200708 Service

1
2007/08 Service Financial Performance
Incorporating Month 10 and Q3
SHA Board 26 March 2008
2
Contents
Topic Slide Highlights and Key
Themes 3 Financial Overview - 4 Trust
Performance - 7 Trust Q3 risk
ratings - 12 PCT Performance - 15 PCT Q3
risk ratings - 20 Appendices - 22 Appendix
1 Service Performance - 23 Appendix 2 SHA
Financial Performance - 38
3
Highlights and Key Themes

• Month 10 forecast outturn of 300m is in line
  with the control total set at Month 7 and
  incorporates the additional investment programme
  agreed at that time
• Stronger financial performance overall is
  reflected in improved financial risk ratings at
  Q3, with only 4 PCTs and 4 Trusts remaining in
  the lowest rating band. We are accelerating the
  work to develop sustainable solutions for the
  small number of organisations with significant
  historic debts.
• Progress on governance improvement has also been
  strong, and we are proposing 5 more Trusts and 2
  PCTs for promotion to green ratings
• Intensive action to improve data quality and
  reduce backlogs has resulted in a strong
  improvement in 18 week access to treatment
  performance in recent months. However, we remain
  slightly behind the relevant trajectories and are
  likely to miss the March milestone for admitted
  patients by a small percentage. We have
  intensified our support to the most challenged
  Trusts and PCTs to ensure success in meeting the
  final December 2008 targets.
• A number of Trusts are still failing to deliver
  on the 98 AE 4 hour wait standard. We have
  activated escalation procedures and provided
  intensive support to those who require it. As a
  consequence we expect most organisations to
  return to a 98 run rate in the coming weeks.
• MRSA cases have been reduced by 30 over the last
  year, and the rolling 3-month performance is
  within the target level set by the Department of
  Health for the SHA as a whole going forward. We
  continue to work intensively with the small
  number of Trusts who are regularly exceeding
  their trajectories. C diff cases also continue
  to fall sharply.

4
Overview
5
Service Financial Performance Pan London
Financial Overview at Month 10

• Adjusted Plan reflects the impact of FT part year
  starts
• Adjusted M7 reflects the impact of movement in
  PCT lodgings/surplus as a result of the
  additional investment programme
• Month 7 Forecast Outturn set as Control Total for
  both NHS London and individual Trusts/PCTs

6
Use of Surplus Short Term and Long Term
Investment

• Short Term
• Additional investment plans for 2007/08
  incorporate the following-
• Infection control
• 18 weeks getting ahead
• Early discharge
• Health promotion
• Primary care access quality
• Accelerating capability investments and HfL
  preparation
• LPfIT ICT
• LAS improvements
• Long Term
• Need for surplus carry forward to deliver
  strategic ambitions-
• HfL investment in upgrading extending the
  range reach of primary care services pump
  priming double running required
• Investment in the public health / staying healthy
  agenda e.g. new programmes in areas such as
  vascular prevention
• MPET funding to invest in the transformational
  workforce strategy
• CSR settlement higher than expected but slowing
  down compared to previous years

7
Trust Performance
8
Overview of 07/08 Financial Performance

• Foundation Trusts
• During the course of the year 3 organisations
  achieved foundation status (East London and the
  City Mental Health Trust Central and North West
  London Mental Health Trust and Camden and
  Islington Mental Health Social Care Trust) with
  an adverse impact on planned out-turn
• At the outset of the year 14 trusts had planned
  to achieve FT status. The significant slippage
  in the pipeline has also been seen at the
  national level
• Financially Challenged Trusts
• We have been working with our 7 financially
  challenged organisations (BHRT, Bromley,
  Lewisham, QMS, QEH, West Middlesex and Whipps X)
  on a range of solutions to resolve their current
  levels of debt (estimated will be 336m as at 31
  March 2008) and cummulative deficits (estimated
  will be approximately 244 as at 31 March 2008)

Source Trust Annual Plan Templates. Original
Plan figures taken from prior year Board Seminar
pack 2007/08 Outturn include FT balances
apportioned to the date of authorisation

• Financial Performance
• In aggregate the trusts are expected to deliver a
  surplus of c.25m compared with an original
  annual plan surplus of 27m
• Within the overall position a number of
  organisations have significantly under-performed
  (including BHRT-26m Bromley-16m), primarily
  due to CIP shortfalls, and over-performed
  (including Imperial 10m Barts and the London
  7m and Epsom and St Hellier 7m)

9
NHS Trust Financial Performance (excluding FTs)

• Overall Trust position at M7 per summary includes
  a provision for anticipated increase in Trust
  forecast outturn due to additional investment in
  meeting 18 weeks target (4.9m)
• Excludes FTs authorised in year

Key Red adverse variance from Plan
Yellow movement gt 1m from Control Total
10
NHS Trust Financial Performance - Significant
adverse variances

• Trust
• Barking Havering Redbridge Hospitals
• (M10YTD 28.8m deficit, FCOT 39.9m deficit plan
  was 14.3m deficit).
• Control Total set at M7 at 39.9m deficit
• Bromley Hospitals
• (M107YTD 12.9m deficit, FCOT 18.7m deficit
  plan was 2.8m deficit).
• Control Total set at M7 at 9m deficit
• North West London Hospitals (M10YTD 1.8m
  deficit, FCOT breakeven plan was 6m surplus).
• Control Total set at M7 at 1.3m surplus
• Whipps Cross
• (M10YTD 1m deficit, FCOT 1.1m deficit plan was
  4.7m surplus).
• Control Total set at M 7 at 1.1m deficit.

• Reasons
• Failure to implement 25m CIP, resulting in
  deterioration to forecast IE deficit, from 14m
  in Q1 to 40m at Q2.
• IE forecast has deteriorated between M7 and M9
  and reflects an adverse movement from both plan
  and control total.
• Shortfall in SLA income and CIPs, budget
  overspends and revised PFI accounting treatment.
• IE forecast has deteriorated between month 7 and
  month 9 and reflects an adverse movement from
  both plan and control total.
• Deterioration in forecast due to need to deliver
  greater activity to achieve 18 weeks milestones
  at costs above tariff.
• Unidentified CIPs (3.5m) and further operational
  pressures/slippage on identified CIP schemes
  (3.2m).

• Actions
• New Interim CEO and FD recently appointed.
• Provider Agency has agreed an action plan with
  the Trust to strengthen financial controls, which
  is being closely monitored.
• Weekly cash-flow reporting from the Trust to the
  Provider Agency.
• Trust has implemented a revised Turnaround
  Programme and project management structure. First
  draft of 3 year programme to be reviewed by the
  Provider Agency in December.
• Interim CEO appointed by NHSL June 2007.
• Trust provided a recovery plan in October which
  is being closely monitored by Provider Agency.
• As part of the Financially Challenged Trust
  process the Provider Agency has facilitated the
  four outer south east London (OSEL) trusts in
  defining inter-trust opportunities for
  efficiency).
• Trust has strengthened internal performance
  management/ accountability, resulting in
  mitigating actions being identified and improving
  forecast outturn.
• Trust has engaged Healthworks to ensure
  improved delivery of 2007/08 CIPs and identify
  sustainable savings for 2008/09 onwards.
• Monthly progress reviews with Provider Agency.
• Trust is implementing recovery plan to improve
  the forecast position which the Provider Agency
  is closely monitoring.

11
NHS Trust Financial Performance - Significant
favourable variances

• Reasons
• 3m improvement between M7 and M9.
• Improved position due to a court ruling in favour
  of Trust giving a benefit of 0.8m, debt recovery
  of 1.2m, avoidance of redundancies following
  loss of Pathology SLA, underspends within
  clinical directorates of 2.1m, reduced income
  losses following transfer of services and closure
  of private patient ward and higher interest
  received. Combined these have resulted in an
  improved benefit of 8.5m compared to the M7
  forecast offset by increased staff costs of 4.1m
  and standardisation of asset lives following the
  merger.
• Higher YTD surplus primarily due to
  income/activity over-performance.
• Improved forecast due to release of 6m provision
  for redundancies due to happen in 07/08 as part
  of the recovery plan Trust feels provision no
  longer needed as staff leaving through natural
  wastage.

• Actions
• Trust is examining all options to hit the agreed
  control total.
• Ongoing Monitoring by Provider Agency
• Trust expects the income over- performance to
  stop and reduce over the reminder of the
  financial year.
• Ongoing monitoring by Provider Agency.
• Ongoing monitoring by Provider Agency.

• Trust
• Imperial College Healthcare
• (M10 YTD 12.3m surplus, FOT 13m surplus
  original plans were 3.4m surplus).
• Control Total set at M7 was 10m surplus.
• Barts the London
• (M10 YTD 15.4m surplus, FOT 12.5m surplus plan
  was 5.4m surplus).
• Control Total set at M7 was 12.5m
• Epsom St Helier
• (M10 YTD 0.8m deficit, FOT 0.5m surplus plan
  was 6.5m deficit).
• Control Total set at M7 was 0.5m surplus

12
NHS Trust Q3 risk ratings
Note Forecast outturn at Q3 not M10 FIMs, which
also excludes FTs
13
Trust Quality and safety ratings

• For acute trusts
• MRSA year-on-year reduction targets breached/will
  be breached by 15 Trusts vs the 20 indicated at
  the beginning of the year.Cdif although not
  yet measured as a target, will become an issue
  for 08/09 as some trusts are missing expected
  target
• Maximum wait of 4 hours in AE breached/due to be
  breached by 18 Trusts vs the 10 indicated at the
  beginning of the year
• Progress towards 18 week maximum wait likely to
  be breached by 4 Trusts vs 6 at the beginning of
  the year.
• Maximum wait of 6 months for inpatients breached
  by 4 Trusts despite only 1 trust indicating a
  problem at the beginning of the year
• Patients with operations cancelled for
  non-clinical reasons to be offered another
  binding date within 28 days breached by 4 Trusts
  vs 2 at the beginning of the year
• Minimising delayed transfers of care by 2008
  breached by 5 Trusts despite only 1 indicating
  this as an issue earlier in the year
• 7 Trusts breached other national core standards
• For Mental Health Trusts and London Ambulance
  Service
• Targets are limited and have been achieved by all
  but 1 trust.

4 20 6
3 19 8
Count Red Count Amber Count Green
Note Excludes CNWL and ELCMHT FTs at 1st May 07
and 1st November 07 respectively
14
Q3 2007/08 Quality and Safety risk ratings
Queen Elizabeth
Imperial College
Barnet Chase
Weighting
Royal Brompton
West Middlesex
North Middlesex
Great Ormond
Street Hospital
The Hillingdon
Royal National
Ealing Hospital
NWL Hospitals
Queen Mary's
Barts and the
Newham UHT
Orthopaedic
Epsom St
Healthcare
Royal Free
Harefield
Whittington
St George's
Lewisham
Whipps X
Hospitals
Kingston
Hospitals
Bromley
Hospital
Hospital
Hospital
London
Mayday
Sidcup
BHRT
Helier
Farm
Core Standard/Target
Max. 31 days diagnosis to treatment for all
1.0
cancers
Max. 62 days urgent referral to treatment
1.0
for all cancers
Max. waiting time of 6 months for inpatients
1.0
Max. waiting time of 13 weeks for outpatients
1.0
MRSA year on year reduction
1.0
Progress on 18 weeks
Sexual health -48hr access to GUM clinic
N/A
N/A
1.0
N/A
N/A
N/A
N/A
by 2008
Imp. of choice booking - elective O/P
1.0
booking
Max. wait of 4hrs in AE
N/A
N/A
N/A
0.4
All pts cancelled ops offered another date
0.4
within 28days
All MIs to receive thrombolysis within 60 mins
N/A
N/A
N/A
0.4
of call
Max. wait of 3 months for revascularisation
0.4
N/A
N/A
N/A
Max. wait of 2 weeks for urgent GP referral to
0.4
O/P for suspected Cancer
Max. wait of 2 weeks for Rapid Access Chest
0.4
N/A
Pain Clinics
Minimising delayed transfers of care by 2008
0.4
1
Other Core Standards
5
1
3
2
4
0.4
1
Overall Quality Safety Rating
Breach
15
PCT Performance
16
PCT Financial Performance

• Overall PCTs are forecasting a surplus of 100m
  against a Plan of 17m. This has been mainly
  driven by
• Prescribing underspends
• Stronger than anticipated carry forward from
  2006/07
• Contingencies within plans at the start of
  2007/08 of a minimum of 0.5 which have not been
  required to offset risks in year
• No PCT agreed a deficit Plan at the beginning of
  the year.
• Three PCTs forecasting a year end deficit in
  2007/08.

17
PCT Financial Performance
Key Red adverse variance from Plan
Yellow movement gt 1m from Control Total
18
PCT Financial Performance - Significant adverse
variances

• Actions
• New FD recently appointed.
• Since month 10, the Care Trust have agreed fixed
  outturn positions with main providers to minimise
  risk and undertaken a detailed bottom up review
  which has reduced the exposure to the overspend
  previously forecast and released reserves and
  underspends to bring the latest FOT back to the
  plan of breakeven.
• SHA continuing to closely monitor.
• The PCT are implementing and continuing to work
  on mitigating actions and have presented an
  updated plan to the SHA.
• SHA continuing to closely monitor.
• The PCT has a recovery plan and is working hard
  to deliver a balanced position. Going forward
  the organisation has developed plans to
  demonstrate its financial sustainability in a
  challenged health economy.
• SHA continuing to closely monitor.
• No further action required as PCT still achieving
  above statutory duty of breakeven.

• Reasons
• Acute contract overperformance on key contracts
  based on latest notified position by the Trusts.
• Reflects completed findings of a full review of
  the financial position undertaken by the new
  interim management.
• Revised savings and successful outcome of
  negotiations with Barnet Chase Farm NHS Trust.
• Despite continued pressure on acute
  overperformance, the PCT has seen a stemming of
  activity which they are working to sustain. The
  forecast deficit position is a reflection of
  increased activity greater than planned in a
  number of areas including critical care.
• Reflects technical restatement of contingency
  within forecast outturn.

• PCT
• Bexley Care Trust
• (M10YTD 2.4m deficit, FCOT 2.9m deficit plan
  was breakeven).
• Control Total set at M7 was 2.9m deficit.
• Enfield PCT
• (M10YTD 11.3m deficit, FCOT 13.3m deficit plan
  was breakeven).
• Control Total set at M7 was 9.95m deficit.
• Hounslow PCT
• (M10YTD 2.2m deficit, FCOT 2.4m deficit plan
  was breakeven).

19
PCT - Significant favourable variances

• PCT
• Brent PCT
• (M10 YTD 1m surplus, FOT 1.8m surplus original
  plans were breakeven).
• Control Total set at M7 was 1.6m deficit.
• Hammersmith and Fulham PCT
• (M10 YTD 10.7m surplus, FOT 12.5m surplus plan
  was breakeven).
• Control Total set at M7 was 10m surplus
• Kingston PCT
• (M10 YTD 4.9m surplus, FOT 3.5m surplus plan
  was breakeven).
• Control Total set at M7 was 1.5m surplus

• Reasons
• Improvement due to review of financial management
  systems, reduction in capital charges estimate,
  large number of vacancies within provider
  services and continued review of expenditure on
  continuing care.
• Improvement due to benefit of Market Forces
  Factor following creation of Imperial College.
  The benefit was not expected. In addition, risks
  have not materialised and as such contingency
  held has been released and the PCT has benefitted
  from higher levels than expected of prescribing
  savings.
• Improved forecast due to underspends within the
  Provider Arm, an improved prescribing position,
  corporate services vacancies and review of
  2006/07 accruals offset by commissioning
  overspends.

• Actions
• PCT are actively working to deal with remaining
  upside and downside risk and are in regular
  dialogue with the SHA
• PCT have set a 3 5 year financial plan which
  shows investments and addresses impact of
  non-recurrent savings.
• SHA continue to monitor.
• PCT are working to stabilise forecast and bring
  forward investment plans wherever possible.
• SHA continues to closely monitor.

20
PCT Risk Ratings Q3
? Increase from Q2, ? Decrease from Q2
21
Proposed Changes to PCT Ratings for Q3
25
FINANCE

• The Board is asked to confirm the change to the
  following PCTs finance ratings from a 2 to a 3,
  and (for Hillingdon from a 1 to a 2) in line with
  their better than planned financial position at
  month 9
• - Havering - Lewisham - Sutton Merton -
  Waltham Forest - Hillingdon
• The Board is asked to confirm the change to the
  following PCTs finance ratings from a 2 to a 1,
  due to their deterioration in position at month
  9, in line with the ratings scoring methodology
  
• - Bexley - Hounslow

GOVERNANCE

• The Board is asked to confirm the change in
  rating from amber to green for Newham and Waltham
  Forest PCTs and from red to amber for Hillingdon
  PCT, as governance issues which impacted on the
  initial rating have now been resolved
  satisfactorily

• n

QUALITY AND OUTCOMES

• The Board is asked to confirm the change in
  ratings in accordance with the scores shown in
  the previous page. The scores relating to the
  separate elements for key targets and other
  targets are shown for information
• All PCTs with the exception of Tower Hamlets will
  remain on monthly monitoring in accordance with
  the Regime. Monthly review meetings will be
  held with PCTs where the latest available
  information indicates that this is appropriate

• n

22
Appendices

• Service Performance
• 2 SHA Financial Performance

23
Appendix 1 - Service Performance
24
AE waits in 4 hours - trend
25
AE waits in 4 hours performance by Trust
26
AE the position

• YTD performance is 97.4 (13 Trusts/FTs are above
  98 and 14 are below)
• Performance has deteriorated sharply over the
  last 3 months, at 95-96 each week
• Over this recent period London is performing
  worse than the other SHA regions
• A few Trusts have been consistently well below
  98, BHRT YTD performance is 91.9, Whipps Cross
  is 95.6 and Bromley Hospitals is 95.8
• Winter pressures, in terms of bad weather and
  seasonal flu havent been an issue
• Norovirus has affected a few Trusts (e.g. St.
  Georges)
• Delayed transfers of care have been an issue in
  just a couple of places (BHRT Lewisham), which
  has been actioned to reduce delays
• There is some anecdotal evidence of bed pressures
  being exacerbated by greater focus on isolation
  of patients with HCAIs, but it does not appear to
  be that significant
• Staffing shortages are a major problem in a
  couple of the worst performing Trusts (BHRT
  Bromley) with shifts unable to be filled with
  locums or NHSP and bank/agency sources

27
AE action taken by the SHA

• All Trusts below 98 were asked to produce
  recovery trajectories to indicate their recovery
  pathway to sustainable 98
• A weekly review is undertaken by the Provider
  Agency CE and the Director of Finance
  Performance including on the need for
  intervention and further support to challenged
  Trusts
• Key under-performing Trusts with their PCTs
  called in to see NHS London, to examine what the
  problems are, what they are doing to tackle them
  together, and whether NHS London can help
• Expert support has been working with Trusts
  (BHRT, Bromley, Whipps Cross, West Middx, Ealing,
  Lewisham, St. Georges, plus NWLHs and Barts and
  the London have their own support), to review
  against established best practice and make
  recommendations for improved performance. The SHA
  is monitoring delivery of the agreed action plans
  
• We have circulated learning points from the
  intervention teams to all CEs
• Trust performance is being closely monitored with
  a view to sending in further intervention visits
  as required
• Most challenged Trusts and PCTs called in for
  second round of follow-up meetings to confirm
  necessary focus on the situation and what
  progress has been made and Chairs and CEs have
  been called in to see the SHA Chair and CE

28
Ambulance response times (to w/e 9 March)
29
HCAIs MRSA trend
There has been a 30 reduction over the last
year, although the rate of decrease has now
slowed.
The number of Trusts at or better than trajectory
for the last 3 months has increased to 14 out of
31
SHA target set by DH is 210
14 above trajectory at Feb.08
Further 20 reduction needed to achieve March
3-month rolling trajectory
Against annual trajectory the Trusts most over
target are Hillingdon Ealing Barts the
London Newham North Middlesex Epsom St
Helier Queen Elizabeth Whittington
30
HCAIs C. diff. trend (ages 65)
Most of the reduction is at a few Trusts, some of
which had very high historical levels, i.e.
Whipps Cross (-51), BCF (-52), QEH (-69),
BHRT (-58)
There has been a year-on-year increase at 16
Trusts as at Q3, e.g. UCLH (54), Ealing (43),
Royal Free (30), Epsom St Helier (22)
After a fairly long static period there was a big
fall in Q2, which has improved again in Q3
31
HCAIs - action

• We have received a central allocation of 5m for
  MRSA which is being used to support a wide range
  of initiatives by Trusts and PCTs to improve
  infection control
• We are setting up a network of the DIPC's and
  senior infection control nurses mainly to improve
  their insight and leadership in taking the HCAI
  agenda forward
• We are in regular contact with those Trusts which
  are off trajectory to check on progress with
  their action plans and visits from the
  Turnaround Director for HCAI are being targeted
  to specific trusts
• We are working with the HPA both about data and
  potential actions that Trusts could take forward
  to make improvements C. diff. will become a
  much higher focus with the new national target
  for 2008-11, building on the start made with
  local targets
• Trusts have been requested to benchmark
  themselves against the HCC Maidstone Tunbridge
  Wells report and to produce an action plan for
  improvements.  These plans have been reviewed by
  the SHA (see separate report)
• We will also be commencing work with PCT's about
  their own provision, and also their commissioning
  and performance management role with their
  providers

32
18 weeks RTT (admitted) - actual v. plan
(commissioner)
PTL data not reported by most FTs, overall
performance will be slightly better than this
Slowly increasing trend partly due to backlog (of
patients who have already waited gt18 weeks) being
treated March PTL report is for first week only
33
18 weeks RTT (non-admitted)- actual v. plan
(commissioner)
PTL data not reported by most FTs, overall
performance will be slightly better than this
Slowly increasing trend partly due to backlog (of
patients who have already waited gt18 weeks) being
treated March PTL report is for first week only
34
18 weeks the current position

• PTL data for the first week in March 08 is very
  encouraging, with performance for admitted
  patients improving to 79 treated within 18
  weeks, and performance for non-admitted patients
  up to 88
• This suggests that the March milestone (90) for
  non-admitted patients could be achieved, and the
  admitted patient milestone (85) will almost
  certainly not be achieved but performance could
  be above 80 which is a big improvement on the
  44 in March 07
• There is a very large variation in performance,
  with some Trusts reaching both the milestones
  whilst a few Trusts are a long way off as they
  are still working through a sizeable backlog of
  patients who have already waited over 18 weeks
  and therefore are reporting no weekly improvement
  
• Data quality continues to be an issue,
  particularly for tertiary centres. The current
  London average is 7 unknown clock starts (for
  admitted pathways), although most Trusts are now
  reporting the clock start for all patients
  treated
• Inter-Provider Transfers remains an issue across
  London with low compliance with the requirement
  for referring Trusts to forward a data set, we
  have written to all CEs on the process for
  transferring data electronically
• From 31 March the maximum wait for diagnostics is
  6 weeks. Progress has been good but there is a
  high risk that some Trusts may have a small
  number of 6 week breaches at 31 March, and BHRT
  is likely to fail the target by quite a wide
  margin

35
18 weeks - SHA action

• NHS London will continue to review progress
  against both data completeness and trajectory and
  escalate attention and support for organisations
  on a weekly basis. The weekly review is
  undertaken by the Director of Finance
  Performance and the Provider Agency CE
• Several Trusts are now aiming to exceed the March
  milestone for admitted patients to compensate for
  those that do not achieve it. PCTs will be
  purchasing the increased activity
• 5 PCTs are acting as sector leads and
  co-ordinating dissemination of key messages to
  all PCTs and Trusts in their patches
• An e-mail bulletin is now sent out to CEs and 18
  week leads highlighting key messages and actions
  required, with a particular emphasis on action to
  be taken to maximise March performance
• NHS London has agreed with the national Intensive
  Support Team that in-depth support will be
  continued for BHRT, RNOH, Barnet Chase Farm,
  Royal Brompton Harefield, Imperial, Newham and
  W.Middx. Bromley and Whipps Cross are now also
  receiving support. The IST has recently
  undertaken diagnostic reviews at Kingston and
  St. Georges
• Beyond March we will be undertaking a review of
  the programme of action needed to deliver the end
  December target, which will include an ongoing
  focus on those Trusts and PCTs that miss the
  March milestones by a significant margin and
  ensuring that local action plans are tackling all
  bottlenecks and any problem specialties (e.g.
  Orthopaedics) and sub-specialties
• An enhanced performance management rigour will
  need to be continued through to at least December
  08

36
Smoking quitters to Q3
07/8 change Q1 10905 (18) Q2 11461
(31) Q3 9470 (-4.5) YTD 31836 (16)
At Q2 we were on target but performance in Q3 has
been significantly lower than Q1 Q2, therefore
there is a risk that the outturn could be lower
than in 2006/07
37
Appendix 2 SHA Financial Performance
38
SHA Financial Performance (MPET)

• Between month 7 and month 10 there has been an
  increase in the forecast outturn surplus by
  0.6m. There has been further slippage on tuition
  contracts, as the academic year contracts values
  have been agreed, salary support, as data has
  been received from Trusts/PCTs validating the
  number of starters, and a forecast surplus on the
  Deanery.
• The impact of this slippage has been reduced
  by a net increased investment on Strategic fund /
  development projects and increased investment
  supporting the implementation of MMC.
• The vast majority of the MPET outturn has now
  been established through 2007/08 SLAs with
  PCTs/Trusts and HEIs. The outturn risks are
  mostly on development and strategic fund schemes,
  outstanding tuition contracts with HEIs,
  additional investment schemes, student grants and
  the Deanery.

39
SHA Financial Performance (Admin and other
Reserves)

• The SHA admin budget underspend is largely as a
  result of the incidence of personal injury cases
  seen in the first quarter of the year that has
  not been replicated in the following months.
• The majority of the FT and other reserves reflect
  the funding set aside during the planning process
  to offset the impact of potential in-year FT
  starts on the aggregate London financial position
• The allocations from the central budget bundle
  have now been finalised resulting in a reduced
  underspending
• It has now been agreed to defer the receipt of
  interest on the SHAs cash deposit until 2008/09
• Additional investment plans have now been put in
  place to accelerate spend on areas such as 18
  weeks, health promotion and HfL preparation. The
  total investment is now forecast to be slightly
  less than that estimated at Month 7. The forecast
  outturn at M10 includes a provision for slippage
  on additional investment and other programmes in
  terms of delivery of the Control Total

40
SHA Financial Performance (Hosted Budgets)

• The Cancer Action Team (CAT) is showing
  significant year to date underspend which results
  from slippage in commencement of some
  workstreams. This will reduce to between 0.8m
  and 1.5m by M12
• The HfL underspend has increased and reflects the
  requirement to carry forward monies into 2007/08
  to fund the initiative
• The LPfIT underspend has increased largely due to
  a benefit from the unwinding of a National
  redundancy provision

41
SHA Financial Performance

• The following additional SHA financial
  information is appended in annex 1-
• The SHA Balance Sheet
• The SHA performance against our prompt payment
  target of 95
• A reconciliation of the SHA Central budget bundle
• Additional breakdown of the SHA Budget as
  follows-
• The SHA admin budget by directorate
• The SHA Hosted Services and Projects budget
• The LPfIT budget
• The National Commissioning Group Budget

42
ANNEX 1
43
SHA Financial Performance
44
SHA Financial Performance
45
SHA Financial Performance
46
SHA Financial Performance