Performance of the NHS provider. sector for the quarter ended 31. December 2018

Transcription

1 Performance of the NHS provider sector for the quarter ended 31 December 2018

2 Contents Overview at Q3 2018/19 Performance comparisons 2.3 Income analysis 2.4 Employee expenses pay costs 1.0 Operational performance 2.5 NHS provider vacancies 1.1 Operational performance overview 2.6 Agency ceiling performance 1.2 Accident and emergency 2.7 Non-pay cost pressures 1.3 Diagnostic waiting times 2.8 Efficiency savings 1.4 Elective waiting times 2.9 Implied provider productivity 1.5 Cancer waiting times 2.10 Capital expenditure 1.6 Ambulance improvement programme 2.11 Q3 financial performance overview by integrated care system 1.7 Infection control 2.12 Year-end financial position 1.8 Mental health (1) 3.0 Financial performance by provider 1.9 Mental health (2) 4.0 Operational performance by provider 1.10 Mental health (3) 5.0 Vacancy position by sector and region 1.11 Winter resilience preparations 2018/ Organisation splits to calculate ICS financial performance 2.0 Financial performance 7.0 Timetable of future publications 2.1 Financial performance overview by sector & region End notes and glossary 2.2 Income & expenditure

3 Overview at Quarter 3, 2018/19 (1/6) Introduction Today s NHS continues to meet the challenge of a growing and ageing population, seeing high and sustained levels of demand. Demand for emergency admissions through accident and emergency (A&E) departments remained high in early winter: the number of emergency admissions in Quarter /19 increased on average by more than 785 patients per day compared with Q3 2017/18. This continues the upward trend of the last two years, when emergency admissions during Quarter 3 increased by 5.5% (from 2016/17 to 2017/18) and 6.3% (from 2017/18 to 2018/19) respectively. Staff continue to work extremely hard to care for patients, including the 6.16 million people who came to A&E during Quarter 3 2.3% more than the same period last year. It is noteworthy that, despite this significant rise in demand, the NHS treated 106,863 more patients in 4 hours than in the same quarter last year 1. In preparation for winter, providers worked hard to cope with the surge in demand. The NHS will benefit from a second year of enhanced, national winter planning and capital investment. Reforms across the NHS, from primary care through to acute care, have supported both emergency and elective care by freeing up capacity and improving flow. At the end of Quarter 1, the provider sector had a planned deficit for the year of 519 million. During quarters 2 and 3 we used the revised framework for the Provider Sustainability Fund (PSF) as an incentive for trusts to reduce this to 394 million. NHS Improvement and NHS England regional teams have worked with the most challenged health economies to continue efforts to manage the residual local planning gap. Against the revised plan for 2018/19, the provider sector reported a year-to-date deficit of 1,247 million in Quarter 3, which is 34 million better than the same period last year but 261 million more than planned. This is mainly due to a small proportion of providers whose position has significantly deteriorated: we expect their boards to take firm action to achieve their plans. The NHS Long Term Plan, published in January, sets out our ambitions for improvement over the next decade and our plans over the five years of the new funding settlement. Success will depend on NHS organisations achieving their plans each year. It is therefore crucial that boards take the necessary action to fulfil the plans they agreed this year, as any shortfall during 2018/19 would have significant implications for the following year. For the majority of trusts continuing to deliver against their plans, along with those minority with the biggest challenges who are striving to get as close to plans as possible, this is an essential foundation for the longer term sustainability of services. 1.The performance figures in this overview are total NHS performance figures as published by NHS England. Further information is available in the Winter Preparations board paper.

4 Overview at Quarter 3, 2018/19 (2/6) In response to high and sustained levels of demand, NHS staff saw more people in under four hours than last year Demand for hospital services has continued to increase. There were over 1.20 million emergency admissions via A&E (type 1), 6.1% more than in the same period last year. Total emergency admissions in the year to date from all sources not just A&E also increased by 5.8% from last year. This consists of an 11.2% increase in patients with zero days length of stay and a 2.7% increase in patients who remain in hospital one day or longer. Providers treated more emergency patients within the key operational standard (5.4 million patients compared with 5.3 million in Quarter /18), in response to the sustained demand for care. Reform is underway to further improve the resilience of the system to build the capacity and capability of primary care, NHS 111 and NHS 111 Online, hear and treat and see and treat, reducing long stays in hospital and increasing same day emergency care. These actions have been undertaken as part of the winter preparations and this transformation agenda will continue as we move into the new year. There has also been significant capital investment to improve emergency care by increasing capacity and improving patient flow. A&E performance remains below the NHS Constitution standard of 95%: at 87.7% it has fallen slightly relative to Quarter 3 last year (87.9%). Freeing beds improves elective performance and makes managing winter easier Alongside rising demand, high levels of bed occupancy and delayed discharges affected providers ability to admit patients needing planned care. Providers made progress in reducing delayed discharges. There were almost 268,300 acute bed days or 2,916 beds lost to patients awaiting discharge who did not need an acute hospital bed. This is just under 43,000 fewer bed days delayed compared with the same period last year, equivalent to freeing over 466 beds to offset the continuing increase in emergency admissions that leads to very high occupancy levels. To help tackle capacity constraints, there is a national ambition to lower bed occupancy by reducing the number of long-stay patients (and long-stay bed days) who do not need to be in acute hospitals. Patients in hospital for more than three weeks occupy about one-fifth of beds. Many are older people who may deteriorate if they stay in hospital. The ambition was to reduce by 25% the number of long-stay patients (those in hospital for 21 days or more) by December 2018 from the 2017/18 baseline equivalent to freeing over 4,800 beds. The aim is to free capacity, beds and staff time, enabling more patients to be treated and improving the flow of those being admitted via A&E. At 31 December 2018 we had reduced the number of long-stay patients by the equivalent of nearly 1,950 beds.

5 Overview at Quarter 3, 2018/19 (3/6) In Quarter 3, NHS 111 received 4.4 million calls, an increase of over 243,000 on the same period last year, with 53.7% of calls triaged with clinical input. In addition, all ambulance providers have implemented new response time standards and performance continues to improve. In the most time critical category 1 standard, reserved for the sickest of patients, the two key response time measures have improved and both show considerable reductions in patient waits from the same period last year. Performance standards for planned care show mixed results Patient care without admission accounts for 78% of planned hospital activity this highlights that diagnostics and outpatient services have a significant effect on patients waiting-time experience. In aggregate, providers did not meet the standard that only 1% of patients should wait over six weeks for 14 of the 15 key diagnostic tests: 3.30% waited more than six weeks. More patients received treatment for cancer following an urgent GP referral for cancer treatment (40,303, an increase of 2,806 on the same quarter last year). Four of the eight cancer waiting-time standards that apply were achieved during the quarter. In December 2018, the NHS met the standard that patients experiencing a first episode of psychosis should be treated within two weeks of referral to mental health services: 76.7% started treatment within two weeks (763 out of 995 patients), relative to a standard of 53%. The total waiting list for planned hospital care has declined by 31,215 since Quarter 2. At the end of December 2018, it stood at 4.3 million when including estimates for providers that did not submit data for the month, compared with 4.0 million in December Providers started treatment within 18 weeks for more patients this year: 1.01 million compared with 0.98 million last year (published by NHS England). 86.6% of patients waiting to start treatment had been waiting no longer than 18 weeks, compared with the standard of 92%. In the same period last year, performance was 88.2%. Workforce challenges contributing to operational pressures Our data indicates the scale of the workforce challenge facing providers. In addition to their 1.1 million whole-time equivalent staff, providers have 100,500 vacancies. The decrease since Quarter 2 (about 5,000 whole-time equivalents) is a result of expected substantive recruitment aligned with new graduate intakes. However, the current vacancy position remains a challenge, particularly in the nursing workforce. Every unfilled shift poses an operational challenge on the front line, so we are supporting providers to improve staff retention and sharing best practice as part of the drive to reduce temporary staffing.

6 Overview at Quarter 3, 2018/19 (4/6) Agency spend remains under control, but many vacancies are difficult to fill The NHS has steadily reduced the costs of agency staffing since While agency savings are non-recurrent and must be achieved each year, we expect providers to succeed again in controlling these costs, so the ceiling for agency spend has reduced from 2.5 billion in 2017/18 to 2.2 billion in 2018/19. This in turn has reduced the Quarter 3 ceiling to 1,656 million. Against this lower target, providers spent 1,795 million, a 139 million overspend slightly up on the 1,779 million reported for the same period in 2017/18. The reduction in agency staff costs since 2015 is a considerable achievement in view of record demand and extreme pressure on the acute sector. Following the changes in the last two years for nursing and medical agency staff, the same rigour and collaborative approach needs to be applied to managing all temporary staffing Operational pressures continue to affect NHS finances The provider sector reported a year-to-date deficit of 1.25 billion at Quarter 3, which is 34 million better than the same period last year but 261 million worse than planned. This includes the year-to-date distribution of 2.45 billion from the Provider Sustainability Fund (PSF). The PSF aims to encourage trusts to provide sustainable, efficient, effective and economic care and is focused on achieving sustainability, accelerating financial recovery and improving urgent and emergency care. During quarters 2 and 3 we used the PSF framework to offer providers additional incentive payments to improve their financial position. These incentives affected a small number of providers but enabled us to reset the plan forecast deficit from 519 million in Quarter 1 to 439 million in Quarter 2 and subsequently to 394 million during Quarter 3: 42 providers signed up to revised plans to improve their forecast position by 112 million. Of these, most are currently forecasting they will achieve their revised control totals. Looking at the year to date variances: after excluding PSF, 60 providers had adverse variances and 11 of these were over 10 million, a deterioration since Quarter 2 when 44 providers had adverse variances of which two were over 10 million. Key contributing factors cited by providers include difficulties in achieving planned efficiency savings, operational cost pressures relating to temporary staffing and substantive workforce pressures including the extent to which the Agenda for Change pay awards are fully funded, contracting difficulties, quality investment and unplanned emergency activity displacing elective income.

7 Overview at Quarter 3, 2018/19 (5/6) The reported deterioration among a small proportion of providers explains most of the overall deterioration in the sector. This requires focused and firm action by their boards the whole NHS is under considerable pressure and it is clearly not appropriate for a few organisations to receive disproportionate financial support from the rest of the NHS. Work has continued throughout the year to identify further savings and to manage the financial risks in 2018/19. Against the lower planned deficit of 394 million for the year, the sector currently forecasts it will overspend by 267 million. This is after the technical adjustments detailed in the main report and represents a 148 million deterioration from the Quarter 2 reported position. The technical adjustments include donated asset income of 256 million, which results from the Carillion collapse, and two private finance initiative assets being brought onto trust books as part-donated assets. Of the 230 providers, 43 are performing better than plan (after excluding PSF). Of these, 11 have agreed reset plans, while 32 others that did not change their plans also forecast they will overperform. A further 114 forecast they will be on plan, leaving 73 forecasting an overspend against plan by the year end. Of these, 22 providers (9.6%) forecast a variance from plan of more than 10 million at Quarter 3, an increase on the six identified at Quarter 2. In aggregate, these 22 providers account for 396 million 74% of the sector forecast variance to plan, excluding PSF. We are working through our regional teams to reduce this forecast overspend through intensive efforts to improve financial controls in these providers. Providers made significant savings but still fell below ambitious targets, so continued focus on productivity is critical During 2017/18, providers cost improvement programmes saved 3.2 billion (3.7%) in highly challenging operating conditions. Planned efficiency savings for 2018/19 are set even higher, at 3.6 billion or 4.1% of total expenditure. Planned savings for the year to Quarter 3 were 2,338 million (3.5%). Savings achieved were 2,094 million (3.1%) which, although significant, were 244 million below the plan. Provider boards should decide now how to recover this position in Quarter 4: the shortfall in cost improvements is a key factor in providers whose financial position has deteriorated.

8 Overview at Quarter 3, 2018/19 (6/6) Specific efficiency savings linked to workforce productivity, resource optimisation and benchmarking through the Model Hospital are estimated to be 1,213 million year to date, forecast to rise to 1.8 billion by the year end. The Carter report 1 identified a savings opportunity of 5.8 billion across specific work programmes. This work is for five years; in the first year (2017/18), 1.4 billion was achieved and in the current year 1.9 billion is included in provider plans. The Getting It Right First Time (GIRFT) programme supports the search for efficiency and productivity gains by promoting a reduction in unwarranted clinical variation: 20 million of the PSF is earmarked for this work. We continue to help providers maximise the benefit from efficiency savings, providing national and technical forums for sharing best practice. Despite constrained capital, major improvements in patient facilities were approved In preparation for winter, the government issued 145 million of capital funding, this investment has increased capacity for acute services this winter: 81 schemes received funding, providing much needed capacity to help meet the increasing demands on A&E services. Significant improvements in patient facilities were agreed in Quarter 3 as the result of a further wave of capital announcements for sustainability and transformation partnerships (STPs). This includes outline approvals for 88.5 million of diagnostic equipment and transformation of urgent and emergency care in Humber, Coast and Vale STP; 9.1 million for oncology and MRI re-provision at Royal Cornwall Hospitals NHS Trust; 86 million to transform mental health and substance misuse services for Camden and Islington NHS Foundation Trust and 36 million for emergency department development at Walsall Healthcare NHS Trust. While the additional capital for STPs has been welcome, considerable pressure remains in the short term on core NHS capital budgets, with achieving financial balance on the provider core capital budgets across 2018/19 and 2019/20 being particularly challenging. Looking ahead: challenges for the rest of 2018/19 The provider sector s planned deficit of 394 million reflects the challenges it faces. Despite efforts in Quarter 3, operational and financial performance remains under severe pressure. While the financial trajectory for the rest of the year looks ambitious, most providers report that their board-approved plans will be achieved, and they should be given the headroom and support to deliver. At the same time, we will work intensively with providers whose forecasts have deteriorated at Quarter 3, to understand the causes and the remedies. 1.Unwarranted variation: A review of operational productivity and performance in English NHS acute hospitals (Lord Carter of Coles, published June 2015)

9 Performance comparisons Activity and capacity Q YTD Plan Q YTD Actual Finance and productivity Q YTD Actual Plan Q3 Variance YTD from Q3 YTD variance 17/18 from plan A&E attendances (millions) % 4.3% Non-elective admissions (millions) % 5.4% Elective admissions (millions) (0.1%) 0.7% First outpatients attendances (millions) General & acute beds (average daily open Q2 2018/19) % 2.1% - 100, ,945 - (0.6%) Nurses (WTE) 352, , ,175 (1.1%) 0.6% Medical staff (WTE) 125, , , % 4.9% Cost weighted activity growth 1.1% 3.0% 0.8% 2.0% 1.4% Q Actual Q Actual Surplus/deficit ( m) (986) (1,247) (1,281) Total income ( m) 62,257 63,194 60,453 Expenditure ( m) (63,717) (65,207) (62,369) Efficiency savings ( m) 2,338 2,094 2,139 Efficiency savings (%) 3.5% 3.1% 3.3% Total pay costs excl agency ( m) (38,153) (39,108) (37,144) Agency ceiling performance ( m) (1,656) (1,795) (1,779) % of providers signed up to a control total % 89.8% % of providers forecasting a surplus at Q3 54.8% 47.8% 46.8% Published operational performance Target Q Actual Q Actual A&E 4 hour performance 95% 87.69% 87.91% Diagnostics (as at 31 December 2018) 1% 3.30% 2.18% RTT (as at 31 December 2018) 92% 86.61% 88.17% Cancer 62-day 85% 79.46% 83.15% Ambulance Category 1 (mean time and 90 th centile response time) December 2018 Ambulance Category 2 (mean time and 90 th centile response time) December 2018 mean: 7 mins 90 centile: 15 mins mean: 18 mins 90 centile: 40 mins Quality and safety Target or ceiling 7:06 12:24 22:22 46:21 Q Actual 8:52 15:24 29:36 62:59 Q Actual Infection MRSA Infection - C. Diff 1, ,149 General & acute bed occupancy (Q2 2018/19) % 88.99% Acute delayed discharges (days) - 268, ,151 >12-hour A&E trolley waits >52-week waits - 2,237 1,750 Number of providers in special measures Notes: Activity & Capacity table: Elective and outpatient activity calculated with working day adjustment Activity & Capacity table: A&E attendances figure from SUS dataset All tables : Quality and performance figures are at a national aggregate level

10 1.0 Operational performance

11 1.1 Operational performance overview Metrics Target / Ceiling NHS Improvement NHS England Accident & emergency: 1 October 31 December 2018 A&E attendances - 5,658,313 6,162,220 Performance All A&E types (%) 95% 86.65% 87.69% Performance Acute providers only (%) 95% 85.78% 85.78% Type 1 performance (%) 95% 81.20% 81.20% Diagnostics: at 31 December 2018 Number of diagnostic tests waiting 6 weeks+ (%) 1% 3.41% 3.30% Referral to treatment (RTT): at 31 December weeks incomplete (%) 92% 86.15% 86.61% 52-week waits (number) - 2,153 2,237 Cancer: 1 October 31 December week GP referral to 1 st outpatient, cancer (%) 93% 92.78% 92.77% 2-week referral to 1 st outpatient - breast symptoms (%) 93% 88.73% 88.73% 31-day wait from diagnosis to first treatment (%) 96% 96.73% 96.74% 62-day urgent GP referral to treatment for all cancers (%) 85% 79.36% 79.46% 62-day referral from screening services 90% 88.11% 88.09% Ambulances: December 2018 Category 1 7 mins / 15 mins 7:06 / 12:24 7:06 / 12:24 Category 2 18 mins / 40 mins 22:22 / 46:21 22:22 / 46:21 Category 3 No standard / 120 mins NA / 156:23 NA / 156:23 Category 4 No standard / 180 mins NA / 189:39 NA / 189:39 Infection control: 1 October 31 December 2018 C. Difficile (Total cases) 1, Notes: NHS Improvement performances above are based on the performances of 151 NHS foundation trusts and 79 NHS trusts. NHS England performances are based on performances of NHS trusts, NHS foundation trusts and independent sector organisations for A&E, diagnostics, RTT and cancer. Performance has been rated red where there has been failure to meet a national standard.

12 1.2 Accident and emergency Percentage of A&E all type patients seen within 4 hours NHS England reported an overall A&E performance of 87.69%, which included the performance of independent sector organisations. NHS providers performance deteriorated from 87.91% in Q3 2017/18 to 86.65% in Q3 2018/19. There were 5.66 million attendances at NHS A&E departments, an increase of 2.1% (like-for-like) compared to the same quarter last year. Last year, A&E departments were under significant operational pressures due to record levels of patients requiring emergency admissions. This quarter, the number of patients attending a major (type 1) A&E department and requiring admitted care reached 1.2 million, an increase of 6.1% on the same quarter last year. Bed capacity constraints due to high occupancy rates and delayed transfers of care continued to affect patient flow. However, despite these challenges, 106,863 more patients were seen within four hours than a year ago. There were also 268,230 bed days lost due to delayed transfers of care in acute hospitals, a decrease of 11.5% (34,921 delayed days) from the same period a year ago. Recognising these challenges, particularly around increased demand compared to last year, the urgent and emergency care programme has continued to drive forward its transformation programmes alongside higher intensity operational delivery, to ensure progress on both important areas of work, in and out of hospital. In July, we announced an ambition to reduce the number of long-stay patients and bed days in hospital by 25%, to release at least 4,000 beds and reduce avoidable harm to patients associated with deconditioning. To support this we published improvement guides, ran training programmes for system leadership teams, relocated the Emergency Care Improvement Support Team (ECIST) into the regions to support local systems, and much more. As of December 2018, the NHS had reduced the number of long-stay patients by 10%, with 15% of the ambition remaining. 145 million of provider capital investment has increased capacity for acute services ahead of this winter: 81 schemes received funding, providing much needed capacity to help meet the increasing demands on A&E services. The government investment of 240 million for adult social care has been crucial to improving discharges by increasing capacity through better patient flow into social care, and reducing unnecessary admissions. NHS chief executives have worked closely with local authority chief executives to realise the maximum benefit from this investment.

13 1.3 Diagnostic waiting times Percentage of diagnostic patients waiting over six weeks Diagnostic waiting times are key to achieving the referral to treatment (RTT) target as most patients referred for hospital treatment will require a diagnostic test. The national waiting-time target for diagnostics states that less than 1% of patients should wait six weeks or more for a test. At the end of December 2018, 896,969 patients were waiting for a diagnostic test in NHS providers, a decrease of 3.8% from the last month. Compared to the same time last year, the waiting list increased by 8.9% (like-for-like). This resulted in more patients waiting longer than six weeks. Performance deteriorated to 3.41% at the end of December 2018 (NHS England performance was 3.30%) compared to 2.27% for the same period last year. This was a 2.51% deterioration on November Diagnostic performance by procedures December 2018 In aggregate, providers failed to achieve the waiting-time standard for 14 out of the 15 key diagnostic tests one more than the same period last year. Non-obstetric ultrasound was one of the best-performing tests despite having the largest waiting lists (35.5% of the total diagnostics waiting list), with 1.3% of patients waiting over six weeks at the end of the month. Urodynamics (12.9%) and colonoscopy (13.6%) saw the largest percentages of patients waiting over six weeks but were two of the smaller waiting lists, with just under 5% (about 46,000) of the patients reported in December Rapid diagnostic and assessment centres are being piloted in 10 areas. These are intended to diagnose cancers early in people who do not have alarm symptoms for a specific type of cancer. In addition, the urgent and emergency care programme continues to roll out standardised urgent treatment centres open 12 hours a day, seven days a week, staffed by clinicians with access to diagnostics and bookable via NHS111.

14 1.4 Elective waiting times RTT 18-week performance and size of waiting list by month After sustained efforts to manage demand, GP referral growth has steadily declined since April 2016, with low growth (0.3%) from April to December 2018 compared to the same period in We are continuing our work to reduce avoidable demand for elective care and implementing interventions across the elective pathway to ensure that patients are referred to the most appropriate healthcare setting, first time. As of January 2019, 181 out of 185 clinical commissioning groups (98%) had compliant MSK triage services to ensure patients access the most appropriate services and receive personalised decisions about their treatment plans, which can reduce MSK referrals to hospital. NHS providers continue to fail to achieve the national referral to treatment (RTT) incomplete pathways target of 92%. Performance for December 2018 was 86.15% (NHS England performance was 86.61%), a drop of 1.6% compared to the same period last year. At the end of December 2018, it was 3.92 million, a 9.8% increase compared to a year ago (like-for-like and excluding providers that have restarted reporting this year). Three providers did not report incomplete RTT performance in December After adding the missing providers data to the waiting list, the total was 4.3 million nationally. In line with the drop in performance and the increase in the overall waiting list, the number of patients waiting longer than 52 weeks for treatment increased. At the end of December 2018, 2,153 patients (2,237 at NHS England aggregate) were waiting over a year for treatment compared to 1,688 in December 2017, although this was a decrease from the 2,333 waiting in November Other measures include producing 12 specialty-level transformation handbooks, rolling out capacity alerts functionality across all regions, and delivering high impact interventions focussing on first contact practitioners in MSK services and ophthalmology. A first contact practitioner service enables patients with an MSK issue, who would usually see their GP, either to refer themselves directly to physiotherapy services or see a first contact practitioner based in general practice. Enabling people to self refer to first contact MSK practitioner services can speed up access to treatment, reduce GP workload and associated costs, improve patient experience and reduce inappropriate referrals to secondary care. As of January 2019, 41 out of 42 STPs (98%) confirmed first contact practitioner pilot sites and 40 have gone live. We are working with trusts to understand how their elective activity will meet projected demand, while reducing 52 week waits and late cancellations. This work is addressing forecast under-delivery of commissioned activity by enabling neighbouring NHS trusts to share capacity where possible, including with the independent sector. Outsourcing activity must be done as efficiently as possible, and we have been working through the NHS Partners Network of independent sector providers to ensure that this is achieved.

15 1.5 Cancer waiting times 62-day (urgent GP referral) wait for first treatment by month Four of the cancer waiting-time standards were failed: two-week GP referral to first outpatient appointment, 14-day referral to first outpatient breast symptoms; 62-day (urgent GP referral) waitingtime target for first treatment and 62-day screening from service referral. NHS providers failed to achieve the national target of 85% for 62-day (urgent GP referral) with a performance of 79.36% (NHS England performance was 79.46%). This was 3.6% lower than achieved in the same quarter last year (83.14%). The specialties contributing most to the underperformance were urological (excluding testicular), lower gastrointestinal and lung. These accounted for only 41.8% of activity but contributed to more than half the reported breaches (57.1%). 62-day (urgent GP referral) wait for first treatment by specialty 1 October - 31 December 2018 We worked with partner organisations to improve cancer performance by reducing diagnostic delays. We continue to work with NHS England to introduce the 28-day faster diagnosis standard for cancer patients. The standard is being piloted in preparation for national rollout. Two-week GP referral to first outpatient appointment saw a deterioration in performance: 92.78% compared to 94.89% in the same period last year. 14-day referral to first outpatient breast symptoms saw a deterioration in performance: 88.73% compared to 95.14% in the same period last year. 62-day screening from service referral saw a deterioration in performance: 88.11% compared to 90.69% in the same period last year.

16 1.6 Ambulance Improvement Programme The last year has seen the biggest ever change to ambulance service standards anywhere in the world. Based on an evaluation of 14 million calls, the Ambulance Response Programme standards have been implemented across England. In July 2017 NHS England announced new performance standards for ambulance services in England to be applied to every 999 call for the first time. This was a result of findings from the Ambulance Response Programme, the largest study of ambulance services in the world. The new standards aim to: I. prioritise the sickest patients, to ensure they receive the fastest response II. encourage clinically and operationally efficient behaviour, so the patient gets the response they need first time and in a clinically appropriate timeframe III. end unacceptably long waits by ensuring resources are distributed more equitably among all patients contacting the ambulance service. To do this we introduced three initiatives: 1. Dispatch on disposition (including nature of call) We gave call handlers more time to assess 999 calls that are not immediately life-threatening before assigning an ambulance. This makes sure the response is right for the patient s needs. We added three questions to the start of a 999 call asking about the patient s breathing and level of consciousness. This makes sure that immediately lifethreatening calls, particularly cardiac arrest, are identified early. 2. A new system of clinical prioritisation for all 999 calls We developed an evidence-based system to prioritise 999 calls to match the patient s urgency and clinical needs to the most appropriate response. 3. New ambulance service measures, indicators and standards We developed measures to make sure the sickest patients receive the fastest response, that all patients get the best response first time, and that no-one waits an unacceptably long time for an ambulance. Response times from the reporting providers have been collated to create the aggregated national table: National aggregate Category C1 to C4 response times December 2018 National Standard: Mean / 90th Centile Count of incidents Category 1 7 mins / 15 mins 60,046 Category 1T no standard 41,096 Category 2 18 mins / 40 mins 408,693 Category 3 no standard / 120 mins 176,296 Category 4 no standard / 180 mins 15,072 Mean 90th centile (hrs:mins:sec) (hrs:mins:sec) 0:07:06 0:10:56 0:22:22 1:06:07 1:24:13 0:12:24 0:20:28 0:46:21 2:36:23 3:09:39 In December 2018 there were 24,700 calls to 999 answered per day, an increase of 2.3% on November. In December 2018, the C1 90th centile response time was 12 minutes and 24 seconds an improvement from November making it the shortest time ever. The C1 mean was 7 minutes 06 seconds in December 2018, a small improvement on November. Five services met the C1 mean standard of 7 minutes in December while 10 met the 90th centile response time of 15 minutes the same as November. Two services met the C2 mean standard of 18 minutes, and four services met the C2 90th standard of 40 minutes. One service met the two-hour C3 and five services met the three-hour C4 standards. Further details can be found in Section 4 of this report. Driving up performance Since the introduction of the new Ambulance Response Programme standards we have seen improvements in performance for the most seriously ill patients and most trusts are close to achieving standards on Category 1 calls. Category 2 remains a challenge for some trusts. Discussion with challenged trusts took place to identify key barriers to delivery and tailor support over winter. A long-term plan to reduce avoidable conveyance is in development, identifying interventions already in use, and to evaluate new opportunities for reducing conveyance. We continue to work with ambulance and acute trusts to tackle hospital handover delays: we monitor these daily, working with regions to develop improvement trajectories and support challenged trusts. Lord Carter s recently published review of the ambulance service identified improvement opportunities in quality and efficiency. As part of this work, a 36 million investment in the ambulance service was used buying 256 state-of-the-art vehicles: more than half were on the road for winter. The investment was also used to establish make-ready hubs, that allow better restocking, refuelling and cleaning of ambulances. Work continues on implementing the full recommendations

17 1.7 Infection control Number of Clostridium Difficile (C. Diff) cases Number of Escherichia coli (E.coli) cases reported 938 provider-apportioned C. difficile cases were reported in Q3 2018/19 compared to 1,149 in the same quarter last year: a reduction of 18.4%. The 938 C. difficile cases reported was 17.9% under the ceiling set for Q3 2018/19 of 1,142. Year to date there were 3,248 C. difficile cases a reduction of 8.5% on the same period in 2017/18. Number of Hospital Onset Meticillin-resistant Staphylococcus aureus (MRSA) cases reported 70 hospital onset MRSA cases were reported in Q3 2018/19, 4.5% more than the 67 cases reported in the same quarter last year. Year to date there were 212 MRSA cases a reduction of 0.9% on the same period in 2017/18. 10,612 E. coli cases were reported compared to 10,302 in the same quarter last year an increase of 3.0%. Year to date there were 32,936 E. coli cases an increase of 4.4% from the same period in 2017/18. This increase was in cases with an onset out of hospital; hospital-onset cases remain below last years outturn. The Secretary of State s ambition is to reduce healthcare-associated Gram-negative bloodstream infections (GNBSIs) by 50% by March During 2017/18 and 2018/19 there has been a quality premium target for CCGs to reduce E.coli (the most prevalent GNBSI) by 10%. Data shows urinary tract infection (UTI) is a significant risk factor for GNBSI. We therefore completed a UTI breakthrough collaborative to help trusts and systems reduce by 5% the number of patients acquiring healthcare-associated UTI/CAUTI (catheter associated urinary tract infection) and/or the number of catheters in the pilot settings. Cohort 1 of the UTI collaborative was completed with 28 systems focusing on a significant cause of E. coli BSI. Cohort 2 delivery continues with 15 systems. The director of infection prevention & control executive development programme is now complete; 53 participants took part. Support continues to be provided to the 30 CCGs with the highest rates and numbers of E. coli. BSI.

18 1.8 Mental health (1) Early Intervention in psychosis treated within two weeks of referral Proportion of patients on CPA who were followed up within seven days after discharge from psychiatric inpatient care The NHS has a clear commitment to value mental health equally with physical health. As outlined in Achieving better access for mental health services by 2020, a key element of this is to ensure people have timely access to evidence-based and effective treatment. For the Early Intervention in Psychosis (EIP) access and waiting-time standard, patients must be treated with a NICE-recommended package of care within two weeks of referral. During 2018/19 the waiting-time standard is 53%, increasing to 60% by 2020/21. In December 2018, 76.7% of patients started treatment within two weeks of referral. The waiting-time standard was therefore met. This is an improvement from 76.2% in November 2018 and from 73.2% in December ,015 patients were waiting to start treatment at the end of December 2018, of whom 590 were waiting more than two weeks. Another key indicator is the proportion of patients in adult mental illness specialties on the Care Programme Approach (CPA) who were followed up within seven days of discharge from psychiatric care in the quarter. During Quarter /19, 95.7% of such patients were followed up within seven days of discharge. This compares with 95.8% in Quarter /19, and 96.7% in Quarter /18.

19 1.9 Mental health (2) Psychological therapies waiting times Psychological therapies recovery rates Psychological Therapies is an NHS programme that offers NICEapproved interventions for treating people with depression and anxiety. The waiting-time standards for this service are that 75% of patients who finish their course of treatment should wait less than six weeks to enter treatment, and 95% should wait less than 18 weeks. During November 2018, 89.2% of patients waited less than six weeks, and 99.1% waited less than 18 weeks to enter treatment. Both standards were, therefore, achieved. The six-week performance was 0.1% lower than October The 18-week performance of 99.1% was a 0.1% increase on the previous month. To measure outcomes, a key government target is that 50% of eligible referrals to Psychological Therapies should move to recovery. In November 2018, 51.9% of such referrals were moving to recovery. Therefore, the standard was achieved. This compares with 51.8% in October 2018 and 50.4% in November 2017.

20 1.10 Mental health (3) Mental Health Investment Standard (MHIS) The Five Year Forward View for Mental Health and its implementation plan set a challenging agenda to deliver access standards for key mental health services. The MHIS requires commissioners to increase spending on mental health services at least in line with the amount by which their funding allocation has been increased overall. CCGs must provide financial information to NHS England on whether they are meeting the MHIS. This is crucial data to hold the programme to account through the published mental health dashboard and the quarterly deep-dive processes with regions. There remains, however, continued pressure to understand whether the funding is reaching the front line and is correctly targeted. NHS England and NHS Improvement joint working To help manage the programme effectively and build confidence in the sector, NHS England and NHS Improvement agreed to collect data to crosscheck mental health spend in commissioner returns with mental health income in provider returns. This enables a review of mental health spend/income alignment by national teams, supported by regional teams in NHS England and NHS Improvement, and helps improve the communication and transparency of data between providers and commissioners. 2018/19 plan refresh provider/commissioner alignment The first detailed collection of mental health income in provider plans was undertaken as part of the 2018/19 plan refresh. As with any new data collection, data quality improvements are required to produce a dataset to analyse outcomes. Significant progress to improve data quality and alignment has been made in the 2018/19 planning round and work will continue during 2018/19.

21 1.11 Winter resilience preparations 2018/19 Overview We are now in the middle of the main period of winter pressure, and focusing on those areas that will support excellent patient care. Increasing capacity and reducing length of stay will help providers to be ready for winter pressure, limit the impact of winter on elective care and prevent long waits in A&E. Continuing the transformation agenda will help to build the capacity and capability of primary care, NHS 111 and NHS 111 Online, hear and treat and see and treat, reducing long stays in hospital and increasing same day emergency care ahead of winter. Performance was 87.7% compared to 87.9% in Quarter 3 last year, a decrease of 0.2%. This has been driven by higher attendances, higher conversion rates and sustained high levels of bed occupancy. More than 5.4 million people were seen within four hours, over 100,000 more patients compared to Q3 2017/18. During Quarter 3: 143,000 calls per day were offered by NHS 111, this is about 8,000 more calls per day than Q3 2017/ % of triaged calls had clinical input, the highest ever percentage. In December, every ambulance trust achieved the Category 1 90th percentile response time. Key actions: Winter operating function is in place seven days a week with 24-hour on-call cover to support regional and local teams with managed response to surge. Several actions on length of stay include targeted support for the most challenged systems; increased use of the independent sector to help clear the elective backlog; 145 million of capital funding agreed across 81 schemes; 240 million put into adult social care to support the NHS in managing winter pressures and 36 million to buy 256 ambulances. This is delivering improvements to patient care across the service right now. Since October 2018, everyone across the country has had more convenient access to GP services, including appointments during evenings and weekends that provide more than 9 million additional appointments per year.

22 2.0 Financial performance

23 2.1 Financial performance overview by sector and region Year to date Month /19 Forecast outturn 2018/19 Number of Variance to Deficit Variance to Deficit Plan Actual Plan Forecast 9 months ended 31 December 2018 by sector providers plan Providers plan Providers m m m No. m m m No. Acute 133 (1,601) (2,168) (567) 104 (1,447) (2,354) (907) 95 Ambulance (5) 4 Community Mental Health (36) 11 Specialist (19) 6 Control total basis surplus / (deficit) including PSF (1) 230 (1,460) (2,013) (553) 134 (1,102) (2,067) (965) 120 Techincal adjustments incl. uncommitted PSF , Less GIRFT funded from PSF (20) (20) 0 Reported Deficit before Technical adjustments (986) (1,247) (261) (394) (917) (523) Exceptional technical adjustment (accounting treatment of Carillion PFI part-donated assets) Reported adjusted financial position surplus / (deficit) including all PSF (2) (986) (1,247) (261) (394) (661) (267) Year to date Month /19 Forecast outturn 2018/19 Number of Variance to Deficit Variance to Deficit Plan Actual Plan Forecast 9 months ended 31 December 2018 by region providers plan Providers plan Providers m m m No. m m m No. London 36 (302) (412) (110) 18 (189) (341) (152) 14 Midlands 69 (615) (892) (277) 44 (639) (1,046) (407) 42 North 70 (396) (455) (59) 41 (282) (448) (166) 36 South 55 (147) (254) (107) 31 8 (232) (240) 28 Control total basis surplus / (deficit) including PSF (1) 230 (1,460) (2,013) (553) 134 (1,102) (2,067) (965) 120 Techincal adjustments incl. uncommitted PSF , Less GIRFT funded from PSF (20) (20) 0 Reported Deficit before Technical adjustments (986) (1,247) (261) (394) (917) (523) Exceptional technical adjustment (accounting treatment of Carillion PFI part-donated assets) Reported adjusted financial position surplus / (deficit) including all PSF (2) (986) (1,247) (261) (394) (661) (267) 1. Surplus/(deficit) control total basis is calculated as surplus/(deficit) before AME impairments, transfers, donated asset income, and donated asset depreciation for all providers. 2. The sector-reported adjusted financial position surplus/(deficit) includes DEL Impairments, prior period adjustments, and excludes donated asset income and donated asset depreciation as this reflects how control total performance is measured. An adjustment is needed to add the figures back to provide the reported sector surplus/(deficit).

24 2.2 Income and expenditure The provider sector reported a year-to-date deficit of 1,247 million, 34 million better than the same period last year but 261 million worse than plan. 9 months ended 31 December 2018 Year to date Month /19 Plan Actual Variance to plan m m m % The sector forecasts an adverse variance to plan of 267 million, a deterioration of 148 million from Quarter 2 ( 119 million). Without the technical adjustment for donated assets (see below), this deterioration would have been 404 million. Income from patient care activities 55,421 56, % Other income 6,836 6, % Employee expenses (39,809) (40,903) (1,094) (2.7%) Non pay costs (23,908) (24,304) (396) (1.7%) Control total basis surplus/(deficit) including PSF (1,460) (2,013) (553) (37.9%) Techincal adjustments Uncommitted PSF % Reported Adjusted Financial Position Surplus / (Deficit) incl. all PSF 9 months ended 31 December 2018 by sectors Acute m Ambulance m (986) (1,247) (261) (26.5%) Community m Mental Health m Specialist m Income from patient care activities 41,672 1,841 1,787 8,527 2,491 Other income 5, Employee expenses (29,912) (1,329) (1,298) (6,758) (1,606) Non pay costs (19,515) (555) (576) (2,423) (1,235) Control total basis surplus/(deficit) including PSF Number of Trusts off plan Year to Date Month /19 (2,168) Year to date Forecast outturn 2018/19 Total > 10m Total > 10m Trusts off plan at Quarter 3 (excluding PSF) Trusts off plan at Quarter 2 (excluding PSF) Trusts off plan at Quarter 3 (including PSF) Trusts off plan at Quarter 2 (including PSF) The overall position continues to be skewed by a small number of underperforming providers. Excluding PSF, 22 providers (9.6%) forecast a variance from plan of more than 10 million at Quarter 3 (six at Quarter 2). Fifteen of these forecast at Quarter 2 they would achieve their plan. In aggregate, these 22 providers account for 396 million (74%) of the sector forecast variance to plan excluding PSF. The common themes underlying these variances include difficulties in achieving cost improvement programmes, staffing and Agenda for Change (AfC) pressures, contracting difficulties, quality investment and unplanned emergency activity displacing elective income. Our regional teams are working through a range of interventions with these providers. The variances for both income and expenditure are affected by the NHS pay award for staff on AfC grades, which was not included in plan as it was not known at the start of the year. This is shown in large variances for pay costs that are partially compensated by increased patient care income due to the additional government funding (estimated to be 780 million). Providers say AfC is causing cost pressures, and this is having a serious consequence for a small number of providers as it has impeded their ability to achieve their PSF funding. The forecast for the year includes 256 million of exceptional technical adjustments. After Carillion collapsed, two PFI hospitals were brought onto providers books as part-donated assets (Sandwell and West Birmingham million and Royal Liverpool and Broadgreen million). The adjustment for donated asset income is consistent with previous years and the accounting treatment has been agreed with the Department of Health and Social Care. The reported sector financial position included 749 million of uncommitted PSF funding. In 2018/19, the PSF replaced the Sustainability and Transformation Fund introduced in 2016/17 to encourage trusts to provide sustainable, efficient, effective and economic care accelerating financial recovery and improving urgent and elective care. The PSF has the same aims and principles.

25 2.3 Income analysis Year to date Month /19 9 months ended 31 December 2018 Plan Actual Variance to plan m m m % Elective income 7,211 7,049 (162) (2.2%) Non-elective income 10,938 11, % First outpatient income 2,802 2, % Follow up outpatient income 3,331 3, % A&E income 1,786 1, % High cost drugs income from commissioners (excluding pass-through costs) 3,293 3, % Other NHS clinical income 11,368 10,865 (503) (4.4%) Acute services 40,729 40, % Mental Health services 6,421 6, % Ambulance services 1,801 1, % Community services 5,477 5, % Other 993 1, % Total income from patient care activities 55,421 56, % Research and development % Education and training 1,924 1, % Charitable and other contributions to expenditure % Non-patient care services provided 997 1, % Support from DH for mergers % Provider sustainability fund (PSF) 1, (276) (24.7%) Recharged Pay costs accounted on a gross basis % Lease rentals received % Other 1,617 1,590 (27) (1.7%) Total other income 6,836 6, % Total income 62,257 63, % Total income was 63.2 billion, which was 937 million (1.5%) above plan for this period. This increased significantly from Quarter 2, when the reported over-recovery against plan was 428 million. Most of this increase is due to including central funding for the AfC pay award during Quarter 3. In most returns this was included in the other category of patient care income, which shows a 593 million (59.7%) over-recovery against plan. Without this large component the Quarter 3 variances comprise a 304 million (0.5%) over-recovery for income from patient care activities and 40 million (0.6%) for other income. The sector recovered significantly more income than planned for non-elective care ( 362 million or 3.3%), A&E income ( 53 million or 3.0%) and high cost drugs income ( 373 million or 11.3%). This overrecovery was offset by an under-recovery of elective income ( 162 million or 2.2%), continuing the trend previously identified by which profit-making elective income is crowded out by loss-making nonelective income and zero-margin pass-through drug costs. The other variances within the income from the patient care category included an over-recovery of 60 million (or 1.1%) for community services and an under-recovery of 503 million (4.4%) for other NHS clinical income which comprises a range of other clinical income with no single material items. Within the category of other income, there were over-recoveries on non-patient care services of 194 million (19.5%) and education and training of 65 million (3.4%). The provider income relating to the PSF shows an under-utilisation of 276 million; this is held centrally and is recorded as uncommitted PSF (see Table 2.1). The sector forecasts it will finish the year with an over-recovery on income of 1,157 million made up of 1,188 million (1.6%) for patient care activities and offset by a 31 million (0.3%) under-recovery for other income. A significant element of this forecast over-recovery (about 780 million) is attributable to AfC.

26 2.4 Employee expenses pay costs Pay and agency costs year to date 9 months ended 31 December 2018 Plan Actual m m m % Medical staff 9,967 10,323 (356) (3.6%) Nursing staff 15,693 16,026 (333) (2.1%) Other staff 14,149 14,554 (405) (2.9%) Total employee expenses 39,809 40,903 (1,094) (2.7%) Of w hich - Bank 2,089 2,482 (393) (18.8%) - Agency ceiling performance 1,656 1,795 (139) (8.4%) Pay and agency costs forecast outturn 9 months ended 31 December 2018 Plan Forecast m m m % Medical staff 13,270 13,679 (409) (3.1%) Nursing staff 20,912 21,435 (523) (2.5%) Other staff 18,832 19,452 (620) (3.3%) Total employee expenses 53,014 54,566 (1,552) (2.9%) Of w hich Year to date Month /19 Forecast outturn 2018/19 Variance Variance - Bank 2,779 3,265 (486) (17.5%) - Agency ceiling performance 2,200 2,370 (170) (7.7%) Providers employ about 1.1 million whole-time equivalent (WTE) staff and have 0.1 million vacancies. The pay bill is the single largest area of expenditure, and the NHS has made managing it and recruiting to fill key staff vacancies a priority. For 2018/19, the provider sector has planned to spend 53 billion, a 1.4% increase on the 52 billion outturn for 2017/18. This is before the financial impact of the NHS pay awards relating to AfC staff. For the year to date, the sector reports a 1,094 million negative variance against plan. This sharp deterioration since the earlier months of the year was accentuated by the inclusion from Quarter 2 onward of the AfC pay awards which were not included in the plan or the earlier months figures. On a YTD basis this accounted for about 620 million, leaving a variance not related to AfC of 474 million. The overall pay costs for the year are forecast to be overspent by 1,552 million of which AfC is expected to be 833 million, with the balance of 719 million relating to non-afc factors. The government has so far (at Quarter 3) committed around 780 million of additional funding to the provider sector to meet these costs, with potential further funding subject to an application process to the DHSC for services operating under dynamic AfC conditions that will be completed in Quarter 4. The YTD overspend is prevalent in all sectors, but the largest variance is in the acute sector, which overspent by 928 million. This reflects continuing intense operational pressure in that sector. Overspending also occurred in all other sectors, totalling 166 million. Of the overall forecast overspend of 1,552 million for the year, we estimate acute providers will account for 1,254 million. Overspending in the other sectors is forecast to be 298 million, including 191 million for mental health services. Other than the costs of AfC pay awards, a key driver of the overspending against pay budgets was the increase in temporary staffing: bank staff overspending was 393 million and agency staff 139 million against the ceiling. This continues the trend identified in 2017/18 of providers increasing use of temporary (especially bank staff) to manage workload in the face of increased unplanned demands, high levels of vacancies, sickness/absence and staff turnover. Because of these pressures, overall spending on bank and agency staff is up by 316 million (8.0%) on the same period in 2017/18, with this increase attributable to volume increases rather than price.

27 2.5 NHS provider vacancies 12 months ending 31st December /18 Q3 2017/18 Q4 2018/19 Q1 2018/19 Q2 2018/19 Q3 Nursing Vacancy Rate 10.2% 10.2% 12.0% 12.0% 11.0% WTE Vacancies 35,934 35,794 42,231 42,370 39,148 Medical Vacancy Rate 7.9% 7.8% 9.4% 7.6% 7.1% WTE Vacancies 9,738 9,635 11,870 9,670 8,953 Other staff Vacancy Rate 8.1% 7.7% 8.0% 7.7% 7.4% WTE Vacancies 55,896 53,325 55,971 53,854 52,420 Total Workforce Vacancy Rate 8.7% 8.4% 9.3% 8.9% 8.4% Total Workforce WTE Vacancies 101,567 98, , , ,521 Trusts in England employ almost 1.1 million WTE staff and have an additional 100,500 posts vacant. Supporting providers to manage this workforce position while delivering of high quality healthcare is a key priority for NHS Improvement. We publish provider vacancy rates at an aggregate national, regional and sector position to provide detailed understanding of where variation exists across regions and healthcare sectors. The decrease in vacancies observed since Q2 2018/19 (about 5,000 WTEs) is due to continuing substantive recruitment and new graduates joining the workforce. However, the current vacancy position remains a challenge, particularly within the nursing workforce. There is significant regional and sector vacancy variation, with the London region and the mental health sector having the highest numbers proportionately. Nursing: trusts substantively employ over 316,000 WTE registered nurses. In addition, there are over 39,000 WTE vacancies. Intelligence suggests approximately 80% are being filled by a combination of bank (64%) and agency staff (36%). Medical: trusts substantively employ almost 118,000 WTE doctors. In addition, there are almost 9,000 WTE vacancies, of which approximately 90% are being filled by a combination of bank (47%) and agency (locum) staff (53%). *The information above represents management information only and not an official statistic. **Data published within this report may vary from that in our previous publications as it incorporates retrospective amendments submitted by providers. NHS Digital also publishes vacancy-related data which can be found as part of the NHS Vacancy Statistics: England series. The latest publication for data up to September 2018, can be found via: We are publishing these NHS vacancy statistics as an experiment. They were created from administrative data related to published vacancy adverts obtained from NHS Jobs, the NHS s main recruitment website. This information is not directly comparable to the data in this publication because of differences in methodology and definition. We recommend that different data sources are considered when drawing conclusions from vacancy-related data as they each have different strengths and weaknesses for example, the NHS Jobs data should be considered a minimum figure for the actual number of vacancies advertised at any time. More detail is included in the Future developments section of the NHS Digital publication, which covers the intention to change the NHS vacancy statistics publication into a compendium, including NHS Jobs, electronic staff record and NHS Improvement data.

28 2.6 Agency ceiling performance Agency ceiling performance Year to date Month /19 9 months ended 31 December 2018 Plan Actual Variance m m m % Agency ceiling performance 1,656 1,795 (139) (8.4%) Agency costs as a % of total pay costs 4.2% 4.4% Agency ceiling performance Forecast outturn 2018/19 9 months ended 31 December 2018 Plan Forecast Variance m m m % Agency ceiling performance 2,200 2,370 (170) (7.7%) Agency costs as a % of total pay costs 4.1% 4.3% Agency breakdow n Year to date Month /19 9 months ended 31 December 2018 Dec-17 Dec-18 Movement m m m % Medical staff % Nursing staff (25) (3.7%) Other Staff % Total 1,781 1,795 (14) (0.8%) We have established agency ceilings for all providers. This work began in 2015/16 for nurses and has been expanded to all staff groups. Since then, agency costs have steadily decreased due to our initiatives and action taken by providers. Since April 2017 these have consistently been below 5% of overall pay costs, and we forecast that this level will be maintained throughout the year. This is a considerable reduction on the 7.2% reported in April 2015 at the start of our initiatives and the peak of 8.2% in July Because of the success in controlling these costs, we reduced the ceiling target from 2.5 billion in 2017/18, to 2.2 billion in 2018/19. This in turn reduced the ceiling for the first three quarters of the year to 1,656 million. Against this lower target, providers spent 1,795 million a 139 million overspend but only slightly up on the 1,779 million reported for the same period in 2017/18. The overspend is driven by volume increases and not agency rates; in fact, the average prices per shift are 6% less than for the same period last year. The forecast year-end figures show the sector expects to overspend by 170 million against the agency ceiling. This has deteriorated from the 32 million overspend reported in Quarter 2 but is still 37 million (2%) lower than the 2017/18 outturn. However, this position may be ambitious, given the year-to-date figures and historic trends. Our analysis of current data suggests the outturn may be higher (between 2.4 billion and 2.5 billion). We will do further work with regional leads to mitigate this risk. The continued reduction in the proportion of agency staff costs to total pay bill is a significant achievement in view of the record levels of demand and the extreme pressure on the acute sector. By controlling agency spending, the changes of the last three years have led to more workforce planning and improved value for money in this area of significant spend.

29 2.7 Non-pay cost pressures Non-pay expenditure showed an overspend against plan of 396 million (1.7%), up from 104 million (0.7%) in Quarter 2. The largest 9 months ended 31 December 2018 by sectors 9 months ended 31 December 2018 Financial sanctions including penalties Sanctions reinvested Sub-total: Financial sanctions Marginal rate emergency tariff impact MRET reinvested Sub-total: MRET Readmissions Readmissions reinvested Sub-total: Readmissions Delayed transfers of care (DToC) - expenditure incurred on blocked capacity DToC - reimbursement from Local Authorities Sub-total: Delayed transfers of care Waiting list initiative w ork Outsourcing of w ork to other providers Plan Actual Variance to plan m m m % Purchase of healthcare from other providers 1,445 1,628 (183) (12.7%) Purchase of social care (11) (7.1%) Drugs costs 5,566 5,583 (17) (0.3%) Clinical supplies and services (excluding drugs costs) Year to date Month /19 5,030 5,194 (164) (3.3%) General supplies and services 1,145 1,151 (6) (0.5%) Clinical negligence insurance 1,533 1, % Consultancy (31) (23.5%) Establishment % Premises 2,302 2,454 (152) (6.6%) Other non pay items 5,913 5, % Total non pay 23,908 24,304 (396) (1.7%) Year to date actual Forecast Outturn m m (112) (153) (20) (30) (44) (60) (1) (1) area of overspending was the purchase of healthcare from other providers, 183 million. Most of this, 160 million, was from non-nhs providers - up by 18.7% on plan. This continues the pattern of overspending driven by capacity constraints in the system. There were also overspends of 164 million on clinical supplies and services, 31 million on consultancy and 152 million on premises. These were partly offset by a large underspend of 139 million (2.4%) on other. The sector forecasts non-pay costs will be 32.1 billion at the year end, representing a forecast overspend against plan of 570 million. Introducing control totals and the STF (now PSF) in 2016/17 significantly reduced national sanctions against providers. In previous years, underperformance against national standards often resulted in financial sanctions levied on providers. Since the STF, providers have not faced these penalties if they accepted their control totals. Consequently, the level of net sanctions reduced to 99 million in 2016/17, 40 million in 2017/18 and is forecast to be 42 million in 2018/19. The impact of the marginal rate emergency tariff (MRET) was 282 million, up on the 223 million reported last year. This reflects the higher emergency activity that is contributing to the financial pressure in the acute sector. Providers spent 115 million on waiting list initiatives and 173 million on outsourcing, slightly up on the same period last year. In 2017/18, the government allocated 1 billion extra funding to social care. A proportion was to be used to reduce the volume of delayed transfers of care and help free hospital beds. Although costs did not reduce significantly in 2017/18, activity recorded in the second half of the year and in the first nine months of 2018/19 suggests progress is being made. The Quarter 3 direct costs reported amount to 102 million compared to 119 million in the same period last year, indicating that the much larger indirect benefits from controlling this activity are starting to be achieved. Continuing improvement in this area is vitally important as fulfilling financial plans depends on achieving several key assumptions around risk management, agreed activity levels and bed availability. Consequently, we made this a key priority for 2018/19.

30 2.8 Efficiency savings 9 months ended 31 December 2018 Year to date Month /19 Plan Actual Variance Variance m m m % Recurrent 2,059 1,492 (567) (28%) Non Recurrent % Total efficiency savings 2,338 2,094 (244) (10%) Efficiencies as a % of Spend 3.5% 3.1% 9 months ended 31 December 2018 Forecast outturn 2018/19 Plan Forecast Variance Variance m m m m Recurrent 3,126 2,365 (761) (24%) Non Recurrent % Total efficiency savings 3,577 3,264 (313) (9%) Efficiencies as a % of Spend 4.1% 3.6% During 2017/18, providers achieved savings through cost improvement programmes (CIPs) of 3.2 billion or 3.7% in the most difficult operating conditions. For 2018/19 planned efficiency savings were set even higher, at 3.6 billion or 4.1% of total expenditure. Of this, the planned CIP achievement for Quarter 3 was 2,338 million (3.5%). At the end of the third quarter, the sector had saved 2,094 million (3.1%). Although significant, this was 244 million below the ambitious plan. The main areas of underachievement were pay efficiencies and non-pay efficiencies, down on plan by 180 million and 76 million respectively. This was compensated by a small overachievement on income CIPs of 12 million. Operational pressures and high vacancy levels affected the ability to achieve planned CIP schemes. Delivery of CIPs tends to strengthen in the second half of the year, and the Quarter 3 position is comparable to the same period last year when 2,139 million (3.3%) of CIPs were achieved. The Quarter 3 figures continue the trend of underperformance against recurrent CIPs compensated by overperformance of non-recurrent CIPs. Providers planned to deliver 2,059 million (or 88%) of their year-to-date efficiencies through recurrent schemes but achieved recurrent savings of only 1,492 million (71%). By contrast, savings achieved from nonrecurrent schemes rose from 279 million (12%) at plan to 602 million (29%). In 2016/17 we established an operational productivity team to help the sector increase efficiency and accelerate implementation of Lord Carter s recommendations. This work continued through 2017/18 and into this financial year. For Quarter 3 the specific efficiency savings linked to Lord Carter s productivity themes in workforce productivity, resource optimisation and benchmarking (Model Hospital) are estimated to be 1,213 million and are forecast to rise to 1.8 billion by the year end. The delivery of efficiency and productivity gains is supported by the Getting It Right First Time (GIRFT) programme, which promotes a reduction in unwarranted clinical variation resulting in improvements in quality and productivity; 20 million of the PSF has been allocated to support this work. We continue to work with providers to maximise the benefit of efficiency savings, by providing national and technical forums for sharing best practice.

31 2.9 Implied provider productivity Implied productivity calculation Month ended 31 December 2018 Year to date M9 2018/19 Total Pay Non Pay m m m Expenditure, all trusts 2017/18 62,368 38,923 23,445 Expenditure, all trusts 2018/19 65,219 40,903 24,316 Cost change on previous year 2,851 1, Cost change % 4.6% 5.1% 3.7% Estimated impact of inflation (as per NHS tariff 1 ) 3.2% 3.7% 2.3% NHS real terms cost change 1.4% 1.4% 1.4% Grow th in cost w eighted activity 2 3.0% 3.0% 3.0% Implied productivity 1.6% 1.6% 1.6% 1 Includes the inflationary impact of CNST premium increases, has been updated to reflect A4C costs not distributed through tariff. At Quarter 3, overall estimated inflation has been reduced by 0.1%and non-pay inflation by 0.3%to reflect the fact that actual CNST premium costs increased by a lower level than assumed in national tariff. 2 Elective and outpatient growth rates are adjusted for differences in the number of working days in the comparator period Cost Improvement Programs Delivered Month ended 31 December 2018 Year to date M9 2018/19 Total 1 Pay Non Pay m m m CIPS Delivered 2, Expenditure for CIPS calculation 67,313 41,678 25,192 Cost Improvement Programs % Delivered 3.1% 1.9% 3.5% 1 The total includes pay and non pay CIPs as well as those relating to income (not seperately listed above) Note: *The implied productivity measure is an early view of NHS provider productivity. It uses an early cut of activity data. It is not adjusted for quality or case-mix changes and uses assumed NHS inflation in national tariff rather than actual inflation. By reviewing the change in provider costs, adjusted for estimated unavoidable inflationary pressures, and then comparing these cost changes to the change in provider outputs, it is possible to calculate the implied productivity of the provider sector. The total implied productivity for Quarter 3 was 1.6%, which is up on the values reported at Quarters 1 and 2 (1%). Overall underlying productivity appears to be slightly up on final levels achieved in the 2017/18 financial year (1.2%). The productivity improvement has been driven by activity growth rather than cost reductions. The estimated inflation figure was updated during Quarter 2 to reflect the impact of the Agenda for Change pay award in the yearto-date figures. The pay inflation percentage has increased from 2.1% at Quarter 1 to 3.7% in Quarter 2. At Quarter 3 total inflation and non pay inflation rates have been amended further to reflect the fact that actual Clinical Negligence Scheme for Trusts (CNST) premium costs increased by a lower level than assumed in the national tariff. This in turn caused the total estimated inflationary pressures to rise from 2.3% in Quarter 1 to 3.2% in Quarter 3. We use cost improvement programmes (CIPs) to monitor providers plans to contain costs. The level of their CIPs is greater than the underlying productivity improvement. This is because several provider initiatives contain one-off costs: for example, profits from the sale of surplus land. These savings need to be made again the following year, so would appear as a required cost improvement but would not appear as an underlying change in productivity. In addition, many providers fund investments in quality improvement through efficiencies these quality improvements are not measured through cost-weighted activity. Delivered CIPs are running at twice the level of implied productivity, with a greater proportion of non pay CIPs not appearing as a productivity gain.

32 2.10 Capital expenditure 9 months ended 31 December 2018 by sector Year to date Month /19 Plan Actual Variance to plan m m m % Acute 2,371 1,868 (503) (21.2%) Ambulance (16) (21.6%) Community (19) (38.0%) Mental Health (184) (40.0%) Specialist (79) (31.1%) Total CDEL 3,209 2,408 (801) (25.0%) 9 months ended 31 December 2018 by sector Forecast outturn 2018/19 Plan Forecast Variance to plan m m m % Acute 3,422 3,145 (277) (8.1%) Ambulance % Community (6) (8.2%) Mental Health (123) (18.4%) Specialist (70) (19.6%) Total CDEL 4,644 4,185 (459) (9.9%) Provider Capital Summary Foundation Trust NHS Trust Forecast outturn Capital Departmental Expenditure Limit m m m Gross capital expenditure 2,823 1,854 4,677 Disposals / other deductions (194) (25) (219) Net Capital expenditure 2,629 1,829 4,458 Less donations and grants received (127) (188) (315) Less PFI capital (IFRIC12) (60) (68) (128) Plus PFI residual interest Purchase of financial assets The latest provider plan submissions included capital departmental expenditure limit (CDEL) expenditure of billion in 2018/19. The forecast CDEL expenditure at Month 9 is billion, an underspend against plan of 459 million. DHSC told us that 3.46 billion of is available to providers in 2018/19. We believe that keeping to this budget carries a high risk given trust plans exceed it by 1.2 billion and the Month 9 forecast exceeds the budget by 725 million. We worked with providers to refine their forecasts and ensure they are realistic. We wrote to 90 trusts that forecast significant capital spend in Quarter 4, and regional teams are working closely with trusts ahead of Month 10 to ensure CDEL forecast positions remain realistic and deliverable. Providers at Month 9 had spent billion on capital schemes, which was 801 million below plan at this stage of the year. The spend at Month 9 represents 58% of the sector forecast of billion at Month 9 meaning billion remains to be spent in the last three months of the year to achieve the forecast. At 31 December 2018, Foundation trusts forecast CDEL expenditure of billion (61% of the total forecast). NHS trusts forecast billion (39% of the total sector forecast). Whilst the additional capital allocation for sustainability and transformation partnerships has been very welcome there remains considerable pressure in the short term on core NHS capital budgets, with achieving financial balance on the provider core capital budgets across financial years 2018/19 and 2019/20 being particularly challenging. Sale of financial assets (12) 0 (12) Total CDEL 2,532 1,653 4,185

33 2.11 Quarter 3 financial performance overview by integrated care system In 2018/19 NHS England and NHS Improvement introduced the voluntary rollout of integrated care systems (ICSs). This was to reinforce the importance integration will play in improving the long-term sustainability of vital patient services, many of which cross organisational boundaries. In ICSs, NHS commissioners and providers, working with GP networks, local authorities and others, agree to share responsibility (in ways consistent with their individual legal obligations) for how they use their collective resources to benefit local populations. There are 14 systems in the ICS development programme. Eight agreed to link their Provider Sustainability Fund (PSF) resources to their ICS financial performance in 2018/19. The table below compares ICS s financial performance at the end of Quarter 3 against plan, including PSF. ICS Name Region PSF Linked to System Performance Number of Provider CTs Accepted* YTD Plan incl. PSF 000s Year to date YTD Actual incl. PSF 000s Total System Variance incl. PSF 000s Total System Variance excl. PSF 000s Provider Sustainability Funding (PSF) PSF Allocated (in Plan only if accepted CT) 000s YTD Actual 000s PSF Variance 000s Bedfordshire, Luton & Milton Keynes (BLMK) M & E Yes 3/3 (1,135) (16,430) (15,295) (9,820) 20,334 14,859 (5,475) Berkshire West North Yes 2/2 5,136 5, ,187 9,186 (1) Dorset South Yes 4/4 7,709 8, ,359 31,360 30,401 (959) Frimley Health South Yes 3/3 23,623 24, ,827 19,827 0 Greater Manchester North Yes 8/10 * (57,600) (67,406) (9,806) 3,982 65,981 52,194 (13,788) Nottinghamshire M & E Yes 3/3 (19,272) (56,856) (37,584) (18,916) 31,840 13,172 (18,668) South Yorkshire and Bassetlaw (SYB) North Yes 6/7 * (31,888) (23,664) 8,224 13,315 41,584 36,493 (5,091) Surrey Heartlands South Yes 3/3 16,503 11,648 (4,855) (1,396) 32,512 29,053 (3,459) Buckinghamshire South No 1/1 (6,665) (33,244) (26,579) (18,819) 7,760 0 (7,760) Gloucestershire South No 3/4 (16,117) (16,789) (672) 53 7,011 6,286 (725) Lancashire and South Cumbria North No 4/6 (106,331) (114,031) (7,700) (4,848) 11,350 8,498 (2,852) Suffolk and North East Essex South No 6/6 (28,473) (43,649) (15,176) (4,611) 16,254 5,689 (10,565) West Yorkshire North No 11/12 (28,656) (31,251) (2,595) 8,808 75,803 64,400 (11,403) West, North and East Cumbria North No 3/3 (30,199) (40,721) (10,522) (9,821) 9,139 8,438 (701) * Where the system agreed to link PSF to system performance and not all providers accepted their individual control totals, systems will work towards system improvement plans to improve their aggregate positions as part of their commitment to working together in meeting operational and financial challenges. NB In Q3 provider plan and actual values are inclusive of any improvements made to plans at an organisational level following the in-year plan reset process and CCG plan and actual exclude draw down values.

34 2.12 Year-end financial position Control total, PSF and financial special measures data by sector as at December 2018 Sector No of trusts accepted control total No of trusts included PSF in year-to-date position No of trusts forecast to receive full or partial PSF at the year end No of trusts in Financial Special Measures Acute Ambulance Community Mental Health Specialist Total For 2018/19, the sector seeks to build on the financial grip achieved in the last two financial years. Despite continuing financial pressures from increasing demand particularly in urgent and emergency care, we set a challenging plan to reduce the sector deficit initially to 519 million. We subsequently amended this, as part of the plan reset process, to 394 million (see below). In 2018/19 we introduced new provider control totals, detailing the minimum improvement we expect in financial positions for the year. The PSF of 2.45 billion replaced STF and is linked to providers achieving control totals. At Quarter 3, 201 out of 230 providers (87%) had accepted their individual control totals. During quarters 2 and 3 we used the PSF to offer providers additional bonus payments to improve their financial position. These incentives, which affected a small number of providers, enabled us to reset the plan forecast from 519 million in Quarter 1 to 439 million and subsequently to 394 million in Month 7. Of the 42 providers who signed up to the additional incentive, most are forecasting they will achieve this improvement by the year end. In total, 43 providers are forecasting to be above plan at the year end with 114 forecasting to be on plan. Against this lower plan, the sector forecasts it will overspend by 267 million. Our regional teams are working to reduce this overspend as well as close the residual planning gap to secure a balanced financial position for the NHS. For greater financial sustainability, providers must move from one-off and short-term improvements to the in-year financial position and identify recurrent long-term savings. To help assess the underlying financial position consistently, the 2018/19 planning guidance included a detailed definition. Providers aggregate financial plans revealed that the sector carried forward an underlying deficit from 2017/18 into 2018/19 of 4.3 billion ( 1.85 billion net if it is assumed the PSF will be deployed in the provider sector in future). Our regional teams continue to directly support all providers. Nine of the most financially challenged will continue to receive intensive financial improvement support through special measures. Since special measures was introduced (through to Month /19), six providers showed significant financial improvement and exited the regime including two (Maidstone and Tunbridge Wells NHS Trust and Gloucestershire Hospitals NHS Foundation Trust), which exited during Quarter 3.

35 3.0 Financial performance by provider

36 3.1 Financial performance by provider London (1/1) Control Total Basis Surplus Deficit Including PSF Year to date Forecast Outturn Control Total (CT) Accepted? YTD Plan YTD Actual Variance FOT Plan FOT Variance Provider Sustainability Fund (PSF) PSF in Plan (CT acceptors only) YTD Actual FOT Provider Name Barking, Havering and Redbridge University Hospitals NHS Trust No (42,477) (47,793) (5,316) (52,500) (60,400) (7,900) Barnet, Enfield And Haringey Mental Health NHS Trust Yes (3,326) (2,619) 707 (3,346) (3,346) 0 1,640 1,066 1,640 Barts Health NHS Trust No (48,050) (59,420) (11,370) (56,785) (84,685) (27,900) Camden and Islington NHS Foundation Trust No 628 (123) (751) 6,644 6, ,144 1,928 4,144 Central and North West London NHS Foundation Trust Yes 241 (1,211) (1,452) 2,746 1,098 (1,648) 4,118 2,677 4,118 Central London Community Healthcare NHS Trust Yes 4,124 4, ,186 7, ,590 2,984 4,590 Chelsea and Westminster Hospital NHS Foundation Trust Yes 17,075 17, ,784 26, ,859 18,109 27,859 Croydon Health Services NHS Trust Yes (4,323) (6,697) (2,374) (2,842) (6,511) (3,669) 12,218 5,559 8,552 East London NHS Foundation Trust Yes 5,541 5, ,032 9, ,428 2,228 3,428 Epsom and St Helier University Hospitals NHS Trust Yes (21,965) (22,387) (422) (13,663) (15,624) (1,961) 14,529 7,483 12,568 Great Ormond Street Hospital for Children NHS Foundation Trust Yes 9,173 9, ,066 12, ,571 4,921 7,571 Guy's and St Thomas' NHS Foundation Trust Yes 10,076 4,208 (5,868) 27,738 19,612 (8,126) 31,070 14,137 25,011 Homerton University Hospital NHS Foundation Trust Yes 6,457 7, ,653 11, ,990 7,144 10,990 Hounslow and Richmond Community Healthcare NHS Trust Yes 1,313 1, ,965 1, , ,268 Imperial College Healthcare NHS Trust Yes (3,063) (3,063) 0 13,603 11,535 (2,068) 34,163 22,206 34,163 King's College Hospital NHS Foundation Trust Yes (102,344) (144,885) (42,541) (124,498) (179,622) (55,124) 21,532 2,261 2,261 Kingston Hospital NHS Foundation Trust Yes 5,019 5, ,074 17, ,074 11,748 18,074 Lewisham and Greenwich NHS Trust Yes (27,196) (30,563) (3,367) (35,470) (41,599) (6,129) 17,595 8,006 12,317 London Ambulance Service NHS Trust Yes 1,240 1, ,472 4,333 (139) 6,728 4,374 6,728 London North West University Healthcare NHS Trust Yes (28,108) (45,551) (17,443) (31,369) (32,434) (1,065) 27,255 9,539 27,255 Moorfields Eye Hospital NHS Foundation Trust Yes 2,681 6,905 4,224 6,697 6, ,838 3,144 4,838 North East London NHS Foundation Trust Yes 3,624 3, ,503 3, ,237 2,104 3,237 North Middlesex University Hospital NHS Trust Yes (6,718) (8,542) (1,824) (9,549) (12,790) (3,241) 9,401 4,277 6,581 Oxleas NHS Foundation Trust Yes 1,437 1, ,965 2,421 (544) 2,094 1,361 2,094 Royal Brompton and Harefield NHS Foundation Trust Yes (20,247) (17,329) 2,918 (217) (5,269) (5,052) 11,516 7,485 7,485 Royal Free London NHS Foundation Trust No (51,167) (56,127) (4,960) (65,826) (67,352) (1,526) Royal National Orthopaedic Hospital NHS Trust Yes (12,143) (9,259) 2,884 (7,012) (6,980) 32 1, ,232 South London and Maudsley NHS Foundation Trust Yes 1,282 1, , (2,493) 3,181 2,067 2,067 South West London and St George's Mental Health NHS Trust Yes 1,287 1,273 (14) 2,476 2, , ,382 St George's University Hospitals NHS Foundation Trust Yes (18,199) (42,161) (23,962) (16,376) (49,706) (33,330) 12,624 1,894 1,894 Tavistock and Portman NHS Foundation Trust Yes 914 1, ,034 1, The Hillingdon Hospitals NHS Foundation Trust Yes (5,981) (18,224) (12,243) (7,619) (22,558) (14,939) 6, The Royal Marsden NHS Foundation Trust Yes 19,844 29,252 9,408 33,221 33,213 (8) 22,597 14,689 22,597 The Whittington Health NHS Trust Yes 8,983 8, ,675 21,893 (782) 21,380 13,897 21,380 University College London Hospitals NHS Foundation Trust Yes (12,116) (11,067) 1,049 14,525 39,539 25,014 20,723 9,429 16,682 West London NHS Trust Yes 4,733 4, ,457 7, ,987 2,591 3,987 London Total (301,752) (412,755) (111,003) (189,050) (341,637) (152,588) 373, , ,696

37 3.2 Financial performance by provider Midlands and East (1/2) Control Total Basis Surplus Deficit Including PSF Year to date Forecast Outturn Control Total (CT) Accepted? YTD Plan YTD Actual Variance FOT Plan FOT Variance Provider Sustainability Fund (PSF) PSF in Plan (CT acceptors only) YTD Actual FOT Provider Name Basildon and Thurrock University Hospitals NHS Foundation Trust No (22,023) (24,793) (2,770) (26,818) (26,818) Bedford Hospital NHS Trust Yes (5,185) (11,677) (6,492) (6,670) (17,144) (10,474) 7, Birmingham and Solihull Mental Health NHS Foundation Trust Yes ,938 1, ,088 1,357 2,088 Birmingham Community Healthcare NHS Foundation Trust Yes 3,310 3, ,351 4, ,278 1,481 2,278 Birmingham Women s and Children's NHS Foundation Trust Yes 12, (11,832) 15,125 15, , ,952 Black Country Partnership NHS Foundation Trust Yes (1,322) (218) 1,104 (684) (614) 70 1,868 1,214 1,868 Burton Hospitals NHS Foundation Trust Yes (4,200) (4,202) (2) (4,200) (4,202) (2) 1,135 1,135 1,135 Cambridge University Hospitals NHS Foundation Trust No (69,048) (68,750) 298 (93,791) (93,652) Cambridgeshire and Peterborough NHS Foundation Trust Yes 2,106 (512) (2,618) 3,176 3, , ,529 Cambridgeshire Community Services NHS Trust Yes 1,586 1, ,117 2, , ,508 Chesterfield Royal Hospital NHS Foundation Trust Yes 2,247 (2,309) (4,556) 5,296 5, ,399 2,240 6,399 Coventry and Warwickshire Partnership NHS Trust Yes (1,143) (1,135) 8 2,154 2, ,727 1,123 1,727 Derbyshire Community Health Services NHS Foundation Trust Yes 3,002 5,561 2,559 4,075 4, ,161 1,404 2,161 Derbyshire Healthcare NHS Foundation Trust Yes 1,584 1, ,331 2, , ,117 Dudley And Walsall Mental Health Partnership NHS Trust Yes 975 1, ,391 1, East And North Hertfordshire NHS Trust Yes (6,263) (17,685) (11,422) (281) (19,581) (19,300) 14,362 3,519 3,519 East Midlands Ambulance Service NHS Trust Yes (4,065) (1,521) 2,544 (4,649) (4,649) 0 1, ,313 East of England Ambulance Service NHS Trust Yes 3,471 1,733 (1,738) 3,105 (2,033) (5,138) 1, East Suffolk and North Essex NHS Foundation Trust Yes (17,281) (35,270) (17,989) (21,593) (21,593) 0 18,812 1,867 18,812 Essex Partnership University NHS Foundation Trust Yes (2,365) 2,380 4,745 (2,720) 3 2,723 3,251 2,113 3,251 George Eliot Hospital NHS Trust Yes (10,061) (13,673) (3,612) (14,276) (15,543) (1,267) 4,222 1,034 2,955 Hertfordshire Community NHS Trust Yes 1,329 1, ,077 2, , ,288 Hertfordshire Partnership University NHS Foundation Trust Yes 1,271 1, ,135 2, ,775 1,154 1,775 James Paget University Hospitals NHS Foundation Trust Yes (7,566) (7,879) (313) (7,271) (7,924) (653) 3,112 1,696 2,458 Kettering General Hospital NHS Foundation Trust Yes (16,858) (16,853) 5 (7,802) (18,694) (10,892) 7,459 4,849 4,849 Leicestershire Partnership NHS Trust Yes 2,248 2, ,273 3, ,348 1,526 2,348 Lincolnshire Community Health Services NHS Trust Yes 2,071 2, ,874 2, ,908 1,240 1,908 Lincolnshire Partnership NHS Foundation Trust Yes 1,237 1, ,096 2, , ,515 Luton and Dunstable University Hospital NHS Foundation Trust Yes 5,067 4,972 (95) 15,758 15, ,838 6,916 11,658 Mid Essex Hospital Services NHS Trust No (35,258) (46,586) (11,328) (47,257) (60,746) (13,489) Midlands Partnership NHS Foundation Trust Yes 1,780 (5,465) (7,245) 4,548 (5,000) (9,548) 4, Milton Keynes University Hospital NHS Foundation Trust Yes (12,117) (12,270) (153) (13,125) (14,162) (1,037) 12,064 7,168 11,027 Norfolk and Norwich University Hospitals NHS Foundation Trust No (41,586) (46,020) (4,434) (54,193) (57,993) (3,800) Norfolk and Suffolk NHS Foundation Trust Yes (1,041) (1,032) ,206 1,434 2,206 Norfolk Community Health and Care NHS Trust Yes (2,138) (2,045) 93 (1,867) (1,867) North Staffordshire Combined Healthcare NHS Trust Yes 1,063 1, ,023 2, , ,103 North West Anglia NHS Foundation Trust Yes (26,407) (39,400) (12,993) (28,767) (55,736) (26,969) 17,222 5,253 5,253 Northampton General Hospital NHS Trust Yes (14,400) (15,137) (737) (18,514) (18,514) 0 9,191 5,147 9,191

38 3.3 Financial performance by provider Midlands and East (2/2) Control Total Basis Surplus Deficit Including PSF Year to date Forecast Outturn Control Total (CT) Accepted? YTD Plan YTD Actual Variance FOT Plan FOT Variance Provider Sustainability Fund (PSF) PSF in Plan (CT acceptors only) YTD Actual FOT Provider Name Northamptonshire Healthcare NHS Foundation Trust Yes 1,023 1, ,588 1, ,610 1,047 1,610 Nottingham University Hospitals NHS Trust Yes 4,550 (30,285) (34,835) 7,884 (40,323) (48,207) 32,746 3,439 3,439 Nottinghamshire Healthcare NHS Foundation Trust Yes 4,512 4, ,422 7,092 (330) 3,843 2,303 3,513 Queen Elizabeth Hospital King's Lynn NHS Foundation Trust Yes (9,288) (26,834) (17,546) (9,694) (37,624) (27,930) 6, Royal Papworth Hospital NHS Foundation Trust No (13,120) (8,443) 4,677 (15,800) (11,500) 4, Sandwell And West Birmingham Hospitals NHS Trust Yes (6,083) (8,187) (2,104) 3, (3,317) 11,056 5,030 7,739 Sherwood Forest Hospitals NHS Foundation Trust Yes (27,959) (28,526) (567) (33,972) (35,037) (1,065) 12,395 7,430 11,330 Shropshire Community Health NHS Trust Yes South Warwickshire NHS Foundation Trust Yes 5,645 5, ,227 9, ,879 4,472 6,879 Southend University Hospital NHS Foundation Trust Yes (8,251) (9,201) (950) (10,540) (11,510) (970) 10,786 6,040 9,815 Staffordshire and Stoke on Trent Partnership NHS Trust Yes (2,217) (1,861) 356 (2,217) (1,861) The Dudley Group NHS Foundation Trust Yes 3,203 1,533 (1,670) 8,239 (4,685) (12,924) 9,043 4,115 4,115 The Ipswich Hospital NHS Trust Yes (6,272) (6,560) (288) (6,272) (6,560) (288) 1, The Princess Alexandra Hospital NHS Trust Yes (17,407) (18,755) (1,348) (20,436) (22,003) (1,567) 8,035 3,656 6,468 The Robert Jones and Agnes Hunt Orthopaedic Hospital NHS Foundation Yes ,937 1, The Royal Orthopaedic Hospital NHS Foundation Trust Yes (4,270) (4,790) (520) (6,002) (6,002) The Royal Wolverhampton NHS Trust Yes 3,856 3, ,210 (3,185) (14,395) 11,415 7,420 7,420 The Shrewsbury And Telford Hospital NHS Trust Yes (8,478) (16,084) (7,606) (8,615) (22,950) (14,335) 9,824 1,032 1,032 United Lincolnshire Hospitals NHS Trust No (53,864) (66,295) (12,431) (74,700) (89,400) (14,700) University Hospitals Birmingham NHS Foundation Trust Yes (30,602) (34,098) (3,496) (38,045) (37,995) 50 23,761 11,880 23,761 University Hospitals Coventry And Warwickshire NHS Trust Yes (15,619) (18,629) (3,010) (9,693) (33,570) (23,877) 15,450 7,030 7,030 University Hospitals of Derby and Burton NHS Foundation Trust Yes (23,131) (40,862) (17,731) (22,043) (49,777) (27,734) 15,350 1,338 1,338 University Hospitals of Leicester NHS Trust Yes (9,027) (50,900) (41,873) 754 (49,496) (50,250) 21,947 2,304 2,304 University Hospitals of North Midlands NHS Trust No (48,753) (56,976) (8,223) (44,802) (44,802) Walsall Healthcare NHS Trust Yes (13,623) (22,666) (9,043) (10,496) (24,019) (13,523) 4, West Hertfordshire Hospitals NHS Trust No (41,488) (38,812) 2,676 (52,900) (49,700) 3, West Midlands Ambulance Service NHS Foundation Trust Yes 3,697 3, ,035 2, ,943 1,263 1,943 West Suffolk NHS Foundation Trust Yes (9,296) (6,451) 2,845 (10,006) (10,174) (168) 3,657 2,212 3,492 Worcestershire Acute Hospitals NHS Trust Yes (24,027) (51,939) (27,912) (23,704) (72,504) (48,800) 17, Worcestershire Health and Care NHS Trust Yes 2,528 2, ,370 3, ,689 1,098 1,689 Wye Valley NHS Trust Yes (19,596) (27,578) (7,982) (22,801) (33,541) (10,740) 4, Midlands and East Total (615,341) (891,628) (276,284) (638,831) (1,045,531) (406,700) 402, , ,705

39 3.4 Financial performance by provider North (1/2) Control Total Basis Surplus Deficit Including PSF Year to date Forecast Outturn Control Total (CT) Accepted? YTD Plan YTD Actual Variance FOT Plan FOT Variance Provider Sustainability Fund (PSF) PSF in Plan (CT acceptors only) YTD Actual FOT Provider Name Aintree University Hospital NHS Foundation Trust No (20,647) (21,243) (596) (29,050) (29,288) (238) Airedale NHS Foundation Trust Yes 555 (367) (922) 5,206 3,769 (1,437) 4,788 2,179 3,351 Alder Hey Children's NHS Foundation Trust Yes 12,424 12, ,192 32, ,731 16,075 24,731 Barnsley Hospital NHS Foundation Trust Yes (7,274) (7,259) 15 (7,833) (7,820) 13 8,869 5,765 8,869 Blackpool Teaching Hospitals NHS Foundation Trust Yes (6,575) (7,854) (1,279) (3,966) (5,938) (1,972) 6,575 2,992 4,603 Bolton NHS Foundation Trust Yes 5,014 2,851 (2,163) 12,717 10,556 (2,161) 11,094 5,048 8,931 Bradford District Care NHS Foundation Trust Yes ,381 1, Bradford Teaching Hospitals NHS Foundation Trust Yes (1,759) (3,559) (1,800) 2, (2,012) 10,321 4,696 8,308 Bridgewater Community Healthcare NHS Foundation Trust No (6,123) (7,675) (1,552) (7,594) (7,594) Calderdale and Huddersfield NHS Foundation Trust No (33,713) (33,713) 0 (43,048) (43,047) Cheshire and Wirral Partnership NHS Foundation Trust Yes ,119 1, , ,378 City Hospitals Sunderland NHS Foundation Trust Yes (11,096) (11,265) (169) (11,909) (12,591) (682) 6,495 3,539 5,813 Countess of Chester Hospital NHS Foundation Trust Yes (1,414) (6,589) (5,175) 2,963 (10,928) (13,891) 7,297 1,788 1,788 County Durham and Darlington NHS Foundation Trust Yes (2,366) (4,194) (1,828) 8,081 6,182 (1,899) 18,091 9,859 16,192 Cumbria Partnership NHS Foundation Trust Yes (1,772) (2,487) (715) (2,078) (2,078) 0 2, ,333 Doncaster and Bassetlaw Teaching Hospitals NHS Foundation Trust Yes (11,574) (11,540) 34 (6,615) (16,018) (9,403) 16,238 10,555 10,555 East Cheshire NHS Trust Yes (13,031) (13,597) (566) (16,233) (17,932) (1,699) 7,664 3,877 5,965 East Lancashire Hospitals NHS Trust Yes (6,377) (7,945) (1,568) (7,748) (9,317) (1,569) 8,050 3,663 6,480 Gateshead Health NHS Foundation Trust Yes (1,130) (10,102) (8,972) 742 (14,083) (14,825) 7,282 1,093 1,093 Greater Manchester Mental Health NHS Foundation Trust Yes 2,269 2, ,292 2, ,492 1,620 2,492 Harrogate and District NHS Foundation Trust Yes (620) (441) 179 3,983 4, ,983 2,589 3,983 Hull And East Yorkshire Hospitals NHS Trust Yes 2, (1,698) 2,364 (656) (3,020) 12,586 6,482 9,566 Humber Teaching NHS Foundation Trust Yes (1,419) (1,388) 31 1,151 1, ,012 1,308 2,012 Lancashire Care NHS Foundation Trust Yes (2,324) (2,323) 1 (1,679) (1,679) 0 2,199 1,430 2,199 Lancashire Teaching Hospitals NHS Foundation Trust No (36,593) (38,726) (2,133) (46,441) (46,441) Leeds and York Partnership NHS Foundation Trust Yes 14,367 19,922 5,555 28,043 28, ,427 11,977 18,427 Leeds Community Healthcare NHS Trust Yes 2,842 3, ,041 4, ,333 1,517 2,333 Liverpool Heart and Chest Hospital NHS Foundation Trust Yes 6,742 6, ,654 9, ,592 3,635 5,592 Liverpool Women's NHS Foundation Trust Yes (2,437) (329) 2,108 (1,601) (1,101) 500 3,608 2,345 3,608 Manchester University NHS Foundation Trust Yes 16,782 8,035 (8,747) 32,847 19,368 (13,479) 44,931 20,444 31,452 Mersey Care NHS Foundation Trust Yes 4,210 4, ,485 5, ,643 2,368 3,643 Mid Cheshire Hospitals NHS Foundation Trust Yes (245) (1,746) (1,501) 5,243 2,722 (2,521) 8,428 3,834 5,900 North Cumbria University Hospitals NHS Trust Yes (31,512) (41,269) (9,757) (37,628) (37,628) 0 11,579 7,526 11,579 North East Ambulance Service NHS Foundation Trust Yes (966) 695 1,661 (712) (712) 0 1, ,003 North Tees and Hartlepool NHS Foundation Trust No (17,068) (10,982) 6,086 (20,220) (17,202) 3, North West Ambulance Service NHS Trust Yes 1,403 1, ,839 1, ,422 1,574 2,422 North West Boroughs Healthcare NHS Foundation Trust Yes (1,974) (2,969) 1, Northern Lincolnshire and Goole NHS Foundation Trust Yes (28,842) (43,470) (14,628) (32,385) (55,609) (23,224) 7,

40 3.5 Financial performance by provider North (2/2) Control Total Basis Surplus Deficit Including PSF Year to date Forecast Outturn Control Total (CT) Accepted? YTD Plan YTD Actual Variance FOT Plan FOT Variance Provider Sustainability Fund (PSF) PSF in Plan (CT acceptors only) YTD Actual FOT Provider Name Northumberland, Tyne and Wear NHS Foundation Trust Yes 1,173 2, ,524 3, ,028 1,318 2,028 Northumbria Healthcare NHS Foundation Trust Yes 19,209 19, ,143 25, ,066 7,843 12,066 Pennine Care NHS Foundation Trust Yes (3,577) (1,219) 2,358 (6,369) (6,369) 0 1,924 1,251 1,924 Rotherham Doncaster and South Humber NHS Foundation Trust Yes 5,730 6, ,358 8, ,588 3,632 5,588 Salford Royal NHS Foundation Trust Yes (1,925) (4,736) (2,811) 5, (4,406) 14,687 6,683 10,281 Sheffield Children's NHS Foundation Trust Yes (1,416) (1,346) 70 1,882 1, ,495 2,271 3,495 Sheffield Health and Social Care NHS Foundation Trust Yes 3,726 4, ,408 5, ,681 2,393 3,681 Sheffield Teaching Hospitals NHS Foundation Trust Yes (1,342) 5,745 7,087 5,104 (2,727) (7,831) 26,103 11,877 18,272 South Tees Hospitals NHS Foundation Trust Yes (910) (896) 14 3,804 3, ,900 9,035 13,900 South Tyneside NHS Foundation Trust Yes (10,742) (9,460) 1,282 (12,065) (11,019) 1,046 2,954 1,920 2,954 South West Yorkshire Partnership NHS Foundation Trust Yes (298) 942 1, ,670 1,736 2,670 Southport And Ormskirk Hospital NHS Trust No (22,158) (22,612) (454) (28,818) (28,818) St Helens And Knowsley Teaching Hospitals NHS Trust Yes 3,531 1,032 (2,499) 10,993 (5,994) (16,987) 12,821 5,834 5,834 Stockport NHS Foundation Trust No (26,807) (25,981) 826 (33,820) (33,820) Tameside and Glossop Integrated Care NHS Foundation Trust Yes (16,066) (15,889) 177 (19,149) (19,149) 0 4,221 2,743 4,221 Tees, Esk and Wear Valleys NHS Foundation Trust Yes 6,630 7, ,864 9, ,663 3,031 4,663 The Christie NHS Foundation Trust Yes 18,990 19, ,319 25, ,102 9,166 14,102 The Clatterbridge Cancer Centre NHS Foundation Trust Yes 1,811 3,180 1,369 2,203 3,553 1, The Leeds Teaching Hospitals NHS Trust Yes 12,728 6,456 (6,272) 45,074 35,353 (9,721) 57,403 30,993 47,682 The Mid Yorkshire Hospitals NHS Trust Yes (12,718) (14,833) (2,115) (5,410) (20,202) (14,792) 14,254 7,126 7,126 The Newcastle Upon Tyne Hospitals NHS Foundation Trust Yes 2,854 2, ,947 12, ,947 8,415 12,947 The Pennine Acute Hospitals NHS Trust No (53,897) (53,737) 160 (68,858) (68,858) The Rotherham NHS Foundation Trust No (15,988) (15,750) 238 (20,283) (20,283) The Royal Liverpool and Broadgreen University Hospitals NHS Trust No (37,948) (43,144) (5,196) (39,690) (54,248) (14,558) The Walton Centre NHS Foundation Trust Yes 2,088 2, ,254 3, ,263 1,471 2,263 University Hospitals of Morecambe Bay NHS Foundation Trust No (51,546) (54,135) (2,589) (69,449) (69,449) Warrington and Halton Hospitals NHS Foundation Trust Yes (16,213) (17,122) (909) (16,881) (17,845) (964) 4,942 2,249 3,978 Wirral Community NHS Foundation Trust Yes 1,505 1, ,193 2, , ,455 Wirral University Teaching Hospital NHS Foundation Trust No (20,937) (24,828) (3,891) (25,042) (27,338) (2,296) Wrightington, Wigan and Leigh NHS Foundation Trust Yes (1,323) (1,286) 37 1, (846) 8,060 5,239 7,214 York Teaching Hospital NHS Foundation Trust Yes (6,563) (7,921) (1,358) (1,835) (4,783) (2,948) 12,479 6,427 9,484 Yorkshire Ambulance Service NHS Trust Yes 4,134 4, ,188 4, ,123 1,380 2,123 North Total (395,719) (454,503) (58,783) (282,306) (448,041) (165,735) 517, , ,051

41 3.6 Financial performance by provider South (1/2) Control Total Basis Surplus Deficit Including PSF Year to date Forecast Outturn Control Total (CT) Accepted? YTD Plan YTD Actual Variance FOT Plan FOT Variance Provider Sustainability Fund (PSF) PSF in Plan (CT acceptors only) YTD Actual FOT Provider Name 2gether NHS Foundation Trust Yes Ashford and St Peter's Hospitals NHS Foundation Trust Yes 18,047 16,450 (1,597) 37,215 35,597 (1,618) 26,789 15,795 25,171 Avon and Wiltshire Mental Health Partnership NHS Trust Yes (2,295) (2,241) 54 (2,635) (2,635) 0 1, ,262 Berkshire Healthcare NHS Foundation Trust Yes 1,608 2,802 1,194 2,397 3,897 1,500 2,433 1,582 2,433 Brighton and Sussex University Hospitals NHS Trust Yes (42,299) (43,751) (1,452) (55,106) (57,731) (2,625) 10,294 5,147 7,669 Buckinghamshire Healthcare NHS Trust Yes 4,960 (21,648) (26,608) 9,893 (25,407) (35,300) 11, Cornwall Partnership NHS Foundation Trust Yes 2,178 2, ,695 3, Dartford and Gravesham NHS Trust Yes (6,025) (11,326) (5,301) (5,135) (19,565) (14,430) 5, Devon Partnership NHS Trust Yes 3,331 3, ,928 3, ,194 1,426 2,194 Dorset County Hospital NHS Foundation Trust Yes (6,672) (5,913) 759 (1,325) (8,479) (7,154) 5,873 3,817 3,817 Dorset Healthcare University NHS Foundation Trust Yes 5,051 5, ,852 7, ,230 4,050 6,230 East Kent Hospitals University NHS Foundation Trust No (22,974) (29,992) (7,018) (29,830) (42,155) (12,325) East Sussex Healthcare NHS Trust No (33,369) (35,521) (2,152) (45,000) (45,000) Frimley Health NHS Foundation Trust Yes 21,865 21, ,837 32, ,165 17,008 26,165 Gloucestershire Care Services NHS Trust Yes 2,215 2, ,102 3, ,996 1,297 1,996 Gloucestershire Hospitals NHS Foundation Trust Yes (18,650) (19,333) (683) (18,821) (29,804) (10,983) 8,060 4,514 4,514 Great Western Hospitals NHS Foundation Trust Yes (5,202) (5,198) 4 (5,300) (8,894) (3,594) 7,126 4,632 4,632 Hampshire Hospitals NHS Foundation Trust Yes (2,999) (4,917) (1,918) 4,767 1,785 (2,982) 10,976 5,189 7,983 Isle of Wight NHS Trust No (14,612) (21,736) (7,124) (17,149) (30,102) (12,953) Kent and Medway NHS and Social Care Partnership Trust Yes (2,561) (2,560) 1 (1,829) (1,826) 3 1,547 1,006 1,547 Kent Community Health NHS Foundation Trust Yes 2,117 3,721 1,604 3,128 5,000 1,872 2,474 1,608 2,474 Maidstone And Tunbridge Wells NHS Trust Yes 1,619 1, ,741 11, ,718 8,266 12,718 Medway NHS Foundation Trust Yes (27,863) (30,262) (2,399) (34,169) (46,143) (11,974) 12,663 5,762 5,762 North Bristol NHS Trust Yes (15,345) (16,602) (1,257) (18,383) (21,537) (3,154) 16,176 9,058 13,022 Northern Devon Healthcare NHS Trust No (9,622) (13,094) (3,472) (11,877) (16,664) (4,787) Oxford Health NHS Foundation Trust Yes (2,565) (9,680) (7,115) 1,939 (7,945) (9,884) 2, Oxford University Hospitals NHS Foundation Trust Yes (2,150) (3,454) (1,304) 25,726 25, ,321 8,579 15,321 Poole Hospital NHS Foundation Trust Yes (6,898) (7,737) (839) (3,713) (14,635) (10,922) 9,142 4,984 4,984 Portsmouth Hospitals NHS Trust No (25,199) (30,281) (5,082) (29,900) (34,810) (4,910) Royal Berkshire NHS Foundation Trust Yes 4,171 3,529 (642) 8,989 8,089 (900) 12,673 8,237 12,673 Royal Cornwall Hospitals NHS Trust Yes (11,009) (10,970) 39 (11,889) (11,889) 0 8,871 5,766 8,871 Royal Devon and Exeter NHS Foundation Trust Yes 1,093 1, ,272 6, ,222 7,944 12,222 Royal Surrey County Hospital NHS Foundation Trust Yes 2,340 4,571 2,231 4,350 4, ,447 6,899 10,279 Royal United Hospitals Bath NHS Foundation Trust Yes 9,249 7,117 (2,132) 12,762 9,475 (3,287) 10,958 4,986 7,671 Salisbury NHS Foundation Trust Yes (4,645) (7,914) (3,269) (5,165) (9,665) (4,500) 3, Solent NHS Trust Yes (511) (485) 26 (371) (371) 0 2,020 1,313 2,020 Somerset Partnership NHS Foundation Trust Yes 2,786 2, ,111 4, ,303 1,497 2,303 South Central Ambulance Service NHS Foundation Trust Yes (718) (692) 26 (764) (764) 0 1, ,493 South East Coast Ambulance Service NHS Foundation Trust Yes (590) (504) ,782 1,809 2,782 South Western Ambulance Service NHS Foundation Trust No

42 3.7 Financial performance by provider South (2/2) Control Total Basis Surplus Deficit Including PSF Year to date Forecast Outturn Control Total (CT) Accepted? YTD Plan YTD Actual Variance FOT Plan FOT Variance Provider Sustainability Fund (PSF) PSF in Plan (CT acceptors only) YTD Actual FOT Provider Name Southern Health NHS Foundation Trust Yes (908) (892) 16 3,384 (8,787) (12,171) 4,089 2,658 2,658 Surrey and Borders Partnership NHS Foundation Trust Yes 8,022 8, ,205 24, ,287 9,936 15,287 Surrey And Sussex Healthcare NHS Trust Yes 5,659 6, ,149 16, ,270 6,026 9,270 Sussex Community NHS Foundation Trust Yes 1,947 1, ,894 3, ,916 1,895 2,916 Sussex Partnership NHS Foundation Trust Yes 2, (1,440) 3, (2,330) 2, Taunton and Somerset NHS Foundation Trust Yes (6,504) (6,458) 46 (4,464) (13,248) (8,784) 5,872 3,817 3,817 The Queen Victoria Hospital NHS Foundation Trust Yes 5,316 (3,766) (9,082) 13,951 (5,655) (19,606) 9, The Royal Bournemouth and Christchurch Hospitals NHS Foundation Trus Yes 14,927 14, ,619 24, ,000 17,550 27,000 Torbay and South Devon NHS Foundation Trust Yes (8,033) (9,192) (1,159) 1,725 (6,225) (7,950) 6,148 2,797 2,797 University Hospital Southampton NHS Foundation Trust Yes 17,813 17, ,445 29, ,040 16,276 25,040 University Hospitals Bristol NHS Foundation Trust Yes 13,514 13, ,480 16,855 (1,625) 15,480 10,062 13,855 University Hospitals Plymouth NHS Trust Yes (8,791) (25,963) (17,172) (3,823) (29,550) (25,727) 12,444 1,307 1,307 Western Sussex Hospitals NHS Foundation Trust Yes 11,113 11, ,437 17, ,252 10,564 16,252 Weston Area Health NHS Trust Yes (6,713) (11,344) (4,631) (10,269) (14,511) (4,242) 2, Yeovil District Hospital NHS Foundation Trust Yes (15,174) (15,145) 29 (16,744) (20,178) (3,434) 3,142 2,042 2,042 South Total (147,100) (254,109) (107,009) 8,133 (231,793) (239,928) 427, , ,983 Total for all providers (1,459,912) (2,012,995) (553,079) (1,102,053) (2,067,001) (964,951) 1,721, ,026 1,296,435

43 3.8 Key variances year to date Quarter 3 Favourable variances to date: top 10 best performers (excl PSF) Org Name YTD Plan YTD Actual Variance Sheffield Teaching Hospitals NHS Foundation Trust 1 (18,309) (6,132) 12,177 The Royal Marsden NHS Foundation Trust 2 5,156 14,563 9,407 North Tees and Hartlepool NHS Foundation Trust 3 (17,068) (10,982) 6,086 Leeds and York Partnership NHS Foundation Trust 4 2,390 7,945 5,555 University College London Hospitals NHS Foundation Trust 5 (25,586) (20,496) 5,090 Essex Partnership University NHS Foundation Trust 6 (4,478) 267 4,746 Royal Papworth Hospital NHS Foundation Trust 7 (13,120) (8,443) 4,677 Moorfields Eye Hospital NHS Foundation Trust 8 (464) 3,761 4,225 Royal Surrey County Hospital NHS Foundation Trust 9 (6,400) (2,328) 4,072 West Suffolk NHS Foundation Trust 10 (11,673) (8,663) 3,010 Adverse variances to date: top 10 worst performers (excl PSF) Org Name Largest Variances from plan (excl PSF) year to date Largest Variances from plan (excl PSF) year to date YTD Plan YTD Actual Variance King's College Hospital NHS Foundation Trust 1 (116,340) (147,146) (30,806) University Hospitals of Leicester NHS Trust 2 (23,292) (53,204) (29,912) Buckinghamshire Healthcare NHS Trust 3 (2,800) (21,648) (18,848) St George's University Hospitals NHS Foundation Trust 4 (26,405) (44,055) (17,650) Nottingham University Hospitals NHS Trust 5 (16,735) (33,724) (16,989) Worcestershire Acute Hospitals NHS Trust 6 (35,601) (51,939) (16,338) Queen Elizabeth Hospital King's Lynn NHS Foundation Trust 7 (13,253) (26,834) (13,581) United Lincolnshire Hospitals NHS Trust 8 (53,864) (66,295) (12,431) Barts Health NHS Trust 9 (48,050) (59,420) (11,370) Mid Essex Hospital Services NHS Trust 10 (35,258) (46,586) (11,328)

44 3.9 Key variances forecast outturn Quarter 3 Favourable variances forecast outturn: top 10 best performers (excl PSF) Org Name FOT Plan FOT Actual Variance University College London Hospitals NHS Foundation Trust 1 (6,198) 22,857 29,055 Royal Papworth Hospital NHS Foundation Trust 2 (15,800) (11,500) 4,300 West Hertfordshire Hospitals NHS Trust 3 (52,900) (49,700) 3,200 Royal Surrey County Hospital NHS Foundation Trust 4 (9,097) (5,929) 3,168 North Tees and Hartlepool NHS Foundation Trust 5 (20,220) (17,202) 3,018 Essex Partnership University NHS Foundation Trust 6 (5,971) (3,248) 2,723 Kent Community Health NHS Foundation Trust ,526 1,872 Berkshire Healthcare NHS Foundation Trust 8 (36) 1,464 1,500 The Clatterbridge Cancer Centre NHS Foundation Trust 9 1,667 3,017 1,350 South Tyneside NHS Foundation Trust 10 (15,019) (13,973) 1,046 Adverse variances forecast outturn: top 10 worst performers (excl PSF) Org Name Largest Variances from plan (excl PSF) forecast outturn Largest Variances from plan (excl PSF) forecast outturn FOT Plan FOT Actual Variance King's College Hospital NHS Foundation Trust 1 (146,030) (181,883) (35,853) Worcestershire Acute Hospitals NHS Trust 2 (41,511) (72,504) (30,993) University Hospitals of Leicester NHS Trust 3 (21,193) (51,800) (30,607) Barts Health NHS Trust 4 (56,785) (84,685) (27,900) Buckinghamshire Healthcare NHS Trust 5 (2,045) (25,407) (23,362) St George's University Hospitals NHS Foundation Trust 6 (29,000) (51,600) (22,600) Queen Elizabeth Hospital King's Lynn NHS Foundation Trust 7 (15,795) (37,624) (21,829) Nottingham University Hospitals NHS Trust 8 (24,862) (43,762) (18,900) Northern Lincolnshire and Goole NHS Foundation Trust 9 (39,583) (55,609) (16,026) University Hospitals Coventry And Warwickshire NHS Trust 10 (25,143) (40,600) (15,457)

45 4.0 Operational performance by provider

46 4.1 Best and worst operational performance (1/3) A&E 4-hour standard ten best and worst performing providers during Quarter acute providers only Best performing trusts Total attendances 4-hour breaches Q Performance Luton and Dunstable University Hospital NHS Foundation Trust 38, % Yeovil District Hospital NHS Foundation Trust 14, % North Tees and Hartlepool NHS Foundation Trust 43,621 1, % Sheffield Children's NHS Foundation Trust Barnsley Hospital NHS Foundation Trust Dorset County Hospital NHS Foundation Trust The Newcastle Upon Tyne Hospitals NHS Foundation Trust South Tees Hospitals NHS Foundation Trust South Warwickshire NHS Foundation Trust Northumbria Healthcare NHS Foundation Trust 15, % 24, % 23, % 61,715 2, % 37,790 1, % 19, % 55,658 2, % Worst performing trusts United Lincolnshire Hospitals NHS Trust Shrewsbury And Telford Hospital NHS Trust Nottingham University Hospitals NHS Trust Stockport NHS Foundation Trust Wye Valley NHS Trust Total attendances 4-hour breaches Q Performance 38,978 13, % 33,740 10, % 52,406 15, % 24,350 7, % 15,970 4, % Worcestershire Acute Hospitals NHS Trust 47,289 12, % King's College Hospital NHS Foundation Trust 70,328 17, % University Hospitals Of Leicester NHS Trust 65,294 16, % St Helens And Knowsley Hospitals NHS Trust 29,185 7, % Wirral University Teaching Hospital NHS Foundation Trust 31,707 7, %

47 4.1 Best and worst operational performance (2/3) RTT 18-week ten best and worst performing providers at end of December 2018 acute and specialist providers only Best performing trusts Waiting list 0-18 week waiters December 2018 Performance The Christie NHS Foundation Trust 1,413 1, % Lancashire Care NHS Foundation Trust The Clatterbridge Cancer Centre NHS Foundation Trust The Royal Marsden NHS Foundation Trust Homerton University Hospital NHS Foundation Trust Southport And Ormskirk Hospital NHS Trust North Middlesex University Hospital NHS Trust Barnsley Hospital NHS Foundation Trust Moorfields Eye Hospital NHS Foundation Trust South Tyneside NHS Foundation Trust 5,460 5, % % 2,123 2, % 18,511 17, % 10,120 9, % 11,466 10, % 11,671 11, % 28,992 27, % 3,115 2, % Worst performing trusts East Kent Hospitals University NHS Foundation Trust Northern Lincolnshire and Goole NHS Foundation Trust Royal Free London NHS Foundation Trust Queen Victoria Hospital NHS Foundation Trust Waiting list 0-18 week waiters December 2018 Performance 53,160 38, % 27,957 20, % 66,776 48, % 13,950 10, % Wye Valley NHS Trust 14,226 10, % Taunton and Somerset NHS Foundation Trust King's College Hospital NHS Foundation Trust Basildon and Thurrock University Hospitals NHS Foundation Trust Brighton And Sussex University Hospitals NHS Trust 23,624 18, % 74,546 58, % 29,135 22, % 43,257 33, % Plymouth Hospitals NHS Trust 26,798 21, %

48 4.1 Best and worst operational performance (3/3) Cancer 62-day standard ten best and worst performing providers in quarter acute and specialist providers only Best performing trusts Number treated Within 62 days Q Performance South Tyneside NHS Foundation Trust % Kingston Hospital NHS Foundation Trust % Birmingham Children's Hospital NHS Foundation Trust % Worst performing trusts Liverpool Women's NHS Foundation Trust Royal Brompton and Harefield NHS Foundation Trust The Clatterbridge Cancer Centre NHS Foundation Trust Number treated Within 62 days Q Performance % % % Frimley Health NHS Foundation Trust % Mid Cheshire Hospitals NHS Foundation Trust % Dartford And Gravesham NHS Trust % Gateshead Health NHS Foundation Trust Wrightington, Wigan and Leigh NHS Foundation Trust St George's University Hospitals NHS Foundation Trust % % % Bolton NHS Foundation Trust % The Christie NHS Foundation Trust % Maidstone And Tunbridge Wells NHS Trust Southend University Hospital NHS Foundation Trust University College London Hospitals NHS Foundation Trust Bradford Teaching Hospitals NHS Foundation Trust % % % % The Royal Wolverhampton NHS Trust % Mid Essex Hospital Services NHS Trust %

49 4.2 Operational performance by provider London (1/1) ORGANISATION A&E (95%) RTT Incomplete (92%) RTT 52 weeks Diagnostics (<1.00%) Cancer 62 days - GP referral (85%) Cancer 2 weeks - GP referral (93%) Cancer 2 weeks - breast symptoms (93%) Cancer 31 days - Diagnosis to 1st Treat. (96%) Barking, Havering And Redbridge University Hospitals NHS Trust 80.61% 82.87% % 87.85% 93.58% 98.65% 98.30% 2 Barts Health NHS Trust 85.78% 84.72% % 87.45% 95.92% 99.62% 99.25% 14 Central and North West London NHS Foundation Trust % % 0 Central London Community Healthcare NHS Trust 98.92% 88.09% 0 0 Chelsea and Westminster Hospital NHS Foundation Trust 94.63% 92.68% % 89.81% 95.98% 94.62% 97.22% 3 Croydon Health Services NHS Trust 84.70% 92.01% % 84.80% 97.44% 96.13% 98.72% 1 Epsom And St Helier University Hospitals NHS Trust 90.45% 87.80% % 88.29% 97.29% 99.29% 5 Great Ormond Street Hospital for Children NHS Foundation Trust 92.09% % % 3 Guy's and St Thomas' NHS Foundation Trust 86.21% 86.60% % 73.10% 96.50% 99.29% 96.00% 4 Homerton University Hospital NHS Foundation Trust 94.90% 96.73% % 89.29% 96.36% 95.69% % 1 Hounslow and Richmond Community Healthcare NHS Trust 99.97% % % 0 Imperial College Healthcare NHS Trust 89.71% 83.95% % 86.57% 94.09% 94.93% 98.21% 7 King's College Hospital NHS Foundation Trust 74.52% 77.95% % 80.30% 90.88% 97.94% 97.72% 17 Kingston Hospital NHS Foundation Trust 89.26% 93.78% % 96.29% 99.15% 99.56% 99.67% 2 Lewisham and Greenwich NHS Trust 87.07% 85.74% % 74.72% 96.38% 95.78% 97.77% 3 London North West Healthcare NHS Trust 89.76% 80.56% % 86.08% 92.70% 94.62% 97.51% 9 Moorfields Eye Hospital NHS Foundation Trust 99.30% 94.79% % 91.30% 97.18% 0 North East London NHS Foundation Trust 98.97% 98.43% 0 0 North Middlesex University Hospital NHS Trust 87.25% 95.39% % 75.76% 93.16% 90.31% 99.08% 5 Royal Brompton and Harefield NHS Foundation Trust % % 51.72% % 96.84% 1 Royal Free London NHS Foundation Trust 85.26% 73.15% % 77.20% 89.11% 91.89% 98.11% 9 Royal National Orthopaedic Hospital NHS Trust % % 80.49% 94.82% % 0 South West London and ST George's Mental Health NHS Trust 95.30% 0 0 St George's University Hospitals NHS Foundation Trust 87.10% 0.56% 89.97% 96.23% 96.49% 97.94% 8 The Hillingdon Hospitals NHS Foundation Trust 83.30% 84.33% % 85.33% 95.35% 94.49% 99.03% 2 The Royal Marsden NHS Foundation Trust 97.17% % 75.96% 78.01% 96.60% 9 The Whittington Hospital NHS Trust 87.41% 92.07% % 88.97% 93.58% % 6 University College London Hospitals NHS Foundation Trust 84.50% 89.81% % 63.64% 94.05% 81.84% 96.94% 8 London 87.66% 85.25% % 82.18% 94.23% 94.14% 97.82% 119 C.Diff cases

50 4.2 Operational performance by provider Midlands and East (1/2) ORGANISATION A&E (95%) RTT Incomplete (92%) RTT 52 weeks Diagnostics (<1.00%) Cancer 62 days - GP referral (85%) Cancer 2 Cancer 2 weeks - weeks - GP breast referral (93%) symptoms (93%) Cancer 31 days - Diagnosis to 1st Treat. (96%) Basildon and Thurrock University Hospitals NHS Foundation Trust 94.82% 77.98% % 76.66% 97.07% 92.86% 96.31% 6 Bedford Hospital NHS Trust 91.59% 89.05% % 81.26% 95.28% 94.66% 97.41% 0 Birmingham Women and Children's Hospital NHS Foundation Trust 85.47% 92.03% % 95.24% 96.63% % 0 Birmingham Community Women's NHS Healthcare Foundation NHS Trust Foundation Trust 93.95% 0 Black Burton Country Hospitals Partnership NHS Foundation NHS Foundation Trust Trust 95.69% Cambridge University Hospitals NHS Foundation Trust 85.21% 89.29% % 78.22% 94.62% 98.13% 96.48% 10 Cambridgeshire and Peterborough NHS Foundation Trust % 0 0 Cambridgshire Community Services NHS Trust 95.26% % 0 Chesterfield Royal Hospital NHS Foundation Trust 88.96% 91.95% % 85.62% 91.68% 91.88% 98.55% 2 Coventry and Warwickshire Partnership NHS Trust % % 0 University Hospitals of Derby and Burton NHS Foundation Trust 86.70% 90.56% % 78.04% 95.80% 94.39% 97.92% 12 Derbyshire Community Health Services NHS Foundation Trust 99.99% 94.84% % 0 Derbyshire Healthcare NHS Foundation Trust 92.66% 0 0 Dudley and Walsall Mental Health Partnership NHS Trust 99.28% 0 0 East And North Hertfordshire NHS Trust 88.32% 88.08% % 70.33% 97.02% 94.21% 93.80% 7 East Suffolk and North Essex NHS Foundation Trust 92.99% 88.14% % 74.53% 93.41% 92.60% 96.69% 14 Essex Partnership University NHS Foundation Trust 0 George Heart of Eliot England Hospital NHS NHS Foundation Trust Trust 79.93% 83.70% % 76.11% 97.24% 94.38% % 2 Hertfordshire Community NHS Trust % 86.38% 0 0 Hinchingbrooke Ipswich Hospital Health NHS Trust Care NHS Trust 0 James Paget University Hospitals NHS Foundation Trust 90.56% 85.71% % 85.81% 97.10% 95.22% 99.68% 1 Kettering General Hospital NHS Foundation Trust 82.55% 83.21% % 88.95% 98.11% 98.05% 97.64% 3 Leicestershire Partnership NHS Trust 94.11% % 0 Lincolnshire Community Health Services NHS Trust 98.48% 0 Lincolnshire Partnership NHS Foundation Trust 0 Luton and Dunstable University Hospital NHS Foundation Trust 98.00% 92.00% % 86.76% 95.76% 93.43% % 2 Mid Essex Hospital Services NHS Trust 81.86% 0.49% 68.04% 88.44% 46.87% 89.80% 13 Midlands Partnership NHS Foundation Trust 97.24% % 0 Milton Keynes Hospital NHS Foundation Trust 91.42% 88.89% % 84.62% 96.83% 93.33% 99.11% 2 Norfolk and Norwich University Hospitals NHS Foundation Trust 79.40% 81.87% % 71.85% 75.07% 55.36% 96.11% 4 C.Diff cases

51 4.2 Operational performance by provider Midlands and East (2/2) ORGANISATION A&E (95%) RTT Incomplete (92%) RTT 52 weeks Diagnostics (<1.00%) Cancer 62 days - GP referral (85%) Cancer 2 weeks - GP referral (93%) Cancer 2 weeks - breast symptoms (93%) Cancer 31 days - Diagnosis to 1st Treat. (96%) Norfolk Community Health and Care NHS Trust 98.37% 0 0 North West Anglia NHS Foundation Trust 85.81% 85.84% % 79.49% 91.05% 82.10% 97.61% 12 Northampton General Hospital NHS Trust 85.37% 81.48% % 80.81% 89.96% 60.46% 96.37% 1 Northamptonshire Healthcare NHS Foundation Trust 98.56% 0 0 Nottingham University Hospitals NHS Trust 69.80% 93.39% % 79.50% 95.31% 97.97% 96.25% 15 Papworth Hospital NHS Foundation Trust 90.49% % 80.00% 97.10% 2 Sandwell And West Birmingham Hospitals NHS Trust 78.91% 92.17% % 86.61% 97.40% 98.05% 97.84% 5 Sherwood Forest Hospitals NHS Foundation Trust 94.14% 90.01% % 82.71% 96.55% 94.89% 98.36% 11 Shrewsbury And Telford Hospital NHS Trust 68.00% 92.27% % 81.35% 84.75% 60.89% 99.10% 4 Shropshire South Essex Community Partnership Health University NHS NHS TrustFoundation Trust 99.89% 95.08% % 0 South Warwickshire NHS Foundation Trust 95.03% 92.69% % 77.89% 97.36% 97.35% 97.65% 4 Southend University Hospital NHS Foundation Trust 83.41% 84.93% % 62.76% 89.79% 38.48% 93.30% 5 Staffordshire and Stoke on Trent Partnership NHS Trust 0 The Dudley Group NHS Foundation Trust 84.20% 93.22% % 82.54% 95.58% 96.15% 98.47% 7 The Princess Alexandra Hospital NHS Trust 76.81% 92.52% % 84.19% 98.23% 97.69% 97.55% 2 The Queen Elizabeth Hospital, King's Lynn, NHS Foundation Trust 82.04% 78.48% % 83.00% 97.69% 99.00% 97.48% 6 The Robert Jones and Agnes Hunt Orthopaedic Hospital NHS Foundation Trust % % 62.50% % % 0 The Royal Orthopaedic Hospital NHS Foundation Trust 87.11% % 72.00% 98.77% % 1 The Royal Wolverhampton NHS Trust 91.06% 90.75% % 67.41% 85.55% 69.97% 89.43% 6 United Lincolnshire Hospitals NHS Trust 65.07% 83.07% % 72.82% 80.84% 70.09% 97.04% 16 University Hospitals Birmingham NHS Foundation Trust 76.10% 86.92% % 79.57% 91.91% 80.57% 96.51% 35 University Hospitals Coventry And Warwickshire NHS Trust 88.73% 84.61% % 81.88% 95.97% 98.98% 96.56% 7 University Hospitals Of Leicester NHS Trust 74.78% 85.30% % 77.25% 88.41% 57.14% 95.35% 16 University Hospitals of North Midlands NHS Trust 85.01% 79.97% % 82.03% 95.55% 97.36% 96.99% 12 Walsall Healthcare NHS Trust 83.01% 90.01% % 89.37% 94.53% 94.34% 99.07% 4 West Hertfordshire Hospitals NHS Trust 80.40% 82.87% % 82.02% 93.50% 94.16% 96.03% 2 West Suffolk NHS Foundation Trust 93.09% 88.30% % 78.91% 85.33% 72.49% 99.49% 3 Worcestershire Acute Hospitals NHS Trust 73.71% 80.14% % 73.02% 94.26% 95.72% 11 Worcestershire Health And Care NHS Trust 98.35% 0 0 Wye Valley NHS Trust 73.32% 75.57% % 77.36% 94.96% 25.58% 11 Midlands and East 84.07% 86.84% % 77.99% 92.27% 83.40% 96.51% 284 C.Diff cases

52 4.2 Operational performance by provider North (1/2) ORGANISATION A&E (95%) RTT Incomplete (92%) RTT 52 weeks Diagnostics (<1.00%) Cancer 62 days - GP referral (85%) Cancer 2 weeks - GP referral (93%) Cancer 2 weeks - breast symptoms (93%) Cancer 31 days - Diagnosis to 1st Treat. (96%) 5 Boroughs Partnership NHS Foundation Trust 99.01% 0 Aintree University Hospital NHS Foundation Trust 76.83% 89.57% % 73.79% 87.74% 86.44% 97.78% 2 Airedale NHS Foundation Trust 91.23% 93.09% % 87.55% 94.06% 92.24% % 1 Alder Hey Children's NHS Foundation Trust 93.32% 92.04% % % 98.59% % 0 Barnsley Hospital NHS Foundation Trust 96.50% 95.06% % 88.10% 94.93% 93.53% 98.48% 6 Blackpool Teaching Hospitals NHS Foundation Trust 86.01% 80.96% % 82.57% 88.85% 52.24% 98.87% 6 Bolton NHS Foundation Trust 85.58% 88.66% % 89.97% 96.68% 82.49% 99.40% 3 Bradford District Care NHS Foundation Trust 97.68% 0 0 Bradford Teaching Hospitals NHS Foundation Trust 77.97% 79.52% % 64.31% 73.01% % 88.28% 5 Bridgewater Community Healthcare NHS Foundation Trust 99.14% 99.79% % % 97.68% 97.14% 0 Calderdale and Huddersfield NHS Foundation Trust 90.08% 92.16% % 88.91% 99.11% 98.58% 99.60% 1 City Hospitals Sunderland NHS Foundation Trust 91.27% 92.37% % 84.34% 96.42% 98.95% 6 Countess of Chester Hospital NHS Foundation Trust 82.19% 84.93% % 88.22% 97.96% % 98.46% 4 County Durham and Darlington NHS Foundation Trust 90.59% 90.04% % 87.96% 94.48% 93.97% 98.90% 5 Cumbria Partnership NHS Foundation Trust 95.94% % 0 Doncaster and Bassetlaw Hospitals NHS Foundation Trust 92.11% 86.60% % 84.89% 92.25% 90.87% 99.33% 7 East Cheshire NHS Trust 78.63% 79.11% % 85.71% 95.44% 73.21% 99.29% 5 East Lancashire Hospitals NHS Trust 80.99% 92.01% % 81.97% 95.08% 92.14% 98.58% 5 Gateshead Health NHS Foundation Trust 93.21% 92.26% % 90.68% 97.21% 98.29% 99.47% 2 Harrogate and District NHS Foundation Trust 93.76% 89.90% % 86.29% 98.55% 98.21% 99.23% 0 Hull And East Yorkshire Hospitals NHS Trust 83.30% 81.99% % 69.95% 95.00% 89.93% 93.93% 6 Humber NHS Foundation Trust % 97.86% 0 0 Lancashire Care NHS Foundation Trust 97.58% % 0 Lancashire Teaching Hospitals NHS Foundation Trust 81.79% 79.80% % 80.83% 96.70% 95.09% 96.25% 11 Leeds Community Healthcare NHS Trust 96.39% % % 0 Leeds Teaching Hospitals NHS Trust 82.02% 86.58% % 70.53% 93.64% 85.04% 94.49% 29 Liverpool Community Health NHS Trust 0 Liverpool Heart and Chest Hospital NHS Foundation Trust % % 87.10% % % 1 Liverpool Women's NHS Foundation Trust 97.81% 85.90% % 42.86% 95.81% 79.45% 0 Manchester University NHS Foundation Trust 84.19% 87.71% % 80.90% 95.16% 97.43% 98.04% 24 Mid Cheshire Hospitals NHS Foundation Trust 85.71% 92.01% % 91.69% 97.61% 96.11% 98.15% 4 Mid Yorkshire Hospitals NHS Trust 83.62% 87.42% % 82.34% 97.29% 88.30% 97.25% 8 C.Diff cases

53 4.2 Operational performance by provider North (2/2) ORGANISATION A&E (95%) RTT Incomplete (92%) RTT 52 weeks Diagnostics (<1.00%) Cancer 62 days - GP referral (85%) Cancer 2 weeks - GP referral (93%) Cancer 2 weeks - breast symptoms (93%) Cancer 31 days - Diagnosis to 1st Treat. (96%) North Cumbria University Hospitals NHS Trust 92.19% 80.04% % 81.99% 92.16% 78.70% 93.63% 7 North Tees and Hartlepool NHS Foundation Trust 97.14% 93.64% % 84.89% 94.83% 95.83% 99.71% 5 Northern Lincolnshire and Goole NHS Foundation Trust 86.10% 72.69% % 75.20% 97.21% 94.03% 99.31% 4 Northumberland, Tyne and Wear NHS Foundation Trust 99.55% 0 0 Northumbria Healthcare NHS Foundation Trust 95.03% 92.72% % 80.00% 95.34% 98.06% % 6 Pennine Acute Hospitals NHS Trust 82.96% 85.06% % 74.57% 77.03% 53.36% 97.19% 11 Pennine Care NHS Foundation Trust % 0.00% % 0 Royal Liverpool And Broadgreen University Hospitals NHS Trust 86.50% 80.61% % 73.53% 91.72% 98.08% 91.87% 9 Salford Royal NHS Foundation Trust 81.98% 89.02% % 87.06% 95.56% 97.36% 6 Sheffield Children's NHS Foundation Trust 96.99% 92.19% % 98.18% % 3 Sheffield Teaching Hospitals NHS Foundation Trust 87.12% 92.00% % 70.69% 95.00% 93.44% 92.92% 18 South Tees Hospitals NHS Foundation Trust 95.20% 88.61% % 82.86% 95.59% 97.37% 95.51% 10 South Tyneside NHS Foundation Trust 94.84% 94.77% % 86.75% 93.03% % 5 South West Yorkshire Partnership NHS Foundation Trust % % 0 Southport And Ormskirk Hospital NHS Trust 89.10% 95.76% % 78.00% 95.01% 98.69% 2 St Helens And Knowsley Hospitals NHS Trust 75.04% 92.40% % 85.35% 93.78% 93.69% 97.71% 6 Stockport NHS Foundation Trust 70.94% 82.73% % 76.97% 89.53% 44.33% 98.14% 12 Tameside Hospital NHS Foundation Trust 92.64% 92.18% % 88.80% 96.85% 95.36% % 4 The Christie NHS Foundation Trust % % 54.79% 96.36% 2 The Clatterbridge Cancer Centre NHS Foundation Trust 97.52% % 54.52% 82.35% 99.22% 0 The Newcastle Upon Tyne Hospitals NHS Foundation Trust 95.92% 93.30% % 78.57% 93.14% 93.09% 94.93% 20 The Rotherham NHS Foundation Trust 87.25% 93.85% % 81.63% 94.46% 90.77% 97.42% 3 The Walton Centre NHS Foundation Trust % % % % 1 University Hospitals of Morecambe Bay NHS Foundation Trust 84.47% 83.01% % 80.87% 96.10% 96.76% 98.71% 12 Warrington and Halton Hospitals NHS Foundation Trust 79.60% 92.33% % 86.22% 94.35% 94.95% 98.92% 5 Wirral Community NHS Trust 99.85% % % 0 Wirral University Teaching Hospital NHS Foundation Trust 76.01% 80.08% % 87.11% 94.11% % 22 Wrightington, Wigan and Leigh NHS Foundation Trust 80.63% 92.55% % 90.33% 96.43% 94.13% 2 York Teaching Hospital NHS Foundation Trust 89.36% 81.46% % 79.80% 92.12% 95.31% 5 North 87.40% 87.51% % 79.63% 93.31% 89.90% 96.68% 321 C.Diff cases

54 4.2 Operational performance by provider South (1/2) ORGANISATION A&E (95%) RTT Incomplete (92%) RTT 52 weeks Diagnostics (<1.00%) Cancer 62 days - GP referral (85%) Cancer 2 weeks - GP referral (93%) Cancer 2 weeks - breast symptoms (93%) Cancer 31 days - Diagnosis to 1st Treat. (96%) Ashford and St Peter's Hospitals NHS Foundation Trust 78.97% 91.08% % 83.78% 94.94% 97.47% 96.86% 4 Berkshire Healthcare NHS Foundation Trust % 98.97% % 0 Brighton And Sussex University Hospitals NHS Trust 79.90% 78.35% % 71.03% 85.17% 89.44% 97.52% 9 Buckinghamshire Healthcare NHS Trust 89.21% 87.39% % 83.72% 96.45% 98.48% 97.50% 13 Cornwall Partnership NHS Foundation Trust % % 0 Dartford And Gravesham NHS Trust 84.70% 92.02% % 91.63% 97.06% 97.48% % 1 Dorset County Hospital NHS Foundation Trust 96.22% 78.99% % 80.78% 93.16% 81.54% 98.33% 6 Dorset Healthcare University NHS Foundation Trust % % 0 East Kent Hospitals University NHS Foundation Trust 80.67% 72.43% % 76.07% 90.99% 82.56% 97.36% 7 East Sussex Healthcare NHS Trust 92.03% 89.92% % 71.80% 96.45% 94.87% 93.25% 15 Frimley Health NHS Foundation Trust 87.41% 91.32% % 94.13% 97.05% 95.31% 99.88% 8 Gloucestershire Care Services NHS Trust 99.13% 0.00% 0 Gloucestershire Hospitals NHS Foundation Trust 89.76% 0.20% 72.61% 92.15% 97.19% 93.64% 9 Great Western Hospitals NHS Foundation Trust 87.31% 87.63% % 89.32% 95.76% 96.67% 98.96% 5 Hampshire Hospitals NHS Foundation Trust 78.72% 88.47% % 79.48% 93.59% 96.26% 97.39% 8 Isle of Wight NHS Trust 78.76% 81.55% % 75.00% 96.35% 94.94% 99.11% 0 Kent Community Health NHS Trust 99.77% 95.79% % 0 Maidstone And Tunbridge Wells NHS Trust 89.99% 81.61% % 60.98% 88.21% 76.42% 96.65% 7 Medway NHS Foundation Trust 83.04% 80.97% % 83.09% 75.80% 64.04% 95.62% 8 North Bristol NHS Trust 81.53% 87.41% % 83.23% 83.97% 55.73% 95.83% 10 Northern Devon Healthcare NHS Trust 85.70% 79.04% % 81.92% 68.92% 71.25% 96.50% 0 Oxford Health NHS Foundation Trust 96.60% 0 Oxford University Hospitals NHS Foundation Trust 87.82% 81.89% % 73.03% 97.34% 96.38% 91.91% 12 Oxleas NHS Foundation Trust 96.52% % 0 Poole Hospital NHS Foundation Trust 91.45% 81.86% % 79.26% 98.57% % 98.48% 3 Portsmouth Hospitals NHS Trust 78.14% 80.22% % 85.59% 97.40% 96.58% 98.34% 2 Queen Victoria Hospital NHS Foundation Trust 99.86% 74.47% % 85.00% 92.88% 94.82% 0 Royal Berkshire NHS Foundation Trust 87.41% 92.53% % 85.11% 96.81% 98.48% 98.01% 2 Royal Cornwall Hospitals NHS Trust 92.73% 82.78% % 85.06% 95.81% 89.74% 98.84% 7 Royal Devon and Exeter NHS Foundation Trust 90.87% 82.64% % 71.44% 81.44% 98.32% 95.49% 2 Royal Surrey County Hospital NHS Foundation Trust 85.75% 88.97% % 71.96% 94.06% 87.82% 96.48% 6 C.Diff cases

55 4.2 Operational performance by provider South (2/2) ORGANISATION A&E (95%) RTT Incomplete (92%) RTT 52 weeks Diagnostics (<1.00%) Cancer 62 days - GP referral (85%) Cancer 2 weeks - GP referral (93%) Cancer 2 weeks - breast symptoms (93%) Cancer 31 days - Diagnosis to 1st Treat. (96%) Royal United Hospitals Bath NHS Foundation Trust 80.03% 87.30% % 84.29% 90.40% 94.66% 98.36% 12 Salisbury NHS Foundation Trust 87.41% 93.08% % 82.87% 94.91% % 97.87% 1 Solent NHS Trust 99.55% % 0 Somerset Partnership NHS Foundation Trust 99.13% 99.84% % 0 Southern Health NHS Foundation Trust % 92.18% % 0 Surrey And Sussex Healthcare NHS Trust 91.52% 89.34% % 86.55% 93.99% 88.80% 95.53% 5 Sussex Community NHS Trust 98.97% 97.06% % 0 Taunton and Somerset NHS Foundation Trust 90.11% 76.62% % 78.66% 95.00% 95.65% 97.79% 7 The Royal Bournemouth and Christchurch Hospitals NHS Foundation Trust 91.59% 85.66% % 85.45% 96.13% 97.67% 96.79% 2 Torbay and South Devon NHS Foundation Trust 84.94% 81.77% % 77.93% 80.85% 93.62% 97.59% 3 University Hospital Southampton NHS Foundation Trust 88.37% 85.68% % 74.92% 83.03% 37.32% 89.27% 12 University Hospitals Bristol NHS Foundation Trust 85.53% 89.31% % 86.64% 96.04% 98.64% 9 University Hospitals Plymouth NHS Trust 81.54% 78.38% % 77.04% 95.43% 97.78% 95.36% 7 Western Sussex Hospitals NHS Foundation Trust 93.73% 81.27% % 80.77% 95.36% 95.52% 98.86% 9 Weston Area Health NHS Trust 82.69% 92.82% % 72.83% 90.93% 85.00% 2 Yeovil District Hospital NHS Foundation Trust 97.16% 90.59% % 84.70% 93.76% 97.44% 1 South 87.68% 84.38% % 79.40% 91.90% 90.06% 96.50% 214 C.Diff cases

56 4.2 Operational performance by provider Ambulance - denotes not available. 1 Centiles for England in this spreadsheet are a mean of trusts' centiles, weighted by their count of incidents.

57 5.0 Vacancy position by sector and region

58 5.1 Nursing vacancy position Table 1: Registered Nursing vacancies (WTE) Table 2: Registered Nursing vacancies (percentage rate) Region Sector 2017/18 Q3 2017/18 Q4 2018/19 Q1 2018/19 Q2 2018/19 Q3 2017/18 Q3 2017/18 Q4 2018/19 Q1 2018/19 Q2 2018/19 Q3 London Acute 6,703 6,576 6,841 6,751 6, % 14.1% 14.7% 14.5% 13.3% Ambulance % 8.2% 11.3% 17.0% 18.5% Community % 11.9% 12.8% 12.7% 13.6% Mental Health 2,132 2,103 2,039 2,146 1, % 17.6% 16.9% 17.6% 16.2% Specialist % 6.6% 8.9% 10.1% 8.1% London Total 9,479 9,224 9,559 9,647 8, % 14.1% 14.6% 14.7% 13.5% Midlands and East Acute 7,357 7,434 9,431 9,236 8, % 10.7% 13.3% 13.1% 11.9% Ambulance % 0.0% 0.0% 0.0% 0.0% Community % 8.7% 7.8% 8.1% 7.2% Mental Health 2,076 1,635 2,391 2,411 2, % 9.1% 12.4% 12.6% 11.6% Specialist % 9.6% 5.9% 7.0% 4.9% Midlands and East Total 10,309 10,007 12,474 12,349 11, % 10.2% 12.6% 12.5% 11.3% North Acute 5,693 5,987 7,537 7,821 7, % 7.4% 9.2% 9.6% 8.7% Ambulance % 19.7% 24.1% 20.8% 32.3% Community % 2.5% 1.0% 1.1% 1.1% Mental Health 1,814 1,830 2,074 2,196 1, % 8.9% 9.8% 10.4% 9.3% Specialist % 3.2% 6.2% 7.3% 5.2% North Total 7,721 8,068 9,954 10,408 9, % 7.4% 9.1% 9.5% 8.5% South Acute 6,523 6,704 7,619 7,380 7, % 11.3% 12.8% 12.4% 11.9% Ambulance % 15.6% 6.0% 8.5% 9.7% Community % 13.1% 11.5% 11.9% 11.0% Mental Health 1,228 1,145 2,071 2,008 1, % 8.5% 14.7% 14.1% 12.5% Specialist % 18.8% 22.8% 24.3% 22.2% South Total 8,424 8,495 10,244 9,966 9, % 10.9% 13.0% 12.7% 12.0% National Total Acute 26,276 26,701 31,428 31,188 29, % 10.4% 12.1% 12.1% 11.1% Ambulance % 14.1% 12.9% 12.6% 18.6% Community 1,475 1,529 1,234 1,269 1, % 9.0% 8.4% 8.6% 8.1% Mental Health 7,250 6,714 8,575 8,762 7, % 10.5% 12.9% 13.1% 11.9% Specialist , % 6.3% 7.5% 8.6% 6.6% Grand Total 35,934 35,794 42,231 42,370 39, % 10.2% 12.0% 12.0% 11.0%

59 5.2 Medical vacancy position Table 1: Medical vacancies (WTE) Table 2: Medical vacancies (percentage rate) Region Sector 2017/18 Q3 2017/18 Q4 2018/19 Q1 2018/19 Q2 2018/19 Q3 2017/18 Q3 2017/18 Q4 2018/19 Q1 2018/19 Q2 2018/19 Q3 London Acute 1,457 1,548 1,903 1,598 1, % 7.4% 8.8% 7.2% 6.7% Ambulance % 0.0% 46.4% 86.8% 72.3% Community % 28.6% 21.7% 25.7% 28.3% Mental Health % 9.2% 9.1% 9.0% 9.6% Specialist % 8.8% 11.2% 8.8% 4.4% London Total 1,889 2,008 2,414 2,071 1, % 7.8% 9.1% 7.6% 6.9% Midlands and East Acute 2,781 2,685 3,479 2,785 2, % 9.5% 11.8% 9.6% 8.7% Ambulance % 0.0% 0.0% 0.0% 0.0% Community % 8.9% 10.7% 5.6% 6.6% Mental Health % 9.5% 13.0% 12.3% 12.8% Specialist % 6.4% 7.5% 8.1% 7.9% Midlands and East Total 3,211 3,051 3,971 3,248 3, % 9.4% 11.7% 9.7% 9.0% North Acute 2,453 2,466 2,848 2,150 1, % 8.0% 9.2% 6.9% 6.1% Ambulance % 6.5% 0.0% 0.0% 0.0% Community % 14.1% 4.9% 4.6% 4.5% Mental Health % 12.5% 13.4% 11.7% 12.0% Specialist % 4.9% 4.5% 2.4% 2.6% North Total 3,026 2,918 3,309 2,533 2, % 8.3% 9.3% 7.0% 6.4% South Acute 1,263 1,270 1,839 1,475 1, % 4.8% 6.8% 5.4% 5.2% Ambulance % 0.0% 0.0% 13.2% 19.6% Community % 13.6% 11.4% 15.9% 12.1% Mental Health % 14.8% 12.9% 12.5% 12.7% Specialist % 0.0% 2.8% 0.0% 0.0% South Total 1,611 1,659 2,176 1,818 1, % 5.7% 7.3% 6.0% 5.8% National Total Acute 7,954 7,969 10,070 8,008 7, % 7.5% 9.2% 7.3% 6.7% Ambulance % 2.6% 14.7% 51.8% 50.6% Community % 12.2% 11.0% 10.7% 9.8% Mental Health 1,232 1,194 1,282 1,221 1, % 11.4% 12.1% 11.4% 11.7% Specialist % 6.8% 8.0% 6.3% 4.4% Grand Total 9,738 9,635 11,870 9,670 8, % 7.8% 9.4% 7.6% 7.1%

60 5.3 Total workforce vacancy position Total Workforce Vacancy WTE Total Workforce Vacancy % Rate Region Sector 2017/18 Q3 2017/18 Q4 2018/19 Q1 2018/19 Q2 2018/19 Q3 2017/18 Q3 2017/18 Q4 2018/19 Q1 2018/19 Q2 2018/19 Q3 London Acute 15,834 15,331 17,170 16,170 15, % 11.3% 12.6% 11.8% 11.4% Ambulance % 3.6% 4.4% 6.5% 2.4% Community % 11.2% 11.4% 12.3% 12.2% Mental Health 5,222 4,998 4,798 5,160 4, % 12.9% 12.3% 13.1% 11.5% Specialist 1,410 1,179 1,423 1,463 1, % 7.3% 8.7% 8.9% 8.1% London Total 23,425 22,218 24,149 23,725 22, % 11.1% 12.0% 11.7% 10.9% Midlands and East Acute 20,767 20,419 24,257 22,877 21, % 9.0% 10.5% 9.9% 9.4% Ambulance ,046 1, % 4.1% 7.8% 7.8% 7.0% Community 1,951 1,922 1,443 1,482 1, % 8.8% 8.1% 8.3% 7.7% Mental Health 6,054 6,059 6,639 6,874 6, % 10.5% 10.9% 11.2% 10.5% Specialist % 6.4% 4.8% 4.2% 3.8% Midlands and East Total 29,773 29,560 33,839 32,699 31, % 9.0% 10.2% 9.8% 9.3% North Acute 16,580 15,906 19,170 18,408 17, % 5.9% 7.0% 6.7% 6.2% Ambulance % 4.5% 4.5% 4.1% 4.3% Community % 4.7% 4.5% 5.3% 5.6% Mental Health 5,346 5,377 5,574 5,308 5, % 8.6% 8.7% 8.3% 7.9% Specialist 857 1, % 6.9% 4.8% 3.7% 3.3% North Total 23,799 23,284 26,339 25,168 23, % 6.3% 7.1% 6.7% 6.3% South Acute 17,150 16,847 18,630 17,465 17, % 8.4% 9.3% 8.7% 8.5% Ambulance 1, % 8.3% 8.4% 7.1% 5.1% Community 1,229 1,237 1,299 1,288 1, % 8.9% 9.3% 9.1% 8.6% Mental Health 4,910 4,538 4,713 4,570 4, % 10.1% 10.5% 10.1% 9.2% Specialist % 11.6% 15.7% 14.6% 12.8% South Total 24,569 23,692 25,745 24,302 23, % 8.7% 9.5% 8.9% 8.5% National Total Acute 70,331 68,503 79,227 74,920 72, % 8.2% 9.4% 8.9% 8.5% Ambulance 2,592 2,312 2,850 2,846 2, % 5.3% 6.5% 6.3% 5.1% Community 4,121 4,048 3,544 3,670 3, % 8.3% 8.2% 8.5% 8.1% Mental Health 21,533 20,972 21,724 21,912 20, % 10.3% 10.4% 10.4% 9.6% Specialist 2,991 2,920 2,728 2,546 2, % 7.0% 6.6% 6.1% 5.6% Grand Total 101,567 98, , , , % 8.4% 9.3% 8.9% 8.4%

61 6.0 Organisation splits to calculate integrated care systems (ICS) financial performance

62 6.1 Organisation splits to calculate ICS financial performance The ICS financial performance overview table is derived by aggregating the individual provider and commissioner performance data as published, respectively, in this report by NHS Improvement and NHS England publications. Individual organisations performance has been pro-rated where necessary as per the organisational percentage splits from the tables below. Berkshire West North % in ICS North South Yorkshire and Bassetlaw (SYB) Berkshire Healthcare NHS Foundation Trust 60% Barnsley Hospital NHS Foundation Trust 100% NHS Berkshire West CCG 100% Doncaster and Bassetlaw Teaching Hospitals NHS Foundation Trust 100% Royal Berkshire NHS Foundation Trust 100% NHS Barnsley CCG 100% Greater Manchester NHS Bassetlaw CCG 100% Bolton NHS Foundation Trust 100% NHS Doncaster CCG 100% Greater Manchester Mental Health NHS Foundation Trust 100% NHS Rotherham CCG 100% Manchester University NHS Foundation Trust 100% NHS Sheffield CCG 100% Collective unallocated 100% Rotherham Doncaster and South Humber NHS Foundation Trust 100% NHS Bolton CCG 100% Sheffield Children's NHS Foundation Trust 100% NHS Bury CCG 100% Sheffield Health and Social Care NHS Foundation Trust 100% NHS Heywood Middleton&Rochdale CCG 100% Sheffield Teaching Hospitals NHS Foundation Trust 100% NHS Manchester CCG 100% The Rotherham NHS Foundation Trust 100% NHS Oldham CCG 100% West, North and East Cumbria NHS Salford CCG 100% Cumbria Partnership NHS Foundation Trust 100% NHS Stockport CCG 100% NHS North Cumbria CCG 100% NHS Tameside & Glossop CCG 100% North Cumbria University Hospitals NHS Trust 100% NHS Trafford CCG 100% North West Ambulance Service NHS Trust 6% NHS Wigan Borough CCG 100% West Yorkshire Pennine Care NHS Foundation Trust 100% Airedale NHS Foundation Trust 100% Salford Royal NHS Foundation Trust 100% Bradford District Care NHS Foundation Trust 100% Stockport NHS Foundation Trust 100% Bradford Teaching Hospitals NHS Foundation Trust 100% Tameside and Glossop Integrated Care NHS Foundation Trust 100% Calderdale & Huddersfield NHS Foundation Trust 100% The Christie NHS Foundation Trust 100% Harrogate and District NHS Foundation Trust 100% The Pennine Acute Hospitals NHS Trust 100% Leeds and York Partnership NHS Foundation Trust 100% Wrightington, Wigan and Leigh NHS Foundation Trust 100% Leeds Community Healthcare NHS Trust 100% Lancashire and South Cumbria Leeds Teaching Hospitals NHS Trust 100% Blackpool Teaching Hospitals NHS Foundation Trust 100% Mid Yorkshire Hospitals NHS Trust 100% East Lancashire Hospitals NHS Trust 100% NHS Airedale, Wharfedale and Craven CCG 100% Lancashire Care NHS Foundation Trust 100% NHS Bradford City CCG 100% Lancashire Teaching Hospitals NHS Foundation Trust 100% NHS Bradford Districts CCG 100% NHS Blackburn with Darwen CCG 100% NHS Calderdale CCG 100% NHS Blackpool CCG 100% NHS Greater Huddersfield CCG 100% NHS Chorley & South Ribble CCG 100% NHS Harrogate and Rural District CCG 100% NHS East Lancashire CCG 100% NHS Leeds CCG 100% NHS Fylde & Wyre CCG 100% NHS North Kirklees CCG 100% NHS Greater Preston CCG 100% NHS Wakefield CCG 100% NHS Morecambe Bay CCG 100% South West Yorkshire Partnership NHS Foundation Trust 100% NHS West Lancashire CCG 100% Tees, Esk and Wear Valleys NHS Foundation Trust 6% North West Ambulance Service NHS Trust 26% Yorkshire Ambulance Service NHS Trust 55% University Hospitals of Morecambe Bay NHS Foundation Trust 100% % in ICS Midlands and East Bedfordshire, Luton & Milton Keynes (BLMK) % in ICS Frimley Health Bedford Hospital NHS Trust 100% Berkshire Healthcare NHS Foundation Trust 40% Luton and Dunstable University Hospital NHS Foundation Trust 100% Frimley Health NHS Foundation Trust 100% Milton Keynes University Hospital NHS Foundation Trust 100% NHS NE Hampshire & Farnham CCG 100% NHS Bedfordshire CCG 100% NHS Surrey Heath CCG 100% NHS Luton CCG 100% NHS Berkshire East CCG 100% NHS Milton Keynes CCG 100% Surrey and Borders Partnership NHS Foundation Trust 22% Nottinghamshire Surrey Heartlands NHS Mansfield & Ashfield CCG 100% Ashford and St Peter's Hospitals NHS Foundation Trust 100% NHS Newark & Sherwood CCG 100% NHS Guildford & Waverley CCG 100% NHS Nottingham City CCG 100% NHS North West Surrey CCG 100% NHS Nottingham North & East CCG 100% NHS Surrey Downs CCG 100% NHS Nottingham West CCG 100% Royal Surrey County Hospital NHS Foundation Trust 100% NHS Rushcliffe CCG 100% Surrey and Borders Partnership NHS Foundation Trust 64% Nottingham University Hospitals NHS Trust 100% Gloucestershire Nottinghamshire Healthcare NHS Foundation Trust 100% 2gether NHS Foundation Trust 81% Sherwood Forest Hospitals NHS Foundation Trust 100% Gloucestershire Care Services NHS Trust 100% Gloucestershire Hospitals NHS Foundation Trust 100% % in South ICS NHS Gloucestershire CCG 100% Buckinghamshire South Western Ambulance Service NHS Foundation Trust 14% Buckinghamshire Healthcare NHS Trust 100% Suffolk and North East Essex NHS Buckinghamshire CCG 100% Colchester Hospital University NHS Foundation Trust 100% Dorset East of England Ambulance Service NHS Trust 16% Dorset County Hospital NHS Foundation Trust 100% Essex Partnership University NHS Foundation Trust 11% Dorset Healthcare University NHS Foundation Trust 100% Ipswich Hospital NHS Trust 100% NHS Dorset CCG 100% NHS Ipswich and East Suffolk CCG 100% Poole Hospital NHS Foundation Trust 100% NHS North East Essex CCG 100% The Royal Bournemouth and Christchurch Hospitals NHS Foundati 100% NHS West Suffolk CCG 100% South % in ICS Norfolk and Suffolk NHS Foundation Trust 33% West Suffolk NHS Foundation Trust 100%

63 7.0 Timetable of future publications

64 7.1 Timetable of future publications Performance Report Publication Dates 2018/19 Period Date Quarter 4 30 May 2019