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									                                                                                     2002/03 Financial Recovery Plan


                      Directorate: Croydon                 Period         9


                                                                        Revised
                                   Action      Action     Action       Year End       Variance     On
                                   (Red)      (Amber)    (Green)       Forecast      at Month 9   Target                                        Original Assumptions

Directorate Position                  (180)        79       (602)               0          848     NO

                                                                                                           Not recruting to various posts (HTT). 2 Fs, 2 Gs, 1 A&C. plus Hear Us post (131k). Non-recurrent
Borough Wide Services                                                      (216)           (91)    NO
                                                                                                           underspends on psychologists and liaison psychiatry.
                                                                                                           Appointment of 6 Grade Gs in community teams (Dower funding), offset by savings in Day Care.
Community Services                                           (26)              58            0     YES
                                                                                                           Reduced to a minimal service.
                                                                                                           £50k income generation from Selhurst Rd, staff savings Selhurst Rd. Overspend in ICU mostly
Inpatient Services                                          (169)          (195)           (23)    NO
                                                                                                           non-recurrent.

Placements:

     Difficult to Place                             79                        257          252     NO      Original forecast expenditure under-estimated. Assertive action to minimise impact.

     Overspill                        (180)                                   334          511     NO      Assertive management of bed situation to eliminate overspill after month 6

Forensic                                                      (5)               5            8     YES     Assume unable to appoint a locum consultant

                                                                                                           Recharge SS for part of Karl von-Buen's salary. LMR, Modern Matron posts frozen (£30k).
General Management                                           (26)              32           43     NO
                                                                                                           PRISM Academic Unit underspend non-recurrent.

Medical                                                            1       (114)           (81)    YES

Drugs                                                              9          227          229     NO

                                                                                                           Increased controls on locum/agency staff. All requests to recruit staff to go through the
Miscellaneous                                                (50)             (50)           0      ?
                                                                                                           management board. All requests for non-mandatory training to go through management board.

Non-Recurrent PCT Funding                                   (336)          (336)             0      ?      Meeting arranged with Angela Gibson




     SOUTH LONDON & MAUDSLEY NHS TRUST                                                            Croydon m5                                                                                      Page 1
                                                                                     2002/03 Financial Recovery Plan


                  Directorate:   CAMHS                  Period                   9


                                                                         Year        Variance
                                 Action      Action     Action           End         at Month        On
                                 (Red)      (Amber)    (Green)         Forecast          9          Target                                          Original Assumptions

Directorate Position                (271)       (58)        51               -            67    ?

3 Year contract Income 02/03                                                                                  3 Year Contract value adjustment from 01/02 to 02/03 to be added to budgets. Further analysis
- Lambeth, Southwark &              (117)                                  (117)         (117) YES           underway, but currently uncertain due to lack of final agreement from ex-LSL PCTs and non-
Lewisham PCTs                                                                                                adherence to agreed SE sector 3 year rolling average.
3 Year contract Income 02/03
                                                                                                              Shortfall on difference between baseline 02/03 funding of £788k for Snowsfield, and agreed cost
- Lambeth, Southwark &              (146)                                  (146)         (120) YES
                                                                                                             of 6 Snowsfield beds at £934k at 02/03 proces.
Lewisham PCTs
                                                                                                              3 Year Contract value adjustment from 01/02 to 02/03 to be added to budgets. Uncertain due to
3 Year contract Income 02/03
                                    (164)                                  (164)           -    ?            lack of final agreement from Croydon PCT and non-adherence to agreed SE sector 3 year rolling
- Croydon PCT
                                                                                                             average.
                                                                                                              All 3 units recosted and equal price set for all Inpatient beds + no intensive option. However, this
Inpatient bed recosting                                        -             -             -
                                                                                                             will not impact on 02/03 income streams.
                                                                                                              Introduction of new guidance and additional Senior control on inpatient wards to reduce use of
CAMHS Nat & Spec Division           (140)                          -       191           115    YES          agency & bank nurses. Snowsfield expected to reduce £20k a month on agency nursing spend
                                                                                                             from month 7.
CAMHS Nat & Spec Division -                                                                                   Non-rec funding from Corporate reserves to maintain Snowsfield at an establishment to support
                                    146                                    146           120    YES
Snowfield                                                                                                    10 beds, whilst income shortfall on LSL beds.

CAMHS Nat & Spec Division -                                                                                   Non-rec funding from Corporate reserves to maintain Adolescent Unit establishment, whilst
                                    150                                    150           117    YES
Adolescent Unit                                                                                              income shortfall on LSL & Croydon contract.
Unaccounted income &                                                                                          Review of expected income (mainly non PCT) & recharges to ensure they are all accounted and
                                                                             -             -
recharges.                                                                                                   received. JR & PM to review.
CAMHS management costs                                      26              (32)           (7) ?             £26k non-rec adjustment in m7, and balance projected as straight line to year end.

Croydon CAMHS                                               25              (90)          (55) ?             Recruitment to some vacant posts, but maintaining underspend position.

Lambeth CAMHS                                                  -            (86)          (62) ?             Straight line projection. Orchard Lodge income anticipated in Mth 8 (£43K)
                                                                                                              £37k YTD overspend relates to placement invoices from 01/02. It is expected that no more
Southwark CAMHS                                 (58)       -                 -             (1) YES
                                                                                                             placement costs will occur in 02/03.
Lewisham CAMHS                                                 -           146            77    YES          Straight line projection.




     SOUTH LONDON & MAUDSLEY NHS TRUST                                                              CAMHS m5                                                                                         Page 2
                                                                                     2002/03 Financial Recovery Plan


                    Directorate: Specialist               Period                 9


                                                                                     Variance
                                  Action       Action     Action    Year End         at Month        On
                                  (Red)       (Amber)    (Green)    Forecast             9          Target                                          Original Assumptions

Directorate Position                  (713)        95       (285)        -               757    NO

3 Year contract Income 02/03 -                                                                               3 Year Contract value adjustment from 01/02 to 02/03 to be added to budgets. Further analysis
Lambeth, Southwark &                   (94)                              (94)              -    YES          underway, but currently uncertain due to lack of final agreement from ex-LSL PCTs and non-
Lewisham PCTs                                                                                                adherence to agreed SE sector 3 year rolling average.
                                                                                                              3 Year Contract value adjustment from 01/02 to 02/03 to be added to budgets. Uncertain due to
3 Year contract Income 02/03 -
                                      (348)                             (348)              -    ?            lack of final agreement from Croydon PCT and non-adherence to agreed SE sector 3 year rolling
Croydon PCT
                                                                                                             average.
                                                                                                              3 year Contract value adjustment from 01/02 to 02/03 to be added to budgets. Further analysis
3 Year contract Income 02/03 -
                                      (101)                             (101)              -    ?            underway, but currently uncertain due to large number of unsigned contracts with National & SE
Other PCTs
                                                                                                             sector PCTs.
                                                                                                             Additional costs from trying to meet waiting time targets (O/P 21 wks by 31st March 03). Costs
Waiting Times targets                             157                   170                65 YES
                                                                                                             only just starting to feed through the accounts.

Waiting Time PCT income               (170)                             (170)              -    ?             Additional income to increase capacity and hit outpatient waiting time targets

                                                                                                              Additional bits of non-rec income expected from both LSL & B,B&G. LSL have confirmed £70k of
Addictions                                                  (108)            -             14 YES
                                                                                                             this in month 5, and B,B&G expected to pay additional FP10 funding.
                                                                                                              A report is currently being reviewed by the 7 PCTs who commission I/P servies to assess a
Addictions Inpatient Review                                                  -             -                 proposal for additional resources to reflect increase in acuity / complexity of caseload. Uncertain
                                                                                                             funding 02/03.
                                                                                                              New MIETS nursing establishment expected to remove nursing variance, however risk transferred
Learning Difficulties                   -                               (161)             105 NO
                                                                                                             to generation of CPC activity to offset additional budget.

MRI & Neuroradiology                                                    (120)            (220) YES            Straight line projection.

National Division                                 (62)                  554               453 YES             Action on inpatient ward nursing spends - to be reviewed.

Pathology Service                                            (70)            -             59 NO              Overspend offset by non-rec reduction on neurophysiology recharges.

                                                                                                              High locum costs expected to reduce from month 6 due to the appointment of 4 new staff.
Pharmacy staffing                                            (40)       308               310 NO             Service will still overspend, but bid will be made for 2 additional posts needed to meet demands of
                                                                                                             recent developments.

Specialist Services Central                                  (67)        (38)             (29) YES            Includes £30k one-off redundancy costs in month 6, but £67k non-rec savings to offset this.




     SOUTH LONDON & MAUDSLEY NHS TRUST                                                              Specialist m5                                                                                     Page 3
                                                                              2002/03 Financial Recovery Plan


                   Directorate: Southwark               Period           9


                                                                    Year      Variance
                                Action       Action     Action      End       at Month       On
                                (Red)       (Amber)    (Green)    Forecast        9         Target                                        Original Assumptions

Directorate Position                 (69)      (221)        75          70          71 YES           Excludes Forensic
Directorate Position                (552)      (221)        75         681         633 YES           Includes Forensic

                                                                                                      A number of posts will be frozen. Use of Ambition agency nurses will cease from mid-Sept. Year
CMHTs (North & South)                                      125           0         -152 YES
                                                                                                     end forecast of break-even across CMHTs.
                                                                                                      Break-even at year-end. The overspill budget is offsetting the Ruskin unit overspend caused by
Guys Inpatients                                 (46)                     0          96 NO            establishment shortfall of 3wte. Budget changes done & posts now established from spare
                                                                                                     overspill budget.
Maudsley Inpatients - Mamora                                                                          Mamora Rd closure end Sept. Budget used to fund current establishment shortfalls (overspends),
                                               (175)                    60         108 NO
Rd closure                                                                                           therefore saving full 6 months of Mamora Rd budget (although some of this transfers to Lambeth).
Maudsley Inpatients -
                                                          (200)       -200         -100 YES          Budget reserve sat in month 12 for ex-EMROC cost centre.
EMROC balance
Maudsley Inpatients -
                                     (15)                               -15          -6 YES          Agreed funding for 3E grades at night, but only 2.5 in budget - Southwark to review 3rd E grade.
Emergency Clinic
                                                                                                      Savings on closure of Dower will be used to buy remaining SCU beds from Lambeth. Therefore
Rehab                                                      (70)          0         110 NO
                                                                                                     break-even year end.
                                                                                                      Inherent budget shortfall + locum + sick leave. Currently vacant = 3 Consultant & 5 staff grade
Clinical Director - Medical                                 50         396         279 YES           posts. Recruitment to vacant posts underway, but additional £90k spend assumed based on worst
                                                                                                     case scenario. £40k new drug funding in m7.
                                                                                                      Unfunded posts, but 50% of the overspend should be split equally between Southwark / CAMHS /
Psychology                           (54)                               23          -26 YES
                                                                                                     Specialist for Munro Clinic cost pressure.
Strat & Dev Mgr - HTT                                      141        -140         -211 YES          Current underspend in HTT is not expected to continue into month 5 due to appointments.

Central Costs                                               18          -42         -11 ?            Admin vacancies on social worker support cost centre.

Occupational Therapy                                        11           -8         -16 YES          Agreed underspend on non-pay.

Forensic - non MDOs                 (197)                   -          360         293 ?             DHU management being improved and impact expected around m6 or 7.

Forensic - MDOs                     (286)                   -          252         269 ?             Forensic placement plan needs to be confirmed.




        SOUTH LONDON & MAUDSLEY NHS TRUST                                                   Southwark m5                                                                                  Page 4
                                                                               2002/03 Financial Recovery Plan


                   Directorate: Older Adults                Period         9


                                                                         Revised      Variance
                                                Action     Action       Year End      at Month
                                Action (Red)   (Amber)    (Green)       Forecast          9       On Target                                   Original Assumptions

Directorate Position                   (478)      (104)      (152)               0         221      NO

                                                                                                              ECT post filled, and income from development forum non-recurrent. I.e. Underspends
Central Services                                                14             (46)          5      NO
                                                                                                              will not continue.
                                                                                                              Implementaion of controls on banks and agency (54K), transfer of Moreland Lodge
                                                                                                              expenditure to capital (£17k) and anticipation of surplus income for Liaison service
Croydon                                 (98)       (74)         46              49         157      NO
                                                                                                              (20k), Amberley Lodge inocme (50k), Underspend in Dementia service is partially non-
                                                                                                              recurr

Drugs                                                               4           35           5      YES

                                                                                                               Improved agency nursing controls and closure of 6 beds on Knights Hill, OT post frozen
Lambeth                                                      (146)               5          65      NO
                                                                                                              from month 5.
                                                                                                               Horizon pushing through increased charge. DN to negotiate with Lewisham PCT to
Lewisham                                                      (12)             288         264      NO
                                                                                                              fund additional payment.
                                                                                                               Southwark PCT to provide additional non-recurrent funding (£380k), OT Post frozen
Southwark                              (380)                  (58)          (301)         (275)      ?
                                                                                                              from month 5 (17k), maintenance expenditure non-recurrent (15k)
                                                                                                               Selective vacancy freeze implemented (£20k) and strict limitations on non-mandatory
Miscellaneous Savings                              (30)                        (30)          0       ?
                                                                                                              training.




     SOUTH LONDON & MAUDSLEY NHS TRUST                                                     Old Adults m5                                                                                  Page 5
                                                                                  2002/03 Financial Recovery Plan


                   Directorate: Lewisham               Period                 9


                                                                   Year           Variance
                                Action      Action     Action      End            at Month        On
                                (Red)      (Amber)    (Green)    Forecast             9          Target                                          Original Assumptions

Directorate Position                (47)        20       (259)        -                182   YES          If rate of forensic underspend is maintained, supporting people funding received &
                                                                                                          recharges to other directorates for special care are confirmed
COS Service                                                12             -             25   NO           Expected to break-even at year end.

Lewisham - Central                                         -          (86)              18   NO           Straight line projection
                                                                                                           Complex recharging arrangements with LBL. MISG funding agreed at £91k, plus £36k funds
Lewisham - Community                                      (95)        (28)             133   NO           agreed for month 6.
                                                                                                           Month 12 reserve held back for outstanding payments. Need to offset locum cover for maternity
                                                                                                          leave (est. of £32k). Non-pay pressures being offset by development funding.
Lewisham - Drugs                                           -         134               109   YES          No change in expenditure or fundig expected. Underlying cost pressure.

Lewisham - Acute recharges                                                -             47   ?             Recharges to other Directorates be confirmed
                                                                                                           Part of the overspend (£34k YTD) is due to high level of obs on outliers from other boroughs -
Lewisham - Ladywell                 (47)                  (50)        69                52   YES          proposed to recharge this from m7.
                                                                                                           Remainder is air-conditioning (£50k) that will not occur from m7 onwards and possibly be
                                                                                                          transferred to capital (not in this projection). Main focus is on maintaining improved position on
                                                                                                          agency/bank spend.
                                                                                                           Difficult ot predict year end postion, but £150k underspend at year end is prudent estimate.
Lewisham - MDOs                                 52                   (108)            (260) YES
                                                                                                          Possible that it could be more underspent.
Lewisham - Medical                   -                                82                78   NO           No change in expenditure or funding expected. Underlying cost pressure.
                                                                                                           Additional spend assumes that some of the vacant posts will be recruited to towards the last 3 to
Lewisham - Psychology                                      15         (71)             (73) YES
                                                                                                          4 months of the year.
                                                                                                           Bondway savings agreed at £30k. Costs of individual placement unlikely to be paid (accrual
Lewisham - Rehabilitation                                (141)        41                53   YES          released at £24k). Heather Close has had £30k of one off maintenance in m1-5, plus remove
                                                                                                          £11k accrual for kitchen work (will be capital).
Lewisham - Rehabilitation                      (32)                   (32)              -    YES          Supporting People funding expected to be at least £32k, and could be as much as £100k.




     SOUTH LONDON & MAUDSLEY NHS TRUST                                                       Lewisham m5                                                                                         Page 6
                                                                                 2002/03 Financial Recovery Plan


                   Directorate: Lambeth                Period              9



                                Action      Action     Action    Year End      Variance at
                                (Red)      (Amber)    (Green)    Forecast       Month 9      On Target                                          Original Assumptions

Directorate Position               (185)       (73)        22        (56)             126    NO          Excludes Forensic
Directorate Position               (371)        (6)        22        718              993    NO          Includes Forensic

                                                                                                          ES3 expected to reduce nursing overspend from m5 £29k YTD overspend to break-even for rest
NE Sector                           (69)                               80             104    NO
                                                                                                         of year saving £64k. Overspill reduction from m5 onwards saving £6k.

                                                                                                          New A grade staff recruited for escort duties should reduce nursing overspend. AL3 projected to
SE Sector                           (60)                              115             127    NO          reduce overspend from £33k in mth 4 to £3k at year end saving £40k. Overspill expected to stop
                                                                                                         saving £20k.
                                                                                                          Eden ward projected to reduce overspend from £57k (high obs) at mth 5 to £137k at year end
SW Sector                           (19)                              185             173    NO
                                                                                                         saving £19k. Managed via recruitment and strict working to numbers.
                                                                                                          Nelson ward predicted to reduce nursing overspend from £38k in mth 5 to £55k at year end. Have
NW Sector                           (37)                               40             135    NO          been issues around high obs & long term sick, but now predicting £37k saving by working under
                                                                                                         hours.
LEO                                                        -           79             100    NO          LEO has £34k overspend at m4 due to over-establishment which will not be reduced in year.
                                                                                                          Lloyd Still overspent £90k at m4 due to high neuropsychiatry obs (3 clients), but a £63k reduction
North Sector                                   (73)                   179             218    NO          planned by working with these clients. Increase of £20k in case mgt due to unfilled vacanices.
                                                                                                         £24k uninvoiced rent + £5k TSA recharge.
                                                                                                          Some non-rec underspends in m1 to 5, hence not a straight line forecast + working time directive
Rehab Services                                             89         (89)           (114) YES
                                                                                                         cost pressure at £54k.
                                                                                                          Cost pressures on medical staff will continue to year end (incremental slippage, Disc pts). £25k
Central Services                                           25        (729)           (753) NO
                                                                                                         spend against Womens Centre reserve of £678k for full year.
                                                                                                          AMH Placements: Tertiary referral ending at end of m6 + others soon? Projects expected to
Other                                                     (35)        140             181    NO
                                                                                                         overspend by £75k at year end (currently £42k over).
Developments                                               24          24               -    YES         Unavoidable development pressures no yet incurred: Cultural needs £9k; Modern Matron £15k.
                                                                                                          Part Yr income/savings due from closure of Dower/SCU beds £98k, and Mamora Rd at £43k.
Income                                                    (81)        (81)            (45) YES           Offset by one SCU patient recharge for 4 mths. Less approx. £10k per month for delayed patient
                                                                                                         transfer.
Forensic - MDOs                    (186)                              774             781    ?           MDO growth assumes +1 per month (20% growth) which may be high.
                                                                                                          WiC to hold 3 posts vacant for rest of year (SHO, psychologist, OT). Glencairn added 3 new staff
Forensic - non MDOs                             67                     -               86    NO          to reduce agency spend & switched A grades to escort duties. OATS consultant post vacant until
                                                                                                         Jan 03.




        SOUTH LONDON & MAUDSLEY NHS TRUST                                                        Lambeth m7                                                                                       Page 7

								
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