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«Apologies: Mr P Hill Director of Operations Mr J Stokoe Non-Executive Director In Attendance: For Item 7 Miss L Wilkinson Head of Risk Management Mr ...»

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SALISBURY NHS FOUNDATION TRUST

Minutes of the Finance Committee

Held on 20 April 2009

Present: Mr L March Chairman

Mr B Bull Non-Executive Director

Mr R Burrows Non-Executive Director

Mr M Cassells Director of Finance &

Procurement

Mr M Kershaw Chief Executive

Apologies: Mr P Hill Director of Operations Mr J Stokoe Non-Executive Director In Attendance: For Item 7 Miss L Wilkinson Head of Risk Management Mr J Williams Secretary to the Committee MINUTES 1.

The minutes of the meeting held on 25 March 2009 were accepted as a true record.

MATTERS ARISING

2.

Re-Statement of Opening Balances to Comply with International Financial Reporting Standards (IFRS) MC advised that, following discussions with the Audit Commission, he had amended the figures for the Private Finance Initiative (PFI) shown in the opening balances for 2008/09 in IFRS format and informed Monitor accordingly.

MC shared with the Committee a report from the Audit Commission following their review of the Trust’s overall arrangements for restating its opening balances as at 1 April 2008 in accordance with IFRS. The Trust had been assessed as ‘amber’ which, as explained in the report, was the highest assessment that could be given at this stage to any Trust with a PFI asset.

The Committee noted the information given.

REVIEW OF TERMS OF REFERENCE

3.

The Committee reviewed the Terms of Reference and, following the change made during the year in respect of the reporting arrangements for Odstock Medical Ltd, made one amendment as follows:Reporting arrangements into the Committee from sub-Committees:Current wording.

While there are no formal sub-committees which report directly to the Finance Committee, the Committee will receive monthly reports on the progress of Odstock Medical Ltd Revised wording While there are no formal sub-committees which report directly to the Finance Committee, the Committee will receive periodic reports on the progress of Odstock Medical Ltd The amended Terms of Reference would be presented to the Board JW on 8 June 2008 for ratification.

FINANCE REPORT TO 31 MARCH 2009 (YEAR END) 4.

MC reported that earnings before interest, tax, depreciation and amortisation (EBITDA) amounted to £11.73m which was 5% above the planned figure of £11.20m. This translated into an income and expenditure surplus of £2.54m compared with £1.84m in the FT Plan.

Income totalled £169.89m, £9.34m above the planned figure of £160.55m while expenditure stood at £158.16m, £8.81m over the planned figure of £149.35m. Working Capital, including cash balances of £13.19m, remained strong while 80% of the cost improvement targets had been achieved (which incorporated the residual target from 2007/08). The composite risk rating remained unchanged at four.

For reasons fully described to both the Finance Committee and the Trust Board in previous reports the activity was ahead of plan in all areas but, most notably, in respect of elective day cases which at 24,664 were 3,798 above the target figure of 20,866 (although it was recognised that some out-patient procedures were being captured under this heading ), initial out-patients which at 80,374 were 4,483 above the target figure of 75,891 and out-patient follow ups which at 132,685 were 4,892 above the target figure of 127,793.

In advising that the year end surplus stood at £2.54m against a predicted figure of £3.5m a month earlier MC commented that, in March, activity was substantially higher than for previous months in order to achieve contract targets. In delivering this activity costs were incurred on consumables, agency staff and external providers at premium rates.

However over £1m would be invoiced and recognised in 2009/10 as part of the quarter 4 ‘freeze date’ calculations in June and, additionally, a provision of £0.5m had been made against income in respect of potential PCT challenges and penalties that may come in the quarter 4 ‘freeze period’.

The additional activity in March had produced a collective year end Directorate overspend of £1.29m of which Critical Care and Medicine were most significantly overspent at £1.33m and £0.57m respectively.

The Capital Programme for the year totalled £4.1m against available funds of £8.5m. The reasons for this level of underspend had been explained in previous reports to both the Finance Committee and the Trust Board.

The Committee noted the report and that a surplus of £2.54m had been achieved for the 2008/09 financial year.

CURRENT POSITION WITH 2009/10 CONTRACT NEGOTIATIONS 5.

MC advised that contract negotiations, particularly with Wiltshire and Dorset PCTs were ongoing and challenging. Both Wiltshire and Dorset PCTs had indicated they had a finite funding with which to fund their desired activity levels, and also the South West operating network target, and this was resulting in difficult discussions.

MC presented a paper with supporting information that summarised the position with each PCT together with a note of the specific issues being faced by the Trust. As advised to the Finance Committee on 25 March 2009, and to the Board on 6 April 2009, the current draft Source and Application of Funds showed the Trust only achieving a balanced position for 2009/10 on the back of an aggressive savings programme.





In appreciating the current situation the Committee agreed that it was important for the Trust to maintain an active dialogue with commissioners in an attempt to find a mutually agreeable solution rather than (ultimately) resort to the arbitration route. A number of ideas were suggested which included the possible slippage from the current referral to treatment time of thirteen weeks (particularly towards the back end of the year) and the need for the Trust to develop and implement plans to reduce the length of stay.

The Committee noted the report and supported the continuation of an active dialogue between the Trust and each of its commissioners to arrive at a mutually acceptable position for 2009/10.

QUARTER 4 RETURN TO MONITOR

6.

Finance MC presented the reporting template as required by Monitor. This reconfigured the financial information provided within the Finance Report and reconfirmed the composite risk rating of four.

Governance MK advised that the Trust continued to achieve all of the Compliance Framework targets apart from:Thrombolysis For the fourth successive quarter the Trust had failed to meet the Thrombolysis ‘call to needle’ target because of the ‘time’ issues faced by the Great Western Ambulance Service ( GWAS ) in delivering patients to the Trust, and this would result in a year end amber rating for Governance. The full background to this position was well known to both the Finance Committee and the Trust Board (as well as to Monitor and the South West Strategic Health Authority). On 12 February 2009 MK had met with Anthony Marsh, Interim Chief Executive at GWAS, and agreed a programme of joint working that would include an action plan to be prepared by GWAS to improve their performance. On 2 April 2009 Owen Ainsley had met with representatives from GWAS and a revised Action Plan had been agreed which would be subject to close monitoring.

MK mentioned that on 16 March 2009 GWAS had announced that David Whiting, Director of Operations at East Midlands Ambulance Service NHS Trust had been appointed Chief Executive with effect from 1 April 2009.

Waiting Time of Four Hours in A&E As advised to the Trust Board on 6 April 2009 the achievement of the 98% target in quarter four was under threat following the month only performance of 96% in January. Notwithstanding a strong finish to the year, with a 99% performance in March, the figure for the quarter narrowly missed the target with an outturn of 97.7%. However the overall figure for the year was ahead of target at 98.3%. MK added that the Trust had arranged a multi-disciplinary meeting at the end of April to learn from the issues faced in December and January.

The Committee noted this information and approved the quarter 4 return to Monitor which had to be submitted by 30 April 2009. JW

QUARTERLY REVIEW OF ASSURANCE FRAMEWORK AND

7.

RISK REGISTER

LW presented the Assurance Framework and appropriate extract from the Trusts Risk Register for quarterly review.

–  –  –

Additionally the Committee felt that the possible failure of budgetary control, and the possible failure to meet savings targets, should be reviewed outside of the meeting by LW with MC and MK to ensure LW/MC the nature of the risk and the potential positive assurances and gaps MK in assurance were effectively identified.

Turning to the Risk Register the Committee agreed that the overspend against budget incurred in 2008/09 by Critical Care should be included on the Risk Register with a score of 12 or above until such time as the Directorate showed an ability to operate within pre-determined budgets; LW to discuss with Owen Ainsley, LW/OA Directorate Manager.

–  –  –

ANY OTHER BUSINESS

8.

The Committee agreed to change the date of the Finance Committee meeting in August from Monday 24 August 2009 to Friday 21 August ALL 2009.

DATE AND TIME OF NEXT MEETING

9.

The next meeting will be held on Friday 22 May 2009 at 9:30am in the Boardroom.

–  –  –

For the 2008/09 year OML achieved sales of £1.35m which translated into a net profit of £146,008 against a planned break even position. This was the first year the company had passed £1m in revenue, exceeded plan and made a profit. PC and IS have a presentation outlining the reasons for this level of performance, the current market place, progress with product re-design and developments and aspirations for the future. These included forecast sales of £1.45m in 2009/10.

–  –  –

The Committee congratulated the management team on the positive outcome.

4. FINANCE REPORT TO 30 APRIL 2009 (MONTH 1) MC reported that earnings before interest, tax, depreciation and amortisation (EBITDA) amounted to £1.20m which exactly matched the planned figure. This translated into an income and expenditure surplus of £0.16m compared with £0.12m in the FT plan.

Both the income at £14.4m and the expenditure at £13.12m were in line with the forecast figures. Working Capital, including cash balances of £8.3m, was sound but only 57% of the savings targets had been achieved. The composite risk rating stood at 3 (whilst historically this has been 4 Monitor has revised the basis of calculation for 2009/10).

Both initial out-patient appointments and follow up out-patient appointments were ahead of plan at 6,568 against a target of 6,019 and 12,673 against 11,812 respectively. Non-elective short stays at 432 were also ahead of plan while elective in-patients, elective day cases and non-elective longer stays were all broadly in line with the planned figures.

Collectively the Directorate budgets were £314,000 overspent with a range of individual positions. However Critical Care was showing a deficit of £229,000 and the Committee were concerned that this unsatisfactory position had arisen so soon after their meeting with the Directorate Management Team in March 2009 when assurance had been sort about the future financial performance of the Directorate. MC advised that this situation was well before himself, MK and PH and it was likely that additional management resource would be appointed to the Directorate to assist in the identification and management of activities that would result in improved financial management.

The balance sheet for April reflected the impact of the International Financial Reporting Standards (IFRS) and the fact that the PFI scheme had been revalued to give a non-current asset value of £11.9m. As a consequence the income and expenditure reserve had been reduced by £11.2m.

While the Trust enjoyed a £7m working capital facility MC was intending to seek a low cost five year loan to fund the Emergency Department and Cardiac Catheter Laboratory schemes from the Foundation Trust financing facility. This facility was likely to be in the order of £4m; any surplus cash could then be invested short term to off-set costs.

In conclusion MC commented that, as ever, with month 1 only figures the trend line was uncertain but the overall picture would become clearer when the month 2 figures were available.

The Board noted the report.

5. CURRENT POSITION WITH 2009/10 CONTRACT NEGOTATIONS MC gave a resume of the 2009/10 contract negotiations and informed the Committee that agreements had been reached with Wiltshire and Hampshire PCTs but negotiations with Dorset PCT were ongoing. However with the Wiltshire contract in place MC expected that this would aid the discussions with Dorset.

As a result of the various negotiations MC had revised the based estimates for 2009/10 to show a planned surplus of 1.84m.

The Committee noted the progress made with the negotiations with Hampshire and Wiltshire PCT, the current position with Dorset PCT and forecast surplus for 2009/10.

6. CAPITAL DEVELOPMENT REPORT

This paper set out the up to date position on the current position with some of the more significant Capital Schemes on the hospital site.

Of particular note was the work now underway to build the Cardiac Catheter Laboratory and Emergency Department Extension. When this was complete, expected October/November 2009, work would start on the Internal Reconfiguration of the Emergency Department.

Elsewhere the Medical Records storage facility on level 1 of the PFI building had been completed, the laundry storage scheme was underway and revised enabling works had been agreed in respect of the Phase 3 Paediatric Scheme. Good progress was also being made with the work required to comply with the National Mandatory Standards to provide a single sex accommodation by 30 June 2009.

The Committee noted the report.

7. SERVICE LINE REPORTING PRESENTATION

MC was joined by Jane Marrott and Susan Long who gave a presentation to the Committee showing how the Service Line reporting process works.



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