NHS FIFE

Report to NHS Fife Acute Services DivisionCommittee

Financial Report for the Period to 30th September2013

Introduction

This report provides an update on the financial position at Period 6 for the Acute Services Division of NHS Fife. Whilst the report shows that the Division continues to overspend against budget, NHS Fife is projecting a breakeven outturn against budget for the health board at the year-end.

Income and Expenditure

The Income and Expenditure position for the Acute Services Division for thesixmonths to 30th Septemberis showing an overspend of£4,210kagainst an available budget of £85,514k for the year to date. This information is summarised in the following table with additional information provided in Appendix 1 and the body of this report.

Financial Position to 30th September 2013

2013/14
Annual Budget
£’000 / YTD
Budget
£’000 / Expenditure
£’000 / Variance
£’000 / P5
Variance
£’000
Clinical Directorates/
Pay & Price Reserves / 159,128 / 80,610 / 85,007 / 4,397 / 3,479
Other Directorates / 10,187 / 4,904 / 4,717 / (187) / (130)
Total / 169,315 / 85,514 / 89,724 / 4,210 / 3,349

Income Analysis

The Financial Framework and budgets for 2013/14 were approved by the Board at their meeting in March 2013. Throughout the year additional allocations will be received and budget adjustments will be made accordingly.

The main budget allocations in Period 6 are:

£k

Capacity Plan 274

DCE Urology60

Consultant increments 162

NES Junior Doctors77

Commentary

The following narrative provides a high level summary of individual over and underspent budgets at this time within the various Directorates of the Division.

  • Planned Care and Surgery: £2,679k overspent – 8.5%

The key areas of overspend (£1,877k in Pay and £802kin Supplies)areset out in the summary table below.

Planned Care / Reasons for overspend / Management Actions
Theatres & Anaesthetics: £780k / This relates to Medical agency staffing covering sickness/vacancies, specialty doctors covering junior rotas and increased volume and cost of Surgical Instruments/Sundries used. / Specialty doctors replaced in mid August by clinical fellows.
Obstetrics and Gynaecology: £632k / The overspend is due toNHS Locum cover for consultant post and previous medical agency costs. Nursing expenditure is exceeding budgets across services. / New consultant in post. This will reduce the need for medical agency staff.
Orthopaedics:£512k / The overspend is in junior medical staffing,mainly related to vacancy cover by agency staff, and increase in waiting list activity. / Alternative solution to cover electives is being pursued.
Paediatrics:£497k / This relates to medical agency costs covering sickness, a vacancy and gaps in the rota. / From July interviews, one post appointed. Capacity Plan postnot yet appointed to.
  • Emergency Care and Medicine: £2,709k overspent–9.9%

The key areas of overspend (£1,732k in Pay and £977k in Supplies) are highlighted in the table below.

Emergency Care / Reasons for overspend / Management Actions
Admission Units 1 & 2: £156k / This relates to nursing costs in excess of available budget and the use of nurse bank to cover additional capacity, maternity leave and sickness. / Recruitment for additional posts being reviewed.
Care of the Elderly: £392k / This relates in part to the use of nurse bank to cover sickness. / Bank nursing requirements reviewed routinely.
Haematology: £390k / This relates to the use of nurse bank to cover sickness, and an increase in drugs and surgical sundries spend related to activity. / Ongoing review of use of bank nursing and drugs expenditure. Additional budget allocated for 13/14to reduce drugs overspend.
Cardiology: £219k / This relates to nursing costs exceeding available budget and, particularly, the use of bank to cover sickness. Also an increase in surgical sundries costs related to activity. / Strict adherence to Management of Ill Health Policycontinues.
Respiratory Medicine:£280k / This relates in the main to nursing costs exceeding available budget, plus an increase in surgical sundries costs related to additional activity. / Ongoing review of use of bank nursing.
Infectious Diseases: £107k / This relates to nursing costs exceeding available budget, the use of bank to cover sickness, and costs associated withdrugs. / Use of bank nursing continues to be reviewed. Drugs expenditure under review.
Renal: £99k / Use of nurse bank to cover sickness in the wards. / Use of bank nursing continues to be reviewed.
Dermatology: £210k / This relates to nursing costs in excess of budget, additional waiting list activity and additional drugs costs. / Ongoing review of sickness and skill mix. Drugs expenditure under review.
General Medical: £708k / This relates to nursing costs associated with additional surge capacity. / These additional costs are being minimised as far as possible. Surge capacity requirement being reviewed.
Emergency Care: £76k / This relates to nursing costs in excess of budget. / Ongoing review of use of bank nursing.
  • Ambulatory Care:£311k overspent –1.5%

The key areas of overspend (£63k in Pay and £248k in Supplies)are shownin the table below.

Ambulatory Care / Reasons for overspend / Management Actions
Radiology: £324k / This relates to agency costs covering sickness and the existing consultant post vacancy and Capacity Plan/Detect Cancer Early posts. Continued use of external assistance to support waiting list activity. / Currently using external agency for support.
Endoscopy: £214k / The overspend mainly relates to endoscopy surveillance patients through use of Medinet, andsurgical instruments. / Under review.

Other areas of variance within the Acute Services Division are shown below:

  • Nursing, Therapies and Rehab:£135k overspent –3.9%

The overspend is due to Nurse Bank administration, the Hospital at Night service and AHPs.

  • Director of Acute Services:£240kunderspent

This is comprised of an underspend of £32k within Pays, and£208k within Supplies.

  • Medical Director and PGME:£69kunderspent – 10.8%

Pays are underspent by £70k, and supplies by £1k.

The balance of funding remaining in the generalreserveis in respect of additional flexibility which has not yet been distributed to individual directorates or services.

Graphs are included for the Division to show the movement in-year for both pay and supplies expenditure against budget.

Year End Forecast

At this stage the Acute Services Division does not anticipate achieving a breakdown outturn by the year end. There is however a requirement for the Division to control spend as far as possible between now and the end of the year in support of NHS Fife achieving year-end financial targets.

Efficiency Savings

The Division identified cash releasing savings of £190k at the time of the approval of the Financial Framework in March 2013. Achievement of this will be required as a minimum, as well as delivering further cash and non-cash savings to meet the Efficient Government target of 3%.

A total of £17k of savings have been identified for the year, with £9K of savings delivered at period 6. It is still expected that the £190k will be delivered in full by the year end.

Capital

The Capital allocation at 30th September2013 for the Acute Services Division is £10,742k, as shown in Appendix 2.

This allocation comprises: Main Schemes £7.8m, Minor Capital £886k, Capital Equipment £909k and other specific allocations. Expenditure to the end of Septembertotalled £2.872m. The Acute Services Division capital programme is managed in conjunction with other capital programmes across Fife.

Summary

After 6months, the year to date position shows an overspend of £4,210k on revenue budgets for the year and a spend of £2.9m within the capital programme.Some additional allocations havebeen attributed to the Acute Services Division however the underlying trend of overspend continues, and management action is required to control the overspend through the remainder of the year. A number of Capacity Plan posts have been added this month with the expectation that the use of external support will start to reduce.

Recommendations

The Committee is asked to:

  • Notethe contents of this report

ANDREW McCREADIE

Assistant Director of Finance

18thOctober 2013

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