Integrated Performance Report. NHS Rotherham Board 6 July 2011

Transcription

1 Integrated Performance Report NHS Rotherham Board 6 July 2

2 CONTENTS Introduction Pg 2 Efficiency Pg 3-6 Rotherham Outcomes Pg 7- Contract Performance Pg -13 Finance Pg

3 INTRODUCTION Report format.. This report covers four key aspects of performance in a format similar to last month: Efficiency Rotherham wide outcomes (this report includes additional benchmarking information) Individual contract performance Finance The June report incorporated a summary of the Yorkshire & Humberside SAAP (Single Assurance and Accountability Process), no further updates have been received but as they are received they will be reflected upon future board reports. The June report also included a list of the Public Health Measures which will be reported on a quarterly or annual basis. The first quarterly report will be available for the next board report. There are three other areas which are key to measuring an integrated approach to performance: Quality: Workforce: Risk: Regular assurance of provider quality is through the Audit and Quality Assurance Committee, which covered RDASH s approach to quality on 13 April and RFT on 1 June 2. Workforce will be reported to Board on a 6 monthly basis. The substantially revised risk assurance framework was approved by the Board in June 2. Key Performance issues Efficiency Activity data is only available up to 3 th April 2, but early indications are that none elective activity, which is the key metric for measuring the impact of the Long Term Conditions and Urgent Care QIPP, is marginally higher than the affordable trajectory and the equivalent period last year. Outcomes and contract management Mixed sex accommodation and Accident and Emergency Waiting Times at RFT were the main two challenges outlined in the June Integrated Performance Report. MSA rates at RFT are now under control with zero breaches reported in May 2(See RFT Contract Performance Section for further detail). A recovery plan/trajectory has been agreed with RFT and the DoH to get the overall 95% of patients waiting less than 4 hours in A&E back on target by July 2. At the 26 th June the RFT performance stood at 94.31%. C. Diff levels in April were significantly higher than planned. This trend has continued in May. It remains as a major risk and a District wide meeting is planned for early July to consider C.diff infection control. 2

4 EFFICIENCY Overview.. There are five efficiency programmes in 2/12. Current predictions are that these programmes are largely on track based upon April 2 activity data, other than Long Term Conditions where activity is above the affordable trajectory. Efficiency Programmes 2/12 Programme Area Efficiencies Target savings as at May Long Term Conditions/Urgent Care Long Term Conditions/Urgent Care 218, Planned Care Planned Care 654, Medicines Management Prescribing 22, Non Clinical Productivity Running Costs 36, Specialised Services Specialised Services 32, GRAND TOTAL 1,466, Prescribing... Current performance against outcomes and milestones Spend to April 2 was below the affordable trajectory but there are important risks associated, see below. Expenditure for cardiovascular and gastrointestinal prescribing decreased by 5.4% and 4.71% respectively, in 2/ this was partially due to work undertaken within the year. Continence achieved a cost reduction on the previous year s expenditure so that product costs are now below 28/9 expenditure and the new specialist foodstuffs project (Gluten Free) achieved a cost saving of 5, in the seven months since it started operating. These savings were offset by strong cost growth (increases) in dementia drugs of 22% and new diabetes drugs of.5%; this is in direct response to recent NICE guidance. Strong growth (increase) was also seen in antibiotics of 25% and SSRI anti-depressants of 45%, these increases are not volume driven but due to drugs not being available at drug tariff prices. NHS Rotherham s prescribing is largely in accordance with NICE guidance in these areas. Pharmacies are currently authorised to endorse prescriptions with no cheaper stock available for these drugs and this is resulting in cost increases. Similarly there has been a 2% increase in the cost of pharmaceutical specials (drugs formulated for a specific patient); current arrangements in the NHS pharmaceutical contract make it difficult to contain the cost growth in this area. Risks and mitigation NHS Rotherham experienced an annual growth of 2.48% for the financial year 2/, this compares to 2.47% for Yorkshire and Humber and 3.24% for England. The affordable trajectory for 2/12 was set at 2.2% uplift on the predicted outturn. Since the outturn was predicted there have been prescribing cost increases. This means that the affordable trajectory is only an uplift of 1.1% on the actual outturn, and achieving this trajectory will be extremely challenging. All the prescribing efficiency programmes are on track but the trends detailed above means that the trajectory will only be achieved if all the programmes fully achieve and may require the addition of other cost reduction plans. 3

5 Apr- May- Jun- Jul- Aug- Sep- Oct- Nov- Dec- Feb- Jun- Jul- Aug- Sep- Oct- Nov- Dec- Jan-12 Feb-12 Mar-12 Apr- May- Jun- Jul- Aug- Sep- Oct- Nov- Dec- Feb- Jun- Jul- Aug- Sep- Oct- Nov- Dec- Jan-12 Feb-12 Mar-12 EFFICIENCY Mitigation of prescribing risks is by horizon scanning and by increased achievement of saving in other areas. Performance against trajectory and milestones 4, 3,9 3,8 3,7 3,6 3,5 3,4 3,3 3,2 3, 3, 2,9 2,8 2,7 2,6 2,5 Prescribing Costs Apr- May- Jun- Jul- Aug- Sep- Oct- Nov- Dec- Feb- Jun- Jul- Aug- Sep- Oct- Nov- Dec- Jan-12 Feb-12 Mar-12 Actual (s) 3,467 3,295 3,529 3,646 3,335 3,633 3,428 3,46 3,677 3,299 3,165 3,664 3,21 Trajectory (s) 3,439 3,331 3,535 3,728 3,326 3,655 3,75 3,5 3,862 3,379 3,277 3,783 Long Term Conditions & Urgent Care Current performance against outcomes and milestones The long term condition and urgent care programme requires 1.3 million savings in 2/12. It is still early in the new financial year but the April 2 None Elective activity level of 2621 was higher than the trajectory levels of 2463 and higher than in the same month in 2. Risks and mitigation The Single Integrated Plan outlined 1.3 Million of savings for 2/12. This is reflected by the affordable trajectory for non electives in the chart. There are considerable risks associated with this, as it requires successful delivery of the transformation in community services following the integration of services with RFT. NHS Rotherham and the Commissioning Executive are carrying out a considerable amount of work in this area. The QIPP plan has four workstreams: ensuring care is in the most appropriate setting, long term conditions management, pathways efficiency and ensuring accurate coding by providers. The newly agreed RFT contract has a range of incentives such as a 3% marginal tariff for emergency admissions and CQUIN incentives to reduce emergency admissions to affordable levels. NHSR has invested in initiatives to reduce non-elective expenditure to facilitate the containment of activity within affordable levels in 2/12. In future years, 5 million has been allocated in the SIP for alternative investments in community provision that prevent admissions. A multi agency summit meeting was held on 8 th June which agreed a list of prioritised actions, including: o Alternative levels of Care o Single point of access o Integrated Health and Social Primary Care Teams o Changes to A&E A Long Term Conditions Urgent Care Committee has been established and will meet for the first time on 31 st August 2. Performance against trajectory and milestones Non Elective 15 5 Apr- May- Aug- Nov- Mar- May- Aug- Nov- Mar- Jun-Jul- Sep-Oct- Dec-Feb- Jun-Jul- Sep-Oct- Dec-Jan-12Feb Actual Trajectory (-1.6%)

6 Apr- May- Jun- Jul- Aug- Sep- Oct- Nov- Dec- Feb- Jun- Jul- Aug- Sep- Oct- Nov- Dec- Jan-12 Feb-12 Mar-12 Apr- May- Jun- Jul- Aug- Sep- Oct- Nov- Dec- Feb- Jun- Jul- Aug- Sep- Oct- Nov- Dec- Jan-12 Feb-12 Mar-12 EFFICIENCY Planned Care. Current performance against outcomes and milestones The planned care programme requires 4.1 million savings in 2/12. In April elective activity was just on the affordable trajectory, first outpatient activity was below the affordable trajectory but this month included the additional Royal Wedding bank holiday so the data should be treated with caution. Validated data for May using the activity returns that are currently required by the DH/SHA will be available on 29 June. Risks and mitigation The in-year risks of not achieving the affordable trajectories have been mitigated by the 2/12 contract agreement with our largest provider (RFT) which commits NHS Rotherham and RFT to work together to achieve the affordable trajectories. Activity above trajectory will be paid at marginal tariff, nevertheless it is extremely important that we hit the trajectory as it impacts on affordability for 212/13. The Clinical Referral management Ctte (CRMC) has completed work on the diabetic and orthopaedic pathways. This has included dissemination of guidance electronically and face to face discussions with 4 primary care clinicians at the May PLT events. Work is currently being completed on the gynaecology, dermatology and ophthalmology care pathways, improving the quality of referral letters, virtual clinics are being trialled for haematology and rheumatology referrals and referral audits are being incentivised in the GP Local Incentive Scheme. The CRMC carried out an annual review of progress on 22 June. ENT has been added as an additional work stream and the group will scope oral surgery and audiology which although low volume specialities have had large recent increases in referral numbers. Performance against trajectory and milestones Elective inpatient/day case Apr- May- Jun-Jul- Aug- Sep-Oct- Nov- Dec-Feb- Mar- Actual May- Jun- Jul- Aug- Sep-Oct- Nov- Dec-Jan-12Feb-12 Mar- 12 Trajectory (.1%) All First Outpatients Apr- May- Jun-Jul- Aug- Sep-Oct- Nov- Dec-Feb- Mar- Actual May- Jun-Jul- Aug- Sep-Oct- Nov- Dec-Jan-12Feb-12 Mar- 12 Trajectory (-.2%)

7 EFFICIENCY Specialised Services.. Current performance against outcomes and milestones The specialised services programme requires 176, savings in 2/12.The programme is delivered by the SCG, which is attended by NHS Rotherham s Chief Executive. Risks and mitigation Any risks will be managed by the SCG in 2/12 with plans to align the Y&H SCG efficiency programmes with the other SCGs in England in 212/13. Management Costs/Running Costs Current performance against outcomes and milestones Management/running costs programme requires 2.2 million savings in 2/12. The cost base and associated budgets have been adjusted to reflect these savings. Risks and mitigation There is still lack of clarity about the precise definition of running costs which will be externally performance managed as an independent measure. NHS Rotherham is confident that management/running costs targets will be deliverable in 2/12. Savings will continue to accrue as a result of the previous voluntary redundancies schemes. Current efforts are concentrated on making savings on non pay running costs. A long list of potential savings has been drawn up and work is underway to deliver this. It is highly likely that further savings will be required in order to plan for the 212/13 reductions. Performance against trajectory and milestones 2, 18, 16, 14, 12,, 8, 6, 4, 2, Jun- Jul- Aug- Sep- Oct- Nov- Dec- Jan-12 Feb-12 Mar-12 6

8 ROTHERHAM OUTCOMES Overview.. This report shows performance against all the 26 Headline Measures in the 2/12 Operating Framework. The charts include micrographs to indicate trends and benchmarking data where this is available. The Operating Framework also includes 81 supporting measures. Definitions and data are currently available for most of them, however a small number remain outstanding. Last month, a list of the key Public Health metrics was incorporated into the report for quarterly and annual measurement. The first quarterly report will be produced for the next Board meeting. The Performance Management team at NHS Rotherham continues to monitor an extensive list of Performance Metrics. Key performance issues and risks Headline Measures Mixed Sex Accommodation The rate of MSA breaches has now fallen back dramatically, with zero cases reported at RFT in May and 3 NHSR cases reported at STH. Accident and Emergency Measures HQUa Total time in A&E department for admitted patients (95 th percentile) remains higher than the contracted 4 hours threshold at 5 hours 2 minutes. In addition the single longest wait for an admitted patient was 12 hours 15 minutes, with 6 hours set as the threshold. Time to initial assessment is also much higher than planned, with a 95 th percentile performance at RFT of 44 minutes against a plan of 15 minutes. Further details can be seen in the Contract Performance section Item 2. Performance for the Care UK Walk in Centre is not currently available for these metrics. C-Difficile Commissioner Target The provisional levels of c-diff (Hospital and Community acquired) to May 2 amount to 21 cases against a target of 14. Further details of the RFT Hospital acquired cases can be found in the Contract Performance Report Item 5. Supporting Measures VTE Risk Assessment rate - RFT amounted to 87.6% in April compared to a target of 9%. Whilst Rotherham compares favourably with the England average this will be carefully monitored and raised with RFT. Ambulance Clinical Quality This month saw the publication of a new set of Clinical Quality Indicators for Ambulance Services. Whilst it is early in the year and the data reliability may be being developed, a number of the indicators are showing some initial cause for concern. Ambulance Service Trusts are held accountable for this performance however these issues are being raised at the Ambulance Services Consortium Board meeting in July. PROMS information has been published for PROMS (Patients Reported Outcome Measures) relating to January 2. At RFT patients are reporting lower levels of health improvement (post operatively) for Hip Replacement, Knee replacement and Varicose Veins. This information will be considered at the NHSR/RFT Clinical Quality Performance Meeting. 7

9 HQU13 HQU12 HQU HQUb HQUa HQU9 HQU8b HQU8a HQU7 HQU6 HQU5 HQU4 HQU3_2 HQU3_1 HQU2 HQU1 ROTHERHAM OUTCOMES Key: Ref: Measure Incidence of MRSA: Commissioner (Number) - Target - Good Performance (On target or better than target) - Rotherham - Actual - Underperformance (Target not achieved but variance not significant) - Yorkshire & Humber - Poor Performance (Significant variance from target) - England Headline Measures Target Objective Latest Data Position to Date Plan to Date Variance 1 5 Performance Direction Benchmarking Data (based on population rates or percentage comparisons) C-difficile: Commissioner target (Number) Category A ambulance calls meeting 8 minute target for Yorkshire & Humberside (%) A M J J A S O N D J F M Category A ambulance calls meeting 19 minute target for Yorkshire & Humberside (%) A M J J A S O N D J F M Patient Experience Score (average of 5 domains) Mar- (Annual) Mar 9 Mar Mar- Referral to Treatment times - admitted 95th centile (wks) Referral to Treatment timesnon-admitted 95th centile (wks) Referral to Treatment times - incompleted pathways 95th centile (wks) Mixed sex accommodation breaches (rate per FFCEs) - Commissioner Mixed sex accommodation breaches (rate per FFCEs) - Provider 1 5. Unplanned re-attendance rate at A&E within 7 days of original attendance 3.58% 5.% -1mins 2seconds 1 5. Total time in A&E department (RFT) Admitted - 95th centile 5hrs 2mins 4hrs 1hr 2mins Total time in A&E department (RFT) Non Admitted - 95th centile 3hrs 47mins 4hrs -13mins Left department without being seen (RFT) - rate 3.97% <5.% -1mins 3seconds 5 Time to initial assessment (RFT) - 95th centile 44mins 15mins 29mins 5 7 Time to treatment in department (RFT) - median 1hr 6mins 1hr 6mins 6 5 8

10 SQU3_Ambulance Clinical Quality SQU1 HRS8 HRS7 HRS6 HRS4 HRS3 HRS2 HRS1 HQU16 HQU15 HQU14 ROTHERHAM OUTCOMES Ref: Measure Cancer 2 week wait (aggregate measure = 2ww GP Urgent referral + 2ww Breast Symptoms) Cancer 62 day waits (aggregate measure = referral from GP + referral from screening programme + referral from consultant upgrade) Emergency readmissions within 3 days - Showing 28 day readmission as proxy Target Objective Latest Data Dec- Qtr3 (Quarterly) Headline Measures continued Position to Date Plan to Date Variance Performance Direction A M J A M J J A S O N D J F M J A S O N D J F M Qtr1 / Qtr2 / Qtr3 / Benchmarking Data (based on population rates or percentage comparisons) Qtr3 / Financial forecast outturn & performance against plan Financial performance score for NHS Trusts See Table 1 under Finance section of this report See Table 1 under Finance section of this report Delivery of running cost target 36, 36, 2 A M J J A S O N D J F M Progress on delivery of QIPP savings 1,467, 1,466, 1, 5 Non-elective G&A FFCEs excluding well babies A M J J A S O N D J F M Numbers waiting on an incomplete Referral to Treatment pathway Number of Health Visitors Data not yet available - Due to be available next month Underperforming Supporting Measures 95 VTE Risk Assessment Re-contact rate following discharge of care (via telephone and treatment at scene) (in seconds) Re-contact rate following discharge of care (telephone) (in seconds) Re-contact rate following discharge of care (treatment at scene) (in seconds) Re-contact rate: proportion of calls from patients for whom are frequent callers (in seconds) Time to anwer call (95th percentile) (in seconds) Time to anwer call (longest time) (in seconds) A M J J A S O N D J F M Calls closed with telephone advice Incidents managed without need to transport to A&E

11 SQU23 SQU22 SQU_PROMS Scores SQU9 ROTHERHAM OUTCOMES Number of patients receiving NHS primary dental services within a 24 month period Qtr3 (Quarterly) Supporting Measures continued , 16, 15, Qtr1 / Qtr2 / Qtr3 / Qtr4 / Qtr4 / Groin - Hernia J F M A M J J A S O N D Hip Replacement J F M A M J J A S O N D Knee Replacement J F M A M J J A S O N D Varicose Veins J F M A M J J A S O N D Cervical Screening test results received within 2 weeks J J A S I N D J F M A M Screening for Diabetic retinopathy (%) M J J A S O N D J F M A Qtr3 /

12 CONTRACT PERFORMANCE Rotherham Foundation Trust (RFT) Key Performance Issues.. Background Issue Mitigating Actions 1. Eliminating Mixed Sex Accommodation (EMSA) Eliminating Mixed Sex Accommodation (EMSA) - The RFT published full compliance to the EMSA guidance from 1 st April 2. The overarching requirement of the guidance is to eliminate nonclinically justified mixed sex breaches across NHS accommodation. Further to reporting EMSA breaches in December (29) and January (41) the RFT have continued to report further breaches in February (33), March (52) and April (45). In May this figure has been reduced to (Zero) and re-validated data for April gives a performance at 19 instead of the originally reported 45 which is a great improvement. Having had a number of emergency meetings with TRFT, NHSR agreed a new quality assurance process with RFT to ensure governance arrangements were fully in place within the TRFT in order to monitor EMSA effectively. As a result of implementing new processes within the TRFT we are pleased to report that EMSA breaches were reduced considerably in April from the original submitted figure and TRFT reported zero breaches in May. NHSR have continued to be in regular contact with the SHA around this issue and although considerable improvement has been noted NHSR will continue to provide high levels scrutiny of this delivery area. 2. Accident and Emergency The RFT has a target to achieve 95% of patients waiting less than 4 hours in A&E from arrival to admission, transfer or discharge. 3. Indicators for the Implementation of the Stroke Strategy and Transient Ischaemic Attack The RFT have targets with regard to the area of Stroke: 1) Respond to 6% of higher risk Transient Ischaemic Attack (TIA) patients within 24 hours of the patients first contact with a health professional. 2) Percentage of patients who spend at least 9% of their time on a stroke unit (Target 8%. Further to the reporting of poor A&E performance against the 95% 4 hour target during the month of April, the RFT did improve performance during the month of May achieving 95.9%. Although this met the monthly target, concerns continue to be raised as the month on month figure continues to be below the 95% target. For comparison at the same point last year TRFT were performing at 99.5%. We understand that staffing issues and the complexity of patients presenting into A&E are the main issues for poor performance. 1) Performance against the TIA target has been inconsistent throughout the year, as at April the figure being achieved was 45.24%, which meant that the Trust failed this target. At the end of April the Trust have reported an improved performance position of 68.18% 2) Performance for quarter 4 was 74.6% and although the target was achieved in the three previous quarters the indicator is measured on quarter 4 performance, therefore the trust failed this target in 2/12. At the end of April the Trust have reported an improved performance position of % NHSR have held extraordinary meetings with TRFT to understand and gain further assurance of the actions being taken within A&E in order to improve performance. Additional consultant cover will be available to A&E from Mid June which will impact on performance; NHSR and TRFT are also working jointly to develop A&E GP triage which should be in place from the 1st September. NHSR have agreed revised A&E trajectory targets for the remainder of the year to ensure 95% performance is achieved from Quarter 2 onwards. Actions to improve this target have been raised by NHSR at formal contract performance meetings with the RFT and have also been actioned within the stroke strategy group. Improved performance has been seen with regard to these indicators in the last month due to improved processes within the Trust, this target will continue to be monitored closely. Additional stroke indicators have been introduced for the /12 financial year which NHSR will monitor closely.

13 4. Access to diagnostic Tests The RFT have a target to ensure that nobody waits over 6 weeks for identified 15 key diagnostic tests. 5. Clostridium difficile Infection (C-diff) The RFT has a target to reduce the number of C-Diff incidents year on year; the target for the Acute side of provision at the RFT in 2/12 is 42. CONTRACT PERFORMANCE In December and January there were a total of 7 breaches of the 6 week target, in March there were a further 234 breaches taking the total for the year to 387. Echocardiography has been the main area where the trust has breached over the last few months. This has improved during the month of April where the Trust reported 19 breaches of the 6 week target. In Quarter four (/) there were 16 reported cases of C-diff at the Trust, although this was within the annual contractual target, concerns were raised around increasing levels of C-diff Incidence at the Trust. Moving into the new contract year the plan around C-diff for April was 4 cases with an actual performance being 5 cases in May the plan was for 4 cases and the actual performance was 6, this therefore continues to raise concerns. The improvement in performance is due to the full staffing within cardiology, therefore it is expected that the number of breaches will continue to decrease going forward. NHS Rotherham s Infection Control lead is continuing to work closely with TRFT Infection Prevention and Control Team. The RFT continue to report that they are on red alert with regard to C-diff. NHSR have coordinated an Infection Control Review meeting with the Trust Infection Prevention and Control Team to take place in early July. There are a number of sanctions within the contract if the Trust does not meet the annual targets. Other Contracts Key Performance Issues.. Background Issue Mitigating Actions 1. Introduction of a new adult service model at RDaSH A new adult service model was introduced at RDaSH following work with local clinicians with the intention of improving services for NHS Rotherham patients. The introduction of the new adult service model has raised a number of concerns amongst GPs across Rotherham. To address these concerns and work with RDaSH to develop this new service a monthly meeting between NHS Rotherham and RDaSH has been arranged. This group is working on: - Standards for information to GPs guidelines - READ Code Audit to ensure that all discharge letters from RDaSH services have the appropriate READ Code included. - Service Specifications for services included in the New Adult Model 2. Communication Issues relating to the Renal Dialysis Patient Transport Services (PTS) procurement NHS Rotherham is leading on a procurement exercise for Renal Dialysis PTS. The new service is starting on 1 st July 2 and discussions are There has been media interest in the fact that YAS have lost the Renal Dialysis PTS contract. An initial press release has been issued and further communication material is being prepared for the launch of the new service on the 1 st July. 12

14 reaching conclusion with the new providers to ensure a smooth transition from the incumbent provider (YAS). 3. SCG procurement for locked & unlocked mental health placements A procurement exercise was undertaken (as part of the SCG QIPP programme) to commission locked & unlocked mental health placements jointly led by the SCG and CPC. 4. Sheffield Teaching Hospitals FT (STHT) Contract NHS Rotherham is an associate to the contract and there are current issues with certain national performance targets. 5. RDaSH memory service The contract requires a lead time of 12 weeks from initial assessment to diagnosis of dementia CONTRACT PERFORMANCE There have been delays in the procurement process and a failure by the CPC to issue the contract briefing document which has made it difficult to implement the procurement locally. The trust is currently not meeting the maximum 2 week wait for breast referrals and the maximum 62 days from referral from national screening to treatment cancer targets and also the C Diff target. The current waiting time is averaging 12 to 16 weeks. A meeting was held on th June and it was agreed that further action needed to be undertaken to implement this across Yorkshire & Humberside. NHS Sheffield, as co-ordinating commissioner has raised these issues through the contract and STHT is preparing action plans to improve performance. Regular meetings with providers to discuss how to improve the situation. Also, investigating the pathway to understand where bottle necks are and make appropriate improvements. Primary Care Contract There are currently no new significant issues to report. 13

15 FINANCE Finance & Contracting Performance Report: Period ended 31 May 2 Performance against Resource Allocations and Cash Limits. Revenue Resource Allocation NHS Rotherham has been notified of a revenue resource limit allocation of 464m. This includes recurrent allocations of 451m and 13m non-recurrent additions. The 2/12 plan assumes a surplus of 2.2m. Capital Resource Limit NHS Rotherham has submitted a plan for capital projects of 1m. We have recently received approval in principle that these plans can go ahead therefore progress is underway with a final check being made before costs are committed. Cash Limit NHS Rotherham is on plan to manage within its cash limit allocation of 462m Key Points and Risks Running Costs as previously reported the cost base and associated budget have already been removed to reflect the savings in the plan we still await confirmation of our new target; Rotherham FT the position at the end of April shows a profiled overspend of approx 2k, primarily in emergency and planned activity. The final contract negotiations for 2/12 included an agreed envelope for activity in planned care and it is expected that the Trust will manage performance within the agreed funding. Also an element of the CQUIN Scheme is linked to reducing emergency admissions and would result in non payment if activity is over plan. Financial performance will continue to be monitored as the year progresses and will be kept under review. Out of Area - The current variance is being investigated however the view is that the main cause is due to small fluctuations in activity volume which can have a major impact on the financial variance due to the extremely high average cost of patient care i.e. 14k p.a. Negotiations are also to commence with Providers to acquire a more competitive contract price in line with other South Yorkshire Commissioners. Other providers early information is showing that other providers are within the agreed contract values. Partnership as at month two the year to date activity total is predominantly independent sector expenditure. The current activity levels indicate we are on target to meet the budget set, this assumes all indicators regarding Continuing Care activity remain constant throughout the year. Prescribing information relating to April s activity will not be available until June. Early months data is not robust enough to provide a realistic forecast at this stage, due to any effect of new drugs and pricing changes, together with changes in monthly spending profiles, not yet known. 14

16 FINANCE Finance & Contracting Performance Report: Period ended 31 st May 2 Operating Cost Statement. NHS Rotherham Description Resource Limit Operating Cost Statement Period Ended 31st May 2 Year to Date Forecast Outturn Operating Resource Variance Costs Limit Operating Costs Variance Over / (Under) Over / (Under) % % Hospital & Community Health Services Rotherham NHS Foundation Trust 27,843 27, ,59 167,59. Sheffield Teaching Hospitals NHS FT 4,4 4,4. 24,685 24,685. Rotherham, Doncaster & South Humber MHFT 4,772 4, ,632 28,632. Doncaster & Bassetlaw Hospitals NHS FT 1,924 1,924.,545,545. Specialised Commissioning Group 6,45 6,45. 38,428 38,428. Other 4,913 5, ,48 29, Sub Total 49,971 5, ,829 3, Primary Care PMS & GMS 4,5 4, ,89 33, Prescribing 7,82 7,82. 42,798 42,798. Dental (PDS & ngds) 2,63 1,939 (124) (6.) 12,378 12, Pharmacy 1,47 1, ,442 8,442. Other Commissioned Primary Care Services 1,6 1,589 (21) (1.3) 9,838 9, Sub Total 16,662 16,616 (46) (.3) 7,346 7, Corporate Chief Executive & Modernisation ,768 2,679 (89) (3.2) Finance, Contracting & Procurement (34) (5.) 3,855 3,778 (77) (2.) Intelligence & Performance (12) (1.9) 3,632 3,599 (33) (.9) Public Health & DAT (27) (2.9) 5,595 5,538 (57) (1.) Estates 1, 1, ,623 2,561 (62) (2.4) Sub Total 3,781 3,736 (45) (1.2) 18,473 18,155 (318) (1.7) Partnership RMBC (inc Sec.28) ,341 2,341. Continuing Care & Free Nursing Care 2,62 2, ,6 15,5 () (.6) Learning Disabilities - Pooled Budget 1,167 1,167. 7,3 7,3. Sub Total 4,14 4, ,955 24,855 () (.4) Central Budgets 2,196 1,638 (558) n/a 13,38,235 (2,145) n/a Sub Total 2,196 1,638 (558) n/a 13,38,235 (2,145) n/a Grand Total 76,75 76,375 (375) (.5) 463,87 461,783 (2,2) (.5) IMPORTANT NOTE : Underspends are shown in brackets, and overspends in RED 15