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Procedure for start-up, tuning and shut down of profile 3 SIFT FAMS analyser

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NIHR Southampton Biomedical Research Centre The NIHR Southampton Biomedical Research Centre (BRC) has a
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UHS Green Plan 2025-2028

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Green Plan 2025 - 2028 Approved November 2025 Contents 1 Executive Summary 2 Introduction and Context 3 Organisational Vision 4 Review o
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Finance and Performance Reports 2023-24 Month 6 September 2023

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Report to the Trust Board of Directors Title: Agenda item: Sponsor: Author: Date: Purpose Finance Report 2023-24 Month 6 12.3 Ian Howard – Chief Financial Officer Philip Bunting – Director of Operational Finance David O’Sullivan – Assistant Director of Finance – Financial Performance 9 November 2023 Assurance or reassurance Approval Ratification Information X Issue to be addressed: Response to the issue: The finance report provides a monthly summary of the key financial information for the Trust. Finance and Investment Committee reviewed a detailed monthly finance report, including a review of forecast outturn and a spotlight on the capital and cash position. The full report is available to Trust Board members for background reading. The Committee agreed to highlight: M6 Financial Position UHS is reporting a deficit of £1.8m in September compared with a deficit plan of £2.3m. This is therefore £0.5m favourable to plan. The in-month position does however include nonrecurrent benefits relating to ERF (assumed to be non-recurrent at this stage), VAT reviews and additional back-dated income. YTD the deficit is £22.6m compared to a plan of £19m so £3.6m adverse to plan. The variance is due to the following three specific items: • Underfunded 22/23 non-consolidated pay award (Serco) - £1m. • 23/24 underfunded AfC pay award - £1m pressure YTD (£2m estimated for 23/24). This has reduced from the previous month as partial mitigations have been identified. • 23/24 underfunded medical pay award - £1.6m pressure YTD (£3.2m estimated for 23/24). This has also reduced in month as £1.4m of mitigations (full year calculation) have been identified mainly relating to education funding. ERF and Industrial Action ERF income of £1.2m is reported in month relating to a reassessment of prior period performance following the receipt of a further month of national data. The YTD position now includes £4.8m of ERF income with performance estimated at 114% against a revised target of 111%. Performance for September was 109% despite the significant challenge of managing industrial action which took place jointly for consultants and junior doctors. This covered a four-day period with three days of junior doctor strikes and two days of consultant strikes, one of which took place concurrently with junior doctors. Estimates value the loss of activity due to industrial action at £4.6m YTD as shown in the table below with a further £1.2m incurred in additional premium backfill costs. Page 1 of 31 Industrial Action Financial Impact Assessment (£m) Direct Cost Impact Estimated Loss of (Backfill less strike Month Income pay reductions) April 1.50 0.30 May 0.00 0.00 June 0.30 0.10 July 1.00 0.30 August 0.80 0.30 September 1.00 0.20 Total 4.60 1.20 Total Financial Impact 1.80 0.00 0.40 1.30 1.10 1.20 5.80 So far, the only adjustment to the ERF target relates to months up to April which reduced the annual target by 2%. Further announcements are expected in coming weeks although remain unconfirmed. We are however anticipating full relief for the impact of industrial action on the financial position of the Trust. Underlying Position The September reported position included several one-off items, as reported above. The Committee asked for the underlying position calculation to be reviewed, to included additional ERF income that would have been earned without industrial action, as well as adjusting for true non-recurrent savings only. This will be completed for M7, with the position expected to be in the region of £5m deficit per month. Deficit Drivers The underlying deficit continues to be driven by a number of underlying system pressures seen in 22/23, for which we have not been able to recover to date: • Non-pay inflation beyond funded levels • Impact of energy prices (with gas prices impacting UHS particularly hard) • High-cost drugs spend (previously pass-through) • Number of patients not meeting criteria to reside, impacting capacity (opening expensive “surge” capacity / bed capacity restricting elective activity) In 23/24, we are now seeing further pressures, notably: • Unfunded elements of pay awards - £0.4m per month. • The impact of industrial action is impacting our performance, both activity levels and capacity to deliver recurrent CIP. • Workforce pressures as substantive recruitment is not offset with temporary staffing reductions - £0.7m per month. • Covid testing funding reductions not immediately offset with cost reductions - £0.2m per month. • Mental health nursing pressures - £0.2m per month. • Tariff efficiency reductions not offset by recurrent CIP delivery - £0.7m per month. • Further growth in the number of patients not meeting the criteria to reside. These have been consistently at 200 with some weeks peaking at over 240. Unfunded additional activity is a further pressure for UHS where we are YTD providing activity above block funded level for free in the following areas: • £6.5m of outpatient follow up appointments • £3.8m of non-elective • £2.4m of other treatments UHS continues to target demand management within these areas shifting outpatients to patient initiated follow up protocols often via the My Medical Record platform. Page 2 of 31 Forecast Our submitted forecast to NHS England maintains delivery of a £26m deficit. This was underpinned by a £0.3m per month improvement to the financial position during 2023/24. The current YTD performance and run rate suggests it will be extremely challenging to achieve the planned position without additional funding due to industrial action costs. Finance Committee considered several potential forecasts, ranging from £26m deficit to £50m deficit, depending on the level of financial relief from industrial action and funding of pay-award pressures, as well as the level of H2 financial improvement being delivered. Due to the current funding uncertainty, it was recommended and agreed that the forecast remains at £26m until further clarity is received. Cost Improvement Plans Whilst £72m of CIP opportunities have been identified, the most-likely risk assessed position sits at £59m. Whilst we have made good progress with CIP performance, it is heavily supported by non-recurrent delivery that cannot be relied upon for underlying financial improvement. Capital A capital spotlight report highlighted that due to slippage and changes to funding, the Trust had a risk of under-spending against its CDEL target. However, we have identified £5.8m of schemes to bring-forward from the 2024/25 approved capital programme into 2023/24, mainly accelerating strategic maintenance schemes and medical equipment replacement. A further additional £1.3m of schemes have been prioritised as must-do schemes due to emerging risks (e.g., steam ducts propping). We are therefore slightly over-programmes, which is likely to be offset by further slippage risk and is within manageable levels. The risk of under-delivery has therefore been mitigated. The capital prioritisation process for 2024/25 and 2025/26 will soon commence using the multiyear programme already shared with finance and investment committee as a starting point. Planning 2024/25 The planning process for 2024/25 has been launched internally within the ICS in order to give an early indication of scale of financial challenge for the next financial year. Further updates will be provided at future finance and investment committees. Cash Spotlight The Committee considered a spotlight report into cash, which highlighted that cash has reduced from £105m to £68m in-year, driven largely by the Trust’s underlying deficit. The report highlighted the work of the finance team to maximise and safeguard the Trust’s cash position going forwards. A number of cash forecasts were considered, dependent on the underlying financial position of the Trust. However, it was anticipated the Trust would end the year with cash of circa £30m and may be required to request national cash support in either Q1 or Q2 of 2024/25. This is of course heavily dependent on income levels, industrial action relief and the impact of financial recovery measures across the ICB. Due to the scale of deterioration the Trust is rightfully ensuring future investment decisions show a cognisance of the scale of cash attrition to ensure projects can be completed and investments made responsibly with financing an important consideration. Page 3 of 31 Implications: • Financial implications of availability of funding to cover growth, cost pressures and new activity. • Organisational implications of remaining within statutory duties. Risks: (Top 3) of carrying out the change / or not: • Financial risk relating to the underlying run rate and projected potential deficit if the run rate continues. • Investment risk related to the above • Cash risk linked to volatility above • Inability to maximise CDEL (which cannot be carried forward) and the risk of a reducing internal CDEL allocation for 2024/25 due to the forecast deficit for 2023/24. Summary: Trust Board is asked to: Conclusion • Note the finance position. and/or • Note the update on capital. recommendation • Note the risk on the Trust’s cash position. Page 4 of 31 M6 Finance Report Page 5 of 31 Report to Trust Board October 2023 Ian Howard, CFO Philip Bunting, DOOF David O’Sullivan, Asst DOF Summary Page 6 of 31 2 Finance Dashboard Position (objective 5a) YTD vs. Plan Forecast Underlying Capital (objective 5d) YTD Forecast CIP (objective 5a) Identification Delivery Productivity (objective 5a) Page 7 of 31 3 Overall Position Page 8 of 31 4 Executive Summary In Month and Year to date Highlights: 1. In Month 6, UHS reported a deficit position of £1.8m which was £0.5m favourable to plan. YTD the deficit is now £ 22.6m which is £3.6m adverse to plan. The total plan for the year is £26m deficit which is currently forecast for delivery. The YTD shortfall to plan is a result of funding pressures relating to national pay awards for Agenda for Change and Medical staff. 2. The underlying position in September is a £6.1m deficit, which is in line with previous months run rates. This position exclu des the favourable impact of ERF overperformance within the overall trust position. 3. CIP delivery is reporting marginally behind plan YTD with £27.1m delivered vs plan of £27.8m. Of the value identified to date, £17.9m is non-recurrently delivered CIP. Annually, £71.7m of savings have been identified in plans, 104% of the trust target of £69m. A risk assessment of schemes has taken place which reduces the expected yield of schemes down to £59.1m - 86%. There is continued focus on savings identification and delivery to support financial recovery. 4. The themes seen in M6 were: 1. UHS is over its elective recovery target to the end of M6 at 114% / £4.8m favourable. Performance continues to be impacted by both industrial action and an increase in non-elective activity. Further changes to ERF targets are anticipated nationally but are not yet known. 2. Medical Pay Awards costs have been paid within the M6 position. This has resulted in a £1.8m pressure (above funded levels) YTD. The forecast annual impact of this is £3.2m. 3. Underlying drivers for the monthly financial deficit largely remain as per 22/23 including inflation, energy, drugs and incre ased volumes of patients not meeting the criteria to reside. 4. Upward workforce trends remain a risk with particular pressures around additional nursing spend related to providing safe car e for mental health patients and costs relating to cover for industrial action. 5. Surge capacity also remains open at times to support flow at times of peak bed pressure. Page 9 of 31 5 Overall Financial Position Income Clinical Income Pass-through Drugs & Devices Other Income Total Revenue Costs Pay - Substantive Pay - Bank Pay - Agency Drugs Pass-through Drugs & Devices Clinical Supplies Other non pay Total Operating Expenses Remove Depreciation and Amortisation Donated Income Profit/(Loss) from Operations (EBITDA) Add Less Non Operating Income Non Operating Expenditure Budget Full Year £000's Plan £000's Current Actual £000's Variance £000's Plan £000's Year to date Actual £000's Variance £000's 839,728 186,582 176,791 1,203,101 69,978 15,548 14,117 99,643 69,964 16,141 14,190 100,295 14 (592) (73) (652) 419,869 93,291 85,439 598,599 431,921 101,091 82,321 (12,052) (7,800) 3,118 615,333 (16,734) 630,404 43,631 15,070 35,928 186,582 67,008 225,801 1,204,424 38,037 (16,583) 20,131 2,166 (34,189) 52,521 3,876 1,287 2,994 15,548 5,793 18,749 100,769 3,128 (617) 1,385 181 (3,486) 55,136 4,189 1,092 3,223 16,141 1,497 18,764 100,041 3,024 (886) 2,392 391 (3,905) 2,615 313 (195) 228 592 (4,297) 15 (728) (104) (269) (1,007) (210) 419 313,401 23,667 8,254 17,966 93,291 35,797 114,749 607,124 18,972 (6,231) 4,216 1,086 (19,296) 331,885 24,948 6,751 16,529 101,091 31,589 115,700 628,493 18,383 (4,560) 663 2,585 (22,360) 18,484 1,281 (1,503) (1,436) 7,800 (4,208) 950 21,368 (589) 1,671 3,553 (1,499) 3,064 Net Surplus / (Deficit) incl Impairments & Donation Less Donated Income Less Profit on disposals Less Gain/ Loss on absorption Add back Donated Depreciation Add back Impairments Total Net Surplus / (Deficit) (11,892) (16,583) 0 0 2,475 0 (26,000) (1,920) (617) 0 0 204 0 (2,333) (1,122) (886) 0 0 178 0 (1,830) (798) (13,994) (19,112) 269 (6,231) (4,560) 0 0 0 0 0 0 26 1,225 1,041 0 0 0 (503) (19,000) (22,631) Page 10 of 31 5,118 (1,671) 0 0 184 0 3,631 UHS has submitted an annual plan position of £26m deficit for the 2023/24 financial year. In September a deficit position of £1.8m was reported, £0.5m favourable to plan. The YTD position of £22.6m deficit is £3.6m adverse to the planned deficit target of £19.0m. In Clinical Income ERF overperformance is reported at £4.8m YTD. This figure include an adjustment to April ERF baseline target at 2%. Future amendments are anticipated but have not been confirmed to date. The balance of the YTD favourable position on clinical income is as a result of pay award funding received above initial planning assumptions totalling £10.4m. Pay expenditure continues to exceed plan, due to pressures from the national pay awards, requirements for mental health nursing support, staffing of surge capacity areas, unfunded workforce growth in prior periods and lower than planned pay CIP Delivery. £10.4m of the pay variance is additional pay award funding offset within clinical income. Non pay categories (excluding pass through) are under plan YTD largely as a result of several nonrecurrent benefits taken in year. 6 Run Rates • The UHS run rate position has continued in M6 at a deficit of £1.8m which is lower than planned levels, however is the result of a number of non recurrent benefits released into the position. • The improved run rate trend in the second half of 2022/23 financial year was delivered by non recurrent means with the underlying position remaining challenging. This has continued into 2023/24. • Pressures continue across all expenditure and income types with notable challenges experienced in month detailed below. • Pay – Continued pressures as a result of national pay awards for AFC and medical staff, industrial action and mental health nurs ing. • Non Pay – Cost pressures relating to Energy increases and inflationary pressures on clinical supplies. Trends can be volatile du e to pass through drugs and devices which are not uniform each month. • Income – the run rate reduced in month following receipt of funding towards medical pay awards and ERF in M5. YTD ERF performance is reporting over plan by £4.8m / 114%. Page 11 of 31 7 Run Rates Page 12 of 31 8 Underlying Position / Risk Analysis Tbals The graph shows the underlying position for the Trust from April 2022 to present. This differs from the reported financial position as it has been adjusted for non recurrent items (one offs) to get a true picture of the run rate. Risk Variable Unidentified CIP Workforce Pressures CIP Delivery Risk Inflationary Pressure Unfunded Activity MH Nursing Covid Testing Criteria to Reside / Surge Capacity Energy Unfunded Pay Award Total Risk Mitigations Additional CIP ERF (Including IA adjustments) Stretch CIP Net Risk Risk @ Plan £m 15.8 0.0 18.2 8.0 0.0 0.0 0.0 0.0 0.0 0.0 42.0 (18.0) 0.0 0.0 Pag2e41.30of 31 Risk - current £m 0.0 8.4 9.9 0.0 2.5 2.3 1.2 1.2 2.1 6.2 33.8 0.0 (19.8) (7.5) 6.5 The average underlying position for 23/24 to date is £6.0m deficit. M6 figures showed a position of £6.1m. Due to the variability and unknown national picture on ERF (due to industrial action pressures), these figures have been excluded from underlying calculations. The decline since 2022/23 has primarily been driven by escalating pay award pressures, pressures related to activity, including the need for surge beds and impacts of strike actions in addition to the challenge of delivering efficiencies. A table outlining risks is also shown matching forecast scenario 2 on slide 12. 9 Key Variance Drivers Page 14 of 31 Key variance bridge A recurrent underlying deficit position was carried forward from the previous financial year of circa £4m per month. Trust plans were for month on month improvement reaching breakeven by financial year end. The graph to the left provides the following analysis: Stage 1) Items driving the Trust adverse position from planned £19.0m deficit to £22.6m reported YTD. Stage 2) Sets out non recurrent benefits to the position that bridge to the underlying deficit at M6 of £36.2m. ERF overperformance has also been removed from the underlying position. 10 Key Variance Drivers Page 15 of 31 Key variance pressures The following table sets out the key recurrent drivers that have resulted in adverse movements to plan in the underlying position during the 2023/24 financial year. - The yellow boxes represent pressures out of the organisations direct control and total £5.6m YTD of the adverse position to plan. - The red boxes identify pressures within the organisations control and total £11.6m YTD of the additional deficit to plan. - ERF overperformance has been removed from underlying position figures. These items require mitigation to deliver a breakeven underlying position moving forwards in addition to delivering the originally planned deficit reductions. 11 Forecasting / Forward View Page 16 of 31 The graphs provide forecast scenarios on a monthly and cumulative scenario for remainder of the financial year. 1) Delivery of plan. Resulting in a year end out turn deficit of £26m. 2) Original plan plus full impact of pay award pressures, receipt of industrial action support and £7.5m additional run rate efficiency improvement - £32.5m out turn. 3) Original plan plus full impact of pay award pressures, receipt of industrial action support, no further efficiency improvements - £40.0m out turn. 4) Original plan plus full impact of pay award pressures, no industrial action support or further efficiency improvements £50m out turn. 12 Cost Improvement Programme Page 17 of 31 UHS Total - £71.7m identified 104% of the total 23/24 requirement of £69m. Of the identified UHS total, £9.9m is Pay, £32.3m is Non-Pay, and £29.5m Income. Divisions and Directorates - £42.0m of CIP schemes identified. This represents 98% of the 23/24 target of £43.1m Central Schemes - £29.7m of CIP schemes identified. This represents 115% of the 23/24 target of £25.9m M 6 Trust YTD delivery is £27.1m. An increase in month of £6.3m. YTD delivery is below plan by £0.7m. Of the £27.1m delivered: £12.9m has been transacted by Divisions and Directorates £14.3m has been transacted through Central Schemes. £17.9m is non-recurrent. This includes £9.8m of non-recurrent Central Schemes. 13 Cost Improvement Programme • A risk assessment has been undertaken of the identified schemes to date in the table above. • The expected yield from plans is currently £59.1m, 86% of the 23/24 requirement • A significant reduction to total identification has taken place in month following review of the highest risk assessed items. Due to insufficient enabling plans and progress at ICS level, the £11.2m of system wide schemes based upon Carnall Farrar opportunity assessment for improved patient flow and reduction of non ‘criteria to reside’ occupancy have been removed. Page 18 of 31 14 Capital Page 19 of 31 Summary Position: Total capital expenditure (trust and external) YTD is £13.7m vs plan of £23.8m with a forecast outturn of £55.2m. To achieve the forecast position, £4.6m of expenditure has been agreed to be brought forward from 24/25 to replace slippage on 23/24 schemes. Trust Funded: To the end of M6, £12.2m has been spent on trust funded schemes against a YTD plan of £23.2m, with an annual forecast outturn of £47.7m Exte rnally Funded: To the end of September, £1.5m has been spent on externally funded schemes vs a YTD plan of £0.6m, with an annual forecast spend of £7.5m. 15 Capital Top 5 schemes by YTD Expenditure Value £000s Oncology Centre Ward Expansion Levels D&E Donated Estates Schemes Information Technology Programme Decarbonisation Schemes Strategic Maintenance Plan 6,235 2,262 2,178 4,500 2,124 Year to Date Actual 3,152 2,528 2,013 1,941 1,663 Variance 3,083 (266) 165 2,559 461 Plan 7,135 2,624 5,800 11,259 5,200 Forecast Actual 6,926 3,317 5,800 11,259 7,240 Variance 209 (693) 0 0 (2,040) • Spend on the wards expansion scheme remains high on a monthlybasis as the skyway link bridge element is constructed. • The Banksy funded staff welfare schemes (the welfare hub, PAH roof garden and staff room refurbishment) are complete • Informatics YTD expenditure has been incurred mainlyon staffing, core infrastructure and the ED & Flow contract. • The first milestone of the decarbonisation scheme has been reached meaning that £1.3m of costs are now due for payment. • Strategic Maintenance costs were high in month 6 at £1.1m, due to significant expenditure on the PAH substation (£0.6m) Top 5 Schemes by YTD Variance Year to Date Forecast £000s Plan Actual Variance Plan Actual Fit out of F Level Theatres (VE) 3,396 73 3,323 8,500 6,827 Oncology Centre Ward Expansion Levels D&E 6,235 3,152 3,083 7,135 6,926 Decarbonisation Schemes 4,500 1,941 2,559 11,259 11,259 Neonatal Expansion 2,283 287 1,996 10,030 7,917 CT Scanner 1,560 0 1,560 1,560 1,560 Variance 1,673 209 0 2,113 0 • Phase 3a of the F level theatres is now due to start in October and complete around Aug 24. • All works on the oncologyward expansion scheme (including the skywaylink bridge) will not be complete until Jan 24. • Decarbonisation scheme onlycommenced in August, but plans are in place to ensure the planned £11.3m of the grant are completed byMar 24. • Phase 1 of the neonatal expansion has commenced, and the scheme should complete in Jun 24. • The installation of the CT scanner will be later than originallyplannPeadgaen2d0woifll3th1erefore be accounted for Mar 24. 16 Statement of Financial Position 2022/23 M1 M2 M3 M4 M5 M6 MoM Statement of Financial Position YE Act Act Act Act Act Act Act Movement £m £m £m £m £m £m £m £m The September statement of financial position illustrates net assets of £566.6m which is £4.0m down on August. Fixed Assets Inventories Receivables Cash Payables Current Loan Current PFI and Leases 620,431 15,753 95,056 105,018 (229,641) (1,533) (12,580) 617,160 18,104 93,552 105,475 (237,019) (1,533) (12,202) 619,161 18,074 89,834 85,892 (218,352) (1,533) (12,153) 620,900 18,455 73,434 81,557 (202,499) (1,533) (11,347) 622,082 16,941 75,632 66,895 (195,495) (1,533) (11,228) 621,364 19,317 92,177 62,611 (212,574) (1,533) (10,705) 621,497 19,487 53,710 68,286 (184,559) (1,533) (10,272) 133 170 (38,467) 5,675 28,015 0 433 Net Assets 592,504 583,537 580,923 578,967 573,294 570,657 566,616 (4,041) Non Current Liabilities (24,624) (22,798) (22,759) (22,848) (21,545) (21,307) (21,426) (119) Non Current Loan (5,302) (5,302) (5,302) (4,802) (4,802) (4,802) (4,534) 268 Non Current PFI and Leases (108,576) (105,561) (107,100) (108,888) (107,948) (107,416) (104,644) 2,772 Total Assets Employed 454,002 449,876 445,762 442,429 438,999 437,132 436,012 (1,120) Public Dividend Capital Retained Earnings Revaluation Reserve 286,212 102,068 65,722 286,212 97,942 65,722 286,212 93,828 65,722 286,212 90,494 65,722 286,212 87,065 65,722 287,328 84,082 65,722 287,328 82,962 65,722 0 (1,120) 0 Total Taxpayers' Equity 454,002 449,876 445,762 442,428 438,999 437,132 436,012 (1,120) Page 21 of 31 Cash increased by £5.7m to £68.3m, following receipt of additional clinical and R&D income in month. The main movements in month were due to: - Receivables: Decreased by £38.5m following a reduction of £6.1m in accrued clinical income and £12.9m decrease in prepayments largely due to timings of M6 invoices paid in August. - Payables: Decreased by £28.0m in M6. This was due to £7.3m relating to medical and serco pay awards now paid, £4.9m decrease in PDC creditor as the half year payment was made in month. There were also entries that netted off between receivables and payables totalling £15m. 17 Cash and Payments Page 22 of 31 The cash balance increased by £5.7m to £68.3m in September. The reduction in year has been driven chiefly by the underlying deficit. In year volatility has however been influenced by: - The timing of pay award funding versus payments made to staff and HMRC/NHS Pensions Authority - Capital programme timings including slippage versus plan - Higher R&D receipts and VAT recovery The minimum cash holding position is set at £30m. Based on current trajectory, we are expected to reach this level by the end of the financial year in April 2024. There is on average a £5.5m cash outflow per the detailed inputs. This has moved out from December as per the M05 forecast due to maintaining the cash position in M06, which has been improved due to paying invoices as they fall due, rather than processed. Better Payment Practice Code (BPPC) performance in September is over the 95% target for both count and value. 18 Further Analysis of Position Page 23 of 31 19 Income / ERF The graph shows the ERF performance for 23/24 as well as a trend against plan for 22/23. In 23/24 the Trust has a target to achieve 111% (reduced from 113% following industrial action) of 19/20 activity for elective inpatients, outpatient first attendances and outpatient procedures. Delivery above this targeted level will generate additional funding for the Trust. ERF Performance (Target = 113%) Elective Spells Daycase Outpatients Firsts Outpatients Procedures Overall ERF Performance Excess Outpatient Follow Ups £'000s Excess Non Elective and ED £'000s Excess Other £'000s At the end of Month 6, ERF activity has been reported above plan to the value of £4.8m / 114%. Apr-23 May-23 Jun-23 108% 124% 100% 114% 108% 119% 115% 125% 112% 131% 133% 126% 118% 123% 110% £940 £1,388 £1,013 £34 £867 £1,709 £390 £536 £753 Jul-23 104% 112% 113% 133% 112% £894 -£4 £31 Aug-23 Sep-23 109% 90% 111% 115% 125% 125% 128% 125% 115% 109% £1,290 £1,010 £828 £322 -£65 £757 Oct-23 Nov-23 Dec-23 Jan-24 Page 24 of 31 Feb-24 Mar-24 Total 104% 113% 119% 127% 114% £6,535 £3,756 £2,402 No further decisions have been made to date on further national reductions to the ERF baseline following industrial action days between May and September. The table shows monthly achievement by POD type vs 19/20 baseline. Significant non ERF related activity is currently being provided by UHS above its block funded levels, totalling £12.7m. 20 Clinical Income - Elective Page 25 of 31 21 Clinical Income – Non Elective and Other Page 26 of 31 22 Staff Costs Pay Expenditure: • Pay costs have been normalised for the backdated impact of pay awards on the above graph (Payments made in M4 AFC and M6 Medical). • The normalised pay spend has increased by £0.6m between August and September. Of which £0.4m related to increased substantive costs and £0.2m for temporary staffing. • The main drivers of substantive cost increases in the month were: - ACP staff received pay arrears (backdated to April 23) of £0.25m following completion of a regrading exercise. - Increased Junior Doctor costs of circa £0.1m following an increase in WTE headcount in months 5 and 6. • Costs of staffing surge capacity in month totalled £0.11m, up from £0.07m in M5. Total spend YTD is now £0.59m. • Mental health temporary staffing costs remained flat in month at £0.67m. This sees a continued increase in average spend in the area compared with 22/23 values £0.40m and 23/24 average to date of £0.59m. Total spend YTD to the end of M6 is £3.56m. • Staffing WTE has increased by 84 WTE in month. This growth takes WTE actuals further away from planned values for the year. Page 27 of 31 23 Temporary Staffing Costs Page 28 of 31 Bank: Bank expenditure increased in month from £4.1m up to £4.2m. Increases have been experienced in: - Nursing up £72k - Admin staff up £72k Decrease of costs were experienced in: - Medical staff down £39k. - Scientific and Technical down £2k Age ncy: Agency costs increased in month by £0.1m up to £1.4m overall. Reductions were experienced in: - Nursing Staff down by £63k - Scientific and Technical down by £13k Increases were experienced across other staff groups: - Admin Staffing up by £158k - Medical Staff up £4k 24 Non-Pay Costs Non Pay Expenditure: • Other non pay has reduced in month back to expected levels following high costs in M5 relating to backdated inflation costs for Propco. • Non pass through drugs spend has increased in month by £0.8m overall. Increase were experienced within the care groups of Cancer, Specialist Medicine and Child Health. Costs are being investigated in collaboration with pharmacy to understand drivers and if pass through income may be available. • Clinical supplies costs have reduced in month by £4.0m, this is predominately due to non recurrent one-off benefits recognised in September. Page 29 of 31 25 CIP – Recurrent Pay Identification WTE and £ Re current Pay CIP: • The above table demonstrates the Pay CIP target for the organisation in 2023/24 based on WTE and £ values • On a WTE basis 61 WTE have been identified YTD, 16% of the 392 WTE target • On a £’s basis £3.2m have been identified YTD, 22% of the £14.6m target Page 30 of 31 26 Page 31 of 31 Report to the Trust Board of Directors Title: Agenda item: Sponsor: Author Date: Purpose Performance KPI Report 2023-24 Month 6 12.2 David French, Chief Executive Officer Sam Dale, Associate Director of Data and Analytics 9 November 2023 Assurance or Approval reassurance Y Ratification Information Issue to be addressed: The report aims to provide assurance: • Regarding the successful implementation of our strategy • That the care we provide is safe, caring, effective, responsive, and well led Response to the issue: The Performance KPI Report reflects the current operating environment and is aligned with our strategy. Implications: This report covers a broad range of trust performance metrics. It is (Clinical, intended to assist the Board in assuring that the Trust meets Organisational, regulatory requirements and corporate objectives. Governance, Legal?) Risks: (Top 3) of carrying out the change / or not: This report is provided for the purpose of assurance. Summary: Conclusion and/or recommendation This report is provided for the purpose of assurance. Page 1 of 22 Report to Trust Board in October 2023 Performance KPI Board Report Covering up to September 2023 Sponsor – David French, Chief Executive Officer Author – Sam Dale, Associate Director of Data and Analytics Page 2 of 22 Report to Trust Board in October 2023 Report guide Chart type Cumulative Column Example Cumulative Column Year on Year Line Benchmarked Line & bar Benchmarked Control Chart Variance from Target Explanation A cumulative column chart is used to represent a total count of the variable and shows how the total count increases over time. This example shows quarterly updates. A cumulative year on year column chart is used to represent a total count of the variable throughout the year. The variable value is reset to zero at the start of the year because the target for the metric is yearly. The line benchmarked chart shows our performance compared to the average performance of a peer group. The number at the bottom of the chart shows where we are ranked in the group (1 would mean ranked 1st that month). The line shows our performance, and the bar underneath represents the range of performance of benchmarked trusts (bottom = lowest performance, top = highest performance) A control chart shows movement of a variable in relation to its control limits (the 3 lines = Upper control limit, Mean and Lower control limit). When the value shows special variation (not expected) then it is highlighted green (leading to a good outcome) or red (leading to a bad outcome). Values are considered to show special variation if they -Go outside control limits -Have 6 points in a row above or below the mean, -Trend for 6 points, -Have 2 out of 3 points past 2/3 of the control limit, -Show a significant movement (greater than the average moving range). Variance from target charts are used to show how far away a variable is from its target each month. Green bars represent the value the metric is achieving better than target and the red bars represent the distance a metric is away from achieving its target. Page 3 of 22 Report to Trust Board in October 2023 Introduction The Performance KPI Report is presented to the Trust Board each month. The report aims to provide assurance: • regarding the successful implementation of our strategy; and • that the care we provide is safe, caring, effective, responsive, and well led. The content of the report includes the following: • The ‘Spotlight’ section, to enable more detailed consideration of any topics that are of particular interest or concern. The selection of topics is informed by a rolling schedule, performance concerns, and requests from the Board; • An ‘NHS Constitution Standards’ section, summarising the standards and performance in relation to service waiting times; and • An ‘Appendix,’ with indicators presented monthly, aligned with the five themes within our strategy. This month, the following changes have been made to the report. • Data change: The medication errors data (metric 11) for August 2023 has been reduced from 4 to 3 cases as the severity for one case has been re- assessed and downgraded • Data Omission. The latest HSMR metrics reflect the July position as the latest statistics are yet to be published on the Healthcare Evaluation Data (HED) dashboards. Page 4 of 22 Report to Trust Board in October 2023 Summary This month the ‘Spotlight’ section contains an update on performance for RTT Waiting Times. The RTT spotlight highlights that: • Excluding a small cohort of corneal transplant patients impacted by national availability of tissue grafts, there are zero patients on the UHS RTT waiting list who have been waiting over 104 weeks for their elective treatment and three patients waiting over 78 weeks at the end of September. • The hospital targeted zero (non-corneal) patients waiting over 78 weeks by the end of October, however the extreme operational pressures experienced in the hospital at the end of October required a handful of complex but lower priority 78 week cases to be rescheduled into November. • The trust is in line with its submitted forecast which committed to having zero patients waiting over 65 weeks by March 2024. Performance against this target is being closely monitored and discussed with caregroups in weekly performance meetings. • A national Patient Initiated Digital Mutual Aid System (PIDMAS) will be launched imminently to understand how many patients on the waiting list would consider being treated at an alternative provider if deemed clinically appropriate. Areas of note in the appendix of performance metrics include: 1. We await the validated September position for Cancer waiting times, however August’s position reflects a further increase on two week wait performance (74.0%) putting UHS into the second quartile for this metric and the 62 day standard when compared to other Teaching Hospitals 2. The diagnostic waiting list continues to decrease every month within this financial year and now stands at 8,447 with 20% of patients waiting over six weeks. 3. Despite a decline in the number of category 2 pressure ulcers per 1000 bed days, both category 2 and 3 remain above the year to date target position. An ongoing campaign to increase awareness and enable staff to feel more confident with pressure ulcer prevention is underway and we are seeing a huge rise in the uptake of this education in the last quarter. 4. The percentage of births delivered by caesarean continue at the same increased rate. Whilst the department are implementing training and education strategies to ensure birth preference conversations happen early in the pathway, this will take time to reflect in the metrics. 5. The percentage of UHS women booked onto a continuity of carer pathway has remained below target throughout the year. The current CoC provision was affected by staffing and operational pressures over the summer. The majority of this has affected continuity around intrapartum care. The maternity service is trialling a different way to recruit into these teams by offering more flexible options for midwives to increase recruitment into these rewarding but very challenging roles. To give assurance the maternity service monitors and audits outcomes to ensure that groups most likely to be offered a CoC model are not showing as exceptions in our data or when clinically reviewing adverse o utcomes. Page 5 of 22 Report to Trust Board in October 2023 6. The decline in the September metric for Research and Development income reflects the cessation of the £20m COVBOOST grant which was previously contributing approximately £1m per month. The department also reprofiled Biomedical Research Centre funding from the National Institute of Health Research as it is expected to be deferred until 2024/25. Ambulance response time performance The latest unvalidated weekly data provided by the South Coast Ambulance Service (SCAS) shows that UHS does not significantly contribute to ambulance handover delays. In the week commencing 16th October 2023, our average handover time was 18 minutes 9 seconds across 801 emergency handovers, and 20 minutes 52 seconds across 45 urgent handovers. There were 44 handovers over 30 minutes, and 20 handovers taking over 60 minutes (the majority on 21 October) within the unvalidated data. Page 6 of 22 Report to Trust Board in October 2023 Spotlight Report Spotlight: Referral to Treatment Waiting Times The following information is based on the validated September 2023 submission, with operational insight based on the latest position for our long waiters. Overview In the 2023/24 NHS operational planning guidance, the priority for elective care was to eliminate waits of over 65 weeks by March 2024 (except where patients choose to wait longer or in specific specialties). In 2022/23, an equivalent priority was set for waits of over 78 weeks. To support and monitor Trust trajectories against the 2023/24 target, the national team have laid out additional in-year targets around patient pathway validation and outpatient referrals waiting for their first attendance. This is alongside the roll out of a national Patient Initiated Digital Mutual A id scheme (PIDMAS). This spotlight paper outlines the Trust’s current and forecast position against the national target, illustrates how we compare with our peer Trusts and explores some of the challenges, specialties and interventions which are influencing our position. Waiting Times Overview Graph 1 highlights the recent slowing down of the growth of the UHS PTL (patient treatment list) compared to the significant increases seen since January 2020. Graph 1 – RTT PTL volumes by waiting time The PTL was 59,253 at the end of September 2023, an increase of 5% since April 2023 (56,568). This compares to a PTL increase of 10% which seen across the equivalent period in 2022. It also highlights the waiting time cohort changes as we transition our focus from patients waiting over 78 weeks to the in-year target focussed on patients waiting over 65 weeks. Within the current PTL, there are 21 patients who have been waiting over 78 weeks and 349 who have been waiting over 65 weeks . In September 2022, the equivalent numbers were 286 (78 weeks) and 986 (65 weeks). Page 7 of 22 Report to Trust Board in October 2023 Spotlight Report Patients waiting over 78 and 104 weeks The only UHS patients waiting over 104 weeks in 23/24, are a small cohort of Ophthalmology patients (one in October) waiting for corneal transplants. This clinical situation is echoed across the country as the procedure is reliant on graft tissue being made available by the NHS Blood and Transfusion Centre. Excluding corneal patients, the Trust had three patients waiting over 78 weeks at the end of September. These patients have been within a handful of challenged specialties including Gynaecology, Urology and Paediatrics. In most cases, the required surgery is complex often requiring joint surgeons and was provisionally booked before 78 weeks. However, industrial action, clinical complications or managing a higher priority patient has required a cancellation. Any 78 week breaches have always been rebooked in the following month. We targeted zero (non corneal) patients waiting over 78 weeks by the end of October, however the very recent extreme pressures on our emergency services and elective capacity particularly within Trauma & Orthopaedics has inevitably impacted the planned surgery dates for a small cohort of long waiting patients, who have now been rescheduled for November. Patients waiting over 65 weeks At the end of September the Trust had 425 patients on the PTL who have been waiting over 65 weeks. As part of the Trust’s commitment to achieve the national target of zero 65 week waits by March’24, we submitted a glide which we are pro-actively monitoring every month. The performance team meet with each division to review individual patients who have not been booked against a target which we have stepped down from 78 weeks in April’23 to 65 weeks by December’23. This gives us clear line of sight against our glide, ensures services are pro-actively managing the appropriate cohorts and highlights consultants who need capacity plans or alternative pathway options to be explored. The Trust is currently in line with the 65 week glide submitted (see graph 4). Graph 2: Volume of patients waiting over 78 weeks by month Graph 3: Volume of patients waiting over 65 weeks by month Page 8 of 22 Report to Trust Board in October 2023 Spotlight Report 30,000 25,000 20,000 15,000 10,000 5,000 Apr/23 May/23 Jun/23 Jul/23 Aug/23 Sep/23 Oct/23 Nov/23 Dec/23 Jan/24 Feb/24 Mar/24 All Divisions Glide All Divisions Actual Graph 4: UHS 65 week performance glide and actual position Comparison with other Trusts In the latest available data (August’23) UHS places in the top quartile for the number of patients waiting over 65 weeks compared to other Teaching Hospital. This is illustrated in Graph 5. It should be noted that the metric is based on overall volume of patients rather than a percentage of the Trust’s overall PTL size which has not been made available. Graph 5: Teaching hospital comparator: patients waiting over 65 weeks Page 9 of 22 Report to Trust Board in October 2023 Spotlight Report Outpatient Referrals To support and gain assurance on our 65 week trajectories, the national team asked Trusts to ensure all patients who could breach 65 weeks by 31st March 2024, had their first outpatient appointment before the end of October 2023. Each service has therefore been working to ensure first outpatient appointments for this cohort are brought forward where necessary and appropriate. We envisage that a handful of specialties do not have the capacity to hit that target leaving approximately 800 patients unseen before 31st October, however, the majority of these patients have appointments in November with a small tail following soon after. The UHS glide against this target is shown in graph 6. The main challenged specialties are ENT, Paediatric Orthopaedics and Neurology. Volume of patients who will have breached 65 weeks by 31st March 24 and haven't had a first OP appointment 1000 800 600 400 200 0 Aug-23 Sep-23 Oct-23 Nov-23 Dec-23 Jan-24 Feb-24 Mar-24 UHS Graph 6: 65 week risk cohort waiting for a first OP appointment Patient Validation To ensure patient treatment lists are appropriately validated by hospitals, we have also been set a target of 90% of patients waiting over 12 weeks to have been validated by the end of October. This validation process ensures that patients are being reported on the appropriate waiting time and pathway and do still wish to proceed with their intended treatment, diagnostic or consultation. UHS employ both a central validation team and validation leads in each of the caregroups to support this process. This is now alongside our patient texting service which ensures appropriate contact is maintained with the patient and changes in need are understood. The Trust expects to achieve the 90% target through a combination of these approaches. PIDMAS The national team will imminently roll out a patient initiated digital mutual aid system. At the time of writing, the digital solution has been tested in a handful of pilot sites with an intended launch for all trusts at the end of October. The process is to enable patients to declare whether they would consider being offered to an alternative provider for their treatment. This will initially be offered to patients waiting over 40 weeks and will involve a text to a patient redirecting them to a digital platform where they can express their preference and how far they are willing to travel for treatment. This will then be reliant on clinical approval for suitability and another Trust declaring appropriate capacity. The process is being overseen by the I CB. Whilst the intention is to improve waiting times for patients, the solution is still in its infancy and not being used to influence the UHS forecast pos ition on long waiting patients. Page 10 of 22 Report to Trust Board in October 2023 Spotlight Report NHS Constitution - Standards for Access to services within waiting times The NHS Constitution* and the Handbook to the NHS Constitution** together set out a range of rights to which people are entitled, and pledges that the NHS is committed to achieve, including: The right to access certain services commissioned by NHS bodies within maximum waiting times, or for the NHS to take all reasonable steps to offer you a range of suitable alternative providers if this is not possible • Start your consultant-led treatment within a maximum of 18 weeks from referral for non-urgent conditions • Be seen by a cancer specialist within a maximum of 2 weeks from GP referral for urgent referrals where cancer is suspected The NHS pledges to provide convenient, easy access to services within the waiting times set out in the Handbook to the NHS Constitution • All patients should receive high-quality care without any unnecessary delay • Patients can expect to be treated at the right time and according to their clinical priority. Patients with urgent conditions, such as cancer, will be able to be seen and receive treatment more quickly The handbook lists 11 of the government pledges on waiting times that are relevant to UHS services, such pledges are monitore d within the organisation and by NHS commissioners and regulators. Performance against the NHS rights, and a range of the pledges, is summarised below. Further information is available within the Appendix to this report. * https://www.gov.uk/government/publications/the-nhs-constitution-for-england/the-nhs-constitution-for-england ** https://www.gov.uk/government/publications/supplements-to-the-nhs-constitution-for-england/the-handbook-to-the-nhs-constitution-for-england Page 11 of 22 Report to Trust Board in October 2023 NHS Constitution Monthly Jul Aug Sep Oct Nov Dec Jan Feb Mar Apr May Jun Jul Aug Sep target YTD 75% % Patients on an open 18 week pathway (within 18 weeks ) 31 UHSFT 65.1% 63.2% 4 5 6 5 5 5 5 5 4 4 4 4 5 4 ≥92% Teaching hospital average (& rank of 20) South East average (& rank of 17) 6 6 6 5 5 5 5 5 6 6 5 5 6 6 50% 63.7% % Patients following a GP referral for 100% suspected cancer seen by a specialist within 8 9 89.1% 10 13 17 14 13 15 17 17 17 16 16 16 2 weeks (Most recently externally reported 38 data, unless stated otherwise below) UHSFT Teaching hospital average (& rank of 20) 4 4 8 18 11 16 11 13 10 18 19 16 13 74.0% 10 South East average (& rank of 17) 55% ≥93% Cancer waiting times 62 day standard - 100% Urgent referral to first definitive treatment (Most recently externally reported data, 39 unless stated otherwise below) UHSFT 11 11 17 14 17 14 18 14 14 9 14 13 10 15 66.3% 63.7% Teaching hospital average (& rank of 19) South East average (& rank of 17) 4 40% 4 10 11 7 12 11 7 14 5 9 3 7 6 ≥85% 100% Patients spending less than 4hrs in ED - 58.6% (Type 1) 62.3% 7 5 4 9 12 9 8 8 12 28 UHSFT 7 4 5 7 6 6 ≥95% Teaching hospital average (& rank of 16) South East average (& rank of 16) 25% 4 3 4 4 4 4 3 3 3 5 7 5 5 5 7 40% 24.8% % of Patients waiting over 6 weeks for diagnostics 37 UHSFT Teaching Hospital average (& rank of 20) 9 9 11 11 11 12 12 12 8 10 7 7 7 8 7 9 20.0% 8 7 9 8 8 8 12 11 11 11 10 10 ≤1% South East Average (& rank of 18) 0% 70.8% 65.4% 62.2% 21.0% Page 12 of 22 Report to Trust Board in October 2023 Outstanding Patient Outcomes,Safety and Experience Appendix Outcomes 1 HSMR - UHS HSMR - SGH 2 HSMR - Crude Mortality Rate Jul Aug Sep Oct Nov Dec Jan Feb Mar Apr May Jun Jul Aug Sep 88.76 86.95 84.99 83.48 75 3.1% 2.9% 2.7% Monthly target ≤100 <3% YTD 82.7 2.6% YTD target ≤100 <3% 2.5
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Finance and Performance Reports 2022-23 Month 2 May 2022

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Report to the Trust Board of Directors Title: Agenda item: Sponsor: Author: Date: Purpose Issue to be addr
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Papers Trust Board - 25 July 2024

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Agenda Trust Board – Open Session Date 25/07/2024 Time 9:00 - 13:00 Location Anaesthetic Seminar Room (CE95/99), E
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Papers Trust Board - 29 November 2022

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Date Time Location Chair Agenda Trust Board – Open Session 29/11/2022 9:00 - 13:20 Conference Room, Heartbeat/Microsoft Teams
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