Performance of the NHS provider sector for the quarter ... · Performance of the NHS provider...

Performance of the NHS provider sector for the quarter ended 30 September 2018

Contents


Overview at Q2 2018/19 2.3 Income analysis

Performance comparisons 2.4 Employee expenses – pay costs

1.0 Operational performance 2.5 NHS provider vacancies

1.1 Operational performance overview 2.6 Agency ceiling performance

1.2 Accident and emergency 2.7 Non-pay cost pressures

1.3 Diagnostic waiting times 2.8 Efficiency savings

1.4 Elective waiting times 2.9 Implied provider productivity

1.5 Cancer waiting times 2.10 Capital expenditure

1.6 Ambulance improvement programme 2.11 Q2 financial performance overview by integrated care system (ICS)

1.7 Infection control 2.12 Year-end financial position

1.8 Mental health (1) 3.0 Financial performance by provider

1.9 Mental health (2) 4.0 Operational performance by provider

1.10 Mental health (3) 5.0 Vacancy position by sector and region

1.11 Winter resilience preparations 2018/19 6.0 Organisation splits to calculate ICS financial performance

2.0 Financial performance 7.0 Timetable of future publications

2.1 Financial performance overview by sector &

region

End notes and glossary

2.2 Income & expenditure

Overview at Quarter 2, 2018/19 (1/6)

Introduction

As today’s NHS meets the challenge of a growing and ageing population, pressures on the service are greater than ever.

Demand for emergency admissions through an A&E department continues to break records and remains high ahead of winter. With the number of emergency admissions in Q2 2018/19 increasing on average by more than 940 per day compared to Q2 2017/18. This continues the upward trend of the last two years, when emergency admissions during Quarter 2 increased by 2.5% (from 2016/17 to 2017/18) and 5.9% (from 2017/18 to 2018/19) respectively.

Staff continue to work extremely hard to care for patients, including the 6.18 million people who came to accident and emergency(A&E) during Quarter 2 – 4.3% more than the same period last year. Overall, providers treated more emergency patients within the key operational standard (5.52 million patients in Q2 2018/19 compared with 5.34 million patients in Q2 2017/18), despite theextremely challenging environment. However, the enormous demand for services affected overall A&E performance, which declinedto 89.3% nationally compared with 90.1% in the same period last year. (1)

At the end of Quarter 1, the provider sector had a planned deficit for the year of £519 million. This is unaffordable. NHS Improvement and NHS England regional teams have worked with the most challenged health economies to help close the residual local planning gap. The work identified further opportunities for improvement in some organisations, bringing the planned deficit at Quarter 2 down to £439 million for the year end and £1,142 million for the quarter.

But against the revised plan for 2018/19, the provider sector reported a year-to-date deficit of £1,229 million in Quarter 2, which is £78 million worse than the same period last year and an £87 million negative variance against plan. This position is mainly due to a small proportion of providers whose position has significantly deteriorated: we expect their boards to take firm action to achieve their plans.

In preparation for winter, providers are working hard to cope with the expected surge in demand. While the NHS will benefit from a second year of enhanced, national winter planning, no-one underestimates the challenges this will present for hard-pressed frontline staff.

On 29 October, the Chancellor confirmed the funding settlement for the NHS in England for the next five years, beginning in April 2019. In return, the government has asked the NHS to produce a long-term plan by the autumn, setting out our ambitions for improvement over the next decade and our plans for achieving them over the five years of the funding settlement. Preparation of the long-term plan is enabling the NHS to build its response to the challenges and opportunities ahead. It is therefore crucial that boards take the necessary action to achieve the plans they signed up to this year as any shortfall in delivery during 2018/19 would have significant implications for the following year. Achieving plans in 2018/19 is an essential foundation for the longer-term sustainability of services.


1.The performance figures in this overview are total NHS performance figures as published by NHS England. Further information is available in the Winter Preparations

2018-19 board paper.


Despite intense pressure, NHS staff saw more people in under four hours than last year

Demand for hospital services continued to increase. There were over 1.15 million emergency admissions via A&E (type 1), 7.0% more than in the same period last year. A&E performance remains significantly below the NHS Constitution standard of 95%. Performance was 89.3%, which was worse than the previous quarter (89.9%) and Quarter 2 last year (91.1%). However, providers treated more emergency patients within the standard: they saw 5.52 million patients in under four hours compared with 5.34 million in the same period last year.

Total emergency admissions in the year to date from all sources – not just A&E – also increased by 5.9% from last year. This consists of a 10.5% increase in patients with zero days length of stay and a 2.5% increase in patients who remain in hospital one day or longer.

Freeing bed capacity means providers can better perform elective work and prepare for winter

Alongside rising demand, high levels of bed occupancy and delayed discharges affected providers’ ability to admit patients needing planned care.

Overall, providers made progress in reducing delayed discharges. There were just under 282,000 acute bed days – or 3,096 beds – lost to patients awaiting discharge who did not need an acute hospital bed. This is just over 62,000 fewer bed days delayed compared with the same period last year, equivalent to freeing over 682 beds to offset the continuing increase in emergency admissions that leads to very high occupancy levels.

To help tackle capacity constraints, there is a new national ambition to lower bed occupancy by reducing the number of long-stay patients (and long-stay bed days) in acute hospitals. Patients in hospital for more than three weeks occupy about one-fifth of beds. Many are older people who may deteriorate if they stay in hospital. The ambition is to reduce by 25% the number of long-stay patients (those in hospital for 21 days or more) by December 2018 from the 2017/18 baseline – equivalent to freeing over 4,800 beds. This will free capacity, beds and staff time, enabling more patients to be treated and improving the flow of those being admitted via A&E.

At 30 September 2018 we had already reduced the number of long-stay patients by the equivalent of nearly 2,470 beds (some of these beds will also be included in delayed discharge bed numbers above). While this is good progress, the ambition remains challenging. It is especially important we free much-needed capacity before winter.

We are learning from last winter and focusing on what we know will have the biggest impact on access and quality of care for patients. In Quarter 2, NHS 111 received 3.9 million calls, an increase of over 300,000 on the same period last year. September saw the highest ever proportion of NHS 111 calls triaged with clinical input – 53.1% – while the average during the quarter was over 50%. In addition, all ambulance providers have implemented new response standards.



Performance standards for planned care show mixed results

Patient care without admission accounts for 78% of planned hospital activity – this highlights that diagnostics and outpatient services have a significant effect on patients’ waiting-time experience. In aggregate, providers failed to meet the standard – that only 1% of patients should wait over six weeks – for all 15 key diagnostic tests: 2.67% waited more than six weeks.

More patients received treatment for cancer following an urgent GP referral for cancer treatment (41,300, an increase of 3,200 on the same quarter last year). Four of the eight cancer waiting-time standards that apply were not achieved. This falls short of the level patients should expect.

In September 2018, the NHS met the standard that patients experiencing a first episode of psychosis should be treated within twoweeks of referral to mental health services: 76.1% started treatment within two weeks (766 out of 1,007 patients).

Due to demand increasing above plan, the total waiting list for planned hospital care has continued to grow. At the end of September 2018, it stood at 4.3 million when including estimates for providers that did not submit data for the month, compared with 4.1 million in September 2017; 86.7% of patients waiting to start treatment had been waiting no longer than 18 weeks, compared with the standard of 92%. In the same period last year, performance was 89.1%. Yet providers started treatment within 18 weeks for more patients this year: 6.87 million compared with 6.86 million last year (published by NHS England).

Operational pressures continue to affect NHS finances

The provider sector reported a year-to-date deficit of £1.23 billion at Quarter 2, which is £78 million worse than the same period last year and an £87 million adverse variance to the plan. This includes the year-to-date distribution of £2.45 billion from the Provider Sustainability Fund (PSF). The PSF aims to encourage providers to provide sustainable, efficient, effective and economic care and is focused on achieving sustainability, accelerating financial recovery and improving urgent and emergency care.

Looking at the year to date variances after excluding PSF, 44 providers had adverse variances and 13 were over £5 million. Key factors cited by providers as contributing to adverse variances include slippage in planned efficiency savings, operational costpressures relating to temporary staffing and substantive workforce pressures, and a range of risks including the extent to which the Agenda for Change pay awards are fully funded. The reported deterioration among a small proportion of providers explains most ofthe overall deterioration in the provider sector. This requires focused and firm action by their boards – the whole NHS is under considerable pressure and it is clearly not appropriate for a few organisations to receive disproportionate financial support.



Work continues to identify further savings and incentives to close the planning gap and manage the financial risks to secure a

balanced financial position in 2018/19. Against the lower planned deficit of £439 million, the sector currently forecasts it will

overspend by £119 million. There are 44 providers that have improved their forecast end of year position excluding PSF by £112

million since Quarter 1 with the majority agreed in revised plans. But the overall position has moved adversely, with 36 providers

deteriorating their positions by £152 million. The majority of this is focused in a small number of providers, with nine providers

reporting forecast deteriorations of over £5 million. We are working through our regional teams to reduce this forecast overspend

as well as close the residual local planning gap.

Agency spend remains under control, but many vacancies are difficult to fill

Agency costs have steadily decreased since 2015 because of NHS Improvement’s initiatives and provider action. While agency

savings are non-recurrent and must be achieved each year, we expect providers to succeed again in controlling these costs, so

the ceiling for agency spend has reduced from £2.5 billion in 2017/18 to £2.2 billion in 2018/19. This in turn has reduced the

Quarter 2 ceiling to £1,115 million. Against this lower target, providers spent £1,208 million, a £93 million overspend – slightly up

on the £1,194 million reported for the same period in 2017/18.

The reduction in agency staff costs since 2015 is a considerable achievement in view of record demand and extreme pressure on

the acute sector. Following the changes in the last two years for nursing and medical agency staff, during 2018/19 the same rigour

and collaborative approach needs to be applied to managing all temporary staffing.

Our data indicates the scale of the workforce challenge facing providers. In addition to their 1.1 million whole-time equivalent staff,

providers have 103,000 vacancies. The decrease since Quarter 1 (4,600 whole-time equivalents) is a result of expected

substantive recruitment aligned with new graduate intakes during the quarter. However, the current vacancy position remains a

challenge, particularly in the nursing workforce. Every unfilled shift poses an operational challenge on the front line, so we are

supporting providers to improve the retention of staff and sharing best practice case studies as part of the focus on reducing

temporary staffing.



Providers made significant savings but below ambitious targets, so continued focus on productivity is critical

During 2017/18, providers’ cost improvement programmes saved £3.2 billion (3.7%) in highly challenging operating conditions. Planned efficiency savings for 2018/19 are set even higher, at £3.6 billion or 4.1% of total expenditure. Planned savings forQuarter 2 were £1,339 million (3.0%).

Savings achieved were £1,214 million (2.7%) which, although significant, were £125 million below the plan. Provider boards should decide now how to recover this position in Quarter 3, as the shortfall in cost improvements is a key factor in providers whose financial position has deteriorated.

Specific efficiency savings linked to workforce productivity, resource optimisation and benchmarking through the Model Hospital are estimated to be £713 million, forecast to rise to £1.9 billion by the year end. The Carter report identified a savings opportunity of £5.8 billion across specific work programmes. This work is for five years; in the first year, 2017/18, £1.4 billion was achieved and in the current year £1.9 billion is included in provider plans. The Getting It Right First Time (GIRFT) programme supports the search for efficiency and productivity gains by promoting a reduction in unwarranted clinical variation: £20 million of the PSF is earmarked for this work.

We continue to help providers maximise the benefit from efficiency savings, providing national and technical forums for sharing best practice.

Despite constrained capital funds, major improvements in patient facilities were approved

In preparation for winter, the government issued £145 million of capital funding to help several providers improve emergency care by increasing capacity and improving patient flow, including University Hospitals of North Midlands NHS Trust (£9 million), University Hospitals of Derby and Burton NHS Foundation Trust (£8 million) and East Kent Hospitals University NHS Foundation Trust (£6 million). Eighty schemes have been agreed in principle, and providers have given assurances that each will be completed before 24 December 2018.

Significant improvements in patient facilities were agreed in Quarter 2 as a result of the capital allocated to sustainability and transformation partnerships. This includes outline approvals for a £312 million sustainable services project at The Shrewsbury and Telford Hospital NHS Trust and £147 million for ‘One Acute Network’ in Dorset with funding for that project being awarded to Poole Hospital NHS Foundation Trust and The Royal Bournemouth and Christchurch Hospitals NHS Foundation Trust.


Looking ahead: challenges for the rest of 2018/19

The provider sector’s planned deficit of £439 million reflects the challenges it faces. Despite efforts in Quarter 2, operational and financial performance remains under severe pressure. Whilst the financial trajectory for the second half of the year looks ambitious, the vast majority of providers are reporting that their board approved plans will be delivered and they should be given the headroom and support to deliver. At the same time, we will work intensely with the small number of providers that have deteriorated their forecast at Q2 to understand the drivers for the deterioration and the remedial action.

It is essential that boards deliver their plans and recover the position by Quarter 3, focusing urgently on tackling long stays in hospital and delivering cost improvements. Achieving plans in 2018/19 is an essential foundation for sustaining services in thelonger term.

To help prepare for winter, we are underpinning actions on length of stay with targeted support for the most challenged systems,improvement guides, training for system leadership teams and relocating the Emergency Care Improvement Support Team to the regions to support local systems.

To achieve greater financial sustainability, providers must improve both in-year and underlying financial performance. They mustrely less on one-off and short-term actions and identify recurrent and long-term savings.

Our regional teams are working with them to manage delivery risks and maximise productivity and other opportunities. We continue to provide intensive support to providers in the greatest financial difficulty through our special measures programme.

The long-term plan for the NHS will present a significant opportunity for it to build its response to the challenges and opportunities ahead but will need to be based on strong delivery in 2018/19. Any shortfall would have significant implications for the following year.



Performance comparisons


Notes:

• Activity & Capacity table: Elective and outpatient activity calculated with working day adjustment

• Activity & Capacity table: A&E attendances figure from SUS dataset

• All tables : Quality and performance figures are at a national aggregate level

Finance and productivity

Plan 2018/19

£m

Q2 2018/19

Actual £m

Q2 2017/18

Actual

Surplus/deficit (£m) (1,142) (1,229) (1,151)

Total income (£m) 41,170 41,598 39,926

Expenditure (£m) (42,580) (43,245) (41,388)

Efficiency savings (£m) 1,339 1,214 1,257

Efficiency savings (%) 3.0% 2.7% 2.9%

Total pay costs excl agency (£m) (25,479) (25,947) (24,640)

Agency ceiling performance (£m) (1,115) (1,208) (1,194)

% of providers signed up to a control total - 87.4% 90.1%

% of providers forecasting a 2018/19 a surplus at Q252.6% 51.7% 51.9%

Activity and capacity

Q2 2018

YTD Plan

Q2 2018 YTD

Actual

Q2 2017 YTD

Actual

Q2 2018

YTD

variance

from plan

Variance

from Q2

YTD 17/18

A&E attendances (millions) 9.48 9.57 9.16 0.9% 4.7%

Non-elective admissions (millions) 3.21 3.24 3.07 1.0% 5.0%

Elective admissions (millions) 3.99 3.98 3.92 (0.4%) 0.5%

First outpatients attendances

(millions)10.20 10.55 10.23 3.5% 1.7%

General & acute beds (average

daily open – Q1 2018/19) - 101,259 102,898 - (1.6%)

Nurses (WTE) 351,962 344,085 343,182 (2.2%) 0.3%

Medical staff (WTE) 125,000 125,854 120,888 0.7% 4.1%

Cost weighted activity growth 0.6% 2.2% 1.3% 1.6% 0.5%

Published operational performance

TargetQ2 18/19

Actual

Q2 17/18

Actual

A&E 4 hour performance 95% 89.31% 90.11%

Diagnostics (as at 30 September

2018)1% 2.67% 1.99%

RTT (as at 30 September 2018) 92% 86.67% 89.10%

Cancer 62-day 85% 78.61% 82.03%

Ambulance – Category 1

(mean time and 90th centile

response time) – September 2018

mean: 7 mins

90 centile: 15 mins

7:20

12:46N/A

Ambulance – Category 2

(mean time and 90th centile

response time) – September 2018

mean: 18 mins

90 centile: 40 mins

21:41

44:28N/A

Quality and safety

Target or

ceiling

Q2 18/19

Actual

Q2 17/18

Actual

Infection – MRSA 0 69 67

Infection - C. Diff 1,110 1,219 1,271

General & acute bed occupancy (Q1

2018/19)- 89.92% 89.14%

Acute delayed discharges (days) - 281,714 343,775

>12-hour A&E trolley waits - 456 201

>52-week waits - 3,156 1,778

Number of providers in special measures - 20 22


1.0 Operational performance

1.1 Operational performance overview


Metrics Target / Ceiling NHS Improvement NHS England

Accident & emergency: July – September 2018

A&E attendances - 5,648,429 6,176,928

Performance – All A&E types (%) 95% 88.34% 89.31%

Performance – Acute providers only (%) 95% 87.58% 87.58%

Type 1 performance (%) 95% 83.45% 83.45%

Diagnostics: at 30 September 2018

Number of diagnostic tests waiting 6 weeks+ (%) 1% 2.73% 2.67%

Referral to treatment (RTT): at 30 September 2018

18 weeks incomplete (%) 92% 86.19% 86.67%

52-week waits (number) - 3,063 3,156

Cancer: July – September 2018

2-week GP referral to 1st outpatient, cancer (%) 93% 91.60% 91.59%

2-week referral to 1st outpatient - breast symptoms (%) 93% 90.16% 90.16%

31-day wait from diagnosis to first treatment (%) 96% 96.80% 96.81%

62-day urgent GP referral to treatment for all cancers (%) 85% 78.52% 78.61%

62-day referral from screening services 90% 89.26% 89.35%

September 2018

Category 1 7 mins / 15 mins 7:20 / 12:46 7:20 / 12:46

Category 2 18 mins / 40 mins 21:41 / 44:28 21:41 / 44:28

Category 3 No standard / 120 mins NA / 146:09 NA / 146:09

Category 4 No standard / 180 mins NA / 196:33 NA / 196:33

Infection control: July – September 2018

C. Difficile (Total cases) 1,110 1,219 1,219

Notes:

NHS Improvement performances above are based on the performances of 154 NHS foundation trusts and 80 NHS trusts.

NHS England performances are based on performances of NHS trusts, NHS foundation trusts and independent sector organisations for A&E, diagnostics, RTT and cancer.

Performance has been rated red where there has been failure to meet a national standard.

1.2 Accident and emergency


Percentage of A&E all type patients seen within 4 hours

Number of providers failing the 4 hour A&E target by month

• Last year, A&E departments were under significant operational pressures due to

record levels of patients requiring emergency admissions. This quarter, the

number of patients attending a major (type 1) A&E department and requiring

admitted care reached approximately 1.15 million, an increase of 7.0% on the

same quarter last year.

• Bed capacity constraints due to high occupancy rates and delayed transfers of

care continued to affect patient flow, in line with increases in attendances and

admissions: 125,215 patients waited more than four hours for a bed, 7.4% more

than a year ago. There were also 281,714 bed days lost due to delayed transfers

of care in acute hospitals, a decrease of 18.1% (62,061 delayed days) from the

same period a year ago.

• Recognising these challenges, particularly around increased demand compared

to last year, the urgent and emergency care programme continued its

transformation programmes alongside higher intensity operational delivery, to

ensure progress on both important areas of work in and out of hospital.

• In July, we announced an ambition to reduce the number of long-stay patients

and bed days in hospital by 25% to release at least 4,000 beds and reduce

avoidable harm to patients associated with deconditioning. In support of this we

published improvement guides, ran training programmes for system leadership

teams, repurposing the Emergency Care Improvement Support Team (ECIST) to

the regions to support local systems, and much more. As of September 2018, the

NHS was halfway to achieving the ambition, having reduced the number of long-

stay patients by 13%.

• Provider capital investment of £145 million is increasing capacity for acute

services ahead of winter, with 80 schemes agreed in principle. Providers have

given assurances that each scheme will be completed before the 24 December.

These will provide much-needed capacity and support A&E performance this

winter.

• The recent announcement of £240 million for adult social care will be crucial to

easing winter pressures on the NHS, increasing capacity by improving patient

flow into social care and reducing unnecessary admissions. NHS chief

executives are working with local authority chief executives to get the maximum

benefit from this investment.

• NHS England reported an overall A&E performance of 89.31%,

which included the performance of independent sector

organisations. NHS providers’ performance deteriorated from

89.24% in Q2 2017/18 to 88.34% in Q2 2018/19,

• There were approximately 5.65 million attendances at NHS A&E

departments, an increase of 3.9% (like-for-like) compared to the

same quarter last year.

1.3 Diagnostic waiting times

Percentage of diagnostic patients waiting over six weeks

Diagnostic performance by procedures – September 2018

• Diagnostic waiting times are key to achieving the referral to treatment

(RTT) target as most patients referred for hospital treatment will

require a diagnostic test. The national waiting-time target for

diagnostics states that less than 1% of patients should wait six weeks

or more for a test.

• At the end of September 2018, 944,691 patients were waiting for a

diagnostic test in providers, an increase of 1.4% from the last month.

Compared to the same time last year, the waiting list increased by

5.1% (like-for-like). This resulted in more patients waiting longer than

six weeks. Performance deteriorated to 2.73% at the end of

September 2018 (NHS England performance was 2.67%) compared to

2.13% for the same period last year but was an improvement on

August (3.19%).

• In aggregate providers failed to achieve the waiting-time standard for

all 15 key diagnostic tests – two more than the same period last year.

• Non-obstetric ultrasound was one of the best-performing tests despite

having the largest waiting lists (36.6% of the total diagnostics waiting

list), with 1.19% of patients waiting over six weeks at the end of the

month. Urodynamics saw the largest percentage of patients waiting

over six weeks; although relatively small numbers were involved,

12.88% were reported as waiting beyond the standard in September

2018.

• Rapid diagnostic and assessment centres are being piloted in 10

areas. These are intended to diagnose cancers early in people who do

not have ‘alarm symptoms’ for a specific type of cancer.

• In addition, the urgent and emergency care programme is continuing to

roll out standardised urgent treatment centres open 12 hours a day,

seven days a week, staffed by clinicians with access to diagnostics

and bookable via NHS 111.


1.4 Elective waiting times


RTT 18-week performance and size of waiting list by month

Number of providers failing RTT 18 week incomplete target by month

• In line with the drop in performance and the increase in the overall waiting list,

the number of patients waiting longer than 52 weeks for treatment increased. At

the end of September 2018, 3,063 patients (3,156 at NHS England aggregate)

were waiting over a year for treatment compared to 1,707 in September 2017,

although this was a decrease from the 3,306 waiting in August 2018.

• We continue our work to reduce avoidable demand for elective care and

implement interventions across the elective pathway to ensure patients are

referred to the most appropriate healthcare setting, first time.

• As of September 2018, 178 out of 185 (96%) clinical commissioning groups

(CCGs) had established compliant musculoskeletal (MSK) triage services to

ensure patients access the most appropriate services and receive personalised

treatment plans. This can reduce MSK referrals to hospital. A snapshot audit of

143 CCGs with MSK triage showed that when comparing the same two months

in 2016/17 and 2017/18, CCGs complying with the MSK specification saw a 10%

reduction in MSK referrals.

• Other measures undertaken include the generation of 12 specialty-level

transformation handbooks, rollout of capacity alerts functionality across all

regions, and delivery of high impact interventions focusing on first contact

practitioners in MSK services and ophthalmology . A first contact practitioner

(MSK) service enables patients who would usually see their GP to refer

themselves directly to physiotherapy services or see a first contact practitioner

based in general practice. This can speed up access to treatment, reduce GP

workload and associated costs, improve patient experience and reduce

inappropriate referrals to secondary care.

• After sustained efforts to manage demand, GP referral growth has steadily

declined since April 2016. It was almost flat (0.1%) from April to September 2018

compared to the same period in 2017. Recognising the interdependency between

elective care and emergency care and the need to improve performance on both,

we are forming a joint directorate of emergency and elective care with NHS

England. We are working with providers to understand how their elective activity

will meet projected demand while reducing 52-week waits and late cancellations.

This work is addressing forecast under-delivery of commissioned activity by

calling on neighbouring providers where possible, and/or the independent sector.

Outsourcing activity must be done as efficiently as possible, and we have been

working through the NHS Partners Network of independent sector providers to

ensure that.

• NHS providers continue to fail to achieve the national referral to treatment (RTT)

incomplete pathways target of 92%. Performance for September 2018 was

86.19% (NHS England performance was 86.67%), a drop of 2.6% compared to

the same period last year.

• Sustained high demand for emergency inpatient care resulted in many providers

struggling to deliver their planned activity due to elective capacity being displaced

or cancelled. The national elective waiting list remained at almost record levels.

At the end of September 2018, it was 3.90 million, a 7.3% increase compared to

a year ago (like-for-like and excluding providers that have restarted reporting this

year). Five providers did not report incomplete RTT performance in September

2018. After adding the missing providers’ data to the waiting list, the total was 4.3

million nationally.

1.5 Cancer waiting times


62-day (urgent GP referral) wait for first treatment by month

62-day (urgent GP referral) wait for first treatment by specialty – Q2 2018-19

• Four of the cancer waiting-time standards were failed: two-week GP

referral to first outpatient appointment, 14-day referral to first

outpatient – breast symptoms; 62-day (urgent GP referral) waiting-

time target for first treatment and 62-day screening from service

referral.

• NHS providers failed to achieve the national target of 85% for 62-day

(urgent GP referral) with a performance of 78.52% (NHS England

performance was 78.61%). This was 3.6% lower than achieved in the

same quarter last year (82.12%).

• The specialties contributing most to the underperformance were

urological (excluding testicular), lower gastrointestinal and lung.

These accounted for only 41.9% of activity but contributed to more

than half the reported breaches (60.9%).

• We worked with partner organisations to improve cancer

performance by reducing diagnostic delays. We continue to work with

NHS England to introduce the 28-day faster diagnosis standard for

cancer patients. The standard is being piloted in preparation for

national rollout.

• Two-week GP referral to first outpatient appointment saw a

deterioration in performance: 91.60% compared to 93.83% in the

same period last year.

• 14-day referral to first outpatient – breast symptoms saw a

deterioration in performance: 90.16% compared to 93.31% in the


• 62-day screening from service referral saw a deterioration in

performance: 89.26% compared to 91.63% in the same period last

year.

1.6 Ambulance Improvement Programme The last year has seen the biggest ever change to ambulance service standards anywhere in the world, based on an evaluation of 14 million calls, which led to the agreement of the Ambulance Response Programme standards and their implementation across all of England.


The last year has seen the biggest ever change to ambulance service

standards anywhere in the world. Based on an evaluation of 14 million calls,

the Ambulance Response Programme standards have been implemented

across England.

In July 2017 NHS England announced new performance standards for

ambulance services in England to be applied to every 999 call for the first time.

This was a result of the findings of the Ambulance Response Programme

(ARP), the largest study of ambulance services in the world.

The new standards aim to:

• I. prioritise the sickest patients, to ensure they receive the fastest response

• II. encourage clinically and operationally efficient behaviour, so the patient

gets the response they need first time and in a clinically appropriate

timeframe

• III. end unacceptably long waits by ensuring resources are distributed more

equitably among all patients contacting the ambulance service.

To do this we introduced three initiatives:

1. Dispatch on disposition (including nature of call) – We gave call

handlers more time to assess 999 calls that are not immediately life-threatening

before assigning an ambulance. This makes sure the response is right for the

patient’s needs.

We added three questions to the start of a 999 call asking about the patient’s

breathing and level of consciousness. This makes sure that immediately life-

threatening calls, particularly cardiac arrest, are identified early.

2. A new system of clinical prioritisation for all 999 calls – We developed

an evidence-based system to prioritise 999 calls to match the patient’s urgency

and clinical needs to the most appropriate response.

3. New ambulance service measures, indicators and standards – We

developed measures to make sure the sickest patients receive the fastest

response, that all patients get the best response first time, and that no-one

waits an unacceptably long time for an ambulance.

Response times from the reporting providers have been collated to create the

aggregated national table:

National aggregate Category C1 to C4 response times – September 2018

• In September 2018 there were 23,700 calls to 999 answered per day, an increase of

3% on August. In September 2018, the C1 90th centile response time was 12

minutes and 46 seconds – the same as August – making it the joint shortest time

ever. The C1 mean was 7 minutes 20 seconds in September 2018, a small increase

on August.

• Four services met the C1 mean standard of 7 minutes in September while 10 met

the 90th centile response time of 15 minutes – the same as August.

• Two services met the C2 mean standard of 18 minutes, and four services met the

C2 90th standard of 40 minutes.

• One service met both the two-hour C3 and three-hour C4 standards, while four

services met the C4 standard.

Driving up performance

• Since introducing the Ambulance Response Programme standards performance for

the most seriously ill patients has improved, and most providers are close to

achieving standards on Category 1 calls. Category 2 remains a challenge for some

providers but is the priority for all providers to improve as winter approaches. To

help ambulance services achieve the standards, funding was made available earlier

this year for 256 vehicles and vehicle preparation facilities at a cost of £36.3 million.

A long-term plan to reduce avoidable journeys is being developed, identifying

interventions in use and evaluating new opportunities. We continue to work with

ambulance and acute providers to tackle hospital handover delays, which are

monitored daily.

• Lord Carter’s review of the ambulance service identified improvement opportunities

in quality and efficiency. As part of this work, a £36 million investment in the

ambulance service bought 256 state-of-the-art vehicles. More than half will be on

the road for winter. ‘Make-ready’ hubs will enable better restocking, refuelling and

cleaning of ambulances.

Count of

incidents

Category 1 51,744

Category 1T 34,906

Category 2 352,326

Category 3 169,080

Category 4 13,799

0:07:20

0:11:33

0:21:41

1:02:28

1:22:54

0:12:46

0:21:43

0:44:28

2:26:09

3:16:33

7 mins / 15 mins

no standard

18 mins / 40 mins

no standard / 120 mins

no standard / 180 mins

National Standard:

Mean / 90th Centile

Mean

(hrs:mins:sec)

90th centile

(hrs:mins:sec)

1.7 Infection control

• 11,615 E. coli cases were reported compared to 11,057 in the

same quarter last year – an increase of 5.0%.

• Year to date there were 22,315 E. coli cases – an increase of

5.0% from the same period in 2017/18. This increase has been in

the cases with an onset out of hospital, hospital onset cases

remain below last years outturn.

• The Secretary of State’s ambition is to reduce ‘healthcare-

associated’ Gram-negative bloodstream infections (GNBSIs) by

50% by March 2021. During 2017/18 and 2018/19 there has been

a quality premium target for CCGs to reduce E. coli (the most

prevalent GNBSI) by 10%.

• Voluntary risk factor data is being submitted to the Public Health

England data capture system, and analysis of early data shaped

the 2018/19 programme.

• Data shows urinary tract infection (UTI) is a significant risk factor

for GNBSI. We therefore completed a UTI breakthrough

collaborative to help 27 providers reduce by 5% the number of

patients acquiring healthcare-associated UTI/CAUTI (catheter

associated urinary tract infection) and/or reduce by 5% the number

of catheters in the pilot settings. A second cohort with 15 acute

providers and 20 CCGs has now begun.

Number of Hospital Onset Meticillin-resistant Staphylococcus aureus

(MRSA) cases reported

Number of Clostridium Difficile (C. Diff) cases

• 1,219 provider-apportioned C. difficile cases were reported compared

to 1,271 in the same period last year: a reduction of 4.1%. The 1,219

C. difficile cases reported exceeded the ceiling set for Quarter 2 of

1,110.

• Year to date there were 2,301 C. difficile cases – a reduction of 4.1%

on the same period in 2017/18.

Number of Escherichia coli (E.coli) cases reported

• 69 hospital onset MRSA cases were reported, 3.0% more than the 67

cases reported in the same quarter last year.

• Year to date there were 118 MRSA cases – a reduction of 5.6% on

the same period in 2017/18.


1.8 Mental health (1)

• The NHS has a clear commitment to value mental health equally

with physical health.

• As outlined in Achieving better access for mental health services

by 2020, a key element of this is to ensure people have timely

access to evidence-based and effective treatment. For the Early

Intervention in Psychosis (EIP) access and waiting-time

standard, patients must be treated with a NICE-recommended

package of care within two weeks of referral. During 2018/19 the

waiting-time standard is 53%, increasing to 60% by 2020/21.

• In September 2018, 76.1% of patients started treatment within

two weeks of referral. The waiting-time standard was therefore

met. This is an improvement compared to 74.4% in August

2018, but a decrease from 76.7% in September 2017.

• 1,144 patients were waiting to start treatment at the end of

September 2018, of whom 536 were waiting more than two

weeks.

• Another key indicator is the proportion of patients in adult mental

illness specialties on the Care Programme Approach (CPA) who

were followed up within seven days of discharge from

psychiatric care in the quarter.

• During Quarter 2 2018/19, 95.7% of such patients were followed

up within seven days of discharge. This compares with 95.8% in

Quarter 1 2018/19, and 96.7% in Quarter 2 2017/18.

• This paragraph has not been updated from Q1.

Proportion of patients on CPA who were followed up within seven

days after discharge from psychiatric inpatient care

Early Intervention in psychosis – treated within two weeks of referral


1.9 Mental health (2)

• Psychological Therapies is an NHS programme that offers NICE-

approved interventions for treating people with depression and

anxiety.

• The waiting-time standards for this service are that 75% of patients

who finish their course of treatment should wait less than six weeks to

enter treatment, and 95% should wait less than 18 weeks.

• During August 2018, 89.7% of patients waited less than six weeks,

and 99.2% waited less than 18 weeks to enter treatment. Both

standards were, therefore, achieved. The six-week performance was

0.5% higher than July 2018. The 18-week performance was 0.1%

higher.

• To measure outcomes, a key government target is that 50% of eligible

referrals to Psychological Therapies should move to recovery. In

August 2018, 50.7% of such referrals were moving to recovery.

Therefore, the standard was achieved. This compares with 51.6% in

July 2018 and 50.8% in August 2017.

Psychological therapies – recovery rates

Psychological therapies – waiting times


1.10 Mental health (3) OS

Mental Health Investment Standard (MHIS)

The Five Year Forward View for Mental Health and its implementation plan set a challenging agenda to deliver access standards for key mentalhealth services. As part of the funding framework to support this, the MHIS requires commissioners to increase spending on mental health servicesat least in line with the amount by which their funding allocation has been increased overall.

CCGs must provide financial information to NHS England on whether they are meeting the MHIS. This provides NHS England with crucial data tohold the programme to account through the published mental health dashboard and the quarterly deep-dive processes with regions.

There remains, however, continued pressure to understand whether the funding is reaching the front line and is correctly targeted.

Joint NHS England and NHS Improvement working

To help manage the programme effectively and build confidence in the sector, NHS England and NHS Improvement agreed to collect data to cross-check mental health spend in commissioner returns with mental health income in provider returns. This enables a review of mental healthspend/income alignment by national teams, supported by regional teams in NHS England and NHS Improvement, and helps improve thecommunication and transparency of data between providers and commissioners.

2018/19 plan refresh – provider/commissioner alignment

The first detailed collection of mental health income in provider plans was undertaken as part of the 2018/19 plan refresh. As with any new datacollection, data quality improvements are required to produce a dataset to analyse outcomes. Significant progress to improve data quality andalignment has been made in the 2018/19 planning round and work will continue during 2018/19.



1.11 Winter resilience preparations 2018/19Overview

We are learning from last winter and focusing on what we know will have the biggest impact on access and quality of care for patients.

• Increasing capacity and reducing length of stay will help providers to be ready for winter pressure, limit the impact of winter on elective care and

prevent long waits in A&E.

• Continuing the transformation agenda will help to build the capacity and capability of primary care, NHS 111 and NHS 111 Online, hear and treat

and see and treat, reducing long stays in hospital and increasing same day emergency care ahead of winter.

• Focusing on patient safety, we are working with professionals and other stakeholders to understand how we can support increased flu vaccination

rates for staff; we have developed patient safety triggers, identifying systems where patient safety is at greatest potential risk. These will include

early identification of any outbreaks of influenza and Noro virus, for example, to support systems to manage effectively and reduce potential impact.

Performance was 89.3% compared to 90.1% in Quarter 2 last year, a decrease of 0.8%. This has been driven by higher attendances, higher conversion

rates and sustained high levels of bed occupancy.

During Quarter 2:

• 3.9 million calls came in to NHS 111, an increase of

over 300,000 compared to Quarter 2 last year

• in each month, over 50% of calls saw an average of

over 50% triaged will clinical input, with the highest

ever proportion of NHS 111 calls with clinical input

recorded in September at 53.1%

• new ambulance response standards were implemented

across all ambulance providers in mainland England

• since February 2017 the NHS has released 1,963 beds

by reducing delayed transfers of care to discharge.

• Key actions:

• Winter operating function is in place seven days a week with 24-hour on-call cover to support regional and local teams with managed response to surge.

• Several actions on length of stay include targeted support for the most challenged systems; increased use of the independent sector to help clear the

elective backlog; £145 million of capital funding agreed across about 80 acute providers; £240 million put into adult social care to support the NHS in

managing winter pressures and £36 million to buy 256 ambulances.

• Since October 2018, everyone across the country has had more convenient access to GP services, including appointments during evenings and

weekends that provide more than 9 million additional appointments per year.

2.0 Financial performance


2.1 Financial performance overview by sector and region

1. Surplus/(deficit) control total basis is calculated as surplus/(deficit) before AME impairments, transfers, donated asset income, and donated asset depreciation for all providers.

2. The sector-reported adjusted financial position surplus/(deficit) includes DEL Impairments, prior period adjustments, donated asset income and donated asset depreciation as

these items have been excluded from the control total. An adjustment is needed to add the figures back to provide the reported sector surplus/(deficit).


Number of

providersPlan Actual

Deficit

ProvidersPlan Forecast

Deficit

Providers

£m £m £m No. £m £m £m No.

Acute 133 (1,427) (1,684) (257) 118 (1,475) (1,813) (338) 87

Ambulance 10 0 2 2 5 3 4 1 5

Community 17 6 10 4 4 28 29 1 4

Mental Health 53 6 13 7 21 142 133 (9) 10

Specialist 17 5 12 7 7 118 117 (1) 5

Control total basis surplus / (deficit) including PSF (1) 230 (1,410) (1,647) (237) 155 (1,184) (1,530) (346) 111

Technical adjustments including uncommitted PSF 268 418 150 765 992 227

Less GIRFT funded from PSF (20) (20)

Reported adjusted financial position surplus / (deficit)

including all PSF (2) (1,142) (1,229) (87) (439) (558) (119)

Number of

providersPlan Actual

Deficit

ProvidersPlan Forecast

Deficit

Providers

£m £m £m No. £m £m £m No.

London 36 (265) (331) (66) 22 (176) (272) (96) 14

Midlands 69 (529) (645) (116) 47 (644) (774) (130) 38

North 70 (400) (424) (24) 49 (318) (366) (48) 32

South 55 (216) (247) (31) 37 (46) (118) (72) 27

Control total basis surplus / (deficit) including PSF (1) 230 (1,410) (1,647) (237) 155 (1,184) (1,530) (346) 111

Technical adjustments including uncommitted PSF 268 418 150 765 992 227

Less GIRFT funded from PSF (20) (20)

Reported adjusted financial position surplus / (deficit)

including all PSF (2) (1,142) (1,229) (87) (439) (558) (119)

6 months ended 30 September 2018 by region

6 months ended 30 September 2018 by sector

Year to date Month 6 2018/19 Forecast outturn 2018/19

Year to date Month 6 2018/19 Forecast outturn 2018/19

Variance

to plan

Variance

to plan

Variance

to plan

Variance

to plan

2.2 Income and expenditure


• The provider sector reported a year-to-date deficit of £1.23 billion which

is £78 million worse than the same period last year. This represents an

£87 million negative variance against plan and is £109 million worse that

the position reported at Quarter 1 (£22 million surplus).

• The overall figures for both income and expenditure were affected by

including the NHS pay award for staff on Agenda for Change (AfC) pay

grades, which was not included in plan as it was not known at the start

of the year. This has resulted in increased income and pay costs in the

year to date and forecast outturn figures. The government has included

extra income (£779 million over the full year) to cover the additional pay

costs. The report looks to focus on the variances excluding the AfC

impact, which is neutral due to income and expenditure increasing. The

overspend recorded against plan of £561 million on employees’

expenses is largely offset by an over-recovery of patient care income of

£423 million, the majority of which is AfC. There was also a £104 million

overspend on non-pay costs, up on the £26 million variance reported at

Quarter 1.

• There were 87 providers off plan, with 19 reporting variances greater

than £5 million. If the PSF is excluded, 44 providers reported

overspends against plan, 13 over £5 million. The forecast for the full

year is that 83 providers will be off plan at the year end with 14 over £5

million. If the PSF is excluded, this reduces to 36 providers forecasting

to be off plan, of which nine will be over £5 million. All of the net

overspending occurred in the acute sector which was £1.7 billion over

plan. Key factors cited by providers as contributing to adverse variances

include slippage in making planned efficiency savings, volume changes,

operational and cost pressures relating to temporary staffing and

substantive workforce pressures, and the AfC pay award.

• The reported sector financial position included £418 million of technical

adjustments including uncommitted PSF funding. In 2018/19, the PSF

replaced the Sustainability and Transformation Fund (STF) introduced in

2016/17 to encourage providers to provide sustainable, efficient,

effective and economic care. The PSF has the same aims, and the

government injected an additional £650 million focused on sustainability,

accelerating financial recovery and improving urgent and emergency

care. As previously, the release of the PSF in 2018/19 will be based on

achieving agreed financial control totals and meeting access standards.

Plan Actual

£m £m £m %

Income from patient care activities 36,791 37,214 423 1.1%

Other income 4,379 4,384 5 0.1%

Employee expenses (26,594) (27,155) (561) (2.1%)

Non pay costs (15,986) (16,090) (104) (0.7%)

Control total basis surplus/(deficit)

including PSF(1,410) (1,647) (237) (16.8%)

Technical adjustments including uncommitted PSF268 418 150 56.0%

Reported Adjusted Financial Position

Surplus / (Deficit) incl all PSF(1,142) (1,229) (87) (7.6%)

Year to date Month 6 2018/19

6 months ended 30 September 2018Variance to plan

Acute

£m

Ambulance

£m

Community

£m

Mental

Health

£m

Specialist

£m

Income from patient care

activities 27,512 1,214 1,202 5,640 1,646

Other income 3,569 32 68 465 250

Employee expenses (19,852) (879) (872) (4,489) (1,064)

Non pay costs (12,913) (365) (387) (1,603) (821)

Control total basis

surplus/(deficit) including

PSF

(1,684) 2 11 13 11

Control total basis surplus

/ (deficit) %(5.4%) 0.2% 0.9% 0.2% 0.6%

Year to Date Month 6 2018/196 months ended 30

September 2018 by

sectors

2.3 Income analysis


• Total income was £41.6 billion, which was £428 million (1.0%)

above plan for this period. This increased significantly from the

Quarter 1 position, when the reported over-recovery against plan

was £42 million. Most of this increase is due to including, central

funding for the Agenda for Change (AfC) pay award during Quarter

2. In most returns this was included in the ‘other’ category of patient

care income, which shows a £389 million (58.1%) over-recovery

against plan. Without this large component the Quarter 2 variances

comprise a £34 million (0.1%) over-recovery for income from patient

care activities and of £5 million (0.1%) for other income.

• The sector recovered significantly more income than planned for

non-elective care (£218 million or 3.0%), A&E income (£34 million

or 2.9%) and high cost drugs income (£76 million or 3.5%). This

over-recovery was offset by an under-recovery of elective income

(£116 million or 2.4%), continuing the trend previously identified by

which profit-making elective income is crowded out by loss-making

non-elective income and zero-margin pass-through drug costs.

• The other variances within the income from the patient care

category included an over-recovery of £26 million (or 0.7%) for

community services and an under-recovery of £218 million (2.9%)

for other NHS clinical income. Within the category of other income,

there were over-recoveries on non-patient care services of £29

million (4.4%) and education and training of £33 million (2.6%). The

provider income relating to the PSF shows an under-utilisation of

£150 million; this is held centrally as part of the technical

adjustments including uncommitted PSF (see Table 2.1).

• The sector forecasts it will finish the year with an over-recovery on

income of £981 million made up of £1,043 million (1.4%) for patient

care activities and offset by a £62 million (0.7%) under-recovery for

other income. A significant element of this forecast over-recovery

(about £779 million) is attributable to AfC.

Plan Actual

£m £m £m %

Elective income 4,779 4,663 (116) (2.4%)

Non-elective income 7,227 7,445 218 3.0%

First outpatient income 1,859 1,853 (6) (0.3%)

Follow up outpatient income 2,212 2,219 7 0.3%

A&E income 1,188 1,222 34 2.9%

High cost drugs income from

commissioners (excluding pass-

through costs) 2,188 2,264 76 3.5%

Other NHS clinical income 7,540 7,323 (217) (2.9%)

Acute services 26,993 26,989 (4) (0.0%)

Mental Health services 4,278 4,287 9 0.2%

Ambulance services 1,194 1,197 3 0.3%

Community services 3,657 3,683 26 0.7%

Other 669 1,058 389 58.1%

Total income from patient care

activities36,791 37,214 423 1.1%

Research and development 520 537 17 3.3%

Education and training 1,282 1,315 33 2.6%

Charitable and other contributions to

expenditure 33 35 2 6.1%

Non-patient care services provided 662 691 29 4.4%

Support from DH for mergers 29 29 0 0.0%

Provider sustainability fund (PSF) 590 440 (150) (25.4%)

Recharged Pay costs accounted on a

gross basis 145 161 16 11.0%

Lease rentals received 51 58 7 13.7%

Other 1,067 1,118 51 4.8%

Total other income 4,379 4,384 5 0.1%

Total income 41,170 41,598 428 1.0%

6 months ended 30 September

2018

Variance to plan



2.4 Employee expenses – pay costs• Last year, total pay costs topped £52 billion, which was £1.5 billion

higher than plan and 3.3% up on 2016/17. For 2018/19, the provider

sector has planned to spend £53 billion, a 1.4% increase on the £52

million outturn for 2017/18. This is before the financial impact of the

NHS pay awards relating to Agenda for Change (AfC) staff.

• For the year to date, the sector reports a £561 million negative

variance against plan. This sharp deterioration since Quarter 1 (£42

million overspend) was accentuated by the inclusion during this quarter

of the AfC pay awards which were not included in the plan or Q1

figures. On a YTD basis, this accounted for circa £410 million leaving

an increase not related to AfC of £151 million. The overall pay costs for

the year are forecast to be £1.01 billion of which AfC is expected to be

£836 million with the balance of £246 million relating to non AfC

factors. The government has so far (at Quarter 2) committed £779

million of additional funding to the provider sector to meet these costs,

with potential further funding subject to an application process to the

Department of Health and Social Care for services operating under

dynamic AfC conditions (as detailed in national guidance).

• The YTD overspend is prevalent in all sectors, but the largest variance

is in the acute sector, which overspent by £483 million. This reflects

continuing intense operational pressure in that sector. Overspending

also occurred in all other sectors, totalling £80 million. Of the overall

forecast overspend of £1.1 billion for the year, it is estimated that acute

providers will account for £828 million. Overspending in the other

sectors is forecast to be £254 million, including £158 million for mental

health services.

• Other than the costs of AfC pay awards, a key driver of the

overspending against pay budgets was the increase in temporary

staffing: bank staff overspending was £260 million and agency staff

£93 million. This continues the trend identified in 2017/18 of increasing

use of temporary (especially bank staff) by providers to manage

workload in the face of increased demands, high levels of vacancies,

sickness/absence and staff turnover. As a result of these pressures,

overall spending on bank and agency staff is up by £246 million (10%)

on the same period in 2017/18.

Pay and agency costs Year to date

Plan Actual

£m £m £m %

Medical staff 6,659 6,811 (152) (2.3%)

Nursing staff 10,484 10,683 (199) (1.9%)

Other staff 9,451 9,661 (210) (2.2%)

Total employee expenses 26,594 27,155 (561) (2.1%)

Of w hich

- Bank 1,399 1,659 (260) (18.6%)

- Agency ceiling performance 1,115 1,208 (93) (8.3%)


Variance


2018

Pay and agency costs forecast outturn

Plan Forecast

£m £m £m %

Medical staff 13,270 13,438 (168) (1.3%)

Nursing staff 20,913 21,336 (423) (2.0%)

Other staff 18,833 19,324 (491) (2.6%)

Total employee expenses 53,016 54,098 (1,082) (2.0%)

Of w hich

- Bank 2,779 3,155 (376) (13.5%)

- Agency ceiling performance 2,200 2,232 (32) (1.5%)

Forecast outturn 2018/19

Variance


2018

• Providers employ about 1.1 million whole-time equivalent (WTE) staff

and have 0.1 million vacancies. The pay bill is the single biggest area of

expenditure, and the NHS has made managing it and recruiting to fill key

staff vacancies a priority (see Section 2.5).

Performance of the NHS provider sector for the quarter ended 30 June 2018

2.5 NHS provider vacancies

*The information above represents management information only and not an official statistic.

**Data relating to 2017/18 varies slightly than that previously reported. This is due to the data being collected and presented on a more accurate basis from Q1 18/19,

using actual WTE vacancy data collected from NHS providers. It also incorporates some minor retrospective amendments to the data previously submitted by

providers.

• There are currently almost 1.1 million WTE staff employed by

NHS trusts in England with an additional 103,000 posts

vacant. Managing this by recruitment of substantive staff and

effective use of temporary staffing (bank and agency) is a

key priority for NHS Improvement.

• We are publishing provider vacancy rates at an aggregate

national, regional and sector position.

• The decrease in vacancies observed since Q1 2019/19 (circa

4,600 WTEs) is a result of expected substantive recruitment

aligned with new graduate outturn during the quarter.

However, the current vacancy position remains a challenge,

particular within the Nursing workforce.

• There is significant regional and sector vacancy variation,

with the London region and the mental health sector having

the highest numbers proportionately.

• Nursing: trusts substantively employ over 310,000 WTE

registered nurses. In addition, there are over 40,000 WTE

vacancies, of which approximately 80% are being filled by a

combination of bank (64%) and agency staff (36%).

• Medical: trusts substantively employ over 116,000 WTE

doctors. In addition, there are over 9,000 WTE vacancies, of

which approximately 85% are being filled by a combination of

bank (47%) and agency (locum) staff (53%).

12 months ending 30th September 2018

2017/18 Q2 2017/18 Q3 2017/18 Q4 2018/19 Q1 2018/19 Q2

Nursing Vacancy Rate 11.2% 10.2% 10.2% 11.7% 11.6%

WTE Vacancies 39,154 35,934 35,794 41,337 40,877

Medical Vacancy Rate 8.3% 7.9% 8.1% 9.3% 7.4%

WTE Vacancies 10,096 9,676 9,982 11,616 9,337

Other staff Vacancy Rate 8.0% 8.0% 7.6% 7.8% 7.5%

WTE Vacancies 54,987 55,678 52,698 54,511 52,607

Total Workforce Vacancy Rate 9.0% 8.7% 8.4% 9.1% 8.7%

Total Workforce WTE Vacancies 104,237 101,287 98,475 107,463 102,821

2.6 Agency ceiling performance


• We have established agency ceilings for all providers. This work

began in 2015/16 for nurses and has been expanded to all staff

groups.

• Since then, agency costs have steadily decreased due to our

initiatives and action taken by providers. Since April 2017 these

have consistently been below 5% of overall pay costs, and we

forecast that this level will be maintained throughout the year.

This is a considerable reduction on the 7.2% reported in April

2015 at the start of our initiatives and the peak of 8.2% in July

2015.

• Because of the success in controlling these costs, we reduced

the ceiling target from £2.5 billion in 2017/18, to £2.2 billion in

2018/19. This in turn reduced the ceiling for the first half of the

year to £1,115 million. Against this lower target, providers spent

£1,208 million – a £93 million overspend but only slightly up on

the £1,194 million reported for the same period in 2017/18. The

overspend is driven by volume increases and not agency rates;

in fact, the average prices per shift are 15% less than for the


• The forecast year-end figures show the sector expects to

overspend by £32 million against the agency ceiling. This has

deteriorated from the £87 million underspend reported in Quarter

1 but is still £175 million (7%) lower than the 2017/18 outturn.

However, this position may be ambitious, given the year-to-date

figures and historic trends. Our analysis of current data suggests

the outturn may be higher (between £2.4 billion and £2.5 billion).

We will do further work with regional leads to mitigate this risk.

• The continued reduction in the proportion of agency staff costs to

total pay bill is a significant achievement in view of the record

levels of demand and the extreme pressure on the acute sector.

By controlling agency spending, the changes of the last three

years have led to more workforce planning and improved value

for money in this area of significant spend.

Agency ceiling performance

6 months ended 30 September 2018 Plan Actual

£m £m £m %

Agency ceiling performance 1,115 1,208 (93) (8.3%)

Agency costs as a % of total pay costs 4.2% 4.4%

Agency ceiling performance

6 months ended 30 September 2018 Plan Forecast

£m £m £m %

Agency ceiling performance 2,200 2,232 (32) (1.5%)

Agency costs as a % of total pay costs 4.1% 4.1%

Agency Conparison to the last financial year

6 months ended 30 September 2018

Sep-17 Sep-18 £m £m £m %

Medical staff 471 477 (6) (1.3%)

Nursing staff 457 474 (17) (3.7%)

Other Staff 266 257 9 3.4%

Total 1,194 1,208 (14) (1.2%)

Movement


Variance

Variance



2.7 Non-pay cost pressures


Plan Actual Variance to plan

£m £m £m %

Purchase of healthcare from other providers 967 1,064 (97) (10.0%)

Purchase of social care 103 110 (7) (6.8%)

Drugs costs 3,710 3,699 11 0.3%

Clinical supplies and services – (excluding

drugs costs)3,379 3,415 (36) (1.1%)

General supplies and services 770 778 (8) (1.0%)

Clinical negligence insurance 1,026 1,011 15 1.5%

Consultancy 91 104 (13) (14.3%)

Establishment 461 465 (4) (0.9%)

Premises 1,539 1,601 (62) (4.0%)

Other non pay items 3,940 3,843 97 2.5%

Total non pay 15,986 16,090 (104) (0.7%)

6 months ended 30 September 2018 by

sectors


Year to

date

actual

Forecast

Outturn

£m £m

90 165

(69) (131)

21 34

177 345

(14) (29)

163 316

123 241

(25) (50)

98 191

69 148

(1) (2)

68 146

76 137

125 241

Waiting list initiative work

Financial sanctions including penalties

Sanctions reinvested

Sub-total: Financial sanctions

Marginal rate emergency tariff impact

MRET reinvested

Sub-total: MRET

Readmissions

Readmissions reinvested

Outsourcing of work to other providers

Sub-total: Readmissions

Delayed transfers of care (DToC) - expenditure incurred on blocked

DToC - reimbursement from Local Authorities

Sub-total: Delayed transfers of care


• Non-pay expenditure showed an overspend against plan of £104 million

(0.7%), up from £26 million (0.3%) in Quarter 1. The largest area of

overspending was the purchase of healthcare from other providers – £97

million (10%), most (£90 million, up by 15.7% on plan) from non-NHS

providers. This continues the pattern of overspending driven by capacity

constraints in the system. There were also overspends of £36 million on

clinical supplies and services, £13 million on consultancy and £62 million on

premises. These were offset by a large underspend of £97 million (2.5%) on

‘other’. The sector forecasts non-pay costs will be £31.8 billion at the year

end, representing a forecast overspend against plan of £245 million.

• Introducing control totals and the STF (now PSF) in 2016/17 significantly

reduced national sanctions against providers. In previous years,

underperformance against national standards often resulted in financial

sanctions levied on providers. Since the STF (now PSF), providers have not

faced these penalties if they accepted their control totals. Consequently, the

level of net sanctions reduced to £99 million in 2016/17, £40 million in

2017/18 and is forecast to be £34 million in 2018/19.

• The impact of the Marginal Rate Emergency Tariff (MRET) was £163 million,

slightly up on the £133 million reported in the same period last year.

Providers spent £76 million on waiting list initiatives and £125 million on

outsourcing, both slightly up on the same period last year (£72 million for

waiting list initiatives and £102 million for outsourcing).

• In 2017/18, the government allocated £1 billion extra funding to social care.

A proportion was to be used to reduce the volume of delayed transfers of

care and help free hospital beds. Although costs did not reduce significantly

in 2017/18, activity recorded in the second half of the year and in the first six

months of 2018/19 suggests progress is being made. The Quarter 2 direct

costs reported amount to £68 million compared to £80 million in the same

period last year, indicating that the much larger indirect benefits from

controlling this activity are starting to be achieved. Continuing improvement

in this area is vitally important as fulfilling financial plans depends on

achieving several key assumptions around risk management, agreed activity

levels and bed availability. Consequently, we made this a key priority for

2018/19.

2.8 Efficiency savings


• During 2017/18, providers achieved savings through cost improvement

programmes (CIPs) of £3.2 billion or 3.7% in the most difficult operating

conditions. For 2018/19 planned efficiency savings were set even higher,

at £3.6 billion or 4.1% of total expenditure. Of this, the planned CIP

achievement for Quarter 2 was £1,339 million (3.0%).

• At the end of the second quarter, the sector had saved £1,214 million

(2.7%). Although significant, this was £125 million below the ambitious

plan. The main areas of underachievement were pay efficiencies and non-

pay efficiencies, down on plan by £81 million and £49 million respectively.

This was compensated by a small overachievement on income CIPs.

Operational pressures and high vacancy levels affected the ability to

achieve planned CIP schemes. Delivery of CIPs tends to strengthen in the

second half of the year, and the Quarter 2 position is comparable to the

same period last year when £1,257 million (2.9%) of CIPs were achieved.

• The Quarter 2 figures continue the trend of underperformance against

recurrent CIPs compensated by overperformance of non-recurrent CIPs.

Providers planned to deliver £1,167 million (or 87%) of their year-to-date

efficiencies through recurrent schemes but achieved recurrent savings of

only £900 million (74%). By contrast, savings from non-recurrent schemes

rose from £172 million (or 13%) at plan to £314 million (or 26%).

• In 2016/17 we established an operational productivity team to help the

sector increase efficiency and accelerate implementation of Lord Carter’s

recommendations. This work continued through 2017/18 and into this

financial year. For Quarter 2 the specific efficiency savings linked to Lord

Carter’s productivity themes in workforce productivity, resource

optimisation and benchmarking (Model Hospital) are estimated to be £713

million and are forecast to rise to £1.9 billion by the year end. The delivery

of efficiency and productivity gains is supported by the Getting It Right

First Time (GIRFT) programme, which promotes a reduction in

unwarranted clinical variation resulting in improvements in quality and

productivity; £20 million of the PSF has been allocated to support this

work.

• We continue to work with providers to maximise the benefit of efficiency

savings, by providing national and technical forums for sharing best

practice.

1.1%

2.3%

0.5%

2.0%0.6%

0.7%

0.1%

0.7%2.0%

3.3%

0.6%

3.0%

0.0%

0.5%

1.0%

1.5%

2.0%

2.5%

3.0%

3.5%

Savings - Pay Savings - Non Pay Income Total

Efficiency Programmes

Actual - recurrent Actual - non recurrent Plan: total

Plan Actual Variance Variance

£m £m £m %

Recurrent 1,167 900 (267) (23%)

Non Recurrent 172 314 142 83%

Total efficiency savings 1,339 1,214 (125) (9%)

Efficiencies as a % of Spend 3.0% 2.7%

Plan Forecast Variance Variance

£m £m £m £m

Recurrent 3,124 2,680 (444) (14%)

Non Recurrent 452 733 281 62%

Total efficiency savings 3,576 3,413 (163) (5%)

Efficiencies as a % of Spend 4.1% 3.8%






2.9 Implied provider productivity

• By reviewing the change in provider costs, adjusted for estimated

unavoidable inflationary pressures, and then comparing these cost

changes to the change in provider outputs, it is possible to calculate

the implied productivity of the provider sector.

• The total implied productivity for Quarter 2 was 1.0%, which is

consistent with the value reported at Quarter 1. But this masks

changes in the split of the pay and non-pay values: pay fell from

0.9% to 0.8% and non-pay rose from 1% to 1.4%. Overall underlying

productivity appears to be slightly below the levels achieved in the

2017/18 financial year. Pay and non-pay productivity rates are much

closer than seen in recent years.

• For Quarter 2, the estimated inflation figure was updated to reflect

the impact of the Agenda for Change (AfC) pay award in the year-to-

date figures. The pay inflation percentage has increased from 2.1%

at Quarter 1 to 3.7%. This in turn caused the total estimated

inflationary pressures to rise from 2.3% to 3.3%.

• We use cost improvement programmes (CIPs) to monitor providers’

plans to contain costs. The level of their CIPs is greater than the

underlying productivity improvement. This is because several

provider initiatives contain one-off costs: for example, profits from

the sale of surplus land. These savings need to be made again the

following year, so would appear as a required cost improvement but

would not appear as an underlying change in productivity. In

addition, many providers fund investments in quality improvement

through efficiencies – these quality improvements are not measured

through cost-weighted activity.

• Delivered CIPs are running at more than twice the level of implied

productivity, with a similar distribution between pay and non-pay.

Note: *The implied productivity measure is an early view of NHS provider

productivity. It uses an early cut of activity data. It is not adjusted for quality

or case-mix changes and uses assumed NHS inflation in national tariff

rather than actual inflation.

Implied productivity calculation

Month ended 30 September 2018

Total Pay Non Pay

£m £m £m

Expenditure, all trusts 2017/18 41,388 25,834 15,554

Expenditure, all trusts 2018/19 43,245 27,155 16,090

Cost change on previous year 1,857 1,321 536

Cost change % 4.5% 5.1% 3.4%

Estimated impact of inflation (as per NHS tariff 1) 3.3% 3.7% 2.6%

NHS real terms cost change 1.2% 1.4% 0.8%

Grow th in cost w eighted activity 2 2.2% 2.2% 2.2%

Implied productivity 1.0% 0.8% 1.4%

Cost Improvement Programs Delivered

Month ended 30 September 2018

Total 1 Pay Non Pay

£m £m £m

CIPS Delivered 1,214 462 494

Expenditure for CIPS calculation 44,459 27,617 16,584

Cost Improvement Programs % Delivered 2.7% 1.7% 3.0%

1 The total includes pay and non pay CIPs as well as those relat ing to income (not seperately listed above)

Year to date M6 2018/19

1 Includes the inf lat ionary impact of CNST premium increases, has been updated to ref lect A4C costs not distributed

through tarif f

2 Elect ive and outpat ient growth rates are adjusted for dif ferences in the number of working days in the comparator period

Year to date M6 2018/19

2.10 Capital expenditure


• The latest provider plan submissions included capital

departmental expenditure limit (CDEL) expenditure of £4.644

billion in 2018/19.

• The forecast CDEL expenditure at Month 6 is £4.462 billion,

an underspend against plan of £182 million.

• The Department of Health and Social Care told us that £3.46

billion of capital is available to providers in 2018/19. We

believe that keeping to this budget carries a high risk as

provider plans exceed it by £1.2 billion and the Month 6

forecast exceeds the budget by £1 billion.

• Historically, providers overestimate capital spend at plan

stage and in the early months of the year. However, given

the sector underspent last year, we are working with

providers to achieve more realistic and credible forecasts.

• Providers at Month 6 had spent £1.194 billion on capital

schemes, which was £700 million below plan at this stage of

the year. The spend at Month 6 represents 27% of the sector

forecast of £4.462 billion at Month 6, meaning £3.3 billion

remains to be spent in the second half of the year to achieve

the forecast.

• At the same stage in 2017/18 providers had spent £1.079

billion and forecast £3.94 billion; they ended the year with an

outturn position of £3.063 billion. Providers had therefore

spent 35% of the outturn position by Month 6 in 2017/18 and

spent £1.94 billion in months 7 to 12.

• Foundation trusts forecast CDEL expenditure of £2.828

billion (63% of the total forecast). NHS trusts forecast £1.634

billion (37% of the total sector forecast).



Plan Actual Variance to plan

£m £m £m %

Acute 1,400 892 (508) (36.3%)

Ambulance 42 32 (10) (23.8%)

Community 30 14 (16) (53.3%)

Mental Health 253 139 (114) (45.1%)

Specialist 169 117 (52) (30.8%)

Total CDEL 1,894 1,194 (700) (37.0%)



Plan Forecast Variance to plan

£m £m £m %

Acute 3,422 3,303 (119) (3.4%)

Ambulance 124 151 27 21.8%

Community 73 70 (3) (4.1%)

Mental Health 668 595 (73) (10.9%)

Specialist 357 343 (14) (3.9%)

Total CDEL 4,644 4,462 (182) (3.9%)

Provider Capital Summary Foundation Trust

NHSTrust

Forecast outturn

Capital Departmental Expenditure Limit £m £m £m

Gross capital expenditure 3,052 1,693 4,745

Disposals / other deductions (113) (19) (132)

Net Capital expenditure 2,939 1,674 4,613

Less donations and grants received (127) (38) (165)

Less PFI capital (IFRIC12) (58) (81) (139)

Plus PFI residual interest 76 79 155

Purchase of financial assets 30 0 30

Sale of financial assets (32) 0 (32)

Total CDEL 2,828 1,634 4,462


2.11 Q2 financial performance overview by integrated care system (ICS)

In 2018/19, to reinforce the importance integration will play in improving the long-term sustainability of vital patient services – many of which cross

organisational boundaries – NHS England and NHS Improvement introduced the voluntary rollout of integrated care systems (ICSs).

In integrated care systems, NHS commissioners and providers, working with GP networks, local authorities and others, agree to share responsibility

(in ways consistent with their individual legal obligations) for how they use their collective resources to benefit local populations.

There are 14 systems in the ICS development programme. Eight agreed to link their Provider Sustainability Fund (PSF) resources to their ICS’s

financial performance in 2018/19.

The table below compares the ICS financial performance of CCGs and providers at the end of Quarter 2 against plan, including PSF.

* Where the system agreed to link PSF to system performance and not all providers accepted their individual control totals, systems will work towards system improvement plans to improve their

aggregate positions as part of their commitment to working together in meeting operational and financial challenges.

NB Provider plan and actual values are net of any improvements made to plans at an organisational level following the in year plan reset process and CCG plan and actual exclude draw down values

ICS Name Region

PSF Linked

to System

Performance

Number

of

Provider

CTs

Accepted*

YTD Plan

incl. PSF

£000s

YTD

Actual

incl. PSF

£000s

Total

System

Variance

incl. PSF

£000s

Total

System

Variance

excl. PSF

£000s

PSF Allocated

(in Plan only if

accepted CT)

£000s

YTD

Actual

£000s

PSF

Variance

£000s

Bedfordshire, Luton & Milton Keynes M & E Yes 3/3 (6,019) (14,603) (8,584) (5,993) 10,320 7,729 (2,591)

Berkshire West North Yes 2/2 (550) 508 1,058 1,058 4,947 4,947 (0)

Dorset South Yes 4/4 (10,378) (10,610) (232) 727 9,289 8,330 (959)

Frimley Health South Yes 3/3 9,785 10,201 416 416 9,598 9,598 (0)

Greater Manchester North Yes 8/10 * (72,810) (79,586) (6,776) 649 31,328 23,903 (7,425)

Nottinghamshire M & E Yes 3/3 (21,703) (45,933) (24,230) (15,878) 17,144 8,792 (8,352)

South Yorkshire and Bassetlaw North Yes 6/7 * (39,543) (38,867) 676 3,416 19,807 17,066 (2,741)

Surrey Heartlands South Yes 3/3 (5,231) (5,277) (46) 1,592 7,370 5,732 (1,638)

Buckinghamshire South No 1/1 (7,104) (20,371) (13,267) (9,088) 4,179 0 (4,179)

Gloucestershire South No 3/4 (15,528) (15,445) 83 83 3,579 3,579 0

Lancashire and South Cumbria North No 4/6 (80,726) (82,648) (1,923) (387) 6,111 4,576 (1,536)

Suffolk and North East Essex South No 6/6 (22,928) (30,607) (7,679) (3,190) 8,706 4,217 (4,489)

West Yorkshire North No 11/12 (58,494) (59,692) (1,198) 4,646 25,236 19,391 (5,844)

West, North and East Cumbria North No 3/3 (24,396) (33,742) (9,346) (5,293) 4,921 868 (4,053)

Year to date Provider Sustainability Funding (PSF)

2.12 Year-end financial position


• For 2018/19, the sector seeks to build on the financial grip achieved in

the last two financial years. Despite continuing financial pressures from

increasing demand for urgent and emergency care, we made a

challenging plan to reduce the sector deficit initially to £519 million. We

amended this, as part of the plan reset process, to £439 million (see

below).

• In 2018/19 we introduced new provider control totals, detailing the

minimum improvement we expect in financial positions for the year. The

PSF of £2.45 billion replaced STF and is linked to providers achieving

control totals. At the end of Quarter 2, 201 out of 230 providers (87%)

had accepted their individual control totals. During the quarter we used

the PSF framework to offer providers additional bonus payments to

improve their financial position. These incentives, which affected a small

number of providers, enabled us to reset the plan forecast from £519

million in Quarter 1 to £439 million.

• Against this lower plan, the sector forecasts it will overspend by £119

million. Our regional teams are working to reduce this overspend as well

as close the residual planning gap to secure a balanced financial position

for the NHS.

• For greater financial sustainability, providers must move from one-off

and short-term improvements to the in-year financial position and identify

recurrent long-term savings. To help assess the underlying financial

position consistently, the 2018/19 planning guidance included a detailed

definition. Providers’ aggregate financial plans revealed that the sector

carried forward an underlying deficit from 2017/18 into 2018/19 of £4.3

billion (£1.85 billion net if it is assumed the PSF will be deployed in the

provider sector in future).

• Our regional teams continue to directly support all providers. Eleven of

the most financially challenged will continue to receive intensive financial

improvement support through special measures. Since special measures

was introduced (through to Quarter 2 2018/19), four providers showed

significant financial improvement and exited the regime – one of them,

Brighton and Sussex University Hospitals NHS Trust, during Quarter 2.

Sector

No of trusts

accepted

control total

No of trusts

included PSF in

year-to-date

position

No of trusts

forecast to

receive full or

partial PSF at

the year end

No of trusts in

Financial

Special

Measures

Acute 107 99 104 11

Ambulance 9 9 9 0

Community 16 15 15 0

Mental Health 53 52 53 0

Specialist 16 15 16 0

Total 201 190 197 11

Control total, PSF and financial special measures data by sector

as at September 2018


3.0 Financial performance by provider

3.1 Financial performance by provider – London (1/1)


Provider Name

Control Total

(CT)

Accepted? YTD Plan YTD Actual Variance FOT Plan FOT Variance

PSF inPlan (CT

acceptors

only) YTD Actual FOT

Barking, Havering and Redbridge University Hospitals NHS Trust No (30,658) (34,918) (4,260) (52,500) (53,361) (861) 0 0 0

Barnet, Enfield And Haringey Mental Health NHS Trust Yes (2,839) (2,247) 592 (3,346) (3,579) (233) 1,640 574 1,640

Barts Health NHS Trust No 3,990 (21,679) (25,669) (1,900) (69,565) (67,665) 54,885 0 0

Camden and Islington NHS Foundation Trust Yes (212) (198) 14 6,644 6,644 0 4,144 1,451 4,144

Chelsea and Westminster Hospital NHS Foundation Trust Yes 1,807 2,068 261 14,784 18,784 4,000 19,859 6,951 19,859

Central London Community Healthcare NHS Trust Yes 2,291 2,308 17 7,186 7,186 0 4,590 1,607 4,590

Central and North West London NHS Foundation Trust Yes (6,048) (4,941) 1,107 2,746 2,746 0 4,118 1,442 4,118

Croydon Health Services NHS Trust Yes (5,482) (6,766) (1,284) (2,842) (4,125) (1,283) 12,218 2,993 10,935

East London NHS Foundation Trust Yes 2,589 2,611 22 9,032 9,032 0 3,428 1,200 3,428

Epsom and St Helier University Hospitals NHS Trust Yes (17,110) (17,223) (113) (13,663) (19,980) (6,317) 14,529 4,432 8,790

Great Ormond Street Hospital for Children NHS Foundation Trust Yes 5,808 5,823 15 12,066 12,501 435 7,571 2,650 7,571

Guy's and St Thomas' NHS Foundation Trust Yes (8,062) (11,319) (3,257) 27,738 21,809 (5,929) 31,070 7,612 27,808

The Hillingdon Hospitals NHS Foundation Trust Yes (4,867) (12,815) (7,948) (7,619) (10,058) (2,439) 6,181 0 4,018

Homerton University Hospital NHS Foundation Trust Yes 3,261 4,100 839 11,653 11,114 (539) 10,990 3,308 10,451

Hounslow and Richmond Community Healthcare NHS Trust Yes 723 727 4 1,965 1,965 0 1,268 444 1,268

Imperial College Healthcare NHS Trust Yes (8,328) (9,866) (1,538) 13,603 12,065 (1,538) 34,163 10,419 32,625

King's College Hospital NHS Foundation Trust Yes (72,250) (86,669) (14,419) (124,498) (130,958) (6,460) 21,532 2,261 15,072

Kingston Hospital NHS Foundation Trust Yes (2,585) (2,566) 19 2,074 7,074 5,000 8,074 2,826 8,074

Lewisham and Greenwich NHS Trust Yes (20,251) (26,950) (6,699) (35,470) (38,168) (2,698) 17,595 1,847 15,748

London Ambulance Service NHS Trust Yes (4,403) (4,381) 22 (1,528) 331 1,859 2,728 955 2,728

Moorfields Eye Hospital NHS Foundation Trust Yes 1,098 1,879 781 6,697 6,697 0 4,838 1,694 4,838

North East London NHS Foundation Trust Yes 3,616 3,618 2 3,503 3,503 0 3,237 1,133 3,237

North Middlesex University Hospital NHS Trust Yes (4,707) (5,680) (973) (9,549) (10,958) (1,409) 9,401 2,304 8,414

London North West University Healthcare NHS Trust Yes (25,103) (24,524) 579 (31,369) (32,434) (1,065) 27,255 9,539 27,255

Oxleas NHS Foundation Trust Yes 784 119 (665) 2,965 2,276 (689) 2,094 314 2,094

Royal National Orthopaedic Hospital NHS Trust Yes (7,476) (5,214) 2,262 (7,012) (6,992) 20 1,232 431 1,232

Royal Brompton and Harefield NHS Foundation Trust Yes (15,556) (14,232) 1,324 (217) (4,998) (4,781) 11,516 4,030 7,485

Royal Free London NHS Foundation Trust No (37,294) (40,403) (3,109) (65,826) (67,388) (1,562) 0 0 0

The Royal Marsden NHS Foundation Trust Yes 6,844 13,018 6,174 24,221 27,220 2,999 16,597 5,808 16,597

South London and Maudsley NHS Foundation Trust Yes 976 1,021 45 2,506 1,525 (981) 3,181 1,113 3,181

St George's University Hospitals NHS Foundation Trust Yes (18,862) (27,587) (8,725) (16,376) (16,704) (328) 12,624 1,894 12,624

South West London and St George's Mental Health NHS Trust Yes (1,412) (1,399) 13 2,476 2,476 0 1,382 483 1,382

Tavistock and Portman NHS Foundation Trust Yes 625 741 116 1,034 1,034 0 703 246 703

University College London Hospitals NHS Foundation Trust Yes (12,183) (13,939) (1,756) 14,525 12,349 (2,176) 20,723 5,077 18,547

West London NHS Trust Yes 2,509 2,509 0 7,457 7,457 0 3,987 1,395 3,987

The Whittington Health NHS Trust Yes 3,382 3,547 165 22,675 21,893 (782) 21,380 7,483 21,380

London Total (265,385) (331,426) (66,042) (176,165) (271,585) (95,422) 400,733 95,916 315,823

Control Total Basis Surplus Deficit Including PSF Provider Sustainability Fund (PSF)

Year to date Forecast Outturn

3.2 Financial performance by provider – Midlands and East (1/2)


Provider Name

Control Total

(CT)


PSF inPlan (CT

acceptors


Basildon and Thurrock University Hospitals NHS Foundation Trust No (16,746) (16,053) 693 (26,818) (26,818) 0 0 0 0

Birmingham Women’s and Children's NHS Foundation Trust Yes 8,132 (703) (8,835) 15,125 15,125 0 10,952 0 10,952

Bedford Hospital NHS Trust Yes (4,290) (8,145) (3,855) (6,670) (6,670) 0 7,381 775 7,381

Birmingham Community Healthcare NHS Foundation Trust Yes 2,368 2,523 155 4,351 4,351 0 2,278 798 2,278

Birmingham and Solihull Mental Health NHS Foundation Trust Yes (776) (4) 772 1,938 1,938 0 2,088 731 2,088

Burton Hospitals NHS Foundation Trust Yes (4,200) (4,200) 0 (4,200) (4,200) 0 1,135 1,135 1,135

Cambridgeshire Community Services NHS Trust Yes 1,056 1,066 10 2,117 2,117 0 1,508 528 1,508

Cambridgeshire and Peterborough NHS Foundation Trust Yes (2) 316 318 2,162 2,162 0 1,853 649 1,853

Cambridge University Hospitals NHS Foundation Trust No (51,434) (51,372) 62 (93,791) (93,749) 42 0 0 0

Chesterfield Royal Hospital NHS Foundation Trust Yes (1,462) (1,452) 10 5,296 5,296 0 6,399 2,240 6,399

Coventry and Warwickshire Partnership NHS Trust Yes (2,204) (1,900) 304 2,154 2,154 0 1,727 604 1,727

University Hospitals of Derby and Burton NHS Foundation Trust Yes (18,652) (25,894) (7,242) (22,043) (22,043) 0 15,350 1,338 15,350

Derbyshire Community Health Services NHS Foundation Trust Yes 1,866 3,856 1,990 4,075 4,075 0 2,161 756 2,161

Derbyshire Healthcare NHS Foundation Trust Yes 842 973 131 2,331 2,331 0 1,117 391 1,117

Dudley And Walsall Mental Health Partnership NHS Trust Yes 593 638 45 1,391 1,391 0 703 246 703

East And North Hertfordshire NHS Trust Yes (10,838) (11,999) (1,161) (281) (1,788) (1,507) 14,362 3,518 12,854

The Ipswich Hospital NHS Trust Yes (6,272) (6,560) (288) (6,272) (6,560) (288) 1,124 787 787

East Midlands Ambulance Service NHS Trust Yes (2,833) (847) 1,986 (4,649) (4,649) 0 1,313 460 1,313

Essex Partnership University NHS Foundation Trust Yes (1,848) 1,697 3,545 (2,720) (2,720) 0 3,251 1,138 3,251

East Suffolk and North Essex NHS Foundation Trust Yes (12,596) (20,505) (7,909) (21,593) (21,593) 0 18,812 1,866 18,812

East of England Ambulance Service NHS Trust Yes 3,355 3,356 1 3,105 3,105 0 1,983 694 1,983

George Eliot Hospital NHS Trust Yes (7,964) (8,392) (428) (14,276) (15,543) (1,267) 4,222 1,035 2,955

Hertfordshire Community NHS Trust Yes 889 916 27 2,077 2,077 0 1,288 451 1,288

Hertfordshire Partnership University NHS Foundation Trust Yes 542 708 166 2,135 2,135 0 1,775 621 1,775

James Paget University Hospitals NHS Foundation Trust Yes (6,231) (6,554) (323) (7,271) (8,205) (934) 3,112 762 2,178

The Princess Alexandra Hospital NHS Trust Yes (13,352) (14,032) (680) (20,436) (21,280) (844) 8,035 1,969 7,191

Kettering General Hospital NHS Foundation Trust Yes (13,713) (13,713) 0 (7,802) (18,715) (10,913) 7,459 2,611 4,849

Leicestershire Partnership NHS Trust Yes 1,260 1,260 0 3,273 3,273 0 2,348 822 2,348

Royal Papworth Hospital NHS Foundation Trust No (8,526) (5,319) 3,207 (15,800) (15,800) 0 0 0 0

University Hospitals of Leicester NHS Trust Yes (17,231) (39,982) (22,751) 754 (49,495) (50,249) 21,947 2,304 2,305

Lincolnshire Community Health Services NHS Trust Yes 1,220 1,282 62 2,874 2,989 115 1,908 668 1,908

Lincolnshire Partnership NHS Foundation Trust Yes 669 870 201 1,079 1,418 339 837 293 837

Luton and Dunstable University Hospital NHS Foundation Trust Yes 1,129 1,127 (2) 15,758 15,806 48 11,838 3,724 11,658

Mid Essex Hospital Services NHS Trust No (24,432) (31,822) (7,390) (47,257) (60,746) (13,489) 0 0 0

Midlands Partnership NHS Foundation Trust Yes (852) (6,558) (5,706) 4,548 4,548 0 4,478 0 4,478

Norfolk and Norwich University Hospitals NHS Foundation Trust No (29,191) (29,105) 86 (54,193) (54,193) 0 0 0 0

North Staffordshire Combined Healthcare NHS Trust Yes 264 359 95 1,423 1,423 0 703 246 703

Northamptonshire Healthcare NHS Foundation Trust Yes 594 599 5 1,588 1,588 0 1,610 564 1,610



3.3 Financial performance by provider – Midlands and East (2/2)


Provider Name

Control Total

(CT)


PSF inPlan (CT

acceptors


Nottingham University Hospitals NHS Trust Yes (2,022) (24,971) (22,949) 7,884 4,446 (3,438) 32,746 3,438 29,308

University Hospitals of North Midlands NHS Trust No (36,836) (39,767) (2,931) (44,802) (44,802) 0 0 0 0

North West Anglia NHS Foundation Trust Yes (23,080) (23,240) (160) (28,767) (29,157) (390) 17,222 6,028 17,222

Norfolk Community Health and Care NHS Trust Yes (2,063) (1,830) 233 (1,867) (1,867) 0 831 291 831

Norfolk and Suffolk NHS Foundation Trust Yes (567) (560) 7 (178) 22 200 1,806 632 1,806

Nottinghamshire Healthcare NHS Foundation Trust Yes 1,980 2,168 188 7,422 7,422 0 3,843 1,267 3,843

Queen Elizabeth Hospital King's Lynn NHS Foundation Trust Yes (8,781) (16,761) (7,980) (9,694) (34,231) (24,537) 6,101 0 0

Sandwell And West Birmingham Hospitals NHS Trust Yes (5,434) (6,594) (1,160) 3,489 2,328 (1,161) 11,056 2,709 9,895

Northampton General Hospital NHS Trust Yes (11,151) (11,107) 44 (18,514) (18,514) 0 9,191 3,217 9,191

The Robert Jones and Agnes Hunt Orthopaedic Hospital NHS Foundation Trust Yes (1) 6 7 1,937 1,937 0 833 292 833

The Royal Orthopaedic Hospital NHS Foundation Trust Yes (3,520) (3,515) 5 (6,002) (6,002) 0 613 215 613

The Royal Wolverhampton NHS Trust Yes (3,824) (4,991) (1,167) 11,210 7,785 (3,425) 11,415 2,797 7,990

Sherwood Forest Hospitals NHS Foundation Trust Yes (21,411) (21,555) (144) (33,972) (33,972) 0 12,395 4,087 12,395

Black Country Partnership NHS Foundation Trust Yes (1,131) (348) 783 (684) (683) 1 1,868 653 1,868

Shropshire Community Health NHS Trust Yes 75 80 5 966 966 0 838 294 838

United Lincolnshire Hospitals NHS Trust No (35,995) (43,464) (7,469) (74,700) (74,700) 0 0 0 0

South Warwickshire NHS Foundation Trust Yes 2,408 2,103 (305) 9,227 8,917 (310) 6,879 2,098 6,569

Staffordshire and Stoke on Trent Partnership NHS Trust Yes (2,217) (1,861) 356 (2,217) (1,861) 356 0 0 0

Milton Keynes University Hospital NHS Foundation Trust Yes (10,258) (10,566) (308) (15,825) (16,862) (1,037) 10,264 3,230 9,227

The Dudley Group NHS Foundation Trust Yes 400 (234) (634) 8,239 7,289 (950) 9,043 2,216 8,093

Southend University Hospital NHS Foundation Trust Yes (7,012) (6,273) 739 (10,540) (10,540) 0 10,786 3,775 10,786

University Hospitals Coventry And Warwickshire NHS Trust Yes (16,789) (18,409) (1,620) (9,693) (11,315) (1,622) 15,450 3,785 13,828

University Hospitals Birmingham NHS Foundation Trust Yes (21,965) (21,927) 38 (38,045) (38,045) 0 23,761 8,316 23,761

Walsall Healthcare NHS Trust Yes (10,177) (14,875) (4,698) (10,496) (11,987) (1,491) 4,969 522 3,478

West Hertfordshire Hospitals NHS Trust No (29,872) (30,227) (355) (52,900) (52,900) 0 0 0 0

West Midlands Ambulance Service NHS Foundation Trust Yes 3,515 3,570 55 2,035 2,035 0 1,943 680 1,943

West Suffolk NHS Foundation Trust Yes (7,157) (7,041) 116 (10,006) (10,171) (165) 3,657 1,115 3,492

The Shrewsbury And Telford Hospital NHS Trust Yes (7,480) (10,326) (2,846) (8,615) (11,562) (2,947) 9,824 1,032 6,877

Worcestershire Acute Hospitals NHS Trust Yes (22,220) (32,820) (10,600) (23,704) (26,185) (2,481) 17,807 0 15,938

Worcestershire Health and Care NHS Trust Yes 1,686 1,686 0 3,370 3,370 0 1,689 591 1,689

Wye Valley NHS Trust Yes (16,277) (18,720) (2,443) (22,801) (31,045) (8,244) 4,421 0 0

Midlands and East Total (528,041) (645,932) (117,892) (644,762) (775,347) (130,588) 398,308 88,004 342,050



3.4 Financial performance by provider – North 1/2


Provider Name

Control Total

(CT)


PSF inPlan (CT

acceptors


North West Boroughs Healthcare NHS Foundation Trust Yes (39) (39) 0 995 995 0 1,492 522 1,492

Aintree University Hospital NHS Foundation Trust No (13,783) (14,257) (474) (29,050) (29,317) (267) 0 0 0

Airedale NHS Foundation Trust Yes (1,625) (905) 720 5,206 4,703 (503) 4,788 1,172 4,285

Alder Hey Children's NHS Foundation Trust Yes 4,369 4,370 1 32,192 32,192 0 24,731 8,656 24,731

Barnsley Hospital NHS Foundation Trust Yes (6,805) (6,786) 19 (8,733) (8,433) 300 8,269 2,894 8,269

Blackpool Teaching Hospitals NHS Foundation Trust Yes (7,367) (7,730) (363) (3,966) (4,657) (691) 6,575 1,611 5,884

Bolton NHS Foundation Trust Yes 1,541 403 (1,138) 12,717 11,553 (1,164) 11,094 2,718 9,929

Bradford Teaching Hospitals NHS Foundation Trust Yes (4,828) (5,859) (1,031) 2,807 1,723 (1,084) 10,321 2,528 9,237

Bradford District Care NHS Foundation Trust Yes (350) (300) 50 1,381 1,381 0 993 348 993

Bridgewater Community Healthcare NHS Foundation Trust No (4,719) (4,699) 20 (7,594) (7,594) 0 0 0 0

Calderdale and Huddersfield NHS Foundation Trust No (24,549) (24,309) 240 (43,048) (43,040) 8 0 0 0

Countess of Chester Hospital NHS Foundation Trust Yes (2,594) (3,359) (765) 2,963 (10,968) (13,931) 7,297 1,789 1,789

The Christie NHS Foundation Trust Yes 12,660 12,671 11 25,319 25,319 0 14,102 4,935 14,102

The Clatterbridge Cancer Centre NHS Foundation Trust Yes 1,133 2,147 1,014 2,203 2,203 0 536 188 536

Cumbria Partnership NHS Foundation Trust Yes (1,294) (1,293) 1 (2,078) (2,078) 0 2,333 817 2,333

Cheshire and Wirral Partnership NHS Foundation Trust Yes (87) 117 204 1,119 1,119 0 1,378 483 1,378

County Durham and Darlington NHS Foundation Trust Yes (6,720) (8,604) (1,884) 8,081 6,182 (1,899) 18,091 4,432 16,192

Doncaster and Bassetlaw Teaching Hospitals NHS Foundation Trust Yes (11,945) (11,944) 1 (6,615) (6,615) 0 16,238 5,684 16,238

East Cheshire NHS Trust Yes (9,751) (9,720) 31 (16,233) (16,233) 0 7,664 2,087 7,664

East Lancashire Hospitals NHS Trust Yes (5,006) (5,852) (846) (7,748) (9,318) (1,570) 8,050 1,972 6,480

Gateshead Health NHS Foundation Trust Yes (2,655) (6,280) (3,625) 742 742 0 7,282 1,093 7,282

Greater Manchester Mental Health NHS Foundation Trust Yes 1,434 1,434 0 2,292 2,292 0 2,492 872 2,492

Harrogate and District NHS Foundation Trust Yes (3,692) (3,667) 25 3,983 4,129 146 3,983 1,394 3,983

Hull And East Yorkshire Hospitals NHS Trust Yes (1,229) (1,795) (566) 2,364 1,798 (566) 12,586 3,839 12,020

Humber Teaching NHS Foundation Trust Yes (1,888) (1,648) 240 1,151 1,151 0 2,012 704 2,012

Lancashire Care NHS Foundation Trust Yes (2,480) (2,257) 223 (1,679) (1,679) 0 2,199 770 2,199

Lancashire Teaching Hospitals NHS Foundation Trust No (28,892) (27,239) 1,653 (46,441) (46,441) 0 0 0 0

Leeds and York Partnership NHS Foundation Trust Yes 6,782 7,629 847 28,043 28,043 0 18,427 6,449 18,427

Leeds Community Healthcare NHS Trust Yes 1,693 2,044 351 4,041 4,041 0 2,333 817 2,333

The Leeds Teaching Hospitals NHS Trust Yes (5,569) (8,850) (3,281) 22,574 20,353 (2,221) 42,403 11,439 32,682

Liverpool Heart and Chest Hospital NHS Foundation Trust Yes 3,667 3,679 12 9,654 9,654 0 5,592 1,957 5,592

Liverpool Women's NHS Foundation Trust Yes (2,392) (890) 1,502 (1,601) (1,601) 0 3,608 1,263 3,608

Manchester University NHS Foundation Trust Yes 1,878 (2,815) (4,693) 32,847 28,129 (4,718) 44,931 11,008 40,213

Mersey Care NHS Foundation Trust Yes 2,393 2,393 0 5,485 5,485 0 3,643 1,275 3,643

Mid Cheshire Hospitals NHS Foundation Trust Yes (1,167) (2,047) (880) 5,243 4,358 (885) 8,428 2,065 7,543

The Mid Yorkshire Hospitals NHS Trust Yes (8,501) (9,249) (748) (5,410) (5,410) 0 14,254 4,134 14,254

University Hospitals of Morecambe Bay NHS Foundation Trust No (35,093) (37,704) (2,611) (69,449) (69,449) 0 0 0 0

The Newcastle Upon Tyne Hospitals NHS Foundation Trust Yes 3,276 3,299 23 12,947 12,947 0 12,947 4,531 12,947



3.5 Financial performance by provider – North 2/2


Provider Name

Control Total

(CT)


PSF in Plan (CT

acceptors


Northern Lincolnshire and Goole NHS Foundation Trust Yes (22,370) (26,269) (3,899) (32,385) (44,456) (12,071) 7,198 0 0

North Cumbria University Hospitals NHS Trust Yes (25,172) (34,573) (9,401) (37,628) (37,628) 0 11,579 0 11,579

North East Ambulance Service NHS Foundation Trust Yes (337) 264 601 (712) (412) 300 1,003 351 1,003

North Tees and Hartlepool NHS Foundation Trust No (12,371) (8,149) 4,222 (20,220) (20,220) 0 0 0 0

Northumberland, Tyne and Wear NHS Foundation Trust Yes (189) 1,425 1,614 3,524 3,524 0 2,028 710 2,028

Northumbria Healthcare NHS Foundation Trust Yes 12,328 12,386 58 25,143 25,143 0 12,066 4,223 12,066

North West Ambulance Service NHS Trust Yes 1,152 1,232 80 1,839 1,839 0 2,422 848 2,422

The Pennine Acute Hospitals NHS Trust No (39,131) (39,105) 26 (68,858) (68,858) 0 0 0 0

Pennine Care NHS Foundation Trust Yes (2,321) (666) 1,655 (6,369) (6,369) 0 1,924 674 1,924

Rotherham Doncaster and South Humber NHS Foundation Trust Yes 839 1,711 872 2,058 4,158 2,100 1,388 486 1,388

The Rotherham NHS Foundation Trust No (11,897) (11,727) 170 (20,283) (20,283) 0 0 0 0

The Royal Liverpool and Broadgreen University Hospitals NHS Trust No (27,538) (30,051) (2,513) (39,690) (39,690) 0 0 0 0

Salford Royal NHS Foundation Trust Yes (7,803) (9,265) (1,462) 5,374 968 (4,406) 14,687 3,598 10,281

Sheffield Children's NHS Foundation Trust Yes (3,990) (3,893) 97 1,882 1,882 0 3,495 1,223 3,495

Sheffield Health and Social Care NHS Foundation Trust Yes 2,012 2,307 295 4,532 4,824 292 3,097 1,084 3,097

Sheffield Teaching Hospitals NHS Foundation Trust Yes (3,834) (4,713) (879) 5,104 2,363 (2,741) 26,103 6,395 23,362

Southport And Ormskirk Hospital NHS Trust No (15,800) (15,748) 52 (28,818) (28,818) 0 0 0 0

South Tees Hospitals NHS Foundation Trust Yes (4,946) (4,923) 23 3,804 3,804 0 13,900 4,865 13,900

South Tyneside NHS Foundation Trust Yes (8,326) (7,176) 1,150 (12,065) (12,065) 0 2,954 1,034 2,954

St Helens And Knowsley Teaching Hospitals NHS Trust Yes (1,570) (2,144) (574) 10,993 10,416 (577) 12,821 3,910 12,244

Stockport NHS Foundation Trust No (20,035) (19,784) 251 (33,820) (33,820) 0 0 0 0

City Hospitals Sunderland NHS Foundation Trust Yes (9,500) (9,884) (384) (11,909) (12,591) (682) 6,495 1,591 5,813

South West Yorkshire Partnership NHS Foundation Trust Yes (1,664) (284) 1,380 (1,156) (655) 501 1,470 515 1,470

Tameside and Glossop Integrated Care NHS Foundation Trust Yes (12,288) (12,120) 168 (19,149) (19,149) 0 4,221 1,477 4,221

Tees, Esk and Wear Valleys NHS Foundation Trust Yes 3,486 3,698 212 6,864 7,879 1,015 2,663 932 2,663

The Walton Centre NHS Foundation Trust Yes 1,114 1,115 1 3,254 3,257 3 2,263 792 2,263

Warrington and Halton Hospitals NHS Foundation Trust Yes (12,513) (13,031) (518) (16,881) (17,399) (518) 4,942 1,211 4,424

Wrightington, Wigan and Leigh NHS Foundation Trust Yes (3,704) (3,317) 387 1,682 111 (1,571) 8,060 2,821 6,489

Wirral University Teaching Hospital NHS Foundation Trust No (16,277) (18,122) (1,845) (25,042) (25,360) (318) 0 0 0

Wirral Community NHS Foundation Trust Yes 825 1,007 182 2,193 2,193 0 1,455 509 1,455

York Teaching Hospital NHS Foundation Trust Yes (7,992) (7,665) 327 (1,835) (2,356) (521) 12,479 3,806 11,917

Yorkshire Ambulance Service NHS Trust Yes 3,718 3,718 0 4,188 4,188 0 2,123 743 2,123

North Total (400,288) (423,655) (23,369) (317,682) (365,921) (48,239) 493,908 140,245 447,343



3.6 Financial performance by provider – South (1/2)


Provider Name

Control Total

(CT)


PSF in Plan (CT

acceptors


Ashford and St Peter's Hospitals NHS Foundation Trust Yes 3,955 3,921 (34) 13,215 12,568 (647) 10,789 3,129 10,142

Avon and Wiltshire Mental Health Partnership NHS Trust Yes (1,948) (1,870) 78 (2,635) (2,635) 0 1,262 441 1,262

Hampshire Hospitals NHS Foundation Trust Yes (5,196) (5,722) (526) 4,767 3,720 (1,047) 10,976 2,794 9,930

Berkshire Healthcare NHS Foundation Trust Yes 507 1,780 1,273 2,397 3,897 1,500 2,433 852 2,433

The Royal Bournemouth and Christchurch Hospitals NHS Foundation Trust Yes 4,112 4,151 39 24,619 24,619 0 27,000 9,449 27,000

Brighton and Sussex University Hospitals NHS Trust Yes (30,575) (31,109) (534) (55,106) (55,724) (618) 10,294 2,985 9,676

University Hospitals Bristol NHS Foundation Trust Yes 7,599 7,620 21 18,480 16,855 (1,625) 15,480 5,418 13,855

Buckinghamshire Healthcare NHS Trust Yes 646 (12,692) (13,338) 9,893 6,312 (3,581) 11,938 0 8,357

Cornwall Partnership NHS Foundation Trust Yes 1,398 1,468 70 2,695 2,695 0 747 261 747

Dartford and Gravesham NHS Trust Yes (6,977) (9,071) (2,094) (5,135) (19,582) (14,447) 5,135 770 770

Devon Partnership NHS Trust Yes 2,479 2,479 0 3,928 3,928 0 2,194 768 2,194

Dorset County Hospital NHS Foundation Trust Yes (4,780) (4,386) 394 (1,325) (1,325) 0 5,873 2,056 5,873

Dorset Healthcare University NHS Foundation Trust Yes 2,928 3,149 221 7,852 7,852 0 6,230 2,181 6,230

East Kent Hospitals University NHS Foundation Trust No (15,675) (17,059) (1,384) (29,830) (29,894) (64) 0 0 0

East Sussex Healthcare NHS Trust No (23,864) (24,563) (699) (45,000) (45,000) 0 0 0 0

Frimley Health NHS Foundation Trust Yes 10,161 10,256 95 32,837 32,839 2 26,165 9,158 26,165

Gloucestershire Care Services NHS Trust Yes 1,339 1,339 0 3,012 3,012 0 1,936 677 1,936

2gether NHS Foundation Trust Yes 478 493 15 864 893 29 903 316 903

Gloucestershire Hospitals NHS Foundation Trust Yes (16,892) (16,704) 188 (18,821) (22,666) (3,845) 8,060 2,821 5,239

Great Western Hospitals NHS Foundation Trust Yes (5,028) (4,985) 43 (5,300) (5,300) 0 7,126 2,494 7,126

Southern Health NHS Foundation Trust Yes (3,976) (3,970) 6 3,384 3,384 0 4,089 1,431 4,089

Isle of Wight NHS Trust No (11,353) (13,301) (1,948) (17,149) (17,149) 0 0 0 0

Kent Community Health NHS Foundation Trust Yes 1,208 1,453 245 3,128 3,128 0 2,474 866 2,474

Kent and Medway NHS and Social Care Partnership Trust Yes (3,556) (3,555) 1 (1,829) (1,828) 1 1,547 541 1,547

Maidstone And Tunbridge Wells NHS Trust Yes (3,604) (3,571) 33 11,741 11,741 0 12,718 4,451 12,718

Medway NHS Foundation Trust Yes (22,542) (22,370) 172 (34,169) (35,499) (1,330) 12,663 3,102 11,333

North Bristol NHS Trust Yes (11,072) (11,948) (876) (18,383) (18,383) 0 16,176 4,691 16,176

Northern Devon Healthcare NHS Trust No (7,170) (7,685) (515) (11,877) (12,208) (331) 0 0 0

Oxford Health NHS Foundation Trust Yes (2,439) (5,893) (3,454) 1,939 (7,945) (9,884) 2,715 407 407

Oxford University Hospitals NHS Foundation Trust Yes (12,707) (2,962) 9,745 25,726 25,726 0 15,321 5,362 15,321

University Hospitals Plymouth NHS Trust Yes (8,457) (17,472) (9,015) (3,823) (29,550) (25,727) 12,444 1,307 1,307

Poole Hospital NHS Foundation Trust Yes (4,984) (5,871) (887) (3,713) (4,672) (959) 9,142 2,240 8,183

Portsmouth Hospitals NHS Trust No (18,667) (18,619) 48 (29,900) (29,900) 0 0 0 0

The Queen Victoria Hospital NHS Foundation Trust Yes 1,315 1,318 3 13,951 13,952 1 9,325 3,264 9,325

Royal Devon and Exeter NHS Foundation Trust Yes (2,160) (2,013) 147 6,272 6,501 229 12,222 4,278 12,222

Royal Berkshire NHS Foundation Trust Yes (854) (755) 99 8,989 8,089 (900) 12,673 4,436 12,673

Royal Cornwall Hospitals NHS Trust Yes (8,652) (8,646) 6 (11,889) (11,889) 0 8,871 3,105 8,871

Royal Surrey County Hospital NHS Foundation Trust Yes (2,753) (746) 2,007 (1,650) (650) 1,000 9,447 2,315 6,613

Royal United Hospitals Bath NHS Foundation Trust Yes 3,611 (1,682) (5,293) 12,762 11,611 (1,151) 10,958 1,151 9,807

Salisbury NHS Foundation Trust Yes (4,349) (4,725) (376) (5,165) (5,165) 0 3,795 930 3,795

Provider Sustainability Fund (PSF)Control Total Basis Surplus Deficit Including PSF


3.7 Financial performance by provider – South (2/2)


Provider Name

Control Total

(CT)


PSF in Plan (CT

acceptors


South Central Ambulance Service NHS Foundation Trust Yes (603) (586) 17 (764) (764) 0 1,493 523 1,493

South East Coast Ambulance Service NHS Foundation Trust Yes (3,722) (3,596) 126 (769) (756) 13 1,782 623 1,782

Solent NHS Trust Yes (966) (897) 69 (971) (971) 0 1,620 568 1,620

Somerset Partnership NHS Foundation Trust Yes 1,327 1,336 9 4,111 4,111 0 2,303 806 2,303

University Hospital Southampton NHS Foundation Trust Yes 8,973 7,614 (1,359) 29,445 27,943 (1,502) 25,040 7,262 23,538

Torbay and South Devon NHS Foundation Trust Yes (7,326) (7,959) (633) 1,725 1,079 (646) 6,148 1,506 5,502

Surrey and Borders Partnership NHS Foundation Trust Yes (658) (642) 16 3,205 3,205 0 1,287 450 1,287

Surrey And Sussex Healthcare NHS Trust Yes (816) 1,058 1,874 16,149 16,149 0 9,270 3,245 9,270

Sussex Community NHS Foundation Trust Yes 664 675 11 3,144 3,144 0 2,416 845 2,416

Sussex Partnership NHS Foundation Trust Yes 1,295 559 (736) 3,206 876 (2,330) 2,084 313 313

South Western Ambulance Service NHS Foundation Trust No 0 (842) (842) 0 (842) (842) 0 0 0

Taunton and Somerset NHS Foundation Trust Yes (6,713) (6,693) 20 (4,464) (4,464) 0 5,872 2,055 5,872

Western Sussex Hospitals NHS Foundation Trust Yes 5,865 5,882 17 17,437 17,437 0 16,252 5,688 16,252

Weston Area Health NHS Trust Yes (4,410) (7,266) (2,856) (10,269) (10,269) 0 2,165 0 2,165

Yeovil District Hospital NHS Foundation Trust Yes (10,876) (10,864) 12 (16,744) (20,178) (3,434) 3,142 1,099 2,042

South Total (216,461) (246,740) (30,279) (45,807) (117,943) (72,135) 391,995 115,429 352,554

Total for all providers (1,410,175) (1,647,753) (237,582) (1,184,415) (1,530,797) (346,384) 1,684,944 439,594 1,457,769



3.8 Key variances year to date Quarter 2


Favourable variances to date: top 10 best performers (excl PSF)

Org Name

YTD Plan YTD Actual Variance

Oxford University Hospitals NHS Foundation Trust 1 (18,069) (8,324) 9,745

The Royal Marsden NHS Foundation Trust 2 1,035 7,210 6,175

North Tees and Hartlepool NHS Foundation Trust 3 (12,371) (8,149) 4,222

Essex Partnership University NHS Foundation Trust 4 (2,986) 559 3,545

Royal Papworth Hospital NHS Foundation Trust 5 (8,526) (5,319) 3,207

Royal Surrey County Hospital NHS Foundation Trust 6 (6,059) (3,060) 2,999

Royal National Orthopaedic Hospital NHS Trust 7 (7,907) (5,645) 2,262

Derbyshire Community Health Services NHS Foundation Trust 8 1,110 3,100 1,990

East Midlands Ambulance Service NHS Trust 9 (3,293) (1,307) 1,986

Surrey And Sussex Healthcare NHS Trust 10 (4,061) (2,187) 1,874

Adverse variances to date: top 10 worst performers (excl PSF)

Org Name

YTD Plan YTD Actual Variance

University Hospitals of Leicester NHS Trust 1 (24,912) (42,286) (17,374)

Nottingham University Hospitals NHS Trust 2 (13,483) (28,409) (14,926)

Buckinghamshire Healthcare NHS Trust 3 (3,533) (12,692) (9,159)

King's College Hospital NHS Foundation Trust 4 (79,786) (88,930) (9,144)

United Lincolnshire Hospitals NHS Trust 5 (35,995) (43,464) (7,469)

Mid Essex Hospital Services NHS Trust 6 (24,432) (31,822) (7,390)

Barts Health NHS Trust 7 (15,220) (21,679) (6,459)

St George's University Hospitals NHS Foundation Trust 8 (23,281) (29,481) (6,200)

University Hospitals Plymouth NHS Trust 9 (12,813) (18,779) (5,966)

Queen Elizabeth Hospital King's Lynn NHS Foundation Trust 10 (10,916) (16,761) (5,845)

year to date

Largest Variances from plan (excl PSF)

year to date


3.9 Key variances forecast outturn Quarter 2


Favourable variances forecast outturn: top 10 best performers (excl PSF)

Org Name

FOT Plan FOT Actual Variance

The Leeds Teaching Hospitals NHS Trust 1 (19,829) (12,329) 7,500

Kingston Hospital NHS Foundation Trust 2 (6,000) (1,000) 5,000

Chelsea and Westminster Hospital NHS Foundation Trust 3 (5,075) (1,075) 4,000

Royal Surrey County Hospital NHS Foundation Trust 4 (11,097) (7,263) 3,834

The Royal Marsden NHS Foundation Trust 5 7,624 10,623 2,999

Rotherham Doncaster and South Humber NHS Foundation Trust 6 670 2,770 2,100

London Ambulance Service NHS Trust 7 (4,256) (2,397) 1,859

Berkshire Healthcare NHS Foundation Trust 8 (36) 1,464 1,500

Tees, Esk and Wear Valleys NHS Foundation Trust 9 4,201 5,216 1,015

South West Yorkshire Partnership NHS Foundation Trust 10 (2,626) (2,126) 500

Adverse variances forecast outturn: top 10 worst performers (excl PSF)

Org Name

FOT Plan FOT Actual Variance

University Hospitals of Leicester NHS Trust 1 (21,193) (51,800) (30,607)

Queen Elizabeth Hospital King's Lynn NHS Foundation Trust 2 (15,795) (34,231) (18,436)

University Hospitals Plymouth NHS Trust 3 (16,267) (30,857) (14,590)

Mid Essex Hospital Services NHS Trust 4 (47,257) (60,746) (13,489)

Barts Health NHS Trust 5 (56,785) (69,565) (12,780)

Dartford and Gravesham NHS Trust 6 (10,270) (20,352) (10,082)

Countess of Chester Hospital NHS Foundation Trust 7 (4,334) (12,756) (8,422)

Kettering General Hospital NHS Foundation Trust 8 (15,261) (23,564) (8,303)

Oxford Health NHS Foundation Trust 9 (776) (8,352) (7,576)

Northern Lincolnshire and Goole NHS Foundation Trust 10 (39,583) (44,456) (4,873)

Largest Variances from plan (excl PSF) forecast outturn


forecast outturn


4.0 Operational performance by provider


4.1 Best and worst operational performance (1/3)

A&E 4-hour standard – ten best and worst performing providers during quarter 2 2018/19 – acute providers only

Best performing providersTotal

attendances

4-hour

breaches

Q2 2018-19

Performance

Yeovil District Hospital NHS

Foundation Trust13,915 268 98.07%

Luton and Dunstable University

Hospital NHS Foundation Trust36,848 715 98.06%

Sheffield Children's NHS


North Tees and Hartlepool NHS

Foundation Trust43,511 1,057 97.57%

Northumbria Healthcare NHS


Basildon and Thurrock University

Hospitals NHS Foundation Trust37,966 1,356 96.43%

Alder Hey Children's NHS


Sherwood Forest Hospitals NHS


South Tyneside NHS Foundation

Trust17,352 728 95.80%

South Warwickshire NHS


Worst performing providersTotal

attendances

4-hour

breaches

Q2 2018-19

Performance

United Lincolnshire Hospitals NHS

Trust41,728 12,021 71.19%

Shrewsbury And Telford Hospital

NHS Trust34,483 9,195 73.33%

Wye Valley NHS Trust 16,557 4,006 75.80%

North Bristol NHS Trust 23,581 5,440 76.93%

Stockport NHS Foundation Trust 25,331 5,834 76.97%

Worcestershire Acute Hospitals NHS

Trust50,738 11,473 77.39%

University Hospitals Of Leicester

NHS Trust61,041 13,797 77.40%

Nottingham University Hospitals NHS

Trust50,656 11,217 77.86%

St Helens And Knowsley Hospitals

NHS Trust28,497 6,296 77.91%

The Princess Alexandra Hospital

NHS Trust26,277 5,787 77.98%



RTT 18-week – ten best and worst performing providers at end of September 2018 – acute and specialist providers only

Best performing providers Waiting list0-18 week

waiters

September 2018

Performance

Lancashire Care NHS Foundation

Trust437 434 99.31%

The Clatterbridge Cancer Centre

NHS Foundation Trust412 405 98.30%

The Christie NHS Foundation Trust 1,485 1,455 97.98%

The Royal Marsden NHS


Homerton University Hospital NHS


North Middlesex University

Hospital NHS Trust10,528 10,063 95.58%

South Tyneside NHS Foundation

Trust3,866 3,692 95.50%

Southport And Ormskirk Hospital

NHS Trust9,905 9,441 95.32%

Barnsley Hospital NHS Foundation

Trust12,472 11,859 95.08%

Derbyshire Healthcare NHS

Foundation Trust418 394 94.26%

Worst performing providers Waiting list0-18 week

waiters

September

2018

Performance

Northern Lincolnshire and Goole

NHS Foundation Trust29,230 20,266 69.33%

Wye Valley NHS Trust 14,667 10,737 73.21%

Queen Victoria Hospital NHS


Bradford Teaching Hospitals NHS


Royal Free London NHS Foundation

Trust67,993 51,204 75.31%

East Kent Hospitals University NHS


Taunton and Somerset NHS


Wirral University Teaching Hospital

NHS Foundation Trust26,557 20,804 78.34%

George Eliot Hospital NHS Trust 10,942 8,578 78.40%

Plymouth Hospitals NHS Trust 25,906 20,310 78.40%



Cancer 62-day standard – ten best and worst performing providers in quarter 2 2018/19 – acute and specialist providers only

Best performing providersNumber

treated

Within 62

days

Q2 2018/19

Performance

South Tyneside NHS Foundation Trust 191.0 184.0 96.34%

Bolton NHS Foundation Trust 190.0 179.0 94.21%

Mid Cheshire Hospitals NHS Foundation

Trust227.0 213.0 93.83%

Frimley Health NHS Foundation Trust 406.5 374.5 92.13%

Tameside Hospital NHS Foundation

Trust127.5 116.5 91.37%

St Helens And Knowsley Hospitals NHS

Trust273.5 245.5 89.76%

Salford Royal NHS Foundation Trust 212.0 190.0 89.62%

Liverpool Heart and Chest Hospital NHS

Foundation Trust42.5 38.0 89.41%

Chelsea and Westminster Hospital NHS


Dartford And Gravesham NHS Trust 148.0 131.5 88.85%

Worst performing providersNumber

treated

Within 62

days

Q2 2018/19

Performance

Liverpool Women's NHS Foundation Trust 34.5 14.5 42.03%

Royal Brompton and Harefield NHS


East Sussex Healthcare NHS Trust 144.0 83.5 57.99%

The Royal Wolverhampton NHS Trust 325.0 191.0 58.77%

The Clatterbridge Cancer Centre NHS


The Christie NHS Foundation Trust 262.0 158.5 60.50%

Maidstone And Tunbridge Wells NHS

Trust349.0 217.0 62.18%

Royal National Orthopaedic Hospital NHS

Trust19.5 12.5 64.10%

University College London Hospitals NHS


Southend University Hospital NHS



4.2 Operational performance by provider – London (1/1)

ORGANISATION A&E (95%)RTT Incomplete

(92%)

RTT 52

weeks

Diagnostics

(<1.00%)

Cancer 62

days - GP

referral (85%)

Cancer 2

weeks - GP

referral (93%)

Cancer 2 weeks -

breast

symptoms (93%)

Cancer 31

days -

Diagnosis to

1st Treat.

(96%)

C.Diff cases

Barking, Havering And Redbridge University Hospitals NHS Trust 83.16% 83.20% 1 12.60% 86.03% 93.07% 99.41% 98.40% 3

Barts Health NHS Trust 86.44% 83.88% 71 1.00% 86.23% 91.89% 97.28% 98.85% 10

Central and North West London NHS Foundation Trust 100.00% 0 0.00% 0

Central London Community Healthcare NHS Trust 99.23% 94.82% 0 0

Chelsea and Westminster Hospital NHS Foundation Trust 95.37% 92.03% 0 2.25% 89.20% 88.55% 88.41% 98.33% 3

Croydon Health Services NHS Trust 85.67% 93.01% 3 0.25% 87.31% 97.16% 97.62% 99.53% 6

Epsom And St Helier University Hospitals NHS Trust 94.92% 86.67% 8 1.16% 86.81% 96.38% 99.23% 9

Great Ormond Street Hospital for Children NHS Foundation Trust 92.24% 5 5.86% 100.00% 100.00% 1

Guy's and St Thomas' NHS Foundation Trust 87.30% 87.92% 12 0.99% 71.47% 98.10% 100.00% 95.49% 5

Homerton University Hospital NHS Foundation Trust 94.73% 96.66% 0 0.18% 81.52% 98.03% 96.43% 97.64% 1

Hounslow and Richmond Community Healthcare NHS Trust 99.99% 100.00% 0 0.00% 0

Imperial College Healthcare NHS Trust 88.80% 82.62% 46 0.75% 79.71% 88.39% 94.56% 96.86% 12

King's College Hospital NHS Foundation Trust 78.24% 79.41% 449 7.16% 74.17% 80.55% 94.62% 97.08% 29

Kingston Hospital NHS Foundation Trust 89.67% 93.15% 3 0.25% 96.34% 99.24% 100.00% 99.66% 6

Lewisham and Greenwich NHS Trust 89.02% 85.18% 0 0.67% 79.64% 95.43% 94.94% 97.53% 4

London North West Healthcare NHS Trust 90.73% 80.78% 35 0.74% 81.14% 93.01% 95.49% 97.90% 13

Moorfields Eye Hospital NHS Foundation Trust 98.59% 93.86% 2 0.00% 100.00% 88.89% 95.24% 0

North East London NHS Foundation Trust 99.14% 99.56% 0 0

North Middlesex University Hospital NHS Trust 86.49% 95.58% 0 0.31% 82.63% 95.40% 92.09% 99.09% 8

Royal Brompton and Harefield NHS Foundation Trust - 92.46% 1 0.00% 50.00% 100.00% 98.95% 2

Royal Free London NHS Foundation Trust 89.05% 75.31% 53 1.64% 78.81% 88.93% 89.82% 97.93% 21

Royal National Orthopaedic Hospital NHS Trust - 88.65% 1 0.22% 64.10% 97.87% 96.77% 1

South West London and ST George's Mental Health NHS Trust 94.72% 0 0

St George's University Hospitals NHS Foundation Trust 91.58% 0.39% 84.31% 95.00% 81.24% 98.64% 7

The Hillingdon Hospitals NHS Foundation Trust 83.30% 83.92% 0 0.14% 85.77% 93.20% 94.39% 99.57% 7

The Royal Marsden NHS Foundation Trust 97.37% 2 75.10% 88.12% 90.52% 97.12% 19

The Whittington Hospital NHS Trust 90.02% 92.10% 0 0.97% 86.96% 93.07% 98.53% 100.00% 3

University College London Hospitals NHS Foundation Trust 85.01% 90.21% 0 1.06% 65.89% 93.25% 69.89% 91.25% 12

London 89.07% 85.37% 692 2.33% 80.56% 92.38% 93.36% 97.18% 182


4.2 Operational performance by provider – Midlands and East (1/2)


(92%)

RTT 52

weeks

Diagnostics

(<1.00%)

Cancer 62

days - GP

referral (85%)

Cancer 2

weeks - GP

referral (93%)

Cancer 2 weeks -

breast

symptoms (93%)

Cancer 31

days -

Diagnosis to

1st Treat.

(96%)

C.Diff cases

Basildon and Thurrock University Hospitals NHS Foundation Trust 96.43% 79.13% 14 1.00% 73.87% 95.27% 92.86% 95.58% 6

Bedford Hospital NHS Trust 87.99% 87.24% 0 0.66% 80.73% 95.52% 96.23% 97.78% 5

Birmingham Women and Children's Hospital NHS Foundation Trust 95.31% 92.30% 0 0.40% 76.00% 96.67% 100.00% 0

Birmingham Community Healthcare NHS Foundation Trust 92.58% 0 0Birmingham Women's NHS Foundation Trust 0Black Country Partnership NHS Foundation Trust 93.10% 0 0Burton Hospitals NHS Foundation Trust 6Cambridge University Hospitals NHS Foundation Trust 87.47% 88.87% 4 0.64% 81.23% 94.12% 95.85% 98.98% 26

Cambridgeshire and Peterborough NHS Foundation Trust 100.00% 0 0

Cambridgshire Community Services NHS Trust 89.57% 0 5.99% 0

Chesterfield Royal Hospital NHS Foundation Trust 91.37% 87.11% 9 5.84% 82.47% 96.28% 94.51% 98.32% 5

Coventry and Warwickshire Partnership NHS Trust - 99.38% 0 0.00% 0

University Hospitals of Derby and Burton NHS Foundation Trust 88.61% 90.79% 12 0.53% 79.53% 95.99% 94.62% 97.40% 12

Derbyshire Community Health Services NHS Foundation Trust 99.98% 95.20% 0 0.00% 0

Derbyshire Healthcare NHS Foundation Trust 94.26% 0 0

Dudley and Walsall Mental Health Partnership NHS Trust 100.00% 0 0

East And North Hertfordshire NHS Trust 85.37% 68.51% 95.15% 92.70% 91.74% 9

East Suffolk and North Essex NHS Foundation Trust 94.65% 88.92% 1 1.23% 72.95% 94.43% 88.63% 96.88% 10

Essex Partnership University NHS Foundation Trust 0

George Eliot Hospital NHS Trust 88.29% 78.40% 7 3.18% 72.38% 97.25% 95.06% 100.00% 4Heart of England NHS Foundation Trust18

Hertfordshire Community NHS Trust 98.86% 87.94% 0 0

Hinchingbrooke Health Care NHS Trust 0Ipswich Hospital NHS Trust6

James Paget University Hospitals NHS Foundation Trust 91.54% 86.89% 0 0.03% 78.68% 94.57% 97.16% 99.69% 2

Kettering General Hospital NHS Foundation Trust 83.33% 79.21% 2 0.34% 88.47% 97.33% 97.98% 98.70% 9

Leicestershire Partnership NHS Trust 99.44% 0 0.00% 0

Lincolnshire Community Health Services NHS Trust 97.93% 0

Lincolnshire Partnership NHS Foundation Trust 0

Luton and Dunstable University Hospital NHS Foundation Trust 98.06% 89.64% 0 0.84% 86.42% 95.99% 97.80% 100.00% 0

Mid Essex Hospital Services NHS Trust 84.15% 0.49% 69.96% 92.52% 66.38% 89.60% 11

Midlands Partnership NHS Foundation Trust 97.07% 0 0.00% 0

Milton Keynes Hospital NHS Foundation Trust 91.44% 86.88% 24 0.84% 88.19% 97.14% 98.08% 98.72% 7

Norfolk and Norwich University Hospitals NHS Foundation Trust 82.02% 83.13% 15 0.92% 72.29% 81.16% 95.96% 96.56% 11


4.2 Operational performance by provider – Midlands and East (2/2)


(92%)

RTT 52

weeks

Diagnostics

(<1.00%)

Cancer 62

days - GP

referral (85%)

Cancer 2

weeks - GP

referral (93%)

Cancer 2 weeks -

breast

symptoms (93%)

Cancer 31

days -

Diagnosis to

1st Treat.

(96%)

C.Diff cases

Norfolk Community Health and Care NHS Trust 98.28% 0 0

North West Anglia NHS Foundation Trust 88.02% 86.25% 1 3.18% 79.64% 92.94% 95.00% 97.81% 10

Northampton General Hospital NHS Trust 90.96% 80.31% 0 0.02% 80.70% 70.79% 39.67% 95.85% 5

Northamptonshire Healthcare NHS Foundation Trust 99.46% 0 0

Nottingham University Hospitals NHS Trust 77.86% 92.91% 14 2.90% 79.43% 96.49% 97.69% 94.84% 18

Papworth Hospital NHS Foundation Trust 87.33% 4 0.77% 83.33% 100.00% 5

Sandwell And West Birmingham Hospitals NHS Trust 83.31% 92.00% 3 1.73% 86.70% 97.33% 97.27% 98.10% 1

Sherwood Forest Hospitals NHS Foundation Trust 95.92% 90.57% 21 0.84% 75.68% 95.41% 97.84% 98.92% 12

Shrewsbury And Telford Hospital NHS Trust 73.33% 92.68% 0 0.19% 84.09% 79.16% 51.15% 98.99% 4

Shropshire Community Health NHS Trust 99.91% 93.18% 0 0.00% 0South Essex Partnership University NHS Foundation Trust 0South Warwickshire NHS Foundation Trust 95.75% 90.21% 3 6.40% 79.89% 94.03% 95.19% 97.49% 2

Southend University Hospital NHS Foundation Trust 90.70% 87.64% 9 0.91% 66.38% 88.61% 61.89% 92.61% 7

Staffordshire and Stoke on Trent Partnership NHS Trust 0

The Dudley Group NHS Foundation Trust 86.01% 93.14% 0 1.30% 82.17% 95.00% 95.37% 97.30% 5

The Princess Alexandra Hospital NHS Trust 77.98% 92.36% 8 0.86% 82.30% 97.04% 99.12% 97.16% 2

The Queen Elizabeth Hospital, King's Lynn, NHS Foundation Trust 84.34% 81.19% 7 0.56% 80.71% 94.64% 98.10% 97.39% 9

The Robert Jones and Agnes Hunt Orthopaedic Hospital NHS

Foundation Trust- 90.29% 0 0.84% 25.00% 100.00% 100.00% 1

The Royal Orthopaedic Hospital NHS Foundation Trust 85.31% 20 0.36% 73.91% 100.00% 100.00% 0

The Royal Wolverhampton NHS Trust 92.29% 90.82% 0 2.37% 58.77% 86.64% 71.60% 90.37% 8

United Lincolnshire Hospitals NHS Trust 71.19% 82.03% 20 2.78% 78.14% 84.82% 50.41% 97.55% 12

University Hospitals Birmingham NHS Foundation Trust 81.24% 87.63% 1 0.52% 82.27% 93.02% 92.17% 97.49% 28

University Hospitals Coventry And Warwickshire NHS Trust 89.28% 83.17% 4 0.10% 81.13% 87.93% 91.55% 96.14% 10

University Hospitals Of Leicester NHS Trust 77.40% 85.25% 0 0.84% 73.95% 92.82% 88.77% 96.29% 13

University Hospitals of North Midlands NHS Trust 85.30% 79.60% 77 2.73% 84.53% 95.11% 98.54% 98.89% 20

Walsall Healthcare NHS Trust 80.80% 89.02% 0 0.17% 84.90% 95.04% 93.75% 100.00% 5

West Hertfordshire Hospitals NHS Trust 82.28% 83.20% 111 1.10% 85.21% 94.49% 95.19% 97.29% 5

West Suffolk NHS Foundation Trust 90.76% 89.80% 2 0.55% 84.32% 89.50% 94.20% 100.00% 3

Worcestershire Acute Hospitals NHS Trust 77.39% 81.00% 0 8.45% 73.81% 80.58% 77.35% 97.78% 10

Worcestershire Health And Care NHS Trust 99.51% 0 0

Wye Valley NHS Trust 75.80% 73.21% 70 0.00% 83.82% 86.78% 32.48% 93.61% 6

Midlands and East 86.42% 86.56% 463 1.59% 78.18% 91.63% 87.06% 96.73% 348


4.2 Operational performance by provider – North (1/2)


(92%)

RTT 52

weeks

Diagnostics

(<1.00%)

Cancer 62

days - GP

referral (85%)

Cancer 2

weeks - GP

referral (93%)

Cancer 2 weeks -

breast

symptoms (93%)

Cancer 31

days -

Diagnosis to

1st Treat.

(96%)

C.Diff cases

5 Boroughs Partnership NHS Foundation Trust 99.49% 0

Aintree University Hospital NHS Foundation Trust 86.79% 89.02% 0 2.66% 77.69% 93.23% 89.37% 97.71% 11

Airedale NHS Foundation Trust 90.57% 92.04% 0 0.98% 85.24% 95.29% 97.47% 100.00% 2

Alder Hey Children's NHS Foundation Trust 96.09% 92.15% 0 0.20% 95.45% 100.00% 0

Barnsley Hospital NHS Foundation Trust 93.62% 95.08% 0 0.48% 87.78% 96.77% 93.62% 100.00% 4

Blackpool Teaching Hospitals NHS Foundation Trust 83.35% 80.64% 36 0.37% 80.51% 84.81% 20.40% 99.81% 10

Bolton NHS Foundation Trust 86.41% 89.12% 8 0.87% 94.21% 97.94% 94.54% 100.00% 7

Bradford District Care NHS Foundation Trust 97.21% 0 0

Bradford Teaching Hospitals NHS Foundation Trust 83.49% 75.09% 3 0.83% 67.26% 59.70% 100.00% 87.95% 7

Bridgewater Community Healthcare NHS Foundation Trust 99.50% 98.93% 0 0.00% 81.82% 90.00% 0

Calderdale and Huddersfield NHS Foundation Trust 91.09% 93.00% 0 0.87% 86.71% 97.67% 98.43% 100.00% 3

City Hospitals Sunderland NHS Foundation Trust 89.83% 93.16% 0 0.63% 80.91% 95.53% 97.96% 10

Countess of Chester Hospital NHS Foundation Trust 86.52% 87.39% 2 7.27% 84.58% 97.94% 96.62% 99.68% 7

County Durham and Darlington NHS Foundation Trust 89.87% 91.32% 0 0.03% 87.68% 95.47% 92.66% 98.56% 5

Cumbria Partnership NHS Foundation Trust 92.47% 0 0.00% 0

Doncaster and Bassetlaw Hospitals NHS Foundation Trust 92.85% 87.96% 3 0.59% 85.69% 87.13% 92.80% 99.76% 2

East Cheshire NHS Trust 83.72% 81.59% 0 18.36% 81.22% 95.39% 94.12% 100.00% 4

East Lancashire Hospitals NHS Trust 79.57% 92.06% 0 0.86% 78.74% 94.63% 91.64% 98.02% 7

Gateshead Health NHS Foundation Trust 95.64% 92.02% 0 0.61% 76.60% 96.85% 95.47% 99.24% 5

Harrogate and District NHS Foundation Trust 94.58% 90.64% 0 0.21% 85.24% 98.13% 90.00% 99.60% 9

Hull And East Yorkshire Hospitals NHS Trust 85.53% 81.66% 21 7.01% 68.89% 95.20% 89.51% 93.42% 13

Humber NHS Foundation Trust 99.92% 98.28% 0 0

Lancashire Care NHS Foundation Trust 99.31% 0 0

Lancashire Teaching Hospitals NHS Foundation Trust 85.36% 79.53% 55 2.00% 81.15% 96.79% 95.40% 94.00% 13

Leeds Community Healthcare NHS Trust 97.31% 0 5.49% 0

Leeds Teaching Hospitals NHS Trust 85.61% 87.06% 137 0.33% 68.65% 84.48% 42.60% 95.01% 43

Liverpool Community Health NHS Trust 100.00% 0

Liverpool Heart and Chest Hospital NHS Foundation Trust - 92.31% 0 13.88% 89.41% 100.00% 100.00% 0

Liverpool Women's NHS Foundation Trust 98.47% 87.18% 12 3.12% 42.03% 93.65% 81.05% 0

Manchester University NHS Foundation Trust 87.46% 88.90% 26 1.88% 79.31% 93.85% 94.88% 98.54% 30

Mid Cheshire Hospitals NHS Foundation Trust 85.40% 92.42% 0 0.44% 93.83% 96.72% 94.66% 98.77% 10

Mid Yorkshire Hospitals NHS Trust 85.26% 87.93% 0 0.49% 78.58% 98.35% 98.33% 97.40% 16


4.2 Operational performance by provider – North (2/2)


(92%)

RTT 52

weeks

Diagnostics

(<1.00%)

Cancer 62

days - GP

referral (85%)

Cancer 2

weeks - GP

referral (93%)

Cancer 2 weeks -

breast

symptoms (93%)

Cancer 31

days -

Diagnosis to

1st Treat.

(96%)

C.Diff cases

North Cumbria University Hospitals NHS Trust 91.09% 84.32% 0 3.89% 84.52% 92.67% 86.53% 96.93% 8

North Tees and Hartlepool NHS Foundation Trust 97.57% 93.83% 0 0.75% 84.43% 93.60% 98.45% 98.97% 7

Northern Lincolnshire and Goole NHS Foundation Trust 86.63% 69.33% 297 11.00% 74.50% 96.32% 89.05% 98.66% 8

Northumberland, Tyne and Wear NHS Foundation Trust 100.00% 0 0

Northumbria Healthcare NHS Foundation Trust 96.85% 93.38% 0 0.48% 72.50% 97.70% 97.10% 99.75% 5

Pennine Acute Hospitals NHS Trust 86.84% 85.85% 38 1.55% 72.46% 70.33% 86.18% 96.84% 16

Pennine Care NHS Foundation Trust 100.00% 0.00% 0 6.68% 0

Royal Liverpool And Broadgreen University Hospitals NHS Trust 88.06% 80.11% 3 2.24% 77.49% 91.62% 96.79% 93.85% 12

Salford Royal NHS Foundation Trust 88.83% 91.01% 0 1.02% 89.62% 95.30% 98.36% 10

Sheffield Children's NHS Foundation Trust 97.88% 92.03% 0 0.52% 90.91% 2

Sheffield Teaching Hospitals NHS Foundation Trust 88.39% 92.05% 0 0.39% 74.94% 96.49% 93.42% 91.94% 31

South Tees Hospitals NHS Foundation Trust 95.60% 89.21% 0 1.13% 83.78% 92.36% 97.37% 95.84% 14

South Tyneside NHS Foundation Trust 95.80% 95.50% 0 0.06% 86.32% 84.72% 100.00% 6

South West Yorkshire Partnership NHS Foundation Trust - 97.24% 0 0.00% 0

Southport And Ormskirk Hospital NHS Trust 88.35% 95.32% 0 4.03% 74.61% 94.69% 97.60% 2

St Helens And Knowsley Hospitals NHS Trust 77.91% 89.76% 87.04% 88.89% 97.70% 5

Stockport NHS Foundation Trust 76.97% 83.38% 8 0.29% 79.43% 88.71% 72.15% 95.36% 9

Tameside Hospital NHS Foundation Trust 93.45% 92.24% 0 0.03% 91.37% 95.77% 97.88% 99.44% 4

The Christie NHS Foundation Trust - 97.98% 0 0.00% 60.50% 96.11% 5

The Clatterbridge Cancer Centre NHS Foundation Trust 98.30% 0 0.00% 59.74% 100.00% 97.41% 0

The Newcastle Upon Tyne Hospitals NHS Foundation Trust 95.66% 92.70% 0 0.93% 78.52% 95.05% 93.13% 95.90% 25

The Rotherham NHS Foundation Trust 86.20% 94.07% 0 0.44% 85.37% 93.92% 90.87% 98.25% 3

The Walton Centre NHS Foundation Trust - 93.63% 0 0.00% 100.00% 100.00% 3

University Hospitals of Morecambe Bay NHS Foundation Trust 86.69% 82.28% 10 1.82% 79.93% 90.69% 96.47% 99.00% 2

Warrington and Halton Hospitals NHS Foundation Trust 85.47% 92.61% 0 0.15% 86.75% 94.19% 91.77% 99.46% 10

Wirral Community NHS Trust 99.66% 100.00% 0 0.00% 0

Wirral University Teaching Hospital NHS Foundation Trust 82.40% 78.34% 40 0.83% 88.37% 92.11% 100.00% 96.93% 11

Wrightington, Wigan and Leigh NHS Foundation Trust 89.65% 92.93% 0 1.21% 88.77% 94.67% 97.31% 98.04% 4

York Teaching Hospital NHS Foundation Trust 90.25% 83.11% 1 5.09% 86.55% 96.91% 8

North 88.96% 87.55% 700 2.18% 79.40% 91.43% 89.58% 96.69% 428

Performance of the NHS provider sector for the quarter ended 30 September

2018

4.2 Operational performance by provider – South (1/2)


(92%)

RTT 52

weeks

Diagnostics

(<1.00%)

Cancer 62

days - GP

referral (85%)

Cancer 2

weeks - GP

referral (93%)

Cancer 2 weeks -

breast

symptoms (93%)

Cancer 31

days -

Diagnosis to

1st Treat.

(96%)

C.Diff cases

Ashford and St Peter's Hospitals NHS Foundation Trust 78.48% 90.66% 2 3.17% 87.18% 90.63% 96.67% 97.55% 1

Berkshire Healthcare NHS Foundation Trust 100.00% 99.51% 0 1.20% 0

Brighton And Sussex University Hospitals NHS Trust 82.67% 80.73% 0 17.87% 71.99% 85.57% 95.93% 98.44% 18

Buckinghamshire Healthcare NHS Trust 87.89% 88.69% 0 0.00% 82.71% 93.16% 97.27% 95.82% 10

Cornwall Partnership NHS Foundation Trust - 95.30% 0 0.00% 0

Dartford And Gravesham NHS Trust 87.91% 91.34% 0 0.95% 88.85% 95.79% 94.95% 100.00% 9

Dorset County Hospital NHS Foundation Trust 95.62% 81.30% 0 16.01% 74.54% 90.82% 95.12% 98.38% 1

Dorset Healthcare University NHS Foundation Trust - 92.95% 0 0.00% 0

East Kent Hospitals University NHS Foundation Trust 78.82% 76.27% 129 1.43% 66.87% 93.63% 90.50% 96.07% 9

East Sussex Healthcare NHS Trust 91.31% 87.91% 0 1.40% 57.99% 100.00% 99.20% 90.05% 13

Frimley Health NHS Foundation Trust 90.17% 92.02% 0 0.60% 92.13% 97.29% 96.15% 99.62% 5

Gloucestershire Care Services NHS Trust 98.49% 0.00% 0

Gloucestershire Hospitals NHS Foundation Trust 90.23% 0.62% 73.82% 88.94% 97.45% 95.80% 16

Great Western Hospitals NHS Foundation Trust 92.24% 86.35% 12 12.88% 82.07% 94.77% 96.70% 96.10% 8

Hampshire Hospitals NHS Foundation Trust 83.63% 89.10% 2 3.13% 76.98% 93.13% 96.94% 98.69% 11

Isle of Wight NHS Trust 81.09% 81.06% 0 3.85% 76.70% 96.43% 96.46% 98.60% 1

Kent Community Health NHS Trust 99.81% 91.32% 1 3.65% 0

Maidstone And Tunbridge Wells NHS Trust 92.59% 79.69% 9 0.60% 62.18% 76.42% 65.41% 96.45% 19

Medway NHS Foundation Trust 81.65% 81.77% 11 0.76% 81.63% 72.61% 94.16% 98.38% 6

North Bristol NHS Trust 76.93% 85.34% 55 1.83% 81.34% 90.21% 93.41% 95.45% 11

Northern Devon Healthcare NHS Trust 84.35% 79.35% 104 29.87% 71.14% 68.48% 89.19% 97.07% 3

Oxford Health NHS Foundation Trust 98.00% 0

Oxford University Hospitals NHS Foundation Trust 87.75% 82.92% 199 1.89% 70.06% 97.57% 96.02% 93.88% 15

Oxleas NHS Foundation Trust 95.24% 0 0.00% 0

Poole Hospital NHS Foundation Trust 90.44% 85.30% 0 0.93% 82.30% 98.96% 100.00% 98.27% 5

Portsmouth Hospitals NHS Trust 81.14% 83.31% 4 4.11% 84.34% 96.67% 96.35% 98.46% 7

Queen Victoria Hospital NHS Foundation Trust 99.58% 74.04% 127 2.67% 84.00% 95.57% 91.80% 0

Royal Berkshire NHS Foundation Trust 95.08% 92.54% 0 0.92% 77.37% 94.97% 95.88% 97.09% 4

Royal Cornwall Hospitals NHS Trust 92.30% 81.36% 151 5.24% 83.35% 95.85% 96.21% 95.50% 8

Royal Devon and Exeter NHS Foundation Trust 91.50% 83.56% 89 13.29% 73.82% 84.77% 96.63% 95.45% 8

Royal Surrey County Hospital NHS Foundation Trust 92.52% 89.20% 1 1.70% 68.16% 92.09% 80.55% 97.05% 5


4.2 Operational performance by provider – South (2/2)


(92%)

RTT 52

weeks

Diagnostics

(<1.00%)

Cancer 62

days - GP

referral (85%)

Cancer 2

weeks - GP

referral (93%)

Cancer 2 weeks -

breast

symptoms (93%)

Cancer 31

days -

Diagnosis to

1st Treat.

(96%)

C.Diff cases

Royal United Hospitals Bath NHS Foundation Trust 83.37% 87.44% 3 4.91% 84.17% 94.98% 94.34% 98.54% 8

Salisbury NHS Foundation Trust 87.06% 92.23% 0 0.63% 84.38% 93.44% 96.23% 96.94% 1

Solent NHS Trust 99.42% 0 3.53% 0

Somerset Partnership NHS Foundation Trust 99.21% 99.81% 0 0.00% 0

Southern Health NHS Foundation Trust 100.00% 93.87% 0 0.57% 0

Surrey And Sussex Healthcare NHS Trust 95.23% 89.09% 16 0.14% 82.30% 93.11% 92.81% 91.67% 11

Sussex Community NHS Trust 98.95% 97.70% 0 0.17% 0

Taunton and Somerset NHS Foundation Trust 90.92% 76.65% 53 24.33% 76.52% 95.49% 92.75% 97.72% 2

The Royal Bournemouth and Christchurch Hospitals NHS Foundation

Trust94.52% 86.78% 0 6.69% 80.95% 92.44% 96.61% 96.89% 6

Torbay and South Devon NHS Foundation Trust 88.09% 81.03% 87 7.74% 83.04% 76.72% 94.27% 98.14% 4

University Hospital Southampton NHS Foundation Trust 86.11% 85.29% 6 1.94% 72.37% 88.66% 78.35% 95.16% 7

University Hospitals Bristol NHS Foundation Trust 88.44% 88.52% 10 1.87% 87.34% 95.46% 98.51% 12

University Hospitals Plymouth NHS Trust 81.45% 78.40% 136 13.49% 72.65% 94.80% 92.81% 97.25% 7

Western Sussex Hospitals NHS Foundation Trust 93.59% 80.01% 1 0.59% 79.73% 96.07% 92.75% 97.78% 8

Weston Area Health NHS Trust 89.10% 92.87% 0 0.00% 67.84% 88.52% 83.12% 97.01% 2

Yeovil District Hospital NHS Foundation Trust 98.07% 90.01% 0 5.00% 93.03% 94.44% 0

South 89.06% 84.79% 1208 5.15% 77.28% 91.54% 92.79% 96.77% 261


4.2 Operational performance by provider – Ambulance

- denotes not available.

1 Centiles for England in this spreadsheet are a mean of trusts'

centiles, weighted by their count of incidents.

Ambulance

Service

Count of

Incidents

Total

(hours)

Mean

(min:sec)

90th centile

(min:sec)1

Count of

Incidents

Total

(hours)

Mean

(min:sec)

90th centile

(min:sec)1

Count of

Incidents

Total

(hours)

Mean

(min:sec)

90th centile

(min:sec)1

Count of

Incidents

Total

(hours)

Mean

(min:sec)

90th centile

(min:sec)1

Standard - 7:00 15:00 18:00 40:00 - 2:00:00 - 3:00:00

East Midlands 5,834 723 7:26 13:20 33,670 18,359 32:43 1:08:48 11,550 15,170 1:18:48 3:11:45 175 158 0:54:08 2:27:50

East of England 6,150 824 8:02 14:24 37,833 16,176 25:39 0:52:45 12,344 17,757 1:26:19 3:30:33 2,240 3,685 1:38:42 4:07:38

Isle of Wight 68 12 10:19 22:03 900 283 18:50 0:40:33 871 642 0:44:12 2:35:02 231 352 1:31:28 3:48:30

London 8,697 1,008 6:57 11:27 50,690 16,452 19:28 0:39:48 20,885 20,073 0:57:40 2:16:42 2,445 2,753 1:07:33 2:16:15

North East 2,343 242 6:12 10:37 17,670 5,964 20:15 0:41:18 8,468 10,718 1:15:56 3:01:51 373 494 1:19:31 3:41:53

North West 8,012 1,064 7:58 13:18 47,404 17,986 22:46 0:48:33 21,596 24,596 1:08:20 2:40:22 3,345 5,168 1:32:41 3:13:00

South Central 2,489 301 7:15 13:12 20,896 5,623 16:09 0:32:16 14,416 12,192 0:50:45 1:58:27 970 1,201 1:14:17 2:47:12

South East Coast 3,369 432 7:41 14:12 28,205 9,067 19:17 0:36:11 19,457 27,717 1:25:28 3:12:32 771 1,423 1:50:46 4:01:15

South Western 4,353 496 6:50 12:41 37,725 16,975 27:00 0:56:56 17,462 21,019 1:12:13 2:45:10 638 1,619 2:32:16 5:49:39

West Midlands 5,361 605 6:46 11:41 41,147 8,209 11:58 0:21:49 30,590 16,765 0:32:53 1:12:40 1,500 1,250 0:50:00 2:05:38

Yorkshire 5,068 617 7:18 12:28 36,186 12,254 20:19 0:42:11 11,441 9,392 0:49:15 1:57:25 1,111 962 0:51:57 3:51:53

Category 1 Category 2 Category 3 Category 4


5.0 Vacancy position by sector and region


5.1 Nursing vacancy positionTable 1: Registered Nursing vacancies (WTE) Table 2: Registered Nursing vacancies (percentage rate)

Region Sector 2017/18 Q2 2017/18 Q3 2017/18 Q4 2018/19 Q1 2018/19 Q2 2017/18 Q2 2017/18 Q3 2017/18 Q4 2018/19 Q1 2018/19 Q2

London Acute 7,455 6,703 6,576 6,799 6,752 16.0% 14.5% 14.1% 14.7% 14.4%

Ambulance 1 6 2 3 6 2.9% 22.7% 8.2% 11.3% 17.0%

Community 201 204 214 232 228 12.0% 11.4% 11.9% 12.8% 12.7%

Mental Health 2,141 2,132 2,103 2,039 2,147 17.1% 16.7% 17.6% 16.9% 17.6%

Specialist 418 434 329 444 515 8.4% 8.6% 6.6% 8.9% 10.1%

London Total 10,215 9,479 9,224 9,517 9,649 15.6% 14.4% 14.1% 14.6% 14.6%

Midlands and East Acute 8,368 7,357 7,434 8,915 8,365 12.2% 10.7% 10.7% 12.7% 12.0%

Ambulance 1 1 - - - 1.9% 1.3% 0.0% 0.0% 0.0%

Community 705 611 648 480 496 9.0% 8.2% 8.7% 7.9% 8.1%

Mental Health 2,221 2,076 1,635 2,391 2,411 12.0% 11.2% 9.1% 12.4% 12.6%

Specialist 326 264 289 172 206 10.9% 8.8% 9.6% 5.9% 7.0%

Midlands and East Total 11,622 10,309 10,007 11,957 11,477 11.8% 10.5% 10.2% 12.1% 11.7%

North Acute 6,510 5,693 5,987 7,573 7,609 8.2% 7.1% 7.4% 9.3% 9.3%

Ambulance 16 16 33 40 34 10.9% 11.0% 19.7% 24.1% 20.8%

Community 120 62 81 24 27 3.7% 1.9% 2.5% 1.0% 1.1%

Mental Health 1,817 1,814 1,830 2,077 2,196 8.9% 8.8% 8.9% 9.8% 10.4%

Specialist 202 136 137 280 330 4.7% 3.2% 3.2% 6.2% 7.3%

North Total 8,664 7,721 8,068 9,994 10,196 8.0% 7.1% 7.4% 9.1% 9.3%

South Acute 6,712 6,523 6,704 7,469 7,284 11.4% 11.0% 11.3% 12.6% 12.2%

Ambulance 27 34 22 7 10 18.1% 22.3% 15.6% 6.0% 8.5%

Community 519 598 585 426 451 11.8% 13.4% 13.1% 10.0% 10.5%

Mental Health 1,356 1,228 1,145 1,919 1,760 10.0% 9.1% 8.5% 13.7% 12.8%

Specialist 38 41 38 48 50 18.5% 19.5% 18.8% 22.8% 24.3%

South Total 8,653 8,424 8,495 9,869 9,556 11.2% 10.8% 10.9% 12.7% 12.3%

National Total Acute 29,045 26,276 26,701 30,755 30,010 11.4% 10.3% 10.4% 11.9% 11.6%

Ambulance 45 57 57 50 50 11.6% 14.3% 14.1% 13.0% 12.6%

Community 1,545 1,475 1,529 1,162 1,202 9.0% 8.7% 9.0% 8.0% 8.2%

Mental Health 7,534 7,250 6,714 8,426 8,514 11.6% 11.1% 10.5% 12.7% 12.9%

Specialist 985 875 794 944 1,101 7.9% 7.0% 6.3% 7.5% 8.6%

Grand Total 39,154 35,934 35,794 41,337 40,877 11.2% 10.2% 10.2% 11.7% 11.6%


5.2 Medical vacancy positionTable 1: Medical vacancies (WTE) Table 2: Medical vacancies (percentage rate)

Region Sector 2017/18 Q2 2017/18 Q3 2017/18 Q4 2018/19 Q1 2018/19 Q2 2017/18 Q2 2017/18 Q3 2017/18 Q4 2018/19 Q1 2018/19 Q2

London Acute 1,775 1,450 1,543 1,835 1,568 8.4% 7.0% 7.4% 8.5% 7.1%

Ambulance - - - 2 11 0.0% 0.0% 0.0% 46.4% 86.8%

Community 10 17 18 13 15 21.0% 26.9% 28.7% 21.7% 25.7%

Mental Health 177 222 247 245 248 6.8% 8.5% 9.3% 9.1% 9.0%

Specialist 147 192 194 250 198 6.9% 8.7% 8.8% 11.2% 8.8%

London Total 2,110 1,881 2,003 2,346 2,041 8.2% 7.4% 7.8% 8.9% 7.5%

Midlands and East Acute 2,883 2,773 2,942 3,314 2,638 10.2% 9.8% 10.3% 11.5% 9.1%

Ambulance - - - - - 0.0% 0.0% 0.0% 0.0% 0.0%

Community 60 52 45 49 24 11.6% 10.3% 8.9% 9.5% 5.6%

Mental Health 334 325 252 363 349 12.4% 12.1% 9.8% 13.0% 12.4%

Specialist 85 57 68 80 90 8.0% 5.5% 6.4% 7.5% 8.1%

Midlands and East Total 3,362 3,207 3,306 3,806 3,101 10.3% 9.8% 10.1% 11.5% 9.3%

North Acute 2,488 2,423 2,447 2,845 2,126 8.2% 8.0% 8.0% 9.2% 6.8%

Ambulance 1 0 0 - - 20.8% 10.4% 6.5% 0.0% 0.0%

Community 16 19 21 5 5 11.7% 13.2% 14.9% 4.9% 4.6%

Mental Health 403 385 372 380 339 14.2% 13.7% 12.8% 13.4% 11.7%

Specialist 163 165 83 76 41 9.6% 9.4% 4.9% 4.5% 2.4%

North Total 3,071 2,992 2,924 3,306 2,510 8.7% 8.5% 8.3% 9.3% 7.0%

South Acute 1,285 1,246 1,263 1,806 1,374 4.9% 4.7% 4.8% 6.7% 5.1%

Ambulance - - - - 0 0.0% 0.0% 0.0% 0.0% 13.2%

Community 34 50 49 43 66 9.7% 13.5% 13.5% 12.3% 18.0%

Mental Health 235 298 438 304 244 11.0% 13.8% 20.3% 13.6% 11.2%

Specialist - 3 - 4 - 0.0% 1.8% 0.0% 2.8% 0.0%

South Total 1,554 1,596 1,750 2,157 1,684 5.4% 5.5% 6.0% 7.3% 5.6%

National Total Acute 8,431 7,892 8,195 9,801 7,706 8.0% 7.5% 7.7% 9.1% 7.1%

Ambulance 1 0 0 2 11 10.9% 4.3% 2.8% 14.7% 51.8%

Community 120 137 134 110 110 11.4% 12.8% 12.4% 10.7% 11.5%

Mental Health 1,149 1,230 1,308 1,293 1,180 11.2% 12.0% 12.7% 12.3% 11.1%

Specialist 395 417 345 410 329 7.8% 8.1% 6.8% 8.0% 6.3%

Grand Total 10,096 9,676 9,982 11,616 9,337 8.3% 7.9% 8.1% 9.3% 7.4%

60 |

6.0 Organisation splits to calculate integrated care systems (ICS) financial performance



6.1 Organisation splits to calculate ICS financial performance

The ICS financial performance overview table is derived by aggregating the individual provider and commissioner performance data as published,

respectively, in this report by NHS Improvement and NHS England publications.

Individual organisations’ performance has been pro-rated where necessary as per the organisational percentage splits from the tables below.

North% in

ICSNorth

% in

ICS

Berkshire West South Yorkshire and Bassetlaw (SYB)

Berkshire Healthcare NHS Foundation Trust 60% Barnsley Hospital NHS Foundation Trust 100%

NHS Berkshire West CCG 100% Doncaster and Bassetlaw Teaching Hospitals NHS Foundation Trust 100%

Royal Berkshire NHS Foundation Trust 100% NHS Barnsley CCG 100%

Greater Manchester NHS Bassetlaw CCG 100%

Bolton NHS Foundation Trust 100% NHS Doncaster CCG 100%

Greater Manchester Mental Health NHS Foundation Trust 100% NHS Rotherham CCG 100%

Manchester University NHS Foundation Trust 100% NHS Sheffield CCG 100%

Collective unallocated 100% Rotherham Doncaster and South Humber NHS Foundation Trust 100%

NHS Bolton CCG 100% Sheffield Children's NHS Foundation Trust 100%

NHS Bury CCG 100% Sheffield Health and Social Care NHS Foundation Trust 100%

NHS Heywood Middleton&Rochdale CCG 100% Sheffield Teaching Hospitals NHS Foundation Trust 100%

NHS Manchester CCG 100% The Rotherham NHS Foundation Trust 100%

NHS Oldham CCG 100% West, North and East Cumbria

NHS Salford CCG 100% Cumbria Partnership NHS Foundation Trust 100%

NHS Stockport CCG 100% NHS North Cumbria CCG 100%

NHS Tameside & Glossop CCG 100% North Cumbria University Hospitals NHS Trust 100%

NHS Trafford CCG 100% North West Ambulance Service NHS Trust 6%

NHS Wigan Borough CCG 100% West Yorkshire

Pennine Care NHS Foundation Trust 100% Airedale NHS Foundation Trust 100%

Salford Royal NHS Foundation Trust 100% Bradford District Care NHS Foundation Trust 100%

Stockport NHS Foundation Trust 100% Bradford Teaching Hospitals NHS Foundation Trust 100%

Tameside and Glossop Integrated Care NHS Foundation Trust 100% Calderdale & Huddersfield NHS Foundation Trust 100%

The Christie NHS Foundation Trust 100% Harrogate and District NHS Foundation Trust 100%

The Pennine Acute Hospitals NHS Trust 100% Leeds and York Partnership NHS Foundation Trust 100%

Wrightington, Wigan and Leigh NHS Foundation Trust 100% Leeds Community Healthcare NHS Trust 100%

Lancashire and South Cumbria Leeds Teaching Hospitals NHS Trust 100%

Blackpool Teaching Hospitals NHS Foundation Trust 100% Mid Yorkshire Hospitals NHS Trust 100%

East Lancashire Hospitals NHS Trust 100% NHS Airedale, Wharfedale and Craven CCG 100%

Lancashire Care NHS Foundation Trust 100% NHS Bradford City CCG 100%

Lancashire Teaching Hospitals NHS Foundation Trust 100% NHS Bradford Districts CCG 100%

NHS Blackburn with Darwen CCG 100% NHS Calderdale CCG 100%

NHS Blackpool CCG 100% NHS Greater Huddersfield CCG 100%

NHS Chorley & South Ribble CCG 100% NHS Harrogate and Rural District CCG 100%

NHS East Lancashire CCG 100% NHS Leeds CCG 100%

NHS Fylde & Wyre CCG 100% NHS North Kirklees CCG 100%

NHS Greater Preston CCG 100% NHS Wakefield CCG 100%

NHS Morecambe Bay CCG 100% South West Yorkshire Partnership NHS Foundation Trust 100%

NHS West Lancashire CCG 100% Tees, Esk and Wear Valleys NHS Foundation Trust 6%

North West Ambulance Service NHS Trust 26% Yorkshire Ambulance Service NHS Trust 55%

University Hospitals of Morecambe Bay NHS Foundation Trust 100%

Midlands and East% in

ICSSouth

% in

ICS

Bedfordshire, Luton & Milton Keynes (BLMK) Frimley Health

Bedford Hospital NHS Trust 100% Berkshire Healthcare NHS Foundation Trust 40%

Luton and Dunstable University Hospital NHS Foundation Trust 100% Frimley Health NHS Foundation Trust 100%

Milton Keynes University Hospital NHS Foundation Trust 100% NHS NE Hampshire & Farnham CCG 100%

NHS Bedfordshire CCG 100% NHS Surrey Heath CCG 100%

NHS Luton CCG 100% NHS Berkshire East CCG 100%

NHS Milton Keynes CCG 100% Surrey and Borders Partnership NHS Foundation Trust 22%

Nottinghamshire Surrey Heartlands

NHS Mansfield & Ashfield CCG 100% Ashford and St Peter's Hospitals NHS Foundation Trust 100%

NHS Newark & Sherwood CCG 100% NHS Guildford & Waverley CCG 100%

NHS Nottingham City CCG 100% NHS North West Surrey CCG 100%

NHS Nottingham North & East CCG 100% NHS Surrey Downs CCG 100%

NHS Nottingham West CCG 100% Royal Surrey County Hospital NHS Foundation Trust 100%

NHS Rushcliffe CCG 100% Surrey and Borders Partnership NHS Foundation Trust 64%

Nottingham University Hospitals NHS Trust 100% Gloucestershire

Nottinghamshire Healthcare NHS Foundation Trust 100% 2gether NHS Foundation Trust 81%

Sherwood Forest Hospitals NHS Foundation Trust 100% Gloucestershire Care Services NHS Trust 100%

Gloucestershire Hospitals NHS Foundation Trust 100%

South% in

ICS NHS Gloucestershire CCG 100%

Buckinghamshire South Western Ambulance Service NHS Foundation Trust 14%

Buckinghamshire Healthcare NHS Trust 100% Suffolk and North East Essex

NHS Buckinghamshire CCG 100% Colchester Hospital University NHS Foundation Trust 100%

Dorset East of England Ambulance Service NHS Trust 16%

Dorset County Hospital NHS Foundation Trust 100% Essex Partnership University NHS Foundation Trust 11%

Dorset Healthcare University NHS Foundation Trust 100% Ipswich Hospital NHS Trust 100%

NHS Dorset CCG 100% NHS Ipswich and East Suffolk CCG 100%

Poole Hospital NHS Foundation Trust 100% NHS North East Essex CCG 100%

The Royal Bournemouth and Christchurch Hospitals NHS Foundation Trust100% NHS West Suffolk CCG 100%

Norfolk and Suffolk NHS Foundation Trust 33%

West Suffolk NHS Foundation Trust 100%

62 |

7.0 Timetable of future publications


63 |

7.1 Timetable of future publications

Performance Report Publication Dates 2018/19

Period Date

Quarter 3 7 Mar 2019

Quarter 4 30 May 2019


End notes and glossary


End notes

1

All financial information in this report is based on unaudited monitoring returns from 230 licensed NHS trusts and NHS

foundation trusts operating as at 30 September 2018. Those licensed providers include 151 NHS foundation trusts (FTs)

and 79 NHS trusts (non-FTs).

2Surplus/(deficit) control total basis is calculated as surplus/(deficit) before AME impairments, transfers, donated asset

income, and donated asset depreciation for all providers.

3

The sector reported adjusted financial position surplus/(deficit) includes DEL Impairments, Prior Period Adjustments,

donated asset income and donated asset depreciation, as these items have been excluded from the control total an

adjustment is needed to add the figures back to provide the reported sector surplus/(deficit).

4 The financial data is extracted from individual provider returns at Quarter 2.

5As at September 2018, a total of 201 providers have signed up to their control totals. This is based on the returns

submitted for Quarter 2.

6 157 providers reported performance against the A&E target in quarter 2 2018-19.

7181 providers reported against RTT incomplete pathway targets in September 2018. The admitted and non-admitted

targets were removed in September 2015.

8

144 providers reported performance against the breast cancer: 2-week wait target for quarter 2 2018-19.

145 providers reported performance against the GP referral: 62-day wait target for quarter 2 2018-19.

126 providers reported performance against the all cancers: 2-week wait target for quarter 2 2018-19.

Glossary (1/2)


A&E Accident and emergency departments offer a 24-hour, 7-day a week service to assess and treat patients with serious injuries or illnesses.

A&E standardThe objective that any patient attending an A&E department is seen and transferred, admitted or discharged within 4 hours of arrival. The objective performance against this target is 95% of patients. If a provider falls below this performance level, it is deemed to have breached the target.

Ambulance standard

Category 1 - Time critical life-threatening event needing immediate intervention and/or resuscitation

Category 2 – Potentially serious conditions (ABCD problem) that may require rapid assessment, urgent on-scene intervention and/or urgent transport.

Category 3 – Urgent problem (not immediately life-threatening) that needs treatment to relieve suffering (e.g pain control) and transport or assessment and management at scene with referral where needed within a clinically appropriate timeframeCategory 4 - Problems that are not urgent but need assessment (face to face or telephone) and possibly transport within a clinically appropriate timeframe

Admitted patient A patient who is formally admitted to a hospital for treatment. This includes admission that is not overnight, ie day cases.

Cancer waiting-time targets

A series of objective waiting times for patients referred for cancer diagnosis and treatment. Each target has a different objective performance. The waiting times for cancer patients are much stricter than the RTT targets, but the RTT targets include cancer patients.

CCG Clinical commissioning group

CIPCost improvement programme - usually a 5-year planned cost reduction programme to improve the productivity and streamline operational structures to provide efficient, effective services.

Cost weighted activity growth rate

The cost weighted activity is calculated by applying individual cost weights based on average reference costs to elective inpatient, non-elective inpatient, A&E attendance and outpatient attendance activities. This method allows combined cost weighted activity to be derived for different periods, so activity growth based on cost weighted activity could be calculated.

CQCCare Quality Commission - the independent regulator of health and adult social care services in England that ensures care provided by hospitals, dentists, ambulances, care homes and home care agencies meets government standards of quality and safety.

Day case A patient who is admitted and treated without staying overnight, eg for day surgery.DHSC Department of Health and Social Care, the government department responsible for the NHS.

DToCA delayed transfer of care occurs when a patient is considered ready to leave their current care (acute or non-acute) for home or another form of care but still occupies a bed.

Elective patient Elective surgery or procedure is scheduled in advance because it does not involve a medical emergency.

Government Spending categories (DEL and AME)

Total government expenditure is split into two categories:Delegated Expenditure Limits (DEL): this is the amount that government departments are allocated to spend. This amount, and how it is split between government departments, is set in spending reviews.Annually Managed Expenditure (AME): this is money spent in areas outside budgetary control on items that may be unpredictable or not easily controlled by government departments.

High cost drugs Expensive drugs typically used for specialist treatments, eg cancer, that are excluded from the Payment by Results (PbR) tariff as they would not be fairly reimbursed. Commissioners and providers agree appropriate local prices.

HMT Her Majesty’s Treasury, the government department that fulfils the function of a ministry of finance.

Glossary (2/2)


68 |

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