note and discuss performance within the domains comment on the changes to the dashboard Fiona Elliott, Director of Planning and Performance

Transcription

1 ITEM: 9/24 DOC: 3 Meeting: Trust Board Date: 18 February 29 Title: Executive Summary: Dashboard Report Performance exception report There are 4 red rated key performance indicars (KPIs) report: o MRSA performance. Detail of this will be reported the board in the infection control report. o Staff sickness and absence which has deteriorated from 6.2% 6.6% in December. A sickness and absence action plan will be presented the Board in March which will detail the actions being taken reduce the incidence. o The year--date surplus against plan is shown as red as the actual surplus is lower than the year--date planned surplus of 2.19m. Further detail will be presented the Board in the finance report. o The DH has set a new target for performance against breaches in single sex accommodation. Full details of how this KPI will be measured have not yet been made available. Early indications are that all patient accommodation and bathroom facilities, other than those in the emergency department and critical care settings, will be included. The DH have stated that organisations will be heavily fined for breaches from 21. The performance run chart demonstrates improvement in this KPI however it is red rated as there have been a number of breaches in the month. KPI development The Board discussed how reflect the underlying financial deficit in the dashboard at the January meeting. A new KPI which reflects the position has been added the finance domain. It is red rated reflect an underlying deficit year date and is forecasted continue year end. Action: To: o o note and discuss performance within the domains comment on the changes the dashboard Report from: Fiona Elliott, Direcr of Planning and Performance Financial Validation Tim Jaggard, Deputy Direcr of Finance Lead: Direcr of Finance Compliance with statute, directions, policy, guidance Lead: All direcrs Reference: The Intelligent Board Report

2 Compliance with Healthcare Commission Core/Developmental Standards Lead: Direcr of Nursing & Clinical Development Compliance with Audirs Local Evaluation standards (ALE) Lead: Direcr of Finance Evidence for self-certification under the Monir compliance regime Lead: All direcrs Reference: Control of Infection Reference: n/a Compliance framework reference: Appendix C3

3 KPI development 1. Single sex accommodation The board agreed that data showing performance against breaches in single sex accommodation should be monired through the dashboard. The data for this KPI is available for the first time within the patient experience domain. There appears be no national benchmarking for this KPI and no common way for Trusts measure ongoing performance. Single sex accommodation is monired externally by the healthcare commission through patient responses in the in-patient survey. This is a once a year measure. In 28/9 NHS London set a target reduction for each Trust through the operating framework be managed by the host PCT. The Whittingn s target was reduce from 3% 27% the number of patients reporting in the in-patient survey that they were accommodated in mixed sex accommodation on their initial admission hospital. This target is being stretched further in 29/1 and the proposed reduction is from 27% 25%. The Board will recall that on 7 Ocber 28, NHS London visited the Trust review performance against single sex accommodation and the action plan following this is focussing on the following key areas: o o o o Moniring breaches Reducing the incidence of mixed sex accommodation Improving patient experience of single sex bays on mixed wards Providing patients with written information explaining that they may be in a mixed area until they are admitted a main ward The Trust currently monirs single sex breaches on a daily basis. Areas at risk of breach are Mary Seacole ward, the Coronary Care Unit (CCU) and the four bedded high dependency bay on Nightingale ward. The Trust is reviewing its high dependency bed configuration and it is intended that these will increase by March 29. It is anticipated that this increase will enable better segregation and reduce single sex accommodation breaches. The Trust is preparing a business case for the expansion of Mary Seacole ward. This will include a review of the medical beds configuration, and achievement of tal segregation by gender will be given a high priority within this. It is proposed that the measure of performance for this KPI will be monir the absolute numbers of single sex accommodation breaches look for a continued reduction in single sex breaches. Within the dashboard the following methodology has been applied: I. The performance relates general acute accommodation. Critical Care, paediatric and maternity accommodation is not included II. The measure reflects the number of breaches per day and is presented in weekly tals III. The denominar is the number of occupied general acute bed days by weekly tals IV. A patient is considered be a breach for each day they are accommodated in a mixed sexed area V. Every patient in the mixed sex area (e.g a bay on a ward) is counted as a breach The Board is asked discuss and approve the methodology for moniring performance against this KPI

4 2. MRSA screening The Board is aware that by April 29 all non-elective or emergency patients and all surgical elective patients must be screened for MRSA on admission hospital. The Trust is now screening all elective in patients and non elective patients and screening of day case patients is due commence within the next month. Following the appointment of an infection control surveillance officer the data on patient screening is now included in the dashboard for the first time. Actions relating improving the rates of screening and the performance against the commencing of patients on suppression therapy following a positive screen result will be reported the Board through the infection control report presented by the Direcr of Infection Prevention and Control.

5 PERFORMANCE DASHBOARD REPORT : January 29 External Assessments Ratings Annual health check Risk Ratings Use of Resources Quality of Service Financial Non-Financial Current Good Good 3.35 Amber Predicted Good Good 3.3 Green Clinical Quality Patient Experience Access and Targets Current Period G Current Period G Current Period A Forecast Outturn G Forecast Outturn G Forecast Outturn A Adverse Incidents G Net Promoter Score G National Targets - Monir/Prov Agency A Never Events Patients Survey Scores G National Targets - Other G Overall Mortality Rate G Complaints G 18 week Referral Treatment (RTT) G Avoidable Mortality G Hospital Cancellations G Hospital Acquired Infections - MRSA R Readmission Rate G Cleanliness G Hospital Acquired Infections - C. diff G Single Sex Accommodation G Strategy Workforce & Efficiency Finance Day Treatment Centre Current Period A Year date Period G Additional activity against plan A Forecast Outturn A Forecast Outturn G updated Ocber 28 Strategic Redevelopment Projects Length of Stay G YTD FC % Target progress date G DNA Rate A Risk rating G G Surgical DC % Rate G I&E variance from plan R G Market Share Theatre utilisation Actual I&E surplus/deficit G G First Outpatient Activity G OP Follow Up Ratio A Performance against SLA G G Non-Elective Activity G Sickness Absence Rate R Cost Improvement Plan G G Day Case Surgery G Turnover Rate G Cash position against plan G G Maternity Deliveries G Vacancy Rate G Underlying deficit R R 1

6 Clinical Quality Period: December 28 note: Dr Fosters data refreshed Ocber 28 (exc Readmissions), Trust data November 28 Adverse Incidents Overall Mortality Rate 25 Number of High Risk Incidents Benchmark (Dr Fosters Intelligence. Stardardised Mortality Rate, England, Annual) Standardised on tal England data = Apr-6 Jun-6 Aug-6 Oct-6 Dec-6 Feb-7 Apr-7 Jun-7 Aug-7 Period Oct-7 Dec-7 Feb-8 Apr-8 Jun-8 Aug-8 Oct-8 Dec-8 Trust 1 year SMR Trust 1 year SMR R oyal Free H ospital 74 Newham University H ospital 1 St George's Healthcare 8 Barking Havering & Redbridge Hospitals 1 Homern University Hospital 81 W hipps Cross University Hospital 11 Guy's & St Thomas' 82 Queen Elizabeth Hospital W oolwich 14 The Whittingn Hospital 84 Dartford & G ravesham 14 B rom ley Hospitals 88 W est M iddlesex University Hospital 15 C heslsea & W estm inster 88 E psom & S t Helier U niveristy Hospital 15 Barts & The London 89 Barnet & Chase Farm Hospitals 16 North W est London Hospitals 91 Ealing Hospital 17 University College London Hospital 92 Kingsn Hospital 114 H illingdon Hospital 93 Q ueen M ary's S idcup 116 Kings College Hospital 94 North Middlesex University Hospital 123 Lewisham University Hospital 96 Basildon & Thurrock 126 Green: within normal SPC parameters AND benchmark is better than England Amber: within normal SPC parameterand benchmark is not above England Red: aupper control limit breach or run of 8 points above centre line (average) Mayday Healthcare Target be less than 1 97 Imperial Healthcare n/a source: Safeguard Target under consideration Against a Peer Group of similar London hospitals - last 12 months (Dec 7-Nov 8) Never Events follow methodology be agreed target: be Blue/Green rated 1

7 Clinical Quality Period: December 28 note: Dr Fosters data refreshed Ocber 28 (exc Readmissions), Trust data November 28 Mortality Rates (continued) Readmissions source: Dr Fosters - three month lag in data Mortality Rates over time source: Dr Fosters Benchmark - trend over time Standardised against national data target: be Blue/Green rated Avoidable Mortality target: be Blue/Green rated Defined as "deaths from causes considered amenable health care Healthcare intervention includes preventing disease onset as well as treating disease." Against a Peer Group of similar London hospitals - last 12 months (Aug 7 - Jul 8)) Selected diagnoses and age band (excludes over 75 year old) Avoidable Mortality - deaths per 1 discharges Dec-6 Jan-7 Feb-7 Mar-7 Apr-7 May-7 Jun-7 Jul-7 Aug-7 Sep-7 Oct-7 Nov-7 Dec-7 Jan-8 Feb-8 Ending Mar-8 Apr-8 May-8 Jun-8 Jul-8 Aug-8 Sep-8 Oct-8 Nov-8 Dec-8 source: PAS data Green: within normal SPC parameters AND benchmark is better than England Amber: within normal SPC parameterand benchmark is not above England Red: upper control limit breach or run of 8 points above centre line (average) Target be less than 2 source: Dr Foster Intelligence. Relative Risk = index. Benchmark Year=27/8 target: be Blue/Green rated 2

8 Patient Experience Period: January 29 Net Promoter Score Ward Cleanliness Net Promoter Score 5.% 4.% 3.% 2.% 1.%.% Aug-8 Sep-8 Oct-8 Nov-8 Dec-8 Jan-9 Feb-9 Mar-9 Apr-9 May-9 Jun-9 Jul-9 Aug-9 Sep-9 Oct-9 Nov-9 Dec-9 Jan-1 Feb-1 Mar-1 Jun-8 Jul-8 Aug-8 Sep-8 Oct-8 Nov-8 Dec-8 Jan-9 Feb-9 Mar-9 Apr-9 May-9 Jun-9 Jul-9 Aug-9 Sep-9 Oct-9 Green: within normal SPC parameter AND progress target - be agreed at Dec Trust Board Green: within normal SPC parameter AND progress target (9%) Amber: within normal SPC parameters and no progress target Amber: within normal SPC parameters and no progress target Red: lower control limit breach or run of 8 point below the centre line Red: lower control limit breach or run of 8 point below the centre line Patient Survey Overall how would you rate the care you received? Did you feel you were treated with dignity & respect? 1.% 11.% 9.% 1.% 8.% 9.% 7.% 8.% 7.% 6.% 6.% 5.% 5.% Aug-8 Sep-8 Oct-8 Nov-8 Dec-8 Jan-9 Feb-9 Mar-9 Apr-9 May-9 Jun-9 Jul-9 Aug-9 Sep-9 Oct-9 Nov-9 Dec-9 Jan-1 Feb-1 Mar-1 Aug-8 Sep-8 Oct-8 Nov-8 Dec-8 Jan-9 Feb-9 Mar-9 Apr-9 May-9 Jun-9 Jul-9 Aug-9 Sep-9 Oct-9 Nov-9 Dec-9 Jan-1 Feb-1 Mar-1 Were you involved in the decisions about your care? How clean was the hospital, room or ward you were in? 11.% 1.% 1.% 9.% 9.% 8.% 8.% 7.% 7.% 6.% 6.% 5.% 5.% Aug-8 Sep-8 Oct-8 Nov-8 Dec-8 Jan-9 Feb-9 Mar-9 Apr-9 May-9 Jun-9 Jul-9 Aug-9 Sep-9 Oct-9 Nov-9 Dec-9 Jan-1 Feb-1 Mar-1 4.% Aug-8 Sep-8 Oct-8 Nov-8 Dec-8 Jan-9 Feb-9 Mar-9 Apr-9 May-9 Jun-9 Jul-9 Aug-9 Sep-9 Oct-9 Nov-9 Dec-9 Jan-1 Feb-1 Mar-1 Nov-9 Dec-9 Ward Cleanliness Score 1% 98% 96% 94% 92% 9% 88% source: internal Whittingn surveys source: internal Whittingn surveys 1

9 A S M A S Complaints - numbers Complaints - Dissatisfied Total Complaints Received by Escalation of Complaints 24/5 25/6 26/7 27/8 28/9 % Dissatisfied Complainants 17% 14% 8% 11% 4% No of complaints referred Healthcare Commission No of complaints referred Ombudsman 1 1 Apr-6 Jun-6 Aug-6 Oct-6 Dec-6 Feb-7 Apr-7 Jun-7 Aug-7 Oct-7 Dec-7 Feb-8 Apr-8 Jun-8 Aug-8 Oct-8 Dec-8 Period source: Safeguard Green: within normal SPC parameter AND progress downward step change Amber: within normal SPC parameters and no progress step change Red: lower control limit breach or run of 8 point above the centre line Hospital Cancellations 16.% 15.% 14.% Outpatient Cancellation Rate (by Hospital) see Workforce & Efficiency section for DNA rates Single sex accommodation Each patient counts as a breach for each day that the mixed sex breach occurs Total breach days as a Percentage of occupied bed days in week. 4.5% 4.% 3.5% 3.% % mixed sex breaches 13.% 12.% 2.5% 2.% 1.5% 11.% 1.% 1.% Apr-6 Jun-6 Aug-6 Oct-6 Dec-6 Feb-7 Apr-7 Jun-7 Aug-7 Oct-7 Dec-7 Feb-8 Apr-8 Jun-8 Aug-8 Oct-8 Dec-8 17/11/28 24/11/28 1/12/28 8/12/28 15/12/28 22/12/28 29/12/28 5/1/29 12/1/29 19/1/29 Week beginning 26/1/29 2/2/29 9/2/29 16/2/29 23/2/29 3/2/29 source: PAS data Green: within normal SPC parameter AND progress target (9.5%) Amber: within normal SPC parameters and no progress target Red: lower control limit breach or run of 8 point above the centre line Source: Daily moniring by bed managers Green: within normal SPC parameter AND progress target Amber: within normal SPC parameters and no progress target Red: lower control limit breach or run of 8 point above the centre line Target under consideration 2

10 Priority Targets Access and Targets 18 weeks Referral Treatment (RTT) December Healthcare Acquired Infections source: monthly 18 week report source: weekly Infection Control flash report note: refreshed first week of January 29 % admitted patients treated within 18 weeks against target Clostridium difficile MRSA Actual Target C-diff: Incidents against trajecry 28/9 Apr-8 May-8 Jun-8 Jul-8 Aug-8 Sep-8 Oct-8 Nov-8 Dec-8 Jan-9 Feb-9 Mar-9 Cummulative Incidents PCT Trajecry Sseasonal Trajecry MRSA: Incidents against trajecry 28/9 Apr-8 May-8 Jun-8 Jul-8 Aug-8 Sep-8 Oct-8 Nov-8 Dec-8 Jan-9 Feb-9 Cumm. pre-48 Cumm. post-48 Pre-48 Post-48 Trajecry Mar-9 % non-admitted patients treated within 18 weeks against target Actual Target Apr-7 C-diff: Rolling tals of incidents Jun-7 Aug-7 Oct-7 Dec-7 Feb-8 Apr-8 Jun-8 Aug-8 Oct-8 Dec-8 Feb-9 3 month trajecry 12 month trajecry Rolling 3 month tal Rolling 12 month tal Apr-7 MRSA: Rolling tals of incidents Jun-7 Aug-7 Oct-7 Dec-7 Feb-8 Apr-8 3 month trajecry Rolling 3 month tal 12 month trajecry Rolling 12 month tal Jun-8 Aug-8 Oct-8 Dec-8 Feb-9 1

11 Infection Control: Cases per bed day Access and Targets Comparison with national and regional trends for MRSA bacteraemia rate Source Health Protection Agency.4 rate per 1 bed days Notes C-Diff data follow.5 Apr Jun 21 Oct Dec 21 Apr Jun 22 Oct Dec 22 Apr Jun 23 Oct Dec 23 Apr Jun 24 Oct Dec 24 Apr Jun 25 Oct Dec 25 Apr Jun 26 Oct Dec 26 Apr Jun 27 Oct Dec 27 Apr Jun 28 Trust Region National MRSA screening compliance: Elective Surgical Patients MRSA screening compliance: Emergency Patients 15.% 75.% 1.% 95.% 9.% 85.% 8.% 75.% 7.% Jun-8 Jul-8 Aug-8 Sep-8 Oct-8 Nov-8 Dec-8 Jan-9 Feb-9 Mar-9 Apr-9 May-9 Jun-9 Jul-9 Aug-9 Sep-9 Oct-9 Nov-9 Dec-9 Jan-1 Feb-1 Mar-1 7.% 65.% 6.% 55.% 5.% 45.% 4.% Jun-8 Jul-8 Aug-8 Sep-8 Oct-8 Nov-8 Dec-8 Jan-9 Feb-9 Mar-9 Apr-9 May-9 Jun-9 Jul-9 Aug-9 Sep-9 Oct-9 Nov-9 Dec-9 Jan-1 Feb-1 Mar-1 2

12 Access and Targets Cancelled Operations for non-clinical reasons: November ED attendances: % treated within 4 hours: November Elective Cancellation Rate ED Waits: within 4 Hours 2.% 99.5% 1.5% 99.% 1.%.5%.% national lerance=.8% 98.5% 98.% 97.5% national standard =98% -.5% Apr-6 Jun-6 Aug-6 Oct-6 Dec-6 Feb-7 Apr-7 Jun-7 Aug-7 Period Oct-7 Dec-7 Feb-8 Apr-8 Jun-8 Aug-8 Oct-8 Dec-8 97.% Apr-6 Jun-6 Aug-6 Oct-6 Dec-6 Feb-7 Apr-7 Jun-7 Aug-7 Period Oct-7 Dec-7 Feb-8 Apr-8 Jun-8 Aug-8 Oct-8 Dec-8 source: PAS data source: EDIS data Other national targets National Target Indicars - reviewed by Monir & Healthcare Commission National Target Indicars - reviewed by the Healthcare Commission only (annual health check) Standard Criteria Target Jan-9 YTD Forecast Standard Criteria Target Jan-9 YTD Forecast Reducing Mortality from Cancer Supporting patient choice and booking Wait from GP Referral until Seen % seen within 14 days 98% 1% 1% 1% Choice of dates offered for Outpatient Appointments % of new referrals 1% 1% 1% 1% Wait from Decision Treat until Treatment % treated within 31 days 98% 1% 1% 1% Choice of dates offered for Elective Admission % of decisions treat 1% 1% 1% 1% Wait from GP Urgent Referral until Treatment % treated within 62 days 95% 1% 98.% 98.% Emergency bed-days Inpatients waiting over 26 weeks Number of emergency bed-days 75 9,481 77,24 - GP referred Outpatient waiting over 13 weeks % Drop from last year % -2% - Ensuring patient right of redress following cancelled operations Drug misusers: information, screening and referra Meeting 5 requirements 1% 1% 1% Operations cancelled for non-clinical reasons % of elective admissions <.8%.58%.38%.4% Reducing inequalities in Infant Mortality Offers of new binding date % within 28 days 95% 1% 1% 1% Smoking in pregnancy at time of delivery % of deliveries <17% 11.9% 9.5% <1% Delayed transfers of care Rate of Breastfeeding at birth % of deliveries 78% 87.5% 88.7% 9.% Number of delayed bed-days ,714 Obesity: compliance with NICE guidance 43 1% 1% % delayed patients as a % of all patients <=3.5% 3.4% 2.% <3% Participation in audits n/a Reducing Mortality from Heart Disease Stroke Care new indicar- be confirmed Wait from GP Referral until Seen in RACP Clinic % seen within 14 days 1% 1% 1% 1% Data quality: ethnic coding new indicar- be confirmed Each national core standard number of standards failed Data Quality: maternity data new indicar- be confirmed Diagnostic Overall Green Diagnostic Waits (non audiology) % waiting within 13 weeks 1% 1% 13 weeks Breaches Total diagnostic tests % waiting within 6 weeks - 1% Wait for MRI Scan appointment % waiting within 6 weeks - 1% Wait for CT Scan appointment % waiting within 6 weeks - 1% Wait for Ultrasound appointment (non-obstetric) % waiting within 6 weeks - 1% All other diagnostic tests (non audiology) % waiting within 6 weeks - 1.% 3

13 Strategy Performance Thresholds Dr Fosters data refreshed November 28 Green: within normal SPC parameter AND progress target Amber: within normal SPC parameters and no progress a target Red: lower control limit breach or run of 8 point below the centre line MARKET SHARE TARGET 1% increase in Market Share for all Activity Types by March 29 First Outpatient Attendances Whittingn: Islingn First OP Attendances Whittingn: Haringey First OP Attendances 44.% 34.% 42.% 33.% 4.% 32.% 38.% 31.% 36.% 3.% 34.% Nov-6 Dec-6 Jan-7 Feb-7 Mar-7 Apr-7 May-7 Jun-7 Jul-7 Aug-7 Sep-7 Oct-7 Nov-7 Dec-7 Jan-8 Feb-8 Mar-8 Apr-8 May-8 Jun-8 Jul-8 Aug-8 Sep-8 Oct-8 Nov-8 29.% Nov-6 Dec-6 Jan-7 Feb-7 Mar-7 Apr-7 May-7 Jun-7 Jul-7 Aug-7 Sep-7 Oct-7 Nov-7 Dec-7 Jan-8 Feb-8 Mar-8 Apr-8 May-8 Jun-8 Jul-8 Aug-8 Sep-8 Oct-8 Nov-8 Non-Elective Admissions 54.% Whittingn: Market Share for Islingn Non Elective Admissions 36.% Whittingn: Market Share for Haringey Non Elective Admissions 52.% 34.% 5.% 48.% 46.% 32.% 3.% 44.% 28.% 42.% 26.% 4.% 24.% Nov-6 Dec-6 Jan-7 Feb-7 Mar-7 Apr-7 May-7 Jun-7 Jul-7 Aug-7 Sep-7 Oct-7 Nov-7 Dec-7 Jan-8 Feb-8 Mar-8 Apr-8 May-8 Jun-8 Jul-8 Aug-8 Sep-8 Oct-8 Nov-8 Nov-6 Dec-6 Jan-7 Feb-7 Mar-7 Apr-7 May-7 Jun-7 Jul-7 Aug-7 Sep-7 Oct-7 Nov-7 Dec-7 Jan-8 Feb-8 Mar-8 Apr-8 May-8 Jun-8 Jul-8 Aug-8 Sep-8 Oct-8 Nov-8

14 Strategy Day Case Surgery (General Surgery, Orthopaedics, Urology, ENT, Gynaecology, Pain Management, Gastroenterology only) Whittingn: Market Share for Islingn Day Case Surgery Whittingn: Market Share for Haringey Day Case Surgery 56.% 5.% 54.% 52.% 45.% 5.% 48.% 4.% 46.% 44.% 35.% 42.% Nov-6 Dec-6 Jan-7 Feb-7 Mar-7 Apr-7 May-7 Jun-7 Jul-7 Aug-7 Sep-7 Oct-7 Nov-7 Dec-7 Jan-8 Feb-8 Mar-8 Apr-8 May-8 Jun-8 Jul-8 Aug-8 Sep-8 Oct-8 Nov-8 3.% Oct-8 Nov-6 Dec-6 Jan-7 Feb-7 Mar-7 Apr-7 May-7 Jun-7 Jul-7 Aug-7 Sep-7 Oct-7 Nov-7 Dec-7 Jan-8 Feb-8 Mar-8 Apr-8 May-8 Jun-8 Jul-8 Aug-8 Sep-8 Nov-8 Note: Impact of the Day Treatment Centre starting show Maternity Deliveries Whittingn: Market Share for Islingn Maternity Deliveries Whittingn: Market Share for Haringey Maternity Deliveries 55.% 5.% 5.% 45.% 45.% 4.% 35.% 4.% 3.% 35.% Nov-6 Dec-6 Jan-7 Feb-7 Mar-7 Apr-7 May-7 Jun-7 Jul-7 Aug-7 Sep-7 Oct-7 Nov-7 Dec-7 Jan-8 Feb-8 Mar-8 Apr-8 May-8 Jun-8 Jul-8 Aug-8 Sep-8 Oct-8 Nov-8 25.% Oct-8 Nov-6 Dec-6 Jan-7 Feb-7 Mar-7 Apr-7 May-7 Jun-7 Jul-7 Aug-7 Sep-7 Oct-7 Nov-7 Dec-7 Jan-8 Feb-8 Mar-8 Apr-8 May-8 Jun-8 Jul-8 Aug-8 Sep-8 Nov-8

15 Strategy

16 Workforce & Efficiency Period: January 29 Average Length of Stay (acute specialties only) Day Case Surgery Rate Average Length of Stay (acute) Surgery DC% 1. 85% % 75% 7% 65% target 4. 6% Apr-6 Jun-6 Aug-6 Oct-6 Dec-6 Feb-7 Apr-7 Jun-7 Aug-7 Oct-7 Dec-7 Feb-8 Apr-8 Jun-8 Aug-8 Oct-8 Dec-8 Apr-6 Jun-6 Aug-6 Oct-6 Dec-6 Feb-7 Apr-7 Jun-7 Aug-7 Oct-7 Dec-7 Feb-8 Apr-8 Jun-8 Aug-8 source: PAS data source: PAS data Green = within normal SPC parameters Green: achieving or above target >= 75% Amber = no progress target (.8 days reduction) Amber = less 75% and no adverse SPC statistical tests met Red: upper control limit breach or run of 8 points above centre line (average) Red: lower control limit breach or run of 8 points below centre line (average) Oct-8 Dec-8 DNA Rate (Outpatients) DNA Rate First Outpatient Attendances DNA Rate Follow up Outpatient Attendances 17.% 17.5% 16.% 17.% 15.% 14.% 13.% target 16.5% 16.% 15.5% 15.% target 12.% 14.5% 14.% 11.% 13.5% Apr-6 Jun-6 Aug-6 Oct-6 Dec-6 Feb-7 Apr-7 Jun-7 Aug-7 Oct-7 Dec-7 Feb-8 Apr-8 Jun-8 Aug-8 Oct-8 Dec-8 source: PAS data source: PAS data Green = within normal SPC parameters or a positive test met Green = within normal SPC parameters or a positive test met Amber = no progress target (13.5%) Amber = no progress target (14.5%) Red: upper control limit breach or run of 8 points above centre line (average) Red: upper control limit breach or run of 8 points above centre line (average) Apr-6 Jun-6 Aug-6 Oct-6 Dec-6 Feb-7 Apr-7 Jun-7 Aug-7 Oct-7 Dec-7 Feb-8 Apr-8 Jun-8 Aug-8 Oct-8 Dec-8 1

17 Workforce & Efficiency Outpatient Follow Up ratio Target be confirmed following SLA agreement with PCTs Outpatient Follow up ratio 2.4 Theatre Utilisation Not updated - data not available New Theatre Management System being installed in Apr-6 Jun-6 Aug-6 Oct-6 Dec-6 Feb-7 Apr-7 Jun-7 Aug-7 Oct-7 Dec-7 Feb-8 Apr-8 Jun-8 Aug-8 Oct-8 Dec-8 source: PAS data Green = within normal SPC parameters Amber = no progress target - once agreed Red: upper control limit breach or run of 8 points above centre line (average) Sickness Absence Rate Vacancy Rate Sickness Absence Rate Vacancy Rate 7.% 6.5% 6.% 5.5% 5.% 4.5% target 17.% 16.5% 16.% 15.5% 15.% 14.5% 14.% 4.% Apr-7 May-7 Jun-7 Jul-7 Aug-7 Sep-7 Oct-7 Nov-7 Dec-7 Jan-8 Feb-8 Mar-8 Apr-8 May-8 Jun-8 Jul-8 Aug-8 Sep-8 Oct-8 Nov-8 Dec % Apr-7 May-7 Jun-7 Jul-7 Aug-7 Sep-7 Oct-7 Nov-7 Dec-7 Jan-8 Feb-8 Mar-8 Apr-8 May-8 Jun-8 Jul-8 Aug-8 Sep-8 Oct-8 Nov-8 Dec-8 source: ESR Green = within normal SPC parameters or a positive test met Amber = no progress target Red: upper control limit breach or run of 8 points above centre line (average) source: ESR Green = within normal SPC parameters or a positive test met Amber = no progress target - target be determined Red: upper control limit breach or run of 8 points above centre line (average) 2

18 Finance Charts detailing information included in dashboard ly Performance Year To Date Performance Full Year Forecast Performance Weighted Weighted Risk rating Weighting Metric Description Metric Value Rating Weighting Metric Description Metric Value Rating Value Value 1% EBITDA achieved (% of plan) % EBITDA achieved (% of plan) The rating is based on the Monir methodology 25% EBITDA margin (%) % EBITDA margin (%) N/A 2% Return on Assets (%) % Return on Assets (%) A working capital facility of 11m is assumed for the liquidity calculation 2% I&E surplus margin (%) % I&E surplus margin (%) % Liquid ratio (days) % Liquid ratio (days) Overall rating 3.35 Overall rating 3.3 This is shown as GREEN in the dashboard as it is >= 3 This is shown as GREEN in the dashboard as it is >= 3 Overall Income & Expenditure Overall I&E - In- Performance Overall I&E - Cumulative Performance Overall I&E - Cumulative Performance Forecast (Likely Case) Forecast performance included here is a surplus of 2m, in line with plan 1, , -1,5 Apr-7 Plan May- 7 Jun-7 Jul-7 Actual Aug- 7 Sep- 7 Oct-7 Nov- 7 Dec- 7 Jan-8 Feb-8 Mar-8 2,5 2, 1,5 1, , -1,5 Plan Apr- 7 May- 7 Actual Jun- 7 Jul- 7 Aug- 7 Sep- 7 Oct- 7 Nov- 7 Dec- 7 Jan- 8 Feb- 8 Mar- 8 2,5 2, 1,5 1, , -1,5 Plan Apr-7 May-7 Jun-7 Actual/Forecast Jul-7 Aug-7 Sep-7 Oct-7 Nov-7 Dec-7 Jan-8 Feb-8 Mar-8 An in-month I&E surplus of 215k against a planned surpluse of 528k giving a negative variance of 313k in the month. Within this, income is 1k below plan, expenditure is 328k above plan and depreciation is 53k below plan this month Cumulative performance is a surplus of 1,737k against a planned surplus of 2,19k giving an adverse variance of 283k. The high year--date planned surplus is due a planned deficit in February (as a result of a shorter month and therefore lower income) which forms part of the plan achieve 2m surplus by the year-end. Within this, income is 1,414k above plan, expenditure is 2,284k above plan, and depreciation is 628k below plan date I&E forecast of 2m surplus, based on likely case. This is based on an updated 'botm up' 1 forecast and is primarily due a number of non-recurrent items such as depreciation savings and income from PCTs for maternity and reducing waiting lists. Performance against SLA - 1 month lag December overperformance was 515k in-month - this is before taking in account additional income targets, e.g. for DTC activity. 9,6 9,4 9,2 9, 8,8 8,6 8,4 8,2 8, 7,8 7,6 Plan Performance against SLA / NCA Plan - In- Apr- 8 May- 8 Actual Jun- 8 Jul-8 Aug- 8 Sep- 8 Oct- 8 Nov- 8 Dec- 8 Jan- 9 Feb- 9 Mar- 9 12, 1, 8, 6, 4, 2, Performance against SLA / NCA Plan - Cumulative Apr- 8 May- 8 Jun- 8 Jul- 8 Aug- 8 Sep- 8 Plan Oct- 8 Nov- 8 Actual Dec- 8 Jan- 9 Feb- 9 Mar- 9 SLA / NCA Plan - Cumulative Performance Forecast (Likely Case) Forecast is achieve SLA value: however, additional activity is needed meet higher income 12, targets for DTC activity and for risk-adjusted demand management. 1, 8, 6, 4, 2, Apr- 8 May- 8 Jun- 8 Jul- 8 Aug- 8 Plan Sep- 8 Oct- 8 Nov- 8 Dec- 8 Actual/Forecast Jan- 9 Feb- 9 Mar- 9 Activity is now 3,798k above SLA plans (excluding additional targets such as DTC activity) after 9 months Forecast overperformance of 6m at year-end, primarily due increasing DTC activity. However, likely case forecast includes provisions for non-payment for follow-up outpatients above SLA target ratios, and for N12 maternity admissions that may require reimbursement.

19 Cost Improvement Plan CIP Performance - In Apr-8 May- Jun- Jul-8 Aug- Sep- Oct-8 Nov- Dec- Jan-9 Feb Target Achieved Mar- 9 CIP Performance - Cumulative 4,5 4, 3,5 3, 2,5 2, 1,5 1, 5 Apr-8 May-8 Jun-8 Jul-8 Aug-8 Sep-8 Oct-8 Nov-8 Dec-8 Jan-9 Feb-9 Mar-9 Ytd Target Ytd Achieved CIP - Cumulative Performance Forecast (Likely Case) 5, Forecast chart be developed for 6 4,5 4, 3,5 3, Shown 2,5 as amber in the dashboard, as there is slippage on a year date basis and 2,forecasts are currently being confirmed 1,5 1, 5 Apr-8 May-8 Jun-8 Jul-8 Aug-8 Sep-8 Oct-8 Nov-8 Dec-8 Jan-9 Feb-9 Mar-9 Ytd Target Actual/Forecast CIP performance in January was around 15k above plan. This was partially due additional income from Reckitt and Eddingn wards wards the CIP figure, offsetting the CIP for closing the wards. Cumulative performance (inclusive of non-recurrent CIP) remains above target at the end of January CIP is forecast be.6m above plan at year-end (including non-recurrent items), primarily due including additional income due Reckitt and Eddingn wards being open for the winter. Recurrent CIP is forecast be 1k below plan. Cash position against plan In- position for 1 (January 29) Rolling Cashflow Forecast 6, The closing Balance at the end of December was 3.2m which is higher than previously forecast by.9m, primarily due a later than usual invoice for the Managed Equipment Service that was therefore not paid in January as anticipated. 5, 4, 3, 2, 1, Apr-8 May-8 Jun-8 Jul-8 Aug-8 Sep-8 Oct-8 Forecast Achieved Nov-8 Dec-8 Jan-9 Feb-9 Mar-9 Apr-9 May-9 Jun-9 Jul-9 Aug-9 Sep-9 Oct-9 Nov-9