Executive Summary – CCG Assurance Framework Solihull CCG: BSOL Finance and Performance Committee - July 2017 Finance Report: 2017/18 M03 Executive Summary – CCG Assurance Framework The year to date financial position is showing a £0.92m adverse variance to plan. This is primarily due to underachievement of QIPP schemes. The forecast outturn position at month 3 is consistent with the planned deficit of £8.3m against allocation (£5.5m in year plus £2.8m carried forward from 2016/17). This forecast is predicated on delivery of the CCGs QIPP plan. The required level of mitigation as at month 3 is £3.7m. The year to date position on QIPP is showing £1.08m underachievement against plan. Currently the CCG is Forecasting QIPP delivery of the £18.0m, but as noted above this requires substantial additional progress to be made. The forecast underlying position (recurrent exit rate) is a deficit of £2.3m.

Summary Financial Position Solihull CCG: BSOL Finance and Performance Committee - July 2017 Finance Report: 2017/18 M03 Summary Financial Position The bottom line forecast outturn is at plan, representing a £8.3m deficit to allocation, of which £5.5m represents the in year deficit with £2.8m carried forward from 2016/17. The year to date position is £0.92m adverse variance to plan at Month 3 which represents little movement from the previous month. Unless QIPP plans succeed in the latter part of the year the CCG will be in a deficit to plan position. The acute year to date position is a £2.1m deficit against plan. This is primarily due to unidentified QIPP schemes. Prescribing is slightly above plan, however this is after removing £2.1m QIPP from Budget. The current data is based on only one month of information (April). Continuing Healthcare is £0.4m Underspent year to date, due to far tighter control of eligibility for services. The Forecast out-trnr of £1m underspend is prudent and will possibly increase in later months. Forecast QIPP delivery is at 100% (page 10 ) but year to date is only 76% due to slippage of schemes. Further detail is available in the financial schedules on pages 15-17.

Underlying Financial Position Solihull CCG: BSOL Finance and Performance Committee - July 2017 Finance Report: 2017/18 M03 Underlying Financial Position The forecast closing underlying position remains a deficit of £2.2m in line with plan. The table above indicates how the underlying position is comprised, reconciling from the forecast £8.3m cumulative deficit.

Solihull CCG: BSOL Finance and Performance Committee -July 2017 Finance Report: 2017/18 M03 Acute Contracts - HEFT The HEFT position at month 2, before the impact of penalties, CQUIN under-delivery and payment queries , is an over-performance of £0.1m. The CCG has adjusted the position for known anomalies within the Trust Monitoring Report. These include profiling of Patient Transport Budget. The reported Budget includes a reduction of £0.3m for QIPP (£3.6m FYE). Payment queries with a year to date value at month 2 represent the value within the Trust monitoring. However, these are likely to be fully mitigated once challenges agreed during contract negotiations are factored in. As at month 2 the CCG had challenged £0.1m of the activity included above.

Acute Contracts – Other providers Solihull CCG: BSOL Finance and Performance Committee - July 2017 Finance Report: 2017/18 M03 Acute Contracts – Other providers HEFT comprises 78% of the acute portfolio by value. The remaining 22% is spread across a number of smaller providers, the next largest being UHBFT at £7.3m. The forecast outturn position is an overspend of £3.9m, 12.0% of plan. The key variance is Unidentified Acute QIPP, which is being partially offset by reserves.

Acute Contracts – Year to Date Activity for M2 2017/18 Solihull CCG: BSOL Finance and Performance Committee -July 2017 Finance Report: 2017/18 M03 Acute Contracts – Year to Date Activity for M2 2017/18 Based on month 2 year to date monitoring the key messages are :- A&E attendances: attendances are 2.2% higher than the same period last year. Emergency admissions: are 3.2% Higher than the same period last year, but are 1% below the previous years monthly average. Planned admitted care (electives and day cases taken together) are 7.4% lower. First outpatients decreased 1% while follow ups decreased 4.5% See charts on page 7 for detail.

Acute Contracts – Year to Date Activity to M1 17/18 Solihull CCG: BSOL Finance and Performance Committee - July 2017 Finance Report: 2017/18 M03 Acute Contracts – Year to Date Activity to M1 17/18 Ambulatory Emergency Care Clinics (AECs) The charts on the left show over the previous 26 months, the relationship between AEC activity, Emergency admissions and conversion rate from A&E (the percentage of A&E attendances which result in an emergency admission/AEC attendance). The intention is that AECs result in fewer full-blown emergency admissions - so as AECs increase, emergency admissions should decrease. As emergency admissions could increase due to other variable factors (such as increased A&E attendances), the conversion rate from A&E to admission is shown - there should be no increase in conversion rate as AECs increase, if they are working as intended. If the conversion rate does increase this is first principles evidence that in some cases patients who would otherwise have been managed within A&E are being managed via AEC. Conversion rate remains on an upward trend, but did reduce in April and remained constant in May.

Continuing Healthcare Solihull CCG: BSOL Finance and Performance Committee -July 2017 Finance Report: 2017/18 M03 Continuing Healthcare M3 activity and costs are consistent with the figures reported last month with a continuing downward trend in under £210 per day, and a significant downwards trend in over £210 from January 2017. The monthly average Continuing Care days are 8% lower in 17/18 when compared to 16/17 as at month 3. The Total Package days over £210 pd has show a considerable favourable reductions in April, May and June.

Solihull CCG: BSOL Finance and Performance Committee - July 2017 Finance Report: 2017/18 M03 Prescribing The figures above represent just one months (April) data. It is difficult to come to any definitive forecasts for the year based on this. The figures above are following the removal of £2.1m prescribing QIPP.

Solihull CCG: BSOL Finance and Performance Committee -July 2017 Finance Report: 2017/18 M03 QIPP - summary The Forecast out-turn is that the CG will recover ytd slippage and deliver the full QIPP target, however currently there is a £4.3m risk of under achievment. The latest position is based upon RAG rating of QIPP schemes. Indicative figures show that all except acute programmes are delivering to target.

Statement of Financial Position / Better Payment Practice Code Solihull CCG: BSOL Finance and Performance Committee -July 2017 Finance Report: 2017/18 M03 Statement of Financial Position / Better Payment Practice Code Better Payment Practice Code (target 95%)

Solihull CCG: BSOL Finance and Performance Committee - July 2017 Finance Report: 2017/18 M03 Risks and Mitigations The net RISK has reduced from £5.7m at month 2 to £3.7m at month 3. The improvement is mainly down to an improvement on the QIPP position. Net risk is £3.7m which is predominantly due to potential under delivery of QIPP At month 3 the CCG has been alerted to a possible allocation adjustment for Prescribed Specialised Services Identification Rule IR issues at UHB, this has been risk adjusted to £0.3m pending further information.

Cash Solihull CCG: BSOL Finance and Performance Committee -July 2017 Finance Report: 2017/18 M03 Cash Notes 1. The top part of the "Efficiency of Cash" shows the opening and closing actual Bank Balances after taking account of actual receipts and payments during the month 2. The bottom part of the table shows the Cash Book balance - this is the value recorded in the Statement of Financial Position(Balance Sheet). The Cash Book balance may not always be the same as the Bank Balance due to unpresented cheques or delays in the BACS payment hitting our bank account.

Solihull CCG: BSOL Finance and Performance Committee -July 2017 Finance Report: 2017/18 M03 Allocations The CCG has had an allocation adjustment for the 16/17 deficit of £2.8m and a number of small allocations totalling £1.5m. The majority of these small allocations are for defined programmes of work. Whilst the IR changes allocations have been made non recurrently it is anticipated that they will be made recurrent from 2019/20.

Summary Financial Schedules Solihull CCG: BSOL Finance and Performance Committee - July 2017 Finance Report: 2017/18 M03 Summary Financial Schedules

Detailed Financial Schedules – Part 1 Solihull CCG: BSOL Finance and Performance Committee - July 2017 Finance Report: 2017/18 M03 Detailed Financial Schedules – Part 1

Detailed Financial Schedules – Part 2 Solihull CCG: BSOL Finance and Performance Committee -July 2017 Finance Report: 2017/18 M03 Detailed Financial Schedules – Part 2