Docstoc

Sale Receipt Template

Document Sample
Sale Receipt Template Powered By Docstoc
					TB Ref: 2009-38
                            WINCHESTER AND EASTLEIGH HEALTHCARE NHS TRUST
                                REPORT TO FEBRUARY 2009 TRUST BOARD MEETING


      Subject       Finance Report – Month 10 (January 2008)
      Sponsor       Simon Wombwell, Director of Finance and IM&T
      Purpose       For Approval
      Executive summary

      The Trust reported a surplus of £48k in the month of January, a surplus for the fifth consecutive month. At the end of January, the
      cumulative position now stands at a deficit of £248k. The current forecast continues to predict a break even for 2008/09. Whilst the
      break even position at year end is below our original Plan (£0.7m surplus) the Strategic Health Authority has confirmed that break
      even is acceptable given the challenges faced by the Trust this year. All other financial targets are expected to be met.

      Strategic context – n/a

      Patient and service user impact – n/a

      Financial implications – As presented.

      Legal implications – n/a

      Risk assessment – There remains some risk around our PCT income position (circa £0.5m), largely in relation to challenges over
      performance above contract. Contingency measures are in place to deliver a breakeven position.




   Trust Board Meeting – February 2009
   Finance Report
                Finance Report to the Trust Board
                January 2008 – Month 10



                Simon Wombwell
                Director of Finance and IM&T




WINCHESTER & EASTLEIGH HEALTHCARE NHS TRUST
1. Key performance indicators


           Area                                                        Commentary                                                         Year-to-   Year-
                                                                                                                                           Date       end
                                                                                                                                          Rating     Rating

   Overall           o   The In-month position for January is a £48k surplus. This continues the delivery of a positive monthly run
   Income &              rate for the fifth month, despite significant operational pressures due to the adverse weather conditions.
   Expenditure       o   The cumulative/year-to-date (YTD) position is a deficit of £0.25m (0.6% of t/o), reduced from £0.3m last
   (slides 4-5)          month.
                     o   The year-end forecast remains break even.
                                                                                                                                          Amber       Red
   Divisional        The key Divisional issues remain:
   Performance       o Cost control whilst coping with extreme weather conditions, which has increased emergency activity and
   (slides 10-14)       made getting to work difficult for many staff.
                     o Activity levels above SLAs, resulting in cost increases mitigated in part by increased income.
                     o Additional staffing levels associated with A&E and temporary wards to support effective patient care and
                        delivery of key targets.

   Cost              o   YTD £2.6m of cost reduction has been achieved against the original YTD target of £3.2m. This relates to the
   Improvement           late start of most schemes; but we remain confident that savings will continue to deliver for the remainder of
   Programme             the year.
   (CIP) (slide 9)   o   Divisions are currently forecasting the achievement of £3.4m of cost reductions against the £5.5m full-year
                         2008/09 target. The balance, of £2.1m, is linked to securing income above SLA values.

   Income       o        YTD income is £3.9m above plan; the biggest contribution is the expected outturn on our contract with
   (including            Hampshire PCT. Our projection continues to indicate that Hampshire PCT will be £2.9m above contract by           Green      Amber
   SLA                   March 09. However, the PCT will continue to challenge around £0.5m, presenting some risk to the financial
   Performance)          position.
   (slide 8)
   Working      o        At month close the Trust cash balance was £4.7m. This was £1.6m less than planned, primarily due to the
   Capital &             timing of capital payments, general creditor/debtor movements and the impact of the year-to-date I&E deficit     Green      Amber
   Treasury              against plan. It should be noted that the cash flow plan currently excludes land sale receipts (due to the
   (slides 15)           uncertainty of timing). This „risk‟ rating has been amended to Amber to reflect the cash impact of the PCT
                         challenging payment for SLA over-performance. However, cash is not considered a major risk this year.

   Capital           The cumulative capital spend is £3.7m (44% of the annual plan: £8.5m), including expenditure relating to             Green      Amber
   (slide 17)        schemes delayed from last year. Work is underway to advance procurement of medical equipment in particular;
                     however, some estates related schemes will remain below target at year end. These underspends will be carried
                     forward to next year.




                                                                                                         WINCHESTER & EASTLEIGH HEALTHCARE NHS TRUST          2
Contents
Contents


                                             Page
      1.   Key Performance Indicators               3
      2.   Summary Income and Expenditure
            i.     In-Month                         4
            ii.    Year-to-Date                     5
      3.   Forecast Outturn                         6
      4.   Monitor Risk Ratings                     7
      5.   Income & SLA Performance                 8
      6.   Cost Improvement Plan (CIP)              9
      7.   Divisional Performance Reports
            i.     Anaesthetics & Surgery           10
            ii.    Medicine & Elderly Care          11
            iii.   Family Services                  12
            iv.    Clinical & Diagnostics           13
            v.     Corporate Services               14
      8.   Working Capital & Treasury
            i.     Balance Sheet                    15
            ii.    Cash Flow                        16
      9.   Capital                                  17
      Annex A - Profiled CIP                        18


                                               WINCHESTER & EASTLEIGH HEALTHCARE NHS TRUST   3
2.i. Income & Expenditure Summary – In- month



                                          In-Month Position            Comparison to             Comparison to             In January the Trust reported a
 In-mth I&E Summary - Trust                                             Previous Mth          Forecast for Current          surplus of £48k against a
                                                                            Actuals                     Mth                 planned deficit of £10k i.e. an in-
                                      Budget     Actual    Variance    Actual   Variance       Forecast    Variance         month      £58k       favourable
                                                                      Previous                 (actual)
                                                                        Mth
                                                                                                                            variance against the plan.
                                       £'000     £'000      £'000      £'000      £'000         £'000       £'000
                                                                                                                           The January position continues
 Income
   SLA Performance Income               9,905      9,316       -589     10,731     -1,415        10,134        -818         to maintain the month-on-month
   Clinical Income                         90         89         -1         81          8           101         -12         improvement of our I&E position,
   Non Clinical Income                  1,217      1,785        568      1,304        481         1,299         486         despite     major    operational
 Income Total                         11,213     11,190         -22    12,116       -926        11,534         -344         pressures due to the adverse
 Expenditure                                                                                                                weather. Last month the Trust
   Pay                                  7,408      7,618       -210      7,984        367         7,624           7         reported a £87k surplus.
   Non Pay                              2,576      2,547         28      3,116        569         2,935         387
 Expenditure Total                     9,984     10,165       -181     11,101        935        10,559          394        The variance to Plan of £221k is
                                                                                                                            mainly due to pay expenditure
 Surplus/(Deficit) before Financing    1,229      1,025       -204      1,016             9        975              50
                                                                                                                            (95%), this cost is associated
 Financing Charges
    Profit/Loss on Asset Disp                0         0          0         -1         -1             0               0     with nursing staff on the
    Depreciation                           600       611        -11        609         -2           625              14     temporary ward, and continued
    Dividend Payment                       369       371         -2        366         -5           369              -2     pressure from A&E locum
    Interest Receivable                    -23        -9        -14        -70        -61           -23             -14
    Interest Payable                        14         5         10         24         20            14              10
                                                                                                                            doctors.
 Financing Charges Total                  960       977         -17       927        -50           985               8
 Net Surplus/(Deficit)                    269         48      -221         89        -40            -10             58     See slide 5 for the Year-to-date
   EBITDA margin                      10.96%     9.16%                 8.38%                    8.45%
                                                                                                                            I&E Summary




                                                                                              WINCHESTER & EASTLEIGH HEALTHCARE NHS TRUST                   4
2.ii. Income & Expenditure Summary – Year-to-Date


                                              YTD Position                Comparison to                     Year-end Forecast              Year-to-date, the Trust is in deficit by
YTD I&E Summary - Trust                                                  Forecast for YTD
                                                                                                                                            £248k    against a planned £1,865k
                                     Budget      Actual      Variance   Forecast    Variance       Budget       Actual     Variance         surplus. This reflects a year-to-date
                                                                        (actual)
                                                                                                                                            £2.1m adverse variance against plan.
                                      £'000       £'000       £'000      £'000       £'000          £'000        £'000      £'000
Income
  SLA Performance Income               98,939     101,300       2,362    102,118         -818      118,750       122,171         3,421
  Clinical Income                         902       1,079         177      1,091          -12        1,072         1,281           209     Year-to-date income over-performance,
  Non Clinical Income                  12,620      13,954       1,333     13,468          486       14,856        16,438         1,582
                                                                                                                                            of £3.9m, reflects, primarily, SLA activity
Income Total                         112,461     116,333       3,872    116,676         -343       134,678      139,890         5,212
                                                                                                                                            above plan. This is predominately due
Expenditure
  Pay                                  74,906      77,863      -2,957     77,870           7        90,657        93,878        -3,222      to Hampshire PCT contract over
  Non Pay                              26,076      29,218      -3,142     29,606         387        31,832        34,665        -2,833      performing against plan, including
Expenditure Total                    100,982     107,082      -6,099    107,476          394       122,489      128,544         -6,055
                                                                                                                                            payment for Rehab activity.
Surplus/(Deficit) before Financing    11,479       9,252      -2,227       9,201             51     12,189       11,347          -842
Financing Charges
   Profit/Loss on Asset Disp                0          -1           1           0              1          0            0              0
   Depreciation                         5,995       5,986           9       5,999             13      7,195        7,187              9    Of   the £6.1m year-to-date adverse
   Dividend Payment                     3,690       3,688           2       3,687             -2      4,428        4,428              0
   Interest Receivable                   -230        -333         103        -349            -16       -276         -379            103     variance on expenditure, £1.9m (32%)
   Interest Payable                       159         160          -1         169              9        187          188             -1     relates to CIPs originally budgeted as
Financing Charges Total                9,614       9,500         114       9,506               6    11,534       11,424             111     cost reduction. The balance relates to
Net Surplus/(Deficit)                  1,865        -248      -2,113        -305             57        655           -77         -732
                                                                                                                                            in-year cost pressures e.g. utilities and
  EBITDA margin                      10.21%       7.95%          0%                                 9.05%        8.11%                      the costs related to increased activity
                                                                                                                                            levels.


 On the 5th January 2009, the Chief Executive and Director of Finance met with counterparts from the PCT and the SHA Director of
 Finance. The two key issues: recognition of rehabilitation activity and adjustments for zero length of stay activities are to be the subject of
 further review and audit in 2009/10. This is a successful outcome for the Trust in 2008/09.




                                                                                                                     WINCHESTER & EASTLEIGH HEALTHCARE NHS TRUST                      5
3. Forecast Outturn


                                               Income - Forecast                      Expenditure - Forecast                  Net
                                                                                                                                                             Incom e & Expenditure Monthly Trajectory
I&E by Division - Year-end Forecast   Target         F/C           Variance       Budget       F/C           Variance       Variance
                                                                                                                                                 12.2
                                      £'000          £'000          £'000         £'000        £'000          £'000          £'000
Surgery & Anaesthetics                  45,623         45,035           -588        34,923       36,062          -1,139         -1,727           12.0
Medicine & Elderly Care                 42,388         45,611          3,223        32,534       37,293          -4,759         -1,536           11.8
Family Services                         26,078         26,286               207     17,808       18,894          -1,086             -878         11.6
Clinical & Diagnostics                   6,757          7,392               635      4,993        4,682               312            946




                                                                                                                                           £'m
                                                                                                                                                 11.4
Corporate Services                       3,694          3,997               303     25,987       26,538           -551              -248
Highcroft, Deanery & Other                    950            891            -59      1,618        1,622                -4            -63         11.2
Reserves                                                                      0      1,342             266       1,076          1,076            11.0
Asset & Debt Management - Other               236            224            -11      6,050        5,986                64             53
                                                                                                                                                 10.8
Central Income - Other                   8,375          9,833          1,458               0             0              0       1,458
                                                                                                                                                 10.6
hotel & General Services                      577            623             45      2,628        2,575                52             98
                                                                                                                                                     Apr   May June July Aug Sept   Oct   Nov   Dec   Jan   Feb   Mar
Total (before Financing Charges)      134,678        139,890           5,212      127,883      133,917          -6,034           -821
Financing Charges                                                             0      6,140        6,047                93             93                      Income                      Expenditure
Total                                 134,678        139,890           5,212      134,023      139,964          -5,941           -728




 Our “10+2” projection is break even, which reflects the agreement with HPCT and the SHA.


 Key assumptions to deliver break even are as follows:
      The position does not take account of any failure to sell assets. Failure to deliver the land sales could impact upon our year end
           position.
      Both the year to date position and forecast position include over performance income from Hampshire PCT continuing at the current
           rate (c£2.9m full year). The PCT continue to challenge this level of over performance, mainly around a small number of individual
           coding and counting issues, but also through demand management initiatives e.g. managing average waits down to 12 weeks and GP
           referral management, which, if successful, would lower our projected income.




                                                                                                                                WINCHESTER & EASTLEIGH HEALTHCARE NHS TRUST                                       6
Monitor Financial Risk Ratings (FRR)


 Monitor adopts a “risk based approach” to regulating NHS Foundation Trusts. To
 support our development towards FT a shadow FRR for the Trust has been              The main metrics are as follows
 calculated. The assessment of risk for each FT signals the degree of concern        EBITA margin: this is earnings before deducting
 and guides the intensity of in-year monitoring. Monitor assesses each individual    interest, taxes, depreciation and amortisation. It is a
 Trust on three main areas and assigns a risk rating, these areas are finance,       measure of cash generation from the day-to-day
 governance and mandatory services – the figures below relate to the FRR.            operations of the business.
                                                                                     EBITDA achieved; this is designed to measure the
                                                                                     ability of the Trust to achieve its financial plans. It
 Metric                   Weight       5         4       3        2        1         emphasises the importance of delivering the Plan.

 EBITDA margin                 25% 11%         9%         5%      1%     <1%         ROA (Return on Assets); measures how efficiently
                                                                                     the Trusts uses its assets.
 EBITDA, % achieved            10% 100%       85%        70%     50%     <50%
 ROA                           20% 6%          5%         3%     -2%     < -2%       I&E Surplus margin; This metric relates the bottom
                                                                                     line surplus to turnover. This is important because
 I&E surplus margin            20% 3%          2%         1%     -2%     < -2%
                                                                                     surpluses define our ability to reinvest for future
 Liquid ratio                  25% 35          25         15      10      <10        growth and delivery of strategic plans.
 Overall rating                                                                      Liquidity ratio (days); This is a measure of our
                                                                                     ability to generate cash and pay our bills.

 Performance to                YTD       YTD    Risk
 end of January                Plan     Actual Rating
                                                               The performance against the Monitor financial framework is calculated
 EBITDA margin                10.21%    7.95%        3         using the year to date financial figures.
 EBITDA, % achieved            100%      78%         3         Based on the year to date performance the Trust would have a Monitor
 ROA                            5%      3.09%        3         risk rating of 2. There are a number of rules which mean if any one
                                                               criterion is ranked at 1 or a 2 then the maximum Trust rating is a 3.
 I&E surplus margin           1.66%     -0.21%       2
 Liquidity ratio                35         6         1
                                                                               WINCHESTER & EASTLEIGH HEALTHCARE NHS TRUST                     7
4. Income & SLA Performance


Purchaser                           Annual     Year to Year to       Year to Date        Variance
                                    Budget      Date Date Actual      Variance           Current
                                                                                                         Overall the position shows an overall over-recovery
                                               Budget                                      Mth           of income of £3.9m for the ten months to the end of
                                    £'000      £'000     £'000     £'000        %         £'000          January.
Divisional Income                                                                                        This is driven by over performance on the Trust‟s
Hampshire PCT                        101,051    84,209    87,145     2,936        3.5%      2,584
Wiltshire PCT                          1,415     1,180     1,381       201       17.1%        139
                                                                                                         clinical contracts, specifically Hampshire PCT.
Southampton City PCT                     977       814       986       172       21.1%        139        Following the 5th January meeting the income risk
Portsmouth City PCT                       80        66       126         60      89.9%          56       has now reduced to an estimated £0.5m.
Isle of Wight PCT                        110        92        65       (27)     -29.3%        (22)
Sub-Total SLA Performance            103,633    86,361    89,703     3,342        3.9%      2,896
Non-Contract PCT income                  767       639       783        144      22.5%          (5)      This position assumes the Trust will be compensated
Planned over-performance on SLA's      2,141     1,784         0    (1,784)    -100.0%     (1,606)       for all the over performance (Rehab, high cost drugs
MFF Income (from Dept of Health)      12,001    10,001    10,001          0       0.0%            0
Other Divisional Income                7,838     6,532     7,772      1,240      19.0%       1,899
                                                                                                         and activity above SLA) without any adjustment for
                                                                                                         recent audits (Zero LoS, Rehab) – now confirmed - or
Sub Total - Divisional Income        126,380   105,317   108,259     2,942       2.8%       3,184        proposed activity reductions for an average wait of 12
Central Income                                                                                           weeks (our assessment is that there are no
Specialist Services Income               117        98         0       (98)    -100.0%        (88)       specialities with significant “routine” patients waiting,
Provider to Provider SLA's             1,282     1,068     1,128         60       5.6%          59
                                                                                                         on average, less than 12 weeks).
Other SLA's                               69        58        42       (16)     -27.0%        (15)
Non-Contract PCT income                    0         0      -106     (106)                    (81)
RTA Income                               324       270       442       172      63.7%         171
Overseas Patients                         93        78        41       (37)    -47.1%         (45)       Note: the year to date position includes £1.7m of
Private Patients                          32        27        58         31    117.5%           33       income for rehabilitation activity (10/12ths).
Education & Training (NESC)            6,083     5,313     5,225       (88)     -1.7%         (88)
Dept of Health Income                      0         0         0          0      0.0%            0       The Trust is forecasting a favourable income position,
R&D Income                               139       116       110        (6)     -5.0%            2       and expects current activity levels to continue for the
Other Central Income                     159       118     1,134     1,016     861.0%            8
Sub-Total Central Income               8,298     7,144     8,074       930      13.0%          -43
                                                                                                         remainder of the financial year.

Total Income                         134,678   112,461   116,333     3,871       3.4%       3,141

                                                                                                     WINCHESTER & EASTLEIGH HEALTHCARE NHS TRUST               8
5. Cost Improvement Plan (CIP)

     Analysis of CIP Performance                                          Annual                                            Year-to-date                       In-Month
                                                    Plan         Forecast             Variance                      Plan      Actual         Variance          Variance
                                                         £‟000          £‟000         £‟000         %                 £‟000          £‟000           £‟000         £‟000
     Anaesthetics & Surgery                          1,633              1,072        -561       -34.3%                 523           452              -70                    7
     Medicine & Community                            1,974                909      -1,065       -54.0%                 564           295             -268                   -6
     Family Services                                   677                396        -281       -41.5%               1,361           822             -538                  -24
     Clinical & Diagnostics                            590                459        -131       -22.2%               1,645           698             -947                  -60
     Corporate Services                                627                576         -51        -8.1%                 491           364             -128                   -2
     Over/(Under) Achievement                    5,500      3,412     (2,088)                   -38.0%               4,583          2,632      (1,952)                     (84)
     Activity Improvements*                                 2,088       2,088                                                       1,740        1,740
     Net of Activity Cost Improvement            5,500      5,500          (0)                                       4,583          4,372        (212)                     (84)
      *SLA performance above the level included in the income Plan "at risk".

 The Trust set a £5.5m (4.2%) Cost Improvement Programme (CIP) target. This means that the Trust must deliver £5.5m of efficiencies
  in order to support the delivery of the planned surplus of £0.7m.
 Divisions are currently forecasting the achievement of £3.4m in cost reduction plans profiled as follows:
   Forecast Savings:        Apr        May        June           July       Aug         Sept            Oct         Nov       Dec            Jan         Feb         Mar          Total
   Corporate Division              4          4       46             45          53            63              58      59            60             60        62             63       576
   Family Services                 0          0        7             19          17            49              52      50            50             50        50             50       396
   Surgery & Anaesthetics          0          0       59             71          25           215             114     112           112            112       137            112     1,072
   Medicine & Elderly             42         56       54             55          76            -3             105     105           105            105       105            106       909
   CADS Division                  28         28       28             28          28            36              47      47            47             47        47             48       459
   Grand Total                    75         88      194            218         200           360             376     373           374            374       401            379     3,412
See Annex A (page 17) for further detail re CIP monthly profile (as requested by Board in August 2008).
 In practice the CIP shortfall (original plans all related to reduced expenditure i.e. „the same for less‟) is mitigated by increased
   income/activity levels (i.e. „more for the same‟). Forecast activity levels, after allowing for some risk that the PCT‟s challenges are
   successful, are expected to deliver the current financial forecast.
 See slides 10-14 for Divisional Reports.


                                                                                                                WINCHESTER & EASTLEIGH HEALTHCARE NHS TRUST                                 9
6.i. Anaesthetics & Surgery Divisional Report

                                                             In-Month Position               Comparison to         YTD          YE
                 Divisional Financial Performance                                             Previous Mth                   Forecast
                                                                                                  Actuals
                                                         Budget    Actual    Variance        Actual   Variance    Variance   Variance
                                                                                            Previous
                                                                                              Mth
                                                          £'000    £'000      £'000          £'000      £'000      £'000       £'000
                Income
                  SLA Performance Income                   3,787     3,552       -235          3,719       -167       -612        -662
                  Clinical Income                              2        26         25              1         26         32          32
                  Non Clinical Income                       -114      -144        -30             34       -177         23          41
                Income Total                              3,675     3,435        -240         3,754       -319       -556        -588
                Expenditure
                  Pay                                      1,896     1,864            32       2,098        234       -373        -287
                  Non Pay                                    891       867            24       1,067        199       -759        -852
                Expenditure Total                         2,787     2,731          56         3,164        433     -1,132      -1,139
                Surplus/(Deficit) before Financing           888      704        -185           590        114     -1,689      -1,727

Financial Performance Summary
 Anaesthetics and Surgery are £185k adverse to target in-month, and are reporting a year to date deficit against plan of £1.7m. The
    variance in month relates to a continued under performance against SLA income against plan. This under performance is attributable to
    a change in case mix in 2008-09, so whilst activity levels remain high, the type of procedures the Division is undertaking are of lower
    financial value.

Divisional Action Plan to Address Year-end Trajectory
 The Division is forecasting a year-end trajectory that is £1.7m adrift from their target position before additional management actions.
    The actions being taken to ensure the trajectory is brought back into line are:
     Continue to control expenditure as the Division approaches year end.
     Continue to improve activity levels where performance is below contracted levels.
.
                                                                                           WINCHESTER & EASTLEIGH HEALTHCARE NHS TRUST      10
 6.ii. Medicine & Elderly Care Divisional Report
                                                         In-Month Position              Comparison to         YTD          YE
          Divisional Financial Performance                                               Previous Mth                   Forecast
                                                                                             Actuals
                                                     Budget     Actual    Variance      Actual   Variance    Variance   Variance
                                                                                       Previous
                                                                                         Mth
                                                      £'000     £'000      £'000        £'000      £'000      £'000       £'000
          Income
            SLA Performance Income                      3,480     3,834        354        3,711        124      2,449      3,116
            Clinical Income                                 8         3         -5            1          2         -6         -4
            Non Clinical Income                            45        85         40           43         42         84        111
          Income Total                                 3,532     3,922        389        3,754        168      2,527      3,223
          Expenditure
            Pay                                         1,887     2,105       -219        2,200         95     -2,217      -2,728
            Non Pay                                       844     1,008       -165          968        -40     -1,702      -2,031
          Expenditure Total                            2,730     3,114       -383        3,168         55     -3,919      -4,759
          Surplus/(Deficit) before Financing             802       808             6       586        222     -1,393      -1,536

Financial Performance Summary
 Medicine is £8k favourable to target in month, after taking account of £389k of income above Plan. Activity levels remain high within the
  Division, which accounts for the year to date deficit position. The existing cost pressures are related to the temporary Mount ward
  remaining open, and the impact of staffing those beds. The Division also has high levels of medical locum spend in A&E, which
  contribute to the in month pay variance £219k.

Divisional Action Plan to address year-end Trajectory
 The Division is forecasting a year-end trajectory that is £1.5m adrift from their target position before additional management actions.
   The actions being taken to ensure the trajectory is brought back into line are:
    Close the temporary ward to minimise the use of temporary staffing.
    Continued targeted improvement in DNA rates for outpatients to ensure maximum productivity is achieved.


                                                                                       WINCHESTER & EASTLEIGH HEALTHCARE NHS TRUST          11
6.iii. Family Services Divisional Report

                                                     In-Month Position            Comparison to            YTD             YE
          Divisional Financial Performance                                         Previous Mth                         Forecast
                                                                                       Actuals
                                                 Budget     Actual    Variance    Actual   Variance       Variance      Variance
                                                                                 Previous
                                                                                   Mth
                                                  £'000     £'000      £'000      £'000      £'000         £'000          £'000
          Income
            SLA Performance Income                  2,127     1,957       -170      2,108       -150                8         101
            Clinical Income                             1         2          2         -1          3                6           7
            Non Clinical Income                        41        46          4         48         -2               88          99
          Income Total                             2,169     2,005       -164      2,155       -150           102            207
          Expenditure
            Pay                                     1,287     1,332        -46      1,346            13       -353           -450
            Non Pay                                   212       287        -74        284            -3       -543           -636
          Expenditure Total                        1,499     1,619       -120      1,629         10          -896         -1,086
          Surplus/(Deficit) before Financing         670       386       -284        525       -139          -794           -878

Financial Performance Summary
 Family Services is showing an adverse variance in the month of £284k, The main reasons for a decrease in income £174k in line with
  the block contract for local prices, but also reflect a change in the counting of maternity births in line with correct data definitions. The
  pay pressures in January reflect the staffing pressures in midwifery and the Division being behind on pay related CIP schemes.

Divisional Action Plan to Address Year-end Trajectory
 The Division is forecasting a year-end trajectory that is £878k adverse against their Plan. The actions being taken to ensure the
  trajectory is brought back into line are:.
  - Review family planning device costs to secure funding from PCT.
  - Pilot texting in Paediatrics to reduce DNA rates, which the early results indicate the pilot is having a positive impact.
  - Involvement of operational staff in the identification of further cost reduction measures.

                                                                                          WINCHESTER & EASTLEIGH HEALTHCARE NHS TRUST             12
6.iv. Clinical & Diagnostics Divisional Report
                                                      In-Month Position              Comparison to            YTD          YE
      Divisional Financial Performance                                                Previous Mth                      Forecast
                                                                                          Actuals
                                                  Budget     Actual     Variance     Actual   Variance       Variance   Variance
                                                                                    Previous
                                                                                      Mth
                                                   £'000      £'000      £'000       £'000      £'000         £'000       £'000
      Income
        SLA Performance Income                         493        466        -27         547        -81           287         287
        Clinical Income                                 10          5         -5          18        -13            21          32
        Non Clinical Income                             60        106         46         116        -10           254         315
      Income Total                                    563        577          14        680       -103           562         635
      Expenditure
        Pay                                            923        891         32         881            -9        221         202
        Non Pay                                        317        382        -65         391             9       -512        -637
        Internal Recharges                            -809       -927        119        -911            16        651         746
      Expenditure Total                               431        345          86        361         16           360         311
      Surplus/(Deficit) before Financing              132        232        100         319        -87           922         946

Financial Performance Summary
 Diagnostics is favourable to target by £100k in-month. This is delivered by favourable performance against income targets (direct
  access pathology and radiology by GPs and other service users) plus internal recharges for activity above plan (note: internal recharges
  result in an equal and opposite cost to other Divisions).

Divisional Action Plan to Address Year-end Trajectory
 The Division is forecasting a year-end trajectory that is £946k favourable to their target position. The actions being taken to ensure
   the trajectory is delivered:
- CIP schemes under fortnightly review.
- Continued exploration of income generation opportunities for non NHS contracts.
- Medical gas, blood and drugs usage monitored alongside activity levels.


                                                                                   WINCHESTER & EASTLEIGH HEALTHCARE NHS TRUST             13
6.v. Corporate Services

                                                       In-Month Position                Comparison to             YTD          YE
   Divisional Financial Performance                                                      Previous Mth                       Forecast
                                                                                             Actuals
                                                   Budget      Actual     Variance      Actual   Variance      Variance      Variance
                                                                                       Previous
                                                                                         Mth
                                                    £'000       £'000      £'000         £'000      £'000         £'000        £'000
   Income
     SLA Performance Income                               0           0          0             0          0           -28          -28
     Clinical Income                                     28          11        -17            45        -34           -36          -51
     Non Clinical Income                                325         588        263           185        404           421          426
   Income Total                                        353         600        247           230        370           358          348
   Expenditure
     Pay                                              1,343      1,349          -6        1,381          33          -161          -24
     Non Pay                                            996        869         127        1,197         328          -403         -475
   Expenditure Total                                 2,339      2,217         121        2,578         361          -564         -498
   Surplus/(Deficit) before Financing               -1,985     -1,618         368       -2,348         730          -206         -151

 Financial Performance Summary
 Corporate Services was favourable against target by £368k in-month, the non pay position has improved through the transfer of catering
 costs to capital, and a savings against provisions costs of £28k.

 Corporate Services Action Plan to Address Year-end Trajectory
 Corporate Services is forecasting a year-end trajectory that is £0.1m adrift from the target position. The actions being taken to
 ensure the trajectory is brought back into line are:
    - Housekeeping – tight control of ongoing cost pressures as well as the impact of control of infection and additional beds.
    - Utilities (energy & rates) – to a large extent this pressure is difficult to control in the short-term. We are maintaining our tight
    control and monitoring energy usage.
    - All other areas within corporate services are expected to deliver to budget, with reviews to establish further savings to mitigate
    the impact of the above pressures.

                                                                                      WINCHESTER & EASTLEIGH HEALTHCARE NHS TRUST            14
7.i. Working Capital & Treasury - Balance Sheet

As per Final Balance Sheet                       Actual Last   Actual to           Movement
   Accts                                           Month         date
  2007/08                                                                   Year-to-date    In-Month
   £'000s                                          £'000s       £'000s        £'000s          £'000s         The Trust cash balance at 31st
             FIXED ASSETS:
                                                                                                              January was £4.7m . This includes
                                                                                                              the property sale receipt for Marlfield
   127,271 TANGIBLE ASSETS                          128,509      128,960          1,689           451
     2,103 INTANGIBLE ASSETS                          2,044        2,031            -72           -13         House (£1.25m Receipt; £0.5m profit
   129,374 TOTAL FIXED ASSETS                       130,553      130,991          1,617           438         on disposal) see slide 15 (cash flow).
           CURRENT ASSETS:
     2,145 STOCKS & WIP                                2,171        2,231            86            60
                                                                                                             Overall Creditors  (our suppliers/we
     1,565 DEBTORS NHS <1yr                            6,499        6,683         5,118           184         owe money). The current level of
     2,496 DEBTORS Non-NHS <1yr                        2,539        2,996           500           457        creditors is at a „normal‟ level given
         0 SHORT TERM INVESTMENTS                          0            0             0             0         the opening balance included an
     6,385 CASH @ BANK                                 6,491        4,742        -1,643        -1,749        advance payment for Tax and NI (paid
    12,591 TOTAL CURRENT ASSETS                       17,699       16,652         4,060        -1,048         in March but not due until April).
            CURRENT LIABILITIES:
     -1,745 CREDITORS NHS <1yr                        -1,602       -1,731              14        -129        Net      total   Debtors             (our
     -8,121 CREDITORS Non-NHS <1yr                   -10,907      -10,150        -2,029           757        customers/who owe us money) has
     -9,866 TOTAL CURRENT LIABILITIES                -12,509      -11,881        -2,015           628         increased in January £641k. The
     2,725 NET CURRENT ASSETS/(LIABILITIES)            5,190        4,770         2,045          -420         increase in NHS debtors relates to the
        364 LONG TERM DEBTORS                            521          493           129           -28         quarterly raising of Non contracted
     -2,500 AMOUNTS FALLING DUE > ONE YEAR            -1,875       -1,875           625             0         activity invoices for quarter 3 activity.
     -1,130 PROVISIONS - LIABILITIES & CHARGES        -1,080       -1,047            83            33
                                                                                                             See slide 16 for Cash Flow.
   128,834 NET ASSETS                               133,310      133,333          4,499            23
             CAPITAL & RESERVES
    57,687   PUBLIC DIVIDEND CAPITAL                  57,687       57,687             0             0
     6,944   INCOME & EXPENDITURE SURPLUS              6,645        6,693          -251            47
     6,366   OTHER RESERVES                            6,366        6,366             0             0
     1,750   DONATION RESERVE                          1,587        1,562          -187           -25
    56,088   REVALUATION RESERVE                      61,024       61,024         4,937             0
             GOVERNMENT GRANT RESERVE                                                 0             0
   128,834 TOTAL CAPITAL & RESERVES                  133,310      133,333         4,499            23

                                                                                              WINCHESTER & EASTLEIGH HEALTHCARE NHS TRUST            15
7.ii. Working Capital & Treasury - Cash Flow

   08/09                           Cash Flow Statement                           Year-to-date
   Plan                                                                 Plan       Actual    Variance                                             2008/09 Cash Flow Forecast
     £'000                                                               £'000        £'000      £'000
     4,997     Operating Surplus                                         4,015        2,668     -1,347
     6,698     Depreciation & Amortisation                               5,581        6,010        429
      -313     Transfer from Donated Asset Reserve                        -261         -249         12




                                                                                                         Cash at Bank £'m
       145     Stocks - (Increase)/Decrease                                  0          -86        -86                      12.0
    -1,506     Debtors - (Increase)/Decrease                            -1,250       -5,747     -4,497                      10.0
     2,402     Creditors - Increase/(Decrease)                           2,305        2,629        324
       -60     Provisions - Increase/(Decrease)                            -45          -83        -38                       8.0
    12,363     Net Cash Inflow/(Outflow) from Operating Activities      10,345        5,142     -5,203                       6.0
               Finance Investments & Servicing, Capital and Dividends                                                        4.0
       276     Interest Received                                           230          333        103                       2.0
      -187     Interest Paid                                              -103         -176        -73
   -10,352     Payments to Acquire Tangible Fixed Assets                -6,691       -3,823      2,868                       0.0
         0     Receipts from Sales of Tangible Fixed Assets                  0        1,194      1,194                          Mar   Apr   May    June   July   Aug   Sept   Oct   Nov   Dec   Jan   Feb   Mar
    -4,428     Dividends Payable                                        -2,140       -3,688     -1,548
    -2,328     Net Cash Inflow/(Outflow) before Financing                1,641       -1,018     -2,659                                      Plan             Actual
               Financing
      -1,250   Working Capital Loan Principle Repaid to DH                -625         -625         0
      -3,578   D cash from above: inflow/(outflow)                       1,016       -1,643     -2,659




The „Cash Flow Statement‟ sets out the cash plan for 2008/09, along with year-to-date performance. From this, a monthly cash flow
forecast has been produced, as per the „2008/09 Cash Flow Forecast‟ chart above.
 Year-to-date cash spending is £2.6m adrift of plan, due to the current in-year deficit, the higher than planned increase in debtors and
  capital spend (last year‟s programme); offset by the £1.25m proceeds from the sale of Marfield House.
 A revised forecast will be undertaken, incorporating a more detailed cash flow format, to assess the impact on cash given the following
  scenarios;
       the risks to the Income and Expenditure forecast identified on slide 6 including the PCT contract over performance challenges, and
       the potential that the Trust does not receive payment for the rehab monies.
   That the expected land sales are not completed before 31 st March.
   Any slippage that may be identified on the capital programme (See slide 17 for Capital.)


                                                                                                                                   WINCHESTER & EASTLEIGH HEALTHCARE NHS TRUST                                    16
 8. Capital


                                                                  A              B               C              D
Planned Schemes                                                                                  Financial Performance
                                            Project Size     08/09 Capital     Actual         Forecast       Forecast
                                                              Programme       Mth 1-10        Mth 11-12       Outturn

                                                                £'000          £'000            £'000          £'000         2008/09 Capital Programme
2007/08 Schemes Brought Forward
A & E (nb scheme on hold)                             499                               78               -78            0
Capitalisation of Project Management                  330               205            121                84          205

                                                                                                                              The capital programme is funded by a
Carbon Footprint - Breast Screening                   204               204            191                13          204
Carbon Footprint 0708 Funding                         206               206            129                77          206
Catering Roof                                           0                 0              0                 0            0
Compton Ward Bed Model
Endoscopy IT System
                                                        0
                                                       56
                                                                          0
                                                                         56
                                                                                        11
                                                                                       138
                                                                                                         -11
                                                                                                         -82
                                                                                                                        0
                                                                                                                       56
                                                                                                                               combination of       depreciation (c.£6.7m
Enterprise Virtual Array
Estates Backlog Maint & Design Costs 0708
                                                       70                70             79
                                                                                       312
                                                                                                          -9
                                                                                                        -312
                                                                                                                       70
                                                                                                                        0
                                                                                                                               annually), cash available from prior year
GP Electronic Prescribing
IM & T 0708
                                                       400
                                                         0
                                                                         81
                                                                          0
                                                                                        35
                                                                                        94
                                                                                                          46
                                                                                                         -94
                                                                                                                       81
                                                                                                                        0
                                                                                                                               slippage (c.£3.6m), loan and/or the raising of
Infection Control
IORT
                                                        98
                                                         2                2
                                                                                       120
                                                                                         0
                                                                                                        -120
                                                                                                           2
                                                                                                                        0
                                                                                                                        2
                                                                                                                               additional Public Dividend Capital (PDC).
Medical Equipment 07/08
Patient Care Wireless System
                                                       679
                                                        57
                                                                          0
                                                                         57
                                                                                       111
                                                                                        61
                                                                                                        -111
                                                                                                          -4
                                                                                                                        0
                                                                                                                       57      The Trust is not anticipating any PDC for
Patient Environment
RAM Capital Software
                                                       151
                                                        60
                                                                         37
                                                                         60
                                                                                        50
                                                                                        68
                                                                                                         -13
                                                                                                          -8
                                                                                                                       37
                                                                                                                       60      2008/09.
Single Sign On Implementation                           96                4              4                 0            4
Taunton / Emau Bed Model (On Hold)                     300               22              2                20           22
Twyford Ward Upgrade          (On Hold)                300                0             47               -47            0
Victoria Ward                                            0                0             27               -27            0
Video Conferncing Equipment                             80               78             79                -1           78
Sub-total 2007/08 Schemes b/f                        3,588            1,082          1,757              -675        1,082     The   analysis shows that the Trust will
2008/09 Schemes                                                                                                                achieve all of its planned capital programme
Estates Major Works
Simulation Suite                                        34               34              40             -6             34      by the end of the Financial year. However
Phlebotomy Works                                        30               30              36             -6             30
Union Office Move
Howarth Theatre Room 3
                                                        25
                                                       220
                                                                         25
                                                                        220
                                                                                          8
                                                                                         24
                                                                                                        17
                                                                                                       196
                                                                                                                       25
                                                                                                                      220
                                                                                                                               current performance shows the Trust has
Andover Endoscopy
Cytology Alterations
                                                       132
                                                        20
                                                                        132
                                                                         20
                                                                                         59
                                                                                          5
                                                                                                        73
                                                                                                        15
                                                                                                                      132
                                                                                                                       20
                                                                                                                               committed £3.7m (42%) year to date and is
Restaurant Toilets
Carbon Footprint 0809 Funding
                                                        30
                                                       770
                                                                         30
                                                                        770
                                                                                                        30
                                                                                                       770
                                                                                                                       30
                                                                                                                      770
                                                                                                                               assuming to spend £5.2m during the
Estates Major Works Various New Projects             1,526
                                                     2,787
                                                                      1,821
                                                                      3,082
                                                                                        32
                                                                                       204
                                                                                                     1,789
                                                                                                     2,878
                                                                                                                    1,821
                                                                                                                    3,082
                                                                                                                               remaining two months. Work is underway to
IM & T 0809
IM & T                                                190               190              31             159            190     establish potential slippage and ensure
IM & T New Projects                                   200
                                                      390
                                                                        119
                                                                        309
                                                                                          3
                                                                                         34
                                                                                                        116
                                                                                                        275
                                                                                                                       119
                                                                                                                       309     underspends are carried forward.
Estates Backlog 0809
Backlog Maintenance                                   800               800            338              462            800
                                                      800               800            338              462            800
Medical Equipment 0809

                                                                                                                              The
X-Ray Tubes                                                                            102              -102            0
Medical Equipment                                    1,320            1,320            408               912        1,320             Capital Prioritisation Group has
Radiology Voice Recognition Software                    24               24                               24           24
Pathology Scanning System                               10
                                                     1,354
                                                                         10
                                                                      1,354            510
                                                                                                          10
                                                                                                         844
                                                                                                                       10
                                                                                                                    1,354
                                                                                                                               recognised the risk of slippage in this years
Other Schemes 0809
MRI Replacement                                      1,000            1,000            910              90          1,000
                                                                                                                               programme and has asked for an
AWMH OPD
RTS Hotline Trolley
                                                     3,000
                                                         8
                                                                      1,320
                                                                          8
                                                                                        19
                                                                                         0
                                                                                                     1,301
                                                                                                         8
                                                                                                                    1,320
                                                                                                                        8
                                                                                                                               assessment of potential slippage and
HR Risk Management Software
Cardboard Compactor
                                                        50
                                                        10
                                                                         50
                                                                         10
                                                                                         0
                                                                                         0
                                                                                                        50
                                                                                                        10
                                                                                                                       50
                                                                                                                       10
                                                                                                                               contingencies for spending available capital
                                                     4,068            2,388            929           1,459          2,388
                                                                                                                               resources.
Sub-total 2008/09 Schemes                            9,399            7,933          2,015           5,918          7,933
Contingency / Slippage
Schemes Total                                       12,987            9,015          3,772           5,243          9,015
Under/(Over) shoot                                                                                                      -


                                                                                                                 WINCHESTER & EASTLEIGH HEALTHCARE NHS TRUST              17
Annex A – Profiled CIP Actual/Forecast 2008/09


           2008/09 Monthly Profile of Divisional CIP Schemes by Category (as requested by Board in August 2008)
 Sum of Actual savings 08/09                        Month
Division                     Work Programme          Apr-08 May-08 Jun-08 Jul-08 Aug-08 Sep-08 Oct-08 Nov-08 Dec-08 Jan-09 Feb-09 Mar-09     Total
Corporate Division           Non Clinical Staffing          4     4      28     23    32      47     43    43     43      43     43     44       399
                             Non Permanent Staffing         0     0       0      0     0       0      0     0      0       0      0      0          0
                             Procurement                    0     0      18     22    21      16     15    16     16      16     18     18       178
Corporate Division Total                                    4     4      46     45    53      63     58    59     60      60     62     63       576
Family Services              Clinical Efficiency            0     0       5      9    10      31     33    32     32      32     32     32       246
                             Non Clinical Staffing          0     0       0      0     0       0      3     3      3       3      3      3         17
                             Non Permanent Staffing         0     0       0      7     7       7      7     7      7       7      7      7         63
                             Procurement                    0     0       3      4     0      11      9     9      9       9      9      9         70
Family Services Total                                       0     0       7     19    17      49     52    50     50      50     50     50       396
Surgery & Anaesthetics       Clinical Efficiency            0     0       0     10     3    128      58    58     58      58     58     58       486
                             Non Clinical Staffing          0     0      20      7     7      43     19    19     19      19     19     19       188
                             Non Permanent Staffing         0     0      22      8     8      25      9     9      9       9      9      9       117
                             Procurement                    0     0      17     45     7      20     29    27     27      27     52     27       281
Surgery & Anaesthetics Total                                0     0      59     71    25    215     114   112    112     112    137    112     1,072
Medicine & Elderly           Clinical Efficiency            0    10       5      5    14      24     40    40     40      40     40     40       300
                             Non Clinical Staffing          0     3       1      2    10      10     10    10     10      10     10     10         88
                             Non Permanent Staffing        42    42      42     42    42     -47     42    42     42      42     42     42       411
                             Procurement                    1     1       6      7    10      10     12    12     12      12     13     14       110
Medicine & Elderly Total                                   42    56      54     55    76      -3    105   105    105     105    105    106       909
CADS Division                Clinical Efficiency            0     0       0      0     0       0     11    11     11      11     11     11         65
                             Non Clinical Staffing         20    20      19     20    20      20     24    24     24      24     24     24       261
                             Non Permanent Staffing         2     2       2      2     2       2      2     2      2       2      2      2         20
                             Procurement                    6     6       7      7     7      15     11    11     11      11     11     12       113
CADS Division Total                                        28    28      28     28    28      36     47    47     47      47     47     48       459
Grand Total                                                75    88     194    218   200    360     376   373    374     374    401    379     3,412
                                                                                      WINCHESTER & EASTLEIGH HEALTHCARE NHS TRUST                 18

				
DOCUMENT INFO
Shared By:
Categories:
Stats:
views:114
posted:11/14/2010
language:English
pages:19
Description: Sale Receipt Template document sample