Performance and Finance Committee Assurance Report

Meeting:

 Public Board

Date:

15.03.2023

Report Title:

Performance and Finance Committee Assurance Report 

Agenda Item:

PUB22/3/97

Committee Date

11.01.2023

Meeting Chair:

Julie Thallon, Non-Executive Director

Meeting quorate

YES

Purpose:

Assurance

Recommendation:

The Board is asked to receive assurance from the business discussed at the meeting and to review the matters for escalation and referral 

Link to Strategic Objective

Be an exceptional place to work, volunteer and learn

Provide outstanding quality of care and performance

X

Be excellent collaborators and innovators as system partners

Be an environmentally and financially sustainable organisation

X 

Summary of Items Considered at the Meeting

Issue

Consideration

Resolution/Outcome

Assurance

 Finance Report

Current financial position and forecast.

Significant risk associated with over-spend in operations to year end continues.  Mitigations available using balance-sheet. Monitoring main areas of high risk around incentives and Private Ambulance Services (PAS).

Advised high level of confidence that forecast deficit position of £1.8-1.9m will be delivered year end with support from balance sheet as required. Noted potential impact on that for 23/24

 Moderate

Corporate Services Benchmarking

Committee to consider any variances against peer trusts.

EEAST consistently at mean with peers. Variance with legal expenditure consistent with high level of HR related expense. 

Noted that equal expenditure doesn’t necessarily indicate optimum levels, particularly around digital and this remains under review.

Executive Leadership Team (ELT) to consider any opportunities from comparators for budget setting or Quality Cost Improvement Programme (QCIP).

Substantial

Annual Budget and Business Plan

Verbal update on December paper to Board.

NHSE guidance received but limited detail which doesn’t influence our current plan. Potential additional central funding to ambulance trusts but no further detail yet.

Discussions underway with commissioners to discuss tariff implications/ opportunities from clinical strategy.

Committee noted further detailed work by ELT planned at workshop on 31/1/23.  Further report to PAF in February.

Moderate

QCIP Risk and Report

Year-end forecast delivery remains very short of target at c£5.1m; £3.8m delivered to date.

Plans for 23/24 concerning – reliance on productivity gains but currently unquantified. 

Committee noted progress and additional expertise commencing in February to support the programme. Slow progress with sufficient plans for 23/24; consideration being given to allocating targets to secure commitment. ELT to work on plans to resolve lack of accountability and culture/ownership issues which are still restraining the programme and potential future schemes and ideas. Concern raised that current plans for 23/24 remain high level and unquantified which needs addressing with some urgency to give confidence and assurance to Board. Further, more quantified plans for 23/24 to be brought back to PAF in February. 

Limited

Capital Investment Group

Currently forecast to slight underspend but with intention to ensure full expenditure of budget by year end.

Committee supported plan.

Substantial

Ongoing performance constraints in the context of continued very high levels of demand. Hospital handover delays continue to exert extreme impact on response times despite some improvement in internal metrics and very recent reductions in activity levels.

New reporting improved and sector level information helpful in highlighting where issues exist. Remains work in progress but welcome improvements. Development continues.

Future consideration discussed around potential to reframe performance targets to reflect ambitions in clinical strategy.

Committee to receive Operational Development Plans at February meeting.

Update paper presented with detail of review, progress and outline options. Advised re current contract status, SNEE re-procurement and new national guidance around a move to regional contracts.

Committee pleased to note progress and extensive work undertaken to review and understand issues with PTS.

Committee agreed that given limited options and in line with agreement at the October PAF, that all contracts should be extended, as per commissioner requests for a further year to March 2024.

Re-procurement has already commenced on the SNEE contract including the wider Essex contract. Committee agreed that the initial expression of interest in the extended contract be supported whilst the PTS review concludes and the Board finalises its decision around strategic direction.

Full and final report with detailed cost, benefit appraisal and options at sector and region-wide levels to be presented to PAF in April.

Committee noted that the need to drive improved efficiency across the trust is directly impacting on several strategic risks.

Committee agreed that main risk areas were sufficiently considered in other papers.  Proposed reframed risks and the relationship with other Committee allocation to be further reviewed at February PAF

Matters for escalation or referral

Issue

Reason

 QCIP

Trust Board

Limited assurance around programme for 23/24.

PTS Procurement 

Trust Board 

Consider the agreement to extend the PTS contracts for 1 year to March 2024.

Consider the agreement to progress to first stage of SNEE re-procurement to allow for full participation in the tender if the review of the services indicates it is the correct strategic decision for the trust.

Meeting:

 Public Board

Date:

15.03.2023

Report Title:

Performance and Finance Committee Assurance Report 

Agenda Item:

PUB22/3/97

Committee Date

22.02.2023

Meeting Chair:

Julie Thallon, Non-Executive Director

Meeting quorate

YES

Purpose:

Assurance

Recommendation:

The Board is asked to receive assurance from the business discussed at the meeting and to review the matters for escalation and referral 

Link to Strategic Objective

Be an exceptional place to work, volunteer and learn

Provide outstanding quality of care and performance

X

Be excellent collaborators and innovators as system partners

Be an environmentally and financially sustainable organisation

X 

Summary of Items Considered at the Meeting

Issue

Consideration

Resolution/Outcome

Assurance

 Key Internal Controls

Development of key internals control for PAF. Discussed process and approach aligned to new BGAF. Further work required to refine.  Need to be clear on Committee areas of responsibility and align to any changes required to terms of reference for the committee. 

Executive Team to work with governance colleagues to develop controls further.  PAF terms of reference and further iteration of controls to be reviewed at meeting in April.

Substantial

Board Assurance Framework

Transition to new strategic risks and format. Further refinement underway and need to ensure balance between too much detail and not enough – need to ensure clearly aligned to Committee papers to enable triangulation.  

Work to continue on with development of new format.  Review again at meeting in April

Substantial

 Finance report

Current financial position and forecast discussed.

High level of confidence that reduced year end deficit of £1m will be delivered as forecast.

Challenges acknowledged in 23/24. 

Limited risk remains from proposed strike action.  

 Moderate

Annual Budget and Business Plan

Draft plan presented. Planning for a breakeven position for 23/24 but requires significant cost reductions across the trust. Budget increase of £10m from commissioners.

Preparing bid for additional funding from NHSE to support operational delivery – c£30m available to EEAST.

Draft plan and bid for submission due end of March.

Continue to develop plan and bid.  Discuss at Board in early March and seek delegated authority for extraordinary PAF to meet and approve prior to submission at the end of March.

Moderate

QCIP Risk and Report

Year-end forecast delivery remains very short of target at c£5.1m.

Plans for 23/24 to meet £13.6m target:

• Allocate targets to service lines
• Further refine large scale transformative projects for delivery in medium to longer term. Business cases due for approval by the end of March.

Plans for allocation of 23/24 target to service lines in place.

Work required on plans to resolve lack of accountability and culture/ownership issues which are still restraining the programme and potential future schemes and ideas. Requested directorate levels plans for next meeting.

Capital Investment Group

Currently forecast to slight underspend but with intention to ensure full expenditure of budget by year end.

Planning for 23/24 plan underway and will be presented to PAF in April.

Operational Performance Report

Ongoing performance constraints in the context of continued very high levels of demand. Hospital handover delays continue with further deterioration to unprecedented levels in Norfolk & Waveney.

New reporting improved and sector level information helpful in highlighting where issues exist. Remains work in progress but welcome improvements. Development continues.

Internal - moderate

External - no assurance

Operational Improvement Plan

First review of the developing Improvement Plan.

Draft plan welcomed; detailed and thorough plan of improvements required with owners assigned with timescales. 

Work in progress but the Committee were encouraged by the initial draft.

Commercial Services Report

First report on Commercial services for the trust to PAF. Overspend reported around CallEEAST as a result of staffing issues; confidence expressed that this will be recovered in 23/24.

Matters for escalation or referral

Issue

Reason

 Key Internal Controls

 Executive

Limited progress on identifying the controls associated with the PAF responsibilities.

QCIP 

Trust Board 

Limited assurance around programme for 23/24.

Limited assurance around changes required to secure accountability and responsibility within directorates and services.