Financial Report - October 2022 (Month 7) & FY23 Board of Directors Report
The financial report for October 2022 (Month 7) and FY23 Board of Directors contains detailed information on income statements, forecast outturn, risks & opportunities, financial performance, Covid-19 costs, pay trends, agency analysis, cost improvement plans, and more. The report showcases the Trust's performance, highlighting a deficit of 1.4m at month 7, better than planned. The internal forecast outturn predicts a 3.2m deficit, 3m better than planned, with adjustments made for various factors such as project costs, additional spend, and backlog maintenance.
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Caring, safe and excellent For Information Finance Report October 2022 (Month 7), FY23 Report to Board of Directors Contents 1. 2. 3. 4. 5. 6. 7. 8. 9. 10. 11. 12. 13. 14. 15. 16. Income Statement & Forecast Outturn Forecast Movement from Previous Month Forecast Risks & Opportunities Directorate Financial Performance Provider Collaborative Financial Performance Covid-19 costs Pay Trends Agency Analysis Cost Improvement Plan Out of Area Placements Statement of Position Cash-flow Working Capital Indicators Capital Investment Programme Reconciliation to NHSE/I Template ICS Financial Position A risk assessment has been undertaken around the legal issues that this paper presents and there are no issues that need to be referred to the Trust Solicitors. Appendix 1 Detailed Directorate Financial Performance 1
Caring, safe and excellent 1. Income Statement & Forecast Outturn INCOME STATEMENT Month 7 Year-to-Date Forecast Plan m 38.9 5.1 44.0 28.3 15.1 43.4 0.5 1.3 -0.7 Actual m 39.9 13.2 53.1 29.3 23.2 52.5 Variance Plan m 268.4 37.6 306.0 198.0 101.2 299.2 6.8 8.9 -2.1 Actual m 275.7 54.4 330.1 207.4 115.4 322.8 Variance Plan m 465.1 64.3 529.4 336.0 184.4 520.3 9.1 15.3 -6.2 Forecast Variance m 474.8 85.2 560.0 352.9 195.3 548.3 11.7 14.9 -3.2 -3.0 -6.2 m 1.1 8.1 9.1 1.0 8.1 9.0 0.1 0.1 0.2 m 7.3 16.8 24.1 9.4 14.2 23.6 0.5 -0.2 0.7 m 9.7 20.8 30.6 17.0 11.0 27.9 2.6 -0.4 3.0 -3.0 0.0 Clinical Income Other Operating Income Operating Income, Total Employee Benefit Expenses (Pay) Other Operating Expenses Operating Expenses, Total EBITDA Financing costs Surplus/ (Deficit) Amounts held for known demand pressures Adjusted Forecast Surplus/ (Deficit) 0.6 1.2 -0.5 7.3 8.7 -1.4 - -6.2 Year-to-Date Performance The Trust reports at 1.4m deficit at month 7, which is 0.7m better than plan. This is made up of overspends against clinical directorate budgets, notably Community 4.9m, offset with unallocated Covid-19 funding ( 4.4m) and contingency reserves. 2
Caring, safe and excellent Forecast Outturn The Trust s internal Forecast Outturn is for a 3.2m deficit, which is 3.0m better than plan. This has been adjusted to agree to the plan of a 6.2m deficit while potential risks and opportunities are more fully assessed. In particular, there are known backlogs across several services that the Trust is considering addressing with non recurrent resources. The forecast is based on the YTD trend continuing with adjustments for known changes. The material changes assumed are: Costs related to the Warneford Park project of 1.7m have been included ( 0.8m is in the YTD position) which had previously been capitalised Additional non-recurrent spend agreed by the Executive Team is in the year-to-go position - 1.0m for backlog maintenance and 0.5m for other non- recurrent spend 0.3m has been included in the year-to-go position for costs relating to the system outage. Overtime payments in the clinical systems team have not yet been paid and additional admin staff are expected to be required to enter backlog information onto the new systems. Additional costs for winter pressures have been included in the forecast for Community Hospitals and the GP Out of Hours service but not other services. Income will be deferred for Provider Collaboratives underspends (so that this can be invested next year) and unspent System Development Funding (SDF) as has been done in previous years Reductions in agency spend due to initiatives from the Improving Quality Reducing Agency programme are not in the forecast and are an opportunity for it to improve Costs for the implementation of the new clinical information systems are included in the forecast The forecast for Oxford Pharmacy Store includes 0.9m of additional profit above plan from contracts with the Department for Health & Social Care. 3
Caring, safe and excellent 2. Forecast movement from previous month Increase = Favourable change Decrease = Adverse change The month 7 forecast improved by 1.1m from the forecast at month 6. The methodology for the agency accrual was changed in month 7 the agency accruals had taken their costs from the workforce management system. It was identified that these costs included VAT for all staffing groups, which is not applicable for nursing and HCA agency costs. This has now been corrected. This has resulted in an improved agency run-rate and forecast. The revised income forecast was a result of reviewing System Development Funding income and against spend and reducing the income that is being deferred. 4
Caring, safe and excellent 3. Forecast Risks & Opportunities Risks Balance sheet adjustments Additional winter pressures BSW CAMHS underspend deferred Non-recurrent spend Opportunities Additional income Agency reduction Restatement of DHSC loan Trainee Doctors credit note OPS more DHSC contracts '000 Likelihood 2,850 Medium 1,000 1,000 450 5,300 '000 Likelihood 2,953 Medium 2,585 Medium 3,006 Medium 265 500 9,309 High Low High High High 5.3m of risks to the forecast have been identified and 9.3m of opportunities. This gives a forecast range of between 12.3m better than plan and 2.3m worse than plan. Forecast range - all risks and opportunities Forecast Outturn to Plan 12,331 -2,278 Full Year Budget Full Year Actual Taking into account only those risks and opportunities assessed as high likelihood there is a forecast range of between 3.8m better than plan and 1.6m better than plan. '000 Upside Forecast Downside Forecast -6,209 -6,209 6,122 -8,487 In addition, the forecast assumes that the Trust will defer at least 13.1m of income at year- end, of which 10.9m relates to Provider Collaboratives. The balance sheet adjustments risk represents the risk of audit opinion requiring the Trust to adjust balance sheet values with an effect on the revenue position. Forecast range - high likelihood risks and opportunities Forecast Outturn to Plan 3,787 1,572 Full Year Budget Full Year Actual The additional income opportunity reflects current discussions with commissioners around additional income to cover overspends in Continuing Healthcare, additional SDF funding and inflation funding plus the release of income deferred at year-end which is not currently in the forecast. '000 Upside Forecast Downside Forecast -6,209 -6,209 -2,422 -4,637 5
Caring, safe and excellent 4. Directorate Financial Performance Month 7 Year-to-Date Forecast Plan m 1.5 0.7 0.3 2.5 0.7 -5.6 0.0 0.0 0.1 2.8 0.5 Actual m Variance Plan m 13.5 6.7 6.9 27.2 7.5 -35.5 0.2 -0.4 0.9 6.9 6.8 Actual m 14.5 Variance Plan m 23.2 11.5 12.0 46.7 12.8 -60.7 0.3 -0.8 1.6 9.2 9.1 Forecast Variance Directorate Oxfordshire & Sw Mental Health Buckinghamshire Mental Health Specialised Services MH Directorates Total Community Services Corporate Oxford Pharmacy Store Research & Development Covid-19 Costs Reserves EBITDA m 0.7 0.3 1.1 2.1 0.3 -0.5 0.0 0.0 0.8 -2.6 0.1 m 1.0 -1.2 -0.2 -0.4 -4.9 -0.1 0.1 0.3 4.4 1.1 0.5 m 23.8 9.0 10.6 43.4 2.6 -64.3 1.2 -0.1 8.8 20.1 11.7 m 0.5 -2.5 -1.4 -3.4 -10.2 -3.6 0.9 0.7 7.2 11.0 2.6 2.2 1.0 1.4 4.6 1.0 -6.1 0.0 0.0 0.9 0.2 0.6 5.5 6.7 26.7 2.6 -35.6 0.3 -0.2 5.4 8.0 7.3 The Corporate position includes 4.2m of agreed spend which is not budgeted for but which offsets with the Reserves underspend - 1.5m for clinical system costs that were originally in the capital plan, 1.7m for costs related to the Warneford Park development and 1.0m for non-recurrent backlog maintenance costs. 2.8m of contingency reserves were allocated out to directorates in month 7 to reduce CIP targets by 50%. Further budget adjustments have been agreed by the Executive Team to allocate some of the Reserves budget to directorates and these will be actioned in future months as figures require finalisation. The following pages include more details on the financial position of each directorate. 6
Caring, safe and excellent Oxfordshire & BSW Mental Health Month 7 Year-to-Date Forecast Plan m 227 (578) (140) (519) (95) (89) (86) 198 79 2,533 51 226 40 (98) (79) 41 96 (1) Actual m 238 (498) (121) (969) 345 (46) (75) 198 279 2,632 Variance Plan m 1,589 (4,058) (978) (3,636) 2,442 (621) (602) 1,399 554 17,729 353 1,583 278 (685) (566) 290 671 Actual m 998 (4,991) (1,570) (5,335) 2,651 (311) (576) 689 2,594 18,969 189 981 449 (2,491) 309 749 752 165 Variance Plan m 2,723 (6,949) (1,677) (6,233) 4,186 (1,065) (1,033) 2,388 947 30,392 607 2,713 476 (1,175) (963) 497 1,150 (16) Forecast Variance Service Line Adolescent Mh Inpatient Adult Mh - Acute Inpatient Adult Mh -Picu Adult Support Adults Management & Indirect Complex Needs Service Early Intervention Service Eating Disorders Inpatient Iapt Mh Community Teams Older People Community Mh Older People Mh Inpatient Ox Comm Adult Eating Disorders Oxford Out Of Area Oxon Camhs Oxon Mental Health Urgent Care Oxon Perinatal Service Provider Collaborative Aed Provider Collaborative Camhs Psychiatric Liaison Services Psychological Therapy Services Recovery College Residential Care Sil Contracts BSW Camhs EBITDA m 11 80 19 m m m (591) (933) (591) (1,699) 209 310 2,054 (8,596) (2,662) (9,115) 4,383 (541) (994) 1,108 4,073 31,989 373 1,742 796 (3,933) 151 1,234 1,283 (670) (1,647) (985) (2,881) 197 524 (450) 440 43 11 26 39 () (710) 2,040 1,240 (164) (602) 171 (1,805) 875 460 (1,280) 3,126 1,598 (235) (971) 320 (2,758) 1,113 737 133 201 99 (36) 42 38 (183) 164 55 15 268 77 (281) 85 97 101 5 1 81 175 90 60 310 14 81 (157) 2,123 1,013 () (9) (3) 52 33 68 39 24 501 46 66 (210) 3,651 547 () 26 (43) (222) (64) (3) (58) 199 2,177 26 40 (21) (28) (28) (20) 177 687 86 (6) (84) (201) (36) 24 (39) 22 1,490 (586) (1,406) (255) 171 (270) 153 13,532 (526) (1,096) (241) 252 (427) 2,276 14,545 (1,004) (2,409) (438) 292 (462) 262 23,203 (980) (1,908) (391) 358 (672) 3,913 23,750 7
Caring, safe and excellent Oxfordshire & BSW Mental Health (cont.) Year-to-Date Performance The Directorate is reporting a favourable position of 1,013k at the end of October driven by the following: Agency use and premiums within Medical and inpatient services ( 5.1m adverse) Out of area inpatient placements driven by Acute & Female PICU beds ( 1.8m adverse) Slippage in IAPT recruitment against Long Term Plan projections which will be resolved in FY24 ( 2.0m favourable) Vacancies across Oxon CAMHS, BSW CAMHS, MH Community Services, Urgent Care, Complex Needs, Management & Community Eating Disorders & Psychological Therapies ( 5.7m favourable) Provider Collaborative ( 264k favourable) Forecast Outturn The Directorate is Forecast to be 547k favourable at the year end which represents a worsening against the year to date position. The main assumptions driving this are Additional spend of 529k against Community Mental Health teams in line with recruitment to Community Mental Health Framework posts A worsening of 347k against Provider Collaboratives Additional spend of 386k within Oxfordshire CAMHS against vacancies and Healios Assessments Risks and Opportunities Items not included in the forecast which may represent a risk to the financial position are as follows: 1m of income deferrals needed to be carried into FY24 for BSW CAMHS 200k potential further Healios spend within Oxfordshire CAMHS Items not included In the forecast which may present a benefit to the financial position are as follows: An increase of income against the Section 75 risk share agreement 150k An increase of SDF income for the Crisis & Home Treatment team for which expenditure is already forecast 197k Actions Required Further work with Inpatient areas and Medical to reduce agency spend Recurrent plans for the Cost Improvement target (this is being met non recurrently in FY23) 8
Caring, safe and excellent Buckinghamshire Mental Health Month 7 Year-to-Date Forecast Plan m 187 128 362 11 17 705 Actual Variance m 395 86 367 (1) 166 1,014 Plan m 3,499 627 2,494 76 34 6,729 Actual m 2,185 508 2,224 556 Variance Plan m 6,049 976 4,267 129 121 11,542 Forecast Variance Service Line Buckinghamshire Adults Buckinghamshire Camhs Buckinghamshire Older People Bucks Psychological Therapies Bucks Social Care EBITDA m 209 (42) m m m (1,314) (119) (271) 481 3,760 842 3,537 720 163 9,021 (2,290) (134) (730) 590 5 (12) 149 308 36 1 42 5,508 (1,221) (2,521) Year-to-Date Performance Buckinghamshire Mental Health reports a YTD adverse variance of 1,221k. The main drivers of this position are: Bucks Adults agency premiums being paid on medical staff ( 1.1m adverse) and also in Inpatient teams ( 0.7m). There is also an overspend against Out of Area Placements (OAPs) ( 0.3m). These are offset by underspends due to vacancies in Urgent care & Adult Eating Disorders & non pay underspends in Urgent care & CMHT s due to changes in ways of working. Bucks Older Adults agency premiums on medical and Inpatient teams ( 0.3m adverse) Underspend due to vacancies in Psychological Therapies, ASD & IAPT ( 0.3m). Non pay underspend in IAPT due to underspend on contracts ( 0.2m) CAMHS services are overspent due to medical agency premiums ( 0.2m) & overspend on unfunded posts in Neuro & Eating Disorders teams due to service pressures. This is partially offset by underspends elsewhere in CAMHS. Forecast Outturn The Directorate is forecast to be 2.5m adverse to budget with existing agency spend pressures expected to continue in line with current trends. The year end position represents a slight worsening against the YTD position The main assumptions driving this are 0.2m of planned spend in Psychological Therapies to deal with waitlists and utilise underspend from vacancies. Circa 0.6m in CMHT s due to a revised Section 75 contract which started on the 1st September Offset by a 0.2m improvement in the OATS position in the second half of the year, due to a reduction in long term PICU/Rehab placements 9
Caring, safe and excellent Buckinghamshire Mental Health (cont.) Risks and opportunities Items not included in the forecast which may represent a risk to the financial position are as follows: 200k estimated increase in agency related to winter pressures (sickness cover in inpatient areas) Items not included in the forecast which may represent a benefit to the financial position are as follows: 500k related to SDF underspends against Community Mental Health Framework which are expected to be deferred into FY24 400k increase in income for the CAMHS Neuro Collaborative team for which expenditure is already forecast Actions Required Further work with Inpatient areas and Medical to reduce agency spend Recurrent plans for the Cost Improvement target 10
Caring, safe and excellent Specialised Services Month 7 Year-to-Date Forecast Plan m (19) 85 335 22 744 (650) 163 (170) (213) 37 (5) 328 Actual Variance m (55) 98 577 446 767 (433) 122 (46) (186) 128 (6) 1,411 Plan m (154) 592 2,712 1,704 5,209 (2,734) 1,294 (334) (1,401) Actual m (128) 390 2,447 1,803 5,464 (2,990) 1,500 (415) (1,458) 128 (44) 6,697 Variance Plan m (250) 1,014 4,649 2,921 8,929 (4,687) 2,219 (572) (2,401) 229 (65) 11,985 Forecast Variance Service Line Forensic Community Mh Forensic Mh - Pre Discharge Forensic Mh Services - Msu Forensic Mh Services -Lsu Forensic Pathway Forensic Support Lds Pathway Management & Indirect Pharmacy Prison In Reach Services Recovery College EBITDA m (35) 14 242 424 22 216 (41) 124 27 91 (1) 1,083 m 26 m (217) 720 4,010 2,669 8,969 (5,326) 2,814 (692) (2,416) 128 (74) 10,584 m 34 (202) (265) 99 256 (256) 205 (81) (57) 83 (6) (198) (294) (639) (252) 40 (639) 594 (119) (15) (101) (8) (1,401) 45 (38) 6,894 11
Caring, safe and excellent Specialised Services (cont.) Year-to-Date Performance Specialised Services report a 198k adverse YTD position due in main to a 367k overspend on Forensic Wards (agency costs, numbers above establishments due to acuity, and penalties for bed day occupation), 256k adverse position in Forensic Support due to agency Consultant usage, and pressure on the PFI budget, and 81k in Forensic Management due to remaining CIP target, offset against favourable positions in Learning Disabilities (LD) due to high number of vacancies, Forensic PC, due to less then planned expenditure (see PC section), and vacancies in the Prisons contract upon commencement of service. In month 7 1,068k of budget was transferred to Specialised from Reserves this was growth funding received from NHS England and mainly covered existing cost pressures. Forecast Outturn The forecast outturn is 1,401k adverse to budget driven by continued pressure on Forensic wards (although agency usage is reducing throughout, and bed occupancy has improved, apart from Thames House currently). Additionally, the forecast assumes that Consultant agency usage within Forensic Support will continue, along with the PFI spend. CIP plans are not based around a direct reduction in spend, so this is currently showing as a pressure offset against a forecast favourable position in LD, due to planned discharges in the coming months for all Out of Area Placements (OAPs), and continuation of vacancies. Risks and opportunities The main risks to the forecast outturn are any delays to planned discharges of LD OAPs, or any new admissions. These placements are very costly, so any changes will have a material impact on the position. In addition, any worsening on bed occupancy or agency usage controls in Forensics would have an adverse effect. Opportunities are centred around developing CIP plans in Forensics. Actions required The Directorate Accountant to work with Financial Accounts to see how much budget can be transferred from Interest Payable, to assist with covering the increasing PFI cost profile in Forensics. CIP plans need to be developed to meet the CIP targets recurrently Continued focus on reducing agency spend 12
Caring, safe and excellent Community Services Month 7 Year-to-Date Forecast Plan m 52 99 417 (1) (7) 158 (640) 493 84 Actual m Variance Plan m 368 693 2,926 (4) (12) 1,109 (1,680) 3,503 586 Actual m Variance Plan m 630 1,189 5,010 (7) (46) 1,901 (2,879) 5,971 1,005 Forecast Variance Service Line Children & Yp Care Community Dental Service Community Rehabilitation Complex Care Community Service First Contact & Primary Care Integrated Intensive Community Care Management Planned & Preventive Care CHC Primary Care Services EBITDA m 13 25 (90) m m (160) 1,289 (1,059) m 66 124 327 8 (360) 58 (3,088) (10) (980) 1,035 (171) (593) (749) (22) (4,879) (790) 100 (6,068) 752 (162) (13) (992) 2,144 (1,851) 2,911 (163) (22) 2,612 () 7 (94) 247 (352) 475 164 (87) 89 288 (19) 80 (1,786) 3,294 (3,389) 4,956 (530) (22) 2,592 (1,740) 1,393 (510) (1,015) (1,536) (22) (10,182) 656 956 300 7,491 12,773 13
Caring, safe and excellent Community Services (cont.) Year-to-Date Performance The Community YTD position is 4,879k adverse to budget. The main drivers for the position are the following: Community Hospitals 3,088k adverse due to pay variance of 2,894k with 1,519k Agency spend and 1,326k Sessional staff expenditure. First Contact and Primary Care 980k adverse driven by 1.1m pay expenditure due to high agency spend in GP Out of Hours and the Minor Injuries Units at 737k and 429k respectively. Sessional staffing spend is 462k across the pathway. The Directorate leadership team have undertaken an innovation week redesign of the service clinical and operating model of GP Out of Hours, leading to development of a new costed model with an operational saving on paper of c. 1 million per year. Continuing Healthcare (CHC) is 749k adverse to budget due to high agency spend in Buckinghamshire and Childrens CHC totalling 975k, 110k adverse in Oxfordshire CHC due to over establishment and unfunded care packages in Childrens CHC at 165k. These are offset by 443k favourable variance in Buckinghamshire CHC due to high vacancies. The Trust is developing a plan with the ICB which may involve exiting these service contracts at the end of this financial year (subject to Exec/Board agreement), which will remove this cost pressure. The District Nursing service within the Planned and Preventative Care pathway reports a 409k adverse position due to high agency costs. Forecast Outturn Community forecast outturn is 10,182k adverse to budget based on continuous pressure in the Community Hospitals, GP Out of Hours and Continuing Healthcare adjusted for winter pressures modelled on last 3 years trend. The forecast assumes that the District Nursing agency spend will reduce from January onward due to the new skill mix and recruitment plan in place, although there is a high risk that this will not be achievable due to service pressures and the need to ensure patient safety. Risks and opportunities Expenditure due to winter pressures could be more or less than the modelling used in the forecast. There is a risk of slippage in the District Nursing plan and difficulty to fill GP Out of Hours shifts could result in offering higher pay rates than forecast. Actions needed Agency spend across the directorate is very high especially in Community Hospitals a plan to reduce this is needed. Finance to support service developments 14
Caring, safe and excellent Corporate Services Month 7 Year-to-Date Forecast Plan m Actual m (1,145) (1,834) (1,167) (618) (407) (22) (476) (461) Variance Plan m (6,907) (11,540) (2,292) (6,089) (1,846) (339) (3,451) (3,052) Actual m (7,387) (11,461) (3,270) (5,512) (1,959) (248) (2,923) (3,038) (31) (35,828) Variance Plan m Forecast Variance m (13,562) (21,024) (6,045) (9,670) (3,329) (418) (5,267) (5,278) (31) (64,624) Service Line Digital & Transformation Estates & Facilities Finance Human Resources Medical Services Mental Health Directors Nursing & Clinical Standards Office Of Ceo Staff Bank EBITDA m m m (1,017) (1,694) (344) (900) (264) (51) (856) (444) (128) (140) (823) 282 (144) 29 379 (17) (7) (568) (479) 80 (978) 577 (114) 91 529 14 (31) (311) (11,841) (19,783) (3,930) (10,308) (3,164) (581) (5,862) (5,231) (1,721) (1,241) (2,115) 638 (165) 163 595 (47) (31) (3,924) (7) (5,569) (6,137) (35,517) (60,700) Year-to-Date Performance The Corporate Services YTD position is 311k adverse against budget. The Finance overspend of 978k adverse is mainly due to the Warneford Park project which is not budgeted for ( 807k YTD) and which is being temporarily held in Finance. Digital & Transformation is 479k adverse, mainly due to costs that were in the capital plan now being accounted for as revenue costs. The Human Resources underspend of 577k is mainly in Learning & Development due to vacancies and Apprenticeship levy income relating to last financial year which was received in this financial year. The Nursing & Clinical Standards underspend of 529k is driven by new transformation funding in the Oxford Health Improvement team resulting in vacancies which are actively being recruited to the forecast assumes that these vacancies will be filled in the coming months. Forecast Outturn The Forecast Outturn for Corporate Services is 3,924k worse than budget. This includes 4.2m of agreed spend which is not budgeted - 1.5m for clinical system costs that were originally in the capital plan (Digital & Transformation), 1.7m for costs related to the Warneford Park development (Finance) and 1.0m for non-recurrent backlog maintenance costs (Estates & Facilities). Other pressures include an increase in the South Central Ambulance Service patient transport contract in Estates & Facilities ( 407k) partly offset with other underspends and a historical pressure on clinical contracts with Oxford University Hospitals (mainly Pathology) show in the Finance position ( 236k). Most of these overspends will be regularised through allocating additional budget from the reserves. 15
Caring, safe and excellent Corporate Services (cont.) Risks and opportunities A credit note has been received for trainee doctors costs which will improve the Medical Services directorate position by 265k. This is not currently in the forecast but will be included from next month. The forecast may improve if additional costs included in the year-to-go position for clinical system development and backlog maintenance costs are less than planned due to the time constraint of completing the work before the end of March 2023. The forecast for the Warneford Park development needs to be worked on in more detail which could result in a change in the forecast. Actions Required Close monitoring of the additional spend in the YTG position to determine how much is likely to be committed by year-end to ensure the forecast is updated accurately each month. A project to re-tender for patient transport services to determine the budget required for this going forward. Budget setting to adequately budget for the Oxford University Hospitals contracts within the Finance Directorate. The Corporate Services directorates have 359k of unmet CIP targets. These are being offset in year by non-recurrent underspends but Directorates need to develop plans for them recurrently. 16
Caring, safe and excellent Research & Development Month 7 Year-to-Date Forecast Plan m (18) (3) (21) Actual m Variance Plan m (422) (23) (445) Actual m (134) (21) (155) Variance Plan m (794) (40) (834) Forecast Variance m (93) (41) (133) Service Line Research & Development Academic Health Science Network EBITDA m 31 () 31 m 288 m 701 13 (4) 10 2 () 290 701 Year-to-Date Performance Research & Development is currently 288k favourable against budget. This is from the release of Novavax vaccine trial income of 132k, Management savings including vacancies of 103k and Studies generating more income than budgeted of 125k. Forecast Outturn The forecast outturn is predicted to be 701k favourable at the year end. The bulk of this is from the full release of Novavax income, expected to be 618k at the year end. Also built into the forecast is Management savings of 261k, as well as 57k of additional Study income. Risks and opportunities Included in the forecast is 100k of costs for Estates work to create a new laboratory at the Clinical Research Facility at the Warneford Hospital. There is a risk that this work won't take place this year, increasing the forecast favourable variance further. Actions required To confirm whether the work can be completed on the new laboratory in this financial year. 17
Caring, safe and excellent Oxford Pharmacy Store Month 7 Year-to-Date Forecast Plan m 29 29 Actual m Variance Plan m 174 174 Actual m 270 270 Variance Plan m 327 327 Forecast Variance m 1,242 1,242 Service Line Oxford Pharmacy Store EBITDA m 12 12 m 95 95 m 915 915 41 41 Year-to-Date Performance The YTD position is 95K better due to savings on pay and non pay costs. Forecast Outturn The Forecast Outturn is 915K better than plan due to a one-off contract with NHS England for Covid-19 drugs distribution. Risks and opportunities There is an opportunity for further contracts with NHS England to distribute Covid-19 drugs with a high likelihood of an improvement in the forecast position of at least 500k. There is always a risk of lower than anticipated sales as they can be very unpredictable due to the nature of the dynamic market. Actions required The Senior Management Team to discuss implementing new measure to bring in new business and also review existing business to fill the sales gap. 18
Caring, safe and excellent 5. 5. Provider Collaboratives Financial Performance - Secure ANNUAL PLAN 2022/2023 YTD PLAN 2022/2023 YTD ACTUALS 2022/2023 YTD VARIANCE FY23 FORECAST FY23 Variance Service Item Description FORENSIC SERVICES OBD EPC Forensic Community 68,978,194 1,857,208 1,848,464 40,237,280 1,083,371 1,078,271 39,421,757 1,188,853 1,078,271 815,522 - 105,482 67,580,155 1,672,702 1,848,464 1,398,039 184,506 0 0 Total PCA 72,683,866 42,398,922 41,688,881 710,041 71,101,321 1,582,545 Infrastructure 1,743,845 1,017,243 761,576 255,667 1,743,845 0 Investment 11,150,215 6,504,292 6,504,292 0 11,150,215 0 Total contract Value 2022/23 85,577,926 49,920,457 48,954,749 965,708 83,995,381 1,582,545 NB position based on Tariff inflator and prices at 2.4%. Further adjustments pending Year-to-Date Performance The Secure Provider Collaborative (PC) YTD position is 966k favourable against budget. This is reported in the Specialised directorate but the underspend is not shown as income will be deferred at year-end. Patient care activity (PCA) is 710k favourable: occupied beddays (OBD) are 815k favourable offsetting overspend on extra packages of care (EPC) which are 105k adverse. The PCA position is reported as breakeven in the Specialised directorate in line with the principles of the PC to reinvest savings into services. Infrastructure costs are 256k favourable due less than planned expenditure across the FIND and provider collaborative teams. Forecast Outturn The Forecast Outturn for the Secure PC is 1,583k favourable to budget. This does not include potential benefits of accrued recharges and savings in respect of FY22 c. 2.4m. The principles of the PC are that savings are considered for re-investment over the period of the contract term and the underspend is not included in the Specialised directorate forecast. 19
Caring, safe and excellent Provider Collaboratives Financial Performance - CAMHS ANNUAL PLAN 2022/2023 YTD PLAN 2022/2023 YTD ACTUALS 2022/2023 YTD VARIANCE FY23 FORECAST FY23 Variance Service Item Description CAMHS Services OBD EPC Bekshire Day Care 20,669,383 1,796,354 1,992,537 12,057,140 1,047,873 1,162,313 10,712,675 1,253,084 1,162,313 1,344,466 - 205,210 18,364,585 2,148,143 1,992,537 2,304,798 - 351,789 0 0 Total PCA 24,458,274 14,267,327 13,128,071 1,139,255 22,505,265 1,953,009 Infrastructure 923,000 538,417 467,212 71,205 821,934 101,066 NB position based on Tariff inflator and prices at 2.4%. Further adjustments pending Total contract Value 2022/23 25,381,274 14,805,743 13,595,283 1,210,460 23,327,200 2,054,074 Year-to-Date Performance The CAMHS Provider Collaborative (PC) YTD position is 1,210k favourable against budget. This is reported in the Oxfordshire & BSW directorate but the underspend is not shown as income will be deferred at year-end. Patient care activity (PCA) is 1,139k favourable: occupied beddays (OBD) are 1,344k favourable offsetting overspend on extra packages of care (EPC) which are 352k adverse. The PCA position is reported as breakeven in the Oxfordshire & BSW directorate in line with the principles of the PC to reinvest savings into services. Infrastructure costs are 71k favourable due less than planned expenditure across the provider collaborative team. Forecast Outturn The Forecast Outturn for the CAMHS PC is 2,054k favourable to budget. This does not include potential benefits of accrued recharges and savings in respect of FY22 c. 3.8m. The principles of the PC are that savings are considered for re-investment over the period of the contract term and are not included in the Oxfordshire & BSW directorate forecast. 20
Caring, safe and excellent Provider Collaboratives Financial Performance Adult Eating Disorder (AED) ANNUAL PLAN 2022/2023 YTD PLAN 2022/2023 YTD ACTUALS 2022/2023 YTD VARIANCE FY23 FORECAST FY23 Variance Service Item Description CAMHS Services OBD EPC Transformation Funding Total PCA 7,271,935 4,241,962 4,896,130 - 654,168 8,121,365 - 849,430 0 0 0 0 0 0 0 0 - 654,168 4,241,962 654,168 - 850,000 7,271,365 850,000 570 7,271,935 4,241,962 0 Infrastructure 658,565 384,163 209,555 174,608 658,565 0 Total contract Value 2022/23 7,930,500 4,626,125 4,451,517 174,608 7,929,930 570 NB position based on Tariff inflator and prices at 2.4%. Further adjustments pending Year-to-Date Performance The AED Provider Collaborative (PC) YTD position is 175k favourable against budget. This is reported in the Oxfordshire & BSW directorate but the underspend is not shown as income will be deferred at year-end. Patient care activity (PCA) is breakeven: occupied beddays (OBD) are 654k adverse offset by transformation funding to support the transition to the integrated step care model (ISCM) of care. Infrastructure costs are 174k favourable due less than planned expenditure across the provider collaborative team. Forecast Outturn The Forecast Outturn for the AED PC is breakeven supported by transformation funding of 850k available in FY23 to support the double running during the implementation of ISCM. Delays in the implementation of the ISCM for which there is a further 850k available will give rise to a financial pressure over the remainder of FY23 of c. 0.2m. 21
Caring, safe and excellent 6. Covid-19 Costs Month 7 Year-to-Date Forecast Plan m 132 132 Actual m 947 947 Variance Plan m 927 927 Actual m 5,352 5,352 Variance Plan m 1,589 1,589 Forecast Variance m 8,818 8,818 Service Line Covid-19 Costs EBITDA m 815 815 m m 4,425 4,425 7,228 7,228 Year-to-Date Performance There is a 4,425k underspend on Covid-19 budgets YTD. The majority of this is non-recurrent Covid-19 funding which is being used to offset pressures elsewhere in the Trust ( 4,389k). The remaining variance is across vaccination centres ( 80k favourable) and the PPE Warehouse ( 44k adverse). Forecast Outturn The forecast is for a favourable variance of 7,228k. This is made up of a 96k adverse variance on the vaccination centres the funding for these changed from September 2022 to a tariff based system rather than all costs being re-imbursed and a 235k adverse variance on the PPE warehouse, offset with non-recurrent Covid-19 funding. Risks and opportunities Agency costs for the vaccination centres are showing as less in the finance system than in the Workforce Management system which suggest that they are understated. This will be investigated before next month but could result in the forecast deteriorating. There is uncertainty about how long the vaccination centres will continue to operate the forecast assumes until the end of the financial year but currently there is only agreement until the end of December. Actions required Finance to investigate the agency accrual and make corrections in month 8. The forecast will need to be updated as more details emerge on how long vaccination centres will operate The vaccination cost centres need to be moved into the Community Directorate as the vaccination service is now being managed by the Community leadership team. 22
Caring, safe and excellent 7. Pay Trends Total Pay Costs 45,000,000 40,000,000 35,000,000 30,000,000 25,000,000 20,000,000 15,000,000 10,000,000 5,000,000 0 Apr-21 May-21 Jun-21 Jul-21 Aug-21 Sep-21 Oct-21 Nov-21 Dec-21 Jan-22 Feb-22 Mar-22 Apr-22 May-22 Jun-22 Jul-22 Aug-22 Sep-22 Oct-22 Agency Bank Substantive Total Cost Budget The increase in pay costs and budget in September 2021 and September 2022 reflect when the pay award was paid to staff along with back pay. The increased costs in March 2022 reflect year-end accounting adjustments for pension costs The methodology for the agency accrual was changed in month 7 to no longer accrue for VAT for nursing and nursing support staff. However, this prompted analysis of the agency figures which showed a large increase in month on Medical staff. costs Further investigation has revealed some issues with the agency accrual workings which will be corrected for month 8. This is not material in terms of overall agency spend (the finance ledger figure is within 1% of the costs shown on the Workforce Management System) but does affect analysis of the trend. 23
Caring, safe and excellent Oxfordshire & BSW Mental Health Buckinghamshire Mental Health 6,000,000 14,000,000 12,000,000 5,000,000 10,000,000 4,000,000 8,000,000 3,000,000 6,000,000 2,000,000 4,000,000 2,000,000 1,000,000 0 0 Agency Bank Substantive Total Budget Agency Bank Substantive Total Budget Specialised The increase in budget in Specialised in October 2022 is due to budget which was transferred from Reserves this was growth funding received from NHS England and mainly covers existing cost pressures. 4,000,000 3,500,000 3,000,000 2,500,000 2,000,000 1,500,000 1,000,000 500,000 0 Agency Bank Substantive Total Budget 24
Caring, safe and excellent Community Corporate 6,000,000 10,000,000 9,000,000 5,000,000 8,000,000 7,000,000 4,000,000 6,000,000 5,000,000 3,000,000 4,000,000 2,000,000 3,000,000 2,000,000 1,000,000 1,000,000 0 0 Agency Bank Substantive Total Budget Agency Bank Substantive Total Budget 25
Caring, safe and excellent 8. Agency Analysis Temporary Staffing as % Total Pay Spend Temporary Staffing Spend Bank as % of Total pay Agency as % of Total pay Agency Actuals Bank Actuals Total Temp Staffing Actuals 27.00% 8,200,000.00 22.00% 7,200,000.00 6,200,000.00 17.00% 5,200,000.00 4,200,000.00 12.00% 3,200,000.00 7.00% 2,200,000.00 1,200,000.00 2.00% 200,000.00 At month 7 25.5m has been spent on agency staff (excluding 6.3m for agency staff at the Covid mass vaccination sites). This is 13% of total staff costs. Note that the graphs above exclude spend in the Covid-19 vaccination centres to show a normalised position. Please refer to the HR report for further details. 26
Caring, safe and excellent 9. 9. Cost Improvement Programme (CIP) CIP / PIP Delivery at Month 07 FY23 FY FY Plan '000 6,067 9,044 YTD Target '000 4,625 3,284 YTD Actual '000 3,447 1,219 YTD Variance '000 -1,178 -2,065 Forecast Variance '000 -2,068 -5,917 Forecast Target '000 7,929 9,044 Projects '000 5,862 3,128 CIP Programme PIP Schemes / Agency Reduction Covid Costs Reduction Total 0 0 0 0 0 0 0 16,974 15,111 7,909 4,666 -3,244 8,989 -7,985 CIP Programme: In line with NHS efficiency requirements that Trust has a CIP target of 7.9m. Budget reductions totalling 7.9m were applied to all Directorates at the start of Financial year. These were reduced by 2.8m in month 7 through allocating reserves to directorates recurrently and this is now shown as CIP delivery. This was a result of agreement by the Executive Team to use available reserves to reduce the requirement for CIPs. Plans to deliver the 7.9m target total 5.9m. Savings reported as at the end of month 7 are 3.4m, 1.2m adverse to target. PIP Programme Schemes : The PIP programme encompasses schemes that are cost avoidance i.e. expenditure items for which there is no funding. It is centred on initiatives to reduce agency costs e.g. price reductions and usage. The target is a 9.0m reduction. The IQRA programme has delivered 1.2m reductions as at the end of month 7, 2.1m adverse to target. Covid Cost Reduction: Covid cost reductions is a cost avoidance programme to address the continuance of expenditure incurred during the 2 year covid period. It is centred on initiatives to reduce staffing costs and the use of ISP contracted beds that have become business as usual and to challenge their validity in the context of the retained covid budget of 7.3m. 27
Caring, safe and excellent 10. Out of Area Placements (OAPs) OAPS are 2.1m overspent at month 7 1.8m in Oxfordshire and 264k in Buckinghamshire. This includes the cost of the Elysium block contract beds at Potters Bar & Chadwick Lodge, which have reduced from 21 beds in April to 4 in October. These costs exclude Secure Transport spend which is currently 270k across the two directorates. 28
Caring, safe and excellent Oxon & Bucks OAPS Spend by bed type The above graphs show spend a sharp increase in cost against Acute beds in month 1 of FY23. This is due to allocations of costs prior to this period being reclaimed from national COVID funding. There was a sharp decrease in cost for Oxon Acute OAPs in month 4 due to release of an FY21 provision There has been a decrease across FY23 in both Oxon & Bucks against Acute bed usage A small increase against PICU beds in Buckinghamshire can be seen there are limited PICU beds available within the trust and this is a male only ward meaning that all female patients requiring a PICU bed are placed out of area Still out at the end of October: Oxon has 5 Acute, 1 PICU, 7 Rehab and 1 Continuing Care beds being used and in Bucks there is 1 Rehab bed 29
Caring, safe and excellent 11. Statement of Financial Position Statement of Financial Position as at 31st October 2022 1. Non-current assets have increased by 24.7m in-year. The in- year increase is driven by the capitalisation of 28.9m of leased assets in accordance with the accounting standard IFRS16 which was adopted by the Trust from the 1st April, and capital additions of 2.7m in the seven month of the year. These additions were offset by depreciation of 6.78m. 31 March 2022 Movement Month 6 FY22 Month 7 FY23 Year to date '000 In month '000 '000 '000 '000 Non-current assets Intangible Assets Property, plant and equipment Finance Leases Trade and other receivables 6,390 155,907 5,529 156,352 26,290 5,442 156,075 25,459 (949) 168 25,459 (88) (277) (831) 0 2. Trade and other receivables have increased by 20.3m in year and 7.8m in month. Most of the in-year increase is due to an increase in accrued income of 8.7m ( 5.7m Provider Collaborative pass through costs & 1.9m Vaccination Centre) and prepayments of 3.8m. 487 499 499 12 0 (1,196) 162,784 Total non-current assets 188,670 187,475 24,690 Current Assets Inventories Trade and other receivables Non-current assets held for sale Cash and cash equivalents Total current assets 2,003 19,702 2,468 32,229 3,005 40,049 1,001 20,347 537 7,819 0 (2,328) 6,028 3. Cash has decreased by 2.3m in month and 16.6m in year. The decrease is in line with the cash flow statement and is largely due to cash payments against financing activities of 5.4m, payments for capital assets of 7.9m (mostly from FY22) and net working capital outflows of 1.4m. 0 0 0 89,517 111,223 75,240 109,937 72,911 115,965 (16,606) 4,742 Current Liabilities Trade and other payables Borrowings Other financial liabilities Finance Leases Provisions Deferred income (75,128) (2,817) (76,641) (1,971) (1,788) (5,530) (3,017) (18,840) (77,302) (2,023) (1,788) (5,447) (3,071) (24,480) (2,174) 794 (1,788) (5,447) (598) (1,696) (661) (52) 0 83 (54) (5,641) 4. Trade and other payables have increased by 2.1m in year and decreased by .6m in month. Increases in accrued expenditure and tax/pension liabilities of 9.6m in year have been offset by decreases in other payable balances of 8.0m 0 (2,473) (22,784) (103,203) Total Current Liabilities (107,787) (114,112) (10,910) (6,326) Non-current Liabilities Trade and other payables Borrowings Finance Leases Provisions Other Liabilities Total non-current liabilities Total assets employed 5. Short term finance lease liabilities have increased by 5.5m in year following the capitalisation of leased assets see note1. 0 0 0 0 (15,784) (15,664) (21,360) (4,182) (1,132) (42,338) 148,483 (15,614) (20,466) (4,148) (1,132) (41,359) 147,968 170 50 894 35 0 979 (515) 0 (20,466) 6. Deferred income has decreased by 1.6m in year and 5.6m in month. (4,524) (1,132) (21,440) 149,364 376 0 (19,919) (1,396) 7. Long term finance leases have increased by 20.4m in year and decreased by 0.9m in-month (repayments against liability) following the capitalisation of leased assets see note 1. Financed by (taxpayers' equity) Public Dividend Capital Revaluation reserve Other reserves Income & expenditure reserve 107,619 27,469 107,619 27,446 107,619 27,446 1 0 0 0 (23) 0 0 0 8. The in-year movements in the I&E reserve reflect the Trust s reported surplus for the year of 1.3m. 14,276 13,417 12,902 (1,374) (515) 149,364 Total taxpayers' equity 148,483 147,968 (1,396) (515) 30
Caring, safe and excellent 12. Cash Flow STATEMENT OF YEAR TO DATE CASH FLOWS Summary Notes Month 7 FY23 Actual '000 Plan '000 Variance '000 The cash flow movements are consistent with the comments made on the Statement of Financial Position. Cash flows from operating activities Operating surplus/(deficit) from continuing operations Operating surplus/(deficit) from discontinuing operations Operating surplus/(deficit) 642 395 247 The closing cash position at Month 07 was 72.9m. 0 0 0 642 395 247 Non-cash income and expense: Depreciation and amortisation Impairments and profit on disposal of assets Income recognised in respect of capital donations (cash and non-cash) (Increase)/Decrease in Trade and Other Receivables (Increase)/Decrease in Inventories Increase/(Decrease) in Trade and Other Payables Increase/(Decrease) in Deferred Income Increase/(Decrease) in Provisions Other Movements in Operating Cashflows NET CASH GENERATED FROM/(USED IN) OPERATIONS 6,724 6,638 86 0 0 0 0 0 0 (20,444) (1,001) 6,909 3,484 1,967 (22,411) 0 (13,341) (3,750) 234 0 (7,857) (1,001) 20,250 7,234 (12) 222 0 0 (3,465) 4,392 Cash flows from investing activities Interest received Purchase of Non Current Assets Sale of PPE Net cash generated from/(used in) investing activities 583 154 429 (63) (7,719) (7,656) 0 0 0 (7,136) (7,502) 366 Cash flows from financing activities Public dividend Capital Received Loans received Loans repaid Capital element of lease rental payments Capital element of Private Finance Initiative Obligations Interest paid Interest element on leases Interest element of Private Finance Initiative obligations PDC Dividend paid Net cash generated from/(used in) financing activities 0 0 0 0 0 0 0 (669) (2,705) (301) (317) (153) (481) (1,378) (6,005) (669) (3,115) (300) (321) (150) (482) (1,310) (6,347) 410 (1) 4 (3) 1 (68) 342 (16,606) 89,517 72,911 (21,706) 89,517 67,811 5,100 Increase/(decrease) in cash and cash equivalents Cash and Cash equivalents at 1st April Cash and Cash equivalents at 31st October 0 5,100 31
Caring, safe and excellent 13. Working Capital Indicators Working Capital Ratios Ratio Target Actual Risk Status Debtor Days 30 59 Debtors % > 90 days 5.0% 14.5% Creditor Days 30 50 BPPC NHS - Value of Inv's pd within target (ytd) 95.0% 91.0% BPPC Non-NHS - Value of Inv's pd within target (ytd) 95.0% 91.0% Cash ( m) 68.8 72.9 Summary Notes Debtor days at month 7 were below target. Debtors % over 90 days are below target due to overdue invoices, specifically with Oxfordshire CCG 1,106k, NHSE 485k and other NHS Provider Collaborative organisations 2,573k. The Creditor days position is below plan due to the high level of accruals for Non-NHS suppliers and the below target BPPC figures. NHS BPPC (which represents 20% of non-pay expenditure) is below target for the year, but is on target in month at 95% Non-NHS BPPC (which represents 80% of non-pay expenditure) is below target for the year, but is only marginally below target in month at 93% . Cash is above target, as outlined in section 7 and 8. 32
Caring, safe and excellent 14. Capital Investment Programme The Trust received an ICS capital allocation of 9,937k. In addition, the Trust is also able to draw on funding from the sale of Trust properties (Shrublands and Harlow - 1,382k), VAT credit reclaims 1,000k and 422k NHS Digital Unified Tech Funding (UTF) in relation to devices and infrastructure and other estates backed PDC of 1,140k. In total therefore, the Trust has 13,881k capital funding in FY23. The first phase of the FY23 capital plan totals 12,356k out of a total funding pot of 13,881k. The balance of funding will be spent on the RIO Electronic Patient Record System 229k, and a range of high-risk projects totalling 2,967k, bringing the total FY23 capital programme to 15,552k. The resulting funding shortfall of 1,671k will be managed as part of the ICS s overall capital allocation. New leases anticipated in FY23 (signed and unsigned) have a capital additions value of 4,116k. The year-to-date actual spend is 2,783k and the forecast outturn is 15,857k, an overspend against budget of 305k. 33
Caring, safe and excellent 15. Reconciliation to NHSE/I Template The financial figures reported in this report are taken directly form the finance ledger. The financial figures reported to NHSE/I each month differ from these figures as they exclude income and costs related to the Section 75 pooled budget and are some minor adjustments to the categories certain items are reported under. The table below provides a reconciliation between the figures reported in this board report to the figures reported on the NHSI template. YTD Actuals at month 7 FY22 National supplied PPE Remove Section 75 Income and Costs Category Changes Board Report NHSI Template m m -2.5 m m m Clinical Income Other Operating Income Operating Income, Total 235.8 41.2 277.0 233.3 41.2 274.5 -2.5 0.0 0.0 Employee Benefit Expenses (Pay) Other Operating Expenses Operating Expenses, Total 178.1 92.2 270.3 -2.4 -0.2 -2.5 175.8 92.1 267.8 0.0 0.0 Non-Operational Income 0.0 EBITDA 6.6 0.0 0.0 0.0 6.6 Profit/(Loss) on asset disposal Depreciation and Amortisation Asset Impairment Interest Other Finance Charge PDC Dividend -0.1 5.8 0.0 0.1 0.4 1.3 -0.1 5.8 0.0 0.1 0.4 1.3 Surplus/ (Deficit) -0.9 0.0 0.0 0.0 -0.9 34
