24th July 2008
Agenda Item 5.2
Contract Income and Activity – June 2008
- Contract Income – Changes in Plan
Changes in the Income budget from May are summarised below,
Income from Activities / Income from Operations / Financing / TOTAL£000 / £000 / £000 / £000
Month 2 / 335,313 / 46,252 / 0 / 381,565
Minor Changes to Welsh Commissioners / 13 / 13
Productive Programme Funding / 319 / 319
MADEL / 73 / 73
Month 3 / 335,645 / 46,325 / 0 / 381,970
- Contract Income –Month 2 Variances against Plan
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 Transplants.
Commentary on the key variances to the end of May is provided below together with a graph showing the overall variances by division.
These differences have been issued to Divisions in Month 3. Some of the key reasons for the differences are,
- Day Case and Elective activity remains high. This is due to further additional activity to reduce waiting times to achieve the 18week referral to treatment targets, in particular General Surgery, Ophthalmology, Adult Cardiology and Oral Surgery.
- Non Elective activity is also higher than planned. Admissions are 7% higher than the same period last year. In addition, PCT demand management schemes have not started.
- Outpatient Follow Ups are also exceeding plan. This is due, in part, tothe impact of growth in elective and day case activity in 2007/08 and also additional clinics in Ophthalmology to reduce the waiting list backlog for Glaucoma patients.
- Reinstatement of the provision for doubtful debts has resulted in a £552k reduction in income.
Reports on monthly activity levels (INC 1), income by PCT (INC 2) and income by specialty and worktype (INC 3) are attached,
Table INC 3 shows the activity and value variance by work type and specialty. This can be reconciled to the £3.4m value variance on table INC 2as follows,
£m
Table INC33.2
Dental Outpatients(0.2)
June Actuals (BMT) 0.1
Market Forces Factor 0.3
2007/08 Income0.1
Welsh Elective(0.1)
Actual Variance Table INC23.4
- 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
- Uncoded activity at the quarterly reconciliation date
- Missing attendance indicators for outpatient attendances
- Unauthorised recording changes
- Unauthorised supply led increases in activity
- Failure to secure prior approval where required
The biggest single risk at this stage is that the PCT will not be able to afford to pay for the activity over performance if it continues at the current rate.
Commissioners do not have to pay for activity that is uncoded by national quarterly reporting deadlines. For information, activity uncoded at the end of May and an estimate of the financial value is,
Division / Specialty / Activity / £Surgery, Head & Neck / ENT / 5 / 5,192
General Surgery / 95 / 218,170
Maxillo-Facial / 5 / 5,484
Ophthalmology / 163 / 138,331
Oral Surgery / 10 / 8,296
Pain Management / 5 / 3,288
Thoracic Surgery / 1 / 3,919
Trauma & Orthopaedics / 49 / 142,952
Urology / 15 / 21,450
Other / 1 / 3,715
Surgery, Head & Neck Total / 349 / 550,795
Women's & Children’s / Obstetrics / 7 / 3,914
Women's & Children’s Total / 7 / 3,914
Specialised Services / Cardiac Surgery / 8 / 72,334
Cardiology / 22 / 45,861
Clinical Oncology / Radiotherapy / 1 / 875
Medical Oncology / 3 / 6,488
Specialised Services Total / 34 / 125,558
Medicine / Accident & Emergency / 34 / 21,850
Dermatology / 12 / 11,056
Elderly Care / 4 / 11,735
General Medicine / 118 / 183,222
Rheumatology / 5 / 3,654
Thoracic Medicine / 1 / 3,354
Medicine Total / 174 / 234,872
Grand Total / 564 / 915,138
The PCT have confirmed agreement that SLA monitoring information shall be provided by 30 calendar days after the month end, but full reconciliation and billing remains quarterly. This reduces the risk to the Trust of non-payment for uncoded spells and a lack of timely activity data.
At the end of June hospital acquired Clostridium Difficile cases were 17% higher than target. If performance continued at this rate relative to the agreed trajectory then the Trust would incur a fine of £2,500,000, being the maximum fine. For information, if performance improvements are not implemented the value of contract fines year to date is given below,
Performance Measure / Surgery / Women's & Children's / Medicine / Specialised Services / Diagnostic & Therapies / Trust Services / TOTAL£000 / £000 / £000 / £000 / £000 / £000 / £000
MRSA / - / - / - / - / - / - / -
C Diff / 49 / - / 178 / 97 / - / 324 / 648
Mothers Who Are Not Smokers / - / - / - / - / - / - / -
Mothers Initiating Breastfeeding / - / (5) / - / - / - / - / (5)
Cancelled Operations / - / - / - / - / - / - / -
Choose & Book slot availability / 0 / 0 / 0 / 0 / - / 0 / 0
4hr A&E wait / - / - / - / - / - / - / -
2hr A&E minor wait / - / - / - / - / - / - / -
Cancer - 31 day diagnosis / 1 / - / - / - / - / 1 / 2
Cancer - 62 day urgent referral / 0 / - / - / - / - / 0 / 0
Cancer - 2 wk urgent referrals / - / - / - / - / - / - / -
Rapid Access Chest pain / - / - / - / - / - / - / -
26wk maximum elective wait / - / - / - / - / - / - / -
13wk maximum outpatient wait / - / - / - / - / - / - / -
TOTAL / 50 / (5) / 178 / 97 / - / 325 / 645
1. All based on Month 2 forecast outturn, except C Diff based on month 3 forecast outturn
2. Positive = fine, Negative = reward
- South West Specialised Commissioning Group
Following the Carter Review published by the Department of Health in May 2006, Specialised Services Groups have a duty to commission specialised services on behalf of their local populations directly from April 2009.
At present South West Specialised Commissioning Group commission 14 of the 35 services, including 8 provided by UH Bristol, most significantly neonatal intensive care, paediatric intensive care and bone marrow transplants.
In order to facilitate commissioning for all specialised services by April 2009 a stocktake exercise is being undertaken to identify what services are provided and the associated activity and income. Divisions have been engaged to identify this activity and the stocktake submission will establish a baseline for an SLA in 2009/10.
- Reference Costs 2007/08
The exercise to produce Reference Costs for 2007/08 is continuing. HRG level costs have been calculated and validated by Divisions.
The Department of Health has delayed the release of collection system and, as a result, the national submission deadline of the 15th August 2008 will be extended by a minimum of one month.
The Trust remains on target to meet the submission deadline.
- Service Line Reporting
An initial meeting was recently held with the Surgery Head & Neck Division to discuss the approach to validating patient level costs for surgical sub-specialties. One of the issues highlighted was the need to have a clear message about how Service Line Reporting information will be used in the future. It was felt that this will be vital in gaining clinical involvement.
It was also agreed that, where possible, costs should reflect the complete patient episode and should not be unbundled. These costs will be shared with the Division during July 2008.
The first Project Board was held on the 3rd July 2008. The meeting was used to give a progress report to the Project Board members. The project plan was also discussed.
Progress reports will be provided each month.
File: Item 5.2 June Contract Income and Activity ReportPage 1 of 5