Business Delivery & Performance Report

Agenda item: A5(vi) Business Delivery & Performance Report May 2017 Healthcare at its very best - with a personal touch

1. EXECUTIVE SUMMARY 1.1. This report outlines the Trust s performance for the period April 2017 to May 2017. This summary pulls out the key issues and implications. 2. INTRODUCTION 2.1. This Business Delivery & Performance Report is reporting the month of April 2017 and May 2017. The format and content of the report will continue to evolve, but it is hoped that Directors find the style of reporting useful, informative and straightforward to follow. 2.2. The remainder of the report sets out the key targets the Trust has to deliver in 2017/18. The report will also specify financial penalties where they apply. 2.3. Whilst there is no real change to the content of national performance indicators in 2017-19, the recent publication of Next Steps on the NHS Five Year Forward View prioritises 4 key areas; urgent and emergency care, primary care, cancer, and mental health. Whilst NHS England recently acknowledged that growing demand will make it difficult to meet the 18 week elective waiting time target, the 92% incomplete target still remains the constitutional goal as well as a contractual requirement with attached penalties. 2.4. The Appendices to this report give a more detailed breakdown of some of the performance measures, for example, performance by Directorate and/or site. However the report itself will include key figures and graphics to demonstrate the Trust s position and, where possible, how it compares to other providers. As always, feedback is most welcome. 3. TRUST WAITING TIMES 3.1. Directors Summary 3.2. This section details the Trust s performance against 18 Weeks, Cancer and Diagnostic standards. As the issues with compliance are increasingly complex, the position is summarised below: The RTT Incomplete (92%), Admitted (90%) and Non-Admitted (95%) targets were all achieved Trust-wide during May 2017. The Trust met the 6 week diagnostic standard in May 2017. The Trust met all but one (2 week Symptomatic Breast) of the Cancer standards in April 2017. Page 1 of 22

3.3. 18 Weeks Referral to Treatment (RTT) 3.4. Table 1 shows the Trust RTT Incomplete performance in May 2017. Whilst the Trust has not yet agreed a Control Total for 2017/18, the Trust submitted an STF Trajectory within the April refresh of the Operational Plan. In order to receive Sustainability & Transformation Funding (STF), providers need to comply with the national standard or the agreed trajectory (where this is below the standard). Table 1: RTT Incomplete Compliance - May 2017 RTT Incomplete Pathways Apr-17 May-17 Jun-17 Jul-17 Aug-17 Sep-17 Total 57,514 57,319 > 18wks 3,561 3,268 Compliance 93.8% 94.3% STF Trajectory Total 56,500 57,100 56,980 57,600 58,300 59,000 > 18wks 3,400 3,321 3,356 3,359 3,184 3,296 Compliance 94.0% 94.2% 94.1% 94.2% 94.5% 94.4% Standard 92% 92% 92% 92% 92% 92% 3.5. Although the Incompletes target was achieved overall, there was a specialty level breach in Trauma and Orthopaedics (626 excess breaches) as shown in Table 2. This will incur a financial penalty of 187.8k for the Trust. 3.6. Directors will be aware of the mediation session with Newcastle Gateshead CCG which took place on 30 th March 2017 regarding the application of 2016 spinal penalties. Whilst the Spinal Task & Finish Group has agreed a renewed focus and the CCG have promised a fair process with regards the application of financial penalties, this is a significant financial risk to the Trust. Table 2: 18 Weeks Compliance within T&O May 2017 RTT Specialty (C) Total PTL Backlog % Excess Breaches Penalty 110 - TRAUMA & ORTHOPAEDICS 3227 391 87.88% 133-39,900 108 - SPINAL SURGERY ORTHOPAEDICS 1545 470 69.58% 347-104,100 10801 - SPINAL SURGERY NEUROSURGERY 815 211 74.11% 146-43,800 Combined 5587 1072 80.81% 626-187,800 3.7. Although the Admitted measure is not a mandatory target, it was achieved overall. However there were 4 areas where the standard was breached at a specialty level; Trauma & Orthopaedics, ENT and Oral Surgery. Page 2 of 22

Penalty per breach 2016/17 Apr-17 May-17 Jun-17 Jul-17 Business Delivery & Performance Report May 2017 3.8. The equivalent Non-Admitted measure was achieved overall, although there were 4 areas where the target was breached at a specialty level; Trauma & Orthopaedics, Neurosurgery, General Medicine and Gastroenterology totaling 168 excess breaching patients comparable with last month). Table 3: Specialty Level Compliance RTT Specialty (C) Non- Admitted (>95%) Admitted (>90%) Incompletes (>92%) 100 - GENERAL SURGERY 95.0% 98.2% 95.3% 101 - UROLOGY 97.7% 92.9% 98.2% 110 - TRAUMA & ORTHOPAEDICS 84.3% 71.9% 87.9% 120 - EAR NOSE & THROAT 95.0% 79.6% 93.8% 130 - OPHTHALMOLOGY 98.7% 97.4% 99.3% 140 - ORAL SURGERY 96.0% 76.9% 94.9% 150 - NEUROSURGERY 94.7% 91.8% 94.5% 160 - PLASTIC SURGERY 95.3% 93.6% 92.3% 170 - CARDIOTHORACIC SURGERY 100.0% 100.0% 94.6% 300 - GENERAL MEDICINE 87.6% 90.7% 93.2% 301 - GASTROENTEROLOGY 89.2% 100.0% 94.8% 320 - CARDIOLOGY 95.3% 91.2% 93.3% 330 - DERMATOLOGY 99.1% 81.3% 98.1% 340 - RESPIRATORY MEDICINE 97.8% 100.0% 97.6% 400 - NEUROLOGY 96.5% 100.0% 97.1% 410 - RHEUMATOLOGY 95.7% 100.0% 94.0% 430 - CARE OF THE ELDERLY 98.5% 100.0% 99.3% 502 - GYNAECOLOGY 98.4% 90.7% 95.8% X01 TOTAL 96.0% 94.6% 92.3% TRUST TOTAL 96.1% 90.3% 94.3% 3.9. Appendix 6 shows the geographical spread of breaches for May to further clarify for Directors where issues lie. Table 4 demonstrates the RTT penalties incurred in 2017/18. 3.10. In May 2017, whilst 5 Directorates reported an increase in their RTT backlog (Table 5), overall there was a reduction of 286 patients waiting. Table 4: RTT Penalties Indicator Incomplete Penalty 2,647,200 230,700 187,800 Agreed Reinvestment 368,985 0 0 300 Control Total Adjustment 1,356,600 0 0 Penalty Total 921,615 230,700 187,800 Page 3 of 22

Total Backlog Backlog >36 weeks Business Delivery & Performance Report May 2017 Table 5: 18 Weeks Backlog by Directorate May 2017 Directorate Backlog Backlog Direction Change from previous month Cancer Services 1 Cardiothoracic Services 222-34 Children s Services 45 Clinical Genetics 40 4 Dental Hospital & School 178 1 ENT 389 19 Internal Medicine 221-31 Musculoskeletal Services 966-172 Neurosciences 364 25 P.O.D. 205-56 Peri-op and Critical Care 107-9 Renal Services 43 2 Surgical Services 382-30 Women s Services 95-5 Trust Total 3268-286 3.11. The contract specifies a zero tolerance on over 52 week waiters and the Trust maintained this target in May 2017. The legally binding contracts also require a quarterly reduction in over 36 week waiters by specialty. There is no penalty stipulated in the contract but it is good practice to achieve this standard (Chart 1). There was a reduction of 58 over 36 week waits in May, this is mainly attributed to Spinal where a bi-annual survey of patients waiting was carried out resulting in a number of patients being removed from the waiting list (where an operation was no longer required). Chart 1: Over 36 week waits (All Specialties) Trend 4500 4000 3500 3000 350 300 250 2500 2000 1500 1000 500 0 200 150 100 50 0 >36 week backlog Total Backlog Page 4 of 22

3.12. Diagnostic Waits 3.13. The Trust met the 99% diagnostic target in May 2017 (99.1%), with 83 over six week breaches. The diagnostic trajectory agreed with commissioners and NHS Improvement planned for a return to compliance by the end of Quarter 1 2017/18 with the cumulative position at M2 of 99.08%. However, there are still a number of key diagnostic services reporting significant capacity pressures which are subject to a diagnostic recovery plan. Nationally, the 99% operational standard was last met in November 2013. Table 6: Diagnostic Breaches (15 Key Diagnostic Tests) Q3 16/17 Q4 16/17 Apr-17 May-17 Number of Breaches 325 240 99 83 Number of Excess Breaches 55 Penalty 11k Number of Patients Waiting 26,904 28,801 10,072 9,720 Compliance 98.8% 99.2% 99.0% 99.1% 4. Cancer Waits 4.1 Due to the timing of submissions, cancer data runs one month behind the majority of performance data, this paper therefore reports the April 2017 position. Appendix 1 shows the Directorate cancer compliance. All breaching services are flagged to ensure that Directors have full view of the high risk areas. 4.2 The Suspected Cancer Two Week Wait (2WW) was achieved for April at 94.3% against the 93% standard but there was a decrease in performance in the Breast Symptomatic 2WW causing the Trust to fail this standard at 89.9%. Analysis showed all breaches were attributed to patient choice. However, the Breast team are reporting continued pressure in the service, particularly around breast radiology. The volume of Suspected Cancer referrals was lower than March but is aligned with the historical pattern. A number of specialties performed below target level, but only Head and Neck recorded capacity issues. The majority of breaches across all specialties are due to patient choice and in particular patients re-scheduling via the Electronic Referral Service. The Corporate Cancer Team have highlighted this issue via the Locality Group. 4.3 The 62 day standard for April was achieved at 86.5%, this is considerably better than the national picture which was reported at 82.7%. Whilst treatment numbers were not particularly high, there were less breaches specifically for NuTH patients. Analysis by tumour group showed breaches were mostly reported in Urology with the pathway originating in Northumbria. Page 5 of 22

4.4 Across the Cancer Alliance, 2 of the 9 Trusts, Northumbria (80.6%) and North Tees (84.6%) failed the 62 day standard in April. Cancer Alliance performance was 86.6% 4.5 The Trust achieved the 62 day screening standard for April at 91.8%. The volume of patients is generally low and breaches are mainly attributed to patient choice. 4.6 The 31 day standard to first treatment was achieved (98.1%). Treatment numbers were lower than previous months and all but one of the breaches occurred in HPB. These were all attributed to radiologist availability to perform a certain procedure. The Radiology Directorate are aware and are exploring solutions. 4.7 The Subsequent Treatment Target for all treatment modalities was achieved for April. 4.8 Looking forward to May 2017, reports show NuTH underperforming in a number of standards. Breast Symptomatic Two Week Wait is reported at 92.6%, breaches again relate to patient choice. Suspected Cancer 2WW is currently 92.8%, breaches in this standard are predominantly patient choice but capacity issues were reported in Head and Neck and Colorectal. The 31 day subsequent drug standard is reported at 97.6%. The 62 day standard is achieved at 87% but to note that none of these percentages are final at the point of writing. The Corporate Cancer Team is reviewing the data and all root cause analyses to ensure all activity has been captured and recorded correctly. Table 7: Breach Re-allocation Summary NUTH performance - April 2017 Prior to breach reallocatioallocation After breach re- Position Breast 100 100 0 u Gynae 90 100 10 p Haem (exc AL) 100 100 0 u Head & Neck 62.5 75 12.5 p HPB 60 60 0 u Lower GI 82.8 78.8-4 q Lung 80 80 0 u Other 0 100 100 p Sarcoma 83.3 80-3.3 q Skin 100 100 0 u Upper GI 80 75-5 q Uro (exc testes) 67.5 80 12.5 p All 86.5 88.9 2.4 p Page 6 of 22

Quarter 1 16/17 Quarter 2 16/17 Quarter 3 16/17 Quarter 4 16/17 April 2017 Business Delivery & Performance Report May 2017 4.9 Applying the breach re-allocation methodology in April 2017 has shown improvement in the position at Trust level. Trusts are encouraged to capture and monitor data at a local level where possible. The National system is not yet capable of interpreting data at this level and indications are that this will not change until a new system is introduced (hence performance is still centrally monitored on the old methodology). (Table 7). Table 8: Cancer Targets as at April 2017 Cancer All cancers: 2 week wait (Target 93.0%) 2 Week Wait for Symptomatic Breast Patients (Cancer Not initially Suspected) (Target 93.0%) All cancers: 1 month diagnosis to first treatment (Target 96.0%) All cancers: 1 month diagnosis to subsequent treatment surgery (Target 94.0%) All cancers: 1 month diagnosis to subsequent treatment drug (Target 98.0%) All cancers: 1 month diagnosis to subsequent treatment radiotherapy (Target 94.0%) All cancers: 2 month urgent referral to treatment (Target 85.0%) Percentage patients referred from cancer screening service treated within 62 days (Target 90.0%) 95.9% 95.6% 94.5% 94.8% 94.3% 96.4% 95.1% 95.5% 97.8% 89.9% 97.9% 98.4% 98.3% 98.1% 98.1% 96.8% 95.8% 96.0% 97.5% 95.5% 100% 99.2% 98.6% 100.0% 99.2% 98.7% 98.6% 98.8% 99.7% 98.9% 85.1% 87.9% 87.9% 88.5% 86.5% 95.2% 95.7% 92.4% 93.1% 91.8% 4.10 The Corporate Cancer Team has commenced a series of review meetings with each individual tumour group team to review and discuss their cancer pathways in detail, to ensure that cancer remains a high priority. The meetings are proving successful with good engagement from the Clinical teams and positive actions identified. It is crucial that each team continue to engage and take a proactive approach to identifying any bottlenecks in the pathway and making improvements. Those teams whose performance continues to be a cause for Page 7 of 22

concern have been scheduled as a priority. Furthermore, the Corporate Cancer Services Team has established a Cancer Steering Group with representation from Corporate Cancer, Clinical Leads and Performance. The group will meet on a monthly basis to drive forward the cancer agenda in order to achieve national and local cancer priorities. 4.11 The Northern Cancer Alliance recently submitted a bid on behalf of the 3 STPs, Northumberland, Tyne and Wear, and North Durham (NTWND), West, North and East Cumbria and Durham, Darlington, Tees, Hambleton, Richmondshire and Whitby (DDTHRW). Whilst the Cancer Alliance have confirmed that funding has been received to implement an early diagnosis transformation programme (Phase 1) and the cancer recovery package/risk stratified follow up model (Phase 2), the Trust is awaiting further details of how this is to be progressed given the individual schemes which were initially identified. At the time of writing, it is understood that bids may be top-sliced to redirect funds to the worst performing centres. 5. EMERGENCY CARE (INCLUDING A&E INDICATORS) 5.1. A&E 5.2. Directors will note that the Trust missed meeting the A&E 4hr standard in May 2017 at 93.1% (Table 9). As reported previously, the main breach reasons are Delays to Be Seen (DTBS) in the ED department which is being compounded by significant medical staffing pressures, particularly junior and middle grade gaps in the ED rota. This will incur a financial penalty of 39.96k (subject to 2017/18 Control Total agreement). The A&E improvement plan is continuing at pace with dedicated clinical and nursing leadership driving the improvements. Chart 2: Total A&E attendances by year Page 8 of 22

5.3. Nationally, the 95% standard was last achieved in July 2015 with April 2016 performance at 90.5% and figures show that the number of patients waiting more than four hours for admission after a decision to admit in A&E has grown nearly tenfold in a decade 1. Chart 2 shows that the number of attendances has been steadily increasing over the years nationally, adding to the pressures faced by departments. 5.4. The Next Steps document strongly indicates that success for STPs in the future will be primarily measured on two key metrics emergency inpatient bed days and emergency admissions growth. To this effect, NHS England is planning to publish metrics for each STP, benchmarking their emergency admission rates and bed days from July 2017. Table 9: Emergency (A&E) Indicators Control Total Emergency Indicators Q1 Q2 Q3 Q4 Apr-17 May-17 A&E 4hr Standard (Target: 95.0%) 95.1% 96.9% 93.3% 114.4k 92.5% 144.3k 94.8% 4.8k 93.1% 39.96k STF Trajectory A&E 4hr Standard N/A 95.1% 95.2% 92.1% 93.4% Trolley waits in A&E >12 hours (Target: Nil) A&E handovers delays >30 minutes (Target: Nil) Handover breaches >60 minutes (Target: Nil) 0 0 0 0 0 0 23 4.6k 12 2.4k 33 6.6k 96 19.2k 41 8.2k 38 7.6k 0 0 0 0 0 0 5.5. The contract also contains a number of local indicators around A&E, with associated figures for items 1-4 located in Appendix 2. 1) Unplanned re-attendance rate - 7 days <5% 2) Left department without being seen rate <5% 3) Time to initial triage/assessment (95th percentile <15 minutes) 4) Time to treatment in department (median <60 minutes) 5) % of patients presenting at type 1 and 2 (major) A & E sites in certain high risk categories who are reviewed by an emergency medicine consultant before being discharged (95% at site level) 6) A & E service experience - qualitative description of what has been done to assess the experience of patients using A&E services, their carers and staff. 5.6. Whilst the Trust reported 38 ambulance handover delays in May 2017, all delays were due to the administrative process of handing over the patient on 1 Data from NHS England Page 9 of 22

Nov-16 Dec-16 Jan-17 Feb-17 Mar-17 Apr-17 May-17 Business Delivery & Performance Report May 2017 the IT system. The ED department are currently working with North East Ambulance Service (NEAS) to try and rectify the issues, particularly as the number of such reported incidents has significantly increased over the last few months. It has also been flagged with Medicine through the Trust Performance Review process. This will incur a financial penalty of 7.6k for the Trust in May and externally, does not look like a recording issue. 5.7. Table 10 shows that the Trust achieved the unplanned re-attendance rate in May 2017. However, the RVI Main ED missed the left department without being seen rate target of 5% in May 2017 at 5.4%, this will incur a 2.6k penalty. Further detail about these indicators, as well as a site breakdown of A&E performance is provided in Appendix 2. Table 10: Local A&E Indicators Local A&E Indicators Unplanned reattendance rate (CCG) (Target: <5.0%) Left department without being seen rate (CCG) (Target: <5.0%) RVI Main ED Eye Casualty RVI Main ED Eye Casualty 3.6% 3.5% 2.4% 3.0% 3.8% 3.5% 3.6% 0.7% 0.3% 0.0% 0.0% 0.3% 0.7% 0.4% 4.2% 5.4% 2.4k 4.5% 4.2% 4.0% 4.1% 5.4% 2.6k 0.3% 0.4% 0.4% 0.7% 0.8% 0.7% 1.1% 5.8. Whilst the time to initial triage/assessment and treatment in ED has historically been presented with a health warning (due to the data recording process), it was hoped that the introduction of the A&E paperlite system (implemented on 9 th November 2016) would be a potential solution. Unfortunately, this has not proved to be the case and the department will need to await the Cerner Single Encounter development to implement real time data recording. Whilst there are no confirmed timescales, the department continue to liaise with the IT department. 5.9. Table 11 shows that the median arrival to treatment in Eye Casualty continues to exceed the 60 minute target. The Directorate has identified that there has been a higher than normal level of attendances and are looking into the patient pathway to see if there are some solutions to provide a better way of working 5.10. Directors will note that the Divert indicator remains within contracts in 2017/18 (both as a penalty for the diverter and an incentive for the receiving Trust). There were no formal diverts to the Trust in April 2017 with 6 from Cramlington reported in May 2017, in contrast there were 40 diverts reported for April and May 2106 (Table 12). Page 10 of 22

Table 11: Time to Treatment in Department Median A&E Key Performance Indicators Target Nov- 16 Dec- 16 Jan- 17 Feb- 17 Mar- 17 Apr- 17 May- 17 RVI - Main <60 Eye Casualty <60 00:56 00:50 01:02 01:04 01:15 01:13 01:05 Walk-in Centre <60 00:12 00:10 00:10 00:10 00:14 00:09 00:14 Molineux Street <60 00:33 00:37 00:31 00:12 00:14 00:27 00:29 Table 12: A&E Ambulance Diverts 5.11. Delayed Transfers of Care 5.12. The Trust reported 1,568 delayed bed days in April 2017, 85% of which were attributed to the NHS. As reported previously, whilst the volume of delays attributable to social care in Newcastle has been consistently low, Newcastle Local Authority has struggled to provide domiciliary packages of care due to market failure (delays were being attributed to NHS). However, to try and create more resilience within the domiciliary care market and support hospital discharge, Newcastle Local Authority has recently commissioned a new Home from Hospital Service from a social enterprise and the Trust will monitor the impact of this over the coming months. 5.13. Following the publication of Next Steps and the recent announcement by the Chancellor of an additional 1 billion for investment in adult social care, a meeting was held on Friday 19 th May 2017 with commissioners, Local Authority, providers, mental health and other stakeholders to agree how Newcastle (as a system) will use the funding. Whilst a system-wide delayed discharge action plan has been drafted, the plan is to prioritise the actions and think about how the funding can be used to support them. It should be recognised that there are already a number of existing commitments that are not funded on a recurrent basis across both health and social care. Page 11 of 22

6. OTHER EXTERNAL PERFORMANCE REQUIREMENTS 6.1. Appendix 3 reports the other contractual and NHSI targets that have not yet been discussed. 6.2. In May 2017, there was one reported case of MRSA (within Medicine), this is the first in 2017/18 and will incur a 10k penalty. 6.3. The Trust reported 2 cases of C-Difficile (both also in Medicine) against a trajectory of 6 in May 2017. The total following appeals for 2017/18 now stands at 6 against a trajectory of 13. It is worth noting that the Trust C-Difficile trajectory in 2017/18 remains the same as the last 2 years at 77. However, infections will now be classed as healthcare onset healthcare-associated if the patient has been in hospital for 2 days or more (previously 3 days or more). Initial analysis showed this would have added another 8 infections (April 2016 to February 2017) to the Trust overall total. 6.4. There were no reportable breaches of urgent cancelled operations, however, there were two reportable breaches of the 28 day cancelled operation standard in May 2017. Directors will note that the cancelled operation reporting process is currently under review. Table 13: Reportable Cancelled Operations Reportable Cancelled Operations Q1 Q2 Q3 Q4 Apr- 17 May- 17 Total number of cancelled 115 134 145 112 48 52 operations Number of 28 day breaches 1 1 1 3 3 2 Urgent operations cancelled for a 2 nd or subsequent time Penalty Amount 6.3k 12.3 k 0 0 0 0 0 0 2.3k TBC TBC TBC 6.5. Whilst NHS England removed the national financial sanctions relating to VTE risk assessment and formulary publication from the Contract in 2016/17, it remains essential that providers continue to meet these (particularly as this indicator is included as a quality/safety measure in the Single Oversight Framework). Performance is reported a month behind due to a lag in coding, the target of 95% was ben met in April at 95.8%. 6.6. Table 14 shows current performance for the joint Psychological Therapies Service Talking Helps Newcastle (THN). A number of discussions have taken place with Executives regarding the longer term future of this service given that CCGs have raised concerns about the performance of the service, and the Page 12 of 22

CCG has not ruled out the re-tender the service in the very near future. However the Trust is being very clear that areas of concern for the CCG do not relate to the aspects of the service delivered by NuTH. Discussions are ongoing and Executive Directors have been kept closely informed of developments. 6.7. There is a data quality penalty for NHS number completeness within inpatient/ outpatient and A&E submitted commissioning datasets. The standard needs to be maintained on an individual monthly basis to avoid a 10 penalty per excess missing number. During 2016/17 (the latest data available), this target was consistently achieved. Table 14: IAPT Progress towards targets Joint Model IAPT Indicators Target Sep-16 Oct-16 Nov-16 Dec-16 Jan-17 Feb-17 Mar-17 Apr-17 May-17 National target: Paired assessment scores for completed episodes (CCG) Penalty: 10 per breach below threshold) Nationally Published Data The proportion of people who have depression and/or anxiety disorders who receive psychological therapies (% against trajectory) (CCG) Local Data Cumulative -The proportion of people who have depression and/or anxiety disorders who receive psychological therapies (% against trajectory) (CCG) Local Data Cumulative target 90% 1.25% 1.18% 1.50% 1.47% 0.90% 1.19% 1.07% 1.52% 0.95% 1.19% 15% annum Have raised a query with NHS Digital regarding data 7.41% 8.89% 10.36% 11.26% 12.45% 13.51% 15.04% 0.95% 2.14% 7.50% 8.75% 10.00% 11.25% 12.50% 13.75% 15.00% 1.25% 2.50% The proportion of people who complete treatment who are moving to recovery (CCG) Local Data % of patients seen within 6 weeks Nationally Published Data % of patients seen within 18 weeks Nationally Published Data 50% 55.0% 45.9% 43.6% 48.0% 46.8% 46.2% 55.4% 46.3% 48.0% 75% 96.4% 98.3% 98.2% 97.4% 97.6% 96.0% 98.0% 98.0% 97.2% 95% 99.0% 99.5% 99.5% 99.5% 99.6% 97.8% 99.5% 99.7% 100.0% Table 15: SUS Data Quality SUS Data Quality Target Oct-16 Nov-16 Dec-16 Jan-17 Feb-17 Mar-17 Completion of a valid NHS Number field in acute (Admitted/Non-Admitted Care) (C) Completion of a valid NHS Number field in acute (A&E) (CCG) 99% 99.1% 99.1% 99.1% 99.4% 99.3% 99.4% 95% 96.9% 97.4% 97.9% 98.1% 97.9% 98.2% 6.8. A CCG CQUIN in 2017/18 will require providers to publish ALL of their applicable services on the E-Referral Service (ERS) by 31 st March 2018. Furthermore, the scheme requires a reduction in Appointment Slot Issues to a mutually agreed trajectory (as close to the national standard of 4% as possible). Work is underway with Directorates to assess current compliance and agree Page 13 of 22

how to increase the proportion of slots available (where appropriate) via ERS as well as agreeing individual action plans to reduce the rate of slot issues. 6.9. Whilst the utilisation rate for ERS is not a target for the Trust, it is monitored by CCGs and is indicative of how ERS is being used in the Trust by Directorates. This is not the same as publication of services, but it is indicative of how available slots are in directorates (MSU has been highlighted as a particular concern). Chart 3: Directorate ERS Utilisation Rate June 2016 May 2017 6.10. As reported previously, the Trust Breast Screening round length (the duration between invitations) continues to exceed the national 36-month standard. Whilst the service has recently been able to utilise capacity on a mobile unit, they will be unable to sustain this level of compliance without additional screening capacity. Executives have been made aware and discussions are ongoing with Estates colleagues. Page 14 of 22

7. RECOMMENDATIONS 7.1. Directors are asked to: 1) receive this report; 2) note the areas of compliance and non-compliance, particularly the risk this poses to high quality patient care and the Trust, both financially and reputationally and; 3) note the actions ongoing to address areas of underperformance. Jo McCallum Senior Business Development Manager (Performance) Helen Byworth Assistant Director of Contracting & Performance Louise Robson Executive Director of Business and Development 16 th June 2017 Page 15 of 22

Day of Surgery Arrival Referral Growth Admitted Waiting OP Waiting Non-Admitted Clock Stops (>95%) Admitted Clock Stops (>90%) Incompletes (>92%) Backlog Backlog direction Relative Risk Length of Stay Outpatient DNA Rates against Peer Outpatient N:R ratio - against peer Cancelled Operations 28 day Breaches Cancelled Operations Cancer Business Delivery & Performance Report May 2017 Appendix 1: Directorate Level Performance Directorate Cancer Services 61% 1.9% 9 502 100.0% 100.0% 99.9% 1 1.18 3.0% 18.66 Cardiothoracic 64% -0.3% 1,234 2,964 96.8% 94.3% 95.0% 222 0.76 10.7% 1.39 8 2m Services Children s Services 86% -3.0% 1,315 2,237 98.7% 99.8% 98.3% 45 1.53 11.5% 1.66 1 2w Clinical Genetics 97.5% 96.7% 40 4.50 Dental Hospital &School 89% -13.9% 958 3,227 97.5% 80.1% 96.0% 178 1.33 10.3% 2.03 1 ENT 94% -13.1% 968 4,461 95.0% 79.6% 94.5% 389 1.18 11.0% 1.44 2 2m Internal Medicine 77% -2.8% 1,075 3,863 93.6% 94.7% 94.5% 221 1.18 13.4% 2.15 4 Musculoskeletal 87% -13.3% 4,111 2,887 90.3% 79.6% 85.0% 966 1.26 10.7% 3.13 2 2w, 2m Neurosciences 81% -15.9% 1,336 2,946 90.8% 89.4% 90.4% 364 1.42 11.5% 2.53 17 P.O.D. 88% -13.3% 3,864 7,992 98.8% 93.4% 98.3% 205 1.48 10.5% 3.19 2 Peri-op and Critical Care 57.9% 124 1,235 72.2% 87.1% 84.1% 107 1.62 7.6% 4.54 Renal Services 90% -7.8% 1,071 1,653 99.1% 93.2% 98.5% 43 1.20 10.2% 2.70 2m Surgical Services 85% -7.3% 1,841 1,913 94.8% 89.7% 90.7% 382 1.34 8.7% 1.27 17 2w, 2w, Therapy Services 2.0% 622 97.7% 98.4% 10 0.00 1m, 2m Women s Services 89% 22.6% 395 2,310 98.5% 90.7% 95.9% 95 0.99 6.1% 2.42 Indicator Tolerance Data period Day of Surgery Arrival - May 2017 Referral Growth - All referrals <0% Red, Amber 0-5%, Green >5% May 2017 compared to May 2016 Admitted Waiting (includes planned and suspended patients) - May 2017 New Outpatients Waiting List - May 2017 Risk Adjusted Length of Stay - Source HED Outpatient DNA Rates against Shelford - Source HED Outpatient New to Review Ratio - against Shelford - Source HED Green = Performance is below (better) than Shelford, RED = Performance is above (worse) than Shelford Cancelled Operations - Source Patient Services Red >0.8% FFCEs May 2017 Cancelled Operations Breaches 28 days - Source Patient Services Red >=1 May 2017 Cancer Breached targets as per national guidance April 2017 April 2016 March 2017 Page 16 of 22

Appendix 2: A&E Performance Page 17 of 22

Actual 16/17 Target Monthly Target Oct-16 Nov-16 Dec-16 Jan-17 Feb-17 Mar-17 Apr-17 May-17 Business Delivery & Performance Report May 2017 Appendix 3: Additional Targets (not covered above) Key Performance Indicators Mixed Sex Accommodation Breaches (c) Sleeping Accommodation Breach 0 0 0 0 0 0 0 0 0 0 0 Cancelled Operations (c) Those not admitted within 28 days 6 0 0 0 1 1 2 0 3 2 No urgent operation should be cancelled for a second time 0 0 0 0 0 0 0 0 0 0 Delayed Transfers of Care Delayed Discharges 1,370 Minimal n/a 101 126 119 110 138 132 TBC 169 HCAI (c) Zero tolerance MRSA 9 0 0 3 0 0 0 2 2 0 1 Rates of Clostridium difficile (cumulative & appeals removed) 57 77 <6-7 7 6 9 4 5 1 4 2 Duty of Candour (c) Failures to notify the Relevant Person of a suspected or actual Reportable Patient Safety Incident 0 0 0 0 0 0 0 0 0 0 0 VTE Assessments Proportion of Patients who have had a VTE Risk Assessment on Admission 95.2% 95% 95% 95.7% 98.8% 95.6% 95.6% 95.7% 95.2% 95.8% Page 18 of 22

Admitted Non-Admitted General Surgery Urology Trauma & Orthopaedics ENT Ophthalmology Oral Surgery Neurosurgery Plastic Surgery Cardiothoracic Surgery General Medicine Gastroenterology Cardiology Dermatology Respiratory Medicine Neurology Rheumatology Geriatric Medicine Gynaecology Bucket Business Delivery & Performance Report May 2017 Appendix 4: RTT Compliance by Specialty and Commissioner, May 2017 Commissioner The Newcastle upon Tyne Hospitals 0 0 55 0 0 0 1 0 n/a 8 11 0 0 0 0 0 0 0 0 NHS NEWCASTLE GATESHEAD CCG 2 0 28 6 0 n/a n/a 1 n/a 3 8 0 0 0 n/a 0 0 0 0 NHS NORTH TYNESIDE CCG n/a n/a 6 2 0 n/a n/a 0 n/a n/a 2 0 0 0 n/a 1 0 0 0 NHS NORTHUMBERLAND CCG n/a n/a 5 0 0 n/a n/a n/a n/a n/a n/a 0 0 0 n/a 1 n/a 0 0 NHS SUNDERLAND CCG n/a n/a n/a n/a n/a n/a n/a n/a n/a n/a n/a n/a 0 n/a n/a n/a n/a n/a 0 NHS SOUTH TYNESIDE CCG n/a n/a 0 0 n/a n/a n/a n/a n/a n/a n/a n/a 0 n/a n/a n/a n/a 0 8 NHS NORTH DURHAM CCG n/a n/a n/a n/a 0 n/a n/a n/a n/a n/a n/a n/a n/a n/a n/a n/a n/a 0 2 NHS DURHAM DALES, EASINGTON AND SEDGEFIELD CCG n/a n/a n/a n/a n/a n/a n/a n/a n/a n/a n/a n/a n/a n/a n/a n/a n/a n/a 0 NHS DARLINGTON CCG n/a n/a n/a n/a n/a n/a n/a n/a n/a n/a n/a n/a n/a n/a n/a n/a n/a n/a 0 NHS HARTLEPOOL AND STOCKTON-ON-TEES CCG n/a n/a n/a n/a n/a n/a n/a n/a n/a n/a n/a n/a n/a n/a n/a n/a n/a n/a 0 NHS SOUTH TEES CCG n/a n/a n/a n/a n/a n/a n/a n/a n/a n/a n/a n/a n/a n/a n/a n/a n/a n/a 0 NHS CUMBRIA CCG n/a n/a n/a 1 n/a n/a n/a n/a n/a n/a n/a n/a n/a n/a n/a n/a n/a n/a 9 Specialised n/a n/a 8 n/a n/a 0 1 n/a n/a n/a n/a n/a n/a n/a 0 n/a n/a n/a 0 The Newcastle upon Tyne Hospitals 0 0 96 34 0 30 0 0 n/a 0 0 0 29 0 0 0 n/a 0 0 NHS NEWCASTLE GATESHEAD CCG 0 0 41 14 0 n/a n/a 0 n/a 0 n/a 0 9 n/a n/a 0 n/a 0 0 NHS NORTH TYNESIDE CCG n/a 0 15 3 0 n/a n/a 0 n/a n/a n/a 2 8 n/a n/a 0 n/a 0 0 NHS NORTHUMBERLAND CCG n/a 0 9 15 0 n/a n/a 0 n/a n/a n/a 0 7 n/a n/a 0 n/a 1 0 NHS SUNDERLAND CCG n/a n/a n/a n/a n/a n/a n/a n/a n/a n/a n/a 4 n/a n/a n/a n/a n/a n/a 0 NHS SOUTH TYNESIDE CCG n/a n/a 4 n/a n/a n/a n/a n/a n/a n/a n/a 0 2 n/a n/a n/a n/a n/a 0 NHS NORTH DURHAM CCG n/a n/a n/a n/a 0 n/a n/a n/a n/a n/a n/a 0 n/a n/a n/a n/a n/a n/a 0 NHS DURHAM DALES, EASINGTON AND SEDGEFIELD CCG n/a n/a n/a n/a n/a n/a n/a n/a n/a n/a n/a n/a n/a n/a n/a n/a n/a n/a 0 NHS DARLINGTON CCG n/a n/a n/a n/a n/a n/a n/a n/a n/a n/a n/a n/a n/a n/a n/a n/a n/a n/a 0 NHS HARTLEPOOL AND STOCKTON-ON-TEES CCG n/a n/a n/a n/a n/a n/a n/a n/a n/a n/a n/a n/a n/a n/a n/a n/a n/a n/a 0 NHS SOUTH TEES CCG n/a n/a n/a n/a n/a n/a n/a n/a n/a n/a n/a n/a n/a n/a n/a n/a n/a n/a 0 NHS CUMBRIA CCG n/a n/a 0 n/a n/a n/a n/a n/a n/a n/a n/a 1 n/a n/a n/a n/a n/a n/a 0 Specialised n/a n/a 15 n/a n/a 31 0 n/a n/a n/a n/a n/a n/a n/a 0 n/a n/a n/a 0 Page 19 of 22

Incompletes General Surgery Urology Trauma & Orthopaedics ENT Ophthalmology Oral Surgery Neurosurgery Plastic Surgery Cardiothoracic Surgery General Medicine Gastroenterology Cardiology Dermatology Respiratory Medicine Neurology Rheumatology Geriatric Medicine Gynaecology Bucket Business Delivery & Performance Report May 2017 Commissioner The Newcastle upon Tyne Hospitals 0 0 626 0 0 0 0 0 n/a 0 0 0 0 n/a 0 0 n/a 0 0 NHS NEWCASTLE GATESHEAD CCG n/a n/a 269 0 n/a n/a n/a 0 n/a 0 0 0 0 n/a n/a 0 n/a 0 0 NHS NORTH TYNESIDE CCG n/a n/a 69 0 n/a n/a n/a n/a n/a n/a n/a 0 n/a n/a n/a n/a n/a n/a 0 NHS NORTHUMBERLAND CCG n/a n/a 51 0 0 n/a n/a n/a n/a n/a n/a 0 n/a n/a n/a n/a n/a n/a 0 NHS SUNDERLAND CCG n/a n/a 15 n/a n/a n/a n/a n/a n/a n/a n/a n/a n/a n/a n/a n/a n/a n/a 0 NHS SOUTH TYNESIDE CCG n/a n/a 30 n/a n/a n/a n/a n/a n/a n/a n/a n/a n/a n/a n/a n/a n/a n/a 0 NHS NORTH DURHAM CCG n/a n/a 21 n/a n/a n/a n/a n/a n/a n/a n/a n/a n/a n/a n/a n/a n/a n/a 0 NHS DURHAM DALES, EASINGTON AND SEDGEFIELD CCG n/a n/a n/a n/a n/a n/a n/a n/a n/a n/a n/a n/a n/a n/a n/a n/a n/a n/a 0 NHS DARLINGTON CCG n/a n/a n/a n/a n/a n/a n/a n/a n/a n/a n/a n/a n/a n/a n/a n/a n/a n/a n/a NHS HARTLEPOOL AND STOCKTON-ON-TEES CCG n/a n/a n/a n/a n/a n/a n/a n/a n/a n/a n/a n/a n/a n/a n/a n/a n/a n/a n/a NHS SOUTH TEES CCG n/a n/a n/a n/a n/a n/a n/a n/a n/a n/a n/a n/a n/a n/a n/a n/a n/a n/a n/a NHS CUMBRIA CCG n/a n/a 18 n/a n/a n/a n/a n/a n/a n/a n/a n/a n/a n/a n/a n/a n/a n/a 0 Specialised n/a n/a 142 n/a n/a 0 0 n/a n/a n/a n/a n/a n/a n/a 0 n/a n/a n/a 0 n/a x Underline Target does not apply/trust level target Target does not apply, < 20 cases in month Target applies and was met Target breached and number of 'excess' breaches Patients subject to a penalty Page 20 of 22