item 6.1 - may 09 finance and workforce board report
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WEST SUFFOLK HOSPITAL NHS TRUST
FINANCE & WORKFORCE REPORT MAY 2009
Linda Potter, Director of Finance
Agenda item 6.1
2
West Suffolk Hospitals NHS Trust Finance & Workforce Report May 2009
Contents:
Executive Summary Income and Expenditure (Trust) Income and Expenditure (Directorate) Directorate Performance Summaries Balance Sheet Cash Flow CIP Summary Capital Report Appendix 1: Agency cost analysis
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West Suffolk Hospitals NHS Trust Finance & Workforce Report May 2009
EXECUTIVE SUMMARYFINANCIAL PERFORMANCE REPORT
TWO MONTHS TO END MAY 2009
FINANCIAL PERFORMANCE SUMMARY
Current Actual 694K
Financial Position Budget 410K
Variance Favourable /
(Adverse)284K
CIP Target 782(savings) Actual 798
I&E Forecast Outturn Recurrent 3.0m as budget surplus
Retained 3.0m
Capital Plan FY 5.3m A major capital expenditure review is current being undetaken linked to the recent 6 facet survey on the Trust estate
Actual Ytd 232k Ependiture on clinical equipment and IM&T
Cash Current Balance 9.5m Creditors being paid promptly; all appropriate historic creditors now cleared, contract over-performance to March 09 paid by SPCT.
Forecast Balance 9.0m Subject to review following confirmation of SLA contract value
Working Capital/ Liquidity Debtors 5.1m Reduced from March due to settlement of PCT invoices
Creditors 17.2m Small increase on March position
Liquidity 17 Estimated days cover
Overall Financial Risk RatingFRR est 3
Key Budget Highlights
Risks & Opportunities
Savings targets are proactively monitored through F&PRG to ensure CIP targets are met.
Surplus. The actual financial position reflects highrer than anticipated income from the first two months contract income. Operational costs are on track with budget.
Budget surplus.
Contract income for May has been assumed to be similar to April pending the publication of May priced activity. Drug costs YTD are still high, although May drug costs were on budget. High cost drugs over and above the SLA value are recoverable via the SLA contract. Pay costs on budget, but include an increase in bank nurse costs in the month.
Slightly ahead of planned savings.
Peformance monitoring will be key to maintaining income and minimising contract penalties, regular review with PCT at SLA meeting.
The high cost drugs budgets (currently overspending) will be adjusted for over-performance following the completion of joint work between Finance and Pharmacy.
Pending updated model from SHA. However with an I&E surplus above plan, debtor/creditor positions similar to March 2009 and estimated liquidity days of 17 would indicate a rating of at least 3
The contract income includes provision for contract penalties, which at this early stage of the contract can only be an estimate.
The May postion reflects provisions for costs associated with Transformation and Foundation Trust project work
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West Suffolk Hospitals NHS Trust Finance & Workforce Report May 2009
INCOME AND EXPENDITURE ACCOUNT TWO MONTHS TO END MAY 2009
£000's Full Year Actual Budget Variance
Health AuthoritiesPrimary Care Trusts (126,804) (21,798) (20,497) 1,301
Other Patient related income (1,248) (260) (208) 52Income From Patient Activities (128,052) (22,058) (20,705) 1,353
Other Operating Income (11,606) (2,117) (1,945) 172
TOTAL INCOME (139,658) (24,175) (22,650) 1,525#REF! #REF! #REF!
NHS Staff 95,135 15,371 15,597 226Agency Staff 210 291 61 (229)
Total Pay 95,345 15,662 15,658 (4)
Drugs 9,852 1,764 1,637 (127)Supplies 11,346 1,787 1,864 77
Other Expenses 12,884 3,054 1,876 (1,178)Depreciation 4,237 706 706 0
Total Non Pay 38,320 7,311 6,083 (1,228)
TOTAL OPERATING EXPENSES 133,665 22,973 21,741 (1,232)
Finance Costs (PDC Dividend & Interest) 2,993 508 499 (9)
IN-YEAR SURPLUS/(DEFICIT) 3,000 694 410 284
Non Recurring Items 0 0 0 0
RETAINED SURPLUS/(DEFICIT) 3,000 694 410 284
YEAR TO DATEBUDGET
COMMENTS ON YEAR-TO-DATE VARIANCES:▪Contract income for May is estimated to be similar to April contract income value - the SLA income budget has been phased on the basis of last year actual profile. The high favourable variance is due to the prudent approach taken in setting the contract income budget.▪ Pay costs overall are on budget, though agency costs continue to be incurred to cover vacancies and absence both in medical and non-medical staff groups. ▪ Allocation of budget for high cost drugs, ambulance contract wil be completed when the SLA position is confirmed and May priced activity is available .▪ Total drug costs for May were just below budget at £0.8m, the cost of any additional high-cost drugs being recoverable through PCT contracts. ▪ The adverse variance on Other Expenses is due to the inclusion of provisions and the phasing of reserves budgets. This will also be reviewed on confirmation of SLA contract value.
I NCOME
EXPENDITUR
E
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West Suffolk Hospitals NHS Trust Finance & Workforce Report May 2009
DIRECTORATE INCOME AND EXPENDITURE ACCOUNTTWO MONTHS ENDING 31 MAY 2009
£000's Full Year Actual Variance Variance
Central Income (LDP/DoH) (126,193) (21,672) 1,276 (19)
Medical Services Directorate (3,036) (604) 83 66Clinical Support Directorate (1,675) (310) 29 12Surgical Services Directorate (2,154) (401) 56 12Facilities Directorate (2,636) (440) 1 8Woman and Child Services (912) (198) 46 (3)Operations Directorate (44) 0 (7) (4)Operational Directorates Total (10,457) (1,953) 208 91
Medical Director (311) (50) (2) (1)Finance and Information (133) (23) 1 0HR (84) (17) 2 5Nursing & Governance (123) (29) 1 (0)Trust Office (25) (4) 0 0Overheads (2,331) (428) 39 86Corporate Directorates Total (3,008) (551) 41 89
TOTAL INCOME (139,658) (24,175) 1,525 161
Medical Services Directorate 36,670 6,292 (210) (96)Clinical Support Directorate 22,125 3,664 14 28Surgical Services Directorate 34,656 5,715 (30) (51)Facilities Directorate 13,120 2,024 121 61Woman and Child Services 11,334 1,815 36 17Operations Directorate 827 127 6 7Operational Directorates Total 118,733 19,636 (63) (35)
Medical Director. 799 120 12 7Finance and Information 3,442 506 15 (0)HR 1,050 166 2 2Nursing & Governance 1,522 244 15 (3)Trust Office 1,470 199 17 13Overheads 9,643 2,609 (1,239) (196)Corporate Directorates Total 17,925 3,845 (1,178) (178)
TOTAL EXPENDITURE 136,658 23,481 (1,241) (213)
Current Year Surplus/ (Deficit) 3,000 694 284 (52)
Non Recurring Costs 0 0 0 0Profit and Loss on Disposal 0 0 0 0Repayment of Historical Deficit 0 0 0 0
Retained Surplus/(Deficit) 3,000 694 284 (52)
BUDGET YEAR TO DATE PREVIOUS MONTH
I NCOME
EXPEND I TURE
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West Suffolk Hospitals NHS Trust Finance & Workforce Report May 2009
PERFORMANCE SUMMARIES The following schedules show the financial and workforce performance for the whole Trust and each of the directorates. Activity variances are based on an estimated profile. Forecast outturn is assumed to match full year budget A detailed forecast will be available after the 1st quarter financial results and included in the July Finance Report The Budget adjustments for additional high cost drugs costs above the SLA value is not reflected in the month
variance stated, pending the completion of a project between Finance and Pharmacy.
Trust
The Trust has generated a surplus of £694K, £284K above budget. Pay costs on budget. Non-pay costs are generally on or below budget, except drugs and services from other Trusts.
Overall nursing costs are 0.6% below budget.
The Trust currently employs 2250.1 WTE staff, an increase of 9.0 WTE on last month.
There are currently 70.25 WTE (84 headcount) employees on maternity leave, compared to 42.95 WTE (54 headcount) for the same period last year.. There are several areas of the hospital where the high level of maternity leave could impact on service delivery and are therefore back filled through temporary staffing.
Green Variance at >0%Amber Variance at 0% >< -2%Red Variance at > -2%
TRUST Income PayNonPay Total
CIPS(Note)
SLA Income £000
SLAActivityNo.
EmployedWTE
SicknessRates (cuml.)
MatLeave
Vacancylevel (No.)
TempStaff %of Total Pay
Agency Staff(£000's)
NHS Loc/BankStaff (£000's)
Totalbudget£000
Forecast CIPs
ForecastSLA £000
ForecastActivityNo.
Cumulative £000's 1,525 (4) (1,237) 284 16 11,181 206,273 2250.1 3.5% 3.1% 209.75 5.8% 291 614 3,000 3,997 126,961 2,400,134 % Variance 7% 0% -16% 69% 2% 8.3% 5.7% -35% 0.0% 0.0% 0.0%% Variance Last month 1% 1% -8% -20% N/A N/A 2241.1 3.7% 3.0% 216.36 5.2% 145 260% Variance Last year(actual to actual) -13% 9% 31% #DIV/0! 16% N/A N/A 2183.4 4.3% 2.0% 122.18 6.3% 316 589 4,600 4,717 105,050 2,089,963
YTD Variance to plan SLA Income Workforce Full Year 0910
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West Suffolk Hospitals NHS Trust Finance & Workforce Report May 2009
Surgery
• Income for the month was better than budget due to increased charges for medical staff to other Trusts of £27k and USAF (Tricare) income of £30k. Pay was £72k more than budget primarily as a result of medical agency staff £60K, Prof. & Tech agency cost £16k, but partially offset by £5k from vacancies. Non-Pay was £42k under budget due to drug savings £15k, hearing aids £26k, orthopaedic appliances £12k and £3k professional fees but an unplanned medical staff recruitment fee of £15k partially offset these savings.
•The Directorate continues to experience high levels of GP referrals necessitating additional outpatient sessions to manage demand, particularly within ENT and Oral Surgery. Referrals in other areas have reached a plateau but remain higher than capacity. New to follow up ratios are within acceptable limits. The majority of additional activity is within outpatients based on activity data.
•Sickness rates on the inpatients wards have improved but maternity leave continues to increase resulting in more backfill from bank staff to meet the current level of elective and emergency activity.
•The use of agency staff was £48k for junior medical staff (Gen. Surgery, Urology, T&O, ENT) and £12k for consultants (Anaesthetics). A further £15k was for the plaster orderly in the Fracture Clinic (long term sick and subsequent retirement) and £5K Admin cover. Locum cost were £50k, primarily in Anaesthetics and Plastics for consultant cover and bank usage was £56k for nurses and medical secretaries to cover sickness, maternity leave, bank holidays, and vacancies.
SURGERYOther Income Pay
NonPay Total
CIPS(Note)
SLA Income £000
SLAActivityNo.
EmployedWTE
SicknessRates (cuml.)
MatLeave
Vacancylevel (No.)
TempStaff %of Total Pay
Agency Staff(£000's)
NHS Loc/BankStaff (£000's)
Totalbudget£000
Forecast CIPs
ForecastSLA £000
ForecastActivityNo.
Cumulative £000's 56 (72) 42 26 0 4,002 13,616 526.1 2.6% 3.2% 49.47 4.2% 80 106 32,502 976 42,784 134,163 % Variance 16% -2% 3% 0% 0% 15.1% 24.8% 6% 0.0% 0.0% 0.0%% Variance Last month 26% -2% 0% -1% N/A N/A 527.1 3.7% 3.1% 48.52 4.7% 57 48% Variance Last year(actual to actual) -302% 5% 4% -1% 63% N/A N/A 541.8 4.8% N/A 23.16 4.2% 27 150 30,542 565 39,150 122,625
YTD Variance to plan WorkforceSLA Income Full Year 0910
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West Suffolk Hospitals NHS Trust Finance & Workforce Report May 2009
Medicine
• The Directorate was overspent by £96k in May 2009. • Directorate activity for the current financial year has not yet been published, therefore it is difficult to ascertain if some of this is due to over performance.• ‘Other Income’ was over recovered by £18k, due to increased charges out for consultants reflecting the Medical staff pay award – made in May and backdated to April. There were also unbudgeted charges to the PCT for staff involved in the Rapid Response Team.• Staffing costs were the biggest contributor to the overspend. Consultant vacancies in Gastroenterology, Oncology, Dermatology, Stroke and A & E have been covered by a combination of additional sessions, locum cover and agency costs. The continued increased demand for Rheumatology outpatients has necessitated additional outpatient sessions.• Agency expenditure was concentrated on filling Medical vacancies. The main areas using non-NHS staff were Accident and Emergency and junior on-take medical staff.• Nurse costs net of bank expenditure were underspent.• Non pay expenditure was overspent by £15k in the month – the costs of drugs exceeded budget by £8k primarily in Oncology and Haematology and Neurology, the majority of which can be reclaimed from the PCT as part of the high costs drugs excluded from tariff.• The Directorate incurred a one off cost of £6k related to advertising. Normally this is funded via HR, but local nursing staff were targeted as part of a successful recruitment drive.• Increased rental costs for the Mobile Angiography unit (reflecting a new, more resilient unit) have meant expenditure above budget. Income, will exceed the expenditure, is recorded centrally and therefore does not offset the costs to the directorate.
MEDICINEOther Income Pay
NonPay Total
CIPS(Note)
SLA Income £000
SLAActivityNo.
EmployedWTE
SicknessRates (cuml.)
MatLeave
Vacancylevel (No.)
TempStaff %of Total Pay
Agency Staff(£000's)
NHS Loc/BankStaff (£000's)
Totalbudget£000
Forecast CIPs
ForecastSLA £000
ForecastActivityNo.
Cumulative £000's 83 (70) (140) (127) 0 4,140 14,260 645.4 3.9% 4.5% 68.30 7.5% 93 256 33,635 1,116 53,325 143,139 % Variance 16% -2% -9% -2% 0% -4.5% 22.5% 19% 0.0% 0.0% 0.0%% Variance Last month 44% 1% -17% -1% N/A N/A 645.1 4.2% 4.4% 68.90 6.4% 34 110% Variance Last year(actual to actual) -181% 10% 18% 5% 42% N/A N/A 625.0 2.7% N/A 54.06 9.6% 200 205 28,331 782 37,447 125,359
YTD Variance to plan SLA Income Workforce Full Year 0910
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West Suffolk Hospitals NHS Trust Finance & Workforce Report May 2009
Clinical Support
• The directorate underspent this month by £3k: pay costs and income underspent, whilst nonpay overspent.• Income exceeded budget due to the continued support to EIT in A&E: involving both Physiotherapy and Occupational Therapy staff. • A consultant vacancy in Microbiology has been offset by additional PAs worked by the existing consultants and locum cover. New consultant due to take up post in September. Additional sessions in Radiology have meant net costs on consultants exceeded budget.• Vacancies in Physiotherapy, Occupational Therapy, Radiology and Pharmacy have meant significant pay underspends. Departments are having to resort to temporary agency cover as a measure to ensure continued service delivery pending appointments and students qualifying over the summer.• A drug overspend of £18k in the month, mainly in pharmacy is to be investigated.• Medical & Surgical costs exceeded budget by £17k, mainly in Endoscopy. A review of the expenditure has identified this is due to an increase in activity and the purchase a patient monitor. ( £4k )• Pathology equipment and materials were underspent by £19k, this was due to investigations into April 2009 expenditure. Subsequent adjustments have been made to contracts for blood products and the coagulation analyser.• Workload demand in Histopathology has meant that an increasing amount of work has had to be referred to an outside agency. In May this amounted to £10k. A new consultant recently approved by TEG, will address this longer term. • Services received continue to overspend. Addenbrookes charges in Radiology are expected to be settled immanently, addressing the current budget allowances which have been made to reflect this historical overspend. Additional provision has also been made for Speech and Language Therapy, anticipating additional costs for the Stroke/Thrombolysis service started in April.
CLINICAL SUPPORTOther Income Pay
NonPay Total
CIPS(Note)
SLA Income £000
SLAActivityNo.
EmployedWTE
SicknessRates (cuml.)
MatLeave
Vacancylevel (No.)
TempStaff %of Total Pay
Agency Staff(£000's)
NHS Loc/BankStaff (£000's)
Totalbudget£000
Forecast CIPs
ForecastSLA £000
ForecastActivityNo.
Cumulative £000's 29 119 (105) 43 0 756 173,420 426.8 3.8% 3.4% 44.44 5.0% 67 64 20,451 876 10,115 2,079,505 % Variance 10% 4% -11% 1% 0% -8.3% 2.6% 11% 0.0% N/A N/A% Variance Last month 9% 5% -9% 2% N/A N/A 419.7 3.7% 3.0% 49.91 5.4% 34 36% Variance Last year(actual to actual) -25% 11% 16% 11% -26% N/A N/A 406.6 4.8% N/A 52.81 4.7% 15 96 18,504 1,149 10,060 1,806,371
YTD Variance to plan SLA Income Workforce Full Year 0910
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West Suffolk Hospitals NHS Trust Finance & Workforce Report May 2009
Woman & Child
•The favourable variance to budget is driven mainly by £38.1k in vacant positions, 11.9k in lower drug cost, £3.3k less rent of clinic space, £9.8k in transport cost due to last year credits received, additional USAF income of £26.2k and £20.3k from EWTD funds. These savings were partially offset by extra session payments of £8.8k and £18.8k in bank usage.
•Sickness rates are improving but maternity leave remains high. Use of bank staff (£56.8k) reflects the four bank holidays in the period. Paediatrics have used agency staff to support the service. Locum staff (£27.6k) are being used to cover the vacancies for the hybrid consultants in Paediatrics although part of this cost is offset by additional EWTD income (£20.3k).
WOMAN & CHILDOther Income Pay
NonPay Total
CIPS(Note)
SLA Income £000
SLAActivityNo.
EmployedWTE
SicknessRates (cuml.)
MatLeave
Vacancylevel (No.)
TempStaff %of Total Pay
Agency Staff(£000's)
NHS Loc/BankStaff (£000's)
Totalbudget£000
Forecast CIPs
ForecastSLA £000
ForecastActivityNo.
Cumulative £000's 46 10 26 83 0 1,694 4,812 215.1 3.1% 3.6% 8.76 6.0% 10 89 10,422 304 20,736 43,326 % Variance 30% 1% 15% 5% 0% 0.5% 36.6% 4% 0.0% 0.0% 0.0%% Variance Last month -13% 1% 8% 2% N/A N/A 215.9 3.5% 3.6% 7.89 4.1% 4 31% Variance Last year(actual to actual) -542% 7% -7% -4% 76% N/A N/A 191.9 5.1% N/A 32.56 5.8% 17 73 10,006 1,422 14,157 35,633
YTD Variance to plan SLA Income Workforce Full Year 0910
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West Suffolk Hospitals NHS Trust Finance & Workforce Report May 2009
Facilities
Income has evened out from April and is now on budget.
PaySSD (£6k) – vacancy on hold.Housekeeping (£45k) – additional bank & agency staff for continuation of enhanced clean.Facilities Admin (£11k) – phasing of vacancy for Director post.
Non Pay is generally under spending across the directorate as some non essential spend is being held until July as requested. Some key areas of under spend are as follows:Estates (£50k), HRS (£5k), EBME (£34k), SSD (£5k) & Purchasing (£5k) - service contracts, phasing of budget in line with timing of contracts is required.Utilities (£10k), lower tariffs & operation of CHP.Portering (£7k) – has incorrect credit, to be corrected.Switchboard (£5k) – telephone calls reduced by installation of GSM gateway (fixed calls to mobiles)
WorkforceSickness monitoring & return to work interview process is now established across the directorate and continues to reduce sickness/absence.
FACILITIESOther Income Pay
NonPay Total
CIPS(Note)
SLA Income £000
SLAActivityNo.
EmployedWTE
SicknessRates (cuml.)
MatLeave
Vacancylevel (No.)
TempStaff %of Total Pay
Agency Staff(£000's)
NHS Loc/BankStaff (£000's)
Totalbudget£000
Forecast CIPs
ForecastSLA £000
ForecastActivityNo.
Cumulative £000's 1 (29) 151 122 0 262.8 4.1% 0.7% 16.81 8.1% 5 87 10,485 367% Variance 0% -3% 15% 7% 0% 22% 0.0%% Variance Last month 4% -1% 12% 8% 260.2 4.0% 0.7% 20.36 5.4% 0 30% Variance Last year(actual to actual) -2% 1% 5% 2% -15% 255.26 3.4% N/A 25.85 7.5% 30 55 8,610 427
YTD Variance to plan SLA Income Workforce Full Year 0910
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West Suffolk Hospitals NHS Trust Finance & Workforce Report May 2009
Corporate
• Corporate report is a consolidation of Finance and Information, Human Resources and Communications, Medical Director, Nursing and Governance, Trust Office and Overhead Directorates. Reserves are excluded from this report.
• Agency and bank staff are being used in Finance, HR and the Nursing Directorate, but the overall pay variance is favourable.
• Both Income and Non Pay variances are favourable overall. Overheads have some unbudgeted non pay costs which are offset by additional income.
•The sickness and maternity rates remain below the overall Trust rates.
CORPORATEOther Income Pay
NonPay Total
CIPS(Note)
SLA Income £000
SLAActivityNo.
EmployedWTE
SicknessRates (cuml.)
MatLeave
Vacancylevel (No.)
TempStaff %of Total Pay
Agency Staff(£000's)
NHS Loc/BankStaff (£000's)
Totalbudget£000
Forecast CIPs
ForecastSLA £000
ForecastActivityNo.
Cumulative £000's 41 35 29 105 16 159.2 1.8% 0.3% 21.44 2.7% 16 12 15,912 343% Variance 9% 3% 4% 4% 15% 172% 0.0%% Variance Last month 14% 2% 14% 14% 158.4 0.4% 0.3% 20.25 2.2% 7 5% Variance Last year(actual to actual) 44% 14% 17% 44% 56% 148.3 1.7% N/A 12.81 3.9% 27 9 5,852 346
YTD Variance to plan SLA Income Workforce Full Year 0910
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West Suffolk Hospitals NHS Trust Finance & Workforce Report May 2009
£000 MARCH 2009 May 2009
Forecast March 2010
FIXED ASSETS:Tangible assets 77,989 77,466 78,261TOTAL FIXED ASSETS 77,989 77,466 78,261
CURRENT ASSETS:Stocks 2,157 2,209 2,137Debtors 5,882 5,123 5,632Cash (incl petty cash) 5,862 9,468 9,161TOTAL CURRENT ASSETS 13,901 16,800 16,930
CREDITORS:Amounts falling due within one year (15,544) (17,216) (17,812)
NET CURRENT ASSETS/(LIABILITIES) (1,643) (416) (882)TOTAL ASSETS LESS CURRENT LIABILITIES 76,346 77,050 77,379
CREDITORS:Amounts falling due after more than one year (3,500) (3,500) (1,850)Provision for Liabilities and charges (393) (404) (379)
TOTAL ASSETS EMPLOYED 72,453 73,146 75,150
FINANCED BY:Public dividend capital 58,250 58,250 58,250Revaluation reserve 15,874 15,874 15,874Donated asset reserve 3,665 3,665 3,362Income and expenditure reserve (5,336) (4,643) (2,336)
TOTAL TAXPAYERS EQUITY 72,453 73,146 75,150Last Year Apr-09 May-09
Trade debtor days - NHS 3.7 3.9 6.0Trade debtor days - Non NHS 121.1 70.4 77.6Trade creditor days 12.8 16.7 5.1Non NHS invoices paid within 10 days (%) 2.8 46.1 42.8
KPI LY YTD FYDebtors as % of turnover 4.8% 7.8% 4.3%Creditors as % of operational expenses 13.3% 27.6% 14.2%Liquidity (days) 0 17 17
BALANCE SHEET AS AT 31 MAY 2009
The balance sheet reflects the position of the Trust as at 31 Mayl 2009. In line with Government request the Trust is paying SMEs within 10 days where possible. The current high level of cash reflects the receipt of overperformance invoices. No indexation of fixed assest has been assumed as there is insufficient guidance to determine what the likely change in values will be. The Trust will undertake a revaluation exercise during the year. This will be undertaken by professional valuers and is scheduled to be complete by July 2009
The decrease in the month represents the excess of depreciation over the additions in the month. The forecast does not allow for any revaluation of assets.
Stocks are in line with expectations. The stock value shows a slight increase in the month and this was mainly within pharmacy stock. Debtors have reduced since the year end as a result of the payment of some overperformance invoices.
The current high level of cash reflects the receipt of overperformance invoices in previous months. The level of surplus has enabled the Trust to pay creditors within 10 days without impacting on the level of cash..
Creditors are in line with expectations. Principal creditors are Trade £3.6m, Tax/NI/Pension £3.1, Vinci income £2.1m other deferred income £2.1m,loans £1.7m and accruals £4.6m
The balance at the year end represents the value of the new DoH loan that is outstanding after 1 year. The original loan is now all repayable within 1 year
The revaluation reserve has not moved. The Trust will be undertaking a revaluation of estate exercise during the year in accordance with guidance.
The movement in the year represents the forecast surplus for the year.
Debtor and creditor days are calculated on the basis of the balances on the debtor and purchase ledgers and comparing to the invoices raised in the month. They exclude any prepayments and accruals. Non NHS trade debtor days include USAF invoices that can take up to 120 days to resolve. The increase in the NHS debtor day figure is due to the CPH invoicing during May.
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West Suffolk Hospitals NHS Trust Finance & Workforce Report May 2009
West Suffolk Hospitals - Rolling cash forecast to 31 March 2011
£000
APRIL MAY JUNEQTR to JUNE
2009QTR to SEPT
2009QTR to DEC
2009QTR to MAR
2010FULL YEAR
2009/10 QTR to JUNE QTR to SEPT QTR to DEC QTR to MARFULL YEAR
2010/11
INCOME
BAL B/FWD 5,858 7,737 9,468 5,858 9,603 9,162 9,792 5,858 9,161 10,013 10,131 9,592 9,161
NHS Clinical Income 11,693 11,350 10,100 33,143 30,300 30,300 30,300 124,043 31,050 31,050 31,050 31,050 124,200
Other NHS Income 1,309 801 685 2,795 2,070 2,070 2,070 9,005 2,125 2,130 2,130 2,130 8,515
Loan/PDC advance 0 0 0 0 0 0 0 0 0 0 0 0 0
Income Generation 97 91 93 281 279 279 279 1,118 294 294 294 294 1,176
RTA 19 70 21 110 63 63 63 299 63 63 63 63 252
Interest 0 2 15 17 45 45 45 152 45 45 45 45 180
Misc Other 554 359 322 1,235 968 968 968 4,139 1,023 1,018 1,018 1,018 4,077
Disposal of Property 0 0 0 0 0 0 0 0 0 0 0 0 0
TOTAL INCOME 13,672 12,673 11,236 37,581 33,725 33,725 33,725 138,756 34,600 34,600 34,600 34,600 138,400
EXPENDITURE
Pay Costs 4,677 4,745 4,475 13,897 13,425 13,425 13,425 54,172 13,545 13,545 13,545 13,545 54,180
Tax/Pension 3,089 3,132 3,031 9,252 9,093 9,093 9,093 36,531 9,229 9,297 9,297 9,297 37,120
Creditors 2,555 1,632 1,923 6,110 5,769 5,769 5,663 23,311 5,448 5,448 5,448 5,338 21,682
Drugs/Stores/NHS Litigation 1,236 1,367 1,075 3,678 3,225 3,225 2,949 13,077 3,549 3,549 3,549 3,267 13,914
PDC Payments 0 0 0 0 1,372 0 1,372 2,744 0 1,364 0 1,364 2,728
Interest on loans 0 0 0 0 124 0 102 226 0 83 0 70 153
Capital expenditure 236 66 597 899 333 1,583 927 3,742 1,977 696 3,300 1,848 7,821
Misc 0 0 0 0 0 0 0 0 0 0 0 0 0
Repayment of loans 0 0 0 0 825 0 825 1,650 0 500 0 500 1,000
TOTAL EXPENDITURE 11,793 10,942 11,101 33,836 34,166 33,095 34,356 135,453 33,748 34,482 35,139 35,229 138,598
BALANCE C/fwd 7,737 9,468 9,603 9,603 9,162 9,792 9,161 9,161 10,013 10,131 9,592 8,963 8,963
FORECAST FORECAST
The cash flow forecast reflects the actual cash position as at 31 May 2009. The model takes account of the Department of Health loan including its repayment schedule and interest charges. The Trust is required to report against EFL however relaxation of rules allow for Trust's hold cash balances above it's EFL target. The figure for April includes the receipt of overperfomance on contracts up to the end of the financial year. Creditor payments were fairly low as the previous month figure was high as a result of moving to paying creditors quicker. May represents a more typical level of payments. Debtor payments were lower than the prevoius months.
ACTUAL FORECAST
15
West Suffolk Hospitals NHS Trust Finance & Workforce Report May 2009
2009/10 CIP REPORT as at 31st May 2009
COST SAVINGS ACHIEVED - To date TOTAL COST SAVINGS - Full year
Directorate £000 Target Actual Variance%
VarianceOriginal target
Projected Variance%
Variance Woman and Child 72 72 - 0% 304 304 - 0% Surgery 163 163 - 0% 976 976 - 0% Facilities 56 56 - 0% 367 367 - 0% Finance and Information 41 46 5 13% 115 115 - 0% HR and Communications 6 6 0 4% 18 18 - 0% Nursing and Governance 7 9 1 18% 7 7 - 0% Medical Director 1 1 0 17% 8 8 - 0% Trust Office 22 31 8 38% 34 34 - 0% Overheads 27 27 - 0% 160 160 - 0% Operations 12 12 0 1% 17 17 - 0% Clinical Support 186 186 - 0% 876 876 - 0% Medicine 189 189 - 0% 1,116 1,116 - 0%
TOTAL 782 798 16 2% 3,997 3,997 - 0%
SUMMARISED CIP TYPE COST SAVINGS ACHIEVED - To dateTOTAL COST SAVINGS -Target -
Full year (£'000s)
Projection
RecurrentNon-
recurrentRecurrent
Non-recurrent
Total
Target Actual Target Actual PAY 231 231 262 265 1,463 874 2,337 AGENCY/BANK 27 27 2 2 163 15 178 DRUGS 17 17 - - 101 - 101 CLINICAL SUPPLIES 21 21 - - 123 - 123 OTHER NON-PAY 186 194 34 34 1,114 133 1,247 IT COSTS 2 7 - - 12 - 12
TOTAL 483 497 299 301 2,975 1,022 3,997
16
West Suffolk Hospitals NHS Trust Finance & Workforce Report May 2009
The
Cap
ital b
udge
t will
be
agre
ed in
Jun
e 20
09.
The
cur
rent
rep
ort r
efle
cts
the
2009
/10
impa
ct o
f sc
hem
es c
ontin
ued
from
200
8/09
and
any
urg
ent e
quip
men
t pur
chas
es.
Wes
t S
uff
olk
Hos
pita
l NH
S T
rust
Cap
ital P
rogr
amm
e 2
009-
2010
Rev
ised
To
tal
To
tal
Sch
eme
Bu
dg
etE
xpen
dit
ure
Fo
reca
st20
09-1
0as
at
31 M
ay 0
9E
xpen
dit
ure
Pre
-Co
mm
itm
ents
(in
c 08
/09
Co
ntr
actu
al C
om
mit
men
ts)
Pha
rmac
y U
nit/R
obot
ic
1,27
0,00
03,
295
1,26
9,49
5E
duca
tion
Cen
tre
- Le
ctur
e T
heat
re45
0,00
00
450,
141
Oth
er c
osts
707,
000
25,2
3570
2,31
7T
ota
l2,
427,
000
28,5
302,
421,
953
Sit
e S
ervi
ces/
Bac
klo
g M
ain
ten
ance
To
tal
290,
000
014
,834
Clin
ical
Eq
uip
men
t R
epla
cem
ent
To
tal
629,
000
114,
552
225,
996
No
n C
linic
al E
qu
ipm
ent
To
tal
150,
000
00
IM &
TE
lect
roni
c R
oste
ring
(c/fw
d 08
/09)
128,
000
81,6
0611
9,56
7N
HS
Num
ber
Inte
rfac
ing
164,
000
3,62
316
4,00
0A
dditi
onal
EP
RO
Fun
ctio
nalit
y50
,000
3,15
350
,451
Oth
er18
6,85
50
189,
855
To
tal
528,
855
88,3
8352
3,87
4
Dev
elo
pm
ent
Sch
emes
Sin
gle
Sex
Acc
omm
odat
ion
566,
000
056
6,00
0O
ther
00
0T
ota
l56
6,00
00
566,
000
To
tal a
ll C
apit
al p
roje
cts
4,59
0,85
523
1,46
43,
752,
656
Ass
et D
ispo
sal (
land
sal
es)
Pha
se 2
Har
ps C
lose
100,
000
5454
To
tal C
om
mit
men
t4,
690,
855
231,
518
3,75
2,71
0
Cap
ital
Fu
nd
ing
4,27
2,00
0A
dd
itio
nal
Ext
ern
al F
un
din
g1,
016,
000
Cap
ital
Exp
end
itu
re L
imit
5,28
8,00
05,
288,
000
5,28
8,00
0
Un
der
/(O
ver)
Co
mm
itte
d59
7,14
55,
056,
482
1,53
5,29
0
17
West Suffolk Hospitals NHS Trust Finance & Workforce Report May 2009
Appendix 1
AGENCY COSTS ANALYSIS (based on costs as at May 2009)
The following graphs illustrate the breakdown of agency expenditure incurred during the two months to May 2009
The analysis has focused on the Medical Agency costs as this is the largest area of agency expenditure incurred by the Trust.
The graphical information analyses the expenditure by the staff type, the location (department) and by the reason (type) for the agency expenditure
The Trust, as part of it’s budget setting process, does not generally set budgets for agency expenditure, unless there is a specific and long-term need for agency expenditure required.
The Trust to date is maintaining total pay costs to budget. The majority of agency costs is linked to covering vacant posts, with low agency cost associated with staff
absence.
18
West Suffolk Hospitals NHS Trust Finance & Workforce Report May 2009
Total pay is currently in line with total budget Total pay analysis show agency costs are currently 1.86% of total pay costs There are no agency nursing costs incurred by the Trust to date
Total Pay Analysis
10
11
12
13
14
15
16
Actual Budget
Mill
ions
Pay
cos
ts £
m Agency
NHS Staff
Agency Costs Analysis
0
50
100
150
200
250
300
350
Actual Budget
Thou
sand
sAg
ency
cos
t £k Other staff
Nursing staff
Medical staff
Graph 1 Graph 2
19
West Suffolk Hospitals NHS Trust Finance & Workforce Report May 2009
Graph 3 illustrates the majority of the budget is linked to substantive posts Locum costs are costs paid at NHS pay rates and are therefore not included as agency costs Graphs 3 and 4 illustrate only a small proportion of agency cost is planned
Medical staff cost breakdown
4,200
4,300
4,400
4,500
4,600
4,700
4,800
4,900
Actual Budget
Thou
sand
s£k
Agency
Locum
Substantive
Medical Agency Costs
0
50
100
150
200
250
Actual Budget
Thou
sand
s£k
Other Medics
Junior Drs
Consultants
Graph 3 Graph 4
20
West Suffolk Hospitals NHS Trust Finance & Workforce Report May 2009
Graph 5 indicates that consultant substantive and locum budget covers the costs of substantive locum and agency expenditure Graph 6 illustrates that almost all the consultant agency cost relates to covering vacant consultant posts Graph 7 indicates only several areas were expecting to have to fund agency costs; vacant posts are driving the remaining agency cost
Anal
ysis
of C
onsu
ltant
Cos
ts
2,20
0
2,30
0
2,40
0
2,50
0
2,60
0
2,70
0
2,80
0
2,90
0
3,00
0
3,10
0
Actu
al
Budg
et
Thousands
£k
CONS
ULTA
NTS
ADDI
TION
AL W
ORK
AGEN
CY C
ONS
VACA
NCY
COVE
RAG
ENCY
CON
SSI
CK L
EAVE
AGEN
CY C
ONS
STUD
Y LE
AVE
AGEN
CY C
ONS
EXTR
A CO
VER
AGEN
CY C
ONS
ANNU
AL L
EAVE
LOCU
MCO
NSUL
TANT
CONS
ULTA
NTS
Co
ns
ult
an
t A
ge
nc
y C
os
ts b
y L
oc
ati
on
0
20
,00
0
40
,00
0
60
,00
0
80
,00
0
10
0,0
00
12
0,0
00
Ac
tua
l B
ud
ge
t
£
An
ae
sth
eti
cs
Mic
rob
iolo
gy
Str
ok
e
A&
E
Me
dic
ine
o
n-t
ak
e
GU
M
Ha
em
ato
log
y
Rh
eu
ma
tolo
gy
Co
nsu
ltan
t Ag
ency
co
sts
by
typ
e
0
20,0
00
40,0
00
60,0
00
80,0
00
100,
000
120,
000
Act
ual
Bud
get
£
annu
al le
ave
stud
y le
ave
sick
leav
eex
tra
cove
rst
aff v
acan
cy
Ove
rspe
nd
£90k
Graph 5 Graph 6 Graph 7
21
West Suffolk Hospitals NHS Trust Finance & Workforce Report May 2009
Graphs 8 and 9 illustrates that there is significant pressure on junior doctor costs with a large number of vacancies at junior doctor level.
Ana
lysi
s of
Jun
ior D
octo
r Cos
ts
1,25
0
1,30
0
1,35
0
1,40
0
1,45
0
1,50
0
1,55
0
Act
ual
Bud
get
Thousands
£k
Age
ncy
Jnr D
rE
xtra
Sic
k Le
ave
Age
ncy
Jnr D
rE
xtra
Stu
dyLe
ave
Age
ncy
Jnr D
rE
xtra
A/L
Age
ncy
Jnr D
rE
xtra
cov
er
Age
ncy
Jnr D
rV
acan
cy C
over
Locu
m J
nrD
octo
rs
Jnr D
octo
rs
Ove
rspe
nd £
68k
Jun
ior
Dr
Ag
ency
co
sts
by
loca
tion
0
20406080
100
120
Act
ual
Bud
get
Thousands
Uro
logy
EN
T
Gen
Sur
gery
T&O
Obs
tetr
ics
Pae
diat
rics
A&
E
Med
icin
e on
-tak
e
Jun
ior
Dr
Ag
ency
co
sts
by
typ
e
0
20,0
00
40,0
00
60,0
00
80,0
00
100,
000
120,
000
Act
ual
Bud
get
£
annu
al le
ave
stud
y le
ave
sick
leav
e
extr
a co
ver
staf
f vac
ancy
Graph 8 Graph 9 Graph 10
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