WSET SUFFOLK HOSPITALS NHS TRUST

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Title slide
FINANCE WORKFORCE REPORT

• SEPTEMBER 2009
• Linda Potter, Director of Finance

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CONTENTS

• Executive Summary
• Financial Risk Rating
• Income and Expenditure (Trust)
• Performance Summaries
• CIP Summary
• Service Line Report (August 09 summary)
• Balance Sheet
• Cash Flow
• Capital Report

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EXECUTIVE SUMMARY
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FINANCIAL RISK RATING (FRR SHA model)
To turn the amber rating for underlying year-end
performance to green (from 3 to 4) the Trust
would need to reduce operational costs or
increase income by approximately 200k. This
would have the effect of increasing the forecast
outturn surplus from 6.0m to 6.2m.
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PERFORMANCE SUMMARIES

• The following schedules show the financial and
  workforce performance for the whole Trust and
  each of the directorates.
• Activity is for the period to August 09 and
  variances are based on an estimated profile.
• An income for September has been estimated.
• The Trust currently forecasts to achieve a
  surplus of 6m.

• The Trust has generated a surplus of 4.6m,
  1.04m above the revised, phased budget. Pay
  costs are 1.2 above budget, and include 1.25m
  of agency costs. Non-pay costs are generally on
  or below budget, except drugs, and other
  expenses, which include 0.5m provisions for
  costs associated with Transformation and
  Foundation Trust associated work, and backlog
  maintenance.
• Overall nursing staff costs are 1.7 below
  budget. Medical staff costs (incl. agency) are
  4.4 over budget.
• The Trust currently employs 2194.2 WTE staff.
  Prior month figure was an estimate as it included
  both outgoing and incoming Junior Doctors as part
  of the August rotation.
• There are currently 63.40 WTE (79 headcount)
  employees on maternity leave, compared to 37.08
  WTE (50 headcount) for the same period last year.
  There are several areas of the hospital where the
  high level of maternity leave could impact on
  service delivery and are therefore back filled
  through temporary staffing. Sickness rate for
  the month remains as for August.

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SURGERY DIRECTORATE

• There has been no decrease in the Outpatient
  demand and it continues as at previous month
  levels. Additional outpatient sessions to manage
  demand are required in General Surgery, TO, ENT,
  Ophthalmology and Oral Surgery. New to follow up
  ratios are being addressed in General Surgery,
  Urology and Oral. The number of procedures being
  undertaken in outpatients are also sustained in
  General Surgery, ENT and Ophthalmology. There is
  also a Suffolk wide increase in non-elective ENT.
• Income for the month was better than budget due
  to invoices for the use of medical staff 91k,
  SLA Income 9k and Private Patients of 24k. Pay
  was more than budget primarily as a result of
  medical staff 338k, due to extra session
  payments, Prof. Tech agency cost 79k, and
  nursing bank 190k but partially offset by 159k
  from staff vacancies. Non-Pay exceeds the budget
  129k for contracted work plastics, ENT, and
  dental. MSE was over by 153k due to equipment
  replacements and general supplies in theatres.
  Savings were achieved in drugs 37k and in
  purchasing hearing aids 9k, however the demand
  for hearing aids is rising and an analysis of
  this is being undertaken..
• Sickness/absence and maternity leave rates have
  increased on the inpatients wards and the levels
  still necessitate backfill by from bank staff.
• The use of agency staff was 236k for junior
  medical staff (Urology, TO, ENT) and 117 for
  consultants (Anaesthetics). A further 79k was
  for the plaster orderly in the Fracture Clinic
  (long term sick and subsequent retirement) plus
  3k nursing. Locum cost were 243k, primarily in
  Anaesthetics for consultant cover and bank usage
  was 190k for nurses and 44k for medical
  secretaries to cover sickness, maternity leave
  and vacancies.

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MEDICINE DIRECTORATE

• Activity SLA income continues to exceed
  contract.
• Directorate income over performed in the month.
• Overspend in medical staffing relates to
• 87k agency expenditure covering maternity leave
  and vacant posts
• payment for additional out-patient activity
  demand driven mainly in Gastroenterology (7k),
  Dermatology (8k), Oncology (4k) and Cardiology
  (11k).
• In mitigation the directorate received funding
  from reserves for Dr Chatterji in respect of
  swine flu preparations.
• Nurse agency costs of 45k were incurred across
  the wards as not all vacant shifts could be
  covered by bank staff. Expenditure in this area
  will continue until vacancies are filled
  (recruitment in progress), and staff on maternity
  leave ( of staff on maternity leave is reducing
  slowly) return to work. There is a need to
  maintain core levels of staffing in clinical
  areas.
• Drug expenditure was high. The Directorate
  benefited from adjustments in respect of drugs
  supplied not invoiced over the last year (29k in
  Oncology), and from a retrospective budget claim
  for a high cost drug Exenatide. The Trust were
  notified in the month that the PCT would fund
  this Diabetes drug going back to April (41k).
• Office Equipment/Printing and Stationery was
  overspent in the month related to new
  consultants and their secretaries as detailed in
  approved business cases.

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CLINICAL SUPPORT DIRECTORATE

• The Directorate under-spent in this month by
  185k. The main factor was the successful
  agreement of Radiology charges with Addenbrookes.
  The Directorate benefited by 124k.
• There was reduced income in September mainly due
  to funding being transferred to another
  directorate (20k Antibiotic post). Early
  Intervention Team income continues (an extended
  SLA is currently being negotiated), however this
  was offset by reduced private patient income
  across all areas of the Directorate.
• The consultant vacancy in Biochemistry meant
  medical staff were underspent. The fifth
  Histopathologist post is currently being covered
  by a locum, and agency, contributing to agency
  cost increase in the month. Finally, additional
  Radiology sessions were incurred although reduced
  from last month.
• Allied Health Professionals (OT, Physiotherapy
  Radiography) and Scientific Professionals staff
  (Pharmacy and Pathology) continue with vacancies
  mitigated by some backfilling with agency staff.
• Pathology equipment and materials were underspent
  by 47k, against an overspend of 31k in August.
  The variance in August was followed up and
  adjustments made this month. Alongside these
  adjustments there was also lower spend than is
  usual on chemicals this month.
• .

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WOMAN CHILD DIRECTORATE

• The favourable variance to budget is driven
  mainly by 91.3k in vacant positions, 27.6k in
  lower drug cost, 9.9k less rent of community
  midwifery clinic space, 15.2k in transport cost
  (prior year), additional USAF income of 211.5k
  and 67.9k from EWTD funds. These savings were
  partially offset by extra session payments of
  51.5k and 58.9k for the wards bank usage and
  33.8k in MSE and other supply cost.
• Activity data reflects a significant increase in
  gynaecology referrals over last year and recorded
  activity is 38.4 (July 09) up year-on-year
  through August. Paediatric referrals are up
  13.6 but recorded activity is down by 7.8
  primarily due to no longer having the
  gastroenterology patients. Activity vs the SLA
  through August is down mainly in midwifery and
  obstetrics reflecting over-commissioned activity
  by Suffolk PCT.
• Sickness rates have improved from the August
  position but maternity leave remains high. Use
  of bank staff (225.7k) reflects the level of
  maternity leave and long term sick and
  vacancies. Paediatrics have used agency staff to
  support the service. Locum staff (102.3k) are
  being used to cover the vacancies for the hybrid
  consultants in Paediatrics although part of this
  cost is offset by additional EWTD income
  (67.9k). Non-NHS Agency cost is primarily due
  to Junior Doctor coverage in Paediatrics.

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FACILITIES DIRECTORATE

• Income has continued to improve.
• Pay
• Housekeeping additional budget for compliance
  with standards for national cleanliness now
  included.
• SSD underspend as a result of vacancies.
• Estates underspend as a result of vacancies.
• Facilities Admin underspend due to vacancies.
• Non Pay is generally under spending across the
  directorate.
• Utilities continue to underspend due to lower
  tariffs.
• Laundry contract swing from August has rectified
  this month.
• Central Med Surg overspend forecast on
  mattresses, as at October 9th, estimated at 40k,
  result of audit.
• Workforce
• Long Term sickness in August has reduced as
  anticipated, with some of the long term sick
  staff retiring, leaving or returning to work.
  Referrals to Occupational Health continue.

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CORPORATE DIRECTORATE

• Corporate report is a consolidation of Finance
  and Information, Human Resources and
  Communications, Medical Director, Nursing and
  Governance, Trust Office, Overhead, Sudbury and
  the Central Operations Directorates. Reserves
  are excluded from this report.
• The overall pay variance is favourable. Agency
  and bank staff are still being used in Finance
  and the cost of bank nurses on mandatory training
  are included in these Corporate numbers.
• The Income variance is favourable due mainly to
  RTA (169k variance) income and some central
  funding which have associated unbudgeted costs,
  for example Pandemic Flu funding.
• Overheads include a budget for Collaborative Hub
  led savings, while these will savings actually
  arise throughout the Trust. The non-pay variance
  also includes provisions for unbudgeted
  consultancy work associated with Transformation
  and Foundation Trust and other projects, creating
  the high adverse variance.
• The Maternity rates remain below the overall
  Trust rate. The sickness rate for corporate areas
  reflects an adjustment this month.

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Summary Service Line Report for August 2009
The above table shows financial performance by
main specialty lines for the period to Aug 09.
This summary now reflects the changes to the
income budget made to the August financial
reports. Although the variances have changed
significantly to reflect the more accurate budget
data, actual performance continues as in previous
months. Surgery is to investigate
under-performance in Trauma and Orthopaedics.
The current Obstetric performance reflects
over-commissioned activity by NHS Suffolk The SLR
above reflects the published August financial
information.
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