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Mersey Care NHS Foundation Trust Care at a Glance Report
Report Area
Regulatory Position (Internal Reporting)
Regulation – Overview
Regulation – Quality of Care
Regulation – Finance and Use of Resources
Regulation – Leadership and Improvement
Regulation – Operational Performance
Strategy
Strategic Wheel – Overview
Our Services Top Lines reviewed at QAC
Our People Top Lines reviewed at PIFC
Our Resources Top Lines reviewed at PIFC
Our Future Top Lines reviewed at PIFC
Operational Transformation
Transformation - Overview
Transformation - Local
Transformation - Secure
Transformation - Specialist LD
Transformation - Community
Appendices
Safe Staffing Report - Trust
Our Services KPIs - Local
Our People KPIs - Local
Our Future KPIs - Local
Our Services KPIs - Secure
Our People KPIs - Secure
Our Future KPIs - Secure
Our Services KPIs - SpLD
Our People KPIs - SpLD
Our Future KPIs - SpLD
Finance Report
Contents
EC: B2
TB: C2 1
Regulation - Single Oversight Framework / CQC
CQC Rating
3 3 3 3
1 1
2
0
1
2
3
4
Apr-
17
May-1
7
Jun-1
7
Jul-17
Aug
-17
Sep
-17
Oct-
17
NHSi Finance & Use of Resources Score
2 2 2 2 2 2 2
0
1
2
3
4
Ap
r-1
7
May
-17
Jun
-17
Jul-
17
Au
g-17
Sep
-17
Oct
-17
NHSi Segment Score
EC: B2
TB: C2 2
Regulation - Quality of Care
(Internal Reporting)
Measure TypeData
FrequencyThreshold Q4 16/17 Q1 17/18 Q2 17/18 Q3 17/18 Q4 17/18
Written
Complaints -
rate
Caring Quarterly TBC 34.4 29.1 *
Staff FFT %
recommended
- care
Caring Quarterly TBC 68.63% 67.41% 71.13%
* Local data not available.
Trend Source
NHS Digitial
NHS England
National Data
Measure TypeData
FrequencyThreshold Apr-17 May-17 Jun-17 Jul-17 Aug-17 Sep-17 Oct-17 Nov-17 Dec-17 Jan-18 Feb-18 Mar-18 Source
Occurrence of
Never EventSafe
Monthly (six
monthly
rolling)
Green - 0,
Red - 1 or
more
0 0 0 0 0 0 0MCFT Internal
Reporting
Patient Safety
Alerts not
completed by
deadline
Safe Monthly
Green - 0,
Red - 1 or
more
0 0 0 0 0 0 0
NHS
Improvement
(publicly
available)
Admissions to
adult facilities of
patients under 16
years old
Safe Monthly
Green - 0,
Red - 1 or
more
0 0 0 0 0 0 0MCFT Internal
Reporting
Mental health
scores from FFT -
% positive
Caring Monthly 86.67% 86.91% 88.26% 89.99% 85.53% 93.32% 88.51%MCFT Internal
Reporting
Community
scores from
Friends and
Family Test - %
positive
Caring Monthly TBC 100% 100% * NHS England
Mixed Sex
Accommodation
Breaches
Caring MonthlyNational
Median 30 0 0 0 0 0 0
MCFT Internal
Reporting
CQC Community
Mental Health
Survey
Organisational
HealthAnnual 8.91 ***
Care Quality
Commission
Aggressive Cost
Reduction Plans
Organisational
HealthMonthly
National
Median
4.1%
2.83% 2.83% 2.83% 2.83% 2.83% 2.83% 2.83%MCFT Internal
Reporting
Care Programme
approach follow
up within 7 days
Effective Monthly 95% 92.00% 93.72% 94.67% 94.07% 95.56% 95.05% 92.73%MCFT Internal
Reporting
% clients in
settled
accomodation
Effective Monthly
National
Median
64%
63.00% 62.00% 62.00% 61.00% *** *** ***NHS Digital
via MHSDS
% clients in
employmentEffective Monthly
National
Median
9%
3.00% 4.00% 4.00% 4.00% *** *** ***NHS Digital
via MHSDS
** CQC Community Mental Health Survey results published in November 2017. The trust has been reported as better than expected. Details to follow.
*** Data not reported on locally, data is reported on via NHS Digital.
* October 2017 data not available
Trend
EC: B2
TB: C2 3
Regulation - Finance & Use of Resources
(Internal Reporting)
Financial Risk Measure Apr-17 May-17 Jun-17 Jul-17 Aug-17 Sep-17 Oct-17 Nov-17 Dec-17 Jan-18 Feb-18 Mar-18
Days 28 22 21 24 22 21 20
Risk Score 1 1 1 1 1 1 1
RAG Green Green Green Green Green Green Green
Rating 3 3 3 3 3 3 2
Risk Score 1 1 1 1 1 1 2
RAG Green Green Green Green Green Green Yellow
Rating 3.03% 2.71% 2.80% 3.00% 2.80% 2.22%
Risk Score 1 1 1 1 1 1 1
RAG Green Green Green Green Green Green Green
Rating 0.12% 0.10% (0.10%) 0.00% 0.04% 0.02%
Risk Score 1 1 2 1 1 1 1
RAG Green Green Yellow Green Green Green Green
Rating 56.0% 52.3% 50.9% 57.3% 42.8% 42.7% 44.00%
Risk Score 4 4 4 4 3 3 3
RAG Red Red Red Red Amber Amber Amber
3 3 3 3 1 1 2
Amber Amber Amber Amber Green Green YellowOverall Financial Sustainability RAG
Liquidity days
Capital services capacity
I&E Margin
I&E Margin Variance (based on
original plan)
Agency Spend
Finance Score
EC: B2
TB: C2 4
Regulation - Operational Performance (Internal Reporting)
MeasureData
FrequencyThreshold Apr-17 May-17 Jun-17 Jul-17 Aug-17 Sep-17 Oct-17 Nov-17 Dec-17 Jan-18 Feb-18 Mar-18 Source
People with a first episode of
psychosis begin treatment
with a NICE recommended
care package within 2 weeks
of referral.
Quarterly
(three
month
rolling)
50% 62.79% 66.67% 72.97% 82.05% 75.47% 70.77% 63.83% Unify Return
Accommodation Status Monthly 85% 80.50% 80.20% 81.07% 80.06% 79.67% 78.80% 81.73%MCFT Internal
Reporting
Commissioner Org Code Monthly 95% 99.98% 99.99% 99.99% 99.99% 99.99% 99.99% *MCFT Internal
Reporting
Date of Birth Monthly 95% 100% 100% 100% 100% 100% 100% *MCFT Internal
Reporting
Employment Status (adults) Monthly 85% 83.62% 82.45% 78.04% 82.45% 82.06% 81.20% 83.97%MCFT Internal
Reporting
Ethnicity Monthly 85% 82.00% 82.26% 82.17% 83.31% 82.88% 82.88% 82.85%MCFT Internal
Reporting
Current gender Monthly 95% 100% 100% 100% 100% 100% 100% *MCFT Internal
Reporting
Registered GP Org Code Monthly 95% 98.41% 98.12% 98.08% 98.36% 98.32% 98.05% *MCFT Internal
Reporting
NHS Number Monthly 95% 98.82% 98.50% 98.74% 99.08% 99.09% 98.70% *MCFT Internal
Reporting
Postcode Monthly 95% 99.73% 99.72% 99.73% 99.72% 99.72% 99.71% *MCFT Internal
Reporting
Patients requiring acute care
who received best practice
gatekeeping assessment
Monthly 95% 97.62% 88.78% 88.16% 98.21% 95.85% 92.86% 93.98%MCFT Internal
Reporting
IAPT - proportion of people
completing treatment who
move to recovery (from IAPT
minimum dataset)
3-month
rolling
>=50%
green;
<50% red
85.10% 89.48% 94.64% 96.06% 96.21% 95.50% 95.62%MCFT Internal
Reporting
IAPT – waiting time to begin
treatment (from IAPT minimum
data set) within six weeks
3-month
rolling
>=75%
green;
<75% red
98.27% 98.78% 99.41% 99.91% 100% 100% 100%MCFT Internal
Reporting
Trend
* Local data not available due to submission due on Wednesday 22.11.2017.
MeasureData
FrequencyThreshold Q4 16/17 Q1 17/18 Q2 17/18 Q3 17/18 Q4 17/18
IAPT - proportion of people completing
treatment who move to recovery (from
IAPT minimum dataset)
Quarterly >=50% green;
<50% red30.50% 31.59% 33.78%
Ensure that cardio-metabolic
assessment and treatment for people
with psychosis is delivered routinely in
inpatient wards
Annual>=90% green;
<90% red66.00%
Ensure that cardio-metabolic
assessment and treatment for people
with psychosis is delivered routinely in
early intervention in psychosis services
Annual>=90% green;
<90% red
Not
Applicable
Ensure that cardio-metabolic
assessment and treatment for people
with psychosis is delivered routinely in
early intervention in community mental
health services (people on CPA)
Annual>=65% green;
<65% red8.00%
CQUIN - to be
reported on in
Q4 2017/18
Trend Source
MCFT Internal
Reporting
CQUIN - to be
reported on in
Q4 2017/18
CQUIN - to be
reported on in
Q4 2017/18
EC: B2
TB: C2 5
Regulation - Leadership & Improvement
(Internal Reporting)
MeasureData
FrequencyThreshold Mar-17 Apr-17 May-17 Jun-17 Jul-17 Aug-17 Sep-17 Oct-17 Nov-17 Dec-17 Jan-18 Feb-18 Mar-18 Source
NHS Staff Survey Annual 3.68 3.63 NHS England
Proportion of Temporary Staff Monthly
National
Median
4.60%
5.57% 5.57% 5.13% 5.01% 5.13% 4.66% 4.91% 4.93%MCFT Internal
Reporting
Staff sickness Monthly
National
Median
4.46%
6.93% 6.36% 6.47% 6.76% 6.70% 6.54% 7.22%MCFT Internal
Reporting
Turnover Monthly
Internal -
Between
8% and
12%
15.66% 15.75% 15.22% 14.49% 14.13% 13.73% 13.53%MCFT Internal
Reporting
Trend
EC: B2
TB: C2 6
RAG Kitemark RAG Kitemark
RAG Kitemark RAG KitemarkTrend line
Risks associated with Contracts from Board
Assurance Framework
No of Restrictive Practice Incidents
Win Rate
Self-harm incidents (Project wards Arnold,
Dee, Harrington and Poplar)
Assaults on staff
Plan Surplus v Actual
Patient Experience Friends and Family
Plan Cashflow v Actual
Estate Category B (Metric under review)
Trend lineMetric
Delayed Discharges
Detention of BME under MHA
Safe Staffing Levels
Physical Health for new admissions (local
division only)
Strategic Priorities 2017/18 - Summary
Metric Trend line Metric
No of STEIS Incidents
Trend line
No of Actual and Potential Suicides
Metric
Sickness Absence
Vacancies Vs Budgeted Establishment
Globlar Digital Exemplar - Delivery against milestone plan to
attract the external funding
Substantive leader in place for 3 months or
more (Self Assessment)
Completion of Core Statutory Training
Involved in the development of your care
plan
Turnover Rate
EC: B2
TB: C2 7
Trust Level Strategic Priorities - Our Services - Key Performance Indicators
% BME Detained within last 12 months under the Mental
Health Act
% of shifts filled by nurses against planned establishment
(NHS England Fill rate measure) / CHPPD
Equitable - Detention Under MHA by BME
Service Users
Effective - Physical Health Screening for New
Admissions
Safe - STEIS Incidents
No of STEIS Incidents
Patient Centred - Friends & Family
% likely to recommend our service to friends and family
% of new admissions who have had physical health screening
completed (NAS Standard) (Local Division Only)
Timely - Delayed Discharge
Deyaled Transfers of Care (Step Change Nov 2016)
Efficient - Safe Staffing Levels
40.00%
50.00%
60.00%
70.00%
80.00%
90.00%
100.00%
110.00%
Mean Average Upper control limit Lower control limit Target
5.00%
10.00%
15.00%
20.00%
25.00%
30.00%
35.00%
40.00%
Mean Average Upper control limit Lower control limit Target
0
5
10
15
20
25
30
35
Mean Average Upper control limit Lower control limit
0.00%
10.00%
20.00%
30.00%
40.00%
50.00%
60.00%
70.00%
80.00%
90.00%
100.00%
Mean Average Upper control limit Lower control limit Target
90.00%
95.00%
100.00%
105.00%
110.00%
115.00%
120.00%
Mean Average Upper control limit Lower control limit Target
EC: B2
TB: C2 8
Trust Level Strategic Priorities - Our People - Key Performance Indicators
A productive, skilled workforce
Sickness Absence
Vacancy Rate % Involved in the development of your care plan
Side by side with service users and carers
Substantive leader in place for 3 months or more (Self
Assessment)
Great managers and teams A productive, skilled workforce
Completion of Core Statutory Training
Great managers and teams A productive, skilled workforce
Turnover % (Step Change March 2017)
70.00%
75.00%
80.00%
85.00%
90.00%
95.00%
100.00%
Mean Average Upper control limit Lower control limit Target
0.00%
2.00%
4.00%
6.00%
8.00%
10.00%
12.00%
Mean Average Upper control limit Lower control limit Target
0.00%
1.00%
2.00%
3.00%
4.00%
5.00%
6.00%
7.00%
8.00%
9.00%
Mean Average Upper control limit Lower control limit Target
89.00%
90.00%
91.00%
92.00%
93.00%
94.00%
95.00%
96.00%
97.00%
98.00%
Mean Average Upper control limit Lower control limit Target
30.00%
40.00%
50.00%
60.00%
70.00%
80.00%
90.00%
100.00%
Mean Average Upper control limit Lower control limit Target
EC: B2
TB: C2 9
Current Rating
Delivery against milestone plan to attract the
external funding
Trust Level Strategic Priorities - Our Resources - Key Performance Indicators
Estate category B Global Digital Exemplar
Buildings that work for us Technology that helps us provide better care
Finance
Plan Surplus v Actual
Finance
Plan Cashflow v Actual
-619
-290
-715
-1,011
-445
-160-223
-£1,200
-£1,000
-£800
-£600
-£400
-£200
£0
Apr-
17
Ma
y-1
7
Jun-1
7
Jul-17
Aug-1
7
Sep-1
7
Oct-
17
No
v-1
7
De
c-1
7
Jan-1
8
Fe
b-1
8
Ma
r-1
8
Surplus (£000) Excluding I&E impairments
Actual surplus Planned surplus
20,711 21,15722,749
26,594 27,41729,055
27,595
£0
£5,000
£10,000
£15,000
£20,000
£25,000
£30,000
£35,000
Apr-
17
Ma
y-1
7
Jun-1
7
Jul-17
Aug-1
7
Sep-1
7
Oct-
17
No
v-1
7
De
c-1
7
Jan-1
8
Fe
b-1
8
Ma
r-1
8
Cash Balance (£000)
Actual cash balance Planned cash balance
A1.02%
B69.39%
C29.59%
as at April 2015
New metric in development
EC: B2
TB: C2 10
Trust Level Strategic Priorities - Our Future - Key Performance Indicators
Research and innovation Research and innovation Grow our service
Actual & Potential Suicide count - Community Team Caseload
(rolling 12 months) Physical restraint reduction Win Rate
Research and innovation Research and innovation Effective partnerships
Self-harm incidents (Project wards only Arnold, Dee,
Harrington and Poplar)Assaults on Staff (Step Change Nov 2016) Risks associated with Contracts from Board Assurance Framework
If the Trust continues
to fail to achieve the
appropriate levels of
compliance with
Safeguarding training,
then a performance
notice may be issued
from CCG resulting in
financial and
reputational damage
for the Trust.
16 316
Initial Risk
RatingTarget Score
Current Risk
RatingTitle
0%
10%
20%
30%
40%
50%
60%
70%
80%
90%
100%
0
1
2
3
4
5
6
7
8
9
No
of
Bid
s Y
TD
Bids YTD Win Rate % Target
50
100
150
200
250
300
350
Mean Average Upper control limit Lower control limit Target
commencement of intervention
10
15
20
25
30
35
40
Mean Average Upper control limit Lower control limit Target
EC: B2
TB: C2 11
Metric
Apr-17 May-17 Jun-17 Jul-17 Aug-17 Sep-17 Oct-17 Nov-17 Dec-17 Jan-18 Feb-18 Mar-18
Plan 925 965 956 993 926 963 1036 991 868 1029 1014 1038
Actual 935 1163 1092 1112 1068 1020 1137
Plan 30.00 30.00 30.00 30.00 30.00 30.00 30.00 30.00 30.00 30.00 30.00 30.00
Actual 26.66 27.04 26.89 26.96 25.92 19.61
Plan 16.70% 16.70% 16.70% 16.70% 16.70% 16.70% 16.70% 16.70% 16.70% 16.70% 16.70% 16.70%
Actual 25.59% 23.63% 25.53% 25.59% 25.00% 20.97% 21.23%
Plan 3.83% 3.83% 3.83% 3.83% 3.83% 3.83% 3.83% 3.83% 3.83% 3.83% 3.83% 3.83%
Actual 5.73% 5.81% 5.83% 5.83% 6.00% 5.95% 6.92%
Plan 85.00% 85.00% 85.00% 85.00% 85.00% 85.00% 85.00% 85.00% 85.00% 85.00% 85.00% 85.00%
Actual 94.57% 95.54% 94.59% 95.50% 94.87% 93.72% 95.53%
Plan 33.4 33.4 33.4 33.4 33.4 33.4 33.4 33.4 33.4 33.4 33.4 33.4
Actual 32.0 42.0 31.0 33.0 46.0 34.0 39.0
Plan 7.50% 7.50% 7.50% 7.50% 7.50% 7.50% 7.50% 7.50% 7.50% 7.50% 7.50% 7.50%
Actual 7.26% 6.55% 5.93% 6.69% 6.92% 6.67% 8.15%
Plan 0 0 0 0 0 0 0 0 0 0 0 0
Actual 11 8 3 4 9 3 4
Plan 17.26% 17.26% 17.26% 17.26% 17.26% 17.26% 17.26% 17.26% 17.26% 17.26% 17.26% 17.26%
Actual 8.86% 7.73% 15.42% 14.66% 15.13% 13.61% 12.02%
Plan 4.80% 6.00% 6.00% 6.00% 6.00% 6.00% 6.00% 6.00% 6.00% 6.00% 6.00% 6.00%
Actual 7.09% 6.42% 6.60% 7.56% 7.12% 6.69% 6.60%
Plan 95.00% 95.00% 95.00% 95.00% 95.00% 95.00% 95.00% 95.00% 95.00% 95.00% 95.00% 95.00%
Actual 96.39% 92.52% 95.49% 94.47% 96.74% 93.81% 93.82%
Plan 5.00% 5.00% 5.00% 5.00% 5.00% 5.00% 5.00% 5.00% 5.00% 5.00% 5.00% 5.00%
Actual 9.24% 10.62% 10.39% 11.39% 11.59% 12.06% 10.73%
Plan £6,875 £5,357 £6,150 £6,467 £6,235 £6,255 £5,997
Actual £7,004 £5,247 £6,050 £5,997 £6,072 £6,170 £6,153
Plan £1,062 £170 £170 £170 £170 £170 £199 £199 £199 £199 £199 £199
Actual £913 £42 £87 £22 £4 £62 £86
149 128 83 148 166 108 113
GOVERNANCE
The operational lead is Donna Robinson
The Accountable Director is Mark Hindle
Assurance is provided to the Performance Investment and Finance Committee
* Reported with a month timelag to allow service users to be assessed who were referrered at the end of September 2017.
** In October 2017, out of the eight wards within Adult Mental Health, six wards are achieving better than the NHS Benchmark 2015-16 Discharged Patients LOS.
INPATIENTS - Number of unplanned Adult Acute Out
of Area Placements (Count of Service Users)
INPATIENTS - AMH Discharged Patients LOS (in-
month) achieving better than the NHS benchmark 2015-
16 Discharged Patients LOS (mean average).
% Incidents that result in harm
% Vacancies against budget
CIP's £000
Budget £000
Absence rate
COMMUNITY - Average Days between Referral date to
the First Seen in Assessment Service's*
COMMUNITY - AMH DNA Rate for 1st appointments
only
INPATIENTS - AMH Delayed Discharges
INPATIENTS - AMH Bed Occupancy (excluding leave)
Patient Experience Friends and Family
Local Transformation Plan
12 Month Trend
Line
COMMUNITY - New referrals from GP practice
Local Division
2017/18
COMMUNITY/INPATIENTS - % Caseload on Clusters
1, 2 and 3
EC: B2
TB: C2 12
Metric
Apr-17 May-17 Jun-17 Jul-17 Aug-17 Sep-17 Oct-17 Nov-17 Dec-17 Jan-18 Feb-18 Mar-18
Plan 16521 16521 16521 16521 16521 16521 16521 16521 16521 16521 16521 16521
Actual 20652 18387 18576 18732 18960 18057 18340
Plan 7.50% 7.50% 7.50% 7.50% 7.50% 7.50% 7.50% 7.50% 7.50% 7.50% 7.50% 7.50%
Actual 3.30% 3.17% 3.18% 3.63% 3.64% 3.51% 2.89%
Plan
Actual N/A 46.69 27.56 18.97 21.62 46.53 10.44
Plan 7.42% 7.42% 7.42% 7.42% 7.42% 7.42% 7.42% 7.42% 7.42% 7.42% 7.42% 7.42%
Actual 6.77% 4.22% 6.49% 4.83% 3.70% 4.55% 5.79%
Plan 4.80% 6.00% 6.00% 6.00% 6.00% 6.00% 6.00% 6.00% 6.00% 6.00% 6.00% 6.00%
Actual 6.95% 6.79% 6.82% 7.39% 7.04% 7.47% 8.55%
Plan 95.00% 95.00% 95.00% 95.00% 95.00% 95.00% 95.00% 95.00% 95.00% 95.00% 95.00% 95.00%
Actual 73.45% 81.44% 77.57% 69.64% 84.62% 78.43% 75.25%
Plan 5.00% 5.00% 5.00% 5.00% 5.00% 5.00% 5.00% 5.00% 5.00% 5.00% 5.00% 5.00%
Actual 5.66% 5.35% 5.76% 5.80% 6.36% 6.07% 6.34%
Plan £4,536 £3,881 £4,087 £4,016 £4,070 £4,044 £4,027
Actual £4,526 £3,935 £4,057 £3,996 £4,065 £4,019 £3,993
Plan £166 £166 £166 £166 £166 £166 £166 £166 £166 £166 £166 £166
Actual £166 £166 £166 £166 £166 £166 £166£0.00 £0.00 £0.00 £0.00 £0.00 £0.00 £0.00
GOVERNANCE
The operational lead is Des Johnson
The Accountable Director is Mark Hindle
Assurance is provided to the Performance Investment and Finance Committee
Reduction in time spent in long term
segregation (days)*
Delayed discharges
% Incidents that result in harm
Reduction in LOS in Low Secure based on
discharged patients (months)**
Plan to be confirmed
Secure Transformation Plan
Secure Division
12 Month Trend
Line
2017/18
Patient Experience Friends and Family
Absence rate
* Data has been reported for this indicator, however, this is still in the 'sense check' stage. The figures reported show the total cumulative segregation in days. In line with the
Reducing Long-term Segregation: A Zero Approach, the plan has been aligned to the outcome: To Reduce Long-term Segregation by 20%. The baseline used is April 2017.
**Based on discharged patients in the period. Where it states N/A this represents that there were no discharges within that month. Plan to be confirmed by the division.
% Vacancies against budget
Budget £000
CIP's £000
EC: B2
TB: C2 13
Metric
Apr-17 May-17 Jun-17 Jul-17 Aug-17 Sep-17 Oct-17 Nov-17 Dec-17 Jan-18 Feb-18 Mar-18
Plan 5 4 10 8 7 12 8 9 9 12 1 24
Actual 3 2 1 1 2 5 2
Plan 143 143 143 143 143 143 143 143 143 143 143 143
Actual 134 133 133 132 130 129 128
Plan
Actual
Plan 19.93% 19.93% 19.93% 19.93% 19.93% 19.93% 19.93% 19.93% 19.93% 19.93% 19.93% 19.93%
Actual 4.48% 4.95% 1.65% 9.66% 9.73% 6.89% 2.85%
Plan 4.80% 6.00% 6.00% 6.00% 6.00% 6.00% 6.00% 6.00% 6.00% 6.00% 6.00% 6.00%
Actual 10.74% 9.40% 9.48% 8.40% 8.92% 8.36% 10.31%
Plan 95.00% 95.00% 95.00% 95.00% 95.00% 95.00% 95.00% 95.00% 95.00% 95.00% 95.00% 95.00%
Actual 81.44% 76.47%
Plan 5.00% 5.00% 5.00% 5.00% 5.00% 5.00% 5.00% 5.00% 5.00% 5.00% 5.00% 5.00%
Actual 4.48% 19.56% 20.76% 19.19% 19.41% 17.31% 20.83%
Plan £2,224 £1,818 £1,882 £1,908 £1,891 £2,007 £2,129
Actual £2,239 £2,017 £1,850 £1,978 £2,006 £2,001 £2,033
Plan
Actual
GOVERNANCE
The operational lead is Lee Taylor
The Accountable Director is Mark Hindle
Assurance is provided to the Performance Investment and Finance Committee
*The Friends and Family Test in the Specialist LD Division is asked as part of the quarterly patient experience survey. The Division’s survey is different to the Trust-wide patient
experience survey and is completed quarterly until the data systems can be aligned in an easy-read format.
SpLD Transformation Plan
Specialist Learning Disabilities Division
12 Month Trend
Line
No of service users discharged
No of service users
Absence rate
% Vacancies against budget
2017/18
CIP's £000
% of workforce in posts within the new
clinical model
Patient Experience Friends and Family *
No CIP's for SpLD
Metric in development
Budget £000
% Incidents that result in harm
EC: B2
TB: C2 14
Metric
Apr-17 May-17 Jun-17 Jul-17 Aug-17 Sep-17 Oct-17 Nov-17 Dec-17 Jan-18 Feb-18 Mar-18
Plan 1 1 1 1 1 1 1 1 1 1Actual 1 1 3 2 1
Plan 0 0 0 0 0 0 0 0 0 0Actual 0 0 0 0 0
Plan 95.00% 95.00% 95.00% 95.00% 95.00% 95.00% 95.00% 95.00% 95.00% 95.00%
Actual 89.40% 89.30% 92.80% 92.87% 94.40%
Plan 95.00% 95.00% 95.00% 95.00% 95.00% 95.00% 95.00% 95.00% 95.00% 95.00%
Actual 91.30% 92.10% 93.20% 94.45% 93.79%
Plan 7.50% 7.50% 7.50% 7.50% 7.50% 7.50% 7.50% 7.50% 7.50% 7.50%
Actual 15.80% 20.86% 18.77% 11.85% 9.97%
Plan 36.65% 36.65% 36.65% 36.65% 36.65% 36.65% 36.65% 36.65% 36.65% 36.65%
Actual 37.50% 28.96% 34.46% 29.60% 36.67%
Plan 6.00% 6.00% 6.00% 6.00% 6.00% 6.00% 6.00% 6.00% 6.00% 6.00%
Actual 6.81% 6.98% 8.29% 7.62% 9.43%
Plan 95.00% 95.00% 95.00% 95.00% 95.00% 95.00% 95.00% 95.00% 95.00% 95.00%
Actual 98.18% 100.00% 100.00% 100.00% 100.00%
Plan 5.00% 5.00% 5.00% 5.00% 5.00% 5.00% 5.00% 5.00% 5.00% 5.00%
Actual 6.07% 6.35% 8.01% 7.94% 10.76%
Plan £1,986 £2,001 £1,999 £2,003 £2,000
Actual £1,986 £2,001 £2,008 £2,006 £1,985
Plan
Actual
GOVERNANCE
The operational lead is Judith Malkin
The Accountable Director is Trish Bennett
Assurance is provided to the Performance Investment and Finance Committee
• Delayed transfers of care has been added as metric to replace the % of urgent care referrals
District Nurse Falls Risk Assessment Tool
completionDistrict Nurse Malnutrition Universal
Screening Tool completion
% Vacancies against budget
Budget £000
CIP's £000
% Incidents that result in harm
Absence rate
No CIP's for SSCD
Patient Experience Friends and Family
Pressure Ulcers: Number of Grade 3 CAA
Pressure Ulcers: Number of Grade 4 CAA
Ward 35: Delayed Discharges
2017/18
South Sefton Community Transformation Plan
South Sefton Community Division
3 Month Trend
Line
EC: B2
TB: C2 15
Please note the following appendices are provided for information
Safe Sustainable Staffing Trust Level
Our Services
The operational lead for Our Services is Steve Morgan , The Accountable Director is Ray Walker, Performance is reviewed by the Executive CommitteeAssurance is through the Quality Assurance Committee
Our People
The operational lead for Our People is Claire Almond, The Accountable Director is Amanda Oates, Performance is reviewed by the Executive CommitteeAssurance is through the Performance and Investment Committee
Our Future
The Accountable Director is Louise Edwards, Performance is reviewed by the Executive CommitteeAssurance is through the Performance and Investment Committee
Finance Dashboard
Appendices
EC: B2
TB: C2 16
Safe Sustainable Staffing Dashboard
Fill rate reported as over 100% mainly due to the need to support observation levels. Recruitment to vacancies continues to be challenging across the
divisions. Local division report ongoing delay for staff awaiting start dates and have escalated to head of HR to address. Secure division have recruited
to posts but also awaiting start dates. SLDD vacancy at 17% due to site retraction.
Mandatory training rates are being monitored with an aim for 100%. A significant decrease in incidents is reported with a corresponding increase in
patient experience .
EC: B2
TB: C2 17
Local Division Strategic Priorities - Our Services - KPI's
Safe - STEIS Incidents Timely - Delayed Discharge
Effective - Physical Health Screening for New
Admissions
No of STEIS Incidents Delayed Transfers of Care - April 2016 to October 2017% of new admissions who have had physical health screening
completed (NAS Standard) (Local Division only)
Equitable - Detention Under MHA by BME
Service Users
Efficient - Safe Staffing Levels Patient Centred - Friends & Family
% BME Detained within last 12 months under the Mental
Health Act
% of shifts filled by nurses against planned establishment
(NHS England Fill rate measure) / CHPPD
Step Change Sept 2016
% likely to recommend our service to friends and family
0.00%
1.00%
2.00%
3.00%
4.00%
5.00%
6.00%
7.00%
8.00%
9.00%
Mean Average Upper control limit Lower control limit Target
75.00%
80.00%
85.00%
90.00%
95.00%
100.00%
105.00%
Mean Average Upper control limit Lower control limit Target
0.00%
5.00%
10.00%
15.00%
20.00%
25.00%
30.00%
35.00%
40.00%
Mean Average Upper control limit Lower control limit Target
0
5
10
15
20
25
Mean Average Upper control limit
0.00%
10.00%
20.00%
30.00%
40.00%
50.00%
60.00%
70.00%
80.00%
90.00%
100.00%
Mean Average Upper control limit Lower control limit Target
EC: B2
TB: C2 18
Local Division Strategic Priorities - Our People - KPIs
A productive, skilled workforce
Turnover
Great managers and teams A productive, skilled workforce A productive, skilled workforce
Substantive leader in place for 3 months or more (Self
Assessment)
Completion of Core Statutory Training
(Step Change Feb 2017)Sickness Absence
Side by side with service users and carers
Vacancy Rate % Involved in the development of your care plan
Great managers and teams
0.00%
1.00%
2.00%
3.00%
4.00%
5.00%
6.00%
7.00%
8.00%
9.00%
Mean Average Upper control limit Lower control limit Target
4.00%
6.00%
8.00%
10.00%
12.00%
14.00%
16.00%
Mean Average Upper control limit Lower control limit Target
0.00%
2.00%
4.00%
6.00%
8.00%
10.00%
12.00%
14.00%
Mean Average Upper control limit Lower control limit Target
50.00%
60.00%
70.00%
80.00%
90.00%
100.00%
110.00%
Mean Average Upper control limit Lower control limit Target
0.00%
20.00%
40.00%
60.00%
80.00%
100.00%
120.00%
Mean Average Upper control limit Lower control limit Target
EC: B2
TB: C2 19
Local Division Strategic Priorities - Our Future - KPI's
Research and innovation Research and innovation
Actual & Potential Suicide count - Community Team Caseload
(rolling 12 months)Physical restraint reduction
TitleInitial
Risk
Current Risk
RatingTarget Score
If the Trust continues
to fail to achieve the
appropriate levels of
compliance with
Safeguarding
training, then a
performance notice
may be issued from
CCG resulting in
financial and
reputational damage
for the Trust.
16 16 3
Research and innovation Research and innovation Effective partnerships
Self-harm incidents (Project wards Dee & Harrington)
Assaults on staff rolling 12 months (assaults on staff resulting
in harm for inpatient wards only per 1000 staff headcount)
Step Change Jan 2017
Risks associated with Contracts from Board Assurance Framework
0
20
40
60
80
100
120
140
Mean Average Upper control limit Lower control limit Target
0
5
10
15
20
25
30
35
40
Mean Average Upper control limit Lower control limit Target
0
10
20
30
40
50
60
70
80
90
100
Self Harm Mean Average Upper Natural Process Limit Lower Natural Process Limit
EC: B2
TB: C2 20
Secure Division Strategic Priorities - Our Services - KPI's
Safe - STEIS Incidents Timely - Delayed Discharge
Effective - Physical Health Screening for New
Admissions
No of STEIS Incidents Deyaled Transfers of Care (Step Change Oct 2016)% of new admissions who have had physical health screening
completed (NAS Standard)
Data not yet available
Equitable - Detention Under MHA by BME
Service Users
Efficient - Safe Staffing Levels Patient Centred - Friends & Family
% BME Detained within last 12 months under the Mental
Health Act
% of shifts filled by nurses against planned establishment
(NHS England Fill rate measure) / CHPPD
% likely to recommend our service to friends and family
(Step Change Feb 2017)
94.00%
96.00%
98.00%
100.00%
102.00%
104.00%
106.00%
108.00%
110.00%
112.00%
Upper control limit Lower control limit Target
0.00%
10.00%
20.00%
30.00%
40.00%
50.00%
60.00%
70.00%
80.00%
90.00%
100.00%
Mean Average Upper control limit Lower control limit Target
0
5
10
15
20
25
Mean Average Upper control limit
EC: B2
TB: C2 21
Secure Division Strategic Priorities - Our People - KPI's
A productive, skilled workforce
Turnover
Great managers and teams A productive, skilled workforce A productive, skilled workforce
Substantive leader in place for 3 months or more (Self
Assessment)
Completion of Core Statutory Training
(Step Change Feb 2017)Sickness Absence
Side by side with service users and carers
Vacancy Rate % Involved in the development of your care plan
Great managers and teams
0.00%
1.00%
2.00%
3.00%
4.00%
5.00%
6.00%
7.00%
8.00%
9.00%
Mean Average Upper control limit Lower control limit Target
4.00%
6.00%
8.00%
10.00%
12.00%
14.00%
16.00%
Mean Average Upper control limit Lower control limit Target
0.00%
2.00%
4.00%
6.00%
8.00%
10.00%
12.00%
14.00%
Mean Average Upper control limit Lower control limit Target
50.00%
60.00%
70.00%
80.00%
90.00%
100.00%
110.00%
Mean Average Upper control limit Lower control limit Target
0.00%
20.00%
40.00%
60.00%
80.00%
100.00%
120.00%
Mean Average Upper control limit Lower control limit Target
EC: B2
TB: C2 22
Secure Division Strategic Priorities - Our Future - KPI's
Research and innovation Research and innovation Effective partnerships
Self-harm incidents (Project wards Arnold & Poplar)Assaults on staff rolling 12 months (assaults on staff resulting
in harm for inpatient wards only per 1000 staff headcount)
Risks associated with Contracts from Board Assurance
Framework
Research and innovation Research and innovation
Actual & Potential Suicide count - Community Team Caseload
(rolling 12 months)Physical restraint reduction
TitleInitial
Risk
Current Risk
RatingTarget Score
If the Trust continues
to fail to achieve the
appropriate levels of
compliance with
Safeguarding
training, then a
performance notice
may be issued from
CCG resulting in
financial and
reputational damage
for the Trust.
16 16 3
0
10
20
30
40
50
60
70
80
Mean Average Upper control limit Lower control limit Target
0
1
2
3
4
5
Mean Average Target
0
10
20
30
40
50
60
70
Self Harm Secure Mean Average Upper Natural Process Limit
EC: B2
TB: C2 23
SpLD Division Strategic Priorities - Our Services - KPI's
Safe - STEIS Incidents Timely - Delayed Discharge
Effective - Physical Health Screening for New
Admissions
No of STEIS IncidentsDelayed Transfers of Care - April 2016 to October 2017 (Step
Change Feb 2017)
% of new admissions who have had physical health screening
completed (NAS Standard)
Data not currently available at Divisional level
Equitable - Detention Under MHA by BME
Service Users
Efficient - Safe Staffing Levels Patient Centred - Friends & Family
% BME Detained within last 12 months under the Mental
Health Act
% of shifts filled by nurses against planned establishment
(NHS England Fill rate measure) / CHPPD
Data unavailable until alignment of systems for
SpLDD
60.00%
70.00%
80.00%
90.00%
100.00%
110.00%
120.00%
130.00%
140.00%
Mean Average Upper control limit Lower control limit Target
0
1
2
3
4
5
6
7
Mean Average Upper control limit
0.00%
2.00%
4.00%
6.00%
8.00%
10.00%
12.00%
14.00%
16.00%
18.00%
20.00%
Mean Average Upper control limit Target
EC: B2
TB: C2 24
SpLD Division Strategic Priorities - Our People - KPI's
Data unavailable until alignment of systems
for SpLDD
A productive, skilled workforce
Turnover (Step Change Jan 2017)
Great managers and teams A productive, skilled workforce A productive, skilled workforce
Substantive leader in place for 3 months or more (Self
Assessment)Completion of Core Statutory Training Sickness Absence
Side by side with service users and carers
Vacancy Rate % Involved in the development of your care plan
Great managers and teams
0.00%
2.00%
4.00%
6.00%
8.00%
10.00%
12.00%
Mean Average Upper control limit Lower control limit Target
0.00%
20.00%
40.00%
60.00%
80.00%
100.00%
120.00%
Mean Average Upper control limit Lower control limit Target
0.00%
5.00%
10.00%
15.00%
20.00%
25.00%
Mean Average Upper control limit Lower control limit Target
0.00%
20.00%
40.00%
60.00%
80.00%
100.00%
120.00%
140.00%
Mean Average Upper control limit Lower control limit Target
EC: B2
TB: C2 25
SpLD Divisions Strategic Priorities - Our Future - KPI's
No Risks to report associated with Contracts
from Board Assurance Framework
Effective partnerships
Self-harm incidents (Project wards only Arnold, Dee,
Harrington and Poplar)
Assaults on staff rolling 12 months (assaults on staff resulting
in harm for inpatient wards only per 1000 staff headcount)
Risks associated with Contracts from Board Assurance
Framework
Research and innovation Research and innovation
Actual & Potential Suicide count - Community Team Caseload
(rolling 12 months)Physical restraint reduction
Data not currently available at Divisional level
No Suicides to report within last 12 months
rolling period
Research and innovation Research and innovation
0
20
40
60
80
100
120
140
160
180
Mean Average Upper control limit Lower control limit Target
0
100
200
300
400
500
600
700
800
900
Mean Average Upper control limit Lower control limit
EC: B2
TB: C2 26
Finance Dashboard 2017/18 - Month 7
Finance and Use of Resources Metrics Weight M7 Plan M7 ActualYear End
Plan
Year End
Forecast
Capital Service Capacity 20% 2 2 2 2
Liquidity 20% 1 1 1 1
I&E Margin 20% 1 1 1 1
Distance from financial plan 20% 1 1
Agency Spend 20% 2 3 2 3
Overall Score (after overrides) 100% 2 2 2 2
Agenda Item No: B2
MERSEY CARE NHS FOUNDATION TRUST
Month 7 Financial Performance
OVERALL FINANICAL PERFORMANCE 1. The trust is reporting a surplus of £3.463m at Month 7. It is forecast to achieve the
control total of £5.162m at the year end. A summary of the financial position is provided in Table 1.0 and detailed in Appendix A. Table 1.0 – Summary Financial Position – Month 7
2. From Table 1.0 it can be seen divisional pressures, in month 7, are being supported by the local, secure and corporate divisions. A more detailed analysis is provided in Appendix B. Key areas to note:
a) The local division underspend at month 7 of £0.837m is due to non recurrent funding in the division. This will reduce in future months as vacant posts are recruited to. Currently overspends within out of Area Treatments (OATs), Talk Liverpool, radiology and nuclear medicine alongside CIP underachievement of £1.2m. The forecast outturn for 2017/18 is breakeven and includes additional growth funding of £0.385m and £0.428m CQUIN. The forecast is assumes: non-delivery of £1.2m CIP; a high level of OATs activity; overspends in Talk Liverpool, agency spend for Supported Living Services (SLS) and an increase in costs as newly funded posts are recruited to. It is also anticipated back pay will be paid to SLS staff amounting to £0.463m. The STAR Unit transferred to the Specialised LD division in month 7, however the year to date overspend of £0.327m has been retained within the Local Division.
b) The secure division is underspent by £0.100m as a consequence of vacancies, offset in part by non pay cost pressures. The division is forecast to breakeven. CIP savings of £1.256m have been delivered to month 7 and the plan of £2.200m is forecast to be delivered. However £0.263m is being delivered non-recurrently, therefore recurrent plans need to be developed for 2018/19.
c) The Specialist LD division is £0.449m overspent at month 7. The overspend is related to the operational requirement for additional staffing required to deliver
YTD
BudgetYTD Actual
YTD
Variance
Annual
Budget
Forecast
OutturnVariance
£000 £000 £000 £000 £000 £000
Income 153,415 153,318 (97) 265,200 265,138 (62)
Total Income 153,415 153,318 (97) 265,200 265,138 (62)
Expenditure
Local Division (41,810) (40,973) 837 (72,586) (72,586) 0
Secure Division (28,662) (28,562) 100 (49,519) (49,519) 0
Specialist Learning Disabilities (15,394) (15,844) (449) (26,333) (27,077) (744)
Sefton Community Division (9,989) (9,985) 4 (20,203) (20,360) (156)
Corporate Division (Excl. Medical Services & LCH) (26,333) (25,844) 490 (46,148) (45,698) 450
LCH (182) (346) (163) (230) (1,230) (1,000)
Medical Services (12,316) (13,088) (773) (20,971) (21,821) (850)
Informatics Merseyside (IM) (6,008) (6,008) (0) (10,461) (10,461) 0
Sub Total - Divisional Expenditure (140,693) (140,649) 44 (246,450) (248,750) (2,300)
Reserves & Other Budgets (5,659) (9,206) (3,547) (9,988) (10,376) (388)
Revaluation Reserve (3,600) 3,600 (3,600) (850) 2,750
Other Budgets & Reserves (9,259) (9,206) 53 (13,588) (11,226) 2,362
I&E Surplus/(Deficit) 3,463 3,463 0 5,162 5,162 0
Division
Agenda Item No: B2
increased levels of clinical observations, especially in low secure services. The transfer of the STAR unit from the local division has generated an in month overspend of £0.034m due to agency usage associated with patient acuity. The division has spent £0.928m on agency and £2.108m on bank staff to month 7. Additional staffing costs linked to unplanned care continue to be closely monitored by the management team. The forecast position has been amended to reflect delays in patient discharges from a breakeven position to £0.500m overspent In addition, the transfer of the STAR unit has increased the forecast by £0.244m to £0.744m overspent.
d) Sefton community services division is breakeven at month 7, mainly due to vacancies in clinical areas, which are non-recurrently supporting the CIP position. The forecast outturn for 2017/18 is £0.150m overspent due to additional posts of £0.282m, which have been approved to stabilise the Division’s services and meet winter pressures. The division is currently undertaking a number of clinical service reviews, there is a risk this may identify further cost pressures. The impact of service reviews will be monitored regularly and the forecast outturn position will be updated accordingly.
e) The corporate division is under-spending across executive nursing, finance, estates, corporate governance and workforce, offsetting overspends within IPI, perfect care and costs associated with the LCH bid.
f) Medical services are overspending as a result of senior medical staffing costs within the local division. These are currently being offset by underspends within the specialist learning disabilities medical staff and vacancies across junior medical staff areas. A plan has been developed by the Medical Director, to reduce spend by £1.5m in 2018/19. This is currently being verified by the finance.
COST IMPROVEMENT PLANS (CIP) 3. The target CIP for 2017/18 is £6.210m. At month 7, the target is £3.801m of which
£2.740m has been delivered. The areas of underachievement are within the local and corporate divisions.
a) The local division have a month 7 CIP target of £2.109m and have achieved £1.217m. Schemes that are under achieving include the community services redesign and income generation. The forecast for the division indicates a recurrent underachievement against the CIP of £1.2m in 2017/18. Delivery of the recurrent CIP target is critical to the trusts ability to meet its control total for 2018/19. The division is currently developing alternative schemes.
b) The corporate division have a year to date CIP target of £0.533m of which
£0.365m has been achieved. The underachieving schemes relate to the pharmacy drugs review and executive nurse patient safety review. Alternative schemes have been requested from the relevant executive directors.
4. It is essential recurrent replacement schemes for the above are required to be presented
to the Quality Assurance Committee in during quarter four by the respective director.
FINANICAL RISKS 5. The Trust is currently planning to meet the control total of £5.162m. However there are
financial risks of circa £2.750m for 2017/18. The key areas are summarised below:
Agenda Item No: B2
a) Medical services - The medical services budget is forecast to overspend by £0.850m.
b) Specialist LD division - The division has a £0.744m overspend. Delays in discharges are becoming more likely as availability of client placements outside the trust becomes more difficult. This could result in an over spend of up to £0.500m, in addition to £0.244m relating to the transfer of Local services in month 7.
c) Sefton community services division – The division is forecasting a £0.156m overspend position. This reflects the need to stabilise the new service.
d) New business developments – The trust will incur additional costs associated with being selected as the preferred provider for the Liverpool Community Health Service. These are currently estimated at £1.000m.
6. Remedial action plans for the areas identified above should be presented and monitored
through the Performance, Investment and Finance Committee in December by the relevant Chief Operating Officer or Executive Lead.
7. As part of the financial planning for 2018/19 work has been undertaken to assess the
financial risks. In total these amount to £4.970m and include:
a) Medical Services (£1.0m) – Overspend to continue into 2018/19 whilst case load review is undertaken and recruitment takes place.
b) Local Division (1.470m) – This includes cost pressures for SLS (£0.100m), OATS (£0.500m), YMCA (£0.250m) and IAPT services (£0.620m)
c) Specialist LD division (£0.500m) – A similar financial position to 2017/18 is anticipated resulting in an overspend.
d) Corporate CIP Under achievement (£1.0m) – At present there are insufficient plans to meet the £4.0m corporate CIP target.
e) LCH Support (£1.0m) – The financial envelope associated with LCH services included the requirement to achieve £1.0m in efficiencies. There are currently no robust plans to meet this target.
8. Unless these issues are resolved there will be long term financial implications for the trust.
9. A paper will be presented to the Executive Committee and the Performance, Investment and Finance Committee detailing the proposed financial plan and associated risks for 2018/19 in December 2017.
NHS IMPROVEMENT RISK RATING 10. The overall ‘use of resources’ risk rating is currently at level 2, which is on plan.
11. Capital services capacity measures how well the Trust can meet fixed payments
associated with capital financing (e.g. lease interest payments, public dividend capital). The trust is able to cover the payments 2.39 times.
12. Liquidity measures the availability of liquid (cash) resources to be able to meet liabilities
as they fall due. The Trust is currently at 20 days, which is rated as 1.
13. The I&E margin metric measures the percentage of financial performance surplus compared to operating income. This is currently at 2.22% and is rated at 1.
Agenda Item No: B2
14. The I&E margin distance from plan, compares the planned I&E metric to actual performance. The trust is on plan and is rated at 1.
15. The agency rating measures agency spend against the ceiling applied by NHS Improvement. At month 7, agency spend totals £5.734m, which is 44% above national target levels and this metric is rated at 3, compared to a plan of 2. An analysis of agency costs is provided in Appendix C. Divisions have developed remedial action plans from all divisions to identify areas where agency spends will reduce.
CAPITAL EXPENDITURE 16. At the end of October capital costs of £9.162m have been incurred. This is £6.056m
below plan as a result of slippage against the following schemes: Liverpool & Southport inpatient facilities, pharmacy relocation, Kevin White Unit redevelopment and the Trust decant facility.
17. A review of the 2017/18 capital programme has been undertaken and submitted to NHSi. The forecast outturn has reduced by £8.888m to £28.930m due to slippage in the Medium Secure Unit (MSU), Local Secure Unit (LSU) and Southport Inpatient Facility.
18. Southport Inpatient Facility is underspent by £1.668m due to delays with planning permission. The trust is forecasting £2.250m will be spent in 2017/18.
19. The business case for the MSU (£60.700m) is currently with the Department of Health (DH) awaiting Ministerial, then Treasury, approval.
CASH POSITION 20. At the end of October the cash balance is £27.595m, which is £7.791m above plan. This
is driven by a combination of slippage on capital investment and favourable working capital movements. A detailed analysis is provided in Appendix D.
21. The statutory duty to pay 95% of suppliers within 30 days has been achieved in September at 97.7%. (NHS suppliers are 98.5% and Non NHS suppliers are 97.7%).
22. The trust has requested a loan of £60.700m to finance the MSU. Once Treasury approval for the scheme has been received, the trust will develop an accurate draw down profile for the funds. It is anticipated that the first receipt will be in January 2018 (£6.370m) and will continue until 2019/20. This can be seen in the cash flow statement in Appendix D.
23. Treasury approval for the MSU was expected in November but is subject to DH and ministerial approval which is yet to be granted. Delays at this stage may impact on the draw down profile.
24. During 2018/19, planned expenditure on the Southport Inpatient Facility will reduce the trust’s cash balance to £5.000m which equates to 10 days working capital.
FORWARD LOOK 25. The revaluation reserve of £3.600m is currently being held to support forecast
overspends of £2.399m in 2017/18. It is proposed the remaining balance of £0.850m is
Agenda Item No: B2
utilised non-recurrently to support transformation schemes within the trust. Options will be evaluated by the executive team and will be included in the December finance paper.
RECOMMENDATIONS 26. The Board is asked to:
a) Note the current financial position and planned achievement of the control
total.
b) Agree and monitor the recommendation for replacement CIP schemes to be
presented to the Quality Assurance Committee in January by the Chief
Operating Officer of the local division, the Medical Director and Executive
Nurse Director.
c) Note the risks associated with the 2017/18 financial position and require the
following to be presented at the December Performance, Investment and
Finance Committee:
o Chief Operating Officer to provide assurance of the financial position
for Local and specialist learning disabilities division
o Medical Director to provide a recovery plan for the local medical
staffing budget.
d) Note the financial risk of £4.970m associated with 2018/19.
e) Proposed plans for the remaining revaluation reserves funding of £0.850m to
be agreed by the executive team and included in the December finance
paper.
Neil Smith Executive Director of Finance November 2017
Plan Actual Variance Plan Actual Variance
Contract Income 144,641 144,120 (521) 252,503 249,982 (2,521)
Sustainability & Transformation Funding (STF) 582 582 (0) 1,294 1,294 0
Informatics Merseyside Income 4,688 4,698 10 7,966 7,966 0
Operational Income 6,052 6,563 510 10,354 9,334 (1,020)
Total Income 155,964 155,963 (1) 272,116 268,576 (3,540)
Employee Expenses (119,511) (115,461) 4,050 (210,250) (200,667) 9,583
Non Pay Expenses (25,527) (29,312) (3,785) (43,798) (49,421) (5,623)
EBITDA (Earnings before interest, tax, depreciation and amortisation) 10,926 11,190 264 18,069 18,488 419
EBITDA Margin % 7.01% 7.17% 0.17% 7% 7% 0%
Capital Charges (3,201) (3,305) (104) (5,491) (5,734) (243)
Public Dividend Capital (2,830) (2,830) 0 (4,930) (4,930) (0)
Provisions unwinding of discount (53) (53) 0 (53) (53) 0
Interest Payable (1,345) (1,410) (65) (2,375) (2,491) (116)
Interest Receivable 63 32 (31) 108 43 (65)
Carbon Credits (97) (161) (64) (166) (161) 5
I&E Surplus 3,463 3,463 (0) 5,162 5,162 0
I&E Surplus Margin % 2% 2% 0% 2% 2% 0%
Capital Impairment 0 0 0 (8,435) (2,755) 5,680
Net I&E Surplus 3,463 3,463 (0) (3,273) 2,407 5,680
FoTYTDStatement of Comprehensive Income (SoCI)
Appendix A
Statement of Comprehensive Income (SOCI)
Budget
£000
Actual
£000
Variance
£000
265,680 Income 153,415 153,318 (98)
265,680 Total Income 153,415 153,318 (98)
EXPENDITURE
Local Division
(42,025) Liverpool (24,475) (22,776) 1,699
(8,911) Management (4,719) (4,899) (179)
(21,650) Sefton & Kirby (12,615) (13,298) (683)
(72,586) Sub-Total Local Division (41,810) (40,973) 837
Secure Division
(36,301) High Secure (21,053) (20,720) 333
(13,126) Medium & Low Secure (7,609) (7,842) (233)
(49,427) Sub-Total Secure Division (28,662) (28,562) 100
Specialist LD Division
(399) Divisional Services (388) (1,064) (676)
(926) Management (535) (477) 58
(21,380) Forensic & High Support (12,497) (12,315) 182
(497) Forensic Support Service (290) (269) 21
(2,890) Local LD Services (1,684) (1,718) (34)
(26,093) Sub-Total Specialist LD Division (15,394) (15,844) (449)
Corporate Division
(3,020) Board (1,783) (1,795) (12)
(3,893) Executive Nurse (2,202) (1,981) 222
(2,939) Finance (1,662) (1,626) 37
(14,937) Estates & Facilities (8,802) (8,392) 410
(3,189) Corporate Govn & Business Dev (1,775) (1,667) 108
(7,403) Informatics & Performance Impr (3,663) (3,693) (30)
(182) LCH Bid (182) (347) (164)
(23,514) Medical Services (13,781) (14,544) (764)
(2,242) Perfect Care (1,526) (1,782) (255)
0 Calderstones Transition (86) (86) (0)
(5,782) Workforce (3,368) (3,365) 3
(67,102) Sub-Total Specialist LD Division (38,831) (39,278) (447)
Sefton Division
(2,521) Sefton Corporate Services (1,216) (1,202) 14
(17,683) Sefton Cross Divisional Services (8,773) (8,783) (10)
(20,203) Sub-Total Sefton Division (9,989) (9,985) 4
(10,311) Informatics Merseyside (IM) (6,008) (6,008) (0)
(14,797) Other Budgets & Earmarked Reserves (9,259) (9,206) 53
(260,518) Total Expenditure (149,952) (149,855) 98
5,162 Net Surplus/(Deficit) before technical adjustments 3,463 3,463 (0)
Divisions
Month 7 2017/18Annual
Budget
£000Year to Date
Appendix B
Financial Position by Division
01,0002,0003,0004,0005,0006,0007,0008,000
Apr
May Jun Jul
Aug
Sept
Oct
Nov Dec Jan
Feb
Mar
£'0
00
Agency Spend - Trust WideActual Agency Spend Agency Cap
0100200300400500600700800900
Apr
May Jun Jul
Aug
Sept
Oct
Nov Dec Jan
Feb
Mar
£'0
00
Agency Spend - Corporate DivisionActual Agency Spend Agency Cap
0
50
100
150
200
250
Apr
May Jun Jul
Aug
Sept
Oct
Nov Dec Jan
Feb
Mar
£'0
00
Agency Spend - Secure DivisionActual Agency Spend Agency Cap
0200400600800
1,0001,2001,4001,6001,800
Apr
May Jun Jul
Aug
Sept
Oct
Nov Dec Jan
Feb
Mar
£'0
00
Agency Spend - Local DivisionActual Agency Spend Agency Cap
0100200300400500600700800900
Apr
May Jun Jul
Aug
Sept
Oct
Nov Dec Jan
Feb
Mar
£'0
00
Agency Spend - iMerseyside (IM)Actual Agency Spend Agency Cap
0200400600800
1,0001,2001,4001,6001,800
Apr
May Jun Jul
Aug
Sept
Oct
Nov Dec Jan
Feb
Mar
£'0
00
Agency Spend - Specialist LD DivisionActual Agency Spend Agency Cap
Agency spend within the corporate division to month 7 is £0.513m, compared to a ceiling of £0.455m. An option being considered by the Executive team as part of the recovery plan is to cease all corporate agency spend.
At £5.734m, the Trust is 44.0% above its agency ceiling as at October 2017. This equates to a risk score of 3. The main areas of high agency usage continue to be the local division and medical staff. Action plans have been requested from all areas operating above the ceiling to reduce the forecast outturn.
The local division agency spend as at month 7 is £1.529m, which is £0.909m above the ceiling of £0.621m. The overspend relates largely to agency nursing costs covering vacancies and sickness. The division has started to address agency use as part of a key action in the divisions recovery plan.
Agency usage within the secure division remains at a minimum
Specialist learning disability division's agency spend at month 7 is £1.073m which is above the ceiling by £0.098m. Remedial action plans continue in place and further reductions are expected as the service retracts.
As at end of October, IM's agency spend is £0.676m compared with its agency ceiling of £0.457m. Temporary staff are used to resource change notices on SLA's and to fill vacancies that require specialist skill sets. However the main driver of agency spending has been resourcing the Liverpool Community Health SLA due to the uncertainty of the future direction of the organisation. Plans to recruit to posts have been developed and the level of spend should reduce to within the ceiling by March 2018.
Appendix C
Cumulative Agency Spend by Division
0
100
200
300
400
500
600
700
Ap
r
May Jun Jul
Au
g
Sep
t
Oct
No
v
Dec Jan
Feb
Mar
£'0
00
Agency Spend - LCH South Sefton DivisionActual Agency Spend Agency Cap
The south sefton division transferred to Mersey Care on 1st June. The agency spend to October is £0.328m, which is slightly above the ceiling of £0.292m. The spend is mainly within district nursing, discharge planning and intermediate care.
0200400600800
1,0001,2001,4001,6001,8002,000
Ap
r
May Jun Jul
Au
g
Sep
t
Oct
No
v
Dec Jan
Feb
Mar
£'0
00
Agency Spend - MedicsActual Agency Spend Agency Cap
As at end of October, medical agency/locum spend is £1.595m, compared to a ceiling of £1.064m. This is mainly due to senior medical staffing costs within the local division, offset in part by vacancies across junior medical staff and senior medical staff within Specialist LD. A recovery plan has been developed by the Medical Director and the level of spend will reduce slightly in 2017/18, but the full year effect of the saving is £1.5m.
Cumulative Agency Expenditure by Division - October 2017
Statement of Cash Flows (CF)
April May June July August September October November December January February March
£000s £000s £000s £000s £000s £000s £000s £000s £000s £000s £000s £000s
CASH FLOWS FROM OPERATING ACTIVITIES
Operating Surplus/(Deficit) 1,262 997 1,325 1,402 1,043 868 989 851 527 694 1,208 (996)
Depreciation and Amortisation 446 447 461 490 490 490 480 463 493 494 490 490
Impairments and Reversals 0 0 0 0 0 0 0 0 400 0 0 2,355
Interest Paid (160) (196) (198) (198) (197) (254) (207) (209) (212) (211) (208) (255)
Dividend Paid 0 0 0 0 0 (1,609) 0 0 0 0 0 (3,291)
Losses 0 0 0 0 0 0 0 0 0 0 0 0
(Increase)/Decrease in Inventories 18 (22) (12) 15 (41) 18 42 (6) (6) (6) 0 0
(Increase)/Decrease in Trade and Other Receivables (1,106) 3,712 (2,629) 2,706 1,084 (290) 267 (1,267) (1,267) (1,265) 0 0
Increase/(Decrease) in Trade and Other Payables 637 (937) 3,266 264 (269) 3,153 (902) 881 882 881 (137) (5,104)
Increase/(Decrease) in Other Current Liabilities 0 0 0 0 0 0 0 0 0 0 0 0
Increase/(Decrease) in Provisions (526) (19) 383 (274) (331) 317 (839) 334 333 (16) (6) 252
Net Cash Inflow/(Outflow) from Operating Activities 571 3,982 2,596 4,405 1,779 2,693 (170) 1,047 1,150 571 1,347 (6,549)
CASH FLOWS FROM INVESTING ACTIVITIES
Interest received 4 4 7 3 4 6 4 0 0 1 5 5
(Payments) for Property, Plant and Equipment (1,383) (3,507) (979) (530) (884) (1,030) (1,130) (1,985) (3,033) (3,608) (4,873) (5,417)
(Payments) for Intangible Assets 0 0 0 0 0 0 0 0 0 0 0 0
Proceeds of disposal of assets held for sale (PPE) 0 0 0 0 0 0 0 0 0 0 0 0
Net Cash Inflow/(Outflow)from Investing Activities (1,379) (3,503) (972) (527) (880) (1,024) (1,126) (1,985) (3,033) (3,607) (4,868) (5,412)
NET CASH INFLOW/(OUTFLOW) BEFORE FINANCING (808) 479 1,624 3,878 899 1,669 (1,296) (938) (1,883) (3,036) (3,521) (11,961)
CASH FLOWS FROM FINANCING ACTIVITIES
New Public Dividend Capital 0 0 0 0 0 0 0 1,250 0 0 0 500
Loans received from DH - New Capital Investment Loans 0 0 0 0 0 0 0 0 0 6,370 0 0
Public Dividend Capital repaid in year 0 0 0 0 0 0 0 0 0 0 0 0
Other Capital Receipts 0 0 0 0 0 0 0 0 0 0 0 0
Loans repaid to DH - Capital Investment Loans Repayment of Principal 0 0 0 0 0 0 0 0 0 0 0 (64)
Capital Element of Finance Leases and PFI (33) (34) (32) (33) (74) (33) (164) (50) (55) (54) (60) (63)
Net Cash Inflow/(Outflow)from Financing (33) (34) (32) (33) (74) (33) (164) 1,200 (55) 6,316 (60) 373
Net Increase/(Decrease) in Cash (841) 445 1,592 3,845 825 1,636 (1,460) 262 (1,938) 3,280 (3,581) (11,588)
Cash at the Beginning of the Period 21,553 20,712 21,157 22,749 26,594 27,419 29,055 27,595 27,857 25,919 29,199 25,618
Cash at the End of the Financial Period 20,712 21,157 22,749 26,594 27,419 29,055 27,595 27,857 25,919 29,199 25,618 14,030
ForecastActual
Appendix D
Statement of Cash Flow