1. NHS Merton CCG Finance Report Month 11 – as at 28 th February 2015 1

2. ContentsSlide Number EXECUTIVE SUMMARY3 BALANCED SCORECARD – FINANCE DOMAIN4 INCOME AND EXPENDITURE POSITION5 QUALITY, INNOVATION, PRODUCTIVITY AND PREVENTION (QIPP)6 ACUTE PERFORMANCE7 – 10 NON ACUTE PERFORMANCE11 PRESCRIBING AND PRIMARY CARE12 STATEMENT OF FINANCIAL POSITION13 CASH AND BETTER PAYMENT PRACTICE POLICY14 RISKS AND MITIGATIONS15 APPENDICES16 - 24 2 Finance Report – Month 11

3. EXECUTIVE SUMMARY 3 Eleven months to 28 th February 2015 For the eleven months to 28 th February 2015, NHS Merton CCG is reporting a year to date and full year improvement from plan of £0.5m. As reported from Month 9 onwards, this improvement from plan in the year to date and full year position specifically relates to return of the unused legacy continuing healthcare contributions from NHS England. There has been a non recurrent reduction in the revenue resource limit of £0.2m in Month 11. This relates to a 2013/14 repayment to the South West London risk pool for learning disabilities. Acute commissioning is over performing by £1.4m year to date, forecast to increase to an over spend of £1.6m by year end. St George’s NHS Trust is forecast to over perform by £0.7m, this is the position as reported in Month 10. Discussions with the trust regarding a year end settlement are currently on going. Epsom & St Helier NHS trust are reporting under performance of £0.3m primarily in elective activity and critical care, this has worsened considerably from what has been reported previously owing to an increase in activity in emergency and outpatient procedures. Kingston Hospital NHS Foundation trust is forecast to over perform by £0.1m mostly owing to over performance in critical care and outpatients. An over spend of £0.3m is forecast for non acute commissioning. This has worsened slightly from last month owing to an increase in the forecast position for children’s placements which are now forecast to over spend by £0.5m. Primary care is forecast to over spend by £0.7m, over spends are reported on prescribing, out of hours and care of older people local enhanced services. An over spend of £0.7m is reported on corporate costs, a full year under spend of £0.2m is reported on running costs owing to lower than anticipated admin spend at the Nelson Health Centre, however, this is offset by higher than anticipated programme spend related to the Nelson Health Centre. The forecast over spends are being offset by under spends on investments, release of CCG SLA reserve, partial release of contingency fund and return of Merton’s remaining contribution of £0.7m from the SWL risk pool contribution. QIPP – Year to date over achievement of £0.2m and full year over achievement of £0.1m is forecast. Recommendation Governing Body is asked to approve the Month 11 finance report and note the risks on slide 15.

4. BALANCED SCORECARD – FINANCE DOMAIN 4 The financial indicators are part of the CCG assurance framework used by NHS England. The overall financial performance and financial management performance is rated as green.

5. INCOME AND EXPENDITURE 5 Year to date (YTD) and full year (FY) actuals are on target The £319k continuing care provision created in 13/14 has been released in Month 11 as NHSE guidance states that any claims up to 31/04/2014 will be paid from the legacy provision held by NHSE. A business case has been submitted by South West London Commissioning Collaborative on behalf of South West London CCGs (excluding Croydon CCG) to drawdown the increased surplus in 2015/16. Risks to the position are detailed on slide 15.

6. QIPP 6 A YTD over achievement of £0.2m is reported. This is mostly owing to the acute challenges scheme which is reporting a YTD achievement of £1.4m. To date £0.7m of challenges have been agreed, a further £1.5m of most likely challenges are included in the reported acute position. A FY over achievement of £85k is reported, this relates to higher than planned savings on the mental health contracts scheme, in- reach nursing scheme and the musculoskeletal scheme where slippage on the planned investment is reported offset by under achievement of some planned care schemes that owing to procurement reasons could not be implemented this year.

7. STATEMENT OF CONTRACT POSITION – At Month 10 not Month 11 7 The three highest value contracts will be discussed in further detail on slides 8 - 10. Moorfield’s - YTD over performance of £0.2m is driven by high cost drugs and day case activity. The over performance in day case activity is particularly being seen in the cataracts speciality. Croydon – YTD over performance of £0.2m is owing to maternity and critical care. Royal Marsden – The YTD under spend of £0.3m is primarily in electives, emergency and critical care. Queen Mary’s – YTD over spend of £0.3m is owing to high activity levels in the older peoples services and electives. Chelsea & Westminster – The YTD over spend of £0.3m is in obstetrics and outpatient follow ups. Births are above plan. University College London – YTD under spend of £0.1m is in electives and critical care.

8. ST GEORGE’S NHS TRUST - Month 10 extrapolated to Month 11 8 Commentary The YTD and FY over spend of £0.7m is mostly reported on maternity (£406k), emergency (£310k) and non elective (£241k) seen in general medicine. The biggest movement is being seen in the general medicine category for emergency activity. It is the lengths of stay for two days and over where an increase in activity is being seen, this is being investigated with the trust. Negotiations are also on going with regards to reaching a year end settlement with the trust.

9. EPSOM AND ST HELIER’S NHS TRUST - Month 10 extrapolated to Month 11 - 9 Commentary The YTD position is reporting break-even and the FY position is a minor over spend of £22k. The position has worsened considerably from last month owing to an increase in emergency activity and outpatient procedures. The over performance of £0.4m in outpatient procedures mainly relates to eyes and periorbita procedures and disorders category, a shift from day cases to outpatient procedures is being seen in this category. The recording of non elective activity at the trust is also being investigated.

10. KINGSTON NHS TRUST - Month 10 extrapolated to Month 11 10 Commentary The YTD over performance of £0.1m is mostly owing to an increase in activity in outpatients (£127k), maternity (£92k) and critical care (£219k). The over spend in critical care is owing to one long stay critical care patient (95 bed days) who was discharged in Month 7’s freeze position. Some of the over performance is offset by under performance in emergency (£424k). Direct access over performance (£84k) is a result of activity shifts from St Helier’s to Kingston NHSFT. The FY forecast is over performance of £0.1m.

11. NON ACUTE PERFORMANCE 11 Commentary The £0.2m YTD and FY over spend reported on mental health placements is owing to an increase in the number of placements. The YTD and FY £0.1m under spend on mental health ‘other’ relates to lower than anticipated costs on Mental Health enquiries and dementia services. The YTD and FY over spend of £0.4m is primarily owing to a learning disability patient currently an inpatient in a hospital. The YTD and FY under spend on community services is owing to slippage on investment schemes, namely, dementia nurses, rapid response team and step up and step down beds. The slippage has increased from previous months as further slippage is reported on dementia nurses and interface geriatricians. Community (cont’d) A YTD and FY under performance of £0.2m on continuing care is reported. NHS Merton CCG has been over charged for block bed recharges, the over charge is currently being calculated, NHS Sutton CCG will be invoiced for the over charge before year end. The YTD and FY over spend on ‘other’ mostly relates to an over spend on children’s placements offset by slippage on better care fund investments and musculoskeletal services.

12. PRESCRIBING AND PRIMARY CARE BUDGETS 12 Commentary The £0.2m YTD and FY over spend of £0.2m on prescribing is owing to an increase in items prescribed in particular for cardiovascular, central nervous system, respiratory and endocrine system. The YTD and FY over spend of £0.2m on local enhanced services relates to an over spend of £0.3m on the Care of Older People LIS offset by a slight under spend on the Diabetes LES. The FY over spend of £0.1m reported on Out of Hours is owing to recharges from Sutton CCG for Merton patients attending the Seldoc Out of Hours service. The YTD and FY over spend on ‘other’ primary care relates to statutory medical fees, the over spend arose owing to a number of claims related to the last quarter of 13/14 received in 14/15.

13. STATEMENT OF FINANCIAL POSITION (SOFP) 13 Commentary The £315k for property, plant and equipment is made up of assets under construction which mainly relate to IT equipment for the Nelson Health Centre. Accounts receivables balance has increased by £0.2m from previous month. The movement is due to an increase in aged receivables of £0.1m and an increase in the continuing care risk pool of £0.1m. The cash position is as per the cash flow statement on slide 14. Current liabilities have decreased by £0.2m from last month. The decrease is due to a decrease in payables of £0.6m and an increase in accruals of £0.4m. The £15m total comprises of £11m of payables and £4.3m of accruals. The £48k current provision and £271k non current provision is the £319k continuing care provision created in 2013/14.

14. CASH MANAGEMENT AND BETTER PAYMENT PRACTICE POLICY 14 Commentary The cash target has been amended from 5% to 1.25% of the monthly cash draw down. The month end cash balance as at 31 st January is – 3.51% of the cash drawn. The BPPC is above target in terms of volume and value of invoices.

15. RISKS AND MITIGATIONS 15 Worst case acute risk relates to the risk of potential over performance in acute over and above the position reported and the reserves available. The continuing care risk relates to higher than anticipated growth in placements. Non recurrent measures to mitigate risks are year end settlements, continuing care block bed over charges and receipt of funding from other CCGs for GP Led Health Centre recharges.

16. 16 APPENDICES Appendix number DescriptionSlide number 1Acute Commissioning17 2Mental Health18 3Other Non Acute19 4Primary Care & Prescribing20 5Corporate and Estates21 6Reserves22 7QIPP dashboard23 8Investments dashboard24

17. ACUTE COMMISSIONING – Appendix 1 17

18. Mental Health & PLD – Appendix 2 18

19. Other Non Acute – Appendix 3 19

20. Primary Care & Prescribing – Appendix 4 20

21. Corporate and Estates – Appendix 5 21

22. Reserves – Appendix 6 22

23. QIPP DASHBOARD – Appendix 7 23

24. INVESTMENT DASHBOARD – Appendix 8 24