        (1,405)         13

Willesden                                              9,002         9,677          (676)          8

Sub total                                             63,118        70,751        (7,633)         12

High Cost Risk Pool                                    2,289         1,262         1,028
Total                                                 65,407        72,013        (6,605)         10



• Above based on month 8 SUS data from 16 out of 22 providers and is prior to the impact of
challenges.

• PBC actual is higher than total PCT position as it is based on SUS data and is for PbR spend
which is over performing at a higher rate than non-PbR.
                                                                                                       28
PBC Variance

The variance is attributable to a combination of five factors:

a) A potential offset for out-patient challenges is not yet reflected;

b) Any non-achievement of demand management plans assumed in plan;

c) Potential under commissioning as activity based on projection of Apr-Sep 07;
d) Increase in activity levels in 08-09;

e) Unplanned coding/counting and clinical practice changes in 08-09.
Actions

Develop the PBC activity recovery plan between PCT and PBC leads for report
back to January’09 Board meeting.




                                                                                  29
Performance Report 2008-09
 The 2008-09 Performance report is monitoring 2 main areas as set out in the Health Care Commission Performance Management framework: The
  Health Care Commission will assess performance in relation to the existing commitments and national priorities outlined in the Operating Framework
  for the NHS in England 2008-09.
 In addition to National Priorities and Existing Commitments, the PCT will also monitor:
  – London Priorities - national commitments but for the London SHA area.
  – Local Priorities- priorities and any corresponding targets agreed locally.
  – Additional PCT Commitments- These include some commitments which are in the PCT’s Operating Plan but are not measured by the Health Care
    Commission as well as prior commitments which the PCT failed to achieve in 2007-08. Although, these are also no longer measured by the
    Healthcare Commission and do not contribute to the performance rating for the PCT in 2008-09, the PCT will continue to monitor these locally.
 Indicators which are shaded have to meet minimum service standards as defined by the SHA.
 The RAG status for each indicator is based on the thresholds the SHA has provided.
 Risk rating for each indicator is based on an assessment made by the Director of the level of risk to achieving the year-end target.
 Areas currently identified as RED are:
        % of people who spend at least 90% of their time on a stroke unit
        18 weeks RTT Data completeness for non admitted pathways
        CVD Mortality rate
        4 week smoking quitters
        Immunisations
        Access to Maternity Services
        Access to Dental Services
        Category A ambulance response rate within 8 mins
        Early intervention in Psychosis
        Breast screening for women aged 53-70 yrs
        BMI status recording among GP population
        Choose and Book

 Most of the monthly and quarterly indicators have data up to December 08 and Q2 08-09. Indicators and narrative in brown font have been
  updated with most up to date data and comments.
 Data quality for indicators has been applied as below:
     High – Data for the indicator has been submitted in a regular and timely manner and assurance of the quality of data has been provided.
     Medium- Only one of the above applies to the indicator.
     Low- None of the above applies to the indicator.

 This report has also introduced a time series/trend analysis for:
     4 week smoking quitters
     MRSA
                                                                                                                                                   30
 Overall PCT Rating
• Current rating for the PCT is as below:                                                      SHA Q2 Provisional rating:

      National Priorities        Weak                                                                      Weak
      Existing Commitments       Partly Met                                                                Partly Met

      Overall rating             Fair                                                                      Fair

 The methodology used above follows the SHA’s rating process: Each indicator is scored Green (Achieved), Amber (Underacheived), Red (Failed)
  and scores 3/2/0 points accordingly.
 For National Priorities, a maximum of 69 points are available. If the PCT scores 90% and above of available points, it will be rated ‘Excellent’ in this
  area. If the PCT scores 80% and above of available points, it will be rated ‘Good’ in National Priorities, and 71% and above of available points will be
  rated as ’Fair’. Anything below this will be rated as ‘Weak’.
 For Existing Commitments, a maximum of 42 points are available. If the PCT scores 38 points and over, the PCT will have ‘Fully Met’ this area. If the
  PCT scores 34 points and over, then it would have ‘Almost Met’ the Existing Commitments, and 30 points and over will be rated as ‘Partly Met’.
  Anything below this will be ‘Not Met’.
 The Overall PCT score will be determined as follows:

             Quality of Services Rating        Existing Commitments                National Priorities

             Excellent                         Fully Met                           Excellent

             Good                              Fully Met or Almost Met             Excellent or Good

             Fair                              Partly Met                          Any rating permissible

             Weak                              Weak                                Any rating permissible

 NB: The HCC quality of services rating also includes meeting core standards but these are not monitored in this paper .

 Please note:

      2007-08 data was used for Patient experience of Primary care indicators and NHS staff survey:Job Satisfaction indicator.
      The denominator for Access to Maternity Services has changed.
      The SHA have scored the PCT as having ‘Underacheived’ the immunisation indicator as performance was measured against 2007-08 data
        rather than Q1 or Q2 08-09 data. However, the PCT has measured itself against Q2 08-09 data.
      The breastscreening rating is a preliminary assessment of the PCT’s performance for 2007-08 based on eligible population at present.




                                                                                                                                                         31
Performance Report- Year end position as at March 08 and Current Status

                                                                                                                                  Risk
                                                                                                                                 rating
                                                                                                                     Actual/       for               2009   2010
                                                                        March 08    Annual   Reporting               Current      Marc      Data      -10    -11
  National Priorities                                           Owner    Status      Plan     period       Plan      Status       h 09     quality   Plan   Plan

                                                                          New
  No of C-Difficile infections (Brent registered patients)       PH     indicator    180     YTD Nov 08    120          71                 Medium    171    167

  18 week wait milestone -% of admitted patients should have
  been seen in 18 weeks                                          SC                  90%       Nov-08      89%        93.4%                Medium    90%    90%

  18 week wait milestone -% of non-admitted patients should
  have their RTT clock stopped within 18 weeks                   SC                  95%       Nov-08      94%        97.6%                Medium    95%    95%

  % of direct access audiology pathways whose RTT clock                   New
  stopped during the month who waited 18 weeks or less           SC     indicator    95%       Nov-08      88%        98.6%                Medium    95%    95%

                                                                                     90-                   90-
  18 week Data Quality- Admitted data completeness               SC                 110%       Oct-08     110%         97%                 Medium    N/A    N/A

                                                                                     90-                   90-
  18 week Data Quality- Non Admitted data completeness           SC                 100%       Oct-08     100%       89.92%                Medium    N/A    N/A

                                                                                                          Annual Survey- results not yet
  Satisfaction with telephone access to GP practice (%)         PCCS                 83%      2008-09                known                  N/A      85%    87%

  Ability to see GP within 48 hours if wanted (%)                                                         Annual Survey- results not yet
                                                                PCCS                 83%      2008-09                known                  N/A      85%    89%

  Ability to book GP consultation 3+ days ahead if wanted (%)                                             Annual Survey- results not yet
                                                                PCCS                 73%      2008-09                known                  N/A      75%    77%

  Ability to see a specific GP if wanted (%)                                                              Annual Survey- results not yet
                                                                PCCS                 84%      2008-09                known                  N/A      86%    88%

  Satisfaction with GP practice opening times (%)                                                         Annual Survey- results not yet
                                                                PCCS                 79%      2008-09                known                  N/A      81%    83%

  Average of five elements of access to primary care                                                      Annual Survey- results not yet
                                                                PCCS                 80%      2008-09                known                  N/A      82%    85%




                                                                                                                                                            32
Performance Report- Year end position as at March 08 and Current Status(2)
                                                                                                                      Risk
                                                                                                                     rating
                                                                                                                       for              2009-   2010-
                                                                     March 08    Annual   Reportin                   March     Data      10      11
National Priorities                                          Owner    Status      Plan    g period   Plan   Actual     09     quality   Plan    Plan

% of patients with suspected cancer waiting 2 weeks or                                    YTD Nov
less from GP urgent referral to 1st OP appointment            SC                 100%       08       100%   100%              Medium    100%    100%

% of patients with cancer treated within one month from
diagnosis (decision to treat) (*Excluding new cancer                                      YTD Nov
strategy commitment)                                          SC                 100%       08       100%   100%              Medium    100%    100%

% of patients with cancer waiting less than two months
between GP urgent referral and treatment (*Excluding                                      YTD Nov
new cancer strategy commitment)                               SC                 100%       08       100%   99.4%             Medium    100%    100%

% of people who spend at least 90% of their time on a                  New
stroke unit                                                   SC     indicator    65%     Q2 08-09   60%     52%               Low      70%     80%

% of people who have a TIA who are scanned and                         New
treated within 24 hours                                       SC     indicator    25%     Q2 08-09   33%     36%               Low      45%     60%

All age all causes mortality per 100,000 of the population
(males)                                                                New
                                                              PH     indicator    615     2004-06    615     676              Medium    589     564

All age all causes mortality per 100,000 of the population
(females)                                                              New
                                                              PH     indicator    401     2004-06    401     436              Medium    387     374

CVD mortality rate (per 100,000 of population aged
under 75 years)                                                                   82.8
                                                              PH                          2005-07     84     89               Medium    81.7    80.7

Cancer mortality rate (per 100,000 of population aged
under 75 years)                                                                  96.16                                                  94.07   91.97
                                                              PH                          2005-07    101     98               Medium

                                                                                          YTD Nov
                                                                                                                                        2,022   2,360
4 week smoking quitters with NHS services                     PH                  1756      08       720     276              Medium




                                                                                                                                                   33
Performance Report- Year end position as at March 08 and Current Status (3)
                                                                                                                             Risk
                                                                                                                            rating
                                                                                                                              for              2009-   2010-
                                                                          March 08    Annual   Reporting                    March     Data      10      11
 National Priorities                                              Owner    Status      Plan     period     Plan    Actual     09     quality   Plan    Plan

 % of women who have seen a midwife or a maternity
 healthcare professional, for health and social care assessment
 of needs, risks and choices by 12 completed weeks of                       New
 pregnancy                                                         SC     indicator    50%     Q2 08-09    50%      31%               Low      70%     90%

 Sexual health - Teenage conception rates                          SC                  34.8      2006       40       40              Medium    23.1    19.6

 Percentage of children in Year R with height and weight
 recorded who are obese.                                          PCCS      N/A       10.9%     2007-08    11.1%   10.70%            Medium    11.0%   11.1%

 Percentage of children in Year 6 with height and weight
 recorded who are obese.                                          PCCS      N/A       22.1%     2007-08    23.3%   22.50%            Medium    22.1%   22.0%

 Immunisation rate for children aged 1 who have ben
 immunised for Diphtheria, Tetanus, Polio, Pertussis,
 Haemophilus influenza type b (Hib) - (DTaP/IPV/Hib)              PCCS                 75%     Q2 08-09    75%     77.7%              Low      85%     90%

 Immunisation rate for children aged 2 who have been
                                                                                       50%                 50%
 immunised for Pneumococcal infection (PCV) - (PCV)               PCCS                         Q2 08-09            35.8%              Low      75%     90%

 Immunisation rate for children aged 2 who have been
 immunised for Haemophilus influenza type b (Hib), meningitis                          75%                 75%
 C (MenC) - (Hib/MenC)                                            PCCS                         Q2 08-09            52.9%              Low      85%     90%

 Immunisation rate for children aged 2 who have been
                                                                                       75%                 75%
 immunised for measles, mumps and rubella (MMR) - (MMR)           PCCS                         Q2 08-09            63.8%              Low      85%     90%

 Immunisation rate for children aged 5 who have been
 immunised for Diphtheria, Tetanus, Polio, Pertussis                                   85%                 85%
 (DTaP/IPV) (booster doses)                                       PCCS                         Q2 08-09            41.7%              Low      87%     90%

 Immunisation rate for children aged 5 who have been
 immunised for measles, mumps and rubella (MMR) (booster                               80%                 80%
 doses)                                                           PCCS                         Q2 08-09            42.4%              Low      85%     90%




                                                                                                                                                       34
Performance Report- Year end position as at March 08 and Current Status (4)
                                                                                                                    Risk
                                                                                                                   rating
                                                                                                                     for              2009-   2010-
                                                                  March 08    Annual   Reporting                   March     Data      10      11
 National Priorities                                      Owner    Status      Plan     period     Plan   Actual     09     quality   Plan    Plan

 Immunisation rate of 90% for human papilloma virus                 New                YTD Dec
 vaccine for girls aged around 12-13 years                PCCS    indicator    90%       08        90%    92.20%            Low       90%     90%

 Immunisation rate for children aged 13 to 18 who
 have been immunised with a booster dose of
 tetanus, diphtheria and polio                            PCCS                 50%     Q2 08-09    50%     39%               Low      75%     90%

 % of women aged 53-64 yrs screened for breast
 cancer                                                    SC                  70%      2007-08    70%    44.2%             Medium    70%     70%

 % of women aged 65-70 yrs screened for breast
 cancer                                                    SC                  65%      2007-08    65%    42.6%             Medium    65%     65%

 Prevalence:% of infants totally or partially breastfed             New                 YTD Q2                               Very
                                                                              48.4%
 at 6-8 weeks                                             PCCS    indicator              08-09     25%    68.0%              Low      53.1%   58.0%

 Coverage: The number of children with a
 breastfeeding status recorded as a percentage of all               New                 YTD Q2     60.0                      Very
 infants due for a 6–8 week check                         PCCS    indicator    85%       08-09      %     86.0%              Low      90%     95%

 Has a full range of CAMH services for children and
 young people with learning disabilities been                       New         4                   4
 commissioned for the council area?                        SC     indicator            Q2 08-09             4               Medium      4       4

 Do 16 and 17 year olds from the council area who
 require mental health services have access to
                                                                                4                   4
 services and accommodation appropriate to their                    New
 age and level of maturity?                                SC     indicator            Q2 08-09             4               Medium      4       4

 Are arrangements in place for the council area to
 ensure that 24 hour cover is available to meet urgent
 mental health needs of children and young people                               4                   4
 and for a specialist mental health assessment to be                New
 undertaken within 24 hours or the next working day        SC     indicator            Q2 08-09             4               Medium      4       4

 Is a full range of early intervention support services
 delivered in universal settings and through targeted
 services for children experiencing mental health                               2                   2
 problems commissioned by the Local Authority and                   New
 PCT in partnership’ (Indicator in Development)            SC     indicator            Q2 08-09             2               Medium      3       4

 Percentage of the population aged 15 - 24 screened                                     YTD Q2     8.47
 or tested for chlamydia                                   SC                  17%       08-09      %     3.38%             Medium    17%     17%



                                                                                                                                                    35
Performance Report- Year end position as at March 08 and Current Status (5)
                                                                                                                         Risk
                                                                                                                        rating
                                                                                                                          for              2009   2010
                                                         March 08      Annual     Reporting                             March     Data      -10    -11
 National Priorities                           Owner      Status        Plan       period        Plan       Actual        09     quality   Plan   Plan

 No of drug users using crack and/or opiates
 recorded as being in structured drug
 treatment in a financial year who were
                                                                        1000                                                               1100   1210
 discharged from treatment after 12 weeks or
 more, or who were discharged from
 treatment in a care plan                       SC     New indicator               Q2 08-09      931         934                 Medium

 Adult inpatient patient experience score                                                       Annual Survey- results not yet
                                                                         75                                                                77     80
 (Acute Trust)                                  SC                                 2008-09                 known                  N/A

 Adult outpatient patient experience score                                                      Annual Survey- results not yet
                                                                         73                                                                75     78
 (Acute Trust)                                  SC                                 2008-09                 known                  N/A

 A&E patient experience score (Acute Trust)                                                     Annual Survey- results not yet
                                                                         71                                                                73     76
                                                SC                                 2008-09                 known                  N/A

 Patient experience score (Community                                                            Annual Survey- results not yet
                                                                         75                                                                77     79
 mental health trust)                           SC                                 2008-09                 known                  N/A

 Patient experience score (PCT survey of                                                        Annual Survey- results not yet
                                                                         72                                                                74     78
 primary care services)                        PCCS                                2008-09                 known                  N/A

 Number of patients receiving NHS primary
 dental services located within the PCT area                                                                                               165,   165,
 within a 24 month period                      PCCS    New indicator   168,726     Q2 08-09     168,726    156,264               Medium    537    537

 National NHS staff survey: Job Satisfaction                                                    Annual Survey- results not yet
                                                                        3.40                                                               3.43   3.46
                                               ODHR                                2008-09                 known                  N/A

 Existing Commitments

                                                                                 YTD W/E 28th
 98% of A&E waits in 4 hours                    SC                      98%        Dec 08        98%        98.25%               Medium    98%    98%

 Outpatient waits 13 week breaches              SC                       0       YTD Nov 08       0            7                 Medium     0      0

 Inpatient waits 26 week breaches               SC                       0       YTD Nov 08       0            0                 Medium     0      0

 No of patients waiting more than 3 months
 for Cardiac revascularisation                  SC                       0       YTD Nov 08       0            0                 Medium     0      0

 Sexual health - % of patients accessing                                                                                                   100    100
 GUM clinic within 48 hours                     SC                      100%     YTD Nov 08      100%       99.5%                Medium     %      %

 % of Delayed transfers of Care (acute) per                                                                                                3.5    3.5
 hospital occupied bed days                     SC                      3.5%       Q2 08-09      3.5%       1.46%                Medium    %      %
                                                                                                                                                         36
Performance Report- Year end position as at March 08 and Current Status (6)

                                                                                                             Risk
                                                       March 08   Annual   Reporting                      rating for    Data     2009-10   2010-11
 Existing Commitments                         Owner     Status     Plan     period       Plan    Actual   March 09     quality    Plan      Plan

 Category A Ambulance response within 19
 mins                                          SC                  95%     YTD Dec 08    95%     98.3%                 Medium     95%       95%

 Category A Ambulance response within 8
 mins                                          SC                  79%     YTD Dec 08    79%     72.7%                 Medium     79%       79%

 Category B Ambulance response within 19
 mins                                          SC                  95%     YTD Dec 08    95%     82.6%                 Medium     95%       95%

 % offered diabetic retinopathy screening     PDE                 100%      Q3 08-09     100%    99.96%                Medium     100%      100%

 Number of new cases for early intervention
 of psychosis                                  SC                   65     YTD Sept 08    30       16                  Medium      65        65

 Number of Crisis resolution episodes          SC                  868     YTD Sept 08    432     393                   Low       868       868

 Data quality on Ethnic Group                  SC                  80%     YTD Nov-08    80%     85.40%                Medium     80%       80%

 London Priorities

 % of newly diagnosed HIV infected patients           New
 with <200 cells per mm3                       PH     indicator    23%      2008-09              N/A                   Medium     19%       15%

 % of TB cases whose treatment was                    New
 completed                                     PH     indicator    82%      Q2 2008      82%     80.8%                 Medium     90%       905

 Local Priorities

 Delayed transfers of Care (non acute and                                  YTD Dec-08
 acute) per 100,000 of the population aged            New                   (W/E 14th
 18 yrs+                                       SC     indicator     15       Dec 08)      15       14                  Medium      13        11

 Adults and older people receiving direct
 payments and/or individual budgets (per              New
 100,000 of the population)                    SC     indicator    172      Q3 08-09      156    167.9                 Medium    238.04    387.41

 Percentage of Carers receiving a ‘carer’s            New
 break’ or a specific carer’s service          SC     indicator   19.60%    Q3 08-09     14.7%   15.38%                Medium    24.6%     29.60%




                                                                                                                                                  37
Performance Report- Year end position as at March 08 and Current Status (7)

                                                                                                                                Risk
                                                                                                                               rating
                                                                                                                                 for               2009   2010
                                                                           March 08    Annual   Reporting                      March      Data      -10    -11
 Additional PCT commitments                                        Owner    Status      Plan     period     Plan   Actual        09      quality   Plan   Plan

 % of GP practices in the PCT offering extended opening in                   New
 compliance with Department of Health guidelines                   PCCS    indicator    50%      Jan-08     50%     74%                  Medium    75%    96%

                                                                                                YTD Dec
 New cases of MRSA (performance at 'hosted' Trust)                  PH                   32       08        24      22                   Medium

 No of practices with PCT validated registers of patients with                                                        Annual data
 symptoms of CVD with an absolute risk of CVD events greater                                                       collection- results
 than 20%                                                          PCCS                  67      2008-09    N/A     not yet known         N/A      67     67

 Health inequalities - % of GP population as having a BMI status
 recorded                                                          PCCS                 42%     Q2 08-09    42%    34.6%                  Low      42%    42%

 Number of Community Matrons and Other Case managers               PDE                   15     Q2 08-09    15      19                   Medium    15     15

 Number of Very High Intensity Users being case managed by
 Community Matrons                                                 PDE                  961     Q2 08-09    961     770                  Medium    961    961

 Choice & booking - % of first outpatient bookings to be made
 using Choose & Book                                               PCCS                 90%      Dec-08     90%     23%                  Medium    90%    90%

 Key:

 SC- Director of Strategic Commissioning

 PH- Director of Public Health

 PCCS- Director of Primary and Community Commissioning
 Services

 PDE - Director of Provider Development and Estates

 ODHR - Director of Organisational Development and Human
 Resources




                                                                                                                                                          38
Smoking Quitters
                                                                           4 week Smoking quitters 2008-09


                        300



                        250



                        200
       No of quitters




                                                                                                                                                 Actual
                        150
                                                                                                                                                 Plan


                        100



                        50



                         0
                              Apr-08   May-08   Jun-08   Jul-08   Aug-08      Sep-08     Oct-08     Nov-08   Dec-08   Jan-09   Feb-09   Mar-09
                                                                                    Month




    • The 07-08 actual was 186 for the year, an average of 16 quitters per month
    • The chart above shows the monthly plan to achieve the 2008-09 operating plan target of 1756.
    • The year-to-date November 08 actual is 276, 61.6% below the profiled target.



                                                                                                                                                          39
MRSA
                                                                            No of MRSA Cases at NWLH against Plan


                     6




                     5




                     4
       No of cases




                                                                                                                                                                       Actual
                     3
                                                                                                                                                                       Plan



                     2




                     1




                     0
                         Apr-07 May-07 Jun-07 Jul-07 Aug-07 Sep-07 Oct-07 Nov-07 Dec-07 Jan-08 Feb-08 Mar-08 Apr-08 May-08 Jun-08 Jul-08 Aug-08 Sep-08 Oct-08 Nov-08
                                                                                           Month




•   In 2006-07, NWLH reported 51 cases of MRSA, and in 2007-08, 33 cases were reported.
•   This is a 35% reduction In MRSA cases between 2006-07 and 2007-08.
•   The 2008-09 target is 32 cases.
•   0 MRSA cases were reported by NWLH for November.
•   Between April and December there have been a total of 22 MRSA cases reported at NWLH, against a plan of 24 cases..

                                                                                                                                                                                40
National Priorities narrative
 18 weeks data completeness- Non admitted (Director of Strategic Commissioning):

  – Reasons for poor performance:

     In October, NWLH had problems submitting data (Audiology data was not filtering through), and we have been
      reassured that this will be resolved for the upcoming months. NHS London have confirmed that they are happy with
      NWLH’s data completeness adjustment and this should reflect in November’s monthly performance (figures yet to be
      published)
     As at week ending 21st December, NWLH has improved in data completeness at 110.59%.
     Brent provider has been adjusted due to reporting problems and is now red at 170%. Reporting is an issue because of
      the complexities of the Provider consultant led pathways and the limitations of RIO and also difficulty in data collection
      in the Community Paediatric Service.

  – Action taken:

     There is a North West sector meeting on 23rd January to discuss Interprovider transfers and issues with supplying the
      MDS including clock starts, which should improve data completeness.
     Brent Provider is in the process of recruiting to expand the 18 weeks project team which will include an ICT Project
      manager, a Database Architect and Management Information Analysts to support the reporting function. Develop and
      implement clinic outcome forms with codes to ensure all scenarios for 1st definitive treatment or where clocks continue
      to count are captured for each service.




                                                                                                                                   41
National Priorities narrative (2)
 Stroke patients spending 90% of their time on a stroke unit (Owner: Director of Strategic Commissioning):

  – Reasons for poor performance:

      This is an improvement from Q1’s figure which was 22.3%. NWLH do not have an easy way of measuring this data. They have now managed
       to get the whole of the patient stay analysed so the time spent on the stroke unit where patients may have had to start their stay on one of their
       HDU beds is now included.
      NWLH do not as yet have a stroke unit which includes the hyper acute phase of the care – this is currently carried out in the AAU (acute
       assessment unit) where they have HDU beds.
      However, the stroke outreach team pick up all stroke patients every morning following their admission so the stroke physician is involved at an
       early stage, which is how they have improved their activity. Patients are moved onto the stroke unit as soon as it is appropriate medically.

  – Action taken:

      NWLH plan to rectify this by submitting a proposal for a hyper acute stroke unit (HASU) when these beds within the stroke unit will be available.
      Current performance is in the high 80% for amount of time spent on the stroke unit.

 Smoking quitters (Owner: Director of Public Health):
  – Reasons for poor performance:
      The discontinuation of the community advisor scheme at the end of March 2007 was a major contributing factor in the decrease in performance.
      Trained community advisors (mainly pharmacists) played a pivotal role in providing structured 1:1 support sessions to clients on a drop-in basis
         at their local pharmacy.
  – Action taken:
      A business case and project plan has been written and presented to Practice Based Commissioning to mainstream the smoking cessation
         service and provide additional funding. This has been supported and will go to the investment panel following helpful comments on expanding
         the scheme.
        Staffing: A Stop Smoking Service Manager was appointed and has been in post from the 13th October 2008. A Stop Smoking Specialist was
         appointed and has been in post from the 6th October. Interviews for the post of Stop Smoking Specialist were held on the 31st October 2008 and
         appointment has been made starting in December. A job Description and KSF outline has been written and submitted for the post of Stop
         Smoking Administrator. Specific roles and duties have been allocated to the Stop Smoking Specialists; these include a Stop Smoking Contract
         Services Coordinator and a Stop Smoking Community Development Coordinator.
        Recruiting Community Advisors in Primary care: Am list of pharmacies and GPs contrcated to provide this service has been established.
         Those not contracted will be targeted.
        Stop Smoking Service: The Stop Smoking Service is mapped to the location of smokers in Brent. Ward profiles, including a breakdown of
         population demographics and smoking prevalence is being undertaken. A Monitoring Tool will be introduced to track data and enable resources
         to be more effectively targeted (presentation of the tool took place on the 7th November 2008).
        Local Enhanced Service Agreements: Pharmacies - 46 Pharmacies have agreed to a local enhanced service agreement on smoking. Within
         these 46 there are over 80 Community Advisers. 25 GP practices have signed an agreement to provide a stop smoking service.
        Promoting giving up smoking: A ‘Till-Roll’ advertising campaign will take place in January in three Neighbourhood Renewal Areas. The ’25
         Quits’ incentive scheme was launched in December before Christmas. It has been welcomed positively by Pharmacists and a number of
         General Practices. We have at present received a claim for 150 quits from a single pharmacy. The service is being advertised on local radio.
         Advertising space has been bought in upcoming publications.                                                                                   42
National Priorities narrative (3)
 Childhood Immunisation (Owner: Director of Primary Care and Community Commissioning Services):

  – Reasons for poor performance:

     Problems with the late recording and inputting of data of immunisations to the Community Information System.
     Difficulties in ensuring data from GP practices is regularly provided to the Child Health Team for inputting on the information system.
     There are reported difficulties in maintaining services because of cut backs in staffing levels due to turnaround.
     Lack of consistency and provision of call and recall systems across general practice .

  – Action taken:

       Root cause analysis undertaken.
       Problems identified and understood at PCT Level.
       Childhood Immunisation manager in post since 22nd December 2008.
       Data analyst now in post to support programme.
       MMR Catch Up Campaign underway.
       Additional support in place to start call/recall process for the 16 practices which currently do not operate a call/recall system.
       Training planned for HV admin staff to ensure all localities use the same process to identify current cohort and liaise with GP practices .

 Chlamydia Screening (Owner: Director of Strategic Commissioning)

  – Reasons for poor performance

     The service has not to date commissioned sufficient activity to achieve its targets .
     In addition, it has taken the Chlamydia Screening Office some time to galvanise and co-ordinate services.

  – Action taken:

       Chlamydia Screening office action plan in place
       GP and Pharmacy incentivisation scheme introduced
       Online Screening Service in Place
       Practical support to GPs and pharmacists in place to improve uptake
       Additional capacity in place to deliver additional screens




                                                                                                                                                      43
National Priorities narrative (4)
 Breast Screening for women aged 50-70 yrs (Owner: Director of Strategic Commissioning):
  – Reasons for poor performance:
      There have been performance issues with our Breast Screening Service highlighting slippage in the service. These issues were raised and lead to the
        temporary suspension of the service for five months at the beginning of 2007.
      The service is now fully operational but there is now extended slippage of 10 months which will cause an inability for us to reach our 70% target.
      Similarly, this resulted in a delay in full implementation of the age extension to 70.

  – Action taken :
      We are developing an action plan with the PCT consortia and working with the service to increase capacity to bring down the round length. This will include
        investing in new equipment, extra staff, possible extended screening times and Sunday screening. We are waiting for a response from Barnet and Chase
        Farm Hospitals.
 Dental Services (Owner: Director of Primary Care and Community Commissioning Services):
  – Reasons for poor performance
      Lack of awareness around how to access NHS dentistry in Brent.
      Trust and confidence in NHS dentistry has been eroded over recent years- Public perceive that NHS dentistry is not available as a result of media coverage of
        hotspots around country
      Confusion about what is NHS dental care and what is only available privately, lack of provision of costed treatment plans by dentists for their patients

  – Action taken:

      Dental practices offered additional UDA’s are confirming that these can be delivered in year.
      Meetings have taken place with nearly all the dental under performers and the under performance has been discussed. Plans have been
       agreed with them either to deliver the underperformance and their 2008 2009 contract values, to claw back some of the underperformance and
       for the contractor to deliver the remainder and their 2008/2009 contract value or to claw back the full under performance.
      Meetings have commenced with Contractors who have over performed to understand the reasons for this.
      Dental Contracts Manager has started working for NHS Brent.
 CVD Mortality rate (Owner: Director of Public Health):
  – Reasons for poor performance:
      The under 75 circulatory disease (CVD) mortality rate for Brent in 2006 was 85.99 per 100,000 population which is slightly above the plan of 84 per 100,000
        population.
      The mortality rate in Brent has reduced from 140.16 in 1998 and has already exceeded the national target to reduce CVD mortality by 40% by 2010 from the
        1998 baseline.
  – Action taken:
      Improving outcomes in terms of circulatory disease continues to be a key priority for the PCT.
      This year the PCT has invested c. £500,000 in its smoking cessation programme. The PCT is in the process of developing a vascular health strategy and
        vascular health is one of the key initiatives in its forthcoming commissioning strategy plan.



                                                                                                                                                                       44
National Priorities narrative (5)
 Access to Maternity Services (Owner: Director of Strategic Commissioning):
  – Reasons for poor performance:
     Development plans to address the target commenced in June 08 and therefore significant improvements are unlikely to be realised until quarter
      4 due to the time lag between booking and EDD (estimated date of delivery)
     Additionally, since quarter 1 there has been a change to the denominator used to calculate performance against this indicator which has had a
      negative impact on performance levels. We will therefore be asking providers to resubmit collated results for quarters 1 and 2 based on the
      new data collection using the revised denominator to get an accurate assessment of performance year to date
     Furthermore, there is now an issue regarding data completeness given the absence of valid data from 3 to 4 acute trusts, commissioned to
      provide maternity care, who we have not received data from.
  – Action taken:
     Historically, Brent has approximately 18% late bookings. This is due to a combination of factors; late GP referrals and a number of cultural
      issues which are known to affect the highest numbers of service users such as:
      – Language barriers (with up to 130 known languages spoken within the borough)
      – Migrant population
      – “Health tourists”
      – Population mobility
      – Failed asylum seekers and refugees
      – Socio-economic deprivation

     There is considerable local focus on improving performance against this target at our primary provider of maternity care, Northwick Park
      Hospital. However, there is further work to do with other providers of maternity care e.g. Imperial, Ealing and Barnet as we have noted a shift in
      booking patterns to other hospitals which may be the result of negative media attention following the independent enquiry arising from three
      SUI’s which concluded in June 2008.
     The implementation of transnuchal screening is being used to progress this target by encouraging GPs to refer early with a guarantee that
      those referred by 9 completed weeks of pregnancy will be guaranteed transnuchal screening by the end of 10 completed weeks. A new
      proforma that must be faxed in to the local maternity unit has been implemented to improve reliability and timeliness of referral receipt.
     We are addressing the wider cultural issues known to affect service users in a number of ways as part of the Healthcare Commission Service
      Review Action Plan. Specifically, implementation of the new integrated community midwifery model which focuses on ensuring that vulnerable
      service users and those identified with the highest levels of need receive timely services. Work with children’s centres and other community
      venues are being effectively targeted to improve maternity outcomes for service users experiencing barriers as identified.




                                                                                                                                                           45
Existing Commitments narrative
 Crisis resolution episodes (Owner: Director of Strategic Commissioning)

  – Reasons for poor performance:

     The Trust are not recording all the Crisis Resolution Team activities, including that which emanates via Accident and
      Emergency into acute in –patient care.
     Data robustness from Central and North West London NHS Foundation Trust therefore continues to be a challenge.
     The links between Crisis Resolution Team, admissions and facilitated discharges is still not fully operational. We are
      continuing to put pressure on the Trust to link data collection to A&E mental health activity and there has been some
      progress this quarter.

  – Action taken:

     We have asked the Trust to report to the PCT on a fortnightly basis all Crisis resolution episodes, admissions and
      discharges, all acute in patient admissions and discharges and all Mental health Accident and Emergency admissions
      and discharges. This will enable the PCT to be alerted of any potential problems at an early stage.
     The Trust has also employed an Assistant Director of Information who is working to improve data collection and
      information recording. We are monitoring this in our contract monitoring meetings. Despite a lot of effort chasing
      boundary Trusts where we have contracts, there is still outstanding activity data from one Trust.

 New Cases of Psychosis (Owner: Director of Strategic Commissioning):

  – Reasons for poor performance:

     The Early Intervention in Psychosis team as currently configured does not have sufficient capacity to deliver on the
      national target. Moving forward, the PCT has determined to commission a more holistic, innovative service to meet this
      target.

  – Action taken:

     Initial plans to invest additional resources to increase the team’s overall capacity to meet the target are underway. An
      investment bid is being sought from the PCT’s Programme Funds to progress this and we expect to improve on our
      position by year end.
                                                                                                                                 46
Existing Commitments narrative (2)
 Category A ambulance calls responding within 8 minutes and Cat B ambulance calls responding within 19 minutes
  (Owner: Director of Strategic Commissioning):.

  – Reasons for poor performance:

     Pan London volume increase coupled with increase hospital delays which are impacting negatively on LAS ability to have available resources
      to respond in a timely manner.
     First week of December highest recorded Cat A volumes and significant pan London A&E capacity issues   .
  – Action taken:

     Continuation of 10 point action plan implemented for recovery
     Daily London wide Teleconference to ascertain positions of all hospitals
      –   Includes: Number of patients waiting in A&E, number of ambulances queuing, number of patients waiting for beds in assessment wards, bed
          capacity within hospital.




                                                                                                                                                   47
Additional PCT Existing Commitments narrative
       Choose and Book (Owner: Director of Primary and Community Commissioning Services):
    –        Reasons for poor performance:
              Poor usage of Choose and Book within NHS Brent by GP Practice; Practices not familiar in the use of choose and book Practices not
               confident in the use of the system
              No choose and book Local Enhanced Service in place
              We have also noted the IT helpdesk at NHS Brent have not yet developed experience in rectifying IT issues with the CAB software, owing to
               limited resources
              Slot issues at Acute Trust
              Out of date Directory of Service at NWLH
    –        Action taken:
              Experienced Choose and Book Manager recruited with start date of end February agreed
              Interviews for facilitators have taken place but candidates not suitable so further interviews required and scheduled for early February with the
               aim of them starting at the same time as the Choose and Book Manager
              NHS London choose and book diagnostic visit booked and actions will be programmed into the Choose and Book manager’s work.
       Very High Intensity Users (Owner:Director of Provider Development and Estates):
    –        Reasons for poor performance:
              Low levels of employment of community matrons reflect national and local recruitment issues and the financial recovery planning of the PCT.
               This has resulted in a cautious 2008-9 community nursing services budget, with potential to apply for investment funding upon the completion
               of a strategic and operational review of community nursing / admission avoidance services is completed during October 2008.
              Community Matrons and Case Managers remaining within the joint Intermediate Care Co-ordination Service (DH Funded POPP) work within
               the community nursing teams. The ICCS team comprise 10 Case Manager who also case manage VHIU’s, using a different model of case
               finding: EARLI Tool. The emphasis of the Case Worker’s is on prevention of admission where social issues are prevalent
              In addition to Community matrons, and Case Manager’s there are a number of case managers who are Nurses, working to case find and
               case manage people with Long Term Conditions.
              The inclusion of these additional case managers and their activity was deemed acceptable following a negotiation between London PCT’s and
               the DH during 2007-8 (in liaison with SHA) However, at that time NHS Brent did not add in the figures from the case manager’s and LTC
               Nurse Case Manager’s.
    –        Action taken:
              Once the reviews have been completed, stakeholders, commissioners and providers will evaluate the options, costs and impacts of a range of
               potential service models. Depending upon the model / models of care that confirm the agreed strategic direction of Community Services,
               Project bids will be submitted to the Investment Panel for scrutiny and evaluation




                                                                                                                                                               48
Additional PCT Existing Commitments narrative (2)
 GP recording of BMI Status (Owner: Director of Primary Care and Commissioning Services):

  – Reasons for poor performance:

     BMI position is poor as it is not part of QOF.

  – Action taken:

     Currently 22 practices are participating in a pilot being supported by Imperial College to extract clinical data from practice clinical information
      systems including BMI and smoking. We are exploring the feasibility of extending this to all practices for 2008/09 as part of the incentive
      scheme to share health status data.
     A data Capture LES will be introduced which will see an increase in data returns from GP practices.




                                                                                                                                                            49
SUMMARY OPERATING COST STATEMENT
FOR 9 MONTHS ENDING 31st DECEMBER 2008
                                                Annua l                   Year to Date
                                                Budge t    Budge t       Actua l       Va ria nce       Va ria nce
                                                  £000s     £000s        £000s           £000s              %

Commissioning Services
 Commissioning of Healthcare
 Acute Commissioning                            198,896      149,070       154,869         (5,799)        (3.89)%

 Joint W orking Commissioning                    78,059       58,515        56,631           1,884          3.22%

 Sub-tota l:                                    276,955      207,585       211,500         (3,915)         (1.89)%

 Primary Care
 Medical Contract                                44,539       32,939        31,685           1,254          3.81%

 Dental Contract                                 13,476       10,107         9,946               161        1.59%

 Pharmacy Contract                                1,767        1,444         1,608           (164)       (11.36)%

 Prescribing                                     38,081       28,700        26,896           1,804          6.29%

 Community Trusts (including Brent Provider)     36,315       27,150        27,226               (76)     (0.28)%

 Sub-tota l:                                    134,178      100,340        97,361           2,979          2.97%

 Ma na ge me nt Costs                            13,539        9,069         9,010                59        0.65%

 COMMISSIONING Tota l:                         424,672      316,994       317,871            (877)         1.73%
                                                                     `
Provider Services
 Expenditure                                     42,297       31,727        32,089           (362)        (1.14)%

 Income - Brent                                 (37,876)     (28,382)     (28,382)                  0       0.00%

 Income - Other                                  (4,421)      (3,345)       (3,247)              (98)     (2.93)%

 PROVIDER SERVICES Tota l                           (0)              0         460           (460)       (4.07)%
 TOTAL (Before Reserves):                      424,672      316,994       318,331         (1,337)        (0.42)%

Reserves and Commitments
 Balance sheet movements                              1                                             0       0.00%

 Contingency                                      2,370                                             0       0.00%

 New Investment Programme (phase 2)               6,147        2,378                         2,378          0.00%

 Investment Programme slippage (phase 1)            736                                             0       0.00%

 Specific Reserves                                  396                                             0       0.00%

 Reserves and Anticipated Allocations            (1,430)      (1,430)                      (1,430)          0.00%

 Surplus for investment 2009-10                  12,446       11,559                        11,559       100.00%

 RESERVES Tota l:                               20,666       12,507                0       12,507       100.00%

TOTAL for Brent tPCT:                          445,338     329,501       318,331          11,170          3.39%


                                                                                                                50
COMMISSIONING OF HEALTHCARE
FOR 9 MONTHS ENDING 31st DECEMBER 2008

                                            Annual                 Year to Date
                                            Budget    Budget    Actual   Variance    Variance
                                              £000s     £000s     £000s     £000s          %

Acute Commissioning
 Acute and Foundation Trusts

 North West London                           81,835    61,376    63,754    (2,378)    (3.87)%
 Imperial College Healthcare                 46,448    34,836    36,541    (1,705)    (4.89)%
 Royal Free                                   9,117     6,838     7,051     (213)     (3.11)%
 Other Acute Trusts                          28,840    21,793    23,317    (1,524)    (6.99)%

 Sub-total - Acute and Foundation Trusts    166,240   124,843   130,663    (5,820)    (4.66)%

 Other Service Level Agreements
 Consortia Led Commissioning                 17,876    13,408    13,680     (272)     (2.03)%

 High Cost Drugs                               582       437       461        (24)    (5.49)%
 Non Contracted Activity                      1,922     1,442     1,586     (144)     (9.99)%
 PCTs                                         1,277      958       865         93      9.71%
 Minor Budgets                                3,202     2,135     1,795       340     15.93%

 Sub-total - PCTs                            24,859    18,380    18,387        (7)    (0.04)%

 HIV / AIDS and Sexual Health

 Consortia Led HIV and AIDS Commissioning     5,641     4,231     4,247       (16)    (0.38)%

 Local HIV/ Treatment and Care                 769       576       509         67     11.63%

 Sexual Health                                1,387     1,040     1,063       (23)    (2.21)%

 Sub-total - HIV / AIDS & Sexual Health       7,797     5,847     5,819        28       0.48%

Total Acute Commissioning                   198,896   149,070   154,869    (5,799)    (3.89)%



                                                                                            51
COMMISSIONING OF HEALTHCARE
FOR 9 MONTHS ENDING 31st DECEMBER 2008

                                                               Annua l                   Ye a r to Da te
                                                               Budge t      Budge t   Actua l    Va ria nce   Va ria nce
                                                                    £000s     £000s    £000s         £000s            %

Joint Commissioning
  Me nta l He a lth

  Central and North W est London Mental Health                     33,205   24,904    24,836            68       0.27%

  Consortia Led Mental Health Commissioning                         6,788     5,091    4,580           511      10.04%

  Mental Health Trusts                                              2,011     1,508    1,362           146       9.68%

  Sub-tota l - Me nta l He a lth                                   42,004   31,503    30,778           725       2.30%
  Long Te rm Be dde d Se rvice s

  Continuing Care / Section 28a                                    21,886   16,414    16,346            68       0.41%

  Registered Free Nursing Care                                      3,572     2,679    2,135           544      20.31%

  Continuing Care Assessment Team                                    458       344       207           137      39.83%

  Sub-tota l - Long Te rm Be dde d Se rvice s                      25,916   19,437    18,688           749       3.85%

  Olde r Pe ople / Re ha bilita tion/ Physica lly Disa bilitie s

  Consortia Led Rehabilitation and PD Commissioning                 1,104      827       731            96      11.61%

  Palliative Care (K & C PCT)                                       1,021      766       766             0       0.00%

  Minor Budgets                                                      566       425       562         (137)    (32.24)%

  Sub-tota l - Olde r Pe ople / Re ha b/ Phys Dis                   2,691     2,018    2,059           (41)     (2.03)%



  Childre n a nd Fa milie s

  Consortia Led Children's Commissioning                             805       604       508            96      15.89%

  Minor Budgets                                                      811       579       564            15       2.59%

  Cost per Case                                                      634       476       390            86      18.07%

  Barnet, Enfield and Haringey Mental Health Trust                   235       176       176             0       0.00%

  Sub-tota l - Childre n a nd Fa milie s                            2,485     1,835    1,638           197      10.74%

  Othe r Joint Commissioning

  Substance Misuse                                                  3,874     2,905    2,815            90       3.10%

  Learning Disabilities                                              715       536       441            95      17.72%

  Cost per Case                                                      374       281       212            69      24.56%

  Sub-tota l - Othe r                                               4,963     3,722    3,468           254       6.82%

Tota l Joint W orking                                              78,059   58,515    56,631         1,884       3.22%



                                                                                                                     52
PRIMARY CARE SERVICES
FOR 9 MONTHS ENDING 31st DECEMBER 2008
                                        Annual                      Year to Date
                                        Budget       Budget      Actual  Variance   Variance
                                          £000s        £000s      £000s     £000s         %


Medical Contract
 Baseline Contracts                      25,178       19,117     19,058        59     0.31%
 Enhanced Services                         5,024       3,263      2,292       971    29.76%
                                           3,896
 Quality & Outcomes Framework (QOF) - Aspiration       2,922      2,922         0     0.00%
                                           2,613
 Quality & Outcomes Framework (QOF) - Achievement      1,944      1,944         0     0.00%
 Out Of Hours                                726         544        538         6     1.10%
 Premises & PCO Managed Budgets            7,102       5,149      4,931       218     4.23%
 Total Medical Contract                  44,539       32,939     31,685     1,254     3.81%

Dental Contract
 Dental Services                         15,676       11,757     11,578      179      1.52%
 Patient Charge Income                   (2,200)      (1,650)    (1,632)     (18)     1.09%
 Total Dental Contract                   13,476       10,107       9,946     161      1.59%

Pharmacy Contract
 Pharmacy Services                        1,767        1,444      1,608     (164)   (11.36)%
 Total Pharmacy Contract                  1,767        1,444      1,608     (164)   (11.36)%

Prescribing
 Practice Costs                          36,632       27,613     26,084     1,529     5.54%
 Central Drugs Bill Charges                 933          700        488       212    30.29%
 Prescribing Incentive Scheme               364          273        273         0     0.00%
 Other                                      152          114         51        63    55.26%
 Total Prescribing                       38,081       28,700     26,896     1,804     6.29%

Community Trusts
 Brent Provider Services                 35,232       26,338     26,338         0      0.00%
 Other Community Trusts                   1,083          812        888      (76)    (9.36)%
 Total Community Trusts                  36,315       27,150     27,226      (76)    (0.28)%



TOTAL PRIMARY CARE                    134,178       100,340     97,361     2,979     2.97%

                                                                                           53
PCT MANAGEMENT
FOR 9 MONTHS ENDING 31st DECEMBER 2008
                                 Annual             Year to Date
                                 Budget    Budget    Actual Variance Variance
                                   £000s    £000s     £000s        £000s         %

PCT Management Costs

 Chief Executive Office            1,163      855       945         (90)   (10.53)%

 Public Health                     1,860    1,295     1,332         (37)    (2.86)%

 Strategic Commissioning           2,319    1,343     1,353         (10)    (0.74)%

 Primary Care Commissioning        3,536    2,067     2,029          38      1.84%

 Human Resources                    784       589       586           3      0.51%

 Finance and Performance           3,580    2,698     2,498         200      7.41%

 Clinical Leadership                297       222       267         (45)   (20.27)%


 Total Direct Management Costs   13,539    9,069    9,010           59     0.65%


                                                                                 54
PROVIDER SERVICES DETAIL
FOR 9 MONTHS ENDING 31st DECEMBER 2008
                                                         Annua l                     Ye a r to Da te
                                                         Budge t       Budge t     Actua l   Va ria nce   Va ria nce
                                                           £000s         £000s      £000s        £000s              %

Income

 Other Income from Brent PCT                            (37,876)      (28,382)    (28,382)           0       0.00%

 SLA Income - Other PCTs                                 (1,579)       (1,184)     (1,170)         (14)     (1.18)%

 Other Income                                            (2,842)       (2,161)     (1,478)       (683)    (31.61)%

 Dietetics (expenditure part of Specialist Services)                                 (56)           56

 Sure Start                                                                         (142)          142

 Refugees & Asylum Seek ers                                                          (61)           61

 QOF 0708 + Miscellaneous income                                                    (340)          340


TOTAL INCOME                                           (42,297)      (31,727)    (31,629)        (98)     (0.31)%

Expenditure

 Children's services                                       3,527         2,645      2,588           57       2.16%

 Community Nursing                                         6,193         4,641      4,722          (81)     (1.75)%

 Intermediate care and rehabilitation                      5,589         4,192      4,036          156       3.72%

 Learning disability services                              2,044         1,497      1,630        (133)      (8.88)%

 Pathways                                                  2,719         1,921      1,801          120       6.25%

 Specialist Services                                       4,569         3,422      3,299          123       3.59%

 Operational Services                                      7,440         5,580      5,908        (328)      (5.88)%

 Managed Practices and Other                               3,263 0       2,405      2,793        (388)    (16.13)%

 Management, Catering and Other                                                        10         (10)    #DIV/0!

 * Sure Start                                                                          94         (94)

 **Refugees & Asylum Seek ers                                                          50         (50)

 ***Trust Managed Practices                                                                          0

 Recharges and reserves                                    6,953         5,424      5,302          122       2.25%


TOTAL EXPENDITURE                                       42,297        31,727      32,089        (362)     (1.14)%

TOTAL EXPENDITURE LESS INCOME                               (0)             0        460        (460)

                                                                                                                    55
BALANCE SHEET
FOR 9 MONTHS ENDING 31st DECEMBER 2008
                                                            Opening        Year To Date
                                                            Balance    Change           Balance
                                                    Notes     £000s      £000s            £000s


 Fixed Assets
 Intangible Assets                                                0         82               82
 Land & Buildings                                            50,221        414           50,635
 Plant & Equipment                                              275        (84)             191
 IT Equipment                                                 1,322       (447)             875
 Asset Under Construction and Payments on Account               925        345            1,270
 Investments                                                    212        (12)             200
 Sub-total for Fixed Assets:                                 52,955        298           53,253

 Current Assets
 Stocks                                                           0          0                0
 Debtors                                                      4,777     (3,582)           1,195
 Cash at bank & in hand                                          12        419              431
 Sub-total for Current Assets                                 4,789     (3,163)           1,626

 Creditors - due within one year                            (36,295)    (5,460)         (41,755)
 Bank Overdraft                                                   0          0                0

NET CURRENT ASSETS \ (LIABILITIES)                          (31,506)    (8,623)         (40,129)

TOTAL ASSETS LESS CURRENT LIABILITIES                        21,449     (8,325)          13,124

 Creditors - due after one year                                   0          0                0

 Provisions for liabilities & charges                        (4,468)       207           (4,261)
TOTAL ASSETS EMPLOYED                                       16,981     (8,118)           8,863

FINANCED BY:
 General Fund                                               (10,496)   (10,286)         (20,782)
 Revaluation Reserve                                         27,477      2,168           29,645
 Donated Asset Reserve                                            0          0                0
TOTAL CAPITAL AND RESERVES                                  16,981     (8,118)           8,863


                                                                                                   56
 CAPITAL EXPENDITURE
 FOR 9 MONTHS ENDING 31st DECEMBER 2008

                                                               Annual             Year to Date              Forecast
   Capital Programme                                           Budget    Budget        Actual    Variance     Outturn
                                                                £000s     £000s          £000s      £000s        £000s

 Brought Forw ard Schemes 2007-08
   Kingsbury Security                agreed by CCG 20/5/08          9                                   0              0
   Willesen H/V room adaptations     agreed by CCG 20/5/08          8                                   0              0
   Health & Safety Projects                                                                14        (14)          14
   IM & T Upgrades                                                                        (11)         11         (11)
 Agreed Schemes
   RIO Project                       agreed by Board 27/3/08      787       286           286           0         630
   GP system of Choice (GPSOC)       agreed by CCG 20/5/08        438        73            73           0         329
   PC Replacement Programme          agreed by CCG 21/9/08        275                                   0         275
   Dental                            agreed by CCG 20/5/08        206        50            50           0          50
   Sudbury PCC                       agreed by CE                 150        22            22           0         150
   Backlog of Maintenance Projects   agreed by CCG 14/7/08         57                                   0          57
   Willesden MRSA Upgrades           agreed by CE                  40                                   0          40
   Server - Business Continuity      agreed by CCG 21/9/08         27                                   0          27
   Wheelchairs Move                  agreed by CE                  20         4             4           0              4
   Willesden BADP Access             agreed by CCG 12/8/08          6                                   0              6
 Schemes aw aitng approval
   Chalkhill PCC Commissioning                                    300         4             4           0         300
   Hillside PCC Commissioning                                     300         4             4           0         300
   Willesden Deferred Asset Cost                                  295       305           305           0         305
   Estate Disposal enabling costs                                 150                                   0          90
   HQ Commissioning costs                                         100                                   0          60
   Health & Safety Projects                                        55                                   0          33
   Wembley Centre local schemes                                    30                                   0          18
   Kilburn Square local schemes                                    10                                   0              6
   Unallocated budget to date                                               250                       250        (453)
 Disposals
   College Road                                                  (580)                                  0        (580)

 TOTAL CAPITAL                                                 2,683       998           751         247       1,650

 NOTIFIED CAPITAL RESOURCE LIMIT (CRL)                         2,146                                           2,146
Notes:
 1 CCG - Capital Control Group
 2 CE    - Chief Executive


                                                                                                                       57
                                  Cash Flow Report to 31 December 2008
                                                     Planned Cash    Actual Cash    Actual as
                                                         Drawings      Drawings         % of
Month                                                        £’000          £’000     Annual
April - June                                              105,959        100,861      23.2 %
July                                                       35,385         39,062       9.0 %
August                                                     35,448         28,131       6.5%
September                                                  35,905         30,358       7.0%

October                                                    36,142         39,162        9.0%
November                                                   36,791         35,094        8.1%
December                                                   36,791         35,361        8.1%
January – March                                           108,671
Total                                                     431,092        308,029       70.8%
Remaining Cash Available to Draw down                                    123,064       29.3%
Total                                                                    431,092      100.0%


  Initial Cash Limit                                      455,105
+ Notified Cash Limit Adjustments                            3,074

  Current Cash Limit                                      458,179

- Other anticipated adjustments                               (87)
- Planned Under Drawing                                   (27,000)
Total Available Cash                                      431,092



Cash drawings to date are below plan and do not include over-performance payments
on acute contracts.
Drawings include PPA and dental payments at national level                                      58
                                Aged Debtors and Prompt Payment Policy
A) Aged Debtor Analysis                                           30.9.08      31.10.08     30.11.08     31.12.08
                                                                   £000s          £000s        £000s       £000s
0-30 days                                           )               1,219             438        489         430
31-60 days                                          )                 268             812        159         182
61-90 days                                          )                  33             116        427          39
Over 90 days                                                          475             376        378         538
Sub Total                                                           1,995          1,742      1,453        1,189
Less bad debt provision                                              -749           - 636      - 636       - 457
NHS credit notes analysed as debtors                                                                         138
Other debtor items/prepayments                                       237              65       273           325
Total                                                              1,483           1,171      1,090        1,195

 B) Better Payment Practice Code            07-08        07-08    Apr-Dec 08   Apr-Dec 08   This Month   This Month
                                          Number         £000s       Number         £000s      Number         £000s

 Total non-NHS bills paid in the year      25,412        57,768      15,833        27,092       1,874        3,099

 Total non-NHS bills paid within target    20,735        52,126      14,658        21,856       1,783        2,969

 % of non-NHS bills paid within target     81.6%         90.2%        92.6%        80.7%        95.1%        95.8%

 Total NHS bills paid in the year           2,564       317,241        1,958     213,252          213       21,711

 Total NHS bills paid within target         2,219       308,438        1,306     191,516          118       20,781

 % of NHS bills paid within target         86.5%         97.2%        66.7%        89.8%        55.4%        95.7%


  The Aged Debtor analysis shows a decrease in older and current but an increase in medium
 term debt.
  Prompt Payments include a change to the recorded date for receipt of invoices which has
 adversely affected performance. An Action Plan to improve PSPP is being implemented.

                                                                                                                      59
  Overview of allocation at month 9
Allocation                                                     £’000

Total at Month 1                                             444,200

 New Allocations:
  Dental                                                        222
  Young peoples DAT                                             169
  Child death review processes                                   60

 Moves from anticipated to actual                               434

 Anticipated changes                                            109

 Total at Month 2                                             445,194

 New Allocations / Adjustments:
  07/08 carry forward                                           1,700
  High cost area supplement                                       628
  Charge for excess 07/08 bank balance                             (5)

 Moves from anticipated to actual – debt repay/TILT/levies     (3,082)

 Anticipated changes (dental VT/cap-rev tfr)                      552

 Allocation at Month 3 and Month 4                            444,987



                                                                         60
Overview of allocation at month 9
Allocation                           £’000

Total at Month 4                    444,987

 New Allocations / Adjustments:
  HPV vaccine funding                    92
  MMR Catch up                           60
  Rape Havens                           (81)
  HCAS adjustment                       (39)
  Minor central adjustments               (9)

 Moves from anticipated to actual      (532)

 Anticipated changes                     39

 Total at Month 5                    444,517

 New Allocations / Adjustments:
  HCAS additional funding               735
  Funding for overseas visitors         314

 Moves from anticipated to actual      (200)

 Anticipated changes                   (716)

 Total at Month 6                    444,650
                                                61
Overview of allocation at month 9
Allocation                            £’000

Total at Month 6                     444,987

 New Allocations / Adjustments:
  MFF adjustment                       (717)
  Haemoglobinopathy training grant       75

 Moves from anticipated to actual       (273)

 Anticipated changes                     (48)

 Total at Months 7 & 8               444,024

 New Allocations / Adjustments:
  Clinical Excellence Awards          1,255
  NW London Perinatal Network           396
  2007-08 carry forward              (1,233)
  Other                                 (28)

 Moves from anticipated to actual       837

 Anticipated changes                     87

 Total at Month 9                    445,338

                                                62

				
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