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thequarter.
Quarter 1 2012/13 An update from David Flory, Deputy NHS Chief Executive
Index
01 Introduction
04 Quality
04 HCAI
05
Patient experience
09 Referral to
treatment
13 A&E
14 Ambulance
16 Cancer
18 Long-term
conditions
18 Mental health
22 Emergency
admissions
23 Stroke
23 Dentistry
24 Innovation
25 Productivity
25
Finance
29 Activity
31 Workforce
34 Prevention
34
Health visitors
35 Maternity and
newborn
35 Breastfeeding
35 Smoking
36
Screening (venous
thromboembolism,
breast, cervical,
bowel, diabetic
retinopathy)
37 Immunisation
37
NHS health checks
38 Reform
38 Choice
42 Provision
43 Commissioning
45 Public health
47 Annexes
Introduction
The quarter provides the defi nitive account of how the NHS is
performing at national level against the requirements and indicators
set out in the NHS Operating Framework 2012/13
1
. This edition of the
quarter covers the period from April to June 2012, quarter one (Q1),
the fi rst quarter of the 2012/13 performance year.
As Sir David Nicholson set out in the year
2011/12, 2012/13 represents a crucial year for
the NHS as we complete the planned handover
of health services to new organisations from
April 2013. The passage of the Health and
Social Act 2012 set out the legal framework
that underpins these changes and the next
few months will see the new organisations
preparing to take responsibility for delivery
in the future.
These changes represent an important
opportunity to build new ways of working
that will bridge traditional organisational
boundaries. The planning work which took
place throughout 2011/12 puts us in a strong
position to capitalise on this opportunity and
my primary focus is to ensure the handover of
a strong aggregate performance for the NHS,
with a healthy fi nancial position, to give new
organisations the best possible foundations to
succeed in the future.
Service performance
maintained
The NHS Operating Framework 2012/13
sets out a challenging performance agenda,
balancing the key performance standards with
more outcome-focused measures to prepare
for the future system. Work is ongoing through
the published NHS, Public Health and Social
Care Outcomes frameworks to better align
the defi nition of success across each of these
key delivery organisations. The draft mandate
sets out a framework for future accountability.
Future editions of the quarter will look to refl ect
this progress and it is encouraging to see where
data currently exists, the NHS is beginning to
show progress against these broader measures,
for example in mental health.
Q1 has seen the strong picture reported from
quarter four (Q4) 2011/12 maintained, with
performance indicators showing the NHS
continuing to maintain or improve on all key
measures.
• MRSA bacteraemia were 30 percent lower
than during the same quarter last year and
C. diffi cile infections were 27 percent lower
1 http://www.dh.gov.uk/en/Publicationsandstatistics/Publications/PublicationsPolicyAndGuidance/DH_131360
Gateway reference
number 18244
Quarter 1 2012/13
Enter
thequarter.
• access to services continued to be maintained,
with the NHS delivering above the NHS
constitutional commitment to treatment
within 18 weeks of referral for 90 percent
of admitted patients and 95 percent of
non-admitted services. In addition, the new
standard for 92 percent of patients on an
incomplete pathway to be waiting less than
18 weeks was exceeded, with performance
at 94.1 percent at the end of June 2012
• the number of breaches of mixed sex
accommodation continued to decrease to
a breach rate of 0.2 per 1,000 episodes –
the lowest level ever
• key cancer standards continue to be achieved
across all eight performance measures
• key emergency treatment standards for A&E
access and ambulance response times were
also maintained.
These achievements are hard won and should
be recognised because they have been delivered
in a climate where we know individuals and
organisations are in a state of transition. It is
essential that staff at all levels of the system
continue to focus on performance delivery as
this will lay a fi rm foundation to deliver a secure
transition in the short term and a successful
foundation trust (FT) pipeline in the future.
A secure fi nancial position
The NHS delivered a solid aggregate fi nancial
position at the end of 2011/12. Q1 fi gures
indicate this surplus will be maintained at the
end of 2012/13, with a forecast surplus of
£1,153 million. This places the NHS in a strong
position for future delivery.
The maintenance of this strong fi nancial
position is dependent on the continued
delivery of quality, innovation, productivity
and prevention (QIPP) savings, as programmes
continue to refi ne the way services are
provided. While 2011/12 performance on QIPP
was encouraging, focus needs to continue
through transition and into future years.
QIPP plans have been developed and are
owned by local NHS organisations to make
sure savings plans are anchored in local clinical
reality. The continued successful delivery of the
QIPP challenge is dependent on the successful
delivery of the transformational changes the
NHS has planned, and it is encouraging to
see NHS organisations are continuing to report
that these programmes are on track, with
25 percent of 2012/13 savings delivered.
A managed transition
Progress against the reform programme
continues at pace. Appointments to the NHS
Commissioning Board (NHS CB) are continuing
and the senior structures are in place in readiness
for transition over 2012/13. The confi guration
of clinical commissioning groups (CCGs) has
been confi rmed, with the NHS CB responsible
for supporting the development of CCGs as
they move through the authorisation process.
Delegation of commissioning budgets from
PCTs to emerging CCGs has been very successful
with at least 99 percent of those budgets
requested by emerging CCGs delegated to them
as sub committees of PCT boards, an excellent
indicator of the positive transition towards CCG
governance and leadership. Plans were also
announced in July that the NHS CB will host
and fund a small number of strategic clinical
networks, building on the success of network
activity in the NHS, which will lead to signifi cant
improvements in the delivery of patient care.
The NHS Trust Development Authority (NHS
TDA) was established on 1 June 2012, creating
for the very fi rst time an organisation that
will provide leadership for quality, support for
strong management and a governance structure
tailored specifi cally to help develop NHS trusts
on their journey to FT status.
Quarter 1 2012/13
2
thequarter.
102 NHS trusts currently remain in the FT
pipeline and progress against each NHS trust’s
plans for achieving FT status, as set out in
their individual tripartite formal agreements
(TFAs), is being monitored closely. To refl ect
the fundamental relationship between the
TFA process and performance delivery, we
have integrated TFA monitoring and the NHS
Performance Framework. Annex 5 shows the
results for the latest quarter including the new
TFA data. This is to make sure NHS trusts are
clear on the equal priority for delivery against
plans to become FTs and the continuing delivery
of performance requirements as set out in
the NHS Operating Framework. Achievement
of FT status will only be delivered through
sustained performance delivery. Equally, delivery
against ongoing performance requirements
will only be achieved through the governance
and organisational developments required to
achieve FT status being put in place.
Meanwhile Public Health England has made
some notable progress, with Duncan Selbie
now in post as Chief Executive. Work is under
way across NHS and local authority structures
to make sure that new working relationships
are built and, through directors of public health
locally, strong and accountable health and
wellbeing boards are in place to discharge their
responsibilities. Primary care trust (PCT) clusters
are already delegating powers relating to public
health to local authorities to promote shadow-
working during this transition year, and good
progress is being made in the key areas of
HR and workforce.
Conclusion
The continued achievements highlighted in
this report are a testament to the hard work
of individual NHS staff throughout the system
and I want to thank them for their continued
hard work. However, we cannot be complacent
and as the year progresses, we must continue
to focus on maintaining and improving
performance, to make sure the NHS is in
the best possible position to manage a
smooth transition to the new health system
from April 2013.
Quarter 1 2012/13
3
Quarterly pro-rata ambition for 2012-13
Apr-Jun
Jul-Sep
Oct-Dec
Jan-Mar
Apr-Jun
Jul-Sep
Oct-Dec
Jan-Mar
Apr-Jun
Jul-Sep
Oct-Dec
Jan-Mar
Apr-Jun
Jul-Sep
Oct-Dec
Jan-Mar
Apr-Jun
Jul-Sep
Oct-Dec
Jan-Mar
Apr-Jun
Quarterly MRSA totals
1,200
800
400
0
2007/8 2008/9 2009/10 2010/11 2011/12 2012/13
thequarter.
ytQuali
HCAI
2
Performance status: improved
MRSA infections were 30 percent lower and
C. diffi cile infections were 27 percent lower
than the same quarter last year.
For 2012/13, the NHS Operating Framework
continues to prioritise the achievement of the
MRSA and C. diffi cile objectives. This requires
NHS commissioners and providers to identify
and agree plans for reducing infections in
line with national objectives; an annual
decrease of 29 percent for MRSA and
18 percent for C. diffi cile.
MRSA
In Q1, a total of 223 MRSA bloodstream
infections were reported, a 30 percent
reduction on the same quarter last year.
Figure 1: MRSA bacteraemia: quarterly totals between April 2007 and June 2012
1,600
2 http://www.hpa.org.uk/Topics/InfectiousDiseases/InfectionsAZ/HCAI/
LatestPublicationsFromMandatorySurveillanceMRSACDIAndGRE/
Quarter 1 2012/13
4
Quarterly CDI cases aged 2+
20,000
15,000
10,000
5,000
0
Quarterly pro-rata ambition for 2012-13
Apr-Jun
Jul-Sep
Oct-Dec
Jan-Mar
Apr-Jun
Jul-Sep
Oct-Dec
Jan-Mar
Apr-Jun
Jul-Sep
Oct-Dec
Jan-Mar
Apr-Jun
Jul-Sep
Oct-Dec
Jan-Mar
Apr-Jun
Jul-Sep
Oct-Dec
Jan-Mar
Apr-Jun
2007/8 2008/9 2009/10 2010/11 2011/12 2012/13
thequarter.
C. diffi cile
In addition, from April 2012, the Department
For C. diffi cile, 3,650 infections were reported
of Health introduced new guidance that
in Q1, a 27 percent improvement on the same
strengthens C. diffi cile testing and reporting
quarter last year.
arrangements, helping healthcare providers
improve the management of C. diffi cile
infection.
Figure 2: C. difficile cases aged two or more years: quarterly totals between April 2007
and June 2012
Patient experience
Eliminating mixed sex
accommodation
3
Performance status: improved
The overall trend of steadily reducing breaches
continued over Q1. After a one-off increase
reported for April 2012 (due to the position
at a small handful of trusts), the fi gures for
May and June resumed the downward trend.
From April 2011, all providers of NHS-funded
care have been required to declare compliance
with the national defi nition, or face fi nancial
penalties. From this date, fi nes of £250 for
every breach were introduced. This money
is reinvested into patient care.
Reporting requires all breaches of sleeping
accommodation to be captured for each patient
affected. Figures are revised every six months
following validation with commissioners.
Nineteen months of data is now available and
there has been a steady reduction in the breach
rate as shown in Figure 3 (Q1 fi gures in shaded
boxes). *Asterisked fi gures are unrevised.
3 http://transparency.dh.gov.uk/2012/07/10/mixed-sex-accommodation/
Quarter 1 2012/13
5
0
thequarter.
Figure 3: Number of breaches of mixed sex
accommodation
Month
MSA
breaches
Breach
rate
June 2012 *325 0.2
May 2012 *434 0.3
April 2012 *559 0.4
March 2012 466 0.3
February 2012 581 0.4
January 2012 626 0.4
December 2011 795 0.6
November 2011 937 0.6
October 2011 1,236 0.8
September 2011 1,063 0.7
August 2011 1,083 0.8
July 2011 1,075 0.7
June 2011 1,939 1.3
May 2011 1,908 1.4
April 2011 2,236 1.6
March 2011 5,466 3.6
February 2011 8,031 6.0
January 2011 8,708 6.4
December 2010 11,802 8.4
Figure 4: Mixed sex accommodation total breaches and breach rate for England
2,000
4,000
6,000
8,000
10,000
12,000
14,000
Dec 10
Jan 11
Feb 11
Mar 11
Apr 11
May 11
Jun 11
Jul 11
Aug 11
Sep 11
Oct 11
Nov 11
Dec 11
Jan 12
Feb 12
Mar 12
Apr 12
May 12
Jun 12
0
0
0
0
0
0
0
0
ec
10
an
11
eb
11
a
r 11
pr
11
ay 11
un
11
l
11
ug
11
ep
11
Oct
11
ov
11
ec
11
a
n 1
2
e
b 12
ar 1
2
p
r 12
a
y 12
u
n 1
2
0
1
2
3
4
5
6
7
8
9
Number of MSA breaches
MSA breaches per 1,000 FCE’s
Breach rate MSA breaches
The reporting arrangements ensure a higher
degree of scrutiny and transparency to
eliminate mixed sex accommodation. Breaches
of guidance relating to bathrooms, WCs, and
day areas in mental health units are monitored
and resolved locally through the usual contract
arrangements. Occurrences of mixing in the
best interests of patients are monitored locally
but not reported centrally.
Quarter 1 2012/13
6
thequarter.
Friends and family
On Friday 25 May 2012 the Prime Minister
announced details of a ‘friends and family test’
to be implemented in the NHS in response to
recommendations made by the Nursing Care
Quality Forum.
He said:
“We’re moving ahead quickly [with] the friends
and family test. In every hospital, patients are
going to be able to answer a simple question:
whether they’d want a friend or relative to be
treated there in their hour of need. By making
tho
se answers public we’re going to give
everyone a really clear idea of where to get the
best care – and drive other hospitals to raise
their game.”
From April 2013, patients will be asked a
simple question to identify whether they would
recommend their friends or family to receive
similar care or treatment in a particular acute
hospital ward or accident and emergency unit.
Guidance on how to implement the friends and
family test within adult inpatient and A&E services,
which was developed in conjunction with the
NHS, was published on 4 October 2012.
4
Patient Reported Outcome
Measures (PROMs)
5
Performance status: improved
Participation rates in PROMs data collections
continue to rise, with 74 percent of eligible
patients completing a pre-operative
questionnaire in 2011/12, compared to 70
percent in 2010/11 and 66 percent in 2009/10.
The latest provisional data covering April
2011 to March 2012 shows a continuing
improvement in compliance. The number of
patients returning pre-operative questionnaires
(182,930) and the national participation rate
Figure 5: Headline PROMs data, England
(74 percent) show a clear upward trend. The
national participation rate is approximately
4 percentage points higher than in 2010/11,
which in turn was 3.7 percentage points higher
than in 2009/10.
The data for April 2011 to March 2012 published
on 15 August 2012 shows the percentage
of patients reporting an improvement for all
four procedures has been maintained. For
example, 95.9 percent of patients receiving a
hip replacement and 91.6 percent of patients
receiving a knee replacement report an
improvement, up from 95.8 percent and
91.4 percent respectively in 2010/11.
Procedure Year*
Average health
gain (EQ-5D,
case-mix
adjusted)
% of patients
reporting
improved
health status**
Hip replacement
2009/10 0.411
87.2 – 95.7
2010/11 0.405
86.7 – 95.8
2011/12 0.417 87.4 – 95.9
Knee replacement
2009/10 0.295
77.6 – 91.4
2010/11 0.299
77.9 – 91.4
2011/12 0.305 78.8 – 91.6
Varicose vein
2009/10 0.094
52.4 – 83.4
2010/11 0.094
51.6 – 82.5
2011/12 0.096 53.5 – 83.7
Groin hernia
2009/10 0.082
49.3
2010/11 0.085
50.5
2011/12 0.088 50.2
* 2009/10 and 2010/11 data fi nalised; 2011/12 is provisional data meaning scores are subject to change as
more data is processed throughout the year.
** Ranges present the EQ-5D index score and condition-specifi c scores. There is no condition-specifi c measure
for groin hernia surgery.
4 http://www.dh.gov.uk/health/2012/10/guidance-nhs-fft/
5 http://www.hesonline.nhs.uk/Ease/ContentServer?siteID=1937&categoryID=1295
Quarter 1 2012/13
7
thequarter.
Analysis
6
of the 2011/12 data indicates that a
number of organisations seem to be ‘outliers’
on certain procedures, when compared to
the national average. Figure 6 shows the
organisations whose performance is statistically
better than the national average for two
outcome measures. 11 other organisations
appear as a positive outlier for one outcome
measure.
Figure 6: List of potential statistical positive ‘outlier’ organisations for 2011/12
(provisional data)
Organisation name Procedure
Royal Devon and Exeter NHS Foundation Trust Hip replacement
The Horder Centre – St John’s Road, Sussex
Hip replacement
Inclusion criteria: Statistically above average scores (>3 standard deviations) for EQ-5D index and condition
specifi c index (Oxford hip score or Oxford knee score or Aberdeen varicose vein score).
Figure 7 shows organisations whose outcomes
are statistically below the average for two
outcome measures. There are 15 other
organisations that appear as a negative outlier
for one outcome measure. Organisations in
Figure 7 are encouraged to investigate their
own score to understand any underlying
causes for the variation in performance.
Figure 7: List of potential statistical negative ‘outlier’ organisations for 2011/12
(provisional data)
Organisation name Procedure
Barts and the London NHS Trust Varicose vein
Doncaster and Bassetlaw Hospitals NHS Foundation Trust Knee replacement
Heart of England NHS Foundation Trust Hip replacement
Royal National Orthopaedic Hospital NHS Trust Knee replacement
South London Healthcare NHS Trust Knee replacement
The Hillingdon Hospitals NHS Foundation Trust Hip replacement
Walsall Healthcare NHS Trust Hip replacement
Inclusion criteria: Statistically below average scores (> 3 standard deviations) for EQ-5D index and condition
specifi c index (Oxford hip score, Oxford knee score or Aberdeen varicose vein score).
6 The outlier methodology was published on the Department’s website in July 2011
http://www.dh.gov.uk/en/Publicationsandstatistics/Publications/PublicationsPolicyAndGuidance/DH_128440.
Quarter 1 2012/13
8
45
50
55
60
65
70
75
80
85
90
95
100
Percentage of RTT pathways
Mar 07
May 07
Jul 07
Sep 07
Nov 07
Jan 08
Mar 08
May 08
Jul 08
Sep 08
Nov 08
Jan 09
Mar 09
May 09
Jul 09
Sep 09
Nov 09
Jan 10
Mar 10
May 10
Jul 10
Sep 10
Nov 10
Jan 11
Mar 11
May 11
Jul 11
Sep 11
Nov 11
Jan 12
Mar 12
May 12
Admitted (unadjusted) Non-admitted
Admitted (adjusted) Incomplete
Month
thequarter.
Referral to treatment
(RTT) consultant-led
waiting times
7
Performance status: maintained
The patient right ‘to access services within
maximum waiting times, or for the NHS to
take all reasonable steps to offer you a range
of alternative providers if this is not possible’
remains in the NHS Constitution in England.
8
In the three months to June 2012, the NHS
as a whole continued to deliver the NHS
Constitution standards, that 90 percent of
admitted patients and 95 percent of non-
admitted patients should start their treatment
within 18 weeks of referral (Figure 8). In June
2012, 92.1 percent of admitted patients and
97.8 percent of non-admitted patients started
treatment within 18 weeks.
The NHS has delivered the 2012/13 operational
standard that 92 percent of patients on an
incomplete pathway should have been waiting
less than 18 weeks, at the end of each of the
three months of this quarter. At the end of June
2012, 94.1 percent of patients on an incomplete
pathway had been waiting less than 18 weeks.
Figure 8: Percentage of RTT pathways within 18 weeks, England
All organisations must make sure patients
receive clinically appropriate treatment in
accordance with the NHS Constitution. To
deliver the NHS Constitution right, and in the
best interests of patients, it is good practice
to publish local access policies that have been
agreed with clinicians and patients and are in
line with national referral to treatment rules.
Where current performance does not meet the
NHS Constitution operational standards, action
must be taken to make sure patients are not
waiting unnecessarily to start treatment and to
make sure improvements are made as quickly
as possible.
7 http://transparency.dh.gov.uk/2012/06/29/rtt-waiting-times/
8 http://www.dh.gov.uk/en/Publicationsandstatistics/Publications/PublicationsPolicyAndGuidance/DH_132961
Quarter 1 2012/13
9
thequarter.
Figure 9 shows the 10 organisations reporting
the best performance against the 2012/13
performance measures in June 2012.
Figure 9: Acute trusts with best performance on referral to treatment waits in June 2012
Performance thresholds
Name
Royal National Hospital for Rheumatic Diseases
NHS Foundation Trust
<90% <95% <92% >20
Total
indicators
worse than
threshold
Adm %
within
18 weeks
Non-adm
% within
18 weeks
Incomplete
% within
18 weeks
Treatment
functions
not met
100.0% 98.4% 99.1% 0 0
West Suffolk NHS Foundation Trust
100.0% 100.0% 100.0% 0 0
Chesterfi eld Royal Hospital NHS
Foundation Trust
99.1% 99.9% 99.2% 0 0
Gateshead Health NHS Foundation Trust
98.4% 99.3% 98.3% 0 0
Clatterbridge Centre for Oncology NHS
Foundation Trust
97.6% 96.9% 97.6% 0 0
Northampton General Hospital NHS Trust
97.4% 98.8% 97.1% 0 0
University Hospitals Birmingham NHS
Foundation Trust
97.2% 99.6% 95.8% 0 0
Blackpool Teaching Hospitals NHS
Foundation Trust
96.4% 97.7% 95.1% 0 0
Salford Royal NHS Foundation Trust
Liverpool Women’s NHS Foundation Trust
96.1%
96.1%
96.8%
96.6%
97.4%
92.9%
0
0
0
0
Quarter 1 2012/13
10
thequarter.
Figure 10 shows the 10 organisations reporting
the poorest performance across the 2012/13
performance measures in June 2012.
Figure 10: Acute trusts with poorest performance on referral to treatment waits
in June 2012
Performance thresholds
Name
Mid Staffordshire NHS Foundation Trust
The Robert Jones and Agnes Hunt
Orthopaedic Hospital NHS Foundation Trust
Imperial College Healthcare NHS Trust
James Paget University Hospitals NHS
Foundation Trust
Nottingham University Hospitals NHS Trust
Pennine Acute Hospitals NHS Trust
Guy’s and St Thomas’ NHS Foundation Trust
North Bristol NHS Trust
Shrewsbury and Telford Hospital NHS Trust
The Walton Centre NHS Foundation Trust
<90% <95% <92% >20
Total
indicators
worse than
threshold
Adm %
within
18 weeks
Non-adm
% within
18 weeks
Incomplete
% within
18 weeks
Treatment
functions
not met
74.0% 88.7% 84.1% 26 4
3
3
2
2
2
2
2
1
1
48.5% 86.2% 68.1% 6
82.5% 95.5%
99.4%
98.7%
95.4%
97.0%
97.1%
96.6%
97.6%
91.5% 22
72.4% 85.3% 12
8
18
13
84.5% 91.6%
86.4% 90.1%
88.4% 90.7%
90.5% 61.1% 23
77.5% 94.6%
97.6%
4
183.8%
During the three months to June 2012, the
NHS has also made good progress in reducing
numbers of patients still waiting a long time
to start treatment. In particular, the number of
patients still waiting over a year at the end of
June 2012 has reduced to 3,500 (0.1 percent
of total waiting list), compared to 13,257 (0.5
percent of total waiting list) at the end of June
2011. This reduction is a result of action taken
by local health communities to treat patients
who have been waiting a long time, and action
taken to validate waiting lists.
Average waiting times for the 15 key diagnostic
tests remained low and stable in the three
months to June 2012. This has been achieved
during a period of increasing activity. In the
three months to June 2012, total diagnostic
activity increased by 7 percent (267,000 tests)
compared to the same period in 2011.
In April and May, the NHS as a whole delivered
the 2012/13 operational standard for diagnostic
waiting times, that less than 1 percent of
patients should be waiting six weeks or longer
for a diagnostic test. The standard was not
delivered for June 2012, with 1.3 percent of
patients waiting six weeks or longer for one
of the 15 key diagnostic tests at the end of
the month.
A small number of trusts are responsible for a
large proportion of the waits of six weeks or
longer reported at the end of June 2012.
Figure 11 shows the acute trusts with the
largest percentages of waits of six weeks or
longer at the end of June 2012.
Quarter 1 2012/13
11
thequarter.
Figure 11: Acute trusts reporting the largest percentages of diagnostic waits of six weeks
or longer at the end of June 2012
Provider name
Number of
6+ week
waits
Total number
of patients
waiting for
a diagnostic
test
6+ week
waits as a
percentage
of total
waits
Brighton and Sussex University Hospitals NHS Trust
1,163 6,302 18.5%
University Hospitals of Leicester NHS Trust
660 7,683 8.6%
Gloucestershire Hospitals NHS Foundation Trust
490 5,745 8.5%
University Hospitals Bristol NHS Foundation Trust
370 4,506 8.2%
Bradford Teaching Hospitals NHS Foundation Trust
332 4,573 7.3%
King’s College Hospital NHS Foundation Trust 330 5,054 6.5%
Sherwood Forest Hospitals NHS Foundation Trust
292 4,504 6.5%
Hampshire Hospitals NHS Foundation Trust
260 4,025 6.5%
Peterborough and Stamford Hospitals NHS
Foundation Trust
206 3,314 6.2%
Mid Staffordshire NHS Foundation Trust
193 3,600 5.4%
Guy’s And St Thomas’ NHS Foundation Trust 190 3,932 4.8%
The Dudley Group of Hospitals NHS Foundation Trust
146 3,071 4.8%
Oxford University Hospitals NHS Trust
142 3,059 4.6%
Ipswich Hospital NHS Trust
140 3,507 4.0%
Heart of England NHS Foundation Trust
136 3,653 3.7%
East and North Hertfordshire NHS Trust
134 3,974 3.4%
Great Western Hospitals NHS Foundation Trust
East Cheshire NHS Trust
125
112
4,040
3,932
3.1%
2. 8%
Quarter 1 2012/13
12
thequarter.
A&E
9
Performance status: maintained
At Q1, 96.6 percent of patients spent four
hours or less from arrival to admission, transfer
to discharge, across all A&E types. This remains
above the 95 percent standard, although
slightly lower than the same period last year.
Figure 12 shows performance against the total
time indicator, with quarterly monitoring A&E
return (QMAE) as the data source until quarter
two 2011/12 (Q2). Following the fundamental
review of data returns consultation, QMAE
ceased to be collected from January 2012.
Situation (sit-rep) data, which is directly
comparable, is now the data source.
New clinical quality indicators for A&E were
introduced in April 2011. These have put in
place more meaningful performance measures
that balance timeliness of care with other
indicators of quality, including clinical outcomes
and patient experience. There are eight clinical
quality indicators, which will continue to be in
place during 2012/13 for local use.
In line with the previous quarter, the NHS
should continue to focus on improving data
quality for these indicators in 2012/13, as
well as ensuring compliance with the total
time indicator.
Figure 12: Percentage of patients spending four hours or less at all types of A&E
by quarter, England
70
75
80
85
90
95
100
Percentage
Q1
2011/12
97.0%
97.3%
96.3%
95.8%
96.6%
Q3
2011/12
Q4
2011/12
Q1
2012/13
Q2
2011/12
DH QMAE collection, DH WSitAE collection from Q3 2011/12
Note scale does not start at zero
9 http://transparency.dh.gov.uk/2012/06/14/ae-info/
Quarter 1 2012/13
13
thequarter.
Ambulance
10
Performance status: maintained
Performance data on the Category A calls
eight-minute response time standard (A8) of 75
percent and the 19-minute (A19) transportation
standard of 95 percent is published monthly.
From June 2012, response times for the A8
standard were reported separately for Category
A Red 1 calls (defi ned as incidents presenting
conditions which may be immediately life
threatening) and Category A Red 2 calls
(defi ned as incidents presenting conditions
which may be life threatening, but less time-
critical), in line with changes announced to the
NHS in May 2012. This change also introduced
different clock start times for Red 1 and Red
2 calls and therefore for Q1 it is not possible
to provide an aggregated fi gure for the A8
standard. For Q2 2012/13, it will be possible
to provide separate aggregated fi gures for
Category A Red 1 and Category A Red 2 calls,
as these categorisations will have been used
across all three months of the period.
For the fi rst two months of Q1, 75.5 percent
of Category A calls were responded to in eight
minutes. In June 2012, 75.4 percent of Category
A Red 1 and 77.3 percent of Category A Red 2
calls were responded to within eight minutes.
The proportion of Category A calls resulting
in an ambulance arriving at the scene within
19 minutes of a request for transport being
made was 96.6 percent, comparable to the Q4
2011/12 fi gure of 96.5 percent.
The data shows that fast response times for the
most seriously ill patients are being maintained,
as represented in Figures 13 and 14.
Figure 13: Percentage of Category A calls responded to within eight minutes of call being
connected (England)
50
55
60
65
70
75
80
Apr May June July Aug Sep Oct Nov Dec Jan Feb Mar
2011/12 2012/13 2012/13 (Red 1) 2012/13 (Red 2) Standard
Percentage
Prior to April 2011, data for the Category A 8 minutes measure was collected weekly via the weekly sit-reps, but has been
aggregated here to create a monthly time series. The weekly period covered each month will vary, either covering a period
of four or fi ve weeks.
Data for Category A 8 minutes measure for June 2012 onwards is now split into two categories, Red
1 and Red 2. Due to the way Red 1 and Red
2 ‘clock starts’ are defi ned they do not sum to the old Category A 8 data and
therefore they have been shown separately on the graph.
10 http://transparency.dh.gov.uk/category/statistics/amb-quality-indicators/
Quarter 1 2012/13
14
Standard
2011/12 2012/13
thequarter.
Figure 14: Percentage of Category A calls responded to within 19 minutes of call being
connected (England)
93.5
94.0
94.5
95.0
95.5
96.0
96.5
97.0
97.5
Apr May June July Aug Sep Oct Nov Dec Jan Feb Mar
Percentage
Ambulance data is also collected and published
monthly on the clinical quality indicators.
No performance standards have been set for
these indicators.
There were over 1,191,000 emergency
journeys in Q1. The system measures for Q1
show that 1.1 percent of callers abandoned
their call before the call was answered by the
ambulance service, compared to 1.2 percent
in Q4 2011/12. The proportion of patients
re-contacting the ambulance service following
discharge of care by telephone remained the
same in Q1 as in Q4 2011/12, at 14 percent.
The re-contact rate following discharge of care
from treatment at the scene rose slightly from
5.6 percent in Q4 2011/12 to 5.8 percent in Q1.
The proportion of calls closed with telephone
advice was 5.7 percent in Q1, an increase from
the Q4 2011/12 fi gure of 5.6 percent. The
proportion of incidents receiving a face-to-face
response from ambulance services, that were
managed without the need for transport to
A&E, increased to 35.1 percent in Q1 from 34.4
percent in Q4 2011/12.
Quarter 1 2012/13
15
thequarter.
Cancer
11
Performance status: maintained
The NHS has continued to maintain
performance for all cancer waiting times
measures in the NHS Operating Framework
2012/13. All requirements for maximum waiting
times for diagnosed and suspected cancer
patients were met during Q1, and performance
was above the published operational standards.
Figure 15: Performance against cancer waiting time standards
Measure
Operational
standard
Q1 2012/13
Performance
Maximum two-week wait for fi rst outpatient appointment for
patients referred urgently with suspected cancer by a GP
93% 95.2%
Maximum two-week wait for fi rst outpatient appointment for
patients referred urgently with breast symptoms (where cancer
was not initially suspected)
93% 95.2%
Maximum two month (62-day) wait from urgent GP referral to fi rst
defi nitive treatment for cancer
85% 87.5%
Maximum 62-day wait from referral from an NHS screening service
to fi rst defi nitive treatment for all cancers
90% 94.6%
Maximum 62-day wait for fi rst definitive treatment following
a consultant’s decision to upgrade the priority of the patient
(all cancers)
No operational
standard has
been set
93.9%
Maximum one month (31-day) wait from diagnosis to fi rst
defi nitive treatment for all cancers
96% 98.4%
Maximum 31-day wait for subsequent treatment where that
treatment is surgery
94% 97.4%
Maximum 31-day wait for subsequent treatment where that
treatment is an anti-cancer drug regimen
98% 99.6%
Maximum 31-day wait for subsequent treatment where the
treatment is a course of radiotherapy
94% 97.5%
All data is taken from the Q1 2012/13 National Statistics and are provider-based (including Welsh and unknowns)
Only five providers failed to achieve the
operational standard for three or more cancer
waiting times measures in Q1 2012/13 (see
Figure 16 below).
11 http://transparency.dh.gov.uk/category/statistics/provider-waiting-cancer/
Quarter 1 2012/13
16
thequarter.
Figure 16: Cancer waiting time standards: identified outlier organisations
Cancer waiting
times standard
All cancer two week wait
All cancer one month standard
31-day standard: subsequent surgery
31-day standard: subsequent anti-cancer
drug regimen
31-day standard: subsequent radiotherapy
Two month fi rst treatment standard
62-days from screening service
Two week wait for breast symptoms
Number of measures failed
Required
operational
standard
93% 96% 94% 98% 94% 85% 90% 93%
Provider % % % % % % % % n
Barts and the London
NHS Trust
94.1% 96.9% 97.4% 100.0% 96.6%
97.2%
94.9%
99.8%
100.0%
81.3% 87.5% 88.1% 3
7
4
4
3
Imperial College
Healthcare NHS Trust
92.9% 91.3% 86.9% 97.0% 66.0% 68.2% 90.2%
United Lincolnshire
Hospitals NHS Trust
93.4% 97.8% 96.0%
96.0%
100.0%
96.9% 83.8% 87.7% 87.9%
Nottingham
University Hospitals
NHS Trust
91.2% 95.1% 99.7%
100.0%
81.3% 94.4%
96.7%
89.2%
Gloucestershire
Hospitals NHS
Foundation Trust
88.2% 99.7% 83.0% 87.2%
Period: Q1 2012/13 (April, May and June)
Basis: Provider-based including Welsh cross-border patients and ‘unknowns’
Defi nitions: DSCN 20/2008
Note 1: Only providers reporting five or more cases in the period are identified in this analysis
Note 2: Only providers that failed three or more waiting times requirements in the period are identified in this analysis
Quarter 1 2012/13
17
Enhancing quality of
life for people with
long-term conditions
Long-term conditions
The NHS Operating Framework 2012/13 sets out
the commitment to transform care for people
with long-term conditions, a central challenge
to delivering better quality and productivity.
For 2012/13, performance will be judged across
three key measures:
• the proportion of people feeling supported
to manage their condition
• unplanned hospitalisation for chronic
ambulatory care sensitive conditions (adults)
• unplanned hospitalisation for asthma,
diabetes and epilepsy (in under 19s).
As this is an existing measure, baseline data
for the proportion of people feeling supported
to manage their condition is already available
and will be updated every six months. Work is
currently underway to develop the remaining
two new indicators and once data is available,
it will be published alongside other performance
data in the quarter.
Domain two of the NHS Outcomes Framework
2012/13
12
(Enhancing quality of life for people
0.0
0.5
1.0
1.5
2.0
2.5
Q1
2010/11
Q3
2010/11
Q4
2010/11
Q1
2011/12
Q2
2011/12
Q4
2011/12
Q3
2011/12
Q2
2010/11
Access rate
National Operating Framework trajectory
thequarter.
with long-term conditions) sets out a broader
suite of measures for measuring performance in
future years.
Mental health
The NHS Operating Framework 2012/13 states
that PCT clusters need to consider the mental
health outcomes strategy No Health Without
Mental Health
13
to support local commissioning.
For 2012/13, particular focus is needed on
improving access to psychological therapies (IAPT),
children and young people, and offender health.
Improving access to
psychological therapies
The latest provisional data for Q4 2011/12
shows the number of people entering IAPT
treatment services has continued to improve in
comparison to previous quarters.
In Q4 2011/12:
• 244,960 people were referred for psychological
therapies, an increase of over 14 percent from
Q3. This represents 2.42 percent of all people
entering mental health treatment nationally
• 149,916 people entered treatment, an
increase of over 15 percent since Q3
• a total of 5,640 people moved off sick pay
and benefi ts, an increase of 152 people or
2.7 percent since Q3.
Figure 17: Number of people entering IAPT treatment nationally
Percentage
0.0
0.5
1
.
0
1
.
5
2
.
0
2.5
g
Q1
2010
/11
Q3
2010
/11
Q4
2010
/11
Q
1
2011
/12
Q2
2011
/12
Q
4
2011
/12
Q3
2011
/12
Q2
2010
/11
12 http://www.dh.gov.uk/en/Publicationsandstatistics/Publications/PublicationsPolicyAndGuidance/DH_131700
13 http://www.dh.gov.uk/en/Publicationsandstatistics/Publications/PublicationsPolicyAndGuidance/DH_123766
Quarter 1 2012/13
18
thequarter.
Specialist community mental health services
continue to provide high quality services. In
meeting the QIPP challenge, PCTs met 33.7
percent of the full year plans for people
with the fi rst onset of early psychosis. Crisis
resolution home treatment (CRHT) teams
treated 97.9 percent of acute mentally ill
patients who would otherwise have required
admission to hospital.
Early intervention (EI)
Early intervention in psychosis teams saw
2,528 new patients in Q1, which is 33.7 percent
of the total plans for the year (7,500 yearly).
Figure 18: EI services: Number of new cases seen in Q1 of 2012/13 by SHAs compared
to yearly plans
SHA name
Yearly plans
set for new
cases of
psychosis
served by EI
teams
Total number
of new EI
cases in year
Percentage
of new cases
plans met
England 7,500 2,528 34%
North East 459 169 37%
North West 1,203 389 30%
Yorkshire and the Humber 803 304 34%
East Midlands 577 206 42%
West Midlands 816 234 30%
East of England 658 254 34%
London 1,392 451 33%
South East Coast 515 146 40%
South Central 468 151 28%
South West 609 224 40%
Data source: Department of Health
Quarter 1 2012/13
19
thequarter.
Crisis resolution
In Q1, 97.9 percent of all admissions to
psychiatric inpatient wards were gate kept by
CRHT teams, compared to 97.0 percent in the
same period in 2011/12. Nine SHAs met the
threshold that 95 percent of admissions were
gate kept and seven SHAs achieved over
97.9 percent, the national average.
Figure 19:
Crisis resolution services: The proportion of patients gate kept by CRHT teams
in Q1 by SHAs
Name
Number of
admissions
to acute
wards gate
kept by
CRHT teams
Total
number of
admissions
to acute
wards
Proportion of
admissions
to acute
wards that
were gate
kept by the
CRHT teams
England 17,716 18,092 97.9%
North East 726 739 98.2%
North West 2,895 2,941 98.4%
Yorkshire and the Humber 1,596 1,616 98.8%
East Midlands 1,110 1,135 97.8%
West Midlands 1,685 1,694 99.5%
East of England 1,663 1,779 93.5%
London 4,058 4,120 98.5%
South East Coast 1,439 1,452 99.1%
South Central 1,136 1,182 96.1%
South West 1,408 1,434 98.2%
Data source: Department of Health
Quarter 1 2012/13
20
thequarter.
Care programme approach (CPA)
follow-up
Of all patients on a CPA that were discharged
from psychiatric inpatient care, 97.5 percent
were followed up within seven days of
discharge, an improvement from 96.7 percent
in the same period last year. All SHAs met the
threshold that at least 97 percent of patients
are followed up within seven days of discharge.
Figure 20:
CPA: The proportion of patients followed up within seven days of discharge
in Q1 by SHAs
Name
Number of
patients
followed up
within seven
days
Total number
of patients
discharged
Proportion
of patients
followed up
within seven
days
England 16,650 17,078 97.5%
North East 962 985 97.7%
North West 2,749 2,829 97.2%
Yorkshire and the Humber 1,342 1,382 97.1%
East Midlands 1,162 1,194 97.3%
West Midlands 1,897 1,952 97.2%
East of England 1,574 1,614 97.5%
London 2,781 2,849 97.6%
South East Coast 942 968 97.3%
South Central 1,584 1,631 97.1%
South West 1,657 1,674 99.0%
Data source: Department of Health
Quarter 1 2012/13
21
thequarter.
Helping people to
recover from episodes
of ill health or
following injury
Emergency admissions for acute
conditions that should not usually
require hospital admission
This measure in the NHS Operating Framework
2012/13 is derived directly from the overarching
indicator for domain three of the NHS
Outcomes Framework 2012/13 ‘Helping
people to recover from episodes of ill health
or following injury’.
The NHS Information Centre for Health and
Social Care (NHS IC) has published quarterly
fi gures for this indicator from 2003/04
to 2010/11. They show an increase in the
proportion of emergency admissions for acute
conditions that should not usually require
hospital admission over the period. These
conditions include (but are not limited to) ear,
nose and throat infections, kidney and urinary
tract infections, and heart failure.
The Department estimates it should be possible
to reduce emergency hospital admissions
from 2011/12 to 2014/15 through local QIPP
programmes, which aim to identify trends in
inappropriate local emergency admission. Local
initiatives are being developed in partnership
with primary care that would assist with this
reduction.
Supporting this, from 2011/12 the Quality and
Outcomes Framework
14
contains indicators
that reward GP practices for working to reduce
emergency admissions. From April 2012, the
framework contains new indicators on reducing
avoidable A&E attendances through improving
care provided and access to primary care. These
indicators could reduce avoidable admissions,
by providing incentives to reduce emergency
admissions.
The Department will continue to monitor
emergency admissions for acute conditions that
should not usually require hospital admission
and would expect local NHS organisations
to focus on improving local provision of care
to reduce the number of avoidable A&E
admissions. Figures for Q1 2011/12 will be
published by the NHS IC in December 2012.
14 http://www.nhsemployers.org/Aboutus/Publications/Documents/QOF_2012-13.pdf
Quarter 1 2012/13
22
thequarter.
Stroke
Performance status: maintained
Improving stroke care remains a priority for
the NHS and latest data shows the NHS is
maintaining improvements and will continue to
iron out regional variations, which is crucial to
improving outcomes for patients.
In Q1, 84.3 percent of stroke patients spent
90 percent or more of their hospital stay in a
stroke unit. This is an increase in performance
compared to Q4 2011/12, where the
corresponding fi gure was 81.7 percent.
There is clear evidence that care in a stroke unit
improves outcomes. This has increased by over
20 percent since 2009, but there is still variation
between areas and the NHS is continuing to
work on this.
70.8 percent of transient ischaemic attack cases
with a higher risk of minor stroke were treated
within 24 hours. This is a slight decrease on Q4
2011/12, where the corresponding fi gure was
71.2 percent, but a 15 percent increase since
the corresponding quarter in 2009.
Maintaining this improvement is crucial to
reducing the likelihood of people going on to
experience a full stroke.
Dentistry
Performance status: maintained
Latest data for Q1 shows the number of
patients accessing NHS dentistry has been
maintained from Q4 2011/12 at approximately
29.6 million, having grown from a fi gure of
26.9 million in June 2008. There has been an
overall increase of 402,000 patients accessing
services, based on the same quarter in the
previous year.
Part of the Department’s plan to tackle
children’s dental health, and more specifi cally
those at risk of cavities, was published in our
paper Delivering Better Oral Health.
15
It is part
of the broader preventative approach to oral
care that is widely supported by dentists. As a
consequence of this approach, the number of
fl uoride varnish procedures has gone up by
63.5 percent since last year.
In April 2011, the Department announced pilots
to run in advance of the introduction of a new
dental contract based on registration, capitation
and quality, with the aim of increasing access
and enabling dentists to focus on improving oral
health. Elements needed to design that new
contract are being piloted in 70 dental practices
across England – these started on 1 September
2011 and will run until March 2013. The new
contract and new commissioning system should
deliver a service where dentists are encouraged
and motivated to deliver high quality care,
focused on improving patients’ oral health.
Figure 21: Number of patients seen by an NHS dentist (millions)
20
22
24
26
28
30
Millions
31 Mar 06
31 Mar 07
31 Mar 08
30 Jun 08
30 Sep 08
31 Dec 08
31 Mar 09
30 Jun 09
30 Sep 09
31 Dec 09
31 Mar 10
30 Jun 10
30 Sep 10
31 Dec 10
31 Mar 11
30 Jun 11
30 Sep 11
31 Dec 11
31 Mar 12
30 Jun 12
15 http://www.dh.gov.uk/en/Publicationsandstatistics/Publications/PublicationsPolicyAndGuidance/DH_102331
Quarter 1 2012/13
23
thequarter.
Innovation
In December 2011, the Department published
Innovation Health and Wealth
16
(IHW), which
sets out a delivery agenda for spreading
innovation at pace and scale throughout the
NHS. It recommends a number of actions
that will deliver signifi cant improvements in
the quality and value of care delivered in the
NHS. They are designed as an integrated set of
measures that together will support the NHS in
achieving a systematic and profound change in
the way it operates.
The NHS Operating Framework 2012/13 made
it clear that the role of innovation will be critical
if we are to continue to improve outcomes for
patients and deliver value for money.
NHS organisations were asked to make an
immediate start by developing plans in local
areas to deliver against this ambitious agenda,
with a particular focus on the High Impact
Innovations identifi ed in IHW. The rapid spread
of telehealth technology, improving the quality
of children’s wheelchair services, the routine use
of fl uid monitoring technologies, and provision
of carer’s breaks for those looking after people
with dementia will make a real difference to the
quality and experience of people’s lives, as well
as delivering productivity improvements.
We have now launched www.innovation.nhs.uk
where implementation guidance and support
for each of the innovations can be found.
The website allows users to:
• learn about the innovations
• read case studies
• access support to help with implementation
including procurement
• help with business case development and
service re-design
• benchmark performance
• share their experiences
• score others’ case studies
• develop ideas and online communities.
The website discussion forums enable
innovators from the NHS, public, private,
academic, scientifi c and business communities
to get in touch, share ideas, and post details of
their own innovations.
To embed innovative practice in future
delivery, from April 2013, compliance
with these High Impact Innovations will
become a pre-qualifi cation requirement for
Commissioning for Quality and Innovation
(CQUIN) payments. IHW also made clear
that National Institute for Health and Clinical
Excellence (NICE) Technology Appraisals (TAs)
should be automatically included, where
clinically appropriate, in local treatment lists
(formularies). The law is quite clear on this
point. All NICE TAs carry a statutory funding
obligation and patients have a legal right to
access NICE recommended medicines and
technologies – this is non-negotiable.
Formularies have an important role in
underpinning safe and effective use of
medicines. However, they should not duplicate
NICE assessments or challenge an appraisal
recommendation. Once on formularies, there
should be no further barriers to the use or
prescription of technologies or medicines.
Some good progress has been made, but
there is much more to do to reduce variation
across the country. With that in mind, Sir
David Nicholson wrote to all NHS organisations
requesting they publish information which
sets out which NICE TAs are included in their
local formularies. PCT clusters and clinical
commissioning groups (CCGs) will need to take
the lead in working towards publication by
1 April 2013 at the very latest.
It will be important that the publications are
online, and are clear, simple and transparent,
so patients, the public and stakeholders can
easily understand them.
From 1 April 2013, we intend to make this a
standard term and condition in NHS contracts.
Our intention remains unequivocal – to support
patient access to NICE approved medicines
and technologies.
16 http://www.dh.gov.uk/en/Publicationsandstatistics/Publications/PublicationsPolicyAndGuidance/DH_131299
Quarter 1 2012/13
24
thequarter.
Productivity
Finance
The returns for the fi rst quarter of 2012/13
show that, overall, the NHS is forecasting a
healthy surplus.
SHAs and PCTs are forecasting an overall
surplus of £1,153 million, which is in line with
the NHS Operating Framework 2012/13, and
represents 1.2 percent of the total SHA/PCT
revenue resources. NHS trusts (excluding FTs)
are forecasting an overall surplus of £71 million
at Q1 for 2012/13.
Figure 22: NHS financial performance by SHA area – PCT/SHA sector
2009/10 2010/11 2011/12
Q1 2012/13
Forecast
outturn
£m
80
185
185
%
Resource
limit
1.6
1.4
2.0
£m
70
215
187
%
Resource
limit
1.3
1.5
1.9
£m
64
267
189
%
Resource
limit
1.2
1.9
1.8
£m
60
267
189
%
Resource
limit
1.1
1.8
1.8
North East
North West
Yorkshire and the Humber
NHS North of England 450 1.6 472 1.6 520 1.7 516 1.7
East Midlands
West Midlands
East of England
83
80
137
1.2
0.8
1.5
90
73
101
1.2
0.7
1.0
90
92
108
1.1
0.9
1.1
65
62
83
0.8
0.6
0.8
NHS Midlands and East 300 1.2 264 1.0 290 1.0 210 0.7
London
382 2.4 392 2.3 442 2.6 212 1.2
NHS London 382 2.4 392 2.3 442 2.6 212 1.2
South East Coast
South Central
South West
NHS South of England
Total
17
50
60
95
0.7
0.9
1.1
65
67
115
0.9
1.0
1.3
86
72
177
1.1
1.1
1.9
59
48
108
0.8
0.8
1.2
205 0.9 247 1.1 335 1.4 215 0.9
1,337 1.5 1,375 1.4 1,587 1.6 1,153 1.2
There is one PCT, North Yorkshire and York PCT, forecasting a defi cit of £19 million at Q1.
17 The SHA/PCT overall surplus for 2011/12 has been revised from £1,583 million, reported at Q4, to £1,587 million
following receipt of Peterborough PCT’s fi nal audited accounts.
Quarter 1 2012/13
25
thequarter.
There are fi ve NHS trusts forecasting a gross
operating defi cit of £160 million at Q1. These
are South London Healthcare NHS Trust (£54
million operating defi cit), Barking, Havering
and Redbridge Hospitals NHS Trust (£40 million
operating defi cit), Mid Yorkshire Hospitals
NHS Trust (£26 million operating defi cit),
Epsom and St Helier University Hospitals NHS
Trust (£19 million operating defi cit) and North
West London Hospitals NHS Trust (£21 million
operating defi cit).
Figure 23: NHS financial performance by SHA area – trust sector
2009/10 2010/11 2011/12
Q1 2012/13
Forecast
outturn
£m
10
15
14
%
Turnover
3.0
0.5
0.6
£m
3
21
10
%
Turnover
2.9
0.7
0.4
£m
2
29
(5)
%
Turnover
3.8
0.9
(0.2)
£m
0
37
(4)
%
Turnover
0.0
1.2
(0.2)
North East
North West
Yorkshire and the Humber
NHS North of England 39 0.7 34 0.6 26 0.4 33 0.6
East Midlands
West Midlands
East of England
18
53
30
0.7
1.6
1.4
2
30
23
0.1
0.9
0.9
23
33
12
0.7
0.8
0.5
21
43
17
0.6
1.0
0.8
NHS Midlands and East 101 1.2 55 0.6 68 0.7 81 0.8
London
(3) (0.0) (20) (0.2) (96) (1.1) (98) (1.3)
NHS London (3) (0.0) (20) (0.2) (96) (1.1) (98) (1.3)
South East Coast
South Central
South West
NHS South of England
Total
18
37
(7)
28
1.5
(0.3)
1.3
16
8
28
0.6
0.3
1.3
4
12
30
0.2
0.6
1.4
16
11
28
0.6
0.6
1.2
58 0.8 52 0.7 46 0.7 55 0.8
195 0.7 121 0.4 44 0.1 71 0.2
While it is important to recognise the strong
overall fi nancial position of the service, it
remains important to focus on the small
number of organisations who are not managing
their fi nances.
The Department is continuing to work in
conjunction with SHAs to make sure the
organisations reporting a defi cit have robust
plans in place for fi nancial recovery, while
continuing to improve the quality of services
to patients. Additionally, it is important to
ensure that these organisations are in a suitable
position to meet the requirements for FT status
moving forward.
18 The overall trust position for 2011/12 accounts has been revised from £45 milion reported at Q4 to £44 million,
following receipt of the fi nal audited accounts position for East Midlands Ambulance Service NHS Trust.
Quarter 1 2012/13
26
thequarter.
Figure 24: SHA and PCT sector surplus and (defi cit) 2009/10 to 2012/13 Q1 forecast
0
200
400
600
800
1000
1200
1400
1600
1800
£million
2009/10 2010/11 2011/12 2012/13
Quarter 1 Forecast
Surplus
Deficit
(200)
Figure 25: Trust sector surplus and (operating defi cit) 2009/10 to 2012/13 Q1 forecast
0
100
200
300
400
500
£million
2009/10 2010/11 2011/12 2012/13
Quarter 1 Forecast
Surplus
Deficit
(200)
(100)
(300)
In addition to the gross operating defi cit, there is a gross technical defi cit of £84 million in 19 NHS trusts (four of these
organisations also have an operating defi cit).
A technical defi cit is a defi cit arising due to one or more of the following:
a) Impairments to fi xed assets – an impairment charge is not considered part of the organisation’s operating position.
b) The revenue cost of bringing private finance initiative (PFI) assets onto the balance sheet (due to the
introduction of international fi nancial reporting standards (IFRS) accounting in 2009/10) – NHS trusts’ fi nancial performance
measurement needs to be aligned with the guidance issued by HM Treasury measuring Departmental expenditure.
Therefore, the incremental revenue expenditure resulting from the application of IFRS to PFI is not chargeable for overall
budgeting purposes and should be reported as technical.
c) The impact of the change in accounting for donated assets and government grant reserves.
Quarter 1 2012/13
27
thequarter.
QIPP Savings
In the Q4 2011/12 edition of the quarter,
we reported that the NHS had secured £5.8
billion of effi ciency savings, representing an
encouraging start to meeting the up to
£20 billion QIPP challenge.
At the end of the fi rst quarter of 2012/13, the NHS
has continued this good progress, forecasting
a further £5.1 billion of annual savings. In the
fi rst three months of this year, the
NHS has
already delivered £1.2 billion of QIPP savings
(see Figures 26 and 27), which equates to
25 percent of the forecast annual savings.
This year’s savings, together with last year’s,
represent a solid fi nancial platform for 2013/14
and beyond, as the NHS moves the focus of
the savings towards transformational service
change. Delivering the quality improvements
and effi ciency savings required over the
remainder of the QIPP period will require
the NHS to focus on transformational service
change through clinical service redesign.
Figure 26: 2012/13 NHS England QIPP savings by SHA cluster
Total 2012/13 QIPP SHA cluster
QIPP category
London
SHA
Midlands
and East
SHA
North of
England
SHA
South of
England
SHA
Grand
total
£m £m £m £m £m
Acute services
568 789 701 691 2,749
Ambulance services
10 25 24 20 79
Community services
97 98 86 76 357
Continuing healthcare
26 34 32 30 122
Mental health and learning disabilities services 113 124 96 72 405
Non-NHS healthcare (inc reablement)
12 20 34 18 84
Prescribing
77 103 135 132 447
Primary care, dental, pharmacy, opthalmic 57 32 44 65 198
Specialised commissioning
Other
Grand total
35
83
1,078
110
70
1,404
79
115
1,346
47
82
1,233
271
350
5,062
Figure 27: 2012/13 NHS England QIPP savings by SHA cluster
0
1,000
2,000
3,000
4,000
5,000
6,000
£ million
SHA cluster
London SHA
North of England SHA South of England SHA Grand totalMidlands and East SHA
5,062
1,242
2012/13 forecast annual QIPP savings at Q1
2012/13 Q1 year to date savings achieved
Quarter 1 2012/13
28
-6
GP Other Total 1st Daycase Ordinary Total Non-elective A&E A&E
referrals referrals referrals Outpatients elective elective elective FFCEs attendances attendances
FFCEs FFCEs FFCEs at type 1 depts at all depts
Q1 2010/11
Q1 2011/12 Q1 2012/13
1
A&E attendances are shown by volume per day, all other indicators are shown by absolute volume.
thequarter.
Activity
19
Overall, in response to the QIPP challenge,
the ambition of the NHS is to redesign
pathways to make sure patients are treated
in the appropriate setting. This is expected to
result in a reduction in unplanned emergency
admissions. Although a modest reduction in
activity levels was seen in 2011/12 compared
with 2010/11, the fi rst quarter of 2012/13 is
showing a small increase in all areas.
Elective activity
On elective activity, Q1 shows:
• GP referrals were 2.5 percent higher than the
same period in the previous year
• other referrals for a fi rst outpatient
appointment were 5.9 percent higher than
the same period in the previous year
• GP referrals seen were 0.6 percent higher
than the same period the previous year
• all fi rst outpatient attendances were
1.2 percent higher than the previous year
• elective activity (admissions) growth was
2.6 percent, compared with 3.5 percent at
the same stage of 2011/12.
Emergency activity
On non-elective activity, Q1 shows:
• non-elective activity (admissions) were
2.4 percent higher than the previous year
• A&E attendances at type 1 A&E departments
were slightly higher (1.1 percent) than the
previous year
• A&E attendances at all type A&E departments
were 1.6 percent higher than the previous year
• urgent and emergency ambulance journeys
per day were 0.8 percent higher than the
previous year.
The data is largely in line with the seasonal
pattern seen in previous years, and it is too
soon to say whether there has been a change
in the underlying trend. The picture is further
complicated by the unique distribution of bank
holidays and school half-term holidays, which
will impact on NHS activity patterns.
Figure 28: Year-to-date growth in activity indicators – England, by volume
1
-4
-2
0
2
4
6
Percentage
19 http://transparency.dh.gov.uk/2012/07/ 05/hospital-activity/
Quarter 1 2012/13
29
GP Other Total 1st Daycase Ordinary Total Non-elective A&E A&E
referrals referrals referrals Outpatients elective elective elective FFCEs attendances attendances
FFCEs FFCEs FFCEs at type 1 depts at all depts
Q1 2010/11
Q1 2011/12 Q1 2012/13
1
A&E attendances are shown by volume per day, all other indicators are shown by absolute volume.
thequarter.
0
1
2
3
4
5
6
Millions
Figure 29: Year-to-date total volume for activity indicators – England, in millions
1
Quarter 1 2012/13
30
Workforce
20
Over this period, there has been a slight decrease
in staff numbers in the hospital and community
health services (HCHS) workforce statistics,
published by the NHS IC on a monthly basis.
The publication mainly focuses on staff working
in hospitals, PCTs and SHAs and does not fully
refl ect the increasing number of healthcare
professionals moving into community settings
delivering care closer to patients’ homes, nor
primary care, bank or agency staff.
As part of the education and training reform
programme, the Department is working with
thequarter.
workforce colleagues in SHAs and the NHS
IC to develop a process to better refl ect and
capture the effect of service redesign on the
NHS workforce.
Figure 30 details the full time equivalent (FTE)
changes in key NHS staff groups between Q4
2011/12 and Q1 2012/13. It uses the middle data
point for each quarter, i.e. February 2012 for Q4
and May 2012 for Q1. This better represents the
average workforce throughout the period and
is most relevant when comparing to fi nance,
activity and other data.
Figure 30: Changes in key NHS staff groups between Q4 2011/12 and Q1 2012/13
England
Q4
2011/12
Q1
2012/13
Q4 to Q1
change
Q4 to Q1
% change
FULL TIME EQUIVALENTS (FTE) Feb 12 May 12
All HCHS doctors (non locum)
All HCHS doctors (locum)
99,602
2,036
99,147
2,058
–455
22
–0.5%
1.1%
All HCHS doctors (incl locums) 101,638 101,205 –433 –0.4%
Qualifi ed midwives
Qualifi ed health visitors
Qualifi ed school nurses
21,067
8,207
1,192
21,055
8,190
1,146
–12
–17
–46
–0.1%
–0.2%
–3.8%
Qualified nursing, midwifery and health visiting staff
308,100 306,999 –1,101 –0.4%
Qualifi ed allied health professions
Qualifi ed healthcare scientists
Other qualifi ed scientifi c, therapeutic and technical staff
63,312
29,132
40,550
62,897
28,881
40,502
–415
–251
–48
–0.7%
–0.9%
–0.1%
Total qualifi ed scientific, therapeutic and technical staff
132,993 132,280 –713 –0.5%
Qualified ambulance staff 17,999 17,869 –130 –0.7%
Professionally qualified clinical staff 560,730 558,353 –2,377 –0.4%
Support to clinical staff 290,089 289,209 –881 –0.3%
Central functions
Hotel, property and estates
Total managers
96,679
56,232
36,233
95,535
55,820
35,596
–1,143
–412
–637
–1.2%
–0.7%
–1.8%
NHS infrastructure support 189,143 186,951 –2,193 –1.2%
Total 1,039,963 1,034,513 –5,450 – 0.5%
Copyright © 2012 Health and Social Care Information Centre. All rights reserved
20 http://www.ic.nhs.uk/statistics-and-data-collections/workforce
Quarter 1 2012/13
31
thequarter.
Health and wellbeing
The Department is committed to supporting
the NHS to improve the health and wellbeing
of its staff. This is not just because we want
staff to be happy and healthy, but because
there is compelling evidence that a positive
staff experience has a direct, positive impact on
patient experience.
Moreover, promoting staff health and wellbeing
can help reduce sickness absence, which costs
the NHS around £1.7 billion each year and
places additional pressure on colleagues.
The Department continues to work with the
NHS to reduce sickness absence through
tackling the main causes of ill health. Five high-
impact changes have been identifi ed that build
on the NHS Health and Wellbeing Framework
published in July 2011.
21
1. Developing local, evidence-based plans
2. with strong, visible leadership
3. supported by improved management
capability
4. with access to better, local, high-quality,
accredited occupational health services
5. where staff are encouraged and enabled to
take more responsibility for their health.
The Department is working with a variety of
organisations including NHS Employers, the
Royal College of Physicians Health and Work
Development Unit and NHS Plus to commission
work to deliver these changes. Work is
underway on pathfi nder projects in each SHA
cluster to develop local initiatives aligned to the
high-impact changes.
Sickness absence
The latest report published by the NHS IC,
based on data from the Electronic Staff Record
(ESR), provided the results for January to March
2012. This showed that sickness absence has
risen by 0.12 percentage points, compared to
the same quarter in 2011, moving from 4.24
percent to 4.37 percent in 2012. The annual
moving average sickness absence, a better
measure that takes out seasonal effect, rose
by 0.03 percentage points to 4.12 percent.
The Department is continuing to work with
SHA cluster workforce directors and the
Social Partnership Forum to try to accelerate
delivery to ensure we move towards the QIPP
target. It also continues to work on specifi c
projects within the NHS run by a range of
delivery partners and designed to help NHS
organisations reduce their levels of sickness
absence. Considering the signifi cant change
seen across the NHS and its impact on staff, the
Department is confi dent the actions taken are
having a positive impact on sickness absence
rates across the NHS.
21 http://www.dh.gov.uk/en/Publicationsandstatistics/Publications/PublicationsPolicyAndGuidance/DH_128691
Quarter 1 2012/13
32
3.90
3.95
4.00
4.05
4.10
4.15
4.20
4.25
4.30
4.35
4.40
4.45
Mar 10
Apr 10
May 10
Jun 10
July 10
Aug 10
Sep 10
Oct 10
Nov 10
Dec 10
Jan 11
Feb 11
Mar 11
Apr 11
May 11
Jun 11
Jul 11
Aug 11
Sep 11
Oct 11
Nov 11
Dec 11
Jan 12
Feb 12
Mar 12
Percentage
thequarter.
Figure 31: NHS sickness absence: 12 month rolling annual average
re 31: NHS sickness absence: 12 month rolling annual average
Staff engagement
Evidence shows where levels of staff
engagement and health and wellbeing are
high, trusts are much more likely to have a
better quality of patient care, better fi nancial
performance and lower sickness absence
amongst staff.
The NHS staff survey provides the NHS with
data on staff engagement each year. National
NHS staff survey results published in March
2011 showed staff engagement fell marginally
across NHS trusts between 2010 and 2011
at 3.61, on a scale of 1 (low) to 5 (high),
compared to 3.63 the previous year. The 2011
staff survey results were published on 20 March
2012. Survey data was gathered between mid-
September and mid-December 2011.
Details of how individual employers can
improve staff health and wellbeing, raise
engagement and reduce sickness absence
are available on the NHS Employers website
at www.nhsemployers.org.
NHS staff survey data is available via Picker
Institute at www.nhsstaffsurveys.com.
Quarter 1 2012/13
33
thequarter.
ention
Health visitors
The Government has committed to increase
the number of health visitors by 4,200 (from a
May 2010 baseline) by April 2015. Supported
by the Department’s four-year transformational
programme, the aim is to develop health visiting
services that are universal, energised, improve
health outcomes and reduce inequalities.
Since March 2011, an initial group of health
visitor early implementer sites (EIS) have been
working to deliver the new health visiting
service model, as well as helping to lead a
v
step-change in the way services are provided
across the country. This innovative work was
showcased to representatives of the profession
e
in April and a second wave of 20 EIS began in
May 2012.
22
Pr
The number of FTE health visitors has increased
by 339 (4.2 percent) since May 2010 and the
total number of FTE health visitors at the end
of May 2012 was 8,431. This fi gure is taken
from the health visitor minimum data set, which
collects from SHAs the number of health visitors
on the ESR, in addition to those not recorded
on ESR. The total fi gure provided also includes
over 200 health visitors that are not counted by
the ESR, for example those directly employed
by local authorities and social enterprises that
do not use the ESR. The data does not include
bank and agency staff.
These fi gures are in line with expectations, and
it is predicted that we will see a gradual decline
in numbers until the autumn, when the next
cohort of health visiting trainees begin to enter
the workforce.
A management letter to NHS colleagues,
issued on 1 August 2012, sets out the actions
needed to keep this commitment on track and
presents a trajectory of growth (with regional
breakdowns) in health visitor numbers to
April 2015.
23
7,600
7,800
8,000
8,200
8,400
8,600
8,800
9,000
9,200
9,400
FTEs
Apr 12 May 12 Jun 12 Jul 12 Aug 12 Sep 12 Oct 12 Nov 12 Dec 12 Jan 13 Feb 13 Mar 13
0
2,000
4,000
6,000
8,000
10,000
12,000
14,000
2013/142012/132011/12 2014/15
Annual Position 2011/12–2014/15
Plan
Actual
Plan
Actual
Quarter 1 2012/13
34
Figure 32: Health visitor trajectories, England
Reporting now includes ESR and non-ESR data. This ensures we accurately include health visitors that are employed within
organisations not using ESR, for example local authorities. This graph shows the combined total.
22 http://www.dh.gov.uk/health/2012/06/hveis
23 http://www.dh.gov.uk/health/2012/08/health-visiting-actions//
thequarter.
Maternity and newborn
Early access to antenatal care promotes greater
choice for women and ensures they receive the
right care at the right time, helping to tackle the
negative impact of health inequalities from the
start and improve the health and wellbeing of
mother and baby.
The performance standard for the percentage
of women having an assessment of their health
and social care needs, risks and choices by 12
weeks and six days of pregnancy is 90 percent.
The latest data indicates performance is being
maintained above the standard. 92.8 percent of
women who gave birth in Q1 saw a maternity
healthcare professional within 12 weeks and
six days of pregnancy. The fi gure is comparable
to Q4 2011/12 when 94.7 percent of women
who gave birth had an assessment within the
specifi ed time period.
Breastfeeding
Breastfeeding is good for babies and mothers
and it is encouraging to see another increase in
the number of women starting to breastfeed.
We have set our commitment to support
breastfeeding through the Healthy Child
Programme. The breastfeeding initiation rate
was 74.0 percent in Q1 2012/13, the same
as the annual percentage for 2011/12 and
slightly higher than 2010/11 (73.7 percent).
The prevalence of breastfeeding at six to eight
weeks in Q1 2012/13 was 46.9 percent of
infants due a six to eight week check, a slight
increase on the fi gure of 46.3 percent recorded
in Q1 2011/12.
Smoking
24
The latest fi gures show an increase across all
measures for people accessing and successfully
quitting with NHS Stop Smoking services in
England, compared to the same period in
previous years. The latest data covers the full
year 2011/12, although the data is provisional
and subject to the usual end-of-year revisions
following validation.
816,444 people set a quit date through NHS
Stop Smoking services, an increase of 3.7
percent (28,917) on the fi nal fi gure for the same
period in 2010/11 (787,527), and an increase of
7.7 percent (58,907) on the fi nal fi gure for the
same period in 2009/10 (757,537).
At the four week follow-up 400,955 people
had successfully quit (based on self-report),
49 percent of those setting a quit date. This
is an increase of 4.5 percent (17,407) on the
fi nal fi gure for the same period in 2010/11
(383,548), and an increase of 7.2 percent
(27,001) on the fi nal fi gure for the same period
in 2009/10 (373,954).
72 percent of successful quitters at the four
week follow-up had their results confi rmed by
carbon monoxide verifi cation. This percentage
was 70 percent based on fi nal fi gures for
the same period in 2010/11 and 69 percent
based on fi nal fi gures for the same period in
2009/10. This demonstrates an improvement
in the quality of services provided as it is
recommended that services validate their quit
rates this way.
Of the 26,080 pregnant women who set
a quit date, 11,623 successfully quit at the
four week follow-up (45 percent). This
compares to 21,839 setting a quit date and
9,864 (45 percent), successfully quitting in the
same period 2010/11.
Total expenditure on NHS Stop Smoking
services was £88.2 million, an increase of 4.6
percent (£3.9 million) on the fi nal fi gure for
the same period in 2010/11 (£84.3 million)
and an increase of 5 percent (£4.4 million) on
the fi nal fi gure for the same period in 2009/10
(£83.9 million). The cost per quitter was £220
compared with £220 based on fi nal fi gures for
the same period in 2010/11 and £224 based on
fi nal fi gures for the same period in 2009/10.
These fi gures do not include expenditure on
pharmacotherapies.
Among SHAs, NHS Yorkshire and the Humber
reported the highest proportion of successful
quitters (53 percent), while NHS North East and
NHS North West reported the lowest success
rate (45 percent).
Among PCTs, Leeds PCT reported the highest
proportion of successful quitters (71 percent),
while Blackpool PCT reported the lowest
success rate (34 percent).
24 http://smokefree.nhs.uk/
Quarter 1 2012/13
35
thequarter.
Screening
VTE (venous thromboembolism)
risk assessment
Of the 3.3 million adult patients admitted to
NHS-funded acute care between April and June
2012, 93.4 percent of these received a VTE
risk assessment on admission, a slight increase
compared to Q4 2011/12 (92.5 percent). This
means that the NHS has exceeded the national
goal of 90 percent for three consecutive
quarters and for the fi rst time, all SHAs have
achieved over 90 percent performance.
275 providers (out of 309 providers who
submitted data), reported that at least 90
percent of adult admissions to hospital were risk
assessed for VTE, compared to 240 in March
2012, 223 in December 2011, and 18 in July
2010 when the collection fi rst began.
Breast screening
The NHS Operating Framework 2012/13 states
NHS organisations should continue working
to meet the expectations in service specifi c
outcomes strategies that have been published,
including those for cancer. The Cancer
Outcomes Strategy
25
states that all screening
services should take part in the breast screening
randomisation project and that full roll-out
to all women aged 47 to 49 and 71 to 73 is
expected to be completed after 2016.
Latest data for June 2012 shows that 52 out
of 80 local programmes (65 percent) have
implemented the extension randomisation
project (screening women aged 47 to 49 or
71 to 73, depending on the randomisation
protocol). This is an increase of 44 percent since
the programme began in November 2010.
While the pace of implementation has slowed
recently, the Department will continue to
work with NHS cancer screening programmes
to improve the uptake of and conversion
to digital mammography and to make sure
local programmes are able to begin the age
extension randomisation as soon as possible.
Cervical screening test results
The NHS Operating Framework 2012/13 states
NHS organisations should continue to work
to meet the expectations in service specifi c
outcomes strategies that have been published,
including cancer outcomes strategy standards.
As recommended by the Advisory Committee
on Cervical Screening, the operational standard
for women receiving their results within 14
days has been set at 98 per cent. At the end of
June 2012, the percentage of women receiving
their results within 14 days was 95.7 per cent, a
slight decrease from the fi gure of 98.1 per cent
at the end of Q4 2011/12.
The picture for Q1 was complicated by the
unique distribution of bank holidays and school
half-term holidays, which impacts on NHS
activity patterns. The Department would expect
fi gures to improve over the coming months to
meet the operational standard for 2012/13.
Bowel screening
From 23 August 2010, all 153 PCTs in England
were offering bowel cancer screening to
people in the 60 to 69 years age range who are
registered with a GP. This completed the initial
roll-out of the NHS bowel cancer screening
programme (BCSP) across England. By the
end of June 2012, nearly 15 million kits
(14,973,335) had been sent out, and over
8 million (8,472,765) returned. Over 13,000
(13,059) cancers had been detected, and over
65,000 (66,957) patients had undergone polyp
removal. Men and women over the age limit
can request a testing kit every two years, and
over 180,000 (181,503) have self-referred for
screening so far.
The NHS BCSP is currently being extended to
men and women aged 70 up to their 75th
birthday. The NHS Operating Framework
2011/12 states that the extensions begun in
2010/11 should have continued and been
maintained for 2011/12. Centres whose
end of original two-year screening round
was in 2011/12 should have implemented
the extension on completion of the original
round. Those whose end of original round falls
beyond 2011/12 should prepare to expand on
completion of the original round. The NHS
Operating Framework 2012/13 states that NHS
organisations should continue to work to meet
the expectations in service specifi c outcomes
25 http://www.dh.gov.uk/en/Publicationsandstatistics/Publications/PublicationsPolicyAndGuidance/DH_123371
Quarter 1 2012/13
36
thequarter.
strategies that have been published, including
cancer. In addition, all deadlines for the full roll-
out of programmes highlighted in previous NHS
Operating Frameworks should be completed
within the established timescale.
As at June 2012, 38 of the 58 local screening
centres (68 percent) had implemented the
extension. When the extension is fully rolled
out, around 1 million more men and women
will be screened each year.
The number of local bowel screening centres
inviting the older age group up to their
75th birthday has slowed due to issues with
endoscopy capacity. Those PCTs that began the
original programme later will not begin the age
extension until later in 2012/13.
Diabetic retinopathy
At Q1, 98.5 percent of people with diabetes
were offered screening for diabetic retinopathy
during the previous 12 months, a decrease of
0.5 percent on the previous quarter.
However, this is in the context of an ever
increasing number of people with diabetes.
Latest fi gures for Q1 show that the number
of people offered screening in the previous 12
months has actually increased this quarter from
2.36 million at Q4 to 2.39 million. The slight
dip in the percentage fi gure in Q1 is due to the
number of people with diabetes rising from
2.59 million at Q4 to 2.62 million at Q1. When
the screening programme was introduced in
2003, the number of people with diabetes
stood at 1.3 million.
The majority of PCTs continue to offer screening
to all people with diabetes and it remains
the case that more people with diabetes
are being offered screening for retinopathy
than ever before, and to higher standards.
England (alongside other UK countries) leads
the world in this area – this is the fi rst time a
population-based screening programme for
diabetic retinopathy has been introduced on
such a large scale. However, there are still some
organisations that are not offering screening
to everyone with diabetes. The Department
is working closely with partners in the NHS
Diabetic Eye Screening Programme to further
improve the standards, quality and coverage of
screening programmes across the country.
Immunisation
Data available for Q4 2011/12 shows childhood
immunisation uptake rates have increased since
the previous quarter.
Data on vaccine uptake rates for early
childhood vaccinations are collected at a
child’s fi rst, second and fi fth birthday. Of the
16 measurements taken on uptake for various
vaccines, 13 show an increase compared
with Q3, two show no change, and one
(meningitis C at age one) shows a decrease
of 0.1 percentage points.
The largest increases in vaccine uptake were
for one dose of MMR vaccine by age two (from
91.5 percent to 92.0 percent), two doses of
MMR vaccine by age fi ve (from 86.2 percent to
86.9 percent), the Hib/MenC booster by age
fi ve (from 90.0 percent to 90.7 percent) and the
PCV booster by age fi ve (from 86.9 percent to
88.0 percent).
MMR uptake in England has returned to
levels not seen since 1998 when vaccination
rates dipped following the publication of the
discredited Wakefi eld research. MMR uptake
(one dose by age two) exceeds 90 percent in
all SHA areas except London, where it is 86.2
percent but demonstrating a strong upward
trend. Vaccine uptake rates are lowest in
London, but the rate of improvement is greatest
in this area. Therefore, the gap with the rest of
England is steadily narrowing.
The latest available data for Q4 2011/12
relating to England is available from the Health
Protection Agency
26
.
NHS health checks
The NHS Operating Framework 2012/13
includes a performance measure for the NHS
health check programme to support the full
roll-out of the service in 2012/13.
Data for Q1 shows that 587,500 people, or
3.8 percent of the estimated 15 million people
eligible for the programme, were offered an NHS
health check. This compares favourably with
2.7 percent of the eligible population who were
offered a check in Q1 2011/12 and shows local
areas are continuing to make progress in the
implementation of their programmes.
26 http://www.hpa.org.uk/web/HPAweb&HPAwebStandard/HPAweb_C/1211441442288
Quarter 1 2012/13
37
thequarter.
Reform
Choice
Patient choice
Indicators suggest the take-up of patient
choice, where it is offered, is slowly improving.
The Choose and Book system is being used to a
high level in most areas.
Three separate measures are used to assess
whether choice is being offered by referrers,
using the Choose and Book system, to refer
patients for fi rst consultant outpatient services.
Proportion of GP referrals to fi rst
outpatient appointments booked
using Choose and Book
Choose and Book utilisation remained relatively
stable over the quarter. The overall utilisation
rate was 50 percent in June 2012, based
on outturn GP referrals to fi rst outpatient
appointments, which was slightly higher than
the May fi gure of 49 percent. During June
2012, 91 percent of all GP practices made some
bookings through Choose and Book, but there
is signifi cant variation in level of usage between
practices. Choose and Book is also used for
an additional 180,000 referrals per month
to other services, which include allied health
professionals, GPs with special interests and
assessment services. This represents a steady
increase in bookings through Choose and Book
to services other than fi rst outpatient services.
Figure 33: Proportion of GP referrals to fi rst outpatient appointments booked using
Choose and Book
0
10
20
30
40
50
60
Percentage
April 2012 May 2012 June 2012
En
g
land total
Quarter 1 2012/13
38
thequarter.
Bookings to services where named
consultant-led team was available
The Department released contract guidance
in October 2011 to support providers and
commissioners in England when implementing
choice of a named consultant-led team for a
fi rst consultant-led outpatient appointment
for elective care, where clinically appropriate.
Included within the NHS standard contracts
for 2012/13 is a requirement for providers
to comply with choice guidance issued by
the Department. Provider organisations are
continuing to add named consultants against
specifi ed Choose and Book services. Latest
reports indicate the percentage of secondary
care fi rst outpatient bookings made through
Choose and Book to services where named
clinicians are available, even if not selected, has
increased slightly to 81 percent at the end of
Q1, in line with the pattern of steady increases
over previous months. The variation in this
measure ranges from 89 percent in North West
and West Midlands SHA areas to 74 percent in
the London SHA area.
Figure 34: Bookings to services where national consultant-led team was available
(even if not selected)
0
20
40
60
80
100
Percentage
April 2012 May 2012
England total
June 2012
Trend in volume of patients being
treated at non-NHS hospitals
Patients should have the opportunity to
choose from a range of providers for their fi rst
outpatient appointment, including those in
the independent sector. This indicator shows
a percentage of patients who have exercised
choice, since it is likely that an alternative NHS
provider was also offered to them.
An increasing percentage of Choose and Book
bookings made to the independent sector may
indicate more choice being offered to patients.
This indicator should also be considered in
conjunction with the system indicator, Use of
Choose and Book. Relatively high percentages
of Choose and Book bookings made to the
independent sector may not indicate what
is happening overall, if Choose and Book
utilisation is low.
Quarter 1 2012/13
39
thequarter.
Figure 35: Proportion of patients being treated at non-NHS hospitals
0
2
4
6
8
10
Percentage
April 2012 May 2012
England total
June 2012
Improving people’s electronic
access to services and their own
health and care records
The Information Strategy for Health and
Adult Social Care, The Power of Information:
Putting us all in control of the health and care
information we need, published on 21 May
2012
27
, sets out a vision in which being able
to access and share our own records can help
us take part in decisions about our own care
in a genuine partnership with professionals. It
states that by 2015, all general practices will be
expected to make available electronic booking
and cancelling of appointments, ordering of
repeat prescriptions, communication with
the practice and access to records to anyone
registered with the practice.
From April 2013, general practices that provide
online access to records and other transactional
services will be shown on the NHS Choices
website (or its successor national online portal).
In previous quarters, we have reported on the
number of general practices with functionality
for patients to access their full medical records
online and how many had this functionality
enabled. We also reported on the number
of practices that have functionality enabled
so patients can request repeat medication
and manage their own appointments, all of
the above setting the baseline for this data
going forward.
Figures from previous quarters show that
uptake of electronic access by general practices
has been slow and the number of practices with
functionality has not changed signifi cantly from
the end of 2011. It is clear that further progress
needs to be made to improve NHS performance
on improving patient’s electronic access to
services and their own health and care records.
The Department expects to see GP practices
increasingly implementing this functionality and
offering this service. To realise this opportunity
where it exists, GP practices that can already
provide online access are encouraged to
do so as soon as possible, moving towards
100 percent enabled functionality by the end
of this Parliament.
The NHS IC has developed new data collection
for quarterly reporting on this indicator during
2012/13, requiring the collation and validation
of complex data. The initial collection identifi ed
issues with data quality and completeness which
are now being addressed. Comprehensive data
will now be available in November 2012 and
thereafter on a quarterly basis.
27 http://www.dh.gov.uk/health/2012/05/information-strategy/
Quarter 1 2012/13
40
thequarter.
Summary Care Record (SCR)
28
The SCR provides the minimum information
required to support safe patient care in urgent
or emergency situations. Patients can choose to
opt out of having an SCR and will be asked for
their permission before their SCR is viewed.
More records are now being accessed and local
health communities are actively demonstrating
how the SCR is delivering improvements to
patient care. Leeds Teaching Hospitals NHS
Trust has found that using the SCR dramatically
reduced the time taken to complete drug
reconciliations, providing a faster and safer
service to patients. Crucially, the time taken
to complete reconciliations was reduced on
average from 35 minutes to 19. This represents
a 55 percent reduction in the time spent
undertaking drug histories and medicines
reconciliations.
In Q1, approximately 2.5 million new SCRs were
created for patients, taking the total to 15.8
million. This period also saw the highest ever
weekly viewings of the SCR, with over 3,350
accesses by health care professionals using the
SCR to support safe treatment and care. The
average weekly viewing fi gures in this period
increased to 2,200. In addition, six PCTs began
creating records for their patients meaning a
total of 99 PCTs have now created records for
patients in 2,315 GP practices. The number of
PCTs with a critical mass of over 60 percent of
patients with an SCR increased by fi ve to a total
of 24 in Q1. Over 39.7 million citizens have now
been written to about the introduction of the
SCR and their options, with the NHS Operating
Framework requiring that the patients that
have been written to about SCRs have a record
created by March 2013 at the latest.
Performance has signifi cantly improved and the
programme needs to maintain these efforts to
ensure that commitments in the NHS Operating
Framework 2012/13 are met.
Figure 36: Number of summary care records created
0
2
4
6
8
10
12
14
16
18
2010/11
Q1
Number of patients with an SCR
2010/11
Q2
2010/11
Q3
2010/11
Q4
2011/12
Q1
2011/12
Q2
2011/12
Q3
2012/13
Q1
2011/12
Q4
Records created (millions)
28 http://www.connectingforhealth.nhs.uk/systemsandservices/scr
Quarter 1 2012/13
41
thequarter.
Provision
At the end of Q1 2012/13, 102 NHS trusts
remained in the pipeline, with 144 FTs now
authorised. The expectation remains for the
majority of NHS trusts to achieve FT status
by 2014, as stand-alone organisations, as
part of an existing FT, or in some other
organisational form.
It has been agreed that NHS trusts will only
have planned authorisation dates post-April
2014 with a nationally agreed plan, which
may include new management arrangements.
This has contributed to the increased grip and
momentum on the pipeline.
A range of actions continue to be taken to
support the delivery of the FT pipeline. These
include:
• solutions to support the small number of NHS
trusts with intractable fi nancial issues which
would prevent them meeting the viability
requirements of the FT assessment process.
These include support where PFI affordability
and legacy debt are issues beyond local
recovery
• the Board Governance Assurance Framework
to support NHS trust boards through a
combination of self and independent
assessment processes, to make sure they
are appropriately skilled and prepared to be
assessed for and operate effectively with the
increased autonomy of FT status
• the facilitation of solutions for NHS trusts
who will not achieve FT status in their current
organisational form, including mergers and
acquisitions with other NHS partners
• use of the unsustainable provider regime
(UPR) for NHS trusts which are not viable and
where no other realistic solution is available.
The use of the UPR is a particularly important
development to the delivery of the FT pipeline
and signals that where necessary progress is not
being made to establish clinically and fi nancially
sustainable provision of high quality healthcare
services, radical solutions will be found. The
UPR provides a transparent and robust process
to effect a rapid resolution of problems within
signifi cantly challenged NHS organisations and
provides a powerful lever in the event of failure
to deliver against plans to achieve FT status.
On 1 June 2012, the NHS TDA was established,
creating for the very fi rst time an organisation
that will provide leadership for quality, support
for strong management and a governance
structure tailored specifi cally to help develop
NHS trusts on their journey to FT status.
With oversight of 102 NHS trusts that provide
services ranging from acute hospital-based
care, through to community and mental health
services, the main focus of the NHS TDA will
be to help each NHS trust secure sustainable,
high quality services for the patients and
communities they serve.
As an independent organisation, the NHS TDA
will work closely with other important national
bodies such as the NHS CB, the Care Quality
Commission and Monitor to help to ensure they
play an important role in providing broader
health system leadership to deliver sustainable,
high quality care.
In June, the NHS TDA held the inaugural
meeting of the Board to agree the sign-off of
a suite of governance documents required for
legal establishment.
On 29 June the NHS TDA hosted its fi rst
conference allowing all NHS trust chairs and
chief executives the chance to learn more
about the emerging shape of the NHS TDA and
to contribute their thoughts and ideas to the
operating model that will underpin all that will
be done moving forward. At the conference,
the appointments of Ralph Coulbeck as Director
of Strategy and Bob Alexander as Director of
Finance were announced.
Quarter 1 2012/13
42
thequarter.
Commissioning
Commissioning development is a key part of
the Health and Social Care reforms, focusing on
the design, development and establishment of
CCGs and commissioning support units (CSUs),
making sure enabling tools are in place to allow
the new commissioning system to fl ourish.
The programme has made good progress in Q1
with particular focus on the following:
NHS Commissioning Board
The NHS CB was successfully established as an
executive non-departmental public body on 1
October 2012, in preparation for taking on its
full responsibilities from April 2013. Many of
the senior posts that will lead the organisation
have already been appointed and news of the
successful candidates is regularly updated on
the NHS CB website.
29
Confi rmation of plans for a small number of
national clinical networks to improve health
services for specifi c patient groups or conditions
were announced in July 2012. Called ‘strategic
clinical networks’
30
, these organisations will
build on the success of network activity in the
NHS which has led to signifi cant improvements
in the delivery of patient care. The networks will
be hosted and funded by the NHS CB and the
conditions or patient groups chosen for the fi rst
strategic clinical networks are:
• cancer
• cardiovascular disease (including cardiac,
stroke, diabetes and renal disease)
• maternity and children’s services
• mental health, dementia and neurological
conditions.
New arrangements for local health emergency
preparedness, resilience and response will
commence from 1 April 2013, as part of
changes the Health and Social Care Act 2012
makes to the health system. A key feature of
the new arrangements is the formation of local
health resilience partnerships.
These partnerships will provide strategic forums
for joint planning for emergencies for the new
health system and will support the health
sector’s contribution to multi-agency planning
through local resilience forums. They are not
statutory organisations and accountability for
emergency preparedness and response remains
with individual organisations.
Clinical commissioning groups
Work on the underpinning frameworks and
rules for CCGs continues. The Health and Social
Care Act 2012 sets out the high-level framework
for the establishment of CCGs and provides for
regulations to set out more specifi c provisions. The
NHS (Clinical Commissioning Groups) Regulations
2012 were laid in Parliament on 26 June 2012
and make provision for the membership,
names, establishment and governance of CCGs,
as well as setting out the updated functions of
CCG’s key duties and powers.
In May 2012, the NHS CB confi rmed the
proposed confi guration of CCGs and 35 CCG
applications were received on 2 July 2012
as part of the fi rst wave to authorisation.
Profi ling and confi guration of waves two to
four have been agreed and can be located on
the NHS CB website.
31
The authorisation process for CCGs remains
on schedule, with receipt on 3 September
2012 of applications from CCGs in wave two.
All 67 proposed CCGs in the second wave
have submitted their applications to the NHS
CB, which is responsible for supporting the
development of CCGs as they move through
authorisation. The site visits to the 35 CCGs in
authorisation wave one began on 4 September
with NHS North Staffordshire CCG and
continued throughout the month.
During the fi rst quarter, a nationally procured
assessment centre has been running for anyone
who is interested in coming forward for one of
the three specifi ed leadership roles in CCGs: the
chair of the governing body, the accountable
offi cer or chief fi nance offi cer. The outputs
of the assessment centre are being used by
29 http://www.commissioningboard.nhs.uk/appointments/
30 http://www.commissioningboard.nhs.uk/2012/07/26/strat-clin-networks/
31 http://www.commissioningboard.nhs.uk
Quarter 1 2012/13
43
thequarter.
CCGs to support their selection decisions for
these key roles. Final appointments for the
accountable offi cer role, whether clinical or
managerial, will be made by the NHS CB as part
of the authorisation process.
The CCG learning and support tool provides
access to the development resources that
meet current learning needs and which every
proposed CCG can expect to be able to access
during 2012/13. It is designed to support
CCGs as they prepare for authorisation, the
clinical leadership of commissioning and their
development beyond authorisation. During
Q1, the web tool was refreshed to capture the
development informed by work undertaken
with proposed CCGs and national primary care
organisations. The learning and support web
tool is on the NHS CB website.
32
During Q1, the CCG team has also published
support documents relating to CCG
authorisation including a two-part guide to
the CCG authorisation assessment process:
• ‘CCG authorisation: Draft guide for assessors
participating in site visits’
33
which is a follow-
on to ‘CCG authorisation: Draft guide for
assessors undertaking desktop review’
34
and is also intended to accompany ‘CCG
authorisation: a draft guide for applicants’
35
• ‘CCG authorisation: Supplement for assessors
reviewing CCG commissioning support
arrangements’
36
• Frequently asked questions (FAQs) on
authorisation
37
• A new framework has also been published on
collaborative commissioning.
38
Delegated budgets
The delegation of eligible commissioning
budgets to emerging CCGs as part of the
integrated performance measures of the NHS
Operating Framework takes place as part
of the broader transfer of decision-making
responsibilities from PCTs and SHAs and the
overall design of CCG governance structures.
Progress against the delegation of eligible
commissioning budgets has been used as an
indicator, highlighting any issues CCGs might
have around commissioning and fi nancial
management and provides CCGs with the
opportunity to build a ‘track record’ in advance
of them formally taking on their commissioning
responsibilities and becoming statutory
organisations from 1 April 2013. Until this
point, PCT and SHA cluster chief executives
retain responsibility and accountability for
commissioning budgets.
NHS North of England and NHS South of
England had both delegated 100 percent of
budgets applied for by CCGs by the end of Q4
2011/12. In Q1 2012/13, NHS Midlands and East
also achieved 100 percent and NHS London
achieved 99 percent. NHS North of England and
NHS South of England remain at 100 percent.
Commissioning support
During Q1, the commissioning support team
facilitated the second part of the commissioning
support service (CSS) assurance process,
checkpoint two. 23 CSUs have been cleared
to progress to checkpoint three, which takes
place in Q2.
The recruitment process for CSS managing
directors began in Q1, with ten initial
appointments made from a ring-fenced pool,
and further appointments progressing in Q2.
Commissioning enablers
The code of conduct guidance was published
on 2 July 2012, which sets out additional
safeguards that CCGs will be advised to use
when commissioning services for which GP
practices could be potential providers.
32 http://www.commissioningboard.nhs.uk/resources/resources-for-ccgs/learning-support/
33 http://www.commissioningboard.nhs.uk/fi les/2012/07/site-visit-guide.pdf
34 http://www.commissioningboard.nhs.uk/fi les/2012/ 05/Assessors_guide_FINAL_310512.pdf
35 http://www.commissioningboard.nhs.uk/fi les/2012/04/ccg-auth-app-guide.pdf
36 http://www.commissioningboard.nhs.uk/fi les/2012/08/cmsng-support.pdf
37 http://www.commissioningboard.nhs.uk/fi les/2012/08/app-guide-faq.pdf
38 http://www.commissioningboard.nhs.uk/fi les/2012/03/collab-commiss-frame.pdf
Quarter 1 2012/13
44
thequarter.
Going forward
14 November 2012 will see the launch
and fi rst annual national event of the NHS
Commissioning Assembly. Sir David Nicholson
and a group of CCG leaders are inviting the
clinical lead (the clinical chair or chief clinical
offi cer) from every CCG to attend. The
assembly will be the collective commissioning
leadership for England, bringing together
leaders responsible for NHS commissioning
decisions to create shared leadership for the
healthcare system, and to deliver a shared work
programme to improve outcomes for patients.
The initiative includes the annual national
event and several proposed working groups.
Members will be the current clinical lead from
each CCG in England, plus directors from across
the NHS CB, and local area team directors.
CCGs will be asked to deliver improvements in
quality for their patients across the fi ve domains
of the NHS Outcomes Framework. NICE and the
NHS IC have published their recommendations
39
on those health care measures that can be used
as indicators of how well CCGs are doing in each
domain. The NHS CB will now work with CCGs
and other stakeholders to establish how these
can be used to support planning and assurance.
All current CSUs will proceed to be hosted by
the NHS CB. The decision was taken following
checkpoint two of the business review
process, where the number of CSUs reduced
to 23, and subsequent evaluation made it
clear each is viable in terms of scale. The NHS
Commissioning Board Authority and NHS
Business Services Authority (NHS BSA) agreed
that the NHS BSA will provide an employment
partnership service for CSU staff during the
hosting period up to 2016. This means the NHS
CB will host (provide oversight and direction
to) CSUs, while the NHS BSA will be the legal
employer of CSU staff.
This decision will also ensure there is stability
and continuity for CCGs as they prepare
for and progress through the authorisation
process, and
as they carry out the procurement
of their choice
of commissioning support
from April 2013.
No CSUs will now be stopped at checkpoint
three, although this does not rule out further
size variation or adjustment to confi gurations
as a result of the assurance process. Instead,
the focus will be on making sure all CSUs are
as good as they can be by April 2013.
Public health
The transformation of the delivery of public
health is part of the wider changes the
Government set out under the Health and Social
Care Act 2012. ‘Healthy Lives Healthy People:
our
strategy for public health in England’
40
published
in November 2010, set out the
Government’s vision for a new public health
system, putting local government and local
communities at the heart of improving health
and wellbeing for their populations and
tackling inequalities.
The NHS Operating Framework 2012/13
requires PCT clusters to work with local
authorities to develop the vision and strategy
for their new public health role. They
are preparing local systems for the new
c
ommissioning arrangements and ensuring
new clinical governance systems are in place.
In addition, new arrangements for emergency
planning, resilience and response are being
tested and plans made for the formal transfer
of staff into new organisations.
2012/13 is a crucial year for the transition of
public health responsibilities to local authorities
and the Department is working alongside the
Local Government Association and PCT and
SHA clusters, as well as the NHS CB to make
sure this process is as smooth as possible. The
Department will build on the strength of the
relationships that have already been developed
to make sure that, moving forward, the delivery
of public health in the new structure is robust,
secure and builds on the good practice that is
already in place.
39 http://www.nice.org.uk/aboutnice/cof/cof.jsp
40 http://www.dh.gov.uk/en/Publicationsandstatistics/Publications/PublicationsPolicyAndGuidance/DH_121941
Quarter 1 2012/13
45
thequarter.
Public Health England will have a role in
supporting the new public health system in
conjunction with local partners. While, like
other organisations, it does not offi cially come
into being until April 2013, many practical steps
are already being undertaken to make sure this
transition period is fully utilised, and the Chief
Executive Designate of Public Health England,
Duncan Selbie, is already in post. In many
areas of the country, public health teams are
already co-located within local authorities or
are planning to be in the near future, and the
majority have agreed where the local Director
of Public Health (and proposed reporting
arrangements) will sit in the new structure. PCT
clusters are already delegating powers relating
to public health to local authorities to promote
shadow-working during this transition year, and
good progress is being made in the key areas of
HR and workforce.
Local directors of public health will have a vital
role to play as key health advisors for local
authorities and, with statutory positions on
health and wellbeing boards, will promote
collaboration and joined-up delivery of services.
During this transition period, local directors
are helping to ensure that arrangements put
in place are robust, undertaking a key role in
ensuring public health services and programmes
are transferred appropriately.
Health and wellbeing boards are already
beginning to come together in shadow
form in preparation for taking on their new
responsibilities from April 2013. They will
provide strategic leadership, strengthen the
infl uence of local authorities and elected
representatives in shaping healthcare
commissioning, and will support partnership
working and integrated commissioning across
the NHS, public health and social care.
During the remainder of 2012/13, the
Department will continue to work with local
authorities and PCT clusters on their plans for
the implementation of the new system over
this transition period. Working together, PCT
clusters and local authorities will need to:
• test arrangements for the role of public health
in emergency planning, in particular the role
of the director of public health and local
authority based public health by October 2012
• ensure an early draft of legacy and handover
documents is produced by October 2012
• have agreed, workable information
governance arrangements in place that will
ensure public health teams have access to the
information they need to carry out their duties
from 1 April 2013, by end of December 2012
• ensure fi nal legacy and handover documents
are produced by January 2013.
The Department will continue to hold the NHS
to account for robust planning and delivery
against NHS Operating Framework milestones,
with full recognition that strong leadership from
local government will be necessary to ensure a
smooth transition, as part of the shared ambition
to create the new local public health system.
Quarter 1 2012/13
46
thequarter.
Annex 1
NHS North of England
SHA and PCT name
2009/10
Annual
accounts
surplus/
(defi cit)
£000s
2010/11
Annual
accounts
surplus/
(defi cit)
£000s
2011/12
Annual
accounts
surplus/
(defi cit)
£000s
2012/13 Q1
Forecast
outturn
surplus/
(defi cit)
£000s
2012/13 Q1
Forecast
outturn
revenue
resource
limit (RRL)
£000s
2012/13 Q1
Forecast
outturn
surplus/
(defi cit)
as % RRL
County Durham PCT 1,020 1,016 1,008 1,000 1,040,510 0.1%
Darlington PCT 301 315 316 300 191,737 0.2%
Gateshead PCT 504 192 35 300 402,405 0.1%
Hartlepool PCT 125 100 100 100 190,626 0.1%
Middlesbrough PCT 278 600 600 600 305,796 0.2%
Newcastle PCT 945 258 314 500 521,410 0.1%
North East SHA 72,036 64,754 59,319 55,450 337,788 16.4%
North Tyneside PCT 475 355 380 250 398,777 0.1%
Northumberland Care PCT 220 1,370 319 250 587,173 0.0%
Redcar and Cleveland PCT 513 150 150 150 270,482 0.1%
South Tyneside PCT 1,819 460 542 300 330,204 0.1%
Stockton-on-Tees Teaching PCT 424 400 400 400 337,903 0.1%
Sunderland Teaching PCT 845 382 976 400 576,453 0.1%
North East subtotal SHA/PCTs
79,505 70,352 64,459 60,000 5,491,264 1.1%
SHA and PCT name
2009/10
Annual
accounts
surplus/
(defi cit)
£000s
2010/11
Annual
accounts
surplus/
(defi cit)
£000s
2011/12
Annual
accounts
surplus/
(defi cit)
£000s
2012/13 Q1
Forecast
outturn
surplus/
(defi cit)
£000s
2012/13 Q1
Forecast
outturn
revenue
resource
limit (RRL)
£000s
2012/13 Q1
Forecast
outturn
surplus/
(defi cit)
as % RRL
Ashton, Leigh and Wigan PCT
Blackburn with Darwen PCT
Blackburn with Darwen Teaching Care Trust Plus PCT (1)
Blackpool PCT
Bolton PCT
Bury PCT
Central and Eastern Cheshire PCT
Central Lancashire PCT
Cumbria Teaching PCT
E
ast Lancashire Teaching PCT
Halton and St Helens PCT
Heywood, Middleton and Rochdale PCT
Knowsley PCT
Liverpool PCT
Manchester PCT
North Lancashire Teaching PCT
North West SHA
Oldham PCT
Salford PCT
Sefton PCT
Stockport PCT
Tameside and Glossop PCT
Trafford PCT
Warrington PCT
640
717
n/a
2,532
996
413
1,007
3,030
229
1,021
295
579
576
5,287
481
1,565
157,339
1,381
993
498
231
980
534
222
1,900
n/a
1,373
1,392
983
236
1,501
1,632
(5,926)
3,336
500
1,933
1,610
14,768
347
2,200
175,418
1,000
2,319
2,500
350
1,000
1,500
250
2,726
n/a
1,376
1,399
992
253
3,474
3,662
4,195
3,324
500
2,155
1,617
9,204
1,293
2,200
215,124
2,015
2,180
2,548
695
1,000
701
500
2,807
n/a
1,413
1,441
1,000
750
3,547
3,762
2,000
3,424
2,689
1,950
1,650
4,941
3,256
2,844
211,973
2,075
2,328
2,624
917
1,000
1,900
1,588
594,476
n/a
303,104
316,050
508,938
325,831
750,798
807,754
910,453
716,126
621,561
411,648
352,529
1,062,373
1,069,113
598,987
945,958
441,448
505,258
554,623
489,855
446,389
388,879
336,148
0.5%
n/a
0.5%
0.5%
0.2%
0.2%
0.5%
0.5%
0.2%
0.5%
0.4%
0.5%
0.5%
0.5%
0.3%
0.5%
22.4%
0.5%
0.5%
0.5%
0.2%
0.2%
0.5%
0.5%
Quarter 1 2012/13
47
thequarter.
2009/10 2010/11 2011/12 2012/13 Q1
2012/13 Q1
Forecast 2012/13 Q1
Annual Annual Annual Forecast outturn Forecast
accounts
surplus/
accounts
surplus/
accounts
surplus/
outturn
surplus/
revenue
resource
outturn
surplus/
SHA and PCT name
(defi cit)
£000s
(defi cit)
£000s
(defi cit)
£000s
(defi cit)
£000s
limit (RRL)
£000s
(defi cit)
as % RRL
Western Cheshire PCT 1,279 985 1,966 2,033 500,101 0.4%
Wirral PCT 2,047 2,031 2,001 3,088 659,156 0.5%
North West subtotal SHA/PCTs 184,872 215,138 267,100 267,000 14,617,556 1.8%
SHA and PCT name
2009/10
Annual
accounts
surplus/
(defi cit)
£000s
2010/11
Annual
accounts
surplus/
(defi cit)
£000s
2011/12
Annual
accounts
surplus/
(defi cit)
£000s
2012/13 Q1
Forecast
outturn
surplus/
(defi cit)
£000s
2012/13 Q1
Forecast
outturn
revenue
resource
limit (RRL)
£000s
2012/13 Q1
Forecast
outturn
surplus/
(defi cit)
as % RRL
Barnsley PCT 3,461 3,395 2,953 3,500 487,028 0.7%
Bassetlaw PCT (2) n/a n/a 1,680 1,700 203,381 0.8%
Bradford and Airedale Teaching PCT 7,550 6,680 8,165 7,500 946,908 0.8%
Calderdale PCT 2,679 4,224 3,468 3,600 363,851 1.0%
Doncaster PCT 4,177 2,691 2,688 2,250 589,222 0.4%
East Riding of Yorkshire PCT 3,684 5,185 5,197 5,200 513,985 1.0%
Hull Teaching PCT 3,820 3,714 3,113 19,400 558,247 3.5%
Kirklees PCT 2,928 7,900 8,239 6,600 699,882 0.9%
Leeds PCT 5,002 20,124 25,086 23,200 1,403,027 1.7%
North East Lincolnshire Care Trust Plus (3) 2,222 2,181 1,783 1,400 298,411 0.5%
North Lincolnshire PCT 1,249 3,693 1,998 2,000 276,836 0.7%
North Yorkshire and York PCT 317 242 209
(19,000) 1,232,395 (1.5%)
Rotherham PCT 2,042 2,192 2,196 2,200 468,539 0.5%
Shef
fi eld PCT 4,479 499 489 500 1,022,723 0.0%
Wakefield District PCT 7,388 3,095 3,074 3,100 657,385 0.5%
Yorkshire and the Humber SHA 133,982 121,052 118,177 125,902 710,514 17.7%
Yorkshire and the Humber subtotal SHA/PCTs 184,980 186,867 188,515 189,052 10,432,334 1.8%
NHS North of England total SHA/PCTs 449,357 472,357 520,074 516,052 30,541,154 1.7%
2009/10 2010/11 2011/12 2012/13 Q1 2012/13 Q1
Annual
accounts
surplus/
Annual
accounts
surplus/
Annual
accounts
surplus/
Forecast
outturn
surplus/
2012/13 Q1
Forecast
Forecast
outturn
surplus/
Trust name
(operating
defi cit)
£000s
(operating
defi cit)
£000s
(operating
defi cit)
£000s
(operating
defi cit)
£000s
outturn
turnover
£000s
(operating
deficit) as %
turnover
North East Ambulance Service NHS Trust (4) 4,736 3,120 2,312 n/a n/a n/a
Northumberland, Tyne and Wear NHS Trust (5) 5,296 n/a n/a n/a n/a n/a
South Tees Hospitals NHS Trust (6) 131 n/a n/a n/a n/a n/a
North East subtotal trusts 10,163 3,120 2,312 0 0 0.0%
Quarter 1 2012/13
48
thequarter.
Trust name
2009/10
Annual
accounts
surplus/
(operating
defi cit)
£000s
2010/11
Annual
accounts
surplus/
(operating
defi cit)
£000s
2011/12
Annual
accounts
surplus/
(operating
defi cit)
£000s
2012/13 Q1
Forecast
outturn
surplus/
(operating
defi cit)
£000s
2012/13 Q1
Forecast
outturn
turnover
£000s
2012/13 Q1
Forecast
outturn
surplus/
(operating
deficit) as %
turnover
5 Boroughs Partnership NHS Trust (7) 2,210 n/a n/a n/a n/a n/a
Bridgewater Community Healthcare NHS Trust (8) n/a 388 1,804 1,702 167,647 1.0%
East Cheshire NHS Trust 3,926 806 277 1,700 173,569 1.0%
East Lancashire Hospitals NHS Trust 287 723 3,025 3,900 386,011 1.0%
Liverpool Community Health NHS Trust (9) n/a 2,654 3,530 3,123 141,536 2.2%
Liverpool Heart and Chest Hospital NHS Trust (10) 1,827 n/a n/a n/a n/a n/a
Manchester Mental Health and Social Care NHS Trust 532 (482) 1,516 1,021 102,069 1.0%
M
ersey Care NHS Trust 3,000 7,359 5,000 4,000 203,829 2.0%
North Cumbria University Hospitals NHS Trust 327 1,356 1,095 1,000 221,870 0.5%
North West Ambulance Service NHS Trust 1,041 2,065 1,558 2,500 253,389 1.0%
Pennine Acute Hospitals NHS Trust 620 259 3,553 5,700 558,799 1.0%
Royal Liverpool Broadgreen University Hospitals 4,021 4,238 5,472 7,309 410,451 1.8%
NHS Trust
Southport and Ormskirk Hospital NHS Trust 500 853 204 1,700 176,331 1.0%
St Helens and Knowsley Teaching Hospitals NHS Trust 225 296 305 2,742 269,502 1.0%
Wirral Community NHS Trust (11) n/a n/a 717 900 63,904 1.4%
Trafford Healthcare NHS Trust (12) (6,048) 319 482 n/a n/a n/a
U
niversity Hospitals of Morecambe Bay NHS Trust (13) 2,126 305 n/a n/a n/a n/a
Walton Centre for Neurology and Neurosurgery 424 n/a n/a n/a n/a n/a
NHS Trust (14)
North West subtotal trusts 15,018 21,139 28,538 37,297 3,128,907 1.2%
Trust name
2009/10
Annual
accounts
surplus/
(operating
defi cit)
£000s
2010/11
Annual
accounts
surplus/
(operating
defi cit)
£000s
2011/12
Annual
accounts
surplus/
(operating
defi cit)
£000s
2012/13 Q1
Forecast
outturn
surplus/
(operating
defi cit)
£000s
2012/13 Q1
Forecast
outturn
turnover
£000s
2012/13 Q1
Forecast
outturn
surplus/
(operating
deficit) as %
turnover
Airedale NHS Trust (15)
Bradford District Care Trust
Hull and East Yorkshire Hospitals NHS Trust
Humber Mental Health Teaching NHS Trust (16)
Leeds Community Healthcare NHS Trust (17)
Leeds Teaching Hospitals NHS Trust
Mid Yorkshire Hospitals NHS Trust
Scarborough and North East Yorkshire Healthcare
N
HS Trust
South West Yorkshire Mental Health NHS Trust (18)
Yorkshire Ambulance Service NHS Trust
Yorkshire and the Humber subtotal trusts
NHS North of England total trusts
605
103
7,601
1,351
n/a
963
871
1,914
569
518
14,495
39,676
49
104
4,701
n/a
n/a
2,051
983
1,874
n/a
237
9,999
34,258
n/a
108
4,878
n/a
2,577
4,207
(19,217)
1,899
n/a
428
(5,120)
25,730
n/a
1,450
5,911
n/a
1,306
11,476
(26,000)
0
n/a
1,975
(3,882)
33,415
n/a
137,428
478,124
n/a
134,564
982,853
434,450
121,837
n/a
200,749
n/a
1.1%
1.2%
n/a
1.0%
1.2%
(6.0%)
0.0%
n/a
1.0%
2,490,005 (0.2%)
5,618,912 0.6%
F
or foundation trusts the forecast position is only for the time when the organisation was an NHS trust
1 Blackburn with Darwen Teaching Care Trust Plus PCT was formerly Blackburn with Darwen PCT pre-April 2010.
2 Bassetlaw PCT is being reported under the Yorkshire and the Humber SHA region from 1 April 2011. Prior to this, they were reported under the
East Midlands SHA region.
3 North East Lincolnshire Care Trust Plus was formed following the dissolution of North East Lincolnshire PCT on 1 September 2007.
4 North East Ambulance Service Trust achieved foundation trust status on 1 November 2011.
5 Northumberland, Tyne and Wear NHS Trust achieved foundation trust status on 1 December 2009.
6 South Tees Hospitals NHS Trust achieved foundation trust status on 1 May 2009.
7 5 Boroughs Partnership NHS Trust achieved foundation trust status on 1 March 2010.
Quarter 1 2012/13
49
thequarter.
8 On 1 April 2011, Bridgewater Community Healthcare NHS Trust changed its name from Ashton, Leigh and Wigan Community Healthcare NHS Trust,
which was established as an NHS trust on 1 November 2010, taking on the provider services of NHS Ashton, Leigh and Wigan.
9 Liverpool Community Health NHS Trust was established as an NHS trust on 1 November 2010 taking on the provider services of Liverpool Primary
Care Trust.
10 Liverpool Heart and Chest Hospital NHS Trust achieved foundation trust status on 1 December 2009.
11 Wirral Community NHS Trust was formed on 1 April 2011.
12 On 1 April 2012, Trafford Healthcare NHS Trust (RM4) merged with Central Manchester Foundation Trust.
13 University Hospitals of Morecambe Bay NHS Trust achieved foundation trust status on 1 October 2010.
14 Walton Centre for Neurology and Neurosurgery NHS Trust achieved foundation trust status on 1 August 2009.
15 Airedale NHS Trust achieved foundation trust status on 1 June 2010.
16 Humber Mental Health Teaching NHS Trust achieved foundation trust status on 1 February 2010.
17 Leeds Community Healthcare NHS Trust was formed on 1 April 2011.
18 South West Yorkshire Mental Health NHS Trust achieved foundation trust status on 1 May 2009.
In addition to the operating deficits in 2012/13 shown above, the following organisation(s) also forecast a technical deficit (£m) in the
same period. A technical deficit is a deficit arising due to:
a) impairments,
b) incurring additional revenue charges associated with bringing PFI assets on to the balance sheet due to the introduction of IFRS
accounting in 2009/10, or
c) the impact of the change in accounting for donated assets and government grant reserves.
This is not recognised for NHS budgeting purposes.
Mersey Care NHS Trust (£2m)
Mid Yorkshire Hospitals NHS Trust (£0.8m)
North Cumbria University Hospitals NHS Trust (£7m)
Note: SHA and PCT turnover equals the Revenue Resource Limit (RRL) they are allocated. Trust turnover is all the income they receiv
e
including income from PCTs. Trust income should therefore be excluded from any aggregation of SHA economy turnover to avoid
double counting resources.
Quarter 1 2012/13
50
thequarter.
Annex 2
NHS Midlands and East
SHA and PCT name
2009/10
Annual
accounts
surplus/
(defi cit)
£000s
2010/11
Annual
accounts
surplus/
(defi cit)
£000s
2011/12
Annual
accounts
surplus/
(defi cit)
£000s
2012/13 Q1
Forecast
outturn
surplus/
(defi cit)
£000s
2012/13 Q1
Forecast
outturn
revenue
resource
limit (RRL)
£000s
2012/13 Q1
Forecast
outturn
surplus/
(defi cit)
as % RRL
Bassetlaw PCT (1) 1,434 2,595 n/a n/a n/a n/a
Derby City PCT 650 30 2,982 1,487 465,987 0.3%
Derbyshire County PCT 1,873 11,212 8,028 4,000 1,219,485 0.3%
East Midlands SHA 59,092 22,905 45,148 28,917 443,059 6.5%
Leicester City PCT 241 6,192 3,665 5,532 577,183 1.0%
Leicestershire County and Rutland PCT 1,148 10,502 6,270 7,223 985,725 0.7%
Lincolnshire Teaching PCT 7,264 14,314 9,525 7,500 1,251,308 0.6%
Milton Keynes PCT (2) n/a n/a 505 100 378,586 0.0%
Northamptonshire Teaching PCT 4,642 10,528 7,058 3,508 1,088,938 0.3%
Nottingham City PCT 2,448 6,841 3,412 3,400 575,139 0.6%
Nottinghamshire County Teaching PCT 4,514 5,017 3,372 3,333 1,109,662 0.3%
East Midlands subtotal SHA/PCTs 83,306 90,136 89,965 65,000 8,095,072 0.8%
SHA and PCT name
2009/10
Annual
accounts
surplus/
(defi cit)
£000s
2010/11
Annual
accounts
surplus/
(defi cit)
£000s
2011/12
Annual
accounts
surplus/
(defi cit)
£000s
2012/13 Q1
Forecast
outturn
surplus/
(defi cit)
£000s
2012/13 Q1
Forecast
outturn
revenue
resource
limit (RRL)
£000s
2012/13 Q1
Forecast
outturn
surplus/
(defi cit)
as % RRL
Birmingham East and North PCT 2,453 522 240 1,000 781,592 0.1%
Coventry Teaching PCT 4,644 6,247 5,766 5,800 615,363 0.9%
Dudley PCT 362 794 5,992 4,992 536,063 0.9%
Heart of Birmingham Teaching PCT 7,615 9,555 830 1,000 593,747 0.2%
Herefordshire PCT 778 111 291 254 298,334 0.
1%
North Staffordshire PCT 515 1,162 714 1,000 361,922 0.3%
Sandwell PCT 89 1,222 8,889 7,666 610,840 1.3%
Shropshire County PCT 490 872 1,295 1,000 485,419 0.2%
Solihull PCT (3) 16 531 281 1,000 355,998 0.3%
South Birmingham PCT 4,700 500 736 1,000 663,708 0.2%
South Staffordshire PCT 2,200 378 353 750 987,169 0.1%
Stoke on Trent PCT 2,588 3,115 1,993 2,000 527,932 0.4%
Telford and Wrekin PCT 4,522 467 1,098 1,000 276,625 0.4%
Walsall Teaching PCT 6,022 5,437 2,597 2,112 491,840 0.4%
Warwickshire PCT 594 176 177 200 861,903 0.0%
West Midlands SHA 19,732 23,204 37,534 11,088 543,161 2.0%
Wolverhampton City PCT 19,365 15,692 19,682 16,808 498,417 3.4%
Worcestershire PCT 3,519 3,470 3,044 3,000 898,688 0.3%
West Midlands subtotal SHA/PCTs 80,204 73,455 91,512 61,670 10,388,721 0.6%
Quarter 1 2012/13
51
thequarter.
SHA and PCT name
2009/10
Annual
accounts
surplus/
(defi cit)
£000s
2010/11
Annual
accounts
surplus/
(defi cit)
£000s
2011/12
Annual
accounts
surplus/
(defi cit)
£000s
2012/13 Q1
Forecast
outturn
surplus/
(defi cit)
£000s
2012/13 Q1
Forecast
outturn
revenue
resource
limit (RRL)
£000s
2012/13 Q1
Forecast
outturn
surplus/
(defi cit)
as % RRL
Bedfordshire PCT 236 498 504 500 629,746 0.1%
Cambridgeshire PCT 501 398 499 0 899,588 0.0%
East of England SHA 135,389 83,960 94,829 69,350 655,354 10.6%
Great Yarmouth and Waveney PCT 352 1,625 1,009 1,000 414,775 0.2%
Hertfordshire PCT (4) 1,611 638 513 6,200 1,766,223 0.4%
Luton PCT 400 506 256 0 329,713 0.0%
Mid Essex PCT 1,007 3,767 1,121 1,000 540,879 0.2%
Norfolk PCT 695 959 1,403 1,000 1,245,622 0.1%
North East Essex PCT 2,993 2,998 1,143 1,000 563,854 0.2%
Peterborough PCT (12,832) 389 4,110 0 282,301 0.0%
S
outh East Essex PCT 2,014 1,093 879 200 572,339 0.0%
South West Essex PCT 1,614 48 252 650 681,903 0.1%
Suffolk PCT 2,578 3,560 1,070 1,100 962,714 0.1%
West Essex PCT 815 721 620 1,000 451,827 0.2%
East of England subtotal SHA/PCTs 137,373 101,160 108,208 83,000 9,996,838 0.8%
NHS Midlands and East total SHA/PCTs 300,883 264,751 289,685 209,670 28,480,631 0.7%
Trust name
2009/10
Annual
accounts
surplus/
(operating
defi cit)
£000s
2010/11
Annual
accounts
surplus/
(operating
defi cit)
£000s
2011/12
Annual
accounts
surplus/
(operating
defi cit)
£000s
2012/13 Q1
Forecast
outturn
surplus/
(operating
defi cit)
£000s
2012/13 Q1
Forecast
outturn
turnover
£000s
2012/13 Q1
Forecast
outturn
surplus/
(operating
deficit) as %
turnover
Derbyshire Mental Health Services NHS Trust (5) 1,014 379 n/a n/a n/a n/a
Derbyshire Community Health Services NHS Trust (6) n/a n/a 1,419 1,769 185,627 1.0%
East Midlands Ambulance Service NHS Trust 2,016 467
1,402
1,544 148,641 1.0%
Leicestershire Partnership NHS Trust 1,732 1,700 6,562 4,200 275,552 1.5%
Lincolnshire Community Health Services NHS Trust (7) n/a n/a 1,081 1,510 104,172 1.4%
Northampton General Hospital NHS Trust 2,081 1,109 504 1,000 240,416 0.4%
Northamptonshire Healthcare NHS Trust (8) 29 n/a n/a n/a n/a n/a
Nottingham University Hospitals NHS Trust 7,256 5,010 4,764 4,328 777,063 0.6%
Nottinghamshire Healthcare NHS Trust 2,387 6,505 6,896 5,322 417,640 1.3%
United Lincolnshire Hospitals NHS Trust 1,282 (13,880) 320 886 402,524 0.2%
U
niversity Hospitals of Leicester NHS Trust 51 1,013 88 46 727,335 0.0%
East Midlands subtotal trusts 17,848 2,303 23,036 20,605 3,278,970 0.6%
Trust name
2009/10
Annual
accounts
surplus/
(operating
defi cit)
£000s
2010/11
Annual
accounts
surplus/
(operating
defi cit)
£000s
2011/12
Annual
accounts
surplus/
(operating
defi cit)
£000s
2012/13 Q1
Forecast
outturn
surplus/
(operating
defi cit)
£000s
2012/13 Q1
Forecast
outturn
turnover
£000s
2012/13 Q1
Forecast
outturn
surplus/
(operating
deficit) as %
turnover
Birmingham Community Health Care Trust (9) n/a 686 2,559 2,948 245,198 1.2%
Coventry and Warwickshire Partnership NHS Trust (10) 3,690 2,936 4,589 6,194 202,540 3.1%
Dudley and Walsall Mental Health Partnership 376 883 1,163 1,080 67,388 1.6%
NHS Trust
George Eliot Hospital NHS Trust 1,164 112 45 0 113,607 0.0%
North Staffordshire Combined Healthcare NHS Trust 449 698 891 1,282 76,822 1.7%
Robert Jones and Agnes Hunt Orthopaedic Hospital 2,054 1,618 741 n/a n/a n/a
NHS Trust (11)
Royal Wolverhampton Hospitals NHS Trust 8,035 7,964 9,297 7,677 371,012 2.1%
Sandwell and West Birmingham Hospitals NHS Trust 7,260 2,193 1,863 3,877 423,076 0.9%
Quarter 1 2012/13
52
thequarter.
Trust name
2009/10
Annual
accounts
surplus/
(operating
defi cit)
£000s
2010/11
Annual
accounts
surplus/
(operating
defi cit)
£000s
2011/12
Annual
accounts
surplus/
(operating
defi cit)
£000s
2012/13 Q1
Forecast
outturn
surplus/
(operating
defi cit)
£000s
2012/13 Q1
Forecast
outturn
turnover
£000s
2012/13 Q1
Forecast
outturn
surplus/
(operating
deficit) as %
turnover
Shrewsbury and Telford Hospital NHS Trust 712 26 59 1,900 302,284 0.6%
Shropshire Community Health NHS Trust (12) n/a n/a 1,397 1,485 78,240 1.9%
Staffordshire and Stoke on Trent Partnership n/a n/a 1,527 2,004 359,261 0.6%
NHS Trust (13)
South Warwickshire General Hospitals NHS Trust (14) 5,581 n/a n/a n/a n/a n/a
University Hospital of North Staffordshire NHS Trust 5,644 4,141 1,050 0 445,900 0.0%
University Hospitals Coventry and Warwickshire 10,234 4,162 1,465 2,053 483,454 0.4%
NHS Trust
Walsall Healthcare NHS Trust (15) 1,998 3,247 4,164 4,616 215,971 2.1%
West Midlands Ambulance Service NHS Trust 255 99 925 3,900 192,627 2.0%
Worcestershire Acute Hospitals NHS Trust 3,135 287 88 1,500 330,948 0.5%
Worcestershire Health and Care NHS Trust (16) 700 700 1,500 2,048 166,204 1.2%
Wye Valley NHS Trust (17) 1,165 46 71 0 173,690 0.0%
West Midlands subtotal trusts 52,452 29,798 33,394 42,564 4,248,222 1.0%
Trust name
2009/10
Annual
accounts
surplus/
(operating
defi cit)
£000s
2010/11
Annual
accounts
surplus/
(operating
defi cit)
£000s
2011/12
Annual
accounts
surplus/
(operating
defi cit)
£000s
2012/13 Q1
Forecast
outturn
surplus/
(operating
defi cit)
£000s
2012/13 Q1
Forecast
outturn
turnover
£000s
2012/13 Q1
Forecast
outturn
surplus/
(operating
deficit) as %
turnover
Bedford Hospitals NHS Trust 612 274 197 0 202,801 0.0%
Bedfordshire and Luton Mental Health and Social Care 463 n/a n/a n/a n/a n/a
Partnership NHS Trust (18)
Cambridgeshire Community Services NHS Trust (19) n/a 1,044 681 1,540 153,834 1.0%
East and North Hertfordshire NHS Trust 2,499 3,328 3,568 3,600 341,372 1.1%
East of England Ambulance Service NHS Trust 757 2,364 3,121 4,107
228,787 1.8%
Hertfordshire Community NHS Trust (20) n/a 184 1,030 1,229 122,578 1.0%
Hinchingbrooke Health Care NHS Trust 598 79 186 0 103,446 0.0%
Mid Essex Hospital Services NHS Trust 2,551 3,660 (2,156) 1,089 255,824 0.4%
N
orfolk Community Health and Care NHS Trust (21) n/a 552 637 1,100 120,641 0.9%
Suffolk Mental Health Partnership NHS Trust (22) 1,513 335 n/a n/a n/a n/a
Ipswich Hospital NHS Trust 3,351 1,260 137 0 223,864 0.0%
Princess Alexandra Hospital NHS Trust 511 415 461 1,819 172,252 1.1%
Queen Elizabeth Hospital Kings Lynn NHS Trust (23) 4,510 1,931 n/a n/a n/a n/a
West Hertfordshire Hospitals NHS Trust 5,699 7,358 3,657 2,800 263,561 1.1%
West Suffolk Hospitals NHS Trust (24) 6,273 194 251 n/a n/a n/a
East of England subtotal trusts 29,337 22,978 11,770 17,284 2,188,960 0.8%
NHS Midlands and East total trusts 99,637 55,079 68,200 80,453 9,716,152 0.8%
For foundation trusts the forecast position is only for the time when the organisation was an NHS trust
1 Bassetlaw PCT is being reported under the Yorkshire and the Humber SHA region from 1 April 2011.
2 Milton Keynes PCT became part of East Midlands SHA from 1 April 2011. Prior to this, it was reported under the South Central SHA region.
3 Solihull Care Trust changed its name to Solihull Primary Care Trust, following the transfer of their community services to other organisations on
1 April 2011.
4 Hertfordshire PCT was formed by the merger of East and North Hertfordshire (5P3) and West Hertfordshire PCT (5P4) on 1 April 2010.
5 Derbyshire Mental Health Services NHS Trust achieved foundation trust status on 1 February 2011.
6 Derbyshire Community Health Services NHS Trust was formed on 1 April 2011.
7 Lincolnshire Community Health Services NHS Trust was formed on 1 April 2011.
8 Northamptonshire Healthcare NHS Trust achieved foundation trust status on 1 May 2009.
9 Birmingham Community Health Care NHS Trust (RYW) was established as an NHS Trust on 1 November 2010, taking on the provider services of
NHS Birmingham East and North, NHS Heart of Birmingham and NHS South Birmingham.
Quarter 1 2012/13
53
thequarter.
10 Coventry and Warwickshire Partnership NHS Trust was formed from the Mental Health elements of Rugby PCT, Coventry Teaching PCT, North
Warwickshire PCT and South Warwickshire PCT.
11 Robert Jones and Agnes Hunt Orthopaedic Hospital NHS Trust achieved foundation trust status on 1 August 2011.
12 Shropshire Community Health NHS Trust was formed on 1 July 2011. The new Trust will combine community health services from Shropshire County
PCT and Telford and Wrekin PCT into a single organisation.
13 Staffordshire and Stoke on Trent NHS Partnership Trust (R1E) was formed on 1 September 2011, bringing together community health services previously
provided by NHS North Staffordshire, NHS Stoke on Trent and South Staffordshire PCT.
14 South Warwickshire General Hospitals NHS Trust achieved foundation trust status on 1 March 2010.
15 Walsall Healthcare NHS Trust was formed on 1 April 2011, following the integration of Walsall Hospitals NHS Trust and NHS Walsall Community Health.
16 Worcestershire Health and Care NHS Trust was established on 1 July 2011 to manage the vast majority of the services which were previously managed
by Worcestershire Primary Care NHS Trust’s provider arm, as well as the mental health services that were managed by Worcestershire Mental Health
Partnership NHS Trust.
17 Hereford Hospitals NHS Trust changed its name to Wye Valley NHS Trust on 1 April 2011, following Herefordshire’s health and adult social care
providers joining to form an integrated provider of acute, community and social care in England.
18 On 1 April 2010, South Essex Partnership University NHS Foundation Trust (SEPT) took over Bedfordshire and Luton Mental Health and Social Care
Partnership NHS Trust (BLPT). BLPT made history by being the fi rst NHS trust to put itself up for merger with an established NHS foundation trust.
19 Cambridgeshire Community Services NHS Trust is a new trust formed on 1 April 2010.
20 Hertfordshire Community NHS Trust (RY4) was established on 1 November 2010, taking on the provider services of Hertfordshire PCT.
21
Norfolk Community Health and Care NHS Trust (RY3) was established on 1 November 2010, taking on the provider services of Norfolk Primary Care Trust.
22 Suffolk Mental Health Partnership NHS Trust (RT6), merged with Norfolk and Waveney Mental Health NHS Foundation Trust on 1 January 2012 to
become Norfolk and Suffolk NHS Foundation Trust.
23 Queen Elizabeth Hospital King’s Lynn NHS Trust achieved foundation trust status on 1 February 2011.
24 West Suffolk Hospitals NHS Trust achieved foundation trust status on 1 December 2011.
In addition to the operating deficits in 2012/13 shown above, the following organisation(s) also forecast a technical deficit (£m) in the
same period. A technical deficit is a deficit arising due to:
a) impairments,
b) incurring additional revenue charges associated with bringing PFI assets on to the balance sheet due to the introduction of IFRS
accounting in 2009/10, or
c) the impact of the change in accounting for donated assets and government grant reserves.
This is not recognised for NHS budgeting purposes.
East and North Hertfordshire NHS Trust (£6m)
Nottingham University Hospitals NHS Trust (£7m)
Sandwell & West Birmingham Hospitals NHS Trust (£0.3m)
University Hospital of North Staffordshire Hospital NHS Trust (£29m)
West Hertfordshire Hospitals NHS Trust (£4m)
Note: SHA and PCT turnover equals the Revenue Resource Limit (RRL) they are allocated. Trust turnover is all the income they receiv
e
including income from PCTs. Trust income should therefore be excluded from any aggregation of SHA economy turnover to avoid
double counting resources.
Quarter 1 2012/13
54
thequarter.
Annex 3
NHS London
SHA and PCT name
2009/10
Annual
accounts
surplus/
(defi cit)
£000s
2010/11
Annual
accounts
surplus/
(defi cit)
£000s
2011/12
Annual
accounts
surplus/
(defi cit)
£000s
2012/13 Q1
Forecast
outturn
surplus/
(defi cit)
£000s
2012/13 Q1
Forecast
outturn
revenue
resource
limit (RRL)
£000s
2012/13 Q1
Forecast
outturn
surplus/
(defi cit)
as % RRL
Barking and Dagenham PCT 3,377 62 3,567 3,285 353,228 0.9%
Barnet PCT 139 134 (13,955) 0 604,979 0.0%
Bexley Care PCT 51 486 2,274 3,508 367,984 1.0%
Brent Teaching PCT 16,334 17,416 21,576 21,500 575,038 3.7%
Bromley PCT 249 6,899 6,111 5,020 519,015 1.0%
Camden PCT 12 11,807 43,162 21,595 533,703 4.0%
City and Hackney Teaching PCT 9,346 6,594 13,164 6,464 550,754 1.2%
Croydon PCT 3,412 5,535 838 0 598,317 0.0%
Ealing PCT 3 34 37 0 615,498 0.0%
Enfi eld PCT (10,491) 11 (17,188) 0 505,901 0.0%
G
reenwich Teaching PCT 608 5,327 4,770 4,710 494,461 1.0%
Hammersmith and Fulham PCT 10,538 3,513 5,496 7,084 373,467 1.9%
Haringey Teaching PCT 29 170 (17,439) 500 484,853 0.1%
H
arrow PCT 126 677 150 0 365,100 0.0%
Havering PCT 1,528 932 873 4,095 430,336 1.0%
Hillingdon PCT 19,380 5 44 0 418,549 0.0%
Hounslow PCT 40 42 150 0 419,441 0.0%
Islington PCT 1,121 10,261 20,837 9,084 481,238 1
.9%
Kensington and Chelsea PCT 3,985 3,410 10,166 7,332 379,201 1.9%
Kingston PCT 103 2,623 4,515 3,959 284,661 1.4%
Lambeth PCT 988 6,430 6,867 7,000 672,001 1.0%
Lewisham PCT 90 5,287 5,445 5,520 550,217 1.0%
London SHA 288,675 257,187 255,672 30,000 1,855,290 1.6%
Newham PCT 1,107 7,104 9,738 5,800 582,834 1.0%
Redbridge PCT 6,232 6,217 6,644 4,027 432,331 0.9%
Richmond and Twickenham PCT 112 2,845 7,742 6,223 302,369 2.1%
Southwark PCT 628 1,365 5,987 5,857 552,404 1.1%
Sutton and Merton PCT (2,286) 266 6,457 4,528 608,382 0.7%
T
ower Hamlets PCT 6,753 6,973 8,985 10,363 534,302 1.9%
Waltham Forest PCT 0 27 100 4,292 449,927 1.0%
Wandsworth PCT 4,386 12,322 16,709 10,522 610,146 1.7%
Westminster PCT 15,010 9,866 22,890 19,344 586,128 3.3%
London total SHA/PCTs 381,585 391,827 442,384 211,612 17,092,055 1.2%
NHS London total SHA/PCTs 381,585 391,827 442,384 211,612 17,092,055 1.2%
Quarter 1 2012/13
55
thequarter.
Trust name
2009/10
Annual
accounts
surplus/
(operating
defi cit)
£000s
(22,309)
5,069
239
11,707
n/a
1,106
36
2,877
7,368
n/a
9,102
6,753
2,412
1,425
6,044
(8,025)
547
2,035
(42,067)
2,286
12,933
258
1,026
1,167
(4,996)
139
(2,868)
(2,868)
2010/11
Annual
accounts
surplus/
(operating
defi cit)
£000s
(32,986)
3,154
274
(1,506)
2,196
4,913
28
3,332
8,617
n/a
5,146
1,058
2,724
1,002
3,103
258
n/a
6,587
(40,865)
2,579
6,459
307
(911)
3,970
214
508
(19,839)
(19,839)
2011/12
Annual
accounts
surplus/
(operating
defi cit)
£000s
(49,913)
2,221
2,023
(3,940)
3,835
3,967
2,304
(12,277)
1,869
1,667
(8,419)
1,427
3,184
2,751
669
(7,534)
n/a
8,200
(65,063)
2,158
6,101
n/a
1,102
4,881
1,777
1,120
(95,890)
(95,890)
2012/13 Q1
Forecast
outturn
surplus/
(operating
defi cit)
£000s
(39,732)
0
1,931
0
1,814
2,509
8
(19,447)
n/a
699
500
1,727
3,270
3,093
1,904
(20,600)
n/a
n/a
(54,167)
1,600
6,245
n/a
2,322
3,438
1,602
3,504
(97,780)
(97,780)
2012/13 Q1
Forecast
outturn
turnover
£000s
413,058
349,616
185,311
1,237,701
188,962
234,101
225,298
329,326
n/a
56,679
950,116
236,335
203,891
289,180
179,143
374,294
n/a
n/a
430,494
162,580
625,627
n/a
108,998
228,588
145,823
275,497
7,430,618
7,430,618
2012/13 Q1
Forecast
outturn
surplus/
(operating
deficit) as %
turnover
(9.6%)
0.0%
1.0%
0.0%
1.0%
1.1%
0.0%
(5.9%)
n/a
1.2%
0.1%
0.7%
1.6%
1.1%
1.1%
(5.5%)
n/a
n/a
(12.6%)
1.0%
1.0%
n/a
2.1%
1.5%
1.1%
1.3%
(1.3%)
(1.3%)
Barking, Havering and Redbridge Hospitals NHS Trust
Barnet and Chase Farm Hospitals NHS Trust
Barnet, Enfield and Haringey Mental Health NHS Trust
Barts Health NHS Trust (1)
C
entral London Community Healthcare NHS Trust (2)
Croydon Health Services NHS Trust (3)
Ealing Hospital NHS Trust
Epsom and St Helier University Hospitals NHS Trust
Great Ormond Street Hospital for Children NHS Trust (4)
Hounslow and Richmond Community Healthcare
NHS Trust (5)
Imperial College Healthcare NHS Trust (6)
L
ewisham Hospital NHS Trust
Kingston Hospital NHS Trust
London Ambulance Service NHS Trust
North Middlesex University Hospitals NHS Trust
North West London Hospitals NHS Trust
Royal Brompton and Harefi
eld NHS Trust (7)
Royal Free Hampstead NHS Trust (8)
South London Healthcare NHS Trust (9)
South West London and St George’s Mental Health
N
HS Trust
St George’s Healthcare NHS Trust
The Hillingdon Hospital NHS Trust (10)
Royal National Orthopaedic Hospital NHS Trust
We
st London Mental Health NHS Trust
West Middlesex University Hospital NHS Trust
W
hittington Hospital NHS Trust
London total trusts
NHS London total trusts
For foundation trusts the forecast position is only for the time when the organisation was an NHS Trust
1
Barts Health NHS Trust was created on 1 April 2012, following the merger of Barts and the London NHS Trust (RNJ), Newham University Hospital
NHS Trust (RNH) and Whipps Cross University Hospital NHS Trust (RGC).
2 Rebranding of Central West London Community Services to Central London Community Healthcare was completed in July 2009. Central London
Community Healthcare NHS Trust (RYX) was established on 1 November 2010.
3 Mayday Healthcare NHS Trust changed its name to Croydon Health Services NHS Trust (RJ6) on 1 October 2010.
4 Great Ormond Street Hospital for Children NHS Trust achieved foundation trust status on 1 March 2012.
5 Hounslow and Richmond Community Healthcare NHS Trust was formed on 1 April 2011.
6 Imperial College Healthcare NHS Trust was formed from St Mary’s NHS Trust and Hammersmith Hospitals NHS Trust.
7 Royal Brompton and Harefield NHS Trust achieved foundation trust status on 1 June 2009.
8 Royal Free Hampstead NHS Trust achieved foundation trust status on 1 April 2012.
9 South London Healthcare NHS Trust was formed from the merger of Queen Elizabeth Hospital NHS Trust (RG2), Bromley Hospitals NHS Trust (RG3),
and Queen Mary’s Sidcup NHS Trust (RGZ).
10 Hillingdon Hospital NHS Trust achieved foundation trust status on 1 April 2011.
Quarter 1 2012/13
56
thequarter.
In addition to the operating deficits in 2012/13 shown above, the following organisation(s) also forecast a technical deficit (£m) in the
same period. A technical deficit is a deficit arising due to:
a) impairments,
b) incurring additional revenue charges associated with bringing PFI assets on to the balance sheet due to the introduction of IFRS
accounting in 2009/10, or
c) the impact of the change in accounting for donated assets and government grant reserves.
This is not recognised for NHS budgeting purposes.
Barking, Havering and Redbridge University Hospitals NHS Trust (£0.8m)
Barnet, Enfield and Haringey Mental Health NHS Trust (£2m)
North West London Hospitals NHS Trust (£2m)
South London Healthcare NHS Trust (£5m)
South West London and St George’s Mental Health NHS Trust (£2m)
Note: SHA and PCT turnover equals the Revenue Resource Limit (RRL) they are allocated. Trust turnover is all the income they receiv
e
including income from PCTs. Trust income should therefore be excluded from any aggregation of SHA economy turnover to avoid
double counting resources.
Quarter 1 2012/13
57
thequarter.
Annex 4
NHS South of England
SHA and PCT name
2009/10
Annual
accounts
surplus/
(defi cit)
£000s
2010/11
Annual
accounts
surplus/
(defi cit)
£000s
2011/12
Annual
accounts
surplus/
(defi cit)
£000s
2012/13 Q1
Forecast
outturn
surplus/
(defi cit)
£000s
2012/13 Q1
Forecast
outturn
revenue
resource
limit (RRL)
£000s
2012/13 Q1
Forecast
outturn
surplus/
(defi cit)
as % RRL
Brighton and Hove City Teaching PCT 1,071 4,618 4,604 750 499,222 0.2%
East Sussex Downs and Weald PCT 1,230 2,656 476 750 590,898 0.1%
Eastern and Coastal Kent PCT 6,130 11,972 8,957 12,000 1,314,393 0.9%
Hastings and Rother PCT 3,841 6,496 2,707 750 344,527 0.2%
Medway PCT 3,689 4,282 4,496 4,582 465,288 1.0%
South East Coast SHA 44,586 45,768 62,090 19,327 303,797 6.4%
Surrey PCT (13,622) (11,934) 1,028 10,000 1,731,143 0.6%
We
st Kent PCT 2,013 776 1,066 10,363 1,057,925 1.0%
West Sussex PCT 725 733 512 750 1,338,881 0.1%
South East Coast subtotal SHA/PCTs 49,663 65,367 85,936 59,272 7,646,074 0.8%
SHA and PCT name
2009/10
Annual
accounts
surplus/
(defi cit)
£000s
2010/11
Annual
accounts
surplus/
(defi cit)
£000s
2011/12
Annual
accounts
surplus/
(defi cit)
£000s
2012/13 Q1
Forecast
outturn
surplus/
(defi cit)
£000s
2012/13 Q1
Forecast
outturn
revenue
resource
limit (RRL)
£000s
2012/13 Q1
Forecast
outturn
surplus/
(defi cit)
as % RRL
Berkshire East PCT 101 147 1,250 1,200 598,297 0.2%
Berkshire West PCT 1,449 1,646 3,580 6,471 680,674 1.0%
Buckinghamshire PCT 1,368 715 127 1,714 732,434 0.2%
Hampshire PCT 486 457 4,015 6,456 1,977,285 0.3%
Isle of Wight NHS PCT 2,382 2,519 2,508 2,573 269,985 1.0%
Milton Keynes PCT (1) 605 551 n/a n/a n/a n/a
Oxfordshire PCT 1,901 2,250 2,224 2,244 937,542 0.
2%
Portsmouth City Teaching PCT 5,207 724 1,674 3,385 359,273 0.9%
South Central SHA 45,125 54,788 54,785 20,100 343,404 5.9%
Southampton City PCT 917 2,885 1,965 3,920 428,580 0.9%
South Central subtotal SHA/PCTs 59,541 66,682 72,128 48,063 6,327,474 0.8%
SHA and PCT name
2009/10
Annual
accounts
surplus/
(defi cit)
£000s
2010/11
Annual
accounts
surplus/
(defi cit)
£000s
2011/12
Annual
accounts
surplus/
(defi cit)
£000s
2012/13 Q1
Forecast
outturn
surplus/
(defi cit)
£000s
2012/13 Q1
Forecast
outturn
revenue
resource
limit (RRL)
£000s
2012/13 Q1
Forecast
outturn
surplus/
(defi cit)
as % RRL
Bath and North East Somerset PCT 1,924 2,685 2,685 2,763 294,610 0.9%
Bournemouth and Poole Teaching PCT 2,886 5,356 5,356 5,897 597,388 1.0%
Bristol Teaching PCT 4,974 6,955 3,955 3,955 779,982 0.5%
Cornwall and Isles of Scilly PCT 6,064 8,562 8,570 8,822 949,579 0.9%
Devon PCT 237 3,546 3,538 3,500 1,263,897 0.3%
Dorset PCT 4,374 6,133 6,133 6,717 684,566 1.0%
Gloucestershire PCT 6,216 8,685 8,685 8,946 962,621 0.9%
North Somerset PCT 48 1,552 1,063 1,063 347,656 0.3%
Plymouth Teaching PCT 1,400 4,190 2,204 2,215 465,229 0.5%
Somerset PCT 5,751 7,965 7,965 7,965 890,254 0.9%
Quarter 1 2012/13
58
thequarter.
SHA and PCT name
2009/10
Annual
accounts
surplus/
(defi cit)
£000s
2010/11
Annual
accounts
surplus/
(defi cit)
£000s
2011/12
Annual
accounts
surplus/
(defi cit)
£000s
2012/13 Q1
Forecast
outturn
surplus/
(defi cit)
£000s
2012/13 Q1
Forecast
outturn
revenue
resource
limit (RRL)
£000s
2012/13 Q1
Forecast
outturn
surplus/
(defi cit)
as % RRL
South Gloucestershire PCT 39 1,527 1,397 1,397 387,577 0.4%
South West SHA 56,756 51,054 117,832 42,094 435,524 9.7%
Swindon PCT 2,080 1,096 2,967 3,047 321,344 0.9%
Torbay Care Trust 1,808 2,494 2,494 n/a n/a n/a
Torbay PCT (2) n/a n/a n/a 7,468 288,036 2.6%
Wiltshire PCT 0 3,200 2,005 2,000 691,392 0.3%
South West subtotal SHA/PCTs 94,557 115,000 176,849 107,849 9,359,655 1.2%
NHS South of England total SHA/PCTs 203,761 247,049 334,913 215,184 23,333,203 0.9%
Trust name
2009/10
Annual
accounts
surplus/
(operating
defi cit)
£000s
2010/11
Annual
accounts
surplus/
(operating
defi cit)
£000s
2011/12
Annual
accounts
surplus/
(operating
defi cit)
£000s
2012/13 Q1
Forecast
outturn
surplus/
(operating
defi cit)
£000s
2012/13 Q1
Forecast
outturn
turnover
£000s
2012/13 Q1
Forecast
outturn
surplus/
(operating
deficit) as %
turnover
Ashford and St Peter’s Hospitals NHS Trust (3) 6,275 3,188 n/a n/a n/a n/a
Brighton and Sussex University Hospitals NHS Trust 10,227 4,512 42 2,878 594,802 0.5%
Dartford and Gravesham NHS Trust 115 206 393 0 167,768 0.0%
East Sussex Healthcare NHS Trust (4) 350 (4,704) 87 2,800 368,786 0.8%
Kent and Medway NHS and Social Care Partnership Trust
1,524 13 538 1,097 170,286 0.6%
Kent Community Health NHS Trust (5) n/a 1,429 1,470 2,114 212,200 1.0%
Maidstone and Tunbridge Wells NHS Trust 189 1,710 300 0 361,390 0.0%
Royal Surrey County Hospital NHS Trust (6) 4,554 n/a n/a n/a n/a n/a
South East Coast Ambulance Service NHS Trust (7) 1,130 3,153 n/a n/a n/a n/a
Surrey and Sussex Healthcare NHS Trust 7,755 875 (6,056) 0 209,801 0.0%
Sus
sex Community NHS Trust (8) 649 675 1,918 1,889 176,075 1.1%
Western Sussex Hospitals NHS Trust (9) 4,138 5,234 5,350 5,224 358,419 1.5%
South East Coast subtotal trusts 36,906 16,291 4,042 16,002 2,619,527 0.6%
Trust name
2009/10
Annual
accounts
surplus/
(operating
defi cit)
£000s
2010/11
Annual
accounts
surplus/
(operating
defi cit)
£000s
2011/12
Annual
accounts
surplus/
(operating
defi cit)
£000s
2012/13 Q1
Forecast
outturn
surplus/
(operating
defi cit)
£000s
2012/13 Q1
Forecast
outturn
turnover
£000s
2012/13 Q1
Forecast
outturn
surplus/
(operating
deficit) as %
turnover
Buckinghamshire Healthcare NHS Trust (10) 146 1,026 2,848 2,000 333,750 0.6%
Isle of Wight NHS Trust (11) n/a n/a n/a 500 158,374 0.3%
Nuffield Orthopaedic NHS Trust 311 882 n/a n/a n/a n/a
Oxford Learning Disability NHS Trust 181 161 59 284 37,073 0.8%
Oxford Radcliffe Hospitals NHS Trust 106 1,289 n/a n/a n/a n/a
Oxford University Hospital NHS Trust (12) n/a n/a 7,157 3,602 800,596 0.4%
Portsmouth Hospitals NHS Trust (14,877) 159 148 4,263 427,750 1.0%
S
outh Central Ambulance Service NHS Trust (13) 602 1,383 2,049 n/a n/a n/a
Southampton University Hospitals NHS Trust (14) 6,777 2,859 (1,908) n/a n/a n/a
S
olent NHS Trust (15) n/a n/a 1,863 753 183,257 0.4%
Winchester and Eastleigh Healthcare NHS Trust (16) 224 147 n/a n/a n/a n/a
South Central subtotal trusts (6,530) 7,906 12,216 11,402 1,940,800 0.6%
Quarter 1 2012/13
59
thequarter.
Trust name
2009/10
Annual
accounts
surplus/
(operating
defi cit)
£000s
2010/11
Annual
accounts
surplus/
(operating
defi cit)
£000s
2011/12
Annual
accounts
surplus/
(operating
defi cit)
£000s
2012/13 Q1
Forecast
outturn
surplus/
(operating
defi cit)
£000s
2012/13 Q1
Forecast
outturn
turnover
£000s
2012/13 Q1
Forecast
outturn
surplus/
(operating
deficit) as %
turnover
Avon and Wiltshire Mental Health Partnership NHS Trust 1,113 3,219 3,541 2,927 189,114 1.5%
Cornwall Partnership NHS Trust (17) 1,250 n/a n/a n/a n/a n/a
Devon Partnership NHS Trust 209 616 789 3,020 140,316 2.2%
Great Western Ambulance Service NHS Trust 94 849 404 851 86,239 1.0%
North Bristol NHS Trust 6,177 7,888 9,002 7,000 519,916 1.3%
Northern Devon Healthcare NHS Trust 0 252 1,719 2,145 213,381 1.0%
Plymouth Hospitals NHS Trust 2,010 18 15 1,000 390,591 0.3%
Royal Cornwall Hospitals NHS Trust 8,349 7,544 4,437 3,800 311,342 1.2%
Royal United Hospital Bath NHS Trust 5,800 4,195 6,215 4,640 223,221 2.1%
South Western Ambulance Service NHS Trust (18) 511 890 n/a n/a n/a n/a
Torbay and Southern Devon Health and Care n/a n/a n/a 100 133,879 0.1%
NHS Trust (19)
Weston Area Health NHS Trust 2,448 2,607 3,610 2,250 92,868 2.4%
South West subtotal trusts 27,961 28,078 29,732 27,734 2,300,867 1.2%
NHS South of England total trusts 58,337 52,275 45,990 55,138 6,861,194 0.8%
For foundation trusts the forecast position is only for the time when the organisation was an NHS trust
1 Milton Keynes PCT is being reported under the East Midlands SHA region from 1 April 2011.
2 Torbay PCT (5CW) was formed on 1 April 2012, now operating commissioning services of Torbay Care Trust (TAL), which is no longer in existence.
3 Ashford and St. Peter’s Hospitals NHS Trust achieved foundation trust status on 1 December 2010.
4 East Sussex Hospitals NHS Trust (RXC) became East Sussex Healthcare NHS Trust on 1 April 2011.
5 Kent Community Health NHS Trust (RYY) was established as an NHS trust on 1 November 2010 as Eastern and Coastal Kent Community Health NHS
Trust, taking on the provider services of Eastern and Coastal Kent PCT, and changed its name on 1 April 2011, after taking on the provider services of
West Kent PCT.
6 Royal Surrey County Hospital NHS Trust achieved foundation trust status on 1 December 2009.
7 South East Coast Ambulance Service NHS Trust achieved foundation trust status on 1 March 2011.
8 Sussex Community NHS Trust (RDR) was formerly South Downs Health NHS Trust, and changed its name on 1 October 2010.
9 Western Sussex Hospitals NHS Trust was formed from the merger of Royal West Sussex NHS Trust (RPR) and Worthing and Southlands Hospitals
NHS Trust (RPL).
10 Buckinghamshire Healthcare NHS Trust (RXQ) was formerly Buckinghamshire Hospitals NHS Trust. The name change was effective from
1 November 2010.
11 Isle of Wight NHS Trust (R1F), was formed on 1 April 2012, as a provider split from Isle of Wight NHS PCT (5QT).
12 Oxford University Hospitals NHS Trust (RTH) was formed from the merger of Nuffield Orthopaedic NHS Trust (RB1) and the Oxford Radcliffe Hospitals
NHS Trust (RTH) on 1 November 2011.
13 South Central Ambulance Service NHS Trust achieved foundation trust status on 1 March 2012.
14 Southampton University Hospitals NHS Trust achieved foundation trust status on 1 October 2011. The defi cit is a technical defi cit due to a phasing issue
in the months before it became a foundation trust.
15 The integration of PCT provider functions, part of NHS Southampton and NHS Portsmouth’s provider arm services, created a new community services
and mental health provider, Solent NHS Trust on 1 April 2011, which is operating as a direct provider organisation under NHS Southampton City.
16 Winchester and Eastleigh Healthcare NHS Trust merged with Basingstoke and North Hampshire NHS Foundation Trust (RN5), on 9 January 2012.
As a result of this merger, Basingstoke and North Hampshire has changed its name to Hampshire Hospitals NHS Foundation Trust.
17 Cornwall Partnership NHS Trust achieved foundation trust status on 1 March 2010.
18 South Western Ambulance Service NHS Trust achieved foundation trust status on 1 March 2011.
19 Torbay and Southern Devon Health and Care NHS Trust (R1G) was formed on 1 April 2012, as a provider arm split from Torbay Care Trust (TAL).
Quarter 1 2012/13
60
thequarter.
In addition to the operating deficits in 2012/13 shown above, the following organisation(s) also forecast a technical deficit (£m) in the
same period. A technical deficit is a deficit arising due to:
a) impairments,
b) incurring additional revenue charges associated with bringing PFI assets on to the balance sheet due to the introduction of IFRS
accounting in 2009/10, or
c) the impact of the change in accounting for donated assets and government grant reserves.
This is not recognised for NHS budgeting purposes.
Brighton and Sussex University Hospitals NHS Trust (£8m)
Dartford and Gravesham NHS Trust (£1m)
Kent and Medway NHS and Social Care Partnership Trust (£0.6m)
Maidstone and Tunbridge Wells NHS Trust (£2m)
North Bristol NHS Trust (£1m)
Plymouth Hospitals NHS Trust (£2m)
Note: SHA and PCT turnover equals the Revenue Resource Limit (RRL) they are allocated. Trust turnover is all the income they receiv
e
including income from PCTs. Trust income should therefore be excluded from any aggregation of SHA economy turnover to avoid
double counting resources.
Quarter 1 2012/13
61
Quarter 1 2012/13
e
s
c
t
n
lu
a
s
m
e
r
r
o
k
f
r
r
o
e
ew
1 PS Q
mFra
HN
thequarter.
In 2012/13 TFA monitoring and the NHS
Performance Framework were brought together.
This publication refl ects this and the change
from quarterly to monthly reporting for the
NHS Performance Framework. It shows the
fi rst published TFA monitoring ratings for
all the remaining acute and ambulance NHS
trusts alongside the monthly NHS Performance
Framework results across Q1. The TFA process
is now informed by the NHS Performance
Framework ratings and a set of rules exist to
ensure consistency across the integrated process.
For mental health trusts, NHS Performance
Framework results are available on a less
frequent timescale so local intelligence is used
to inform the TFA RAG ratings for these trusts.
For community trusts, there are no performance
framework results, so local intelligence is also
used for these trusts. A similar integrated
process for these trusts is being developed.
The TFA monitoring and the NHS Performance
Framework were bought together to ensure
NHS trusts are clear on the equal priority for
delivery against plans to become FTs, the
continued delivery of performance and fi nancial
requirements as set out in the NHS Operating
Framework, and full compliance with CQC
standards. Achievement of FT status will only
be delivered through sustained performance
delivery. Equally, delivery against ongoing
performance requirements will only be achieved
through the governance and organisational
developments required to achieve FT status being
put in place. To maintain the momentum of the
FT pipeline, the monitoring of progress against
each NHS trust’s plans for achieving FT status,
as set out in their individual Tripartite Formal
Agreements (TFA), is a key part to making sure
that the necessary progress is being made by
each organisation. Where an NHS trust does
not deliver against the plans set out in its TFA,
and is red rated for three consecutive months,
the Department’s agreed escalation process is
triggered. Intervention may be needed to ensure
the NHS trust gets back on track and in some
circumstances a revised TFA date may be required
with a revised management plan to deliver this.
Figure 1 – Finance performance for April to June
(including all acute and ambulance trusts)**
Performing:
Performance under review:
Underperforming
Total:
April May June
58 58 58
1 1 2
9 9 9
68 68 69
**There are 68 trusts rated on Finance in April and May as opposed to 69 in June as Finance data
was no
t available for those months for the newly formed Barts Health NHS Trust.
Figure 2 – Breakdown of quality of service performance for April to June
(including all acute and ambulance trusts)
April May June
Performing: 49 48 49
Performance under review: 17 17 17
Underperforming 3 4 3
Total: 69 69 69
62
Quarter 1 2012/13
thequarter.
Figure 3 – Breakdown of finance performance and quality of service performance for
Q4 2011/12 for mental health trusts
Finance Quality
performance of service
performance
Performing: 13 13
Performance under review: 0 0
Underperforming 0 0
Total: 13 13
Bringing together the NHS
Performance Framework results
and the TFA ratings
Monthly TFA ratings take account of the latest
available data at the time of discussions to
agree TFA ratings. Because of the delay in
data publication, April data is refl ected in June
TFA ratings, May data in July and June data in
August. There are some instances with quarterly
data sources (such as fi nance) where previous
quarter data is used in the fi rst two months
of any subsequent quarter until latest data is
available. The NHS Performance Framework
results are used alongside other measures
to make a judgement on the TFA rating. It is
therefore possible for an organisation to be
‘performing’ under the performance framework
and still red rated for their TFA if issues are
apparent with their TFA progress. It is not
however possible for an organisation to be
rated anything other than red on their TFA if
any aspect of the performance framework is
judged to be underperforming.
Figure 4 – Breakdown of TFA ratings for June to August (including all acute, ambulance,
mental health and community trusts)*
June ratings July ratings
August ratings
(using April (using May (using June
NHS PF NHS PF NHS PF
results) results) results)
Green: 30 25 28
Amber-Green: 17 15 11
Amber-Red: 29 33 35
Red: 27 29 28
Total: 103 102 102
*There were 103 non-FTs in the data relating to June and 102 in July onwards (Scarborough was
ac
quired by York FT).
63
Quarter 1 2012/13
Annex 5
NHS Performance Framework and TFA results April to June 2012
thequarter.
64
Trust name
April NHS Performance
Framework
June TFA
rating
May NHS Performance
Framework
July TFA
rating
June NHS Performance
Framework
August TFA
rating
Overall fi nance
score
Overall quality of
services score
Overall fi nance
score
Overall quality of
services score
Overall fi nance
score
Overall quality of
services score
Barking, Havering and Redbridge University Hospitals NHS Trust Underperforming Underperforming R Underperforming
Performance under
review
R Underperforming
Performance under
review
R
Barnet and Chase Farm Hospitals NHS Trust Performing Performing R Performing Performing R Underperforming Performing R
Barts Health NHS Trust Performing R Performing AR Underperforming Performing R
Bedford Hospital NHS Trust Performing Performing AG Performing Performing AG Performing Performing AG
Birmingham Community Healthcare NHS Trust G G G
Bridgewater Community Healthcare Trust AG AR AR
Brighton and Sussex University Hospitals NHS Trust Performing
Performance under
review
AR Performing Performing AR Performing
Performance under
review
AR
Buckinghamshire Healthcare NHS Trust Performing Performing R Performing Performing R Performing Performing AG
Cambridge Community Services NHS Trust AG AR AR
Central London Community Healthcare NHS Trust AR AR AR
Croydon Health Services NHS Trust Performing
Performance under
review
R Performing
Performance under
review
R Performing Underperforming R
Dartford and Gravesham NHS Trust Performing
Performance under
review
AR Performing
Performance under
review
AR Performing
Performance under
review
AR
Derbyshire Community Health Services NHS Trust G G G
Ealing Hospital NHS Trust Performing
Performance under
review
R Performing
Performance under
review
R Performing
Performance under
review
R
East and North Hertfordshire NHS Trust Performing
Performance under
review
AR Performing Performing G Performing Performing G
East Cheshire NHS Trust Performing Performing AR Performing Performing AR Performing
Performance under
review
AR
East Lancashire Hospitals NHS Trust Performing Performing AG Performing Performing AG Performing Performing G
East Midlands Ambulance Service NHS Trust Performing Performing AR Performing Underperforming R Performing Performing AR
East of England Ambulance Service NHS Trust Performing Performing G Performing Underperforming R Performing Underperforming R
East Sussex Hospitals NHS Trust Performing
Performance under
review
AR Performing Performing AR Performing Performing AR
Epsom and St Helier University Hospitals NHS Trust Underperforming Performing R Underperforming
Performance under
review
R Underperforming
Performance under
review
R
George Eliot Hospital NHS Trust Performing Performing AR Performing
Performance under
review
AR Performing Performing AR
G
reat Western Ambulance Service NHS Trust Performing Performing G Performing Performing G Performing Performing G
Quarter 1 2012/13
Trust name
April NHS Performance
Framework
June TFA
rating
May NHS Performance
Framework
July TFA
rating
June NHS Performance
Framework
August TFA
rating
Overall fi nance
score
Overall quality of
services score
Overall fi nance
score
Overall quality of
services score
Overall fi nance
score
Overall quality of
services score
Hertfordshire Community NHS Trust AR AR R
Hinchingbrooke Healthcare NHS Trust Underperforming Performing AG Underperforming Performing AR Underperforming Performing R
Hounslow and Richmond Community Healthcare NHS Trust AG AR AR
Hull and East Yorkshire Hospitals NHS Trust Performing Performing AG Performing Performing AG Performing Performing AG
Imperial College Healthcare NHS Trust Underperforming Underperforming R Underperforming Underperforming R Performing
Performance under
review
R
Ipswich Hospital NHS Trust Performing Performing R Performing Performing R Performing Performing AR
Isle of Wight NHS Primary Care Trust Performing Performing G Performing Performing G Performing Performing G
Kent Community Health NHS Trust G AG
Kingston Hospital NHS Trust Performing Performing G Performing Performing G Performing Performing G
Leeds Community Healthcare NHS Trust AG AR AR
Leeds Teaching Hospitals NHS Trust Performing Performing R Performing Performing R Performing Performing R
Lewisham Healthcare NHS Trust Performing Performing G Performing Performing G Performing Performing G
Lincolnshire Community Health Services NHS Trust AG AG AR
Liverpool Community Health NHS Trust G AR
London Ambulance Service NHS Trust Performing Underperforming R Performing Underperforming R Performing Performing R
Maidstone and Tunbridge Wells NHS Trust Performing Performing AR Performing Performing AR Performing Performing AR
Mid Essex Hospital Services NHS Trust Underperforming
Performance under
review
R Underperforming
Performance under
review
R Performing Performing R
Mid Yorkshire Hospitals NHS Trust Underperforming Performing R Underperforming Performing R Underperforming
Performance under
review
R
Norfolk Community Health and Care NHS Trust AR R G
North Bristol NHS Trust Performing
Performance under
review
AR Performing
Performance under
review
AR Performing Performing AR
North Cumbria University Hospitals NHS Trust Performing
Performance under
review
AR Performing
Performance under
review
R Performing
Performance under
review
R
North Middlesex University Hospital NHS Trust Performing
Performance under
review
R Performing
Performance under
review
AR Performing
Performance under
review
AR
North West Ambulance Service NHS Trust Performing Performing G Performing Performing G Performing Performing G
North West London Hospitals NHS Trust Underperforming
Performance under
review
R Underperforming
Performance under
review
R Underperforming
Performance under
review
R
Northampton General Hospital NHS Trust Performing Performing AR Performing Performing R Performing Performing R
Northern Devon Healthcare NHS Trust Performing Perfor
ming R Performing Performing R Performing Performing R
thequarter.
AG
AR
65
Quarter 1 2012/13
Trust name
April NHS Performance
Framework
June TFA
rating
May NHS Performance
Framework
July TFA
rating
June NHS Performance
Framework
August TFA
rating
Overall fi nance
score
Overall quality of
services score
Overall fi nance
score
Overall quality of
services score
Overall fi nance
score
Overall quality of
services score
Nottingham University Hospitals NHS Trust Performing Performing AR Performing
Performance under
review
R Performing Underperforming R
Oxford Learning Disability NHS Trust G AG
Oxford University Hospitals NHS Trust Performing
Performance under
review
AR Performing
Performance under
review
AR Performing
Performance under
review
AR
Pennine Acute Hospitals NHS Trust Performing
Performance under
review
AR Performing Performing AR Performing Performing AR
Plymouth Hospitals NHS Trust Performing Performing AG Performing Performing AR Performing Performing AR
Portsmouth Hospitals NHS Trust Performing Performing AR Performing Performing AR Performing Performing AR
Princess Alexandra Hospital NHS Trust Performing
Performance under
review
AR Performing
Performance under
review
AR Performing
Performance under
review
AR
Royal Cornwall Hospitals NHS Trust Performing Performing G Performing Performing G Performing Performing G
Royal Liverpool Broadgreen Hospitals NHS Trust Performing Performing AG Performing Performing G Performing Performing G
Royal United Hospital Bath NHS Trust Performing Performing G Performing Performing G Performing Performing G
Royal Wolverhampton Hospital NHS Trust Performing Performing G Performing Performing G Performing Performing G
Sandwell and West Birmingham Hospitals NHS Trust Performing Performing AR Performing Performing AR Performing Performing AR
Scarborough and North East Yorkshire NHS Trust G n/a
Shrewsbury and Telford Hospitals NHS Trust Performing Performing AR Performing Performing AR Performing Performing AR
Shropshire, Telford and Wrekin Community Services G G G
Solent NHS Trust G AR
South London Healthcare NHS Trust Underperforming Performing R Underperforming Performing R Underperforming Performing R
Southport and Ormskirk Hospital NHS Trust Performing
Performance under
review
AR Performing
Performance under
review
AR Performing
Performance under
review
AR
St George's Healthcare NHS Trust Performing Performing AR Performing Performing AG Performing Performing AG
St Helens and Knowsley Hospitals NHS Trust Performing Performing R Performing Performing R Performing Performing R
Staffordshire and Stoke on Trent Community Services G G G
Surrey and Sussex Healthcare NHS Trust
Performance under
review
Performance under
review
R
Performance under
review
Performance under
review
R Performing
Performance under
review
R
S
ussex Community NHS Trust AR AR AR
The Royal National Orthopaedic Hospital NHS Trust Performing Performing AR Performing Performing AG Performing Performing AG
The Whittington Hospital NHS Trust Performing Performing AR Performing Performing AR Performing Performing AR
Torbay and South Devon Health and Care Trust G G
United Lincolnshire Hospitals NHS Trust Performing Performing AR Performing Performing AG
Performance under
review
Performing AR
thequarter.
66
AG
n/a
R
AG
thequarter.
Quarter 1 2012/13
Trust name
April NHS Performance
Framework
June TFA
rating
May NHS Performance
Framework
July TFA
rating
June NHS Performance
Framework
August TFA
rating
Overall fi nance
score
Overall quality of
services score
Overall fi nance
score
Overall quality of
services score
Overall fi nance
score
Overall quality of
services score
University Hospital of North Staffordshire Hospital NHS Trust Performing Performing AG Performing Performing AR Performing Performing AR
University Hospitals Coventry and Warwickshire NHS Trust Performing Performing R Performing Performing AR Performing Performing AR
University Hospitals of Leicester NHS Trust Performing Performing R Performing Performing AR Performing
Performance under
review
AR
Walsall Hospitals NHS Trust Performing Performing AG Performing Performing AG Performing Performing AG
West Hertfordshire Hospitals NHS Trust Performing Performing G Performing Performing G Performing Performing G
West Middlesex University NHS Trust Underperforming
Performance under
review
R Underperforming
Performance under
review
R Underperforming
Performance under
review
R
West Midlands Ambulance Service NHS Trust Performing Performing G Performing Performing G Performing Performing G
Western Sussex Hospitals NHS Trust Performing Performing G Performing Performing G Performing Performing G
Weston Area Health NHS Trust Performing Performing G Performing Performing AG Performing Performing AG
Wirral Community Health Services G AR AR
Worcestershire Acute Hospitals NHS Trust Performing Performing R Performing Performing R Performing Performing AR
Worcestershire Health and Care NHS Trust G G G
Wye Valley NHS Trust (Hereford Hospital) Performing Performing AR Performing Performing AR
Performance under
review
Performing AR
Yorkshire Ambulance Service NHS Trust Performing Performing R Performing Performing R Performing Performing R
Please note: April and May Performance Framework results use Q4 2011/12 FIMS data, whereas Q1 2012/13 data is used for June results.
67
thequarter.
Annex 6
Q4 NHS Performance Framework and TFA results –
mental health trusts
Quarter 1 2012/13
68
NHS Performance
TFA results
Framework – Q4 2011/12
Trust name
Overall fi nance Overall quality of
June July August
score services score
Avon and Wiltshire Mental Health Partnership NHS Trust Performing Performing R R R
Barnet, Enfi eld and Haringey Mental Health NHS Trust Performing Performing G G G
Bradford District Care Trust Performing Performing AR R R
Coventry and Warwickshire Partnership NHS Trust Performing Performing G G G
Devon Partnership NHS Trust Performing Performing G G G
Dudley and Walsall Mental Health Partnership NHS Trust Performing Performing G G G
Kent and Medway NHS and Social Care Partnership Trust Performing Performing AG AG AR
Leicestershire Partnership NHS Trust Performing Performing G G G
Manchester Mental Health and Social Care Trust Performing Performing AG AG G
Mersey Care NHS Trust Performing Performing AG AG G
North Staffordshire Combined Healthcare NHS Trust Performing Performing R R R
South West London and St George’s Mental Health NHS Trust Performing Performing R G G
West London Mental Health NHS Trust Performing Performing AG AG AG
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