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Performance of the NHS provider sector for the quarter ended 30 September 2018
Contents
Performance of the NHS provider sector for the quarter ended 30 September 2018
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.
Performance of the NHS provider sector for the quarter ended 30 September 2018
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.
Overview at Quarter 2, 2018/19 (2/6)
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 of the NHS provider sector for the quarter ended 30 September 2018
Overview at Quarter 2, 2018/19 (3/6)
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.
Performance of the NHS provider sector for the quarter ended 30 September 2018
Overview at Quarter 2, 2018/19 (4/6)
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.
Performance of the NHS provider sector for the quarter ended 30 September 2018
Overview at Quarter 2, 2018/19 (5/6)
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.
Performance of the NHS provider sector for the quarter ended 30 September 2018
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.
Overview at Quarter 2, 2018/19 (6/6)
Performance of the NHS provider sector for the quarter ended 30 September 2018
Performance comparisons
Performance of the NHS provider sector for the quarter ended 30 September 2018
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
Performance of the NHS provider sector for the quarter ended 30 September 2018
1.0 Operational performance
1.1 Operational performance overview
Performance of the NHS provider sector for the quarter ended 30 September 2018
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
Performance of the NHS provider sector for the quarter ended 30 September 2018
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.
Performance of the NHS provider sector for the quarter ended 30 September 2018
1.4 Elective waiting times
Performance of the NHS provider sector for the quarter ended 30 September 2018
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
Performance of the NHS provider sector for the quarter ended 30 September 2018
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
same period last year.
• 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.
Performance of the NHS provider sector for the quarter ended 30 September 2018
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.
Performance of the NHS provider sector for the quarter ended 30 September 2018
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
Performance of the NHS provider sector for the quarter ended 30 September 2018
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
Performance of the NHS provider sector for the quarter ended 30 September 2018
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.
Performance of the NHS provider sector for the quarter ended 30 September 2018
Performance of the NHS provider sector for the quarter ended 30 September 2018
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
Performance of the NHS provider sector for the quarter ended 30 September 2018
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).
Performance of the NHS provider sector for the quarter ended 30 September 2018
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
Performance of the NHS provider sector for the quarter ended 30 September 2018
• 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
Performance of the NHS provider sector for the quarter ended 30 September 2018
• 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
Year to date Month 6 2018/19
Performance of the NHS provider sector for the quarter ended 30 September 2018
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%)
Year to date Month 6 2018/19
Variance
6 months ended 30 September
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
6 months ended 30 September
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
Performance of the NHS provider sector for the quarter ended 30 September 2018
• 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
same period last year.
• 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
Year to date Month 6 2018/19
Variance
Variance
Year to date Month 6 2018/19
Forecast outturn 2018/19
2.7 Non-pay cost pressures
Performance of the NHS provider sector for the quarter ended 30 September 2018
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 Month 6 2018/19
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
6 months ended 30 September 2018
• 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
Performance of the NHS provider sector for the quarter ended 30 September 2018
• 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%
6 months ended 30 September 2018
6 months ended 30 September 2018
Year to date Month 6 2018/19
Forecast outturn 2018/19
Performance of the NHS provider sector for the quarter ended 30 September 2018
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
Performance of the NHS provider sector for the quarter ended 30 September 2018
• 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).
6 months ended 30 September 2018 by sector
Year to date Month 6 2018/19
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%)
6 months ended 30 September 2018 by sector
Forecast outturn 2018/19
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
Performance of the NHS provider sector for the quarter ended 30 September 2018
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
Performance of the NHS provider sector for the quarter ended 30 September 2018
• 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
Performance of the NHS provider sector for the quarter ended 30 September 2018
3.0 Financial performance by provider
3.1 Financial performance by provider – London (1/1)
Performance of the NHS provider sector for the quarter ended 30 September 2018
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)
Performance of the NHS provider sector for the quarter ended 30 September 2018
Provider Name
Control Total
(CT)
Accepted? YTD Plan YTD Actual Variance FOT Plan FOT Variance
PSF inPlan (CT
acceptors
only) YTD Actual FOT
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
Year to date Forecast Outturn
Control Total Basis Surplus Deficit Including PSF Provider Sustainability Fund (PSF)
3.3 Financial performance by provider – Midlands and East (2/2)
Performance of the NHS provider sector for the quarter ended 30 September 2018
Provider Name
Control Total
(CT)
Accepted? YTD Plan YTD Actual Variance FOT Plan FOT Variance
PSF inPlan (CT
acceptors
only) YTD Actual FOT
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
Control Total Basis Surplus Deficit Including PSF Provider Sustainability Fund (PSF)
Year to date Forecast Outturn
3.4 Financial performance by provider – North 1/2
Performance of the NHS provider sector for the quarter ended 30 September 2018
Provider Name
Control Total
(CT)
Accepted? YTD Plan YTD Actual Variance FOT Plan FOT Variance
PSF inPlan (CT
acceptors
only) YTD Actual FOT
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
Control Total Basis Surplus Deficit Including PSF Provider Sustainability Fund (PSF)
Year to date Forecast Outturn
3.5 Financial performance by provider – North 2/2
Performance of the NHS provider sector for the quarter ended 30 September 2018
Provider Name
Control Total
(CT)
Accepted? YTD Plan YTD Actual Variance FOT Plan FOT Variance
PSF in Plan (CT
acceptors
only) YTD Actual FOT
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
Control Total Basis Surplus Deficit Including PSF Provider Sustainability Fund (PSF)
Year to date Forecast Outturn
3.6 Financial performance by provider – South (1/2)
Performance of the NHS provider sector for the quarter ended 30 September 2018
Provider Name
Control Total
(CT)
Accepted? YTD Plan YTD Actual Variance FOT Plan FOT Variance
PSF in Plan (CT
acceptors
only) YTD Actual FOT
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
Year to date Forecast Outturn
3.7 Financial performance by provider – South (2/2)
Performance of the NHS provider sector for the quarter ended 30 September 2018
Provider Name
Control Total
(CT)
Accepted? YTD Plan YTD Actual Variance FOT Plan FOT Variance
PSF in Plan (CT
acceptors
only) YTD Actual FOT
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
Control Total Basis Surplus Deficit Including PSF Provider Sustainability Fund (PSF)
Year to date Forecast Outturn
3.8 Key variances year to date Quarter 2
Performance of the NHS provider sector for the quarter ended 30 September 2018
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
Largest Variances from plan (excl PSF)
3.9 Key variances forecast outturn Quarter 2
Performance of the NHS provider sector for the quarter ended 30 September 2018
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
Largest Variances from plan (excl PSF)
forecast outturn
Performance of the NHS provider sector for the quarter ended 30 September 2018
4.0 Operational performance by provider
Performance of the NHS provider sector for the quarter ended 30 September 2018
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
Foundation Trust12,857 272 97.88%
North Tees and Hartlepool NHS
Foundation Trust43,511 1,057 97.57%
Northumbria Healthcare NHS
Foundation Trust54,254 1,711 96.85%
Basildon and Thurrock University
Hospitals NHS Foundation Trust37,966 1,356 96.43%
Alder Hey Children's NHS
Foundation Trust13,519 529 96.09%
Sherwood Forest Hospitals NHS
Foundation Trust39,889 1,628 95.92%
South Tyneside NHS Foundation
Trust17,352 728 95.80%
South Warwickshire NHS
Foundation Trust20,059 853 95.75%
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%
Performance of the NHS provider sector for the quarter ended 30 September 2018
4.1 Best and worst operational performance (2/3)
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
Foundation Trust2,476 2,411 97.37%
Homerton University Hospital NHS
Foundation Trust17,392 16,811 96.66%
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
Foundation Trust14,606 10,815 74.04%
Bradford Teaching Hospitals NHS
Foundation Trust31,106 23,359 75.09%
Royal Free London NHS Foundation
Trust67,993 51,204 75.31%
East Kent Hospitals University NHS
Foundation Trust54,701 41,721 76.27%
Taunton and Somerset NHS
Foundation Trust22,948 17,589 76.65%
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%
Performance of the NHS provider sector for the quarter ended 30 September 2018
4.1 Best and worst operational performance (3/3)
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
Foundation Trust180.5 161.0 89.20%
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
Foundation Trust17.0 8.5 50.00%
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
Foundation Trust151.5 90.5 59.74%
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
Foundation Trust299.0 197.0 65.89%
Southend University Hospital NHS
Foundation Trust287.0 190.5 66.38%
Performance of the NHS provider sector for the quarter ended 30 September 2018
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
Performance of the NHS provider sector for the quarter ended 30 September 2018
4.2 Operational performance by provider – Midlands and East (1/2)
ORGANISATION A&E (95%)RTT Incomplete
(92%)
RTT 52
weeks
Diagnostics
(<1.00%)
Cancer 62
days - GP
referral (85%)
Cancer 2
weeks - GP
referral (93%)
Cancer 2 weeks -
breast
symptoms (93%)
Cancer 31
days -
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
Performance of the NHS provider sector for the quarter ended 30 September 2018
4.2 Operational performance by provider – Midlands and East (2/2)
ORGANISATION A&E (95%)RTT Incomplete
(92%)
RTT 52
weeks
Diagnostics
(<1.00%)
Cancer 62
days - GP
referral (85%)
Cancer 2
weeks - GP
referral (93%)
Cancer 2 weeks -
breast
symptoms (93%)
Cancer 31
days -
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
Performance of the NHS provider sector for the quarter ended 30 September 2018
4.2 Operational performance by provider – North (1/2)
ORGANISATION A&E (95%)RTT Incomplete
(92%)
RTT 52
weeks
Diagnostics
(<1.00%)
Cancer 62
days - GP
referral (85%)
Cancer 2
weeks - GP
referral (93%)
Cancer 2 weeks -
breast
symptoms (93%)
Cancer 31
days -
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
Performance of the NHS provider sector for the quarter ended 30 September 2018
4.2 Operational performance by provider – North (2/2)
ORGANISATION A&E (95%)RTT Incomplete
(92%)
RTT 52
weeks
Diagnostics
(<1.00%)
Cancer 62
days - GP
referral (85%)
Cancer 2
weeks - GP
referral (93%)
Cancer 2 weeks -
breast
symptoms (93%)
Cancer 31
days -
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)
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
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
Performance of the NHS provider sector for the quarter ended 30 September 2018
4.2 Operational performance by provider – South (2/2)
ORGANISATION A&E (95%)RTT Incomplete
(92%)
RTT 52
weeks
Diagnostics
(<1.00%)
Cancer 62
days - GP
referral (85%)
Cancer 2
weeks - GP
referral (93%)
Cancer 2 weeks -
breast
symptoms (93%)
Cancer 31
days -
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
Performance of the NHS provider sector for the quarter ended 30 September 2018
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
Performance of the NHS provider sector for the quarter ended 30 September 2018
5.0 Vacancy position by sector and region
Performance of the NHS provider sector for the quarter ended 30 June 2018
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%
Performance of the NHS provider sector for the quarter ended 30 June 2018
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
Performance of the NHS provider sector for the quarter ended 30 September 2018
Performance of the NHS provider sector for the quarter ended 30 September 2018
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
Performance of the NHS provider sector for the quarter ended 30 September 2018
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
Performance of the NHS provider sector for the quarter ended 30 September 2018
End notes and glossary
Performance of the NHS provider sector for the quarter ended 30 September 2018
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)
Performance of the NHS provider sector for the quarter ended 30 September 2018
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)
Performance of the NHS provider sector for the quarter ended 30 September 2018
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