The Doctor won t. Patients locked out of Cameron s NHS

Transcription

1 The Doctor won t see you now: Patients locked out of Cameron s NHS

2 The Doctor won t see you now: Patients locked out of Cameron s NHS REVEALED: NEW EVIDENCE SHOWS PATIENT CARE IS SUFFERING AS A RESULT OF ANOTHER NHS BROKEN PROMISE BY DAVID CAMERON PATIENTS STRUGGLE FOR APPOINTMENTS AS GP PRACTICES END EVENING AND WEEKEND OPENING AND WALK- IN CENTRES CLOSE A&E VISITS INCREASE BY 1 MILLION THIS YEAR CORRIDOR TROLLEY WAITS DOUBLE Labour conducts survey of GP opening hours to establish true picture after the Department of Health drops national data collection. Survey shows 5.7% drop, equivalent to 477 GP surgeries across England, opting out of offering evening and weekend appointments in the last year. In 2011/12, half of PCTs in England report a drop in the number of GP surgeries offering opening hours during evenings and weekends - the first- ever drop since the extended hours service was introduced. The following PCTs have seen the biggest falls: Hartlepool (31.3%), Newcastle (25%) and Haringey (24.3%). In addition, analysis of weekly NHS hospital activity statistics shows there are now 26 fewer non- hospital providers of emergency care compared to June NHS Walk- in Centres have closed (Bolton; Barnsley; Victoria (London); Ashfield (Nottinghamshire); Stapleford (Nottinghamshire); Tooting (London); Newcastle Central; Leeds (The Light, Headrow); Salford (Pendleton); Manchester Piccadilly; Manchester Withington; Haringey (London)) and further closures are planned adding to the difficulties families are facing in getting access to care.

3 Submissions to NHS Check indicate that people are waiting up to three weeks for GP appointments. Pressure builds on A&E departments as patients options become more limited: 1 million extra visits to A&E are recorded this year and corridor trolley waits double. More patients are waiting longer in A&E as 46 NHS trusts are missing the Government s lowered A&E standard with some dipping below 90%. Labour s NHS Check website ( receives reports of widespread problems in booking GP appointments as Department of Health figures show increased demand for evening and weekend appointments. Before the General Election David Cameron made a specific promise saying: Under the Conservatives you will now be able to see a GP in your area until 8pm seven days a week. This will make a huge difference to all those people who struggle to get an appointment with a GP at a time that suits them. David Cameron, Daily Mail, 12 April 2010 Labour calls on the Government to: 1. Restore the national survey of GPs opening hours and instruct CCGs that it remains a priority. 2. Work to restore GP extended opening hours to 2010/11 levels with immediate effect. 3. Call a halt to the closure of NHS Walk- in Centres pending a review. 4. Take urgent action to ensure all A&Es in England are meeting the 4- hour target. 5. Investigate and publish the reasons why the Govt believes GP extended opening hours are declining. Introduction The NHS in England is currently undergoing is biggest- ever top- down re- organisation at the same time as facing the toughest financial challenge in its 64- year history. This has led to concerns that standards of patient care will deteriorate. To monitor the situation, Labour introduced its NHS Check website earlier this year. This aim was to give people a simple way of reporting their experiences with NHS care and expose the reality of what is happening on the ground in the NHS. The issues being reported through NHS Check, including the rationing of treatments exposed in June s NHS Report and the restrictions on access to GPs detailed in this report, point to the effects of the Government s reorganisation.

4 Labour has said all along that the Government s reorganisation combined with the financial challenge will have a destabilising effect on the NHS which will negatively impact on services for patients. Since NHS Check opened in May, 1,352 people have reported problems with deteriorating standards. It quickly became clear to us that one of the most common complaints received was from people reporting difficulties in accessing timely and convenient GP appointments. Here is a selection of the reports that NHS Check has received: My 4 year old son was rather poorly last week, I kept him off school, phoned the local doctors surgery and to my dismay I was held at 19th in the queue. When I finally spoke to the receptionist she told me there were no more appointments left! I was fuming to say the least. Mr K. (Hartlepool) When I couldn t get my elderly mother an appointment to see her doctor last month, we took her down to the Accident & Emergency. Her illness wasn t an emergency but I felt we had little choice. Mrs P. (Essex) After contacting GP surgery informed I would have to wait 8 days for an appointment which I feel is excessive. If I feel I am unwell I need to see my GP sooner than that. If I have a serious illness I need it treated or referred to appropriate specialist quickly, if not, I need reassurance. Ms C. (Birmingham) Waiting times at our local GP surgery for a routine appointment are now two to three weeks. My son has bad eczema but not an emergency and I think 2 and a half weeks for an appointment is ridiculous. Ms G. (Birmingham)

5 It is impossible to get an appointment at my GP's. The response for an urgent appointment is "ring up at 8.00 tomorrow morning" the outcome of that is engaged tone for at least ten minutes then "sorry all appointments have been taken try tomorrow". This is a relatively new experience I think there must be a shortage of doctors. Mrs B. (Keighley) I have not been unfortunate enough to have to visit my doctor but I have heard of people who are very disgruntled with the NHS particularly our village surgery whereby the wait for an appointment can be a long one. Mr P. (Wellingborough) Waiting time to see a GP at our surgery is now 2 weeks. Also, I have a 89 year old mother who is currently having a few health issues resulting in regular appointments at hospital. These appointment times are never met. Each consultation is at least 1 1/2 hours late. Mr P. (Wallington) My wife rang up to make an appointment to see the doctor as she has had a cough for 4 weeks and was told no appointments available for 3 weeks and that my wife should go to the walk in centre. The receptionist insists she had " had a cough for 4 weeks so what of it" and that there was no way of seeing the doctor any sooner, but the government are running adverts telling people to see their doctor if you have had a cough for '3 weeks or more'. This has been fairly typical of late in trying to get appointments with my wife's surgery. Mr G. (Norwich) In our GP's surgery - there are now days during the week when the surgery is closed due to 'training days'!! I rang up one day because I had a sick child to find that I had to ring Mdoc - emergency doctors - which I did - but after trying to get through for 30mins gave up. Mrs G. (Bromley) Unable to get an appointment within 48hrs at the GP surgery despite having a chronic condition, MS. When Labour were in Government I was able to get 1 within 48hrs. I dread to think what will happen when the GPs have control over all the health budget if we can't get to see them promptly. Ms S. (Stockport)

6 I used to be able to make a GP appointment within a few days and get a choice of several Doctors, now it's at least a week to see a choice of just one. Ms C. (London, SW18) I cannot get an appointment at my doctors for a week from when I ring. This has only started in the last twelve months. If I rang on one day the latest I got an appointment was two days after. You have to get better now before you get an appointment. Also when my elderly mother aged 85 fell on her cold kitchen floor I was told it would be up to 4 hours for an ambulance. Anon Prompted by these reports, Labour decided to conduct a survey of all PCTs/CCGs in England to establish the true picture on GP opening hours. PCTs were asked to provide figures on the number of GP practices offering extended opening hours in 2010/11 and 2011/12. Some also provided information for 2012/13. Overall, information has been received from 91 Primary Care Trusts (PCTs) in England. More than two thirds of the data was directly provided by Primary Care Trusts and data given to the Health Service Journal earlier this year has been used for 27 PCTs. The HSJ data was collected through Freedom of Information requests and included deprivation scoring ( care/exclusive- poor- patients- face- shorter- gp- opening- hours/ article). KEY FINDINGS Fewer GP surgeries offered extended hours opening in 2011/12 compared to 2010/11 Over half of PCTs (56% / 51 PCTs) reported a decrease in the number of surgeries offering extended opening hours in the last year; a third (32% / 29 PCTs) reported a flat- lining following consecutive increases under Labour. Amongst the 91 PCTs, 234 fewer GP surgeries offered extended opening hours in 2011/12 compared to 2010/11. PCTs registered a 5.7% decrease from 4087 to the first fall since the initiative started. If applied across England, a six per cent reduction in practices offering evening and weekend opening across the 8316 practices equates to 477 GP surgeries opting out.

7 Only 11 PCTs reported an increase in the number of surgeries seeing patients during evening and weekends with one or two additional practices. Of areas losing large numbers of surgeries, the 10 PCTs most affected were: v Hartlepool 15 of 16 down to 10 of 16 surgeries. Was 93.8% now 62.5%. Decrease of 31.3%. v Newcastle 33 of 36 down to 24 of 36 surgeries. Was 91.7% now 66.7%. Decrease of 25%. v Haringey 47 of 51 down to 36 of 53 surgeries. Was 92.2% now 67.9%. Decrease of 24.3%. v Central Lancashire 56 of 87 down to 40 of 85 surgeries. Was 64.4% now 47.1%. Decrease of 17.3%. v Ashton, Wigan & Leigh 55 of 65 down to 45 of 65 surgeries. Was 84.6% now 69.2%. Decrease of 15.4%. v Cumbria - 69 of 85 down to 55 of 81 surgeries. Was 81.2% now 67.9%. Decrease of 13.3%. v Hull 38 of 53 down to 30 of 51 surgeries. Was 71.7% now 58.8%. Decrease of 12.9%. v Enfield 55 of 62 down to 45 of 57 surgeries. Was 88.7% now 78.9%. Decrease of 9.8%. v County Durham - 69 of 86 down to 61 to 84 surgeries. Was 80.2% now 72.6%. Decrease of 7.6%. v Medway 53 of 63 down to 47 of 61 surgeries. Was 84.1% now 77.1%. Decrease of 7%. Please see Appendix 1 for full list of PCTs who responded to the survey. Policy context During the 2005 General Election campaign Tony Blair was tackled on live television over difficulties in booking GP appointments and the issue emerged as a major nationwide concern. Following the election, Labour put renewed energy into ensuring patients were able to see their doctor within the 48- hour target. More GP practices were required to offer extended opening hours services to enable patients to see their GP in the evening or at weekends.

8 As incoming Prime Minister in 2007, Gordon Brown made the issue of GP appointments a priority for his Government with the evening and weekend extended opening hours scheme in his first year. "Today we know that too many GP surgeries are not open out of hours or at weekends. We will increase access to existing GP surgeries so that patients can get the services they want at times that are convenient to them and to bring more choice." Gordon Brown, 5 October 2007 Negotiations with the British Medical Association meant that year after year increasing numbers of doctors agreed to keep surgery doors open into the evenings and weekends - allowing patients to book appointments around work and family life. In May 2008, 1,644 GP practices offered extended opening hours out of a total of 8,068 GP practices. In 2009, that figure had increased significantly to 6,322 out of 8,262 GP practices. Yet last year saw the first fall in the number of GP practices offering extended hours. Labour has identified 3 factors which may be behind the drop. 1. The Government s NHS re- organisation has distracted and destabilised the NHS. When maximum grip and focus was needed to deal with the efficiency challenge and maintaining standards of patients care, the Government chose to put the NHS through unnecessary upheaval. As a result, Primary Care Trusts took their eye off the ball due to focussing on enforced changes to structures and the resulting loss of clinical and administrative staff. Primary Care Trusts themselves are being dismantled before the new Clinical Commissioning Groups are ready to take control leading to drift and chaos in the system. 2. The Government s decision to discontinue the national survey, which collected and published the data on the number of GP practices offering extended opening hours in each PCT area, sent a signal that increasing the numbers offering extended opening hours was no longer a priority. 3. As the Government hands over control of the NHS to GPs, excluding other clinicians from commissioning decisions, serious questions are raised over potential conflict of interests. Family doctors have more than a personal interest in decisions surrounding extended surgery hours acting as both the commissioner and the provider they are in an ideal position to heavily influence the provision of primary care. It has raised questions over whether the public interest rather than professional interest will take precedence when decisions about extended opening hours are being made. We are calling on the Government to investigate and publish the reasons for the fall in the number of GP practices offering extended opening hours. An important part of Labour s drive to improve access to primary care was the Walk- In Centre programme, which opened up access to doctors and nurses without the need to make an appointment. Patients had the choice of seeing their own doctor at a more convenient time or visiting a Walk- in Centre for quick access to primary care. In turn the

9 NHS benefited from the cost- effectiveness of keeping expensive A&E visits to a necessary minimum. The cost to the NHS GP An average GP appointment costs the NHS 25 Walk- in- centre Each visit to a walk- in centre costs the NHS from 63 A&E A visit to A&E can cost the NHS from 59 to 117 It is far more cost effective to the NHS for patients to be seen by their GP in the first instance. The costs of patients going directly to A&E is potentially far more than if they were to go to a walk- in centre, but in addition to the cost issue, the increase in patients referring straight to A&E departments puts added pressure on those departments. Another Cameron broken promise As with many other successful Labour policies on the NHS, David Cameron promised at the election to keep the family- friendly hours. In fact, during the General Election campaign, he made a specific promise to go even further: Under the Conservatives you will now be able to see a GP in your area until 8pm seven days a week. This will make a huge difference to all those people who struggle to get an appointment with a GP at a time that suits them. David Cameron, Daily Mail, 12 April 2010 Yet the opposite is happening. On Cameron s watch, patients in practices across England are seeing evening and weekend openings being stopped. Yet now that surgery hours are being reduced and Walk- in Centres are closing, A&E units are placed under increasing strain - exposing the growing gap between David Cameron s hollow promises and the reality of a shrinking NHS under his Government. David Cameron promised: No top- down reorganisation of the NHS BROKEN The Government promised no top- down reorganizations of the NHS, a promise included in the Coalition Agreement. Yet they imposed the biggest reorganisation of the NHS in its 64- year history and at a time of financial challenge.

10 To increase spending on the NHS for every year of this Parliament BROKEN The Government promised to increase spending on the NHS for every year of this Parliament, yet figures show that spending on the NHS has fallen for the each of the last two years. Treasury figures released recently (Public Expenditure Statistical Analyses 2012) show that in the current year 2011/12 the Government has cut spending on the NHS by 20m and in 2009/10 to 2010/11 by 766m. A moratorium on hospital closures BROKEN Before the General Election David Cameron and Andrew Lansley posed for photos promising a moratorium on hospital closures. Since the election hospital closures have continued. No rationing of treatments based on cost BROKEN Health Ministers have repeatedly said that treatments must not be rationed for reasons of cost and that if evidence were presented they would act. Last month Labour presented a dossier of evidence showing 125 treatments being rationed across England, a number of them based on cost. This was supported by an RNIB survey of PCTs/Trust about cataract treatments which also showed the treatment being rationed due to cost rather than clinical need. Access to GPs surgeries at evenings and weekends BROKEN Before the election David Cameron promised that patients would be able to see a GP up to 8pm, 7 days a week. This report exposes the reality on the ground where walk- in centres are being closed, fewer GPs are offering extended hours and there is growing pressure on A&Es. Patient survey reveals increased demand for evening/weekend opening An official Department of Health 1 survey of patient satisfaction with GP services has revealed that the demand for surgeries to open before 8am, in the evenings and at weekends has increased in the last year. Responses from patients in 2009/10 primarily (52%) called for surgeries to be open on Saturdays, with only 26% calling for evening appointment and 4% on a Sunday. Yet two years later the 2011/12 data shows an even higher percentage wanting Saturday surgery (71%), an almost trebling of patients wanting evening appointments (66%) and calls for Sunday rocketing to 29%. 1 patient.co.uk/results/download/_y6q2/y6w2_pct_unweighted.xls

11 NHS Walk- in Centres closed, facing closure or hours cut back Next Tuesday (31 st July) another NHS Walk- in Centre will close its doors to patients. Yet the Department of Health has admitted to not keeping track of their closures. Analysis of weekly NHS hospital activity statistics, by the House of Commons library, show there are now 26 fewer non- hospital providers of emergency care (including urgent care units) compared to June a 25% reduction. Visits to Walk- in Centres increased annually until 2009/10 and relieved pressure on A&E departments by providing easy access to treatment for minor ailments. Yet in 2010/11 visits dropped from 2,699,798 to 2,486,793 as centres began to close their doors resulting in more patients visiting A&E with non- urgent cases. Since May 2010: Bolton Closure expected: 31/7/12 Barnsley Walk- in Centre Closed: 30/11/11 Victoria (London) Walk- in Centre Closed: December 2011 Ashfield (Nottinghamshire) Closed: September 2011 Stapleford (Nottinghamshire) Closed: September 2011 Tooting (London) Closed: 2011 Newcastle Central Closed: May 2011 Leeds (The Light, Headrow) Closed: 30/11/11 Salford (Pendleton) Closed: 1/9/11 Manchester Piccadilly Closed: 2011

12 Manchester Withington Closed: 2011 Haringey (London) Closed: March 2011 Facing threat of closure Tollgate Lodge (London) Springfield Health Centre (London) Reduced opening hours since May 2010 Doncaster Harrow (London) Bedford Stockport Bath Southampton Extra pressure on A&E units Patient numbers increase by 1 million and trolley waits double. The cumulative effect of a number of Government policies is piling pressure on A&E Departments resulting in higher numbers missing their waiting targets and having a dramatic impact on patient care. Whilst the lack of alternative access to care for minor injuries and non- urgent conditions has driven patient visits up, cuts to local authority social care budgets have left increasing numbers of older people turning to A&E at the same time as nursing job losses have left the frontline under- resourced. A&Es across England recorded close to 1 million extra visits in 2011/12 compared to 2009/10 as the annual number of visits rose from 20,511,908 to 21,480,589. The number of people waiting longer than 4 hours in A&E to be admitted to hospital, so- called trolley waits, also doubled in a single year - from 51,569 in 2010/11 to 106,945 in

13 2011/12, according to the Department of Health s weekly statistics 2. Whilst 8- hour long trolley waits had more than doubled between 2009/10 and 2010/11 4,972 to 10,525 in just 61 hospital trusts, according to a new Freedom of Information request by the Labour Party. The statistics confirm fears raised by the Royal College of Nursing in May 2012 who stated that more than half of A&E nurses reported daily sightings of patients treated in corridors, whilst a fifth said they saw this happening hourly 3. At present 46 hospital trusts are on average missing the A&E target to treat 95% of patients within 4 hours. The ten worst performing A&E trusts this year according to the Government s target are: NOTTINGHAM UNIVERSITY HOSPITALS NHS TRUST 85.45% CROYDON HEALTH SERVICES NHS TRUST 89.19% MAIDSTONE AND TUNBRIDGE WELLS NHS TRUST 89.84% MID ESSEX HOSPITAL SERVICES NHS TRUST 90.14% HAMPSHIRE HOSPITALS NHS FOUNDATION TRUST 90.30% MILTON KEYNES HOSPITAL NHS FOUNDATION TRUST 90.54% NORTH WEST LONDON HOSPITALS NHS TRUST 91.08% HEART OF ENGLAND NHS FOUNDATION TRUST 91.35% UNIVERSITY HOSPITALS OF LEICESTER NHS TRUST 91.65% UNIVERSITY HOSPITAL SOUTHAMPTON NHS FOUNDATION TRUST 91.66% Please see Appendix 2 for a full list of trusts failing to meet the Government s lowered 95% target. Government letting patients pay the price Patients suffering from minor injuries or conditions want the quickest possible access to primary care. More available appointments with the family GP at evenings and weekends, in addition to centres treating patients without pre- booking, helped to keep the pressure off A&E. Patients felt more comfortable presenting themselves at a doctor s surgery or Walk- in centre with a seemingly minor ailment - yet whilst many appear to have turned to A&E, others will not have sought any other professional medical advice in its place. David Cameron s recent Health & Social Care Act has given control of NHS budgets to GPs at a time of unprecedented financial challenges within the NHS and against a background of growing patient need. In stark contrast to his pre- election promises, David Cameron has betrayed the NHS budget cuts, staff losses and ward closures and the Department of Health s own data shows that patients are paying the price. The Department of Health incredibly - does not know how many Walk- in Centres are being lost and can only confirm that the GP- led Clinical Commissioning Groups have the power to 2 ae- sitreps / 3

14 close them down. There could be no clearer illustration of random chaos of the NHS re- organisation as the Government tries to wash its hands of service reductions on the ground. The Government offers warm words on moving health care into the community and away from the hospital yet primary care access is being drastically slashed while social care budget cuts damage long term care provision. It abandoned Labour s strict 98% A&E target soon after the General Election and now curbed access to primary care has contributed to the factors applying fresh pressure on A&E units across England. Patients are left facing longer waits for a GP appointment and longer waits in A&E - experiences widespread amongst contributors to Labour s NHS Check. Conclusion David Cameron urgently needs to set out a convincing plan for how he will deliver his election promise of all patients having access to GPs open in the evening. Specifically Labour makes these calls on the government: Labour calls on the Government to: 1. Restore the national survey of GPs opening hours and instruct CCGs that it remains a priority. 2. Work to restore GP extended opening hours to 2010/11 levels with immediate effect. 3. Call a halt to the closure of NHS Walk- in Centres pending a review. 4. Take urgent action to ensure all A&Es in England are meeting the 4- hour target. 5. Investigate and publish the reasons why the Govt believes GP extended opening hours are declining.

15 Appendix PCT Number of GP practices offering extended hours Total number of GP practices Number of GP practices offering extended hours Total number of GP practices Ashton, Leigh & Wigan Barnet Barnsley Bassetlaw Bath and North East Somerset Blackburn Blackpool Bolton Bournemouth and Poole Bradford Airedale Brighton and Hove Bristol Buckinghamshire Bury Calderdale Cambridgeshire Camden Central and Eastern Cheshire Central Lancashire City & Hackney County Durnham Cornwall Coventry Cumbria Derby City Derbyshire County Doncaster Dorset Dudley East Lancashire East Riding of Yorkshire Enfield ESDW Great Yarmouth and 24 24

16 Waveney Hampshire Haringey Hartlepool Hastings and Rother Hertfordshire Heywood, Middleton & Rochdale Hull Isle of Wight Islington Kensington & Chelsea Kingston Kirklees Leeds Lincolnshire Liverpool Luton Medway Middlesborough Milton Keynes Newcastle Newham Norfolk North Tyneside Northamptonshire Nottingham City Oldham Oxfordshire Peterborough Plymouth Portsmouth Redcar and Cleveland Richmond Sandwell Sefton Somerset South Gloucestershire Southampton Stockport Stockton on Tees Suffolk Surrey Swindon Tameside and Glossop 27 18

17 Telford Torbay Tower Hamlets Trafford Wakefield District Walsall Warrington Warwickshire West Kent West Sussex Western Cheshire INCOMPARABLE DATA Westminster Wirral Wolverhampton Total

18 Appendix 2 NHS Hospital Trust Percentage in 4 hours - Major A&E NOTTINGHAM UNIVERSITY HOSPITALS NHS TRUST 85.4% CROYDON HEALTH SERVICES NHS TRUST 89.2% MAIDSTONE AND TUNBRIDGE WELLS NHS TRUST 89.8% MID ESSEX HOSPITAL SERVICES NHS TRUST 90.1% HAMPSHIRE HOSPITALS NHS FOUNDATION TRUST 90.3% MILTON KEYNES HOSPITAL NHS FOUNDATION TRUST 90.5% NORTH WEST LONDON HOSPITALS NHS TRUST 91.1% HEART OF ENGLAND NHS FOUNDATION TRUST 91.4% UNIVERSITY HOSPITALS OF LEICESTER NHS TRUST 91.7% UNIVERSITY HOSPITAL SOUTHAMPTON NHS FOUNDATION TRUST 91.7% PETERBOROUGH AND STAMFORD HOSPITALS NHS FOUNDATION TRUST 91.7% CAMBRIDGE UNIVERSITY HOSPITALS NHS FOUNDATION TRUST 91.8% NORTH BRISTOL NHS TRUST 92.2% NORTH MIDDLESEX UNIVERSITY HOSPITAL NHS TRUST 92.4% SHERWOOD FOREST HOSPITALS NHS FOUNDATION TRUST 92.6% WEST HERTFORDSHIRE HOSPITALS NHS TRUST 92.9% ISLE OF WIGHT NHS TRUST 92.9% GATESHEAD HEALTH NHS FOUNDATION TRUST 93.0% CITY HOSPITALS SUNDERLAND NHS FOUNDATION TRUST 93.3% SOUTH WARWICKSHIRE NHS FOUNDATION TRUST 93.3% FRIMLEY PARK HOSPITAL NHS FOUNDATION TRUST 93.4% ROYAL UNITED HOSPITAL BATH NHS TRUST 93.4% ST HELENS AND KNOWSLEY HOSPITALS NHS TRUST 93.5% DONCASTER AND BASSETLAW HOSPITALS NHS FOUNDATION TRUST 93.6% HEATHERWOOD AND WEXHAM PARK HOSPITALS NHS FOUNDATION TRUST 93.6% GREAT WESTERN HOSPITALS NHS FOUNDATION TRUST 93.7% ALDER HEY CHILDREN'S NHS FOUNDATION TRUST 93.8% BARNET AND CHASE FARM HOSPITALS NHS TRUST 93.8% YORK TEACHING HOSPITAL NHS FOUNDATION TRUST 93.8% COUNTY DURHAM AND DARLINGTON NHS FOUNDATION TRUST 93.9% BARKING, HAVERING AND REDBRIDGE UNIVERSITY HOSPITALS NHS TRUST 94.0% MID STAFFORDSHIRE NHS FOUNDATION TRUST 94.1% GLOUCESTERSHIRE HOSPITALS NHS FOUNDATION TRUST 94.1% ROYAL FREE LONDON NHS FOUNDATION TRUST 94.1% THE ROYAL WOLVERHAMPTON HOSPITALS NHS TRUST 94.1% WORCESTERSHIRE ACUTE HOSPITALS NHS TRUST 94.2% EALING HOSPITAL NHS TRUST 94.4%

19 SHEFFIELD TEACHING HOSPITALS NHS FOUNDATION TRUST 94.4% ROYAL DEVON AND EXETER NHS FOUNDATION TRUST 94.5% THE PRINCESS ALEXANDRA HOSPITAL NHS TRUST 94.6% WARRINGTON AND HALTON HOSPITALS NHS FOUNDATION TRUST 94.6% BIRMINGHAM CHILDREN'S HOSPITAL NHS FOUNDATION TRUST 94.7% SOUTH DEVON HEALTHCARE NHS FOUNDATION TRUST 94.7% BURTON HOSPITALS NHS FOUNDATION TRUST 94.7% ST GEORGE'S HEALTHCARE NHS TRUST 94.7% HOMERTON UNIVERSITY HOSPITAL NHS FOUNDATION TRUST 94.8% SOUTH TYNESIDE NHS FOUNDATION TRUST 95.1% LEWISHAM HEALTHCARE NHS TRUST 95.2% NORTH CUMBRIA UNIVERSITY HOSPITALS NHS TRUST 95.3% SANDWELL AND WEST BIRMINGHAM HOSPITALS NHS TRUST 95.3% SOUTHPORT AND ORMSKIRK HOSPITAL NHS TRUST 95.3% UNIVERSITY HOSPITALS BRISTOL NHS FOUNDATION TRUST 95.4% WIRRAL UNIVERSITY TEACHING HOSPITAL NHS FOUNDATION TRUST 95.5% UNIVERSITY HOSPITAL OF SOUTH MANCHESTER NHS FOUNDATION TRUST 95.8%