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WEST SUFFOLK
HOSPITAL NHS TRUST
FINANCE & WORKFORCE REPORT
JULY 2009
Linda Potter, Director of Finance
West Suffolk Hospitals NHS Trust Finance & Workforce Report July 2009
Contents:
Executive Summary
Financial Risk Rating
Income and Expenditure (Trust)
Performance Summaries
CIP Summary
Service Line Report (June 09 summary)
Balance Sheet
Cash Flow
Capital Report
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West Suffolk Hospitals NHS Trust Finance & Workforce Report July 2009
EXECUTIVE SUMMARY
FINANCIAL PERFORMANCE REPORT
FOUR MONTHS TO END JULY 2009
FINANCIAL PERFORMANCE SUMMARY
Surplus. The actual financial position reflects higher than anticipated income from the first four months contract income (5.1% above budget).
Current Actual 1.24m
Operational costs are 4.84% over budget.
Financial Position Budget 1.16m Budget surplus.
Variance Contract income for July has been estimated pending the publication of July priced activity. Drug costs YTD continue at a high run rate though
Favourable / 76K the majority of that additional costs relate to high cost drugs which is recoverable via the SLA contract with the PCT. Toal pay costs are 0.76%
(Adverse) over budget. Pay costs includ £934K of medical locum and agency costs.
CIP Target 1,469
(savings) Ahead of planned savings driven by higher than planned achievement in pay savings both recurrent and non-recurrent. Surgery
Actual 1,738
underperformance on CIPs linked to high extra session payments and costs of completing work by external bodies.
I&E Forecast Outturn Recurrent 3.0m Current projected forecast outturn based on July financial position.
Retained 3.0m
Capital Plan FY 5.3m The recent agreement on the long-term capital plan will see capital expenditure increase during the remainder of the financial year.
Actual Ytd 0.6m Expenditure on clinical equipment and IM&T, further capital spend phased for the rest of the year.
Cash Current Balance 11.3m Creditors being paid promptly; underspend on capital contributing to high cash balance.
Forecast Balance 9.8m Subject to review following confirmation of SLA contract value
Working Capital/ Liquidity Debtors 4.6m June position £3.9m
Creditors 17.6m Increase on June level (16.5m); creditor value will vary linked to timing of creditor payment runs.
Liquidity 33 days Improved cash and debtor position has greatly increased the Trusts ability to cover immediate liabilities.
Strong performance in all rating measures for the 4 months to July. Note: there was an error in the June published FRR which stated a 5 rating
FRR 4
Overall Financial Risk Rating for the 1st quarter. This has now been corrected. The forecast outturn rating was not affected and remains at 4.
Key Budget Highlights The July postion reflects increased agency and drug costs, provisions for costs associated with Transformation and Foundation Trust project work and backlog maintenance.
The contract income includes provision for contract penalties, which at this early stage of the contract can only be an estimate.
The high cost drugs budgets now include adjustments for over-performance.
Risks & Opportunities Peformance monitoring will be key to maintaining income and minimising contract penalties, regular review with PCT at SLA meeting.
Savings targets are proactively monitored through Directorate Performance Reviews and as part of Transformation programme to ensure CIP targets are met.
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West Suffolk Hospitals NHS Trust Finance & Workforce Report July 2009
WEST SUFFOLK HOSPITAL FINANCIAL RISK RATING (FRR - SHA model)
Financial Risk Ratings Month Jul-09
Full year outturn
Actual YTD forecast
Annual Risk Risk
Plan rating Score ratings Score ratings
Criteria Metric Weight 5 4 3 2 1 09/10 09/10 09/10 09/10 09/10
Underlying 3 8.1% 3 7.6% 3
performance EBITDA margin % 25% 11 9 5 1 <1
Achievement of 5 129.4% 5 97.6% 4
plan EBITDA achieved % 10% 100 85 # 70 50 <50
Financial 5 7.9% 5 7.9% 5
efficiency Return on assets % 20% 6 5 3 2 <-2
5 2.8% 4 2.2% 4
I&E surplus margin % 20% 3 2 1 -2 <-2
5 32.8 4 32.8 4
Liquidity Liquid ratio days 25% 60 25 15 10 <10
4.50 4.05 3.95
Average
Overriding 0 0 0
rules Overriding rules At least one criteria on Plan 1 or 2
5 4 4
Overall rating Overall rating
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West Suffolk Hospitals NHS Trust Finance & Workforce Report July 2009
INCOME AND EXPENDITURE ACCOUNT
FOUR MONTHS TO END JULY 2009
BUDGET YEAR TO DATE Previous FORECAST
Month
£000's Full Year Actual Budget Variance Variance Full Year
Health Authorities
I Primary Care Trusts (127,239) (44,235) (41,939) 2,295 1,322 (133,488)
N
Other Patient related income (1,248) (781) (416) 366 290 (1,680)
C
Income From Patient Activities (128,487) (45,016) (42,355) 2,661 1,612 (135,168)
O
M
E Other Operating Income (11,205) (4,339) (3,825) 514 368 (12,417)
TOTAL INCOME (139,692) (49,355) (46,180) 3,175 1,980 (147,585)
#REF! #REF! #REF! (147,585)
NHS Staff 94,957 30,813 31,334 521 331 94,695
E E Agency Staff 183 868 108 (760) (589) 1,582
X Total Pay 95,140 31,681 31,442 (239) (258) 96,276
P
E Drugs 9,941 3,728 3,682 (46) (27) 10,740
N Supplies 11,362 3,899 3,809 (89) (5) 11,688
D Other Expenses 13,018 6,383 3,673 (2,710) (1,319) 16,599
I Depreciation 4,237 1,412 1,412 1 1 4,237
T Total Non Pay 38,559 15,421 12,576 (2,845) (1,350) 43,264
U
R TOTAL OPERATING EXPENSES 133,699 47,102 44,018 (3,084) (1,608) 139,539
Finance Costs (PDC Dividend & Interest) 2,993 1,011 998 (13) (11) 3,042
IN-YEAR SURPLUS/(DEFICIT) 3,000 1,242 1,164 78 361 5,004
Non Recurring Items 0 2 0 (2) (2) 2
RETAINED SURPLUS/(DEFICIT) 3,000 1,240 1,164 76 359 5,002
COMMENTS ON YEAR-TO-DATE VARIANCES:
▪Contract income for Juy is estimated.The SLA income budget has been phased on the basis of last year actual
profile. The high favourable variance is due to the prudent approach taken in setting the contract income budget.
(This budget will be represented for the August report)
▪ Pay costs overall are 0.75% above budget. Agency costs continue to be incurred to cover vacancies and
absence both in medical and non-medical staff groups.
▪ The adverse variance on Other Expenses is due to the inclusion of provisions and the phasing of reserves
budgets. This will also be reviewed on confirmation of SLA contract value and subsequent reprview of the budget
in September.
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West Suffolk Hospitals NHS Trust Finance & Workforce Report July 2009
PERFORMANCE SUMMARIES
The following schedules show the financial and workforce performance for the whole Trust and each of the directorates.
Activity is for the period to June 09 and variances are based on an estimated profile.
The Trust currently forecasts to achieve the budget surplus of £3m.
Budget adjustments for additional high cost drugs costs above the SLA value are now reflected in the cumulative variances stated.
TRUST Financial Performance Contract Performance Workforce Performance
Same
Last period Last Same
July 2009 £000 Current month Last year June 2009 £000 month period Last July 2009 £000 Same
Variance to Variance Variance variance Actual to Variance year Actual to Last period
Budget % % % date Variance % % variance % date month Last year
Income 3,175 6.9% 5.8% -13.2% SLA Activity (No.) 622,557 3.2% 8.3% N/A Employed WTE 2242.9 2253.9 2187.0
Pay (239) -0.8% -1.1% -1.8% Sickness Rates (June) 3.5% 3.4% 4.2%
Non-Pay (1,363) -8.6% -12.2% -40.5% SLA Income (£000) 32,302 6.4% 5.7% N/A Mat Leave 3.2% 3.0% 1.6%
Net Total 1,573 79.8% 79.8% -11.8% Vacancy level (wte) 239.56 211.11 207.56
Temp Staff % of Total Pay 6.9% 6.7% 6.4%
CIPs 267 18.2% 18.9% 22.9% Agency Staff (£000's) 868 667 596
NHS Locum/Bank Staff (£000's) 1,332 916 1,223
Forecast Variance Forecast Variance
FULL YEAR 2009/10 £000 FULL YEAR 2009/10 £000
outturn Budget Variance % outturn Budget Variance %
Net Total (Surplus)/Deficit (3,000) (3,000) 0 0.0% SLA Activity (No.) 2,501,580 2,400,134 101,446 4.2%
CIPs 4,618 3982 636 16.0% SLA Income (£000) 132,805 126,980 5,825 4.6%
The Trust has generated a surplus of £1,240k, £76k (6.5%) above budget, due to income above current plan. Pay costs are 0.76%
above budget, although these costs include £934k of medical locum and agency. Non-pay costs are generally on or below budget,
except drugs and other expenses which includes provisions for costs associated with Transformation and Foundation Trust associated
work, and backlog maintenance.
Overall nursing staff costs are 1.8% below budget. Medical staff costs (incl. agency) are 3.5% over budget.
The Trust currently employs 2242.9 WTE staff, an decrease of 11 WTE on last month.
There are currently 70.76 WTE (86 headcount) employees on maternity leave, compared to 34.11 WTE (44headcount) for the same
period last year. There are several areas of the hospital where the high level of maternity leave could impact on service delivery and
are therefore back filled through temporary staffing
Green Variance at >0%
Amber Variance at 0% >< -2%
Red Variance at > -2% 6
West Suffolk Hospitals NHS Trust Finance & Workforce Report July 2009
Surgery Directorate
SURGERY Financial Performance Contract Performance Workforce Performance
Same
Last period Last Same
July 2009 £000 Current month Last year June 2009 £000 month period Last July 2009 £000 Same
Variance to Variance Variance variance Actual to Variance year Actual to Last period
Budget % % % date Variance % % variance % date month Last year
Income 76 10.9% 13.4% -24.1% SLA Activity (No.) 34,216 12.0% 8.6% N/A Employed WTE 521.6 524.8 534.9
Pay (242) -2.8% -2.4% -5.5% Sickness Rates (June) 3.0% 2.7% 4.8%
Non-Pay (103) -3.6% -2.7% -8.2% SLA Income (£000) 11,877 11.9% 6.7% N/A Mat Leave 3.8% 3.0% N/A
Net Total (269) -2.5% -1.8% -5.8% Vacancy level (wte) 65.2 52.9 30.0
Temp Staff % of Total Pay 6.5% 5.7% 4.3%
CIPs (182) -56.0% -54.5% -27.4% Agency Staff (£000's) 290 199 73
NHS Locum/Bank Staff (£000's) 294 187 292
Forecast Variance Forecast Variance
FULL YEAR 2009/10 £000 FULL YEAR 2009/10 £000
outturn Budget Variance % outturn Budget Variance %
Net Total Expenditure 33,463 32,716 (748) -2.3% SLA Activity (No.) 134,163 134,163 0 0.0%
CIPs 630 976 (346) -35.5% SLA Income (£000) 42,784 42,784 0 0.0%
Outpatient demand continues to rise. Analysis of the prior 2 years and 1st Quarter 09/10 has shown a step increase year on year. Additional outpatient sessions
to manage demand are required in General Surgery, T&O, ENT, Ophthalmology and Oral Surgery. New to follow up ratios are being addressed in General
Surgery, Urology and Oral. The number of procedures being undertaken in outpatients has also increased in General Surgery, ENT and Ophthalmology. There
is also a Suffolk wide increase in non-elective ENT. It is planned to improve capacity in T&O and Ophthalmology through recruiting additional consultant/clinical
staff later in the year.
Non-SLA income for the month was better than budget due to invoices for the use of medical staff £55k, SLA Income £6k and Private Patients of £15k. Pay
was more than budget primarily as a result of medical staff £178k due to extra session payments, Prof. & Tech agency cost £52k, and nursing bank £104k but
partially offset by £93k from vacancies. Non-Pay exceeds the budget £58k for contracted work – plastics, ENT, and dental. MSE was over by £70k due to
equipment replacements in theatres. Savings were achieved in purchasing hearing aids £21k.
Sickness/absence and maternity leave rates have increased on the inpatient wards, along with an increase in vacancy level necessitating backfill from bank.
The use of agency staff was at a cost of £187k for junior medical staff (Urology, T&O, ENT) and £54k for consultants (Anaesthetics). A further £37k was for the
plaster orderly in the Fracture Clinic (long term sick and subsequent retirement) plus £12k admin. Locum cost were £158k, primarily in Anaesthetics for
consultant cover and bank usage was £104k for nurses and £27k medical secretaries to cover bank holidays, sickness, maternity leave and vacancies.
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West Suffolk Hospitals NHS Trust Finance & Workforce Report July 2009
Medicine Directorate
MEDICINE Financial Performance Contract Performance Workforce Performance
Same
Last period Last Same
July 2009 £000 Current month Last year June 2009 £000 month period Last July 2009 £000 Same
Variance to Variance Variance variance Actual to Variance year Actual to Last period
Budget % % % date Variance % % variance % date month Last year
Income 140 13.9% 14.5% -28.2% SLA Activity (No.) 38,803 18.7% 18.6% N/A Employed WTE 640.5 650.3 614.3
Pay (277) -3.1% -3.0% -4.2% Sickness Rates (June) 4.0% 3.3% 4.2%
Non-Pay (156) -4.7% -2.9% -5.0% SLA Income (£000) 10,784 9.9% 9.7% N/A Mat Leave 3.8% 3.9% N/A
Net Total (293) -2.6% -1.9% -3.7% Vacancy level (wte) 61.19 63.37 64.83
Temp Staff % of Total Pay 8.6% 8.4% 9.5%
CIPs 127 33% 55.5% 88.0% Agency Staff (£000's) 307 242 360
NHS Locum/Bank Staff (£000's) 498 350 442
Forecast Variance Forecast Variance
FULL YEAR 2009/10 £000 FULL YEAR 2009/10 £000
outturn Budget Variance % outturn Budget Variance %
Net Total Expenditure 34,793 33,386 (1,407) -4.2% SLA Activity (No.) 143,139 143,139 0 0.0%
CIPs 1,744 1116 628 56.3% SLA Income (£000) 53,325 53,325 0 0.0%
• The Directorate overspent in the month by £110k, taking the year to date overspend to £293k.
• ‘Other Income’ was over recovered by £27k in the month .
• The overspend on pay (£55k) has reduced as predicted. There was a fairly even split of additional expenditure between medical staff and nursing.
The medical staff covering junior doctors absence and vacancies across the Directorate and in A&E. Nursing expenditure – bank and agency – was
required to ensure core ward staffing levels across four areas. The Directorate has had to use nursing agencies as the bank have been unable to fill
all the vacant shifts. Aggressive recruitment to vacancies – medical and nursing – continues.
• Non-pay expenditure was the biggest contributor to the overspend - £82k in the month. Contributors to this include :
• Mobile Angiography suite – at a higher rate than budgeted, to ensure newer and more resilient equipment – covered by SLA income
• ECG machine in A&E – to replace condemned equipment
• Lease and consumables for blood analysers in A&E and EAU as part of the programme of improvement in Emergency services
• Charges for consumables, PICC lines etc.
• Drug expenditure budget has been estimated and will be adjusted as necessary next month.
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West Suffolk Hospitals NHS Trust Finance & Workforce Report July 2009
CLINICAL SUPPORT
Clinical Support Directorate
Financial Performance Contract Performance Workforce Performance
Same
Last period Last Same
July 2009 £000 Current month Last year June 2009 £000 month period Last July 2009 £000 Same
Variance to Variance Variance variance Actual to Variance year Actual to Last period
Budget % % % date Variance % % variance % date month Last year
Income 97 17.2% 16.4% -1.6% SLA Activity (No.) 538,026 1.9% -3.5% N/A Employed WTE 429.5 428.1 407.3
Pay 195 3.6% 3.5% 5.0% Sickness Rates (June) 3.0% 3.4% 3.5%
Non-Pay (184) -9.7% -9.9% -7.0% SLA Income (£000) 4,136 24.1% 7.3% N/A Mat Leave 3.2% 3.6% N/A
Net Total 108 1.6% 1.4% 2.2% Vacancy level (wte) 44.26 45.12 53.19
Temp Staff % of Total Pay 5.4% 5.6% 5.7%
CIPs 137 41.4% 39.3% 10.4% Agency Staff (£000's) 149 127 48
NHS Locum/Bank Staff (£000's) 136 92 225
Forecast Variance Forecast Variance
FULL YEAR 2009/10 £000 FULL YEAR 2009/10 £000
outturn Budget Variance % outturn Budget Variance %
Net Total Expenditure 20,296 20,451 155 0.8% SLA Activity (No.) 2,079,505 2,079,505 0 0.0%
CIPs 1,154 876 278 31.7% SLA Income (£000) 10,115 10,115 0 0.0%
• The directorate underspent this month by £37k: pay costs and income underspent, whilst nonpay overspent – as per the previous months.
• The Early Intervention Team pilot period ended in A&E however SCH have approached the Trust to continue the current service for 3 yrs on an SLA
basis - formal negotiations are currently taking place.
• Locum cover continues in Microbiology prior to the new consultant starting in September. The advert for the appointment of a fifth Histopathologist is
out and locum cover is imminent – in the interim current demand is being managed with ongoing agency costs – proportionally higher this month to
cover the summer leave period. The shared Chemical Pathologist post with Addenbrookes becomes vacant this month when the postholder leaves for
a fulltime position at Addenbrookes. Interim cover has been agreed for the service from Ipswich whilst longer term plans are agreed . Additional
sessions in Radiology continue to be incurred in order to meet continued demand to bring down waiting lists in MRI, CT and Ultrasound.
• Vacancies in Physiotherapy, Occupational Therapy, Radiology and Pharmacy continue to result in the pay underspend. Plans are progressing to
move establishment from posts that continue to be difficult to fill to other service areas which require additional resource. Departments are having to
resort to temporary agency cover as a measure to ensure continued service delivery pending appointments and students qualifying over the summer.
• Chemicals in Pathology continue to be overspent but this also includes £16k for additional blood products – currently being verified. Specialist
equipment costs increased due to the purchase of urology equipment ahead of the new endoscopy unit opening this month.
• Addenbrookes radiology charges - services received continue to overspend although the charges are being discussed with Addenbrookes. Provision
continues to be made for Speech and Language Therapy, anticipating additional costs for the Stroke/Thrombolysis service. To date no credits have
been received on the Blood Transfusion contract.
• The Directorate continues to forecast an underspend for year end.
9
West Suffolk Hospitals NHS Trust Finance & Workforce Report July 2009
Woman & Child
WOMAN & CHILD Financial Performance Contract Performance Workforce Performance
Same
Last period Last Same
July 2009 £000 Current month Last year June 2009 £000 month period Last July 2009 £000 Same
Variance to Variance Variance variance Actual to Variance year Actual to Last period
Budget % % % date Variance % % variance % date month Last year
Income 282 91.5% 103.3% 2.8% SLA Activity (No.) 10,817 -2.7% -17.2% N/A Employed WTE 213.6 213.5 197.4
Pay (16) -0.5% -0.7% 0.7% Sickness Rates (June) 3.1% 4.2% 6.5%
Non-Pay 22 6.3% 15.2% -6.5% SLA Income (£000) 4,721 -15.5% -20.1% N/A Mat Leave 3.8% 3.8% N/A
Net Total 287 8.4% 10.2% 0.0% Vacancy level (wte) 14.85 10.29 27.03
Temp Staff % of Total Pay 7.1% 6.7% 5.1%
CIPs 12 9.2% 0.9% -25.7% Agency Staff (£000's) 36 29 25
NHS Locum/Bank Staff (£000's) 204 140 137
Forecast Variance Forecast Variance
FULL YEAR 2009/10 £000 FULL YEAR 2009/10 £000
outturn Budget Variance % outturn Budget Variance %
Net Total Expenditure 9,958 10,416 (458) 4.4% SLA Activity (No.) 43,326 43326 0 0.0%
CIPs 304 304 0 0.0% SLA Income (£000) 20,736 20736 0 0.0%
The favourable variance to budget is driven mainly by £60.6k in vacant positions, £15.9k in lower drug cost, £6.6k less rent of community
midwifery clinic space, £12.7k in transport cost due to last year credits received, additional USAF income of £244.4k and £38.1k from EWTD
funds. These savings were partially offset by extra session payments of £26.8k and £50.0k for the wards’ bank usage.
Activity data reflects a significant increase in gynaecology referrals over last year and recorded activity is 38.4% up year-on-year through July.
Paediatric referrals are up 13.6% but recorded activity is down by 7.8% primarily due to no longer having the gastroenterology patients.
Activity vs the SLA through June is down mainly in midwifery and obstetrics will be under review in relation to the SLA targets in the contract.
Sickness rates have improved from the March position but maternity leave remains high. Use of bank staff (£142.2k) reflects continued
demand for cover mainly due to mat leave and long term sick. Paediatrics have used agency/locum staff to support the service including
vacancy cover for the hybrid consultant posts, although part of this cost is offset by additional EWTD income (£38.1k).
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West Suffolk Hospitals NHS Trust Finance & Workforce Report July 2009
FACILITIES Financial Performance
Facilities
Contract Performance Workforce Performance
Same
Last period Last Same
July 2009 £000 Current month Last year June 2009 £000 month period Last July 2009 £000 Same
Variance to Variance Variance variance Actual to Variance year Actual to Last period
Budget % % % date Variance % % variance % date month Last year
Income 25 2.8% 2.0% -1.7% SLA Activity (No.) Employed WTE 261.6 261.0 267.36
Pay 22 1.0% -3.0% -6.4% Sickness Rates (June) 4.5% 5.5% 3.9%
Non-Pay 249 12.1% 12.9% -10.8% SLA Income (£000) Mat Leave 0.3% 0.3% N/A
Net Total 296 8.4% 6.3% -10.2% Vacancy level (wte) 21.97 18.59 13.75
Temp Staff % of Total Pay 8.6% 8.3% 7.8%
CIPs 97 78.9% 67.0% 54.9% Agency Staff (£000's) 22 15 72
NHS Locum/Bank Staff (£000's) 178 129 106
Forecast Variance Forecast Variance
FULL YEAR 2009/10 £000 FULL YEAR 2009/10 £000
outturn Budget Variance % outturn Budget Variance %
Net Total Expenditure 10,751 10,768 (17) 0.2% SLA Activity (No.)
CIPs 401 367 34 9.3% SLA Income (£000)
Income has continued to improve in Catering (£19k) and accommodation charges (£5k).
Pay
Housekeeping - overspend has been reduced through provision of additional budget to meet compliance with Standards for National Cleanliness.
SSD – underspend (£8k) as a result of vacancies.
Estates – underspend (£15k) as a result of vacancies.
Non Pay is generally under spending across the directorate as some non essential spend was held back until July as requested.
Some key areas of under spend - Estates (£25k), EBME (£35k), SSD (£15k) & Purchasing (£10k) - service contracts, phasing of budget in line with timing of
contracts is required.
Utilities (£73k), lower tariffs & operation of CHP.
Switchboard (£9k) – telephone calls reduced by installation of GSM gateway (fixed calls to mobiles)
Workforce
Sickness has improved from last month. Two members of staff on long term sick have now left the trust.
11
West Suffolk Hospitals NHS Trust Finance & Workforce Report July 2009
Corporate
CORPORATE Financial Performance Contract Performance Workforce Performance
Same
Last period Last Same
July 2009 £000 Current month Last year June 2009 £000 month period Last July 2009 £000 Same
Variance to Variance Variance variance Actual to Variance year Actual to Last period
Budget % % % date Variance % % variance % date month Last year
Income 320 38.7% 32.6% 2.2% SLA Activity (No.) Employed WTE 161.2 161.2 150.1
Pay 68 3.1% 1.6% 3.1% Sickness Rates (June) 1.8% 1.6% 2.6%
Non-Pay (691) -41.9% -47.3% 34.1% SLA Income (£000) Mat Leave 0.3% 0.6% N/A
Net Total (303) -5.7% -8.9% 0.4% Vacancy level (wte) 30.64 19.40 19.70
Temp Staff % of Total Pay 3.2% 2.9% 4.1%
CIPs 73 46.5% 18.0% 36.1% Agency Staff (£000's) 38 29 51
NHS Locum/Bank Staff (£000's) 30 17 25
Forecast Variance Forecast Variance
FULL YEAR 2009/10 £000 FULL YEAR 2009/10 £000
outturn Budget Variance % outturn Budget Variance %
Net Total Expenditure 16,223 15,961 262 -1.6% SLA Activity (No.)
CIPs 368 343 25 7.3% SLA Income (£000)
• Corporate report is a consolidation of Finance and Information, Human Resources and Communications, Medical Director, Nursing
and Governance, Trust Office and Overhead Directorates. Reserves are excluded from this report.
• Agency and bank staff are still being used in Finance, but the overall pay variance is favourable, due to delays in recruitment.
• The Income variance is favourable due mainly to RTA (£125k) income and Eastern Deanery funding (55k) and some central
funding for Corporate projects, which have associated unbudgeted costs.
• Overheads include a budget for Collaborative Hub led savings, while these will savings actually arise throughout the Trust. The non-
pay variance also includes provisions for consultancy work associated with Transformation and Foundation Trust projects.
•The sickness and maternity rates remain below the overall Trust rates.
12
West Suffolk Hospitals NHS Trust Finance & Workforce Report July 2009
2009/10 CIP REPORT as at 31st July 2009
COST SAVINGS ACHIEVED - To date TOTAL COST SAVINGS - Full year
% Original %
Directorate £000 Target Actual Variance Projected Variance
Variance target Variance
Woman and Child 130 131 1 1% 304 304 - 0%
Surgery 325 193 (133) -41% 976 630 (346) -35%
Facilities 123 182 60 49% 351 401 49 14%
Finance and Information 60 84 24 40% 115 140 25 22%
HR and Communications 9 13 4 42% 18 23 5 28%
Nursing and Governance 7 15 7 103% 7 15 8 104%
Medical Director 3 2 (0) -4% 8 9 2 20%
Trust Office 25 62 38 152% 34 43 9 26%
Overheads 53 53 - 0% 160 160 - 0%
Operations 15 19 4 26% 17 23 6 36%
Clinical Support 331 468 137 42% 876 1,142 266 30%
Medicine 388 515 127 33% 1,116 1,495 380 34%
TOTAL 1,469 1,738 269 18% 3,982 4,385 403 10%
TOTAL COST SAVINGS -
SUMMARISED CIP TYPE COST SAVINGS ACHIEVED - To date
Projected - Full year (£'000s)
Non-
Projection Recurrent Non-recurrent Recurrent Total
recurrent
Target Actual Target Actual
PAY 543 612 413 554 1,716 1,093 2,809
AGENCY/BANK 54 28 5 5 126 15 141
DRUGS 34 40 - - 109 - 109
CLINICAL SUPPLIES 41 28 - - 108 - 108
OTHER NON-PAY 299 338 77 127 966 237 1,203
IT COSTS 4 7 - - 15 - 15
TOTAL 975 1,052 494 686 3,041 1,344 13
4,385
West Suffolk Hospitals NHS Trust Finance & Workforce Report July 2009
Summary Service Line Report for June 2009
Specialty Summary Report Specialty Summary Report Specialty Summary Report
Period to 30th June 2009 Period to 30th June 2009 Period to 30th June 2009
Actual Budget Variance
Total Income to Total Total Income to Total Total Income to Total
Surplus / Surplus / Surplus /
cover Specialty Expenditure cover Specialty Expenditure cover Specialty Expenditure
Deficit Deficit Deficit
Costs after CRES Costs after CRES Costs after CRES
Surgical Directorate Surgical Directorate Surgical Directorate
General Surgery 2,838,811 3,207,805 (368,994) General Surgery 2,748,094 3,174,899 (426,805) General Surgery 90,717 32,906 57,811
Urology 1,070,846 1,217,743 (146,897) Urology 972,419 1,188,451 (216,032) Urology 98,427 29,291 69,135
Trauma & Orthopaedics 4,300,793 3,838,223 462,570 Trauma & Orthopaedics 3,983,723 3,815,813 167,910 Trauma & Orthopaedics 317,070 22,410 294,660
Ear, Nose & Throat 1,176,498 845,817 330,681 Ear, Nose & Throat 748,613 760,475 (11,862) Ear, Nose & Throat 427,885 85,342 342,543
Ophthalmology 1,908,002 1,342,664 565,338 Ophthalmology 1,463,912 1,307,743 156,168 Ophthalmology 444,091 34,921 409,170
Dental Surgery 284,835 235,390 49,445 Dental Surgery 242,338 241,943 396 Dental Surgery 42,496 (6,553) 49,049
Plastic Surgery 276,245 198,950 77,295 Plastic Surgery 194,523 169,105 25,418 Plastic Surgery 81,722 29,845 51,877
Thoracic Surgery 5,076 5,963 (887) Thoracic Surgery 4,861 3,286 1,575 Thoracic Surgery 215 2,677 (2,462)
Total Surgical Directorate 11,861,106 10,892,555 968,551 Total Surgical Directorate 10,358,484 10,661,716 (303,232) Total Surgical Directorate 1,502,622 230,839 1,271,783
Medical Directorate Medical Directorate Medical Directorate
General Medicine 3,784,536 3,427,696 356,840 General Medicine 3,981,010 3,330,725 650,285 General Medicine (196,475) 96,971 (293,446)
Geriatric Medicine 2,646,775 3,284,003 (637,229) Geriatric Medicine 3,391,917 3,296,455 95,462 Geriatric Medicine (745,143) (12,452) (732,691)
Cardiology 711,681 629,337 82,344 Cardiology 373,320 612,149 (238,829) Cardiology 338,361 17,188 321,173
Coronary CU 8,467 224,008 (215,541) Coronary CU 1,920 217,713 (215,793) Coronary CU 6,547 6,295 252
Clinical Haematology 795,787 650,962 144,825 Clinical Haematology 570,813 646,566 (75,753) Clinical Haematology 224,973 4,396 220,577
Dermatology 422,002 400,251 21,752 Dermatology 467,904 408,483 59,420 Dermatology (45,901) (8,233) (37,669)
Thoracic Medicine 416,128 606,126 (189,998) Thoracic Medicine 421,501 626,626 (205,124) Thoracic Medicine (5,374) (20,500) 15,126
GU Medicine 354,463 340,847 13,616 GU Medicine 369,071 356,458 12,613 GU Medicine (14,608) (15,612) 1,003
Neurology 181,819 180,210 1,608 Neurology 163,074 181,182 (18,108) Neurology 18,745 (971) 19,716
Rheum 630,617 744,701 (114,084) Rheum 783,108 727,673 55,435 Rheum (152,491) 17,028 (169,519)
Clinical Oncology 933,999 914,153 19,845 Clinical Oncology 695,506 901,284 (205,778) Clinical Oncology 238,493 12,870 225,623
Pain 133,172 142,575 (9,404) Pain 186,520 151,809 34,712 Pain (53,348) (9,233) (44,115)
A&E 1,001,512 1,784,067 (782,556) A&E 1,058,871 1,698,450 (639,579) A&E (57,360) 85,617 (142,977)
Total Medical Directorate 12,020,956 13,328,938 (1,307,981) Total Medical Directorate 12,464,537 13,155,573 (691,035) Total Medical Directorate (443,581) 173,365 (616,946)
Woman & Child Woman & Child Woman & Child
Maternity Services Maternity Services Maternity Services
Obstetrics 996,421 737,320 259,101 Obstetrics 1,761,517 734,848 1,026,669 Obstetrics (765,096) 2,472 (767,568)
Midwifery 703,384 820,440 (117,056) Midwifery 710,350 830,123 (119,773) Midwifery (6,966) (9,683) 2,717
Community Midwifery 325,110 480,213 (155,104) Community Midwifery 343,792 484,701 (140,909) Community Midwifery (18,683) (4,488) (14,195)
Ante Natal 24,022 268,177 (244,155) Ante Natal 24,491 271,847 (247,356) Ante Natal (469) (3,670) 3,201
Total 2,048,936 2,306,150 (257,214) Total 2,840,150 2,321,520 518,631 Total (791,214) (15,369) (775,845)
Children's Services Children's Services Children's Services
Paediatrics 1,037,174 822,715 214,459 Paediatrics 914,238 832,163 82,075 Paediatrics 122,936 (9,449) 132,384
SCBU 653,307 458,209 195,099 SCBU 446,389 471,478 (25,089) SCBU 206,918 (13,269) 220,188
Total 1,690,481 1,280,924 409,558 Total 1,360,627 1,303,641 56,986 Total 329,854 (22,718) 352,572
Gynaecology 1,079,100 956,638 122,462 Gynaecology 818,334 937,972 (119,637) Gynaecology 260,765 18,666 242,100
Total Woman & Child 4,818,517 4,543,712 274,806 Total Woman & Child 5,019,112 4,563,133 455,979 Total Woman & Child (200,594) (19,421) (181,174)
Other Support Services Other Support Services Other Support Services
including Critical Care, Direct 3,164,544 2,246,239 918,305 including Critical Care, Direct 3,344,550 2,311,534 1,033,016 including Critical Care, Direct (180,006) (65,295) (114,711)
Access and Block Items Access and Block Items Access and Block Items
Trust Total 31,865,123 31,011,443 853,680 Trust Total 31,186,683 30,691,955 494,728 Trust Total 678,441 319,489 358,952
The above table shows financial performance by main specialty lines for the period to June 09. Surgery performance shows a
better than budget position, partly due to the conservative income budget set, and the impact of HRG 4 pricing which indicates
a switch between elective and non-elective tariff prices. Although activity is above plan in Medicine specialties, costs are
exceeding income. Actual income and costs for Woman and Child Directorate and the ‘Other Support Service’ areas are
broadly in line with the budget. The SLR above reflects the published June financial information.
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BALANCE SHEET AS AT 31 JULY 2009
March 2009 July 2009 Forecast March 2010
£000's £000's £000's £000's £000's £000's
FIXED ASSETS:
Tangible Fixed Assets 77,989 77,098 78,887
CURRENT ASSETS:
Stocks and work in progress 2,157 2,149 2,137
Debtors
NHS Debtors 3,412 2,191 1,512
Non NHS Trade debtors 732 618 682
Provision for impairment of debtors (96) (96) (96)
Prepayments 687 1,226 687
Other debtors 1,147 681 997
5,882 4,620 3,782
Cash at bank and in hand 5,862 11,333 9,975
TOTAL CURRENT ASSETS 13,901 18,102 15,894
CREDITORS:
Current Installments on loans (1,650) (1,650) (1,650)
NHS Creditors (1,775) (2,894) (1,859)
Non NHS trade creditors - Revenue (1,650) (667) (1,200)
Non NHS trade creditors - Capital (734) (195) (1,999)
Tax and Social security (1,932) (1,952) (1,990)
Other Creditors and Accruals (4,267) (6,888) (5,183)
Deferred Income (3,536) (3,357) (3,493)
CURRENT LIABILITIES (15,544) (17,603) (17,374)
West Suffolk Hospitals NHS Trust
NET CURRENT ASSETS/(LIABILITIES) (1,643) 499 (1,480)
TOTAL ASSETS LESS CURRENT LIABILITIES 76,346 77,597 77,407
CREDITORS:
Loans falling due after more than one year (3,500) (3,500) (1,850)
Provision for Liabilities and Charges (393) (404) (404)
TOTAL ASSETS EMPLOYED 72,453 73,693 75,153
TAXPAYERS EQUITY:
Public dividend capital 58,250 58,250 58,250
Revaluation reserve 15,874 15,874 15,874
Donated asset reserve 3,665 3,665 3,365
Income and expenditure reserve (5,336) (4,096) (2,336)
TOTAL TAXPAYERS EQUITY 72,453 73,693 75,153
KPI Mar 2009 Apr 2009 May 2009 Jun 2009 Jul 2009
Trade debtor days - NHS 3.7 3.9 6.0 4.1 5.1
Trade debtor days - Non NHS 121.1 70.4 77.6 41.1 46.6
Trade creditor days 12.8 16.7 5.1 0.2 1.3
Non NHS invoices paid within 10 days (%) 2.8 53.6 47.8 55.8 55.4
The balance sheet reflects the position of the Trust as at 31 July 2009 and the forecast as at 31 March 2010. The main areas for
consideration are:-
Fixed assets - The movements reflect the value of the capital programme less the depreciation charge. No indexation of fixed
assets has been assumed as there is insufficient guidance to determine what the likely change in values will be. The Trust is
currently in the process of revaluing its land and buildings using the District Valuation Service.
Debtors - The main change from the start of the year relates to the level of overperformance invoices included within NHS debtors.
These have now been received and reflect a more normal level of debtors. All other debtors remain consistent with the start of the
year. Included within debtors there is a total of £503k in relation to the Collaborative Procurement Hub, £381k of this related to recent
quarterly invoicing.
Cash and bank - The level of cash remains high and will continue at this level. The main reason for this is the reciept of
underperformance invoices and the increase in non trade creditors (principally capital - as projects have a delayed start and therefore
Finance & Workforce Report July 2009
invoices are likely to be accrued at the year end).
Creditors and loans - As noted above capital creditors will be high at the year end. The level of loans will decrease reflecting the
agreed repayment schedule. In line with Government request the Trust is paying SMEs within 10 days where possible. There are a
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number of revenue creditors in relation to the CPH these are relatively small. The reserve in relation to the CPH surplus of income
over expenditure totalling £1,237K is held within other creditors
West Suffolk Hospitals NHS Trust Finance & Workforce Report July 2009
West Suffolk Hospitals - Rolling cash forecast to 31 March 2011
ACTUAL FORECAST FORECAST FORECAST
£000
QTR to JUNE QTR to SEPT QTR to DEC QTR to MAR FULL YEAR FULL YEAR
2009 JULY AUG SEPT 2009 2009 2010 2009/10 QTR to JUNE QTR to SEPT QTR to DEC QTR to MAR 2010/11
INCOME
BAL B/FWD 5,858 10,417 11,329 11,921 10,417 10,186 10,711 5,858 9,975 10,632 10,750 10,211 9,975
NHS Clinical Income 34,570 11,342 10,256 10,256 31,854 30,768 30,768 127,960 31,050 31,050 31,050 31,050 124,200
Other NHS Income 3,403 607 685 685 1,977 2,070 2,070 9,520 2,125 2,130 2,130 2,130 8,515
Loan/PDC advance 0 0 0 0 0 0 0 0 0 0 0 0 0
Income Generation 292 103 93 93 289 279 279 1,139 294 294 294 294 1,176
RTA 150 27 21 21 69 63 63 345 63 63 63 63 252
Interest 2 3 15 15 33 45 45 125 45 45 45 45 180
Misc Other 1,865 695 323 322 1,340 968 968 5,141 1,023 1,018 1,018 1,018 4,077
Disposal of Property 0 0 0 0 0 0 0 0 0 0 0 0 0
TOTAL INCOME 40,282 12,777 11,393 11,392 35,562 34,193 34,193 144,230 34,600 34,600 34,600 34,600 138,400
EXPENDITURE
Pay Costs 14,127 4,666 4,666 4,666 13,998 13,998 13,998 56,121 13,740 13,545 13,545 13,545 54,375
Tax/Pension 9,409 3,184 3,031 3,031 9,246 9,093 9,093 36,841 9,229 9,297 9,297 9,297 37,120
Creditors 7,714 5,575 1,923 1,923 9,421 5,769 5,663 28,567 5,448 5,448 5,448 5,338 21,682
Drugs/Stores/NHS Litigation 4,027 -1,353 1,075 1,075 797 3,225 2,949 10,998 3,549 3,549 3,549 3,267 13,914
PDC Payments 0 0 0 1,372 1,372 0 1,372 2,744 0 1,364 0 1,364 2,728
Interest on loans 0 0 0 124 124 0 102 226 0 83 0 70 153
Capital expenditure 446 -207 106 111 10 1,583 927 2,966 1,977 696 3,300 1,848 7,821
Misc 0 0 0 0 0 0 0 0 0 0 0 0 0
Repayment of loans 0 0 0 825 825 0 825 1,650 0 500 0 500 1,000
TOTAL EXPENDITURE 35,723 11,865 10,801 13,127 35,793 33,668 34,929 140,113 33,943 34,482 35,139 35,229 138,793
BALANCE C/fwd 10,417 11,329 11,921 10,186 10,186 10,711 9,975 9,975 10,632 10,750 10,211 9,582 9,582
The cash flow forecast reflects the actual cash position as at 30 June 2009. The model takes account of the Department of Health loan including its repayment schedule and
interest charges. The Trust is required to report against EFL however relaxation of rules allow for Trust's hold cash balances above it's EFL target. The figure for April includes the
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receipt of overperfomance on contracts up to the end of the financial year. Creditor payments were high as a result of the continued drive to pay small and medium enterprises
quicker and also having five payment runs compared with May that had four payment runs.
West Suffolk Hospital NHS Trust Capital Programme 2009-2010
Revised Total Total
Scheme Budget Expenditure Forecast
2009-10 as at 31 Jul 09 Expenditure
Pre-Commitments (inc 08/09 Contractual Commitments)
Pharmacy Unit/Robotic 1,427,000 100,322 1,427,322
Education Centre - Lecture Theatre 494,000 3,496 493,982
Other costs 707,000 56,949 647,020
Total 2,628,000 160,768 2,568,325
Site Services/Backlog Maintenance
Total 1,023,835 7,647 1,075,835
Clinical Equipment Replacement
Total 274,000 217,445 271,426
Non Clinical Equipment
Total 101,000 12,870 5,474
IM & T
Electronic Rostering (c/fwd 08/09) 128,000 83,345 118,221
West Suffolk Hospitals NHS Trust
NHS Number Interfacing 164,000 13,269 154,552
Additional EPRO Functionality 50,000 5,432 50,743
Contract Management System (Sollis) Development 129,000 0 129,000
Data Warehouse Software Development 145,000 0 145,000
Orders & Results Pathology Development 100,000 0 100,000
Other 325,000 36,678 280,062
Total 1,041,000 138,724 977,578
Development Schemes
Single Sex Accommodation 566,000 80,385 371,385
Other 363,000 0 116,000
Total 929,000 80,385 487,385
Total all Capital projects 5,996,835 617,838 5,386,022
Asset Disposal (land sales) Phase 2 Harps Close 25,000 545 545
Total Commitment 6,021,835 618,383 5,386,567
Capital Funding 4,237,000
Additional External Funding 1,045,000
Capital Expenditure Limit 5,282,000 5,282,000 5,282,000
Under/(Over) Committed -739,835 4,663,617 -104,567
Finance & Workforce Report July 2009
17
This report now reflects the recently agreed capital programme
