FINANCIAL RISK RATING (FRR – SHA model) To move the Underlying Performance rating for full year outturn forecast from amber to green (from 3 to 4) the Trust would need to reduce operational costs or increase income by approximately £450k. This would have the effect of increasing the forecast outturn surplus from £6.0m to £6.4m.
The following schedules show the financial and workforce performance for the whole Trust and each of the directorates.
Activity relates to the period to October 09 and variances are based on an estimated profile.
Contract income for November has been estimated.
The Trust currently forecasts to achieve a surplus of £6m.
The Trust has generated a surplus of £4.8 m, £0.2m above the revised, phased budget. Pay costs remain at just over 1% above budget, and include £1.68m of agency costs. Non-pay costs are generally on or below budget, which includes costs for new clinical and medical equipment purchased across the Trust.
Overall nursing staff costs are 1.5% below budget. Medical staff costs (incl. agency) are 5.6% over budget.
The Trust currently employs 2214.6 WTE staff an increase of 14 wte since October.
There are currently 72.23 WTE (91 headcount) employees on maternity leave, compared to 48.08 WTE (60 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.
Sickness rate for the month is 4.15%. The cumulative sickness rate for the year is 3.78%
Month 7 (October) activity showed a Directorate over performance in the region of 5,400 actual activity, and £900k in value. November activity not available at the time of writing this report.
The Directorate was over spent £94k in the month.
Income was £39k better than budget - the majority of this was due to recovery of consultant staff costs (£16k - Oncology and Neurology), Nurses (£7k), R & D income (5k), alcohol awareness (£4k) and £6k funding for equipment for the Stroke service - much of this income is matched by additional cost.
Covering consultant vacancies in Accident & Emergency and Cardiology added significantly to costs: A&E £40k in the month, Cardiology incurred £35k in additional sessions and a further £5k of locum costs. Other than Cardiology, additional sessional costs were less than previous months. Further locum costs were incurred to cover consultant maternity leave in Haematology.
Nursing costs were £41k above budget. Agency costs reduced to £3k in the month, bank costs remained high. £15k referred to posts funded by income detailed above, £19k for posts that have been approved, via business cases, with no additional funding (Medical Day Treatment Unit and Discharge Unit). The remainder was concentrated on a number of wards with high levels of maternity leave and/or sickness in order to maintain clinical standards.
Non pay costs were underspent, including a reduction in charges for Mobile Angiography - contract based on number of patients seen.
There has been little change since last month’s report. Activity remains above plan by approx 12% along with the associated income. Outpatient demand continues to require additional sessions to manage demand in General Surgery, (particularly 2 week wait rapid access colo-rectal), T&O, ENT, Ophthalmology and Oral Surgery. The PCT are attempting to provide a GDP solution for minor oral surgery which, once implemented, will reduce demand in Oral (no time frame yet). New to follow up ratios are satisfactory. Discussions also taking place with Addenbrookes over additional permanent sessions for vascular and plastics. Income for the month was better than budget due to invoices for the use of medical staff £104k, SLA Income £12k and Private Patients of £38k. Pay was more than budget primarily as a result of medical staff £514k, due to extra session payments, Prof. & Tech agency cost £109k, and nursing bank £278k but partially offset by £230k from staff vacancies. Non-Pay exceeds the budget £187k for contracted work – plastics, ENT, and dental. MSE was over by £276k due to equipment replacements and general supplies in theatres. Cost of appliances and other supplies were £96k over. Sickness/absence and maternity leave rates have improved on the inpatients wards but the levels still necessitate backfill by bank staff. The use of agency staff was £271k for junior medical staff (Urology, T&O, ENT) and £104k for consultants (Anaesthetics). A further £109k for non-medical agency includes cover for Audiologist (£54k) and the Plaster Orderly (£55k) in the Fracture Clinic (this position has now been recruited to), plus £11k nursing. Locum cost were £355k, primarily in Anaesthetics for consultant cover and bank usage was £278k for nurses and £65k for medical secretaries to cover sickness, maternity leave and vacancies. SURGERY DIRECTORATE
The favourable variance to budget is driven mainly by £128.4k in vacant positions, £15.6k in lower drug cost, £13.2k lower rent costs for community midwifery clinic space, £22.2k in transport cost due to last year credits received, Lower SLA charges £0.9k, additional USAF income of £378.8k and £116.5k from EWTD funds. These savings were partially offset by extra session payments of £55.8k and £84.8k for the wards’ bank usage and £44.7k in MSE and other supply cost
Activity data reflects a significant increase in gynaecology referrals over last year and recorded activity is 30.9% up year-on-year through October. Paediatric referrals are up 6.3% but recorded activity is down by 3.8% primarily due to no longer having the gastroenterology patients. Activity vs the SLA through October is down mainly in midwifery and obstetrics due to over-commissioned levels by the PCT. This will be now be subject to a contract variation.
Sickness rates have improved from the October position but maternity leave has increased. Use of bank staff (£305.3k) reflects vacancy cover, maternity leave and long term sick cover. Paediatrics have used agency staff to support the service. Locum staff (£173.9k) are being used to cover the vacancies for the hybrid consultants in Paediatrics although part of this cost is offset by additional EWTD income (£116.5k). Non-NHS Agency cost is primarily due to Junior Doctor coverage in Paediatrics.
The Directorate was over spent this month by £81k .
Income was greater than budgeted due to the continued support for the Early Intervention Team and running the Newmarket hospital pharmacy service on an interim basis.
Radiology Consultants were successful in an appeal regarding on call duties and received an increase of one Programmed Activity back dated to May 09. This is not included within budgets (net cost £25k year to date).
Consultant vacancies meant expenditure on locums in Chemistry (£4k) and Histopathology (£9k), with the latter also incurring a further £11k in referred work. A locum Radiologist is working above their established hours to manage current departmental workload with additional sessions also being required.
Vacancies in other professions are also being addressed, with Pharmacy now at establishment. There is still some agency staff to cover rehabilitation and Microbiology, which has several vacancies at the moment.
Medical and Surgical equipment and Pathology equipment were above budget (£6k and £19k respectively), in part to cover activity levels, though there is some increase in analyser stocks with the new contract in chemistry about to start.
The National Blood service contract was over spent by £19k this month, despite receiving a credit (national contingency savings) of £15k for the first six months, with more expected in January. Costs are being reviewed in light of the higher cost in the month.
CLINICAL SUPPORT DIRECTORATE
Income Continues to improve. Pay SSD – underspend as a result of vacancy. Estates – underspend as a result of vacancies. Facilities Admin – underspend due to vacancy. Non Pay underspend has reduced this month. Utilities continue to underspend due to lower tariffs. Central Med & Surg – overspend forecast on mattresses has been removed to central fund. Workforce The majority of short term sickness is within the Trust target of 3.5%. It was hoped that the Long Term sickness would reduce in October as some staff were on a phased return to work. Regular analysis of the sickness will highlight the variance. FACILITIES DIRECTORATE
Corporate report is a consolidation of Finance and Information, Human Resources and Communications, Medical Director, Nursing and Governance, Trust Office, Overhead, Sudbury and the Central Operations Directorates. Reserves are excluded from this report.
The overall pay variance remains favourable. Agency and bank staff are still being used in Finance to support FT work, IT and payroll. The cost of bank nurses on mandatory training are included in these Corporate numbers.
The Income variance is favourable due mainly to RTA (£204k variance) income and some funding which has associated unbudgeted costs, for example: Pandemic Flu, IT support contracts and Research.
The Overheads budget includes a CIP for Collaborative Hub led savings, but these savings actually arise elsewhere throughout the Trust, contributing to the adverse variance. The non-pay variance also includes provisions for unbudgeted consultancy work associated with Transformation and Foundation Trust and other projects, creating the high adverse variance.
The Maternity and sickness rates are below the overall Trust rate.
On the basis of the level of surgical activity delivered during the year the Performance Review Group has recognised that the original CIP target for Surgery will not be met, and despite Surgery seeking alternative CIPs, this will not be deliverable in year.
The above table shows financial performance by main specialty lines for the period to October 09 . This summary now reflects the changes to the income budget made to the September financial reports. In addition, the October financial position now reflects the actual income position for the first quarter SLA contract. The current Obstetric performance reflects over-commissioned activity by NHS Suffolk The SLR above reflects the published October financial information . Summary Service Line Report for October 2009