Service Quality & Performance Report

Agenda item A5(ii) Service Quality & Performance Report April January 2017 Healthcare at its very best - with a personal touch

Service Quality & Performance Report February 2017 1. EXECUTIVE SUMMARY 1.1. This report outlines a level of detail regarding the Trust s performance for the period April 2016 to January 2017. This summary pulls out the key issues and implications. 1.2. An at a glance Performance Summary is provided on page 1 which shows the RAG (Red/Amber/Green) ratings of each indicator and performance trends compared to the previous period. 2. INTRODUCTION 2.1. This Business Delivery & Performance Report is reporting the period April 2016 to January 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 activity and key targets the Trust has to deliver in 2016/17. The report will also specify financial penalties where they apply. 2.3. The Appendices give a more detailed breakdown of some of the performance, for example, performance by Directorate and/or site level and additional activity such as critical care, maternity and chemo/radiotherapy. 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 Diagnostics standards. As the issues with compliance are increasingly complex, the position is summarised below: The Incomplete (92%) 18 Weeks target was achieved Trust-wide during January 2017. The Admitted (90%) 18 Weeks target was achieved Trust-wide during January 2017. The Non-Admitted (95%) 18 Weeks target was achieved Trust-wide during January 2017. The Trust met the 6 week diagnostic standard in January 2017. Page 1 of 23

Service Quality & Performance Report February 2017 The Trust met all but one of the Cancer standards in December 2016. 3.3. 18 Weeks Referral to Treatment (RTT) 3.4. Table 1 shows the Trust performance by specialty for the 18 weeks targets in January 2017: 92% of incomplete pathways are under 18 weeks 95% of non-admitted patients are treated within 18 weeks Local 90% of admitted patients are treated within 18 weeks Monitoring Table 1: 18 Weeks Compliance by Speciality January 2017 RTT Specialty (C) Non- Admitted (>95%) Admitted (>90%) Incompletes (>92%) 100 - GENERAL SURGERY 95.4% 90.0% 94.8% 101 - UROLOGY 100.0% 91.1% 97.7% 110 - TRAUMA & ORTHOPAEDICS 82.3% 78.9% 83.0% 120 - EAR NOSE & THROAT 96.6% 91.9% 94.9% 130 - OPHTHALMOLOGY 98.8% 94.9% 99.0% 140 - ORAL SURGERY 87.2% 78.2% 95.3% 150 - NEUROSURGERY 97.9% 93.2% 96.0% 160 - PLASTIC SURGERY 95.3% 90.8% 92.6% 170 - CARDIOTHORACIC SURGERY 100.0% 100.0% 97.5% 300 - GENERAL MEDICINE 95.1% 100.0% 95.3% 301 - GASTROENTEROLOGY 95.6% 100.0% 95.6% 320 - CARDIOLOGY 95.7% 92.3% 92.9% 330 - DERMATOLOGY 96.9% 76.0% 92.2% 340 - RESPIRATORY MEDICINE 98.1% 100.0% 98.5% 400 - NEUROLOGY 97.6% 100.0% 97.7% 410 - RHEUMATOLOGY 85.2% 100.0% 94.3% 430 - CARE OF THE ELDERLY 98.3% 100.0% 97.6% 502 - GYNAECOLOGY 97.1% 91.1% 93.9% X01 TOTAL 94.9% 91.4% 92.2% TOTAL 95.1% 90.1% 93.6% 3.5. Directors will note that the Trust met all of the RTT standards at an aggregate level in January 2017 and this is particularly encouraging when you consider the RTT national position which continues to deteriorate at pace. England s referral to treatment waiting times topped 20 weeks in December; the worst performance since March 2011 and given that the incomplete pathways target was not formally announced until several months later (November 2011), one could argue that the English NHS has returned to the pre-target performance. 3.6. Although the Incompletes target was achieved overall, there was a specialty level breach in Trauma and Orthopaedics (751). In total, the penalty will amount to a fine of 225.3k for January 2017 (Table 2). However, the control Page 2 of 23

Penalty per breach Jul-16 Aug-16 Sept-16 Oct-16 Nov-16 Dec-16 Jan-17 Service Quality & Performance Report February 2017 total guidance states that if the provider has been granted access to the general element of the Sustainability and Transformation Fund, no repayment will be required in relation to any breach of the RTT threshold. Discussions are ongoing as per paragraph 1.7. Table 2: 18 Weeks Compliance within T&O January 2017 RTT Specialty (C) Total Backlog % Excess Penalty PTL Breaches 110 - TRAUMA & ORTHOPAEDICS 3425 583 82.98% 309 92,700 108 - SPINAL SURGERY ORTHOPAEDICS 1733 508 70.69% 370 111,000 10801 - SPINAL SURGERY NEUROSURGERY 869 142 83.66% 73 21,900 Combined 6027 1233 79.54% 751 225,300 3.7. Whilst the Admitted target was achieved overall, there were 3 areas where the standard was breached at a specialty level; Trauma & Orthopaedics, Dermatology and Oral Surgery totaling 136 excess breaching patients (an increase of 57 from last month). 3.8. Whilst the Non-Admitted target was achieved overall, there were 3 areas where the standard was breached at a specialty level; (Trauma & Orthopaedics, Oral Surgery and Rheumatology) totaling 165 excess breaching patients (an increase of 46 from last month). 3.9. Appendix shows the geographical spread of breaches for January to further clarify for Directors where issues lie. In almost all cases, services experiencing breaches have developed action plans to achieve compliance and in most cases, they are providing additional capacity to treat patients. Table 3 demonstrates the RTT penalties incurred April 2016 to January 2017. Table 3: RTT Penalties Indicator Incomplete Penalty 184.8k 185.1k 247.5k 256.5k 206.7k 231k 225k Agreed Reinvestment 300 0 0 0 TBC TBC TBC TBC Penalty Total 184.8k 185.1k 247.5k TBC TBC TBC TBC 3.10. In January 2017, all Directorates (with the exception of one) reported a reduction of their RTT backlog. Directorates of note are Dental Hospital & School and POD. Page 3 of 23

Service Quality & Performance Report February 2017 Table 4: 18 Weeks Backlog by Directorate January 2017 Directorate Backlog Change from previous month Backlog Direction Cancer Services 0 0 Cardiothoracic Services 158-95 Children s Services 58-12 Clinical Genetics 17 7 Dental Hospital & School 52-173 ENT 255-52 Internal Medicine 285-2 Musculoskeletal Services 1125-83 Neurosciences 316-16 P.O.D. 325-172 Peri-op and Critical Care 73-43 Renal Services 21-26 Surgical Services 324-10 Therapy Services 20 Women s Services 120-29 Trust Total 3149-706 3.11. The contract specifies a zero tolerance on over 52 week waiters and the Trust maintained this target in January 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. 3.12. Chart 1 shows that the over 36 week waiters in January 2017 were comparable with December. The sustainable reduction is due to an increased focus and new patient-specific actions to reduce the number of long-waiters. Chart 1: Over 36 week waits (All Specialties) Trend Page 4 of 23

Service Quality & Performance Report February 2017 3.13. As shown in Table 5, Newcastle was ranked 2 nd in the Shelford Group for RTT Incomplete performance in December 2016 and is comfortably above the England average of 89.7%. Table 5: RTT Performance NuTH vs Shelford & England Provider Name Jul-16 Aug-16 Sep-16 Oct-16 Nov-16 Dec-16 England 91.3% 90.9% 90.6% 90.4% 90.5% 89.7% THE NEWCASTLE UPON TYNE HOSPITALS NHS FOUNDATION TRUST CAMBRIDGE UNIVERSITY HOSPITALS NHS FOUNDATION TRUST CENTRAL MANCHESTER UNIVERSITY HOSPITALS NHS FOUNDATION TRUST GUY'S AND ST THOMAS' NHS FOUNDATION TRUST IMPERIAL COLLEGE HEALTHCARE NHS TRUST KING'S COLLEGE HOSPITAL NHS FOUNDATION TRUST OXFORD UNIVERSITY HOSPITALS NHS FOUNDATION TRUST SHEFFIELD TEACHING HOSPITALS NHS FOUNDATION TRUST UNIVERSITY COLLEGE LONDON HOSPITALS NHS FOUNDATION TRUST UNIVERSITY HOSPITALS BIRMINGHAM NHS FOUNDATION TRUST 94.7% 94.7% 93.6% 93.7% 94.1% 93.3% 90.8% 90.4% 90.0% 90.1% 90.7% 90.2% 92.1% 92.1% 91.2% 91.0% 91.6% 91.6% 91.5% 90.6% 89.5% 89.6% 89.9% 88.8% 84.6% 83.3% 81.6% 83.4% 83.6% 81.9% 82.0% 82.2% 80.8% 79.3% 78.3% 77.1% 90.0% 89.6% 89.1% 89.5% 89.5% 92.8% 93.0% 93.0% 93.7% 93.9% 93.6% 93.2% 92.9% 93.2% 93.3% 93.4% 92.8% 92.5% 92.1% 92.1% 92.3% 92.7% 92.1% 3.14. Table 6 shows the number of patients waiting to be seen for a first appointment by length of wait (all current patients regardless of appointment status). The accompanying Chart 2 shows that the total number of patients waiting for a first appointment in January 2017 has decreased by 1,925 (a similar pattern in 2015/16), as has the proportion of patients waiting over 18 weeks (a decrease of circa 0.55%). Table 6: Weeks from Referral to First Seen 2016/17 Apr-16 May-16 Jun-16 Jul-16 Aug-16 Sep-16 Oct-16 Nov-16 Dec-16 Jan-17 0 to 5 weeks 11,206 11,197 12,227 12,557 11,874 12,086 12,829 11,924 10,024 11,526 06 to 11 weeks 17,225 17,568 17,391 18,022 19,850 18,811 18,381 17,352 18,941 16,251 12 to 15 weeks 4,599 4,799 4,836 5,542 5,997 5,524 5,140 4,675 5,215 4,683 16 to 18 weeks 1,375 1,736 1,781 1,786 2,070 2,348 2,121 1,771 1,892 2,142 Greater than 18 weeks 3,365 3,343 3,131 3,218 3,385 3,424 3,628 3,522 3,838 3,383 Grand Total 37,770 38,643 39,366 41,125 43,176 42,193 42,099 39,244 39,910 37,985 Page 5 of 23

Waiting list size Service Quality & Performance Report February 2017 Chart 2: Outpatient Waiters (All Specialties) Trend 50,000 45,000 40,000 35,000 30,000 25,000 20,000 15,000 10,000 5,000 0 Trust OPWL by wait group '0 to 5 weeks '06 to 11 weeks '12 to 15 weeks '16 to 18 weeks 'Greater than 18 weeks 3.15. Table 7 shows the top 5 Directorates/Specialties (based on volume of patients waiting for a first outpatient appointment). Whilst Maxillofacial/Oral Surgery is showing an increasing trend, ENT s outpatient waiting list continues to reduce. Table 7: Top 5 all patients awaiting a 1st Outpatient Appointment Directorate Aug-16 Sep-16 Oct-16 Nov-16 Dec-16 Jan-17 Ophthalmology 4532 4343 4415 4296 4231 4293 ENT 4367 4306 4377 4157 4182 4072 Maxillofacial/Oral Surger 4225 4095 4172 3947 3768 4014 Cardiothoracic 3400 3532 3854 3714 4017 3611 Medicine and COE 3919 3961 3948 3473 3695 3470 3.16. Diagnostic Waits 3.17. Whilst the Trust met the 99% diagnostic target in January 2017, achieving 99.1%, there are still significant workforce pressures within Radiology (including cardio exams), Paediatric Sleep Studies (respiratory physiology), Echocardiography and Urodynamics. Furthermore, this will continue to be exacerbated by winter pressures which, in itself, could create further capacity constraints. The departmental action plans continue to progress at pace and this is reflected within the January performance, although the Trust s position will remain vulnerable whilst the issues around MRI remain unresolved on a recurrent basis. Page 6 of 23

Service Quality & Performance Report February 2017 Table 8: Diagnostic Breaches (15 Key Diagnostic Tests) Jul-16 Aug-16 Sept-16 Oct-16 Nov-16 Dec-16 Jan-17 Number of Breaches 110 163 139 118 90 117 81 Number of Excess Breaches 13 72 53 29 0 30 0 Penalty 2.6k 14.4k 10.6k 5.8k - 6k - Number of Patients Waiting 9,637 9,039 8,552 8,802 9,108 8,996 9,036 Compliance 98.9% 98.2% 98.4% 98.7% 99.01% 98.7% 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 December 2016 and Quarter 3 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 Breast Symptomatic Two Week Wait target and the 2WW Suspected Cancer target continue to be achieved. Whilst the numbers of 2WW Suspected Cancer referrals reduced significantly, this pattern fits with historical data suggesting this to be seasonal. Further analysis of the data against November figures showed decreases predominantly in Head and Neck (-69) and Skin (-63). The breaches equated to 5% and were all as a result of patient choice. The projected outturn for 2WW Suspected Cancer referrals in 2016/17 shows an overall increase of 3% in comparison to 2015/16. Whilst the volume of 2WW Suspected Cancer referrals for Quarter 3 reduced in comparison to Quarters 1 and 2, the Breast Symptomatic referrals showed a growth for the same period. The Quarterly target was achieved across both standards. 4.3. The 62 day target for December and Quarter 3 were achieved (achieving 88.1% and 87.9% respectively). Whilst performance is nationally reported at Trust level, internal reporting by tumour group shows the same areas consistently falling below the 85% standard. Furthermore, several tumour groups have failed every quarter; Lung, Hepatobiliary & Pancreatic (HPB), Upper GI, Head & Neck and Cancer of Unknown Primary (CUP). The numbers of CUP are small so one breach can result in a failure of the standard. 4.4. Across NESCN, 2 of the 9 Trusts, South Tees (77.9%) and Durham & Darlington (83.2%), failed the 62 day standard for Quarter 3. The national average was reported at 82.1%. Page 7 of 23

Service Quality & Performance Report February 2017 4.5. The Trust failed the screening standard for December, reporting performance at 88.4% against the 90% standard. The breaches attributed to this were in Bowel Screening. Although patient choice was a factor, analysis has identified a number of areas for improvement which are being addressed with the tumour site team. The standard was achieved for Quarter 3 at 92.4%. 4.6. The Trust achieved the 31 day standard to first treatment for December (98%) and Quarter 3 (98.3%) against the 96% standard. Treatment numbers show a slight fluctuation each month and the projected outturn for 2016/17 currently shows minimal growth in number of treatments. 4.7. The Subsequent treatment target for all treatment modalities was achieved for December and Quarter 3. The Subsequent Drug Treatment numbers continue to be reviewed to ensure the administering of drugs is captured in a robust and timely way. 4.8. Looking forward to January 2017, data is currently undergoing validation, but reports show all cancer standards, with the exception of the 62 day standard, on target to achieve. The 62 day standard is currently showing performance at 83.9% against the 85% standard. Whilst the volume of breaches is higher than usual, this is most likely due to patient initiated delays around the Christmas period. The breaches are predominantly within Lung, Colorectal and Urology and Root Cause Analyses (RCAs) are underway to better understand the delay reasons. 4.9. The Corporate Cancer Team continues to work with all tumour groups to establish robust processes to support the new breach re-allocation guidance. The national IT system will not be available until April 2017 so in the interim, providers must work together to implement local solutions for reporting. A breach re-allocation policy has been drafted by the Cancer Alliance with input from all stakeholders and the Corporate Cancer Team continues to work with Directorates to ensure robust processes are in place for receiving and recording accurate dates when patients are transferred to the Trust. 4.10. Whilst applying the breach re-allocation methodology in November 2016 showed an overall improvement in Trust performance, unfortunately, this is not the case for December. Using the same methodology results in deterioration of the 62 day standard at a Trust level and, in some tumour groups, there is a significant shift in compliance (Table 9). Page 8 of 23

Service Quality & Performance Report February 2017 Table 9: Breach Re-allocation Summary NUTH performance - December 2016 Prior to breach After breach reallocation re-allocation Position Brain/CNS 100 100 0 u Breast 100 100 0 u Gynae 80 50-30 q Haem (exc AL) 66.7 66.7 0 u Head & Neck 91.7 92.3 0.6 p Lower GI 83.3 84 0.7 p Lung 76.5 75.9-0.6 q Other 33.3 0-33.3 q Sarcoma 66.7 50-16.7 q Skin 98.3 98.3 0 u Upper GI 77.1 69.8-7.3 q Uro (exc testes) 87.5 94.6 7.1 p All 88.1 87.3-0.8 q 4.11. As reported previously, the Backstop policy requires review and weekly reporting to the CCG of any long waiters (patients classified as waiting 104 days or more). Patients are often delayed because of medical fitness or diagnostic uncertainty. In all cases, the patients are being actively tracked and clinical teams are aware of their pathway status. The pathway of any patient who has waited more than 104 days to be treated is reviewed by the Trust Cancer Clinician and assessed for harm. Since implementation in October 2015, none of the long wait patients have been identified as coming to harm. 4.12. The Corporate Cancer Team continues to review and discuss cancer pathways with each Directorate to ensure that cancer remains a high priority. It is crucial that each site specific tumour group continue to engage and take a pro-active approach to identifying any bottlenecks in the pathway and making improvements. 4.13. As reported previously, the Northern Cancer Alliance have 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). They are asking for funding to implement a transformation programme focussing on early diagnosis of cancer, the cancer recovery package and a stratified follow up model. Feedback is expected in March 2017. Page 9 of 23

Quarter 1 16/17 Quarter 2 16/17 Oct-16 Nov-16 Dec-16 Quarter 3 16/17 Service Quality & Performance Report February 2017 Table 10: Cancer Targets as at December 2016 Cancer All cancers: 2 week wait (C,M) (Target 93.0%) 2 Week Wait for Symptomatic Breast Patients (Cancer Not initially Suspected) (C,M) (Target 93.0%) All cancers: 1 month diagnosis to first treatment (C,M) (Target 96.0%) All cancers: 1 month diagnosis to subsequent treatment surgery (C,M) (Target 94.0%) All cancers: 1 month diagnosis to subsequent treatment drug (SS,M) (Target 98.0%) All cancers: 1 month diagnosis to subsequent treatment radiotherapy (SS,M) (Target 94.0%) All cancers: 2 month urgent referral to treatment (C,M) (Target 85.0%) Percentage patients referred from cancer screening service treated within 62 days (C,M) (Target 90.0%) 95.9% 95.6% 94.2% 94.6% 94.9% 94.5% 96.4% 95.1% 97.0% 95.0% 94.4% 95.5% 97.9% 98.4% 99.3% 97.5% 98.0% 98.3% 96.8% 95.8% 96.5% 94.8% 96.9% 96.0% 100% 99.2% 96.6% 99.4% 100% 98.6% 98.7% 98.6% 98.5% 98.9% 99.0% 98.8% 85.1% 87.9% 87.2% 88.8% 88.1% 87.9% 95.2% 95.7% 96.3% 93.1% 88.4% 92.4% Page 10 of 23

Service Quality & Performance Report February 2017 5. EMERGENCY CARE (INCLUDING A&E INDICATORS) 5.1. Directors will note that the Trust failed to meet the A&E 4hr target in January 2017 at 91.0% which is the lowest performance this fiscal year (Table 11). Unfortunately, the A&E performance for Type 1 (main RVI ED) missed meeting the standard at 85.8% for the 6 th consecutive month. The department are citing beds waits, patient flow issues as well as significant Delays to Be Seen (DTBS) as the main breach reasons. This is being further exacerbated by significant medical staffing pressures, particularly the junior and middle grade gaps in the ED rota. Looking forward, the February performance is currently at 92.9% (as at 13 th February). 5.2. Despite the significant pressures in ED, the staff continues to maintain a safe department; they are currently piloting the use of the observation lounge as an ambulance handover assessment area. Furthermore, the performance is well above the NHS England average (all types) of 86.2%. When national performance is assessed purely for Type 1 EDs, the national performance is lower still at 79.3%. 5.3. Whilst the year to date A&E performance (all types) is currently at 94.6%, it will be extremely challenging to recover the annual position (a maximum allowance of 15 breaches per day from 7th February 2017). This is particularly important now that the Trust has agreed control totals as Sustainability & Transformation Funding (STF) can be earned back if providers are able to recover the A&E performance on a cumulative basis. 5.4. As reported previously, NHS Improvement recently announced that hospitals will be rated against a new A&E standard in 2017. This will combine the waiting time target with clinical standards and data on staff and patient experience. Whilst the four hour target will remain the headline indicator, the new metrics will be designed to give a clearer picture of the health of A&E departments. Whilst the metrics are still to be finalised, initial work has commenced within the Trust to demonstrate performance against waiting times for conditions such as stroke PCI and the sepsis 6 bundle. 5.5. From April 2017, NHS Trusts will have to report how quickly they are treating patients experiencing mental health crisis in A&E or hospital wards as part of new NHS England standards. Liaison psychiatry is one of nine priority areas as set out in the 2 year planning guidance for 2017-19 and NHS England recently announced a transformation fund which A&E delivery boards could bid against to extend liaison psychiatry services (as per paragraph 5.12). Whist the Psychiatric Liaison Service for Newcastle currently operates 8am to 9pm 7 days a week (with Older Peoples service Monday-Friday 9am-5pm), Northumberland Tyne & Wear NHS Trust has requested funding to recruit Page 11 of 23

Jul-16 Aug-16 Sept-16 Oct-16 Nov-16 Dec-16 Jan-16 Service Quality & Performance Report February 2017 additional staff into the team to meet core 24 standards and to ensure the service is provided on a 24/7 basis accordingly. Table 11: Emergency (A&E) Indicators Emergency Indicators Percentage of A & E attendances where the patient was admitted, transferred or discharged within 4 hours of their arrival at an A&E department (CCG,M) (Target: 95.0%) Trolley waits in A&E >12 hours (CCG) (Target: Nil) All handovers between ambulance and A & E must take place within 15 minutes Handovers >30 minutes (CCG) (Target: Nil) Handover breaches >60 minutes (CCG) (Target: Nil) 97.4% 96.8% 96.5% 95.5% 92.9% P lty 41.6k 91.4% P lty 72.8k 91.0% P lty 76.32K 0 0 0 0 0 0 0 4 P lty 800 5 P lty 1k 3 P lty 600 7 P lty 1,400 5 P lty 1k 21 P lty 4.2k 37 P lty 7.4k 0 0 0 0 0 0 0 5.6. The Trust reported 37 ambulance handover delays in January 2017; the highest number reported since April 2014. However, all but one delay was due to the administrative process of handing over the patient on the IT system with the other due to competing pressures. Whilst these breaches could incur a penalty of 7.4k for the Trust, this indicator is included within the A&E bundle linked to the control total and the suspension of financial penalties in the Quality Schedule. Chart 3: Ambulance Handover Breaches Rate per 1000 > 30 Minutes Page 12 of 23

Jul-16 Aug-16 Sept-16 Oct-16 Nov-16 Dec-16 Jan-17 Service Quality & Performance Report February 2017 5.7. NSECH continues to show very high numbers of ambulance breaches and this shows no signs of easing; in fact their reportable ambulance breaches increased by circa 73% (190) in January 2017 compared to the average reported from April to December 2016. Furthermore, North Durham, Darlington and City Hospitals Sunderland are also reporting a high number of breaches in recent months, all of which increases the risk of ambulance deflections to the RVI ED. 5.8. 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. 5.9. Table 12 shows that the Trust achieved both the unplanned re-attendance rate and the left department without being seen rate in January 2017. Further detail about these indicators, as well as a site breakdown of A&E performance is provided in Appendix 2. Table 12: Local A&E Indicators Local A&E Indicators Unplanned re-attendance rate (CCG) (Target: <5.0%) Left department without being seen rate (CCG) (Target: <5.0%) RVI Main ED 3.8% 4.5% 3.7% 3.2% 3.6% 3.5% 2.4% Eye Casualty 4.1% 2.1% 2.9% 0.6% 0.7% 0.3% 0.0% RVI Main ED 3.4% 3.9% 4.2% 3.6% 4.2% 5.4% 4.5% Eye Casualty 0.5% 0.6% 0.3% 0.5% 0.3% 0.4% 0.4% 5.10. The time to initial triage/assessment in ED (Table 13) has consistently failed to achieve the 15 minute target throughout 2016/17. Whilst there has previously been a health warning against this data, the A&E paperlite system (implemented on 9 th November) has improved real-time data capture and will allow the department to clearly identify the bottlenecks in the department. Page 13 of 23

Apr-15 May-15 Jun-15 Jul-15 Aug-15 Sep-15 Oct-15 Nov-15 Dec-15 Jan-16 Feb-16 Mar-16 Apr-16 May-16 Jun-16 Jul-16 Aug-16 Sep-16 Oct-16 Nov-16 Dec-16 Service Quality & Performance Report February 2017 Table 13: Time to Initial Triage/Assessment in Department 95 th percentile A&E Key Performance Indicators RVI - Main Emergency Department Target <15 mins Jul- 16 Aug- 16 Sep- 16 Oct- 16 Nov- 16 Dec- 16 Jan- 17 01:19 00:42 00:48 00:42 01:19 00:44 01:31 5.11. The median arrival to treatment time in main ED has improved from a high of 1 hour 32 minutes in December to 30 minutes in January (Table 14). However, eye casualty just missed meeting the 60 minute target at 62 minutes. Table 14: Time to Treatment in Department Median A&E Key Performance Indicators Target 15/16 Jul- 16 Aug- 16 Sept- 16 Oct- 16 Nov- 16 Dec- 16 RVI - Main <60 00:36 00:54 00:56 00:58 01:17 01:32 00:30 Eye Casualty <60 00:57 01:11 01:01 01:09 00:56 00:50 01:02 Walk-in Centre <60 00:11 00:10 00:20 00:10 00:12 00:10 00:10 Molineux Street <60 00:18 00:17 00:24 00:31 00:33 00:37 00:31 5.12. The Trust reported a reduction in delayed bed days to 1,060 in December 2016 (Chart 4). However, the number of patients awaiting assessment significantly increased in December although may be due to the Christmas holiday period. Repatriation to other hospitals is still a major cause for concern and whilst broad principles have been agreed (linked to the accepting of deflected or diverted patients) this is yet to be finalised. Chart 4: Trust reported Delayed Bed Days Jan- 17 1,400 No. of Days Delayed (NHS) 1,200 1,000 800 600 400 200 0 Non-acute NHS Care Community equipment Assessment Care package Patient choice Total days delayed Page 14 of 23

Service Quality & Performance Report February 2017 5.13. Directors will note that the Divert indicator remained within contracts in 2016/17. Table 15 shows the ambulance diverts for 2016/17 and whilst this equates to a financial incentive for the Trust of 172.5k, the pressure this creates within A&E and the wider Trust is more of a concern. Table 15: A&E Ambulance Diverts 5.14. OTHER EXTERNAL PERFORMANCE REQUIREMENTS 5.15. Appendix 3 reports the other contractual and Monitor targets that have not yet been discussed. 5.16. There were no reported cases of MRSA in January 2017, meaning a year to date total of 5 (post successful appeals). 5.17. In January 2017, the Trust reported 4 cases of C-Difficile infections against a trajectory of 6. The infections were reported in Medicine (2) and Surgery (2). Taking into account 16 successful appeals, the year to date total is 52, 12 below the cumulative trajectory of 64. 5.18. There were no reportable breaches of the urgent cancelled operation, with one breach of the 28 day standard in Paediatric Surgery due to lack of beds (Table 16) in January 2017. Table 16: Reportable Cancelled Operations Reportable Cancelled Operations Q1 Q2 Q3 Jan-17 Total number of cancelled operations 115 134 145 41 Number of 28 day breaches 1 1 1 1 Urgent operations cancelled for a 2 nd or subsequent time 0 0 0 0 Penalty Amount 6.3k 12.3k 2.3k TBC Page 15 of 23

Jul Aug Sep Oct Nov Dec Jan Service Quality & Performance Report February 2017 5.19. Whilst NHS England has removed the national financial sanctions relating to VTE risk assessment and formulary publication from the Contract for 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). Due to significant pressures in coding, performance is reported one month behind. The Trust was compliant in December 2016, achieving 95.6% against the 95% standard. 5.20. Whilst the Psychological Therapies line in the community contract rolled over into 2016/17, the joint clinical model with NuTH and NTT commenced in April 2016. Table 17 shows current performance for the new joint service Talking Helps Newcastle (THN). Whilst the moving to recovery performance showed a slight drop in January 2017, the service have agreed a robust action plan to ensure sustained delivery against the standard as they move into 2017/18. Table 17: IAPT Progress towards targets Joint Model IAPT Indicators Target 2016/17 National target: Paired assessment scores for completed episodes (CCG) Penalty: 10 per breach below threshold) Nationally Published Data 90% Have raised a query with NHS Digital regarding data The proportion of people who have depression and/or anxiety disorders who receive psychological therapies (% against trajectory) (CCG) Local Data 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 1.25% 1.22% 1.28% 1.18% 1.50% 1.47% 0.90% 1.19% 50% 40.4% 32.1% 55.0% 45.9% 43.6% 48.0% 46.8% 75% 97.3% 96.1% 96.4% 98.3% 98.2% 97.4% 97.6% 95% 99.2% 98.3% 99.0% 99.5% 99.5% 99.5% 99.6% 5.21. 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. For 16/17, this target has been consistently achieved. Table 18: SUS Data Quality SUS Data Quality Target Jul-16 Aug-16 Sep-16 Oct-16 Nov-16 Dec-16 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% 99.2% 99.1% 99.2% 99.1% 99.1% 99.1% 95% 97.8% 97.1% 97.7% 96.9% 97.4% 97.9% Page 16 of 23

Service Quality & Performance Report February 2017 6. RECOMMENDATIONS 6.1. 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 and any key risks for 2017/18. Jo McCallum Senior Business Development Manager (Performance) Helen Byworth Assistant Director of Contracting & Performance Louise Robson Executive Director of Business and Development 15 th February 2016 Page 17 of 23

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 Service Quality & Performance Report February 2017 Appendix 1: Directorate Level Performance Directorate Cancer Services 59% -1.3% 30 426 100% 100% 100% 0 1.21 3.2% 18.54 0 0 2m Cardiothoracic 61% 14.0% 1,187 2,655 96.6% 91.3% 96.4% 158 0.74 10.1% 1.44 10 0 2m Services Children s Services 88% 46.0% 1,210 2,054 96.6% 99.7% 97.4% 58 1.39 10.8% 1.85 1 1 2w Clinical Genetics 99.4% 98.3% 17 4.00 Dental Hospital &School 100% 4.1% 884 4,192 98.2% 92.0% 98.8% 52 1.01 10.5% 2.05 0 0 ENT 94% -3.4% 940 4,360 95.3% 90.3% 96.7% 255 1.17 10.1% 1.41 3 0 1m Internal Medicine 60% 0.3% 1,103 3,613 90.6% 97.9% 93.4% 285 1.17 12.5% 2.26 0 0 Musculoskeletal 90% -1.3% 4,036 3,053 89.8% 83.7% 84.9% 1125 1.20 9.8% 3.14 1 0 2m Neurosciences 84% 0.4% 1,344 2,767 85.3% 94.3% 93.1% 316 1.41 11.1% 2.48 9 0 P.O.D. 92% -4.6% 4,005 7,634 97.7% 92.6% 97.4% 325 1.42 10.2% 3.11 0 0 2w Peri-op and Critical Care 100% 25.6% 183 938 85.6% 87.5% 89.7% 73 1.53 7.6% 6.14 0 0 Renal Services 95% -8.6% 1,010 1,462 100.0 91.9% 99.0% 21 1.12 10.0% 2.61 1 0 2w, 1m Surgical Services 86% 2.8% 1,707 1,889 95.7% % 90.6% 92.3% 324 1.30 8.3% 1.27 16 0 1m, 2m, Scr Therapy Services 1.6% 645 98.6% 95.8% 20 Women s Services 96% 5.6% 558 2,268 96.7% 90.7% 94.9% 120 1.02 6.1% 2.71 0 0 2m Indicator Tolerance Data period Day of Surgery Arrival - January 2017 Referral Growth - All referrals <0% Red, Amber 0-5%, Green >5% January 2017 compared to January 2016 Admitted Waiting (includes planned and suspended - patients) December 2016 New Outpatients Waiting List - December 2016 Risk Adjusted Length of Stay - Source HED Outpatient DNA Rates against Shelford - Source HED Outpatient New to Review Ratio - against Shelford - Green = Performance is below (better) than Shelford, RED = Performance is above (worse) than Shelford October 2015 September 2016 Page 18 of 23

Service Quality & Performance Report February 2017 Source HED Cancelled Operations - Source Patient Services Red >0.8% FFCEs January 2017 Cancelled Operations Breaches 28 days - Source Patient Services Red >=1 January 2017 Cancer tbc December 2016 Page 19 of 23

Service Quality & Performance Report February 2017 Appendix 2: A&E Performance A&E Key Performance Indicators Threshold Apr-16 May-16 Jun-16 Jul-16 Aug-16 Sep-16 Oct-16 Nov-16 Dec-16 Jan-17 Unplanned re-attendance rate - 7 days RVI - Main Emergency Department 5% 1.8% 2.3% 3.0% 3.8% 4.5% 3.7% 3.2% 3.6% 3.5% 2.4% Total time spent in A&E department (All Attendances) Eye Casualty 5% 1.4% 0.6% 2.8% 4.1% 2.1% 2.9% 0.6% 0.7% 0.3% 0.0% Walk-in Centre 5% 0.2% 0.2% 0.3% 0.4% 0.0% 0.6% 0.3% 0.2% 0.1% 0.1% Molineux Street 5% 0.0% 0.0% 0.0% 0.1% 0.0% 0.0% 0.0% 0.0% 0.1% 0.0% 95% 95% 95% 95% 95% 95% 95% 95% 95% 95% All Emergency Departments (Combined performance) 95% 94.2% 94.7% 96.4% 97.4% 96.8% 96.5% 95.5% 92.9% 91.4% 91.0% RVI - Main Emergency Department 95% 91.3% 92.0% 94.5% 96.0% 94.7% 94.7% 93.4% 89.2% 86.6% 85.8% Left department without being seen rate Eye Casualty 95% 97.9% 97.5% 98.5% 99.0% 98.1% 99.0% 96.2% 98.0% 98.7% 98.1% Walk-in Centre 95% 100.0% 100.0% 100.0% 100.0% 100.0% 100.0% 100.0% 100.0% 100.0% 100.0% Molineux Street 95% 100.0% 100.0% 100.0% 100.0% 100.0% 100.0% 100.0% 100.0% 100.0% 100.0% RVI - Main Emergency Department 5% 3.6% 4.6% 2.9% 3% 3.9% 4.2% 3.6% 4.2% 5.4% 4.5% Eye Casualty 5% 0.3% 0.5% 0.1% 0.5% 0.6% 0.3% 0.5% 0.3% 0.4% 0.4% Walk-in Centre 5% 1.3% 0.9% 1.8% 0.8% 0.0% 1.1% 1.1% 1.2% 1.4% 0.9% Molineux Street 5% 1.2% 1.6% 1.4% 1% 0.0% 1.0% 1.5% 1.9% 2.6% 1.3% Time to initial assessment - 95th percentile (Emergency Ambulance arrivals only) RVI - Main Emergency Department <15 mins 01:21 00:48 01:02 01:19 00:42 00:48 00:42 01:29 00:44 01:31 Time to treatment in department - Median Eye Casualty <15 mins # # # # # # # # # # RVI - Main Emergency Department <60 mins 00:40 00:40 00:37 00:36 00:24 00:56 00:58 01:17 01:32 00:30 Note: # Not provided as minimal data available 2016/17 Eye Casualty <60 mins 00:53 00:50 00:56 00:57 01:27 01:01 01:09 00:56 00:50 01:02 Walk-in Centre <60 mins 00:11 00:12 00:15 00:11 00:10 00:20 00:10 00:12 00:10 00:10 Molineux Street <60 mins 00:20 00:24 00:20 00:18 00:17 00:24 00:31 00:33 00:37 00:31 Page 20 of 23

Actual 15/16 Target Monthly Target Quarter 1 July August Sept Oct Nov Dec Jan Service Quality & Performance Report February 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 21 0 1 1 0 0 0 0 1 1 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 1,088 Minimal n/a 366 115 72 91 101 126 119 HCAI (c) Zero tolerance MRSA 5 0 0 2 0 0 0 3 0 0 0 Rates of Clostridium difficile 67 77 <6-7 10 5 6 5 7 6 9 4 (cumulative & appeals removed) Duty of Candour (c) Failures to notify the Relevant Person of a suspected or actual Reportable Patient Safety Incident VTE Assessments 0 0 0 0 0 0 0 0 0 0 0 Proportion of Patients who have had a VTE Risk Assessment on Admission 96.1% 95% 95% 96.9% 95.2% 96.0% 96.3% 95.7% 98.8% 95.6% Page 21 of 23

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 Service Quality & Performance Report February 2017 Appendix 4: RTT Compliance by Specialty and Commissioner, January 2017 Commissioner The Newcastle upon Tyne Hospitals 0 0 69 0 0 66 0 0 n/a 0 0 0 0 0 0 30 0 0 0 NHS NEWCASTLE GATESHEAD CCG 1 0 42 n/a 0 n/a n/a 0 n/a 1 1 0 0 0 n/a 17 0 0 18 NHS NORTH TYNESIDE CCG n/a n/a 9 0 0 n/a n/a n/a n/a n/a 0 n/a 0 0 n/a 7 0 1 3 NHS NORTHUMBERLAND CCG n/a n/a 2 2 0 n/a n/a n/a n/a n/a n/a n/a 0 0 n/a 3 0 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 n/a n/a n/a n/a n/a n/a 6 NHS SOUTH TYNESIDE CCG n/a n/a n/a 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 1 7 NHS NORTH DURHAM CCG n/a n/a n/a 0 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 8 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 4 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 3 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 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 n/a 6 Specialised n/a n/a 0 n/a n/a 66 0 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 57 0 0 26 0 0 n/a 0 0 0 53 n/a 0 0 n/a 0 0 NHS NEWCASTLE GATESHEAD CCG 2 0 37 0 0 n/a n/a 1 n/a n/a n/a 0 22 n/a n/a 0 n/a 0 0 NHS NORTH TYNESIDE CCG n/a 3 5 1 0 n/a n/a 1 n/a n/a n/a 1 9 n/a n/a n/a n/a 0 2 NHS NORTHUMBERLAND CCG n/a 0 5 0 0 n/a n/a 1 n/a n/a n/a 0 14 n/a n/a n/a 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 n/a n/a n/a n/a n/a n/a n/a 0 NHS SOUTH TYNESIDE CCG n/a n/a 2 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 5 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 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 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 1 n/a n/a 0 n/a n/a n/a n/a n/a n/a 3 n/a n/a n/a n/a n/a n/a 0 Specialised n/a n/a 7 n/a n/a 26 0 n/a n/a n/a n/a n/a n/a n/a 0 n/a n/a n/a 0 Page 22 of 23

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 Service Quality & Performance Report February 2017 Commissioner The Newcastle upon Tyne Hospitals 0 0 751 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 0 373 0 n/a n/a n/a 0 n/a 0 n/a 0 0 n/a n/a 0 n/a 0 0 NHS NORTH TYNESIDE CCG n/a n/a 102 0 n/a n/a n/a n/a n/a n/a n/a n/a 3 n/a n/a n/a n/a n/a 0 NHS NORTHUMBERLAND CCG n/a n/a 78 0 n/a n/a n/a n/a n/a n/a n/a 0 1 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 44 n/a n/a n/a n/a n/a n/a n/a n/a n/a 5 n/a n/a n/a n/a n/a 0 NHS NORTH DURHAM CCG n/a n/a 29 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 14 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 23 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 72 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 23 of 23