Financial Recovery Plan February 2015 (Month 10 reporting) 2015/16 February 2015 (Month 10 reporting) 29.02.16v1

Executive Summary This document provides a summary of the financial recovery plan for west Essex CCG and actions being taken to deliver the planned 1% (£3.6m) surplus with £0.2m head-room by 31st March 2016. As the CCG emerged from Q1, it became clear that the demand pressures were higher than planned particularly with respect to acute non elective performance and GP prescribing. By Month 4 and 5 reporting it has become apparent that this level of demand would impact on the organisation’s ability to deliver the control total. This was reported to NHSE through regular review meetings.   This pressure has been compounded by a series of non-recurring financial hits during 2015/16 totalling some £4m. These include £1.2m to resolve the Barts Health dispute from 2014/15, NHSE finding against the CCG in its £2.4m dispute with UCLH. Additionally there is £1.79m of financial risk relating to unresolved disputes with NHS Property Services. The CCG has reported a surplus with £0.2m of head-room (total £3.78m) for month 10, however this has only been managed by fully depleting the reserves, and assuming that the FRP delivers savings and mitigate risks totalling £5.31m. The M10 FRP accounts for the loss of the RNOH dispute (£0.81m) and the adverse GP prescribing forecast from December (£0.6m). The additional FRP items identified at M9 have now been factored into the main FRP plan as new items totalling £1.7m. There is now no additional flexibility left in the CCG position. Of the original mitigations reported as being required in October 2015, £12.64m has been delivered.

Keeping track of Financial Recovery actions Tracking our Financial Recovery The original WECCG FRP (15.10.15v6) reported a total of £16.03m of mitigations. The latest FRP (29.02.16v1) reports that £12.64m has now been delivered. This represents an increase of £0.83m from the M9 FRP. There have been £4.73m of new schemes. £0.89m of FRP has been removed due to PAH arbitration. £1.93m of FRP has been removed to risk adjust for the BHR dispute and the loss of the RNOH dispute. A balance of £5.31m remains to be delivered. There are no Red rated schemes The next slide shows the detailed bridge between FRP versions.   Blue rated schemes are delivered and have been banked into the CCG position. Total is £12.64m Amber and Green FRP mitigations not yet banked into CCG position. Total is £5.31m

Bridge of movements between the FRP versions M9 and M10  

CCG Run Rate The CCG forecasts are essentially straight line after allowing for non-recurring items such as the UCLH dispute resolution. To meet with NHSE reporting requirements, at month 10 (January), the CCG reported a year to date, per plan, surplus variance of £2.98m. To achieve this £0.5m of reserve was used over and above the planned level of £6.8m (a total of £7.2m used of the maximum £8.2 available). Without this reserve ‘smoothing’ the actual reported position would have been a £2.5m surplus.   The ‘unsmoothed’ year to date position is shown in the above diagram by the blue dotted line. The period between months 5 and 7 saw delivery of FRP actions particularly with regards to stopping investments/spending decisions, contracting, and other risk mitigations. This has continued into month 10, particularly with the factoring in of the positive impacts of the PAH arbitration decision. Month 9 acute activity showed a significant overall drop in planned care but an increase in emergency inpatient activity, this does not appear to have materialised as an increase in cost. High volumes of uncoded activity in month 9 make it difficult to determine the reasons behind the apparent favourable shift in HRG casemix. The CCG has made significant progress but remains £0.2m off trajectory at month 10 reporting largely due to key disputes still remaining unresolved.

Key Acute Activity Variances Non Electives – Continue to be the CCGs most significant pressure largely as a result of coding and counting shifts at PAH resulting in higher average cost per case. Overall activity increased against trend in month 9 although this has not translated into a straight increase in costs. Electives – Are projected to be circa £0.1m above plan at year end driven mainly by over performances at Ramsay Rivers, Mid Essex, and Basildon and Thurrock. The PAH contract is currently projected to underperform by circa £1m. PAH continue to forecast delivery of the 92% RTT standard by the end of March. It is possible that this could drive a additional costs above current forecasts, although the reduction in elective activity over month 9 indicates that the Trust are delivering the target via a more intelligence driven approach rather than simply ramping up volumes. Accident and Emergency – A&E volumes are reduced largely due to the impact of front door initiatives and revised pathways into the PAH ED which bypass A&E. This is not materialising into a straight financial saving due to the Trust ‘improving’ its coding of diagnostics in A&E which is triggering higher costs HRGs. This was a key arbitration issue which went against the CCG. Outpatients – Overall outpatient performance is projected to be unfavourable by £0.4m above plan. Activity in first outpatients continues to be below plan at PAH. Other Variances - Other significant issues include significant forecasted over performances in critical care (£0.70m), high cost drugs (£1.3m), and other clinical services (£0.82m).

Key Inpatient Activity Trends Non Elective Inpatients The graph shows the change to an upward trend in non-elective admissions against plan in M9 across the acute portfolio of contracts predominantly at PAH and the other three main acute providers. The month 9 jump in activity has not translated into a financial pressure. The reasons for this are not yet understood due to the very high volumes of uncoded activity in the PAH M9 flex position. Elective Inpatients Overall elective performance is performing below plan at month 9 particularly at PAH, Ramsay Rivers and Barts Health offset by Addenbrookes. YTD overperformance at Ramsay Rivers, Holly House (Aspen), and Mid Essex are largely offset by significant under performance at PAH and UCLH

Mitigating Plans