Performance of the NHS Provider Sector month ended 30 June 2017

Transcription

1 Performance of the NHS Provider Sector month ended 30 June 2017

2 Contents Overview Q1 Performance comparison 2.2 Income & expenditure 2.3 Income analysis 1.0 Operational performance 2.4 Pay and agency costs 1.1 Operational performance overview 2.5 Non-pay cost pressures 1.2 Accident & emergency (A&E) 2.6 Efficiency savings 1.3 Diagnostic waiting times 2.7 Capital expenditure 1.4 Elective waiting times 2.8 Year-end financial position 1.5 Cancer waiting times 3.0 Financial performance by providers 1.6 Ambulance response times 4.0 Operational performance by providers 1.7 Infection control 5.0 Timetable of future publications 2.0 Financial performance End notes and glossary 2.1 Financial performance overview 2

3 Overview It is still early in the financial year; however, the latest financial results indicate that the provider sector is broadly achieving the financial plan at Q1 for the second year in a row. This strong performance builds on the financial resilience demonstrated in 2016/17, when despite the exceptional unplanned demand for hospital-based care, the sector bucked the trend of recent years and made a 1.7 billion financial improvement. Underlying this improvement in the reported financial position was the delivery of 2.3bn of recurrent cost savings, and a further 0.8bn of non-recurrent savings. This improvement was, therefore, dependent on non-recurrent items which do not address the longer term financial sustainability of many providers. This means that 2017/18 will be another financially challenging year. Building on the financial achievements of last year, the focus for the provider sector this year is to accelerate the financial recovery trajectory on a recurrent basis and to make steady progress towards delivering better care and access for patients, especially those requiring urgent and emergency care (UEC). Operationally, the position is still extremely challenging. The number of elective patients waiting for NHS treatment in England has exceeded 3.6 million for the first time since the waiting time target was introduced in August Historically, this was due to demand for treatment exceeding the capacity available, but in recent months, GP referrals have started to reduce. However, any benefit from reduced referrals has been offset by extremely high levels of bed occupancy, which continue to affect the sector s ability to admit patients who require planned care, and also impacts more generally on hospitals ability to care for patients in a timely, effective manner. The increase in occupancy is in part a result of increased emergency pressure, where the sector has seen a 3.81% increase in emergency admissions via A&E compared to the same period last year. There has also been a lack of progress in reducing delayed discharges. Since the government announced 1 billion investment for adult social care in March 2017, the level of delayed transfers of care has increased. To address this, it will be essential for local health and care systems to work together to ensure sufficient beds are available so that patients can continue to rely on safe, high quality care over the busy winter period. Data published by NHS England showed that A&E performance of 90.29% at Q1 has met the national ambition of delivering 90% by September However, to achieve the national standard of 95% by the end of the year remains challenging. The national UEC programme is now building momentum and winter planning is gathering pace to ensure that NHS is on track to meet this. 3 The NHS provider sector has also had to respond to de-stabilising serious incidents that affected our workforce and activity levels, including: cyber attacks - some trusts suffered severe disruption due to a global ransomware attack. Following the attack some hospitals were forced to cancel routine surgery as they recovered; terrorist attacks in Manchester and London frontline staff responded compassionately to those injured in these tragic events; they responded with courage as terrorist threat warnings were raised to the highest level and the NHS was asked to prepare for further attacks; fire at Grenfell Tower - the most immediate impact within the NHS was on the staff that treated the patients from the fire and on those acute trusts whose buildings are covered with cladding that fails safety tests.

4 Overview - continued The provider sector is planning for a deficit of 496 million by the end of 2017/18. This figure is derived from aggregating provider plans and depends on assumptions around risk management, agreed activity levels and beds being freed up. Resolving the issues preventing patients leaving hospital is vital to enable providers to achieve levels of productivity they plan. The majority of providers have once again set themselves stretching plans to achieve value for money. So far, 206 out of 233 (88%) providers have accepted a control total and 166 (71%) were at or above plan at Q1. To support financial sustainability a further 1.8 billion from the Sustainability and Transformation Fund (STF) has been made available to providers for 2017/18. As in 2016/17, this year s STF will also be used to incentivise financial improvement through agreed financial control totals. NHS Improvement and NHS England have agreed that the general element of this year s STF will continue to be allocated mainly to trusts providing acute emergency care, so that most of them can meet the 95% accident and emergency (A&E) 4-hour waiting time standard by March The STF mechanism is one of a number of measures that have been put in place to stabilise the provider financial position, and to date has been broadly successful at supporting these objectives. The 1.8bn of funding used for STF has been committed to the NHS by government on a recurring basis; however, we must work with NHS England to develop a sustainable strategy for how this funding should flow to the sector. We have continued to see a significant reduction in agency expenditure in the first quarter and, for the first time in recent years, NHS providers has reported an underspend against their plan on agency usage. Despite the positive start to the year, provider plans remain challenging, as they step up their effort to achieve productivity levels that are only possible if sufficient hospital beds are available. The sector reported an aggregate year-to-date deficit of 736 million which was 30 million off plan. A total of 67 providers did not achieve their planned year-to-date financial positions. Their underperformance was driven by a combination of shortfall in operating incomes and slippage in cost improvement programmes (CIPs). Income shortfall - Providers planned to grow overall activity in Q1 by 3.2% on a cost weighted basis. However, this growth has not happened partly because of ongoing pressure on bed capacity and the serious destabilising events. In addition, the two-year national tariff payment system launched in 2017 has disproportionally affected incomes received for elective and outpatient follow up work in some providers and a combined shortfall of 92 million for these two types of work has been reported. Cost improvement programme shortfall This was 102 million against planned CIPs, despite providers delivering 520 million of cost savings and reducing total expenditure by 2.5%. Because the NHS is relying less on agency staff, and turning to more cost-effective bank and substantive roles, bank spend has increased and for the first time exceeded agency expenditure for the quarter. The increased use of bank staff to cover for vacancies and absence has led to an overspend on pay costs. 4 Based on Q1 results, providers forecast that the aggregate full year deficit will be 523 million, which is 27 million worse than plan. Our regional teams are working with providers to capture delivery risks and opportunities, and ensure that providers have plans to mitigate these risks. At a national level, we continue to provide intensive and targeted support to those trusts in financial difficulties through Financial Special Measures and the Financial Improvement Programme.

5 Performance comparisons Activity and Capacity Q1 2017/18 Plan Q1 2017/18 Actual Q1 2016/17 Actual Q1 2017/18 variance from plan Variance from Q1 16/17 A&E attendances (millions) Non-elective admissions (millions) (1.0%) 1.7% Elective admissions (millions) * (1.5%) 2.4%* 1 st Outpatients attendances millions) * (0.5%) 2.2%* General & acute Beds (average daily open) - 102, ,812 - (0.2%) Nurses (WTE) 349, , ,000 (7,000) (0.6%) Medical Staff (WTE) 119, , ,000 (2,000) 2.6% Cost weighted activity growth 3.2% 2.0% 2.1% (1.2%) (0.1%) Published Operational Performance Target Q1 2017/18 Actual Q1 2016/17 Actual A&E attendances 95% 90.29% 90.29% Diagnostics 1% 1.86% 1.47% RTT 92% 90.26% 91.53% Cancer 62-day 85% 81.55% 82.38% Ambulance Red 1 75% 70.76% 70.43% Ambulance Red 2 75% 63.81% 64.42% Ambulance Cat A 95% 91.01% 91.87% Finance and Productivity Plan 2017/18 Actual 2016/17 Actual Q1 year-to-date (YTD) surplus/deficit ( m) (706) (736) (461) Q1 YTD total income ( m) 19,830 19,775 19,583 Q1 YTD expenditure ( m) (20,597) (20,625) (20,176) Q1 YTD efficiency savings ( m) Q1 YTD efficiency savings (%) 2.9% 2.5% 2.4% Q1 YTD total pay costs exc. agency ( m) 12,232 12,298 11,792 Q1 YTD agency costs ( m) % of Trusts signed up to a Control Total at Q1-88% 89% % of Trusts forecasting a 17/18 surplus at Q1 55% 53% 52% Quality and Safety Target or Ceiling Q1 2017/18 Actual Q1 2016/17 Actual Infection MRSA Infection - C. Diff 1,207 1,136 1,099 General & acute bed occupancy % 90.2% Acute delayed discharges (days) - 347, ,080 >12-hour A&E trolley waits >52-week waits - 1, No of providers in special measures Notes: * Elective and Outpatient activity calculated with working day adjustment 5

6 6 1.0 Operational performance

7 1.1 Operational performance overview Metrics Target NHS Improvement NHS England Accident & emergency : April June 2017 A&E attendances - 5,505,993 6,001,335 Performance All A&E types (%) 95% 89.46% 90.29% Performance Acute trusts only (%) 95% 88.67% 88.67% Type 1 performance (%) 95% 85.46% 85.46% Diagnostics: at 30 June 2017 Number of diagnostic tests waiting 6 weeks+ (%) 1% 1.87% 1.86% Referral to treatment (RTT) : at 30 June weeks incomplete (%) 92% 89.96% 90.26% 52-week waits (number) - 1,475 1,544 Cancer: April June week GP referral to 1st outpatient, cancer (%) 93% 93.69% 93.69% 2-week referral to 1st outpatient - breast symptoms (%) 93% 90.67% 90.67% 31-day wait from diagnosis to first treatment (%) 96% 97.52% 97.52% 62-day urgent GP referral to treatment for all cancers (%) 85% 81.48% 81.55% 62-day referral from screening services 90% 92.28% 92.32% Ambulance: April June 2017 Red 1 Calls (%) 75% 70.76% 70.76% Red 2 Calls (%) 75% 63.81% 63.81% Category A Call - ambulance arrived within 19 mins (%) 95% 91.01% 91.01% Infection control: April June 2017 C. Difficile (Total cases) - 1,136 1,136 Notes: NHS Improvement performances above are based on the performances of 153 NHS foundation trusts and 80 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. 7

8 1.2 Accident & emergency 8 Percentage of A&E all type patients seen within 4 hours Number of Trusts failing the 4 hour A&E target by month In Q1 2017/18, NHS England reported an overall A&E performance of 90.29% (including performance of Independent Sector Organisations) and the national ambition of achieving 90% by September 2017 has therefore been met. Performance of NHS providers also showed a small improvement from 89.33% in Q1 2016/17 to 89.46% this quarter. Although the performance is still below the national target, providers are on track to meet the national standard of 95% by the end of the year, as support from Urgent and Emergency Care (UEC) Programme is now accelerating and winter planning is gathering pace. During the quarter, there were c.5.51m attendances at NHS A&E departments, an increase of 2.9% (like-for-like) compared to the same quarter last year, and an increase of 6.5% compared to Q4 2016/17. Last year, A&E departments were under significant operational pressures due to record-level of patients requiring emergency admissions. This quarter, the number of patients attending a major (type 1) A&E department and requiring admitted care reached c.1.08m, which was an increase of 3.81% when comparing to the same quarter last year. Providers have therefore delivered improved performance under substantial (and increased) pressure. As a result of these increases in attendances and admissions, and an increase in delayed transfers of care, bed occupancy of 89.1% remains unsustainably high, which impacts hospitals ability to care for patients in a timely, effective manner. In Q1 2017/18, 347,860 bed days were lost due to delayed transfers of care in acute hospitals, an increase of 0.8% from a year ago. Despite this pressure, 109,469 patients waited more than four hours for a bed during this period, 2.4% less than a year ago. Recognising the challenges, NHS Improvement came together with NHS England at the end of last financial year to create a joint Urgent and Emergency Care (UEC) Programme under a single National Director. The programme has brought together all UEC work across the organisations and wider system into a coherent strategy to drive UEC transformation and A&E performance improvement. At a regional level, NHS Improvement and NHS England Regional Directors have now taken accountability on behalf of both organisations for delivery in local systems, performance managing and supporting changes and improvement. Improving UEC performance and returning the sector performance back to 95% will also form a core component for providers receiving Sustainability and Transformation Fund (STF) in 2017/18 and 2018/19.

9 1.3 Diagnostic waiting times Percentage of diagnostic patients waiting over 6 weeks Diagnostic performance by procedures June 2017 Diagnostic waiting times are a key part in the delivery of the referral to treatment (RTT) target as the majority of patients being 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 Q1 2017/18, 871,239 patients were waiting for a diagnostic test, a decrease of 2.2% from the last quarter. Compared to the same time last year, the waiting list has increased by 0.5% (likefor-like). Despite the decrease in the waiting list, more patients were waiting longer than six weeks. Performance of 1.87% at the end of Q1 2017/18 (NHS England performance was 1.86%) was a significant deterioration in performance compared to 1.50% at Q1 last year and slightly down on Q4 performance of 1.77% Providers in aggregate failed to achieve the waiting time standard for twelve of the 15 key diagnostic tests, two less than in the same period last year. The overall diagnostics performance has been driven by a increase in waiting times for endoscopy tests which contribute to over 10% of the diagnostics waiting list. In June 2017, 5.61% of patients were waiting over six weeks for an endoscopy test compared to 4.26% a year ago. In an effort to increase capacity, NHS Improvement is working with Health Education England to launch the next stage of its programme to train 200 additional Non-Medical Endoscopists by Non-obstetric ultrasound was one of the best performing tests despite having the largest waiting list (35.3% of the total diagnostics waiting list), with only 0.7% of patients waiting over six weeks at the end of the quarter. 9

10 1.4 Elective waiting times RTT 18 week performance and size of waiting list by month Number of trusts failing RTT 18 week incomplete target by month NHS providers continue to fail to achieve the national RTT incomplete standard target of 92%. Performance at the end of the quarter was 89.96% (NHS England performance was also 90.26%) which represents a drop of 1.31% compared to the same period last year. Sustained high demand for emergency inpatient care this year has resulted in many providers struggling to deliver their planned activity due to elective capacity either being displaced or cancelled. In addition the cyber attack had an impact, also further reducing the elective activity completed. The elective waiting list reached a record level of 3.64 million at the end of Q1 2017/18, an 5.4% increase compared to a year ago (like-for-like and excluding providers which have re-commenced reporting this year). 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 also increased. In June 2017, 1,475 patients were waiting over a year for treatment compared to 936 in June 2016, but lower than 1,513 waiting in March Five providers did not report incomplete RTT performance in June The Intensive Support Team is continuing to support the most challenged providers to improve performance by better aligning demand and capacity. We are also supporting a national programme to improve outpatient performance through agreeing pilot sites to use software to improve patient flow and using digital channels to reduce demand and improve access to services. 10

11 1.5 Cancer waiting times 62-day (urgent GP referral) wait for first treatment by month 62-day (urgent GP referral) wait for first treatment by specialty Q1 2017/18 All the cancer waiting-time standards were achieved in Q1 2017/18 except for the two week wait-exhibited breast symptoms (cancer not initially suspected) and 62 day (urgent GP referral) waiting time target for first treatment, the latter has not been delivered for the quarter since Q3 2013/14. In response to increasing demand, more patients began treatment this year. 36,826 patients began cancer treatment in Q1 2017/18, 10.0% more than in the same quarter last year. NHS providers failed to achieve the national target of 85% for 62 day (urgent GP referral) with a performance of 81.6% in Q1 2017/18 (NHS England performance was also 81.6%). This was below the performance achieved in the same quarter last year (82.6%). The specialties that contributed most to the underperformance in Q1 2017/18 were Urological (excluding testicular), Lower Gastrointestinal and Lung. These specialities accounted for only 40.5% of activity, but contributed to more than half of the reported breaches (57.5%). Performance for two week wait - exhibited breast symptoms in Q was 90.7% against the standard of 93%. This was a significant deterioration in performance, 1.2% below the performance achieved for the same period last year. NHS Improvement has worked with partner organisations to improve cancer performance by reducing diagnostic delays. We are also continuing to work with NHS England to introduce the 28 days faster diagnosis standard for cancer patients. The standard is now being piloted at test sites in preparation for national roll-out. 11

12 1.6 Ambulance response times Category A Red 1 and Red 2 performance and volume of response Category A19 performance and volume of responses The national standard states that 75% of calls, presenting conditions which may be immediately life-threatening (Category A Red 1), or lifethreatening but less time-critical (Category A Red 2), should receive an emergency response within eight minutes, and 95% of all Category A responses requiring an ambulance, should be reached within 19 minutes. Ambulance services continue to fail the Red 1, Red 2 and 19 minutes response-time targets with performance of 70.76%, 63.81% and 91.01% respectively. In Q1 2017/18, two of the eight ambulance services* that submitted complete data achieved Cat A red 1 performance target, however none of the services achieved the other two standards. Ambulance services saw an increase in time-critical and life-threatening calls in Q1 2017/18. Ambulance services responded to 35,785 Red 1 calls in the quarter, an increase of 25.9% compared to the same quarter last year. The number of Red 2 responses increased by 5.1% compared to the same period last year.** In recent years, ambulance services have also experienced difficulties in recruiting and retaining paramedic staff which had an impact on their operations. With effect from 1 January 2017, existing paramedic staff were re-banded from band 5 to band 6. This should result in improved recruitment and retention of paramedic staff with a knock on improvement in ambulance trust performance. In July 2017, NHS England announced a new set of performance targets for the ambulance service which will apply to all 999 calls for the first time. These new standards are aimed to remove hidden and long waits including reducing lengthy waits for the frail and elderly, and free up more vehicles and staff to respond to emergencies. These changes are expected to be in place by winter * There are 11 ambulance services including 10 ambulance trusts as well as Isle of Wight NHS Trust. Three trusts (South Western Ambulance Service and Yorkshire Ambulance Service from April 2016, and West Midlands Ambulance Service from June 2016) have been piloting new call categorisations, and, therefore, have not been submitting data for Red 1, Red 2 and Cat A 19 minute responses. ** Comparisons exclude South Western Ambulance Service, Yorkshire Ambulance Service and West Midlands Ambulance Service activity in Q2 2015/16 and Q2 2016/17.

13 1.7 Infection control Number of Clostridium Difficile cases Number of E-Coli cases reported The number of trust apportioned C. Diff cases reported in quarter /18 was 1,136 compared to 1,099 in the corresponding quarter last year. This was an increase of 3.4%. During June 2017, there were 414 C. Diff cases reported, an increase of 15.6% (56 cases) from the same period last year. Number of Meticillin-resistant Staphylococcus Aureus (MRSA) cases reported 83 trust assigned MRSA cases were reported in quarter /18 which is 27.7% higher than the 65 cases reported in quarter /17. During June 2017, there were 23 MRSA cases reported, an increase of 4.5% (one case) from the same month last year. The number of E-Coli cases reported in quarter /18 was 10,181 compared to 9,847 in the corresponding quarter last year. This was an increase of 3.4%. There was also a 2.6% increase reported in June 2017 compared to the same month last year. The Secretary of State s ambition is to reduce healthcare associated Gram-negative bloodstream infections by 50% by March During 2017/18 there is a quality premium target for CCGs to reduce Escherichia coli (the most prevalent Gram-negative bloodstream infection) by 10%, providers will have a contribution to this target as some cases will have had interventions or treatments. At the moment we only have mandatory data for Escherichia coli blood stream infections. The definition of healthcare associated has now been agreed. NHSI and Public Health England (PHE) are in the process of mandating the two other main Gram-negative bloodstream which are Pseudomonas aeruginosa and Klebsiella species, in addition to E.coli. The PHE data capture system (DCS) will also collect the relevant data to assess/assign if these infections are healthcare associated. NHSI have made an application via the BAAS process to make the necessary changes to the DCS but have been told that PHE system needs to be brought into line with the use of national coding. PHE predicts that this will take six months to do, NHS Digital appears to be allowing the process to go ahead so long as PHE have a clear plan to bring the system up to the required standard. 13

14 Financial Performance

15 2.1 Financial performance overview 3 months ended 30 June 2017 by sector Year to Date - Month /18 Forecast Outturn /18 Number of providers Plan Actual Variance Deficit providers Plan Forecast Variance Deficit providers No. m m m No. m m m No. Acute 135 (742) (839) (97) 117 (1,122) (1,245) (123) 87 Ambulance 10 (3) (4) (4) 0 5 Community 18 (1) (3) 4 Mental Health 53 (4) (2) (14) 8 Specialist 17 (18) (15) Surplus / (deficit) control total basis (1) 233 (767) (851) (84) 162 (940) (1,079) (140) 109 Technical adjustments (12) 0 12 (46) 0 46 Uncommitted STF Reported adjusted financial position surplus/(deficit) include all STF (2) (706) (736) (30) (496) (523) (27) 3 months ended 30 June 2017 by region Number of Providers Year to Date - Month /18 Forecast Outturn /18 Plan Actual Variance Deficit providers Plan Forecast Variance Deficit providers No. m m m No. m m m No. London 36 (200) (242) (42) 27 (222) (283) (61) 16 Midlands and East 72 (265) (277) (12) 51 (575) (607) (31) 37 North 70 (180) (214) (34) 50 (172) (189) (17) 34 South 55 (124) (119) (1) (30) 22 Surplus / (deficit) control total basis (1) 233 (767) (851) (84) 162 (940) (1,079) (140) 109 Technical adjustments (12) 0 12 (46) 0 46 Uncommitted STF Reported adjusted financial position surplus/(deficit) include all STF (2) (706) (736) (30) (496) (523) (27) Surplus/(deficit) control total basis are calculated as surplus/(deficit) before AME impairments, transfers, donated asset income, and donated asset depreciation for all trusts. 2. The sector reported adjusted financial position surplus/(deficit) includes DEL Impairments, Prior Period Adjustments, donated asset income and donated asset depreciation as these items have been excluded from the control total an adjustment is needed to add the figures back to provide the reported sector surplus/(deficit). 3. Surplus /deficit before the cost of the GIRFT project.

16 2.2 Income & expenditure 3 months ended 30 June 2017 Year to Date Month /18 Variance to plan Plan m Actual m m % Incomes from patient care activities 17,776 17,768 (8) (0.0%) Other income 2,054 2,007 (47) (2.3%) Employee expenses (excluding agency) (12,232) (12,298) (66) 0.5% Agency staff costs (601) (592) 9 (1.5%) Non pay costs (7,763) (7,735) (28) 0.4% Surplus/(deficit) Control Total including STF (767) (851) (84) 10.9% Adjustments (12) 0 12 (100.0%) Uncommitted STF % Reported financial performance surplus/(deficit) (706) (736) (30) 4.2% 3 months ended 30 June 2017 by sectors Operating income from patient care activities Acute m Year to Date 30 June 2017 Actual m Mental Ambulance Community Health m m m Specialist m 13, , Other income 1, Employee expenses (8,928) (412) (452) (2,023) (483) Agency staff costs (444) (6) (19) (110) (14) Other non-operating items (6,204) (173) (202) (767) (389) Control Total basis surplus/(deficit) including STF (839) 0 4 (2) (15) Control Total basis Surplus/(deficit) % (5.7%) 0.0% 0.6% (0.1%) (1.7%) The provider sector reported a year-to-date deficit of 736 million for the first quarter of 2017/18, which was 30 million worse than planned. The adverse variance was a result of the total income being 0.3% below plan at Q1, while total costs were 0.1% higher than plan. 67 providers reported an adverse year-to-date variance to plan at Q1, including 10 trusts with an adverse variance of more than 5 million. Most of these trusts attributed the underperformance largely to slippage in the delivery of planned efficiency savings, income shortfalls due to lower than planned activity, and continued reliance on bank and agency staff. A number of providers were impacted by the cyber attacks, the terrorist attacks in Manchester and London and the Grenfell Fire. The reported sector financial position also included 116 million of uncommitted Sustainability and Transformation Fund (STF). STF was introduced in 2016/17 to encourage trusts to provide sustainable, efficient, effective and economic care. This year, access to the 1.8 billion fund will build on progress achieved in 2016/17 with the aim of accelerating financial recovery and improving urgent and emergency care. NHS Improvement wrote to all providers in September 2016 as part of the planning process to confirm 2 year control totals and in June 2017 to confirm the performance conditions. Access to STF in 2017/18 will be based on achieving agreed financial control totals, and delivering A&E 4-hour waiting time performance and front door streaming to GPs. Based on year-to-date performance, trusts have included 154 million of STF in their reported year-to-date position. 16

17 2.3 Income analysis 3 months ended 30 June 2017 Year to Date Month /18 Variance to plan Plan m Actual m m % Elective income 2,304 2,252 (52) (2.3%) Non-elective income 3,433 3, % First outpatient income % Follow up outpatient income 1,076 1,036 (40) (3.7%) A&E income % High cost drugs income (excluding pass-through costs) 1,040 1,033 (7) (0.7%) Other NHS clinical income 3,558 3, % Acute services 12,879 12, % Mental Health services 2,116 2, % Ambulance services (8) (1.3%) Community services 1,778 1,777 (1) (0.1%) Other (81) (19.4%) Total income from patient care activities 17,776 17,768 (8) (0.0%) Research and development (R&D) (18) (7.0%) Education and training % Charitable and other contributions to expenditure (0) (1.4%) Non-patient care services provided % Support from DH for mergers (0) (0.4%) Sustainability and transformation fund (STF) Recharged Pay costs accounted on a gross basis (42) (21.5%) % Lease rentals received (18) (50.3%) Other (0) (0.0%) Total other income 2,054 2,007 (47) (2.3%) Total income 19,830 19,775 (55) (0.3%) The provider sector s total operating incomes at Q1 was 55 million (0.3%) behind plan. This was largely driven by a 47 million shortfall in non patient care incomes. R&D and rental incomes were off plan by a total of 36 million. The provider level incomes was also affected adversely by a number of trusts not meeting their STF targets. Trusts in aggregate forecast that they may not fully recover the shortfall for non-patient care related incomes this year. Although total incomes from patient care activities were only slightly below plan by 8 million, significant income shortfalls were reported in relation to elective inpatient and follow-up outpatient work. Elective inpatient activity at Q1 was 1.5% below plan, however, the income shortfall compared to plan was over 2.3%. Further analysis showed that over 94% of elective incomes were based on national tariff, and most of the income shortfall at Q1 was related to this element. In 2017, NHS England and NHS Improvement launched a two-year national tariff payment system alongside a new payment currency (HRG4+). The new tariff system appears to have had a significant impact on some providers. Similarly, changes to how outpatient activities are being reimbursed through national tariff also affected many trusts revenue position, as the new tariff system is designed to incentivise a move to more efficient models of care, therefore, follow-up attendances are being under-reimbursed under the new tariff system. Review of activity and income showed that the follow up attendances were 2.7% behind plan at Q1, but incomes was 3.7% ( 40 million) lower than planned. Similar to elective work, national tariff based incomes accounted for 95% of non-elective incomes. But in contrast, incomes have not been affected in the same way by the new payment system, as non-elective activity was 1% below plan but income was 1.1% ( 39 million) above plan. Overall, providers forecast they would exceed their planned patient care incomes at the year end. To achieve this trajectory, providers will need to increase their current activity level. So far, Q1 activity levels compared to the same period last year do show increases after having adjusted elective activity for working days. 17

18 2.4 Pay and agency costs 3 months ended 30 June 2017 Year to Date - Month /18 Plan Actual Variance m m m % Permanent staff 11,689 11, % Bank staff (161) (31.2%) Agency & contract staff % other staff % Total 12,834 12,891 (57) (0.4%) Agency costs as a % of total pay costs 4.7% 4.6% Forecast outturn - month /18 Plan Actual Variance m m m % Permanent staff 46,180 46,384 (203) (0.4%) Bank staff 2,008 2,248 (240) (12.0%) Agency & contract staff 2,500 2, % Other staff % Total 50,795 50,953 (158) (0.3%) Agency costs as a % of total pay costs 4.9% 4.4% We have continued to see a significant reduction in agency expenditure in the first quarter. Overall agency spend of 592 million at Q1 was 169 million lower (22%) than Q1 last year and 282 million (32%) than Q1 2015/16. Also, for the first time in recent years, NHS providers has reported an underspend against their year-to-date plan. In aggregate, agency spend as a percentage of total NHS pay bill has fallen from 6.5% in Q1 2016/17 to 4.6% in Q1 2017/18. Overall, providers are on track to deliver the agency expenditure ceiling of 2.5 billion this year. The largest reduction in agency expenditure has been for administrative and estates staff, where spend fell by 41% compared to Q1 2016/17. Expenditure on medical and dental agency staff also fell by 15% compared to Q1 last year, with trusts currently on trajectory to meet their medical locum reduction targets. This reduction in agency spend was in part achieved by shifting agency workers and shifts into more cost-effective bank and substantive roles. As a result, bank spend has increased and for the first time exceeded agency expenditure for the quarter; however it is important to note that overall temporary staffing (agency and bank) spend has fallen by 6.5%. NHS providers employ almost 1.1 million WTE (whole time equivalent) staff, and the pay bill is the single biggest area of expenditure. NHS Improvement will continue to work with all providers to ensure that the NHS workforce is sustainable and future pay costs are under control. 18

19 2.5 Non-pay cost pressures Year to Date - M3 2017/18 Variance to plan 3 months ended 30 June 2017 Plan m Actual m m % Purchase of healthcare from NHS bodies (11) (6.2%) Purchase of healthcare from non-nhs bodies (28) (11.5%) Purchase of healthcare from other providers (39) (9.2%) Purchase of social care (4) (7.0%) Drugs costs 1,781 1, % Clinical supplies and services clinical (excluding drugs costs) 1,667 1,671 (4) (0.2%) General supplies and services % Clinical Negligence Insurance (1) (0.2%) Consultancy (12) (29.2%) Establishment (2) (1.0%) Premises - business rates payable to local (10) (11.3%) authorities Premises - other (6) (0.9%) Premises (17) (2.2%) Other operating costs 1,527 1, % Other non operating items 1,904 1, % Total Non Pay 7,763 7, % 3 months ended 30 June Year to date Actual Forecast outturn m m Financial Sanctions (Fines) (36) (119) Sanctions reinvested Sub-total: Financial Sanctions (23) (75) Marginal Rate Emergency Tariff (MRET) (78) (285) MRET reinvested 3 14 Sub-total: MRET (75) (271) Readmissions (63) (246) Readmissions reinvested Sub-total: Readmissions (53) (203) Delayed transfers of care (DToC) - expenditure incurred on blocked capacity (42) (167) DToC - reimbursement from Local Authorities 0 1 Sub-total: Delayed Transfers of Care (42) (166) Waiting list initiative work (37) (124) Outsourcing of work to other providers (52) (198) The provider sector reported a 28 million underspend on non-pay items for the first quarter of this financial year. In particular, providers spent 15 million less on general supplies and 8 million less on drugs than planned. In contrast, purchase of healthcare from both NHS and non- NHS bodies exceeded plan by 39 million (9.2%), suggesting that capacity constraints may still be an issue within the sector. In addition, costs of premises were 16 million higher than planned, partly due to the business rates payable to the local authorities, and consultancy costs were 29.2% more than plan due to trusts seeking external support. We continue to monitor financial penalties and sanctions, as well as additional costs incurred as a result of capacity constraints. Last year, NHS England and NHS Improvement agreed to suspend national sanctions and replace them with trust-specific incentives linked to agreed performance improvement plans. This led to a dramatic reduction in fines being levied on providers by commissioners. This arrangement will continue this year. Providers forecast at Q1 that their financial sanctions would reduce from last year s 99 million to 75 million. At Q1, trusts forecast that overall spending on waiting list initiative (WLI) and outsourcing is likely to fall from last year s level. In 2016/17, the record level of demand had a significant financial impact on providers, resulting in 209 million being spent on WLI and 381 million on outsourcing. This year, providers project that annual costs would be 124 million and 198 million respectively. In 2017, the government allocated 1 billion extra funding to social care, part of this will be used to reduce delayed transfer of care which should help to free up beds in acute providers. However, providers in aggregate do not expect that the annual costs associated with blocked capacity to fall significantly this year, as year-to-date costs were almost unchanged when compared to Q1 last year. This is a concern as delivery of the financial plan is dependent on a number of key assumptions around risk management, agreed activity levels and beds availability being addressed.

20 2.6 Efficiency savings 3 months ended 30 June 2017 Year to date - Month /18 Plan Actual Variance m m m Recurrent (161) Non-recurrent Total efficiency savings (102) Efficiencies as a % of spend 2.9% 2.5% 3 months ended 30 June 2017 Forecast outturn Plan FOT Variance m m m Recurrent 3,362 3,026 (336) Non-recurrent Total efficiency savings 3,666 3,519 (147) Efficiencies as a % of spend 4.3% 4.1% Efficiency savings delivered through cost improvement programs (CIPs) have reduced total operating costs by 520 million (or 2.5%) during the first quarter of this financial year. The savings achieved included 84 million from income generation schemes. The total savings delivered to date was 102 million or 16% behind plan. The largest under-delivery was pay cost savings which was 20% behind plan, but both non-pay savings and income generation schemes were also behind plan by 15% and 10% respectively. Whilst providers had planned to deliver 93% of their year-to-date cost savings through recurrent schemes, they continue to rely on non-recurrent savings to bridge the shortfall. Overall, 19% of the total savings were from non-recurrent schemes, compared to 7% in the plan. Last year, NHS Improvement established an Operational Productivity Directorate to support the sector deliver increased levels of efficiency and accelerate the implementation of recommendations from Lord Carter s review. The team has developed a programme of work including workforce productivity, resource optimisation and benchmarking (model hospital). These programmes have provided much needed focus on efficiency for the sector. So far, savings achieved through Carter programme accounted for 35% of the overall delivery. Providers have set out plans to deliver a total of 3.7 billion savings this financial year, the current forecast suggests that providers may fall short of this target by 147 million. To achieve the current forecast saving outturn of 3.5 billion, providers need to identify detailed schemes for a further 332 million in the remainder of the year in addition to the 3.1 billion of schemes that have been identified. NHS Improvement will continue to work with all providers to increase the level of efficiency wherever possible to ensure that the sector achieves the planned trajectory. 20

21 2.7 Capital expenditure 3 months ended 30 June 2017 By sectors Year to Date - M3 2017/18 Variance to plan Plan m Actual m m % Acute (259) (40.3%) Ambulance (14) (52.6%) Community 16 6 (11) (64.4%) Mental Health (46) (43.4%) Specialist (38) (43.9%) Total CDEL (367) (41.9%) 3 months ended 30 June 2017 Forecast outturn at Q1 2017/18 Forecast outturn 2017/18 Variance to plan Plan m Forecast m m % Acute 3,343 3,305 (38) (1.1%) Ambulance (8) (6.1%) Community % Mental Health % Specialist (9) (2.8%) Total CDEL 4,330 4,289 (41) (0.9%) Foundation Trust NHS Trust Total m Fcast m m Gross capital expenditure 3,102 1,512 4,614 Disposals / other deductions (139) (1) (140) Net Capital expenditure 2,963 1,511 4,474 Less donations and grants received (150) (40) (190) Less PFI capital (IFRIC12) (79) (72) (151) Plus PFI residual interest Purchase of financial assets Sale of financial assets Total CDEL 2,811 1,479 4,289 The latest provider plan submissions included Capital Departmental Expenditure Limit (CDEL) expenditure of billion in 2017/18. The forecast CDEL expenditure at Month 3 is billion, an underspend against plan of 41 million. Discussions between the Department of Health and NHS Improvement to establish the level of capital resource available to the provider sector in 2017/18 remain ongoing, although initial indications are that this could be set at 2.9 billion, a significant shortfall on plans. In 2016/17 Providers spent 2.94 billion in CDEL terms. This exceeded the level of capital resource available to the provider sector in 2016/17 by 0.2 billion. Historically NHS providers over estimate capital spend at plan stage and therefore NHS Improvement has developed its own likely estimate of provider capital spend of 3.4 billion (before GP and A&E streaming funding). This spend is largely approved or committed. Providers at Month 3 had spent 509 million on capital schemes, which was 367 million below plan. Foundation Trusts are forecasting CDEL expenditure of billion (or 66% of the total forecast). NHS Trusts are forecasting billion (representing 34% of the total sector forecast). 21

22 2.8 Year-end financial position Month 3 ended 30 June 2017 by sector No of trusts accepted control total No of trusts included STF in its year-to-date position No of trusts forecast to receive full or partial STF at the year end No of trusts in Finance Special Measures (FSM) Acute Ambulance Community Mental Health Specialist Total In 2016/17, the provider sector tightened its financial control and grip, and accelerated its financial recovery with the support of STF. The sector successfully reduced its annual deficit from 2.47 billion in 2015/16 to a deficit of 791 million in 2016/17. Building on last year s success, NHS Improvement has introduced a new set of control totals outlining the minimum level of improvement expected in financial position for 2017/18. At Q1, 206 out of 233 providers have accepted their individual control totals. Plans submitted indicate a total sector planned deficit of 496 million for 2017/18 with the support of 1.8 billion STF. At Q1, providers forecast to end the year with an aggregate deficit of 523 million, 27 million worse than planned. To achieve this trajectory, providers will need to step up their effort in meeting their planned activity level and deliver 3 billion efficiency savings during the remainder of the year. Our regional teams continue to provide direct support to all providers in an effort to identify and deliver any upside opportunities and mitigate any downside risks, to ensure that the plans stay on track. In addition, nine of the most financially challenged trusts will continue to receive intensive support through the Financial Special Measures (FSM) programme. United Lincolnshire NHS Trust enters the FSM regime as a result of this quarter s performance, bringing the total number of trusts in FSM to ten. Since FSM was introduced, three trusts have demonstrated significant financial improvement and exited the regime. Furthermore, a number of trusts are receiving targeted support through Financial Improvement Programmes which is now in its second wave. This year, a further 1.8 billion STF has been made available. Similar to last year s arrangements, providers that signed up to their control totals are eligible for this fund, but receiving the fund will depend on achieving the financial control totals and meeting the performance plans set out for the urgent and emergency care standard. Although the fund will be allocated primarily to trusts providing acute emergency care as they face greater financial and operational challenges, it also includes elements of funding designed to support non-acute services, which in turn will support the overall sustainability of the provider sector. 22

23 Financial Performance by Providers

24 3.1 Financial performance by providers London Provider Name Control Total (CT) Accepted? Control Total Basis Surplus Deficit Including STF Year to date Forecast Outturn YTD Plan YTD Actual Variance FOT Plan FOT Variance Sustainability & Transformation Fund (STF) STF Allocated (In Plan only if accepted CT) Barking, Havering and Redbridge University Hospitals NHS Trust YES ( 757) ( 1,172) ( 415) 1, ( 420) 18,652 2,378 18,232 Barts Health NHS Trust YES ( 31,077) ( 51,460) ( 20,384) ( 45,971) ( 45,971) 0 39, ,570 Chelsea and Westminster Hospital NHS Foundation Trust YES ( 2,310) ( 1,969) 341 7,074 7, ,122 2,386 14,390 Croydon Health Services NHS Trust YES ( 7,623) ( 7,562) 61 ( 10,447) ( 10,447) 0 8,688 1,303 8,688 Epsom and St Helier University Hospitals NHS Trust YES ( 11,032) ( 10,379) 653 ( 17,832) ( 17,832) 0 10,332 1,550 10,332 Guy's and St Thomas' NHS Foundation Trust YES ( 3,504) ( 11,776) ( 8,272) 19,094 17,934 ( 1,160) 22, ,353 The Hillingdon Hospitals NHS Foundation Trust NO ( 5,173) ( 5,130) 43 ( 8,476) ( 8,476) ( 0) Homerton University Hospital NHS Foundation Trust YES ( 1,130) ( 472) 658 6,393 6, , ,393 Imperial College Healthcare NHS Trust NO ( 14,977) ( 14,977) 0 ( 41,000) ( 41,000) King's College Hospital NHS Foundation Trust NO ( 27,060) ( 27,189) ( 129) ( 37,880) ( 38,484) ( 604) Kingston Hospital NHS Foundation Trust YES ( 1,729) ( 941) 788 8,519 8, ,656 1,148 7,656 Lewisham and Greenwich NHS Trust YES ( 7,745) ( 16,456) ( 8,711) ( 22,763) ( 60,076) ( 37,313) 16, North Middlesex University Hospital NHS Trust NO ( 7,062) ( 8,336) ( 1,274) ( 22,391) ( 22,391) London North West Healthcare NHS Trust YES ( 20,819) ( 21,240) ( 421) ( 49,545) ( 49,545) 0 19,381 2,471 18,364 Royal Free London NHS Foundation Trust NO ( 17,445) ( 20,796) ( 3,351) ( 32,775) ( 27,400) 5, St George's University Hospitals NHS Foundation Trust NO ( 15,726) ( 22,590) ( 6,864) ( 28,453) ( 45,000) ( 16,547) University College London Hospitals NHS Foundation Trust YES ( 1,660) ( 1,252) 408 9,826 ( 332) ( 10,158) 14,736 2,629 9,997 The Whittington Hospital NHS Trust YES ( 1,540) ( 1,506) ,671 1,001 6,671 London Ambulance Service NHS Trust YES ( 2,002) ( 125) 1,877 ( 2,402) ( 2,402) 0 1, ,359 Central London Community Healthcare NHS Trust YES ,013 5, , ,842 Hounslow and Richmond Community Healthcare NHS Trust YES ,178 2, Barnet, Enfield And Haringey Mental Health NHS Trust YES ( 2,716) ( 2,439) 277 ( 4,616) ( 4,616) 0 1, ,166 Camden and Islington NHS Foundation Trust YES 462 ( 78) ( 540) 2,168 2, Central and North West London NHS Foundation Trust YES ( 1,948) ( 2,694) ( 746) 2,927 2, , ,347 East London NHS Foundation Trust YES ,411 12, , ,438 North East London NHS Foundation Trust YES ,920 3, , ,302 Oxleas NHS Foundation Trust YES ( 277) ( 1,078) ( 801) 3,129 3, , ,489 South London and Maudsley NHS Foundation Trust YES ( 1,961) ( 1,942) 19 2,344 2, , ,681 South West London and St George's Mental Health NHS Trust YES ( 787) ( 769) 18 18,634 18, Tavistock and Portman NHS Foundation Trust YES West London Mental Health NHS Trust YES ( 857) ( 881) ( 24) 5,329 5, , ,414 Great Ormond Street Hospital for Children NHS Foundation Trust YES 1,891 1, ,728 9, , ,384 Moorfields Eye Hospital NHS Foundation Trust YES ,100 1, ,299 Royal National Orthopaedic Hospital NHS Trust NO ( 5,281) ( 4,135) 1,146 ( 18,186) ( 18,186) Royal Brompton and Harefield NHS Foundation Trust YES ( 12,278) ( 10,198) 2,080 ( 5,638) ( 5,602) 36 8,189 1,647 8,608 The Royal Marsden NHS Foundation Trust YES 1,363 2, ,432 3, , ,264 London Total ( 199,638) ( 241,825) ( 42,187) ( 222,220) ( 282,998) ( 60,778) 221,741 23, ,462 YTD Actual FOT 24

25 3.2 Financial performance by providers Midlands and East (1/2) Provider Name Control Total (CT) Accepted? Control Total Basis Surplus Deficit Including STF Year to date Forecast Outturn YTD Plan YTD Actual Variance FOT Plan FOT Variance Sustainability & Transformation Fund (STF) STF Allocated (In Plan only if accepted CT) Basildon and Thurrock University Hospitals NHS Foundation Trust YES ( 4,578) ( 7,576) ( 2,998) ( 12,571) ( 12,571) ( 0) 10, ,724 Bedford Hospital NHS Trust YES ( 3,335) ( 2,859) 476 ( 8,842) ( 8,842) 0 5, ,249 Burton Hospitals NHS Foundation Trust YES ( 3,311) ( 3,309) 2 ( 9,527) ( 9,526) 1 5, ,383 Cambridge University Hospitals NHS Foundation Trust YES ( 11,019) ( 10,346) 672 ( 42,100) ( 42,100) ( 0) 16,954 2,544 16,954 Chesterfield Royal Hospital NHS Foundation Trust YES ,040 6, , ,066 Colchester Hospital University NHS Foundation Trust YES ( 6,083) ( 5,118) 965 ( 22,013) ( 21,832) 181 8,848 1,547 9,068 University Hospitals Coventry And Warwickshire NHS Trust YES ( 4,448) ( 4,761) ( 313) ( 292) ( 622) ( 330) 14,649 1,867 14,319 Derby Teaching Hospitals NHS Foundation Trust NO ( 12,938) ( 12,656) 282 ( 41,601) ( 36,601) 5, The Dudley Group NHS Foundation Trust YES 1,104 1, ,104 11, ,574 1,286 8,574 East And North Hertfordshire NHS Trust YES ( 9,722) ( 9,576) 146 ( 7,744) ( 7,743) 1 10,214 1,532 10,214 George Eliot Hospital NHS Trust YES ( 4,944) ( 4,930) 14 ( 13,217) ( 13,216) 1 4, ,003 Heart of England NHS Foundation Trust YES ( 4,045) ( 13,443) ( 9,398) ( 7,539) ( 7,221) , ,315 The Ipswich Hospital NHS Trust YES ( 5,198) ( 5,198) 0 ( 18,118) ( 18,118) 0 7,105 1,066 7,105 James Paget University Hospitals NHS Foundation Trust YES ( 2,172) ( 2,165) 7 2,112 2,112 ( 0) 4,427 1,488 5,251 Kettering General Hospital NHS Foundation Trust NO ( 6,184) ( 6,677) ( 493) ( 19,938) ( 19,539) Queen Elizabeth Hospital King's Lynn NHS Foundation Trust YES ( 2,494) ( 5,652) ( 3,158) ( 6,523) ( 16,300) ( 9,777) 5, University Hospitals of Leicester NHS Trust NO ( 17,597) ( 17,559) 38 ( 26,700) ( 26,700) ( 0) Luton and Dunstable University Hospital NHS Foundation Trust YES ( 1,212) ( 1,214) ( 2) 10,105 10, ,418 1,263 8,418 Mid Essex Hospital Services NHS Trust YES ( 9,322) ( 9,263) 59 ( 24,534) ( 24,534) 0 9,096 1,364 9,096 Milton Keynes University Hospital NHS Foundation Trust YES ( 5,615) ( 5,487) 128 ( 18,825) ( 18,825) 0 7,300 1,376 7,580 Northampton General Hospital NHS Trust YES ( 4,063) ( 4,243) ( 180) ( 13,546) ( 13,546) 0 8,715 1,111 8,715 University Hospitals of North Midlands NHS Trust NO ( 35,140) ( 32,560) 2,580 ( 119,078) ( 119,078) Norfolk and Norwich University Hospitals NHS Foundation Trust YES ( 2,998) ( 3,022) ( 24) 4,406 4, ,285 1,993 13,285 Nottingham University Hospitals NHS Trust YES ( 7,457) ( 7,958) ( 501) ( 10,714) ( 11,238) ( 524) 23,286 2,969 22,762 North West Anglia NHS Foundation Trust YES ( 15,094) ( 14,745) 349 ( 40,305) ( 40,305) 0 12,247 1,837 12,247 The Princess Alexandra Hospital NHS Trust YES ( 7,129) ( 7,031) 98 ( 21,554) ( 21,554) 0 7, ,352 Sandwell And West Birmingham Hospitals NHS Trust YES ( 4,925) ( 5,162) ( 237) 9,933 9,698 ( 235) 10,482 1,336 10,247 Sherwood Forest Hospitals NHS Foundation Trust YES ( 10,085) ( 10,030) 55 ( 37,623) ( 37,623) 0 8,814 1,741 9,233 The Shrewsbury And Telford Hospital NHS Trust YES ( 2,523) ( 2,712) ( 189) ( 6,063) ( 6,063) 0 9,315 1,188 9,105 Southend University Hospital NHS Foundation Trust YES ( 5,443) ( 3,896) 1,547 ( 14,591) ( 14,591) 0 7,670 1,570 8,089 South Warwickshire NHS Foundation Trust YES 1,454 1, ,769 7, , ,892 University Hospitals Birmingham NHS Foundation Trust YES 1,724 1, ,015 13,014 ( 1) 16,896 2,954 17,315 United Lincolnshire Hospitals NHS Trust YES ( 14,025) ( 23,946) ( 9,921) ( 48,564) ( 75,000) ( 26,436) 14, Walsall Healthcare NHS Trust NO ( 6,948) ( 7,228) ( 280) ( 20,757) ( 20,757) West Hertfordshire Hospitals NHS Trust YES ( 9,128) ( 9,326) ( 198) ( 15,040) ( 15,040) 0 10,663 1,360 10,423 West Suffolk NHS Foundation Trust YES ( 2,986) ( 2,758) 229 ( 5,928) ( 5,592) 336 5, ,297 The Royal Wolverhampton NHS Trust YES ( 2,160) ( 2,100) 60 11,641 11, ,894 1,484 9,894 Worcestershire Acute Hospitals NHS Trust YES ( 10,763) ( 11,271) ( 508) ( 29,988) ( 30,558) ( 570) 12,663 1,749 12,512 Wye Valley NHS Trust YES ( 8,451) ( 8,450) 1 ( 24,610) ( 24,610) 0 4, ,192 YTD Actual FOT 25

26 3.2 Financial performance by providers Midlands and East (2/2) Provider Name Control Total (CT) Accepted? Control Total Basis Surplus Deficit Including STF Year to date Forecast Outturn YTD Plan YTD Actual Variance FOT Plan FOT Variance Sustainability & Transformation Fund (STF) STF Allocated (In Plan only if accepted CT) East of England Ambulance Service NHS Trust NO ( 61) ( 59) East Midlands Ambulance Service NHS Trust YES ( 1,312) ( 924) 388 ( 5,396) ( 5,396) West Midlands Ambulance Service NHS Foundation Trust YES 2,248 2, ,245 2, , ,382 Birmingham Community Healthcare NHS Foundation Trust YES 1,237 1, ,800 4, , ,620 Cambridgeshire Community Services NHS Trust YES ,999 1, , ,072 Derbyshire Community Health Services NHS Foundation Trust YES 570 2,191 1,621 4,923 4,923 ( 0) 1, ,537 Hertfordshire Community NHS Trust YES 32 ( 450) ( 482) 1,972 1, Lincolnshire Community Health Services NHS Trust YES 760 1, ,348 3, , ,357 Norfolk Community Health and Care NHS Trust YES ( 187) ( 112) 75 2,033 2, Shropshire Community Health NHS Trust YES ( 242) ( 95) Staffordshire and Stoke on Trent Partnership NHS Trust NO ( 6,158) ( 3,060) 3,098 ( 10,000) ( 10,000) Birmingham and Solihull Mental Health NHS Foundation Trust YES ( 1,819) 54 1,873 2,024 2, , ,485 Cambridgeshire and Peterborough NHS Foundation Trust YES 61 ( 579) ( 640) 2,249 2, , ,318 Coventry and Warwickshire Partnership NHS Trust YES ( 831) ,276 2, , ,286 Derbyshire Healthcare NHS Foundation Trust YES ,764 2, Dudley And Walsall Mental Health Partnership NHS Trust YES ,839 1,839 ( 0) Essex Partnership University NHS Foundation Trust YES ( 1,039) ( 194) 845 ( 6,635) ( 6,635) ( 0) 2, ,701 Hertfordshire Partnership University NHS Foundation Trust YES ,048 2, , ,681 Leicestershire Partnership NHS Trust YES ,115 3, , ,671 Lincolnshire Partnership NHS Foundation Trust YES ( 69) ,143 1, Northamptonshire Healthcare NHS Foundation Trust YES ,624 1, , ,521 North Staffordshire Combined Healthcare NHS Trust YES ( 114) ( 68) 46 1,400 1, Norfolk and Suffolk NHS Foundation Trust YES ( 923) ( 905) 18 ( 1,147) ( 1,147) 0 1, ,284 Nottinghamshire Healthcare NHS Foundation Trust YES 2,491 2, ,622 9, , ,733 Black Country Partnership NHS Foundation Trust NO ( 1,022) ( 619) 403 ( 3,179) ( 3,163) South Staffordshire and Shropshire Healthcare NHS Foundation Trust YES 1,075 1, ,517 3, , ,078 Worcestershire Health and Care NHS Trust YES ,402 4, , ,201 Birmingham Women s and Children's NHS Foundation Trust YES ( 869) ( 865) 4 11,470 11,470 ( 0) 7,788 5,037 11,657 Papworth Hospital NHS Foundation Trust NO ( 634) ( 1,811) ( 1,177) ( 3,272) ( 3,272) The Robert Jones and Agnes Hunt Orthopaedic Hospital NHS Foundati YES ( 476) ( 742) ( 266) 1,105 1,105 ( 0) The Royal Orthopaedic Hospital NHS Foundation Trust YES ( 1,955) ( 2,347) ( 392) ( 6,182) ( 6,183) ( 0) Midlands and East Total ( 264,743) ( 276,780) ( 12,038) ( 575,359) ( 606,654) ( 31,295) 372,703 53, ,598 YTD Actual FOT 26

27 3.3 Financial performance by providers North (1/2) Provider Name Control Total (CT) Accepted? Control Total Basis Surplus Deficit Including STF Year to date Forecast Outturn YTD Plan YTD Actual Variance FOT Plan FOT Variance Sustainability & Transformation Fund (STF) STF Allocated (In Plan only if accepted CT) Aintree University Hospital NHS Foundation Trust YES ( 2,559) ( 2,749) ( 190) ( 6,842) ( 7,033) ( 191) 8,500 1,084 8,308 Airedale NHS Foundation Trust YES ( 932) ( 927) 5 4,421 4, , ,116 Barnsley Hospital NHS Foundation Trust YES ( 4,042) ( 4,020) 22 ( 10,557) ( 10,557) 0 5, ,880 Blackpool Teaching Hospitals NHS Foundation Trust YES ( 3,232) ( 3,429) ( 197) 3,739 3,529 ( 210) 9,351 1,192 9,141 Bolton NHS Foundation Trust YES ( 837) ( 410) ,128 10, ,889 1,006 7,711 Bradford Teaching Hospitals NHS Foundation Trust YES ( 600) ( 767) ( 167) 1,977 1,757 ( 220) 9,786 1,248 9,566 Calderdale and Huddersfield NHS Foundation Trust YES ( 8,014) ( 7,997) 16 ( 15,934) ( 15,934) 0 10,098 1,515 10,098 Countess of Chester Hospital NHS Foundation Trust YES ( 1,468) ( 1,576) ( 108) ( 2,628) ( 2,979) ( 351) 5, ,838 County Durham and Darlington NHS Foundation Trust YES ( 5,134) ( 5,058) 76 3,736 3,736 ( 0) 12,866 2,097 13,033 Doncaster and Bassetlaw Teaching Hospitals NHS Foundation Trust YES ( 7,911) ( 7,894) 17 ( 16,084) ( 16,084) ( 0) 11,547 2,151 11,966 East Cheshire NHS Trust YES ( 5,607) ( 5,435) 172 ( 20,241) ( 20,241) 0 4, ,036 East Lancashire Hospitals NHS Trust YES ( 194) ( 194) 0 ( 863) ( 863) 0 11,272 1,856 11,437 Gateshead Health NHS Foundation Trust YES ( 604) ( 606) ( 2) ( 2,321) ( 2,105) 216 5, ,328 Harrogate and District NHS Foundation Trust YES 403 ( 2,760) ( 3,163) 5,909 5, , ,777 Hull And East Yorkshire Hospitals NHS Trust YES ( 2,766) ( 6,894) ( 4,128) , ,933 Lancashire Teaching Hospitals NHS Foundation Trust YES ( 11,010) ( 10,992) 18 ( 7,766) ( 7,766) 0 11,292 1,694 11,292 The Leeds Teaching Hospitals NHS Trust YES ( 14,905) ( 11,263) 3,642 9,072 9, ,042 3,456 23,042 Central Manchester University Hospitals NHS Foundation Trust YES ( 589) ( 492) 97 10,706 10, ,210 3,451 20,629 Mid Cheshire Hospitals NHS Foundation Trust YES ( 918) ( 390) ( 1) 5, ,993 The Mid Yorkshire Hospitals NHS Trust YES ( 5,759) ( 5,957) ( 198) ( 2,302) ( 2,606) ( 304) 13,515 1,723 13,211 University Hospitals of Morecambe Bay NHS Foundation Trust NO ( 17,857) ( 18,674) ( 817) ( 58,613) ( 58,613) The Newcastle Upon Tyne Hospitals NHS Foundation Trust NO ( 681) ( 17,208) ( 9,704) 7, Northern Lincolnshire and Goole NHS Foundation Trust YES ( 4,031) ( 10,510) ( 6,479) ( 13,232) ( 13,693) ( 461) 10, ,777 North Cumbria University Hospitals NHS Trust YES ( 11,002) ( 10,996) 6 ( 44,223) ( 44,223) 0 8,234 1,235 8,234 North Tees and Hartlepool NHS Foundation Trust YES 404 ( 5,847) ( 6,252) 3,047 2,377 ( 670) 6, ,206 Northumbria Healthcare NHS Foundation Trust YES 4,200 4, ,368 24,368 ( 0) 8,580 1,706 8,999 The Pennine Acute Hospitals NHS Trust YES ( 9,202) ( 9,171) 31 ( 11,263) ( 11,263) 0 18,100 3,134 18,519 The Rotherham NHS Foundation Trust NO ( 4,654) ( 5,111) ( 457) ( 13,556) ( 13,556) The Royal Liverpool and Broadgreen University Hospitals NHS Trust NO ( 2,524) ( 8,608) ( 6,084) ( 4,590) ( 14,400) ( 9,810) Salford Royal NHS Foundation Trust YES ( 3,075) ( 3,025) 50 ( 1,367) ( 1,367) ( 0) 10,444 1,751 10,628 Sheffield Teaching Hospitals NHS Foundation Trust YES ( 5,017) ( 4,011) 1,006 ( 4,219) ( 4,219) 0 18,562 3,203 18,981 Southport And Ormskirk Hospital NHS Trust NO ( 5,970) ( 7,830) ( 1,860) ( 18,121) ( 18,121) South Tees Hospitals NHS Foundation Trust YES ( 7,692) ( 7,659) 33 7,421 7,421 ( 0) 13,180 1,977 13,180 South Tyneside NHS Foundation Trust YES ( 1,716) ( 3,489) ( 1,773) ( 888) ( 888) ( 0) 4, ,320 St Helens And Knowsley Teaching Hospitals NHS Trust YES 1,374 1, ,536 8, ,117 1,368 9,117 Stockport NHS Foundation Trust NO ( 9,022) ( 8,679) 343 ( 27,220) ( 27,220) City Hospitals Sunderland NHS Foundation Trust YES ( 2,718) ( 5,776) ( 3,057) ( 5,744) ( 5,744) ( 0) 9, ,656 Tameside and Glossop Integrated Care NHS Foundation Trust NO ( 6,769) ( 6,990) ( 221) ( 24,347) ( 24,346) University Hospital of South Manchester NHS Foundation Trust NO ( 5,290) ( 5,085) 205 ( 6,274) ( 6,274) Warrington and Halton Hospitals NHS Foundation Trust YES ( 3,041) ( 3,040) 1 ( 3,657) ( 3,657) 0 7,029 1,054 7,029 Wrightington, Wigan and Leigh NHS Foundation Trust YES ( 3,421) ( 3,382) 39 ( 664) ( 664) 0 6,443 1,385 6,862 Wirral University Teaching Hospital NHS Foundation Trust YES ( 3,711) ( 3,911) ( 200) ( 426) ( 625) ( 199) 8,875 1,131 8,675 York Teaching Hospital NHS Foundation Trust YES ( 5,405) ( 9,851) ( 4,446) 3,194 3, , ,832 YTD Actual FOT 27

28 3.3 Financial performance by providers North (2/2) Provider Name Control Total (CT) Accepted? Control Total Basis Surplus Deficit Including STF Year to date Forecast Outturn YTD Plan YTD Actual Variance FOT Plan FOT Variance Sustainability & Transformation Fund (STF) STF Allocated (In Plan only if accepted CT) North East Ambulance Service NHS Foundation Trust YES ( 1,418) ( 1,418) North West Ambulance Service NHS Trust YES ,152 2, , ,141 Yorkshire Ambulance Service NHS Trust YES ,408 3, , ,510 Bridgewater Community Healthcare NHS Foundation Trust YES ( 678) ( 675) 3 ( 523) ( 523) 0 1, ,306 Leeds Community Healthcare NHS Trust YES ,034 3, Liverpool Community Health NHS Trust YES 324 ( 885) ( 1,209) 1,296 ( 1,501) ( 2,797) 1, Wirral Community NHS Foundation Trust YES ( 51) ( 43) 8 1,571 1, North West Boroughs Healthcare NHS Foundation Trust YES ( 1,241) ( 907) 334 1,061 1, , ,061 Bradford District Care NHS Foundation Trust YES ( 1,375) ( 331) 1,044 1,578 1, Cumbria Partnership NHS Foundation Trust YES ( 1,613) ( 1,467) 146 ( 3,204) ( 3,204) 0 1, ,659 Cheshire and Wirral Partnership NHS Foundation Trust YES ( 948) ( 404) Greater Manchester Mental Health NHS Foundation Trust YES ,355 2, , ,772 Humber NHS Foundation Trust YES ( 234) ( 190) , ,431 Lancashire Care NHS Foundation Trust YES ( 72) ( 1,291) ( 1,219) 2,167 2, , ,085 Leeds and York Partnership NHS Foundation Trust YES ,679 3, , ,015 Mersey Care NHS Foundation Trust YES 1,832 1, ,162 5, , ,294 Northumberland, Tyne and Wear NHS Foundation Trust YES 1,043 1, ,091 7, , ,923 Pennine Care NHS Foundation Trust YES 605 ( 1,580) ( 2,185) 3,183 ( 6,600) ( 9,783) 1, Rotherham Doncaster and South Humber NHS Foundation Trust YES ,068 2, Sheffield Health and Social Care NHS Foundation Trust YES ,564 1, South West Yorkshire Partnership NHS Foundation Trust YES ( 127) ,417 2, , ,394 Tees, Esk and Wear Valleys NHS Foundation Trust YES 2,766 2, ,076 10, , ,313 Alder Hey Children's NHS Foundation Trust YES ( 2,627) ( 2,574) , ,524 The Christie NHS Foundation Trust YES 2,571 2, ,284 10,284 ( 0) 1, ,495 The Clatterbridge Cancer Centre NHS Foundation Trust YES 315 1, ,199 4, Liverpool Heart and Chest Hospital NHS Foundation Trust YES ,867 6, , ,554 Liverpool Women's NHS Foundation Trust YES ( 1,529) ( 1,482) 47 ( 3,998) ( 3,995) 3 3, ,206 Sheffield Children's NHS Foundation Trust YES ( 1,216) ( 1,186) , ,485 The Walton Centre NHS Foundation Trust YES ,757 3, , ,609 North Total ( 179,546) ( 213,690) ( 34,143) ( 171,604) ( 188,738) ( 17,134) 391,598 53, ,759 YTD Actual FOT 28

29 3.4 Financial performance by providers South (1/2) Provider Name Control Total (CT) Accepted? Control Total Basis Surplus Deficit Including STF Year to date Forecast Outturn YTD Plan YTD Actual Variance FOT Plan FOT Variance Sustainability & Transformation Fund (STF) STF Allocated (In Plan only if accepted CT) Ashford and St Peter's Hospitals NHS Foundation Trust YES 1,161 1, ,033 14, ,672 1,151 7,672 Hampshire Hospitals NHS Foundation Trust YES ( 2,899) ( 3,005) ( 106) 8,317 8,317 ( 0) 9,460 1,419 9,460 The Royal Bournemouth and Christchurch Hospitals NHS Foundation T YES ( 2,249) ( 2,168) 81 ( 6,648) ( 6,648) 0 6, ,400 Brighton and Sussex University Hospitals NHS Trust YES ( 18,943) ( 18,736) 207 ( 65,349) ( 65,349) ( 0) University Hospitals Bristol NHS Foundation Trust YES 220 ( 71) ( 291) 12,957 10,261 ( 2,696) 13,313 1,697 10,617 Buckinghamshire Healthcare NHS Trust YES ,457 6, ,489 1,273 8,489 Dartford and Gravesham NHS Trust YES ( 1,537) ( 1,517) 20 1,642 1, ,303 1,095 7,303 Dorset County Hospital NHS Foundation Trust YES ( 3,633) ( 1,463) 2,170 ( 2,906) ( 2,906) 0 4, ,176 East Kent Hospitals University NHS Foundation Trust YES ( 6,037) ( 5,088) 949 ( 4,445) ( 5,099) ( 654) 14,537 1,526 13,883 East Sussex Healthcare NHS Trust YES ( 11,278) ( 11,500) ( 222) ( 26,522) ( 26,745) ( 223) 9,910 1,264 9,687 Frimley Health NHS Foundation Trust YES 1,279 4,081 2,802 22,820 22,769 ( 51) 18,606 2,791 18,606 Gloucestershire Hospitals NHS Foundation Trust NO ( 10,212) ( 10,179) 33 ( 14,619) ( 14,619) Great Western Hospitals NHS Foundation Trust YES ,796 1,145 ( 651) 6,756 1,013 6,047 Isle of Wight NHS Trust YES ( 1,212) ( 5,897) ( 4,685) ( 366) ( 18,835) ( 18,469) 3, Maidstone And Tunbridge Wells NHS Trust YES ( 3,334) ( 3,524) ( 190) 6,673 6,422 ( 251) 11,177 1,425 10,926 Medway NHS Foundation Trust YES ( 10,851) ( 10,747) 104 ( 37,847) ( 37,846) 1 9,006 1,351 9,006 North Bristol NHS Trust YES ( 7,741) ( 7,340) 401 ( 18,731) ( 18,731) ( 0) 13,637 1,739 13,330 Northern Devon Healthcare NHS Trust YES ,922 3, , ,945 Oxford University Hospitals NHS Foundation Trust YES ( 4,490) ( 11,132) ( 6,642) 39,279 39, , ,324 Plymouth Hospitals NHS Trust YES ( 7,720) ( 7,577) 143 ( 3,060) ( 3,060) 0 11,799 1,770 11,799 Poole Hospital NHS Foundation Trust YES ( 2,453) ( 1,918) 535 ( 3,078) ( 2,958) 120 6, ,500 Portsmouth Hospitals NHS Trust YES ( 5,878) ( 6,133) ( 255) 9,660 9,358 ( 302) 13,431 1,712 13,129 Royal Devon and Exeter NHS Foundation Trust YES ( 2,206) ( 57) 2,149 ( 534) ( 534) 0 8,691 1,363 8,750 Royal Berkshire NHS Foundation Trust YES ( 3,587) ( 2,922) 665 4,629 4, ,012 1,352 9,012 Royal Cornwall Hospitals NHS Trust YES ( 3,721) ( 3,533) 188 1,281 1, ,412 1,262 8,412 Royal Surrey County Hospital NHS Foundation Trust YES ( 2,242) 1,221 3,463 ( 5,331) ( 5,331) 0 6,718 1,427 7,137 Royal United Hospitals Bath NHS Foundation Trust YES ( 1,702) ( 1,687) 15 12,841 10,503 ( 2,338) 7, ,454 Salisbury NHS Foundation Trust NO ( 1,875) ( 3,187) ( 1,312) ( 6,989) ( 6,989) University Hospital Southampton NHS Foundation Trust YES 1,022 2,959 1,937 27,116 27, ,806 2,753 17,888 Torbay and South Devon NHS Foundation Trust YES ( 4,382) ( 2,698) 1,684 4,593 4, , ,830 Surrey And Sussex Healthcare NHS Trust YES 1,087 1, ,307 21, ,789 1,318 8,789 Taunton and Somerset NHS Foundation Trust YES ( 4,048) ( 3,967) 81 ( 310) ( 310) 0 7,020 1,053 7,020 Western Sussex Hospitals NHS Foundation Trust YES 2,471 2, ,920 14, ,557 1,734 11,557 Weston Area Health NHS Trust YES ( 1,817) ( 1,817) 0 ( 6,035) ( 6,035) 0 3, ,079 Yeovil District Hospital NHS Foundation Trust YES ( 5,422) ( 5,394) 28 ( 13,083) ( 13,084) ( 0) 4, ,294 YTD Actual FOT 29

30 3.4 Financial performance by providers South (2/2) Provider Name Control Total (CT) Accepted? Control Total Basis Surplus Deficit Including STF Year to date Forecast Outturn YTD Plan YTD Actual Variance FOT Plan FOT Variance Sustainability & Transformation Fund (STF) STF Allocated (In Plan only if accepted CT) South Central Ambulance Service NHS Foundation Trust YES ( 423) ( 366) 57 ( 1,385) ( 1,385) 0 1, ,062 South East Coast Ambulance Service NHS Foundation Trust YES ( 1,977) ( 1,960) 17 ( 955) ( 955) 0 1, ,266 South Western Ambulance Service NHS Foundation Trust NO Gloucestershire Care Services NHS Trust YES ,987 1, , ,020 Kent Community Health NHS Foundation Trust YES ,026 3, , ,759 Solent NHS Trust YES ( 586) ( 586) 1 ( 1,547) ( 1,547) 0 1, ,152 Sussex Community NHS Foundation Trust YES ,658 4, , ,718 Avon and Wiltshire Mental Health Partnership NHS Trust YES ( 1,164) ( 1,979) ( 815) 2,614 2, , ,197 Berkshire Healthcare NHS Foundation Trust YES ,478 2, , ,731 Cornwall Partnership NHS Foundation Trust YES ( 462) ( 397) Devon Partnership NHS Trust YES ,604 2, Dorset Healthcare University NHS Foundation Trust YES 89 1,224 1,135 2,195 2, , ,215 2gether NHS Foundation Trust YES ( 6) Southern Health NHS Foundation Trust YES ( 70) ( 66) 3 2,865 2, , ,908 Kent and Medway NHS and Social Care Partnership Trust YES ( 1,354) ( 1,343) 11 ( 2,834) ( 2,834) 0 1, ,100 Oxford Health NHS Foundation Trust YES ( 356) ,895 1, , ,350 Somerset Partnership NHS Foundation Trust YES ,893 2, , ,638 Surrey and Borders Partnership NHS Foundation Trust YES ,521 2, ,612 Sussex Partnership NHS Foundation Trust YES 1,073 ( 86) ( 1,159) 4,968 ( 0) ( 4,968) 1, The Queen Victoria Hospital NHS Foundation Trust YES ,716 1, South Total ( 123,543) ( 118,952) 4,591 29,532 ( 809) ( 30,341) 324,565 44, ,568 YTD Actual FOT 30

31 Operational Performance by Providers

32 4.1 Best and worst operational performance (1/3) A&E 4-hour standard ten best and worst performing trusts during Q1 2017/18 - acute trusts only Best performing trusts Total attendances 4-hour breaches Q1 2017/18 performance Luton and Dunstable University Hospital NHS Foundation Trust 38, % North Tees and Hartlepool NHS Foundation Trust 43, % Dorset County Hospital NHS Foundation Trust 24, % Yeovil District Hospital NHS Foundation Trust 12, % Sheffield Children's NHS Foundation Trust 14, % Royal Surrey County Hospital NHS Foundation Trust 17, % South Tyneside NHS Foundation Trust 17, % Harrogate and District NHS Foundation Trust 15, % Gateshead Health NHS Foundation Trust 29,633 1, % South Tees Hospitals NHS Foundation Trust 38,388 1, % Worst performing trusts Total attendances 4-hour breaches Q1 2017/18 performance East Kent Hospitals University NHS Foundation Trust 53,331 12, % The Princess Alexandra Hospital NHS Trust 25,438 5, % University Hospitals Of Leicester NHS Trust 59,288 12, % Portsmouth Hospitals NHS Trust 37,454 8, % United Lincolnshire Hospitals NHS Trust 38,978 7, % Shrewsbury And Telford Hospital NHS Trust 35,504 6, % Gloucestershire Hospitals NHS Foundation Trust 34,710 6, % Wirral University Teaching Hospital NHS Foundation Trust 31,684 6, % Aintree University Hospital NHS Foundation Trust 41,840 7, % North Bristol NHS Trust 22,652 4, % 32

33 4.1 Best and worst operational performance (2/3) RTT 18-week ten best and worst performing trusts at end of Q1 2017/18 - acute and specialist trusts only Best performing trusts Waiting list 0-18 week waiters Q1 17/18 Performance Worst performing trusts Waiting list 0-18 week waiters Q1 17/18 Performance Lancashire Care NHS Foundation Trust % The Christie NHS Foundation Trust 1,480 1, % Northern Lincolnshire and Goole NHS Foundation Trust Kettering General Hospital NHS Foundation Trust 29,288 22, % 22,443 17, % Mid Cheshire Hospitals NHS Foundation Trust 11,129 10, % King's College Hospital NHS Foundation Trust 84,337 64, % Liverpool Heart and Chest Hospital NHS Foundation Trust % Wye Valley NHS Trust 13,454 10, % The Royal Marsden NHS Foundation Trust 1,704 1, % University Hospitals of North Midlands NHS Trust 49,252 39, % The Clatterbridge Cancer Centre NHS Foundation Trust Homerton University Hospital NHS Foundation Trust North Middlesex University Hospital NHS Trust % 17,041 16, % 9,367 9, % Mid Yorkshire Hospitals NHS Trust 34,694 28, % George Eliot Hospital NHS Trust 9,881 8, % Medway NHS Foundation Trust 21,868 18, % Moorfields Eye Hospital NHS Foundation Trust 27,892 26, % Wirral University Teaching Hospital NHS Foundation Trust 22,437 18, % Sheffield Teaching Hospitals NHS Foundation Trust 41,332 39, % West Suffolk NHS Foundation Trust 19,931 16, % 33

34 4.1 Best and worst operational performance (3/3) Cancer 62-day standard ten best and worst performing trusts in Q1 2017/18* - acute and specialist trusts only Best performing trusts Number treated Within 62 days Q1 17/18 Performance South Tyneside NHS Foundation Trust % Mid Cheshire Hospitals NHS Foundation Trust % South Tyneside NHS Foundation Trust % Kingston Hospital NHS Foundation Trust % Tameside Hospital NHS Foundation Trust % Worst performing trusts The Clatterbridge Cancer Centre NHS Foundation Trust Royal Brompton and Harefield NHS Foundation Trust Basildon and Thurrock University Hospitals NHS Foundation Trust University College London Hospitals NHS Foundation Trust Guy's and St Thomas' NHS Foundation Trust Number treated Within 62 days Q1 17/18 Performance % % % % % Wrightington, Wigan and Leigh NHS Foundation Trust % University Hospitals Birmingham NHS Foundation Trust % Bolton NHS Foundation Trust % Southend University Hospital NHS Foundation Trust % Frimley Health NHS Foundation Trust % The Christie NHS Foundation Trust % Airedale NHS Foundation Trust % The Princess Alexandra Hospital NHS Trust % Maidstone And Tunbridge Wells NHS Trust Worcestershire Acute Hospitals NHS Trust % % * Trusts with l0 or fewer patients treated have not been included in this analysis 34

35 4.2 Operational performance by providers - London 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 Cancer 31 days - GP referral (96%) Barking, Havering And Redbridge University Hospitals NHS Trust 85.50% 92.19% % 81.57% 97.22% 97.95% 99.31% 4 Barts Health NHS Trust 85.53% 5.81% 78.05% 96.84% 97.33% 98.31% 21 Central and North West London NHS Foundation Trust % % 0 Central London Community Healthcare NHS Trust 99.08% 97.99% 0 0 Chelsea and Westminster Hospital NHS Foundation Trust 93.75% 91.16% % 80.24% 91.95% 90.29% 98.36% 5 Croydon Health Services NHS Trust 90.13% 92.24% % 89.75% 97.12% 99.20% 98.35% 5 Epsom And St Helier University Hospitals NHS Trust 95.27% 91.01% % 87.01% 94.59% 97.03% 13 Great Ormond Street Hospital for Children NHS Foundation Trust 89.26% % % % % 3 Guy's and St Thomas' NHS Foundation Trust 88.09% 88.49% % 65.31% 92.56% 88.00% 93.70% 5 Homerton University Hospital NHS Foundation Trust 94.02% 96.66% % 79.07% 98.42% 98.83% % 1 Hounslow and Richmond Community Healthcare NHS Trust 99.99% % % 0 Imperial College Healthcare NHS Trust 90.07% 85.04% % 83.67% 89.47% 67.71% 96.97% 9 King's College Hospital NHS Foundation Trust 85.41% 77.02% % 81.03% 92.91% 84.82% 97.15% 16 Kingston Hospital NHS Foundation Trust 89.84% 94.55% % 95.77% 98.87% 98.96% % 2 Lewisham and Greenwich NHS Trust 91.20% 90.71% % 78.38% 94.80% 99.32% 98.13% 7 London North West Healthcare NHS Trust 84.58% 90.01% % 76.52% 92.82% 93.47% 98.26% 16 Moorfields Eye Hospital NHS Foundation Trust 97.49% 96.19% % 96.97% 82.09% 0 North East London NHS Foundation Trust 99.46% % 0 0 North Middlesex University Hospital NHS Trust 82.74% 96.54% % 88.27% 96.37% 98.17% 99.06% 9 Royal Brompton and Harefield NHS Foundation Trust N/A 92.71% % 62.50% % 91.95% 4 Royal Free London NHS Foundation Trust 88.33% 92.15% % 83.67% 93.57% 92.45% 97.46% 16 Royal National Orthopaedic Hospital NHS Trust N/A 93.14% % 73.17% 98.14% 95.35% 0 South West London and ST George's Mental Health NHS Trust 97.59% 0 0 St George's University Hospitals NHS Foundation Trust 90.75% 2.60% 86.63% 73.23% 79.86% 96.59% 4 The Hillingdon Hospitals NHS Foundation Trust 86.80% 92.37% % 85.71% 97.20% 98.23% 98.71% 2 The Royal Marsden NHS Foundation Trust 96.77% % 97.39% 93.61% 97.98% 13 The Whittington Hospital NHS Trust 92.36% 92.39% % 86.57% 93.93% 96.61% % 6 University College London Hospitals NHS Foundation Trust 91.04% 92.92% % 65.10% 94.29% 93.18% 92.65% 16 London 89.60% 89.32% % 79.87% 93.51% 91.31% 96.85% 177 C.Diff cases 35

36 4.2 Operational performance by providers 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 weeks - GP referral (93%) Cancer 2 weeks - breast symptoms Cancer 31 days - GP referral (96%) Basildon and Thurrock University Hospitals NHS Foundation Trust 91.09% 83.97% % 64.95% 87.82% 87.73% 94.83% 7 Bedford Hospital NHS Trust 95.36% 92.61% % 86.03% 95.40% 97.32% 98.93% 3 Birmingham Children's Hospital NHS Foundation Trust 95.12% 93.49% % % 97.10% % 0 Birmingham Community Healthcare NHS Foundation Trust 94.34% 0 0 Birmingham Women's NHS Foundation Trust 71.43% % 0 Black Country Partnership NHS Foundation Trust 96.86% 0 0 Burton Hospitals NHS Foundation Trust 93.70% 94.76% % 79.94% 93.65% 42.24% 98.30% 4 Cambridge University Hospitals NHS Foundation Trust 95.61% 92.06% % 79.12% 95.92% 97.30% 96.92% 15 Cambridgeshire and Peterborough NHS Foundation Trust 98.06% 0 0 Cambridgshire Community Services NHS Trust 99.69% % 0 Chesterfield Royal Hospital NHS Foundation Trust 90.77% 91.20% % 80.26% 76.40% 43.96% 94.26% 2 Colchester Hospital University NHS Foundation Trust 87.74% 86.59% % 75.91% 94.00% 86.91% 93.75% 7 Coventry and Warwickshire Partnership NHS Trust N/A % % 0 Derby Teaching Hospitals NHS Foundation Trust 87.03% 92.24% % 73.04% 96.12% 93.64% 95.40% 17 Derbyshire Community Health Services NHS Foundation Trust 99.99% 96.74% % 0 Derbyshire Healthcare NHS Foundation Trust 94.40% 0 0 Dudley and Walsall Mental Health Partnership NHS Trust 98.95% 0 0 East And North Hertfordshire NHS Trust 86.95% 88.93% % 69.87% 98.37% 93.23% 89.10% 6 George Eliot Hospital NHS Trust 94.73% 82.03% % 89.87% 95.19% 95.04% 98.59% 1 Heart of England NHS Foundation Trust 84.41% 92.34% % 86.70% 94.86% 93.93% 98.39% 8 Hertfordshire Community NHS Trust 99.58% 97.73% 0 0 Hinchingbrooke Health Care NHS Trust 50.00% 0 Ipswich Hospital NHS Trust 92.44% 94.58% % 78.38% 94.95% 76.54% 96.24% 6 James Paget University Hospitals NHS Foundation Trust 94.53% 89.95% % 87.50% 97.19% 96.47% 99.66% 4 Kettering General Hospital NHS Foundation Trust 86.28% 76.03% % 89.06% 96.59% 93.75% % 7 Leicestershire Partnership NHS Trust 99.57% % 0 Lincolnshire Community Health Services NHS Trust 99.29% 0 Lincolnshire Partnership NHS Foundation Trust 95.16% 0 0 Luton and Dunstable University Hospital NHS Foundation Trust 98.96% 92.72% % 89.44% 95.38% 96.74% % 5 Mid Essex Hospital Services NHS Trust 85.59% 87.33% % 93.95% 94.58% 93.36% 12 Milton Keynes Hospital NHS Foundation Trust 92.00% 91.85% % 87.38% 96.71% 96.53% % 1 Norfolk and Norwich University Hospitals NHS Foundation Trust 91.27% 85.47% % 76.54% 92.99% 97.66% 97.91% 7 C.Diff cases 36

37 4.2 Operational performance by providers 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 Cancer 31 days - GP referral (96%) Norfolk Community Health and Care NHS Trust 91.00% 0 0 Northampton General Hospital NHS Trust 87.18% 92.02% % 75.61% 89.34% 65.83% 95.69% 4 Northamptonshire Healthcare NHS Foundation Trust % 0 0 Nottingham University Hospitals NHS Trust 81.69% 95.73% % 77.30% 93.87% 93.99% 96.34% 21 Papworth Hospital NHS Foundation Trust 86.21% % 82.76% % 0 Peterborough and Stamford Hospitals NHS Foundation Trust 87.88% 93.91% % 85.29% 94.16% 85.31% 99.49% 14 Sandwell And West Birmingham Hospitals NHS Trust 83.31% 93.37% % 86.29% 93.65% 96.43% 98.50% 5 Sherwood Forest Hospitals NHS Foundation Trust 96.04% 92.73% % 84.89% 94.89% 96.24% 98.59% 8 Shrewsbury And Telford Hospital NHS Trust 80.46% 88.39% % 82.35% 93.65% 93.49% 99.18% 10 Shropshire Community Health NHS Trust 99.93% 94.32% % 0 South Essex Partnership University NHS Foundation Trust 0 South Warwickshire NHS Foundation Trust 95.59% 90.86% % 87.66% 93.98% 94.74% 98.39% 4 Southend University Hospital NHS Foundation Trust 92.51% 85.35% % 67.12% 95.48% 96.43% 93.80% 8 Staffordshire and Stoke on Trent Partnership NHS Trust 98.77% % 0 The Dudley Group NHS Foundation Trust 92.38% 95.00% % 80.46% 96.59% 98.23% 98.44% 5 The Princess Alexandra Hospital NHS Trust 77.32% 93.26% % 91.34% 98.43% 98.52% 99.25% 3 The Queen Elizabeth Hospital, King's Lynn, NHS Foundation Trust 88.64% 92.03% % 79.60% 97.44% 97.13% 98.39% 7 The Robert Jones and Agnes Hunt Orthopaedic Hospital NHS Foundation Trust N/A 90.17% % 66.67% % % 0 The Royal Orthopaedic Hospital NHS Foundation Trust 0.38% 66.67% 97.56% 96.55% 1 The Royal Wolverhampton NHS Trust 93.37% 91.00% % 76.56% 92.98% 95.47% 96.59% 11 United Lincolnshire Hospitals NHS Trust 80.15% 89.89% % 69.90% 90.52% 75.42% 95.81% 21 University Hospitals Birmingham NHS Foundation Trust 84.92% 92.22% % 66.67% 94.20% 95.24% 97.63% 22 University Hospitals Coventry And Warwickshire NHS Trust 82.59% 85.47% % 83.48% 92.44% 98.33% 99.26% 7 University Hospitals Of Leicester NHS Trust 78.27% 92.29% % 79.15% 94.62% 91.17% 96.00% 11 University Hospitals of North Midlands NHS Trust 81.69% 79.99% % 78.24% 99.08% 98.93% 97.90% 23 Walsall Healthcare NHS Trust 84.13% 84.72% % 88.00% 93.43% 95.70% 99.19% 2 West Hertfordshire Hospitals NHS Trust 83.31% 90.74% % 89.88% 94.74% 90.52% 99.11% 3 West Suffolk NHS Foundation Trust 95.12% 83.36% % 86.69% 94.21% 94.24% % 6 Worcestershire Acute Hospitals NHS Trust 82.30% 84.25% % 68.48% 68.41% 44.73% 97.21% 5 Worcestershire Health And Care NHS Trust 98.24% 0 0 Wye Valley NHS Trust 89.73% 77.41% % 84.64% 95.54% 89.77% 97.57% 6 Midlands and East 88.17% 89.46% % 79.05% 93.32% 89.04% 97.04% 319 C.Diff cases 37

38 4.2 Operational performance by providers 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 Cancer 31 days - GP referral (96%) 5 Boroughs Partnership NHS Foundation Trust % 0 Aintree University Hospital NHS Foundation Trust 81.07% 93.19% % 84.71% 94.37% 88.96% 98.03% 18 Airedale NHS Foundation Trust 94.07% 93.20% % 91.45% 96.53% 99.07% % 2 Alder Hey Children's NHS Foundation Trust 95.97% 92.12% % % % 0 Barnsley Hospital NHS Foundation Trust 90.69% 92.31% % 90.53% 94.97% 94.25% 99.48% 1 Blackpool Teaching Hospitals NHS Foundation Trust 86.95% 90.02% % 83.00% 93.50% 98.37% 97.74% 9 Bolton NHS Foundation Trust 84.58% 93.01% % 92.88% 97.11% 74.20% 99.65% 7 Bradford District Care NHS Foundation Trust % 0 0 Bradford Teaching Hospitals NHS Foundation Trust 85.10% 88.65% % 78.87% 94.19% % 98.43% 7 Bridgewater Community Healthcare NHS Foundation Trust 98.09% 99.68% % 97.92% 95.23% 97.37% 0 Calderdale and Huddersfield NHS Foundation Trust 90.61% 92.55% % 88.38% 88.53% 92.06% % 3 Central Manchester University Hospitals NHS Foundation Trust 93.57% 92.17% % 78.37% 93.21% 97.19% 18 City Hospitals Sunderland NHS Foundation Trust 94.47% 94.67% % 77.39% 96.87% 97.43% 5 Countess of Chester Hospital NHS Foundation Trust 86.69% 90.07% % 83.84% 95.92% 84.35% 98.97% 6 County Durham and Darlington NHS Foundation Trust 92.87% 93.47% % 88.09% 93.96% 96.01% % 2 Cumbria Partnership NHS Foundation Trust 97.49% 98.29% % 0 Doncaster and Bassetlaw Hospitals NHS Foundation Trust 91.43% 90.85% % 85.07% 90.58% 92.51% 98.94% 10 East Cheshire NHS Trust 83.92% 93.29% % 90.16% 98.19% 92.50% 98.51% 5 East Lancashire Hospitals NHS Trust 82.93% 92.39% % 89.95% 94.49% 93.75% 99.50% 8 Gateshead Health NHS Foundation Trust 96.43% 95.44% % 87.31% 93.93% 96.07% % 4 Harrogate and District NHS Foundation Trust 96.73% 93.66% % 85.98% 96.41% 95.67% 99.59% 2 Hull And East Yorkshire Hospitals NHS Trust 93.27% 85.15% % 74.64% 95.54% 94.55% 96.27% 15 Humber NHS Foundation Trust % 99.57% % 0 Lancashire Care NHS Foundation Trust % 0 0 Lancashire Teaching Hospitals NHS Foundation Trust 90.44% 85.07% % 83.08% 97.50% 95.93% 95.96% 16 Leeds Community Healthcare NHS Trust 99.59% % 0 Leeds Teaching Hospitals NHS Trust 90.55% 88.72% % 76.70% 95.06% 95.18% 97.47% 29 Liverpool Community Health NHS Trust % 0 Liverpool Heart and Chest Hospital NHS Foundation Trust N/A 97.51% % 89.52% % 98.33% 1 Liverpool Women's NHS Foundation Trust 98.01% 94.83% % 85.45% 97.87% % 0 Mid Cheshire Hospitals NHS Foundation Trust 92.72% 97.56% % 96.65% 97.40% 93.40% 99.63% 13 Mid Yorkshire Hospitals NHS Trust 88.50% 81.61% % 85.53% 96.54% 96.57% 97.07% 5 C.Diff cases 38

39 4.2 Operational performance by providers 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 Cancer 31 days - GP referral (96%) North Cumbria University Hospitals NHS Trust 90.86% 92.63% % 82.56% 95.08% 77.59% 96.97% 5 North Tees and Hartlepool NHS Foundation Trust 98.47% 94.12% % 85.75% 91.86% 94.00% 99.70% 13 Northern Lincolnshire and Goole NHS Foundation Trust 82.30% 75.88% % 71.91% 96.11% 93.85% 98.50% 4 Northumberland, Tyne and Wear NHS Foundation Trust % % 0 Northumbria Healthcare NHS Foundation Trust 93.45% 93.14% % 81.52% 94.85% 97.26% 98.13% 5 Pennine Acute Hospitals NHS Trust 83.66% 92.21% % 79.07% 92.09% 99.69% 99.16% 14 Pennine Care NHS Foundation Trust 99.98% 1.69% 0 Royal Liverpool And Broadgreen University Hospitals NHS Trust 89.56% 87.29% % 86.40% 90.68% 94.13% 97.37% 8 Salford Royal NHS Foundation Trust 85.17% 93.01% % 89.63% 95.18% 99.18% 3 Sheffield Children's NHS Foundation Trust 97.81% 94.04% % % % 1 Sheffield Teaching Hospitals NHS Foundation Trust 92.04% 95.88% % 78.81% 95.80% 95.42% 98.23% 22 South Tees Hospitals NHS Foundation Trust 96.26% 92.67% % 86.58% 93.69% 85.71% 98.47% 8 South Tyneside NHS Foundation Trust 96.97% 95.63% % 96.51% 97.28% % 0 South West Yorkshire Partnership NHS Foundation Trust N/A 98.22% % 0 Southport And Ormskirk Hospital NHS Trust 90.31% 94.01% % 82.08% 94.38% 98.86% 3 St Helens And Knowsley Hospitals NHS Trust 86.82% 93.16% % 87.36% 94.89% 95.08% 98.67% 9 Stockport NHS Foundation Trust 85.78% 92.67% % 86.54% 97.96% 96.30% % 9 Tameside Hospital NHS Foundation Trust 85.63% 93.15% % 94.98% 95.24% 99.65% % 4 The Christie NHS Foundation Trust N/A 99.05% % 67.13% 98.10% 6 The Clatterbridge Cancer Centre NHS Foundation Trust 96.75% % 62.17% 97.41% 1 The Newcastle Upon Tyne Hospitals NHS Foundation Trust 94.54% 94.46% % 86.61% 93.85% 92.48% 98.61% 6 The Rotherham NHS Foundation Trust 87.48% 95.50% % 86.65% 95.81% 94.66% 97.04% 2 The Walton Centre NHS Foundation Trust N/A 95.87% % 98.59% % 2 University Hospital of South Manchester NHS Foundation Trust 92.44% 87.33% % 86.32% 94.95% 92.79% 99.40% 13 University Hospitals of Morecambe Bay NHS Foundation Trust 86.91% 89.20% % 83.98% 96.08% 93.36% 97.90% 2 Warrington and Halton Hospitals NHS Foundation Trust 91.55% 92.86% % 75.23% 94.33% 87.44% 96.91% 5 Wirral Community NHS Trust 98.69% % % 0 Wirral University Teaching Hospital NHS Foundation Trust 81.04% 82.67% % 87.66% 95.62% 83.57% 96.75% 8 Wrightington, Wigan and Leigh NHS Foundation Trust 89.63% 95.60% % 93.65% 97.04% 95.51% 99.07% 6 York Teaching Hospital NHS Foundation Trust 90.89% 89.11% % 80.53% 86.55% 93.81% 97.22% 7 North 90.19% 90.77% % 83.47% 94.45% 93.37% 98.23% 352 C.Diff cases 39

40 4.2 Operational performance by providers 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 Cancer 31 days - GP referral (96%) Ashford and St Peter's Hospitals NHS Foundation Trust 88.46% 93.60% % 88.29% 94.67% 95.36% 98.88% 1 Berkshire Healthcare NHS Foundation Trust % % % 0 Brighton And Sussex University Hospitals NHS Trust 86.60% 86.87% % 80.75% 94.05% 96.51% 99.53% 6 Buckinghamshire Healthcare NHS Trust 91.26% 90.65% % 85.59% 93.19% 91.59% 99.33% 6 Cornwall Partnership NHS Foundation Trust 99.69% % % 0 Dartford And Gravesham NHS Trust 86.96% 93.88% % 88.04% 96.39% 98.07% 99.17% 5 Dorset County Hospital NHS Foundation Trust 98.40% 85.00% % 85.80% 86.25% 68.57% 99.33% 3 Dorset Healthcare University NHS Foundation Trust N/A 97.65% % 0 East Kent Hospitals University NHS Foundation Trust 77.29% 85.07% % 72.83% 95.41% 90.45% 95.48% 11 East Sussex Healthcare NHS Trust 83.22% 92.21% % 73.98% 96.26% 96.01% 98.00% 15 Frimley Health NHS Foundation Trust 91.22% 92.58% % 91.94% 96.18% 95.89% 98.62% 6 Gloucestershire Care Services NHS Trust 99.39% 0.00% 0 Gloucestershire Hospitals NHS Foundation Trust 80.87% 5.15% 75.25% 89.14% 92.77% 95.50% 7 Great Western Hospitals NHS Foundation Trust 88.89% 92.03% % 79.56% 88.80% 47.76% 98.12% 3 Hampshire Hospitals NHS Foundation Trust 93.77% 93.47% % 85.24% 96.41% 94.56% 99.07% 5 Isle Of Wight NHS Trust 82.52% 91.85% % 81.55% 97.61% 99.34% 98.57% 4 Kent Community Health NHS Trust 99.92% 99.52% % 0 Maidstone And Tunbridge Wells NHS Trust 88.89% 87.05% % 67.28% 92.63% 88.16% 92.50% 11 Medway NHS Foundation Trust 86.59% 82.42% % 78.57% 76.99% 85.92% 97.12% 3 North Bristol NHS Trust 81.34% 87.78% % 84.48% 89.01% 90.31% 95.75% 10 Northern Devon Healthcare NHS Trust 92.29% 4.82% 85.77% 92.41% 77.78% 98.88% 3 Oxford Health NHS Foundation Trust 96.39% 0 Oxford University Hospitals NHS Foundation Trust 85.92% 89.81% % 83.86% 93.72% 98.68% 97.45% 16 Oxleas NHS Foundation Trust 93.72% % 0 Plymouth Hospitals NHS Trust 84.74% 85.59% % 81.85% 91.99% 11.88% 95.67% 7 Poole Hospital NHS Foundation Trust 93.17% 92.67% % 89.18% 99.25% 97.79% % 3 Portsmouth Hospitals NHS Trust 78.54% 91.53% % 85.51% 97.07% 96.12% 99.01% 12 Queen Victoria Hospital NHS Foundation Trust 99.66% 90.03% % 73.57% 94.32% 96.53% 0 Royal Berkshire NHS Foundation Trust 93.05% 92.92% % 84.04% 95.34% 95.54% 97.76% 6 Royal Cornwall Hospitals NHS Trust 83.95% 90.67% % 85.56% 93.29% 93.10% 97.24% 8 Royal Devon and Exeter NHS Foundation Trust 92.74% 90.29% % 81.25% 94.99% 96.28% 98.12% 7 C.Diff cases 40

41 4.2 Operational performance by providers 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 Cancer 31 days - GP referral (96%) Royal Surrey County Hospital NHS Foundation Trust 97.63% 92.59% % 79.41% 98.69% 97.95% 97.13% 3 Royal United Hospitals Bath NHS Foundation Trust 86.37% 89.69% % 87.55% 95.09% 82.05% 98.29% 13 Salisbury NHS Foundation Trust 94.59% 90.00% % 85.52% 94.99% 95.40% 97.77% 2 Solent NHS Trust 99.35% 0 0 Somerset Partnership NHS Foundation Trust 99.50% 99.46% % 0 Southern Health NHS Foundation Trust 99.66% 94.42% % 0 Surrey And Sussex Healthcare NHS Trust 92.76% 87.34% % 86.65% 93.01% 93.33% 99.21% 10 Sussex Community NHS Trust 95.63% 97.16% % 0.00% % 0 Taunton and Somerset NHS Foundation Trust 94.58% 85.43% % 77.27% 90.55% 94.23% 96.60% 1 The Royal Bournemouth and Christchurch Hospitals NHS Foundation Trust 93.81% 92.17% % 89.71% 97.57% % 97.32% 5 Torbay and South Devon NHS Foundation Trust 92.19% 86.62% % 85.21% 84.03% 83.58% 98.52% 6 University Hospital Southampton NHS Foundation Trust 87.82% 92.01% % 87.62% 94.71% 86.99% 98.32% 9 University Hospitals Bristol NHS Foundation Trust 84.81% 90.98% % 78.87% 95.00% 94.54% 7 Western Sussex Hospitals NHS Foundation Trust 94.63% 90.58% % 91.10% 95.55% 96.40% 99.87% 5 Weston Area Health NHS Trust 87.63% 95.20% % 71.21% 96.35% 97.53% 99.29% 0 Yeovil District Hospital NHS Foundation Trust 98.16% 94.59% % 89.06% 93.82% 93.81% 97.87% 2 South 89.82% 90.04% % 82.73% 93.38% 88.67% 97.53% 221 C.Diff cases 41

42 4.2 Operational performance by providers Ambulance Cat A Red 1 (75%) Cat A Red 2 (75%) Cat A 19 (95%) East Midlands 72.07% 57.40% 85.57% East of England 72.18% 62.43% 91.28% Isle of Wight 68.85% 73.57% 93.66% London 75.34% 71.68% 94.93% North East 73.48% 58.21% 88.37% North West 66.13% 65.97% 90.64% South Central 75.52% 72.70% 94.91% South East Coast 67.54% 51.56% 88.98% 42

43 4.3 Operational performance by delivery boards A&E (1/9) 43 The performance shown below cover all providers, including independent service providers Board Provider Attendances Breaches 4 hour A&E Performance BANES A&E DELIVERY BOARD % RD1 Royal United Hospitals Bath NHS Foundation Trust % BARNET & ENFIELD A&E DELIVERY BOARD % RAL Royal Free London NHS Foundation Trust % Y02696 Edmonton GP Walk In Centre % BARNSLEY A&E DELIVERY BOARD % RFF Barnsley Hospital NHS Foundation Trust % BEDFORDSHIRE A&E DELIVERY BOARD % RC1 Bedford Hospital NHS Trust % Y02428 Putnoe Medical Centre Walk In Centre % BERKSHIRE EAST A&E DELIVERY BOARD % NQT10 Assura Reading Llp % RWX Berkshire Healthcare NHS Foundation Trust % BERKSHIRE WEST A&E DELIVERY BOARD % RHW Royal Berkshire NHS Foundation Trust % BHR A&E DELIVERY BOARD % RAT North East London NHS Foundation Trust % RF4 Barking, Havering And Redbridge University Hospitals NHS Trust % Y02973 Orchard Village Walk-In-Centre % Y03082 Harold Wood Walk In Centre % BIRMINGHAM & SOLIHULL A&E DELIVERY BOARD % M85813 Birmingham Wic % NL7 Assura Vertis Urgent Care Centres (Birmingham) % NTPAL Greet General Practice & Urgent Care Centre % RLU Birmingham Women's NHS Foundation Trust RQ3 Birmingham Children's Hospital NHS Foundation Trust % RR1 Heart Of England NHS Foundation Trust % RRK University Hospitals Birmingham NHS Foundation Trust % RYW Birmingham Community Healthcare NHS Foundation Trust Y02568 Solihull Healthcare & Walk-In-Centre Y02615 South Birmingham GP Walk In Centre % BOLTON UEC DELIVERY BOARD % RMC Bolton NHS Foundation Trust % BRADFORD AND AIREDALE A&E DELIVERY BOARD % RAE Bradford Teaching Hospitals NHS Foundation Trust % RCF Airedale NHS Foundation Trust % BRIGHTON A&E DELIVERY BOARD % RXH Brighton And Sussex University Hospitals NHS Trust %

44 4.3 Operational performance by delivery boards A&E (2/9) 44 Board Provider Attendances Breaches 4 hour A&E Performance BRISTOL, NORTH SOMERSET, SOUTH GLOUCESTERSHIRE (BNSSG) A&E DELIVERY BOARD % NLT02 Clevedon Hospital % NLW Bristol Community Health % NLX02 Paulton Memorial Hospital NLX24 Yate West Gate Centre % RA3 Weston Area Health NHS Trust % RA7 University Hospitals Bristol NHS Foundation Trust % RVJ North Bristol NHS Trust % BROMLEY A&E DELIVERY BOARD % AD913 Beckenham Beacon Ucc % Y02147 Urgent Care Centre % BUCKINGHAMSHIRE A&E DELIVERY BOARD % RXQ Buckinghamshire Healthcare NHS Trust % CALDERDALE AND HUDDERSFIELD A&E DELIVERY BOARD % RWY Calderdale And Huddersfield NHS Foundation Trust % Y01069 Local Care Direct Ooh % Y01231 Lcd-Leeds-Ooh % CAMBRIDGE & ELY A&E DELIVERY BOARD % RGT Cambridge University Hospitals NHS Foundation Trust % CAMDEN A&E DELIVERY BOARD % RRV University College London Hospitals NHS Foundation Trust % CENTRAL CHESHIRE A&E DELIVERY BOARD % RBT Mid Cheshire Hospitals NHS Foundation Trust % CENTRAL LANCASHIRE A&E DELIVERY BOARD % RXN Lancashire Teaching Hospitals NHS Foundation Trust % CENTRAL NORFOLK A&E DELIVERY BOARD % NMH01 Norwich Practices Ltd (Castle Mall) % RM1 Norfolk And Norwich University Hospitals NHS Foundation Trust % CHELWEST A&E DELIVERY BOARD % RQM Chelsea And Westminster Hospital NHS Foundation Trust % RT3 Royal Brompton & Harefield NHS Foundation Trust RYX Central London Community Healthcare NHS Trust % CITY & HACKNEY HEALTH AND SOCIAL CARE TRANSFORMATION BOARD % F84747 The Barkantine Practice % RQX Homerton University Hospital NHS Foundation Trust % Y02585 Orient Practice Y03047 St Andrews Walk-In Centre % COASTAL WEST SUSSEX A&E DELIVERY BOARD % RPC Queen Victoria Hospital NHS Foundation Trust % RYR Western Sussex Hospitals NHS Foundation Trust % CORNWALL A&E DELIVERY BOARD % REF Royal Cornwall Hospitals NHS Trust % RJ8 Cornwall Partnership NHS Foundation Trust % COVENTRY & RUGBY A&E DELIVERY BOARD % RKB University Hospitals Coventry And Warwickshire NHS Trust % RYG Coventry And Warwickshire Partnership NHS Trust Y02613 Coventry NHS Healthcare Ctr 0 0 -

45 4.3 Operational performance by delivery boards A&E (3/9) 45 Board Provider Attendances Breaches 4 hour A&E Performance CROYDON A&E DELIVERY BOARD % AF002 Purley Miu AF003 Parkway Miu NX122 Edridge Road Community Health Centre RJ6 Croydon Health Services NHS Trust % DEVON A&E DELIVERY BOARD % L83087 Okehampton Medical Centre % NR5 Livewell Southwest % RA9 Torbay And South Devon NHS Foundation Trust % RBZ Northern Devon Healthcare NHS Trust % RH8 Royal Devon And Exeter NHS Foundation Trust % RK9 Plymouth Hospitals NHS Trust % DGS (ALSO CALLED NORTH KENT) A&E DELIVERY BOARD % RN7 Dartford And Gravesham NHS Trust % DONCASTER & BASSETLAW A&E DELIVERY BOARD % RP5 Doncaster And Bassetlaw Hospitals NHS Foundation Trust % DORSET A&E DELIVERY BOARD % RBD Dorset County Hospital NHS Foundation Trust % RD3 Poole Hospital NHS Foundation Trust % RDY Dorset Healthcare University NHS Foundation Trust RDZ The Royal Bournemouth And Christchurch Hospitals NHS Foundation Trust % DUDLEY A&E DELIVERY BOARD % RNA The Dudley Group NHS Foundation Trust % DURHAM AND DARLINGTON A&E DELIVERY BOARD % RXP County Durham And Darlington NHS Foundation Trust % EAST & NORTH HERTFORDSHIRE A&E DELIVERY BOARD % NEH06 Haverstock Healthcare (Cheshunt Community Hospital) % RWH East And North Hertfordshire NHS Trust % RY4 Hertfordshire Community NHS Trust % EAST KENT A&E DELIVERY BOARD % G82071 Dr Jm Ribchester & Partners % RVV East Kent Hospitals University NHS Foundation Trust % EAST STAFFORDSHIRE A&E DELIVERY BOARD % RJF Burton Hospitals NHS Foundation Trust % EAST SUSSEX A&E DELIVERY BOARD % RDR Sussex Community NHS Foundation Trust % RXC East Sussex Healthcare NHS Trust %

46 4.3 Operational performance by delivery boards A&E (4/9) 46 Board Provider Attendances Breaches 4 hour A&E Performance EASTERN CHESHIRE A&E DELIVERY BOARD % RJN East Cheshire NHS Trust % EPSOM ST HELIER A&E DELIVERY BOARD % RVR Epsom And St Helier University Hospitals NHS Trust % ESSEX SUCCESS REGIME % RAJ Southend University Hospital NHS Foundation Trust % RDD Basildon And Thurrock University Hospitals NHS Foundation Trust % RQ8 Mid Essex Hospital Services NHS Trust % FLYDE COAST A&E DELIVERY BOARD % RXL Blackpool Teaching Hospitals NHS Foundation Trust % FRIMLEY SOUTH A&E DELIVERY BOARD % RDU Frimley Health NHS Foundation Trust % GATESHEAD & NEWCASTLE A&E DELIVERY BOARD % RR7 Gateshead Health NHS Foundation Trust % RTD The Newcastle Upon Tyne Hospitals NHS Foundation Trust % GLOUCESTERSHIRE A&E DELIVERY BOARD % AAH Tetbury Hospital Trust Ltd % R1J Gloucestershire Care Services NHS Trust % RTE Gloucestershire Hospitals NHS Foundation Trust % GREAT YARMOUTH & WAVENEY A&E DELIVERY BOARD % NAX East Coast Community Healthcare C.I.C RGP James Paget University Hospitals NHS Foundation Trust % Y02662 Greyfriars Health Centre GREATER NOTTINGHAM A&E DELIVERY BOARD % NR3 Nottingham Citycare Partnership % RX1 Nottingham University Hospitals NHS Trust % GUILDFORD AND WAVERLEY A&E DELIVERY BOARD % RA2 Royal Surrey County Hospital NHS Foundation Trust % HAMBLETON, RICHMOND & WHITBY AND SOUTH TEES A&E DELIVERY BOARD % RTR South Tees Hospitals NHS Foundation Trust % HARINGEY LOCAL A&E DELIVERY BOARD % RAP North Middlesex University Hospital NHS Trust % HARROGATE AND RURAL DISTRICT A&E DELIVERY BOARD % RCD Harrogate And District NHS Foundation Trust % HEREFORDSHIRE A&E DELIVERY BOARD % RLQ Wye Valley NHS Trust % HERTS VALLEY A&E DELIVERY BOARD % RWG West Hertfordshire Hospitals NHS Trust % HILLINGDON A&E DELIVERY BOARD % E84068 The Ridgeway Surgery % RAS The Hillingdon Hospitals NHS Foundation Trust %

47 4.3 Operational performance by delivery boards A&E (5/9) 47 Board Provider Attendances Breaches 4 hour A&E Performance HULL & EAST YORKSHIRE A&E DELIVERY BOARD % NNF09 Bransholme Health Centre % NNF28 Freedom Centre RV9 Humber NHS Foundation Trust % RWA Hull And East Yorkshire Hospitals NHS Trust % ICHT A&E DELIVERY BOARD % RYJ Imperial College Healthcare NHS Trust % IPSWICH & EAST SUFFOLK A&E DELIVERY BOARD % RGQ Ipswich Hospital NHS Trust % ISLE OF WIGHT A&E DELIVERY BOARD % R1F Isle Of Wight NHS Trust % ISLINGTON A&E DELIVERY BOARD % RKE The Whittington Hospital NHS Trust % RP6 Moorfields Eye Hospital NHS Foundation Trust % KINGSTON & RICHMOND A&E DELIVERY BOARD % RAX Kingston Hospital NHS Foundation Trust % RY9 Hounslow And Richmond Community Healthcare NHS Trust % LAMBETH & SOUTHWARK A&E DELIVERY BOARD % RJ1 Guy's And St Thomas' NHS Foundation Trust % RJZ King's College Hospital NHS Foundation Trust % Y03094 The Junction Hc - Unregistered Patients % LEEDS A&E DELIVERY BOARD % RR8 Leeds Teaching Hospitals NHS Trust % RXG South West Yorkshire Partnership NHS Foundation Trust LEICESTER, LEICESTERSHIRE & RUTLAND A&E DELIVERY BOARD % C82009 Market Harborough Med.Ctr % C82010 Oakham Medical Practice % C82038 Latham House Medical Practice % NJS05 Loughborough Urgent Care Centre % NLO09 Melton Mowbray Urgent Care Centre % NLO10 Oadby & Wigston Urgent Care Centre % NLO11 Market Harborough Urgent Care Centre % NLO12 Oakham Urgent Care Centre % RWE University Hospitals Of Leicester NHS Trust % LEWISHAM, GREENWICH AND BEXLEY A&E DELIVERY BOARD % RJ2 Lewisham And Greenwich NHS Trust % Y03201 Waldron - Hurley Unregistered Practice % LINCOLNSHIRE A&E DELIVERY BOARD % RWD United Lincolnshire Hospitals NHS Trust % RY5 Lincolnshire Community Health Services NHS Trust % LNWHT A&E DELIVERY BOARD % R1K London North West Healthcare NHS Trust % RAN Royal National Orthopaedic Hospital NHS Trust 0 0 -

48 4.3 Operational performance by delivery boards A&E (6/9) 48 Board Provider Attendances Breaches 4 hour A&E Performance LUTON A&E DELIVERY BOARD % RC9 Luton And Dunstable University Hospital NHS Foundation Trust % MANCHESTER CITY-WIDE URGENT CARE TRANSFORMATION AND DELIVERY BOARD % RBV The Christie NHS Foundation Trust RM2 University Hospital Of South Manchester NHS Foundation Trust % RW3 Central Manchester University Hospitals NHS Foundation Trust % MEDWAY & SWALE A&E DELIVERY BOARD % RPA Medway NHS Foundation Trust % MID MERSEY, WARRINGTON &HALTON A&E DELIVERY BOARD % RBN St Helens And Knowsley Hospital Services NHS Trust % RBQ Liverpool Heart And Chest Hospital NHS Foundation Trust RBS Alder Hey Children's NHS Foundation Trust % REP Liverpool Women's NHS Foundation Trust % RET The Walton Centre NHS Foundation Trust RQ6 Royal Liverpool And Broadgreen University Hospitals NHS Trust % RTV 5 Boroughs Partnership NHS Foundation Trust % RW4 Mersey Care NHS Foundation Trust RWW Warrington And Halton Hospitals NHS Foundation Trust % RY1 Liverpool Community Health NHS Trust % RY2 Bridgewater Community Healthcare NHS Foundation Trust % MID YORKSHIRE A&E DELIVERY BOARD % RXF Mid Yorkshire Hospitals NHS Trust % MID-NOTTINGHAMSHIRE A&E DELIVERY BOARD % RK5 Sherwood Forest Hospitals NHS Foundation Trust % MILTON KEYNES A&E DELIVERY BOARD % RD8 Milton Keynes University Hospital NHS Foundation Trust % MORECAMBE BAY A&E DELIVERY BOARD % RTX University Hospitals Of Morecambe Bay NHS Foundation Trust % NORTH TEES A&E DELIVERY BOARD % RVW North Tees And Hartlepool NHS Foundation Trust % NORTH AND MID HAMPSHIRE A&E DELIVERY BOARD % NTPAD St Mary's NHS Treatment Centre % RN5 Hampshire Hospitals NHS Foundation Trust % NORTH EAST ESSEX A&E DELIVERY BOARD % NQ106 Fryatt Hospital % NQ108 Clacton Hospital % RDE Colchester Hospital University NHS Foundation Trust % Y02646 North Colchester Healthcare Centre NORTH EAST SECTOR UEC DELIVERY BOARD % RT2 Pennine Care NHS Foundation Trust % RW6 Pennine Acute Hospitals NHS Trust %

49 Operational performance by delivery boards A&E (7/9)