SUMMARY REPORT. Board of Directors Date of meeting: 1 May P a g e

SUMMARY REPORT Board of Directors Date of meeting: 1 May 2018 Subject Prepared by Approved by Presented by Safe Staffing Report Nursing and Midwifery Eileen Aylott Assistant Director of Nursing, Workforce Gill Hunt Director of Nursing Gill Hunt Director of Nursing Name of meeting considered/approved by Purpose: The purpose of this report is: 1. To provide assurance to the Board in relation to nursing and midwifery safe staffing levels for the month of March 2018. 2. To provide context in relation to the UNIFY safe staffing submission for the month of March 2018. Decision Approval Information Assurance Executive Summary South Tees Hospitals NHS Foundation Trust is committed to ensuring that levels of nursing staff, which includes Nurses (RN), Midwives (RM) and Health Care Support Workers (HCSW), matches the acuity and dependency needs of patients within the organisation. To ensure there is an appropriate level and skill mix of staff to provide safe and effective high quality care. The requirement to publish nursing and midwifery staffing levels on a monthly basis is explicit and is one of the ten expectations specified by the National Quality Board (2013). The fill rate against planned rosters for the month of May at an overall level was: RN / RM day shift 91%, night shift 94% HCSW day shift 93%, night shift 109% A total of 149 red flags were reported during March, which is a reduction from February s report. These are investigated by Clinical Matrons prior to the morning SafeCare meeting on a daily basis. The predominant themes are a shortfall in RN hours and opening of red and amber beds. The introduction of SafeCare as a tool to both report and capture red flags means action can be taken in real time with senior staff able to support ward teams. The Board are asked to note the content of the report and to be assured that staffing levels are sufficient to deliver safe, high quality care with systems and processes in place should staffing levels fall short of those planned. 1 P a g e

Nursing and Midwifery Monthly Staffing Report, April 2018 Eileen Aylott, Assistant Director of Nursing Anita Robinson, E-Rostering Lead April 2018 (data from March 2018) 2 P a g e

Safe Staffing Levels March 2018 Executive Summary The purpose of this report is: 3. To provide assurance to the Board in relation to nursing and midwifery safe staffing levels for the month of March 2018. 4. To provide context in relation to the UNIFY safe staffing submission for the month of March 2018. South Tees Hospitals NHS Foundation Trust is committed to ensuring that levels of nursing staff, which includes Nurses (RN), Midwives (RM) and Health Care Support Workers (HCSW), match the acuity and dependency needs of patients within the clinical areas of the Trust. This includes ensuring that there is an appropriate level and skill mix of staff to provide safe and effective and efficient care. The SafeCare module is now operational with daily review of safe staffing by Centre Associate Directors of Nursing (ADoN) and Clinical Matron s (CM) in hours and Patient Flow out of hours. Red flags and Clinical Judgement status are discussed and mitigated in real time. 1. UNIFY Safe Staffing Return The Trust s safer staffing submission to UNIFY for March 2018 was submitted on 16 th April 2018 with the summary of overall fill rate in the table below with the full report in Appendix 1. Table 1 Overall UNIFY Return fill Rate 2017/2018 2017/2018 rate - RN/RMs rate - RN/RMs rate for both RN and HCA has increased overall during March. April 92.7% 99.0% 95.3% 111.9% May 91.0% 97.4% 95.0% 109.5% June 91.5% 98.3% 93.5% 109.1% July 88.7% 97.4% 93.9% 111.0% August 87.2% 96.9% 92.1% 113.1% September 88.3% 100.3% 91.7% 113.9% October 88.7% 96.6% 93.1% 116.0% November 88.5% 95.1% 93.6% 109.6% December 87.1% 92.8% 92.6% 107.9% January 2018 90.7% 91.2% 93.0% 109.1% February 89.4% 89.2% 93.1% 107.4% March 91.1% 92.6% 94.2% 109.2% 3 P a g e

Centre Associate Directors of Nursing lead the twice daily SafeCare meetings Monday to Friday with Clinical Matrons providing weekend leadership in this area. Temporary staffing requirements are reviewed together with acuity, dependency and clinical judgement to ensure safe staffing levels. Specialist Nurses, Critical Care Outreach and Corporate Nurses have all supported wards with complex patients and those with higher acuity and dependency with both full and part shifts. Matrons provide oversight and assurance across their areas addressing red flags and supporting decision making. The following areas had an RN fill rate for days of less than 80%: Ward 6 were planning 5 RN for 24 beds but worked with 4 which is still within a safe staffing ratio of 1:8, CCU had a lower bed occupancy of 71%. Paediatric and Midwifery teams meet daily to review staffing across the floor and move staff accordingly. Unavailability is adjusted to meet the needs of the service with managers working clinically as required to maintain safe staffing. These areas are not currently on safecare and changes may not always be captured on the roster. Risks to wards with fill rates for RN Nights below 80% have been mitigated with unregistered staff. HCA day fill rates which fell below 80% were in areas with small numbers of staff where sickness and annual leave significantly affects percentages. 2. Temporary Staffing The number of temporary staffing hours requested increased slightly during March as did the fill rate to 77% (16% above the National ). Daily review of all shifts booked has taken place during the morning SafeCare meeting with ADoN s. 3. Red Flag Reporting A total of 149 red flags have been reported during March. These are investigated by Clinical Matrons prior to the morning SafeCare meeting on a daily basis and action to address taken. The predominant themes are a shortfall in RN hours (35), opening of amber beds (67) and Red beds (22). 4. Redeployed staff SafeCare gives the Trust the ability to redeploy staff from an area with excess hours to one which is short using the acuity and dependency calculation to support patient care and ensure effective use of resource. During the month of March 875.55 hours were redeployed across adult inpatient areas via SafeCare. Once the SNCT for children is available the paediatric areas will become visible on safecare and this will allow for full redeployed hours to be captured. 5. Band 5 Vacancy Rate and Recruitment Activity Band 5 vacancies remain static at approximately 35 (unfilled). The Student nurse advert closes at the end of April and currently has 75 applicants. 4 P a g e

OSCE examination dates have been planned for the first group of 5 Filipino nurses at the beginning of May with a second group of 5 planned to arrive in July. Two overseas nurses currently working within the Trust joined the OSCE preparation programme, passed their OSCE and are now working in RN posts. 6. Annual Safe Staffing reviews Adult inpatient ward Safe Staffing reviews will take place in April 2018 (January March Data) and October 2018 (July September data) to provide a winter and summer staffing overview. A full Accident and Emergency safe staffing review is planned for May 2018 in line with the recently published (NHSI, 2018) safe staffing publication, whilst a Paediatric staffing review is in the planning stage and will commence in line with the publication of the new Safer Nursing Care Tool for Children and Young People (SNCT). Neonatal staffing will be reviewed by the Head of Midwifery together with safe Midwifery Staffing as suggested by (NHSI, 2018) recent guidance as both services are interlinked. NHSI District Nursing safe staffing guidance has been published and the teams are currently planning a piece of work with Allocate Software to gather data for a review. Conclusion The Board is asked to receive and note the content of this report. Eileen Aylott, Assistant Director of Nursing, Workforce April 2018 5 P a g e

References Department of Health (2016) Operational productivity and performance in English NHS acute hospitals: Unwarranted variations. An independent report for the Department of Health by Lord Carter of Coles https://www.gov.uk/government/uploads/system/uploads/attachment_data/file/499229/operatio nal_productivity_a.pdf National Quality Board (2016) How to ensure the right people, with the right skills are in the right place at the right time. A guide to nursing, midwifery and care staffing capacity and capability. London Safe, sustainable and productive staffing in maternity services https://nhsicorporatesite.blob.core.windows.net/green/uploads/documents/safe_staffing_mater nity_final_2.pdf Safe, sustainable and productive staffing for neonatal care and children and young people's services https://nhsicorporatesite.blob.core.windows.net/green/uploads/documents/safe_staffing_neon atal_myljchm.pdf Safe, sustainable and productive staffing in urgent and emergency care https://nhsicorporatesite.blob.core.windows.net/green/uploads/documents/safe_staffing_urgen t_and_emergency_care.pdf 6 P a g e

Study Study Appendix 1 JCUH James Cook < 80 80-95 > 95 RN/RMs UEC Critical Care 10,042.67 9,112.83 2,603.17 1,547.50 10,042.02 8,880.00 1,116.00 744.00 90.7% 59.4% 88.4% 66.7% 13.50% 0.10% 5.60% 7.00% 0.30% 4.10% 30.7% 0.148 4.40% 1.70% 5.80% 26.7% UEC AMU JCUH 2,322.00 2,454.00 1,488.00 1,379.83 1,859.00 1,847.00 1,344.75 1,302.75 105.7% 92.7% 99.4% 96.9% 17.80% 0.20% 1.00% 3.80% 22.7% 13.20% 4.60% 4.60% 0.30% 1.10% 23.7% UEC RAFAU 2,495.75 2,231.25 1,473.30 1,486.47 1,109.50 1,061.50 1,488.00 1,332.00 89.4% 100.9% 95.7% 89.5% 14.00% 0.20% 3.40% 0.80% 1.70% 1.40% 21.5% 13.80% 5.20% 19.0% PL JC06 Gastro 1,426.17 1,074.33 1,782.75 1,237.75 713.00 713.00 713.08 816.48 75.3% 69.4% 100.0% 114.5% 11.00% 10.60% 7.50% 0.10% 4.10% 33.4% 17.20% 0.40% 8.80% 3.70% 30.1% COM JC09 (Ward 9) 1,847.33 1,499.33 1,488.00 1,400.67 1,488.00 1,104.00 1,108.00 1,144.00 81.2% 94.1% 74.2% 103.2% 15.00% 0.70% 2.90% 4.10% 4.90% 27.5% 21.40% 1.70% 3.00% 4.10% 0.60% 0.70% 31.4% COM Ward 12 General Medicine 1,646.63 1,384.32 1,483.95 1,700.07 1,116.00 960.00 960.00 1,343.00 84.1% 114.6% 86.0% 139.9% 11.20% 6.00% 8.10% 1.50% 3.00% 29.9% 16.20% 3.70% 4.30% 24.2% COM JC28 (Ward 28) 2,232.00 1,988.00 1,115.50 929.50 1,488.00 1,488.00 744.00 744.00 89.1% 83.3% 100.0% 100.0% 12.90% 0.10% 3.40% 4.70% 1.10% 1.00% 23.3% 11.20% 6.70% 13.30% 0.30% 31.5% UEC AAU JCUH 2,976.00 3,003.83 1,752.00 1,720.83 1,860.00 1,740.00 1,116.00 1,260.00 100.9% 98.2% 93.5% 112.9% 11.60% 2.30% 10.70% 1.40% 2.30% 1.90% 30.2% 14.30% 2.00% 4.30% 20.6% COM Ward 3 1,426.83 1,404.83 1,778.00 1,878.42 885.00 852.00 898.67 1,262.00 98.5% 105.6% 96.3% 140.4% 14.30% 3.50% 9.20% 5.30% 32.2% 14.30% 3.50% 9.20% 5.30% 32.2% COM Ward 10 1,327.25 1,241.42 743.50 1,179.50 1,116.00 755.00 744.00 1,000.67 93.5% 158.6% 67.7% 134.5% 20.00% 0.40% 17.00% 1.70% 39.1% 17.20% 0.50% 6.80% 0.60% 25.1% COM Ward 11 Elderly Care 1,858.47 1,733.80 1,275.23 1,615.90 1,116.00 984.00 744.00 1,571.47 93.3% 126.7% 88.2% 211.2% 16.40% 10.00% 2.70% 5.60% 0.70% 1.90% 37.4% 15.40% 21.50% 0.10% 37.0% PL PCAU 852.00 804.00 839.00 779.00 744.00 732.00 396.00 396.00 94.4% 92.8% 98.4% 100.0% 15.50% 3.00% 0.60% 8.40% 27.5% 11.00% 1.50% 10.70% 20.40% 0.10% 43.8% PL JC35 (Ward 35) 1,856.92 1,830.83 1,486.50 1,486.50 852.00 816.00 744.00 960.00 98.6% 100.0% 95.8% 129.0% 17.10% 0.60% 9.50% 0.90% 2.90% 30.9% 14.30% 3.80% 10.90% 0.50% 29.5% PL JC05 Vas 1,115.00 1,115.00 1,489.17 1,422.00 744.00 708.00 751.33 728.57 100.0% 95.5% 95.2% 97.0% 11.70% 0.40% 11.50% 11.50% 1.70% 2.70% 39.5% 16.20% 11.00% 7.70% 1.30% 0.50% 1.90% 38.6% PL Ward 7 Colo 1,861.00 1,685.67 1,860.50 1,537.17 1,116.00 984.00 1,115.00 1,103.00 90.6% 82.6% 88.2% 98.9% 16.70% 5.10% 2.60% 1.50% 3.60% 29.4% 14.40% 0.50% 10.50% 0.20% 25.5% SP JC04 (Ward 4) 1,647.75 1,424.08 1,116.00 940.17 1,120.50 1,013.00 740.92 740.92 86.4% 84.2% 90.4% 100.0% 0.13 4.70% 7.90% 0.40% 2.70% 28.7% 11.70% 7.40% 25.40% 44.4% SP JC14 Oncology (Ward 14) 1,866.08 1,553.42 1,117.83 1,111.83 1,103.00 1,090.83 743.00 755.00 83.2% 99.5% 98.9% 101.6% 15.50% 6.00% 10.60% 0.60% 3.40% 36.1% 14.40% 0.50% 7.40% 1.70% 0.30% 24.3% SP JC33 Specialty (merger of ward 1 1,577.50 1,303.00 1,402.50 1,394.67 1,116.00 1,092.00 744.00 804.17 82.6% 99.4% 97.8% 108.1% 16.80% 0.60% 0.80% 0.30% 4.00% 22.5% 10.80% 1.80% 1.00% 5.70% 2.80% 22.0% PL JC34 (Ward 34) 1,706.67 1,371.83 2,179.00 1,893.83 827.00 744.00 1,401.00 1,784.00 80.4% 86.9% 90.0% 127.3% 15.10% 7.30% 4.10% 1.50% 27.9% 14.30% 0.60% 4.80% 2.20% 21.8% PL Ward 25 Ortho Plan 1,072.50 999.50 1,069.00 1,015.50 712.00 712.50 395.50 402.50 93.2% 95.0% 100.1% 101.8% 14.70% 0.60% 1.70% 1.30% 2.30% 20.7% 17.70% 0.60% 0.30% 18.6% PL JC36 Trauma 1,857.97 1,826.47 1,495.73 1,592.82 1,116.00 1,104.00 1,010.00 1,334.50 98.3% 106.5% 98.9% 132.1% 12.30% 1.60% 4.00% 1.40% 1.40% 4.60% 25.3% 12.50% 2.20% 10.70% 0.80% 1.60% 27.9% SP Spinal Injuries 2,491.45 2,209.27 1,919.47 1,781.80 1,488.00 1,458.00 1,116.00 1,092.00 88.7% 92.8% 98.0% 97.8% 13.70% 4.50% 14.20% 1.00% 2.30% 35.7% 14.00% 8.30% 0.30% 22.6% SP Cardio MB 743.67 731.50 369.50 398.50 744.00 708.00 0.00 24.00 98.4% 107.8% 95.2% - 16.30% 11.50% 0.30% 28.2% 15.20% 0.50% 15.7% SP CCU JCUH 2,652.00 1,979.33 372.00 378.83 1,860.00 1,824.00 0.00 0.00 74.6% 101.8% 98.1% - 17.90% 1.10% 2.80% 3.40% 0.30% 1.10% 2.00% 28.7% 12.80% 1.30% 14.1% SP CICU JCUH 4,036.25 3,431.33 1,234.50 748.50 3,612.00 3,288.00 744.00 564.00 85.0% 60.6% 91.0% - 13.70% 0.80% 0.40% 11.60% 1.00% 2.30% 29.8% 16.90% 2.20% 0.90% 20.0% SP JC24 (Ward 24) 3,188.83 2,856.92 1,379.17 1,620.00 2,819.00 2,488.92 1,113.50 1,384.83 89.6% 117.5% 88.3% 124.4% 14.00% 4.00% 8.50% 1.20% 3.20% 30.8% 16.40% 2.40% 4.10% 3.20% 1.00% 27.1% SP JC27 Neuro 1,443.00 1,461.82 1,047.17 1,199.08 744.17 748.83 946.00 1,067.00 101.3% 114.5% 100.6% 112.8% 21.20% 4.70% 0.90% 2.10% 28.8% 22.30% 8.50% 1.30% 0.40% 32.3% SP JC26 (Ward 26) 1,131.50 963.50 797.00 1,381.50 743.00 731.00 372.00 833.83 85.2% 173.3% 98.4% 224.1% 17.20% 0.60% 5.50% 1.20% 24.6% 15.30% 2.30% 1.30% 14.20% 33.1% SP JC29 (Ward 29) 1,480.50 1,307.17 1,121.33 1,079.33 1,115.00 995.00 372.00 480.00 88.3% 96.3% 89.2% 129.0% 15.30% 0.40% 6.40% 7.30% 0.80% 2.90% 33.0% 15.10% 1.40% 4.70% 3.30% 2.20% 26.7% SP CADU 768.00 702.00 552.00 330.00 0.00 0.00 0.00 0.00 91.4% 59.8% - - 21.20% 1.30% 2.50% 2.50% 2.50% 30.1% 21.50% 21.5% SP JC31 (Ward 31) 1,929.23 1,788.07 1,214.87 1,133.03 1,115.83 1,115.83 742.67 742.67 92.7% 93.3% 100.0% 100.0% 16.80% 5.90% 1.00% 3.30% 27.0% 17.40% 7.00% 1.30% 3.10% 28.8% SP Cardio HDU 2,100.83 1,877.00 372.00 366.00 1,704.00 1,452.00 371.00 335.00 89.3% 98.4% 85.2% 90.3% 13.70% 0.70% 1.90% 6.40% 0.70% 0.00% 5.90% 29.4% 24.70% 4.90% 29.7% PL Ward 8 1,860.92 1,661.92 1,860.00 1,518.67 1,115.00 1,031.00 1,108.00 963.00 89.3% 81.6% 92.5% 86.9% 16.00% 0.60% 3.90% 2.30% 0.90% 5.90% 29.5% 15.60% 0.40% 5.10% 7.40% 1.70% 3.00% 33.2% COM JC21 (Ward 21) 2,232.00 2,209.00 744.00 522.50 2,232.00 1,908.00 372.00 348.00 99.0% 70.2% 85.5% 93.5% 16.60% 9.20% 2.60% 1.00% 2.10% 31.6% 18.40% 5.10% 0.90% 1.20% 25.6% COM JC22 (Ward 22) 1,116.00 1,100.00 573.00 539.50 1,008.00 945.00 108.00 132.00 98.6% 94.2% 93.8% 122.2% 13.90% 0.90% 3.60% 0.50% 3.40% 22.3% 18.00% 1.30% 19.3% COM JCDS (Central Delivery Suite) 3,874.83 3,807.08 1,005.50 723.50 4,089.17 3,707.00 739.50 708.00 98.3% 72.0% 90.7% 95.7% 14.20% 0.30% 4.70% 1.30% 3.50% 24.0% 15.50% 0.70% 6.70% 2.70% 25.6% COM Neonatal Unit 5,469.00 4,443.25 372.00 324.00 4,464.00 3,686.00 0.00 252.00 81.2% 87.1% 82.6% - 14.20% 0.10% 5.40% 5.40% 1.70% 1.60% 28.5% 28.80% 4.00% 0.50% 33.4% COM Maternity Assessment Unit 1,366.50 1,354.50 324.00 312.00 744.00 744.00 0.00 0.00 99.1% 96.3% 100.0% - 15.90% 5.10% 2.50% 1.50% 3.40% 28.5% 22.20% 8.50% 30.7% COM Paediatric Intensive Care Unit (PIC 1,853.50 1,559.50 229.50 169.00 1,860.00 1,584.00 0.00 0.00 84.1% 73.6% 85.2% - 16.70% 3.10% 6.10% 6.30% 3.40% 1.30% 36.9% 27.10% 27.1% COM Ward 17 JCUH 2,228.50 2,121.30 1,284.00 1,092.00 1,487.83 1,486.08 0.00 0.00 95.2% 85.0% 99.9% - 17.30% 0.50% 6.20% 2.00% 3.50% 29.5% 13.90% 10.00% 4.70% 3.40% 31.9% COM Ward 19 Ante Natal 1,257.00 1,015.25 232.50 140.50 742.83 694.83 0.00 0.00 80.8% - 93.5% - 17.80% 0.70% 4.80% 14.40% 2.50% 40.3% 33.50% 33.5% Site average 90.7% 95.6% 92.8% 115.1% RN/RMs 7 P a g e

Study Da Study Da Study Da Study Da Other A Parentin Sicknes Study D Unknow Workin g Other A Parentin Sicknes Study D Unknow Workin g Study Study FHN < 80 80-95 > 95 RN/RMs COM Ainderby FHN 1,419.00 1,146.75 1,069.50 914.28 713.00 682.50 710.00 722.83 80.8% 85.5% 95.7% 101.8% 13.80% 1.20% 5.90% 1.00% 1.00% 0.30% 23.2% 15.20% 8.40% 2.00% 2.90% 28.5% UEC Clinical Decisions Unit FHN 1,769.00 1,589.50 1,064.50 1,134.50 1,069.50 1,035.00 713.33 678.83 89.9% 106.6% 96.8% 95.2% 18.60% 8.00% 0.30% 2.10% 6.20% 35.1% 10.80% 3.40% 3.20% 0.60% 18.0% UEC FHICU (ICU FHN) 824.50 793.50 319.67 229.67 864.00 828.00 0.00 12.00 96.2% 71.8% 95.8% - 18.00% 0.70% 17.80% 1.10% 2.30% 40.0% 16.70% 16.7% COM Romanby FHN 1,165.08 1,066.92 1,304.50 1,115.50 713.00 713.00 713.00 678.50 91.6% 85.5% 100.0% 95.2% 16.70% 0.50% 0.50% 1.40% 1.80% 20.9% 13.80% 0.50% 4.90% 9.00% 1.00% 0.50% 29.7% COM Rutson FHN 1,167.45 984.83 1,546.48 1,253.98 712.00 712.00 713.00 713.00 84.4% 81.1% 100.0% 100.0% 16.10% 8.40% 2.70% 6.00% 33.2% 19.10% 4.20% 1.20% 1.30% 25.8% PL Allerton Ward FHN 1,489.00 1,318.75 1,116.00 1,074.47 744.00 744.00 744.00 696.00 88.6% 96.3% 100.0% 93.5% 17.50% 0.20% 4.40% 0.30% 4.80% 27.2% 13.50% 2.50% 0.90% 1.20% 18.1% PL Gara Orthopaedic FHN 813.50 801.50 795.47 630.97 713.00 701.67 357.17 358.17 98.5% 79.3% 98.4% 100.3% 28.10% 4.10% 1.10% 2.60% 0.30% 0.20% 36.4% 19.10% 16.80% 0.10% 0.30% 36.3% COM Maternity FHN 1,043.83 916.83 361.50 253.50 743.67 745.17 0.00 0.00 87.8% 70.1% 100.2% - 12.80% 15.50% 7.30% 1.10% 6.00% 42.7% 14.90% 2.40% 17.3% HCA RN/RMs HCA Site 89.7% 84.5% 98.4% 97.7% East Cleveland < 80 80-95 > 95 RN/RMs COM Tocketts Ward East Cleveland Hospital 1,836.40 1,488.90 1,810.25 1,513.25 1,072.17 1,002.50 1,070.17 1,174.33 81.1% 83.6% 93.5% 109.7% 14.30% 1.20% 5.20% 7.40% 1.60% 2.40% 32.0% 11.40% 0.90% 4.30% 6.40% 1.20% 5.30% 29.5% Site 81.1% 83.6% 93.5% 109.7% RN/RMs Redcar < 80 80-95 > 95 RN/RMs COM Zetland 1,588.08 1,349.58 2,172.15 1,989.78 1,069.50 966.00 1,069.17 1,264.00 85.0% 91.6% 90.3% 118.2% 19.10% 4.40% 4.20% 0.10% 7.70% 35.6% 15.30% 3.60% 9.60% 0.20% 0.60% 29.5% Site 85.0% 91.6% 90.3% 118.2% RN/RMs Friary Community Hospital < 80 80-95 > 95 RN/RMs COM Friary Community Hospital 1,109.50 958.75 992.00 956.17 620.75 600.75 310.00 310.00 86.4% 96.4% 96.8% 100.0% 17.70% 8.60% 0.60% 26.9% 16.50% 1.10% 0.50% 18.1% Site 86.4% 96.4% 96.8% 100.0% HCA RN/RMs 8 P a g e

< 80 80-95 > 95 RN/RMs RN/RMs fill Trust Community Care 89.2% 92.8% 91.4% 117.7% Planned Care 91.6% 89.3% 95.9% 108.1% Specialist 88.3% 99.9% 94.5% 118.8% Urgent and Emergency Care 95.5% 88.3% 94.9% 92.2% Trust 91.1% 92.6% 94.2% 109.2% 9 P a g e