REVIEW OF THE YEAR : WHAT WE DO

REVIEW OF THE YEAR : WHAT WE DO Review of the Year 2013/14 9

SERVICE PORTFOLIO Designated Supra-regional Services Designated National Receiving Services CANCER SERVICES Comprehensive Non Surgical Oncology services including Radiotherapy and Chemotherapy Palliative care Macmillan Cancer Information Centre Clinical Trials Centre Sir Bobby Robson Foundation CARDIOTHORACIC SERVICES Adult and Paediatric Cardiology Adult and Paediatric Respiratory Medicine Adult and Paediatric Cardiothoracic Surgery Adult and Paediatric Cardiopulmonary Transplantation Electrophysiology Pacing and defibrillator implantation Angioplasty Thoracic Surgery Pulmonary hypertension Sleep investigation Neonatal and Paediatric extra corporeal membrane oxygenation Cardiothoracic Anaesthesia Primary Pulmonary Hypertension Cardiothoracic Intensive Care CHILDREN S SERVICES Paediatric Medicine Paediatric and Neonatal Surgery Paediatric Oncology including Neuro-oncology Paediatric Continence and Stomacare Forensic Paediatrics Paediatric Endocrinology Paediatric metabolic disease Paediatric Intensive Care Paediatric Immunology and Infectious Diseases including Severe Combined Immunodeficiency Syndrome Paediatric Neurology and Neurosurgery Paediatric Bone Marrow Transplantation CLINICAL SUPPORT SERVICES Physiotherapy Occupational Therapy Dietetics Speech Therapy Chiropody Pharmacy Psychology COMMUNITY SERVICES Outreach and independent living Primary Care interface Assessments and diagnostics Walk-in Centres DENTAL SERVICES (Dedicated Dental Hospital and School) Restorative Dentistry Oral Surgery Oral Medicine Oral and Maxillo Facial Surgery Paediatric Dentistry Orthodontics Dental Emergency Clinic Undergraduate training Postgraduate training Training of dental care professionals DERMATOLOGY SERVICES Dermatology outpatients clinics Dermatology outpatient treatments including Phototherapy and vascular laser treatment Dedicated in-patient services Dermatological Surgery including MohS Paediatric Dermatology Phototesting ELDERLY CARE SERVICES Acute Elderly Care Cardiovascular investigation unit Elderly rehabilitation including Stroke Continuing care Day hospital Respite care Intermediate care Integrated falls services GENETICS SERVICES Clinical Genetics Cytogenetics Molecular Diagnostic Genetics Diagnostic Service for Rare Neuromuscular Diseases Genetics Knowledge Park Mitochondrial DNA Laboratory INTERNAL MEDICINE Cystic fibrosis Respiratory Medicine Acute Stroke Medicine Auto-immune gut disorder Gastroenterology Cardiology Clinical Immunology and Allergy Infectious Diseases and Tropical Medicine (including high security isolation unit) Hepatology Clinical Pharmacology and Poisons Information Service Accident and Emergency Services Urgent Care Services Walk in Centres LABORATORY MEDICINE Clinical Biochemistry Maternal serum screening Clinical Haematology and blood transfusion Microbiology and Infection Control Cellular Pathology (including Neuropathology) Muscle and Nerve Biopsy Service Immunology Open access service Cytology Virology MUSCULOSKELETAL SERVICES Trauma Adult Orthopaedics Paediatric Nephrology Specialist Radiology Emergency Admissions Paediatric Orthopaedics Paediatric Respiratory Medicine Prosthodontics General Medicine Rheumatology Paediatric Rheumatology Periodontology Endocrinology Metabolic Bone Disease Services Paediatric Gastroenterology Dental Sedation Diabetes Bone tumour services 10 Review of the Year 2013/14

Our top priority is always our patients, putting them at the centre of all that we do and providing the highest quality of care in all areas, clinical, safety and the patient experience Specialist spinal surgery NEUROSCIENCE SERVICES Neurosurgery Neurology Epilepsy Services Neurovascular Service Neurophysiology Neuroradiology Deep Brain Stimulation Centre OPHTHALMOLOGY Cataract service Glaucoma service Adult and Paediatric Strabismus (squint) services Ocuplastic service including socket service Multidisciplinary Thyroid orbital service Vitreoretinal surgery Corneal service including transplantation Eye casualty Optometry and Orthoptic clinics Nurse-led pre-admission assessment clinics Dedicated separate adult and paediatric daycase facilities Medical photography Tertiary centre for Photodynamic therapy for age-related maculopathy Rehabilitation for newly registered blind and partially sighted patients OTOLARYNGOLOGY, HEAD AND NECK Ear, Nose and Throat Head and Neck Surgery Audiology and Hearing Aid Services Otology implant services PERI-OPERATIVE AND CRITICAL CARE Anaesthetics Theatres Resuscitation Intensive Care Chronic and Acute pain management High dependency care Recovery Multi-specialty day unit Home ventilation service Critical Care Outreach service PLASTIC AND RECONSTRUCTIVE SURGERY General Plastic and Reconstructive Surgery Vascular laser treatments Cleft lip and palate surgery Burns Hand surgery Head and Neck Surgery (with ENT) Breast reconstructive surgery Paediatric plastic surgery RADIOLOGY General X-ray Contrast Studies Interventional Radiology Magnetic Resonance Imaging Computed Tomography Ultrasound Ward Imaging REGIONAL MEDICAL PHYSICS Nuclear Medicine Radiotherapy Physics and Technology Physiological measurement Critical Care Physics Bone mineral measurement Audiological science Vascular Ultrasound Photomedicine Clinical instrumentation Radiation protection Ultrasound quality assurance Audiometer calibration and repair Technical Aid service Rehabilitation engineering and mobility Clinical and scientific computing equipment development and calibration Bioengineering RENAL SERVICES Acute Nephrology Haemodialysis Specialist Hypertension Services HAEMATOLOGY Transplantation Continuing care and support Specialist Haematology Services Haemato-oncology Haemophilia Bone marrow transplantation Thrombophilia DVT service SURGICAL SERVICES General Surgery Upper gastro-intestinal services Vascular Surgery Colorectal Surgery Endocrine Surgery Liver Transplantation Renal Transplantation Pancreas and Islet Transplantation Hepatobiliary and Pancreatic Surgery Breast care services Disablement services Endoscopy UROLOGY General and Specialised Urological Surgery General Urology Uro-oncology Laparoscopy Incontinence Reconstruction Urodynamics Surgical Andrology Endourology and Lithotripsy Laser Prostatectomy WOMENS SERVICES Gynaecology including Urogynaecology and Colposcopy Obstetrics Fetal Medicine Reproductive Medicine Neonatal Medicine Intensive Care and Special Care Family planning services Community midwifery Maternity Midwifery/obstetric ultrasound and screening Specialist services (multidisciplinary) for pregnant women with substance misuse problems Specialist services (multidisciplinary) for twins and multiples Termination of Pregnancy service Bereavement counselling Birthing Centre (Midwife led) Review of the Year 2013/14 11

12 Review of the Year 2013/14

HOW WE DID Review of the Year 2013/14 13

14 Review of the Year 2013/14

SUMMARY OF SERVICE STATISTICS Dental Hospital Freeman Hospital Campus for Ageing & Vitality Healthcare are at its very ey best with a personal touch Inpatient and Daycase activity 2008/09 2009/10 2010/11 2011/12 2012/13 2013/14 Non-elective Inpatient FCEs 70,988 76,051 83,231 84,341 82,499 85,716 Elective Inpatient FCEs 38,814 37,148 30,904 32,413 32,171 31,315 Day Case FCEs 82,248 83,771 97,584 107,889 106,942 111,514 Total FCEs 192,050 196,970 211,719 224,643 221,612 228,545 % Elective FCEs undertaken as daycases 68% 69.3% 75.9% 76.9% 76.9% 78.1% Average Length of stay 4.08 4.35 4.08 4.17 4.25 4.19 Average % Occupancy 78% 78% 80% 80% 80% 81% OP Activity New outpatient attendances 230,955 254,588 297,304 306,730 310,414 336,405 Review outpatient attendances 638,410 653,418 681,854 727,486 748,430 882,083 Total outpatient attendances 869,365 908,006 979,158 1,034,216 1,058,844 1,218,488 Diagnostic services Laboratory requests 2,490,628 2,772,824 2,759,575 2,882,675 3,002,236 3,138,125 Radiological examinations 434,264 441,361 463,614 498,605 504,751 564,241 Accident & Emergency A&E attendances 92,872 91,382 103,489 125,213 128,634 130,756 Walk in centre attendances 38,316 36,115 28,252 43,949 49,288 49,948 Total attendances 131,188 127,497 131,741 169,162 177,922 180,704 Surgery Cardiopulmonary transplants 78 78 82 77 96 99 Liver transplants 43 34 35 39 41 47 Renal transplants 98 123 139 130 138 147 Bone marrow transplants 99 131 176 206 185 190 Heart Operations (CABGs & PCIs) 3,249 3,248 3,206 3,326 3,068 3,146 Joint Replacements (Hips & Knees) 1,024 1,110 1,385 1,424 1,638 1,648 Cataracts 7,787 8,174 8,023 8,074 8,330 8,349 Reproductive Medicine - Centre for Life No of IVF treatments started 779 982 843 817 656 659 Live birth rate per cycle started 27.8% 24.9% 26.6% 23.3% 24.9% 25.6% Other key statistics Total no of renal dialysis sessions 41,702 43,774 44,227 39,099 39,723 39,695 Total no births 6,301 6,683 7,062 6,992 7,441 7,446 Day hospital attendances 3,710 3,124 3,617 4,834 5,785 4,944 Review of the Year 2013/14 15

PERFORMANCE 16 Review of the Year 2013/14

2013/14 saw the introduction of the new commissioning structure in the NHS, with Primary Care Trusts replaced by Clinical Commissioning Groups (CCGs), and the new body NHS England given greater commissioning responsibility for specialised and public health services. The Trust operated Legally Binding Contracts with thirteen CCGs during 2013/14, as well as a substantial contract with NHS England for services which they commission. Service Level Agreements (SLAs) were also operated with two Scottish Health Boards (Borders and Dumfries and Galloway), and three Local Authorities, the latter of which also increased their commissioning responsibilities. There was an overall increase in activity during 2013/14. The following exhibits show the year on year increase in the number of patients seen and summarises performance against the Annual Plan in relation to: elective & non-elective spells, new & review outpatients and also outpatient procedures. The following exhibit shows patient activity for admitted care (finished consultant episodes), A&E attendances and new outpatients for the last 10 years. There was a further rise in the number of patients seen during the year, just over 35,500 more patients were seen overall compared to the previous year, which equates to a 5% increase in activity mainly in New Outpatient Attendances. 400,000 Patient Activity April - March 2004-2014 New Outpatient Attendances Inpatient & Day Case FCEs A&E Attendances 350,000 300,000 250,000 200,000 150,000 100,000 50,000 0 2004/05 2005/06 2006/07 2007/08 2008/09 2009/10 2010/11 2011/12 2012/13 2013/14 80.0% Variance from Annual Plan 2013/14 - Admitted and Non-Admitted Care - Main Commissioners Elective Non Elective New Outpatients Review Outpatients Daycases and Outpatient procedures 60.0% 40.0% 20.0% 0.0% -20.0% -40.0% -60.0% NHS Darlington CCG NHS Durham Dales, Easington and Sedgefield CCG NHS Gateshead CCG NHS Newcastle North and East CCG NHS Newcastle West CCG NHS North Durham CCG NHS Hartlepool and Stockton-on-Tees CCG NHS Northumberland CCG NHS South Tees CCG NHS South Tyneside CCG NHS Sunderland CCG NHS Cumbria CCG NHS North Tyneside CCG Specialised Commissioning Review of the Year 2013/14 17

Planned Activity The year-end position was slightly below commissioned activity for elective admitted care (-4.5%) and new outpatient (-0.6%), but well above plan for all other categories of activity. In particular, daycase and outpatient procedures were 23.4% higher overall, this is partly due to an increased rate of daycase surgery (in line with best practice) instead of overnight admissions. The new commissioning arrangements resulted in significant changes to allocation of activity to commissioners, particularly with regards to specialised services. It has been important to the Trust to ensure that all activity is commissioned in full, and by the correct commissioner. A number of Clinical Directorates experienced difficulties and delays with consultant recruitment and this resulted in lower elective and outpatient activity levels than had been planned. Clinical discussions have taken place with commissioners about some key areas of increasing demand. National cancer awareness campaigns have also led to increased activity in certain areas such as Urology and Lung Cancer. Even with a mild Winter, non-elective activity still resulted in activity 13.1% higher than commissioned. Development of a new Ambulatory Care Unit within 2013/14 is hoped to significantly reduce the need to admit patients who can be assessed in a more efficient and timely way. A number of services have been challenged to reduce their waiting times in line with national targets, specifically in Oral Surgery, Neurosurgery and Orthopaedics. All specialties saw a number of waiting list initiatives to increase activity and reduce the number of long-waiters. Achieving Waiting Times and National Targets Cancelled Operations The Trust reports cancelled operations as defined by the Department of Health as follows: Cancelled operations that are cancelled for non-medical reasons on the day the patient was due to be admitted to hospital or after they have arrived in hospital. There were 591 cancelled operations reported during the year which is an increase in comparison to the previous year (475). There were three particular clinical Directorates reporting increased cancellations during the year including: Neurosurgery where there was increased reporting of cancellation due to the precedence given to Emergency Surgery and Theatre lists overrunning. General & Vascular Surgery where cancellations increased due to critical care bed availability, Theatre list overruns, Emergency Surgery taking precedence and general bed availability. Paediatrics where there was a general increase in reporting following awareness raising amongst Ward staff. The reasons for cancellation in this Directorate are theatre related and bed capacity. In relation to cancellations as a proportion of elective activity the year end performance was 0.4% which is within the standard performance threshold of less than 0.8%. Only 1 patient breached the standard of re-admission within 28 days following a last-minute cancelled operation. Directorate management and clinical teams are aware of the importance placed upon ensuring patients are readmitted within 28 days of cancellation for non-clinical reasons and will endeavour to work with the patients to offer a suitable date for them. As a proportion of cancellations, the year-end breach performance was 0.2%, again within the standard performance threshold of less than 5%. Referral to Treatment Target Over the year, the Trust has consistently achieved the aggregate Referral to Treatment Targets of 90% of admitted pathways; 95% of non-admitted pathways; and 92% of incomplete pathways this is in line with Monitor requirements. Action plans have been developed to improve the compliance in some challenged specialties in line with the increased demand and treating the backlog of those patients waiting more than 18 weeks; improving the timeliness of treatment and therefore the patient experience of their completed journey to treatment. The exhibit below shows the improvement against the Incompletes target for the three most challenged specialties. Oral Surgery and Neurosurgery achieved significantly in bringing the proportion of log waiters down to less than 8%. In addition, during 2013/14, the Trust did not have any patients breaching the 52 week limit, and reduced the number of patients overall waiting over 36 weeks. 96.0% Pathways of patients not yet treated (Target 92%) April 2013 - March 2014 Compliancy Percentage 94.0% 92.0% 90.0% 88.0% 86.0% 84.0% 82.0% 80.0% 91.7% 86.6% 86.3% 86.3% 85.4% Target 89.5% 89.9% 90.7% 87.7% 84.8% 83.6% 81.5% 92.6% 92.1% 91.4% 91.0% 89.9% 89.7% 84.7% 84.8% 86.0% 85.9% 85.3% 85.0% 86.1% 84.1% 84.7% 84.3% 82.7% 81.4% 92.1% 89.4% 84.9% 93.8% 92.1% 83.8% 78.0% 76.0% 74.0% Apr May Jun Jul Aug Sep Oct Nov Dec Jan Feb Mar Activity Month Trauma & Orthopaedics Oral Surgery Neurosurgery 18 Review of the Year 2013/14

Newcastlee upon Tyne Hospitals NHS Charity Reg No. 1057213 Supporting Newcastle Urology at Freeman Hospital Review of the Year 2013/14 19

6 Week Diagnostic Target During the year the Trust unfortunately reported breaches of the 6 week diagnostic wait for the fifteen key diagnostic tests and which served to reflect the huge demands for our services. There were 40,663 diagnostic tests within this category and 162 patients waited longer than the 6 weeks mainly for MRI imaging, which gave an overall compliance of 99.6% and within the 99% target. The number of patients waiting for diagnostic tests at the end of March 2014 had risen by 772 (10.1%) compared to the previous year, and demand for diagnostic tests is increasing steadily. The exhibit below shows the number of patients that were waiting for diagnostic tests at March 2014 and the numbers seen during the month. 5000 4500 4000 3500 3000 2500 2000 1500 1000 500 Diagnostic Waiting Times & Activity - March 2014 Patients seen during March from Waiting List Patients Waiting 0 MRI CT Non Obstetric Ultrasound Barium Enema DEXA Scan Audiology Assessments Echocardiography Electrophysiology Neurophysiology Respiratory Physiology Urodynamics Colonoscopy Flexi Sigmoidoscopy Cystoscopy Gastroscopy The following exhibit shows the changes in diagnostic waiting lists, with a notable increase in Non-Obstetric Ultrasound. 600 Changes in Diagnostic Waiting lists (March 2014 Compared to March 2013) 500 400 300 200 100 0-100 MRI CT Non Obstetric Ultrasound Barium Enema 20 Review of the Year 2013/14 DEXA Scan Audiology Assessments Echocardiography Electrophysiology Neurophysiology Respiratory Physiology Urodynamics Colonoscopy Flexi Sigmoidoscopy Cystoscopy Gastroscopy

Cancer Waiting Times Two Week Wait - Comparison Performance across all standards was sustained during 2013/14, with all targets achieved. Referrals through the suspected cancer two week rule process increased across all tumour groups by 9%, and by 14% in the two week Breast Symptomatic standard in comparison to 2012/13. This increase impacted across all diagnostic services, particularly radiology where long waits were experienced for reporting of images. The outcome of the increase in referrals reflected a 7% increase in the numbers of patients receiving first treatments for a cancer diagnosis. In order to support earlier diagnosis of cancer and improve survival rates, the Be Clear on Cancer awareness campaigns continued in 2013/14. A number of campaigns, regional and local, were rolled out including Breast, Lung, Urology and Oesophago-gastric. The Trust was prepared for the campaigns and the increase in demand was effectively managed. Nationally, the Be Clear on Cancer campaigns have been evaluated successfully with findings showing that public awareness has been increased and patients are presenting at an earlier stage. More campaigns will be rolled out during 2014/15. Number of Referrals 1600 1550 1500 1450 1400 1350 1300 1250 1200 1150 1100 1050 1000 Apr May Jun July Aug Sep 2012/13 2013/14 Oct Nov Dec Jan Feb Mar The 62 day target remained challenging throughout the year with late referrals from other local providers contributing significantly to the numbers of breaches. Analysis shows that around 50% of patients were referred late in the pathway, often after day 62 and of these late referrals 50% of them breached the target. The reasons for late referrals are multi-factorial and collaboration with the referring providers across the North of England Cancer Network to improve patient pathways is continuous. A&E Waiting Times The Care Quality Commission national Emergency Department waiting time standard is 95%. Despite an increase of 1.5% in the number of patients attending the Royal Victoria Infirmary Emergency Department in comparison to the previous year, the Trust achieved 96% for the 12 month period ending March 2014. There were occasions where the number of over 4 hour waits peaked during the year and these corresponded with emergency activity peaks and bed pressures. The predominant reasons for breaches included those due to patients waiting placement in an appropriate clinical setting and also patients receiving and waiting to be treated in the Emergency Department. During the year there was a particular emphasis in relation to the timely clinical handover of patients arriving by ambulance to the Emergency Department. During the year there were minimal over 30 minute delays in handover i.e. 67 in total representing 0.2% of all ambulance arrivals. Detailed Winter/surge management planning was undertaken and the successful implementation of additional capacity and resources, (enabled through agreement of sufficient funding) ensured that the emergency caseload was very well managed. Funding was supported from a national level with the Trust identified as the local lead provider for delivery of the health and social care response in Newcastle upon Tyne. All Type A&E attendances and waiting time performance for 2013/14 compared to 2012/13 16000 100% 99% All Type A&E attendances 15000 14000 13000 99% 98% 98% 97% 97% 96% % Waiting time performance 96% 12000 95% April May June All Type A&E attendances 2012-13 All Type A&E attendance 2013-14 July August September October November % waiting time performance 2013/14 % waiting time performance 2012/13 December January February March Review of the Year 2013/14 21

Ambulance Handovers Quick handovers between Ambulance and A&E staff are essential. Not only do they benefit the patient being brought in but they are important for the smooth running of the system. If ambulances are delayed at a hospital it means they cannot get out on the road to answer 999 calls. Ambulances are allowed 15 minutes to handover the patient and a further 15 minutes to prepare the vehicle for the next call. Therefore the Trust is monitored on delays over 30 minutes, which are tough targets to achieve. In most cases, the staff within the Emergency Department are so busy being focused on the care of the patient, the handover button is not pressed in a timely fashion. For all breaches, a full review is carried out and whilst any nonperformance is undesirable, NuTH has not demonstrated a risk in clinical care as in all cases, the patients were physically handed over within the timescales but IT systems were not updated in time. At the main Emergency Department the Trust recorded 67 such delays over 30 minutes but no delays more than an hour during 2013/14. Complete handover data across the North East area is available for around 80% of all handovers and the Trust was one of the top performers. 120.0 Handover Breaches (>30mins) per 1000 Complete Ambulance Journeys North East Regional Apr 2013 - Mar 2014 106.7 100.0 85.5 80.0 Rate 60.0 49.1 40.0 32.7 20.0 0.0 0.4 2.0 2.3 2.8 4.5 Queen Elizabeth A&E University Hsp Of North Tees A&E RVI MAIN A&E Hexham General A&E South Tyneside Hosp A&E 7.3 Wansbeck A&E 14.8 North Tyneside General A&E James Cook A&E Sunderland Royal A&E Darlington Memorial A&E Uni Hsp Of North Durham A&E Source: North East Ambulance Service Handover Complete = Arrive at hospital, time of handover and vehicle clear run sequentially. This is to enable analysis of when times of handover are recorded (or not) and those where all times relating to the handover are recorded in the correct sequence. NHS Number Coverage Using the NHS Number helps to share patient information safely, efficiently and accurately thereby aiding in the reduction of clinical risk to patients. Safe clinical treatment of any given patient relies on the information held being particular and pertinent to the patient. Within hospital administration, the NHS Number is important because it helps create a complete record for each patient, enabling information to be safely transferred across organisational boundaries and even babies are given their own NHS Number to link their healthcare records for life. As the delivery of patient care is now often shared across a number of NHS clinical or business areas and suppliers, so the effective linking up and flow of information related to a patient has become even more important. Nationally, the NHS Number is monitored within the Secondary Uses Services (SUS) and the exhibit below shows that Newcastle Hospitals is achieving the nationally mandated targets for patients. Only a small proportion of patients do not have an NHS Number (which includes the Scottish patients who are treated at our hospitals and are not issued with NHS Numbers). 100% SUS Data Quality reports, NHS Number Compliance, April 13 - March 2014 Percentage 90% 80% 70% 60% 50% 40% 30% 20% 10% 99.20% 99.60% 97.40% 0% Source: SUS 22 Review of the Year 2013/14 Admitted Care Outpatients A&E Type of Record Target Admitted patient Care/Outpatients 99% A&E 95% Trust Target

IMRT There is currently a national requirement for Trusts providing Radiotherapy to deliver 24% of treatment as Intensity Modulated Radiation Therapy (IMRT). The target is considered a minimum requirement as IMRT delivers more accurate treatment with less side effects and better patient outcomes. The target is calculated as the percentage of new Inverse Planned IMRT Patients as a proportion of all New Radical Episodes. Data points in red are provisional, and numbers rely heavily on the overall case mix, as the denominator includes cases which are not eligible for IMRT. Recognition has been received from Specialised NHS England Commissioners to reflect the achievements of the Northern Centre for Cancer Care (Freeman Hospital) as we strive to enhance service level provision. 60.0% New Inverse Planned IMRT Patients as a percentage of all new Radical Episodes Apr 2012 - March 2014 (Target 24%) Aspirational Range 50.0% Performance Percentage 40.0% 30.0% 20.0% National Target 10.0% 0.0% Apr-12 May-12 Jun-12 Jul-12 Aug-12 Sep-12 Oct-12 Nov-12 Dec-12 Jan-13 Feb-13 Mar-13 Apr-13 May-13 Jun-13 Jul-13 Aug-13 Sep-13 Oct-13 Nov-13 Dec-13 Jan-14 Feb-14 Mar-14 Activity Month and Year Review of the Year 2013/14 23

Best Practice Tariffs Best Practice Tariffs (BPTs) are one of the enablers for NHS Trusts to improve quality by reducing variation and incentivising best practice care. With best practice defined as care that is both clinical and cost-effective, these tariffs also help the NHS deliver the productivity gains required to meet financial challenges. A significant review of BPTs was undertaken in the Trust in 2013/14 to assess current compliance, identify how implementation could be improved and from that, draw out actions to continually improve the quality of care for our patients. There have been some notable areas of improvement as identified below: Day Cases BPTs were introduced for one procedure in 2010/11, and in 2013/14 they covered 15. Performing procedures as Day Cases offers substantial benefits to patients, including minimum disruption to daily life and reduced waiting times. The bar chart below shows how the Trust compares to peer organisations in 2013/14. However we can do better and the Trust performance is expected to improve in 2014/15 as pathway redesign is currently underway in both Surgery and ENT. 100 80 Day Case Rate Peer top quartile Day Case Rate (%) 60 40 20 0 Fragility Hip Fracture The fragility hip fracture BPT was introduced alongside a national clinical audit and together they aim to improve the level of compliance with defined elements of evidence-based best practice care. There is a clear and steady increase in care meeting the fragility hip fracture BPT criteria and in 2013/14, the Trust delivered the complete package of best practice care to 76% of eligible patients compared to 60% national compliance in Q4 2012/13 (NHFD National Report 2013). Outpatient Procedures As with Day Case procedures, there are significant benefits to performing procedures in an Outpatient setting. In particular, patients have a faster recovery time, the ability to recuperate at home and they can get back to work and daily life sooner. However, it is recognised that patient choice and need must be accounted for and not all cases will be clinically suitable for an Outpatient setting. There are three procedures covered in the BPT and the table below shows that the Trust performance for diagnostic cystoscopies being undertaken in an Outpatient setting is well above the expected rate. NuTH Best Practice Tariff Indicator Achievable Outpatient Rate Trust Performance (Apr to Mar 2014) 11. Outpatient Procedures Diagnostic hysteroscopy 80% 76.2% Diagnostic cystoscopy 50% 81.9% Hysteroscopic sterilisation No target set 40.0% There is significant variation in performance for BPTs nationally and the Trust will continue to remain one of the higher performing organisations by ensuring: strong clinical engagement, understanding and support; senior management and board involvement; frequent accurate reporting of activity data; and follow up of individual cases where best practice had not been delivered. The Trust will continue to remain one of the higher performing organisations by ensuring strong clinical engagement, understanding and support 24 Review of the Year 2013/14

Review of the Year 2013/14 25

OUR ANNUAL PLAN This document forms the Strategic Plan for the period 2014/15 to 2018/19 and describes how the Trust Board plans to deliver appropriate, high quality, cost effective services for patients on a sustainable basis over the next five years in light of the particular challenges facing the sector. Within this context, the document includes the Trust s assessment of the key challenges facing health and social care, the options available to the Trust in the light of these and the strategies to ensure services to patients remain sustainable. 26 Review of the Year 2013/14

Executive Summary The Trust acknowledges that the NHS is facing possibly the most fundamental challenge ever as a consequence of the economic climate, rising demand on service scope and provision and the potential for increased competition. As one of the largest and most successful teaching hospitals in England, providing world class services, employing world class clinicians to benefit all of our patients, we remain confident of our strategy to continue to grow and develop to provide healthcare of the highest standard in terms of quality and safety whilst maintaining operational, clinical and financial sustainability. The Trust completed its 8th year as an NHS Foundation Trust with 2013/14 being another busy and successful year. We continue to strive for excellence and remain one of the leading providers of quality healthcare spanning secondary, tertiary and community services for adults and children. Again we were awarded the CHKS Top 40 Hospitals Awards in 2014 for the 14th consecutive year, one of only two Trusts in the country to achieve this accolade. Our excellence in healthcare is recognised nationally and internationally. In line with the Trust s longstanding ambition and vision to be the healthcare provider for Newcastle, we continue to deliver cutting edge healthcare with new procedures in first class facilities to improve patient care. This is underpinned by the principal of delivering of safe, high quality services by the right people in the right place at the right time and within financial balance. We continue to perform well against various national standards including the Annual Inpatient Survey, CQC Benchmark Report and NHS Friends and Family. Quality and Safety are the cornerstone of our Clinical Strategy to ensure the delivery of patient care. Our achievements are attributable not least to the strong leadership demonstrated at all levels across the organisation and the teams of loyal and dedicated staff who work tirelessly to ensure our patients receive the highest quality of care. The Trust business strategy of targeted growth in key clinical areas to meet rising demand as a result of demographic and disease prevalence, ensure patient choice and to respond to an increasingly competitive market in many areas. This growth in activity is supported by a strong financial balance sheet that provides opportunities for capital investment in key clinical areas. Building capacity and improving efficiency are intrinsic to the delivery of the Trust strategy over the next five years. This is underpinned by strong leadership at all levels across the organisation to drive performance and deliver change to meet the needs of the local health economy. The Trust s longstanding objective to deliver comprehensive community outreach via transformation and in several cases collaboration, is aligned to the national and local initiatives associated with moving activity out of secondary care supported by the Better Care Fund. The 8th Year as an NHS Foundation Trust another busy and most successful year The strong culture of research and innovation supported by formal management relationships with Newcastle University and close working with the University of Northumbria in Newcastle allows the Trust to further develop and promote research and innovation to secure health science, innovation and commercial opportunities to the North East. The Trust has an underlying strength and track record as a first class teaching hospital, consistently delivering high quality services to patients both in and out of hospital including the ability to adapt and change to the environment. Our plans are responsive to the changing needs of the population which allow us to declare that a sustainable future for the Trust and the wider NHS community will be one that embraces collaboration and innovation and identifies means of driving the highest quality clinical care through continuous improvements. The Trust Board is confident that we have a solid base from which we shall continue to deliver world class clinical services and maintain our position as one of the largest and most successful healthcare providers in England. Review of the Year 2013/14 27

PROVIDING TOP QUALITY CARE Newcastle Hospitals Trust named as one of the CHKS 40Top Hospitals 2014 The Newcastle upon Tyne Hospitals NHS Foundation Trust is one of the CHKS 40Top Hospitals for 2014. This is the 14th consecutive year that Newcastle Hospitals has picked up the award - an accolade given to the 40 top performing CHKS client and one of only two Trusts to do so. This client base covers approximately 200 hospitals in England, Wales, Scotland and Ireland. It is therefore becoming more difficult to constantly remain in the Top40 year after year. As well as national awards for patient safety, quality of care and data quality, CHKS celebrates excellence among its clients across the UK. The 40Top Award is based on the evaluation of 22 key performance indicators covering safety, clinical effectiveness, health outcomes, efficiency, patient experience and quality of care. Newcastle Hospitals staff with CHKS director and the award Jason Harries (CHKS), Sandra Mawdesley (Performance Manager) and Kathleen Jaques (Head of Medical Records and Outpatients) I must thank all of our staff as it is their dedication, commitment and hard work that has enabled us to gain the Award since inception in 2000. I would also like to pay tribute to all those who have contributed so much to the continuing success of the Newcastle Hospitals. Kingsley W Smith, Chairman CHKS Awards Top40 Winners Photographs: The Newcastle upon Tyne Hospitals NHS Foundation Trust 28 Review of the Year 2013/14