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WSET SUFFOLK HOSPITALS NHS TRUST20104794131

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WSET SUFFOLK HOSPITALS NHS TRUST20104794131 Powered By Docstoc
					        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




                                                                                    2
                             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.




                                                                                                                                                                                                            3
                   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




                                                                                                                                                       4
            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.

                                                                                                                                                    5
                          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.



                                                                                                                                                                                                        7
                            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.




                                                                                                                                                                                                          8
                          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).




                                                                                                                                                                                                     10
                          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.
                                                                                                                                                                                                                                                       14
                                              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
15




 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

                                                                                                                                                                                                                                                 16
 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

				
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