PPT PowerPoint Presentation Deficit

Document Sample
PPT PowerPoint Presentation Deficit Powered By Docstoc
					2007/08 Service & Financial
Performance
Incorporating Month 10 and Q3




 SHA Board
 26 March 2008
Contents
Topic                                        Slide
Highlights and Key Themes                    3
Financial Overview                       -   4


Trust Performance                        -   7
Trust Q3 risk ratings                    -   12


PCT Performance                          -   15
PCT Q3 risk ratings                      -   20


Appendices                               -   22
Appendix 1 – Service Performance         -   23
Appendix 2 – SHA Financial Performance   -   38




                                                     2
Highlights and Key Themes
•   Month 10 forecast outturn of £300m is in line with the control total set at Month 7 and
    incorporates the additional investment programme agreed at that time
•   Stronger financial performance overall is reflected in improved financial risk ratings at Q3,
    with only 4 PCTs and 4 Trusts remaining in the lowest rating band. We are accelerating the
    work to develop sustainable solutions for the small number of organisations with significant
    historic debts.
•   Progress on governance improvement has also been strong, and we are proposing 5 more
    Trusts and 2 PCTs for “promotion” to green ratings
•   Intensive action to improve data quality and reduce backlogs has resulted in a strong
    improvement in 18 week access to treatment performance in recent months. However, we
    remain slightly behind the relevant trajectories and are likely to miss the March milestone for
    admitted patients by a small percentage. We have intensified our support to the most
    challenged Trusts and PCTs to ensure success in meeting the final December 2008 targets.
•   A number of Trusts are still failing to deliver on the 98% A&E 4 hour wait standard. We
    have activated escalation procedures and provided intensive support to those who require it.
    As a consequence we expect most organisations to return to a 98%+ run rate in the coming
    weeks.
•   MRSA cases have been reduced by 30% over the last year, and the rolling 3-month
    performance is within the target level set by the Department of Health for the SHA as a
    whole going forward. We continue to work intensively with the small number of Trusts who
    are regularly exceeding their trajectories. C diff cases also continue to fall sharply.




                                                                                                      3
Overview




           4
Service & Financial Performance
Pan London Financial Overview at Month 10
                                           Year to Date at M10                    Forecast Outturn at M10



                                           Adjusted                   Adjusted      Adjusted                Movement
                                             Plan            M10        Plan             M7        M10      M7 to M10
                                              £m              £m         £m              £m         £m             £m

 NHS Trusts                                     (6.2)        33.4          17.6         15.3       13.2           (2.1)

 PCTs                                           10.2         85.3          17.3         91.3     100.7             9.4
 Bankings/Lodged funds                              -        96.6                      114.9     115.9             1.0
                                                                                                                     -
 PCT/Trust sub total                             4.0       215.3           34.9        221.5     229.7             8.2
 MPET                                               -        32.1             -         33.6       34.1            0.5
 SHA (including impact of carry forward
 reserves etc)                                   5.5         33.6           6.6         20.0        8.8          (11.2)

 Hosted Budgets                                     -         9.7             -         13.5       15.9            2.4


 Total Central Position                          5.5         75.4           6.6         67.1       58.9           (8.2)

 FTs (part year)                                 6.6         11.4           8.5         11.4       11.4               -

 Total NHSL                                     16.1       302.1           50.0        300.0     300.0                -




  •   Adjusted Plan reflects the impact of FT part year starts
  •   Adjusted M7 reflects the impact of movement in PCT lodgings/surplus as a result of the additional investment programme
  •   Month 7 Forecast Outturn set as Control Total for both NHS London and individual Trusts/PCTs



                                                                                                                               5
Use of Surplus: Short Term and Long
Term Investment
Short Term
Additional investment plans for 2007/08 incorporate the following:-
- Infection control
- 18 weeks – getting ahead
- Early discharge
- Health promotion
- Primary care access & quality
- Accelerating capability investments and HfL preparation
- LPfIT & ICT
- LAS improvements

Long Term
Need for surplus carry forward to deliver strategic ambitions:-
- HfL – investment in upgrading & extending the range & reach of primary care services – pump priming
  & double running required
- Investment in the public health / staying healthy agenda e.g. new programmes in areas such as
  vascular prevention
- MPET funding to invest in the transformational workforce strategy
- CSR settlement higher than expected but slowing down compared to previous years



                                                                                               6
Trust Performance




                    7
Overview of 07/08 Financial Performance
                                                                                                          Foundation Trusts

    £m                           Original 2007/08 Plan      2007/08 Outturn     Variance      %           •   During the course of the year 3 organisations achieved
                                                                                                              foundation status (East London and the City Mental
    Total income                                 7,181.0             7,093.6          -87.4       -1.2%       Health Trust; Central and North West London Mental
                                                                                                              Health Trust and Camden and Islington Mental Health
    EBITDA                                         432.0               391.8          -40.2       -9.3%       & Social Care Trust) with an adverse impact on
                                                                                                              planned out-turn
    Net Surplus/(deficit)                           27.0                24.6           -2.4       -8.9%
                                                                                                          •   At the outset of the year 14 trusts had planned to
    Cash at bank and in hand                        92.0               143.7           51.7   56.2%           achieve FT status. The significant slippage in the
                                                                                                              pipeline has also been seen at the national level
    Total Capex                                    -411.0              -446.1         -35.1       8.5%


    I&E CIP                                        359.0               290.0          -69.0   -19.2%      Financially Challenged Trusts

                                                                                                          •   We have been working with our 7 financially
    Source: Trust Annual Plan Templates. Original Plan figures taken from                                     challenged organisations (BHRT, Bromley, Lewisham,
    prior year Board Seminar pack
                                                                                                              QMS, QEH, West Middlesex and Whipps X) on a
    2007/08 Outturn include FT balances apportioned to the date of                                            range of solutions to resolve their current levels of debt
    authorisation
                                                                                                              (estimated will be £336m as at 31 March 2008) and
                                                                                                              cummulative deficits (estimated will be approximately
                                                                                                              £244 as at 31 March 2008)
Financial Performance
•     In aggregate the trusts are expected to deliver a surplus of c.£25m compared with an
      original annual plan surplus of £27m
•     Within the overall position a number of organisations have significantly under-
      performed (including BHRT-£26m; Bromley-£16m), primarily due to CIP shortfalls,
      and over-performed (including Imperial £10m; Barts and the London £7m; and
      Epsom and St Hellier £7m)



                                                                                                                                                             8
NHS Trust Financial Performance (excluding FTs)

        YTD Versus Plan                               Month 10                      FOT Versus Plan
                                                                                                                   Movement from
              Month 10                                                                   FOT as at                 Control Total (@    FOT as %
 Plan YTD       YTD       Variance     Trust Summary                      FOT in Plan    Month 10     Variance         Mth 7)           of T/O
  £'000s       £'000s      £'000s                                           £'000s        £'000s       £'000s          £'000s             %
                                       Acute
   (11,489)    (28,777)    (17,288)    Barking Havering & Redbridge           (14,295)     (39,900)     (25,605)                   -      -11.8%
      2,162       2,960         798    Barnet & Chase Farm                       2,594        2,611           17                611         1.0%
      3,076      15,432      12,356    Barts and the London                      5,400       12,500        7,100                   -        2.2%
   (10,326)    (12,894)     (2,568)    Bromley Hospitals                       (2,827)     (18,700)     (15,873)            (9,700)       -12.2%
      (357)       1,292       1,649    Ealing                                      300        1,100          800                   -        0.9%
    (7,720)       (793)       6,927    Epsom & St Helier                       (6,532)          490        7,022                490         0.2%
      1,200       6,964       5,764    Great Ormond Street                       2,000        7,003        5,003              2,003         2.5%
      5,500       5,919         419    Hillingdon                                5,600        6,023          423              (229)         3.6%
      1,960      12,277      10,317    Imperial College Healthcare               3,400       13,000        9,600              3,000         1.6%
      1,351       2,401       1,050    Kingston Hospitals                        1,657        2,700        1,043              1,043         1.6%
    (2,787)       4,887       7,674    Lewisham                                (2,365)        2,912        5,277              2,348         1.7%
      3,176       3,092         (84)   Mayday                                    4,000        4,125          125              1,025         2.4%
    (4,117)     (3,006)       1,111    Newham                                  (4,139)      (2,701)        1,438                 (1)       -1.8%
      2,552       2,076       (476)    North Middlesex                           3,000        3,000            -                   -        2.0%
      1,861     (1,823)     (3,684)    North West London Hospitals               5,963            -      (5,963)            (1,308)         0.0%
    (2,935)     (2,902)           33   Queen Elizabeth                         (3,354)      (3,338)           16                   0       -2.3%
    (4,972)     (4,755)         217    Queen Mary's Sidcup                     (6,300)      (6,300)            -                   -       -6.4%
      3,291       3,589         298    Royal Brompton & Harefield                4,805        2,417      (2,388)                 35         1.1%
      5,479      15,041       9,562    Royal Free                                6,274       10,331        4,057                   -        2.4%
      1,728         759       (969)    Royal National Orthopaedic                2,504        1,177      (1,327)              (333)         1.4%
      (811)     (1,421)       (610)    St George's                                   -        4,000        4,000              2,000         1.0%
    (3,799)       (559)       3,240    West Middlesex                          (4,400)      (1,400)        3,000              1,100        -1.1%
      3,880     (1,048)     (4,928)    Whipps Cross                              4,686      (1,100)      (5,786)                   -       -0.6%
      1,200       1,308         108    Whittington                               1,400        1,400            -                   -        0.9%
                                   -   Mental health                                                           -
     1,352        1,282         (71)   Barnet Enfield & Haringey                2,000         2,000            -                 -          1.1%
       830        2,298       1,468    Camden & Islington                       1,000         2,750        1,750                 -          1.9%
     1,003        1,517         514    North East London                        1,106         1,792          686               133          1.6%
     1,376        1,542         166    SW London & St George's                  1,700         1,700            -                 -          1.0%
     1,976        2,011           35   West London                              2,369         2,370            1                 1          1.0%
                                   -   Ambulance Services                                                      -
    (1,864)       4,749       6,613    London Ambulance Service                      -        1,203        1,203               556          0.5%

   (6,224)      33,417      39,641     Trusts Total                           17,547        13,165      (4,382)              2,774         0.2%

• Overall Trust position at M7 per summary includes a „provision‟ for anticipated increase in Trust forecast outturn due to additional investment in
  meeting 18 weeks target (£4.9m)
• Excludes FTs authorised in year                                                               Key: Red = adverse variance from Plan          9
                                                                                                       Yellow = movement > £1m from Control Total
NHS Trust Financial Performance - Significant adverse
variances
•   Trust                            • Reasons                                          •   Actions
   Barking Havering &                  Failure to implement £25m CIP, resulting in       New Interim CEO and FD recently appointed.
    Redbridge Hospitals                  deterioration to forecast I&E deficit, from       Provider Agency has agreed an action plan with
   (M10YTD £28.8m deficit,              £14m in Q1 to £40m at Q2.                          the Trust to strengthen financial controls, which is
    FCOT £39.9m deficit; plan was                                                           being closely monitored.
    £14.3m deficit).                                                                       Weekly cash-flow reporting from the Trust to the
   Control Total set at M7 at                                                              Provider Agency.
    £39.9m deficit                                                                         Trust has implemented a revised Turnaround
                                                                                            Programme and project management structure.
                                                                                            First draft of 3 year programme to be reviewed
                                                                                            by the Provider Agency in December.
   Bromley Hospitals                                                                      Interim CEO appointed by NHSL June 2007.
                                        I&E forecast has deteriorated between M7          Trust provided a recovery plan in October which
   (M107YTD £12.9m deficit,             and M9 and reflects an adverse movement
    FCOT £18.7m deficit; plan was                                                           is being closely monitored by Provider Agency.
                                         from both plan and control total.
    £2.8m deficit).                                                                        As part of the Financially Challenged Trust
                                        Shortfall in SLA income and CIPs, budget           process the Provider Agency has facilitated the
   Control Total set at M7 at £9m       overspends and revised PFI accounting
    deficit                                                                                 four outer south east London (OSEL) trusts in
                                         treatment.                                         defining inter-trust opportunities for efficiency).
                                                                                           Trust has strengthened internal performance
   North West London                   I&E forecast has deteriorated between month        management/ accountability, resulting in
    Hospitals (M10YTD £1.8m              7 and month 9 and reflects an adverse              mitigating actions being identified and improving
    deficit, FCOT breakeven; plan        movement from both plan and control total.         forecast outturn.
    was £6m surplus).                   Deterioration in forecast due to need to          Trust has engaged “Healthworks” to ensure
   Control Total set at M7 at           deliver greater activity to achieve 18 weeks       improved delivery of 2007/08 CIPs and identify
    £1.3m surplus                        milestones at costs above tariff.                  sustainable savings for 2008/09 onwards.
                                                                                           Monthly progress reviews with Provider Agency.
                                        Unidentified CIPs (£3.5m) and further             Trust is implementing recovery plan to improve
   Whipps Cross                                                                            the forecast position which the Provider Agency
                                         operational pressures/slippage on identified
   (M10YTD £1m deficit, FCOT                                                               is closely monitoring.
                                         CIP schemes (£3.2m).
    £1.1m deficit; plan was £4.7m
    surplus).
   Control Total set at M 7 at
    £1.1m deficit.
                                                                                                                                     10
NHS Trust Financial Performance - Significant favourable
variances
•   Trust                           •   Reasons                                           •   Actions

   Imperial College Healthcare        £3m improvement between M7 and M9.                   Trust is examining all options to hit the agreed
   (M10 YTD £12.3m surplus,           Improved position due to a court ruling in            control total.
    FOT £13m surplus; original          favour of Trust giving a benefit of £0.8m, debt      Ongoing Monitoring by Provider Agency
    plans were £3.4m surplus).          recovery of £1.2m, avoidance of redundancies
   Control Total set at M7 was         following loss of Pathology SLA, underspends
    £10m surplus.                       within clinical directorates of £2.1m, reduced
                                        income losses following transfer of services
                                        and closure of private patient ward and higher
                                        interest received. Combined these have
                                        resulted in an improved benefit of £8.5m
                                        compared to the M7 forecast offset by
                                        increased staff costs of £4.1m and
                                        standardisation of asset lives following the
                                        merger.
                                       Higher YTD surplus primarily due to                  Trust expects the income over- performance to
   Barts & the London
                                        income/activity over-performance.                     stop and reduce over the reminder of the
   (M10 YTD £15.4m surplus,                                                                  financial year.
    FOT £12.5m surplus; plan was
                                                                                             Ongoing monitoring by Provider Agency.
    £5.4m surplus).
   Control Total set at M7 was
    £12.5m

   Epsom & St Helier                  Improved forecast due to release of £6m              Ongoing monitoring by Provider Agency.
   (M10 YTD £0.8m deficit, FOT         provision for redundancies due to happen in
    £0.5m surplus; plan was £6.5m       07/08 as part of the recovery plan; Trust feels
    deficit).                           provision no longer needed as staff leaving
   Control Total set at M7 was         through natural wastage.
    £0.5m surplus
                                                                                                                                 11
      NHS Trust Q3 risk ratings
                                                                                                                                                                                                       YTD                   Full Year
                                                    Financial                       Governance                 Services provided                      Quality & Safety                            Surplus/Deficit          Surplus/Deficit
                                                   risk rating                       risk rating                   risk rating                          risk rating                                    (£m)                     (£m)




                                                   Annual Plan




                                                                             Annual Plan




                                                                                                               Annual Plan




                                                                                                                                                 Annual Plan




                                                                                                                                                                                     Monitoring
                                                                                                                                                                                     Financial

                                                                                                                                                                                     Regime




                                                                                                                                                                                                                  Actual
                                                                                                                                                                                                       Plan




                                                                                                                                                                                                                               Plan
                                                                       FOT




                                                                                                                                                                                                                                          FOT
                                                                 YTD




                                                                                           Q1
                                                                                                Q2
                                                                                                     Q3
                                                                                                          Q4


                                                                                                                             Q1
                                                                                                                                  Q2
                                                                                                                                       Q3
                                                                                                                                            Q4


                                                                                                                                                               Q1
                                                                                                                                                                    Q2
                                                                                                                                                                         Q3

                                                                                                                                                                              Q4
               Trust
               Barnet & Chase Farm Hospitals      2              2     2     A             G    G    G         R             A    G    G         A             A    A    A         Monthly       2.3            3.6          2.5        2.6
               Barts And The London               4              4     4     G             G    A    G         G             G    G    G         A             A    A    A         Quarterly     4.6           18.8          5.4       12.5
               BHRT                               1              1     1     A             R    R    R         G             G    A    G         A             R    A    R         Monthly     -14.5          -26.7        -29.1      -39.9
               Bromley Hospitals                  1              1     1     R             R    R    R         G             G    A    G         R             G    G    A         Monthly      -3.8          -12.2         -4.3      -18.7
               Ealing Hospital                    3              4     4     A             G    G    G         G             G    G    G         G             A    A    A         Quarterly    -0.5            1.3          0.3        1.1
               Epsom And St Helier                2              3     4     A             G    A    G         G             G    G    G         R             A    A    A         Monthly      -8.1           -1.1         -6.5        0.0
               Great Ormond St Hospital           3              4     3     A             G    G    G         G             G    G    G         G             G    G    A         Quarterly     0.9            7.0          2.0        7.0
               Imperial College Healthcare        2              3     3     G                       G         G                       G         A                       G         Quarterly     9.3           11.4         10.0       10.0
               Hillingdon Hospital                3              5     5     G             A    G    G         G             G    G    G         A             A    A    A         Quarterly     5.4            5.4          5.6        6.1
               Kingston Hospital                  3              4     4     G             G    G    G         G             G    G    G         G             G    A    A         Quarterly     0.5            1.9          1.7        2.7
               Lewisham Hospital                  2              2     2     A             A    A    A         A             G    G    G         A             R    G    R         Monthly      -1.1            3.7         -2.4        2.9
               Mayday Healthcare                  2              2     2     A             G    G    G         G             G    G    G         A             A    A    R         Monthly       2.9            2.1          4.0        3.6
      Acute
               Newham Hospital                    2              2     2     A             A    R    A         G             G    A    G         R             A    A    A         Monthly      -4.0           -2.9         -4.1       -2.7
               North Middlesex                    2              4     4     G             G    G    G         G             G    G    G         A             A    A    A         Quarterly    -0.9            1.8          3.0        3.0
               North West London Hospitals        2              2     3     A             A    A    G         G             A    A    G         A             R    R    A         Monthly       1.4           -2.7          6.0        0.0
               Queen Elizabeth Hospital           1              1     1     A             A    A    A         G             G    G    G         A             A    A    A         Monthly       0.4            0.1         -3.3       -3.4
               Queen Mary's                       1              1     1     A             A    A    A         R             G    G    G         A             A    A    A         Monthly      -3.4           -3.6         -4.4       -5.5
               Royal Brompton And Harefield       3              4     3     G             G    G    G         A             G    G    G         A             A    A    A         Quarterly     4.4            3.5          4.8        2.4
               Royal Free Hampstead               3              4     4     G             G    G    G         G             G    G    G         A             A    G    G         Quarterly     5.8           14.3          6.3       10.3
               RNOH                               3              4     4     G             G    G    G         A             G    G    G         G             A    A    A         Quarterly     1.3            0.4          2.5        1.2
               St George'S Healthcare             2              2     3     A             G    A    G         A             G    G    G         A             A    A    A         Monthly       2.7            3.3          0.0        2.0
               The Whittington Hospital           3              4     4     G             G    G    G         G             G    G    G         A             A    A    A         Quarterly     1.2            1.4          1.4        1.4
               West Middlesex Hospitals           2              2     3     A             A    G    G         G             A    A    G         A             G    A    A         Monthly      -4.5           -1.0         -4.4       -1.4
               Whipps Cross                       2              2     2     A             A    A    A         A             G    A    G         A             G    G    G         Monthly       2.1           -1.1          4.6       -1.1
               BEHMHT                             4              4     4     G             G    A    A         G             G    G    G         A             G    G    G         Quarterly     2.0            1.3          2.0        2.0
               Camden And Islington Mht           4              5     4     G             G    G    G         G             G    G    G         G             G    G    G         Quarterly     1.0            2.1          1.0        2.7
     Mental
               NELMHT                             4              4     4     G             G    G    G         G             G    G    G         G             G    G    G         Quarterly     0.8            1.3          1.1        1.8
     Health
               SWL & St George's                  3              4     4     A             A    A    G         G             G    G    G         R             A    A    A         Quarterly     1.2            1.4          1.7        1.7
               West London Mental Health          2              2     2     G             G    G    G         G             G    G    G         A             G    G    G         Monthly       1.7            1.9          2.3        2.3
  Ambulance    London Ambulance Service           2              4     3     A             G    G    G         A             G    G    G         A             A    G    G         Quarterly    -2.2            3.9          0.0        1.1
                                                                                                                                                                                                 8.8           40.6          9.7        7.8
                                                                                                                                                                                   Change vs Q2

Note: Forecast outturn at Q3 not M10 FIMs, which also excludes FT’s
                                                                                                                                                                                                                                       12
    Trust Quality and safety ratings
  Trust                                     07/08 Plan 07/08 Q3
  Barnet and Chase Farm                       Amber      Amber           For acute trusts:
  Barts and London                            Amber      Amber           •   MRSA year-on-year reduction targets breached/will be
  BHRT                                        Amber       Red                breached by 15 Trusts vs the 20 indicated at the beginning of
  Bromley Hospitals                            Red       Amber               the year.
  Ealing Hospital                              Green     Amber               Cdif – although not yet measured as a target, will become an
  Epsom and St Helier                          Red       Amber               issue for 08/09 as some trusts are missing expected target
  Great Ormond Street Hospital                 Green     Amber
                                                                         •   Maximum wait of 4 hours in A&E breached/due to be
  Imperial College Healthcare                 Amber      Green
                                                                             breached by 18 Trusts vs the 10 indicated at the beginning of
  Kingston                                     Green     Amber
                                                                             the year
  Lewisham                                    Amber       Red
  Mayday                                      Amber       Red            •   Progress towards 18 week maximum wait likely to be
  Newham                                       Red       Amber               breached by 4 Trusts vs 6 at the beginning of the year.
  North Middlesex                             Amber      Amber
                                                                         •   Maximum wait of 6 months for inpatients breached by 4
  North West London Hospitals                 Amber      Amber               Trusts despite only 1 trust indicating a problem at the
  Queen Elizabeth                             Amber      Amber               beginning of the year
  Queen Mary's Sidcup                         Amber      Amber
  RNOH                                        Amber      Amber           •   Patients with operations cancelled for non-clinical reasons to
  Royal Brompton and Harefield                Amber      Amber               be offered another binding date within 28 days breached by
                                               Green     Green               4 Trusts vs 2 at the beginning of the year
  Royal Free Hampstead
  St Georges                                  Amber      Amber           •   Minimising delayed transfers of care by 2008 breached by 5
  The Hillingdon Hospital                     Amber      Amber               Trusts despite only 1 indicating this as an issue earlier in the
  West Middlesex uni Hospital                 Amber      Amber               year
  Whipps Cross                                Amber      Green
                                                                         •   7 Trusts breached other national core standards
  Whittington Hospital                        Amber      Amber
  BEH MHT                                     Amber      Green           For Mental Health Trusts and London Ambulance Service:
  Camden and Islington MH and SCT              Green     Green
                                                                         •   Targets are limited and have been achieved by all but 1
  NELMHT                                       Green     Green
                                                                             trust.
  SWL and St. Georges                          Red       Amber
  West London MHT                             Amber      Green
  London Ambulance Service                    Amber      Green
                            Count Red            4         3
                            Count Amber         20        19
                            Count Green          6         8
                                                                                                                                            13
Note: Excludes CNWL and ELCMHT FT‟s at 1st May 07 and 1st November 07 respectively
  Q3 2007/08 Quality and Safety risk ratings




                                                                                                                                                                                                                                                                                                                             Queen Elizabeth
                                                                                                   Imperial College




                                                                                                                                                                                                                                                         North Middlesex
                                                                                                                                                                                                                    Barnet & Chase
                                                                                                                                                                                     West Middlesex
                                                                                                                                      Royal Brompton
                                                                                 Street Hospital
                                                               Ealing Hospital




                                                                                                                      NWL Hospitals




                                                                                                                                                                                                                                                                           Royal National
                                                                                 Great Ormond




                                                                                                                                                                    The Hillingdon




                                                                                                                                                                                                                                            Newham UHT




                                                                                                                                                                                                                                                                                                                             Queen Mary's
                                                   Weighting




                                                                                                                                                                                                                    Barts and the




                                                                                                                                                                                                                                                                           Orthopaedic




                                                                                                                                                                                                                                                                                                       Epsom & St




                                                                                                                                                                                                                                                                                                                                               St George's
                                                                                                                                                       Royal Free




                                                                                                                                                                                                      Whittington
                                                                                                                                      & Harefield
                                                                                                   Healthcare




                                                                                                                                                                                                                                                                                                       Lewisham
                                                                                                                                                                                                                                                                                            Whipps X


                                                                                                                                                                                                                                                                                                       Hospitals




                                                                                                                                                                                                                                                                                                       Hospitals
                                                                                                                                                                                                                                                                                                       Kingston
                                                                                                                                                                                                                                                                                                       Bromley
                                                                                                                                                                    Hospital




                                                                                                                                                                                                                                                                                                       Hospital




                                                                                                                                                                                                                                                                                                                             Hospital
                                                                                                                                                                                                                                                                                                                    Mayday
                                                                                                                                                                                                                    London




                                                                                                                                                                                                                                                                                                                             Sidcup
                                                                                                                                                                                                                                     BHRT




                                                                                                                                                                                                                                                                                                       Helier
                                                                                                                                                                                                                    Farm
Core Standard/Target
Max. 31 days diagnosis to treatment for all
                                                 1.0
cancers
Max. 62 days urgent referral to treatment
                                                 1.0
for all cancers
Max. waiting time of 6 months for inpatients
                                                 1.0

Max. waiting time of 13 weeks for outpatients
                                                 1.0

MRSA year on year reduction
                                                 1.0

Progress on 18 weeks

Sexual health -48hr access to GUM clinic
by 2008
                                                 1.0                             N/A               N/A                                N/A                                                             N/A                                                N/A                N/A
Imp. of choice & booking - elective & O/P
booking                                          1.0

Max. wait of 4hrs in A&E                                                         N/A
                                                 0.4                                                                                  N/A                                                                                                                                   N/A
All pts cancelled ops offered another date
                                                 0.4
within 28days
All MIs to receive thrombolysis within 60 mins
of call                                          0.4                                                                                                                                                                N/A                                  N/A                N/A
Max. wait of 3 months for revascularisation
                                                 0.4                                                                                                                                                                N/A                                  N/A                N/A
Max. wait of 2 weeks for urgent GP referral to
O/P for suspected Cancer                         0.4

Max. wait of 2 weeks for Rapid Access Chest
Pain Clinics
                                                 0.4                                                                                                                                                                                                                        N/A
Minimising delayed transfers of care by 2008
                                                 0.4

Other Core Standards                                                                                                  1
                                                 0.4                                                                                                                                                                  3              1                                        4                                      1                 2         5

   Overall Quality & Safety
   Rating
            Breach

                                                                                                                                                                                                                                                                                                                               14
PCT Performance




                  15
PCT Financial Performance


• Overall PCTs are forecasting a surplus of £100m against a Plan
  of £17m. This has been mainly driven by:
   – Prescribing underspends;
   – Stronger than anticipated carry forward from 2006/07;
   – Contingencies within plans at the start of 2007/08 of a
      minimum of 0.5% which have not been required to offset
      risks in year
• No PCT agreed a deficit Plan at the beginning of the year.
• Three PCTs forecasting a year end deficit in 2007/08.




                                                                   16
PCT Financial Performance
       YTD Versus Plan                             Month 10              FOT Versus Plan
                                                                                                        Movement from
             Month 10                                                         FOT as at                 Control Total (@   FOT as % of
Plan YTD       YTD        Variance    PCT Summary               FOT in Plan   Month 10     Variance         Mth 7)            RRL
 £'000s       £'000s       £'000s                                 £'000s       £'000s                       £'000s             %

    4,998       15,801       10,803   Barking and Dagenham            6,000       20,775       14,775                  -          7.5%
    (504)            34         538   Barnet                              -        2,948        2,948              (284)          0.7%
    (342)      (2,468)      (2,126)   Bexley                              -      (2,900)      (2,900)                  0        (1.1%)
    (139)        1,061        1,200   Brent                               -        1,790        1,790              3,427          0.4%
       (0)            -           0   Bromley                             -            -            -                  -          0.0%
         -       3,523        3,523   Camden                              -        4,060        4,060                 29          1.0%
      830        7,706        6,876   City and Hackney                1,000        9,360        8,360                  -          2.3%
         -       3,071        3,071   Croydon                             -        2,600        2,600                  -          0.6%
         -       2,949        2,949   Ealing                              -        4,200        4,200                  -          0.9%
        40    (11,289)     (11,329)   Enfield                            48     (13,308)     (13,356)            (3,358)        (3.6%)
         -       1,254        1,254   Greenwich                          57        1,491        1,434                 80          0.4%
         -      10,726       10,726   Hammersmith and Fulham              -       12,500       12,500              2,500          4.4%
    1,564        1,424        (140)   Haringey                        1,876          538      (1,338)                  -          0.1%
      (86)            -          86   Harrow                              -            -            -                  -          0.0%
    (884)        (346)          538   Havering                            -          300          300                300          0.1%
  (2,089)      (2,604)        (515)   Hillingdon                          -            -            -                  -          0.0%
         -     (2,234)      (2,234)   Hounslow                            -      (2,358)      (2,358)              (266)        (0.8%)
         -       1,381        1,381   Islington                           -        1,450        1,450              1,450          0.4%
      242        6,039        5,797   Kensington and Chelsea              -        5,672        5,672              (770)          1.8%
         -       4,933        4,933   Kingston                            -        3,470        3,470              1,970          1.6%
         -       1,591        1,591   Lambeth                             -        1,950        1,950                  3          0.4%
    (246)          (73)         173   Lewisham                            -            -            -                  -          0.0%
         6       2,824        2,818   Newham                              -        3,300        3,300                  -          0.7%
    1,660       16,921       15,261   Redbridge                       2,000       20,700       18,700              1,075          6.4%
      901          105        (796)   Richmond and Twickenham         1,214          165      (1,049)                  -          0.1%
         -         175          175   Southwark                           -          600          600                600          0.1%
         -       3,120        3,120   Sutton and Merton                   -            -            -                  -          0.0%
         -       3,177        3,177   Tower Hamlets                       -        4,356        4,356              1,356          1.1%
         -           81          81   Waltham Forest                      -          102          102                  -          0.0%
    1,770        6,892        5,122   Wandsworth                      2,124        4,721        2,597                962          1.1%
    2,471        9,493        7,022   Westminster                     3,000       12,176        9,176                223          3.0%

  10,192       85,268       75,076    PCT Totals                    17,319      100,658       83,339              9,297          0.9%
                                                                                   Key: Red = adverse variance from Plan  17
                                                                                        Yellow = movement > £1m from Control Total
PCT Financial Performance - Significant adverse
variances
•   PCT                                 • Reasons                                             •   Actions


                                                                                                 New FD recently appointed.
    Bexley Care Trust                      Acute contract overperformance on key
   (M10YTD £2.4m deficit, FCOT             contracts based on latest notified position by       Since month 10, the Care Trust have agreed
    £2.9m deficit; plan was                                                                       fixed outturn positions with main providers to
    breakeven).                             the Trusts.
                                                                                                  minimise risk and undertaken a detailed bottom
   Control Total set at M7 was £2.9m
    deficit.                                                                                      up review which has reduced the exposure to the
                                                                                                  overspend previously forecast and released
                                                                                                  reserves and underspends to bring the latest
                                                                                                  FOT back to the plan of breakeven.
                                                                                                 SHA continuing to closely monitor.

   Enfield PCT                            Reflects completed findings of a full review of      The PCT are implementing and continuing to
   (M10YTD £11.3m deficit, FCOT            the financial position undertaken by the new          work on mitigating actions and have presented
    £13.3m deficit; plan was
    breakeven).                             interim management.                                   an updated plan to the SHA.
   Control Total set at M7 was            Revised savings and successful outcome of            SHA continuing to closely monitor.
    £9.95m deficit.
                                            negotiations with Barnet & Chase Farm NHS
                                            Trust.

   Hounslow PCT                           Despite continued pressure on acute
   (M10YTD £2.2m deficit, FCOT                                                                  The PCT has a recovery plan and is working
    £2.4m deficit; plan was                 overperformance, the PCT has seen a                   hard to deliver a balanced position. Going
    breakeven).                             stemming of activity which they are working to        forward the organisation has developed plans to
   Control Total set at M7 was £2m         sustain. The forecast deficit position is a           demonstrate its financial sustainability in a
    deficit.                                reflection of increased activity greater than         challenged health economy.
                                            planned in a number of areas including critical
                                                                                                 SHA continuing to closely monitor.
                                            care.

                                                                                                 No further action required as PCT still achieving
                                           Reflects technical restatement of contingency
   Richmond & Twickenham                                                                         above statutory duty of breakeven.
                                            within forecast outturn.
   (M10YTD £0.1m surplus, FCOT
    £0.1m surplus; plan was £1.2m
    surplus).
   Control Total set at M7 was £0.1m
    surplus.                                                                                                                          18
PCT - Significant favourable variances

•   PCT                             •   Reasons                                          •   Actions
                                       Improvement due to review of financial              PCT are actively working to deal with
   Brent PCT
                                        management systems, reduction in capital             remaining upside and downside risk and are in
   (M10 YTD £1m surplus, FOT           charges estimate, large number of vacancies          regular dialogue with the SHA
    £1.8m surplus; original plans       within provider services and continued review
    were breakeven).                    of expenditure on continuing care.
   Control Total set at M7 was
    £1.6m deficit.
   Hammersmith and Fulham
                                       Improvement due to benefit of Market Forces         PCT have set a 3 – 5 year financial plan which
    PCT
                                        Factor following creation of Imperial College.       shows investments and addresses impact of
   (M10 YTD £10.7m surplus,            The benefit was not expected. In addition,
    FOT £12.5m surplus; plan was                                                             non-recurrent savings.
                                        risks have not materialised and as such
    breakeven).                         contingency held has been released and the          SHA continue to monitor.
   Control Total set at M7 was         PCT has benefitted from higher levels than
    £10m surplus                        expected of prescribing savings.

   Kingston PCT                       Improved forecast due to underspends within         PCT are working to stabilise forecast and bring
   (M10 YTD £4.9m surplus, FOT         the Provider Arm, an improved prescribing            forward investment plans wherever possible.
    £3.5m surplus; plan was             position, corporate services vacancies and          SHA continues to closely monitor.
    breakeven).                         review of 2006/07 accruals offset by
   Control Total set at M7 was         commissioning overspends.
    £1.5m surplus




                                                                                                                               19
PCT Risk Ratings – Q3
                                                      Quality &    Key     Other
 PCT                       Finance       Governance   Outcomes    Targets Targets
 Tower Hamlets               4                            ↑          ↑
 City & Hackney              4                            ↑          ↑
 Lambeth                     4                            ↑          ↑
 Southwark                   3
 Harrow                      3
 Kensington & Chelsea        4
 Camden                      4
 Wandsworth                  4                            ↓         ↓
 Westminster                 4
 Waltham Forest              3↑              ↑
 Haringey                    4                                               ↑
 Redbridge                   4
 Richmond & Twickenham       3                                               ↑
 Ealing                      4
 Greenwich                   4                                      ↓
 Hammersmith & Fulham        4
 Islington                   4
 Newham                      4               ↑                      ↓
 Barnet                      4
 Croydon                     4                                      ↑
 Lewisham                    3↑
 Barking & Dagenham          4
 Havering                    3↑
 Bromley                     4                                      ↓
 Sutton & Merton             3↑
 Hillingdon                  2↑              ↑                      ↓        ↑
 Kingston                    2
 Brent                       2                                               ↓
 Bexley                      1↓                                              ↓
 Enfield                     1
 Hounslow                    1↓
                                                                                    20
↑ = Increase from Q2, ↓ = Decrease from Q2
    Proposed Changes to PCT Ratings for Q3
FINANCE
–     The Board is asked to confirm the change to the following PCTs‟ finance ratings from a 2 to a 3, and
      (for Hillingdon from a 1 to a 2) in line with their better than planned financial position at month 9:
      - Havering         - Lewisham             - Sutton & Merton       - Waltham Forest         - Hillingdon


–     The Board is asked to confirm the change to the following PCTs‟ finance ratings from a 2 to a 1, due to
      their deterioration in position at month 9, in line with the ratings scoring methodology:
      - Bexley               - Hounslow

GOVERNANCE
– The Board is asked to confirm the change in rating from amber to green for Newham and
  Waltham Forest PCTs and from red to amber for Hillingdon PCT, as governance issues
  which impacted on the initial rating have now been resolved satisfactorily
       • n
QUALITY AND OUTCOMES
     The Board is asked to confirm the change in ratings in accordance with the scores
      shown in the previous page. The scores relating to the separate elements for „key
      targets‟ and „other targets‟ are shown for information

     All PCTs with the exception of Tower Hamlets will remain on monthly monitoring in
      • n
      accordance with the Regime. Monthly review meetings will be held with PCTs where
                                                                                        21
      the latest available information indicates that this is appropriate
Appendices


 1 Service Performance


 2 SHA Financial Performance




                               22
Appendix 1 - Service Performance




                                   23
     08
        /
        04
     15 /20




                   93%
                         94%
                               95%
                                     96%
                                           97%
                                                 98%
                                                       99%
                                                             100%
       /0 07
         4
     22 /20
       /0 07
         4
     29 /20
       /0 07
         4
     06 /20
       /0 07
         5
     13 /20
       /0 07
         5
     20 /20
       /0 07
         5
     27 /20
       /0 07
         5
     03 /20
       /0 07
         6
     10 /20
       /0 07
         6
     17 /20
       /0 07
         6
     24 /20
       /0 07
         6
     01 /20
       /0 07
         7
     08 /20
       /0 07
         7
     15 /20
       /0 07
         7
     22 /20
       /0 07
         7
     29 /20
       /0 07
         7
     05 /20
       /0 07
         8
     12 /20
       /0 07
         8
     19 /20
       /0 07
         8
     26 /20
       /0 07
         8
     02 /20
       /0 07
         9
     09 /20
       /0 07
         9
     16 /20
       /0 07
         9
     23 /20
       /0 07
         9
                                                                                                          A&E waits in 4 hours - trend




     30 /20
       /0 07
         9
     07 /20
       /1 07
         0
     14 /20
       /1 07
         0
     21 /20
       /1 07
         0
     28 /20
       /1 07
         0
     04 /20
       /1 07
         1
     11 /20
       /1 07
         1
     18 /20
       /1 07
         1
                                                                    London Trust A&E Performance 2007/8




     25 /20
       /1 07
         1
     02 /20
       /1 07
         2
     09 /20
       /1 07
         2
     16 /20
       /1 07
         2
     23 /20
       /1 07
         2
     30 /20
       /1 07
         2
     06 /20
       /0 07
         1
     13 /20
       /0 08
         1
     20 /20
       /0 08
         1
     27 /20
       /0 08
         1
     03 /20
       /0 08
         2
     10 /20
       /0 08
         2
     17 /20
       /0 08
         2
     24 /20
       /0 08
         2
     02 /20
       /0 08
         3
24




     09 /20
       /0 08
         3/
            20
              08
A&E waits in 4 hours –performance by Trust
                                                                         2007/8
                                                             2007-08       YTD
   A&E Performance                 2007-08 2007-08 2007-08   Q4 to w/e   (to w/e
   (as at w/e 9 March)               Q1      Q2      Q3       9 Mar      9 Mar)
   Barking, Havering & Redbridge     95.3%   96.3%   90.6%      82.6%       91.8%
   Whipps Cross                      97.8%   96.3%   95.2%      92.3%       95.6%
   Bromley                           98.1%   98.1%   94.1%      91.4%       95.8%
   Lewisham                          97.0%   97.2%   95.3%      95.9%       96.4%
   West Middlesex                    97.6%   98.2%   94.6%      95.9%       96.6%
   Ealing                            97.3%   98.0%   95.7%      96.7%       96.9%
   North West London Hospitals       97.6%   98.0%   96.4%      95.5%       96.9%
   St. George's                      98.6%   98.7%   96.3%      96.2%       97.5%
   Epsom & St. Helier                98.4%   98.4%   97.4%      95.7%       97.6%
   North Middlesex                   98.7%   98.5%   95.4%      97.9%       97.6%
   Bart's & the London               98.2%   97.9%   97.6%      96.7%       97.7%
   Hillingdon                        98.0%   98.5%   96.9%      98.2%       97.9%
   Queen Elizabeth                   97.7%   98.1%   97.7%      98.2%       97.9%
   Mayday                            98.6%   98.6%   97.7%      96.6%       97.9%
   Homerton                          98.1%   97.7%   98.4%      98.2%       98.1%
   Kingston                          98.6%   98.7%   97.8%      97.3%       98.1%
   Imperial College                  98.4%   98.7%   97.6%      97.9%       98.2%
   Royal Free                        98.5%   98.6%   97.8%      97.7%       98.2%
   UCLH                              99.1%   98.2%   97.6%      97.9%       98.2%
   Queen Mary's Sidcup               98.4%   98.1%   98.1%      98.7%       98.3%
   King's College                    98.4%   98.4%   98.3%      98.3%       98.4%
   Whittington                       98.7%   98.6%   98.3%      98.1%       98.4%
   Newham                            99.0%   98.7%   97.5%      98.7%       98.5%
   Guys & St Thomas'                 98.5%   98.9%   98.5%      98.3%       98.6%
   Chelsea & Westminster             98.6%   98.8%   98.8%      98.8%       98.7%
   Barnet & Chase Farm               99.4%   99.4%   99.3%      99.4%       99.4%
   Moorfields                        99.0%   99.1%   99.9%      99.7%       99.4%

   London                            98.1%   98.2%   96.7%      96.0%      97.4%

   England                           98.3%   98.4%   97.4%      97.3%      97.9%
                                                                                    25
A&E – the position
   – YTD performance is 97.4% (13 Trusts/FTs are above 98% and 14
     are below)
   – Performance has deteriorated sharply over the last 3 months, at 95-
     96% each week
   – Over this recent period London is performing worse than the other
     SHA regions
   – A few Trusts have been consistently well below 98%, BHRT YTD
     performance is 91.9%, Whipps Cross is 95.6% and Bromley
     Hospitals is 95.8%
   – Winter pressures, in terms of bad weather and seasonal flu haven‟t
     been an issue
   – Norovirus has affected a few Trusts (e.g. St. George‟s)
   – Delayed transfers of care have been an issue in just a couple of
     places (BHRT & Lewisham), which has been actioned to reduce
     delays
   – There is some anecdotal evidence of bed pressures being
     exacerbated by greater focus on isolation of patients with HCAIs,
     but it does not appear to be that significant
   – Staffing shortages are a major problem in a couple of the worst
     performing Trusts (BHRT & Bromley) with shifts unable to be filled
     with locums or NHSP and bank/agency sources
                                                                           26
A&E – action taken by the SHA
   – All Trusts below 98% were asked to produce recovery trajectories
     to indicate their recovery pathway to sustainable 98%
   – A weekly review is undertaken by the Provider Agency CE and the
     Director of Finance & Performance including on the need for
     intervention and further support to challenged Trusts
   – Key under-performing Trusts with their PCTs called in to see NHS
     London, to examine what the problems are, what they are doing to
     tackle them together, and whether NHS London can help
   – Expert support has been working with Trusts (BHRT, Bromley,
     Whipps Cross, West Middx, Ealing, Lewisham, St. George‟s, plus NWLHs
     and Bart‟s and the London have their own support), to review against
     established best practice and make recommendations for improved
     performance. The SHA is monitoring delivery of the agreed action
     plans
   – We have circulated learning points from the intervention teams to
     all CEs
   – Trust performance is being closely monitored with a view to
     sending in further intervention visits as required
   – Most challenged Trusts and PCTs called in for second round of
     follow-up meetings to confirm necessary focus on the situation and
     what progress has been made and Chairs and CEs have been
     called in to see the SHA Chair and CE
                                                                            27
    Ambulance response times (to w/e 9 March)
                 Target   Actual    Improving /        Comment / Action
                                   Deteriorating
Category „A‟     75%      78.8%      A marked      Above target and above the
response in 8              YTD     improvement      national average, but see
minutes                            over previous              below
                                       years


Category „A‟      75%     61.2%      Improving      Slightly below the national
response in 8    (takes    YTD         steadily       average, and significant
minutes (from    effect            (68.1% in the   improvement still needed as
call being          in              latest week)     this standard takes effect
connected)       ‟08/9)                                   from 1 April 2008


Category „B‟     90%      84.5%     No change       With the focus on Category
response in 19             YTD                     „A‟ response times there has
minutes                                                  been no increase in
                                                   Category „B‟ response times
                                                                           28
HCAIs – MRSA trend                                         There has been a 30% reduction over the
                                                           last year, although the rate of decrease
                                                           has now slowed.



       London Trusts - 3-month rolling actual v. plan   Trust trajectory           The number of
                                                                                 Trusts at or better
 350                                                    Actual                   than trajectory for
                                                                                 the last 3 months
                                                                                has increased to 14
 300                                                                                  out of 31


 250                                                                            SHA target set by
                                                                                  DH is 210

 200                                                                          14% above
                                                                              trajectory at Feb.‟08

 150                                                                         Further 20% reduction
                                                                              needed to achieve
                                                                             March 3-month rolling
 100                                                                               trajectory

                                                                                Against annual
  50                                                                         trajectory the Trusts
                                                                             most over target are:
                                                                                   Hillingdon
                                                                                     Ealing
  0                                                                          Bart‟s & the London
                                                                                   Newham
                                                                               North Middlesex
                                                                              Epsom & St Helier
                                                                               Queen Elizabeth
                                                                                  Whittington

                                                                                      29
HCAIs – C. diff. trend (ages 65+)


                                                                                       Most of the reduction
                                                                                          is at a few Trusts,
                                                                                        some of which had
                                                                                         very high historical
                                                                                         levels, i.e. Whipps
                                                                                       Cross (-51%), B&CF
                                                                                       (-52%), QEH (-69%),
                                                                                             BHRT (-58%)




                                                                                       There has been a
                                                                                          year-on-year
                                                                                         increase at 16
                                                                                        Trusts as at Q3,
                                                                                      e.g. UCLH (+54%),
                                                                                        Ealing (+43%),
                                                                                      Royal Free (+30%),
                                                                                      Epsom & St Helier
                                                                                             (+22%)




  After a fairly long static period there was a big fall in Q2, which has improved again in Q3
                                                                                             30
HCAIs - action

   –   We have received a central allocation of £5m for MRSA which is being used to support
       a wide range of initiatives by Trusts and PCTs to improve infection control

   –   We are setting up a network of the DIPC's and senior infection control nurses mainly to
       improve their insight and leadership in taking the HCAI agenda forward

   –   We are in regular contact with those Trusts which are off trajectory to check on
       progress with their action plans – and visits from the Turnaround Director for HCAI are
       being targeted to specific trusts

   –   We are working with the HPA both about data and potential actions that Trusts could
       take forward to make improvements – C. diff. will become a much higher focus with the
       new national target for 2008-11, building on the start made with local targets

   –   Trusts have been requested to benchmark themselves against the HCC Maidstone &
       Tunbridge Wells report and to produce an action plan for improvements. These plans
       have been reviewed by the SHA (see separate report)

   –   We will also be commencing work with PCT's about their own provision, and also their
       commissioning and performance management role with their providers




                                                                                                 31
18 weeks RTT (admitted) - actual v. plan (commissioner)


                                    PTL data not                      London Actual                  England Actual
 90%                                reported by                       London PTL                     London Plan
                                    most FTs,
 80%                                overall
                                    performance
                                    will be slightly
 70%                                better than
                                    this
 60%


 50%


 40%


 30%


 20%


 10%


 0%
         M ar   Apr   M ay   June        July          Aug   Sept   Oct     Nov       Dec   Jan'08   Feb'08     M ar'08



       Slowly increasing trend partly due to backlog (of patients who have already
       waited >18 weeks) being treated – March PTL report is for first week only
                                                                                                                 32
18 weeks RTT (non-admitted)- actual v. plan (commissioner)

                                                                 London Actual                  England Actual
 100%                                                            London PTL                     London Plan

 90%

 80%

 70%

 60%
                 PTL data not
                 reported by
 50%             most FTs,
                 overall
 40%             performance
                 will be
                 slightly better
 30%             than this

 20%

  10%

  0%
          M ar    Apr        M ay   June   July   Aug   Sept   Oct     Nov       Dec   Jan'08   Feb'08     M ar'08


        Slowly increasing trend partly due to backlog (of patients who have already
        waited >18 weeks) being treated – March PTL report is for first week only
                                                                                                                 33
18 weeks – the current position
•   PTL data for the first week in March „08 is very encouraging, with performance for admitted
    patients improving to 79% treated within 18 weeks, and performance for non-admitted
    patients up to 88%

•   This suggests that the March milestone (90%) for non-admitted patients could be achieved,
    and the admitted patient milestone (85%) will almost certainly not be achieved but
    performance could be above 80% which is a big improvement on the 44% in March „07

•   There is a very large variation in performance, with some Trusts reaching both the
    milestones whilst a few Trusts are a long way off as they are still working through a sizeable
    backlog of patients who have already waited over 18 weeks and therefore are reporting no
    weekly improvement

•   Data quality continues to be an issue, particularly for tertiary centres. The current London
    average is 7% unknown clock starts (for admitted pathways), although most Trusts are now
    reporting the clock start for all patients treated

•   Inter-Provider Transfers remains an issue across London with low compliance with the
    requirement for referring Trusts to forward a data set, we have written to all CEs on the
    process for transferring data electronically

•   From 31 March the maximum wait for diagnostics is 6 weeks. Progress has been good but
    there is a high risk that some Trusts may have a small number of 6 week breaches at 31
    March, and BHRT is likely to fail the target by quite a wide margin



                                                                                                     34
18 weeks - SHA action

•   NHS London will continue to review progress against both data completeness and trajectory
    and escalate attention and support for organisations on a weekly basis. The weekly review
    is undertaken by the Director of Finance & Performance and the Provider Agency CE

•   Several Trusts are now aiming to exceed the March milestone for admitted patients to
    compensate for those that do not achieve it. PCTs will be purchasing the increased activity

•   5 PCTs are acting as sector leads and co-ordinating dissemination of key messages to all
    PCTs and Trusts in their patches

•   An e-mail bulletin is now sent out to CEs and 18 week leads highlighting key messages and
    actions required, with a particular emphasis on action to be taken to maximise March
    performance

•   NHS London has agreed with the national Intensive Support Team that in-depth support will
    be continued for BHRT, RNOH, Barnet & Chase Farm, Royal Brompton & Harefield,
    Imperial, Newham and W.Middx. Bromley and Whipps Cross are now also receiving
    support. The IST has recently undertaken diagnostic reviews at Kingston and St. George‟s

•   Beyond March we will be undertaking a review of the programme of action needed to deliver
    the end December target, which will include an ongoing focus on those Trusts and PCTs
    that miss the March milestones by a significant margin and ensuring that local action plans
    are tackling all bottlenecks and any problem specialties (e.g. Orthopaedics) and sub-
    specialties

•   An enhanced performance management rigour will need to be continued through to at least
    December „08
                                                                                                  35
                                                                                                                                                                                                                                                                                                                                                          ’07/8 & % change
  Smoking quitters to Q3                                                                                                                                                                                                                                                                                                                                  Q1 – 10905 (+18%)
                                                                                                                                                                                                                                                                                                                                                          Q2 – 11461 (+31%)
                                                                                                                                                                                                                                                                                                                                                          Q3 – 9470 (-4.5%)
                                                                                                                                        4-Week Quitters % of 2007-08 Target
                                                                                                                                                                                                                                                                                                                                                          YTD 31836 (+16%)
100%

                        Q3
90%
                        Q2
80%                     Q1
                        Indicative Target
70%

60%

50%

40%

30%

20%

10%

 0%
                                                                                                                                                                               BEXLEY




                                                                                                                                                                                                                                                                                                                                   HAMMERSMITH & FULHAM
                                                                                                                                                BROMLEY




                                                                                                                                                                                                                                                                     HARINGEY

                                                                                                                                                                                                                                                                                CITY & HACKNEY




                                                                                                                                                                                                                                                                                                                                                                                                              CAMDEN
                                                                             CROYDON




                                                                                                                                                          BARKING & DAGENHAM




                                                                                                                                                                                                                                               ENFIELD

                                                                                                                                                                                                                                                         REDBRIDGE
               EALING




                                                                                                  LAMBETH




                                                                                                                                                                                                               LONDON




                                                                                                                                                                                                                                                                                                                                                           HILLINGDON
                                                                                       HAVERING
       BRENT




                                                                                                                                                                                                                                                                                                                                                                                                     BARNET
                                                KINGSTON




                                                                                                                                                                                                                                                                                                                                                                        ISLINGTON
                                                                                                                                                                                                                        KENSINGTON & CHELSEA
                                                           SUTTON & MERTON




                                                                                                                                                                                                    LEWISHAM




                                                                                                                                                                                                                                                                                                 NEWHAM
                        RICHMOND & TWICKENHAM




                                                                                                                                                                                                                                                                                                          HARROW
                                                                                                                                     HOUNSLOW




                                                                                                                                                                                        GREENWICH




                                                                                                                                                                                                                                                                                                                                                                                    WALTHAM FOREST
                                                                                                                         SOUTHWARK




                                                                                                                                                                                                                                                                                                                   TOWER HAMLETS




                                                                                                                                                                                                                                                                                                                                                                                                                       WESTMINSTER
                                                                                                            WANDSWORTH




                                                                                                           36
 At Q2 we were on target but performance in Q3 has been significantly lower than Q1 & Q2, therefore there is a risk
 that the outturn could be lower than in 2006/07
Appendix 2 – SHA Financial Performance




                                         37
SHA Financial Performance (MPET)
                         Multi-Professional Education & Training (MPET) Financial Position

                                                                                                        Forecast Outturn
                                                                                 Year to Date      FOT          FOT
                                                                                 Variance to     Variance     Variance
                                                                                    M10            M7           M10       Movement
                                                                                    £000s         £000s        £000s       £000s
     Non-Medical Education & Training (NMET)
     Tuition Fees for Nursing & Midwifery Qualification Courses                       (6,927)      (7,326)     (11,129)     (3,803)
     Tuition Fees for Other Non-Medical Professional Qualification Courses            (2,959)        (656)      (3,453)     (2,797)
     Tuition Fees for Post Qualification Nursing Courses                                (270)        (162)          319         481
     Vocational Training for Unqualified Staff                                             16        (357)        (307)           50
     Workforce and Education Development Projects                                     (1,220)          (74)     (1,780)     (1,706)
     Student Grants                                                                     1,726        2,520        2,470         (50)
     Salary Support for Staff in Training                                            (10,137)     (10,212)     (11,139)       (927)
     Essential Skills Health Employment Projects                                          371        (205)          267         472
     Strategic Fund                                                                         0      (3,629)          821       4,450
     0607 carry forward monies                                                        (3,333)      (4,000)      (4,100)       (100)
     Contingency Reserve                                                              (8,333)     (10,000)     (10,000)            0
     NMET Total                                                                      (31,066)     (34,101)     (38,031)     (3,930)

     Post Graduate Medical & Dental Education & Training
     Salaries & Non Pay                                                                 1,108          415        1,309         894
     Post Graduate Medical Education Centres                                               39            0            0           0
     Foundation Programme Infrastructure Costs                                             (1)           0            0           0
     Eastman Dental Training                                                                 0           0            0           0
     Projects to Support the Introduction of Modernising Medical Careers (MMC)          4,412        (350)        4,494       4,844
     Deanery Training & Administration                                                (5,804)            0      (1,000)     (1,000)
     Post Graduate Medical & Dental Education & Training Total                          (246)           65        4,803       4,738

     Undergraduate Medical & Dental Education Total                                     (771)        (914)        (844)          70

     Sub-total MPET                                                                  (32,083)     (34,950)     (34,072)        878

     Additional Investments (transferred to POD Admin from Month 10)                                1,435                   (1,435)

     Grand Total MPET                                                                (32,083)     (33,515)     (34,072)       (557)

• Between month 7 and month 10 there has been an increase in the forecast outturn surplus by £0.6m. There has been further slippage on
tuition contracts, as the academic year contracts values have been agreed, salary support, as data has been received from Trusts/PCTs
validating the number of starters, and a forecast surplus on the Deanery.
• The impact of this slippage has been reduced by a net increased investment on Strategic fund / development projects and increased
investment supporting the implementation of MMC.
• The vast majority of the MPET outturn has now been established through 2007/08 SLAs with PCTs/Trusts and HEIs. The outturn risks are   38
mostly on development and strategic fund schemes, outstanding tuition contracts with HEIs, additional investment schemes, student grants and
the Deanery.
SHA Financial Performance (Admin and other
Reserves)
                                                                                             Forecast Outturn
                                                                Year to Date         FOT          FOT
                                                                Variance at        Variance     Variance
                                                                   M10              at M7        at M10       Movement
                                                                    £000s            £000s        £000s          £000s

    SHA Admin Costs (inc. MPET)                                         2,235          3,770         3,946            176
    Other funds                                                                                                         -
      FT and other reserves                                            21,183         25,419       25,419               -
      Balance of Central Bundle                                         1,123          8,971        1,347          (7,624)
      Balance of 06/07 cfwd                                            12,552         15,062       15,062               -
      Interest on 06/07 cash deposit                                         -         9,352             -         (9,352)
      Other in year allocations                                         2,727          1,585        3,272           1,687
    SHA Total                                                           39,818         64,159       49,046        (15,113)
    Additional Investment                                              (6,209)       (44,178)     (42,800)          1,378
    Provision for slippage on investment programmes                                                 2,600           2,600
    Total                                                              33,609         19,981        8,846         (11,135)

    * Additional investment at M7 includes total required to achieve £300m at time of setting control total (£3.8m)

  • The SHA admin budget underspend is largely as a result of the incidence of personal injury cases seen in the
    first quarter of the year that has not been replicated in the following months.
  • The majority of the FT and other reserves reflect the funding set aside during the planning process to offset the
    impact of potential in-year FT starts on the aggregate London financial position
  • The allocations from the central budget bundle have now been finalised resulting in a reduced underspending
  • It has now been agreed to defer the receipt of interest on the SHAs cash deposit until 2008/09
  • Additional investment plans have now been put in place to accelerate spend on areas such as 18 weeks, health
    promotion and HfL preparation. The total investment is now forecast to be slightly less than that estimated at
    Month 7. The forecast outturn at M10 includes a provision for slippage on additional investment and other
    programmes in terms of delivery of the Control Total                                                           39
SHA Financial Performance (Hosted Budgets)
                                                                                      Forecast Outturn
                                                                Year to Date     FOT        FOT
                                                                Variance at    Variance   Variance
                                                                    M10         at M7      at M10    Movement
                                                                   £000s        £000s      £000s      £000s

   Hosted Services
   Cancer Action Team                                                  5,779      1,500        785       (715)
   London Health Observatory                                             227        160          -       (160)
   Healthcare for London (Post Launch)                                 8,589      9,719     11,755       2,036
   Reducing Healthcare Associated Infections                               -        500          -       (500)
   Hosted Services Total                                               7,411     11,879     12,540         661

   NCG Total *                                                           234        190        129         (61)

   LPfIT Total                                                         2,048      1,451      3,149       1,698

   Hosted Services Total                                               9,693     13,520     15,818       2,298

   * only reflects variances that will impact on SHA position




• The Cancer Action Team (CAT) is showing significant year to date underspend which results from slippage in
  commencement of some workstreams. This will reduce to between £0.8m and £1.5m by M12
• The HfL underspend has increased and reflects the requirement to carry forward monies into 2007/08 to fund the
  initiative
• The LPfIT underspend has increased largely due to a benefit from the unwinding of a National redundancy provision



                                                                                                                  40
SHA Financial Performance

 • The following additional SHA financial information is appended in
   annex 1:-

 • The SHA Balance Sheet

 • The SHA performance against our prompt payment target of 95%

 • A reconciliation of the SHA Central budget bundle

 • Additional breakdown of the SHA Budget as follows:-
     •The SHA admin budget by directorate
     •The SHA Hosted Services and Projects budget
     •The LPfIT budget
     •The National Commissioning Group Budget




                                                                       41
ANNEX 1                            Balance Sheet Position 2007/08 (as at M10)


                                                                   Summary London Balance

                                                                     Opening        Balance @ Movement Opening
                                                                     Balance             31/01       bal to M10
                                                                       £'000             £'000             £'000

Total Fixed Assets                                                      2,902            2,902                 -

Inter London SHA Debtors
Debtors                                                                10,449           17,269             6,820
Cash at bank and in hand                                                    1               10                 9
                                                                       10,450           17,279             6,829

Inter London SHA Creditors

NHS Creditors                                                         (19,921)         (60,702)         (40,781)
MPET Manual Creditors                                                                         -                -
NCG Manual Creditors                                                                          -                -
LPfIT manual Creditors                                                                        -                -
SHA manual Creditors                                                                          -                -
Trade Creditors                                                       (13,276)         (17,721)          (4,445)
Tax & Social Security Creditors                                        (1,889)            (367)            1,522
Other Creditors                                                        (3,685)            (214)            3,471
Accruals & Deferred Income                                             (3,608)                -            3,608
                                                                      (42,379)         (79,004)         (36,625)

Net current assets/(liabilities)                                      (31,929)         (61,725)         (29,796)

Creditors: amounts falling due after more than one year                      -                -                -
Provisions for liabilities and charges                                 (8,238)          (8,045)              193
Total Net Assets                                                      (37,265)         (66,868)         (29,603)

General Fund
Total General Fund                                                    (37,267)         (66,870)           29,603
Revaluation reserve                                                          2                2                -

Taxpayers equity                                                      (37,265)         (66,868)           29,603
                                                                                              -
                                                                                         Portal   Reported
SHA expenditure to M10                                                                                    42,761
SHA Hosted Service to M10                                                                                      -
MPET expenditure M10                                                                                     804,525
NCG expenditure to M10                                                                                   285,620
LPfIT expenditure to M10                                                                                   4,697
less cash drawings to M10                                                                            (1,108,000)
Cost of Capital

Reconciliation to Movement in General Fund to M10                                             -           29,603

                                                                    Number of
                                                                 invoices paid         Value of
                                                                     within 30    invoices paid
Prompt Payment Statistic YTD                                             days    within 30 days
                                                                             %                %
NHS                                                                         95               93
Non NHS                                                                     90               92


                                                                                                                   42
SHA Financial Performance
                                                 Detailed SHA Admin Financial Position

                                                                           Annual Budget                        As at 31 January 2008                                         Forecast Outturn




                                                                               Non                     Year to Date    Year to Date   Year to Date    Year to Date               Expected
                                                           Recurrent         Recurrent     Total         Budget          Actual        Variance        Variance      Budget       Actual         Variance
                                                            £000s             £000s        £000s          £000s           £000s          £000s             %         £000s        £000s           £000s
SHA Admin Costs

Corporate Affairs - Core                                         4,634            8,355      12,989           7,060           6,893          (167)             -2%      12,989        9,217         (3,772)
Corporate Affairs - Flexible Resource Team                       2,898               61       2,959           2,466          2,389            (77)             -3%      2,959         2,883            (77)
Turnaround                                                                          500         500             167            126            (41)            -24%        500           500              -
Communications                                                     658              150         808             629            410           (219)                        808           728            (81)
Finance & Performance                                            2,002           15,765      17,767           2,504          2,485            (19)            -1%      17,767        17,519           (248)
Provider Agency                                                  1,417            5,011       6,428           2,205          2,122            (83)            -4%       6,428         7,184            756
Strategy & Commissioning                                           886            2,476       3,362           1,663          1,340           (323)           -19%       3,362         3,164           (198)
Healthcare for London - Pre Launch                                   -              599         599             599            599              -              0%         599           599              -
Nursing                                                            517              296         813             502            407            (95)           -19%         813           761            (51)
People & OD                                                      2,379            1,759       4,138           2,287          1,563           (724)           -32%       4,138         4,138              -
Public Health (inc emergency planning)                           1,395            9,538      10,933           2,170          1,656           (514)           -24%      10,933        10,388           (545)
Olympic                                                                           1,230       1,230             454               -          (454)           100%       1,230                       (1,230)
Year End 06-07                                                         -              -           -               0            481            481                                     1,500          1,500

Total SHA Admin Costs                                           16,786           45,740      62,526          22,705         20,471          (2,234)           -10%     62,526        58,581         (3,946)

Subjective Analysis Breakdown
Pay Expenditure                                                 11,384            1,921      13,305          10,798         10,040            (758)            -7%
Non Pay Expenditure                                              5,769           43,766      49,535          12,171         12,943             772              6%
Income                                                            (367)              50        (317)           (264)        (2,512)         (2,248)          -850%

Total SHA Admin Costs                                           16,786           45,737      62,523          22,705         20,471          (2,234)           -10%

Budget Reconciliation
Approved by Board 28th March 07                                 13,570                -      13,570                                              -
Virement from MPET Initial                                       2,291                -       2,291
Virement from MPET in year                                         427              100         527
NHS Estates adjustment                                             (62)               -         (62)
Board Development Programme                                          -              158         158
Carry forward from 06/07                                             -            4,915       4,915
Emergency Planning                                                 700                -         700
Personal injury pre-Trust claims                                     -            7,822       7,822
Olympics                                                             -              245         245
ISTC                                                                 -              300         300
Communication                                                        -               66          66
Move London SHA CPD/NVQ allocation to SHA cost                       -                1           1
Move London SHA NVQ allocation to SHA cost                           -               35          35
Transfer to HFL from S&C                                             -               14          14
Bearing Good Witness                                                 -               50          50
High Secure Post                                                     -               25          25
Additional investment programme                                      -           15,737      15,737
clincal excellence                                                   -              305         305
Flu Pandemic                                                         -            1,168       1,168
CSIP*                                                                -           13,974      13,974
Olympics                                                             -              685         685

Annual Budget                                                   16,926           45,600      62,526
* CSIP above represents allocation received via central budget bundle & returned to DH via invoice payment

Whole Time Equivalents (Mth 10)                           Budget WTE        Actual WTE

Corporate Affairs - Core                                              9               8
Corporate Affairs - Flexible Resource Team                           67              53
Corporate Affairs - Turnaround                                        1               1
Communications                                                        7               6
Finance & Performance                                                17              14
Provider Agency                                                      14              15
Strategy & Commissioning                                              8               6
Nursing                                                               5               7
POD                                                                  21              18
Public Health                                                        17               8

Total                                                              166             136
                                                                                                                                                                                                              43
* WTE - excludes staff consultancy and agency.
SHA Financial Performance
                                          Revenue Central Budget Bundle 2007/08 Position


                                                                    £000s

Net allocation for London                                          1,753,471

Less: MPET                                                        (1,018,978)     Budget agreed at March Board

Available allocation net of MPET                                     734,493

Of which:

                                                                                  Includes NCG, Ambulance Radio Contract, Prison Healthcare,
                                                                                  Dangerous Persons with Severe Personality Disorders, NHS Bank
                                                                                  (part), TILT, Clinical Excellence Awards (part), CSIP (part), Mental
                                                                                  Health, Choice & Inclusion (part), LAS planning re terrorist threat,
   Confirmed allocations *                                           575,146      Healthcare for London and Personal Injury pre-Trust claims,
                                                                                  Clinical Excellence Awards (part), CSIP (part), Cancer Services and
                                                                                  Mental Health Choice & Inclusion (part) and Wave 2 ISTCs

                                                                                  Range of PCT spend including: vaccination programmes, QOF,
                                                                                  Recombinant Clotting Factors, NHS Direct - Contestible Out of Hours
   PCT Bundle                                                        158,000      Services, Audiology & CAMHS development

   Uncommitted                                                          1,347

* Included within this figure are the following SHA related allocations that have been actioned to date:-

Emergency Planning                                                       700
Personal injury pre-Trust claims                                       7,822
National Commissioning Group                                         233,400
Cancer Action Team                                                    13,940
Healthcare for London (Post Launch)                                   15,153
CSIP                                                                  13,974
Clinical excellence                                                      305
Olympics funding                                                         685
Balance of Central Bundle                                              1,347
Total Allocated to Date to SHA Budget                                287,326

                                                                                                                                                         44
SHA Financial Performance
                                        Detailed SHA Hosted Services and Projects Financial Position


                                                                                               As at 31 January 2008                                       As at 31 March 2008



                                                                                                                                                   Forecast      Forecast      Forecast
                                                                       Annual        Year to Date   Year to Date   Year to Date                    Outturn       Outturn       Outturn
                                                                       Budget          Budget         Actual        Variance        Variance        Budget       Actuals       Variance
                                                                       £000s            £000s          £000s          £000s            %            £000s         £000s         £000s
  Hosted Services

  Cancer Action Team                                                      16,320           13,599          7,820          (5,779)        -42%          16,320        15,535          (785)
  London Health Observatory                                                1,028              857            630            (227)        -26%           1,028         1,028             -
  Healthcare for London (Post Launch)                                     15,139            9,842          1,258          (8,584)        -87%          15,139         3,384       (11,755)
  National Funds for Reducing Healthcare Associated Infections            15,360           13,648         12,582          (1,066)          0%          15,360        15,360             -

  Total Hosted Services Costs                                             47,847           37,946         22,290        (15,656)         -41%          47,847        35,307       (12,540)

  Budget Reconciliation
  Approved by Board 28th March 07 (LHO)                                    1,002
  LHO 06/07 carry forward                                                    138
  CAT budget from central bundle                                          13,940
  CAT 06/07 carry forward                                                  2,380
  Healthcare for London (Post Launch)                                     15,153
  Reducing Healthcare Associated Infections                               15,360
  transfer from S&C to HfL                                                   (14)
  LHO budget adjustment                                                     (112)

  Annual Budget                                                           47,847




                                                       London Programme for IT Financial Position


                                                                                               As at 31 January 2008                                       As at 31 March 2008

                                                                                                                                                   Forecast      Forecast      Forecast
                                                                       Annual         Jul - Jan       Jul - Jan     July to Jan                    Outturn       Outturn       Outturn
                                                                       Budget          Budget          Actual        Variance       Variance        Budget       Actuals       Variance
                                                                       £000s           £000s           £000s          £000s            %            £000s         £000s         £000s
  LPfIT

  London Programme for IT                                                 10,730 *          6,745          4,697          (2,048)        -30%          10,730         7,581        (3,149)

  Total LPfIT Costs                                                       10,730            6,745          4,697          (2,048)        -30%          10,730         7,581        (3,149)


  * This comprises the actual resource transfer from the Department of Health remitted to NHS London of £6,112k, a resource transfer in respect of the release of an NLOP transition
  reserve by DoH of £891k, a resource transfer in respect of clinical coding of £186k from London's PCT's, aditional investment funding from NHS London of £1,175k, and a brought
  forward funding within NHS London Books of £2,366k. It excludes spend to the value of £1,348k for the period April to June 2007 that was transacted through Department of Health
  ledgers.

  WTE

  Budget                                                                   113.14
  Actual                                                                       82

                                                                                                                                                                                             45
SHA Financial Performance
               Detailed National Commissioning Group Financial Position
                                                                                           As at 31 January 2008
                                                                                                                                Forecast year
                                                                                     Year to       Year to       Year to        end position
                                                                    Annual            Date          Date          Date
                                                                    Budget           Budget        Actual       Variance
                                                                     £'000            £'000         £'000         £'000              £'000
 Expenditure
 NCG Programme(1)                                                     262,715         218,930       218,159            (771)             (1,124)
 NCG Admin                                                              2,119           1,761         1,607            (154)               (130)
            (1)
 LSD Drugs                                                             79,874          66,561        67,755           1,194               1,432
 NCG Learning and Skills Council                                        2,406           2,005         2,005               -                   -
 Total Expenditure                                                    347,114         289,257       289,526             269                 178
 Net of Income Reported within NCG Budgets:
 NCG Income*                                                           (4,644)         (3,870)       (3,870)              -                      -
 NCG Admin (ad hoc income)(2)                                               -               -           (36)            (36)                   (50)
 Total Income                                                          (4,644)         (3,870)       (3,906)            (36)                   (50)
 Net NCG Position                                                     342,470         285,387       285,620             233                    128


 Total Income Budget                                                 £'000            £'000
 Resource Allocation                                                                  342,470
 Income Reported within NCG Budget*
   Learning & Skills Council Income                                      2,406
   Devolved Administration Income                                        2,238
                                                                                        4,644
 Total NCG Income                                                        4,644        347,114


 (1) These budgets are managed on behalf of PCTs, any under or overspend will result in corresponding adjustments between NCG budgets and
 PCT baselines.



 (2) This is net of contributions from local specialised commissioners to fund work being done within the National Specialised Commissioning
 Team on the Specialised Services National Definition Set.



 WTE

 Budget                                                                      23
 Actual                                                                   19.77


                                                                                                                                                      46

				
DOCUMENT INFO