Performance of the NHS provider sector for the month ended 31 December 2017

Performance of the NHS provider sector for the month ended 31 December 2017

Contents Overview Performance comparisons 2.4 Employee expenses pay costs 2.5 NHS provider vacancies 1.0 Operational performance 2.6 Agency ceiling performance 1.1 Operational performance overview 2.7 Non-pay cost pressures 1.2 Accident and emergency (A&E) 2.8 Efficiency savings 1.3 Diagnostic waiting times 2.9 Early view of implied provider productivity 1.4 Elective waiting times 2.10 Capital expenditure 1.5 Cancer waiting times 2.11 Year-end financial position 1.6 Ambulance response times 3.0 Financial performance by provider 1.7 Infection control 4.0 Operational performance by provider 1.8 Winter resilience preparations 2017/18 5.0 Vacancy position by sector and region 2.0 Financial performance 5.1 Nursing vacancy position 2.1 Financial performance overview 5.2 Medical vacancy position 2.2 Income & expenditure End notes and glossary 2.3 Income analysis 2 Performance of the NHS provider sector for the month ended 31 December 2017

Overview at quarter 3, 2017/18 (1/5) Introduction This quarter saw the start of one of the most challenging winter periods that the NHS has had, with demand rising significantly and placing real pressure on the NHS. However, NHS staff have worked extremely hard to care for patients, including the 5.6 million people who came to A&E over this period a quarter of a million more than the same period last year. Overall, providers have succeeded in treating more patients within key operational standards, despite the extremely challenging environment they have been working in. Although record demand for services and variation in performance across the sector have led to a decline in the sector s finances at quarter 3 (Q3), providers have kept A&E performance steady at a national level compared to last year and appear to have stopped the year-onyear decline in performance seen during recent years. Higher than planned levels of A&E activity and high levels of bed occupancy have affected providers ability to admit patients who require planned care, which has had a negative impact on finances. These operational challenges have created financial pressure across the provider sector, particularly within the acute sector. Additionally, there has also been a serious deterioration in the reported financial position in a minority of providers. The degree of deterioration is a matter of concern and has led NHS Improvement to use its regulatory power to protect services and drive improvement. The financial picture demonstrates the need for providers to continue their focus on finances in the last quarter of the year. While good progress continues to be made to reduce the cost of agency staff to the NHS, significant opportunities for improving efficiency and quality overall remain and need to be delivered. It would be unrealistic to assume in most systems that the demand which has been building for a number of years is going to reverse. Therefore, local health systems need to work together to plan for capacity in 2018/19 and beyond that can meet the increasing levels of demand that we will continue to see. 3 Performance of the NHS provider sector for the month ended 31 December 2017

Overview at quarter 3, 2017/18 (2/5) Despite intense operational pressure, NHS staff have seen more people than ever before in under four hours During the first three quarters of this year, demand for hospital services continued to increase, with a significant spike related to winter December saw almost 400,000 emergency admissions via A&E, 5.9% more than in December 2016. The rate of flu-confirmed hospital admissions is around three times higher than last year and greater than the peak reached in the previous seven seasons, making this the most significant flu season since the winter of 2010/11. Despite the continued increase in the number of patients attending A&E and those being admitted to hospital as an emergency, the hard work to prepare for a demanding winter period has paid off. Year-to-date performance against the A&E standard is 89.5%, similar to performance for the same period last year (89.6%), indicating that the year-on-year decline in performance experienced during this period over the previous four years has halted. However, A&E performance remains significantly below NHS Constitution standards. Performance for December was 85.1%, below the previous month (88.8%) and 1.1% lower than the same time last year (86.2%). 659 patients waited over 12 hours in Q3 this is a reduction from 1,262 during the same period last year; nonetheless the NHS s aim remains to eliminate 12 hour trolley waits completely. Demand for emergency care and high levels of bed occupancy have impacted providers ability to perform elective work Alongside rising demand, high levels of bed occupancy have affected providers ability to admit patients who require planned care. In response to these pressures, and a recommendation issued by the NHS National Emergency Pressures Panel on 20 December that providers defer non-urgent inpatient elective care, many providers took the justifiable decision to prioritise emergency activity over elective work. Overall, providers have made progress in reducing delayed discharges. Since February 2017, over 1,400 acute beds have been released by reducing delays to patient discharge, but overall bed occupancy has been affected by delays in transfers of care to other settings, including social care. During Q3 there were around 470,000 bed days across acute, community and mental health providers occupied by delayed discharge patients (accounting for 4.6% of all beds). By the end of December 2017, 88.2% of patients waiting to start treatment had been waiting up to 18 weeks, compared with 89.7% in the same period last year. However, the volume of patients treated within 18 weeks was greater: 10.27 million so far this year, 63,500 more than the same period last year. The Autumn Budget announced 337 million additional funding for the NHS over winter. This funding will have helped offset some of the costs of winter already incurred by providers. 4 Performance of the NHS provider sector for the month ended 31 December 2017

Overview at quarter 3, 2017/18 (3/5) Performance is mixed on other performance standards Providers failed in aggregate to achieve the waiting time standard for 14 of the 15 key diagnostic tests. This decline in performance has been driven partly by a significant increase in demand there were 5.8% more tests requested per working day in December 2017 than in the same period last year. Waiting times for endoscopy tests have increased in particular, which account for around 12% of the diagnostics waiting list. In response to increasing demand, more patients began cancer treatment this year (37,153 during Q3, 2.3% more than in the same quarter last year) and all but one national cancer waiting-time standard was achieved in Q3. NHS providers failed to achieve the target of 85% for 62 day wait for first treatment following an urgent GP referral, with performance of 82.9% in Q3. This was, however, an 0.7% improvement on performance achieved in the same quarter last year (82.2%). NHS Improvement is supporting providers to improve performance in a number of ways, for example through our Intensive Support Team, and by working with Cancer Collaboratives across the country. The combined effects of these pressures have affected NHS finances Operational pressures have had a material impact on NHS finances. At Q3, providers reported a year-to-date deficit of 1,281 million, 365 million above the ambitious plan set for this point in the year. This is attributable to a combination of factors, including overspends on employee costs and non-pay costs of 701 million (1.8%) and 292 million (1.3%) respectively. Part of the increase in non-pay expenditure was for purchasing healthcare from non-nhs bodies this was 144 million above plan, reflecting capacity constraints in Q3. However, non-pay expenditure is expected to be just 1% higher than the levels seen in 2016/17 by the end of the year, which, in view of the inflationary pressures evident during 2017/18, represents a significant achievement. At the start of the year providers ambitiously planned for a real terms reduction in paybill their single biggest area of expenditure driven by a planned reduction in temporary staffing and workforce productivity measures. The overspend in this area reflects the significant pressure caused by increased demand, vacancies and staff sickness/absence. The increase in the deficit has in part been offset by a 254 million rise in income, although this masks the disproportionate effect of higher-thanplanned levels of emergency activity (for which expenditure tends to exceed income), and lower-than-planned elective work (for which income typically exceeds expenditure). This shift in activity, likely to be in part due to the start of the winter period, has resulted in a combined shortfall of 299 million for elective admissions and outpatient work. The operational challenges outlined above have created financial pressure across the provider sector, particularly within the acute sector, where 107 of 136 providers have reported a deficit at Q3. Whilst there have been widespread operational issues, there has also been a small number of providers where performance has diverged materially from the plans approved by Boards at the start of the year. Excluding the positive impact of the Sustainability and Transformation Fund, 20 trusts (9%) reported an adverse variance of over 10 million at Q3. Before further remedial action, the sector is now planning for a deficit of 931 million by the end of 2017/18. 5 Performance of the NHS provider sector for the month ended 31 December 2017

Overview at quarter 3, 2017/18 (4/5) Agency spend continues to fall, but there are high levels of vacancies which are difficult to fill Agency costs have continued to decrease significantly following NHS Improvement initiatives and action taken by providers. At Q3, the sector spent 108 million less than planned and 441 million less than the comparable period last year a dramatic fall of 20%. Despite ongoing pressures, this trend is expected to continue into Q4, with providers forecasting that agency expenditure will underspend by 137 million for the year. However, the use of bank staff was 664 million above plan at Q3, reflecting the need to manage workload in the face of increased demand, high vacancy levels, sickness/absence and staff turnover. For the first time, this report includes NHS Improvement data on workforce, based on management information from the sector this gives us the clearest indication so far of the scale of the workforce challenge facing providers. In addition to the 1.1 million whole time equivalent staff employed by providers, there are around 100,000 vacancies. Although this has reduced slightly in the last quarter, these vacancies will continue to have an impact on provider performance. Providers have not met ambitious cost improvement targets and it is critical that these plans are recovered before year-end Providers set out plans to deliver a total of 3.7 billion savings this financial year. The sector has outperformed the wider economy by delivering an implied 1.8% productivity improvement. This was supported by cost improvements of 3.3% equivalent to 2,139 million of improvements in the first nine months of the year, 97 million higher than the same period in 2016/17. Despite the level of efficiency and cost improvement achieved by providers, there was a shortfall of 329 million against the ambitious level of cost improvements planned to date. Some of the under-performance can be attributed to operational issues (for example, a lack of bed capacity to support theatre productivity CIPs), but there is also wide variation across the sector on efficiency. To achieve the current forecast saving outturn of 3.3 billion, providers must identify a further 86 million of schemes in the remainder of the year. By Q3 the sector had achieved 65% of the forecast efficiency savings for the year to meet the forecast outturn, providers will need to significantly step up the delivery of CIPs in the final quarter. However, the same pattern was seen in 2016/17, so there is evidence to support the increased delivery in the final quarter. 6 Performance of the NHS provider sector for the month ended 31 December 2017

Overview at quarter 3, 2017/18 (5/5) Risks to delivery Looking ahead, the provider sector is planning for a deficit of 931 million by the end of 2017/18, which is 435 million worse than planned. However, the ambitious financial plans which providers set at the start of the year depend on assumptions around risk management including winter costs, agreed activity levels and beds being freed up. The majority of providers have stretching plans to achieve demanding financial control totals. For 2017/18, 211 out of 234 (90%) providers accepted a control total and at Q3 143 are forecasting to be at or above plan by year end. The underperformance of providers which did not achieve their planned year-to-date financial positions was driven by the combination of a shortfall in operating incomes, expenditure on quality improvements and emergency care, and slippage in cost improvement programmes. Last financial year, the improvement in financial performance in the second half of the year was highly dependent on non-recurrent items which do not address the longer term financial sustainability of many providers. This year there are fewer non-recurrent solutions available, which means that 2017/18 has been another financially challenging year. In addition, the cost improvement programmes are back-loaded to the latter part of 2017/18 and this introduces a higher risk to delivery. Provider boards must maintain close oversight and grip of finances during the next three months and focus on recovery back to plan. Our regional teams are working with providers to manage delivery risks and maximise productivity and other opportunities. We continue to provide intensive support to those trusts in the greatest financial difficulties through our Special Measures programme and the Financial Improvement Programme. 7 Performance of the NHS provider sector for the month ended 31 December 2017

Performance comparisons Activity and capacity December 2017 YTD Plan December 2017 YTD Actual December 2016 YTD Actual December 2017 YTD variance from plan Variance from December YTD 16/17 A&E attendances (millions) 16.28 16.53 16.10 1.5% 2.6% Non-elective admissions (millions) 4.58 4.68 4.54 2.2% 3.1% Elective admissions (millions) 6.01 5.87 5.90 (2.1%) (0.4%) 1 st Outpatients attendances (millions) General & acute beds (average daily open Q2 2017/18) 15.51 15.40 15.35 (0.7%) 0.3% - 100,466 102,061 - (1.6%) Nurses (WTE) 349,050 345,117 348,559 (1.1%) (1.0%) Medical staff (WTE) 118,892 121,337 118,516 2.1% 2.4% Cost weighted activity growth 3.3% 2.1% 2.0% (1.2%) 0.1% Published operational performance Target Q3 2017/18 Actual Q3 2016/17 Actual A&E 4 hour performance 95% 87.99% 87.88% Diagnostics 1% 2.18% 1.67% RTT 92% 88.17% 89.70% Cancer 62-day 85% 83.00% 82.25% Ambulance Category 1 (mean time and 90 th centile response time) December 2017 Ambulance Category 2 (mean time and 90 th centile response time) December 2017 mean: 7 mins 90 centile: 15 mins mean: 18 mins 90 centile: 40 mins 8:52 15:25 29:41 63:14 N/A N/A Finance and productivity Plan 2017/18 Actual 2016/17 Actual Month 9 year-to-date (YTD) surplus/deficit ( m) (916) (1,281) (886) Month 9 YTD total income ( m) 60,199 60,453 59,479 Month 9 YTD expenditure ( m) (61,376) (62,369) (60,721) Month 9 YTD efficiency savings ( m) 2,468 2,139 2,042 Month 9 efficiency savings (%) 3.9% 3.3% 3.3% Month 9 YTD total pay costs excl agency ( m) (36,335) (37,144) (35,544) Month 9 YTD agency ceiling performance ( m) (1,887) (1,779) (2,220) % of trusts signed up to a Control Total at Month 9-89.4% 0.0% % of trusts forecasting a 2017/18 surplus at Month 9 81.3% 46.8% 0.0% Quality and safety Target or ceiling Q3 2017/18 Q3 2016/17 Actual Actual Infection MRSA 0 71 75 Infection - C. Diff 1,167 1,150 1,180 General & acute bed occupancy (Q2 2017/18) - 88.91% 89.20% Acute delayed discharges (days) - 303,229 389,880 >12-hour A&E trolley waits - 659 1,262 >52-week waits - 1,750 1,227 Number of providers in special measures - 21 21 Notes: Elective and outpatient activity calculated with working day adjustment Quality and performance figures are at a national aggregate level 8 Performance of the NHS provider sector for the month ended 31 December 2017

1.0 Operational performance 9 Performance of the NHS provider sector for the month ended 31 December 2017

1.1 Operational performance overview Metrics Target NHS Improvement NHS England Accident & emergency: October December 2017 A&E attendances - 5,579,897 6,069,249 Performance All A&E types (%) 95% 86.98% 87.99% Performance Acute trusts only (%) 95% 86.26% 86.26% Type 1 performance (%) 95% 81.77% 81.77% Diagnostics: at 31 December 2017 Number of diagnostic tests waiting 6 weeks+ (%) 1% 2.27% 2.18% Referral to treatment (RTT): at 31 December 2017 18 weeks incomplete (%) 92% 88.01% 88.17% 52-week waits (number) - 1,688 1,750 Cancer: October December 2017 2-week GP referral to 1st outpatient, cancer (%) 93% 94.89% 94.90% 2-week referral to 1st outpatient - breast symptoms (%) 93% 95.14% 95.14% 31-day wait from diagnosis to first treatment (%) 96% 97.73% 97.73% 62-day urgent GP referral to treatment for all cancers (%) 85% 82.91% 83.00% 62-day referral from screening services 90% 90.69% 90.72% Ambulance: December 2017 Category 1 7 mins / 15 mins 8:52 / 15:25 8:52 / 15:25 Category 2 18 mins / 40 mins 29:41 / 63:14 29:41 / 63:14 Category 3 No standard / 120 mins NA / 186:35 NA / 186:35 Category 4 No standard / 180 mins NA / 247:35 NA / 247:35 Infection control: October December 2017 C. Difficile (Total cases) - 1,150 1,150 Notes: NHS Improvement performances above are based on the performances of 154 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. 10 Performance of the NHS provider sector for the month ended 31 December 2017

1.2 Accident and emergency Percentage of A&E all type patients seen within 4 hours Number of trusts failing the 4 hour A&E target by month In quarter three, NHS England reported an overall A&E performance of 87.99% which included performance of Independent Sector Organisations. Performance of NHS providers showed a small improvement from the 86.75% in Q3 2016/17 to 86.98 % in Q3 2017/18. 11 Performance of the NHS provider sector for the month ended 31 December 2017 During the quarter, there were c.5.58 million attendances at NHS A&E departments, an increase of 4.7% (like-for-like) compared to the same period last year. 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.1.13 million, which was an increase of 5.4% when compared to the same quarter last year. Bed capacity constraints due to high occupancy rates and delayed transfers of care have continued to impact on patient flow, in line with increases in attendances and admissions. Improvements have been seen in Q3 2017, 162,942 patients waited more than four hours for a bed, 0.4% less than a year ago. There were also 303,229 bed days lost due to delayed transfers of care in acute hospitals in Q3 2017/18, a decrease of 22.2% (86,651 delayed days) from the same period a year ago. Recognising the challenges, NHS Improvement and NHS England agreed at the end of the 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 is a key focus for 2018/19 and expected standards have been set out in the Joint Planning Guidance. This includes A&E 4 hour performance being managed to 90% before returning to 95% over the longer term, an increased focus on ambulance to hospital handover delays and more focus on ambulance performance with a central transformation team in NHS England and the NHS Improvement / NHS England regional teams taking on a business as usual role for ambulance performance. In terms of the hospitals programme, patient flow remains key and initiatives are being undertaken around frailty, ambulatory emergency care, workforce and the continued roll out of the emergency care dataset, all of which will support a return to the 95% 4 hour A&E target.

1.3 Diagnostic waiting times Percentage of diagnostic patients waiting over 6 weeks Diagnostic performance by procedures December 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 December 2017, nationally, 877,852 patients were waiting for a diagnostic test, an increase of 0.3% from the last month. Compared to the same time last year, the waiting list has increased by 4.3% (like-for-like). This also resulted in more patients waiting longer than six weeks. Performance of 2.27% at the end of December 2017 (NHS England performance was 2.18%) was a deterioration in performance compared to 1.70% for the same period last year and a deterioration on November s performance of 1.81%. Providers in aggregate failed to achieve the waiting time standard for 14 of the 15 key diagnostic tests, three more than the same period last year. The overall diagnostics performance has been driven by an increase in waiting times for endoscopy tests which contribute to just over 12% of the diagnostics waiting list. In December 2017, 6.05% of patients were waiting over six weeks for an endoscopy test compared to 5.52% 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 2018. Non-obstetric ultrasound was one of the best performing tests despite having the largest waiting list (34.6% of the total diagnostics waiting list), with 1.01% of patients waiting over six weeks at the end of the quarter. Urodynamics saw the largest percentage of patients waiting over six weeks, although relatively small numbers, 10.57% were reported as waiting beyond the standard in December 2017. 12 Performance of the NHS provider sector for the month ended 31 December 2017

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 month was 88.01% (NHS England performance was 88.17%) which represents a drop of 1.4% 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 national elective waiting list remained at almost record levels, at the end of December 2017 it was 3.77 million, a 1% increase compared to a year ago (like-for-like and excluding providers which have recommenced reporting this year). Six providers did not report incomplete RTT performance in December 2017. When adding the missing trusts data onto the waiting list, the total waiting list was around 4.0 million nationally. In line with the drop in performance and the increase in the overall waiting list, the number of patients waiting longer than 52 weeks for treatment also increased. In December 2017, 1,688 patients (1,750 at NHS England aggregate) were waiting over a year for treatment compared to 1,229 in December 2016, and more than the 1,374 waiting in November 2017. 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. 13 Performance of the NHS provider sector for the month ended 31 December 2017

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 quarter 3 2017/18 All the cancer waiting-time standards were achieved in quarter 3 2017/18 except for 62 day (urgent GP referral) waiting time target for first treatment. The 62 day (urgent GP referral) has not been delivered since Q3 2013/14. In response to increasing demand, more patients began treatment this year. 37,153 patients began cancer treatment in Q3 2017/18, 2.3% 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 82.91% in Q3 2017/18 (NHS England performance was also 83.00%). This was an 0.7% improvement on performance achieved in the same quarter last year (82.20%). During December 2017 performance was at 84.1% for 62 day (urgent GP referral). This was an improvement from the same month last year, which was 83.0%. The specialties that contributed most to the underperformance in Q3 2017/18 were Urological (excluding testicular), Lower Gastrointestinal and Lung. These specialties accounted for only 40.6% of activity, but contributed to more than half of the reported breaches (55.2%). 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. 14 Performance of the NHS provider sector for the month ended 31 December 2017

1.6 Ambulance response times The historic national standard of Red 1, Red 2 and 19 minutes response-time targets have now ceased. 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 at removing hidden and long waits, including reducing lengthy waits for the frail and elderly, and freeing up more vehicles and staff to respond to emergencies. The change to the dispatch model gives staff slightly more time to identify patients needs and allow quicker identification of urgent conditions. The new target response times cover every single patient, not just those in immediate need. For the most urgent patients there is the collection of mean response time in addition to the 90th percentile, so every response is counted. The change of the rules around what stops the clock, ensures that targets can only be met by doing the right thing for the patient. The new standards are currently reported by ten of the ambulance trusts. The only trust not yet recording the new standards is Isle of Wight who plan to start reporting in spring 2018. Once a call has been triaged the category (Category 1-4) is determined. For Category 1 calls (the most seriously ill patients, those in a cardiac arrest or a state of peri-arrest), has the shortest mean time and 90 th centile expectation for arrival on scene. For categories 2, 3 and 4, the intent is to ensure that patients in these categories who require transportation receive a conveying resource in a timeframe appropriate to their clinical needs. The reporting trusts have been collated to create the aggregated national table: National aggregate Category C1 to C4 response times December 2017 National Standard: Mean / 90th Centile Count of incidents Category 1 7 mins / 15 mins 63,442 Category 1T no standard 43,116 Category 2 18 mins / 40 mins 393,390 Category 3 no standard / 120 mins 179,633 Category 4 no standard / 180 mins 19,765 Mean 90th centile (hrs:mins:sec) (hrs:mins:sec) 0:08:52 0:13:44 0:29:41 1:18:47 1:46:16 1. Centiles (including medians) for England in this table are a mean of trusts' centiles, weighted by their count of calls/incidents. 15:25 0:26:11 1:03:14 3:06:35 4:07:35 December 2017 saw Category 1 90 th centile was outside of the standard of 15 minutes, at 15:25. This was a rise from November 2017, which was 13:48. The mean response time was 8:52 minutes compared to the seven minute target. This was also not achieved in the previous month, recording the mean at 7:57. The Category 2 mean and 90 th centile standards were both not achieved during December. Both Category 3 and 4 saw the 90 th centile expectation not met during December 2017. 15 Performance of the NHS provider sector for the month ended 31 December 2017

1.7 Infection control Number of E.coli cases reported Number of Clostridium Difficile cases The number of trust apportioned C. Diff cases reported in quarter 3 2017 was 1,150 compared to 1,180 in the corresponding quarter last year. This was a decrease of 2.5%. Year to date, there have been 3,554 C. Diff cases reported, a decrease of 0.5% (18 cases) from the same period last year. Number of Meticillin-resistant Staphylococcus Aureus (MRSA) cases reported 71 trust assigned MRSA cases were reported in quarter 3 2017 which is 5.3% lower than the 75 cases reported in quarter 3 2016. Year to date, there have been 228 MRSA cases reported, an increase of 6.0% (13 cases) from the same period last year. The number of E.coli cases reported in quarter 3 2017 was 10,255 compared to 10,137 in the corresponding quarter last year. This was an increase of 1.2%. There was also a 2.0% (624 cases) increase reported year to date compared to the same period last year. The Secretary of State s ambition is to reduce healthcare associated Gram-negative bloodstream infections by 50% by March 2021. During 2017/18 there is a quality premium target for CCGs to reduce Escherichia coli (E.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. We have written to the acute NHS providers and mandated the data collection of Pseudomonas aeruginosa and Klebsiella species blood stream infections, in addition to E.coli (this is back dated to April 2017). All trusts are now submitting this data. The voluntary risk factor data is added to the Public Health England (PHE) data capture system (DCS) and will also collect the relevant data to assess/assign if these infections are healthcare associated. E.coli cases have followed the 2016/17 trend during months one to eight of 2017/18. Previous years have seen a 6-8% year on year increase. Now, for the first time in five years we have seen the increase reduce to 2%, and the seasonal pattern continues. This year, the 10% ambition will not be achieved, as the majority of improvement initiatives will not deliver a full year effect. In 2018/19, NHS Improvement will work with PHE to review all interventions to assess which have the greatest impact. 16 Performance of the NHS provider sector for the month ended 31 December 2017

1.8 Winter resilience preparations 2017/18 Overview Our plan for winter, which is more detailed and intensive than in previous years, has been built around three key pillars. These are: targeted support to our most pressurised systems through bespoke management plans and focused improvement support operational management through structures of continuous monitoring and supporting intervention drawing on a range of live data sources contingency planning to manage expected peaks in demand Historically A&E performance has declined significantly year on year, and this year it seems that the decline has halted. Year to date performance is 89.5%. This remains on par with year to date performance last year (89.6%). Performance for December was 85.1%, driven by high occupancy and an increase in demand pressures from flu and respiratory conditions. During the winter period: Record call volumes were managed through NHS 111 (470,000 more calls offered in December 2017 than the previous month and 13.5% more calls offered per day than the same month last year). We saw the highest ever proportion of NHS 111 calls with clinical input (39.4% in December 2017). New ambulance response standards have been implemented across all ambulance trusts in mainland England. Since February 2017 we have released over 1,400 beds through reduced delays to patient discharge. Key actions: Winter operating function in place 7 days a week with 24 hour on-call cover to support regional and local teams with managed response to surge. Monitoring implementation of actions to release capacity in the system including winter budget monies and the National Emergency Pressures Panel recommendations on planned elective postponement. Standing up flu preparedness response joint working with all system partners. 17 Performance of the NHS provider sector for the month ended 31 December 2017

2.0 Financial performance 18 Performance of the NHS provider sector for the month ended 31 December 2017

2.1 Financial performance overview 9 months ended 31 December 2017 by sector Number of providers Plan Actual Year to Date Month 9 2017/18 Forecast outturn 2017/18 Variance Deficit Providers Plan Forecast Variance Deficit Providers No. m m m No. m m m No. Acute 136 (1,223) (1,974) (751) 107 (1,015) (1,922) (907) 99 Ambulance 10 (4) 8 12 3 (4) 9 13 5 Community 18 12 20 8 5 28 24 (4) 5 Mental Health 53 55 41 (14) 16 125 103 (22) 10 Specialist 17 (17) (11) 6 8 19 92 73 5 Control total basis surplus / (deficit) including STF (1) 234 (1,177) (1,916) (739) 139 (847) (1,694) (847) 124 Technical adjustments (30) 34 64 (92) (15) 77 Uncommitted STF 291 601 310 443 778 335 Reported adjusted financial position surplus / (deficit) including all STF (2) (916) (1,281) (365) (496) (931) (435) 9 months ended 31 December 2017 by region Number of providers Plan Actual Year to Date Month 9 2017/18 Forecast outturn 2017/18 Variance Deficit Providers Plan Forecast Variance 1. 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). 19 Performance of the NHS provider sector for the month ended 31 December 2017 Deficit Providers No. m m m No. m m m No. London 36 (322) (492) (170) 21 (193) (312) (119) 17 Midlands 70 (510) (728) (218) 43 (530) (800) (270) 41 North 73 (261) (439) (178) 43 (154) (332) (178) 37 South 55 (84) (257) (173) 32 30 (250) (280) 29 Control total basis surplus / (deficit) including STF (1) 234 (1,177) (1,916) (739) 139 (847) (1,694) (847) 124 Technical adjustments (30) 34 64 (92) (15) 77 Uncommitted STF 291 601 310 443 778 335 Reported adjusted financial position surplus / (deficit) including all STF (2) (916) (1,281) (365) (496) (931) (435)

2.2 Income & expenditure 9 months ended 31 December 2017 Plan Actual m m m % Income from patient care activities 53,718 54,084 366 0.7% Other income 6,481 6,369 (112) (1.7%) Employee expenses (38,222) (38,923) (701) 1.8% Non pay costs (23,154) (23,446) (292) 1.3% Control total basis surplus/(deficit) including STF (1,177) (1,916) (739) 62.8% Adjustments Uncommitted STF Reported financial performance surplus/(deficit) 9 months ended 31 December 2017 by sectors Acute m Year to Date Month 9 2017/18 Variance to plan (30) 34 64 (213.3%) 291 601 310 106.5% (916) (1,281) (365) 39.8% Year to Date Month 9 2017/18 Actual m Mental Ambulance Community Health Specialist m m m m Income from patient care activities 39,904 1,758 1,940 8,122 2,360 Other income 5,226 45 102 674 322 Employee expenses (28,334) (1,253) (1,402) (6,419) (1,515) Non pay costs (18,770) (542) (620) (2,336) (1,178) Control total basis surplus/(deficit) including STF (1,974) 8 20 41 (11) Control total basis surplus / (deficit) % (4.4%) 0.4% 1.0% 0.5% (0.4%) At Q3 the provider sector reported a year-to-date deficit of 1,281 million against a plan of 916 million deficit, giving an adverse variance of 365 million over plan. This is a deterioration in the actual year-to-date variance since Q2 of 222 million. This adverse variance is attributable to a combination of factors including overspends on both employee costs and non-pay costs of 701 million and 292 million respectively and a 112 million shortfall on other income offset by a positive 366 million variance on patient care income. The net overspending is almost wholly attributable to the acute sector and reflects the significant operational pressures in this sector. The variances for other sectors were less material to the overall position. The figures include the impact of the continued pressure of high levels of non elective activity and the start of the winter period and the cost pressures associated with this. The government has made available 337 million of additional funding to support winter and the provider sector is in receipt of 70% of the available funding. This funding has been included in provider year to date and forecast positions reported at Q3. The key year to date themes reported by providers include material negative variances against plan for: delays in, or failure to achieve efficiency savings ( 224 million); non elective volume changes and pressures relating to workforce including agency and contract staffing ( 300 million) and inflationary pressures. The loss of elective income remains a factor for the sector. 109 providers reported an adverse year-to-date variance to plan at Q3, continuing the upward trend previously identified (87 at Q2 and 67 at Q1). This included 20 trusts who reported adverse variances excluding STF of more than 10 million amounting to 88% of the 428 million variance (29 trusts if STF is included). Trusts are forecasting that the position will improve by the financial year end with 91 trusts forecasting to be overspent against plan. Of these, 27 are forecasting to be overspent by more than 10 million excluding STF (40 trusts if STF is included). The reported sector financial position also included 601 million of uncommitted Sustainability and Transformation Fund (STF). Based on year-to-date performance, trusts have included 569 million of STF in the reported year-to-date position. 20 Performance of the NHS provider sector for the month ended 31 December 2017

2.3 Income analysis Year to Date Month 9 2017/18 9 months ended 31 December 2017 Plan Actual Variance to plan m m m % Elective income 7,029 6,855 (174) (2.5%) Non-elective income 10,390 10,656 266 2.6% First outpatient income 2,755 2,737 (18) (0.7%) Follow up outpatient income 3,279 3,172 (107) (3.3%) A&E income 1,696 1,724 28 1.7% High cost drugs income from commissioners (excluding pass-through costs) 3,153 3,357 204 6.5% Other NHS clinical income 10,748 10,993 245 2.3% Acute services 39,050 39,494 444 1.1% Mental Health services 6,361 6,345 (16) (0.3%) Ambulance services 1,761 1,756 (5) (0.3%) Community services 5,300 5,440 140 2.6% Other 1,246 1,049 (197) (15.8%) Total income from patient care activities 53,718 54,084 366 0.7% Research and development 752 755 3 0.4% Education and training 1,919 1,995 76 4.0% Charitable and other contributions to expenditure 43 64 21 48.8% Non-patient care services provided 849 1,061 212 25.0% Support from DH for mergers 59 60 1 1.7% Sustainability and transformation fund (STF) 879 569 (310) (35.3%) Recharged Pay costs accounted on a gross basis 95 210 115 121.1% Lease rentals received 104 81 (23) (22.1%) Other 1,781 1,574 (207) (11.6%) Total other income 6,481 6,369 (112) (1.7%) Total income 60,199 60,453 254 0.42% At Q3 the sector has recovered 254 million of income above plan levels, significantly up on the 3 million reported at Q2. Patient care income was 366 million better than plan but the sector under-recovered on non patient care by 112 million. The sector recovered significantly more non-elective income than planned ( 266 million or 2.6%) and high cost drugs income ( 204 million or 6.5%). This over recovery was offset by a material under recovery of elective income ( 174 million or 2.5%) and follow up outpatient income ( 107 million or 3.3%). This confirms the continued operational pressure in urgent and emergency care and its overall detrimental impact on the financial position. Non-elective activity is paid for at a marginal rate and has displaced planned elective work and also resulted in lost productivity. As such, profit making elective and outpatient income has been crowded out by loss making non-elective income and zero margin pass through drug costs. The consequent reduction in income also has a serious knock on effect where it results in trusts failing to achieve their plan and consequently losing access to STF funding. Other variances included a large over recovery (of 140 million) for community services and largely offsetting variances for other NHS clinical services (acute) and other (non acute). For other income, there were material over recoveries on education and training ( 76 million), non-patient care services ( 212 million) and an under-recovery on STF ( 310 million). Trusts are forecasting to further improve the position by the financial year end and are reporting an over recovery against planned income levels of 575 million. This is made up of forecast positive variances of 2 million on nonpatient care and 573 million on patient care. Of this the majority is non elective ( 262 million) and high cost drugs income ( 303 million). The National Emergency Pressures Panel made a series of recommendations on 20 December that included providers deferring non-urgent inpatient elective care until January. The recommendation subsequently extended to the end of February and to include outpatient and day case where this would appropriately release clinical time for non-elective care. The income forecast to be received by acute trusts from NHS England and CCGs reduced by 20 million from that reported at month 8, and this is despite 238 million of extra winter funding. It is not clear how much of this reduction is due to January cancellations or if forecast income levels will drop further in month 10 when providers have a clearer picture of the full extent of elective cancellations and actual non elective activity volumes. 21 Performance of the NHS provider sector for the month ended 31 December 2017

2.4 Employee expenses pay costs 9 months ended 31 December 2017 Year to Date Month 9 2017/18 Plan Actual Variance m m m % Medical staff 9,406 9,866 (460) (4.9%) Nursing staff 15,058 15,259 (201) (1.3%) Other staff 13,758 13,798 (40) (0.3%) Total employee expenses 38,222 38,923 (701) (1.83%) Of which - Bank 1,511 2,175 (664) (43.9%) - Agency ceiling performance 1,887 1,779 108 5.7% 9 months ended 31 December 2017 Forecast outturn 2017/18 Plan Forecast Variance m m m % Medical staff 12,505 13,099 (594) (4.8%) Nursing staff 20,026 20,328 (302) (1.5%) Other staff 18,286 18,395 (109) (0.6%) Total employee expenses 50,817 51,822 (1,005) (1.98%) Of which - Bank 1,998 2,841 (843) (42.2%) - Agency ceiling performance 2,500 2,363 137 5.5% NHS trusts employ 1.1 million WTE (whole time equivalent) staff. The pay bill is the single biggest area of expenditure and the NHS has made management of the pay bill and recruitment to fill key staff vacancies a key priority. Total pay costs for the first nine months of the year were 701 million worse than plan. Most of this was driven by adverse variances of 460 million (4.9%) on medical staff and 201 million (1.3%) on nursing staff. The bulk of the overspending took place in the acute sector which overspent by 618 million, up from 245 million at Q2, reflecting the continued operational pressure in the acute sector. A significant overspend of 88 million was also reported in the mental health sector. All regions are reporting overspends on staff costs at month Q3 with Midlands & East ( 238 million) and North ( 256 million) being the highest. Trusts forecast the year end outturn to be 51.8 billion representing an overspend against plan of 1.0 billion and a deterioration since Q2 of 576 million. Forecast pay expenditure is 2.4% higher than in 2016/17, which taking into account the pay inflation assumed in tariff of 2.1%, represents only a 0.3% real terms growth. The overspending against pay budgets has shown up in the use of bank staff which was 664 million above plan at Q3. This reflects the increasing use of bank staff by trusts to manage workload in the face of increased demands, high levels of vacancies, sickness/absence and staff turnover. The increase in the use of bank staff has also been impacted by missed CIP targets on pay and by volume shifts between agency and bank, both of which were not factored into trust plans. This trend is set to continue to the year end with a bank spend forecast of 2,841 million, giving an adverse variance of 843 million. Offsetting the increase in bank, the Q3 figures show a continued reduction in the reliance on agency staff and a 108 million (or 5.7%) positive variance against plan is reported, which has partly been caused by moving agency workers and shifts into bank and substantive roles. Trusts are forecasting that agency expenditure will underspend by 137 million for the year and will be within the agency ceiling of 2.5 billion. Despite the significant increase in bank spend, the overall temporary staff (bank and agency) costs showed a decrease of 110 million or 2.7% on the same period in 2016/17. 22 Performance of the NHS provider sector for the month ended 31 December 2017

2.5 NHS provider vacancies 9 months ended 31 December 2017 2017/18 Q1 2017/18 Q2 2017/18 Q3 Nursing Vacancy Rate 10.9% 11.2% 10.3% WTE Vacancies 38,180 39,004 35,835 Medical Vacancy Rate 9.1% 8.3% 7.9% WTE Vacancies 10,848 10,097 9,676 Other staff Vacancy Rate 7.9% 7.5% 7.5% WTE Vacancies 53,535 51,058 51,942 Total Workforce Vacancy Rate 9.0% 8.7% 8.4% Total Workforce WTE Vacancies 102,563 100,159 97,453 There are currently 1.1 million WTE (whole time equivalent) staff employed by NHS trusts in England with an additional circa 100,000 vacancies. Management of this vacancy position via recruitment of substantive staff and effective use of temporary staffing (bank and agency) is a key priority for NHS Improvement. NHS Improvement aims to publish provider vacancy rates at an aggregate national, regional and sector position to ensure that NHS Improvement s Board is sighted to the full extent on provider workforce risks and challenges. The vacancy reduction observed since Q2 is an outcome of expected substantive recruitment from month 6. There has also been a notable reduction in agency staffing over to bank with the ambition to see this consequently move to a more sustainable substantive staffing model in the future. There is significant regional and sector vacancy variation with the London region and the mental health sector having the highest numbers proportionately. Nursing: NHS trusts employ over 313,000 WTE registered nursing staff. In addition to this substantive workforce, there are over 35,000 WTE vacancies of which approximately 90-95% is currently being filled by a combination of bank (65%) and agency staff (35%). **The information above represents management information only and not an official statistic Medical: NHS trusts employ over 112,000 WTE medical staff. In addition to this substantive workforce, there are over 9,500 WTE vacancies of which approximately 95% is currently being filled by a combination of bank (35%) and agency (locum) staff (65%). 23 Performance of the NHS provider sector for the month ended 31 December 2017

2.6 Agency ceiling performance Agency ceiling performance Year to Date Month 9 2017/18 9 months ended 31 December 2017 Plan Actual Variance m m m % Agency ceiling performance 1,887 1,779 108 5.7% Agency costs as a % of total pay costs 4.9% 4.6% Agency ceiling performance Provider Forecast outturn 2017/18 9 months ended 31 December 2017 Plan Forecast Variance m m m % Agency ceiling performance 2,500 2,363 137 5.5% Agency costs as a % of total pay costs 4.9% 4.6% Agency breakdown 9 months ended 31 December 2017 Year to Date Dec-16 Dec-17 Movement m m m % Medical staff 791 710 81 10.2% Nursing staff 871 679 192 22.0% Other Staff 560 390 170 30.4% Total 2,222 1,779 443 19.9% NHS Improvement has established agency ceilings for all trusts. This work commenced in 2015/16 for nursing staff and has now been expanded to all staff groups. Agency costs have continued to decrease significantly following the initiatives undertaken by NHS Improvement and action taken by providers over the last two years. At Q3, the positive variance was 108 million representing a 5.7% underspend against the planned ceiling and is 441 million or 20% lower than the comparable period last year. As a proportion of total payroll costs the downward trend has continued. By Q3 the cumulative YTD position was 4.6% and the position by individual month had fallen to 4.2% for month 9. This is a considerable reduction on the 7.2% reported in April 2015 at the start of the NHS Improvement initiatives. A risk adjusted most likely forecast outturn based upon previous years performance indicates a final year figure of up to 2.4 billion. This is slightly less optimistic than the 2.36 billion forecast by providers but is well below the overall ceiling of 2.5 billion. The risk adjusted bank spend is forecast to be around 2.90 billion, again higher than the reported position of 2.84 billion. Agency costs have decreased considerably in all staff categories when compared to the levels last year. The largest fall is in other staff which has fallen by 30.4%. This is driven by a significant fall in the administrative and estates staff group amounting to 41.7%. There have also been significant reductions in nursing staff and medical and dental staff, which fell by 22.0% and 10.2% respectively. By controlling the level of agency spending, the changes brought in over the last two years have facilitated a greater level of workforce planning and improved the value for money achieved in this area of significant spend. 24 Performance of the NHS provider sector for the month ended 31 December 2017

2.7 Non-pay cost pressures Year to Date Month 9 2017/18 9 months ended 31 December 2017 by sectors Plan Actual Actual Variance to plan m m m % Purchase of healthcare from other providers 1,267 1,475 (208) (16.4%) Purchase of social care 158 155 3 1.9% Drugs costs 5,356 5,388 (32) (0.6%) Clinical supplies and services (excluding drugs costs) 4,935 5,134 (199) (4.0%) General supplies and services 1,240 1,055 185 14.9% Clinical negligence insurance 1,464 1,465 (1) (0.1%) Consultancy 122 189 (67) (54.9%) Establishment 703 695 8 1.1% Premises 2,257 2,307 (50) (2.2%) Other non pay items 5,652 5,583 69 1.2% Total non pay 23,154 23,446 (292) (1.3%) 9 months ended 31 December 2017 Financial sanctions including penalties Sanctions reinvested Sub-total: Financial sanctions Marginal rate emergency tariff impact MRET reinvested Sub-total: MRET Readmissions Readmissions reinvested Sub-total: Readmissions Delayed transfers of care (DToC) - expenditure incurred on blocked capacity DToC - reimbursement from Local Authorities Sub-total: Delayed transfers of care Waiting list initiative work Outsourcing of work to other providers Year to Date Actual Forecast outturn 2017/18 m m (99) (125) 54 69 (45) (56) (232) (312) 9 18 (223) (294) (194) (256) 33 45 (161) (211) (120) (162) 1 2 (119) (160) (120) (167) (164) (218) The overspend against plan on non pay expenditure has moved from the 70 million (0.5%) reported at Q2, to 292 million (1.3%) at Q3. The largest area of overspending is on the purchase of healthcare from other providers which rose to 208 million at Q3. Of this, 144 million was for purchases of healthcare from non NHS bodies indicating that capacity constraints continue to be an issue. There was also material overspending on clinical supplies and services of 199 million and consultancy costs of 67 million offset by underspending on general supplies and services of 185 million and other non operating items of 69 million. The increase in non pay costs continues to be driven by operational pressures particularly non elective activity and as a result of winter pressures, trusts have also cited inflationary cost increases as a contributory factor. Trusts are forecasting that the year end position will deteriorate further to an overall overspend against plan of 417 million. Despite the overspending noted, the forecast non pay expenditure is only 1% higher than the levels seen in 2016/17, which in view of the inflationary pressures evident during 2017/18, represents a significant achievement against a challenging plan. Since the introduction of control totals and the STF there has been a significant reduction in national sanctions against trusts. The level of net sanctions reduced to 99 million in 2016/17 and trusts are forecasting that they will continue to fall to 56 million in 2017/18. At Q3, trusts had spent 120 million on weighting list initiatives (WLI) and 164 million on outsourcing. The full year forecasts of 167 million and 218 million respectively represent a total expenditure reduction of 204 million when compared to the previous year. Earlier this year, the government allocated 1 billion extra funding to social care. A proportion of this additional funding was to be used to reduce the volume of delayed transfers of care and help free up hospital beds. However, providers in aggregate do not expect that the annual costs associated with blocked capacity will fall significantly this year and year-todate costs were only slightly less ( 5 million) when compared to the same period last year. However, activity recorded over the last three months suggests that some progress is now being made in this area. This is vitally important as the delivery of financial plans depends on achieving a number of key assumptions around risk management, agreed activity levels and the availability of beds. 25 Performance of the NHS provider sector for the month ended 31 December 2017

2.8 Efficiency savings 9 months ended 31 December 2017 Year to Date Month 9 2017/18 Plan Actual Variance Variance m m m % Recurrent 2,271 1,593 (678) (30%) Non Recurrent 197 546 349 177% Total efficiency savings 2,468 2,139 (329) (13%) Efficiencies as a % of Spend 3.9% 3.3% 9 months ended 31 December 2017 Forecast outturn 2017/18 Plan Forecast Variance Variance m m m m Recurrent 3,372 2,557 (815) (24%) Non Recurrent 315 738 423 134% Total efficiency savings 3,687 3,295 (392) (11%) Efficiencies as a % of Spend 4.3% 3.8% For the nine month period to Q3, trusts have delivered efficiency savings through cost improvement programmes (CIPs) that have reduced total operating costs by 2.14 billion (or 3.3%). Although significant, the efficiencies achieved continue to be behind plan, by 329 million (13%). The largest under-delivery continues to be pay cost savings which was 313 million (or 27%) behind plan. Trusts are forecasting that by the year end, the adverse variance on pay CIPs will rise to 428 million. The shortfall of pay CIPs is a key contributor to the overspend on the pay costs budget. The overall shortfall on non-pay savings was 73 million (or 8%) offset by a surplus on income generation schemes of 57 million (or 17%). The Q3 data confirms a continuation of the trend identified in Q1 and Q2 whereby under-performance against recurrent CIPs is being partly compensated by a significant increase in non-recurrent CIPs. Trusts had planned to deliver 2,271 million (or 92%) of their year-to-date efficiencies through recurrent schemes. At Q3, only 1,593 million (or 74%) of the identified savings were from recurrent sources. By contrast savings from non-recurrent schemes has risen from 197 million (or 8%) at plan to 546 million (or 26%) at Q3. The specific efficiency savings linked to Lord Carter s productivity themes in workforce productivity, resource optimisation and benchmarking (Model Hospital) are estimated to be 974 million. The year end forecast confirms that efficiencies linked to these productivity themes will account for 1.5 billion (or 45%) of the overall savings. Providers 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 392 million. To achieve the current forecast saving outturn of 3.3 billion, providers need to identify detailed schemes for a further 86 million in the remainder of the year. By Q3 the sector had achieved 65% of the forecast efficiency savings for the year. In order to meet the forecast outturn, trusts will need to significantly step up the delivery of CIPs in the final quarter. At the same stage in 2016/17, trusts had achieved the same proportion (65%) so there is evidence to support the increased delivery in the final quarter. Despite the adverse variances to plan reported, the sector has achieved 97 million (or 4.7%) more year to date than in the same period last year. NHS Improvement continues to work with providers to maximise this benefit, through the provision of national and technical forums designed to share best practice. 26 Performance of the NHS provider sector for the month ended 31 December 2017

2.9 Early view of implied provider productivity Implied productivity calculation 9 months ended 31 December 2017 Year to Date Month 9 2017/18 Total Pay Non Pay m m m Year to date expenditure, all trusts 2016/17 60,721 37,766 22,955 Year to date expenditure, all trusts 2017/18 62,368 38,923 23,445 Cost change on previous year 1,647 1,157 490 Cost change % 2.7% 3.1% 2.1% Estimated impact of inflation (as per NHS tariff 1 ) 2.4% 2.1% 2.9% NHS real terms cost change 0.3% 1.3% -0.8% Growth in cost weighted activity 2 2.1% 2.1% 2.1% Implied productivity 1.8% 0.8% 2.9% 1 Includes the inflationary impact of CNST premium increases 2 Elective and outpatient growth rates are adjusted for differences in the number of working days in the comparator period Cost improvement programmes delivered 9 months ended 31 December 2017 Year to Date Month 9 2017/18 Total 1 Pay Non Pay m m m CIPS delivered 2,139 864 873 Expenditure for CIPS calculation 64,507 39,787 24,318 Cost improvement programmes % delivered 3.3% 2.2% 3.6% 1 The totals includes Pay and non pay CIPs as well as CIPS relating to income By reviewing the change in provider costs, adjusted for estimated unavoidable inflationary pressures and then comparing these cost changes to the change in provider outputs, it is possible to calculate an early view of the implied productivity of the provider sector. The implied productivity for the nine month period ending 31 December 2017 was 1.8%. Despite the financial pressures experienced by the provider sector, underlying productivity appears to be similar to the levels delivered in the 2016/17 financial year and continues to out-perform the wider economy. The productivity improvement appears to be driven by significant efficiencies in non pay spend with pay productivity improvements being more modest. Cost improvement programmes (CIPS) are the method we use to monitor the plans that providers have to contain costs. The level of cost improvement programmes undertaken by providers are greater than the underlying productivity improvement. This is because a number of initiatives undertaken by providers to contain costs are one offs, for example profits from the sale of surplus land. These savings need to be made again the following year so would appear as a required cost improvement but wouldn t appear as an underlying change in productivity. In addition, many providers are funding investments in quality improvement through efficiencies these quality improvements are not measured through cost weighted activity. The trend in delivered cost improvements matches the implied productivity changes with non pay cost savings being proportionately higher than pay savings. 27 Performance of the NHS provider sector for the month ended 31 December 2017

2.10 Capital expenditure 9 months ended 31 December 2017 by sector 9 months ended 31 December 2017 by sector Year to Date Month 9 2017/18 Plan Actual Variance to plan m m m % Acute 2,285 1,362 (923) (40.4%) Ambulance 79 42 (37) (46.8%) Community 55 28 (27) (49.1%) Mental Health 337 209 (128) (38.0%) Specialist 271 162 (109) (40.2%) Total CDEL 3,027 1,803 (1,224) (40.4%) Forecast outturn 2017/18 Plan Forecast Variance to plan m m m % Acute 3,344 2,564 (780) (23.3%) Ambulance 125 107 (18) (14.4%) Community 76 61 (15) (19.7%) Mental Health 458 374 (84) (18.3%) Specialist 331 270 (61) (18.4%) Total CDEL 4,334 3,376 (958) (22.1%) Foundation Trust NHS Trust Forecast outturn Forecast outturn 2017/18 Fcast m Fcast m Fcast m Gross capital expenditure 2,425 1,179 3,604 Disposals / other deductions (75) (18) (93) Net Capital expenditure 2,350 1,161 3,511 Less donations and grants received (133) (42) (175) Less PFI capital (IFRIC12) (68) (60) (128) Plus PFI residual interest 85 80 165 Purchase of financial assets 7 0 7 Sale of financial assets (8) 0 (8) PPAs 4 0 4 Total CDEL 2,237 1,139 3,376 Provider plans included Capital Departmental Expenditure Limit (CDEL) expenditure of 4.334 billion in 2017/18. The initial Department of Health CDEL budget for 2017/18 of 2.9 billion has increased to 3.273 billion as a result of the autumn budget statement which announced additional funding. The forecast CDEL expenditure at month 9 is 3.376 billion, an underspend against plan of 958 million but an overspend against the revised Department of Health budget of 0.1 billion. At 31 December 2017 providers had spent 1.803 billion on capital schemes, which was 1.224 billion below plan. The yearto-date spend represents 53% of providers own forecasts at this stage of the year. Providers were asked to review their capital forecasts at month 9. As a result the CDEL forecast at month 9 reduced by 376 million from the month 8 forecast level. Letters were sent to trusts who were reporting significant capital spend in quarter 4 and all trusts have been asked to provide an accurate update to their CDEL forecast position in month 10. NHS Improvement will continue to work with providers ahead of the month 10 submission to refine their forecasts. NHS foundation trusts are forecasting CDEL expenditure of 2.237 billion (or 66% of the total forecast). NHS trusts are forecasting 1.139 billion (representing 34% of the total sector forecast). 28 Performance of the NHS provider sector for the month ended 31 December 2017

2.11 Year-end financial position Building on last year s delivery, NHS Improvement continues to support trusts to further improve productivity and reinforce the tighter financial controls introduced last year. We have introduced a new set of trust control totals, setting out the minimum level of improvement expected in financial positions for 2017/18, and linked (as last year) to the renewed 1.8 billion STF. This has been combined with setting very challenging financial plans for 2017/18 which have particularly focused on the control of costs and the improvement of productivity. At Q3, a total of 211 out of 234 providers (90% of the total) had accepted their individual control totals. We are also working with NHS England and shadow integrated care systems to develop system financial controls that will develop a collective approach to managing financial risk across all the NHS commissioners and providers in a local health economy. The board approved trust plans submitted to NHS Improvement confirmed a total sector planned deficit of 496 million for 2017/18 with the support of 1.8 billion STF. At Q3, providers forecast to end the year with an aggregate deficit of 931 million, 435 million worse than planned. This is a deterioration of 308 million on the position reported at Q2. Sector Control total, STF and financial special measures data by sector YTD ended 31 December 2017 No of trusts accepted control total No of trusts included STF in its year-todate position No of trusts forecast to receive full or partial STF at the year end No of trusts in Financial Special Measures Acute 118 105 106 11 Ambulance 8 8 8 0 Community 17 17 17 0 Mental Health 52 45 49 0 Specialist 16 14 16 0 Total 211 189 196 11 In November 2017, the government made available 337 million of additional funding to support winter. The provider sector has received 70% of the available winter funds and this has been included in the forecast positions reported at Q3. Despite this extra income the forecast income position has not increased by this value. This is likely to be due to trusts suspending non urgent elective procedures in January in order to free up beds and clinical time to support non elective care over winter. 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, eleven of the most financially challenged trusts will continue to receive intensive support through the Special Measures programme. This includes one, King s College Hospital NHS Foundation Trust that was brought in during the quarter. Since Special Measures was introduced, three trusts have demonstrated significant financial improvement and exited the regime. Furthermore, a number of trusts have received targeted support through the Financial Improvement Programme which is now in its second wave. 29 Performance of the NHS provider sector for the month ended 31 December 2017

3.0 Financial performance by provider 30 Performance of the NHS provider sector for the month ended 31 December 2017

3.1 Financial performance by provider London (1/1) Control Total Basis Surplus Deficit Including STF Sustainability & Transformation Fund (STF) Year to date Forecast Outturn STF Allocated Provider Name Control Total (CT) Accepted? YTD Plan YTD Actual Variance FOT Plan FOT Variance (In Plan only if accepted CT) YTD Actual FOT Barking, Havering and Redbridge University Hospitals NHS Trust * YES 189 (45,824) (46,013) 1,379 (718) (2,097) 18,652 6,109 16,554 Barnet, Enfield And Haringey Mental Health NHS Trust YES (6,431) (5,993) 438 (4,616) (4,616) 0 1,166 758 1,166 Barts Health NHS Trust YES (67,379) (122,311) (54,932) (45,971) (52,704) (6,733) 39,029 0 32,296 Camden and Islington NHS Foundation Trust YES 1,553 (775) (2,328) 2,168 4,825 2,657 838 0 2,166 Central and North West London NHS Foundation Trust YES (1,270) (1,230) 40 2,927 2,927 0 2,928 1,903 2,928 Central London Community Healthcare NHS Trust YES 3,188 3,205 17 5,013 5,318 305 1,842 1,197 1,994 Chelsea and Westminster Hospital NHS Foundation Trust YES 4,242 5,009 767 7,074 12,715 5,641 14,122 9,179 16,216 Croydon Health Services NHS Trust YES (10,507) (25,319) (14,812) (10,447) (24,995) (14,548) 8,688 1,303 1,303 East London NHS Foundation Trust YES 5,850 3,809 (2,041) 12,411 6,294 (6,117) 2,438 853 854 Epsom and St Helier University Hospitals NHS Trust YES (23,006) (24,390) (1,384) (17,832) (19,382) (1,550) 10,332 5,166 8,782 Great Ormond Street Hospital for Children NHS Foundation Trust YES 6,703 8,261 1,558 9,728 13,108 3,380 5,384 3,500 7,076 Guy's and St Thomas' NHS Foundation Trust YES 9,443 6,457 (2,986) 19,094 24,047 4,953 22,094 10,550 21,528 Homerton University Hospital NHS Foundation Trust YES 2,914 3,397 483 6,393 7,051 658 6,393 4,156 6,393 Hounslow and Richmond Community Healthcare NHS Trust YES 1,408 1,613 205 2,178 2,178 0 902 586 902 Imperial College Healthcare NHS Trust Yes (11,289) (13,678) (2,389) (4,499) (5,643) (1,144) 20,650 8,503 17,006 King's College Hospital NHS Foundation Trust NO (36,935) (82,791) (45,856) (38,484) (92,939) (54,455) 0 0 0 Kingston Hospital NHS Foundation Trust YES 2,518 (3,342) (5,860) 8,519 (2,746) (11,265) 7,656 2,678 2,680 Lewisham and Greenwich NHS Trust YES (19,517) (49,325) (29,808) (22,763) (63,505) (40,742) 16,683 0 0 London Ambulance Service NHS Trust YES (3,335) 80 3,415 (2,402) (2,287) 115 1,940 1,261 2,052 London North West Healthcare NHS Trust YES (42,525) (45,840) (3,315) (49,545) (50,893) (1,348) 19,381 9,254 16,038 Moorfields Eye Hospital NHS Foundation Trust YES 1,587 2,281 694 1,100 6,370 5,270 880 572 4,163 North East London NHS Foundation Trust YES 2,334 2,457 123 3,920 4,421 501 2,302 1,496 2,802 North Middlesex University Hospital NHS Trust NO (17,136) (21,825) (4,689) (22,391) (29,002) (6,611) 0 0 0 Oxleas NHS Foundation Trust YES 768 (694) (1,462) 3,129 3,129 0 1,489 0 1,489 Royal Brompton and Harefield NHS Foundation Trust YES (28,537) (24,018) 4,519 (5,638) (5,638) 0 8,189 5,323 8,189 Royal Free London NHS Foundation Trust YES (41,395) (2,097) 39,298 (11,208) (11,805) (597) 16,292 6,709 13,570 Royal National Orthopaedic Hospital NHS Trust YES (12,951) (12,371) 580 (16,207) (16,207) 0 993 584 993 South London and Maudsley NHS Foundation Trust YES (275) 1,730 2,005 2,344 2,516 172 2,262 1,470 2,389 South West London and St George's Mental Health NHS Trust YES (356) (374) (18) 5,342 2,414 (2,928) 983 638 992 St George's University Hospitals NHS Foundation Trust NO (44,461) (53,259) (8,798) (45,002) (51,200) (6,198) 0 0 0 Tavistock and Portman NHS Foundation Trust YES 692 917 225 950 950 0 500 325 500 The Hillingdon Hospitals NHS Foundation Trust NO (7,686) (9,014) (1,328) (8,476) (7,961) 515 0 0 0 The Royal Marsden NHS Foundation Trust YES 3,104 9,661 6,557 3,432 12,515 9,083 1,847 1,200 6,437 The Whittington Health NHS Trust YES (572) (477) 95 607 1,293 686 6,671 4,336 6,671 University College London Hospitals NHS Foundation Trust YES 6,349 4,206 (2,143) 9,826 12,732 2,906 14,736 7,368 14,326 West London Mental Health NHS Trust YES 308 354 46 5,329 5,329 0 1,414 919 1,414 London Total (322,413) (491,509) (169,097) (192,617) (312,109) (119,491) 259,676 97,896 221,869 * Barking, Havering and Redbridge University Hospitals NHS Trust have identified a potential significant deterioration in their position since reporting at Q3, NHSI is working with them as part of the financial special measures process to agree a recovery plan and revised forecast 31 Performance of the NHS provider sector for the month ended 31 December 2017

3.2 Financial performance by provider Midlands and East (1/2) Control Total Basis Surplus Deficit Including STF Sustainability & Transformation Fund (STF) Year to date Forecast Outturn STF Allocated Provider Name Control Total (CT) Accepted? YTD Plan YTD Actual Variance FOT Plan FOT Variance (In Plan only if accepted CT) YTD Actual FOT Basildon and Thurrock University Hospitals NHS Foundation Trust YES (9,007) (24,142) (15,135) (12,571) (29,748) (17,177) 10,724 0 0 Bedford Hospital NHS Trust YES (7,187) (7,177) 10 (8,842) (8,302) 540 5,249 3,412 5,249 Birmingham and Solihull Mental Health NHS Foundation Trust YES (365) 415 780 2,024 2,024 0 1,485 965 1,485 Birmingham Community Healthcare NHS Foundation Trust YES 3,564 4,376 812 4,800 5,808 1,008 1,620 1,053 2,169 Birmingham Women s and Children's NHS Foundation Trust YES 6,257 5,540 (717) 11,470 11,593 123 7,788 4,361 7,110 Black Country Partnership NHS Foundation Trust NO (2,648) (2,351) 297 (3,179) (3,169) 10 0 0 0 Burton Hospitals NHS Foundation Trust YES (7,420) (7,895) (475) (9,527) (9,458) 69 5,383 3,014 4,898 Cambridge University Hospitals NHS Foundation Trust YES (29,814) (29,601) 213 (42,100) (40,031) 2,069 16,954 11,021 16,954 Cambridgeshire and Peterborough NHS Foundation Trust YES 1,217 (387) (1,604) 2,249 2,249 0 1,318 0 1,318 Cambridgeshire Community Services NHS Trust YES 1,274 1,294 20 1,999 1,999 0 1,072 696 1,072 Chesterfield Royal Hospital NHS Foundation Trust YES 2,544 2,555 11 6,040 6,665 625 6,066 3,943 6,067 Colchester Hospital University NHS Foundation Trust YES (17,883) (13,738) 4,145 (22,013) (18,605) 3,408 8,848 4,225 8,891 Coventry and Warwickshire Partnership NHS Trust YES 356 1,225 869 2,276 2,276 0 1,228 798 1,228 Derby Teaching Hospitals NHS Foundation Trust NO (31,984) (32,782) (798) (41,601) (37,100) 4,501 0 0 0 Derbyshire Community Health Services NHS Foundation Trust YES 2,999 5,961 2,962 4,923 4,923 0 1,537 999 1,537 Derbyshire Healthcare NHS Foundation Trust YES 2,347 3,946 1,599 2,764 4,036 1,272 794 516 1,430 Dudley And Walsall Mental Health Partnership NHS Trust YES 1,395 1,408 13 1,839 1,839 0 500 325 500 East And North Hertfordshire NHS Trust YES (9,795) (22,883) (13,088) (7,744) (9,527) (1,783) 10,214 1,302 7,379 East Midlands Ambulance Service NHS Trust YES (4,066) (232) 3,834 (5,396) 7,048 12,444 934 607 7,156 East of England Ambulance Service NHS Trust NO (54) 2,813 2,867 0 (0) 0 0 0 0 Essex Partnership University NHS Foundation Trust YES (4,408) (4,323) 85 (6,635) (5,890) 745 2,312 1,503 3,057 George Eliot Hospital NHS Trust YES (10,969) (13,726) (2,757) (13,217) (19,619) (6,402) 4,003 1,401 1,401 Heart of England NHS Foundation Trust YES (7,868) (42,841) (34,973) (7,539) (45,940) (38,401) 21,316 0 0 Hertfordshire Community NHS Trust YES 486 556 70 1,972 1,973 1 916 595 916 Hertfordshire Partnership University NHS Foundation Trust YES 1,425 1,963 538 2,048 2,558 510 1,262 820 1,517 James Paget University Hospitals NHS Foundation Trust YES (1,677) (2,069) (392) 2,112 (9,266) (11,378) 4,427 2,479 2,479 Kettering General Hospital NHS Foundation Trust NO (15,728) (21,005) (5,277) (19,938) (19,938) 0 0 0 0 Leicestershire Partnership NHS Trust YES 1,876 1,876 0 3,115 3,116 1 1,671 1,085 1,671 Lincolnshire Community Health Services NHS Trust YES 2,550 3,877 1,327 3,348 3,519 171 1,357 882 1,459 Lincolnshire Partnership NHS Foundation Trust YES 618 629 11 1,143 1,822 679 595 387 937 Luton and Dunstable University Hospital NHS Foundation Trust YES 3,246 3,349 103 10,105 10,115 10 8,418 5,472 8,418 Mid Essex Hospital Services NHS Trust YES (19,432) (36,950) (17,518) (24,534) (55,100) (30,566) 9,096 1,160 1,160 Milton Keynes University Hospital NHS Foundation Trust YES (14,930) (14,938) (8) (18,825) (18,827) (2) 7,300 4,745 7,299 Norfolk and Norwich University Hospitals NHS Foundation Trust YES 1,422 (14,675) (16,097) 4,406 (26,838) (31,244) 13,285 3,853 3,853 Norfolk and Suffolk NHS Foundation Trust YES (2,433) (2,346) 87 (1,147) (547) 600 1,284 834 1,584 Norfolk Community Health and Care NHS Trust YES 839 (738) (1,577) 2,033 (1,953) (3,986) 788 276 276 North Staffordshire Combined Healthcare NHS Trust YES 774 943 169 1,400 1,800 400 500 325 700 32 Performance of the NHS provider sector for the month ended 31 December 2017

3.3 Financial performance by provider Midlands and East (2/2) Control Total Basis Surplus Deficit Including STF Sustainability & Transformation Fund (STF) Year to date Forecast Outturn STF Allocated Provider Name Control Total (CT) Accepted? YTD Plan YTD Actual Variance FOT Plan FOT Variance (In Plan only if accepted CT) YTD Actual FOT North West Anglia NHS Foundation Trust YES (34,672) (34,528) 144 (42,405) (42,405) 0 12,247 7,960 12,247 Northampton General Hospital NHS Trust YES (8,558) (19,190) (10,632) (13,546) (15,964) (2,418) 8,715 1,111 6,297 Northamptonshire Healthcare NHS Foundation Trust YES 1,092 1,139 47 1,624 1,624 0 1,145 745 1,145 Nottingham University Hospitals NHS Trust YES (10,866) (14,867) (4,001) (10,714) (12,335) (1,621) 23,286 11,119 19,269 Nottinghamshire Healthcare NHS Foundation Trust YES 7,288 7,597 309 9,622 9,622 0 2,733 1,776 2,733 Papworth Hospital NHS Foundation Trust NO 686 (5,263) (5,949) (3,272) (10,687) (7,415) 0 0 0 Queen Elizabeth Hospital King's Lynn NHS Foundation Trust YES (5,987) (15,850) (9,863) (6,523) (18,754) (12,231) 5,785 0 0 Sandwell And West Birmingham Hospitals NHS Trust YES (6,424) 4,494 10,918 9,933 7,025 (2,908) 10,482 5,006 7,574 Sherwood Forest Hospitals NHS Foundation Trust YES (27,913) (32,252) (4,339) (37,623) (38,038) (415) 8,814 2,556 7,492 Shropshire Community Health NHS Trust YES 350 441 91 855 1,255 400 596 387 796 South Staffordshire and Shropshire Healthcare NHS Foundation Trust YES 2,865 4,118 1,253 3,517 5,517 2,000 1,078 701 2,078 South Warwickshire NHS Foundation Trust YES 5,340 5,172 (168) 7,769 7,832 63 4,892 2,740 4,452 Southend University Hospital NHS Foundation Trust YES (11,487) (7,798) 3,689 (14,591) (14,813) (222) 7,670 4,295 6,980 Staffordshire and Stoke on Trent Partnership NHS Trust NO (9,408) (6,510) 2,898 (10,000) (9,999) 1 0 0 0 The Dudley Group NHS Foundation Trust YES 7,645 (2,594) (10,239) 11,104 (6,175) (17,279) 8,574 2,487 2,487 The Ipswich Hospital NHS Trust YES (13,790) (20,951) (7,161) (18,118) (17,387) 731 7,105 1,066 7,105 The Princess Alexandra Hospital NHS Trust YES (16,830) (25,356) (8,526) (21,554) (23,440) (1,886) 7,520 959 5,434 The Robert Jones and Agnes Hunt Orthopaedic Hospital NHS Foundation Trust YES 253 (639) (892) 1,105 1,105 0 592 0 592 The Royal Orthopaedic Hospital NHS Foundation Trust YES (5,231) (5,890) (659) (6,182) (6,183) (1) 436 0 436 The Royal Wolverhampton NHS Trust YES 5,345 4,460 (885) 11,641 1,288 (10,353) 9,894 5,541 5,541 The Shrewsbury And Telford Hospital NHS Trust YES (3,309) (15,605) (12,296) (6,063) (20,152) (14,089) 9,315 1,188 1,188 United Lincolnshire Hospitals NHS Trust YES (38,598) (64,213) (25,615) (48,564) (77,000) (28,436) 14,734 0 0 University Hospitals Birmingham NHS Foundation Trust YES 8,115 9,019 904 13,015 15,152 2,137 16,896 10,983 17,096 University Hospitals Coventry And Warwickshire NHS Trust YES (8,271) (10,796) (2,525) (292) (22,438) (22,146) 14,649 6,995 6,995 University Hospitals of Leicester NHS Trust NO (26,305) (25,709) 596 (26,700) (24,457) 2,243 0 0 0 University Hospitals of North Midlands NHS Trust NO (81,449) (84,391) (2,942) (68,933) (66,823) 2,110 0 0 0 Walsall Healthcare NHS Trust NO (16,351) (20,301) (3,950) (20,757) (20,757) 0 0 0 0 West Hertfordshire Hospitals NHS Trust YES (16,705) (36,248) (19,543) (15,040) (35,000) (19,960) 10,663 1,360 1,360 West Midlands Ambulance Service NHS Foundation Trust YES 4,388 4,443 55 2,245 2,245 0 1,382 898 1,382 West Suffolk NHS Foundation Trust YES (4,944) (4,455) 489 (5,928) (5,234) 694 5,200 3,380 5,280 Worcestershire Acute Hospitals NHS Trust YES (24,807) (44,277) (19,470) (29,988) (56,282) (26,294) 12,663 1,615 1,615 Worcestershire Health and Care NHS Trust YES 3,181 3,181 0 4,402 4,402 0 1,201 781 1,201 Wye Valley NHS Trust YES (22,144) (22,868) (724) (27,110) (28,274) (1,164) 4,192 2,001 3,028 Midlands and East Total (509,980) (728,560) (218,580) (529,814) (800,025) (270,212) 372,703 140,705 242,973 33 Performance of the NHS provider sector for the month ended 31 December 2017

3.4 Financial performance by provider North 1/2 Control Total Basis Surplus Deficit Including STF Sustainability & Transformation Fund (STF) Year to date Forecast Outturn STF Allocated Provider Name Control Total (CT) Accepted? YTD Plan YTD Actual Variance FOT Plan FOT Variance (In Plan only if accepted CT) YTD Actual FOT Aintree University Hospital NHS Foundation Trust YES (5,840) (7,305) (1,465) (6,842) (9,169) (2,327) 8,500 4,059 6,141 Airedale NHS Foundation Trust YES 1,489 1,495 6 4,421 4,845 424 4,116 2,675 4,116 Alder Hey Children's NHS Foundation Trust YES (3,335) (3,329) 6 138 7,682 7,544 4,431 2,880 7,975 Barnsley Hospital NHS Foundation Trust YES (9,575) (9,420) 155 (10,557) (9,952) 605 5,880 3,293 5,351 Blackpool Teaching Hospitals NHS Foundation Trust YES 399 (1,114) (1,513) 3,739 2,126 (1,613) 9,351 4,465 7,738 Bolton NHS Foundation Trust YES 2,093 908 (1,185) 10,128 7,995 (2,133) 7,889 3,767 5,700 Bradford District Care NHS Foundation Trust YES (115) 1,929 2,044 1,578 1,986 408 752 489 956 Bradford Teaching Hospitals NHS Foundation Trust YES 223 (4,488) (4,711) 1,977 1,899 (78) 9,786 3,205 8,700 Bridgewater Community Healthcare NHS Foundation Trust YES (1,315) (1,299) 16 (523) (523) 0 1,306 849 1,306 Calderdale and Huddersfield NHS Foundation Trust YES (16,861) (26,281) (9,420) (15,934) (31,337) (15,403) 10,098 2,701 2,701 Central Manchester University Hospitals NHS Foundation Trust YES 4,725 4,725 0 4,725 4,725 0 7,074 7,074 7,074 Cheshire and Wirral Partnership NHS Foundation Trust YES (267) 153 420 980 980 0 980 637 980 City Hospitals Sunderland NHS Foundation Trust YES (5,471) (6,258) (787) (5,744) (6,575) (831) 9,237 5,173 8,406 Countess of Chester Hospital NHS Foundation Trust YES (2,401) (3,197) (796) (3,628) (3,989) (361) 5,189 2,478 4,294 County Durham and Darlington NHS Foundation Trust YES (6,756) (7,850) (1,094) 3,736 2,578 (1,158) 12,866 7,204 11,708 Cumbria Partnership NHS Foundation Trust YES (3,238) (2,051) 1,187 (3,204) (3,204) 0 1,659 1,079 1,659 Doncaster and Bassetlaw Teaching Hospitals NHS Foundation Trust YES (15,504) (15,473) 31 (16,084) (14,672) 1,412 11,547 7,506 11,659 East Cheshire NHS Trust YES (15,351) (14,983) 368 (20,241) (19,961) 280 4,028 1,923 3,613 East Lancashire Hospitals NHS Trust YES (581) (2,526) (1,945) (863) (2,247) (1,384) 11,272 5,382 9,328 Gateshead Health NHS Foundation Trust YES (1,938) (2,165) (227) (2,321) (2,236) 85 5,178 2,900 4,730 Greater Manchester Mental Health NHS Foundation Trust YES 3,334 3,336 2 2,355 2,355 0 1,772 1,152 1,772 Harrogate and District NHS Foundation Trust YES 3,412 3,441 29 5,909 6,298 389 3,777 2,455 3,777 Hull And East Yorkshire Hospitals NHS Trust YES (1,368) (9,420) (8,052) 365 (10,899) (11,264) 11,933 4,177 4,177 Humber NHS Foundation Trust YES 326 326 0 233 233 0 1,431 930 1,431 Lancashire Care NHS Foundation Trust YES 1,187 (1,258) (2,445) 2,167 2,275 108 2,085 0 2,180 Lancashire Teaching Hospitals NHS Foundation Trust YES (18,157) (32,822) (14,665) (7,766) (40,324) (32,558) 11,292 1,694 1,694 Leeds and York Partnership NHS Foundation Trust YES 2,369 2,461 92 3,679 3,680 1 1,015 660 1,015 Leeds Community Healthcare NHS Trust YES 2,184 2,528 344 3,034 3,038 4 948 616 950 Liverpool Community Health NHS Trust YES (1,498) (1,413) 85 (1,501) (1,499) 2 1,296 842 1,298 Liverpool Heart and Chest Hospital NHS Foundation Trust YES 3,623 3,632 9 6,867 6,868 1 2,554 1,660 2,554 Liverpool Women's NHS Foundation Trust YES (3,390) (3,322) 68 (3,998) (3,440) 558 3,206 2,084 3,485 Manchester University NHS Foundation Trust YES 5,144 2,112 (3,032) 19,425 19,203 (222) 19,844 5,794 16,479 Mersey Care NHS Foundation Trust YES 4,167 4,167 0 5,162 5,162 0 1,294 841 1,294 Mid Cheshire Hospitals NHS Foundation Trust YES (58) 856 914 956 2,416 1,460 5,994 3,356 6,274 North Cumbria University Hospitals NHS Trust YES (32,003) (38,936) (6,933) (44,223) (44,223) 0 8,234 1,235 8,234 North East Ambulance Service NHS Foundation Trust YES (19) 61 80 (1,418) (1,413) 5 713 464 718 North Tees and Hartlepool NHS Foundation Trust YES 1,950 (18,719) (20,669) 3,047 (20,431) (23,478) 6,876 0 0 34 Performance of the NHS provider sector for the month ended 31 December 2017

3.5 Financial performance by provider North 2/2 Control Total Basis Surplus Deficit Including STF Sustainability & Transformation Fund (STF) Year to date Forecast Outturn STF Allocated Provider Name Control Total (CT) Accepted? YTD Plan YTD Actual Variance FOT Plan FOT Variance (In Plan only if accepted CT) YTD Actual FOT North West Ambulance Service NHS Trust YES 1,468 1,700 232 2,152 2,152 0 1,722 1,119 1,722 North West Boroughs Healthcare NHS Foundation Trust YES 20 142 122 1,061 1,061 0 1,061 690 1,061 Northern Lincolnshire and Goole NHS Foundation Trust YES (10,020) (32,637) (22,617) (13,232) (39,957) (26,725) 10,238 0 0 Northumberland, Tyne and Wear NHS Foundation Trust YES 4,494 5,918 1,424 7,091 7,092 1 1,923 1,250 1,923 Northumbria Healthcare NHS Foundation Trust YES 16,451 17,447 996 24,368 25,251 883 8,580 5,577 8,580 Pennine Care NHS Foundation Trust YES 2,179 (4,722) (6,901) 3,183 (4,912) (8,095) 1,824 0 0 Rotherham Doncaster and South Humber NHS Foundation Trust YES 1,720 1,970 250 2,068 4,067 1,999 987 641 1,988 Salford Royal NHS Foundation Trust YES (5,603) (4,398) 1,205 (1,367) 1,075 2,442 10,444 5,614 9,992 Sheffield Children's NHS Foundation Trust YES (1,097) (1,093) 4 795 1,050 255 2,485 1,615 2,485 Sheffield Health and Social Care NHS Foundation Trust YES 739 1,738 999 1,564 3,599 2,035 780 507 1,815 Sheffield Teaching Hospitals NHS Foundation Trust YES (5,162) 3,211 8,373 (4,219) (2,309) 1,910 18,562 12,065 18,562 South Tees Hospitals NHS Foundation Trust YES (4,152) (4,079) 73 7,421 (8,934) (16,355) 13,180 8,567 8,567 South Tyneside NHS Foundation Trust YES (2,465) (9,076) (6,611) (888) (11,453) (10,565) 4,202 0 0 South West Yorkshire Partnership NHS Foundation Trust YES 1,309 1,456 147 2,417 2,417 0 1,394 906 1,394 Southport And Ormskirk Hospital NHS Trust NO (14,234) (23,652) (9,418) (18,121) (31,700) (13,579) 0 0 0 St Helens And Knowsley Teaching Hospitals NHS Trust YES 5,903 5,906 3 8,536 9,474 938 9,117 5,926 9,117 Stockport NHS Foundation Trust NO (22,020) (21,542) 478 (27,220) (26,436) 784 0 0 0 Tameside and Glossop Integrated Care NHS Foundation Trust NO (19,194) (19,372) (178) (24,347) (23,726) 621 0 0 0 Tees, Esk and Wear Valleys NHS Foundation Trust YES 7,630 7,751 121 10,076 10,564 488 1,894 1,232 2,138 The Christie NHS Foundation Trust YES 7,713 7,786 73 10,284 64,280 53,996 1,495 972 28,495 The Clatterbridge Cancer Centre NHS Foundation Trust YES 3,040 3,529 489 4,199 4,306 107 380 248 487 The Leeds Teaching Hospitals NHS Trust YES (20,273) (7,158) 13,115 9,072 11,443 2,371 23,042 12,903 23,042 The Mid Yorkshire Hospitals NHS Trust YES (6,986) (18,063) (11,077) (2,302) (20,114) (17,812) 13,515 3,615 3,615 The Newcastle Upon Tyne Hospitals NHS Foundation Trust NO (4,016) (3,079) 937 (9,703) (9,270) 433 0 0 0 The Pennine Acute Hospitals NHS Trust YES (14,854) (18,329) (3,475) (11,263) (39,123) (27,860) 18,100 8,235 8,236 The Rotherham NHS Foundation Trust NO (10,400) (18,673) (8,273) (13,556) (22,297) (8,741) 0 0 0 The Royal Liverpool and Broadgreen University Hospitals NHS Trust NO (5,164) (21,509) (16,345) (4,590) (13,451) (8,861) 0 0 0 The Walton Centre NHS Foundation Trust YES 3,129 3,148 19 3,757 3,967 210 1,609 1,046 1,819 University Hospital of South Manchester NHS Foundation Trust YES (5,947) (5,948) (1) (5,947) (5,948) (1) 2,063 2,062 2,062 University Hospitals of Morecambe Bay NHS Foundation Trust NO (47,287) (51,890) (4,603) (58,613) (62,830) (4,217) 0 0 0 Warrington and Halton Hospitals NHS Foundation Trust YES (4,272) (11,096) (6,824) (3,657) (3,657) 0 7,029 2,460 7,029 Wirral Community NHS Foundation Trust YES 799 819 20 1,571 1,574 3 680 441 680 Wirral University Teaching Hospital NHS Foundation Trust YES (5,903) (20,116) (14,213) (426) (1,957) (1,531) 8,875 1,131 7,343 Wrightington, Wigan and Leigh NHS Foundation Trust YES (2,167) (2,663) (496) (664) (1,216) (552) 6,443 3,609 5,207 York Teaching Hospital NHS Foundation Trust YES (302) (23,752) (23,450) 3,357 (19,946) (23,303) 11,832 0 0 Yorkshire Ambulance Service NHS Trust YES 2,031 3,138 1,107 3,408 3,408 0 1,510 982 1,510 North Total (261,308) (438,688) (177,378) (153,961) (332,207) (178,245) 400,369 181,112 330,336 35 Performance of the NHS provider sector for the month ended 31 December 2017

3.6 Financial performance by provider South (1/2) Control Total Basis Surplus Deficit Including STF Sustainability & Transformation Fund (STF) Year to date Forecast Outturn STF Allocated Provider Name Control Total (CT) Accepted? YTD Plan YTD Actual Variance FOT Plan FOT Variance (In Plan only if accepted CT) YTD Actual FOT 2gether NHS Foundation Trust YES 615 604 (11) 914 945 31 642 417 673 Ashford and St Peter's Hospitals NHS Foundation Trust YES 9,660 9,666 6 14,033 14,042 9 7,672 4,987 7,672 Avon and Wiltshire Mental Health Partnership NHS Trust YES 1,503 (7,575) (9,078) 2,614 (12,100) (14,714) 1,197 0 0 Berkshire Healthcare NHS Foundation Trust YES 1,323 1,849 526 2,478 2,547 69 1,731 1,125 1,800 Brighton and Sussex University Hospitals NHS Trust YES (49,040) (48,571) 469 (65,349) (63,835) 1,514 0 0 0 Buckinghamshire Healthcare NHS Trust YES 4,351 (1,877) (6,228) 6,457 (3,239) (9,696) 8,489 2,462 2,462 Cornwall Partnership NHS Foundation Trust YES (329) 123 452 511 1,867 1,356 531 345 1,209 Dartford and Gravesham NHS Trust YES (119) (14,008) (13,889) 1,642 (17,820) (19,462) 7,303 1,095 1,095 Devon Partnership NHS Trust YES 2,326 2,326 0 2,604 2,604 0 849 552 849 Dorset County Hospital NHS Foundation Trust YES (6,372) (4,220) 2,152 (2,906) (2,476) 430 4,176 2,715 4,176 Dorset Healthcare University NHS Foundation Trust YES 554 3,250 2,696 2,195 3,227 1,032 1,796 1,167 2,312 East Kent Hospitals University NHS Foundation Trust YES (7,690) (10,191) (2,501) (4,445) (7,975) (3,530) 14,537 6,942 11,007 East Sussex Healthcare NHS Trust YES (22,849) (39,792) (16,943) (26,521) (56,148) (29,627) 9,910 1,264 1,264 Frimley Health NHS Foundation Trust YES 13,224 15,143 1,919 22,820 25,564 2,744 18,606 12,094 19,046 Gloucestershire Care Services NHS Trust YES 1,786 2,083 297 1,987 3,627 1,640 1,020 663 1,841 Gloucestershire Hospitals NHS Foundation Trust NO (21,773) (27,801) (6,028) (14,619) (27,398) (12,779) 0 0 0 Great Western Hospitals NHS Foundation Trust YES 1,407 (6,612) (8,019) 1,796 (10,466) (12,262) 6,756 861 861 Hampshire Hospitals NHS Foundation Trust YES 1,305 100 (1,205) 8,317 (6,208) (14,525) 9,460 5,297 5,297 Isle of Wight NHS Trust YES (1,343) (19,121) (17,778) (366) (18,835) (18,469) 3,485 0 0 Kent and Medway NHS and Social Care Partnership Trust YES (2,560) (2,512) 48 (2,834) (2,834) 0 1,100 715 1,100 Kent Community Health NHS Foundation Trust YES 2,132 2,634 502 3,026 3,026 0 1,759 1,143 1,759 Maidstone And Tunbridge Wells NHS Trust YES 1,856 (9,388) (11,244) 6,673 (13,990) (20,663) 11,177 3,912 3,912 Medway NHS Foundation Trust YES (29,893) (39,806) (9,913) (37,847) (55,758) (17,911) 9,006 2,409 2,409 North Bristol NHS Trust YES (15,733) (17,997) (2,264) (18,731) (21,083) (2,352) 13,637 6,512 11,285 Northern Devon Healthcare NHS Trust YES 2,766 2,411 (355) 3,922 3,973 51 3,945 2,209 3,590 Oxford Health NHS Foundation Trust YES 44 203 159 1,895 (580) (2,475) 1,931 1,255 1,255 Oxford University Hospitals NHS Foundation Trust YES 16,652 (15,235) (31,887) 39,279 (5,200) (44,479) 20,324 0 0 Plymouth Hospitals NHS Trust YES (6,949) (8,002) (1,053) (3,060) (2,908) 152 11,799 6,607 10,737 Poole Hospital NHS Foundation Trust YES (2,948) (2,529) 419 (3,078) (2,409) 669 6,500 4,225 6,502 Portsmouth Hospitals NHS Trust YES (23) (28,859) (28,836) 9,660 (36,783) (46,443) 13,431 1,712 1,712 Royal Berkshire NHS Foundation Trust YES 54 (700) (754) 4,629 3,893 (736) 9,012 5,047 8,201 Royal Cornwall Hospitals NHS Trust YES (3,812) (4,561) (749) 1,281 (9,300) (10,581) 8,412 4,710 4,710 Royal Devon and Exeter NHS Foundation Trust YES (2,102) (827) 1,275 (534) 1,720 2,254 8,691 4,867 8,980 Royal Surrey County Hospital NHS Foundation Trust YES (4,654) 634 5,288 (5,331) 1,005 6,336 6,718 4,366 9,188 Royal United Hospitals Bath NHS Foundation Trust YES 11,621 10,791 (830) 12,841 11,947 (894) 7,792 4,189 6,098 36 Performance of the NHS provider sector for the month ended 31 December 2017

3.7 Financial performance by provider South (2/2) Control Total Basis Surplus Deficit Including STF Sustainability & Transformation Fund (STF) Year to date Forecast Outturn STF Allocated Provider Name Control Total (CT) Accepted? YTD Plan YTD Actual Variance FOT Plan FOT Variance (In Plan only if accepted CT) YTD Actual FOT Salisbury NHS Foundation Trust NO (5,764) (10,254) (4,490) (6,989) (11,417) (4,428) 0 0 0 Solent NHS Trust YES (1,368) (1,301) 67 (1,547) (1,350) 197 1,152 749 1,151 Somerset Partnership NHS Foundation Trust YES 1,880 1,880 0 2,893 2,893 0 1,638 1,065 1,638 South Central Ambulance Service NHS Foundation Trust YES (1,068) (1,021) 47 (1,385) (1,385) 0 1,062 690 1,062 South East Coast Ambulance Service NHS Foundation Trust YES (3,225) (3,128) 97 (955) (887) 68 1,266 823 1,325 South Western Ambulance Service NHS Foundation Trust NO 18 18 0 18 18 0 0 0 0 Southern Health NHS Foundation Trust YES 1,407 1,411 4 2,865 2,865 0 2,908 1,890 2,908 Surrey and Borders Partnership NHS Foundation Trust YES 1,305 (921) (2,226) 2,521 2,521 0 915 137 915 Surrey And Sussex Healthcare NHS Trust YES 9,680 9,710 30 21,307 21,307 0 8,789 5,713 8,789 Sussex Community NHS Foundation Trust YES 2,181 2,190 9 4,658 1,497 (3,161) 1,718 1,117 1,117 Sussex Partnership NHS Foundation Trust YES 3,329 (2,376) (5,705) 4,968 (0) (4,968) 1,482 0 0 Taunton and Somerset NHS Foundation Trust YES (1,092) (1,048) 44 (310) 412 722 7,020 4,563 7,020 The Queen Victoria Hospital NHS Foundation Trust YES 1,499 1,505 6 1,716 1,716 0 942 612 942 The Royal Bournemouth and Christchurch Hospitals NHS Foundation Trust YES (5,136) (5,052) 84 (6,648) (5,473) 1,175 6,400 3,584 6,370 Torbay and South Devon NHS Foundation Trust YES (1,279) (820) 459 4,593 5,237 644 5,830 3,789 5,874 University Hospital Southampton NHS Foundation Trust YES 15,784 16,274 490 27,116 34,946 7,830 17,806 11,574 20,806 University Hospitals Bristol NHS Foundation Trust YES 9,149 8,871 (278) 12,957 11,259 (1,698) 13,313 8,354 11,615 Western Sussex Hospitals NHS Foundation Trust YES 9,739 9,786 47 14,920 16,109 1,189 11,557 7,512 11,557 Weston Area Health NHS Trust YES (4,870) (9,060) (4,190) (6,035) (13,874) (7,839) 3,079 393 393 Yeovil District Hospital NHS Foundation Trust YES (10,659) (14,987) (4,328) (13,083) (18,632) (5,549) 4,294 644 644 South Total (83,501) (256,690) (173,190) 29,533 (249,596) (279,129) 324,565 149,073 227,128 Total for All Regions (1,177,202) (1,915,448) (738,245) (846,859) (1,693,937) (847,077) 1,357,314 568,786 1,022,305 Residual costs for Mid Staffordshire NHS Foundation Trust (disolved) 0 (77) (77) 0 (77) (77) 0 0 0 Total for all providers (1,177,202) (1,915,525) (738,322) (846,859) (1,694,014) (847,154) 1,357,314 568,786 1,022,305 37 Performance of the NHS provider sector for the month ended 31 December 2017

4.0 Operational performance by provider 38 Performance of the NHS provider sector for the month ended 31 December 2017

4.1 Best and worst operational performance (1/3) A&E 4-hour standard ten best and worst performing trusts during quarter 3 2017/18 acute trusts only Best performing trusts Total attendances 4-hour breaches Quarter 3 Performance Luton and Dunstable University Hospital NHS Foundation Trust 36,949 610 98.35% Dorset County Hospital NHS Foundation Trust 22,773 546 97.60% Yeovil District Hospital NHS Foundation Trust 13,397 431 96.78% Sheffield Children's NHS Foundation Trust 15,705 578 96.32% South Tees Hospitals NHS Foundation Trust 37,543 1,431 96.19% North Tees and Hartlepool NHS Foundation Trust 42,972 1,643 96.18% Homerton University Hospital NHS Foundation Trust 31,150 1,501 95.18% Chesterfield Royal Hospital NHS Foundation Trust 20,924 1,046 95.00% Harrogate and District NHS Foundation Trust 15,153 769 94.93% Chelsea and Westminster Hospital NHS Foundation Trust 78,925 4,237 94.63% Worst performing trusts The Princess Alexandra Hospital NHS Trust Shrewsbury And Telford Hospital NHS Trust Peterborough and Stamford Hospitals NHS Foundation Trust Total attendances 4-hour breaches Quarter 3 Performance 26,055 8,142 68.75% 30,881 8,605 72.13% 37,434 9,582 74.40% Portsmouth Hospitals NHS Trust 36,263 9,264 74.45% United Lincolnshire Hospitals NHS Trust University Hospitals of North Midlands NHS Trust East Kent Hospitals University NHS Foundation Trust Kettering General Hospital NHS Foundation Trust 39,120 9,594 75.48% 61,401 14,720 76.03% 59,946 14,210 76.30% 21,827 5,075 76.75% North Bristol NHS Trust 22,078 4,995 77.38% Heart of England NHS Foundation Trust 69,052 15,516 77.53% 39 Performance of the NHS provider sector for the month ended 31 December 2017

4.1 Best and worst operational performance (2/3) RTT 18-week ten best and worst performing trusts at end of December 2017 acute and specialist trusts only Best performing trusts Lancashire Care NHS Foundation Trust Waiting list 0-18 week waiters December Performance 264 263 99.62% The Christie NHS Foundation Trust 1,469 1,446 98.43% The Royal Marsden NHS Foundation Trust Homerton University Hospital NHS Foundation Trust Sheffield Teaching Hospitals NHS Foundation Trust The Rotherham NHS Foundation Trust Mid Cheshire Hospitals NHS Foundation Trust South Tyneside NHS Foundation Trust The Clatterbridge Cancer Centre NHS Foundation Trust The Walton Centre NHS Foundation Trust 1,453 1,393 95.87% 17,973 17,211 95.76% 40,442 38,724 95.75% 12,339 11,772 95.40% 12,428 11,838 95.25% 3,657 3,483 95.24% 499 475 95.19% 8,728 8,305 95.15% Worst performing trusts Mid Essex Hospital Services NHS Trust Northern Lincolnshire and Goole NHS Foundation Trust University Hospitals of North Midlands NHS Trust Wirral University Teaching Hospital NHS Foundation Trust East Kent Hospitals University NHS Foundation Trust Waiting list 0-18 week waiters November Performance 46,100 31,996 69.41% 29,459 20,778 70.53% 50,534 37,491 74.19% 22,485 17,470 77.70% 54,384 42,785 78.67% Wye Valley NHS Trust 15,136 11,955 78.98% King's College Hospital NHS Foundation Trust The Royal Orthopaedic Hospital NHS Foundation Trust Kettering General Hospital NHS Foundation Trust University Hospitals Coventry And Warwickshire NHS Trust 74,535 58,894 79.02% 8,293 6,553 79.02% 20,564 16,379 79.65% 30,083 24,114 80.16% 40 Performance of the NHS provider sector for the month ended 31 December 2017

4.1 Best and worst operational performance (3/3) Cancer 62-day standard ten best and worst performing trusts in quarter 3 2017/18 acute and specialist trusts only Best performing trusts Number treated Within 62 days Quarter 3 Performance South Tyneside NHS Foundation Trust 14.0 14.0 100.00% Wrightington, Wigan and Leigh NHS Foundation Trust Mid Cheshire Hospitals NHS Foundation Trust Chelsea and Westminster Hospital NHS Foundation Trust 156.5 150.5 96.17% 186.5 179.0 95.98% 169.5 159.5 94.10% Frimley Health NHS Foundation Trust 405.0 379.5 93.70% Tameside Hospital NHS Foundation Trust 110.0 100.5 91.36% Worst performing trusts The Clatterbridge Cancer Centre NHS Foundation Trust Number treated Within 62 days Quarter 3 Performance 151.5 95.5 63.04% The Christie NHS Foundation Trust 228.5 149.5 65.43% Weston Area Health NHS Trust 68.0 44.5 65.44% Royal National Orthopaedic Hospital NHS Trust Guy's and St Thomas' NHS Foundation Trust 21.0 14.5 69.05% 398.0 280.5 70.48% United Lincolnshire Hospitals NHS Trust 476.5 338.0 70.93% Barnsley Hospital NHS Foundation Trust 215.5 194.0 90.02% Salford Royal NHS Foundation Trust 211.5 192.0 90.78% Harrogate and District NHS Foundation Trust 173.5 157.5 90.78% Bolton NHS Foundation Trust 156.0 141.5 90.71% The Royal Marsden NHS Foundation Trust Worcestershire Acute Hospitals NHS Trust Maidstone And Tunbridge Wells NHS Trust Royal Brompton and Harefield NHS Foundation Trust 209.5 150.5 71.84% 491.0 355.0 72.30% 289.0 210.0 72.66% 22.0 16.0 72.73% 41 Performance of the NHS provider sector for the month ended 31 December 2017

4.2 Operational performance by provider London (1/1) ORGANISATION A&E (95%) RTT Incomplete (92%) RTT 52 weeks Diagnostics (<1.00%) Cancer 62 days - GP referral (85%) Cancer 2 weeks - GP referral (93%) Cancer 2 weeks - breast symptoms (93%) Cancer 31 days - GP referral (96%) Barking, Havering And Redbridge University Hospitals NHS Trust 80.57% 90.70% 7 0.52% 88.87% 96.66% 96.61% 98.06% 3 Barts Health NHS Trust 86.93% 0.79% 85.80% 98.05% 99.57% 99.08% 25 Central and North West London NHS Foundation Trust 100.00% 0 0.00% 0 Central London Community Healthcare NHS Trust 98.82% 92.19% 0 0 Chelsea and Westminster Hospital NHS Foundation Trust 94.63% 92.09% 0 3.07% 94.10% 95.57% 98.35% 99.64% 2 Croydon Health Services NHS Trust 92.36% 92.01% 3 0.56% 89.49% 96.85% 99.71% 99.02% 4 Epsom And St Helier University Hospitals NHS Trust 92.55% 88.03% 3 1.02% 83.56% 96.66% 98.37% 13 Great Ormond Street Hospital for Children NHS Foundation Trust 90.75% 1 1.09% 100.00% 2 Guy's and St Thomas' NHS Foundation Trust 89.44% 87.19% 18 6.01% 70.48% 97.73% 99.14% 94.70% 7 Homerton University Hospital NHS Foundation Trust 95.18% 95.76% 0 0.08% 88.57% 96.26% 95.71% 99.17% 0 Hounslow and Richmond Community Healthcare NHS Trust 99.97% 100.00% 0 0.00% 0 Imperial College Healthcare NHS Trust 86.08% 81.76% 242 1.49% 87.93% 94.78% 95.09% 97.59% 22 King's College Hospital NHS Foundation Trust 80.82% 79.02% 94 1.51% 84.92% 94.66% 95.32% 94.77% 21 Kingston Hospital NHS Foundation Trust 89.52% 94.47% 0 0.15% 89.40% 98.36% 98.48% 98.49% 8 Lewisham and Greenwich NHS Trust 89.20% 88.64% 0 0.73% 77.98% 94.91% 93.96% 97.07% 4 London North West Healthcare NHS Trust 84.63% 82.51% 1 3.12% 85.68% 94.06% 95.79% 97.32% 13 Moorfields Eye Hospital NHS Foundation Trust 99.16% 94.35% 0 0.00% 100.00% 98.00% 100.00% 0 North East London NHS Foundation Trust 99.72% 99.01% 2 0 North Middlesex University Hospital NHS Trust 80.55% 94.27% 0 0.23% 79.81% 93.35% 98.52% 99.59% 3 Royal Brompton and Harefield NHS Foundation Trust N/A 92.93% 0 0.00% 72.73% 100.00% 100.00% 0 Royal Free London NHS Foundation Trust 86.15% 86.70% 45 1.04% 85.19% 93.96% 95.07% 98.61% 22 Royal National Orthopaedic Hospital NHS Trust N/A 91.25% 1 0.26% 69.05% 94.97% 97.14% 1 South West London and ST George's Mental Health NHS Trust 97.97% 0 0 St George's University Hospitals NHS Foundation Trust 86.73% 0.09% 83.92% 97.21% 98.33% 97.31% 4 The Hillingdon Hospitals NHS Foundation Trust 85.29% 89.64% 0 0.00% 86.13% 95.39% 96.59% 99.51% 6 The Royal Marsden NHS Foundation Trust 95.87% 1 71.84% 96.83% 95.75% 96.98% 12 The Whittington Hospital NHS Trust 89.32% 92.07% 0 0.93% 89.09% 95.20% 99.53% 100.00% 4 University College London Hospitals NHS Foundation Trust 86.77% 90.68% 2 0.76% 74.95% 94.90% 95.30% 96.69% 13 London 88.23% 87.54% 420 1.43% 83.22% 95.78% 96.57% 97.47% 189 C.Diff cases 42 Performance of the NHS provider sector for the month ended 31 December 2017

4.2 Operational performance by provider Midlands and East (1/2) ORGANISATION A&E (95%) RTT Incomplete (92%) RTT 52 weeks Diagnostics (<1.00%) Cancer 62 days - GP referral (85%) Cancer 2 weeks - GP referral (93%) Cancer 2 weeks - breast symptoms (93%) Cancer 31 days - GP referral (96%) Basildon and Thurrock University Hospitals NHS Foundation Trust 86.51% 83.11% 4 1.65% 74.18% 94.67% 96.03% 95.50% 7 Bedford Hospital NHS Trust 89.01% 90.88% 0 0.74% 89.43% 95.28% 93.94% 97.90% 2 Birmingham Women and Children's Hospital NHS Foundation Trust 86.86% 92.64% 0 2.66% 84.21% 94.02% 100.00% 2 Birmingham Community Healthcare NHS Foundation Trust 94.21% 0 0 Birmingham Women's NHS Foundation Trust 0 Black Country Partnership NHS Foundation Trust 97.10% 0 0 Burton Hospitals NHS Foundation Trust 89.39% 92.23% 0 0.35% 85.62% 96.38% 99.57% 99.58% 9 Cambridge University Hospitals NHS Foundation Trust 87.33% 88.96% 1 5.00% 81.35% 94.52% 98.04% 97.96% 15 Cambridgeshire and Peterborough NHS Foundation Trust 96.85% 0 0 Cambridgshire Community Services NHS Trust 99.86% 0 25.23% 0 Chesterfield Royal Hospital NHS Foundation Trust 95.00% 91.38% 5 0.19% 79.86% 94.96% 96.79% 96.27% 4 Colchester Hospital University NHS Foundation Trust 89.16% 82.17% 40 0.67% 73.25% 97.51% 95.28% 97.65% 5 Coventry and Warwickshire Partnership NHS Trust N/A 99.48% 0 0.00% 0 Derby Teaching Hospitals NHS Foundation Trust 86.46% 92.00% 5 1.20% 83.29% 97.17% 98.13% 97.29% 19 Derbyshire Community Health Services NHS Foundation Trust 99.98% 94.96% 0 0.00% 0 Derbyshire Healthcare NHS Foundation Trust 92.15% 0 0 Dudley and Walsall Mental Health Partnership NHS Trust 98.94% 0 0 Essex Partnership University NHS Foundation Trust 100.00% 0 0 East And North Hertfordshire NHS Trust 80.03% 77.67% 97.40% 92.65% 94.85% 3 George Eliot Hospital NHS Trust 86.30% 87.18% 0 0.00% 86.62% 97.64% 97.37% 97.06% 1 Heart of England NHS Foundation Trust 77.53% 90.65% 0 0.97% 86.46% 95.31% 95.26% 97.72% 15 Hertfordshire Community NHS Trust 100.00% 94.27% 0 0 Ipswich Hospital NHS Trust 90.65% 91.62% 0 1.36% 87.73% 95.89% 91.07% 96.17% 2 James Paget University Hospitals NHS Foundation Trust 88.67% 89.63% 1 0.23% 90.43% 97.53% 97.84% 100.00% 4 Kettering General Hospital NHS Foundation Trust 76.75% 79.65% 17 0.99% 85.87% 98.43% 98.97% 99.73% 5 Leicestershire Partnership NHS Trust 98.45% 0 0.00% 0 Lincolnshire Community Health Services NHS Trust 98.96% 0 Lincolnshire Partnership NHS Foundation Trust 92.81% 0 0 Luton and Dunstable University Hospital NHS Foundation Trust 98.35% 90.90% 0 5.41% 90.03% 97.20% 97.85% 100.00% 1 Mid Essex Hospital Services NHS Trust 83.63% 69.41% 156 13.31% 73.77% 95.21% 95.51% 90.18% 11 Milton Keynes Hospital NHS Foundation Trust 90.37% 89.39% 5 2.56% 87.43% 95.56% 96.09% 100.00% 2 Norfolk and Norwich University Hospitals NHS Foundation Trust 82.27% 82.20% 21 0.98% 84.25% 96.11% 98.27% 99.19% 10 C.Diff cases 43 Performance of the NHS provider sector for the month ended 31 December 2017

4.2 Operational performance by provider Midlands and East (2/2) ORGANISATION A&E (95%) RTT Incomplete (92%) RTT 52 weeks Diagnostics (<1.00%) Cancer 62 days - GP referral (85%) Cancer 2 weeks - GP referral (93%) Cancer 2 weeks - breast symptoms (93%) Cancer 31 days - GP referral (96%) Norfolk Community Health and Care NHS Trust 96.07% 0 0 North West Anglia NHS Foundation Trust 74.40% 91.00% 0 2.34% 84.68% 95.83% 95.87% 97.91% 11 Northampton General Hospital NHS Trust 84.23% 91.10% 1 0.08% 83.65% 85.64% 63.31% 96.65% 4 Northamptonshire Healthcare NHS Foundation Trust 100.00% 0 0 Nottingham University Hospitals NHS Trust 80.74% 94.15% 2 0.72% 83.94% 96.85% 99.06% 96.91% 29 Papworth Hospital NHS Foundation Trust 83.51% 0 0.47% 94.74% 98.75% 2 Sandwell And West Birmingham Hospitals NHS Trust 82.30% 92.00% 3 0.95% 85.81% 97.26% 98.63% 98.07% 6 Sherwood Forest Hospitals NHS Foundation Trust 90.70% 90.59% 19 0.86% 84.97% 96.84% 97.76% 99.46% 7 Shrewsbury And Telford Hospital NHS Trust 72.13% 93.99% 0 0.43% 86.27% 92.63% 92.54% 99.63% 11 Shropshire Community Health NHS Trust 99.97% 95.70% 0 0.00% 0 South Essex Partnership University NHS Foundation Trust 0 South Warwickshire NHS Foundation Trust 90.10% 91.44% 1 2.28% 85.56% 98.40% 99.02% 99.09% 6 Southend University Hospital NHS Foundation Trust 83.98% 84.30% 8 4.20% 79.54% 97.22% 97.94% 97.11% 11 Staffordshire and Stoke on Trent Partnership NHS Trust 97.13% 0 0.00% 0 The Dudley Group NHS Foundation Trust 84.28% 93.34% 0 0.63% 88.98% 95.18% 96.89% 99.36% 7 The Princess Alexandra Hospital NHS Trust 68.75% 92.00% 0 0.62% 90.37% 98.67% 99.46% 97.69% 1 The Queen Elizabeth Hospital, King's Lynn, NHS Foundation Trust 87.16% 81.32% 0 1.70% 85.23% 95.97% 98.63% 99.38% 12 The Robert Jones and Agnes Hunt Orthopaedic Hospital NHS Foundation Trust N/A 88.84% 0 1.42% 71.43% 100.00% 100.00% 0 The Royal Orthopaedic Hospital NHS Foundation Trust 79.02% 70 0.49% 82.35% 98.36% 96.30% 0 The Royal Wolverhampton NHS Trust 88.72% 90.02% 0 0.88% 76.03% 92.54% 84.39% 97.58% 6 United Lincolnshire Hospitals NHS Trust 75.48% 86.57% 2 3.00% 70.93% 91.19% 89.62% 96.81% 18 University Hospitals Birmingham NHS Foundation Trust 84.05% 92.05% 0 0.52% 76.78% 92.66% 98.26% 98.03% 19 University Hospitals Coventry And Warwickshire NHS Trust 84.15% 80.16% 60 0.15% 86.10% 97.19% 98.32% 98.80% 9 University Hospitals Of Leicester NHS Trust 77.98% 90.18% 1 0.91% 78.76% 94.39% 91.53% 94.83% 15 University Hospitals of North Midlands NHS Trust 76.03% 74.19% 24 0.99% 79.87% 97.76% 98.48% 96.89% 21 Walsall Healthcare NHS Trust 80.71% 81.00% 1 0.85% 88.31% 96.73% 97.87% 100.00% 5 West Hertfordshire Hospitals NHS Trust 80.94% 86.39% 0 0.12% 87.15% 96.07% 97.59% 98.41% 9 West Suffolk NHS Foundation Trust 87.03% 89.04% 15 0.04% 90.02% 92.52% 99.72% 99.73% 10 Worcestershire Acute Hospitals NHS Trust 79.14% 84.46% 14 2.27% 72.30% 89.87% 92.78% 98.06% 6 Worcestershire Health And Care NHS Trust 98.45% 0 0 Wye Valley NHS Trust 78.16% 78.98% 28 0.16% 88.35% 94.43% 91.56% 92.00% 2 Midlands and East 83.97% 86.98% 504 1.63% 82.14% 95.22% 95.55% 97.46% 344 C.Diff cases 44 Performance of the NHS provider sector for the month ended 31 December 2017

4.2 Operational performance by provider North (1/2) ORGANISATION A&E (95%) RTT Incomplete (92%) RTT 52 weeks Diagnostics (<1.00%) Cancer 62 days - GP referral (85%) Cancer 2 weeks - GP referral (93%) Cancer 2 weeks - breast symptoms (93%) Cancer 31 days - GP referral (96%) 5 Boroughs Partnership NHS Foundation Trust 99.59% 0 Aintree University Hospital NHS Foundation Trust 85.24% 91.06% 0 4.88% 86.39% 94.44% 93.41% 96.72% 12 Airedale NHS Foundation Trust 92.58% 92.21% 0 5.19% 86.21% 96.21% 94.64% 100.00% 2 Alder Hey Children's NHS Foundation Trust 93.77% 92.04% 0 0.25% 100.00% 100.00% 95.45% 0 Barnsley Hospital NHS Foundation Trust 88.51% 92.04% 0 0.56% 91.09% 96.41% 98.68% 99.12% 1 Blackpool Teaching Hospitals NHS Foundation Trust 84.81% 86.05% 0 0.59% 83.10% 94.57% 99.55% 99.36% 10 Bolton NHS Foundation Trust 81.77% 88.84% 2 5.32% 90.71% 97.71% 70.60% 100.00% 5 Bradford District Care NHS Foundation Trust 100.00% 0 0 Bradford Teaching Hospitals NHS Foundation Trust 84.13% 2.07% 74.60% 67.72% 100.00% 95.35% 8 Bridgewater Community Healthcare NHS Foundation Trust 98.05% 99.24% 0 0.00% 100.00% 94.90% 100.00% 0 Calderdale and Huddersfield NHS Foundation Trust 92.46% 92.60% 0 1.82% 87.37% 96.88% 95.19% 100.00% 11 City Hospitals Sunderland NHS Foundation Trust 89.96% 93.73% 0 1.39% 85.94% 96.96% 98.70% 5 Countess of Chester Hospital NHS Foundation Trust 81.52% 89.75% 0 1.91% 83.63% 96.10% 90.85% 100.00% 7 County Durham and Darlington NHS Foundation Trust 91.31% 92.12% 0 0.35% 86.72% 94.71% 95.54% 99.40% 6 Cumbria Partnership NHS Foundation Trust 93.96% 0 0.00% 0 Doncaster and Bassetlaw Hospitals NHS Foundation Trust 90.85% 89.65% 1 1.51% 87.42% 93.12% 94.27% 100.00% 6 East Cheshire NHS Trust 81.51% 89.35% 0 12.54% 85.57% 97.37% 96.93% 99.37% 3 East Lancashire Hospitals NHS Trust 84.22% 92.01% 3 0.22% 85.31% 95.09% 97.44% 98.67% 8 Gateshead Health NHS Foundation Trust 93.94% 93.38% 0 0.60% 89.07% 97.42% 99.71% 100.00% 8 Harrogate and District NHS Foundation Trust 94.93% 91.55% 1 0.41% 90.78% 98.75% 96.26% 98.94% 3 Hull And East Yorkshire Hospitals NHS Trust 87.42% 81.25% 30 8.97% 79.03% 95.29% 89.24% 98.07% 8 Humber NHS Foundation Trust 99.88% 95.04% 0 0 Lancashire Care NHS Foundation Trust 99.62% 0 0 Lancashire Teaching Hospitals NHS Foundation Trust 82.64% 84.27% 0 0.53% 82.72% 98.67% 99.52% 96.14% 11 Leeds Community Healthcare NHS Trust 97.65% 0 0.00% 100.00% 0 Leeds Teaching Hospitals NHS Trust 85.20% 88.69% 4 0.66% 75.87% 95.19% 94.22% 96.73% 34 Liverpool Community Health NHS Trust 100.00% 0 Liverpool Heart and Chest Hospital NHS Foundation Trust N/A 91.09% 0 0.86% 90.00% 97.92% 100.00% 0 Liverpool Women's NHS Foundation Trust 98.71% 92.82% 0 1.94% 82.00% 97.87% 96.88% 0 Manchester University NHS Foundation Trust 87.44% 89.98% 25 2.47% 85.30% 95.12% 95.53% 98.17% 25 Mid Cheshire Hospitals NHS Foundation Trust 83.43% 95.25% 0 0.39% 95.98% 97.31% 93.24% 99.64% 2 Mid Yorkshire Hospitals NHS Trust 86.77% 82.97% 0 0.93% 85.67% 96.63% 97.16% 98.42% 7 C.Diff cases 45 Performance of the NHS provider sector for the month ended 31 December 2017

4.2 Operational performance by provider North (2/2) ORGANISATION A&E (95%) RTT Incomplete (92%) RTT 52 weeks Diagnostics (<1.00%) Cancer 62 days - GP referral (85%) Cancer 2 weeks - GP referral (93%) Cancer 2 weeks - breast symptoms (93%) Cancer 31 days - GP referral (96%) North Cumbria University Hospitals NHS Trust 89.75% 86.96% 0 0.56% 88.10% 93.55% 86.63% 97.37% 7 North Tees and Hartlepool NHS Foundation Trust 96.18% 93.20% 0 1.38% 88.78% 94.43% 97.29% 98.30% 7 Northern Lincolnshire and Goole NHS Foundation Trust 90.62% 70.53% 75 7.42% 75.68% 97.08% 96.28% 99.75% 11 Northumberland, Tyne and Wear NHS Foundation Trust 100.00% 0 0 Northumbria Healthcare NHS Foundation Trust 93.58% 92.47% 0 0.06% 83.54% 95.64% 98.63% 98.95% 12 Pennine Acute Hospitals NHS Trust 84.23% 88.04% 1 1.49% 84.14% 91.54% 99.50% 98.60% 10 Pennine Care NHS Foundation Trust 100.00% 0.32% 0 Royal Liverpool And Broadgreen University Hospitals NHS Trust 89.84% 83.74% 0 19.84% 86.20% 95.94% 97.96% 96.96% 11 Salford Royal NHS Foundation Trust 86.44% 92.01% 0 6.66% 90.78% 96.14% 99.46% 8 Sheffield Children's NHS Foundation Trust 96.32% 92.96% 0 1.42% 100.00% 100.00% 100.00% 0 Sheffield Teaching Hospitals NHS Foundation Trust 87.68% 95.75% 0 10.08% 78.67% 96.52% 98.81% 97.17% 15 South Tees Hospitals NHS Foundation Trust 96.19% 89.57% 0 3.32% 84.47% 94.64% 94.74% 96.36% 8 South Tyneside NHS Foundation Trust 93.81% 95.24% 0 0.00% 78.16% 97.13% 100.00% 2 South West Yorkshire Partnership NHS Foundation Trust N/A 94.46% 0 0.00% 0 Southport And Ormskirk Hospital NHS Trust 82.26% 94.21% 0 2.83% 87.25% 96.08% 100.00% 99.41% 8 St Helens And Knowsley Hospitals NHS Trust 87.15% 93.16% 0 0.00% 90.32% 95.40% 96.73% 96.13% 2 Stockport NHS Foundation Trust 78.76% 92.37% 1 0.07% 90.25% 98.47% 98.57% 99.12% 3 Tameside Hospital NHS Foundation Trust 90.44% 92.19% 1 0.00% 91.36% 96.99% 97.62% 100.00% 7 The Christie NHS Foundation Trust N/A 98.43% 0 0.00% 65.43% 98.03% 6 The Clatterbridge Cancer Centre NHS Foundation Trust 95.19% 0 0.00% 63.04% 100.00% 99.05% 0 The Newcastle Upon Tyne Hospitals NHS Foundation Trust 94.61% 94.32% 0 2.35% 83.66% 96.18% 95.96% 96.56% 19 The Rotherham NHS Foundation Trust 84.20% 95.40% 0 0.03% 84.42% 96.45% 94.79% 98.20% 5 The Walton Centre NHS Foundation Trust N/A 95.15% 3 0.07% 100.00% 100.00% 100.00% 1 University Hospitals of Morecambe Bay NHS Foundation Trust 87.69% 86.09% 1 0.95% 86.02% 95.86% 99.67% 99.59% 5 Warrington and Halton Hospitals NHS Foundation Trust 86.88% 92.33% 0 0.43% 87.62% 94.07% 90.77% 98.81% 5 Wirral Community NHS Trust 99.67% 100.00% 0 0.00% 0 Wirral University Teaching Hospital NHS Foundation Trust 83.93% 77.70% 11 1.28% 87.55% 98.24% 98.41% 96.85% 17 Wrightington, Wigan and Leigh NHS Foundation Trust 79.64% 93.82% 2 0.71% 96.17% 96.96% 95.73% 100.00% 5 York Teaching Hospital NHS Foundation Trust 86.97% 85.79% 0 2.52% 82.76% 90.80% 94.86% 98.16% 14 North 88.20% 89.27% 161 2.86% 84.15% 95.06% 95.09% 98.07% 370 C.Diff cases 46 Performance of the NHS provider sector for the month ended 31 December 2017

4.2 Operational performance by provider South (1/2) ORGANISATION A&E (95%) RTT Incomplete (92%) RTT 52 weeks Diagnostics (<1.00%) Cancer 62 days - GP referral (85%) Cancer 2 weeks - GP referral (93%) Cancer 2 weeks - breast symptoms (93%) Cancer 31 days - GP referral (96%) Ashford and St Peter's Hospitals NHS Foundation Trust 85.24% 91.10% 0 1.78% 89.78% 92.11% 96.88% 97.75% 4 Berkshire Healthcare NHS Foundation Trust 100.00% 100.00% 0 0.00% 0 Brighton And Sussex University Hospitals NHS Trust 85.35% 84.50% 49 3.40% 76.88% 94.22% 96.08% 99.28% 16 Buckinghamshire Healthcare NHS Trust 84.78% 90.56% 0 0.87% 82.67% 96.38% 95.94% 96.98% 11 Cornwall Partnership NHS Foundation Trust N/A 100.00% 0 21.74% 0 Dartford And Gravesham NHS Trust 89.00% 92.54% 0 0.81% 85.51% 95.71% 95.44% 99.64% 4 Dorset County Hospital NHS Foundation Trust 97.60% 86.22% 0 12.58% 79.12% 96.69% 100.00% 98.71% 3 Dorset Healthcare University NHS Foundation Trust N/A 96.95% 0 0.47% 0 East Kent Hospitals University NHS Foundation Trust 76.30% 78.67% 80 0.36% 73.65% 95.76% 93.70% 97.19% 6 East Sussex Healthcare NHS Trust 90.91% 90.00% 1 2.31% 77.48% 96.70% 95.72% 97.60% 12 Frimley Health NHS Foundation Trust 89.92% 91.33% 0 0.36% 93.70% 96.51% 95.25% 99.36% 15 Gloucestershire Care Services NHS Trust 99.14% 0.00% 0 Gloucestershire Hospitals NHS Foundation Trust 91.58% 0.75% 74.29% 77.12% 93.36% 96.17% 17 Great Western Hospitals NHS Foundation Trust 85.26% 89.03% 3 6.81% 85.49% 95.87% 93.76% 98.90% 5 Hampshire Hospitals NHS Foundation Trust 81.41% 91.29% 0 1.81% 81.58% 96.33% 96.50% 99.23% 4 Isle Of Wight NHS Trust 85.71% 88.42% 0 1.95% 81.51% 96.98% 98.53% 100.00% 8 Kent Community Health NHS Trust 99.67% 93.64% 0 11.50% 0 Maidstone And Tunbridge Wells NHS Trust 87.78% 82.99% 13 0.85% 72.66% 87.14% 81.93% 97.31% 6 Medway NHS Foundation Trust 87.13% 85.68% 4 3.59% 79.35% 95.22% 89.57% 99.74% 6 North Bristol NHS Trust 77.38% 86.90% 59 2.06% 87.00% 94.64% 96.90% 97.18% 4 Northern Devon Healthcare NHS Trust 89.42% 19.00% 78.34% 92.17% 91.03% 95.59% 2 Oxford Health NHS Foundation Trust 98.01% 0 Oxford University Hospitals NHS Foundation Trust 81.62% 86.09% 90 0.46% 83.45% 96.63% 99.44% 96.26% 10 Oxleas NHS Foundation Trust 96.63% 0 0.00% 0 Plymouth Hospitals NHS Trust 84.57% 81.25% 45 9.55% 78.80% 92.55% 28.48% 96.10% 10 Poole Hospital NHS Foundation Trust 91.12% 88.39% 0 1.50% 85.54% 99.36% 100.00% 98.84% 8 Portsmouth Hospitals NHS Trust 74.45% 88.40% 1 0.97% 81.17% 96.09% 94.80% 99.23% 16 Queen Victoria Hospital NHS Foundation Trust 99.50% 80.48% 18 0.55% 76.47% 94.31% 95.69% 0 Royal Berkshire NHS Foundation Trust 88.41% 92.35% 0 0.95% 86.99% 96.47% 96.58% 97.88% 6 Royal Cornwall Hospitals NHS Trust 87.27% 83.04% 114 3.51% 86.73% 98.11% 97.31% 98.69% 5 Royal Devon and Exeter NHS Foundation Trust 90.67% 86.47% 8 6.11% 83.29% 95.69% 94.74% 98.28% 4 C.Diff cases 47 Performance of the NHS provider sector for the month ended 31 December 2017

4.2 Operational performance by provider South (2/2) ORGANISATION A&E (95%) RTT Incomplete (92%) RTT 52 weeks Diagnostics (<1.00%) Cancer 62 days - GP referral (85%) Cancer 2 weeks - GP referral (93%) Cancer 2 weeks - breast symptoms (93%) Cancer 31 days - GP referral (96%) Royal Surrey County Hospital NHS Foundation Trust 93.57% 91.73% 0 2.58% 76.20% 97.94% 96.74% 98.93% 6 Royal United Hospitals Bath NHS Foundation Trust 80.99% 86.54% 4 1.40% 87.77% 94.37% 94.92% 99.06% 10 Salisbury NHS Foundation Trust 92.90% 92.36% 0 0.88% 82.37% 95.51% 99.21% 96.88% 4 Solent NHS Trust 98.24% 0 0 Somerset Partnership NHS Foundation Trust 99.70% 98.82% 0 0.00% 0 Southern Health NHS Foundation Trust 100.00% 92.73% 0 0.00% 0 Surrey And Sussex Healthcare NHS Trust 93.50% 87.91% 17 0.33% 87.57% 94.50% 91.48% 97.31% 7 Sussex Community NHS Trust 99.08% 98.17% 0 0.00% 0 Taunton and Somerset NHS Foundation Trust 89.49% 82.47% 42 13.15% 74.27% 91.44% 91.92% 97.91% 4 The Royal Bournemouth and Christchurch Hospitals NHS Foundation Trust C.Diff cases 91.27% 88.70% 0 0.41% 88.12% 97.11% 100.00% 98.27% 11 Torbay and South Devon NHS Foundation Trust 91.34% 82.34% 42 3.73% 81.33% 69.36% 94.37% 96.07% 8 University Hospital Southampton NHS Foundation Trust 88.56% 87.86% 4 2.18% 86.44% 93.06% 63.26% 94.97% 4 University Hospitals Bristol NHS Foundation Trust 88.64% 88.29% 9 2.38% 85.54% 94.96% 96.71% 4 Western Sussex Hospitals NHS Foundation Trust 90.75% 87.07% 0 1.31% 89.07% 96.76% 96.31% 100.00% 6 Weston Area Health NHS Trust 84.72% 92.61% 0 1.85% 65.44% 91.48% 96.08% 99.09% 1 Yeovil District Hospital NHS Foundation Trust 96.78% 92.59% 0 0.82% 77.99% 95.48% 96.25% 98.25% 0 South 87.79% 87.22% 603 2.89% 82.36% 93.83% 93.49% 97.76% 247 48 Performance of the NHS provider sector for the month ended 31 December 2017

4.2 Operational performance by provider Ambulance Ambulance Service Count of Incidents Category 1 Category 2 Category 3 Category 4 Total (hours) Mean (min:sec) centile (min:sec) 1 Count of Incidents Total (hours) Mean (min:sec) 90th centile (min:sec) 1 Count of Incidents Total (hours) Mean (min:sec) 90th centile (min:sec) 1 Count of Incidents Total (hours) Mean (min:sec) centile (min:sec) 1 Standard - 7:00 15:00 18:00 40:00-2:00:00-3:00:00 East Midlands 6,581 1,056 9:38 17:11 39,078 25,713 39:29 1:26:08 10,720 18,009 1:40:48 3:59:57 176 269 1:31:41 4:42:22 East of England 7,082 1,086 9:12 16:44 42,450 22,685 32:04 1:05:07 12,080 21,545 1:47:01 4:40:34 5,050 10,731 2:07:30 5:14:02 Isle of Wight - - - - - - - - - - - - - - - - London 8,551 1,056 7:24 12:04 56,491 22,763 24:11 0:51:11 21,108 26,278 1:14:42 2:58:56 2,748 3,768 1:22:16 2:51:49 North East 3,104 360 6:57 12:10 19,629 9,443 28:52 1:00:23 7,790 17,410 2:14:06 5:17:41 619 955 1:32:33 3:36:38 North West 10,295 1,936 11:17 18:37 57,973 43,301 44:49 1:43:58 19,359 24,385 1:15:35 2:54:47 3,630 6,405 1:45:52 3:33:35 South Central 2,894 371 7:42 14:27 22,952 7,317 19:08 0:39:01 16,290 20,508 1:15:32 2:53:18 1,580 2,765 1:45:01 4:09:38 South East Coast 3,642 517 8:31 15:16 31,941 9,950 18:41 0:34:58 23,614 39,183 1:39:33 3:47:52 959 2,411 2:30:52 5:59:15 South Western 2 5,634 971 10:20 18:38 42,018 25,981 37:06 1:16:59 19,959 30,073 1:30:24 3:37:01 1,581 3,316 2:05:51 4:55:31 West Midlands 6,030 709 7:03 12:10 41,673 9,168 13:12 0:24:16 36,274 24,076 0:39:49 1:32:56 2,366 2,543 1:04:30 2:46:15 Yorkshire 9,629 1,315 8:12 14:19 39,185 18,261 27:58 1:00:47 12,439 14,407 1:09:30 2:41:47 1,056 1,844 1:44:46 4:22:05 - denotes not available. 1 Centiles for England in this spreadsheet are a mean of trusts' centiles, weighted by their count of incidents. 2 Data for SWAS comprises 22 to 30 November inclusive. 49 Performance of the NHS provider sector for the month ended 31 December 2017

5.0 Vacancy position by sector and region 50 Performance of the NHS provider sector for the month ended 31 December 2017

5.1 Nursing vacancy position Table 1: Registered Nursing vacancies (WTE) 51 Performance of the NHS provider sector for the month ended 31 December 2017 Table 2: Registered Nursing vacancies (percentage rate) Nursing Region Sector 2017/18 Q1 2017/18 Q2 2017/18 Q3 Region Sector 2017/18 Q1 2017/18 Q2 2017/18 Q3 London Acute 7,060 7,455 6,701 London Acute 15.3% 16.0% 14.5% Ambulance 2 1 6 Ambulance 11.4% 2.9% 22.7% Community 281 201 204 Community 16.2% 12.0% 11.4% Mental Health 1,881 2,141 2,132 Mental Health 15.3% 17.1% 16.7% Specialist 506 418 434 Specialist 10.3% 8.4% 8.6% London Total 9,730 10,215 9,478 London Total 14.9% 15.6% 14.4% Midlands and East Acute 7,895 8,220 7,357 Midlands and East Acute 11.6% 12.1% 10.7% Ambulance 1 1 1 Ambulance 0.8% 1.9% 1.3% Community 740 705 611 Community 9.4% 9.0% 8.2% Mental Health 2,222 2,221 2,076 Mental Health 11.9% 12.0% 11.2% Specialist 275 326 264 Specialist 9.2% 10.9% 8.8% Midlands and East Total 11,132 11,474 10,309 Midlands and East Total 11.4% 11.8% 10.5% North Acute 6,536 6,510 5,693 North Acute 8.1% 8.2% 7.1% Ambulance 14 16 16 Ambulance 9.9% 10.9% 11.0% Community 123 120 62 Community 3.7% 3.7% 1.9% Mental Health 1,573 1,817 1,716 Mental Health 7.8% 8.9% 8.8% Specialist 120 202 136 Specialist 2.9% 4.7% 3.2% North Total 8,367 8,664 7,623 North Total 7.7% 8.0% 7.1% South Acute 6,802 6,711 6,524 South Acute 11.5% 11.4% 11.0% Ambulance 28 27 34 Ambulance 18.7% 18.1% 22.3% Community 599 519 598 Community 13.2% 11.8% 13.4% Mental Health 1,479 1,356 1,228 Mental Health 10.6% 10.0% 9.1% Specialist 44 38 41 Specialist 20.6% 18.5% 19.5% South Total 8,951 8,652 8,425 South Total 11.4% 11.2% 10.8% National Total Acute 28,293 28,895 26,276 National Total Acute 11.1% 11.4% 10.3% Ambulance 45 45 57 Ambulance 11.8% 11.6% 14.3% Community 1,743 1,545 1,475 Community 10.0% 9.0% 8.7% Mental Health 7,155 7,534 7,152 Mental Health 11.0% 11.6% 11.1% Specialist 945 985 875 Specialist 7.7% 7.9% 7.0% Grand Total 38,180 39,004 35,835 Grand Total 10.9% 11.2% 10.3%

5.2 Medical vacancy position Table 1: Medical vacancies (WTE) Table 2: Medical vacancies (percentage rate) Medical Region Sector 2017/18 Q1 2017/18 Q2 2017/18 Q3 Region Sector 2017/18 Q1 2017/18 Q2 2017/18 Q3 London Acute 1,798 1,775 1,450 London Acute 8.9% 8.4% 7.0% Ambulance - - - Ambulance 0.0% 0.0% 0.0% Community 21 10 17 Community 33.1% 21.0% 26.9% Mental Health 287 177 222 Mental Health 10.1% 6.8% 8.5% Specialist 191 147 192 Specialist 8.9% 6.9% 8.7% London Total 2,297 2,110 1,881 London Total 9.1% 8.2% 7.4% Midlands and East Acute 2,934 2,883 2,773 Midlands and East Acute 10.5% 10.2% 9.8% Ambulance - - - Ambulance 0.0% 0.0% 0.0% Community 60 60 52 Community 11.7% 11.6% 10.3% Mental Health 370 334 325 Mental Health 13.6% 12.4% 12.1% Specialist 52 85 57 Specialist 5.2% 8.0% 5.5% Midlands and East Total 3,416 3,362 3,207 Midlands and East Total 10.6% 10.3% 9.8% North Acute 2,624 2,488 2,423 North Acute 8.9% 8.2% 8.0% Ambulance 2 1 0 Ambulance 30.0% 20.8% 10.4% Community 14 16 19 Community 10.1% 11.7% 13.2% Mental Health 329 403 385 Mental Health 12.0% 14.2% 13.7% Specialist 168 163 165 Specialist 10.1% 9.6% 9.4% North Total 3,137 3,071 2,992 North Total 9.2% 8.7% 8.5% South Acute 1,674 1,285 1,247 South Acute 6.6% 4.9% 4.7% Ambulance - - - Ambulance 0.0% 0.0% 0.0% Community 50 34 50 Community 13.6% 9.7% 13.5% Mental Health 271 235 298 Mental Health 12.7% 11.0% 13.8% Specialist 3-3 Specialist 2.2% 0.0% 1.8% South Total 1,998 1,554 1,597 South Total 7.1% 5.4% 5.5% National Total Acute 9,031 8,431 7,893 National Total Acute 8.7% 8.0% 7.5% Ambulance 2 1 0 Ambulance 15.2% 10.9% 4.3% Community 144 120 137 Community 13.4% 11.4% 12.8% Mental Health 1,257 1,149 1,230 Mental Health 12.1% 11.2% 12.0% Specialist 415 395 417 Specialist 8.4% 7.8% 8.1% Grand Total 10,848 10,097 9,676 Grand Total 9.1% 8.3% 7.9% 52 Performance of the NHS provider sector for the month ended 31 December 2017

End notes and glossary 53 Performance of the NHS provider sector for the month ended 31 December 2017

End notes 1 All financial information in this report is based on unaudited monitoring returns from 234 licensed NHS trusts and NHS foundation trusts operating as at 31 December 2017. Those licensed providers include 154 NHS foundation trusts (FTs) and 80 NHS trusts (non-fts). The total financial position reported includes an extra provider, Mid Staffordshire NHS Foundation Trust which is being dissolved during the year. This has been excluded from any count of providers in the document. 2 3 4 Surplus/(deficit) control total basis are calculated as surplus/(deficit) before AME impairments, transfers, donated asset income, and donated asset depreciation for all trusts. 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). As at December 2017, a total of 211 providers have signed up to their control totals. This is based on the returns submitted for month 9. 5 160 trusts reported performance against the A&E target in quarter 3 2017/18. 6 7 185 trusts reported against RTT incomplete pathway targets in December 2017. The admitted and non-admitted targets were removed in September 2015. 130 trusts reported performance against the breast cancer: 2-week wait target for quarter 3 2017/18. 151 trusts reported performance against the GP referral: 62-day wait target for quarter 3 2017/18. 149 trusts reported performance against the all cancers: 2-week wait target for quarter 3 2017/18. 54 Performance of the NHS provider sector for the month ended 31 December 2017

Glossary (1/2) 55 Performance of the NHS provider sector for the month ended 31 December 2017

Glossary (2/2) 56 Performance of the NHS provider sector for the month ended 31 December 2017