Contract Income and Activity

  1. Contract Income - 2007/08 Outturn

Contract incomewas £2.4mover achieved in 2007/08. This is £0.1m higher than the estimated over achievement included in the 2007/08 reported position. National commissioning rules allow for the additional income to be recognised in 2008/09. Whilst the overall estimate proved relatively accurate, there were some differences at divisional level as shown in the chart below.

These differences have been issued to Divisions in Month 1. Some of the key reasons for the differences are described below,

  • The impact of the Norovirus outbreak in March was provided for centrally against Trust Overheads, whilst it seems to have affected Medicine.
  • The transfer of Adult Cardiology work to North Bristol Trust has been more gradual than anticipated. This has resulted in higher than expected income in Specialised Services.
  • Activity in Neonatal Intensive Care was much lower than expected in March. This led to lower than expected income in Women’s & Children’s.

Table INC 1 shows the final 2007/08 outturn activity and value variance by work type and specialty. This can be reconciled to the final £2.4m value variance as follows,

£m

Table INC11.8

Uncoded activity (353 spells)0.6

Bone Marrow Transplants(0.1)

Market Forces Factor0.1

2006/07 Income0.6

Provisions(0.6)

Actual Outturn2.4

  1. Update on 2008/09 SLAs

The table below shows the progress on signed SLAs and unsigned ones with actions to resolve,

Patient Care Service Level Agreements / Value
£m / Progress
BNSSG Primary Care Trusts
Bristol PCT / 28,763 / Agreed
North Somerset PCT / 37,808 / Agreed
South Gloucestershire PCT / 146,116 / Agreed
BNSSG Primary Care Trusts Total / 212,687
Other NHS Primary Care Trusts
Bath & North East Somerset PCT / 12,443 / Agreed
Bournemouth & Poole PCT / 62 / Agreed
BMT Variable Estimates / 2,617 / Agreed
Cornwall PCT / 2,750 / Agreed
Devon PCT / 4,176 / Agreed
Dorset PCT / 701 / Agreed
Gloucestershire PCT / 8,696 / Agreed
Non Contract Activity / 2,098 / No Contract
Plymouth PCT / 963 / Agreed
Somerset PCT / 18,292 / Agreed
Swindon PCT / 2,724 / Agreed
Torbay PCT / 903 / Agreed
Variable Estimates / 3,627 / No Contract
Wiltshire PCT / 7,816 / Agreed
Worcestershire PCT / 144 / Agreed
Other NHS Primary Care Trusts Total / 68,012
Welsh and other Territorial Bodies
Blaenau Gwent LHB / 18 / Write to the commissioner *
Channel Islands & Gibraltar / 22 / No Contract
Health Commission Wales / 4,980 / Write to the commissioner *
Monmouth LHB / 178 / Write to the commissioner *
NCA Territorial Bodies / 838 / No Contract
Overseas Patients / 42 / No Contract
Welsh Variable Estimates / (25) / No Contract
Welsh and other Territorial Bodies Total / 6,054
Specialised Commissioning Consortium
HerefordWorcester LCCB / 356 / Agreed
South West Specialised Commissioning Group / 22,015 / Agreed
West Midland Specialised Services / 288 / Agreed
Specialised Commissioning Consortium Total / 22,659
Patient Care Service Level Agreements Total / 309,412

* Progress chase to conclude SLA in June 2008.

  1. Contract Income – 2008/09 Month 1

Monthly activity information isn’t available until 3 weeks following the month end, due to the timing of this meeting it is not possible to report variances on contract income for the current month. Monthly activity information is available for Bone Marrow Transplant activity, and this shows asmall adverse variance of £8k.

A Service Agreements report is attached as Table INC 2.

  1. Contract Income – 2008/09 Risks

The risks associated with breaching the terms of the contracts are monitored by the Commissioning & Planning Group. The main risks at this stage are,

  • Failure to achieve performance targets.
  • Unauthorised recording changes.
  • Unauthorised supply led increases in activity.
  • Failure to secure prior approval where required.

From May a monthly assessment will be made and included in this report.

Commissioners do not have to pay for activity that is uncoded by national quarterly reporting deadlines. For information activity uncoded at the end of March and an estimate of the financial value is,

Hospital Description / Korner Specialty Description / YTD Activity / Uncoded Episodes Estimated £
Bristol Royal Infirmary / General Surgery / 84 / 149,786
Trauma & Orthopaedics / 27 / 64,894
General Medicine / 127 / 197,529
Gastroenterology / 13 / 7,382
Cardiology / 30 / 78,539
Other / 37 / 70,329
Bristol Royal Infirmary Total / 318 / 568,458
St Michael's / Breast Surgery / 11 / 20,628
Other / 8 / 6,199
St Michael's Total / 19 / 26,826
BristolEyeHospital / 0 / 0
BristolDentalHospital / 2 / 1,688
BristolHaematology & OncologyHospital / 6 / 5,369
BristolRoyalHospital for Children / 1 / 2,202
Private Hospitals / 7 / 12,703
Grand Total / 353 / 617,248
  1. Reference Costs 2007/08

The exercise to produce Reference Costs for 2007/08 is now fully underway. The Divisional Financial Managers are closely involved and this is essential to ensure the costs are as accurate as possible. The Trust is on target to meet the national submission deadline of the 15th August 2008.

  1. Service Line Reporting

The Service Line Reporting project is also underway. Patient level costs for surgical sub-specialties have recently been produced and these will be shared with the Division during June, once the Service Line Reporting Accountantis in post.

It is anticipated that the first Project Board will be held during June.

Progress reports will be provided each month.

Prepared by Richard Smith, 15th May 2008

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