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

Excellence in specialist and community healthcare

Our financial position /

Wandsworth CCG Board - 10th June 2015

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 –

• perationally & 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

Senior staff briefing re: finances May 2015 / St George’s University Hospitals NHS Foundation Trust (10,000) (5,000) 5,000 M1 M2 M3 M4 M5 M6 M7 M8 M9 M10 M11 M12 Surplus/(Deficit) (£000s)

Monthly Surplus/(Deficit)

Actual Plan (20,000) (10,000) 10,000 M1 M2 M3 M4 M5 M6 M7 M8 M9 M10 M11 M12 Surplus/(Deficit) (£000s)

Cumulative Surplus/(Deficit)

Plan Actual Surplus /(Deficit) over 4 month period M1 - M4 (£m) M5 - M8 (£m) M9 - M12 (£m) Plan (£1.0) £4.9 £1.7 Actual (£1.6) £1.9 (£17.0) Variance (£0.6) (£3.0) (£18.7)

What drove the deficit?

Senior staff briefing re: finances May 2015 / St George’s University Hospitals NHS Foundation Trust

• 25,000
• 20,000
• 15,000
• 10,000
• 5,000

5,000 10,000 15,000 20,000 M1 M2 M3 M4 M5 M6 M7 M8 M9 M10 M11

£k

Cumulative variance Income, Pay and non-pay 2014/15 Income variance Pay variance Non pay variance Overall variance

• 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

Trends in Income & Expenditure

Re-setting St George’s on a sustainable footing

• CIP delivery
• Implement downside mitigations from LTFM
• Introduce weekly run rate controls
• Deliver 15/16 Plan
• Reduce Capex in 15/16 by £11m
• Increase working capital loan
• Protect Liquidity
• IBP/LTFM review
• Service line review
• Restructuring corporate cost base
• Workforce efficiency programme
• Alternative approaches to service delivery,
• rganisation configuration and/or partnerships
• Post project evaluation of investments since 13/14
• Revised 5 year capital programme
• Identify £100m improvement over three years
• Re-set Organisation
• n Sustainable

Footing

• Strengthen financial management, budget setting &

forecasting

• Improve financial

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 20th May to conduct Independent Accounting Review. Full

review will take 6 weeks in total.

Turnaround Support:

• 27th 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

Excellence in specialist and community healthcare

Thank you / Questions and answers