mitigations: conflicts of interest - south west london health and … … · - nhse approved the...

of 2

Committee for Collaborative Decision-Making (in public)

Date Thursday, 05 March 2020

Document Title M9 2019/20 Finance Report

Lead Director (Name and Role)

James Murray, SWLA Chief Finance Officer

Clinical Sponsor (Name and Role)

N/A

Author(s) (Name and Role)

Piya Patel, Senior Financial Analyst SWL HCP

Agenda Item No. 7

Attachment No. Paper 05 (b)

Purpose (Tick as Required) Approve Discuss Note

Executive Summary The SWL CiC is provided with the M9 finance report for the six SWL CCGs.

The SWL CCGs’ aggregate forecast outturn is an in-year deficit of £1.8m, which is an

adverse variance to plan and in comparison to Month 8 (surplus of £4.2m) as Sutton CCG

has moved its position by £6.0m. The latest reported position is reflective of its joint

Financial Recovery Plan (FRP) with Epsom and St Helier NHS Trust.

The SWL CCGs’ overall FOT position is dependent on the delivery of £85.6m of QIPP

and non-recurrent measures to bridge the shortfall against the planned £87.2m. The

CCGs do not report that there is any further risk of QIPP delivery slippage nor QIPP

mitigations as at Month 9.

Net risk stands at £1.9m (M8: £7.8m) after contract, performance issues, prescribing and

other risks are mitigated by releasing remaining reserves, other non-recurrent measures

and delaying investment plans. The CCGs continue to work on mitigating the remaining

risk.

Reason the paper is brought to the Committee:

To provide the SWL CIC with the latest finance update.

Key Issues: None

Conflicts of Interest: None

Mitigations: None

of 2

Recommendation: The SWL CIC is asked to note the M9 finance report.

Corporate Objectives This document will impact on the following CCG Objectives:

Meeting our performance and financial objectives: Make the best use of our resources to benefit our patients and communities.

Risks This document links to the following CCG risks:

N/A

Mitigations Actions taken to reduce any risks identified:

N/A

Financial/Resource/ QIPP Implications

N/A

Has an Equality Impact Assessment (EIA) been completed?

N/A

Are there any known implications for equalities? If so, what are the mitigations?

No

Patient and Public Engagement and Communication

N/A

Previous Committees/ Groups Enter any Committees/ Groups at which this document has been previously considered:

Committee/Group Name: Date Discussed:

Outcome:

None

Supporting Documents M9 2019/20 Finance Report

DRAFT & CONFIDENTIAL

Collaborative Decision Making CiC

SWL CCGs Finance Report

M9 2019/20

xxx

MONTH 9 2019/20 FINANCE REPORT (DECEMBER 2019)

1. Summary

2. Key Financial Indicators – YTD & FOT

3. Issues and actions

Technical Appendix

SWL CCGs:

1. Financial Performance

2. Risks & Mitigations

3. QIPP Delivery

4. Acute Commissioning

5. Non Acute Commissioning

6. Primary Care Commissioning

Individual CCG data (Scorecards, Key Financial Statements, Risks & Mitigations)

7. Croydon CCG

8. Kingston CCG

9. Merton CCG

10. Richmond CCG

11. Sutton CCG

12. Wandsworth CCG

Contents

1

M9 Financial Performance

- The CCGs forecast a collective in-year deficit of £1.8m at M9 (M8: £4.2m surplus in line with control totals) due to a reported

movement within Sutton CCG of £6.0m to reflect a deficit of £5.4m. Sutton CCG’s latest financial position now reflects the impact of

its joint financial recovery plan (FRP) with Epsom and St Helier NHS Trust (ESTH) rather than its original 2019/20 QIPP savings

programme. The CCG is working with ESHT and Surrey Downs to extend the FRP to deliver a balanced system position going

forward..

- The current FOT position of £1.8m deficit remains dependent on the delivery of £85.6m of QIPP. YTD QIPP delivery is behind target

by £2.1m, and by year end this shortfall is expected to slightly improve to £1.6m. No further risk of slippage is reported at Month 9.

- Forecast overspends in acute and non acute overperformance expected to be offset by the use of reserves and other mitigating

actions across other five CCGs.

Financial Risk at M9

- Alternative contract arrangements in place this year (block, cap and collar, 50:50 risk share) help to minimise some of the risk against

larger areas of spend. The CCGs report that QIPP delivery, contract and other risks are expected to be managed via the use of

contingency held, release of other reserves and other non recurrent measures.

- Net risk reported to NHSE at M9 has decreased to £1.9m from £7.8m at M8, due to the reported movement within Sutton CCG. Net

risk falls to Sutton CCG (£1.0m of unmitigated risk due to further potential performance issues), Kingston CCG (£0.6m) and Merton

CCG (£0.3m).

1. Summary

2

Financial Planning and Strategy

- SWL submitted its five-year long term plan (LTP) on 15 November 2019, which was further updated in 10 January 2020 to

demonstrate a Control Total compliant trajectory in all years to 2023/24. The development of the five-year plan has been in

conjunction with the SWL Finance and Activity Committee (SWL FAC), supported by SWL working groups and place-based groups.

- Planning guidance from NHSE/I has not been received as at the date of issuing these papers. Signficant work is now underway to

develop the detailed operational plan for 2020/21.

Financial Governance

- NHSE approved the merger application to become one South West London CCG on 1 April 2020, following all of the six CCG GP

memberships voting in favour of the proposal. Work is underway under the Moving Forward Together work programme, including:

- Moving from six ledgers, bank accounts and payroll to one;

- Consulting on proposed staff structures;

- Developing financial policies and standing financial instructions for the new CCG;

- Developing place-based reporting within the CCG and place-based joint working with partners.

- The SWL Governance Oversight Group will review final financial policies in before 1st April..

1. Summary

3

4

2. Key Indicators - Financial Governance (M9 YTD & FOT)

The SWL CCGs’ position deviates from original plan by £6.0m due to Sutton CCG’s forecast position. YTD and

FOT QIPP delivery is behind target by 3.6% and 1.8% respectively, with forecast overachievement of £6.6m in

Croydon, Kingston, and Richmond collectively offset by forecast underachievement of £7.8m in Sutton. CCGs

largely reporting within cash drawdown, BPPC and CRL targets, with Kingston and Merton cash targets missed

in one month to date.

DRAFT & CONFIDENTIAL

SWL CCGs Finance Report

M9 2019/20

Technical Appendix

MONTH 9 2019/20 TECHNICAL ANNEX

SWL CCGs:

1. Financial Performance

2. Risks & Mitigations

3. QIPP Delivery

4. Acute Commissioning

5. Non Acute Commissioning

6. Primary Care Commissioning

Individual CCG data (Scorecards, Key Financial Statements, Risks & Mitigations)

7. Croydon CCG

8. Kingston CCG

9. Merton CCG

10. Richmond CCG

11. Sutton CCG

12. Wandsworth CCG

Technical Annex Contents

6

7

1. SWL CCGs: Financial Performance M9 YTD & FOT

YTD variance in acute

commissioning

expenditure of £16.7m

(FOT £19.2m) and in

non acute

commissioning

expenditure of £5.3m

(FOT £7.3m). See

slides on acute

commissioning and non

acute commissioning

for further details.

Overspends in acute

commissioning, non

acute commissioning

and primary care within

the FOT are expected

to be offset via the use

of reserves and other

mitigating actions.

8

2. SWL CCGs: Risks & Mitigations

Risk of £14.1m and mitigations of £12.4m were reported at Month 9, following the movement in the Sutton CCG

reported position at M9.

Net risk reported to NHSE at Month 9

9

3. SWL CCGs: QIPP Delivery

YTD adverse variance in QIPP delivery of £2.1m and a FOT adverse variance of £1.6m at Month 9, with no further slippage risk reported (slippage risk

was largely reported previously within Sutton CCG, which is now reflected in the reported position).

10

4. SWL CCGs: Acute Commissioning

Total acute commissioning spend is over plan by £19.2m FOT (£16.7m YTD), notably in relation on St George’s,

Epsom and St Helier, London Ambulance, King’s College Hospital and Moorfields activity as well within non

contracted activity.

11

5. SWL CCGs: Non Acute Commissioning

£5.3m YTD overspend in non acute commissioning overall due to activity pressures in continuing care (£6.7m) and

mental health placements (£2.6m) offset by underspend in IAPT, other mental health and other non acute budgets

(£0.7, £1.7m and £1.1m respectively). FOT position reported as overspent by £7.3m.

12

6. SWL CCGs: Primary Care

YTD is reported as in line with plan with a small underspend of £0.3m whereas FOT overspend of £1.7m is forecast,

relating to the profile of spend against primary care delegated and prescribing budgets.

13

7. Croydon CCG

Financial Strategy Financial Performance

- Joint control total between the Trust & CCG with 50:50 risk share –

underpinned by Block Contract for Acute & Community Services and a joint

CIP / QIPP programme.

- Trust Plan includes £8.6m (after QIPP) repatriation income to support local

care for Croydon residents

- Trust plan includes £14.3m CIP programme including driving efficiencies

through a joint Project Management Office (PMO)

- Joint working through the One Croydon Alliance is supporting the delivery

of integrated schemes.

- 5 Year Plans have been refreshed with partners in Croydon to inform the

Croydon Health & Care Transformation Plan for mid-November 2019.

- The CCG is reporting on plan for Month 9 and forecasting £3.5m surplus for

the year end in line with plan

Financial Governance Financial Risk

- Extension of voluntary turnaround arrangements ended on 30 September

from the Trust to Croydon ICP (CCG/Trust) reporting to both Accountable

Officer and Chief Executive. Full handover, including documentation,

complete by end of October.

- Joint CIP and QIPP Operational Board (CQOB) established and working

effectively.

- The Internal Audit programme of both the CCG and the Trust reviews

financial governance and control and QIPP/CIP arrangements. The CCG

Internal Audit for QIPP / CHC & Contracting for 2019/20 have achieved

Reasonable / Substantial Assurance. The Trust Internal Audit for Payroll

was Substantial Assurance and NHS Professional audit was Reasonable

Assurance.

- Finance/Finance Investment & Transformation (FIT) Committee in

Common will oversee performance on a monthly basis. Committee

members attended CQOB Live on 9 and 16 October.

1. Delivery of provider of choice/repatriation ambitions at the scale required.

Delivery of more than 50% of the referral shift and productivity gains (£3.4m

net of QIPP) are required for both organisations to deliver to plan. In

particular, the Trust position relies on most of the opportunity being

delivered. St Georges & Kings continue to aggressively treat off their waiting

list

2. Failure to close beds in line with the Non-Elective/Patient flow programme

linked failure to reduce Length of Stay will result in increased costs,

particular agency costs.(£1.5m)

3. Failure to reduce staffing costs, to bring it in line with budget, due to higher

that planned vacancies and absence cover. This is being addressed in

directorate challenge meetings. (£2.5m)

4. CCG allocation risk on East Surrey patient transfer. (£1.0m)

5. Failure to improve the patient flow pathways in Mental Health impacting on

backlog at A&E and more expensive inpatient overspill."

QIPP Delivery

Year to Date Forecast

Plan Actual Variance%

AchievedPlan Actual Variance

%

Achieved

£m £m £m % £m £m £m %

Summary Area of Spend

Acute Services 5.9 6.1 0.2 103 % 8.6 11.5 2.9 133 %

Mental Health Services 1.4 1.0 (0.4) 71 % 1.9 1.5 (0.4) 80 %

Community Health Services (0.2) (0.2) - 100 % (0.4) (0.4) - 100 %

Continuing Care Services 1.5 1.5 (0.0) 99 % 2.0 2.0 (0.0) 99 %

Primary Care Services 1.3 1.3 - 100 % 1.8 1.8 - 100 %

Primary Care Co-Commissioning - - - 100 % - - - 100 %

Other Programme Services 0.4 1.9 1.5 448 % 4.8 6.1 1.3 127 %

Commissioning Services Total 10.5 11.7 1.2 112 % 18.8 22.6 3.8 120 %

Running Costs - - - 100 % - - - 100 %

Unidentified - - - 100 % - - - 100 %

TOTAL CCG EFFICIENCIES 10.5 11.7 1.2 112 % 18.8 22.6 3.8 120 %

Financial Position

Oct-19 Nov-19 Dec-19

£m £m £m

Intangible Assets - - -

Property, Plant & Equipment 0.2 0.2 0.2

Non Current Assets Total 0.2 0.2 0.2

Cash and Cash Equivalents (0.6) (1.5) (0.5)

Current Trade and Other Receivables 4.1 4.6 4.7

Current Assets Total 3.6 3.1 4.1

Current Other Liabilities (0.8) (0.8) (0.8)

Current Trade & Other Payables (55.3) (49.2) (51.6)

Current Liabilities Total (56.0) (50.0) (52.4)

Non Current Liabilities Total - - -

Total (52.3) (46.7) (48.1)

General Fund 52.3 46.7 48.1

Financed by Taxpayer Equity 52.3 46.7 48.1

Net Position - - -

Statement of Cash Flows


£m £m £m

(Incr.) decr. trade & other receivables (0.0) (0.5) (0.1)

Depreciation, Amortisation 0.0 0.0 0.0

Incr. (decr.) trade & other payables 3.0 (6.0) 2.4

Net operating costs for the financial yr (52.2) (49.7) (49.6)

Cash Flows from Operating Activities (49.3) (56.2) (47.2)

(Payments) for property, plant and

equipment- - -

Cash Flows from Investing Activities - - -

Net Parliamentry Funding Received 49.2 55.3 48.2

Cash Flows from Financing Activities 49.2 55.3 48.2

Grand Total (0.1) (0.9) 0.9

Movement (0.1) (0.9) 0.9

Opening Amount (0.5) (0.6) (1.5)

Closing Amount (0.6) (1.5) (0.5)

Financial Performance

FY

Budget

Forecast

Actual

Forecast

Variance

Forecast

Variance

YTD

Budget

YTD

Actual

YTD

Variance

YTD

Variance

£m £m £m % £m £m £m %

Resource Limit 601.1 601.1 - - 448.4 448.4 - -

Expenditure

Acute Commissioning 331.0 332.5 (1.6) (0.5%) 247.2 247.1 0.1 0.0%

Non Acute Commissioning 130.6 131.0 (0.4) (0.3%) 97.1 97.6 (0.5) (0.5%)

Primary Care 108.5 109.3 (0.8) (0.7%) 81.1 81.0 0.0 0.1%

Running Costs 8.1 7.9 0.2 2.0% 5.9 5.8 0.0 0.8%

Corporate Programme Costs 4.1 4.6 (0.4) (10.3%) 3.2 3.6 (0.3) (10.9%)

Estate Costs 0.3 0.3 0.0 10.1% 0.2 0.2 0.0 10.1%

Other 10.9 10.7 0.2 2.2% 10.1 9.8 0.3 3.4%

STP PMO 1.3 1.3 - - 1.0 1.0 - -

Reserves 2.7 - 2.7 100.0% - (0.3) 0.3 -

Total Applications 597.6 597.6 - - 445.8 445.8 0.0 0.0%

Surplus/(Deficit) 3.5 3.5 0.0 0.0% 2.6 2.6 0.0 0.0%

Prior year deficit (67.2) (67.5) (67.5) (67.2)

Cumulative Surplus/(Deficit) (63.7) (64.0) (64.8) (64.6)

14

7. Croydon CCG

Risks & Mitigations

15

7. Croydon CCG

16

8. Kingston CCG


- A financial plan up until 2023/24 covering the whole of the South

West London STP has been developed, which is expected to be

published later this month. There is activity and financial alignment

between CCG and providers within SW London. However, there

remains a gap between the total allocation and the costs expected

across the system in 2020/21.

- Meetings of the Kingston and Richmond Financial Delivery and

Performance Oversight Group (FDPOG) are taking place, to focus

on assuring delivery of the transformation programmes across the

local system.

- The underlying position improved at Month 9 at a deficit of c.£3.9m

(M8 £4.2m) due to the level of non-recurrent benefits used to offset

increasing overspends in acute, CHC and mental health.

- The CCG plans to meet all business rules in 2019/20.Overspends are

reported in acute, CHC, prescribing and mental health placements.

- Reserves have been fully utilised to enable delivery of the planned

break even position.

- Better Payment Practice Code (BPPC) & cash targets were achieved.

- QIPP savings as at December are £1.8m (M08 £1.8m) over plan. This

is mainly due to a new project Atrial Fibrillation expected to deliver

£0.242m. Additionally, CHC saw the Placement Without Prejudice no

longer eligible savings of £1.4m and improvement in Effective

Commissioning Initiative position improved by £0.377m.


- A draft report from MHIS auditors gives an “except for” opinion,

meaning that changes to reported expenditure are recommended,

however the MHIS was achieved. Staff consultation closed on 23rd

December and staff feedback is being worked through ahead o the

next phase of the Moving Forward Together.

- External auditors completed work on the interim audit in November.

- Net risk slightly improved to £0.6m at month 9 (M08 £0.7m). The main

drivers were a net £0.3m reduction in Risk in Primary Care Networks,

CHC Growth, Prescribing and Mental Health Assessment Unit

combined with £0.2m less mitigations from Non Recurrent benefits

from unutilised prior year accruals.

- The CCG merger will result in significant changes to financial

accounting and reporting, at a time of changes to finance teams. A

project team is in place to manage the process and minimise risk.

QIPP Delivery




%

Achieved

£m £m £m % £m £m £m %


Acute Services 5.5 5.0 (0.5) 91 % 7.7 7.5 (0.3) 96 %

Mental Health Services 0.0 0.2 0.1 346 % 0.1 0.3 0.2 309 %

Community Health Services 0.2 0.2 (0.0) 100 % 0.3 0.3 (0.0) 100 %

Continuing Care Services 1.4 2.7 1.3 194 % 1.7 3.5 1.9 214 %

Primary Care Services 0.8 0.7 (0.1) 91 % 1.0 1.0 (0.0) 100 %


Other Programme Services 0.2 0.2 (0.0) 100 % 0.3 0.3 (0.0) 100 %


Running Costs 0.2 0.2 0.0 100 % 0.2 0.2 0.0 100 %

Unidentified - - - 100 % - - - 100 %


Financial Position


£m £m £m

Intangible Assets 0.1 0.1 0.1







Current Trade and Other Payables (24.1) (23.5) (24.9)

Provisions (0.0) (0.0) 0.0


Non Current Liabilities Total (0.3) (0.3) (0.3)

Total (23.0) (24.4) (26.2)



Net Position - - -



£m £m £m

(Incr.) decr. trade & other receivables 0.9 0.6 (0.3)


Incr. (decr.) trade & other payables 0.1 0.4 1.6

Net operating costs for the financial yr - - -



equipment - - -




Grand Total 0.7 (0.4) (0.5)

Movement 0.7 (0.4) (0.5)




FY

Budget

Forecast

Actual

Forecast

Variance

Forecast

Variance

YTD

Budget

YTD

Actual

YTD

Variance

YTD

Variance

£m £m £m % £m £m £m %

Resource Limit 283.7 283.7 - - 212.7 212.7 - -

Expenditure

Acute Commissioning 149.6 151.1 (1.5) (1.0%) 112.0 113.5 (1.5) (1.4%)


Primary Care 54.7 55.2 (0.5) (0.9%) 40.9 41.3 (0.3) (0.8%)

Running Costs 4.2 4.1 0.1 3.4% 3.2 3.0 0.1 4.4%

Corporate Programme Costs (1.2) (3.8) 2.7 (230.9%) (0.9) (2.6) 1.7 (196.8%)

Estate Costs 0.6 0.6 (0.0) (8.5%) 0.4 0.5 (0.0) (8.5%)

Other - - - - - - - -

STP PMO 0.6 0.6 - - 0.5 0.5 (0.0) (0.0%)

Reserves 2.9 0.3 2.6 90.6% 2.4 0.1 2.3 96.6%

Total Applications 283.7 283.7 (0.0) (0.0%) 212.7 212.7 (0.0) (0.0%)

Surplus/(Deficit) 0.0 0.0 (0.0) (0.0%) 0.0 (0.0) (0.0) (100.4%)

Prior year deficit 6.0 4.5 4.5 4.5

Cumulative Surplus/(Deficit) 6.0 4.5 4.5 4.5

17

8. Kingston CCG

Risks & Mitigations

18

8. Kingston CCG

19

9. Merton CCG


- SWL Health and Care Partnership programme work is ongoing

to deliver system transformation plan.

- Wandsworth and Merton transformation group and Health and

Care Boards respectively have been established to deliver the

health and care strategy for the Boroughs of Merton and

Wandsworth.

- Contracts have been agreed with minimal QIPP outside of

these plans. There is no unidentified QIPP for either CCG.

- A cross system control total for all organisations with SWL has

been issued. The Wandsworth and Merton contributions are in

line with our planned targets.

- 2019/20 is the first year of the recently published 5 year

allocations.

- First draft of the 5 year financial plan linked to the long term

plan for the NHS was submitted at the end of September with

further versions submitted in November and January.

- MCCG forecasts to achieve in-year target balance.

- £3m overspent on acute of which £0.7m is St.G, £0.4m is Croydon, £0.3m

is RM , £0.4m is LAS, £0.3m is Moorfields, £0.7m are NCAs

- CHC is £3.8m overspent due to a step change in activity following the

change in CHC provider last year.

- Overspends covered by the release of £5.7m of reserves.

- The extensive use of non-recurrent reserves is reflected in the CCG’s

£6.3m recurrent deficit.

- A recovery plan has been developed to try and mitigate the risk in the

position and reduce the overspends.

- The CCG is forecasting near full achievement of the QIPP plan.

- The CCG will meet the running cost target.

- During the year to date the CCG has achieved the Better Payment Practice

Code (BPPC) target of paying 95% of invoices in total within 30 days.


- Corporate objectives agreed and board assurance framework

being updated.

- Finance Resource Oversight Group (FROG) oversees QIPP.

- An internal audit plan is in place.

- SWL FCIC is in place.

- A final agreed internal audit programme for both CCGs has

been signed off by the Audit Committee

There are significant risks in:

- Acute – the figures have normalised for critical care peaks and with the

expectation that elective activity will reduce in the winter due to emergency

pressures. Also risks around the IRR transfer and some back ended qipp.

- Mental health – significant historic learning disability risk regarding shared

costs with MBC

- Further risks exist on prescribing due to back ended qiipp, along with

activity risks in MHP and some estates cost risks due to the latest PS true

up.

QIPP Delivery




%

Achieved

£m £m £m % £m £m £m %


Acute Services 5.5 5.0 (0.5) 91 % 8.0 7.2 (0.7) 91 %


Community Health Services (1.3) (1.4) (0.0) 103 % (1.8) (1.9) (0.2) 111 %





Commissioning Services Total 7.8 8.1 0.2 103 % 11.1 11.0 (0.1) 99 %

Running Costs 0.3 0.3 (0.0) 94 % 0.4 0.4 (0.0) 96 %

Unidentified - - - 100 % - - - 100 %

TOTAL CCG EFFICIENCIES 8.1 8.4 0.2 103 % 11.5 11.4 (0.1) 99 %

Financial Position


£m £m £m




Cash and Cash Equivalents 0.1 (0.8) (0.7)






Non Current Liabilities Total - - -

Total (18.9) (17.0) (19.6)



Net Position - - -



£m £m £m

(Incr.) decr. trade & other receivables 0.8 (0.7) (1.4)


Incr. (decr.) trade & other payables (1.7) (2.0) 4.0




equipment - - -




Grand Total 0.5 (0.8) 0.1

Movement 0.5 (0.8) 0.1

Opening Amount (0.4) 0.1 (0.8)

Closing Amount 0.1 (0.8) (0.7)


FY

Budget

Forecast

Actual

Forecast

Variance

Forecast

Variance

YTD

Budget

YTD

Actual

YTD

Variance

YTD

Variance

£m £m £m % £m £m £m %

Resource Limit 300.0 300.0 - - 224.8 224.8 - -

Expenditure



Primary Care 60.3 60.1 0.2 0.4% 45.1 44.2 0.8 1.9%

Running Costs 4.3 4.1 0.2 4.1% 3.2 3.2 0.1 2.6%


Estate Costs 2.0 2.0 (0.0) (1.8%) 1.5 1.5 (0.0) (1.8%)

Other 5.1 5.0 0.1 2.5% 3.8 3.7 0.2 4.1%

STP PMO - - - - - - - -

Reserves 4.8 (1.0) 5.8 120.5% 3.6 (1.2) 4.8 134.5%

Total Applications 300.0 300.0 0.0 0.0% 224.8 224.8 (0.0) (0.0%)

Surplus/(Deficit) - 0.0 0.0 - 0.0 (0.0) (0.0) (110.1%)

Prior year deficit 4.0 3.0 3.0 3.0

Cumulative Surplus/(Deficit) 4.0 3.0 3.0 3.0

20

9. Merton CCG

21

9. Merton CCG

Risks & Mitigations

22

10. Richmond CCG


- A financial plan up until 2023/24 covering the whole of the South West

London STP has been developed, which is expected to be published

later this month. There is activity and financial alignment between CCG

and providers within SW London. However, there remains a gap

between the total allocation and the costs expected across the system

in 2020/21.

- Meetings of the Kingston and Richmond Financial Delivery and

Performance Oversight Group (FDPOG) are taking place, to focus on

assuring delivery of the transformation programmes across the local

system.

- The Month 9 underlying position has remain at 3.4m (M8 £3.4m) deficit,

reflecting the unidentified and non-recurrent QIPP included in the plan.

- At Month 9, the CCG is reporting a £0.08m YTD surplus on the outturn

position and is in line with its business rules for 2019/20 with NHS England.

- To cover the pressures we have seen up to Month 9, particularly in Adult

CHC, we have released nil (M8 £0.5m) of contingency and £1.8m above

the planned non recurrent prior year benefits derived from unutilised year

end accruals to enable delivery of the forecast surplus.

- The unidentified QIPP as it stand at Month 9 is now reduced to zero (M8

£0.2m) which also reflected at the risk position.

- Better Payment Practice Code target was achieved in Month 9.The NHS

England cash target was achieved for Month 9.


- An external audit on the mental health investment standard has finished

and the report is in the process of being finalised.

- Staff consultation closed on 23rd December and staff feedback is being

worked through ahead of the next phase of the Moving Forward

Together.

- External auditors completed work on the interim audit in November.

- The net risk have improve from the final plan submitted on the 15th May

(£2.9m net risks), mainly due to the identifying additional balance sheets

reversals that have reduced the net risks and mitigations to zero (M08

£0.3m) and the unidentified QIPP to zero (M08 £0.2m).

- Cap and collar arrangement have been agreed for the main acute

contracts.

- Potential additional seasonality pressures have been factored in to the risk

position."

QIPP Delivery




%

Achieved

£m £m £m % £m £m £m %


Acute Services 3.5 2.1 (1.5) 59 % 5.0 3.5 (1.5) 70 %


Community Health Services - - - 100 % - - - 100 %

Continuing Care Services 2.2 3.8 1.6 175 % 3.5 4.9 1.4 140 %

Primary Care Services 0.9 0.9 0.0 100 % 1.1 1.1 0.0 100 %




Running Costs - - - 100 % - - - 100 %

Unidentified - - - 100 % 2.1 - (2.1) 0 %


Financial Position


£'m £'m £'m










Non Current Liabilities Total (0.6) (0.6) (0.5)

Total (30.1) (28.2) (26.2)



Net Position - - -



£m £m £m


Depreciation, Amortisation 0.0 - -

Incr. (decr.) trade & other payables (1.3) (2.1) (2.1)




equipment - - -




Grand Total (0.1) (0.2) (0.3)

Movement (0.1) (0.2) (0.3)




FY

Budget

Forecast

Actual

Forecast

Variance

Forecast

Variance

YTD

Budget

YTD

Actual

YTD

Variance

YTD

Variance

£m £m £m % £m £m £m %

Resource Limit 285.6 285.6 - - 213.0 213.0 - -

Expenditure


Non Acute Commissioning 82.8 82.2 0.7 0.8% 62.1 61.3 0.8 1.3%

Primary Care 54.5 54.7 (0.2) (0.4%) 40.7 40.7 0.0 0.1%

Running Costs 4.3 4.2 0.1 2.8% 3.2 3.1 0.1 3.7%


Estate Costs 0.2 0.2 0.0 17.4% 0.2 0.1 0.0 18.6%

Other (1.6) (3.3) 1.8 (112.3%) (1.2) (2.4) 1.2 (105.7%)

STP PMO 0.6 0.6 (0.0) (0.0%) 0.5 0.5 (0.0) (0.0%)

Reserves 1.4 1.4 - - - - - -

Total Applications 285.5 285.5 0.0 0.0% 212.9 212.9 (0.0) (0.0%)

Surplus/(Deficit) 0.1 0.1 0.0 0.2% 0.1 0.1 (0.0) (1.4%)



23

10. Richmond CCG

Risks & Mitigations

24

10. Richmond CCG

25

11. Sutton CCG


- 2019/20 is year 1 of the 5 year allocations notified in 2019/20.

- Contracts have been agreed for 2019/20 but with significant QIPP

outside of contract.

- CCG specific control totals have been notified from NHSE, although

SWLHCP is working to an aggregate system control total including

commissioners and providers.

- The CCG’s financial position now includes the impact of the joint

financial recovery plan (FRP) rather than the original QIPP savings

programme.

- The aim of the CCG is to achieve underlying financial balance though

this is unlikely to be achieved in financial year 2019/20 given the

underlying recurrent deficit of £8.9m at the start of 2019/20 and net risk

to plan of £6.5m.

- The CCG is working on a joint (FRP) with Epsom St Helier NHS Trust

(ESHT) to restore the CCG to a recurrent in-year balanced position by

2020/21.

- The target set by NHSE was for the CCG to achieve an in-year surplus of £0.6m.

- To achieve the NHSE target, the CCG had a net QIPP savings programme of

£16.5m. However, the two year financial recovery plan has first year savings of

only £9.6m.

- At Month 9 the CCG has reported a forecast £5.4m deficit, which is £6.0m off

plan.

- The CCG / ESH risk share agreement for 2019/20 means that a minimum £3.6m

of £7.2m acute QIPP savings will be realised by the CCG. The total savings

realised depends on Trust savings made.

- The CCG has 8 months of acute data available. Work undertaken by the Acute

Commissioning Team at the CSU suggests that the contracts could potentially

overspend by £1.6m at year end.

- The CCG has received the month 7 prescribing data – Significant pressures can

be detected in the PMD forecast both from general prescription and category M

Pricing changes. A £0.6m pressure has been reflected in the CCGs position

- Underlying CHC recurrent spend is in excess of the recurrent budget set,

however, excess year end creditors from 2018/19 are bringing the forecast back

to a £0.3m overspend. - The CCG is forecasting to meet the Mental Health

Investment Standard.


- The financial position is overseen by the Management team, Executive

Management Committee, Finance Committee, Executive Committee

and the Governing Body, all of which meet monthly.

- The Audit committee is responsible for ensuring a robust system of

internal control.

- Annual internal audit plan for 2019/20 has been agreed.

- Board Assurance Framework is updated Bi-monthly.

- Aim is for all internal audit reports to provide at least “reasonable

assurance”. If not the case an action plan in place to do so.

- The net risk to control total is £7.0m. £6.0m reported and £1.0m of further risks.

- The CCG has reviewed the FRP achievement in month 9 and the risks against

the original QIPP programme have been factored into the reported position –

there are no further risks on the QIPP programme.

- Acute performance and continuing healthcare risks have been assessed at

£1.0m.

QIPP Delivery




%

Achieved

£m £m £m % £m £m £m %


Acute Services 6.7 3.9 (2.7) 59 % 8.9 5.2 (3.7) 59 %


Community Health Services 0.2 0.2 0.0 100 % 0.3 0.3 0.0 107 %




Other Programme Services (0.0) 0.2 0.2 (342%) (0.1) 0.3 0.4 (380%)

Commissioning Services Total 9.2 6.5 (2.7) 71 % 12.3 8.7 (3.6) 71 %

Running Costs - - - 100 % - - - 100 %

Unidentified 3.2 - (3.2) 0 % 4.2 - (4.2) 0 %

TOTAL CCG EFFICIENCIES 12.4 6.5 (5.9) 53 % 16.5 8.7 (7.8) 53 %

Financial Position


£'m £'m £'m




Cash and Cash Equivalents 0.2 0.9 -

Current Trade and Other Receivables 1.7 2.5 (1.8)


Current Other Liabilities (0.5) (0.4) 1.0

Current Trade & Other Payables (15.9) (20.2) -


Non Current Liabilities Total - - (20.3)

Total (14.3) (17.1) (20.7)

General Fund 14.3 17.1 -

Financed by Taxpayer Equity 14.3 17.1 -

Net Position - - -



£m £m £m



Incr. (decr.) trade & other payables (3.7) 4.2 0.1




equipment- - -




Grand Total 1.5 0.7 (2.6)

Movement 1.5 0.7 (2.6)

Opening Amount (1.3) 0.2 0.9

Closing Amount 0.2 0.9 (1.8)


FY

Budget

Forecast

Actual

Forecast

Variance

Forecast

Variance

YTD

Budget

YTD

Actual

YTD

Variance

YTD

Variance

£m £m £m % £m £m £m %

Resource Limit 320.4 320.4 - - 240.7 240.7 - -

Expenditure



Primary Care 59.6 59.3 0.2 0.4% 44.3 44.1 0.2 0.5%

Running Costs 4.3 4.3 - - 3.2 3.2 0.0 0.0%

Corporate Programme Costs 16.6 16.3 0.3 1.5% 12.4 12.3 0.2 1.5%

Estate Costs 0.1 0.1 - - 0.1 0.1 (0.0) (1.1%)

Other - - - - - - - -

STP PMO 0.5 0.7 (0.1) (20.6%) 0.4 0.5 (0.1) (20.5%)

Reserves 1.5 - 1.5 100.0% 1.2 - 1.2 100.0%

Total Applications 319.8 325.8 (6.0) (1.9%) 240.3 244.8 (4.5) (1.9%)

Surplus/(Deficit) 0.6 (5.4) (6.0) (1000.0%) 0.5 (4.0) (4.5) (1000.0%)



26

11. Sutton CCG

Risks & Mitigations

27

11. Sutton CCG

28

12. Wandsworth CCG


- SWL Health and Care Partnership programme work is ongoing to

deliver system transformation plan.

- Wandsworth and Merton transformation group and Health and Care

Boards respectively have been established to deliver the health and

care strategy for the Boroughs of Merton and Wandsworth.

- Contracts have been agreed with minimal QIPP outside of these

plans. There is no unidentified QIPP for either CCG.

- A cross system control total for all organisations with SWL has been

issued. The Wandsworth and Merton contributions are in line with

our planned targets.

- 2019/20 is the first year of the recently published 5 year allocations.

- First draft of the 5 year financial plan linked to the long term plan for

the NHS was submitted at the end of September with further

versions submitted in November and January.

- Wandsworth is forecasting to achieve its target however:

- The CCG is forecasting £3.6m overspend on with £2m at

St.Gs, £0.8m at Moorfields, £0.4m at RM and £1m at Imperial.

- £1.4m over on mental health due to mental health placements.

- £0.7m over on community services due to Linden lodge.

- The above overspends have been covered by the use of £6.2m of

reserves.

- The CCG is forecasting near full achievement the QIPP plan. The

CCG is expected to achieve its RCA target.

- During the year to date, the CCG has achieved the Better Payment

Practice Code (BPPC) target of paying 95% of invoices in total within

30 days.


- Corporate objectives agreed and board assurance framework taken

to the respective Boards.

- Finance Resource Oversight Group (FROG) scrutinises both the

QIPP plan and the overall CCG financial positions.

- An internal audit plan is in place

- A final agreed internal audit programme for both CCGs has been

signed off by the Audit Committees.

There are risks in

- Acute – the figures have normalised for critical care peaks and with the

expectation that elective activity will reduce in the winter due to

emergency pressures. Also risks around some back ended QIPP.

- Historic property charges from Property services

- RHHND debt

- Subsidy to K & R for MFF changes.

QIPP Delivery




%

Achieved

£m £m £m % £m £m £m %


Acute Services 7.8 7.5 (0.3) 96 % 10.9 10.4 (0.5) 95 %


Community Health Services (0.6) (0.6) 0.0 100 % (0.7) (0.7) 0.0 100 %


Primary Care Services 1.4 1.5 0.0 100 % 2.0 2.1 0.1 106 %



Commissioning Services Total 10.3 10.1 (0.2) 98 % 14.3 14.2 (0.1) 100 %

Running Costs 0.5 0.4 (0.1) 78 % 0.7 0.6 (0.1) 83 %

Unidentified - - - 100 % - - - 100 %

TOTAL CCG EFFICIENCIES 10.9 10.6 (0.3) 97 % 15.0 14.8 (0.2) 99 %

Financial Position


£m £m £m









NC Provisions - - -


Total (27.5) (27.2) (29.5)



Net Position - - -



£m £m £m

(Incr.) decr. trade & other receivables 3.2 0.0 (8.3)

Depreciation, Amortisation - - -

Incr. (decr.) trade & other payables (6.0) (1.1) 10.9




equipment 0.1 (0.1) 0.0

Cash Flows from Investing Activities 0.1 (0.1) 0.0



Grand Total 2.0 (0.8) 0.4

Movement 2.2 (0.9) 0.4




FY

Budget

Forecast

Actual

Forecast

Variance

Forecast

Variance

YTD

Budget

YTD

Actual

YTD

Variance

YTD

Variance

£m £m £m % £m £m £m %

Resource Limit 527.1 527.1 - - 393.7 393.7 - -

Expenditure



Primary Care 102.0 102.7 (0.7) (0.7%) 76.4 76.9 (0.5) (0.7%)

Running Costs 7.1 7.4 (0.3) (4.1%) 5.4 5.6 (0.3) (4.8%)


Estate Costs 1.3 2.1 (0.8) (62.6%) 1.0 1.6 (0.6) (62.6%)

Other 7.1 4.9 2.2 31.2% 4.7 1.5 3.1 67.3%

STP PMO 2.5 2.5 - - 1.9 1.9 - -

Reserves 4.0 - 4.0 100.0% 3.4 - 3.4 100.0%

Total Applications 527.1 527.1 0.0 0.0% 393.7 393.7 0.0 0.0%

Surplus/(Deficit) 0.0 0.0 (0.0) (0.4%) (0.0) 0.0 0.0 (189.4%)

29

12. Wandsworth CCG

Risks & Mitigations

30

12. Wandsworth CCG