WEST HAMPSHIRE PERFORMANCE REPORT. Based on performance data available as at 11 th January 2018

WEST HAMPSHIRE PERFORMANCE REPORT Based on performance data available as at 11 th January 2018 1

CCG Quality and Performance Executive Summary Introduction: The purpose of this report is to provide an update on both WHCCG performance against key targets, and the performance of providers from whom we commission services. The performance targets reported include those national expectations set out under the NHS Constitution, as well as other key national and local targets against which the CCG is measured. Key message to note this month: There are a number of areas for improvement identified, most notably the continued deterioration in performance against the national standard for 95% patients to be treated or discharged within 4 hours in an A&E Department. WHCCG performance reduced further to 87.82%; with 2244 patients (of 12,202) not being treated within the standard. There was an associated impact on the rate of delays in patients being transferred from ambulances to acute hospitals across Hampshire, detailed further at slide 21. Key achievements Mental health services; the following standards for patients continue to perform well: Care Programme Approach (CPA) CCG achieved 95% standard in Quarter 2 with 97.8% Improving Access to Psychological Therapies (IAPT) national standard of 3.75% achieved in September with 3.86% IAPT recovery rate CCG achieved standard in September with 57.1%. IAPT people seen within 6 and 18 weeks standards of 75% and 95% achieved in September with 89.36% and 100% Early Intervention in Psychosis CCG achieved 100% against the 50% standard in October. Areas for improvement: RTT incomplete waiting times below standard for WHCCG in November, but improvement compared to previous month RTT one patient experienced a 52 week wait, reported in November. RTT backlog at HHFT although meeting the 92% standard, the backlog has increased for WH patients. Diagnostics below standard, mainly due to capacity issues at UHS. Cancer 2 week wait breast symptoms did not achieve standard in November, mainly due to patient choice, administrative and capacity issues at UHS Cancer 31 days treatment (surgery) did not achieve standard in November Cancer 62 days referral to treatment did not achieve standard in November, mainly due to UHS and HHFT Mixed Sex Accommodation 36 breaches recorded in November, 24 at UHS and 12 at HHFT. Dementia Diagnosis below trajectory and standard in December. 2

CCG Performance: NHS Constitution & Operating Plan Targets Target Reporting Level Sep-17 Oct-17 Nov-17 YTD Trend / Direction of Travel (arrows depict change compared to previous month or quarter) Unscheduled Care A&E 4 hour wait 95% CCG 91.64% 91.36% 87.82% 91.88% Category A ambulance calls within 8 minutes - Red 1 75% Trus t 69.53% 73.22% See new 73.88% Category A ambulance calls within 8 minutes - Red 2 75% Trus t 67.27% 68.75% metrics on 70.63% Category A ambulance calls within 19 minutes 95% Trus t 92.74% 93.52% slide 20 94.23% Planned Care 18 weeks referral to treatment times - incompletes 92% CCG 91.81% 91.58% 91.83% 91.83% Number of patients waiting longer than 52 weeks 0 CCG 2 3 1 1 Diagnostics <6 week waits 99% CCG 99.34% 99.27% 98.92% 98.92% Cancer: All 2 week waits (urgent) 93% CCG 95.50% 96.17% 94.12% 95.44% Cancer: 2 week breast symptoms (cancer not initially suspected) 93% CCG 98.41% 97.97% 91.87% 92.15% Cancer: 31 days diagnosis to treatment 96% CCG 98.55% 97.73% 97.09% 97.86% Cancer: 31 days subsequent treatment - surgery 94% CCG 93.75% 92.68% 82.19% 93.65% Cancer: 31 days subsequent treatment - Chemo/Drug 98% CCG 100.00% 100.00% 100.00% 100.00% Cancer: 31 days subsequent treatment - radiotherapy 94% CCG 98.88% 100.00% 98.82% 98.98% Cancer: 62 days urgent referral to treatment 85% CCG 86.71% 82.35% 83.93% 86.15% Cancer: 62 days urgent RTT (104 day waits) 0 CCG 3 7 9 41 Cancer: 62 days screening referral 90% CCG 94.74% 88.89% 100.00% 95.81% Cancer: 62 days consultant decision to upgrade 86% CCG 82.35% 84.62% 60.00% 83.78% Quality Mixed Sex Accommodation 0 CCG 7 16 36 82 Clostridium difficile 133 CCG 14 14 12 101 MRSA bacteraemia 0 CCG 1 0 0 2 3

CCG Performance: NHS Constitution & Operating Plan Targets Description Target Reporting Level Sep-17 Oct-17 Nov-17 YTD Trend / Direction of Travel (arrows depict change compared to previous month or quarter) Mental Health Care Programme Approach (CPA)* 95% CCG 97.80% 97.93% IAPT Access (Rolling 3 month access rate) (annual target 15%) 3.75% CCG 3.86% Data not yet available 7.50% due to timelag with IAPT Recovery rate 50% CCG 57.10% 49.54% published monthly data - IAPT waiting times: 75% of people enter treatment within 6 weeks 75% CCG 89.36% Oct 17 data available in 88.30% IAPT waiting times: 99% of people enter treatment within 18 weeks 95% CCG 100.00% Feb 18. 100.00% Dementia diagnosis rate 66.70% CCG 62.69% 62.77% 63.74% 62.77% Early Intervention in Psychosis - completed (% people seen <2 weeks) 50% CCG 92.31% 100.00% 100.00% 93.94% Reliance on Inpatient care for people with Autism 21 CCG 23 23 Improve access rate to CYPMH 30% CCG Data not yet available Other Operating Plan Metrics E-referrals 80% CCG 60.21% 65.81% 55.24% Personal Health Budget - total number in quarter 54 CCG 120 148 Extended Access 100% CCG Data not yet available Percentage of children waiting less than 18 weeks for a wheelchair 93% CCG 23.08% 39.62% Waiting times for urgent referrals to CYPED within 1 week 50% CCG 20.00% 25.00% Waiting times for routine referrals to CYPED within 4 weeks 78.60% CCG 82.14% 80.85% * : Proportion of people under adult mental health illness specialties on CPA followed up within 7 days of discharge from psychiatric inpatient care during the period. 4

CCG Quality and Performance Points to Note (by exception) Referral to treatment within eighteen weeks incomplete pathways; Of our 4 main providers only Hampshire Hospitals and Salisbury achieved the standard in November 2017 with 93.8%, all other providers are delivering 89-91% against the 92% standard. We anticipate that WHCCG will continue to not achieve the standard in December and January this is both a continuation of the existing performance, but in addition, there has been a high volume of cancellations across the New Year period and there has been national guidance to postpone non-urgent elective procedures during January 2018 in order to free capacity for urgent care patients The two main contributing factors to WHCCG not meeting the RTT standard have been continued poor performance at UHSFT and Royal Bournemouth FT, who are both not achieving the standard. The main specialties impacted are T&O, ENT and Ophthalmology. It should be noted that longer waits within the SHFT MSK triage service (available to all WHCCG patients) are a key factor in causing overall non achievement of the T&O standard for patients within acute providers. One patient awaiting breast surgery waited over 52 weeks for treatment ; but has subsequently been treated Accident and emergency: As indicated earlier, December performance has declined further. None of our main providers achieved the 95% standard in month. HHFT in particular experienced a very significant deterioration during November and December with performance for the latest month 74.87%. A Trust recovery plan has been agreed by both commissioners and there is recognition that a wider set of system actions are also required, as factors impacting performance are not just internal to the Trust. A winter action programme during the week 8-14 th January did lead to significant improvements in performance which the local system is seeking to maintain Cancer waiting times: WHCCG met five of the nine cancer waiting time standards at CCG level in November. The four standards not achieved were: 2 week waits for breast symptoms (cancer not initially suspected) 91.87% vs 93% standard (10 of 123 breaches) 31 day subsequent treatment (surgery) 82.19% vs 94% standard (13 of 73 breaches) 62 day referral to treatment 83.93% vs 85% standard (27 of 168 breaches). Target was not achieved for WHCCG patients at UHS and HHFT. 62 day consultant decision to upgrade patient status 60% vs 86% local target (4 of 10 breaches). WHCCG reviews all 62 day pathways that do not meet the standard individually each month and there are currently two consistent themes: complex diagnostic pathways where there is an ultimately late referral process between two providers as the best course of action is agreed; and long diagnostic waits for urological patients at HHFT. The latter issue has been addressed by the allocation of central funding and the Trust are currently clearing the backlog ahead of the end of January. 104 day breaches there were 9 breaches reported for WHCCG patients in November, an increase on the average number received and of concern to the CCG. Of these, 4 relate to a complex diagnostic pathway, 2 relate to late referrals, 2 capacity issues and 1 other. In terms of tumour type, 4 lung, 2 urological (excluding testicular), 1 Skin, 1 Head and Neck, 1 Gynae 5

CCG Quality and Performance Points to Note (by exception) Diagnostics waiting times: Performance unusually deteriorated in November across the majority of providers. WHCCG did not achieve the 1% standard with 1.08% of patients waiting longer than 6 weeks. This was mainly due to UHS (52 breaches) and HHFT (42 breaches). HHFT has waits above 6 weeks in a range of diagnostic tests, the largest number of patients impacted are in Urodynamics (18) and MRI (10). Extra sessions are in place to deal with the backlog of patients, and an improvement is expected in January. UHS did not achieve the standard in November and are likely not to achieve in December, but an improvement is expected in January. The main pressures are in gastroscopy where there has been both an increase in demand and staff sickness, and the Trust is currently in process of recruiting an additional consultant. There remains pressure on cystoscopy capacity across all providers as a result of referral growth and increase in the number of both 2 week wait referrals and the numbers of patients requiring ongoing surveillance. Mixed sex accommodation: 12 breaches were reported for WHCCG patients in November 2017 against a threshold of 0 majority of which occurred at UHS (24) and HHFT (12). At HHFT, these were ICU patients who were well enough to be discharged from ICU, but no other beds were available. At UHS, the increase represents an improvement in reporting rather than an increase in actual numbers. Previously, the Trust were applying blanket exclusions to AMU, HASU and CCU etc; the WHCCG Quality Team actively working with Trust to legitimately reduce the numbers of breaches by ensuring that reporting remains in line with national guidance and system changes are put in place where required to make improvements for patients Clostridium difficile: 12 incidents were reported at CCG level in November against a threshold of 10. The CCG is exceeding the YTD trajectory with 102 cases v 92 trajectory. Dementia diagnosis: The CCG s diagnosis rate in December is 62.1%; this is below the monthly recovery trajectory of 65.54% and below the national standard of 66.7%. Detailed discussions have taken place with all localities, and practices, as well as the national team and recovery against the standard is expected by March 2019. 6

Detailed summary : HHFT and UHS A&E 4 hour performance December 2017 Tables 1 and 2 show both the performance against the 95% standard each month in this year, and last year; and the number of attendances for our 2 main providers, UHS and HHFT: UHS Type 1: Performance has deteriorated to 83.27% against the 92% standard, a further fall from 90.53% in November Attendances have increased by 3.86% in 17/18 year to date (YTD) HHFT Type 1: Performance has deteriorated significantly in the last 2 months. December performance was 74.87%, a significant deterioration on November performance of 80.69%. Attendances have increased by 1.87% in 17/18 YTD. 7

Detailed summary WHCCG Providers Performance; RTT (all providers) November 2017 Table 1 RTT performance at all providers, for WHCCG patients and Trust wide Table 1 shows performance for WHCCG patients at all of our providers against the 92% standard, as well as Trust wide performance for each provider. Four providers achieved the 92% target for WHCCG patients; including HHFT and Salisbury FT UHS and RBCH both did not achieve the standard for WHCCG patients, a continuation of the annual trend for these providers please refer to slide 10 and slide 15 for more detail. 8

Provider Performance: University Hospital Southampton Foundation Trust Description Target Reporting Level Sep-17 Oct-17 Nov-17 YTD Trend / Direction of Travel (arrows depict change compared to previous month or quarter) Unscheduled Care A&E 4 hour wait 95% Trust 93.34% 91.92% 90.53% 89.30% 12 Hour Trolley Waits (revised at month end in line with UNIFY return) 0 CCG 0 0 1 1 Unplanned re-attendance rate at A&E within 7 days of original attendance 5% CCG 5.93% 5.74% 5.53% 5.80% Total time spent in A&E department - 95th percentile 240 CCG 266 293 313 359 Left department without being seen rate 5% CCG 2.00% 2.94% 2.74% 2.67% Time to initial assessment - 95th centile 15 CCG 67 63 85 68 Time to treatment in department - median 60 CCG 55 59 59 78 Planned Care 18 weeks referral to treatment times - incompletes 92% CCG 89.95% 88.52% 88.92% 88.92% Number of patients waiting longer than 52 weeks 0 CCG 2 3 1 1 Diagnostics <6 week waits 99% CCG 98.83% 98.85% 98.05% 98.05% Cancer: All 2 week waits (urgent) 93% CCG 92.51% 93.98% 90.87% 93.57% Cancer: 2 week breast symptoms (cancer not initially suspected) 93% CCG 93.33% 100.00% 59.09% 80.43% Cancer: 31 days diagnosis to treatment 96% CCG 98.59% 96.89% 94.77% 97.95% Cancer: 31 days subsequent treatment - surgery 94% CCG 92.16% 91.07% 76.79% 94.65% Cancer: 31 days subsequent treatment - Chemo/Drug 98% CCG 100.00% 100.00% 100.00% 100.00% Cancer: 31 days subsequent treatment - radiotherapy 94% CCG 100.00% 100.00% 98.67% 100.00% Cancer: 62 days urgent referral to treatment 85% CCG 89.31% 86.19% 84.18% 87.08% Cancer: 62 days urgent RTT (104 day waits) 0 CCG 1 3 9 29 Cancer: 62 days screening referral 90% CCG 91.67% 88.24% 100.00% 93.75% Cancer: 62 days consultant decision to upgrade 86% CCG 90.00% 100.00% 50.00% 91.67% Patients not seen within 28 days of cancelled operation 0% Trus t 7.61% 6.61% Cancelled Operations for the 2nd time 0 Trus t 0 0 0 0 Quality Mixed Sex Accommodation 0 CCG 0 6 24 30 Clostridium difficile 43 Trus t 3 1 1 25 MRSA bacteraemia 0 Trus t 0 0 0 1 9

University Hospital Southampton Foundation Trust (by exception) Points to note Referral to treatment within eighteen weeks incomplete pathways: UHSFT did not achieve the 92% standard for incomplete pathways at CCG level in November with 88.92% of patients waiting less than 18 weeks, a slight improvement on previous month. UHS did not achieve the 92% standard at trust-wide level in November with 88.34%, main specialty issues being T&O, Urology, Neurology and ENT. Commissioners remain concerned about the continued non-delivery of the 92% standard at the Trust, and continue to work with the Trust to develop plans and actions to address areas of high demand and low performance. Recent guidance from NHSE outlines need for providers to reduce their elective activity to deal with the non-elective demand. The impact of this on the waiting list and backlog will be quantified over the next month in order to agree whether additional action is required to improve waiting times. Diagnostic six week waits: UHSFT did not achieve the standard at CCG level in November. 98.05% patients waited less than six weeks for diagnostic tests; therefore 1.95% (52 patients) waited longer than six weeks compared to the 1% standard. The majority of the breaches occurred in Gastroscopy, Cystoscopy, Colonoscopy and Urodynamics. The Trust have advised that they are likely to miss the target in December but anticipate meeting the standard in January 2018. There has been a combination of factors which have reduced capacity within endoscopy service s; including staff sickness and a shortage of equipment; however an additional consultant has been recruited and equipment purchased to deal with the increase in demand. Accident and emergency: UHSFT did not meet the 95% standard at Trust level in December, deteriorating to 83.27% (compared to 90.53% in November). Both attendances and breaches at the main ED department are higher than last year to date. A full recovery plan, underpinned by a Contract Notice, is in place across CCGs. Cancer waiting times: Monthly UHSFT only met three of the nine standards for WH CCG patients in November 2017. The two key areas which caused this include breast cancer (where cancer is not initially suspected) - an additional consultant has been appointed and started work; and Urology, where there is an increase in urology referrals which has impacted on 2 week wait, 31 day s and 62 days cancer performance; the Trust is currently recruiting an additional Urology Consultant. Standards not achieved as follows: 2 week waits for all cancers (urgent) 90.87% vs 93% standard (72 of 789 patients breached the standard) 2 week waits for breast symptoms (cancer not initially suspected) 59.09% vs 93% standard (9 of 22 patients breached) 31 day first definitive treatment 94.77% vs 96% standard (8 of 153) 31 day subsequent treatment (surgery) 76.79% vs 94% (13 of 56) 62 day referral to treatment 84.18% vs 85% standard (12.5 of 79 breaches). UHS did not achieve standard at trust-wide level with 84.54%. 62 day consultant decision to upgrade patient s status 50% vs 86% local target (2.5 of 5 breaches). Cancelled operations: 7.6% of patients whose operation was cancelled were not offered a binding date within 28 days in Quarter 1 17/18, compared to the 0% standard. This equates to 15 of 197 patients not meeting the standard. Mixed Sex Accommodation: 49 breaches reported in November 2017 against a zero tolerance threshold. The increase in numbers are due to a change in reporting. Clostridium difficile: 12 reportable cases recorded (Trust-wide) in November against a threshold of 10. 102 reportable cases recorded YTD against a threshold of 92. 10

Provider Performance: Hampshire Hospitals Foundation Trust Description Target Reporting Level Sep-17 Oct-17 Nov-17 YTD Trend / Direction of Travel (arrows depict change compared to previous month or quarter) Unscheduled Care A&E 4 hour wait 95% Trust 93.34% 91.92% 80.69% 88.85% 12 Hour Trolley Waits (revised at month end in line with UNIFY return) 0 CCG 0 0 1 1 Unplanned re-attendance rate at A&E within 7 days or original attendance 5% CCG 8.35% 8.16% 8.53% 8.56% Total time spent in A&E department - 95th percentile 240 CCG 358 302 375 285 Left department without being seen rate 5% CCG 2.53% 0.53% 0.39% 2.37% Time to initial assessment - 95th centile 15 CCG 40 36 41 29 Time to treatment in department - median 60 CCG 58 63 69 60 Planned Care 18 weeks referral to treatment times - incompletes 92% CCG 93.07% 93.40% 93.78% 93.78% Number of patients waiting longer than 52 weeks 0 CCG 0 0 0 0 Diagnostics <6 week waits 99% CCG 99.27% 99.17% 98.87% 98.87% Cancer: All 2 week waits (urgent) 93% CCG 97.69% 98.11% 95.89% 96.99% Cancer: 2 week breast symptoms (cancer not initially suspected) 93% CCG 100.00% 98.00% 98.75% 96.29% Cancer: 31 days diagnosis to treatment 96% CCG 100.00% 98.89% 99.06% 98.97% Cancer: 31 days subsequent treatment - surgery 94% CCG 95.83% 94.44% 100.00% 97.73% Cancer: 31 days subsequent treatment - Chemo/Drug 98% CCG 100.00% 100.00% 100.00% 100.00% Cancer: 31 days subsequent treatment - radiotherapy 94% CCG 100.00% 100.00% 100.00% 89.13% Cancer: 62 days urgent referral to treatment 85% CCG 84.16% 75.79% 81.89% 85.35% Cancer: 62 days urgent RTT (104 day waits) 0 CCG 1 4 2 11 Cancer: 62 days screening referral 90% CCG 100.00% 88.89% 100.00% 98.54% Cancer: 62 days consultant decision to upgrade 86% CCG 100.00% 84.62% 57.14% 82.69% Patients not seen within 28 days of cancelled operation 0% Trus t 12.90% 10.17% Cancelled Operations for the 2nd time 0 Trus t 0 0 0 0 Quality Mixed Sex Accommodation 0 CCG 7 10 12 48 Clostridium difficile 11 Trus t 2 1 2 15 MRSA bacteraemia 0 Trus t 0 0 0 0 11

Hampshire Hospitals Foundation Trust (by exception) - Points To Note Referral to treatment within eighteen weeks incomplete pathways: HHFT achieved the 92% standard for incomplete pathways in November at CCG level, with 93.78% waiting less than 18 weeks. HHFT have achieved the RTT incomplete standard since June 2016, currently at 92.64%. At HHFT the majority of specialities continue to perform to 92% with the exception of Trauma & Orthopaedics, Ophthalmology, Dermatology and Neurology. Diagnostic six week waits: HHFT did not achieve the standard at CCG level in November. 98.86% patients waited less than six weeks for diagnostic tests, therefore 1.14% (42 patients) waited longer than six weeks, compared to the 1% standard. The highest number of breaches were recorded in Urodynamics (18) and MRI (10), however the Trust has put in place additional sessions, and engaged a locum consultant to treat the backlog of patients and ensure the Trust meets the 6 week standard by January 2018. Accident and emergency: HHFT did not achieve the 95% standard at Trust level in December with 74.87%, a significant deterioration on November s performance of 80.69%. The STF trajectory of 92% was not met. Performance at HHFT has been under pressure over the last 3 months, although attendances have remained static. There has been particular pressure in managing flow throughout the hospital, and in ensuring that there are not overnight breaches on both sites. A trust recovery plan has been agreed by both main commissioners, and there is recognition a full system plan is required, as factors impacting performance are not just internal to the Trust. Daily resilience is being actively monitored and managed via Resilience Working Group and Local A&E Delivery Group. A winter action programme during the week 8-14 th January did lead to significant improvements in performance which the local system is seeking to maintain The pressures on A&E impacted upon ambulance handover rates at HHFT, which were the second highest regionally during December. Further information is provided in the Integrated Performance Report Cancer waiting times: Monthly HHFT met seven of the nine cancer standards for WHCCG patients in November 2017. The standards not achieved are as follows: 62 day referral to treatment 81.89% vs 85% standard (11.5 of 63.5 breaches). Monthly meetings have been established to specifically review urology breaches, and take actions to minimise delays. 62 day consultant decision to upgrade patient s status 57.14% vs 86% local target (1.5 of 3.5 breaches). Cancelled operations: 12.9% of patients whose operation was cancelled were not offered a binding date within 28 days in Quarter 2 17/18, compared to the 0% standard. This equates to 8 of 62 patients breaching the standard. Mixed sex accommodation: 12 breaches for WHCCG patients were reported in November against a threshold of 0. These were ICU patients who were well enough to be discharged from ICU, but no other beds were available. The CCG has a total of 36 cases YTD. Clostridium difficile: 1 reportable case recorded (Trust-wide) in November against a threshold of 3 cases. 25 reportable cases recorded YTD against a threshold of 29. MRSA 0 cases were reported for November against a threshold of 0. 0 cases YTD reported against a threshold of 0. 12

Provider Performance: Royal Bournemouth & Christchurch Hospitals FT Description Target Reporting Level Sep-17 Oct-17 Nov-17 YTD Unscheduled Care Trend / Direction of Travel (arrows depict change compared to previous month or quarter) A&E 4 hour wait 95% Trust 94.47% 93.96% 95.04% 92.97% 12 Hour Trolley Waits (revised at month end in line with UNIFY return) 0 CCG 0 0 0 0 Unplanned re-attendance rate at A&E within 7 days or original attendance 5% CCG 5.23% 5.95% 5.29% 5.11% Total time spent in A&E department - 95th percentile 240 CCG 547 523 495 635 Left department without being seen rate 5% CCG 2.31% 1.67% 1.96% 2.32% Time to initial assessment - 95th centile 15 CCG 3 18 15 Time to treatment in department - median 60 CCG 73 62 62 67 Planned Care 18 weeks referral to treatment times - incompletes 92% CCG 90.81% 90.22% 90.95% 90.95% Number of patients waiting longer than 52 weeks 0 CCG 0 0 0 0 Diagnostics <6 week waits 99% CCG 100.00% 99.74% 100.00% 100.00% Cancer: All 2 week waits (urgent) 93% CCG 99.42% 97.16% 97.91% 97.68% Cancer: 2 week breast symptoms (cancer not initially suspected) 93% CCG 100.00% 100.00% 100.00% 100.00% Cancer: 31 days diagnosis to treatment 96% CCG 96.88% 97.37% 100.00% 97.45% Cancer: 31 days subsequent treatment - surgery 94% CCG 100.00% 100.00% 100.00% 100.00% Cancer: 31 days subsequent treatment - Chemo/Drug 98% CCG 100.00% 100.00% 100.00% 100.00% Cancer: 31 days subsequent treatment - radiotherapy 94% CCG Cancer: 62 days urgent referral to treatment 85% CCG 88.10% 86.05% 93.75% 87.95% Cancer: 62 days urgent RTT (104 day waits) 0 CCG 1 0 0 1 Cancer: 62 days screening referral 90% CCG 0.00% 100.00% 100.00% 100.00% Cancer: 62 days consultant decision to upgrade 86% CCG 0.00% 100.00% 100.00% 50.00% Patients not seen within 28 days of cancelled operation 0% Trus t 3.75% 0.00% 0.00% 2.03% Cancelled Operations for the 2nd time 0 Trus t 0 0 0 0 Quality Mixed Sex Accommodation 0 CCG 0 0 0 0 Clostridium difficile 14 Trus t 1 6 2 20 MRSA bacteraemia 0 Trus t 0 0 0 0 13

Royal Bournemouth and Christchurch Hospitals NHS Foundation Trust - Points To Note Referral to treatment within eighteen weeks incomplete pathways: RBCHFT did not achieve the 92% standard for incomplete pathways in November at CCG level with 90.95%. At trust-wide level, RBCHFT have not achieved standard for four consecutive months from August to November with 89.92%. The Trust is reporting backlog increases and capacity issues, with medical staffing gaps in Urology and ENT. The MSK service started in October which has had a significant impact on performance, and is being discussed with other commissioners to ascertain if additional funding is required The national guidance to reduce elective patients treated in January has impacted on the backlog; and a review is being completed to understand the full impact of cancellations, and whether any further elective outsourcing is required, by the end of January. Diagnostic six week waits: RBCHFT achieved the diagnostics standard at CCG level in November. 100% of patients waited less than six weeks for diagnostic tests. Accident and emergency: RBCHFT did not achieve the 95% standard at trust level in December with 84.71%. The percentage of patients (Trust-wide) seen within four hours declined from 95.04% in November. The monthly STF trajectory of 91.05% was not achieved in December. Cancer waiting times: Monthly: RBCHFT met all seven of the cancer standards applicable to WHCCG patients in November 2017. Cancelled operations: Performance for cancelled operations rebooked within 28 days for Quarter 2 17/18 was 3.8% (3 of 80 patients), against the 0% standard of being offered a binding date within 28 days of cancellation. Mixed sex accommodation: 0 breaches reported for WHCCG patients in November against a threshold of 0. Zero cases YTD. Clostridium difficile: 2 reportable cases recorded Trust-wide in November. 20 reportable cases recorded YTD against an annual threshold of 9. MRSA: 0 cases were reported Trust-wide in November against a threshold of 0. There have been zero cases YTD against a threshold of 0. 14

Provider Performance: Salisbury NHS Foundation Trust Description Target Reporting Level Sep-17 Oct-17 Nov-17 YTD Trend / Direction of Travel (arrows depict change compared to previous month or quarter) Unscheduled Care A&E 4 hour wait 95% Trust 91.67% 95.03% 95.08% 93.47% 12 Hour Trolley Waits (revised at month end in line with UNIFY return) 0 CCG 0 0 Unplanned re-attendance rate at A&E within 7 days or original attendance 5% CCG 6.27% 5.75% 4.72% 4.92% Total time spent in A&E department - 95th percentile 240 CCG 330 241 262 297 Left department without being seen rate 5% CCG 0.54% 1.15% 1.99% 1.49% Time to initial assessment - 95th centile 15 CCG 87 29 29 87 Time to treatment in department - median 60 CCG 56 54 63 60 Planned Care 18 weeks referral to treatment times - incompletes 92% CCG 93.33% 94.01% 93.83% 93.83% Number of patients waiting longer than 52 weeks 0 CCG 0 0 0 0 Diagnostics <6 week waits 99% CCG 99.66% 98.95% 99.64% 99.64% Cancer: All 2 week waits (urgent) 93% CCG 95.74% 97.33% 100.00% 96.32% Cancer: 2 week breast symptoms (cancer not initially suspected) 93% CCG 100.00% 95.65% 100.00% 96.19% Cancer: 31 days diagnosis to treatment 96% CCG 100.00% 100.00% 100.00% 97.59% Cancer: 31 days subsequent treatment - surgery 94% CCG 100.00% 100.00% 100.00% 92.86% Cancer: 31 days subsequent treatment - Chemo/Drug 98% CCG 0.00% 0.00% 100.00% 100.00% Cancer: 31 days subsequent treatment - radiotherapy 94% CCG Cancer: 62 days urgent referral to treatment 85% CCG 87.50% 80.00% 100.00% 91.67% Cancer: 62 days urgent RTT (104 day waits) 0 CCG 0 0 0 0 Cancer: 62 days screening referral 90% CCG 100.00% Cancer: 62 days consultant decision to upgrade 86% CCG 0.00% 50.00% 100.00% 86.67% Patients not seen within 28 days of cancelled operation 0% Trus t 0.00% 0.00% 0.00% 0.97% Cancelled Operations for the 2nd time 0 Trus t 0 0 0 0 Quality Mixed Sex Accommodation 0 CCG 0 0 0 0 Clostridium difficile 19 Trus t 1 1 2 5 MRSA bacteraemia 0 Trus t 0 0 0 0 15

Salisbury NHS Foundation Trust (SFT) - Points To Note Referral to treatment within eighteen weeks incomplete pathways: SFT achieved the 92% standard for incomplete pathways in November at CCG level with 93.83%. SFT achieved the standard at trust-wide level in November with 92.17%. Diagnostic six week waits: SFT achieved the diagnostic standard at CCG level in November with 99.64% of patients receiving diagnostic tests within six weeks. Therefore 0.36% (1 patient) waited longer than six weeks compared to the 1% standard. At trust-wide level, SFT achieved the standard in November with 99.11%. Accident and emergency: SFT did not achieve the 95% standard at trust level in December with performance of 88.4%. Commissioners continue to work with Wiltshire Local A&E Delivery Board to address improvements in line with the A&E Action Plan. Cancer waiting times: Monthly: SFT met all five cancer standards applicable for WHCCG patients in November 2017. Cancelled operations: SFT achieved the standard for cancelled operations not rebooked within 28 days (0%) in Quarter 2 17/18. Mixed sex accommodation: 0 breaches were reported for WHCCG patients in November against a threshold of 0. Clostridium difficile: 2 reportable cases were recorded in November against a threshold of 2. Only 5 cases reported year to date against threshold of 13. MRSA: 0 cases were reported in November against a threshold of 0. There have been zero cases year to date 16

Provider Performance: Southern Health NHS Foundation Trust Description Learning Disabilities Reporting Level Target Sep-17 Oct-17 Nov-17 % CPA 12 Month Review CCG 95% 100.0% 100.0% 100.0% 100.0% 2.00 % of Referrals receiving first treatment within 7 weeks CCG 90% 96.0% 100.0% 100.0% 99.2% 2.00 Did not attend % CCG 12% 5.2% 6.5% 7.0% 6.4% 3.00 Adult Mental Health % delayed discharge days of total occupied bed days Trust 7.5% 10.3% 10.2% 8.5% 10.6% 1.00 Care Programme Approach (CPA)* CCG 95% 100.0% 96.0% 96.0% 98.2% 2.00 % CPA 12 Month Review CCG 95% 98.7% 98.1% 98.1% 98.9% 2.00 % Bed Occupancy Trust N/A % of Referrals receiving first treatment within 7 weeks CCG 90% 91.8% 94.5% 94.1% 93.4% 1.00 Did not attend % CCG 12% 10.1% 9.9% 9.7% 9.9% 1.00 Older Peoples Mental Health % delayed discharge days of total occupied bed days Trust 7.5% 13.5% 20.6% 14.6% 22.2% 1.00 Care Programme Approach (CPA)* CCG 95% 100.0% 100.0% 100.0% 100.0% 1.00 % CPA 12 Month Review CCG 95% 100.0% 100.0% 100.0% 99.9% 2.00 % Bed Occupancy Trust N/A % of Referrals receiving first treatment within 7 weeks CCG 90% 88.9% 93.8% 92.9% 92.1% 1.00 Did not attend % CCG 12.0% 6.3% 6.7% 7.2% 6.4% 3.00 IAPT 17/18 YTD Trend / Direction of Travel (arrows depict change compared to previous month or quarter) * The proportion of people under adult mental illness specialties on CPA who were followed up within 7 days of discharge from psychiatric in-patient care during the period 17

Southern Health Foundation Trust (SHFT) - Points To Note Referral to treatment within eighteen weeks incomplete pathways: SHFT achieved the standard for incomplete pathways in November at CCG level. Performance was 92.57% vs the 92% standard. The CCG has been working with SHFT to review waiting list management processes for a number of pathways, and SHFT have shared an action plan with the CCG setting out it plans to improve its core waiting list management processes and training. This remains under review by both parties and is not yet agreed In addition we are working to ensure that SHFT deliver the locally agreed waiting time standard of 6 weeks for MSK triage services, in order to contribute to maintaining an overall 18 week RTT standard for all T and O services. Adult Mental Health Services The proportion of people under the Care Programme Approach (CPA) who were followed up within seven days of discharge from psychiatric in-patient care during the period was 100% in October compared to the standard of 95%. The % delayed discharge days of total occupied was 8.5% in November vs the 7.5% standard. The % of referrals receiving first treatment within 7 weeks was 92.9% in November vs the 90% standard. Older People s Mental Health: The proportion of people under the CPA who were followed up within seven days of discharge from psychiatric in-patient care during the period was 100% in October compared to the standard of 95%. 18

Provider Performance: South Central Ambulance Service (SCAS) Ambulance response times New ambulance response time metrics were introduced from 1 November 2017, as previously discussed This shows that SCAS are performing very well against the new Category 1 to 4 measures Category 1 measures the response time for patients with life threatening calls and requires a mean response time of 7 minutes; and a 90 th Percentile of 15 minutes. WHCCG achieved all new standards with the exception of the mean target for category 1 with patients waiting a mean of 7 minutes 48 seconds Category Cat 1 Cat 1 Cat 2 Cat 2 Cat 3 Cat 4 Month to Date: November 2017 Mean 90th Percentile Ambulance handover delays (based on 2017-18 NHS England Winter Daily SitReps (6 week period) Portsmouth Hospitals Trust and HHFT have the highest two rates of ambulance handover delays of over an hour for the South Region, The percentage of ambulances delayed over 30 minutes, by week, for our local providers are set out in the table below PHT had by far the highest rates, reaching 42.63% in the week commencing 25/12/17 PHT and HHFT were the only providers that had a rate exceeding 10% in any of the six weeks There is a programme of work being led by the South West A&E Delivery Board to reduce further ambulance queues in order to improve performance response times; a detailed briefing is provided in the Integrated Performance Report. Mean 90th Percentile 90th Percentile 90th Percentile WEST HAMPSHIRE CCG 00:07:48 00:14:08 00:16:22 00:31:42 01:39:37 02:39:12 SCAS Total 00:07:16 00:13:01 00:14:40 00:28:29 01:50:07 02:54:06 19

Provider Performance: 111 / OOH NHS 111: Calls answered in 60 seconds did not deliver against national standard in December, at 70.69% against a target of 95%. However, it should be noted that the number of calls received in December increased by 32% in month to 61,667 (compared to 46,625 in November), and this was felt to have positively impacted on overall demand for services across the health system Out of Hours (PHL) - call back/triage response times: Two of the four National Quality Requirement (NQR12) 95% standards were met at WHCCG level in November, the standards not met being were: Home visit (Urgent) SLA <120 minutes: 87.4% vs 95% standard. Home visit (Routine) SLA <360 minutes: 93.46% vs 95% standard. Face to face appointment performance remains good, with all standards being compliant with the exception of urgent home visiting where performance has deteriorated compared to previous month. Challenges remain in one and two hour definitive clinical assessment (telephone) performance. Commissioners are in the process of agreeing a contractual Remedial Action Plan for these two standards with a trajectory for compliant performance by September 2017. Provider Area Metric 111 Reporting Level Target Apr-17 May-17 Jun-17 Jul-17 Aug-17 Sep-17 Oct-17 Nov-17 Dec-17 Calls Overview Total Calls offered SHP N/A 51885 49728 44311 47928 44716 42723 45600 46625 61667 435183 Total number of answered calls within 60 seconds as a % of total SHP >=95% 89.01% 89.32% 90.87% 87.60% 91.49% 94.51% 96.16% 93.34% 70.69% 89.22% Call abandoned after 30 seconds SHP <5% 1.46% 1.15% 1.10% 1.68% 0.83% 0.48% 0.37% 0.68% 5.71% 1.50% Warm Trans fers Total Calls To Clinicians (%) SHP 30% YTD 17/18 OOH Call to final disposition NQR12 Clinician Warm Transfers SHP 85% 95.44% 96.50% 95.33% 95.86% 93.87% 92.51% 91.89% 92.17% 93.53% 94.12% Total calls dealt with in OOH (PHL) - Home Visit CCG N/A 2411 2101 1688 1879 1947 2098 1815 1784 2279 18002 Home visit (for West Hampshire) as a percentage (of Urgent and Routine) CCG N/A 14.3% 14.4% 14.2% 13.6% 15.6% 14.9% 13.9% 13.5% 14.3% Total calls dealt with in OOH (PHL) - Base Visit CCG N/A 5692 4576 3436 3752 3949 3727 3678 3588 4598 36996 Base visits for West Hampshire as percentage of total base visits CCG N/A 31.3% 29.5% 27.2% 25.6% 29.0% 27.0% 25.8% 27.2% 27.8% Total calls dealt with in Out of Hours (PHL) - Telephone CCG N/A 8992 8236 7397 8745 6949 7164 8082 8112 11738 75415 Telephone calls for West Hampshire as a percentage of total calls CCG N/A 47.4% 49.6% 51.0% 54.2% 47.3% 50.2% 53.0% 51.9% 50.6% Primary Care Centre (Emergency) - SLA < 60 minutes CCG 95% 100.0% 100.0% 100.0% 100.00% Primary Care Centre (Urgent) - SLA < 120 minutes CCG 95% 95.74% 94.12% 100.00% 94.3% 100.0% 85.71% 96.00% 97.37% 95.40% Primary Care Centre (Routine) - SLA <360 minutes CCG 95% 99.14% 98.82% 99.83% 97.73% 99.76% 98.29% 98.20% 97.87% 98.71% Home Visit (Emergency) - SLA < 60 minutes CCG 95% 100.0% 100.0% 100.0% 100.00% Home Visit (Urgent) - SLA < 120 minutes CCG 95% 96.36% 91.74% 90.55% 90.63% 88.15% 86.45% 90.00% 87.40% 90.16% Homes Visit (Routine) - SLA < 360 minutes CCG 95% 94.67% 94.43% 95.18% 94.79% 92.30% 91.89% 93.44% 93.46% 93.77% 20