Paper 6.1

TRUST BOARD26th June 2014

TITLE Performance Report

EXECUTIVESUMMARY

The Trust did not meet the 4 hour standard in May 2014. Performance forthe month was 92.99%. The Trust experienced unprecedented levels ofattendances in May which was one of the primary pressures in this month.

At aggregate level, the Trust did not deliver against the RTT standard foradmitted pathways but was compliant against the non-admitted andincomplete pathway standards.

The Trust did not meet the 62 day referral to first treatment standard forurgent GP cancer referrals.

BOARDASSURANCE (Risk)/ IMPLICATIONS

Assurance provided that actions in place to return the Trust to compliancewhere performance is off target or not on trajectory.

LINK TOSTRATEGICOBJECTIVE

SO1: Best OutcomesSO4: Top Productivity.

STAKEHOLDER /PATIENT IMPACTAND VIEWS

Patient expectations in terms of access are reflected in NHS performancetargets.

EQUALITY ANDDIVERSITY ISSUES

None identified

LEGAL ISSUES None identified

The Trust Board isasked to:

Review and discuss the report and seek additional assurance.

Submitted by: Valerie Bartlett, Deputy Chief Executive

Date: 18th June 2014

Decision: For Assurance

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PERFORMANCE REPORT

1. INTRODUCTION

The purpose of this paper is to summarise key performance issues and the actions in place toaddress them. Specifically the paper addresses the targets and standards included in the MonitorRisk Assurance Framework:

1.1 AT A GLANCE

Domain StandardComplianc

ethreshold

MAY-14

A&EMaximum waiting time of four hours from arrival toadmission/transfer/discharge

95% 92.99%

RTTMaximum time of 18 weeks from point of referral totreatment (ADMITTED PATIENTS)

90% 83.9%

RTTMaximum time of 18 weeks from point of referral totreatment in aggregate (NON-ADMITTEDPATIENTS)

95% 95.9%

RTTMaximum time of 18 weeks from point of referral totreatment in aggregate (INCOMPLETEPATHWAYS)

92% 95.3%

CANCERAll cancers: 62-day waitfor first treatment

Urgent GP referral forsuspected cancer

85% 80.5%

NHS Cancer ScreeningService referral

90% 50.0%^

CANCERAll cancers: 31-day waitfor second orsubsequent treatment

Surgery 94% 100%

Anti-cancer drugtreatments

98% 100%

CANCERAll cancers: 31-day wait from diagnosis to firsttreatment

96% 100%

CANCERCancer: two week waitfrom referral to date firstseen

All urgent referrals 93% 93.2%

Symptomatic breastpatients

93% 93.1%

^ Total referrals = 1 (2 x 0.5 [shared patients]). Total breaches = 0.5 (1 shared patient).

2. FOUR HOUR STANDARD FOR WAITING TIMES IN A&E

The Trust did not meet the 4 hour wait standard in May. Performance for the month was 92.99%.This represents a downturn in performance compared to the previous month of April (97.01%).

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2.1 MONTHLY PERFORMANCE

MonthPerformance(Monitor)1

PerformanceSPH only2

May 14/15 92.99% 88.80%

April 14/15 97.01% 95.76%

Q4 2013/14

Mar 13/14 96.26% 93.91%

Feb 13/14 93.07% 88.42%

Jan 13/14 94.19% 90.39%

2.2 QUARTERLY PERFORMANCE

2.3 MAY PERFORMANCE SUMMARY

Attendances to the St. Peter’s A&E in May were significantly higher than the previous month, up byaround 800. This level of attendance was significantly higher than the monthly levels seen duringthe entire winter period. The week ending 25th May 2014 saw the highest ever number of A&Eattendances nationally and a number of other local FTs are reporting significant pressures for themonth of May. At present, delivery against the 4-hour A&E standard is at risk for Q1.

Unplanned re-attendances also remained high with the fifth successive month over 5%.

Admissions to the acute emergency care pathway indicated by the conversion rate from A&Eincreasing remained high at 22%

In the first week of May, the Trust’s escalation ward was closed to accommodate building worksdeveloping new cardiac and stroke wards. This ward hosted up to 20 beds which have noweffectively been removed from the Trust’s bed stock. Whilst these beds would normally beclosed over the summer period each year, this year in essence, the effect has been seen twomonths earlier.

1Performance against this standard is represented by % patients admitted/transferred/discharged within 4

hours of arrival time against a target of 95%. Data includes SPH A&E, GUM, EPU & Ashford.

2St. Peter’s A&E performance shown for information.

MonthPerformance(Monitor)1

PerformanceSPH only 2

Q1 2014/15 tbc tbc

2013/14

Q4 2013/14 94.59% 91.07%

Q3 2013/14 95.77% 93.12%

Q2 2013/14 96.34% 94.03%

Q1 2013/14 95.44% 92.50%

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The site remains busy with high numbers of non-elective admissions as well as the continuinghigh levels of activity in the elective sphere as a result of the on-going work to support 18 weekpathways.

2.4 EMERGENCY CARE PATHWAY PROGRAMME UPDATE

The Trust’s emergency care pathway improvement programme is organised into five workstreams.

Workstream 1: A&E Process Redesign

Aims to undertake all assessment, treatment and onward care decisions for all A&E patients within2 hours.

Current and future state pathway mapping complete. Development of RAT (Rapid Assessment & Treatment) process documentation complete. 9th July - senior clinician available in the department for RAT – early assessment by senior

clinician.

Workstream 2: A&E Workforce Redesign

Departmental skill mix review completed. Recruitment process for three consultant posts commenced.

Workstream 3: Acute Hub

Aims to expedite senior assessment to the front of the pathway. The acute hub is working to 5principles:

Operational polices ratified. A new rota, combining the OPAL (Older Persons Assessment & Liaison) team, acute

physicians and some general physicians complete – planned implementation for 1st July. A&E and the acute hub have agreed the pathways for the different patient cohorts to begin

on the 9th July. Specialty in-reach to commence 9th July.

Workstream 4: Consultant Led Ward Care

Each specialty has agreed to the newly defined principles of Consultant-led ward care. Ward activity mapping completed. Criteria-led discharge implemented on two wards.

N.B. Workstream 5 (Ashford Hospital Strategy) is currently on hold whilst NW Surrey CCGundertakes a review of rehabilitation and reablement across NW Surrey. This review isexpected to report in June.

Significant constraints to the improvements in flow throughout the hospital exist as a result ofdelays in recruitment to physician posts. Some key posts – a second stroke consultant andan OPAL consultant - remain vacant despite repeated attempts to recruit.

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3. 18 WEEKS REFERRAL TO TREATMENT TIMES (RTT)

3.1 TRUST POSITION

At aggregate level, the Trust did not deliver against the standard for admitted pathways but wascompliant against the standards for non-admitted and incomplete pathways. At an individualspecialty level, the Trust remains non-compliant against the admitted standard in four specialties,non-compliant against the non-admitted standard in four specialties and non-compliant against theincomplete standard in two specialties.

For the purposes of the Monitor Risk Assurance Framework, performance is measured on anaggregate (rather than specialty) basis and NHS foundation trusts are required to meet the thresholdon a monthly basis. Consequently, the Trust is not compliant for the admitted standard for Q12014/15. This risk has previously been highlighted to Monitor as part of the Trust’s forward look at2014/15.

Failure to meet the 18 week standard at specialty level does not have a further implication withregard to the Risk Assurance Framework, however, failure to achieve at speciality level will incur afinancial penalty under the terms of the contract with North-West Surrey CCG.

3.2 MAY 2014 SPECIALTY PERFORMANCE

May-14

PERFORMANCE

Admittedpathways(Target90%)

Non-admittedpathways(Target95%)

Incompletepathways(Target92%)

General Surgery 82.25% 93.11% 94.41%

Urology 93.00% 97.98% 97.97%

Trauma & Orthopaedics 65.40% 91.50% 88.52%

Ear, Nose & Throat (ENT) 88.42% 95.00% 97.44%

Ophthalmology 94.01% 98.27% 98.18%

Oral Surgery 76.77% 94.81% 96.16%

General Medicine n/a 99.00% 98.13%

Gastroenterology 96.88% 95.34% 98.29%

Cardiology 98.55% 96.42% 95.82%

Dermatology n/a 99.10% 98.49%

Neurology n/a 82.41% 84.63%

Rheumatology n/a 99.38% 98.37%

Geriatric Medicine n/a 100% 97.30%

Gynaecology 92.71% 99.00% 97.87%

Other 97.53% 97.94% 98.91%

Total 83.87% 95.90% 95.33%

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3.2.1 ADMITTED STANDARDThe Trust has experienced some slippage against plan in both ENT and Oral Surgery.These specialties treated a larger than planned number of backlog patients in May, whichaffected performance against the 90% standard. ENT in particular suffered from a number ofpatient cancellations at the end of the month which pushed this specialty into non-compliance – as context, ENT admitted only c.90 patients a month meaning small changesin numbers of patients over and under 18 weeks can have significant effect on the finalpercentage.

This does represent slippage from the initial estimates provided in January. As the Trustbooks all RTT patients chronologically, this will ensure that our longest waiting patients aretreated first and will have the benefit of reducing the admitted waiting list backlog howeverwill have the unwelcome effect of pushing these specialties into non-compliance. As in allspecialties, the Trust continues to ensure that its capacity is utilised most effectively towardslongest waiting patients.

There is more considerable slippage against the plan for recovery in General Surgery. TheTrust has encountered significant issues in obtaining the required private sector capacitywhich was planned for within the recovery trajectory. This is due to a combination of limitedcapacity in the local private sector providers paired with a higher than expected return rate ofreferrals not accepted by these providers. This specialty has also experienced a significantlyhigher than expected rate of additions to the admitted waiting list, an increase of 8%compared to plan. This consistently higher number of additions to the waiting list each weekhas put further pressure on this specialty’s ability to deliver the standard. The Trust hasresponded to this situation by developing a further action plan to address the shortfall incapacity. This plan includes actions to develop additional short term internal capacity as wellas expediting the recruitment of additional permanent consultant surgical staff. The Trust hasagain approached organisations in the local health economy to enquire about additionalcapacity. These actions have been developed and discussed with our colleagues in NorthWest Surrey CCG.

A revised trajectory has been developed with a view to reducing the General Surgerybacklog to a sustainable position by the end of Q2. The specialty has been monitoringprogress against this trajectory for ten weeks is currently consistently meeting the milestonesof this revised plan.

Performance against the trajectory in Trauma and Orthopaedics remains very challenging.Whilst the size of the backlog reduction has been broadly consistent with plan, the size ofthe waiting list continues to remain very high despite additional capacity. This would indicatethat the service may struggle to sustain compliant performance unless the waiting list can bereduced and as a result this specialty is currently exploring options with other NHS providerswith a view to outsourcing a portion of the waiting list to ease this pressure. It is alsobecoming clear that in order to address the size of the waiting list in T&O, discussions arerequired with the CCG with a view to pathway changes that can reduce demand and theseare being actively pursued.

Reductions on backlog against trajectory are provided in Appendix B.

An emerging risk to the Trust’s admitted RTT performance involves the pending restrictionsto access in theatres as a result of vital maintenance work to the ventilation systems. Thisissue is currently being discussed between estates and operational teams however thesustained loss of theatre capacity at this stage of the recovery process presents asubstantial risk to admitted performance across all specialties.

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On 13 June NHS England together with the relevant regulatory bodies announced a jointframework to support planning for operational resilience during 2014/15, covering bothurgent and planned care. Non-recurrent funding allocations will be available to support thedelivery of additional elective activity to improve performance on RTT standards and clearbacklogs. This money is being allocated via area teams who will then agree its use withCCGs and local providers. The Trust is currently awaiting further details of the fundingallocations.

3.2.2 NON-ADMITTED STANDARD

A sizeable backlog has developed over recent months within Neurology. This specialty isnow in a position to begin to clear this backlog with the use of additional capacity; it is notexpected to achieve this for some months however. Performance remains at risk on the non-admitted standard due to the fact that the Neurology specialty routinely only has a breachtolerance of around 5-7 patients a month if it is to meet the 95% standard.

T&O and General Surgery continue to face challenges with this standard as a result of thesize and profile of their waiting lists however continue to make incremental progress.

The Trust aggregate non-admitted standard (used for the purposes of the Monitor RiskAssurance Framework) is not anticipated to be at risk.

3.2.3 INCOMPLETE PATHWAYS STANDARDThe sizable backlogs in Neurology and T&O will continue to put pressure on the 92%incomplete standard until the point where these backlogs are suitably reduced.

The Trust aggregate incomplete standard (used for the purposes of the Monitor RiskAssurance Framework) is not anticipated to be at risk.

3.3 DIAGNOSTICS PERFORMANCE

The Trust has a contractual target to see 99% of all diagnostic referrals (GP direct access andinternal referrals from outpatients) within six weeks from receipt of referral to date of examination;this is place to provide assurance over a key component of the RTT pathway.

TRUST DM01PERFORMANCE

<6wks >6wks %

May-14 4876 16 99.7%

Apr-14 4899 32 99.4%

Mar-14 5007 74 98.5%

Feb-14 4594 63 98.6%

Jan-14 4536 114 97.5%

The Trust is pleased to maintain this high level of performance within its diagnostic services. Achoice of dates is now being offered across the majority of diagnostic tests and the vast majority ofwaits are within national standards providing a best practice patient experience offer within theseservices.

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3.4 CCG JOINT SERVICE INVESTIGATION

NW Surrey CCG has chosen to exercise a contractual option to undertake a Joint ServiceInvestigation into the Trust’s 18 weeks position. This investigation will include a panel made upjointly of CCG staff, Trust representatives and independent members – the panel will have anindependent chair. The scope of the investigation will be to provide assurance over the currentrecovery position as well as understanding the underlying reasons for the problems that arose. Theinvestigation will seek to assure the commissioner and the Trust that appropriate actions are beingtaken and that a robust recovery plan is in place going forward.

The investigation took place w/b 9th and 16th June and the panel has now been adjourned to draftthe report findings. Initial feedback from the panel has been positive and the Trust has beenthanked for the open and honest way in which it approached the process.

The investigation report will be available in line with the dates below:

ASPH Trust Board (31st July 2014) North West Surrey CCG Governing Body (28th July 2014)

discussed at the Joint CCG/Trust Executive Team meeting (30th July 2014)

4. CANCER INDICATORS

The Trust was non-compliant against the 62 day referral to first treatment target for urgent GPreferrals, recording provisional performance of 80.5% in May. The Trust was also not compliantagainst the 62 day standard for patients referred from an NHS Cancer screening service recordingperformance of 50%; however the total number of referrals received by the Trust via this route wasonly two with only one pathway resulting in a breach. Importantly, Monitor will not consider there tobe a breach where trusts fail individual cancer thresholds but only report a single patient breachover the quarter. All other cancer target indicators were compliant in May.

The Trust recorded a total of 9 breaches against the 62 day standard in May (including sharedbreaches with the cancer centre at RSCH). This number of breaches together with those recordedin April places performance against the 62 days standard for Q1at risk – it is not currentlyanticipated that the Trust will be compliant with this standard.

The Urology pathway remains the primary pressure point in terms of cancer performance.Dedicated weekly meetings have been established with the clinical team with the involvement of theDeputy CEO and Chief of Patient Safety. This process has been well supported by the clinicianswithin Urology and a good environment for pathway improvement has been developed.

The Trust operational management team has recently undertaken a review of our CancerPerformance monitoring and governance structures and evaluated our position against recentlypublished guidance from the Intensive Support Team. This has highlighted a number ofopportunities for enhancing these structures and a number of actions have put into place straightaway. A paper with further details of this review will be provided to the board next month.

One key issue requiring urgent attention is the appointment of a Trust Lead Cancer Clinician. Thisimportant post has regrettably remained vacant over the last year despite several attempts toappoint.

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5. STROKE INDICATORS BRIEFING

Performance against the national stroke standards remains inconsistent in areas.

Metric TargetMay-13

Jun-13

Jul-13

Aug-13

Sep-13

Oct-13

Nov-13

Dec-13

Jan-14

Feb-14

Mar-14

Apr-14

A) Proportionof patientsadmitteddirectly to anacute strokeunit within 4hours ofhospital arrival

90% 57% 63% 59% 60% 46% 48% 60% 43% 49% 53% 55% 61%

B) Proportionof patientsspending 90%of their stay ona stroke ward

80% 67% 76% 85% 83% 80% 71% 86% 76% 71% 74% 71% 89%

C) i) Proportionof strokepatientsscanned withinone hour ofhospital arrival

50% 58% 72% 60% 55% 65% 63% 57% 65% 64% 67% 59% 85%

C) ii)Proportion ofstroke patientsscanned within24 hours ofhospital arrival

100% 96% 100% 98% 100% 100% 94% 97% 100% 100% 100% 100% 100%

D)Patientseligible forTHROMBOLYSIS

7 7 5 4 5 8 7 6 7 8 2 15

The Trust operates a stroke unit based across two wards, Holly and Cedar. The service is underchallenge to provide five-day-a-week Consultant ward round cover and have managed this over thelast few months with a locum in place. This is supplemented by specialist nursing and specialisttherapy input enabling cover from 8am to 8pm, 7 days per week.

There remains however, variability of service provision out of hours and no provision for weekendward rounds. The service has identified a series of risks and has put improvement plans in place – asummary of which is below:

Dedicated Hyper-acute Stroke Unit at St Peters hospital - Opens 6th September 2014 Recruit 2nd stroke consultant – interviews 5th June 2014 Development of high risk TIA and low risk TIA clinics on SPH site - high risk moves from

ambulatory care Unit to ward on 6th September 2014. Low risk will move from AshfordOctober 6th 2014

Engagement with RSCH - Implementing partnership plan to create a joint stroke on-call rota. Administrator to help with nurse clinics - on loan from Acute medicine from 27th May

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6. ACTION REQUIRED

The Trust Board is asked to note performance against targets associated with the Monitor RiskAssessment Framework in May 2014 and seek additional assurance as necessary.

Appendices:

Appendix A – A&E performanceAppendix B – Backlog reduction trajectories - General Surgery and T&OAppendix C – Trust Operational Performance Report dashboard – May 2014Appendix D – RTT Indicators

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APPENDIX A: A&E 4-HOUR PERFORMANCE

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APPENDIX B: BACKLOG TRAJECTORY MONITORING

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0

200

400

600

800

1000

1200

1400

Jan-13

Feb-13

Mar-13

Apr-13

May-13

Jun-13

Jul-13

Aug-13

Sep-13

Oct-13

Nov-13

Dec-13

Jan-14

Feb-14

Mar-14

Apr-14

May-14

Jun-14

Nu

mb

er

of

Pat

hw

ays

Incomplete Pathways waiting > 18 Weeks

0

5000

10000

15000

20000

25000

Jan-13

Feb-13

Mar-13

Apr-13

May-13

Jun-13

Jul-13

Aug-13

Sep-13

Oct-13

Nov-13

Dec-13

Jan-14

Feb-14

Mar-14

Apr-14

May-14

Jun-14

Nu

mb

er

of

Pat

hw

ays

Total incomplete pathways

0510152025303540455055606570

Jan-13

Feb-13

Mar-13

Apr-13

May-13

Jun-13

Jul-13

Aug-13

Sep-13

Oct-13

Nov-13

Dec-13

Jan-14

Feb-14

Mar-14

Apr-14

May-14

Jun-14

Nu

mb

er

of

Pat

hw

ays

Incomplete pathways waiting 52+ weeks

0

50

100

150

200

250

300

350

400

450

500

Jan-13

Feb-13

Mar-13

Apr-13

May-13

Jun-13

Jul-13

Aug-13

Sep-13

Oct-13

Nov-13

Dec-13

Jan-14

Feb-14

Mar-14

Apr-14

May-14

Jun-14

Non-Admitted closed > 18 weeks Backlog

0%

10%

20%

30%

40%

50%

60%

70%

80%

90%

100%

Jan-13

Feb-13

Mar-13

Apr-13

May-13

Jun-13

Jul-13

Aug-13

Sep-13

Oct-13

Nov-13

Dec-13

Jan-14

Feb-14

Mar-14

Apr-14

May-14

Jun-14

% w

ith

in 1

8 w

ee

ks

Admitted RTT Performance

Actual Standard

0%

10%

20%

30%

40%

50%

60%

70%

80%

90%

100%

Jan-13

Feb-13

Mar-13

Apr-13

May-13

Jun-13

Jul-13

Aug-13

Sep-13

Oct-13

Nov-13

Dec-13

Jan-14

Feb-14

Mar-14

Apr-14

May-14

Jun-14

% w

ith

in 1

8 w

ee

ks

Non-admitted RTT Performance

Actual Standard

70%

75%

80%

85%

90%

95%

100%

Jan-13

Feb-13

Mar-13

Apr-13

May-13

Jun-13

Jul-13

Aug-13

Sep-13

Oct-13

Nov-13

Dec-13

Jan-14

Feb-14

Mar-14

Apr-14

May-14

Jun-14

% w

ith

in 1

8 w

ee

ks

Incompletes: Percentage Within 18 Weeks

Actual Standard

0

100

200

300

400

500

600

700

800

Jan-13

Feb-13

Mar-13

Apr-13

May-13

Jun-13

Jul-13

Aug-13

Sep-13

Oct-13

Nov-13

Dec-13

Jan-14

Feb-14

Mar-14

Apr-14

May-14

Jun-14

Admitted closed >18 weeks Backlog

Trust Operational Performance Report - May 2014 2014/15

Apr May Jun Jul Aug Sep Oct Nov Dec Jan Feb Mar Apr May YTD

14/15

13/14

Plan

Var Trend

Cancer indicators and

targets Anti Cancer Drug Treatments 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 98% 2.0%

Surgery 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 94% 6.0%

From Consultant Screening Service Referral 100% 100% 100% 100% 100% 93% 100.0% 90% 100.0% 93.8% 100.0% 100% 100% 50.0% 94% 90% 3.8%

Urgent GP Referral To Treatment 87.9% 89.0% 94.8% 87.3% 91.0% 90.4% 90.0% 90.6% 92.1% 93.6% 87.3% 86.5% 74.7% 80.5% 77.6% 85% -7.4%

31-Day Wait For First Treatment All Cancers 100.0% 100.0% 100.0% 100.0% 100.0% 98.9% 100.0% 100.0% 100.0% 97.8% 100.0% 99% 100% 100.0% 100% 96% 4.0%

All Cancers 96.4% 98.3% 97.1% 97.9% 96.6% 95.3% 97.9% 97.9% 95.2% 94.0% 97.2% 95.6% 94.2% 93.2% 94% 93% 0.7%

For symptomatic breast patients 96.4% 98.0% 99.0% 100.0% 93.2% 97.0% 93.8% 98.0% 95.5% 97.2% 97.1% 97.9% 94.1% 93.1% 94% 93% 0.5%

Quality & Safety

Inpatients (Test Score) 68.8 72.1 74.5 77.4 74.2 68.1 73.1 73.0 72.6 74.9 73.7 67.0 71.8 71.3 71.5 70 2.1%

Inpatient (Response Rate) 35.89% 40.39% 47.40% 31.58% 37.00% 40.83% 38.85% 32.10% 45.56% 27.01% 36.30% 43.17% 29.00% 42.59% 35.61% 15% 137.4%

A&E (Test Score) 63.1 51.1 45.3 47.6 49.6 38.9 47.4 54.4 51.6 49.9 42.1 46.1 50.1 43.7 46.9 70 -32.9%

A&E (Response Rate) 3.17% 4.73% 22.46% 19.45% 19.47% 20.49% 17.60% 17.08% 16.83% 17.22% 17.05% 19.06% 17.67% 15.17% 16.34% 15% 9.0%

Maternity Overall (test Score) 77.1 68.1 65.6 68.4 72.7 75.1 73.2 80.0 77.1 72.3 6.7%

Maternity Overall (Response rate) 4.93% 3.75% 5.05% 6.49% 9.64% 16.84% 12.07% 14.31% 13.25% 8% 74.3%

1 0 0 0 0 0 0 3 0 3 0 0 0 0 0 0 0

95.1% 95.40% 95.08% 95.68% 95.68% 95.02% 96.68% 95.78% 96.51% 98.18% 98.11% 97.93% 98.22% 98.23% 96.90% 97.0% -0.10%

8.28% 8.06% 5.59% 8.21% 6.96% 5.35% 4.37% 7.94% 5.97% 7.10% 7.53% 4.70% 5.16% 7.50% 6.4% 8.2% -1.8%

85.7% 82.0% 86.6% 85.5% 86.2% 86.7% 89.3% 85.6% 83.6% 84.0% 83.8% 85.2% 88.0% 85.2% 86.5% 80.0% 6.5%

Activity

84.2% 83.4% 83.5% 84.0% 83.7% 84.7% 83.5% 84.1% 82.7% 85.6% 84.6% 83.2% 84.2% 83.6% 83.9% 84.0% -4.0

8,413 8,524 7,948 8,599 7,773 7,919 8,831 7,976 7,475 9,032 8,326 8,737 8,387 8,233 16,620 - -

5,289 5,440 5,603 6,028 5,263 5,598 6,176 5,840 5,539 6,163 5,429 5,929 5,557 5,661 11,218 - -

Daycase Rate

GP Written Referrals to Hospital

Other Referrals For a First Outpatient Appointment

Breach of Same Sex Accommodation

Smoking During Pregnancy

Breastfeeding Initiation

Friends and Family Test

VTE Risk Assessment

2013/14

Two week wait from referral to date

first seen

All cancers: 62-day wait for first

treatment

All cancers: 31-day wait for second

or subsequent treatment

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