draft nhs manual for accounts 2012 13
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draft nhs manual for accounts 2012 13These send information about how our site is used to a service called Google Analytics. We use this information to improve our site. We’ll use a cookie to save your choice. You can read more about our cookies before you choose. If you are a member of the public looking for health advice, go to the NHS website. And if you are looking for the latest travel information, and advice about the government response to the outbreak, go to the gov.uk website. We also email updates to finance teams. The latest updates will listed on this page. Validation error will be accepted CCG MH exp analysis Op inc (source) is negative. Validation errors resulting from this will be accepted. SoCI Other Providers may choose to leave cells AK117 to AK124 blank. Validation error will be accepted Capital Analysis Schemes Validation errors resulting from this will be accepted. As a clarification to the guidance, this should only apply to that part of the backdated pay award that is in excess of the inflationary assumptions inherent in the planning model and being applied by providers in their pay costs. There are no other changes.For finalising quality accounts by 15 December, a date of 15 October would be reasonable for this; each trust should agree this with their relevant stakeholders. If you are using the optional accounts templates provided by us, changes from the version included in those templates are highlighted in red. This was circulated to providers by email on 27 March. This document gives guidance on completing the TAC schedules. The template will need to be re-linked to the final PFR form, following the guidance in the accounts documents. We will communicate this figure to providers and populate them into month 12 TAC schedules. We have discussed and agreed this approach with the audit community.http://bikidi.com/UpFiles/WebEditorFiles/carf-standards-manual-2015.xml
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In the rare circumstances that the estimate leads to a more significant difference for any particular provider, there is a process where entities can ask for the national figures to be updated. We have updated the guidance to include how to treat the additional contribution in the agreement of balances exercise. An insurance contract is defined as “a contract under which one party (the issuer) accepts significant insurance risk from another party (the policyholder) by agreeing to compensate the policyholder if a specific uncertain future event (the insured event) adversely affects the policyholder”. But the first step for HM Treasury and DHSC is to identify what contracts might be held that would fall under IFRS 17. It’s possible that there may be items currently considered as provisions or contingent liabilities which are in reality insurance contracts. There are a number of important parts of the definition (this list is not complete): So for example we would see readmissions in the NHS as affecting IFRS 15 measurement, and not considered the provision of insurance. Employer pensions and insurance contracts where the entity is the policyholder are also excluded from IFRS 17. If you do have, or have matters that you’re unsure about and would like to discuss further, please get in touch with us. These are now (from December 2019) retained separately as a future reference for providers. Chapter 5 will be the most useful part of this, explaining key elements of the NHS standard contract. Please note that chapter 7 on disclosure requirements is very focused on the requirements of the standard, rather than considering materiality for the NHS. The disclosures in our TAC schedules are designed to meet the most relevant disclosure requirements of IFRS 15, as explained in the TAC Completion Instructions. These items are paid for by NHS England but physically held by providers until they are used.http://soyuzmedexpert.ru/userfiles/carfree-design-manual.xml This stock is seen as being owned by NHS England and so is reflected in its Statement of Financial Position. NHS providers are reminded to ensure that they exclude this consignment stock from their inventory counts and it should not be included within providers’ balance sheets. SESSION 2013-14? 26 FEBRUARY 2014 Our vision is to help the nation spend wisely. Our public audit perspective helps Parliament hold government to account and improve public services. The National Audit Office scrutinises public spending for Parliament and is independent of government. He has statutory authority to examine and report to Parliament on whether departments and the bodies they fund have used their resources efficiently, effectively, and with economy. Our studies evaluate the value for money of public spending, nationally and locally. The material must be acknowledged as National Audit Office copyright and the document title specified. Where third party material has been identified, permission from the respective copyright holder must be sought. Links to external websites were valid at the time of publication of this report. Summary?5 Summary 1 Monitor was created in 2004 as the independent regulator for NHS foundation trusts. It assesses NHS trusts for foundation trust status, and authorises those that meet the requirements to be financially sustainable, well led and locally accountable. It regulates NHS foundation trusts and intervenes where trusts are in significant breach of their regulatory conditions to help them become compliant again. 2 The government’s aim is for all NHS trusts to become NHS foundation trusts, either in their own right or after merger or reconfiguration. NHS foundation trusts are self-governing, enjoy greater financial and operational freedoms than NHS trusts, and are directly accountable to Parliament. At 31 December 2013, there were 147 NHS foundation trusts providing acute, mental health, ambulance and community health services.http://schlammatlas.de/en/node/17666 3 The Health and Social Care Act 2012 expanded Monitor’s role. It is now the sector regulator for health services. Its new responsibilities include ensuring the continuity of services, setting prices for NHS-funded care jointly with NHS England from April 2014, and enforcing rules to prevent anti-competitive behaviour by healthcare commissioners and providers. 4 Monitor is an executive non-departmental public body sponsored by the Department of Health (the Department). It is independent of government in its regulatory judgements. In 2013-14, Monitor’s budget for core running costs is ?48 million and it has over 300 staff. Our report 5 Monitor is an increasingly important part of the health system. Its responsibilities now stretch beyond regulating individual NHS foundation trusts to ensuring continuity of services for patients. Along with the other main regulator, the Care Quality Commission, Monitor is vital to making the reformed health system work effectively and giving the Department assurance in its stewardship role for the health system. 6? Summary? Monitor: Regulating NHS foundation trusts 6 Monitor’s remit is expanding with significant, high profile, new responsibilities. At the same time, its traditional role of regulating NHS foundation trusts is becoming more challenging. The number of NHS foundation trusts is expected to rise to meet the government’s policy commitment. The threat to trusts’ sustainability is growing as the need to make substantial efficiency savings in the NHS puts trusts under increasing financial pressure. And the focus on care quality and effective regulation is greater than ever in the wake of the problems at Mid Staffordshire NHS Foundation Trust. These factors mean that the extent and complexity of Monitor’s work will increase. 7 Against this background, our review of Monitor is well timed. This report examines Monitor’s performance in regulating NHS foundation trusts and how well it is responding to the new challenges it faces.http://www.ejnerkaa-landbrug.dk/images/c24-incubator-shaker-manual.pdf We set out our audit approach in Appendix One and our evidence base in Appendix Two. Key findings Role, governance and resources 8 Monitor has made good progress in preparing for its expanded role. Between 2010-11 and 2013-14, Monitor’s core running costs more than trebled as it prepared to take on its new responsibilities. It met key milestones in 2013, including licensing all existing NHS foundation trusts and publishing a new NHS pricing framework jointly with NHS England. Recruiting the capability Monitor needs and having sufficient capacity, particularly among senior staff, remain key risks to a successful transition. At 31 December 2013, of the 450 staff Monitor expects it will need, 113 posts (25 per cent) remained vacant. Some 51 staff were filling essential roles on an interim basis (paragraphs 1.7, 1.8 and 1.16). 9 Monitor has more to do to explain how it will exercise its new responsibilities. Stakeholders are unclear how Monitor will coordinate with other bodies including NHS England and the NHS Trust Development Authority. Some also raised concerns about what responsibility Monitor has for assessing the impact on trusts of the prices it sets, as well as potential tension between Monitor’s new responsibilities to prevent anti?competitive behaviour while enabling integrated care. Monitor has published guidance on how it will interpret and enforce competition regulations. However, it has taken on some of its new powers more quickly than it has been able to publish guidance and explain to trusts how things will work in practice (paragraphs 1.9 to 1.11). Monitor: Regulating NHS foundation trusts. Summary?7 10 Monitor’s governance has not been good practice in that the same person acted as both chair and chief executive for nearly three years. The Secretary of State appointed an interim chair in January 2014 and expects to make a permanent appointment in autumn 2014. The Department approves Monitor’s budget and business plan.https://controlcert.se/wp-content/plugins/formcraft/file-upload/server/content/files/1629acbee70162---Corningware-sc-60-manual.pdf The Department has not systematically assessed Monitor’s performance, but is seeking to strengthen its oversight of its arm’s-length bodies (paragraphs 1.13 and 1.14). Assessing and authorising trusts 11 Monitor has rigorous processes and standards for assessing NHS trusts applying for foundation trust status, which it has adapted and strengthened. Monitor uses quantitative and qualitative evidence in assessing applicant trusts, which it tests by comparing evidence from different sources. Trusts must show that they are financially sustainable, well led and locally accountable. In July 2010, Monitor introduced new criteria for testing trusts’ governance arrangements for ensuring care quality in the light of lessons from failings in patient care at Mid Staffordshire NHS Foundation Trust. It has kept under review its assumptions for testing trusts’ financial plans and updated them to reflect the more challenging financial environment (paragraphs 2.2, 2.3, 2.6, 2.8 and 2.9). 12 NHS trusts are finding it more difficult to meet the standard Monitor applies. The assessment process is taking longer, and the number and proportion of successful applications has fallen over the last four years. Monitor authorised just two trusts in 2012-13. At 31 December 2013, 98 NHS trusts had not attained foundation trust status. Evidence from NHS foundation trusts is that Monitor’s assessment process had a beneficial impact on their trust, although it demanded a lot of management time (paragraphs 2.5, 2.7, 2.10, 2.13 and 2.14). 13 Monitor’s assessment has focused primarily on the strength of individual applicant trusts, rather than wider risks in local health economies. The interdependence and viability of organisations in local health economies will be an increasingly important part of Monitor’s assessments, in view of the need to ensure that services are sustainable.www.cpfledlighting.com/userfiles/file/Casio-calculator-fx-300es-manual.pdf Monitor is considering how to engage better with commissioners, local authorities and other stakeholders as part of its assessments and how to analyse the viability of local health economies (paragraph 2.9). 14 Few NHS foundation trusts have got into difficulty soon after being authorised, indicating that Monitor’s assessment decisions have been sound. Monitor has set a standard for authorisation which it considers good NHS trusts can achieve. Its aim is that no trust should breach its regulatory conditions within 12 months of authorisation. Just three of the 147 trusts authorised since Monitor was established in 2004 did so. For some trusts that got into difficulty after authorisation, it is likely that some of the underlying issues were present at the point of authorisation (paragraphs 2.15 to 2.19). 8? Summary? Monitor: Regulating NHS foundation trusts Addressing risk in NHS foundation trusts 15 The growth in risk in the foundation trust sector may put unsustainable pressure on Monitor’s capacity to regulate trusts in difficulty or maintain continuity of services. At 30 September 2013, Monitor rated 16 per cent of NHS foundation trusts as highest risk in governance terms, compared with 13 per cent at 31 March 2012; and 6 per cent as highest risk in financial terms, compared with 2 per cent at 31 March 2012. At 31 December 2013, 25 NHS foundation trusts were in breach of their regulatory conditions, an all-time high. The enhanced monitoring and intervention that these trusts require takes an increasing amount of Monitor’s resources (paragraphs 3.6, 3.11, 3.14, 3.30 and 3.31). 16 Monitor has historically used mainly retrospective performance measures in assessing risk, but it strengthened its approach in October 2013. The metrics Monitor uses to assess governance risk, such as performance against clinical targets, have not always warned of underlying issues.http://friluftsgruppen.se/wp-content/plugins/formcraft/file-upload/server/content/files/1629acbef381e7---corningware-programmable-6-qt-slow-cooker-manual.pdf Similarly, the indicators that Monitor used to calculate financial risk ratings did not consider trusts’ future commitments and projections. Monitor changed its risk assessment framework in October 2013 and now includes information from third parties, including patients and whistleblowers, in assessing governance risk. Assessing the impact Monitor has is difficult because of the range of influences on a trust and the difficulty of demonstrating what would have happened if Monitor had not taken action. However, people we interviewed at our case study trusts considered that they took faster or more effective action, or both, because of Monitor than they would have done otherwise. Monitor’s interventions have worked well where the underlying issues are internal to the trust, such as poor leadership or financial management. NHS foundation trusts have regularly taken radical action, such as changing their chair or chief executive, in response. Monitor has often also required trusts to commission external consultancy support or employ turnaround directors (paragraphs 3.21 and 3.24 to 3.27). 18 Monitor’s influence has been less effective where the cause of the trust’s difficulties relate to underlying issues in the local health economy. For an increasing number of trusts in difficulty, the underlying causes are rooted in the local health economy, for example where commissioners are in financial difficulty. In recent months, Monitor has changed its approach to intervening in these trusts. In some cases it has started working with commissioners, the local authority and the NHS Trust Development Authority to find solutions to address these wider issues. Monitor needs to rely on informal influence in these situations, as well as its formal powers of intervention (paragraphs 3.16 to 3.17 and 3.28). Monitor: Regulating NHS foundation trusts. Summary?https://optimus.org.au/wp-content/plugins/formcraft/file-upload/server/content/files/1629acc01da183---Corning-x77-manual.pdf9 19 Monitor has started to increase its work to strengthen governance and financial management in NHS foundation trusts to try to reduce the risk of trusts getting into difficulty. Monitor seeks to support and develop the foundation trust sector. For example, it provides training to strengthen the capability of boards and publishes good practice guidance. To date, Monitor has devoted only a small proportion of its resources to this type of work, and it has not assessed the overall impact or reach of this activity (paragraphs 3.31 to 3.33). Conclusion on value for money 20 We consider that Monitor has achieved value for money in regulating NHS foundation trusts. Its processes for assessing and monitoring trusts are robust, its judgements have mostly been sound, and it has refined its approach in the light of experience. The balance of evidence suggests that Monitor has generally been effective in helping trusts in difficulty to improve. Its impact is particularly clear where the issues arise from weaknesses in trusts’ internal management. 21 Monitor recognises that it needs to adapt how it regulates to address underlying weaknesses in local health economies that increase the risk of financial or clinical failure in individual trusts. It has started to take a more holistic and proactive approach in a number of cases. It will need to continue to develop its approach and work closely with other agencies within the NHS, as well as the Department, if it is to continue to be an effective regulator and provide value for money. Recommendations 22 Monitor is acting in a number of the areas we have highlighted. Our recommendations are designed to reinforce these actions, and help Monitor meet the challenges it faces in regulating NHS foundation trusts in an increasingly difficult environment and in taking on significant new responsibilities.Increasingly the difficulties NHS foundation trusts face cannot be solved by the trusts alone.fecomm-th.com/upload_file/files/Casio-calculator-fx-260-solar-manual.pdf They require integrated action across local health economies. Monitor needs to work closely with other bodies, including local commissioners, to develop solutions that maximise benefit for the NHS overall. It must ensure that its staff have the skills and authority to adopt this kind of approach.Monitor could improve its capability by training its existing employees or recruiting staff with relevant NHS experience and clinical skills. However, it is the Commission that regulates the quality and safety of the care that NHS foundation trusts provide. Monitor should draw on the Commission’s knowledge and skills as far as possible to avoid duplication. 10? Summary? Monitor: Regulating NHS foundation trusts c Monitor needs to explain more fully to the NHS how it will exercise its new responsibilities. There is currently a gap in understanding, and therefore concern, about how Monitor will apply its new powers to benefit patients. In particular, Monitor must make clear how it will weigh up the benefits to patients of potential improvements in the quality of care and cost savings that may arise from service reconfiguration and integration against reduced choice and competition.Monitor needs to establish the best ways of reducing risk in the foundation trust sector and focus resources on these areas.Monitor was unable to comply with its own guidance on corporate governance, as the same person was both the chair and the chief executive for three years. The Department appointed an interim chair in January 2014. An independent chair is needed to boost the capacity of Monitor’s senior team, hold the executive management to account and strengthen Monitor’s accountability to Parliament. Monitor: Regulating NHS foundation trusts. Part One? 11 Part One Role, governance and resources 1.1 This part of the report covers Monitor’s role, including its new responsibilities under the Health and Social Care Act 2012, governance and resources. Role 1.2 Monitor was created in 2004 as the regulator for NHS foundation trusts. At 31 December 2013, there were 147 such trusts. They, together with 98 NHS trusts,1 provide acute, mental health, ambulance and community health services. NHS foundation trusts are self-governing, have greater financial and operational freedoms from government than NHS trusts, and are directly accountable to Parliament. The government intends that all NHS trusts will become foundation trusts, either in their own right or following reconfiguration or merger. 1.3 Since April 2013, Monitor has had a broader role as the sector regulator for health services in England. It has a statutory duty to protect and promote the interests of people using healthcare services, including a role in ensuring service continuity. This represents a shift in focus towards the sustainability of services in the round, rather than protecting individual NHS foundation trusts from failure. Unlike other trusts, NHS Direct is a national body that provides health and advice services to patients. 12? Part One? Monitor: Regulating NHS foundation trusts 1.5 Figure 1 shows how Monitor fits into the health system. The Commission registers trusts, inspects whether they comply with essential standards of quality and safety, and takes enforcement action where they fail to meet the standards. Monitor oversees NHS foundation trusts’ arrangements for ensuring care quality and, where clinical problems persist and affect the performance of the trust, it intervenes to help improve governance. The Commission also provides Monitor with its view on NHS trusts applying for foundation trust status. Monitor and the Commission have agreed a memorandum of understanding to help them work effectively together. Both organisations consider that their relationship is growing stronger as it matures. The Authority supports NHS trusts to improve service quality and sustainability, and to achieve foundation trust status. Monitor and the Authority have a partnership agreement to help them work effectively together. They meet regularly to discuss NHS trusts’ progress towards foundation trust status. In April 2013, Monitor became responsible for preventing anti-competitive behaviour by healthcare commissioners and providers. NHS England will define the services required and design the pricing structure, and Monitor will set prices (the national tariff). Setting the tariff is important because it can influence how commissioners and providers work, as well as how services are designed. Monitor also sets the rules governing how providers and commissioners may themselves determine prices. 2 A number of providers are exempt from having to hold a licence from Monitor, including NHS trusts and providers of primary medical and dental services. Part One? 13 Figure 1 How Monitor fits into the health system Department of Health NHS Trust Development Authority Commissioners Care Quality Commission Monitor Other providers including private and third sector bodies NHS foundation trusts (147) NHS England Clinical commissioning groups Providers NHS trusts (98) Primary care providers (for example GPs, dentists, opticians) Accountability Funding Notes 1 The figure shows, in a simplified way, the main lines of accountability and funding flows between organisations in the health system. 2 Monitor is accountable to the Department for its performance and value for money, but is independent of government in terms of its regulatory decisions. Source: National Audit Office 14. Part One? Monitor: Regulating NHS foundation trusts 1.7 Monitor has made good progress in preparing for its expanded role. It met key milestones during 2013, including licensing all NHS foundation trusts and working with NHS England to develop and publish a pricing framework. 1.8 An important aspect of the transition has been recruiting additional staff with appropriate skills for Monitor’s expanded role, including economists and legal professionals. At 31 December 2013, Monitor had 337 staff, 75 per cent of the 450 staff it expects to need to carry out all its functions. Where business critical posts have not been filled, Monitor has made use of interim staff. At 31 December 2013, 51 staff were working on an interim basis. Some NHS foundation trusts were concerned about how Monitor would work with other bodies, including NHS England and the NHS Trust Development Authority, to fulfil its new responsibilities. For example, they were unclear how it would work with NHS England in setting tariff prices, including who would assess the tariff’s impact on trusts, particularly where prices are used to incentivise providing care in community settings rather than in hospitals. 1.10 Another issue stakeholders raised was about potential tension between Monitor’s different responsibilities, particularly between preventing anti-competitive behaviour and enabling care to be provided in an integrated way. Concerns were raised about the impact competition could have on service reconfiguration. In relation to any proposed merger, the competition authorities will draw on Monitor’s advice when weighing up the implications of reduced competition and choice against the expected benefits to patients. Monitor issued a joint statement with the Competition Commission and the Office of Fair Trading in October 2013, which made a commitment to putting patients’ interests at the heart of the merger process.3 1.11 Monitor has now set out how it intends to support organisations considering a merger, and has also issued guidance to support NHS commissioners in understanding and complying with the procurement, choice and competition regulations. However, Monitor has taken on some of its new powers more quickly than it has been able to publish guidance and explain to trusts how things will work in practice. Governance 1.12 Monitor is an executive non-departmental public body, sponsored by the Department of Health (the Department). It is independent of government in terms of its regulatory decisions. It is accountable directly to Parliament and to the Department for its performance and value for money. 3 Joint statement from the Office of Fair Trading, the Competition Commission and Monitor, Ensuring that patients’ interests are at the heart of assessing public hospital mergers, 17 October 2013. Part One? 15 1.13 The Department approves Monitor’s annual budget and business plan. It has reviewed Monitor’s financial performance and risks at a strategic level, but has not systematically monitored how Monitor performs against its objectives. It also has frequent contact with Monitor about the performance of the foundation trust sector. Following the reforms to the health system, the Department is seeking to strengthen its stewardship arrangements. It has set up a sponsorship unit to oversee relationships with its arm’s-length bodies. 1.14 Monitor’s board comprises three executive and four non-executive members. Between March 2011 and January 2014, the same person was both chair and chief executive. Monitor notes in its annual report that this is not consistent with good practice for corporate governance, as set out in The NHS Foundation Trust Code of Governance and The UK Corporate Governance Code.4 Both documents state that these roles should be carried out by different people and that a chief executive should not go on to be the chair of the same organisation. In October 2013, the Secretary of State proposed a new chair, but the House of Commons Health Committee did not endorse the appointment and the candidate withdrew his application.5 The Secretary of State appointed an interim chair in January 2014 and expects to make a permanent appointment in autumn 2014. 1.15 Monitor measures its own performance using a range of indicators including measures of process (such as time taken to assess applicant trusts), some outcomes (such as number of trusts in breach and time they take to recover), and stakeholder perceptions. Unlike some other regulators, Monitor does not seek to quantify the net financial benefit of its work. Monitor is updating its performance metrics, aiming to include more outcome measures and better reflect its new responsibilities. Resources 1.16 In recent years, Monitor’s spending and staff numbers have increased significantly as it has taken on additional responsibilities and the challenges facing the foundation trust sector have become more complex. Between 2010-11 and 2013-14, Monitor’s spending on core running costs more than trebled, from ?14.8 million to a forecast ?47.7 million (Figure 2 overleaf). In 2012-13, this funding was included within core running costs. The budget for the Cooperation and Competition Panel was ring-fenced in 2012-13, but was part of core running costs in 2013-14. Monitor’s spending and staff for 2013-14 are based on numbers forecast at November 2013. Staff numbers are based on full-time equivalent employees. 3 4 5 6 Source: Monitor The transition budget covers development of policy and future organisational design for Monitor’s new responsibilities. 2 362 Staff 0 50 100 150 200 250 300 350 400 Number of full-time equivalent employees Notes 1 In 2012-13, Monitor’s core running costs budget was ?26.0 million, which comprised ?17.7 million for existing functions and ?8.3 million for preparations for taking on new responsibilities. Part One? Monitor: Regulating NHS foundation trusts Monitor: Regulating NHS foundation trusts. Part One? 17 1.