Performance Report to 30 th April 2014

St George’s Healthcare NHS Trust Performance Report

St George’s Healthcare NHS Trust

Trust Board Period ending 30

th

April 2014

Contents

Section

1 Executive Summary 2 3 4 The Performance Management Framework of the Trust NTDA Accountability Framework Monitor Compliance Framework 5 6 7 Exceptions and Actions Definitions and Metrics Appendices Trends Benchmarking Data

Page

3 5 6 11 13 19 23 27

2

Section 1: Executive Summary The Performance Management Framework

The Trust is realigning its Performance Framework with the requirements of the NHS Trust Development Authority (TDA) and Monitor. The performance report is being updated to cover the new requirements of the TDA Accountability Framework for Trusts and to include greater visibility of performance at Divisional level, alongside Trust wide aggregate performance.

The TDA Accountability Framework

The accountability framework covers three domains – Quality, Finance and Delivering Sustainability. A set of indicators has been identified in each domain and delivery will be evaluated against a threshold and aggregated for each domain. Performance against these indicators will determine a score for each domain. These domain scores in turn contribute towards an overall Escalation score for the Trust. The Trusts will be rated using escalation levels 1 to 5 with Level 1 being the highest and 5 the lowest. The measurement and monitoring process will continue to place each trust in one of five Oversight categories, based on their scoring against the various oversight domains, relevant views of third parties such as the CQC, and the judgement of the TDA . Those categories will be:

Standard Oversight with reduced frequency

– The organisation has developed a sound FT application and received a or Outstanding’ rating from CIH ‘Good

Standard Oversight with standard frequency: Supporting Intervention:

Limited or no delivery issues The organisation has some delivery issues including clinical and/or

Strategic Intervention:

financial challenges The organisation has significant delivery issues clinical and/or financial challenges

Special Measures:

The organisation has significant delivery issues, including serious clinical and/or financial challenges or concerns.

The Trust is also required to sign a self certifications on a monthly basis at Board level covering compliance with Monitor’s license requirements and a set of Board Statements .

The Monitor Compliance Framework

The Trust is reporting an

AMBER/ GREEN

Governance rating and a forecasted position on Continuity of Service Risks Rating of

3.

The trust is forecasting that the Governance rating be Amber / Green or Green from Q1 once ED performance and remedial plans take full effect.

Exceptions

The reportable areas of underperformance at month 1 are as follows :

A&E <4hrs:-

In April performance for ED (Type 1) was 94% and ED & MIU (Type 1 & 3) was 94.7%. 3 St George’s Healthcare NHS Trust

Section 2: Performance Management Framework of the Trust

The Performance Management Framework of the Trust

The Trust continues to operate the Performance Framework presented to the Board and Finance and Performance Committee in April 2012. This is being refreshed to ensure the indicators included within the TDA Accountability Framework for NHS Trusts are reported against and to ensure that Divisional contributions to the Trusts aggregate reported performance are more visible.

The diagrams illustrate the components of the Trust’s Performance Management Framework. The Trust operates escalation processes with Divisions that reflect the national escalation processes and the recommendations in Monitor’s toolkits for implementing Service Line Management. Quarterly Performance Reviews at Divisional Level, regular meetings with our commissioners, weekly Executive management Team meetings to address potential risks are all part of the Trusts Performance Management strategy. - Escalation actions following Divisional reviews have focused on the action plan for recovering A&E 4 hour waits, financial performance within SNT and MedCard Divisions and Cancer performance to look at how delivery of the 62 day target can be improved and sustained.

.

St George’s Healthcare NHS Trust 4

Section 2: Performance Management Framework of the Trust

The Performance Management Framework of the Trust

The performance management arrangements includes quarterly reviews for each Division which review and challenge Divisional progress, with an opportunity for Divisions to share with the Executive team issues of concern. The Trust has extended this process by reporting divisional performance against the metrics within the TDA Accountability Framework, to the Finance and Performance committee on a monthly basis. The Trust reports on the vast majority of these metrics within the existing quarterly review process. The Trust is also currently in the process of reviewing the indicators and thresholds in the scorecard in view of the most recently published TDA Accountability framework technical guidance , updated Monitor Compliance Framework and local Trust objectives. This work is being undertaken in conjunction with the current Performance Framework review. A draft updated performance framework is being sent to the Executive Management Team Meeting on the 27 th May after which a full suite of targets, thresholds and scoring methodology for the trust and divisional scorecards will be agreed and routinely reported on going forward.

Divisional Reports

Divisional rag ratings will be reported in the performance reports on a quarterly basis, however actions and escalation areas will be monitored and reported on a monthly basis and an overview provided. Any adjustments in rag rating will also be reported..

5

Section 3: The NHS Trust Development Authority Accountability Framework for NHS Trusts

6

Section 3: TDA Accountability Framework

The Accountability Framework Key Elements of the Oversight Model

The TDA will assess delivery across three domains as shown in the diagram : - Quality - Finance - Sustainability Against each domain Trusts will report against a series of metrics. These are listed in detail in Section 6 : definitions and metrics For 2014/15 trusts will be scored using escalation levels 1 to 5 with 1 being the highest risk rating and 5 the lowest. This is being done to ensure consistency with the CQC’s approach to assessing risk. The measurement and monitoring process will continue to place each NHS trust in one of five oversight categories, based on their scoring against the various oversight domains, relevant views of third parties such as the CQC, and the judgement of the TDA . Those categories are: 1. Special Measures 2. Intervention due to significant delivery issues 3. Intervention due to some delivery issues 4. Standard Oversight- limited or no delivery issues 5. Standard Oversight : Organisation has a developed a sound FT application and received a ‘Good or Outstanding rating from CIH.

Moderation including CQC Rating warning notices and third party report Quality Score (1 to 5) Caring Score (1-5) Effective Score (1 to 5)report Responsive Score (1 to 5) Safe Score (1 to 5) Well-led (1to 5) Overall Escalation score (1 to 5) Finance RAG Assessment The Trust is also required to sign off self certifications on a monthly basis at Board level covering progress against FT milestones, and compliance with Monitor’s license requirements

Sustainability Score (1-5)

St George’s Healthcare NHS Trust 7

Section 3: TDA Accountability Framework : Access metrics

This section headed ‘Access’ indicates how effective the trust is at providing patients with the appointments and treatment they need and require in accordance with the national standards and the NHS Constitution. The ED target is that 95% or more of patients should be seen and discharged within 4 hours of attending the Emergency Department. In April the Trust failed to meet this target with performance for ED (Type 1) at 94% and ED & MIU (Type 1 +3) at 94.7%. However for Qtr1, the trust is on track for Type 1+3 with performance as at the 22nd May at 95.2%.

In April 1.3% of patients had their operation cancelled for non-clinical reasons against a target of 0.8% and 3.9% were not offered another binding date within 28 days against a target of 5%. The number of operations cancelled for non clinical reasons and rebooked within 28 days has fluctuated over the year due to bed pressures and an increase in the acuity of patients. In April, 36.5% of LAS arrivals to patient handover times were within 15 minutes against the target of 100%. and 88.5% were within 60 minutes. St George's Hospital is not unusual in this regard as all trusts within the sector are underperforming. The trust will continue to monitor performance closely as fines will be applied where patient handovers exceed 30 and 60 minutes.

Not yet available 8 St George’s Healthcare NHS Trust

Section 3: TDA Accountability Framework : Outcome metrics

These indicators measure the outcomes resulting from treatment activity for which the Trust is responsible. The TDA framework includes monitoring Healthcare associated Infections and mortality. The Trust has a target of no more than 40 Cdiff incidents in 2014/15 and the zero tolerance against MRSA continues. In April, the trust met both the CDiff and MRSA target. There were 3 Cdiff incidents against a trajectory of 5 and no MRSA blood stream infections. The trust will continue its programme of close monitoring and vigilance to ensure it remains complaint in 2014/15.

Prevention and education has been the focus throughout 2013/2014, with the trust aiming for zero tolerance of avoidable pressure ulcers.

In April there were 15 reported Grade 3 Pressure Ulcers and no Grade 4’s. All grade 3 and 4 pressure ulcers acquired in our care are investigated as serious incidents, and a. full investigation and Root Cause Analysis is produced for each and reviewed at the Pressure Ulcer Strategy group, chaired by the Deputy Chief Nurse. The PU CQUIN for 14/15 has yet to be agreed.

The trust is reporting 1 Never Event. The incident took place in March, but was not reported on Datix until April when It was promptly declared as a SI . The incident was reported, following the retrieval of a throat swab in recovery following a dental procedure. The patient made a full recovery and did not come to any harm.

The WHO Surgical Checklist is a surgery safety checklist used prior to all surgical procedures. Compliance is just below target at 99%. Care group leads will continue to raise the profile through meetings and working with non compliant areas. 9 St George’s Healthcare NHS Trust

Section 3: TDA Accountability Framework : Quality governance

The Trust is required to respond to 85% of all complaints within 25 days and if this cannot be met, then an extension must be agreed with the complainant. The target then becomes 100% of all of those complaints should be responded to within 25 days or the agreed time In March 70% of all complaints were responded to within 25 working days and 87% were responded to when an agreed extensions was included. The trust has seen an increase in the number of complaints received with 116 complaints in March compared to 103 in February. Complaints remains a key focus and priority for the Chief Nurse & DOO and is being monitored and focused on at divisional, governance and clinical leads meetings. There were 4 EMSA breaches in April. A root cause analysis has been undertaken and reported to the CCG. system.

The trust is reporting research activity from the Research leadership with the aim of increasing its research activity. St George’s Healthcare NHS Trust 10

Section 4: The Monitor Compliance Framework

11

Section 4 : Monitor Compliance Framework

The Trust Rating as at 30th April 2014

• The Trust Overall Rating is

AMBER/GREEN

for Performance and our forecasted position for 2014/15 for

CoSRR is 3

at the end of April.

The 62 Day target was met in Qtr 4 and for the month of March. In March performance was 85.5%, and for the quarter January to March performance was 85.2% Performance Rating • For Qtr 1 to date, the trust is currently non-compliant against the ED target. ED (Type 1) is 94% and ED & MIU (Type 1 & 3) is 94.7%. Current monthly performance for Type 1 & 3 as at the 22nd May is 95.2% Forecasted CoSRR 3

April 2014 Indicators MONITOR COMPLIANCE DASHBOARD FOR ASPIRANT FINANCIAL TRUST

Clostridium( C )difficile- meeting the C.difficile objective

Frequency

Quarterly

Period

Outcomes

Apr-Jun 14

Current /Recent Performance (R/A/G)

3 incident in April 3 cases YTD

Data Completeness CSW

Referral to Treatment Information Referral Information Treatment activity Information Quarterly Quarterly Quarterly Apr-Jun 14 Apr-Jun 14 Apr-Jun 14 Does the trust have a mechanism in place to identify and flag patients with learning disabilities and protocols that ensure that pathways of care are reasonably adjusted to meet the health needs of these patients?

Does the trust provide readily available and comprehensible information to patients with learning disabilities about the following criteria: · treatment options; · complaints procedures; and · appointments?

Does the trust have protocols in place to provide suitable support for family carers who support patients with learning disabilities Does the trust have protocols in place to routinely include training on providing healthcare to patients with learning disabilities for all staff?

Does the trust have protocols in place to encourage representation of people with learning disabilities and their family carers?

Does the trust have protocols in place to regularly audit its practices for patients with learning disabilities and to demonstrate the findings in routine public reports?

Learning Disability Total for Outcomes

* Unvalidated

Threshold

40 50% 50% 50%

Yes Yes Yes Yes Yes Yes

St George’s Healthcare NHS Trust

Weighting achieved 0 0 0 0

1 2 Maximum time of 18 weeks from point of referral to treatment in aggregate- patients on an incomplete pathway 1

Indicators

Maximum time of 18 weeks from point of referral to treatment in aggregate- admitted Cancer first definitive treatment within

31

Day Cancer first definitive treatment within

62

Day 1 Cancer two week wait from referral to date first seen

(2 ww

) 1 All cancer 31 day wait from diagnosis to Treatment 1 A&E maximum waiting time of four hours from arrival to admission/transfer/discharge

Frequency

Quarterly Quarterly Surgery Drug Standard Screening 2ww Breast Standard

Period

Access

Current /Recent Performance (R/A/G) Threshold

Apr-Jun 14

Data awaited predicting compliance

90% Apr-Jun 14

Data awaited predicting compliance

Quarterly Jan Quarterly Jan Quarterly Jan Quarterly Jan – Mar 14 – Mar 14 – Mar 14 – Mar 14

100% (Mar 14) 100% (Qtr to date) YTD 99.2% 100% (Mar 14) 100% (Qtr to date) YTD 100% 85.5% Mar 14 ) 85.2% (Qtr4 ) YTD 83.5% 90.9% (Mar14) 93.4% (Qtr 4) YTD 94.5% 99.3% (Mar 14) 98.2% (Qtr 4) YTD 97.7% 98.1% (Mar 14) 98.9% (Qtr 4) YTD 98% 97.6% (Mar 14) 97.1% (Qtr 4) YTD 97.6%

92% 94% 98% 85% 90% 93% 93% 96% Apr-Jun 14

94.7% (Qtr to date) as at end of April

95%

0 0

1 ##

Total for Access Trust Overall Score for all Target and Indicators

Green <1.0

Amber Green= ≥1 and ≤2 Amber/Red = ≥2 and ≤4 Red= ≥4 12

Weighting achieved 0 0 0 0 0 0 1 1 1

Section 5 : Exceptions and Actions Exceptions and Actions

The following pages provide a summary of performance for the areas where the Trust is not meeting the required standards and the actions being taken to address the performance issues

13 St George’s Healthcare NHS Trust

Section 5: Exceptions and Actions

A&E performance Performance : April – 94.7% all types within 4 hours Actions

In April 94.7% of patients were seen within 4hours, for both Type 1 and Type 3 and for Type 1 only performance was 94.0%. Month of April Quarter to date (Q1) ED (Type 1) 94.0% 94.0% MIU (Type 3) 99.9% 99.9% ED & MIU (Type 1+3) 94.7% 94.7% Year to date 94.0% 99.9% 94.7% Where MIU data are not yet available average daily figures have been used and 100% performance assumed.

•The trust is continuing to be supported by the Emergency Care Intensive Support Team (ECIST) to implement the recommendations which developed over a number of visits over the last 6 months focusing on improving ED patient flow and flow through the organisation (in and out).

•Weekly recovery meetings continue to be held with the Exec team and the cross divisional leadership teams. This has identified further steps the Trust can be taking to improve performance including review of the current week, plans for the weekend, and a look to the week ahead. This will take note of any plans in place that would directly impact on improving ED performance and the overall flow of patients through the system.

•The ED continues to focus on any improvements that can be made to the emergency / urgent pathways. This includes the implementation of the Rapid Assessment and Treatment Service (RATS) 7 days per week to provide early senior intervention in the patients pathway reducing the time to treatment within the ED, the Clinical Director is now supervisory to support the ED team on the shop floor and to help facilitate smooth flow of patients between ED and admitting specialties.

There have also been improvements made to the triage service and the flow of patients linked to this and a clearer focus on the shop floor leadership for the department.

•Following discussion with the TDA and ECIST virtual CDU and PDU patients are now counted in the breach numbers if they have waited more than 4 hours. Work is also underway with the mental health teams to improve response times and the patients experience.

•The Trust has achieved the 95% target for 4 weeks in a row – from week commencing 21 st April to date .

14

Section 5: Exceptions and Actions

18 week Referral to Treatment (RTT) performance : Admitted pathway Performance : 90.10% compliance in April against target of 90% Actions

At the end of April t4 specialities failed to meet the standard.

The trust is reworking and finalising the 18 week model for 14/15 • to include the final agreed SLA numbers per specialty and and • to allow ENT to increase its number of breaches to reduce its backlog and over 40 week waiters.

Cardiology is not compliant for month 1 and will continue to be non compliant until Q3 as the recovery plan is worked through. This is under discussion with commissioners.

Any clinical risks in Cardiology will be reviewed at the June Patient Safety Committee.

This will be completed for month 2 reporting and so the monthly targets will change slightly in the next report

.

Particular focus is being paid to avoiding any 52 week waiters (after declaring 5 in March) and a weekly listing of all patients over 40 weeks is being sent to the Divisional Chairs and DDOs to address with their teams.

RTT Admitted Pathway Performance April 2014

Commissioner Approved plan Achieved Target The Admitted performance only is available at the time of the report being produced, a verbal update will be provided at the Finance & Performance meeting on Outpatients and Incompletes performance.

Reporting speciality

General Surgery Urology Trauma & Orthopaedics Ear, Nose & Throat Maxillofacial Surgery Neurosurgery Plastic Surgery Cardiothoracic Surgery Gastroenterology Cardiology Neurology Dental Vascular Surgery Gynaecology Other

Total

Within

165 111 87 139 65 55 215 76 211 115 53 64 72 226 85

1739

Breach

18 12 8 24 1 6 18 9 8 46 0 3 12 16 10

191

%

90.2

90.2

91.6

85.3

98.5

90.2

92.3

89.4

96.3

71.4

100 95.5

85.7

93.4

15

90.1

Section 5: Exceptions and Actions

18 week Referral to Treatment (RTT) performance : 52 Week Waits Performance : 5 patients waiting over 52 weeks in March Actions

• • The trust recognises and acknowledges the recent increase in the number of patients waiting longer than 52weeks ,most recently five at the end of March. The reasons for the increase in long waiting patients is multi factorial and • include : Technical issues affecting patient tracking lists (PTLs) following the • Cerner PAS upgrade on 22nd February 2014, and subsequently the patient tracking process. Much effort has gone into the corrective work following this upgrade. Multiple cancellations of the same patients where they have been unfit • for surgery. A number of these have been complex patients such as high risk anaesthetic patients requiring repeat pre-op assessments prior to booking which adds to the patient journey A number of patients requiring specialist OP review which have had delays in booking due to capacity constraints. Clinician capacity constraints Significant bed pressures experienced in Q4 2014, which resulted in a high number of elective cancellations, subsequently impacting on patient waits and also trust performance. This had considerable impact during February and March 2014.

52 Week breaches

RTT performance and reducing long waits is a key priority area for the trust, and we are taking pro-active measures to address this accordingly.

Key actions include .

Working through technical issues following the Cerner upgrade; some of which have been resolved and some are still underway. A project board is in place which is reviewing the implementation and monitoring progress/resolution of outstanding issues. Weekly Referral to Treatment management meetings by care group are now in place which track the Patient Tracking List and review at patient level, review capacity and escalate long waits. Weekly escalation email of long waiters is now sent by the Associate Director of Finance, Contracting and Performance to the Divisional Directors of Operations and Divisional Clinical Chairs to review personally and action those patients waiting for more than 40 weeks. A monthly RTT Compliance meeting chaired by an Executive Director is held which reviews; performance by care group with a particular focus on patients waiting 40+ weeks to ensure treatment plans are in place, review/facilitate escalation, provide senior decision making support to drive actions forward, reviews and monitors elective cancellations, their rebooking to target and their impact on RTT performance.

1 0 6 5 4 3 2 Recruitment of additional consultants in clinical areas of capacity constraints, such as ENT The trust has recruited and now has in post a Director of Delivery and Improvement who is leading on service transformation, working closely with the divisions to ensure we implement our capacity plans and meet performance targets as we continue to improve our services. Monthly meetings are being held with South London CSU reviewing RTT performance, and RCAs for long waiting patients.

16

Incomplete Admitted Adjusted Non-Admitted

Section 5: Exceptions and Actions

Performance : Total of 3 Cdiff cases in April vs a monthly trajectory of 5 and a annual target of 40. A total of zero MRSA cases year to date Actions

5 4 3 2 1 5 3 5 4 3 3 3 3 3 3 3 3 2

C.Difficile

With the annual total number of cases below trajectory the trust is happy that it current strategy has reaped results with its lowest ever number of CDiff cases in three years. The trust will continue to maintain its good performance as it faces an even more challenging target of 40 incidents in 2014/15 .which should be achievable

MRSA Bacteraemia

The root cause analysis for each bacteraemia is presented to the HCAI taskforce, The Trust will continue its trust wide communication and vigilance to improve compliance 0 Trajectory

Months

2014/15 Actual (cum) The Trust has a target of no more than 40 Cdiff incidents in 2014/15. There were 3 Cdiff incidents against a trajectory of 5 and no MRSA blood stream infections. The trust will continue its programme of close monitoring and vigilance to ensure it remains complaint in 2014/15.

The zero tolerance against MRSA continues in 2014/15. The trust can report that in April there were no MRSA bacteraemias The Infection control and the Vascular Access teams are also available to provide additional support. Weekly awareness sessions on line care continues In 2014/15 the zero tolerance approach to MRSA bacteraemia (hence no national target) remains, and the trust will maintain its current strategy and continue to monitor this closely to avoid being non compliant Following an appeals process, a 7 th bacteraemia which occurred in March, has been assigned to St George’s bringing the total for 13/14 to 7. It was agreed that this did not cause a clinical infection but could have been a transient bacteraemia as the patient was on antibiotics sensitive to the bacteria. However the guidance does not accommodate this within its definitions and thus had to be assigned as a contaminant which is allocated to the organisation that took the blood culture (St George’s). The chair of the appeal panel will be writing to NHSE

Section 5: Exceptions and Actions

Cancer Performance- 62 Day Performance : 62 Day waits 85.5% compliance against target of 85%

The 62 Day target was met in March, with performance at 85.5%.

All other cancer targets were met for the full year 2013/14.

Actions

The 62 Day target was met in March , with performance at 85.5%. Despite not having met the target for 6 months out of the 12 months the Trust is happy to report that it also met the target for Quarter 4 with performance at 85.2%.

The trust will continue with the following plans to ensure the target is met and sustained:-

1. Implementation of single Cancer Management Team based at SGH, providing full visibility of the cancer performance for the whole organisation

•The scheduling and uploading contract would be transferred to SGH with effect from 1 July 2014 and KHT would take on the activity provided by their consultants.

•Temporary staff have been recruited to the SGH TWR Office to manage the additional workload. Substantive staff will be recruited once the budget transfer takes place.

•Meetings have been held and a new urology pathway will be implemented when new consultants come into post.

2. Development of a 62 day PTL capturing all TWR referrals received at SGH (not including QMH) to ensure performance against this target

• Work started in mid-February as planned and all tumour types are now receiving a PTL although there is more validation work required. Meetings have been set up with clinical leads, service teams and MDT co-ordinators to pro actively manage pathways and take remedial action to avoid any breaches where possible

3. The transfer of the monitoring and reporting of QMH activity to St George’s enabling a direct feed from QMH PAS to the St George’s cancer informatics

•Awaiting resolution by IT before the Infoflex development work can begin • The development work and the commissioning of the new system is expected to be fully operational within 9 – 12 18 months.

Section 6: Definitions and Metrics

19

Section 6: Definitions and metrics

TDA Accountability Framework

The following pages provide details of the metrics included in the TDA performance framework applicable to Acute Trusts.

Caring

Inpatient scores from Friends and Family Test A&E scores from Friends and Family Test Complaints – rate per bed days, MH contacts or calls to ambulance services Inpatient Survey: Q68 Overall I had a very poor/good experience?

Mixed Sex Accommodation Breaches

Well-led

NHS England inpatients response rate from Friends and Family Test NHS England A&E response rate from Friends and Family Test Data Quality of trust returns to the HSCIC NHS Staff Survey: Percentage of staff who would recommend the trust as a place of work NHS Staff Survey: Percentage of staff who would recommend the trust as a place to receive treatment Trust turnover rate Trust level total sickness rate Total trust vacancy rate Temporary costs and overtime as % total pay bill Percentage of staff with annual appraisal

Effective

Summary Hospital Mortality Indicator (HSCIC Published data) Hospital Standardised Mortality Ratio (DFI Quarterly) Hospital Standardised Mortality Ratio – weekend Hospital Standardised Mortality Ratio – weekday Deaths in low risk conditions Emergency re-admissions within 30 days following an elective or emergency spell at the trust

Safe

CDiff MRSA Never Event incidence Medication errors causing serious harm Maternal deaths Proportion of patients risk assessed for Venous Thromboembolism (VTE) Serious incidents Proportion of reported patient safety incidents that are harmful Admission to adult facilities for patients who are under 16 years of age (Number) 20

Section 6: Definitions and metrics

TDA Accountability Framework

The following pages provide details of the metrics included in the TDA performance framework applicable to Acute Trusts

Responsive Responsive contd Finance

Proportion of patients spending more than 4 hours in A&E Urgent operations cancelled for a second time Bottom line I&E position – Forecast compared to plan RTT waiting times for admitted pathways: % within 18 weeks RTT waiting times for non-admitted pathways: % within 18 weeks Proportions of patients not treated within 28 days of last minute cancellation due to non clinical reasons Bottom line I&E position – Year to date actual compared to plan RTT waiting times incomplete pathways RTT over 52 week waiters Diagnostic waiting times: patients waiting over 6 wks for a diagnostic test Proportion of patients receiving first definitive treatment for cancer within 62 days of referral from GP Proportion of patients receiving first definitive treatment for cancer within 62 days of referral from screening Proportion of patients receiving first definitive treatment for cancer within 31 days of decision to treat Proportion of patients receiving subsequent treatment within 31 days (Drug) Proportion of patients receiving subsequent treatment within 31 days (Surgery) Proportion of patients receiving subsequent treatment within 31 days (Radiotherapy Proportion of patients receiving subsequent treatment within 31 days (Radiotherapy Proportion of patients seen within 14 days of urgent GP referral Proportion of patients with breast symptoms seen within 14 days of GP referral Certification against compliance regarding access to health care for people with a learning disability 12 hour trolley waits in A&E Actual efficiency recurring/non recurring compared to plan- Year to date actual compared to plan Actual efficiency recurring/non recurring compared to plan – Forecast compared to plan Forecast underlying surplus/deficit compared to plan Forecast year end charge to capital resource limit Is the Trust forecasting permanent PDC for liquidity purposes?

21

Section 7: Appendices

22

Trends

Monthly Trust Performance

Monthly Trust Performance

Monthly Trust Performance

Appendix 1: Benchmark Data

27

Accident and Emergency (All type): 4 hour wait April 2014

28

Accident and Emergency (Type 1): 4 hour wait April 2014

29

Accident & Emergency: Week Ending 30

th

March 2014 All type A&E: 94.88%, up from 94.69% last week Type 1: 91.71%, up from 91.42% last week

For week ending: 11/5/2014 London is ranked 2 nd for All Types and 3 rd for Type 1 performance.

For QTD performance, London is ranked 2 nd for All Types, and 4 th for Type 1 (National ranking is based on the 4 commissioning regions) 30

NEL NEL NEL NEL NEL NEL NEL NEL NEL NEL SL SL SL SL SL SL SL SL

MRSA Dashboard 2014-15

NB. Trajectories for 2014/15 are Zero for MRSA.

Sector

NWL NWL NWL NWL NWL NWL NWL

Total Trust Name

Barking, Havering And Redbridge Hospitals NHS Trust Barnet And Chase Farm Hospitals NHS Trust Barts Health Trust Great Ormond Street Hospital For Children NHS Trust Homerton University Hospital NHS Foundation Trust North Middlesex University Hospital NHS Trust Royal Free NHS Foundation Trust Royal National Orthopaedic Hospital NHS Trust University College London Hospitals NHS Foundation Trust Whittington Hospital NHS Trust

NEL TOTAL

Chelsea And Westminster Hospital NHS Foundation Trust Ealing Hospital NHS Trust Hillingdon Hospital NHS Trust Imperial College Healthcare NHS Trust North West London Hospitals NHS Trust Royal Brompton And Harefield NHS Trust West Middlesex University NHS Trust

NWL TOTAL

Croydon Healthcare Services NHS Trust Epsom And St Helier NHS Trust Guy's and St Thomas's NHS Foundation Trust King's College Hospital NHS Trust Kingston Hospital NHS Trust Lewisham Healthcare NHS Trust Royal Marsden NHS Foundation Trust St George's Healthcare NHS Trust

SL TOTAL LONDON

2 8 4 7 5 1 1 5

33 90

2 5 12 1 5 4 0 0 5 1

35

3 1 0 10 2 1 5

22 Total for last 12 months Total for last 3 months Number of cases last month (April 2014) Number of cases so far this month (May 2014) 2014-15 YTD Position to 15th May 2014 2013-14 YTD position to the end of April 2013

0 0 0 0 0 0 0 0

0 1

0 0 1 0 0 0 0 0 0 0

1

0 0 0 0 0 0 0

0

0 0 0 1 0 0 0 0

1 4

0 0 1 0 1 0 0 0 0 0

2

0 0 0 1 0 0 0

1

2 2 1 1 2 0 0 0

8 17

0 0 3 0 2 0 0 0 0 0

5

1 0 0 2 0 0 1

4

0 0 0 1 0 0 0 0 1

5

0 0 2 0 1 0 0 0 0 0 3 0 0 0 1 0 0 0 1 0 0 2 3 0 0 0 0

5 10

0 1 0 0 1 2 0 0 0 0

4

1 0 0 0 0 0 0

1 1

Trust above 0 threshold Trust achieving 0 threshold 31

C.Difficile Dashboard 2014-15

Sector Trust Name Annual Trajectory Year to date Trajectory to 15th May Total for last 12 months Total for last 3 months Number of cases last month Number of cases so far this month Number of cases from 1st April 2014 - 15th May 2014 (Provisional) 2013-14 YTD number of cases to end April 2013

NWL NWL NWL NWL NWL NWL NWL NEL NEL NEL NEL NEL NEL NEL NEL NEL NEL SL SL SL SL SL SL SL SL

Total

Barking, Havering And Redbridge Hospitals NHS Trust Barnet And Chase Farm Hospitals NHS Trust Barts Health Trust Great Ormond Street Hospital For Children NHS Trust Homerton University Hospital NHS Foundation Trust North Middlesex University Hospital NHS Trust Royal Free NHS Foundation Trust Royal National Orthopaedic Hospital NHS Trust University College London Hospitals NHS Foundation Trust Whittington Hospital NHS Trust

NEL TOTAL

Chelsea And Westminster Hospital NHS Foundation Trust Ealing Hospital NHS Trust Hillingdon Hospital NHS Trust Imperial College Healthcare NHS Trust North West London Hospitals NHS Trust Royal Brompton And Harefield NHS Trust West Middlesex University NHS Trust

NWL TOTAL

Croydon Healthcare Services NHS Trust Epsom And St Helier NHS Trust Guy's and St Thomas's NHS Foundation Trust King's College Hospital NHS Trust Kingston Hospital NHS Trust Lewisham Healthcare NHS Trust Royal Marsden NHS Foundation Trust St George's Healthcare NHS Trust

SL TOTAL LONDON

40 37 58 24 39 16 40

271 695

8 8 16 65 18 9 19

143

17 37 20 71 7 2 17 38 13 57 19

281

41 48 66 18 40 19 23

266 710

11 12 10 47 20 15 12

127

11 23 34 75 12 4 25 27 8 89 20

317

5.00

4.63

7.25

3.00

4.88

2.00

5.00

33.88

86.88

1.00

1.00

2.00

8.13

2.25

1.13

2.38

17.88

2.13

4.63

2.50

8.88

0.88

0.25

2.13

4.75

1.63

7.13

2.38

35.13

2 5 6 1 1 0 3

19 57

0 1 2 2 0 7 1

13

1 2 5 6 0 1 3 2 0 4 2

25

9 13 12 1 5 5 7

55 149

2 3 0 14 2 3 4

28

3 4 11 11 1 2 12 5 0 15 5

66

4 7 6 1 1 2 5

27 74

0 1 2 2 0 7 1

13

1 2 5 6 0 2 9 2 0 6 2

34

2 2 0 0 0 2 2

8 17 0

0 0 0 0 0 0 0 0 0 0 0 0 1 6 0 0 2 0

9

2 1 5 2 4 1 9

27 80

0 2 0 12 2 1 6

23

3 1 3 5 0 0 2 5 1 10 3

30

Note – The 2014/15 weekly C.diff numbers are aggregated at provider level but not attributed to the Trusts, therefore to avoid giving an inaccurate position we have omitted any comparison to plan and associated RAG rating

.

*

Data in the body of the report may not reflect more recent updates 32