Our financial position / Wandsworth CCG Board - 10 th June 2015 - PowerPoint PPT Presentation

Our financial position / Wandsworth CCG Board - 10 th June 2015 Excellence in specialist and community healthcare

St George’s in context  NHS Providers estimate aggregate deficit for provider sector of £0.9bn 14/15 and planned deficits £2.0-2.5bn 15/16 Senior staff briefing re: finances May 2015 / St George’s University Hospitals NHS Foundation Trust

System pressures have hit St George’s – operationally & financially  Rising demand for emergency care, especially >70yrs  Increased staffing costs to cover peaks in demand  Income lost from planned activity that was cancelled  Costs from procedures carried out elsewhere  Shortfall in cost improvement plans (esp. capacity related)  Not enough control on our spending  Actions were taken but they weren’t enough Senior staff briefing re: finances May 2015 / St George’s University Hospitals NHS Foundation Trust

The impact since Dec 2014 is very dramatic Monthly Surplus/(Deficit) 5,000 Surplus/(Deficit) (£000s) 0 (5,000) (10,000) M1 M2 M3 M4 M5 M6 M7 M8 M9 M10 M11 M12 Actual Plan Cumulative Surplus/(Deficit) 10,000 Surplus/(Deficit) (£000s) 0 (10,000) (20,000) M1 M2 M3 M4 M5 M6 M7 M8 M9 M10 M11 M12 Plan Actual Surplus /(Deficit) over 4 M1 - M4 (£m) M5 - M8 (£m) M9 - M12 (£m) month period (£1.0) £4.9 £1.7 Plan (£1.6) £1.9 (£17.0) Actual (£0.6) (£3.0) (£18.7) Variance Senior staff briefing re: finances May 2015 / St George’s University Hospitals NHS Foundation Trust

What drove the deficit? Cumulative variance Income, Pay and non-pay 2014/15 20,000 15,000 10,000 5,000 Income variance 0 Pay variance M1 M2 M3 M4 M5 M6 M7 M8 M9 M10 M11 £k Non pay variance -5,000 Overall variance -10,000 -15,000 -20,000 -25,000 Senior staff briefing re: finances May 2015 / St George’s University Hospitals NHS Foundation Trust

Trends in Income & Expenditure • The charts shows the movement in the cumulative variance to plan across SLA income, other income, pay and non pay over the last two financial years • The chart on the left shows the position in FY14 • The chart on the right shows the position in FY15

Re- setting St George’s on a sustainable footing • CIP delivery • • Implement downside mitigations from LTFM Deliver 15/16 Plan • Introduce weekly run rate controls • • Reduce Capex in 15/16 by £11m Protect Liquidity • Increase working capital loan • • IBP/LTFM review Re-set Organisation • Service line review on Sustainable • Restructuring corporate cost base Footing • Workforce efficiency programme • Alternative approaches to service delivery, organisation configuration and/or partnerships • Post project evaluation of investments since 13/14 • Revised 5 year capital programme • Identify £100m improvement over three years • • Strengthen financial management, budget setting & Improve financial forecasting systems Senior staff briefing re: finances May 2015 / St George’s University Hospitals NHS Foundation Trust

Monitor investigation overview  Monitor sent a letter to our Chair, Christopher Smallwood, on 1 May 2015 to notify of decision to open investigation  Investigation into whether a potential breach of our license as a foundation trust has taken place – finances and performance (RTT, ED, Cancer)  Triggered by the scale and rapidity of the deterioration in our financial position in the third and fourth quarters  Scope will include the adequacy of our financial reporting and forecasting in 2014/15 and our plans for 2015/16  Monitor also want to “understand why St Georges has been unable to sustain its progress in treating patients more promptly, as requested at the time of its foundation trust authorisation”  Culminates in: Report from the independent accounting review; Update from our turnaround advisory contract; Plans to complete the turnaround. Senior staff briefing re: finances 1 May 2015 / St George’s University Hospitals NHS Foundation Trust

Monitor investigation – where we stand Reviews FY15:  Internal – Finance team are currently working on completing the narrative  Monitor – Monitor team are preparing an analysis of trust finances for David Bennett, CEO PwC – appointed 20 th May to conduct Independent Accounting Review. Full  review will take 6 weeks in total. Turnaround Support: 27 th May – held interviews for Turnaround Directors and advisory support.  KPMG appointed.  Turnaround Director: will be the programme director for service review work  KPMG: will provide advisory support. Their resources will be used to assist IBP/LTFM workstreams 1,2, and 5 year plans  Turnaround work will result in plans to complete turnaround, covering 1, 2 and 5 year horizons Senior staff briefing re: finances May 2015 / St George’s University Hospitals NHS Foundation Trust

Maintaining quality & safety  We have measures in place to secure quality:  Senior clinical input into decisions  QIA process for CIPs and run rate plans led by Jennie Hall & Simon Mackenzie  Safe staffing reporting systems operational in clinical areas  New weekly monitoring of quality indicators to pick up early warning of problems: Serious incident numbers/themes Incidents (falls, pressure ulcers) Staffing incidents (Datix) Complaints Sickness (when available) Senior staff briefing re: finances May 2015 / St George’s University Hospitals NHS Foundation Trust

Takeaway Messages  National challenge: The financial/operational pressures are NHS-wide, however it is our responsibility to manage the implications for St George’s  We’re all in this together: We need to work together to deliver the 15/16 plan: managing our weekly activity and meeting our budgets for the year.  Communication is key: open dialogue must be maintained and everyone can contribute. All thoughts, concerns and ideas will be valued and listened to  Quality and safety: will continue to be priorities and there are measures in place to ensure this Senior staff briefing re: finances May 2015 / St George’s University Hospitals NHS Foundation Trust

Thank you / Questions and answers Excellence in specialist and community healthcare