Business Delivery & Performance Report

Agenda item: A5(viii) Business Delivery & Performance Report April to September 2017 Healthcare at its very best - with a personal touch

1. EXECUTIVE SUMMARY 1.1. This report outlines the Trust s performance for the period April 2017 to September 2017. This summary pulls out the key issues and implications. 2. INTRODUCTION 2.1. This Business Delivery & Performance Report is reporting the period April 2017 to September 2017. The format and content of the report will continue to evolve, but it is hoped that Directors find the style of reporting useful, informative and straightforward to follow. 2.2. The remainder of the report sets out the activity and key targets the Trust has to deliver in 2017/18. The report will also specify financial penalties where they apply. 2.3. The Appendices to this report give a more detailed breakdown of some of the performance measures, for example, performance by Directorate and/or site. However the report itself will include key figures and graphics to demonstrate the Trust s position and, where possible, how it compares to other providers. As always, feedback is most welcome. 3. TRUST WAITING TIMES 3.1. Directors Summary 3.2. This section details the Trust s performance against 18 Weeks, Cancer and Diagnostic standards. As the issues with compliance are increasingly complex, the position is summarised below: The RTT Incomplete (92%), Admitted (90%) and Non-Admitted (95%) targets were achieved Trust-wide during September 2017. The Trust did not meet the 6 week diagnostic standard in September 2017. The Trust failed to meet 3 of the Cancer standards in September 2017; the 2ww Breast Symptomatic, 31 day subsequent treatment for drugs and 62 day screening. 3.3. 18 Weeks Referral to Treatment (RTT) 3.4. Table 1 shows the Trust RTT Incomplete performance in September 2017. The latest NHS figures show a sharp deterioration in waiting list management during August 2017, which suggests for the first time that the NHS has started loosening its grip on RTT waiting list times. Chart 1 shows that although very Page 1 of 20

challenging, the Trust has managed to sustain compliance well above the Shelford average and the NHS national median. Table 1: NuTH RTT Incomplete Compliance - September 2017 RTT Incomplete Pathways Apr-17 May-17 Jun-17 Jul-17 Aug-17 Sep-17 Total 57,514 57,319 56,376 56,989 57,717 58,155 > 18wks 3,561 3,268 3128 3,187 3,147 3,295 Compliance 93.8% 94.3% 94.5% 94.4% 94.5% 94.3% STF Trajectory Total 56,500 57,100 56,980 57,600 58,300 59,000 > 18wks 3,400 3,321 3,356 3,359 3,184 3,296 Compliance 94.0% 94.2% 94.1% 94.2% 94.5% 94.4% Standard 92% 92% 92% 92% 92% 92% Chart 1: RTT Incomplete Performance 3.5. Although the Incompletes target was achieved overall, there was a specialty level breach in Trauma and Orthopaedics (437 excess breaches) as shown in Table 2. This will incur a financial penalty of 131.1k in September 2017 and continues to be a significant financial pressure for the Trust. Whilst the actual Trauma & Orthopaedics (specialty 110) aspect of performance is in its strongest position yet (91.05%), the spinal specialties still have significant capacity pressures which bring down the overall compliance. Page 2 of 20

Table 2: 18 Weeks Compliance within T&O September 2017 RTT Specialty (C) Total PTL Backlog % Excess Breaches Penalty 110 - TRAUMA & ORTHOPAEDICS 3229 289 91.05% 31-9,300 108 - SPINAL SURGERY ORTHOPAEDICS 1677 476 71.62% 342-102,600 10801 - SPINAL SURGERY NEUROSURGERY 803 128 84.06% 64-19,200 Combined 5709 893 84.36% 437-131,100 3.6. Although the Admitted measure is not a mandatory target, it was achieved overall. However there were 3 areas where the standard was breached at a specialty level; Trauma & Orthopaedics, ENT and Oral Surgery. 3.7. The equivalent Non-Admitted measure was achieved overall, although there were 5 areas where the target was breached at a specialty level; Trauma & Orthopaedics, ENT, Neurosurgery, General Medicine and Gastroenterology. Table 3: Specialty Level Compliance RTT Specialty (C) Non- Admitted (>95%) Admitted (>90%) Incompletes (>92%) 100 - GENERAL SURGERY 95.1% 92.9% 94.8% 101 - UROLOGY 98.5% 90.7% 98.0% 110 - TRAUMA & ORTHOPAEDICS 84.9% 77.6% 84.4% 120 - EAR NOSE & THROAT 92.9% 79.6% 93.1% 130 - OPHTHALMOLOGY 98.3% 94.8% 98.9% 140 - ORAL SURGERY 95.3% 86.5% 96.4% 150 - NEUROSURGERY 91.9% 100.0% 92.6% 160 - PLASTIC SURGERY 95.4% 96.7% 92.3% 170 - CARDIOTHORACIC SURGERY 100.0% 100.0% 93.8% 300 - GENERAL MEDICINE 88.6% 97.6% 93.2% 301 - GASTROENTEROLOGY 86.5% 100.0% 94.4% 320 - CARDIOLOGY 95.2% 92.0% 92.7% 330 - DERMATOLOGY 99.3% 95.0% 98.3% 340 - RESPIRATORY MEDICINE 100.0% 100.0% 97.4% 400 - NEUROLOGY 95.5% 100.0% 95.7% 410 - RHEUMATOLOGY 95.2% 100.0% 95.6% 430 - CARE OF THE ELDERLY 98.2% 92.9% 98.4% 502 - GYNAECOLOGY 96.7% 90.6% 95.5% X01 TOTAL 96.1% 92.9% 94.6% TRUST TOTAL 96.0% 90.9% 94.3% Page 3 of 20

Total Backlog Backlog >36 weeks Penalty per breach Apr-17 May-17 Jun-17 Jul-17 Aug-17 Sep-17 Business Delivery & Performance Report September 2017 3.8. Appendix 4 shows the geographical spread of breaches for September 2017 to further clarify for Directors where issues lie. Table 4 demonstrates the RTT penalties incurred in 2017/18. Table 4: RTT Penalties Indicator Incomplete Penalty 230.7k 187.8k 153k 141.9k 141.6k 131.1k Agreed Reinvestment 0 0 0 0 0 0 300 Control Total Adjustment 0 0 0 0 0 0 Penalty Total 230.7k 187.8k 153k 141.9k 141.6k 131.1k 3.9. The contract specifies a zero tolerance on over 52 week waiters and the Trust maintained this target in September 2017 although this required significant individual patient management within Spinal services and the threat of a 52 week breach remains present. The legally binding contracts also require a quarterly reduction in over 36 week waiters by specialty. There is no penalty stipulated in the contract but it is good practice to achieve this standard (Chart 2). There was a reduction of 35 over 36 week waits in September 2017, predominantly within spinal. Chart 2: Over 36 week waits (All Specialties) Trend 4500 4000 3500 3000 2500 2000 1500 1000 500 0 350 300 250 200 150 100 50 0 >36 week backlog Total Backlog Page 4 of 20

Table 5: 18 Weeks Backlog by Directorate September 2017 Directorate Backlog Backlog Direction Change from previous month Cancer Services 0-1 Cardiothoracic Services 250 18 Children s Services 66 8 Dental Hospital & School 154 32 e.p.o.d 654 33 Internal Medicine 240 17 Musculoskeletal Services 852-25 Neurosciences 326 1 Peri-op and Critical Care 79-24 Renal Services 39 0 Surgical Services 448 40 Women s Services 124 46 Trust Total 3295 148 3.10. Diagnostic Waits 3.11. As expected, the Trust failed to meet the 99% diagnostic target in September 2017 (98.0%) and this will incur a financial penalty of 19.4k. Furthermore, given the significant staffing difficulties within MRI and CT, it is unlikely that the Trust can meet and sustain compliance over the coming months. The Radiology department have been given approval to recruit locums to support staffing shortages. In addition to this, given that other Trusts nationally and regionally (Sunderland) have had success in recruiting from Europe, a team is scheduled to visit Rome in October on a recruitment drive. It is hoped that some staff may be in post before the end of the financial year. 3.12. There is a monthly diagnostic meeting (led by B&D) to monitor the individual action plans. Despite the Trust s strong performance compared to others in this area, commissioners and NHS Improvement continue to scrutinise the Trust performance and they are keen to see a return to compliance. Table 6: Diagnostic Breaches (15 Key Diagnostic Tests) Apr-17 May-17 June-17 July-17 Aug-17 Sep-17 Number of Breaches 99 83 153 111 157 190 Number of Excess Breaches 54 23 29 97 Penalty 10.8k 4.6k 5.8k 19.4k Number of Patients Waiting 10,072 9,720 9,770 8,706 9,120 9,229 Compliance 99.0% 99.1% 98.4% 98.7% 98.3% 98.0% Page 5 of 20

4. Cancer Waits 5.1 Due to the timing of submissions, cancer data runs one month behind the majority of performance data, this paper therefore reports the August 2017 position. Appendix 1 shows the Directorate cancer compliance. All breaching services are flagged to ensure that Directors have full view of the high risk areas. 5.2 The Suspected Cancer Two Week Wait (2WW) standard was achieved for August and performance was significantly better than the national average. Whilst there was an unprecedented increase in skin referrals (+338), there were no capacity issues reported and they achieved the target at 97%. The Breast Symptomatic standard was not achieved for August. The Trust reported performance at 88.9% against the 93% standard and breaches were again all attributed to patient choice. The Directorate are closely monitoring this and are analysing the data at a CCG level. Whilst the Trust failed this standard in Quarter 1 and July, the commissioners have agreed to reinvest the financial penalties in Quarter 1 ( 600) following the mitigation put forward by the Trust. 5.3 The 62 day standard for August was achieved at 89.2%. Treatment numbers increased to a level not experienced before, particularly in skin. The majority of breaches occurred in Hepatobiliary (HPB), Lung and Urology. A significant number of breaches were also in the long wait category (i.e. over 104 days). These will be assessed for harm by the Cancer Clinical Lead. 5.4 Across the Northern Cancer Alliance (NCA), 4 Trusts, Cumbria (83.7%), Sunderland (83.8%), Northumbria (80.9%), and North Tees (77.6%) failed the 62 day standard for August. NCA performance overall was 85.9% and National performance was reported at 82.5%. 5.5 The Trust failed the 62 day screening standard for August, reporting 89.5% against the 90% target. The numbers in this standard are relatively low and of the 3 reported breaches, 2 were due to patient choice and 1 as patient fitness. The uptake of screening, particularly bowel screening has been targeted for improvement by NHS England as part of the Early Diagnosis Transformation Funding. 5.6 The 31 day standard to first treatment was achieved for August (98.1%). The numbers of treatments increased in comparison to July, again predominantly in skin. Breaches were mainly cited as capacity issues in radiology. Page 6 of 20

5.7 The 31 Day Subsequent Treatment standard was achieved for Radiotherapy and Surgery but failed for Drugs. Performance against the 98% standard was reported as 95.6%. The breaches in this category were in HPB and all attributed to radiology capacity for patient s undergoing Trans Arterial Chemo Embolisation (TACE). Pressures have been reported for these treatments due to limited capacity. The Radiology Directorate are currently looking at options to improve this. 5.8 Looking forward to September 2017, reports show the Trust currently achieving all standards with the exception of 62 day Screening (89.7%). A review of Quarter 2 data shows that a number of standards are underperforming. Breast symptomatic (standard is 93%) is reported at 90.7%, 31 day subsequent drugs (standard is 98%) are reported at 97.4% and screening (standard is 90%) is reported at 88%. The data in all standards has not yet been fully validated and breach analyses are currently underway. Table 7: Cancer Targets as at August 2017 Cancer Waiting Times Target Apr 17 May 17 Jun 17 Qtr 1 Jul 17 Aug 17 All cancers: 2 week wait 93% 94.3% 93.3% 93.9% 93.9% 96.3% 96.6% 2 Week Wait for Symptomatic Breast Patients (Cancer Not initially Suspected) All cancers: 1 month diagnosis to first treatment All cancers: 1 month diagnosis to subsequent treatment - surgery All cancers: 1 month diagnosis to subsequent treatment - drug All cancers: 1 month diagnosis to subsequent treatment - radiotherapy All cancers: 2 month urgent referral to treatment Percentage patients referred from cancer screening service treated within 62 days 93% 89.9% 92.5% 95.0% 92.5% 90.2% 88.9% 96% 98.1% 98.9% 98.7% 98.6% 97.7% 98.1% 94% 95.5% 98.1% 97.6% 97.1% 93.5% 98.7% 98% 99.2% 98.1% 99.3% 98.9% 98.6% 95.6% 94% 98.9% 99.7% 99.0% 99.2% 98.7% 98.2% 85% 86.5% 87.5% 85.3% 86.4% 82.6% 89.2% 90% 91.8% 100.0% 91.8% 94.3% 87.1% 89.5% Page 7 of 20

Table 8: Breach Re-allocation Summary NUTH performance - August 2017 Prior to breach After breach reallocation re-allocation Position Breast 91.3 91.3 0 u Gynae 80 66.7-13.3 q Haem (exc AL) 93.8 93.3-0.5 q Head & Neck 92.1 90.2-1.9 q HPB 22.2 18.2-4 q Lower GI 90 90.5 0.5 p Lung 77.8 82.1 4.3 p Other 75 67-8 q Sarcoma 100 100 0 u Skin 98.9 98.9 0 u Upper GI 81.8 66.7-15.1 q Uro (exc testes) 75.8 78.7 2.9 p All 89.2 89.3 0.1 p 5.9 Applying the breach re-allocation methodology against August data has shown a slight improvement in performance (Table 7), however, more specialties are experiencing a decline in performance, with the main tumour group being Upper GI. Trusts are encouraged to capture and monitor data at a local level where possible as the national system is not yet capable of interpreting data at this level (see paragraph 5.14). Therefore, performance (as per Table 7) is still centrally monitored using the old methodology. 5.10 As reported previously, the Backstop policy requires review and weekly reporting to the CCG of any patients classified as long waiters (patients waiting 104 days or more). The pathway of any patient who has waited more than 104 days to be treated is reviewed by the Trust Cancer Lead and assessed for harm. Since implementation in October 2015, none of the long wait patients have been identified as coming to harm. 5.11 The Cancer Steering Group are now meeting each month to review progress against the cancer transformation agenda and the actions identified through the individual tumour site review meetings. Cancer improvement plans are currently being refreshed and will be reviewed by the Group at the next meeting at the end of October 2017. 5.12 Two Information standards Notices were published recently setting out changes to the Cancer Datasets. 5.13 The Cancer Outcomes and Services Dataset (COSD) V8 was published on 28 th September 2017. The dataset has been extended with 39 new data items to be collected. Initially there will be a 3 month period from 1 st April 2018 to Page 8 of 20

30 th June 2018 for Trusts to begin submitting data in the relevant format with full conformance from July 2018. 4.14. The National Cancer Waiting Times Monitoring Dataset V2 was released on 5 th October 2017. The new dataset includes 14 new data items and has three main elements : Data items to enable monitoring of the new 28 day to diagnosis standard Data items to enable collection and reporting of breach re-allocations New data collection system with enhanced features to improve data quality, tighter validation and analysis and reporting. 4.15. The new system is expected to be live from 1st April 2018, with providers recording data from 1 st July 2018 and the new 28 day diagnosis standard data from 1 st April 2019. 4.16. Collection of these new data items will be challenging and potentially require resource. The Corporate Cancer Team are currently reviewing the requirements to better understand how this can be achieved. 5. A&E 5.1. Directors will note that the Trust narrowly missed meeting the A&E 4hr standard in September 2017 at 94.43% (Table 9). Whilst the A&E improvement plan is continuing at pace with dedicated clinical and nursing leadership driving the improvements, a team from ECIP (Emergency Care Improvement Programme) visited the ED Department on 25 th and 26 th September 2017. Whilst there were a few opportunities highlighted, most of these had already been identified within the A&E improvement programme. The overall observation from ECIP was that the people and drive are outstanding. 5.2. Across the NHS, achieving the A&E standard is one of the highest priorities and the recent message from Sir David Dalton and Jim Mackey is do everything you can to hit the 4 hour target. Table 9: Emergency (A&E) Indicators Emergency Indicators Apr-17 May-17 Jun-17 Jul-17 Aug 17 Sep-17 A&E 4hr Standard (Target: 95.0%) 94.8% 4.8k 93.1% 39.96k 95.6% 95.7% 95.0% 94.43% 11.4k STF Trajectory A&E 4hr Standard 92.1% 93.4% 93.15% 95.59% 94.92% 94.99% Trolley waits in A&E >12 hours 0 0 0 0 0 0 Page 9 of 20

Emergency Indicators Apr-17 May-17 Jun-17 Jul-17 Aug 17 Sep-17 (Target: Nil) A&E handovers delays >30 minutes (Target: Nil) Handover breaches >60 minutes (Target: Nil) 41 8.2k 38 7.6k 13 2.6k 10 2k 7 1.4k 22 4.4k 0 0 0 0 0 0 5.3. The contract also contains a number of local indicators around A&E, with associated figures for items 1-4 located in Appendix 2. 1) Unplanned re-attendance rate - 7 days <5% 2) Left department without being seen rate <5% 3) Time to initial triage/assessment (95th percentile <15 minutes) 4) Time to treatment in department (median <60 minutes) 5) % of patients presenting at type 1 and 2 (major) A & E sites in certain high risk categories who are reviewed by an emergency medicine consultant before being discharged (95% at site level) 6) A & E service experience - qualitative description of what has been done to assess the experience of patients using A&E services, their carers and staff. 5.4. Whilst the Trust reported 22 ambulance handover delays in September 2017, all delays were due to the administrative process of handing over the patient on the IT system. These delays will incur a financial penalty of 4.4k in September 2017. The ED department are currently working with North East Ambulance Service (NEAS) and NECS to try and understand the inconsistency between patient level data recorded by NEAS and the Trust, particularly with regards the 4hr clock start and overall waiting time in ED. The new Emergency Care Data Set (ECDS) is mandated for Trusts from October 2017, and will provide an improved level of detail about emergency care never collated before. 5.5. Regionally, a work stream has commenced to look at ambulance handovers with a view to developing a standard operating procedure (SOP) for all Trusts to use. There are also discussions around ambulance clearing times (which is a new focus given the lost time following handover). 5.6. Table 10 shows that the Trust achieved the unplanned re-attendance rate in September 2017, along with the left department without being seen rate which was 4.7% in September 2017 against a target of 5%. Further detail about these indicators, as well as a site breakdown of A&E performance is provided in Appendix 2. Page 10 of 20

Feb-17 Mar-17 Apr-17 May-17 Jun-17 Jul-17 Aug-17 Sep-17 Business Delivery & Performance Report September 2017 Table 10: Local A&E Indicators Local A&E Indicators Unplanned reattendance rate (CCG) (Target: <5.0%) Left department without being seen rate (CCG) (Target: <5.0%) RVI Main ED Eye Casualty RVI Main ED Eye Casualty 3.0% 3.8% 3.5% 3.6% 3.1% 3.2% 3.6% 3.1% 0.0% 0.3% 0.7% 0.4% 0.4% 0.1% 0.4% 0.0% 4.2% 4.0% 4.1% 5.4% 2.6k 4.0% 4.1% 4.0% 4.7% 0.7% 0.8% 0.7% 1.1% 0.5% 1.0% 0.6% 0.4% 5.7. Directors will note that the Divert indicator remains within contracts in 2017/18. There were 10 formal diverts to the Trust in September 2017 from Northumbria FT (NSECH) for which a 15k incentive will be received (Table 11). The commissioners agreed to reinvest the 6k divert penalty that the Trust incurred in June 2017 (due to the major incident in Newcastle City Centre). 5.8. Whilst ECIP have developed an action plan with NSECH, the concern is this is not resulting in any change during periods of surge. However, more worryingly, Northumbria have undertaken a capacity and demand modelling exercise as part of winter planning and they are declaring a shortfall of 50 plus beds. Their plan is to convert elective surgical beds at North Tyneside Hospital to try and mitigate against the shortfall. In addition to this, in order to keep their bed occupancy at 90% throughout winter, they will need to discharge circa 90 patients per day. They have been asked to model through the potential impact for other providers and social care. This will be followed up at their operational meeting (which includes ECIP representation). Table 11: A&E Ambulance Diverts Apr-17 May-17 Jun-17 Jul-17 Aug-17 Sep-17 South Tyneside CCG Sunderland CCG Newcastle Gateshead Alliance Northumberland CCG 4 2 6 5 North Tyneside CCG 2 5 5 Durham Dales North Durham CCG Total 0 6 0 2 11 10 Incentive '000s 0.0k 9.0k 0.0k 3.0k 16.5k 15.0k Total 3 Penalty '000s 6.0K Page 11 of 20

Bed Days delayed Daily bed delays Business Delivery & Performance Report September 2017 5.9. Delayed Transfers of Care 5.10. The Trust reported 794 delayed bed days in September 2017, 91% of which were attributable to the NHS. As reported previously, the Trust is required to sustain the current level of DTOCs from September 2017 (this equates to daily bed delays of 35.86). Chart 3 shows that the Trust achieved the daily bed delays target at 26.47 in September 2017. Whilst a regional repatriation policy has been developed, this is awaiting formal sign-off and commitment from all regional providers. Interestingly, Northumbria FT and Gateshead Health have recently implemented the national Choice Policy which gives patients and families 7 days in which to make a decision on their care home of choice. The Trust has not, as yet, proposed any changes although a reduction to 14 days (currently at 21 within NuTH) was one the proposed schemes within the ibcf schedule. Chart 3: Delayed Transfers of Care 1,400 1,200 1,000 800 600 400 200 0 NuTH DTOC Bed Days 60 50 40 30 20 10 0 NHS Delays Social Care Daily Bed Delays Daily Delays Target 5.11. OTHER EXTERNAL PERFORMANCE REQUIREMENTS 5.12. Appendix 3 reports the other contractual and NHSI targets that have not been covered above. 5.13. In September 2017, there was one reported case of MRSA in Cardiothoracic. This takes the total for 2017/18 to 2 which is equivalent to the same period last year. Page 12 of 20

5.14. The Trust reported 7 cases of healthcare onset healthcare-associated C- Difficile infections against a trajectory of 6 in September 2017. These were reported in NCCC (1), Medicine (3), Neuro (1), and Surgical (2). As at September 2017, the Trust is reporting a cumulative total of 34 against a trajectory of 38 (taking into account 5 successful appeals). 5.15. There were no reportable breaches of urgent cancelled operations or the 28 day standard in September 2017. However, the Trust has reported 13 breaches of this standard so far this year, equating to circa 70k of lost income (the Trust does not receive payment for the subsequent operation if the patient is not rescheduled within 28 days). This will be discussed at the Performance & Information meeting. Table 12: Reportable Cancelled Operations Reportable Cancelled Operations Apr-17 May-17 June-17 July-17 Aug-17 Sep-17 Total number of last minute cancelled operations 48 52 45 39 36 31 Number of 28 day breaches 3 2 5 2 1 0 Urgent operations cancelled for a 2 nd or subsequent time 0 0 0 0 0 0 Penalty Amount 7,067 2,793 28,538* 27,113 4,070 0 *Further penalty values to be added once fully coded 5.16. Whilst NHS England removed the national financial sanctions relating to VTE risk assessment in 2016/17, it remains essential that providers continue to meet this standard (particularly as this indicator is included as a quality/safety measure in the Single Oversight Framework). The target of 95% was met in August 2017 at 96.6%. 5.17. Table 13 shows current performance for the joint Psychological Therapies Service Talking Helps Newcastle (THN). The service has made excellent progress in reducing the waiting list (by circa 20%) and the moving to recovery rate in September 2017 was the highest to date. The CCG Executive Committee will meet on Tuesday 21st November to decide on the future of IAPT services in Newcastle. Page 13 of 20

Table 13: IAPT Progress towards targets Joint Model IAPT Indicators National target: Paired assessment scores for completed episodes (CCG) Penalty: 10 per breach below threshold) Nationally Published Data 2017/18 Target 90% Apr-17 May-17 Jun-17 Jul-17 Aug-17 Sep-17 Have raised a query with NHS Digital regarding data The proportion of people who have depression and/or anxiety disorders who receive psychological therapies (% against trajectory) (CCG) Local Data Cumulative -The proportion of people who have depression and/or anxiety disorders who receive psychological therapies (% against trajectory) (CCG) Local Data 1.40% 0.95% 1.19% 1.14% 1.04% 1.03% 0.95% 16.80% 0.95% 2.14% 3.28% 4.31% 5.34% 6.29% Cumulative Target 1.40% 2.80% 4.20% 5.60% 6.25% 7.50% The proportion of people who complete treatment who are moving to recovery (CCG) Local Data % of patients seen within 6 weeks Nationally Published Data 50% 46.3% 48.0% 49.8% 50.0% 47.5% 53.2% 75% 98.0% 97.2% 97.3% 97.5% 97.7% 98.3% % of patients seen within 18 weeks Nationally Published Data 95% 99.7% 100.0% 99.8% 100.0% 99.5% 97.5% 5.18. There is a data quality penalty for NHS number completeness within inpatient/ outpatient and A&E submitted commissioning datasets. The standard needs to be maintained on an individual monthly basis to avoid a 10 penalty per excess missing number. In June and July 2017, this target was consistently achieved. Table 18: SUS Data Quality SUS Data Quality Target Apr-17 May-17 Jun-17 Jul-17 Aug-17 Completion of a valid NHS Number field in acute (Admitted/Non-Admitted Care) (C) Completion of a valid NHS Number field in acute (A&E) (CCG) 99% 99.0% 99.8% 99.6% 99.6% TBC 95% 98.0% 98.2% 98.1% 97.9% TBC 5.19. As reported previously, the Trust Breast Screening round length (the duration between invitations) continues to breach the national 36-month standard. Whilst the service has recently been able to utilise capacity on a mobile unit, they will be unable to sustain this level of compliance without additional physical space. A Service Development Improvement Plan (SDIP) has recently been agreed with commissioners. Executives have been made aware and discussions are ongoing with Estates colleagues. Page 14 of 20

5.20. Chart 4 and 5 show the ereferral utilisation and Appointment Slot Issue (ASI) rates for the Trust over the previous 12 months. As the Trust has agreed to Go Further Faster, there is a commitment to move to full ereferral use for GP referrals ahead of the contractual deadline of October 2018 (the Trust has agreed April 2018). For NuTH, this requires 100% of applicable services (GP referral only) to be published and booked via ereferral or from October 2018, commissioners will not pay for the resulting activity. Chart 6 shows a universal improvement in utilisation rates (dental is a slight exception but ereferral is only used for a tiny proportion of dental (GP) referrals). 5.21. In September 2017, the ASIs further reduced to 7.8% (excluding ENT as per agreement with commissioners). Whilst this is already below the year end trajectory as agreed within the CQUIN indicator (10%), close monitoring will continue. Chart 4: e-referral Utilisation Rate Chart 5: e-referral ASI Rate Page 15 of 20

6. RECOMMENDATIONS 6.1. Directors are asked to: 1) receive this report; 2) note the areas of compliance and non-compliance, particularly the risk this poses to high quality patient care and the Trust, both financially and reputationally and; 3) note the actions ongoing to address areas of underperformance. Jo McCallum Senior Business Development Manager (Performance) Helen Byworth Assistant Director of Contracting & Performance Louise Robson Executive Director of Business & Development 19 th October 2017 Page 16 of 20

Day of Surgery Arrival Referral Growth Admitted Waiting OP Waiting Non-Admitted Clock Stops (>95%) Admitted Clock Stops (>90%) Incompletes (>92%) Backlog Backlog direction Relative Risk Length of Stay Outpatient DNA Rates against Peer Outpatient N:R ratio - against peer Cancelled Operations 28 day Breaches Cancelled Operations Cancer Business Delivery & Performance Report September 2017 Appendix 1: Directorate Level Performance Directorate Cancer Services 79% 1.2% 10 490 100.0% 100.0% 100.0% 0 1.18 3.0% 18.10 Cardiothoracic 68% 0.9% 1,297 3,000 97.0% 94.9% 94.6% 250 0.75 10.8% 1.34 7 2m Childrens Services 90% 1.7% 1,439 2,047 95.9% 98.9% 97.2% 66 1.56 11.2% 1.63 Clinical Genetics 92.1% 95.3% 55 2.33 Dental Services 93% -11.4% 841 4,278 96.7% 88.6% 96.8% 154 1.02 10.3% 2.09 e.p.o.d. 91% -7.9% 4,828 13,221 97.2% 92.7% 96.6% 654 1.26 10.7% 2.33 4 Medicine 69% -2.0% 1,005 3,960 93.2% 95.5% 94.3% 240 1.17 13.3% 2.11 MSU 92% -6.6% 3,901 3,130 90.2% 79.1% 86.8% 852 1.22 10.6% 3.15 1 2w, 1m Neurosciences 88% -5.5% 1,279 3,202 94.2% 91.6% 91.8% 326 1.26 11.4% 2.55 13 Peri-operative & 100% 7.5% 91 943 77.7% 80.0% 88.9% 79 1.60 7.5% 3.77 Critical Renal Services Care 93% -4.5% 1,127 1,524 98.8% 92.0% 98.1% 39 1.23 10.4% 2.74 1 2w,2m Surgical Services 88% -4.1% 1,737 2,321 95.0% 88.4% 89.7% 448 1.27 8.6% 1.27 5 2w, 2w, 1m, 2m, Scr Therapy Services 12.7% 651 97.3% 98.8% 8 Womens Services 99% 16.4% 402 2,693 96.8% 90.6% 95.6% 124 0.97 6.2% 2.25 2m Indicator Tolerance Data period Day of Surgery Arrival - Sep 2017 Referral Growth - All referrals <0% Red, Amber 0-5%, Green >5% Sep 2017 compared to Sep 2016 Admitted Waiting (includes planned and suspended patients) - Sep 2017 New Outpatients Waiting List - Sep 2017 Risk Adjusted Length of Stay - Source HED Green = Performance is below (better) than Outpatient DNA Rates against Shelford - Source HED Shelford, RED = Performance is above (worse) than Aug 2016 Jul 2017 Outpatient New to Review Ratio - against Shelford - Source HED Cancelled Operations - Source Patient Services Shelford Red >0.8% FFCEs Sep 2017 Cancelled Operations Breaches 28 days - Source Patient Services Red >=1 Sep 2017 Cancer Breached targets as per national guidance Aug 2017 Page 17 of 20

Appendix 2: A&E Performance Page 18 of 20

Actual 16/17 Target Monthly Target Feb-17 Mar-17 Apr-17 May-17 Jun-17 Jul-17 Aug-17 Sep-17 Business Delivery & Performance Report September 2017 Appendix 3: Additional Targets (not covered above) Key Performance Indicators Mixed Sex Accommodation Breaches (c) Sleeping Accommodation Breach 0 0 0 0 0 0 0 0 0 0 0 Cancelled Operations (c) Those not admitted within 28 days 6 0 2 0 3 2 5 2 1 0 No urgent operation should be cancelled for a second time 0 0 0 0 0 0 0 0 0 0 Delayed Transfers of Care Delayed Discharges 1,370 Minimal n/a 138 132 TBC 169 145 131 120 91 HCAI (c) Zero tolerance MRSA 9 0 0 2 2 0 1 0 0 0 1 Rates of Clostridium difficile (appeals removed) 57 77 <6-7 5 1 3 1 8 5 10 7 Duty of Candour (c) Failures to notify the Relevant Person of a suspected or actual Reportable Patient Safety Incident 0 0 0 0 0 0 0 0 0 0 0 VTE Assessments Proportion of Patients who have had a VTE Risk Assessment on Admission 95.2% 95% 95% 95.7% 95.2% 95.8% 96.9% 96.0% 96.7% 99.6% Page 19 of 20

Incompletes General Surgery Urology Trauma & Orthopaedics ENT Ophthalmology Oral Surgery Neurosurgery Plastic Surgery Cardiothoracic Surgery General Medicine Gastroenterology Cardiology Dermatology Respiratory Medicine Neurology Rheumatology Geriatric Medicine Gynaecology Bucket Business Delivery & Performance Report September 2017 Appendix 4: RTT Compliance by Specialty and Commissioner, September 2017 Commissioner The Newcastle upon Tyne Hospitals 0 0 437 0 0 0 0 0 n/a 0 0 0 0 0 0 0 n/a 0 0 NHS NEWCASTLE GATESHEAD CCG 0 n/a 178 0 0 n/a n/a 2 n/a 0 0 0 0 n/a n/a 0 n/a 0 0 NHS NORTH TYNESIDE CCG n/a n/a 54 0 n/a n/a n/a n/a n/a n/a n/a 0 n/a n/a n/a n/a n/a 0 0 NHS NORTHUMBERLAND CCG n/a n/a 28 0 n/a n/a n/a n/a n/a n/a n/a n/a n/a n/a n/a n/a n/a 0 0 NHS SUNDERLAND CCG n/a n/a 21 n/a n/a n/a n/a n/a n/a n/a n/a n/a n/a n/a n/a n/a n/a n/a 0 NHS SOUTH TYNESIDE CCG n/a n/a 30 n/a n/a n/a n/a n/a n/a n/a n/a n/a n/a n/a n/a n/a n/a n/a 0 NHS NORTH DURHAM CCG n/a n/a 33 n/a n/a n/a n/a n/a n/a n/a n/a n/a n/a n/a n/a n/a n/a n/a 0 NHS DURHAM DALES, EASINGTON AND SEDGEFIELD CCG n/a n/a 13 n/a n/a n/a n/a n/a n/a n/a n/a n/a n/a n/a n/a n/a n/a n/a 0 NHS DARLINGTON CCG n/a n/a n/a n/a n/a n/a n/a n/a n/a n/a n/a n/a n/a n/a n/a n/a n/a n/a n/a NHS HARTLEPOOL AND STOCKTON-ON-TEES CCG n/a n/a n/a n/a n/a n/a n/a n/a n/a n/a n/a n/a n/a n/a n/a n/a n/a n/a n/a NHS SOUTH TEES CCG n/a n/a n/a n/a n/a n/a n/a n/a n/a n/a n/a n/a n/a n/a n/a n/a n/a n/a n/a NHS CUMBRIA CCG n/a n/a 14 n/a n/a n/a n/a n/a n/a n/a n/a n/a n/a n/a n/a n/a n/a n/a 0 Specialised n/a n/a 66 n/a n/a 0 0 n/a n/a n/a n/a n/a n/a n/a 0 n/a n/a n/a 0 n/a x Underline Target does not apply/trust level target Target does not apply, < 20 cases in month Target applies and was met Target breached and number of 'excess' breaches Patients subject to a penalty Page 20 of 20