Update on 2011/12

Financial Position at M4

Delivery Group

5 September 2011

2

3

2011/12 M04 Financial Position - Overview of year to date (YTD) and Forecast Outturn (FCOT)

Key:

10-11 Final Outturn Plan Actual

Variance from Plan

Variance from Plan at Month 3 Plan Actual

Variance from Plan

Variance from Plan at Month 3

£m £m £m £m £m £m £m £m £m

Trusts (19.1) (75.7) (93.3) (17.7) (11.1) (115.5) (111.5) 4.0 8.7

PCTs 134.6 39.9 24.7 (15.2) (4.4) 122.3 116.1 (6.2) 0.1- - -Sub Total PCTs/Trusts 115.5 (35.7) (68.6) (32.9) (15.5) 6.7 4.5 (2.2) 8.8

MPET (inc. MPET Admin) 40.8 3.5 3.5 - - 10.0 10.0 0.0 -

SHA Admin (inc. LPfIT) 3.8 - 1.2 1.2 2.1 - - - -

Hosted Services 11.0 - 4.1 4.1 3.0 - - - 1.2

Carry Forward & Reserves 106.3 24.1 24.1 - - 95.6 95.6 (0.0) (1.2)

MTFS 95.3 31.4 31.4 - - 94.3 94.3 - -

SHA (inc MTFS) 257.2 59.0 64.3 5.3 5.2 199.9 199.9 (0.0) (0.0)

Total NHSL 372.7 23.3 (4.3) (27.6) (10.4) 206.7 204.4 (2.2) 8.8

Year to Date at M4 Forecast Outturn at M4

Positive figure denotes a surplus/favourable movementNegative figure (X) denotes a deficit/adverse movement

4

2011/12 M04 Financial Position - I&E Variances Excl. Impairments (NHS Trusts)

Month 04

Plan YTDMonth 04

YTD Actual VarianceVariance at Month 03 Trust Summary

Full Year Plan

FOT as at Month 04

Revised Variance

Variance at Month 03

Over/ (Under) Plan YTD

Over/(Under) Plan FOT

£'000s £000s £'000s £'000s £'000s £000s £'000s £'000s £'000s £'000s

924 1,130 206 253 Central London Community Health 2,777 2,776 (1) (2) 1,172 444533 334 (199) (189) Ealing 2,217 2,217 - 1 (385) ()

(20,495) (20,550) (55) 845 Imperial College Healthcare (30,000) (35,000) (5,000) - (3,074) (20,191)(9,143) (9,918) (775) (725) North West London Hospitals (9,700) (9,700) - - 30 -

606 613 7 3 West Middlesex 1,604 1,611 6 () 4 1202 462 260 255 West London 2,533 2,533 (0) () - -

(27,373) (27,929) (556) 442 Sub Total (30,569) (35,564) (4,995) (2) (2,253) (19,747)

(2,299) (1,025) 1,274 1,408 Barnet & Chase Farm 3,000 3,000 (0) - (483) (5,304)

(1,463) (1,585) (122) (792) Barnet Enfield & Haringey 1,884 1,884 (0) 1 (246) (1,079)889 1 (888) (810) North Middlesex 500 500 - - (248) -19 42 23 32 Royal Free 6,673 6,676 3 3 609 247

713 88 (625) (497) Whittington 885 885 (0) (0) (873)

(2,141) (2,479) (338) (659) Sub Total 12,942 12,945 2 4 (1,240) (6,136)

(14,166) (21,348) (7,182) (4,885) Barking Havering & Redbridge (39,800) (39,800) (0) 2 (2,582) (9,666)(1,051) (3,421) (2,370) (1,699) Whipps Cross - - - - (1,600)

(15,217) (24,769) (9,552) (6,584) Sub Total (39,800) (39,800) () 2 (4,183) (9,666)

CIPs Variance

NCL

YTD Versus Plan - Excl. Impairments & IFRS

FOT Versus Plan - Excl. Impairments & IFRS

NWL

ONEL

5

2011/12 M04 Financial Position - I&E Variances Excl. Impairments (NHS Trusts)

Month 04

Plan YTDMonth 04

YTD Actual VarianceVariance at Month 03 Trust Summary

Full Year Plan

FOT as at Month 04

Revised Variance

Variance at Month 03

Over/ (Under) Plan YTD

Over/(Under) Plan FOT

£'000s £000s £'000s £'000s £'000s £000s £'000s £'000s £'000s £'000s

(9,611) (9,254) 357 753 Epsom & St Helier (19,324) (19,324) - 24 (848)(910) (1,146) (236) (237) Kingston Hospitals 2,531 2,531 (0) (0) (393) (711)933 (937) (1,870) (1,502) Croydon Health Services 4,436 4,436 (0) 2 (1,153) (1,738)

(3,148) (4,005) (857) 985 St George's 7,919 7,919 - - (190) -253 579 326 122 SW London & St George's 2,224 2,224 0 (17) () ()936 897 (39) (91) Hounslow and Richmond 1,639 1,639 0 0 - -

(11,546) (13,866) (2,320) 31 Sub Total (575) (575) () 9 (2,584) (2,449)

5,865 2,638 (3,227) (3,022) Barts and the London 2,600 2,600 - - (3,650) (4,333)(335) (1,064) (729) (563) Newham 2,280 2,275 (5) (5) (1,039) (1,840)5,530 1,574 (3,956) (3,585) Sub Total 4,880 4,875 (5) (5) (4,689) (6,173)

(1,732) (2,270) (538) (558) Lewisham 1,090 1,090 - - 424 424(25,993) (28,654) (2,661) (1,744) South London Healthcare NHS Trust (74,176) (65,183) 8,993 9,000 (1,300) 4,040(27,725) (30,924) (3,199) (2,302) Sub Total (73,086) (64,093) 8,993 9,000 (876) 4,464

1,904 530 (1,374) (1,475) London Ambulance Service 2,738 2,737 (1) (326) (499) 793(213) 505 718 653 Royal National Orthopaedic 1,070 1,070 0 0 141 3591,120 4,033 2,913 2,345 Great Ormond Street 6,880 6,880 (0) (0) (138) -2,812 5,068 2,256 1,523 Sub Total 10,688 10,687 (1) (326) (496) 1,152

(75,660) (93,325) (17,665) (11,134) Trusts Total (115,518) (111,525) 3,993 8,680 (16,321) (38,555)

CIPs Variance

SWL

YTD Versus Plan - Excl. Impairments & IFRS

FOT Versus Plan - Excl. Impairments & IFRS

Specialist/Pan London

SEL

INEL

6

Trust Deficits

CIPs YTD Variance

CIPs FOT Variance

Trust Name Month 2

YTD Month 3

YTD Month 4

YTD

Month 4 YTD Plan

M4 YTD Deficit/

YTD Income (Plan)(%

)

Month 04 Actual

Month 04 Plan

Explanation

£000 £000 £000 £000 £000 £000 £000 £000 £000

(1,300) 4,040 South London Healthcare (14,116) (21,656) (28,654) (25,993) (21.2%) (6,998) (6,081)

SLHT is behind plan at month 4 by £2,661k. This is due to temporary staff costs, high drug and theatre costs. The Trust has only included an overperformance value for month 1 of £1.3m but no overperformance values for months 2-4, indications are this could be £5m, however this is not agreed with the PCTs. The Trust is indicating a FOT higher than planned by £9m made up of £4m additional CIP and £5m additional income as late planning adjustments that will be revised in the refresh of plans. The Trust executive team has identified actions to be taken to reduce expenditure levels and ensure that the trust is on plan.

(2,582) (9,666) BHRT (11,873) (15,722) (21,348) (14,166) (16.2%) (5,626) (3,329)

The trust's £2m increase in its YTD deficit includes the continuance of its CQC-related agency cost pressures in midwifery and paediatrics of £492k. This is in addition to a further £680k of clinical and corporate overspeads despite its income overperformance. CIP slippage is a further £970k.

The trust has revised its planned income profile lowering the £3.4m overperformance by £2.3m. CIP out-turn has been increased to £18.7m following an external reevaluation of the trust's overall programme.

The trust continues to forecast to meet its control total and is based on significant reductions in the ongoing cost pressures and includes the benefit of a forecast income overperformance of £10.7m. This is a reduced level following discussions with the Cluster.

(848) 0 Epsom & St Helier (6,457) (7,702) (9,254) (9,611) (8.8%) (1,552) (1,156)

Directorate overspends, CIP non delivery and the shortage of cash are the principal risks. Bi-weekly performance meetings have been established with overspending directorates to manage performance and finance. CIPs are being tracked through the PMO, it should be noted that the bulk of CIPS are planned to start from October so it is imperative that the milestones are met to ensure they are delivered. Cash - a detailed 13 week rolling cash flow has been prepared and cash support has been agreed with the Sector and NHS London.

7

Trust Deficits

CIPs YTD Variance

CIPs FOT Variance

Trust Name Month 2

YTD Month 3

YTD Month 4

YTD

Month 4 YTD Plan

M4 YTD Deficit/

YTD Income (Plan)(%

)

Month 04 Actual

Month 04 Plan

Explanation

£000 £000 £000 £000 £000 £000 £000 £000 £000

30 - North West London Hospitals (6,413) (7,997) (9,918) (9,143) (8.4%) (1,921) (1,871)

Adverse YTD variance due to under recovery of income at Central Middlesex Hospital and Private Patient income. CIPS are currently on track and FCOT CIPS remains unchanged. The trust anticipates that any slippage in CIP performance will be recoverable over the year. The trust FOT assumes receipt of £9m of non-recurrent transitional funding from the NW Cluster - discussions to agree terms are ongoing.

(3,074) (20,191) Imperial College Healthcare (11,896) (16,791) (20,550) (20,495) (6.8%) (3,759) (2,859)

The Trust is reporting a deficit of £20.5m at M4. The CIPs year to date are under delivered by £3m. There is a risk of further CIP slippage impacting on the FOT, to mitigate this the Trust has established a PMO to identify and realise savings opportunities. Activity per M3 SLAM shows a small increase above plan of £250k YTD. Most of the excess activity being in Day cases compensated by reduced activity in Critical Care. The Trust is experiencing additional pressures from the level of NEL marginal cost activity and is forecasting a loss of income for the year of up to £5m at M4.

(1,600) 0 Whipps Cross (2,279) (3,091) (3,421) (1,051) (4.2%) (330) 341

The trust position continues to show a small level of activity overperformance countered by its CIP slippage. The trust revised CIP profile reflects a YTD position £1.2m better.

The trust's CIP plan continues to include a significant level of risk associated with Cluster-dependent schemes, although at present is still forecasting to achieve the overall CIP target, despite as yet unidentified CIP of £4m. A QIPP director has been appointed to reduce the delivery risk as far as possible. The FOT includes a forecast £9m overperformance.

424 424 Lewisham (1,962) (2,477) (2,270) (1,732) (3.1%) 207 187

The Trust is £538K behind plan at the end of M4. This is primarily driven by overspends in the clinical divisions on consumables such as drugs. There is approximately £227k of slippage against the balance unidentified savings in the "final" plan (pre release of internal reserves). The plan includes an income assumption of £6.8m over performance against plan. This is broadly being met. The Trust will have to turn its over performance into income, as yet this has not been agreed. The Trust will have to recover its CIP position although it retains some central contingencies / reserves to help mitigate the position.

8

Trust DeficitsCIPs YTD Variance

CIPs FOT Variance

Trust Name Month 2

YTD Month 3

YTD Month 4

YTD

Month 4 YTD Plan

M4 YTD Deficit/

YTD Income (Plan)(%

)

Month 04 Actual

Month 04 Plan

Explanation

£000 £000 £000 £000 £000 £000 £000 £000 £000

(246) (1,079) Barnet Enfield & Haringey (1,436) (2,005) (1,585) (1,463) (2.5%) 420 (251)

The trust has improved its financial position having extensively reviewed its CIP programmes for realisable savings and revised phasing of programmes in earlier months. It has also recognised £264k of additional income relating to the its Community Services and land sales not reflected in its plan. This has mitigated the CIPs shortfall, now £250k behind plan, while activity is underperforming by £160k.

The trust expects its £1.45m of additional income to cover its proposed redundancy programme of £300k and possible CIPs shortfall of £1.1m. Additional schemes may be required to cover any contract performance shortfall.

(190) - St George's (2,571) (2,835) (4,005) (3,148) (2.0%) (1,170) 672

The Trust is £0.86m behind the FIMS YTD plan. This is a significant deterioration since last month. The Key drivers are: 1) A significant reduction of SLA income resulting from anticipated losses due to penalties arising as part of QIPP readmissions levels, consultant follow up and other ACU data challenges amounting to £3m YTD. 2) Ongoing difficulties arising from shortage of junior doctors in key trust services resulting in premiums paid for temporary staffing. 3) Premium costs of additional capacity to meet elective waiting lists targets both internally provided and externally provided capacity. The Trust is in dialogue with commissioners regarding the additional work to be undertaken to achieve 18 week targets and also the penalties to be levied relating to achivement of KPIs with QIPP plans and other data challenges. Other measures include seeking alternative staffing models to cover shortages in junior doctor numbers and reduce reliance on temporary staffing. The Trust continues to seek further mitigating savings plans to cover the risks in the Challenge programme and address the deficit to plan over the remainder of the year.

(1,039) (1,840) Newham (757) (1,065) (1,064) (335) (1.9%) 1 167

Increases in activity income of £1.5m ytd are offsetting the CIP slippage of £1m specifically on staff supporting staff productivity schemes and expenditure on one off items of £682k ytd. The FOT is on plan. The executive team will be holding a performance review day to confirm CIPs, additional identified income and new savings required.

(393) (711) Kingston Hospitals (1,491) (1,328) (1,146) (910) (1.8%) 182 181

There has been slippage in the first three months of the financial year, with July being on plan. This is primarily due to slippage on the CIP programme. Some income overperformance has been seen in the first 4 months with accompanying pay and non pay overspends. The Trust is taking action on the CIP slippage through its performance management process which includes monthly performance reviews with divisions and its Productivity Board.

9

Trust DeficitsCIPs YTD Variance

CIPs FOT Variance

Trust Name Month 2

YTD Month 3

YTD Month 4

YTD

Month 4 YTD Plan

M4 YTD Deficit/

YTD Income (Plan)(%

)

Month 04 Actual

Month 04 Plan

Explanation

£000 £000 £000 £000 £000 £000 £000 £000 £000

(1,153) (1,738) Croydon Health Services (849) (964) (937) 933 (1.2%) 27 396

£1,100k of the variance relates to the slippage on CIPS YTD. The directorates have been tasked with identifying new CIPS and putting in place recovery plans for the remainder of the financial year. The Trust is currently forecasting a £4.4m surplus, however this is based on delivery of a further £2.2m reduction in expenditure. It has been assumed that this will be delivered with further recovery and expenditure control measures. The actions taken to date are: Recovery Plans in place for each Directorate, Weekly Financial Performance meetings with Directorates tracking actions on Financial Recovery and CIPs, Directorates tasked with identifying additional CIPs, Monthly Business Planning, meetings with Executive Team, Non Pay authorisation limits reduced, All substantive, Bank and Agency requests approved via weekly panel, Chief Executive Letter to all Budget holders reiterating their accountability for Budgetary Control under SFIs, Suspension of Non Mandatory Training. The Trust is bringing forward CIP from 12/13 (the pathology and radiology schemes), and also speeding up implementation of CIPs. This is expected to have an impact from October onwards.

(483) (5,304) Barnet & Chase Farm (1,388) (961) (1,025) (2,299) (0.9%) (64) 70

Although the trust remains ahead of plan, the position has declined by £135k, mainly due to underperformance this month

The trust FOT is dependent on a forecast overperformance of £5.6m to cover its forecast CIP slippage of £5.3m. This includes NR costs related to the delivery of the clinical strategy aleviated somewhat by £0.5m of delayed service developments and £0.2m of other actions.

(248) - North Middlesex (349) 7 1 889 0.0 % (6) 72

The trust recouped much of its activity underperformance position in M4 - £520k over plan, primarily due to concerted action required to reduce its waiting list. Further, the effect of the UCC opening factored into the plan is yet to have its effect on the patient numbers in A&E. Sector overperformance has increased by £0.2m to £0.6m.

However the trust has incurred high variable costs in delivering the waiting list activity and has had significant short-term cost pressures (now some £450k). The clearance of the backlog will continue through to the beginning of September.

Mitigation plans are being developed to cover the £250k shortfall CIP by year-end. The revised control arrangements for saving plans are identifying the issues of slippage to ensure contingency plans are developed to recover the position.

609 247 Royal Free (2,219) (978) 42 19 0.0 % 1,020 1,030

The trust is broadly on plan. CIP programmes are ahead of plan, generally due to the savings made on agency costs outweighing the shortfalls in Corporate QIPP and drugs savings. The CIP over-performance compensates for the income underperformance of £725k.

(873) 0 Whittington (417) 102 88 713 0.1 % (14) 114

The trust is now £660k short of its income plan - overperformance on non-clinical mitigating clinical income performance (£817k behind plan).

CIP slippage of £873k is compensated by the continued underspends resulting from the trust's internal expenditure controls in place.

The trust is expecting to recoup its income shortfall and underachieved CIPs and continues to identify further schemes. Balance sheet provisions of £1m are factored into the FOT.

(12,965) (35,817) Total (66,473) (85,463) (105,046) (87,791) (4.8%) (19,583) (12,317)

Total (deficits only) (66,473) (85,572) (105,177) (90,346) (6.3%) (21,440) (15,546)

Total number of deficits 16 14 13 12 10 6

10

2011/12 M04 Financial PositionI&E Variances (PCTs)

Month 04

Plan YTDMonth 04

YTD VarianceVariance at Month 03

YTD Planned Support

YTD Actual Support PCT Summary

Full Year Plan

FOT as at Month 04 Variance

Variance at Month 03

FOT Planned Support

FOT Actual Support

Over/ (Under) Plan YTD

Over/(Under) Plan FOT

£'000s £'000s £'000s £'000s £'000s £'000s £'000s £'000s £'000s £'000s £'000s £'000s £'000s £'000sNWL

3,862 3,862 - - - - Brent 11,602 11,602 - - 203 195- - - - 6,000 6,000 Harrow - - - - 18,000 18,000 (142) (1,938)

1,808 1,807 (1) 81 (743) (743) Hammersmith and Fulham 5,421 5,421 - - (2,228) (2,228) 73 -1,521 1,521 - 37 (250) (250) Kensington and Chelsea 5,527 5,527 - - (750) (750) - -3,794 3,794 - 44 (691) (691) Westminster 12,577 12,577 - - (2,072) (2,072) 220 01,368 1,368 - 1 (1,408) (1,408) Hounslow 4,110 4,110 - - (4,225) (4,225) 579 -

- - - - (1,424) (1,424) Hillingdon - - - - (4,271) (4,271) (693) -2,026 - (2,026) 6 (1,485) (1,485) Ealing 6,105 6,105 (0) (0) (4,454) (4,454) (430) -

14,379 12,352 (2,027) 169 - - - 45,342 45,342 (0) - - (189) (1,743)

NCL

(5,731) (9,652) (3,921) (2,095) Barnet (17,186) (17,186) 0 0 (5,581) (717)7,367 6,360 (1,007) (126) Camden 22,804 22,804 - 0 (3,118) (125)(6,427) (7,070) (643) (455) Enfield (18,835) (18,835) 0 0 (4,902) 8046,217 3,731 (2,486) (2,002) Islington 18,652 18,652 0 0 (2,408) 511(6,799) (5,869) 930 1,045 Haringey (20,278) (20,278) 0 0 (2,942) (481)

(5,374) (12,500) (7,126) (3,634) - - Sub Total (14,843) (14,843) 0 0 - - (18,951) (9)

ONEL

733 (994) (1,727) (1,525) Barking and Dagenham 2,200 - (2,200) - (716) (3,176)- (2,319) (2,319) (426) Havering - - - - (22) (1,594)

682 685 3 (663) Redbridge 2,000 - (2,000) - (77) (415)- (1,432) (1,432) 441 Waltham Forest - - - - (431) (576)

1,415 (4,060) (5,475) (2,173) - - Sub Total 4,200 - (4,200) - - - (1,247) (5,761)

YTD Versus Plan FOT Versus Plan CIPs Variance

11

2011/12 M04 Financial PositionI&E Variances (PCTs)

Month 04

Plan YTDMonth 04

YTD VarianceVariance at Month 03

YTD Planned Support

YTD Actual Support PCT Summary

Full Year Plan

FOT as at Month 04 Variance

Variance at Month 03

FOT Planned Support

FOT Actual Support

Over/ (Under) Plan YTD

Over/(Under) Plan FOT

£'000s £'000s £'000s £'000s £'000s £'000s £'000s £'000s £'000s £'000s £'000s £'000s £'000s £'000sSWL

2,809 2,809 - - Croydon 8,301 8,301 - - (650) (2,238)1,354 1,354 (0) (53) Kingston 3,963 3,963 (0) (4) (329) (152)1,392 1,392 - - Richmond and Twickenham 4,199 4,199 - - (452) (1,167)699 699 - - Sutton and Merton 3,240 3,240 - - (748) (748)

4,213 4,213 - - Wandsworth 12,322 12,322 - - (228) (576)10,467 10,467 (0) (53) - - Sub Total 32,025 32,025 (0) (4) - - (2,406) (4,881)

INEL

2,072 2,103 31 768 City and Hackney 7,117 7,117 0 115 (0) -3,181 3,206 25 280 Newham 9,737 9,737 (0) 1 (0) (0)2,664 2,777 113 10 Tower Hamlets 8,000 8,000 - - - -7,917 8,086 169 1,058 - - Sub Total 24,854 24,854 0 116 - - (0) (0)

SEL

- - - 50 Bexley 2,245 239 (2,006) - 3,900 -1,298 1,298 - - Bromley 5,993 5,993 - - 99 (0)1,516 1,543 27 171 Greenwich 4,612 4,612 - - (64) -4,507 4,507 (0) (0) Lambeth 6,605 6,604 (0) 0 (566) (2,427)1,792 1,002 (790) - Lewisham 5,375 5,375 - - (472) (1,896)2,001 2,001 - - Southwark 5,857 5,857 - - (408) (2,172)11,114 10,351 (763) 221 - - Sub Total 30,687 28,680 (2,006) 0 - - 2,490 (6,495)

39,918 24,696 (15,222) (4,412) - - PCT Totals 122,265 116,059 (6,207) 112 - - (20,304) (18,889)

YTD Versus Plan FOT Versus Plan CIPs Variance

12

PCT Deficits

QIPP YTD Variance

QIPP FOT Variance

PCT Name Month 2

YTD Actual

Month 3 YTD

Actual

Month 4 YTD

Month 4 YTD Plan

M4 YTD Deficit/

Plan RRL (%)

Month 4 Actual

Month 4 Plan

Explanation FOT as at Month 04

Full Year Plan

£000 £000 £000 £000 £000 £000 £000 £000 £000 £000 £000

(5,581) (717) Barnet (2,416) (6,395) (9,652) (5,731) (5.0%) (3,257) (1,432)

The PCT is reporting an acute overspend of £5.1m (after allowing for an acute reserve) - this is principally in respect of B&CF (c.£2.7m), UCLH (c.£1m), Barts (c.£0.5m) and Imperial (c.£0.5m). This also reflects the adverse variance to QIPP plan of c.£1.4m. The overspends are offset by use of contingency (c.£0.6m) and an underspend against specialist commissioning (c.£0.7m).

The cluster is undertaking a deep dive review of acute performance to understand the root cause of over performance against budget. It has begun to develop a number of turnaround schemes against acute spend, together with recovery/extension schemes associated with mental health, continuing care and prescribing. Extension and early implementation of existing schemes is being pursued together with detailed budget reviews. All spend is currently being authorised by DOF/CE. GP/CCG involvement is increasing and supportive in these actions.

(17,186) (17,186)

(4,902) 804 Enfield (3,770) (5,277) (7,070) (6,427) (4.4%) (1,793) (1,605)

The PCT is reporting an acute overspend of £1.8m (after allowing for an acute reserve) - this is principally in respect of RFH (c.£1.0m) and UCLH (c.£1m). The PCT is also overspent against its continuing care budget (c.£0.5m) and mental health budget (c.£0.1m). This is also reflective of the adverse variance to QIPP plan of c.£3.2m. The overspends are offset by use of contingency (c.£0.5m) and an underspend against primary care prescribing (c.£0.5m).

The cluster is undertaking a deep dive review of acute performance to understand the root cause of over performance against budget. It has begun to develop a number of turnaround schemes against acute spend, together with recovery/extension schemes associated with mental health, continuing care and prescribing. Extension and early implementation of existing schemes is being pursued together with detailed budget reviews. All spend is currently being authorised by DOF/CE. GP/CCG involvement is increasing and supportive in these actions.

(18,835) (18,835)

(2,942) (481) Haringey (3,172) (4,070) (5,869) (6,799) (3.7%) (1,799) (1,685)

The PCT is reporting an acute spend in line with budget (after allowing for an acute reserve). WIthin this position there are overspends in respect of NMUH (c.£0.4m), UCLH (c.£1m) and Homerton (c.£0.2m), whilst RFH is underspent by c.£0.4m. The PCT has some insulation against acute over performance as its main providers are Whittington and NMUH, both of whom are on a cap and collar SLA. The overspends also reflect the adverse variance to QIPP plan of c.£3m. The other key overspend is against continuing care (c.£0.3m). The overspends are offset by use of contingency (c.£0.5m) and underspends against primary care prescribing (c.£0.2m) and mental health (c.£0.4m).

(20,278) (20,278)

13

PCT Deficits

QIPP YTD Variance

QIPP FOT Variance

PCT Name Month 2

YTD Actual

Month 3 YTD

Actual

Month 4 YTD

Month 4 YTD Plan

M4 YTD Deficit/

Plan RRL (%)

Month 4 Actual

Month 4 Plan

Explanation FOT as at Month 04

Full Year Plan

£000 £000 £000 £000 £000 £000 £000 £000 £000 £000 £000

(22) (1,594) Havering (402) (426) (2,319) - (1.7%) (1,893) -

The PCT is in line with plan against its QIPP targets but has overspent against its acute budget (c.£1.4m), ONEL CS (c.£0.5m) and other non-acute budgets (c.£0.7m).

In order to breakeven, despite the current position and ongoing acute overperformance risk, the PCT is assuming that it will receive some intra-sector support.

- -

(431) (576) Waltham Forest 790 441 (1,432) - (1.0%) (1,873) -

The PCT is reporting behind its QIPP plan by c.£0.5m, princiaplly in respect of decommissioning, other demand management and back-office savings. It is also reporting significant overspends of c.£1.9m against its acute budget. These slippages are partially offset by an underspend against primary care together with use of contingency.

In order to breakeven, despite the current position and ongoing acute overperformance risk, the PCT is assuming that it will receive some intra-sector support.

- -

(716) (3,176) Barking and Dagenham (309) (974) (994) 733 (0.9%) (20) 183

The PCT is reporting acute overperformance of £2.1m together with QIPP slippage of £0.7m. The acute overperformance is predominantly with BHRT and is reflected in the trust position. The QIPP is behind plan princiaplly against long-term conditions (£0.3m), medicines and prescribing (£0.2m) and back-office savings (£0.3m). One third of the contingency has been used to offset the overspends.

The PCT is expecting continued acute overperformance/QIPP slippage for the year andhas reduced its FCOT as a result. The FCOT also assumes that it will provide some intra-sector support in order for the cluster to breakeven. Meanwhile, the PCT and cluster is seeking to identify new schemes and bring forward future schemes in order to further mitigate the position.

- 2,200

(77) (415) Redbridge 664 (147) 685 682 0.5 % 832 166

The PCT is currently performing in line with plan; it has offset acute overperformance of c.£2.9m with underspends in non-acute budgets, together with use of contingency and reserves. QIPP is in line with plan although expected to slip by c.£0.4m at year end.

The PCT has a number of risks against its FCOT, most notably the expected continuation of acute overperformance in the cluster. It is currently expecting to have to provide intra-sector support and hence the planned surplus has been eroded. Meanwhile, the PCT and cluster is seeking to identify new schemes and bring forward future schemes in order to further mitigate the position.

- 2,000

(14,672) (6,156) Total (8,615) (16,848) (26,651) (18,276) (1.1%) (9,803) (4,373) (56,299) (52,099)

Total (deficits only) (10,069) (17,289) (27,336) (18,958) (1.3%) (10,635) (4,722) (56,299) (56,299)

Total number of deficits 5 6 6 3 6 3 3 3

14

15

Trust CIPs

Plan YTDActual

Savings Variance % AchievedPlanned Savings

Forecast Savings Variance % Achieved

Unidentified Savings

Unidentified savings as % of FOT

% Delivered YTD of FOT

FOT as % of Turnover

£'000s £'000s £'000s £'000s £'000s £'000s £'000s

Acute 5,858 3,276 (2,582) 55.9% Barking Havering & Redbridge 28,375 18,710 (9,666) 65.9% - 0.0% 17.5% 4.7%3,152 2,669 (483) 84.7% Barnet & Chase Farm 16,977 11,673 (5,304) 68.8% 2,303 19.7% 22.9% 3.4%9,413 5,763 (3,650) 61.2% Barts and the London 41,224 36,891 (4,333) 89.5% - 0.0% 15.6% 5.3%2,412 3,584 1,172 148.6% Central London Community Health 10,452 10,895 444 104.2% 82 0.8% 32.9% 5.9%4,030 2,877 (1,153) 71.4% Croydon Health Services 13,429 11,691 (1,738) 87.1% - 0.0% 24.6% 5.1%2,579 2,194 (385) 85.1% Ealing 12,684 12,684 () 100.0% - 0.0% 17.3% 5.7%

2,616 1,768 (848) 67.6% Epsom & St Helier 18,700 18,700 100.0% - 0.0% 9.5% 5.9%2,964 2,826 (138) 95.3% Great Ormond Street 9,887 9,887 - 100.0% - 0.0% 28.6% 2.9%

858 858 - 100.0% Hounslow and Richmond 3,910 3,910 - 100.0% - 0.0% 21.9% 7.3%13,083 10,009 (3,074) 76.5% Imperial College Healthcare 65,191 45,000 (20,191) 69.0% - 0.0% 22.2% 5.0%

2,897 2,504 (393) 86.4% Kingston Hospitals 11,495 10,784 (711) 93.8% - 0.0% 23.2% 5.5%2,653 3,077 424 116.0% Lewisham 12,339 12,763 424 103.4% 841 6.6% 24.1% 5.7%1,542 503 (1,039) 32.6% Newham 7,178 5,338 (1,840) 74.4% - 0.0% 9.4% 3.2%2,560 2,312 (248) 90.3% North Middlesex 8,410 8,410 - 100.0% - 0.0% 27.5% 4.8%3,550 3,580 30 100.8% North West London Hospitals 19,550 19,550 - 100.0% 1,774 9.1% 18.3% 5.3%7,863 8,472 609 107.7% Royal Free 32,498 32,745 247 100.8% - 0.0% 25.9% 6.0%

614 755 141 123.0% Royal National Orthopaedic 4,020 4,379 359 108.9% - 0.0% 17.2% 4.2%6,997 5,697 (1,300) 81.4% South London Healthcare 26,593 30,633 4,040 115.2% 154 0.5% 18.6% 7.5%6,141 5,951 (190) 96.9% St George's 27,270 27,270 - 100.0% 1,966 7.2% 21.8% 4.5%2,847 2,851 4 100.1% West Middlesex 12,200 12,201 1 100.0% - 0.0% 23.4% 8.5%4,865 3,265 (1,600) 67.1% Whipps Cross 26,296 26,297 100.0% 4,057 15.4% 12.4% 11.2%5,464 4,591 (873) 84.0% Whittington 19,600 19,600 100.0% 1,794 9.2% 23.4% 7.4%

Mental health2,895 2,649 (246) 91.5% Barnet Enfield & Haringey 13,953 12,874 (1,079) 92.3% - 0.0% 20.6% 6.7%2,857 2,857 () 100.0% SW London & St George's 10,018 10,018 () 100.0% - 0.0% 28.5% 5.9%3,520 3,520 - 100.0% West London 11,172 11,172 - 100.0% - 0.0% 31.5% 4.5%

Ambulance Services4,633 4,134 (499) 89.2% London Ambulance Service 14,847 15,640 793 105.3% - 0.0% 26.4% 5.5%

108,863 92,542 (16,321) 85.0% Trusts Total 478,268 439,713 (38,555) 91.9% 12,971 2.9% 21.0% 5.5%

YTD Versus Plan FOT Versus Plan

16

PCT QIPP – Year to Date

PCT2011/12 CIPS

Plan2011/12

CIPS Actual Variance DM Plan DM Actual VarianceDecomm.

PlanDecomm.

Actual VarianceYTD Total

PlanYTD Total

Actual Variance

£'000s £'000s £'000s £'000s £'000s £'000s £'000s £'000s £'000s £'000s £'000s £'000s

NWLBrent 0 0 - 2,868 3,056 188 1,628 1,644 16 4,496 4,699 203Ealing 3,875 2,893 (982) 3,054 3,718 664 250 138 (112) 7,179 6,749 (430)Hammersmith and Fulham 4,228 4,607 379 628 322 (306) - - - 4,856 4,929 73Harrow 0 0 - 3,041 2,824 (217) 439 515 76 3,480 3,338 (142)Hillingdon 1,455 669 (786) 359 395 36 388 445 57 2,202 1,509 (693)Hounslow 80 0 (80) 1,446 2,105 659 - - - 1,526 2,105 579Kensington and Chelsea 1,843 647 (1,196) 839 2,030 1,191 2,047 2,052 5 4,729 4,729 -Westminster 513 526 13 4,715 4,904 189 1,230 1,248 18 6,458 6,678 220

Sub Total 11,994 9,342 (2,652) 16,950 19,354 2,404 5,982 6,041 59 34,926 34,737 (189)

NCLBarnet 3,155 2,449 (706) 767 829 62 5,253 315 (4,938) 9,175 3,594 (5,581)Camden 1,629 3,173 1,544 882 558 (324) 4,387 49 (4,338) 6,898 3,780 (3,118)Enfield 2,384 1,356 (1,028) 505 309 (196) 3,764 86 (3,678) 6,653 1,751 (4,902)Islington 3,086 3,048 (38) 272 1,826 1,554 4,045 121 (3,924) 7,403 4,995 (2,408)Haringey 3,280 2,093 (1,187) 584 1,665 1,081 3,103 267 (2,836) 6,967 4,025 (2,942)

Sub Total 13,534 12,119 (1,415) 3,010 5,188 2,178 20,552 838 (19,714) 37,096 18,145 (18,951)

ONELBarking and Dagenham 1,593 1,335 (258) 1,028 599 (429) 94 65 (29) 2,714 1,998 (716)Havering 354 422 67 1,016 1,043 28 308 191 (117) 1,678 1,655 (22)Redbridge 278 473 195 1,078 1,058 (19) 360 107 (253) 1,715 1,638 (77)Waltham Forest 744 769 25 1,170 898 (271) 494 310 (185) 2,408 1,977 (431)

Sub Total 2,969 2,998 29 4,291 3,599 (692) 1,256 672 (584) 8,516 7,269 (1,247)

2011/12 Year To Date

17

PCT QIPP – Year to Date

PCT

2011/12 CIPS Plan

2011/12 CIPS Actual Variance DM Plan DM Actual Variance

Decomm. Plan

Decomm. Actual Variance

YTD Total Plan

YTD Total Actual Variance

£'000s £'000s £'000s £'000s £'000s £'000s £'000s £'000s £'000s £'000s £'000s £'000s

SWLCroydon 0 0 - 1,669 1,213 (456) 2,199 2,005 (194) 3,868 3,218 (650)Kingston 125 106 (19) 550 246 (304) 1,455 1,449 (6) 2,130 1,801 (329)Richmond and Twickenham 167 12 (155) 617 489 (128) 870 701 (169) 1,654 1,202 (452)Sutton and Merton 8 0 (8) 2,200 2,113 (87) 1,891 1,238 (653) 4,099 3,351 (748)Wandsworth 1,521 1,014 (507) 233 512 279 976 976 - 2,730 2,502 (228)

Sub Total 1,821 1,132 (689) 5,269 4,573 (696) 7,391 6,369 (1,022) 14,480 12,074 (2,406)

INELCity and Hackney 2,577 2,577 - 1,855 1,855 () 2,327 2,327 - 6,759 6,759 ()Newham 3,191 3,191 1,405 1,405 () 457 457 - 5,053 5,053 ()Tower Hamlets 1,894 1,894 - 755 755 1,971 1,971 () 4,620 4,620 -

Sub Total 7,662 7,662 4,015 4,015 () 4,755 4,755 () 16,432 16,432 ()

SELBexley 408 0 (408) 916 889 (27) 492 548 56 1,816 1,437 (379)Bromley 395 662 267 1,780 1,612 (168) 654 654 - 2,829 2,928 99Greenwich 732 957 225 1,077 788 (289) 1,841 1,841 - 3,650 3,586 (64)Lambeth 0 0 - 1,144 1,039 (105) 2,819 2,359 (461) 3,964 3,398 (566)Lewisham 928 684 (244) 911 900 (11) 1,646 1,428 (218) 3,485 3,013 (472)Southwark 2,917 2,728 (189) 703 529 (174) 95 51 (44) 3,715 3,307 (408)

Sub Total 5,380 5,032 (348) 6,531 5,757 (774) 7,547 6,881 (667) 19,458 17,669 (1,789)

PCT Totals 43,359 38,284 (5,075) 40,066 42,486 2,419 47,483 25,556 (21,927) 130,908 106,325 (24,583)

2011/12 Year To Date

18

PCT QIPP – Forecast

PCT

2011/12 CIPS Plan

2011/12 CIPS

Actual Variance DM Plan DM FOT VarianceDecomm.

PlanDecomm.

FOT Variance Total Plan Total FOT Variance

% Delivered

YTD of FOT

FOT % of Annual

PlanFOT as %

of RRL

£'000s £'000s £'000s £'000s £'000s £'000s £'000s £'000s £'000s £'000s £'000s £'000s

NWLBrent - - - 9,008 9,150 142 4,878 4,931 53 13,886 14,081 195 33.4% 101.4% 2.7%Ealing 13,899 15,166 1,267 17,036 16,334 (702) 2,565 2,000 (565) 33,500 33,500 - 20.1% 100.0% 5.8%Hammersmith and Fulham 12,690 13,816 1,126 1,877 751 (1,126) - - - 14,567 14,567 - 33.8% 100.0% 4.2%Harrow - - - 11,882 10,042 (1,840) 2,123 2,026 (98) 14,005 12,067 (1,938) 27.7% 86.2% 3.6%Hillingdon 6,987 6,806 (181) 3,465 3,546 81 2,863 2,963 100 13,315 13,315 - 11.3% 100.0% 3.3%Hounslow 368 - (368) 18,195 18,563 368 - - - 18,563 18,563 - 11.3% 100.0% 4.8%Kensington and Chelsea 5,657 1,941 (3,716) 2,879 6,513 3,634 6,187 6,269 82 14,723 14,723 - 32.1% 100.0% 4.1%Westminster 1,559 1,559 14,530 14,530 3,698 3,698 () 19,787 19,787 33.8% 100.0% 4.2%

Sub Total 41,160 39,288 (1,872) 78,872 79,429 557 22,314 21,886 (428) 142,346 140,603 (1,743) 24.7% 98.8% 4.1%

NCLBarnet 17,850 31,527 13,677 2,325 2,861 536 16,008 1,078 (14,930) 36,183 35,466 (717) 10.1% 98.0% 6.4%Camden 4,923 15,383 10,460 2,694 5,231 2,537 13,343 221 (13,122) 20,960 20,835 (125) 18.1% 99.4% 4.3%Enfield 15,519 25,966 10,447 1,532 3,016 1,484 11,485 358 (11,127) 28,536 29,340 804 6.0% 102.8% 6.3%Islington 9,276 16,191 6,915 822 6,224 5,402 12,244 439 (11,805) 22,342 22,853 511 21.9% 102.3% 5.3%Haringey 18,197 23,621 5,424 1,760 4,374 2,614 9,423 904 (8,519) 29,380 28,899 (481) 13.9% 98.4% 6.4%

Sub Total 65,765 112,686 46,921 9,133 21,705 12,572 62,503 3,000 (59,503) 137,401 137,392 (9) 13.2% 100.0% 5.7%

ONELBarking and Dagenham 7,381 6,604 (777) 4,763 2,432 (2,332) 435 368 (67) 12,580 9,403 (3,176) 21.3% 74.7% 2.9%Havering 1,589 2,067 478 4,530 2,955 (1,575) 1,380 883 (497) 7,498 5,904 (1,594) 28.0% 78.7% 1.5%Redbridge 1,265 2,537 1,272 4,913 4,195 (718) 1,642 672 (970) 7,820 7,405 (415) 22.1% 94.7% 1.9%Waltham Forest 3,013 3,549 536 4,736 3,568 (1,168) 2,002 2,057 56 9,751 9,174 (576) 21.5% 94.1% 2.2%

Sub Total 13,248 14,757 1,508 18,942 13,150 (5,792) 5,458 3,980 (1,478) 37,648 31,887 (5,761) 22.8% 84.7% 2.1%

2011/12 Forecast Year End

19

PCT QIPP – Forecast

PCT

2011/12 CIPS Plan

2011/12 CIPS

Actual Variance DM Plan DM FOT VarianceDecomm.

PlanDecomm.

FOT Variance Total Plan Total FOT Variance

% Delivered

YTD of FOT

FOT % of Annual

PlanFOT as %

of RRL

£'000s £'000s £'000s £'000s £'000s £'000s £'000s £'000s £'000s £'000s £'000s £'000s

SWLCroydon - - - 5,955 4,300 (1,655) 6,596 6,013 (583) 12,551 10,313 (2,238) 31.2% 82.2% 1.9%Kingston 375 345 (30) 2,008 1,925 (83) 4,426 4,387 (39) 6,809 6,657 (152) 27.0% 97.8% 2.5%Richmond and Twickenham 500 250 (250) 1,853 1,505 (348) 2,815 2,246 (569) 5,168 4,001 (1,167) 30.0% 77.4% 1.4%Sutton and Merton 32 24 (8) 6,598 6,511 (87) 7,084 6,431 (653) 13,714 12,966 (748) 25.8% 94.5% 2.3%Wandsworth 4,873 4,118 (755) 1,237 1,416 179 976 976 - 7,086 6,510 (576) 38.4% 91.9% 1.2%

Sub Total 5,780 4,737 (1,043) 17,651 15,656 (1,995) 21,897 20,053 (1,844) 45,327 40,446 (4,881) 29.9% 89.2% 1.8%

INELCity and Hackney 7,731 7,731 - 5,566 5,566 - 6,981 6,981 - 20,278 20,278 - 33.3% 100.0% 4.0%Newham 9,572 9,572 4,216 4,216 () 1,371 1,371 - 15,159 15,159 () 33.3% 100.0% 2.8%Tower Hamlets 5,680 5,680 - 2,444 2,444 - 5,920 5,920 - 14,044 14,044 - 32.9% 100.0% 2.9%

Sub Total 22,983 22,983 12,226 12,226 () 14,272 14,272 - 49,481 49,481 () 33.2% 100.0% 3.2%

SELBexley 5,801 5,893 92 2,808 2,666 (142) 1,594 1,644 50 10,203 10,203 - 14.1% 100.0% 3.0%Bromley 1,184 1,687 503 5,850 5,347 (503) 1,960 1,960 - 8,995 8,994 () 32.6% 100.0% 1.8%Greenwich 2,878 3,686 808 6,343 5,352 (991) 5,619 5,802 183 14,840 14,840 - 24.2% 100.0% 3.3%Lambeth - - - 3,433 3,118 (315) 10,193 8,081 (2,112) 13,626 11,199 (2,427) 30.3% 82.2% 1.8%Lewisham 2,968 2,167 (801) 2,980 2,884 (96) 6,381 5,383 (999) 12,329 10,434 (1,896) 28.9% 84.6% 2.0%Southwark 9,686 9,125 (561) 3,748 2,363 (1,385) 479 253 (226) 13,913 11,741 (2,172) 28.2% 84.4% 2.3%

Sub Total 22,517 22,558 41 25,162 21,730 (3,432) 26,226 23,122 (3,104) 73,905 67,411 (6,495) 26.2% 91.2% 2.3%

PCT Totals 171,453 217,010 45,557 161,987 163,897 1,910 152,669 86,314 (66,356) 486,109 467,220 (18,889) 22.8% 96.1% 3.3%

2011/12 Forecast Year End