Quarterly performance of the provider sector as at 30 June Further underlying data

Transcription

1 Quarterly performance of the provider sector as at 30 June 2016 Further underlying data

2 Contents 1.0 Operational performance 2.2 Income & expenditure 1.1 Operational performance overview 2.3 Pay and agency costs 1.2 Accident & emergency (A&E) 2.4 Non-pay cost pressures 1.3 Diagnostic waiting times 2.5 Cost improvement programmes 1.4 Elective waiting times 3.0 Financial performance by providers 1.5 Cancer waiting times 4.0 Operational performance by providers 1.6 Ambulance response times 5.0 End notes and glossary 1.7 infections control 2.0 Financial performance 2.1 Financial performance overview 2

3 3 1.0 Operational performance

4 1.1 Operational performance overview Metrics Target Sector performance Accident & emergency A&E attendances Q1 2016/17-5,344,295 Performance All A&E types (%) Q1 2016/17 95% 89.31% Performance Acute trusts only (%) Q1 2016/17 95% 88.38% Type 1 performance (%) Q1 2016/17 95% 85.43% Diagnostics Number of diagnostic tests waiting 6 weeks+ (%) June % 1.50% Referral to treatment (RTT) 18 weeks incomplete (%) June % 91.27% 52-week waits (number) at 30 June Cancer 2-week GP referral to 1st outpatient, cancer (%) Q1 2016/17 93% 93.66% 2-week referral to 1st outpatient - breast symptoms (%) Q1 2016/17 93% 91.82% 31-day wait from diagnosis to first treatment (%) Q1 2016/17 96% 97.60% 62-day urgent GP referral to treatment for all cancers (%) Q1 2016/17 85% 82.34% 62-day referral from screening services Q1 2016/17 90% 91.31% Ambulance Red 1 Calls (%) Q1 2016/17 75% 70.43% Red 2 Calls (%) Q1 2016/17 75% 64.43% Category A Call - ambulance arrived within 19 mins (%) 95% 91.90% Infection control C. Difficile (Total cases) Q1 2016/17-1,104 4

5 1.2 Accident and emergency (A&E) 5 Percentage of A&E all-type patients seen within 4 hours Number of trusts failing the 4-hour A&E target by month NHS providers continue to struggle to meet the national A&E target to treat, admit or discharge 95% of patients within four hours of arriving at an A&E department. Performance hit the lowest ever level in Q4 2015/16. However, waiting times started to improve this quarter at 89.31% compared to 86.58% last quarter. Despite the improvement, performance this quarter remained significantly below the level achieved in the same quarter last year (93.45%) and well below the 95% standard. Increasing demand coupled with bed constraints continued to impact on A&E performance. In Q1 2016/17, there were 5.34 million attendances at NHS A&E departments, 6.3% higher than the same quarter last year. Despite the increase in the overall attendances and continued underperformance against the target, providers treated 72,800 more patients within four hours compared to Q1 last year. In addition, a rising number of patients requiring emergency admissions further added to the operational pressure on A&E departments. The number of patients attending a major (Type 1) A&E department and requiring admitted care reached 1.04 million, a rise of 6.4% from the same quarter last year. Continued bed capacity constraints due to high occupancy rates and delayed transfers of care resulted in patients waiting significantly longer in A&E departments for emergency admissions. In Q1 2016/17, 112,117 patients waited longer than four hours on a trolley for a bed, a 60.7% increase from the previous year. In collaboration with NHS England, we are working to support providers to meet and sustain the national A&E performance standard and be more prepared for the challenging winter period. We are bolstering the national Emergency Care Improvement Programme (ECIP) by extending its support from 28 to 40 of the most challenged local health systems. We will support providers to improve patient flow by reducing inpatient bed occupancy and length of stay, and by implementing the SAFER patient flow bundle. We are also working with trusts to support the development of longer-term solutions through the STP planning process and the urgent and emergency care review.

6 1.3 Diagnostic waiting times Percentage of diagnostic patients waiting over 6 weeks Diagnostic performance by procedure June 2016 Diagnostic waiting times are a key part of achieving the referral-totreatment (RTT) target as most patients need a diagnostic test. The national waiting-time target for diagnostics states that less than 1% of patients should wait over six weeks for a test. At the end of Q1 2016/17, 866,525 patients were waiting for a diagnostic test, an increase of 6.8% compared to the end of Q1 2015/16. Despite the increase in the waiting list, fewer patients waited longer than six weeks as diagnostic waiting-time performance improved to 1.50% from 1.88% at June last year. Providers in aggregate failed to achieve the waiting-time standard for 10 of the 15 key diagnostic tests in both this quarter and the same quarter last year. Non-obstetric ultrasound had the largest waiting list of all tests (36% of the total diagnostics waiting list), but only 0.58% of patients were waiting over six weeks at the end of the Q1 2016/17. The overall improvement in diagnostics performance was largely due to a significant reduction in waiting times for endoscopy services. A national programme team, including NHS Improvement and other national bodies, has been working with providers to address endoscopy performance and capacity issues since the start of last year. At the end of Q1 2016/17, 4.25% of patients waited over six weeks for an endoscopy test compared to 8.03% last year. NHS Improvement and NHS England are developing a national diagnostics plan alongside the national elective care plan. In 2016/17, there will be continued focus on addressing long-term challenges such as workforce shortages, ageing equipment and increases in demand. 6

7 1.4 Elective waiting times RTT 18-week performance and size of waiting list by month Number of trusts failing RTT 18-week incomplete target by month Following Sir Bruce Keogh s review of waiting-time standards, the RTT standard for incomplete pathways has become the sole measure of elective waiting-time performance. Due to increasing demand and insufficient planned capacity, the elective waiting list reached 3.45 million at the end of Q1 2016/17. This is a 15.32% increase compared to the previous year and 4.57% compared to the previous quarter.* For a second consecutive quarter, NHS providers failed to achieve the national RTT incomplete standard target of 92% with a performance of 91.27%. This reflects a downward trend from the same period last year, when the sector achieved 92.97%. The number of patients waiting over 52 weeks for treatment increased from 859 last quarter to 936 in Q1 2016/17. The large increase was driven by The Royal Wolverhampton NHS Trust reporting an additional 100 people waiting over 52 weeks. Across the sector, King s College Hospital NHS Foundation Trust (137) and University Hospitals of Leicester NHS Trust (130) reported the largest number of people waiting over 52 weeks. Nine providers did not report incomplete RTT performance at the end of the quarter, so the actual number of people waiting over 52 weeks could be significantly higher. Nationally, NHS Improvement and NHS England are working together on programmes and projects to implement the national elective care plan. Work will focus on reducing demand for elective care and supporting providers to improve performance by enhancing the Intensive Support Team. * Comparisons exclude providers that have recommenced reporting this year. 7

8 1.5 Cancer waiting times 62-day (urgent GP referral) wait for first treatment by month 62-day (urgent GP referral) wait for first treatment by specialty Q1 2016/17 Providers failed to achieve two national cancer waiting-time standards in Q1 2016/17: two-week wait for breast symptoms (where cancer was not initially suspected) and 62-day (urgent GP referral) wait for first treatment. Providers failed the 93% performance standard for a two-week wait for breast symptoms with an overall performance of 91.82%, worse than the performance in the same quarter last year (93.34%). Providers in aggregate also failed to achieve the 62-day cancer waiting-time target, reporting a performance of 82.34% in Q1 2016/17. The number of patients beginning their cancer treatment saw a 6.86% increase from the same quarter last year and reached 35,935 during the quarter. The specialties that contributed most to the underperformance in Q1 2016/17 were urological (excluding testicular), lower gastrointestinal and lung. These specialties accounted for only about 41% of activity, but contributed to more than half the reported breaches (about 57%). NHS Improvement has worked with partners to improve cancer performance by reducing diagnostic delays. We began work with the national Cancer Taskforce to reduce delays by increasing capacity for specific tumour groups at the most challenged trusts. With NHS England we are developing plans to help providers access additional endoscopy capacity from the independent sector. We expect these initiatives will, over time, help reduce waits to begin treatment and improve performance against the cancer 62- day target. Providers continued to achieve all other cancer waiting-time standards in Q1 2016/17. 8

9 1.6 Ambulance response times Category A Red 1 and Red 2 performance and volume of journeys Category A19 performance and volume of journeys The national standard says that 75% of time-critical and lifethreatening Category A (ie Red 1 and Red 2) calls should receive an emergency response within eight minutes, and 95% of all Category A calls should receive an emergency response within 19 minutes. For the fourth consecutive quarter, ambulance services failed Red 1, Red 2 and Category A response-time targets with performances of 70.43%, 64.43% and 91.90% respectively. During Q1 2016/17, none of the eight ambulance services* that submitted complete data achieved the Red 1 and Red 2 standards and only one achieved the Category A19 standard. Ambulance services saw an increase in time-critical and lifethreatening calls during the quarter. Ambulance services responded to 34,839 Red 1 calls in Q1 2016/17, an increase of 5.9% from Q1 2015/16. The number of Red 2 and Cat A calls also saw a 15.5% and 15.0% increase compared to the same period last year.** Due to dispatch-on-disposition pilots at a number of ambulance services, a direct like-for-like performance comparison between Q1 2016/17 and Q1 2015/16 for the Red 2 and Category A standards cannot be made. The pilots allow call handlers extra time to triage Red 2 calls, and result in different clock start times. In February 2015, London Ambulance Service and South Western Ambulance Service NHS Foundation Trust implemented the pilot, and in October 2015 it was introduced at four more ambulance trusts. * There are 11 ambulance services including 10 ambulance trusts as well as Isle of Wight NHS Trust. However, in Q1 2016/17, South Western Ambulance Service, Yorkshire Ambulance Service and West Midlands Ambulance Service did not submit complete data for Red 1, Red 2 and Cat A calls due to a clinical coding review at those services. ** Comparisons exclude South Western Ambulance Service, Yorkshire Ambulance Service and West Midlands Ambulance Service activity in Q1 2015/16 and Q1 2016/17. 9

10 1.7 Infection controls Number of Clostridium Difficile cases Clostridium difficile (C. diff) The number of trust-apportioned C. diff cases reported in Q1 2016/17 was 1,104 compared to 1,332 in the corresponding period last year. This was a decrease of 16.49%. The 1,104 cases reported in Q1 2016/17 were 6.20% lower than those reported in the last quarter. Number of trust-assigned Methicillin-resistant Staphylococcus Aureus cases reported Methicillin-resistant Staphylococcus Aureus (MRSA) 65 MRSA cases were assigned to trusts in Q1 2016/17, 20 fewer than in the same quarter last year. 13 fewer MRSA cases were assigned to trusts this quarter than last quarter. 10

11 Financial performance

12 2.1 Financial performance overview 3 months ended 30 June 2016 by sector Number of providers Year to date - Month /17 Plan Actual Variance Deficit providers m m m No. Acute 137 (547) (568) (21) 103 Ambulance 10 (7) (10) (3) 6 Community 18 (1) (6) (5) 9 Mental health 56 (5) Specialist 17 (15) (11) 4 9 Total surplus/(deficit) - control total (575) (593) (18) 153 Technical adjustments - FT and part-year NHS trusts Reported financial position surplus/(deficit) (554) (571) (17) Unallocated Sustainability and Transformation Fund (STF) STF allocated to providers not accepting the control total STF allocated to providers not achieved Reported financial position surplus/(deficit) after STF (466) (461) 5 3 months ended 30 June 2016 by region Number of providers Year to date - Month /17 Plan Actual Variance Deficit providers m m m No. London 36 (156) (194) (38) 23 Midlands and East 73 (219) (204) North 74 (92) (93) (1) 45 South 55 (108) (102) 6 35 Total surplus/(deficit) - control total (575) (593) (18) 153 Technical adjustments - FT and part-year NHS trusts Reported financial position surplus/(deficit) (554) (571) (17) Unallocated Sustainability and Transformation Fund (STF) STF allocated to providers not accepting the control total STF allocated to providers not achieved Reported financial position surplus/(deficit) after STF (466) (461) 5 1. Surplus/(deficit) comparable to control totals are calculated as surplus/(deficit) before impairments, transfers, donated asset income, donated asset depreciation and gains/(losses) on asset disposals for all trusts. For non-fts, IFRIC 12 adjustments are also deducted. 2. For non-fts, the reported surplus/(deficit) is after deducting donated asset income, donated asset depreciation and gains/(losses) on asset disposals. For FTs, these items should be included, and therefore this adjustment adds the figures back to provide the reported sector surplus/(deficit). This also includes the NHS trust IFRIC12 adjustment for those trusts gaining FT status in year (NHS trust period only). 12

13 2.2 Income & expenditure 3 months ended 30 June 2016 Year to date - Month /17 Plan Actual Variance m m m % Operating revenue for EBITDA 19,535 19, % Pay (12,563) (12,553) 10 (0.1%) Other operating expenses (6,552) (6,642) (90) 1.4% EBITDA (32) (7.6%) All other expenses not included in EBITDA (995) (981) 14 (1.4%) Control total basis surplus/(deficit) (575) (593) (18) 3.1% Technical adjustments - FT and part-year NHS trusts Provider-reported financial position surplus/(deficit) Unallocated Sustainability and Transformation Fund (STF) Sector-reported financial position surplus/ (deficit) EBITDA % 2.1% 2.0% Control total basis surplus/(deficit) (2.9%) (3.0%) 3 months ended 30 June 2016 by sector Acute (4.8%) (554) (571) (17) 3.1 % % (466) (461) 5 (1.1%) Year to date - Month /17 Mental Ambulance Community health Specialist m m m m m Operating revenue for EBITDA 14, , Pay (9,097) (395) (492) (2,114) (455) Other operating expenses (5,366) (145) (222) (599) (310) EBITDA All other expenses not included in EBITDA (767) (26) (18) (132) (38) Control total basis surplus / (deficit) (568) (10) (6) 2 (11) EBITDA % 1.4% 2.9% 1.7% 4.7% 3.4% Control total basis surplus/(deficit) (3.9%) (1.8%) (0.8%) 0.1% (1.4%) The provider sector reported a year-to-date deficit of 461 million at Q1 2016/17, 5 million ahead of plan. The reported sector position represented an improvement compared to the same period last year, which saw an aggregate sector deficit of 930 million. The sector s year-to-date position included a 593 million combined deficit at provider level on control total basis. Financial control totals were introduced for 2016/17 to establish the minimum level of financial performance for both the sector and individual trusts: 214 out of 238 providers have accepted their individual control totals at the time of reporting, and have planned to achieve a full-year financial position that is either equivalent to or better than their control totals. In total, 43 providers failed to deliver their year-to-date control total in Q1. The provider-level deficit was largely affected by operating expenses exceeding the plan by 0.4%, reducing a 0.2% positive variance on operating revenue. Providers continued to overspend on agency staff, drugs and clinical supplies as demand rose. However, compared to Q1 2015/16, variances against plan this quarter were much smaller, indicating that providers are tightening their financial grip. In addition, the number of providers reporting a year-to-date deficit also reduced from 190 at Q1 last year to 153 this quarter, which was four fewer than planned. As part of 2016/17 planning, a 1.8 billion Sustainability and Transformation Fund (STF) was introduced. The fund is aimed at helping providers return to a more sustainable financial footing. Providers are eligible to access the STF if they accept and deliver their individual control totals, and meet an agreed plan for certain waiting-time standards. At Q1 2016/17, 185 trusts met the funding criteria for the quarter. As a result, the reported provider-level deficit (on control total basis) included 340 million of STF expected by these trusts. A further 110 million STF was not allocated at Q1 but reflected in the sector s overall position. The amount was made up of funds held centrally, as well as funds related to trusts that rejected their control totals or failed to achieve their Q1 funding criteria. 13

14 2.3 Pay and agency costs Year to date - Month /17 3 months ended 30 June 2016 Plan Actual Variance m m m % Permanent and bank staff 11,874 11,792 (82) (0.7%) Agency and contract staff % Total 12,563 12,553 (10) (0.1%) Agency costs as a % of total pay costs 5.5% 6.1% The provider sector continued to overspend on agency and contract staff costs during Q1 2016/17. The adverse variance on agency staff costs was offset by an underspend on permanent staff at Q1, resulting in a positive variance on the total pay bill of 10 million. Agency staff costs at Q1 2016/17 represented 6.1% of the total pay bill. Providers in London continued to have the highest spend on agency staff (7.3%). Compared to the same period last year, the spend on agency staff at Q1 2016/17 was over 100 million less. This demonstrates that agency control measures introduced last year continue to have a positive impact on the sector. Providers annual plans for 2016/17 assumed a 2.3% annual growth in total pay costs. Although this is partly related to pay inflation, review of pay growth undertaken by NHS Improvement shows that a number of providers pay growth is in excess of inflation and pension effects. In July 2016, NHS Improvement published Strengthening financial performance and accountability in 2016/17, announcing a wide ranging seven-point set of actions. One action focused on tackling excessive pay bill growth. Over time, we expect to see providers bringing down excess cost growth where possible, including reduction in agency staff, resulting in reduced levels of deficit across the provider sector. In addition, NHS Improvement has recently asked leaders of sustainability and transformation plans (STP) to help identify any existing planned care services relying on fragile and temporary workforce that could be either consolidated, changed or transferred to a neighbouring provider. This will lead to further potential savings. 14

15 2.4 Non-pay cost pressures Year to date - Month /17 3 months ended 30 June 2016 Plan Actual Variance m m m % Employee expenses 12,563 12,553 (10) (0.1%) Drugs 1,671 1, % Supplies and services - clinical (excluding drugs) 1,545 1, % Supplies and services general % Purchase of healthcare from non-nhs bodies (9) (3.4%) Consultancy costs % PFI/LIFT operating expenses (10) (4.3%) Clinical negligence % Premises (13) (1.8%) All other operating non-pay 1,210 1, % Non-pay expense included in EBITDA 6,552 6, % Operating expenditure for EBITDA 19,115 19, % Month 3 3 months ended 30 June /17 m Financial sanctions (fines) 37 Sanctions reinvested (13) Subtotal: Financial sanctions 24 Marginal rate emergency tariff (MRET) 66 MRET reinvested (5) Subtotal: MRET 61 Readmissions 64 Readmissions reinvested (15) Subtotal: Readmissions 49 Delayed transfers of care (DToC) - expenditure incurred on blocked capacity 44 DToC - reimbursement from local authorities (1) Subtotal: Delayed transfers of care 43 Waiting-list initiative work 38 Outsourcing work to other providers 77 In Q1 2016/17, providers reported an adverse variance of 89 million in relation to non-pay items. Reflecting sustained demand pressures, 60% of the overspend was related to drugs and clinical supplies. Providers struggled to cope with rising demand and capacity constraints, leaving many failing to meet the national standards. In previous years, underperformance against national standards often resulted in financial sanctions being levied on providers. However, with the introduction of STF this financial year, providers will not face these penalties if they meet their agreed performance plans for certain waiting time standards. For Q1, providers in aggregate reported total financial sanctions of 24 million and spent 38 million year-to-date on waiting list initiatives. However, we would expect the full-year costs in both areas to be lower than the year before. In contrast, providers have already spent 77 million on outsourcing clinical work to other providers and expect the costs to rise. The current level of spending is likely to be a reflection of constrained capacity due to high demand. Delayed transfers of care (DToC) also continue to have a detrimental impact on many providers both operationally and financially. Compared to Q1 last year, the bed days lost due to DToCs rose by 25%. Providers reported that direct costs associated with DToCs for Q1 was 43 million. Lord Carter, in his review, regarded DToCs as a major problem for the NHS and called for action to tackle this issue. 15

16 2.5 Cost improvement programmes Year to date - Month /17 3 months ended 30 June 2016 Plan Actual Variance m m m Recurrent (111) Non-recurrent Total cost improvement programmes (45) CIPs as a % of spend 2.6% 2.4% In Q1 2016/17, providers delivered 497 million of savings through cost improvement programmes (CIPs), including 109 million from income generation schemes. CIPs reduced total year-to-date expenditure by 2.4%. CIPs achieved were 45 million (8.3%) below the plan. Sustained demand pressures and recruitment difficulties continued to affect providers ability to achieve their planned savings, especially pay cost savings. Current under-delivery against planned pay savings accounted for more than 80% ( 37 million) of the shortfall. 78% ( 385 million) of the savings achieved year-to-date were through recurrent schemes, which was below the planned level of 92% (or 496 million). Providers have managed to compensate this shortfall by delivering 66 million extra savings through non-recurrent CIPs during the quarter. Given the sector s financial challenges, providers have been asked to increase their focus on efficiency this year. Implementing Lord Carter s review recommendations is now gathering momentum. In July, NHS Improvement asked all providers to work with their STP leaders to produce a summary of opportunities for consolidating back office and pathology services. These actions are aimed at delivering both in-year benefits as well as enhanced benefits for ongoing financial sustainability. To help improve efficiency, NHS Improvement has established an efficiency team to take these actions forward. We expect that, as the year progresses, these new measures will allow providers to further strengthen their financial grip and improve their financial standing for the future. 16

17 Financial performance by providers

18 3.1 Financial performance by provider London 18 Provider Name Control Total (CT) Accepted? Control Total Basis Surplus Deficit Including STF Year to date YTD Plan YTD Actual Variance Sustainability & Tranformation Fund YTD Actual Barking, Havering and Redbridge University Hospitals NHS Trust Yes (3,233) (3,231) 2 5,025 Barnet, Enfield and Haringey Mental Health NHS Trust No (3,288) (3,304) (16) 0 Barts Health NHS Trust Yes (22,868) (47,004) (24,136) 0 Camden And Islington NHS Foundation Trust Yes (420) 0 Central And North West London NHS Foundation Trust Yes (1,767) (2,385) (618) 0 Central London Community Healthcare NHS Trust Yes 673 (109) (782) 0 Chelsea And Westminster Hospital NHS Foundation Trust Yes 915 1,962 1,047 3,699 Croydon Health Services NHS Trust No (11,132) (11,132) 0 0 East London NHS Foundation Trust Yes 2, (2,283) 1 Epsom and St Helier University Hospitals NHS Trust Yes (7,785) (7,045) 740 2,825 Great Ormond Street Hospital for Children NHS Foundation Trust Yes (700) 820 1, Guy's And St Thomas' NHS Foundation Trust Yes (5,871) (5,790) 81 4,800 Homerton University Hospital NHS Foundation Trust Yes (341) 977 1,318 1,524 Hounslow and Richmond Community Healthcare NHS Trust Yes Imperial College Healthcare NHS Trust No (14,944) (14,714) King's College Hospital NHS Foundation Trust Yes (20,580) (32,265) (11,685) 0 Kingston Hospital NHS Foundation Trust Yes (559) (880) (321) 2,025 Lewisham and Greenwich NHS Trust Yes (6,830) (6,830) 0 4,150 London Ambulance Service NHS Trust Yes (2,159) (3,039) (880) 0 London North West Healthcare NHS Trust Yes (16,658) (16,528) 130 5,375 Moorfields Eye Hospital NHS Foundation Trust Yes 1,138 1, North East London NHS Foundation Trust Yes 137 2,228 2, North Middlesex University Hospital NHS Trust Yes 7,226 7, ,450 Oxleas NHS Foundation Trust Yes (130) (129) Royal Brompton and Harefield NHS Foundation Trust Yes (6,721) (5,468) 1,253 1,200 Royal Free London NHS Foundation Trust Yes (14,263) (14,173) 90 4,575 Royal National Orthopaedic Hospital NHS Trust Yes (2,808) (2,748) South London And Maudsley NHS Foundation Trust Yes (3,763) (2,498) 1, South West London and St George's Mental Health NHS Trust Yes (253) (1,219) (966) 0 St George's University Hospitals NHS Foundation Trust Yes (14,382) (20,992) (6,610) 0 Tavistock And Portman NHS Foundation Trust Yes The Hillingdon Hospitals NHS Foundation Trust Yes (107) ,675 The Royal Marsden NHS Foundation Trust Yes The Whittington Hospital NHS Trust Yes (1,978) (4,678) (2,700) 0 University College London Hospitals NHS Foundation Trust Yes (6,376) (5,301) 1,075 3,675 West London Mental Health NHS Trust No London Total (155,327) (193,968) (38,641) 46,301

19 3.2 Financial performance by provider Midlands and East (1/2) Provider Name Control Total (CT) Accepted? Control Total Basis Surplus Deficit Including STF Year to date YTD Plan YTD Actual Variance Sustainability & Tranformation Fund YTD Actual Basildon And Thurrock University Hospitals NHS Foundation Trust Yes (3,257) (2,877) 380 2,900 Bedford Hospital NHS Trust Yes (3,623) (2,501) 1,122 1,450 Birmingham And Solihull Mental Health NHS Foundation Trust Yes (2,398) (2,237) Birmingham Children's Hospital NHS Foundation Trust Yes (1,684) (428) 1,255 1,225 Birmingham Community Healthcare NHS Foundation Trust Yes Birmingham Women's NHS Foundation Trust Yes (855) (789) Black Country Partnership NHS Foundation Trust Yes (568) (454) Burton Hospitals NHS Foundation Trust Yes (3,806) (3,702) 104 1,550 Cambridge University Hospitals NHS Foundation Trust No (24,221) (22,214) 2,007 0 Cambridgeshire And Peterborough NHS Foundation Trust No (197) (190) 7 0 Cambridgeshire Community Services NHS Trust Yes Chesterfield Royal Hospital NHS Foundation Trust Yes 1,032 1, ,725 Colchester Hospital University NHS Foundation Trust Yes (7,515) (7,311) 203 2,500 Coventry and Warwickshire Partnership NHS Trust Yes (934) 109 1, Derby Teaching Hospitals NHS Foundation Trust Yes (2,734) (2,712) 22 3,400 Derbyshire Community Health Services NHS Foundation Trust Yes 1,321 2, Derbyshire Healthcare NHS Foundation Trust Yes Dudley and Walsall Mental Health Partnership NHS Trust Yes East and North Hertfordshire NHS Trust Yes (5,789) (4,294) 1,495 2,675 East Midlands Ambulance Service NHS Trust No (3,042) (2,181) East of England Ambulance Service NHS Trust Yes 27 (2,567) (2,594) 0 George Eliot Hospital NHS Trust Yes (4,084) (3,997) 87 1,075 Heart Of England NHS Foundation Trust Yes (6,627) (6,585) 42 5,825 Hertfordshire Community NHS Trust Yes (180) (170) Hertfordshire Partnership University NHS Foundation Trust Yes Hinchingbrooke Health Care NHS Trust Yes (3,468) (3,441) 27 1,000 Ipswich Hospital NHS Trust Yes (5,613) (5,610) 3 1,750 James Paget University Hospitals NHS Foundation Trust Yes (2,204) (1,388) 816 1,450 Kettering General Hospital NHS Foundation Trust Yes (3,618) (3,607) 11 1,900 Leicestershire Partnership NHS Trust Yes (30) (30) Lincolnshire Community Health Services NHS Trust Yes (124) Lincolnshire Partnership NHS Foundation Trust Yes 309 1, Luton And Dunstable University Hospital NHS Foundation Trust Yes (182) (145) 37 2,275 Mid Essex Hospital Services NHS Trust Yes (6,119) (5,300) 819 2,300 Milton Keynes University Hospital NHS Foundation Trust Yes (7,095) (7,063) 32 1,824 Norfolk And Norwich University Hospitals NHS Foundation Trust No (8,757) (9,043) (286) 0 Norfolk And Suffolk NHS Foundation Trust Yes (1,576) (1,161)

20 3.2 Financial performance by provider Midlands and East (2/2) Provider Name Control Total (CT) Accepted? Control Total Basis Surplus Deficit Including STF Year to date YTD Plan YTD Actual Variance Sustainability & Tranformation Fund YTD Actual Norfolk Community Health and Care NHS Trust Yes (785) (584) North Essex Partnership University NHS Foundation Trust Yes 406 (754) (1,160) 0 North Staffordshire Combined Healthcare NHS Trust Yes Northampton General Hospital NHS Trust Yes (3,046) (3,003) 43 2,425 Northamptonshire Healthcare NHS Foundation Trust Yes (12) Nottingham University Hospitals NHS Trust Yes (10,136) (9,884) 252 6,050 Nottinghamshire Healthcare NHS Foundation Trust Yes 1,574 2,603 1, Papworth Hospital NHS Foundation Trust Yes (96) Peterborough and Stamford Hospitals NHS Foundation Trust Yes (5,146) (4,220) 926 2,700 Queen Elizabeth Hospital Kings Lynn NHS Foundation Trust Yes (1,560) (4,084) (2,524) 0 Sandwell and West Birmingham Hospitals NHS Trust Yes (1,162) (674) 488 2,825 Sherwood Forest Hospitals NHS Foundation Trust Yes (19,723) (19,128) 595 2,575 Shrewsbury and Telford Hospital NHS Trust Yes (2,193) (2,193) 0 2,625 Shropshire Community Health NHS Trust Yes (1) South Essex Partnership University NHS Foundation Trust Yes (291) 2,635 2, South Staffordshire and Shropshire Healthcare NHS Foundation Trust Yes 267 1,557 1, South Warwickshire NHS Foundation Trust Yes 1,998 2, ,450 Southend University Hospital NHS Foundation Trust Yes (5,874) (4,111) 1,763 2,053 Staffordshire and Stoke on Trent Partnership NHS Trust No (2,565) (7,721) (5,156) 0 The Dudley Group NHS Foundation Trust Yes 1,900 1, ,625 The Princess Alexandra Hospital NHS Trust Yes (5,830) (5,658) 172 1,975 The Robert Jones And Agnes Hunt Orthopaedic Hospital NHS Foundation Trust Yes The Royal Orthopaedic Hospital NHS Foundation Trust Yes (697) (1,892) (1,195) 0 The Royal Wolverhampton NHS Trust Yes (2,115) (1,869) 246 2,650 United Lincolnshire Hospitals NHS Trust Yes (12,686) (12,372) 314 4,025 University Hospitals Birmingham NHS Foundation Trust Yes 1,500 1, ,100 University Hospitals Coventry and Warwickshire NHS Trust Yes (2,741) (2,731) 10 4,300 University Hospitals of Leicester NHS Trust Yes (8,089) (8,070) 19 5,850 University Hospitals of North Midlands NHS Trust Yes (5,995) (5,943) 52 5,225 Walsall Healthcare NHS Trust Yes (2,913) (2,910) 3 2,100 West Hertfordshire Hospitals NHS Trust Yes (8,476) (8,372) 104 3,000 West Midlands Ambulance Service NHS Foundation Trust Yes 1,145 1, West Suffolk NHS Foundation Trust Yes (3,088) (1,693) 1,395 1,525 Worcestershire Acute Hospitals NHS Trust Yes (10,035) (10,032) 3 3,275 Worcestershire Health and Care NHS Trust Yes 800 1, Wye Valley NHS Trust No (7,880) (8,297) (417) 0 Midlands and East Total (219,003) (204,184) 14, ,100 20

21 3.3 Financial performance by provider North (1/2) 21 Provider Name Control Total (CT) Accepted? Control Total Basis Surplus Deficit Including STF Year to date YTD Plan YTD Actual Variance Sustainability & Tranformation Fund YTD Actual 5 Boroughs Partnership NHS Foundation Trust No (768) (370) Aintree University Hospital NHS Foundation Trust Yes (1,608) (1,575) 34 2,375 Airedale NHS Foundation Trust Yes 1,274 1, ,325 Alder Hey Childrens NHS Foundation Trust No (5,120) (4,919) Barnsley Hospital NHS Foundation Trust Yes (2,098) (2,060) 38 1,650 Blackpool Teaching Hospitals NHS Foundation Trust Yes (2,489) (2,309) 180 2,499 Bolton NHS Foundation Trust Yes 1,101 1, ,301 Bradford District Care NHS Foundation Trust Yes 330 (316) (646) 0 Bradford Teaching Hospitals NHS Foundation Trust Yes 1,061 1, ,750 Bridgewater Community Healthcare NHS Foundation Trust Yes (691) (827) (136) 387 Calderdale And Huddersfield NHS Foundation Trust Yes (5,179) (5,061) 118 2,825 Calderstones Partnership NHS Foundation Trust Yes (1,161) (864) Central Manchester University Hospitals NHS Foundation Trust Yes (2,588) (830) 1,758 5,050 Cheshire And Wirral Partnership NHS Foundation Trust Yes (547) (176) City Hospitals Sunderland NHS Foundation Trust Yes (1,411) (1,157) 254 2,650 Countess Of Chester Hospital NHS Foundation Trust Yes (2,611) (2,611) 0 1,475 County Durham And Darlington NHS Foundation Trust Yes ,900 Cumbria Partnership NHS Foundation Trust Yes (1,807) (951) Doncaster And Bassetlaw Hospitals NHS Foundation Trust Yes (7,130) (5,604) 1,526 2,950 East Cheshire NHS Trust Yes (4,389) (4,045) 344 1,150 East Lancashire Hospitals NHS Trust Yes 1,061 1, ,125 Gateshead Health NHS Foundation Trust Yes ,575 Greater Manchester West Mental Health NHS Foundation Trust No Harrogate And District NHS Foundation Trust Yes 1,337 1, ,150 Hull and East Yorkshire Hospitals NHS Trust Yes (1,942) (1,942) 0 3,500 Humber NHS Foundation Trust Yes Lancashire Care NHS Foundation Trust Yes (348) (1,915) (1,567) 0 Lancashire Teaching Hospitals NHS Foundation Trust Yes (4,769) (8,296) (3,527) 0 Leeds And York Partnership NHS Foundation Trust Yes Leeds Community Healthcare NHS Trust Yes 591 (435) (1,026) 0 Leeds Teaching Hospitals NHS Trust Yes (4,156) (4,134) 22 5,700 Liverpool Community Health NHS Trust Yes (233) (233) Liverpool Heart And Chest Hospital NHS Foundation Trust Yes (1,075) (1,078) (3) 550 Liverpool Womens NHS Foundation Trust Yes (2,103) (2,027) Manchester Mental Health and Social Care Trust Yes (510) (445) Mersey Care NHS Foundation Trust Yes 2,284 2,284 (0) 320 Mid Cheshire Hospitals NHS Foundation Trust Yes (85) ,625 Mid Yorkshire Hospitals NHS Trust Yes (2,862) (2,839) 23 4,175

22 3.3 Financial performance by provider North (2/2) Provider Name Control Total (CT) Accepted? Control Total Basis Surplus Deficit Including STF Year to date YTD Plan YTD Actual Variance Sustainability & Tranformation Fund YTD Actual North Cumbria University Hospitals NHS Trust Yes (13,239) (13,060) 179 2,175 North East Ambulance Service NHS Foundation Trust Yes (837) 618 1, North Tees And Hartlepool NHS Foundation Trust Yes (1,677) 362 2,039 1,975 North West Ambulance Service NHS Trust Yes Northern Lincolnshire And Goole NHS Foundation Trust Yes (4,823) (4,597) 226 2,874 Northumberland, Tyne And Wear NHS Foundation Trust Yes 894 (268) (1,162) 0 Northumbria Healthcare NHS Foundation Trust Yes 5,291 5, ,725 Pennine Acute Hospitals NHS Trust Yes (5,297) (5,273) 24 5,125 Pennine Care NHS Foundation Trust No 76 (167) (242) 0 Rotherham Doncaster And South Humber NHS Foundation Trust Yes Royal Liverpool and Broadgreen University Hospitals NHS Trust Yes 2,119 2, ,425 Salford Royal NHS Foundation Trust Yes (4,325) (1,275) 3,050 2,850 Sheffield Children's NHS Foundation Trust Yes (712) (712) Sheffield Health And Social Care NHS Foundation Trust Yes Sheffield Teaching Hospitals NHS Foundation Trust Yes 1,563 1, ,825 South Tees Hospitals NHS Foundation Trust Yes (3,585) (3,195) 390 3,651 South Tyneside NHS Foundation Trust Yes (2,225) (1,536) 689 1,224 South West Yorkshire Partnership NHS Foundation Trust Yes 1,027 1, Southport and Ormskirk Hospital NHS Trust Yes (2,098) (6,268) (4,170) 0 St Helens and Knowsley Hospital Services NHS Trust Yes ,525 Stockport NHS Foundation Trust Yes (8,819) (8,729) 90 0 Tameside Hospital NHS Foundation Trust Yes (5,482) (5,274) 208 1,725 Tees, Esk And Wear Valleys NHS Foundation Trust Yes 3,194 3, The Christie NHS Foundation Trust Yes 2,278 1,618 (660) (1) The Clatterbridge Cancer Centre NHS Foundation Trust Yes 1,538 1,194 (344) 0 The Newcastle Upon Tyne Hospitals NHS Foundation Trust No 7,465 2,685 (4,781) 0 The Rotherham NHS Foundation Trust Yes ,625 The Walton Centre NHS Foundation Trust Yes (730) (718) University Hospital Of South Manchester NHS Foundation Trust No (4,987) (6,660) (1,673) 0 University Hospitals Of Morecambe Bay NHS Foundation Trust Yes (5,029) (4,713) 316 2,550 Warrington And Halton Hospitals NHS Foundation Trust Yes (3,308) (2,965) 343 2,000 Wirral Community NHS Foundation Trust Yes (45) Wirral University Teaching Hospital NHS Foundation Trust Yes (2,126) (2,143) (17) 2,475 Wrightington, Wigan And Leigh NHS Foundation Trust Yes (1,910) (1,814) 97 1,975 York Teaching Hospital NHS Foundation Trust Yes 223 1, ,400 Yorkshire Ambulance Service NHS Trust Yes (1,500) (1,116) North Total (92,219) (92,786) (567) 109,115 22

23 3.4 Financial performance by provider South Provider Name Control Total (CT) Accepted? Control Total Basis Surplus Deficit Including STF Year to date YTD Plan YTD Actual Variance Sustainability & Tranformation Fund YTD Actual 2Gether NHS Foundation Trust Yes Ashford and St Peter's Hospitals NHS Foundation Trust Yes 3,570 3, ,100 Avon and Wiltshire Mental Health Partnership NHS Trust Yes (374) (374) Berkshire Healthcare NHS Foundation Trust Yes Brighton and Sussex University Hospitals NHS Trust Yes (8,791) (8,738) 53 3,600 Buckinghamshire Healthcare NHS Trust Yes (1,039) (1,005) 34 2,350 Cornwall Partnership NHS Foundation Trust Yes (638) (592) Dartford and Gravesham NHS Trust Yes ,250 Devon Partnership NHS Trust Yes Dorset County Hospital NHS Foundation Trust No (3,324) (2,249) 1,074 0 Dorset Healthcare University NHS Foundation Trust No 581 1,852 1,270 0 East Kent Hospitals University NHS Foundation Trust Yes (5,305) (5,029) 276 4,025 East Sussex Healthcare NHS Trust Yes (13,573) (13,567) 6 2,600 Frimley Health NHS Foundation Trust Yes 3,947 3, ,450 Gloucestershire Care Services NHS Trust Yes (1) 270 Gloucestershire Hospitals NHS Foundation Trust Yes 1,325 1, ,225 Great Western Hospitals NHS Foundation Trust Yes ,225 Hampshire Hospitals NHS Foundation Trust Yes (220) (88) 132 2,574 Isle of Wight NHS Trust Yes (2,483) (2,483) Kent and Medway NHS and Social Care Partnership Trust Yes (1,648) (1,580) 68 0 Kent Community Health NHS Foundation Trust Yes Maidstone and Tunbridge Wells NHS Trust No (8,865) (10,472) (1,607) 0 Medway NHS Foundation Trust Yes (11,879) (11,512) 367 2,100 North Bristol NHS Trust No (14,836) (18,136) (3,300) 0 Northern Devon Healthcare NHS Trust Yes Oxford Health NHS Foundation Trust Yes (587) Oxford University Hospitals NHS Foundation Trust Yes 2,422 2, ,100 Plymouth Hospitals NHS Trust No (11,083) (11,068) 15 0 Poole Hospital NHS Foundation Trust No (3,162) (2,859) Portsmouth Hospitals NHS Trust Yes (4,833) (4,826) 7 3,650 Queen Victoria Hospital NHS Foundation Trust Yes Royal Berkshire NHS Foundation Trust Yes (1,407) (4,540) (3,133) 0 Royal Cornwall Hospitals NHS Trust Yes (5,774) (2,817) 2,957 2,275 Royal Devon And Exeter NHS Foundation Trust Yes (1,216) (746) 469 2,499 Royal Surrey County Hospital NHS Foundation Trust Yes (3,404) (598) 2,806 1,925 23

24 3.4 Performance by provider South (2/2) Provider Name Control Total (CT) Accepted? Control Total Basis Surplus Deficit Including STF Year to date YTD Plan YTD Actual Variance Sustainability & Tranformation Fund YTD Actual Royal United Hospitals Bath NHS Foundation Trust Yes 1,864 (1,290) (3,154) 0 Salisbury NHS Foundation Trust Yes (2,928) (59) 2,869 1,575 Solent NHS Trust Yes (1,378) (1,069) Somerset Partnership NHS Foundation Trust Yes South Central Ambulance Service NHS Foundation Trust Yes (515) (1,448) (933) 0 South East Coast Ambulance Service NHS Foundation Trust No (86) (1,832) (1,746) 0 South Western Ambulance Service NHS Foundation Trust No Southern Health NHS Foundation Trust Yes (293) (128) Surrey And Borders Partnership NHS Foundation Trust Yes 250 (606) (857) 0 Surrey and Sussex Healthcare NHS Trust Yes (4,842) (2,515) 2,327 0 Sussex Community NHS Foundation Trust Yes 426 (259) (685) 0 Sussex Partnership NHS Foundation Trust Yes 551 (1,293) (1,845) 0 Taunton And Somerset NHS Foundation Trust Yes (4,710) (2,724) 1,986 1,875 The Royal Bournemouth And Christchurch Hospitals NHS Foundation Trust Yes (884) (829) 55 1,899 Torbay and South Devon NHS Foundation Trust Yes (3,075) (2,759) 317 1,675 University Hospital Southampton NHS Foundation Trust Yes (3,593) 542 4,135 4,350 University Hospitals Bristol NHS Foundation Trust Yes 3,859 3, ,250 Western Sussex Hospitals NHS Foundation Trust Yes 2,547 2, ,300 Weston Area Health NHS Trust Yes (1,003) (1,003) Yeovil District Hospital NHS Foundation Trust Yes (4,796) (4,782) 14 1,125 South Total (108,379) (102,401) 5,978 73,762 Grand Total (574,928) (593,339) (18,411) 337,278 24

25 Operational performance by providers

26 4.2 Operational performance by providers (1/5) ORGANISATION A&E RTT Cancer 62 day Barking, Havering And Redbridge University Hospitals NHS Trust Barts Health NHS Trust Central and North West London NHS Foundation Trust Central London Community Healthcare NHS Trust Chelsea and Westminster Hospital NHS Foundation Trust Croydon Health Services NHS Trust Epsom And St Helier University Hospitals NHS Trust Great Ormond Street Hospital for Children NHS Foundation Trust 100 Guy's and St Thomas' NHS Foundation Trust Homerton University Hospital NHS Foundation Trust Hounslow and Richmond Community Healthcare NHS Trust Imperial College Healthcare NHS Trust King's College Hospital NHS Foundation Trust Kingston Hospital NHS Foundation Trust Lew isham and Greenw ich NHS Trust London North West Healthcare NHS Trust Moorfields Eye Hospital NHS Foundation Trust North East London NHS Foundation Trust North Middlesex University Hospital NHS Trust Oxleas NHS Foundation Trust Royal Brompton and Harefield NHS Foundation Trust Royal Free London NHS Foundation Trust Royal National Orthopaedic Hospital NHS Trust South West London and ST George's Mental Health NHS Trust St George's University Hospitals NHS Foundation Trust The Hillingdon Hospitals NHS Foundation Trust The Royal Marsden NHS Foundation Trust The Whittington Hospital NHS Trust University College London Hospitals NHS Foundation Trust Basildon and Thurrock University Hospitals NHS Foundation Trust Bedford Hospital NHS Trust Birmingham Children's Hospital NHS Foundation Trust Birmingham Community Healthcare NHS Foundation Trust Birmingham Women's NHS Foundation Trust Black Country Partnership NHS Foundation Trust Burton Hospitals NHS Foundation Trust Cambridge University Hospitals NHS Foundation Trust Cambridgeshire and Peterborough NHS Foundation Trust Cambridgshire Community Services NHS Trust Chesterfield Royal Hospital NHS Foundation Trust

27 4.2 Operational performance by providers (2/5) ORGANISATION A&E RTT Cancer 62 day Colchester Hospital University NHS Foundation Trust Coventry and Warw ickshire Partnership NHS Trust Derby Teaching Hospitals NHS Foundation Trust Derbyshire Community Health Services NHS Foundation Trust Derbyshire Healthcare NHS Foundation Trust Dudley and Walsall Mental Health Partnership NHS Trust East And North Hertfordshire NHS Trust George Eliot Hospital NHS Trust Heart of England NHS Foundation Trust Hertfordshire Community NHS Trust Hinchingbrooke Health Care NHS Trust Ipsw ich Hospital NHS Trust James Paget University Hospitals NHS Foundation Trust Kettering General Hospital NHS Foundation Trust Leicestershire Partnership NHS Trust Lincolnshire Community Health Services NHS Trust Lincolnshire Partnership NHS Foundation Trust Luton and Dunstable University Hospital NHS Foundation Trust Mid Essex Hospital Services NHS Trust Milton Keynes Hospital NHS Foundation Trust Norfolk and Norw ich University Hospitals NHS Foundation Trust Norfolk Community Health and Care NHS Trust Northampton General Hospital NHS Trust Northamptonshire Healthcare NHS Foundation Trust Nottingham University Hospitals NHS Trust Papw orth Hospital NHS Foundation Trust Peterborough and Stamford Hospitals NHS Foundation Trust Sandw ell And West Birmingham Hospitals NHS Trust Sherw ood Forest Hospitals NHS Foundation Trust Shrew sbury And Telford Hospital NHS Trust Shropshire Community Health NHS Trust South Essex Partnership University NHS Foundation Trust South Warw ickshire NHS Foundation Trust Southend University Hospital NHS Foundation Trust Staffordshire and Stoke on Trent Partnership NHS Trust The Dudley Group NHS Foundation Trust The Princess Alexandra Hospital NHS Trust The Queen Elizabeth Hospital, King's Lynn, NHS Foundation Trust The Robert Jones and Agnes Hunt Orthopaedic Hospital NHS Foundation Trust The Royal Orthopaedic Hospital NHS Foundation Trust

28 4.2 Operational performance by providers (3/5) ORGANISATION A&E RTT Cancer 62 day The Royal Wolverhampton NHS Trust United Lincolnshire Hospitals NHS Trust University Hospitals Birmingham NHS Foundation Trust University Hospitals Coventry And Warw ickshire NHS Trust University Hospitals Of Leicester NHS Trust University Hospitals of North Midlands NHS Trust Walsall Healthcare NHS Trust West Hertfordshire Hospitals NHS Trust West Suffolk NHS Foundation Trust Worcestershire Acute Hospitals NHS Trust Worcestershire Health And Care NHS Trust Wye Valley NHS Trust Boroughs Partnership NHS Foundation Trust Aintree University Hospital NHS Foundation Trust Airedale NHS Foundation Trust Alder Hey Children's NHS Foundation Trust Barnsley Hospital NHS Foundation Trust Blackpool Teaching Hospitals NHS Foundation Trust Bolton NHS Foundation Trust Bradford District Care NHS Foundation Trust Bradford Teaching Hospitals NHS Foundation Trust Bridgew ater Community Healthcare NHS Foundation Trust Calderdale and Huddersfield NHS Foundation Trust Central Manchester University Hospitals NHS Foundation Trust City Hospitals Sunderland NHS Foundation Trust Countess of Chester Hospital NHS Foundation Trust County Durham and Darlington NHS Foundation Trust Cumbria Partnership NHS Foundation Trust Doncaster and Bassetlaw Hospitals NHS Foundation Trust East Cheshire NHS Trust East Lancashire Hospitals NHS Trust Gateshead Health NHS Foundation Trust Harrogate and District NHS Foundation Trust Hull And East Yorkshire Hospitals NHS Trust Humber NHS Foundation Trust Lancashire Care NHS Foundation Trust Lancashire Teaching Hospitals NHS Foundation Trust Leeds Community Healthcare NHS Trust Leeds Teaching Hospitals NHS Trust Liverpool Community Health NHS Trust