thequarter.
Quarter 2 2012/13 An update from David Flory, Deputy NHS Chief Executive
Index
01 Introduction
03 Quality
03 HCAI
04
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
26 Productivity
26 Finance
30 Activity
32 Workforce
35 Prevention
35 Health visitors
36 Maternity and
newborn
36 Breastfeeding
36 Smoking
37
Screening (venous
thromboembolism,
breast, cervical,
bowel, diabetic
retinopathy)
38 Immunisation
38
NHS health checks
39 Reform
39 Choice
43 Provision
44 Commissioning
45 Public health
46 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 July to September 2012, quarter
two (Q2), the second quarter of the 2012/13 performance year.
During Q2, we saw the NHS continue to
maintain performance and make further
progress through the transition period while
also responding to the unique challenge
presented by the Olympic and Paralympic
Games. The NHS maintained service delivery
throughout the games period as well as
providing support to the games family which is
a testament to the signifi cant planning efforts
that took place to prepare for this unique
challenge, and the strong collaboration that
occurred at all levels of the system.
Performance delivery secured
Q2 saw the successes reported at quarter one
(Q1) 2012/13 continue against the measures set
out in the NHS Operating Framework 2012/13,
with performance maintained or improved:
MRSA bacteraemia were 14 percent lower
than during the same quarter last year and
C. dif cile infections were 23 percent lower
access to services continued to be maintained,
with the NHS delivering above the NHS
constitutional commitment to treatment
within 18 weeks of referral. We also saw a
continuing reduction in longer waiters with
the 92 percent threshold for incomplete waits
being consistently exceeded
the number of breaches of mixed sex
accommodation continued to decrease to a
breach rate of 0.1 per 1,000 episodes
key cancer standards continue to be achieved
across all eight performance measures
performance around key emergency
treatment standards for A&E access and
ambulance response times remains stable.
These achievements should be recognised
because they are the result of signifi cant efforts
by staff continuing to focus on performance
in what is a period of signifi cant change. It is
vital that these efforts continue as we move
into the winter period. For quarter 3 (Q3) and
quarter 4 (Q4) 2012/13, we will be maintaining
a consistent focus on performance and will
expect those small number of organisations
who continue to under-perform to maintain
a forensic focus on improvement to assure a
stable transition for 2013/14.
1 http://www.dh.gov.uk/en/Publicationsandstatistics/Publications/PublicationsPolicyAndGuidance/DH_131360
Gateway reference
number 18493
Quarter 2 2012/13
Enter
thequarter.
A positive fi nancial position
The NHS has maintained the fi nancial position
from Q1. Latest fi gures indicate that strategic
health authorities (SHAs) and primary care
trusts (PCTs) are forecasting an overall surplus
of £1,184 million, which is in line with the NHS
Operating Framework 2012/13 and a slight
increase from Q1.
In addition, Q2 data shows that the NHS
delivered a further £1.2 billion of Quality,
Innovation, Productivity and Prevention (QIPP)
savings, building on the solid achievements of
Q1 and yielding a combined achievement of
49 percent of the forecast annual savings.
Progress through transition
Progress against the reform agenda continues
with the future shape of delivery now clearly set
out with the publication of the NHS Mandate
2
on 13 November. The coming months will see
focus move towards the planning process as
new NHS organisations begin to set out how
they will deliver against this ambitious challenge.
Clinical commissioning groups (CCGs) are at an
advanced stage of preparation, with all now
moving towards full authorisation. They will be
working alongside legacy organisations over the
next few months through the planning round to
take responsibility for delivery from April.
102 NHS trusts remained in the foundation
trust (FT) pipeline at the end of Q2. We
continue to expect the majority of NHS trusts
to achieve FT status by 2014 either as stand-
alone organisations, as part of an existing
FT, or in some other organisational form. It is
encouraging that 24 trusts are at an advanced
stage in the current application process but
the NHS Trust Development Authority (TDA)
has a signifi cant challenge in securing a full FT
landscape for the future. The publication of
the trust special administrator report into the
future viability of South London Healthcare NHS
Trust is an important step in moving towards a
sustainable health system in south east London.
While it is the last stage of a lengthy process of
engagement, it represents the opportunity to
ensure that all NHS organisations are viable and
safe for the future.
Conclusion
The NHS remains well placed for the future
with a strong underlying delivery and fi nancial
position. This was acknowledged in a recent
report by The King’s Fund, which recognised
the positive performance gains which have been
secured in recent years. However, as both they
and we acknowledge, there is a pressing need to
continue to focus on dealing with the challenges
posed to the NHS as a result of demographic,
nancial and technological challenges and
as the recently published Dr Foster report
recognised, on ensuring that patients are
treated in the most appropriate settings.
We are entering the most challenging phase of
transition and it is vital that efforts are focussed
to ensure that this strong position is maintained
to give successor organisations the best
opportunity to realise their delivery potential
in the future.
2 https://www.wp.dh.gov.uk/publications/fi les/2012/11/mandate.pdf
Quarter 2 2012/13
2
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
Jul-Sep
Quarterly MRSA totals
1,200
800
400
0
2007/8 2008/9 2009/10 2010/11 2011/12 2012/13
1,600
thequarter.
Quality
HCAI
3
Performance status: improved
MRSA bloodstream infections were 14 percent
lower and C. dif cile infections were 23 percent
lower than the same quarter last year.
For 2012/13, the NHS Operating Framework
c
ontinues to prioritise the achievement of the
MRSA and C. dif cile objectives. This requires
NHS commissioners and providers to identify
and agree plans for reducing infections in line
with national objectives.
MRSA
In Q2, a total of 228 MRSA bloodstream
infections were reported, a 14 percent
reduction on the same quarter last year.
Figure 1: MRSA bacteraemia: quarterly totals between April 2007 and September 2012
3 http://www.hpa.org.uk/Topics/InfectiousDiseases/InfectionsAZ/HCAI/
LatestPublicationsFromMandatorySurveillanceMRSACDIAndGRE/
Quarter 2 2012/13
3
20,000
15,000
10,000
5,000
0
2007/8 2008/9 2009/10 2010/11 2011/12 2012/13
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
Jul-Sep
Quarterly CDI cases aged 2+
thequarter.
C. dif cile
For C. diffi cile, 3,866 infections were reported
in Q2, a 23 per cent improvement on the same
quarter last year.
In addition, from April 2012, the Department
of Health introduced new guidance that
strengthens C. dif cile testing and reporting
arrangements, helping healthcare providers
improve the management of C. dif cile
infection.
Figure 2: C. difficile cases aged two or more: quarterly totals between April 2007
and September 2012
Patient experience
Eliminating mixed sex
accommodation
4
Performance status: improved
The overall trend of steadily reducing breaches
continues. In Q2, the total number of reported
breaches was 591. This is down from a total
of 1,318 breaches reported in Q1, an overall
reduction of 55 percent.
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.
Twenty-two months worth of data is now
available. There has been a steady reduction
in the breach rate as shown in Figure 3 (Q2
gures in shaded boxes). *Asterisked fi gures
are unrevised.
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
locally through usual contract arrangements.
Occurrences of mixing in the best interests
of patients are monitored locally but not
reported centrally.
4 http://transparency.dh.gov.uk/2012/07/10/mixed-sex-accommodation/
Quarter 2 2012/13
4
0
Breach rate MSA breaches
thequarter.
Figure 3: Number of mixed sex
accommodation breaches
Month
MSA
breaches
Breach
rate
Sep-12 *182 0.1
Aug-12 *160 0.1
Jul-12 *249 0.2
Jun-12 *325 0.2
May-12 *434 0.3
Apr-12 *559 0.4
Mar-12 466 0.3
Feb-12 581 0.4
Jan-12 626 0.4
Dec-11 795 0.6
Nov-11 937 0.6
Oct-11 1,236 0.8
Sep-11 1,063 0.7
Aug-11 1,083 0.8
Jul-11 1,075 0.7
Jun-11 1,939 1.3
May-11 1,908 1.4
Apr-11 2,236 1.6
Mar-11 5,466 3.6
Feb-11 8,031 6
Jan-11 8,708 6.4
Dec-10 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
Jul 12
Aug 12
Sep 12
0
0
0
0
0
0
0
0
e
c 1
0
a
n
11
eb
11
ar
11
p
r 11
ay 11
u
n 11
J
ul 11
ep
11
Oct
11
o
v 11
e
c 11
a
n 1
2
eb
12
a
r 1
2
pr
12
a
y 1
2
un
1
2
J
ul 12
ug
1
2
ep
12
0
1
2
3
4
5
6
7
8
9
Number of MSA breaches
MSA breaches per 1,000 FCE’s
Quarter 2 2012/13
5
thequarter.
CQC community mental
health survey
5
The results from the community mental health
survey 2012/13 were published by the Care
Quality Commission (CQC) on 13 September
2012. The proportion of patients in 2012 rating
their overall care as excellent was 30 percent,
which is comparable to the fi gure for 2011
(29 percent).
Some notable results are detailed below:
Overall, 79 percent of service users rated the
care received as good, very good or excellent
for some questions, respondents covered
by the Care Programme Approach (CPA)
reported different experiences to those not on
CPA, though this was not unexpected given
the differences in the policy requirements of
the two approaches
results have improved for care plans. More
people have plans that ‘defi nitely’ set out
thei
r goals (43 percent in 2012 from 40
percent in 2011), that ‘defi nitely’ cover what
to do in a crisis (54 percent from 52 percent),
and that have been provided in written or
printed form within the last year (49 percent
from 47 percent)
more people have had more than one
care review meeting in the last 12 months
(34 percent from 32 percent)
results have deteriorated for support from
NHS mental health services in some areas.
More patients reported they received no
help with physical health needs (36 percent
from 31 percent) and care responsibilities
(39 percent from 35 percent), but would
have liked support.
Individual trust scores are included in the
Community Mental Health Survey and
organisations are encouraged to review their
position and consider what action they need
to take to improve patient experience.
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:
“Were 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
those 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, developed in conjunction with the
NHS, was published on 4 October 2012.
6
5 http://www.cqc.org.uk/public/reports-surveys-and-reviews/surveys/community-mental-health-survey-2012
6 http://www.dh.gov.uk/health/2012/10/guidance-nhs-fft
Quarter 2 2012/13
6
thequarter.
Patient Reported Outcome
Measures (PROMs)
7
Performance status: maintained
The latest provisional data covering April
2011 to March 2012 shows a continuing
improvement in compliance. The number of
patients returning pre-operative questionnaires
(184,958) and the national participation rate
(75 percent) show a clear upward trend. The
national participation rate is approximately
5 percentage points higher than in 2010/11,
Figure 5: Headline PROMs data, England
which in turn was 3.7 percentage points higher
th
an in 2009/10.
The data for April 2011 to March 2012
published on 13 November 2012 shows that
the percentage of patients reporting an
improvement for all four procedures has been
maintained. For example, 95.8 percent of
patients receiving a hip replacement report
an improvement, the same fi gure as 2010/11
and 91.7 percent of patients receiving a knee
replacement report an improvement, up from
91.4 percent in 2010/11.
Procedure Year*
Average health
gain (EQ-5D)
% 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 0.416 87.3 – 95.8
Knee replacement
2009/10 0.295 77.6 – 91.4
2010/11 0.299 77.9 – 91.4
2011/12 0.303 78.6 – 91.7
Varicose vein
2009/10 0.094 52.4 – 83.4
2010/11 0.094 51.6 – 82.5
2011/12 0.095 53.3 – 83.3
2012/13 0.104 53.9 – 83.0
Groin hernia
2009/10 0.082 49.3
2010/11 0.085 50.5
2011/12 0.087 49.9
2012/13 0.085 51.6
* 2009/10 and 2010/11 data fi nalised; 2011/12 and 2012/13 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.
*** 2012/13 data covers three months and currently has no data for hip or knee replacement.
Analysis of the 2011/12 data indicates that a
number of organisations seem to be ‘outliers’
on certain procedures when compared
to the national average
8
. Figure 6 shows
the organisations whose performance is
statistically better than the national average
for generic health status and condition-specifi c
questionnaire (where available). 13 other
organisations appear as a positive outlier for
one outcome measure.
7 http://www.hesonline.nhs.uk/Ease/ContentServer?siteID=1937&categoryID=1295
8 The outlier methodology was published on the Departments website in July 2011 http://www.dh.gov.uk/en/
Publicationsandstatistics/Publications/PublicationsPolicyAndGuidance/DH_128440.
Quarter 2 2012/13
7
thequarter.
Figure 6: List of potential statistical positive ‘outlier’ organisations for 2011/12
(provisional data)
Organisation name Procedure
Dorset County Hospital NHS Foundation Trust Hip replacement
Duchy Hospital, Truro Knee replacement
Heart of England NHS Foundation Trust Varicose vein
Royal Devon and Exeter NHS Foundation Trust Hip replacement
South Warwickshire NHS Foundation Trust Groin hernia
Inclusion criteria:
groin hernia: statistically below average scores (> 3 standard deviations) for EQ-5D index
all others: statistically above average scores (> 3 standard deviations) for EQ-5D index and condition specifi c
score (Oxford hip score, Oxford knee score or Aberdeen varicose vein score).
Figure 7 shows those organisations whose outliers for one outcome measure.
outcomes are statistically below the average for Organisations in Figure 7 are encouraged
both the generic health status and condition- to investigate their own score in order to
specifi c questionnaire (where available). understand any underlying causes for the
23 other organisations appear as negative 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
Chester eld Royal Hospital NHS Foundation Trust Hip replacement
Guy’s and St Thomas’ NHS Foundation Trust Knee replacement
Heart of England NHS Foundation Trust Hip replacement
Homerton University Hospital NHS Foundation Trust Knee replacement
North Bristol NHS Trust Knee replacement
Royal Liverpool and Broadgreen University Hospitals NHS Trust Hip replacement
Royal National Orthopaedic Hospital NHS Trust Knee replacement
South London Healthcare NHS Trust Knee replacement
The Dudley Group NHS Foundation Trust Groin hernia
The Hillingdon Hospitals NHS Foundation Trust Hip replacement
Walsall Healthcare NHS Trust Hip replacement
Whipps Cross University Hospital NHS Trust Groin hernia
Inclusion criteria:
groin hernia: statistically below average scores (> 3 standard deviations) for EQ-5D index
all others: 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).
Quarter 2 2012/13
8
thequarter.
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
Jul 12
Sep 12
Admitted (unadjusted) Non-admitted
Admitted (adjusted) Incomplete
Month
Referral to treatment (RTT)
consultant-led waiting times)
9
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
10
.
In the three months to September 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 September 2012, 92.2 percent of admitted
patients and 97.4 percent of non-admitted
patients started treatment within 18 weeks.
The NHS continues to deliver 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
September 2012, 94.4 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 that patients
r
eceive clinically appropriate treatment in
accordance with the NHS Constitution. In order
to deliver the NHS Constitution right, and in the
best interests of patients, it is good practice to
publish local access policies which 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.
9 http://transparency.dh.gov.uk/2012/06/29/rtt-waiting-times/
10 http://www.dh.gov.uk/en/Publicationsandstatistics/Publications/PublicationsPolicyAndGuidance/DH_132961
Quarter 2 2012/13
9
thequarter.
Figure 9 shows the 10 organisations reporting
the best performance against the 2012/13
performance measures in September 2012.
Figure 9: Acute trusts with best performance on referral to treatment waits in
September 2012
Name
Adm %
within
18 weeks
Non-adm
% within
18 weeks
Incomplete
% within
18 weeks
Treatment
functions
not met
West Suffolk NHS Foundation Trust 100.0% 100.0% 100.0% 0
Chester eld Royal Hospital NHS Foundation Trust 98.3% 99.6% 98.9% 0
South Tyneside NHS Foundation Trust 98.1% 99.8% 94.1% 0
Poole Hospital NHS Foundation Trust 97.6% 97.4% 96.9% 0
Liverpool Women’s NHS Foundation Trust 97.0% 96.1% 93.0% 0
Gateshead Health NHS Foundation Trust 96.9% 98.0% 96.6% 0
North Middlesex University Hospital NHS Trust 96.6% 99.0% 99.6% 0
Northampton General Hospital NHS Trust 96.3% 98.4% 97.1% 0
Homerton University Hospital NHS Foundation Trust
City Hospitals Sunderland NHS Foundation Trust
96.3%
95.4%
99.6%
99.0%
98.2%
96.9%
0
0
Figure 10 shows the 10 organisations
reporting the poorest performance across
the 2012/3 performance measures in
September 2012.
Figure 10: Acute trusts with poorest performance on referral to treatment waits in
September 2012
Performance thresholds
Name
Sherwood Forest Hospitals NHS Foundation Trust
The Robert Jones and Agnes Hunt Orthopaedic
Hospital NHS Foundation Trust
Bradford Teaching Hospitals NHS Foundation Trust
Shrewsbury and Telford Hospital NHS Trust
United Lincolnshire Hospitals NHS Trust
James Paget University Hospitals NHS
Foundation Trust
Shef eld Children’s NHS Foundation Trust
St Georges Healthcare NHS Trust
Cambridge University Hospitals NHS
Foundation Trust
Imperial College Healthcare NHS 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
77.9% 91.8% 89.9% 24 4
3
3
2
2
1
1
1
1
1
43.3% 71.4% 75.2% 7
72.3% 93.6% 92.7% 26
80.9% 95.1% 90.0% 12
17
7
3
12
11
17
89.6% 94.6% 92.1%
94.8%
92.2%
94.3%
95.0%
92.8%
75.5% 99.0%
96.5%
97.3%
96.6%
96.2%
84.0%
84.2%
84.3%
85.4%
Quarter 2 2012/13
10
thequarter.
During the three months to September 2012, This reduction means that the number of
the NHS has also made good progress in patients waiting over a year for treatment is at
reducing numbers of patients still waiting a the lowest level since records began, a result
long time to start treatment. In particular, the of action taken by local health communities to
number of patients still waiting over a year treat patients who have been waiting a long
at the end of September 2012 has reduced time, and action taken to validate waiting lists.
to 1,613 (0.1 percent of total waiting list),
Figure 11 shows the 10 organisations with the
compared to 20,097 (0.8 percent of total
most ‘over 52 week waits’ in September 2012.
waiting list) at the end of September 2011.
Figure 11: Providers with highest number of over 52 week waits in September 2012
Trust name
52+ week
waits
King’s College Hospital NHS Foundation Trust 128
Guy’s and St Thomas’ NHS Foundation Trust 125
The Newcastle upon Tyne Hospitals NHS Foundation Trust 124
Imperial College Healthcare NHS Trust 97
The Robert Jones and Agnes Hunt Orthopaedic Hospital NHS Foundation Trust 96
Nottingham University Hospitals NHS Trust 91
Benenden Hospital 70
The Royal Orthopaedic Hospital NHS Foundation Trust 47
Hounslow and Richmond Community Healthcare NHS Trust 43
In July and September, 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 August 2012, with
1.05 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 September
2012. Figure 12 shows the acute trusts with the
largest percentages of waits of six weeks or
longer at the end of September 2012.
Quarter 2 2012/13
11
thequarter.
Figure 12: Providers reporting the largest percentages of diagnostic waits of six weeks
or longer at the end of September 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
University Hospitals Bristol NHS Foundation Trust 423 4,026 10.5%
Papworth Hospital NHS Foundation Trust 57 726 7.9%
Mid Staffordshire NHS Foundation Trust 168 2,387 7.0%
Surrey and Sussex Healthcare NHS Trust 212 3,597 5.9%
South Devon Healthcare NHS Foundation Trust 173 3,018 5.7%
Oxford University Hospitals NHS Trust 346 6,102 5.7%
Hampshire Hospitals NHS Foundation Trust 271 5,225 5.2%
Wirral University Teaching Hospital NHS Foundation Trust 283 5,743 4.9%
Guy’s and St Thomas’ NHS Foundation Trust 195 4,687 4.2%
Gloucestershire Hospitals NHS Foundation Trust 262 6,619 4.0%
Brighton and Sussex University Hospitals NHS Trust 182 5,190 3.5%
The Rotherham NHS Foundation Trust 46 1,366 3.4%
King’s College Hospital NHS Foundation Trust 126 4,542 2.8%
Bradford Teaching Hospitals NHS Foundation Trust 146 5,766 2.5%
Royal Surrey County Hospital NHS Foundation Trust 74 2,943 2.5%
Poole Hospital NHS Foundation Trust 70 3,052 2.3%
West Suffolk NHS Foundation Trust 37 1,732 2.1%
Kingston Hospital NHS Trust 52 2,701 1.9%
Royal Berkshire NHS Foundation Trust
Hinchingbrooke Health Care NHS Trust
44
30
2,635
1,883
1.7%
1.6%
Average waiting times for the 15 key diagnostic
tests have remained low and stable in the three
months to September 2012. This has been
achieved during a period of increasing activity.
In the three months to September 2012, total
diagnostic activity increased by 5.8 percent
(231,000) tests compared to the same period
in 2011.
Quarter 2 2012/13
12
thequarter.
A&E
11
Performance status: maintained
At Q2, 96.9 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 13 shows performance against the total
time indicator, with quarterly monitoring A&E
return (QMAE) as the data source until Q2
2011/12. Following the fundamental review of
data returns consultation, QMAE ceased to be
collected from January 2012. Situation (sitrep)
data, which is directly comparable, will now be
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 13: 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
Q2
2011/12
97.3%
96.3%
95.8%
96.6%
96.9%
Q4
2011/12
Q1
2012/13
Q2
2012/13
Q3
2011/12
DH QMAE collection, DH WSitAE collection from Q3 2011/12
Note scale does not start at zero
11 ht tp: / / t ranspar enc y.dh.g ov.uk / 2012 / 06 /14 / ae- info /
Quarter 2 2012/13
13
thequarter.
Ambulance
12
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.
For Q2 2012/13, separate aggregated fi gures for
Category A Red 1 and Category A Red 2 calls
are displayed. This is the fi rst quarter in which
these categorisations have been used across all
three months of the period.
For Q2, the proportion of Category A Red 1
calls responded to within eight minutes was
75.0 percent nationally. The proportion of
Category A Red 2 calls responded to within
eight minutes was 76.9 percent nationally.
For Q2, 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 96.4 percent nationally,
comparable to the Q1 2012/13 fi gure of 96.6
percent.
The data shows that fast response times for the
most seriously ill patients are being maintained,
as represented in Figures 14 and 15.
Figure 14: 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 sitreps, but has been
aggregated here to create a monthly time series. The weekly period covered each month will vary, covering a period of
either four orve 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 minutes data and therefore they have been shown separately on the graph.
12 http://transparency.dh.gov.uk/category/statistics/amb-quality-indicators/
Quarter 2 2012/13
14
thequarter.
Standard
2011/12 2012/13
Figure 15: 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.
The system measures for Q2 show that:
there were over 1,205,000 emergency
journeys in Q2
the percentage of callers abandoning their
call before the call was answered by the
ambulance service, rose from 1.1 percent in
Q1 to 1.7 percent in Q2
the proportion of patients re-contacting the
ambulance service following discharge of care
by telephone fell from 14 percent in Q1 to
13.1 percent in Q2
the re-contact rate following discharge of
care from treatment at the scene remained
the same in Q2 as in Q1, at 5.8 percent
the proportion of calls closed with telephone
advice rose slightly from 5.7 percent in Q1 to
5.8 percent in Q2
the proportion of incidents receiving a face-
to-face response from ambulance services,
which were managed without the need for
transport to A&E, rose from 35.1 percent in
Q1 to 35.6 percent in Q2.
Quarter 2 2012/13
15
thequarter.
Cancer
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
Q2, and performance was above the published
operational standards.
Figure 16: Performance against cancer waiting time standards
Measure
Operational
standard
Q2 2012/13
Performance
Maximum two-week wait for fi rst outpatient appointment for
patients referred urgently with suspected cancer by a GP
93% 95.4%
Maximum two-week wait for fi rst outpatient appointment for
patients referred urgently with breast symptoms (where cancer
was not initially suspected)
93% 95.7%
Maximum two month (62-day) wait from urgent GP referral to fi rst
defi nitive treatment for cancer
85% 87.3%
Maximum 62-day wait from referral from an NHS screening service
to fi rst defi nitive treatment for all cancers.
90% 94.9%
Maximum 62-day wait for fi rst definitive treatment following a
consultants decision to upgrade the priority of the patient (all cancers)
No operational
standard has
been set
93.2%
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% 97.5%
Maximum 31-day wait for subsequent treatment where that
treatment is an anti-cancer drug regimen
98% 99.8%
Maximum 31-day wait for subsequent treatment where the
treatment is a course of radiotherapy
94% 97.9%
All data are taken from the Q2 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 Q2 2012/13
(see Figure 17 below).
Quarter 2 2012/13
16
thequarter.
Figure 17: Cancer waiting times standards: identifi ed outlier organisations
Cancer waiting
time measure
Maximum two-week wait for fi rst outpatient
appointment for patients referred urgently with
suspected cancer by a GP
Maximum one month (31-day) wait from diagnosis to
rst defi nitive treatment for all cancers
Maximum 31-day wait for subsequent treatment where
that treatment is surgery
Maximum 31-day wait for subsequent treatment where
that treatment is an anti-cancer drug regimen
Maximum 31-day wait for subsequent treatment where
the treatment is a course of radiotherapy
Maximum two month (62-day) wait from urgent GP
referral to fi rst defi nitive treatment for cancer
Maximum 62-day wait from referral from an NHS
screening service to fi rst denitive treatment for
all cancers
Maximum two-week wait for fi rst outpatient
appointment for patients referred urgently with breast
symptoms (where cancer was not initially suspected)
Number of measures failed
Required
operational
standard
93% 96% 94% 98% 94% 85% 90% 93%
Provider % % % % % % % % n
East Sussex
Healthcare NHS Trust
Imperial College
Healthcare NHS Trust
Kingston Hospital
NHS Trust
Southport and
Ormskirk Hospital
NHS Trust
The Princess
Alexandra Hospital
NHS Trust
92.4% 96.3% 100.0% 100.0%
99.0%
100.0%
100.0%
100.0%
95.8%
100.0%
84.4% 90.9% 92.5% 3
5
3
3
4
94.5% 89.1% 89.8% 64.6% 80.7% 91.4%
91.2% 98.0%
98.7%
97.6%
90.9% 89.3% 88.9% 84.7%
92.5% 91.3% 84.1% 100.0%
90.0%
98.0%
89.7% 93.5% 73.7% 91.8%
Period: Q2 2012/13 (July, August and September)
Basis: Provider-based including Welsh cross-border patients and ‘unknowns’
Defi nitions: Amd 23/2011
Note 1: Only providers reporting five or more cases for any one measure in the period are identified in this analysis
Note 2: Only providers that failed to achieve three or more waiting times requirements are identifi ed
Quarter 2 2012/13
17
thequarter.
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 (enhancing
quality of life for people 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 (IAPT)
The latest provisional data for Q1 shows a
small drop in the number of people entering
treatment compared to the previous quarter.
However, the recovery rate achieved by IAPT
services continues to improve.
In Q1 2012/13:
233,027 people were referred for psychological
therapies, a reduction of 13,327 or just over
5 percent compared to quarter four (Q4)
2011/12
146,702 people entered treatment, a
decrease of 1,099 or less than 1 percent
from Q4 2011/12
the number of people reaching recovery
resulting from IAPT treatments increased to
35,663, an increase of 1,365 or nearly 4 percent
compared to Q4 2011/12. This increase led to
the recovery rate of IAPT services improving
from 45.6 percent to 46.1 percent
5,288 people moved off sick pay and benefi ts,
a decrease of 375 people or 6.6 percent
compared to Q4 2011/12.
13 http://www.dh.gov.uk/en/Publicationsandstatistics/Publications/PublicationsPolicyAndGuidance/DH_123766
Quarter 2 2012/13
18
thequarter.
0.0
0.5
1.0
1.5
2.0
2.5
3.0
Q1
2011/12
Q2
2011/12
Q4
2011/12
Q1
2012/13
Q3
2011/12
Figure 18: Number of people entering IAPT treatment nationally
Percentage
0.0
0.5
1.0
1.5
2.0
2.5
3.0
g
Q1
2011/12
Q2
2011/12
Q4
2011/12
Q1
2012/13
Q3
2011/12
England access rate
National Operating Framework trajectory
Early intervention (EI)
Early intervention in psychosis teams saw
5,137 new patients in the fi rst two quarters of
2012/13, which is 68 percent of the total plans
for the year (7,500 yearly).
Figure 19: EI services: number of new cases seen first half 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 5,137 68%
North East 459 370 81%
North West 1,203 814 68%
Yorkshire and the Humber 803 581 72%
East Midlands 577 352 61%
West Midlands 816 462 57%
East of England 658 491 75%
London 1,392 1,038 75%
South East Coast 515 304 59%
South Central 468 319 68%
South West 609 406 67%
Data source: Department of Health
Quarter 2 2012/13
19
thequarter.
Crisis resolution
In Q2, 98.1 percent of all admissions to
psychiatric inpatient wards were gate kept
by crisis resolution home treatment teams
compared to 97.3 percent in the same period in
2011/12. Nine SHAs met over the threshold that
95 percent of admissions were gate kept.
Figure 20: Crisis resolution services: the proportion of patients gate kept by CRHT teams
in Q2 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 gate
kept by
CRHT teams
England 17, 219 17,548 98.1%
North East 682 688 99.1%
North West 2,983 3,034 98.3%
Yorkshire and the Humber 1,511 1,525 99.1%
East Midlands 1,039 1,062 97.8%
West Midlands 1,707 1,736 98.3%
East of England 1,708 1,809 94.4%
London 3,698 3,740 98.9%
South East Coast 1,440 1,453 99.1%
South Central 1,096 1,126 97.3%
South West 1,355 1,375 98.5%
Data source: Department of Health
Quarter 2 2012/13
20
thequarter.
Care programme approach (CPA)
follow-up
Of all patients on a CPA that were discharged
from psychiatric inpatient care, 97.2 percent
were followed up within seven days of discharge,
comparable to the 97.3 percent achieved in
the same period last year. All SHAs met the
threshold of 95 percent of patients being
followed up within seven days of discharge.
Figure 21: CPA: the proportion of patients followed up within seven days of discharge
in Q2 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 16,547 17,018 97.2%
North East 898 915 98.1%
North West 2,741 2,823 97.1%
Yorkshire and the Humber 1,332 1,380 96.5%
East Midlands 1,123 1,164 96.5%
West Midlands 1,949 2,002 97.4%
East of England 1,385 1,422 97.4%
London 2,931 3,041 96.4%
South East Coast 977 1,003 97.4%
South Central 1,462 1,498 97.6%
South West 1,749 1,770 98.8%
Data source: Department of Health
Quarter 2 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
gures for this indicator from 2003/04
to 2011/12. 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. Figures for
2011/12 were published by the NHS IC on
5 December 2012.
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
contained indicators
that reward GP practices for working to reduce
emergency admissions. From April 2012, the
framework also contained 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.
14 http://www.nhsemployers.org/Aboutus/Publications/Documents/QOF_2012-13.pdf
Quarter 2 2012/13
22
thequarter.
Stroke
Performance status: improved
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 Q2, 86.1 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 Q1 2012/13, where the
corresponding fi gure was 84.3 percent.
There is clear evidence that care in a stroke unit
improves outcomes. This has increased by over
25 percent since 2009, but there is still variation
between areas and the NHS is continuing to
work on this.
74.5 percent of transient ischaemic attack cases
with a higher risk of minor stroke were treated
within 24 hours. This is an increase on Q1
2012/13, where the corresponding fi gure was
70.8 percent, and a 25 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 Q2 shows that the number
of patients accessing NHS dentistry has been
maintained from Q1 2012/13 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 302,000 patients accessing
services based on the same quarter in the
previous year.
In October 2012, the Department announced
the second round of the dental pilots scheme.
The pilots have been running since September
2011, 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. The pilots are trialling elements
needed to design that new contract. 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.
Learning from the fi rst round of pilots was also
published in October, and can be found on the
Department’s website.
15
Figure 22: 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
30 Sep 12
15 http://www.dh.gov.uk/health/2012/10/dental-contract-reform/
Quarter 2 2012/13
23
thequarter.
on tiavonIn
Innovation, health and wealth
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 signi 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.
We are making very good progress on delivery
but it is important to maintain momentum and
embed IHW actions in all parts of the new
NHS system.
The ‘comply or explain’ regime remains a
priority and whilst more trusts are compliant
there is more to be done. All NICE Technology
Appraisal recommendations should be
incorporated automatically into relevant
local NHS formularies in a planned way
that supports safe and clinically appropriate
practice. We expect local formularies to be
made publicly available by April 2013.
www.innovation.nhs.uk was launched to
support the NHS in implementing High
Impact Innovations. CQUIN prequalifi cation
guidance will shortly be published and we
have issued a call to the NHS and healthcare
stakeholders to inform the next round of High
Impact Innovations.
Academic Health Science Networks (AHSNs)
will be central in supporting adoption of
innovation in the NHS and all organisations
should be planning how they will work as
part of and in partnership with prospective
AHSNs.
CCGs will have a legal duty to demonstrate
their commitment to innovation. Draft
guidance is under construction and is being
developed with input from NHS Clinical
Commissioning. We expect this to be issued
early in 2013.
Procurement review
Procurement can play a valuable role in driving,
and can have a huge impact on, UK growth.
The scale and nature of the QIPP challenge,
requiring us to make up to £20 billion of
ef ciency savings by 2014/15, means the scale
and pace of change needs to be signifi cant to
meet the challenge facing the NHS. It is for this
reason why one of the themes in IHW was to
improve procurement in the NHS.
In May, the Department published Raising our
Game
17
, which sets out the immediate steps
NHS organisations can take to realise the
ef ciencies we need from procurement. This
is a good start, but we must go further and
be more ambitious, to take advantage of the
enormous buying potential of the NHS so we
can ensure value for money for taxpayers, more
productive relationships with industry, and
better patient access to the very best services,
technologies and medicines.
Since May, Sir Ian Carruthers has led an
open engagement process and has been
working with the NHS, industry, third sector
organisations and a range of stakeholders
and procurement professionals to review
how we can have a modernised procurement
function for the NHS that is as good as any
internationally.
The feedback we have received has been very
consistent and the following themes have
emerged:
We traditionally procure based on cost rather
than outcome. This must change
We must have better access to data and
ensure that we share it
We must put clinicians at the heart of the
procurement process
Procurement should have a permanent place
on the agenda for every board
We must eliminate the duplication of effort
We should have fewer, better-paid, better-
qualifi ed procurement professionals
16 http://www.dh.gov.uk/en/Publicationsandstatistics/Publications/PublicationsPolicyAndGuidance/DH_131299
17 http://www.dh.gov.uk/en/Publicationsandstatistics/Publications/PublicationsPolicyAndGuidance/DH_134376
Quarter 2 2012/13
24
thequarter.
We must work together to harness the
enormous buying power of the NHS. Put
simply, procurement must become a priority
for the NHS and everyone in the NHS.
The report will be published early in 2013.
Healthcare UK
Since the Ministerial Summit in May 2012,
we have been:
Working with UK Trade and Investment
(UKTI) to create a jointly-funded and
governed unit called Healthcare UK (HUK).
HUK will be a single international outward
facing brand for the UK healthcare industry
(public and private) focusing on high value
commercial opportunities (HVOs) and staffed
jointly by UKTI and NHS.
Working with the NHS to design the NHS
facing unit, which will continue to deliver
the essential functions for NHS international
engagement that exist outside of the HVO
commercial objectives of HUK.
HUK was launched in August 2012 at
the British Business Embassy Day on Healthcare
and Life Sciences. A further international
launch is planned for January 2013 at Arab
Health in Dubai.
NHS Innovation Challenge Prizes
A record number of 94 applications were
received for round three of the NHS Innovation
Challenge Prizes. This latest round has
uncovered a collection of NHS innovations
that are truly impressive, representing the very
essence of the NHS and highlighting examples
of brilliant people doing brilliant jobs. We
expect the awards to be made by January 2013
and case studies of all the fi nalists are available
on the Challenge Prizes website.
18
In August, we also received ministerial approval
to work in partnership with industry on a new
set of challenges. As a result of the partnership
a call for suggestions of what is important
to the dementia community is going out
very soon, with a link to the Prime Minister’s
Dementia Challenge. This work illustrates how
the private sector are investing in incentivising
the front line NHS to innovate.
18 http://www.challengeprizes.institute.nhs.uk/the- nalists/round-3-fi nalists/
Quarter 2 2012/13
25
thequarter.
ytivitucdPro
Finance
The returns for Q2 show that, overall, the NHS
is forecasting a healthy surplus.
SHAs and PCTs are forecasting an overall
surplus of £1,184 million, which is in line with
the NHS Operating Framework 2012/13, and
represents 1.2 percent of the total SHA/PCT
revenue resources. This compares to the
£1,153 million surplus forecast at Q1.
NHS trusts (excluding FTs) are forecasting an
overall surplus of £60 million at Q2 for 2012/13
71 million surplus at Q1).
The reduction in the surplus reported for NHS
trusts is mainly due to a few organisations
forecasting a reduction in their surplus at Q2.
Figure 23: NHS financial performance by SHA area – PCT/SHA sector
2009/10 2010/11 2011/12
Q2 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 2.6 243 1.4
NHS London 382 2.4 392 2.3 442 2.6 243 1.4
South East Coast
South Central
South West
NHS South of England
Total
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 1,184 1.2
There is one PCT, North Yorkshire and York PCT, forecasting a defi cit of £19 million at Q2. This is the
same as the defi cit it was forecasting at Q1.
Quarter 2 2012/13
26
thequarter.
As at Q1, there are fi ve NHS trusts forecasting
a gross operating defi cit of £160 million at
Q2. These are South London Healthcare NHS
Trust (£54 million operating de cit), Barking,
Havering and Redbridge Hospitals NHS Trust
(£40 million operating de 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). The same fi ve
NHS trusts were forecasting the same level of
defi cit at Q1.
Figure 24: NHS financial performance by SHA area – trust sector
2009/10 2010/11 2011/12
Q2 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
31
(10)
%
Turnover
0.0
1.0
(0.4)
North East
North West
Yorkshire and the Humber
NHS North of England 39 0.7 34 0.6 26 0.4 21 0.4
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) (97) (1.3)
NHS London (3) (0.0) (20) (0.2) (96) (1.1) (97) (1.3)
South East Coast
South Central
South West
37
(7)
28
58
1.5
(0.3)
1.3
0.8
16
8
28
52
0.6
0.3
1.3
0.7
4
12
30
46
0.2
0.6
1.4
0.7
16
11
28
55
0.6
0.6
1.2
0.8 NHS South of England
Total 195 0.7 121 0.4 44 0.1 60 0.2
Although the overall fi nancial position is
healthy, there are clearly some organisations
that are not managing their fi nancial position.
It is clear there is not a one size fi ts all approach
for speci c organisational issues. We must work
with them and assess the options available to
ensure they become sustainable organisations,
whilst maintaining the quality of patient care.
Quarter 2 2012/13
It is also recognised that the transformational
change and service redesign, driven by QIPP,
is essential to the future fi nancial health of
the NHS.
27
thequarter.
Figure 25: SHA and PCT sector surplus and (deficit) 2009/10 to 2012/13 Q2 for ecast
0
200
400
600
800
1,000
1,200
1,400
1,600
1,800
£ million
2009/10 2010/11 2011/12 Q2 2012/13 forecast
Surplus
(200)
Deficit
Figure 26: Trust sector surplus and (operating defi cit) 2009/10 to 2012/13 Q2 forecast
0
100
200
300
400
500
£ million
2009/10 2010/11 2011/12 Q2 2012/13 forecast
Surplus
Deficit
(200)
(100)
(300)
In addition to the gross operating defi cit, there is a gross technical defi cit of £136 million in 26 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 additional revenue cost of bringing private finance initiative (PFI) assets. onto the balance sheet
the additional revenue costs of bringing PFI assets onto an organisation’s balance sheet, following the introduction of
international fi nancial reporting standards (IFRS) accounting in 2009/10, is not considered part of the organisations
operating position.
c) The impact of the change in accounting for donated assets and government grant reserves.
Quarter 2 2012/13
28
thequarter.
SHA cluster
2012/13 forecast annual QIPP savings at Q2
2012/13 Q2 year-to-date savings achieved
QIPP Savings
At the end of Q2 2012/13, the NHS is
forecasting £5.0 billion of annual ef ciency
savings, a small reduction on the £5.1 billion
forecast at Q1 (see Figures 27 and 28).
During Q2, the NHS delivered a further £1.2
billion of QIPP savings, sustaining the strong
performance reported for the fi rst quarter of
this year. This brings the overall year-to-date
delivery of savings to £2.4 billion, representing
49 percent of the forecast annual ef ciencies.
As we move into the second half of the year,
increasingly focus moves to preparing the
foundations for the transformational changes
required, to sustain successful QIPP delivery
in the third and fourth year of the up to
£20 billion QIPP challenge.
Figure 27: 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 563 775 691 648 2,677
Ambulance services 9 24 24 20 77
Community services 98 98 86 75 357
Continuing healthcare 27 37 33 30 127
Mental health and learning disabilities services 112 122 96 74 404
Non-NHS healthcare (inc reablement) 10 20 33 17 80
Prescribing 82 106 139 145 472
Primary care, dental, pharmacy, opthalmic 47 35 45 67 194
Specialised commissioning
Other
Total
35
75
1,058
107
80
1,404
79
117
1,343
48
107
1,231
269
379
5,036
Figure 28: 2012/13 NHS England QIPP savings by SHA cluster
0
1,000
2,000
3,000
4,000
5,000
6,000
£ million
London SHA North of England SHA South of England SHA Total Midlands and East SHA
5,036
2,447
Quarter 2 2012/13
29
Activity
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 and emergency
admissions. Although a modest reduction in
activity levels was seen in 2011/12 compared to
2010/11, both Q1 and Q2 2012/13 have shown
a small increase in all areas, except ordinary
admissions.
Elective activity
On elective activity, the six months to the end
of Q2 2012/13 show:
GP referrals were 3.0 percent higher than the
same period in the previous year, adjusted for
working days
other referrals for a fi rst outpatient
appointment were 6.2 percent higher than
the same period in the previous year, adjusted
for working days
GP referrals seen were 1.3 percent higher
than the same period the previous year,
adjusted for working days
-6
-4
-2
0
2
4
6
Percentage
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
2010/11
2011/12 2012/13
1
A&E attendances are shown by volume per day, all other indicators are shown by absolute volume.
2
The year-to-date covers the period April to September inclusive in each of the specified years.
thequarter.
Quarter 2 2012/13
30
• all rst outpatient attendances were
1.9 percent higher than the previous year,
adjusted for working days
elective activity (admissions) growth was 2.3
percent, adjusted for working days, compared
with 2.9 percent at the same stage of 2011/12.
Emergency activity
On non-elective activity, the six months to the
end of Q2 2012/13 show:
non-elective activity (admissions) were
3.1 percent higher than the previous year
A&E attendances at type 1 A&E departments
were 2.1 percent higher than the previous year
A&E attendances at all type A&E departments
were 2.2 percent higher than the previous year
urgent and emergency ambulance journeys
per day were 1.5 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. However, the Department
is monitoring activity patterns closely.
Figure 29: Year-to-date growth in activity indicators – England, by volume
1, 2
thequarter.
Quarter 2 2012/13
0
2
4
6
8
10
12
Millions
Figure 30: Year-to-date total volume for activity indicators – England, in millions
1
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
2010/11
2011/12 2012/13
1
The year-to-date covers the period April to September inclusive in each of the specified years.
31
thequarter.
Workforce
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, or
primary care, bank or agency staff.
As part of the education and training reform
programme, the Department is working with
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 31 details the full time equivalent (FTE)
changes in key NHS staff groups between Q1
and Q2 2012/13. It uses the middle data point
for each quarter, that is May 2012 for Q1 and
August 2012 for Q2. This better represents the
average workforce throughout the period and
is most relevant when comparing to fi nance,
activity and other data.
Figure 31: Changes in key NHS staff groups between Q1 and Q2 2012/13
England
Q1
2012/13
Q2
2012/13
Q1 to Q2
change
Q1 to Q2
% change
May 12 August 12
FULL TIME EQUIVALENTS (FTE)
All HCHS doctors (non locum)
All HCHS doctors (locum)
99,147
2,058
100,599
2,007
1,452
51
1.5%
–2.5%
All HCHS doctors (incl locums) 101,205 102,606 1,402 1.4%
Qualifi ed midwives
Qualifi ed health visitors
Qualifi ed school nurses
21,055
8,190
1,146
21,022
8,067
1,180
33
–123
33
0.2%
–1.5%
2.9%
Qualified nursing, midwifery and health visiting staff
306,999 304,566 –2,433 0.8%
Qualifi ed allied health professions
Qualifi ed healthcare scientists
Other quali ed scientifi c, therapeutic and technical staff
62,897
28,881
40,502
63,105
28,726
40,631
208
–155
129
0.3%
0.5%
0.3%
Total quali ed scientific, therapeutic and technical staff
132,280 132,461 181 0.1%
Qualified ambulance staff 17,869 17,693 176 –1.0%
Professionally qualified clinical staff 558,353 557,327 1,026 –0.2%
Support to clinical staff 289,209 288,527 682 0.2%
Central functions
Hotel, property and estates
Total managers
95,535
55,820
35,596
95,235
55,792
35,550
–300
–28
46
0.3%
0.0%
0.1%
NHS infrastructure support 186,951 186,578 373 0.2%
Total 1,034,513 1,032,431 2,081 0.2%
Copyright © 2012 Health and Social Care Information Centre. All rights reserved
Quarter 2 2012/13
32
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 content 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 more than £1.5 billion each year and
places additional pressure on colleagues at work.
The Department has commissioned NHS
Employers to lead work in supporting the NHS
to improve staff health and wellbeing, using
ve high-impact changes that build on the NHS
Health and Wellbeing Framework published in
July 2011.
19
These are:
developing local, evidence-based plans
with strong, visible leadership
supported by improved management
capability
with access to better, local, high-quality,
accredited occupational health services
where staff are encouraged and enabled to
take more responsibility for their health
Current efforts include:
• the identifi cation, production, promotion and
mobilisation of good practice
work to support the 60 most challenged NHS
organisations that could release the biggest
cash savings potential
work to develop performance in parts of the
NHS with particular challenges (for example,
ambulance services, mental health)
support for the development of occupational
health services.
For the future, the mandate to the NHS
Commissioning Board (NHS CB) contains
an objective to make signifi cant progress in
focusing the NHS on preventing illness, with
staff using every contact they have with people
as an opportunity to help people stay in good
health – by not smoking, eating healthily,
drinking less alcohol, and exercising more.
As the countrys largest employer, the NHS
should also make an important contribution by
promoting the mental and physical health and
wellbeing of its own workforce.
Sickness absence
The latest report published by the NHS IC,
based on data from the Electronic Staff Record
(ESR), provided the results for April to June
2012. This showed that sickness absence has
risen by 0.24 percentage points compared to
the same quarter in 2011, moving from 3.77
percent to 4.02 percent. The annual moving
average sickness absence, a better measure
that takes out seasonal effect, rose by 0.06
percentage points between March and June
2012 to 4.18 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 of 3.2 percent.
As part of the work that NHS Employers is
leading to support the NHS in improving staff
health and wellbeing, the Work Foundation
has been commissioned to help NHS managers
improve their ability to support staff in reducing
sickness absence. At its meeting in October,
the NHS Operations Executive committed to
a further push to improve sickness absence
performance and SHA chief executives will be
taking work forward in their areas.
NHS Employers has recently launched a new
interactive web-based tool
20
to calculate
the current cost of sickness absence within
organisations. This includes showing days (and
whole time equivalents) lost. The calculator
then shows what potential savings could be
released or hours reinvested back into services
by achieving organisations’ target sickness
absence absence rates.
19 http://www.dh.gov.uk/en/Publicationsandstatistics/Publications/PublicationsPolicyAndGuidance/DH_128691
20
http://www.nhsemployers.org/HealthyWorkplaces/LatestNews/Pages/Newsicknessabsencesavingscalculatorlaunched.aspx
Quarter 2 2012/13
33
Figure 32: NHS sickness absence: 12 month rolling annual averageg g
thequarter.
3.90
3.95
4.00
4.05
4.10
4.15
4.20
4.25
4.30
4.35
4.40
4.45
Percentage
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
Apr 12
May 12
Jun 12
Staff engagement
Evidence shows that 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 that 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.
Responsibility for future staff surveys transferred
from the Department to the NHS CB on
1 October. The survey will sit in the Public and
Patient Voice and Insight directorate, which is
also taking on responsibility for various patient
experience surveys including GP patients,
cancer patients and bereaved voices. This will
allow a more co-ordinated approach to surveys
and to staff and patient feedback as a whole,
and enable deeper insights to be drawn from
the data. The NHS CB will also be responsible
for the staff aspect of the friends and family
test which will provide real-time granular
information using a single, simple indicator.
The 2012 survey is currently underway and
results will be published towards the end of
February 2013.
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 2 2012/13
34
thequarter.
ventionePr
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.
There are now 49 early implementer sites (EIS)
working to deliver the new health visiting
service model. EIS are the catalyst for service
transformation in a range of settings, ensuring
clinical delivery of the Healthy Child Programme.
They will deliver innovative service improvement
projects that refl ect evidence-based practice,
together with portfolios of measurable progress
on the new service model/family offer. Over 20
case studies stemming from the fi rst year of EIS
are to be published shortly.
The number of FTE health visitors has increased
by 191 (2.4 percent) since May 2010 and the
total number of FTE health visitors at the end
of August 2012 was 8,284. This fi gure is taken
from the health visitor minimum data set, which
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
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 health visitor fi gures are in line with
expectations, and it is predicted that we will
see a gradual decline in numbers until the
Q3 reporting period, when the next cohort
of health visiting trainees begin to enter the
workforce.
During 2011/12, the planned number of training
commissions increased threefold to around
1,600 places. In 2012/13, SHAs are planning to
increase their training commissions even further
to around 2,500 places.
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.
21
Figure 33: Health visitor trajectories, England
21 http://www.dh.gov.uk/health/2012/08/health-visiting-actions/
Quarter 2 2012/13
35
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 continues to
show performance is being maintained above
the performance standard. 95.2 percent of
women who gave birth in Q2 saw a midwife
or maternity healthcare professional within
12 weeks and six days. This is comparable to
Q1 2012/13 when 93.2 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 out our commitment to support
breastfeeding through the Healthy Child
Programme.
The breastfeeding initiation rate was 73.9
percent in Q2, which is just less than the rate
for Q1 and the annual percentage for 2011/12
(both 74.0 percent). However, this is still an
improvement on the rates for 2010/11 (73.7
percent), 2009/10 (72.7 percent) and 2008/09
(71.7 percent).
The prevalence of breastfeeding at six to eight
weeks in Q2 was 47.7 percent of all infants due
a six to eight weeks check, which is slightly
higher than the fi gure of 47.6 percent recorded
in Q2 2011/12. Comparisons are made with
the same quarter in preceding years due to
seasonality.
Smoking
Provisional fi gures for the fi rst quarter of
2012/13 show that 176,945 people set a quit
date through NHS Stop Smoking Services, a
17 percent decrease on the fi nal fi gure for the
same period in 2011/12. However, late returns
are expected to push the latest period’s fi gure
up by about 13 percent, which suggests a
6 percent decrease on last year.
At the four week follow-up, 86,341 people
had successfully quit (based on self-report),
49 percent of those who set a quit date. This
is a 15 percent decrease from the fi nal fi gure
for the same period in 2011/12. However,
once late returns come in, we would expect
this to become a 3 percent decrease.
72 percent of successful quitters had their
results confi rmed by carbon monoxide
validation. This percentage was 72 percent in
2011/12, 70 percent in 2010/11 and 69 percent
in 2009/10. This demonstrates an improvement
in the quality of services provided.
Of the 5,743 pregnant women who set a
quit date, 2,571 successfully quit at the four
week follow-up, little changed from the
corresponding fi gures for last year.
Total expenditure on NHS Stop Smoking
Services was just under £21.3 million, an
increase of 1 percent (£0.3 million) on the fi nal
gure for the same period in 2011/12 (£21.1
million). The cost per quitter is £247 compared
with £207 based on fi nal fi gures for the same
period in 2011/12. However, the cost per quitter
for the latest quarter will fall when late returns
are received. In addition, the real decrease will
be even greater as these fi gures have not been
adjusted for infl ation.
Amongst SHAs, South Central SHA reported
the highest proportion of successful quitters
(57 percent), while West Midlands SHA
reported the lowest success rate (43 percent).
Quarter 2 2012/13
36
thequarter.
Screening (VTE, breast, cervical,
bowel, diabetic retinopathy)
VTE (venous thromboembolism)
risk assessment
Of the 3.4 million adult patients admitted
to NHS-funded acute care between July
and September 2012, 93.9 percent of these
received a VTE risk assessment on admission,
a slight increase compared to Q1 2012/13
(93.4 percent).
293 providers (out of 311 providers who
submitted data), reported that at least 90
percent of adult admissions to hospital were
risk assessed for VTE, compared to 275 in June
2012, 241 in March 2012, and 18 in July 2010
when the collection fi rst began.
Breast screening
The NHS Operating Framework 2012/13
states that NHS organisations should continue
working to meet the expectations in service
specifi c outcomes strategies that have been
published, including those for 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 the end of September 2012, 55 out of
80 local programmes (69 percent) had
implemented the extension randomisation and
a further 9 (11 percent) were unsuitable for
randomisation and were inviting only the 47-49
year-olds. 16 programmes (20 percent) are still
to expand, citing lack of digital mammography,
staffi ng shortfalls and funding as issues.
Cervical screening test results
The NHS Operating Framework 2012/13 states
that NHS organisations should continue to work
to meet the expectations in service specifi c
outcomes strategies that have been published,
including those for cancer.
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 percent. At the end of September
2012, the percentage of women receiving their
results within 14 days was 99.1 percent, an
increase on the Q1 fi gure of 95.7 percent.
Bowel screening
The initial roll-out of the NHS bowel cancer
screening programme (NHS BCSP) across
England was completed on 23 August 2010.
By the end of September 2012, nearly 16 million
kits (15,685,679) had been sent out and nearly
9 million (8,922,699) returned. Over 13,500
(13,649) cancers had been detected, and over
70,000 (70,345) patients had undergone polyp
removal. Men and women over the age limit
can request a testing kit every two years, and
nearly 190,000 (188,304) 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, in order to screen around 1 million more
men and women each year. The NHS Operating
Framework 2011/12 stated that extensions begun
in 2010/11 should continue and be maintained
for 2011/12. Those centres whose end of original
screening round fell beyond 2011/12 should now
be preparing to expand on completion of the
original round. The NHS Operating Framework
2012/13 states that all deadlines for the full
roll-out of programmes highlighted in previous
NHS Operating Frameworks should be
completed within the established timescale.
As at September 2012, 41 of the 58 local
screening centres (72 percent) had implemented
the extension, a 4 percent improvement on the
gure at the end of Q1.
Diabetic retinopathy
At Q2, 98.7 percent of people with diabetes
were offered screening for diabetic retinopathy
in the previous 12 months, comparable to the
gure of 98.5 percent for Q1.
The majority of PCTs continue to offer screening
to all people with diabetes, with more people
with diabetes now being offered screening
for retinopathy than ever before, and to
higher standards. This is in the context
of an ever-increasing number of people with
diabetes. Latest fi gures for Q2 show that
2.39 million people were offered screening and
the number of people with diabetes stands at
2.64 million. When the screening programme
was introduced in 2003, the number of people
with diabetes stood at 1.3 million.
Quarter 2 2012/13
37
thequarter.
England (alongside other UK countries) leads
the world in this area, but the Department
is not complacent and continues to closely
monitor this data. It is working closely with
partners in the NHS diabetic eye screening
programme to further improve the standard,
quality and coverage of screening programmes
across the country.
Immunisation
The latest available data on childhood
vaccination uptake rates cover the quarter
ending 30 June 2012 (Q1 2012/13).
22
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 of uptake for various
vaccines, 11 show an increase compared with
Q4 2011/12, one shows no change, and four
show a decrease. The year-on-year trend, based
on annual data which smoothes out quarterly
uctuations, remains upward.
The largest increases in vaccine uptake were for
vaccinations given by age fi ve. These included
two doses of MMR vaccine (up from 86.9
percent to 87.2 percent), the Hib/MenC
booster (up from 90.7 percent to 91.2 percent)
and the PCV booster (up from 88.0 percent to
88.9 percent).
With regard to seasonal fl u vaccinations,
YTD data to November shows that uptake
among those aged 65 and over, and among
those aged under 65 in clinical risk groups, is
currently lower than at the same point last year.
However, uptake among pregnant women is
signifi cantly higher than the same point last
year. End of season provisional data, providing a
fuller picture of seasonal fl u vaccination, will be
reported in the quarter Q3 2012/13.
It is important that as many at-risk patients
as possible are immunised to protect them
from the serious consequences of fl u, and to
reduce the burden on the NHS of preventable
u-related illness during the winter months.
All relevant staff are urged to do all they can
to increase the uptake of fl u vaccinations for
patients in the clinical at-risk groups.
NHS health checks
The NHS health check programme is a national
performance measure in the NHS Operating
Framework, refl ecting the priority given to the
NHS health check in 2012/13.
PCTs are planning to deliver full roll-out of
the programme this year, compared to 90
percent of full roll-out planned last year. In Q2,
approximately 604,300 people (3.9 percent
of the eligible population), were invited for
an NHS health check. This shows a slight
improvement compared with 3.4 percent of the
eligible population who were offered a health
check in Q2 2011/12 and demonstrates local
areas are continuing to make progress in the
implementation of their programmes.
22 http://www.hpa.org.uk/web/HPAweb&HPAwebStandard/HPAweb_C/1211441442288
Quarter 2 2012/13
38
0
10
20
30
40
50
60
Percentage
July 2012 August 2012
England total
September 2012
thequarter.
Reform
Choice
Patient choice
Indicators suggest the take-up of patient
choice, where it is offered, is slowly improving
and 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 continued to
remain relatively stable over the quarter.
The overall utilisation rate was 51 percent in
September 2012, based on outturn GP referrals
to fi rst outpatient appointments, which was
slightly higher than the August fi gure of 50
percent. During September 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.
Quarter 2 2012/13
Figure 34: Proportion of GP referrals to fi
rst outpatient appointments booked using
Choose and Book
39
thequarter.
Bookings to services where named
consultant-led teams were available
The Department released contract guidance
in October 2011 to support providers and
commissioners in England when implementing
choice of named consultant-led team for a
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 rst outpatient bookings being made
through Choose and Book to services where
named clinicians are available, even if not
selected, has remained stable at 81 percent at
the end of Q2 2012/13 after steady increases in
previous months. The variation in this measure
ranges from 90 percent in the North West SHA
to 68 percent in the South East Coast SHA area.
Figure 35: Bookings to services where national consultant-led team was available
(even if not selected)
0
20
40
60
80
100
Percentage
July 2012 August 2012
England total
September 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 being made to the independent
sector may be indicative of 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 2 2012/13
40
thequarter.
Figure 36: Proportion of patients being treated at non-NHS hospitals
0
2
4
6
8
10
Percentage
July 2012 August 2012
England total
September 2012
Improving people’s electronic
access to services and their own
health and care records
The Power of Information, published in May
2012, sets out our vision for everyone to have
secure electronic access to services and to their
own health and care records, including access
to letters, test results, personal care plans and
needs assessments. Our ambition is that by
2015 all general practices will be expected
to make available electronic booking and
cancelling of appointments, ordering of repeat
prescriptions, secure communication with the
practice and access to their own records to
anyone registered with the practice.
The Department has asked the Royal College
of General Practitioners to lead a partnership
collaboration of other Royal Colleges, patient
representative organisations, the NHS CB
and the British Medical Association. This is to
develop a plan and support for people to be
able to access services and their own health
records in general practice electronically by
2015. The plan is expected to be released in
early 2013.
The indicator in the NHS Operating Framework
2012/13 is: ‘The percentage of the total patient
population who belong to general practices
where patients are able to access their medical
records electronically if they wish to do so
and where patients have registered to be able
to access their medical record electronically’.
Provisional Q2 data gathered by the NHS IC
from general practice information systems
suppliers indicates that:
nearly all general practices (98 percent) now
have functionality for patients to be able to
book and cancel appointments and to order
repeat prescriptions electronically
37 percent of practices have enabled
electronic booking of appointments
40 percent have enabled electronic ordering
of repeat prescriptions.
Overall, data indicates steady growth in the
availability of electronic services for signifi cant
numbers of patients, and suggests a growing
familiarity, for practices and patients, with the
benefi ts of patient online services.
Data also indicates that 6,111 general practices
(75 percent) have functionality in place to allow
patients to view their own medical records
electronically, an increase from the 54 percent
of general practices reported at Q4 2011/12.
However, only 63 general practices (0.8 percent
of the total number of practices in England)
have actually enabled this functionality. This
means that although 42 million patients (75
percent) are registered with a practice that has
functionality in place, only 570,000 patients
(1 percent of the England total), are currently
able – if they request it of their practice – to
view their own records electronically.
Quarter 2 2012/13
41
thequarter.
This is the fi rst time data has been gathered
on each general practice and therefore Q2
data should be viewed as provisional. Q3 data
will benefi t from general practice feedback
and other data quality improvements and the
NHS IC will continue to report these quarterly.
The Department expects to see increasing
numbers of practices introducing and enabling
this functionality and is encouraging them to
implement this as soon as possible.
Summary Care Record
The summary care record (SCR) provides
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.
In Q2, approximately 2.9 million new SCRs
were created for patients, taking the total to
18.7 million. Eight further PCTs began creating
records for their patients, taking the total
number of PCTs across the country to 107.
The number of PCTs with a critical mass of over
60 percent of patients with an SCR increased
by 13 to a total of 37. 39.8 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.
The average number of weekly viewings by
healthcare professionals using the records to
support safe treatment and care rose to 2,734.
As more records are accessed and viewed, local
health communities are actively demonstrating
how the SCR is delivering improvements
to patient care. South Tees, Taunton and
Somerset, and Sheffi eld NHS FTs have all found
that using the SCR has reduced the time taken
to complete drug reconciliations, providing a
faster and safer service to patients.
Local NHS organisations, supported by the
national SCR programme, need to maintain
these efforts to ensure that commitments in the
NHS Operating Framework 2012/13 are met.
Figure 37: Number of summary care records created
0
2
4
6
8
10
12
14
16
18
20
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
2012/13
Q2
2011/12
Q4
Records created (millions)
Quarter 2 2012/13
42
thequarter.
Provision
From the 102 NHS trusts in the FT pipeline
at the end of Q2, 24 were in the advanced
stage of the application process, either with
the Department or with Monitor. It remains
the expectation 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.
In terms of organisations moving out of the FT
pipeline in Q2 2012/13, on 1 July 2012, York
NHS Foundation Trust acquired Scarborough
and North East Yorkshire NHS Trust. Such
transactions are an important mechanism in
supporting the delivery of the FT pipeline, in
particular where NHS trusts have been locally
identifi ed as unsustainable in their current
organisational form.
Work also continues at local and regional level
to ensure trusts are ready to move forward in
the applications process when appropriate. This
includes those NHS trusts with entrenched and
complex issues for which resolution is integral
to them becoming established as sustainable
providers.
The Tripartite Formal Agreements (TFAs)
have ensured there is a much greater shared
understanding of issues that NHS trusts face.
Alongside this, a range of policy products and
frameworks are in place to ensure there will
continue to be a fl ow of sustainable providers
emerging via the FT pipeline.
Ongoing monitoring against TFAs has continued
and Annex 5 gives the latest results of these
in terms of the risk of individual organisations
against their plans. In relation to emerging
issues NHS trusts face, a small number have
missed key TFA milestones and escalation
discussions have taken place to formally agree
revised TFA dates.
The regime for unsustainable NHS providers is
one way in which the Government can work
to secure a sustainable health system in cases
where NHS trusts are either unsustainable in
their current confi guration or at serious risk of
failing to deliver sustainable services, and failing
to comply with the plans in their TFA to move
towards achieving FT status. Legislation sets out
a regime that is a transparent and time limited
process for dealing with trusts in failure.
A trust special administrator (TSA) for South
London Healthcare NHS Trust was appointed
in July 2012 by the former Secretary of State
for Health under the regime. On 29 October,
the TSA published a draft report making
recommendations to the Secretary of State in
relation to securing a sustainable future for
services provided by the trust. Following the
public consultation by the TSA, the Secretary
of State will make a fi nal decision in early 2013
on the recommendations the TSA makes in a
nal report.
Moving forward, the NHS TDA has been
hosting a series of engagement events for trust
clinical, fi nance and communications colleagues
from autumn 2012. These will help establish
the support trusts need on their journey to
sustainable, high quality services and ultimately
FT status. The fi rst of these will enable the
NHS TDA to work with trusts to understand
what good support looks like from the trust
perspective. In early 2013, the NHS TDA and
trusts will discuss speci c issues or topics,
addressing some of the issues that trusts face,
look at what best practice looks like and set
out improvement plans to measure success
in delivery.
Quarter 2 2012/13
43
thequarter.
Commissioning
Good progress has continued in Q2 in all areas
of the commissioning development programme
as the NHS in England moves towards the
establishment of the new clinical commissioning
system.
NHS Commissioning Board
The NHS CB was formally established on
1 October 2012, marking a signifi cant step
forward towards the transformation of the
way we care for patients. It is a new
independent body with executive powers
and specifi c responsibilities.
The fi rst of these responsibilities will be
considering the 211 applications for authorisation
and establishment of the new CCGs.
The NHS CB leaders will start to take on
management responsibility for the teams
managing both 2012/13 operational delivery
(accountable to PCTs and SHAs) and planning
for 2013/14 (accountable to the NHS CB). These
arrangements will embed new system leaders
in the current system, providing continuous
leadership and minimising complexity for staff
carrying out roles relating to the current and
new systems.
Recruitment continues to be a priority for
building the new organisation. There will be
approximately 4,000 posts in the NHS CB,
plus an additional 2,500 staff transferring as
part of family health services. The fi nal part
of the organisational design – the Operations
Directorate – has now been shared with sender
organisations, so the process of fi lling these
posts is now underway. The majority of posts
are expected to be fi lled by the time the NHS
CB becomes fully operational in April 2013.
Clinical commissioning groups
The authorisation process for CCGs remains on
schedule.
To date, all of the 211 emerging CCGs have now
submitted their applications for authorisation to
take on their commissioning responsibilities, with
the NHS CB receiving submissions from the 46
CCGs in wave four at the beginning of November,
the fi nal group to make their application.
The assessment process for CCGs in wave one
has now begun. The authorisation process has
been designed to make sure CCGs are able to
commission safely, use their budgets responsibly
and exercise their functions to improve
quality, reduce inequality and deliver improved
outcomes. A number of assessors’ guides were
published online to ensure authorisation activity
is fair, transparent and consistent.
The NHS CB published revised CCG running
costs allowances (RCAs) for 2013/14 on
9 November 2012. The RCA for a CCG in 2013/14
forms a part of the total allocation, which will
be communicated to each proposed CCG in
December 2012. The fi gures take into account
the latest population projections published by
the Of ce of National Statistics. The revised
RCAs for each of the 211 proposed CCGs are
now available on the NHS CB website.
23
Commissioning support
Work on the establishment of the 23 NHS
commissioning support units (CSUs) has
continued during Q2. A total of 21 of the 23
CSUs now have a managing director. Some
of these roles are shared, and where there is
a joint managing director, there will be some
shared arrangements and services between the
two CSU organisations.
The hosting charge, which the NHS CB will
require CSUs to pay, will cover the costs of
the CSU transition team at the NHS CB and its
work to assure, develop and give form to CSUs.
It will also include costs the NHS CB will incur
to act as employer and host and to provide
infrastructure such as HR, payroll, audit, IT,
estates and legal services.
NHS CB has also published a template service
level agreement (SLA) and guidance
24
on how
to complete SLAs for commissioning support
services. The NHS CB asked CCGs and CSUs
to agree and sign the SLAs by the end of
November 2012. This will enable both CCGs
and CSUs to fi nalise their staf ng structures
and recruit in line with the national HR
transition process.
23 http://www.commissioningboard.nhs.uk/resources/resources-for-ccgs#rca
24 http://www.commissioningboard.nhs.uk/fi les/2012/11/dev-agree-csu.pdf
Quarter 2 2012/13
44
thequarter.
NHS Commissioning Assembly
The fi rst annual national event of the NHS
Commissioning Assembly took place on
14 November 2012 in Doncaster. Sir David
Nicholson invited the clinical lead from each
CCG to attend, along with the leadership team
of the NHS CB.
The NHS Commissioning Assembly is a
forum which brings together all those
with responsibility for NHS commissioning
decisions in England. The purpose of the NHS
Commissioning Assembly is to build effective
r
elationships between CCGs and the NHS CB.
Membership of the NHS Commissioning
Assembly is made up of the lead clinician
from each CCG in England and directors
of the NHS CB.
Going forward
The authorisation outcomes for CCGs will be
considered between December 2012 and March
2013, with CCGs taking on their statutory
responsibilities in April 2013.
Public health
The transfer of the public health function from the
NHS to local government is now well underway,
with the pace of change set to accelerate as
Public Health England prepares to take full
delivery responsibility from April 2013. However,
the Department knows that there is a need for
continued support during the transition and
transformation of the system and has delivered a
number of key actions over the last quarter.
In late September 2012, all chief executives of
single and top-tier local authorities undertook a
self-assessment of the transition process in their
area. The responses provided the basis for stock-
takes at a regional level and a national report
which is currently being developed and which is
due to be published on the Local Government
Association website by the end of 2012.
25
The exercise so far has provided confi dence to
those involved in the transition process and the
Department, that the transition of public health
functions at local level will be successful, and
demonstrates the strength of local government
commitment to achieving this process.
The Department issued £15 million of
transitional support monies to local authorities
in October 2012 to support the costs they
will incur in implementing and managing the
h
andover of public health functions workforce
and associated contracts and infrastructure.
This is in anticipation of the commencement of
statutory responsibility for public health from
April 2013. Letters to PCTs and local authority
chief executives, indicating the allocation
of transitional support to be issued to local
authorities through the PCT resource limited
adjustment, were published on the Department
website on 20 September.
26
A series of regional engagement events was
completed in early November, providing an
opportunity for Duncan Selbie, Chief Executive
designate of Public Health England to speak
with local leaders for public health, plus a wide
range of stakeholders across public health, local
government, the NHS, and the third sector.
A series of documents have also been released by
the Department during September to support the
delivery of the public health transition milestones.
These include a letter and scenario-based
resource pack, around the role of public health
in emergency planning, a series of fact sheets
identifying the health intelligence requirements
for local authorities, a checklist to support local
areas when considering handover and legacy
documentation/processes, and a document
to support understanding of the Contract
Transition process for public health services.
25 http://www.local.gov.uk/
26 http://www.dh.gov.uk/health/2012/09/ph-la-transition
Quarter 2 2012/13
45
thequarter.
Annex 1
NHS North of England
SHA and PCT name
2009/10
Annual
accounts
surplus/
(de cit)
£000s
2010/11
Annual
accounts
surplus/
(de cit)
£000s
2011/12
Annual
accounts
surplus/
(de cit)
£000s
2012/13 Q2
Forecast
outturn
surplus/
(de cit)
£000s
2012/13 Q2
Forecast
outturn
revenue
resource
limit (RRL)
£000s
2012/13 Q2
Forecast
outturn
surplus/
(de cit)
as % RRL
County Durham PCT 1,020 1,016 1,008 1,000 1,042,284 0.1%
Darlington PCT 301 315 316 300 192,073 0.2%
Gateshead PCT 504 192 35 200 402,582 0.0%
Hartlepool PCT 125 100 100 100 190,693 0.1%
Middlesbrough PCT 278 600 600 600 305,296 0.2%
Newcastle PCT 945 258 314 500 527,068 0.1%
North East SHA 72,036 64,754 59,319 55,500 340,268 16.3%
North Tyneside PCT 475 355 380 250 401,025 0.1%
Northumberland Care PCT 220 1,370 319 250 589,098 0.0%
Redcar and Cleveland PCT 513 150 150 150 269,643 0.1%
South Tyneside PCT 1,819 460 542 200 329,923 0.1%
Stockton-on-Tees Teaching PCT 424 400 400 400 346,066 0.1%
Sunderland Teaching PCT 845 382 976 600 576,137 0.1%
North East subtotal SHA/PCTs
79,505 70,352 64,459 60,050 5,512,156 1.1%
SHA and PCT name
2009/10
Annual
accounts
surplus/
(de cit)
£000s
2010/11
Annual
accounts
surplus/
(de cit)
£000s
2011/12
Annual
accounts
surplus/
(de cit)
£000s
2012/13 Q2
Forecast
outturn
surplus/
(de cit)
£000s
2012/13 Q2
Forecast
outturn
revenue
resource
limit (RRL)
£000s
2012/13 Q2
Forecast
outturn
surplus/
(de 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
East 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
211,972
2,075
2,328
2,624
917
1,000
1,900
1,589
595,621
n/a
305,393
316,930
510,762
324,072
763,228
808,568
916,689
719,270
621,983
410,248
353,963
1,060,853
1,090,746
599,603
946,332
444,341
509,936
555,903
492,366
447,858
388,937
337,597
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 2 2012/13
46
thequarter.
2009/10 2010/11 2011/12 2012/13 Q2
2012/13 Q2
Forecast 2012/13 Q2
Annual Annual Annual Forecast outturn Forecast
accounts
surplus/
accounts
surplus/
accounts
surplus/
outturn
surplus/
revenue
resource
outturn
surplus/
SHA and PCT name
(de cit)
£000s
(de cit)
£000s
(de cit)
£000s
(de cit)
£000s
limit (RRL)
£000s
(de cit)
as % RRL
Western Cheshire PCT 1,279 985 1,966 2,033 488,886 0.4%
Wirral PCT 2,047 2,031 2,001 3,088 660,621 0.5%
North West subtotal SHA/PCTs 184,872 215,138 267,100 267,000 14,670,706 1.8%
SHA and PCT name
2009/10
Annual
accounts
surplus/
(de cit)
£000s
2010/11
Annual
accounts
surplus/
(de cit)
£000s
2011/12
Annual
accounts
surplus/
(de cit)
£000s
2012/13 Q2
Forecast
outturn
surplus/
(de cit)
£000s
2012/13 Q2
Forecast
outturn
revenue
resource
limit (RRL)
£000s
2012/13 Q2
Forecast
outturn
surplus/
(de cit)
as % RRL
Barnsley PCT 3,461 3,395 2,953 3,500 493,373 0.7%
Bassetlaw PCT (2) n/a n/a 1,680 1,700 203,332 0.8%
Bradford and Airedale Teaching PCT 7,550 6,680 8,165 7,500 950,060 0.8%
Calderdale PCT 2,679 4,224 3,468 3,600 364,295 1.0%
Doncaster PCT 4,177 2,691 2,688 2,250 590,378 0.4%
East Riding of Yorkshire PCT 3,684 5,185 5,197 5,200 517,457 1.0%
Hull Teaching PCT 3,820 3,714 3,113 19,400 555,591 3.5%
Kirklees PCT 2,928 7,900 8,239 6,600 704,693 0.9%
Leeds PCT 5,002 20,124 25,086 23,200 1,404,228 1.7%
North East Lincolnshire Care Trust Plus (3) 2,222 2,181 1,783 1,400 299,297 0.5%
North Lincolnshire PCT 1,249 3,693 1,998 2,000 277,117 0.7%
North Yorkshire and York PCT 317 242 209
(19,000) 1,245,628 (1.5%)
Rotherham PCT 2,042 2,192 2,196 2,200 468,870 0.5%
Sheffi eld PCT 4,479 499 489 500 1,023,952 0.0%
Wakeeld District PCT 7,388 3,095 3,074 3,100 658,671 0.5%
Yorkshire and the Humber SHA 133,982 121,052 118,177 125,902 707,464 17.8%
Yorkshire and the Humber subtotal SHA/PCTs 184,980 186,867 188,515 189,052 10,464,406 1.8%
NHS North of England total SHA/PCTs 449,357 472,357 520,074 516,102 30,647,268 1.7%
2009/10 2010/11 2011/12 2012/13 Q2 2012/13 Q2
Annual
accounts
surplus/
Annual
accounts
surplus/
Annual
accounts
surplus/
Forecast
outturn
surplus/
2012/13 Q2
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 2 2012/13
47
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 Q2
Forecast
outturn
surplus/
(operating
defi cit)
£000s
2012/13 Q2
Forecast
outturn
turnover
£000s
2012/13 Q2
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 1,703 169,104 1.0%
East Cheshire NHS Trust 3,926 806 277 1,700 176,169 1.0%
East Lancashire Hospitals NHS Trust 287 723 3,025 3,900 391,395 1.0%
Liverpool Community Health NHS Trust (9) n/a 2,654 3,530 3,123 144,719 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) 1,516 699 102,647 0.7%
Mersey Care NHS Trust 3,000 7,359 5,000 4,000 205,111 2.0%
North Cumbria University Hospitals NHS Trust 327 1,356 1,095 1,001 226,229 0.4%
North West Ambulance Service NHS Trust 1,041 2,065 1,558 2,500 259,433 1.0%
Pennine Acute Hospitals NHS Trust 620 259 3,553 25 558,523 0.0%
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 1,700 177,872 1.0%
St Helens and Knowsley Teaching Hospitals NHS Trust 225 296 305 2,752 278,946 1.0%
The Wirral Community NHS Trust (11) n/a n/a 717 900 63,893 1.4%
Trafford Healthcare NHS Trust (12) (6,048) 319 482 n/a n/a n/a
University 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 31,312 3,164,492 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 Q2
Forecast
outturn
surplus/
(operating
defi cit)
£000s
2012/13 Q2
Forecast
outturn
turnover
£000s
2012/13 Q2
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
NHS Trust (18)
South West Yorkshire Mental Health NHS Trust (19)
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
4,611
n/a
1,306
6,342
(26,000)
n/a
n/a
1,975
(10,316)
20,996
n/a
133,932
484,620
n/a
134,762
996,831
437,345
n/a
n/a
202,851
n/a
1.1%
1.0%
n/a
1.0%
0.6%
(5.9%)
n/a
n/a
1.0%
2,390,341 (0.4%)
5,554,833 0.4%
For 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 2 2012/13
48
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 The 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 Scarborough and North East Yorkshire NHS Trust merged with York Teaching Hospital NHS Foundation Trust on 1 July 2012, and is now managed by
York Teaching Hospital NHS Foundation Trust.
19 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 decit (£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 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 Lancashire Hospitals NHS Trust 1m)
Hull and East Yorkshire Hospitals NHS Trust (£5m)
Mersey Care NHS Trust (£3m)
Mid Yorkshire Hospitals NHS Trust (£0.8m)
North Cumbria University Hospitals NHS Trust (£7m)
Pennine Acute Hospitals NHS Trust 13m)
Southport and Ormskirk Hospital NHS Trust (£0.7m)
Note: SHA and PCT turnover equals the Revenue Resource Limit (RRL) they are allocated. Trust turnover is all the income they receive
including income from PCTs. Trust income should therefore be excluded from any aggregation of SHA economy turnover to avoid
double counting resources.
Quarter 2 2012/13
49
thequarter.
Annex 2
NHS Midlands and East
SHA and PCT name
2009/10
Annual
accounts
surplus/
(de cit)
£000s
2010/11
Annual
accounts
surplus/
(de cit)
£000s
2011/12
Annual
accounts
surplus/
(de cit)
£000s
2012/13 Q2
Forecast
outturn
surplus/
(de cit)
£000s
2012/13 Q2
Forecast
outturn
revenue
resource
limit (RRL)
£000s
2012/13 Q2
Forecast
outturn
surplus/
(de 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 1,487 468,755 0.3%
Derbyshire County PCT 1,873 11,212 8,028 4,000 1,213,592 0.3%
East Midlands SHA 59,092 22,905 45,148 28,917 436,155 6.6%
Leicester City PCT 241 6,192 3,665 5,532 581,193 1.0%
Leicestershire County and Rutland PCT 1,148 10,502 6,270 7,223 989,344 0.7%
Lincolnshire Teaching PCT 7,264 14,314 9,525 7,500 1,251,525 0.6%
Milton Keynes PCT (2) n/a n/a 505 100 378,638 0.0%
Northamptonshire Teaching PCT 4,642 10,528 7,058 3,508 1,084,521 0.3%
Nottingham City PCT 2,448 6,841 3,412 3,400 587,660 0.6%
Nottinghamshire County Teaching PCT 4,514 5,017 3,372 3,333 1,112,826 0.3%
East Midlands subtotal SHA/PCTs 83,306 90,136 89,965 65,000 8,104,209 0.8%
SHA and PCT name
2009/10
Annual
accounts
surplus/
(de cit)
£000s
2010/11
Annual
accounts
surplus/
(de cit)
£000s
2011/12
Annual
accounts
surplus/
(de cit)
£000s
2012/13 Q2
Forecast
outturn
surplus/
(de cit)
£000s
2012/13 Q2
Forecast
outturn
revenue
resource
limit (RRL)
£000s
2012/13 Q2
Forecast
outturn
surplus/
(de cit)
as % RRL
Birmingham East and North PCT 2,453 522 240 1,000 795,382 0.1%
Coventry Teaching PCT 4,644 6,247 5,766 5,800 616,623 0.9%
Dudley PCT 362 794 5,992 4,992 536,512 0.9%
Heart of Birmingham Teaching PCT 7,615 9,555 830 1,000 587,778 0.2%
Herefordshire PCT 778 111 291 254
307,894
0.1%
North Staffordshire PCT 515 1,162 714 1,000 365,939 0.3%
Sandwell PCT 89 1,222 8,889 7,666 611,985 1.3%
Shropshire County PCT 490 872 1,295 1,000 483,099 0.2%
Solihull PCT (3) 16 531 281 1,000 356,311 0.3%
South Birmingham PCT 4,700 500 736 1,000 665,540 0.2%
South Staffordshire PCT 2,200 378 353 750 991,536 0.1%
Stoke on Trent PCT 2,588 3,115 1,993 2,000 533,330 0.4%
Telford and Wrekin PCT 4,522 467 1,098 1,000 276,745 0.4%
Walsall Teaching PCT 6,022 5,437 2,597 2,111 492,088 0.4%
Warwickshire PCT 594 176 177 200 862,185 0.0%
West Midlands SHA 19,732 23,204 37,534 11,088 540,397 2.1%
Wolverhampton City PCT 19,365 15,692 19,682 16,808 497,064 3.4%
Worcestershire PCT 3,519 3,470 3,044 3,000 899,116 0.3%
West Midlands subtotal SHA/PCTs 80,204 73,455 91,512 61,669 10,419,524 0.6%
Quarter 2 2012/13
50
thequarter.
SHA and PCT name
2009/10
Annual
accounts
surplus/
(de cit)
£000s
2010/11
Annual
accounts
surplus/
(de cit)
£000s
2011/12
Annual
accounts
surplus/
(de cit)
£000s
2012/13 Q2
Forecast
outturn
surplus/
(de cit)
£000s
2012/13 Q2
Forecast
outturn
revenue
resource
limit (RRL)
£000s
2012/13 Q2
Forecast
outturn
surplus/
(de cit)
as % RRL
Bedfordshire PCT 236 498 504 500 634,538 0.1%
Cambridgeshire PCT 501 398 499 0 907,132 0.0%
East of England SHA 135,389 83,960 94,829 69,350 652,216 10.6%
Great Yarmouth and Waveney PCT 352 1,625 1,009 1,000 414,024 0.2%
Hertfordshire PCT (4) 1,611 638 513 6,200 1,763,891 0.4%
Luton PCT 400 506 256 33 330,732 0.0%
Mid Essex PCT 1,007 3,767 1,121 1,000 545,165 0.2%
Norfolk PCT 695 959 1,403 1,000 1,249,086 0.1%
North East Essex PCT 2,993 2,998 1,143 1,000 559,694 0.2%
Peterborough PCT (12,832) 389 4,110 0 282,410 0.0%
South East Essex PCT 2,014 1,093 879 200 588,382 0.0%
South West Essex PCT 1,614 48 252 650 686,544 0.1%
Suffolk PCT 2,578 3,560 1,070 1,100 963,285 0.1%
West Essex PCT 815 721 620 1,000 455,673 0.2%
East of England subtotal SHA/PCTs 137,373 101,160 108,208 83,033 10,032,772 0.8%
NHS Midlands and East total SHA/PCTs 300,883 264,751 289,685 209,702 28,556,505 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 Q2
Forecast
outturn
surplus/
(operating
defi cit)
£000s
2012/13 Q2
Forecast
outturn
turnover
£000s
2012/13 Q2
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 2,463 185,431 1.3%
East Midlands Ambulance Service NHS Trust 2,016 467
1,402
1,544 155,007 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 1,510 104,508 1.4%
Northampton General Hospital NHS Trust 2,081 1,109 504 320 261,516 0.1%
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 4,328 779,606 0.6%
Nottinghamshire Healthcare NHS Trust 2,387 6,505 6,896 5,324 418,861 1.3%
United Lincolnshire Hospitals NHS Trust 1,282 (13,880) 320 886 403,260 0.2%
University Hospitals of Leicester NHS Trust 51 1,013 88 46 737,904 0.0%
East Midlands subtotal trusts 17,848 2,303 23,036 20,621 3,321,645 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 Q2
Forecast
outturn
surplus/
(operating
defi cit)
£000s
2012/13 Q2
Forecast
outturn
turnover
£000s
2012/13 Q2
Forecast
outturn
surplus/
(operating
deficit) as %
turnover
Birmingham Community Health Care Trust (9) n/a 686 2,559 2,948 249,461 1.2%
Coventry and Warwickshire Partnership NHS Trust (10) 3,690 2,936 4,589 6,694 202,656 3.3%
Dudley and Walsall Mental Health Partnership 376 883 1,163 1,082 67,993 1.6%
NHS Trust
George Eliot Hospital NHS Trust 1,164 112 45 0 120,503 0.0%
North Staffordshire Combined Healthcare NHS Trust 449 698 891 1,282 77,008 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 7,975 378,654 2.1%
Sandwell and West Birmingham Hospitals NHS Trust 7,260 2,193 1,863 3,877 425,591 0.9%
Quarter 2 2012/13
51
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 Q2
Forecast
outturn
surplus/
(operating
defi cit)
£000s
2012/13 Q2
Forecast
outturn
turnover
£000s
2012/13 Q2
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 1,479 78,785 1.9%
Staffordshire and Stoke on Trent Partnership n/a n/a 1,527 2,000 367,866 0.5%
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 0 452,598 0.0%
University Hospitals Coventry and Warwickshire 10,234 4,162 1,465 2,053 482,422 0.4%
NHS Trust
Walsall Healthcare NHS Trust (15) 1,998 3,247 4,164 3,638 221,245 1.6%
West Midlands Ambulance Service NHS Trust 255 99 925 3,900 192,627 2.0%
Worcestershire Acute Hospitals NHS Trust 3,135 287 88 1,500 340,065 0.4%
Worcestershire Health and Care NHS Trust (16) 700 700 1,500 2,048 167,626 1.2%
Wye Valley NHS Trust (17) 1,165 46 71 200 173,881 0.1%
West Midlands subtotal trusts 52,452 29,798 33,394 42,576 4,301,265 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 Q2
Forecast
outturn
surplus/
(operating
defi cit)
£000s
2012/13 Q2
Forecast
outturn
turnover
£000s
2012/13 Q2
Forecast
outturn
surplus/
(operating
deficit) as %
turnover
Bedford Hospitals NHS Trust 612 274 197 127 212,643 0.1%
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 1,540 153,874 1.0%
East and North Hertfordshire NHS Trust 2,499 3,328 3,568 3,600 343,167 1.0%
East of England Ambulance Service NHS Trust 757 2,364 3,121 5,107
231,000 2.2%
Hertfordshire Community NHS Trust (20) n/a 184 1,030 1,229 123,912 1.0%
Hinchingbrooke Health Care NHS Trust 598 79 186 0 106,765 0.0%
Mid Essex Hospital Services NHS Trust 2,551 3,660 (2,156) 1,089 255,824 0.4%
Norfolk Community Health and Care NHS Trust (21) n/a 552 637 1,100 123,604 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 0 224,939 0.0%
Princess Alexandra Hospital NHS Trust 511 415 461 0 178,527 0.0%
The 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 3,100 273,100 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 16,892 2,227,355 0.8%
NHS Midlands and East total trusts 99,637 55,079 68,200 80,089 9,850,265 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, they were 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 2 2012/13
52
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 (FT).
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), which merged with Norfolk and Waveney Mental Health NHS Foundation Trust on 1 January 2012
to become Norfolk and Suffolk NHS Foundation Trust.
23 The 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 decit (£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 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)
Mid Essex Hospital Services NHS Trust 12m)
Nottingham University Hospitals NHS Trust (£7m)
Princess Alexandra Hospital NHS Trust (£0.4m)
Sandwell and 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 receive
including income from PCTs. Trust income should therefore be excluded from any aggregation of SHA economy turnover to avoid
double counting resources.
Quarter 2 2012/13
53
thequarter.
Annex 3
NHS London
SHA and PCT name
2009/10
Annual
accounts
surplus/
(de cit)
£000s
2010/11
Annual
accounts
surplus/
(de cit)
£000s
2011/12
Annual
accounts
surplus/
(de cit)
£000s
2012/13 Q2
Forecast
outturn
surplus/
(de cit)
£000s
2012/13 Q2
Forecast
outturn
revenue
resource
limit (RRL)
£000s
2012/13 Q2
Forecast
outturn
surplus/
(de cit)
as % RRL
Barking and Dagenham PCT 3,377 62 3,567 3,285 350,907 0.9%
Barnet PCT 139 134 (13,955) 0 606,946 0.0%
Bexley Care PCT 51 486 2,274 3,508 368,739 1.0%
Brent Teaching PCT 16,334 17,416 21,576 21,500 563,346 3.8%
Bromley PCT 249 6,899 6,111 5,020 520,836 1.0%
Camden PCT 12 11,807 43,162 21,595 530,321 4.1%
City and Hackney Teaching PCT 9,346 6,594 13,164 6,464 550,185 1.2%
Croydon PCT 3,412 5,535 838 0 607,046 0.0%
Ealing PCT 3 34 37 0 620,239 0.0%
Enfi eld PCT (10,491) 11 (17,188) 0 507,696 0.0%
Greenwich Teaching PCT 608 5,327 4,770 4,710 501,002 0.9%
Hammersmith and Fulham PCT 10,538 3,513 5,496 7,084 374,088 1.9%
Haringey Teaching PCT 29 170 (17,439) 500 486,653 0.1%
Harrow PCT 126 677 150 0 367,666 0.0%
Havering PCT 1,528 932 873 4,095 429,000 1.0%
Hillingdon PCT 19,380 5 44 0 442,529 0.0%
Hounslow PCT 40 42 150 33 426,759 0.0%
Islington PCT 1,121 10,261 20,837 9,084
491,613
1.8%
Kensington and Chelsea PCT 3,985 3,410 10,166 11,332 379,210 3.0%
Kingston PCT 103 2,623 4,515 3,961 283,043 1.4%
Lambeth PCT 988 6,430 6,867 7,000 700,353 1.0%
Lewisham PCT 90 5,287 5,445 5,520 552,831 1.0%
London SHA 288,675 257,187 255,672 52,000 1,858,811 2.8%
Newham PCT 1,107 7,104 9,738 5,800 582,986 1.0%
Redbridge PCT 6,232 6,217 6,644 4,027 430,234 0.9%
Richmond and Twickenham PCT 112 2,845 7,742 6,223 302,141 2.1%
Southwark PCT 628 1,365 5,987 5,859 555,343 1.1%
Sutton and Merton PCT (2,286) 266 6,457 4,528 610,671 0.7%
Tower Hamlets PCT 6,753 6,973 8,985 10,363 550,289 1.9%
Waltham Forest PCT 0 27 100 4,292 446,878 1.0%
Wandsworth PCT 4,386 12,322 16,709 10,522 617,087 1.7%
Westminster PCT 15,010 9,866 22,890 24,344 584,396 4.2%
London total SHA/PCTs 381,585 391,827 442,384 242,649 17,199,844 1.4%
NHS London total SHA/PCTs 381,585 391,827 442,384 242,649 17,199,844 1.4%
Quarter 2 2012/13
54
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