Trust Board meeting in Public: Wednesday 14 November 2018 TB

Trust Board meeting in Public: Wednesday 14 November 20 Title Integrated Performance Report: Month 6 Status History For information. The report provides a summary of the Trust s performance against a range of key performance indicators as agreed by the Trust Board. Board Lead(s) Ms Sara Randall, Acting Director of Clinical Services Key purpose Strategy Assurance Policy Performance Integrated Performance Report M6 Page 1 of 20

Executive Summary 1. In September 20, 1,572 patients waited over four hours from arrival to admission, transfer or discharge from OUH s Emergency Departments. 2. The Trust s four-hour wait performance rose 1% to 88.02%, but this was the second month in which the trajectory level agreed with NHS Improvement was not met. 3. Since March, no patient has waited over 12 hours from a decision to admit to admission. 4. On 30 September 20, 9,036 of 52,951 patients on incomplete elective care pathways at OUH were waiting for over weeks. 5. 82.94% of people awaiting elective care were waiting for less than weeks, a reduction in performance of 1% since August and well below the national 92% standard. 6. Over 52-week waits in Gynaecology remained stable at 158. Another 41 patients were waiting for over 52 weeks for treatment in 13 other specialties. 7. Three cancer waiting time standards were not met in September: the standard for 96% of patients to receive first definitive treatment within 31 days of a decision to treat; for first treatment within 62 days of urgent GP referral; and for first treatment within 62 days of a referral from a screening service. 8. Performance improved again against the two week wait standards. 9. There was a small improvement in the percentage of people receiving first treatment within 62 days of GP referral. Ten tumour sites contributed breaches, with most in Urological, Lower GI and Gynaecological Oncology. 10. Action continues to be taken to secure additional capacity to treat cancer patients within the national standards and to identify improvements to pathways of care. 11. In September, diagnostic wait performance improved again to 1.73% of patients waiting for over six weeks, though this remained outside the 1% national standard. 12. The national standard for providing care for inpatients with stroke on a dedicated stroke unit was not met for the second month and performance on this worsened. During September, there were also forty-three nationally-reportable breaches of the single-sex accommodation standard. Recommendation 13. The Board is asked to receive the Integrated Performance Report for Month 6. Integrated Performance Report M6 Page 2 of 20

Integrated Performance Report: Month 6 (September 20) 1. Key Headlines on Performance 1.1. In September 20, 1,572 patients waited over four hours from arrival to admission, transfer or discharge from OUH s Emergency Departments. The Trust s four-hour wait performance rose 1% to 88.02%. 1.2. During September, no patient waited for over 12 hours in the Emergency Departments from a Decision to Admit (DTA) to admission. 1.3. On 30 September 20, 9,036 of 52,951 patients on incomplete elective care pathways at OUH were waiting for over weeks. 1.4. 82.94% of people awaiting elective care were waiting for less than weeks, a reduction of 1% since August and well below the national 92% standard. 1.5. Over 52-week waits in Gynaecology remained stable at 158. Another 41 patients were waiting for over 52 weeks for treatment in 13 other specialties. 1.6. Last-minute cancellations affected 0.65% of elective admissions in September. 5.9% of these patients were not rebooked within 28 days. 1.7. Diagnostic wait performance improved again to 1.73% of patients waiting for over six weeks, though this was still a breach of the 1% national standard. 1.8. Three cancer waiting time standards were not met in September: the standard for 31 day waits to first treatment from a decision to treat; for first treatment within 62 days of urgent GP referral; and for first treatment within 62 days of a referral from a screening service. 1.9. In September: 1.9.1. There was one case of MRSA bacteraemia, the second reported in 20/19 (the first having been in August). 1.9.2. There were three cases of Clostridium difficile, below the average in the year to date. 1.9.3. The proportion of births taking place involving Caesarean section or assisted delivery rose above the expected level. 1.9.4. 79.63% of patients with acute stroke spent at least 90% of their time on a stroke unit. OUH moved below the national 85% standard in August (at 84.38%). 1.9.5. There were 43 nationally-reportable breaches of the single-sex accommodation standard, taking the year to date total to 289. 1.9.6. 97.73% of inpatients received a VTE risk assessment in September, maintaining OUH performance above the 95% standard which has been met since December 2014. Integrated Performance Report M6 Page 3 of 20

2. Urgent Care and Four Hour Waits Performance 2.1. In September 20, 1,572 patients waited over four hours from arrival to admission, transfer or discharge from OUH s Emergency Departments. The Trust s four-hour wait performance rose 1% to 88.02%. 2.2. The Trust s four-hour wait performance was below the trajectory level for the month agreed with NHS Improvement for the second time in 20/19. 2.3. The GP streaming service at the John Radcliffe treated 535 attendances in September, down slightly from 567 in August. Two waited for longer than four hours. 2.4. In September: 2.4.1. The number of ED attendances per day rose from 402 to 437. 2.4.2. Emergency admissions per day reduced to 199 from 207 in August (and 222 in July). 2.4.3. There were (on average) 52.4 breaches of the 4 hour standard per day, compared to 39.7 in June. In September, the trajectory figure would have been met if there had been no more than 43 breaches per day and the 95% national standard would have been met with no more than 21 per day. 2.4.4. No waits were reported of over 12 hours in OUH s Emergency Departments from a Decision to Admit (DTA). 2.4.5. 384 people (12.8 per day) waited 4-12 hours after a DTA. 2.5. Delayed transfers of care affected 51 patients at the end of September 20, down from 61 in August. 2.6. 1,755 bed days were used by delayed patients at OUH during the month, down from 2,157 in August. 2.7. Of these bed days, 1,316 (74.9%) involved Oxfordshire residents. Northamptonshire residents accounted for 290 bed days (16.5% of the total, up from 12.9% in August). 2.8. Overall, 14.99% of these bed days were associated with delays waiting for social care. 61.7% were waits for NHS care. Integrated Performance Report M6 Page 4 of 20

Figure 1: OUH Emergency Department attendances, waits and emergency admissions from January 2017 500 450 400 350 300 250 200 150 100 50 0 100% 95% 90% 85% 80% 75% 70% 65% 60% 55% 50% 12hr trolley waits Attendances / day Emergency admissions/day 4-12 hr trolley waits / day >4hr waits / day Performance OUH performance detail 2.9. Emergency Department attendances per week rose in early September after a drop in late July and August. Figure 2: ED attendances, weeks ending 7 January 21 October 20 3,400 3,000 2,600 2,200 07-Jan 07-Feb 07-Mar 07-Apr 07-May 07-Jun 07-Jul 07-Aug 07-Sep 07-Oct 2.10. Emergency admissions reduced markedly in late August but rose again in September. Figure 3: Emergency admissions (all sources), weeks ending 7 January 21 October 20 1,700 1,600 1,500 1,400 1,300 1,200 07-Jan 07-Feb 07-Mar 07-Apr 07-May 07-Jun 07-Jul 07-Aug 07-Sep 07-Oct Integrated Performance Report M6 Page 5 of 20

2.11. Four-hour wait performance has been above 85% since April but remains in the 85-90% range. Figure 4: Performance against 4 hour standard, OUH, weeks ending 7 January 21 October 20 95% 90% 85% 80% 75% 70% 07-Jan 07-Feb 07-Mar 07-Apr 07-May 07-Jun 07-Jul 07-Aug 07-Sep 07-Oct 2.12. Breaches of the four hour standard where the person involved was not admitted reduced from a peak in March but rose during September. 400 300 200 100 0 08-Jan- 08-Feb- 08-Mar- 08-Apr- 08-May- 08-Jun- 08-Jul- 08-Aug- 08-Sep- Figure 5: Non-admitted 4 hour breaches per week, weeks ending 8 January 23 September 20 2.13. General and acute bed occupancy (excluding day case, maternity and neonatal beds) has been above 94% since October 2017. Having reduced in late May, bed occupancy rose again over the summer, driven by a reduction in available beds. 102% 100% 98% 96% 94% 92% 90% 88% 07-Jan 07-Feb 07-Mar 07-Apr 07-May 07-Jun 07-Jul 07-Aug 07-Sep 07-Oct Figure 6: % bed days occupied, OUH General and Acute beds, after safe staffing bed reductions 2.14. Progress has continued to be made in reducing the number of bed days occupied by people in OUH beds for over 21 days (termed Super Stranded by NHS Improvement). Since a peak in January of 223 beds being occupied by people with a stay of over 21 days, this total was down 29.15% to 158 in mid-october. 2.15. The number of beds occupied by people staying for over 7 days has also reduced, showing a reduction of 15.7% from 680 on 28 January to 573 on 28 October. Integrated Performance Report M6 Page 6 of 20

Beds occupied 240 220 200 0 160 140 120 100 20-Oct 13-Oct 06-Oct 29-Sep 22-Sep 15-Sep 08-Sep 01-Sep 25-Aug -Aug 11-Aug 04-Aug 28-Jul 21-Jul Figure 7: Number of patients in OUH beds for >21 days, weekly snapshot, 21 July - 24 October 20 Beds occupied 700 650 600 550 500 450 400 07-Jan 07-Feb 07-Mar 07-Apr 07-May 07-Jun 07-Jul 07-Aug 07-Sep 07-Oct Figure 8: Number of patients in OUH beds for >7 days, weekly snapshot, 7 January - 28 October 20 2.1. The John Radcliffe admitted its first patient of the season with influenza during October. Flu vaccination of staff began in October and progress will be reported in future months. Weekly updates on respiratory illness are published by Public Health England at https://www.gov.uk/government/statistics/weekly-national-flu-reports- 20-to-2019-season. As at 31 October, national indications were that flu was below the baseline level expected for hospitalisations but that the Respiratory syncytial virus (RSV) season had begun. RSV usually causes mild respiratory infection in adults and children but can be severe in infants. 2.2. The number of people streamed to GP urgent care alongside the John Radcliffe Emergency Department grew rapidly until May but has since reduced slightly. 2.3. Following a successful pilot, patients already in the Department who are judged suitable for GP care will be streamed to the GP service in November. 2.4. Locum shifts are also being offered to extend the presence of GPs at busy evenings and weekends. 35 30 25 20 15 10 5 0 20-Oct 13-Oct 06-Oct 29-Sep 22-Sep 15-Sep 08-Sep 01-Sep 25-Aug -Aug 11-Aug 04-Aug 28-Jul 21-Jul Figure 9: Number of people streamed per day to GP urgent care, John Radcliffe, 21 July 25 October 20 Integrated Performance Report M6 Page 7 of 20

Key actions 2.5. Key actions in place are: 2.5.1. Improving senior clinical decision making in the Emergency Department by reviewing the out of hours rotas; 2.5.2. The appointment of a new lead Emergency Department clinician; 2.5.3. Reinforcing of internal professional standards and the review of out of hours rotas; 2.5.4. Review of bed availability through a reduction in numbers of stranded patients, with a refreshed plan to be agreed by all Divisions and Trust-wide reviews to move to being twice-weekly; 2.5.5. A Deputy Director of Urgent Care appointed to support cross-divisional flow, working closely with the new Winter Director and her team. 3. Referral to Treatment Time (RTT) Performance 3.1. On 30 September 20, 9,036 of 52,951 patients on incomplete elective care pathways at OUH were waiting for over weeks. 3.2. 82.9% of people awaiting elective care were waiting for less than weeks, a reduction of 1% since August and well below the national 92% standard. 3.3. Over 52-week waits in Gynaecology remained stable at 158. Another 41 patients were waiting for over 52 weeks for treatment in 13 other specialties. 3.4. The total number of people on the Trust s waiting list has stabilised after rapid growth from February 20, but: 3.4.1. the number waiting over weeks has continued to grow; 3.4.2. the proportion of people on the Incomplete waiting list who are waiting for longer than weeks has risen from 14.3% in May to 17% in September; 3.4.3. the Trust s clearance time (equivalent to an average wait ) has risen from 13.04 weeks in January 20 to 15.38 weeks in August; and 3.4.4. the total list size remains oversized. Analysis of the Trust s list in August 20 1 indicated that it was over 4,700 larger than would make it possible to treat 92% of people on it within weeks. Component waits 3.5. 2,296 people completing RTT Admitted pathways in September 20 were treated within weeks (66.96%). 62 completed treatment after more than 52 weeks. 40 of the 62 were admitted to Gynaecology after more than 52 weeks. 3.6. 9,819 patients whose RTT Non-admitted clock stopped in September 20 were within weeks (82.48%). 58 patients on the Non-admitted pathway completed treatment after more than 52 weeks, 32 in Gynaecology. 1 Online analysis by gooroo.co.uk based on data published by NHS England on 11 October 20 Integrated Performance Report M6 Page 8 of 20

Specialty waits and long waits 3.7. The total list size in Gynaecology reduced by 9.5% from July to September. The number waiting for a first outpatient appointment reduced in August and September, but 16 people were waiting at the end of September for over 52 weeks for a first appointment, 43 for 36-52 weeks and a further 308 for -36 weeks. Some clinics continue to have waits of over 44 weeks for a first appointment. 3.8. 1,372 people were waiting for over weeks on incomplete Gynaecology pathways on 30 September: 63.4% of waits were within weeks. 3.9. There were 1,374 52 week waits in England in November 2017 and 3,306 in August 20. In August, OUH had the second-longest waiting times in Gynaecology in England and 52% of the country s over-52 week waits for Gynaecology. 3.10. Other specialties with over 100 people waiting for over weeks in September on incomplete pathways were as follows: Table 1: Services with >100 > week waits on incomplete pathways, September 20 Treatment function % < Number > Number weeks weeks >52 weeks ENT 61.86% 1,263 1 Gynaecology 63.40% 1,214 158 Ophthalmology 80.56% 894 4 Trauma and Orthopaedics 82.87% 653 3 Paediatric ENT 53.69% 509 0 Maxillo Facial Surgery 75.75% 478 1 Urology 80.70% 370 10 Dermatology 90.06% 317 0 Plastic Surgery 72.55% 308 0 Clinical Genetics 84.48% 290 0 Spinal Surgery Service 84.25% 134 6 Paediatric Ophthalmology 64.34% 133 0 Gastroenterology 91.21% 133 0 Endoscopy (Gastroenterology) 87.87% 122 0 Orthodontics 62.89% 1 0 Paediatric Trauma and Orthopaedics 84.41% 104 0 Neurology 92.70% 103 0 Vascular Surgery 83.93% 103 1 3.11. Services with over-52 week waits in September were as follows: Table 2: Waits on incomplete RTT pathways of over 52 weeks by treatment function, September 20 Treatment function Number >52 weeks Gynaecology 158 Urology 10 Spinal Surgery Service 6 Integrated Performance Report M6 Page 9 of 20

Key actions Treatment function Number >52 weeks Ophthalmology 4 Physiotherapy 4 Trauma and Orthopaedics 3 Colorectal Surgery 3 Interventional Radiology 3 Upper Gastrointestinal Surgery 2 Paediatric Spinal Surgery 2 ENT 1 Maxillo Facial Surgery 1 Vascular Surgery 1 Neurosurgery 1 Total 199 3.12. Key actions in place are: 3.12.1. Harm review process to review all patients waiting over 52 weeks; 3.12.2. Capacity alerts in Gynaecology and ENT which warn patients and GPs of long waits and have started to show some reduction in referrals. 3.12.3. Weekly monitoring of progress in treating all patients waiting for over 46 weeks, with the intention to move to 40+ week monitoring before Christmas. 3.12.4. A detailed weekly plan for Gynaecology, with additional surgery for OUH patients being provided by OUH consultants at the Horton Treatment Centre in Banbury, the Manor Hospital in Headington and at the Churchill Hospital. 3.12.5. Arrangements are being made for an external supplier to provide staff to enable currently-closed operating theatres at the Churchill to be used to treat OUH patients waiting for Urology, General Surgery and Gynaecology. 3.12.6. The Surgery and Oncology Division making progress on the staffing of a ward and the equipping of operating theatres at the Horton General to enable a wider range of elective urological surgery to be provided there from February, enabling a greater focus at the Churchill on complex and cancer surgery. 3.12.7. An NHS Improvement-funded data analysis of the Trust s waiting list to review the potential for external waiting list validation to reduce the overall waiting list size by the end of March 2019. 4. Diagnostic Waits 4.1. Diagnostic wait performance improved in September to 1.73% of patients waiting for over six weeks, still breaching the 1% national standard. 4.2. In September, a total of 12,338 people waited for diagnostic tests. 213 people waited for over six weeks, down from 290 in August. 4.3. Waits of over six weeks were concentrated in four services: Integrated Performance Report M6 Page 10 of 20

4.3.1. MRI, which accounted for 61.03% of all waits over six weeks, with 130 patients waiting over 6 weeks and 11 for over 13 weeks; 4.3.2. Colonoscopy, which had 29 waits of over six weeks and one of over 13 weeks; 4.3.3. Gastroscopy, with 25 waits of over six weeks and three of over 13; 4.3.4. Audiology, with 20 waits of over 6 weeks and none of over 13. 4.4. Cardiology echocardiography, where previous delays were due to waits for myocardial perfusion scans following a shortage of isotopes which has now been resolved, had no waits of over six weeks in September. 5. Cancer Overall position on national cancer standards 5.1. Three cancer waiting time standards were not met in September: 5.1.1. the standard for 96% of patients to receive first definitive treatment within 31 days of a decision to treat; 5.1.2. the standard for 62 days to first treatment after urgent GP referral; and 5.1.3. the standard for patients to receive their first treatment within 62 days following referral from a screening service. 5.2. Performance improved again against the two week wait standards. 5.3. Performance improved slightly on first treatment within 62 days of GP referral. Over-62 day waits increased in the Urological tumour site group and nine other tumour sites contributed breaches, with most in Lower GI and Gynaecological Oncology. 5.4. Performance by month since May is shown below. The latest published level for England is also shown. Table 3: OUH performance against national cancer standards Standard At least 93% of patients referred from a GP with suspected cancer will be seen within 2 weeks of referral. At least 93% of patients referred from a GP with breast symptoms but not suspected cancer will be seen within 2 weeks of referral. At least 96% of patients will receive first definitive treatment within 31 days of a decision to treat. At least 85% of patients will receive their first treatment within 62 days of referral from a GP. May- OUH performance % England % Jun- Jul- Aug- Sep- Aug- 95.53 95.66 96.16 97.57 97.94 91.69 89.87 95.20 95.54 96.21 96.38 90.62 96.22 96.42 96.06 94.67 90.04 97 80.21 72.43 71.43 68.06 71.00 79.36 Integrated Performance Report M6 Page 11 of 20

Standard At least 94% of patients will receive subsequent treatment with surgery within 31 days of decision to treat. At least 98% of patients will receive subsequent treatment with anti-cancer drug regimen within 31 days of decision to treat. At least 94% of patients will receive subsequent radiotherapy within 31 days of a decision to treat. At least 90% of patients will receive their first treatment within 62 days following referral from a screening service. May- OUH performance % England % Jun- Jul- Aug- Sep- Aug- 94.23 94.44 95.52 100 94.00 93.83 98.21 100% 98.91 100 100 99.47 97.21 97.09 98.45 98.31 95.41 97.11 86.96 83.87 85.19 96.15 80.0 90.05 Reporting 5.5. As reported to the Board in paper TB20.27, changes have been made to the system used by NHS England to report on cancer wait standards. This involves being able to report on the 38 day handover date for care responsibility between two providers. 5.6. OUH has been using this new method of reporting (in accordance with the national timetable) since reporting its July waiting time figures. The Trust is finding it difficult to upload data due to the changes made, as are other trusts. 5.7. In early September, an upgrade took place to the Trust s Infoflex cancer information system to the latest version to enable capture of the necessary additional data fields in a timely way. 5.8. The upgraded system is taking time to embed. The reported performance figures for subsequent treatment (with surgery, drugs or radiotherapy) may need to be resubmitted due to some data fields having been found to have required verification after the new system was introduced. Reported performance on these three indicators may worsen. Patients referred from a GP with suspected cancer will be seen within 2 weeks 5.9. This standard was met in September. 5.10. The chart below shows the reduction in waits of longer than two weeks since early summer. The Lower GI and Gynaecological oncology tumour site groups contribute most breaches, with numbers in both reducing since July. 5.11. Urological tumour site waits for first contact have remained low, despite the surge in referrals to the service that took place in early summer. Integrated Performance Report M6 Page 12 of 20

100 90 80 70 60 13 50 40 26 24 33 30 30 13 20 17 7 10 9 13 8 7 0 Apr- May- Jun- Jul- Aug- Sep- Urological Upper GI Testicular Skin Sarcoma Other Lung Lower GI Head & Neck Haematological Gynaecological Children's Breast Brain CNS Figure 10: Breaches of the two week wait standard by tumour site group from April 20 First definitive treatment within 31 days of a decision to treat 5.12. Of 271 patients receiving first definitive treatment in September 20, 27 waited for longer than 31 days, performance of 90%. This standard was not met. 5.13. Performance by tumour site is shown below. The impact of growing waits for first urological treatment can be seen. 30 25 20 16 15 16 8 10 8 6 8 5 3 3 4 5 1 2 0 Apr- May- Jun- Jul- Aug- Sep- Urological Upper GI Skin Sarcoma Other Lung Lower GI Head & Neck Haematological Gynaecological Children's Figure 11: Breaches by tumour site of the 31 days to first treatment standard from April 20 First treatment within 62 days of a GP referral with suspected cancer 5.14. In September 20, of 165.5 referrals for which OUH was accountable, 48 did not receive their first treatment within 62 days of urgent referral from a GP. This was a reduction in breaches and in numbers treated. Performance improved by 2.9% to 71.0%. 5.15. Following an agreed protocol, any cancer patient waiting for over 104 days for treatment has a review conducted of potential for clinical harm from the delay and details are reported to the Clinical Governance Committee. Integrated Performance Report M6 Page 13 of 20

5.16. Breaches accountable to OUH by tumour site are shown below. Table 4: People receiving first treatment after 62 days of GP referral with suspected cancer Tumour site group Apr- May- Jun- Jul- Aug- Sep- Breast 3 2 3 3 1 1.5 Gynaecological 5 4 10 5.5 10 6 Haematological 1 1 2.5 1 4 2 Head & Neck 4.5 3.5 1.5 3.5 7.5 3.5 Lower GI 6 2 2 5 12 11.5 Lung 4 5 3 7 7 0.5 Other 0 0.5 1.5 0.5 0.5 Sarcoma 0.5 0.5 0.5 1 3 0.5 Skin 1 1 0 0.5 0 0 Upper GI 0.5 2 1 2 3 1.5 Urological 7.5 17.5 35 23 17 20.5 All cancers 33 38.5 59 53 65 48 5.17. Figure 12 below shows the contribution of Urological breaches since an increase in referrals in early summer. Urological breaches have begun to reduce, but limited treatment capacity means that a raised number is expected until December. Treatment pathways for Gynaecological Oncology, Head and Neck cancer, Lower GI and Lung also remain areas of particular focus. Figure 12: Cancer 62 day breaches by tumour site 70 60 50 17 Urological Upper GI Skin 40 35 23 20.5 Sarcoma Other 30 20 10 0 3 6.5 6 10.5 6 7 4.5 4 5.5 8 7.5 6 2 2.5 3 7.5 9.5 1.5 2 4 5 7.5 6 5 17.5 2 4 2 10 5 12 5.5 10 11.5 6 Lung Lower GI Head & Neck Haematological Gynaecological Breast Integrated Performance Report M6 Page 14 of 20

First treatment within 62 days of screening service referral 5.. This standard was not met in September. Two of patients referred from the breast screening service did not receive first treatment within 62 days and there was one breach in each of the Haematological and Lower Gastrointestinal tumour site groups. Key actions 5.19. Actions being taken include: 5.19.1. Negotiations with providers of temporary clinical staff to support additional theatre lists and staff beds at the Churchill Hospital from November 20 to enable OUH surgeons to operate on patients awaiting cancer surgery. 5.19.2. NHS Improvement and 20:20 are working with key clinicians in the five particularly challenged tumour sites to carry out redesign and where necessary to make recommendations to improve pathways. 5.20. A revised governance structure and reporting dashboard for OUH cancer services is also being developed. 6. Workforce 6.1. The Trust s vacancy rate in September 20 was 7.8%, down from 8.48% in July but remaining above the Trust s target of 5%. 6.2. At the end of September, there were 71.15 more whole time equivalent substantive staff in post than in August. 6.3. Sickness absence was 3.19%, just within the Trust s target level of 3.2%. 6.4. The turnover rate was 13.72%, above OUH s 12% target. 6.5. Costs for bank and agency staffing and financial metrics are reported in the Finance Report. 7. Benchmarking 7.1. Shown in the table below is the Trust s position on national key performance indicators for the latest period for which full data are available for the NHS in England and for Shelford Group teaching hospital trusts. 2 7.2. OUH s 4 hour wait performance in September improved to above the Shelford mean but remained below the national mean. The Trust continued to perform well in August on cancer 2 week waits and waits for subsequent treatment, but performance moved further below these benchmarks on 31 day waits and 62 day waits. RTT performance continued to be below both benchmarks on week and 52 week waits. 2 Cambridge University Hospitals, Central Manchester University Hospitals, Guy s and St Thomas, Imperial College Healthcare, King s College Hospital, Newcastle-Upon-Tyne Hospitals, Oxford University Hospitals, Sheffield Teaching Hospitals, University Hospitals Birmingham and University College London Hospitals. Integrated Performance Report M6 Page 15 of 20

Table 5: Key performance indicators for OUH, NHS England and Shelford Group trusts (nationally-published data). Note: NHS England 4 hour performance includes activity provided by non-acute Trusts. Indicator % 4 hour waits from Emergency Department attendance to admission/transfer/discharge <2 week waits to first appointment from urgent GP referral with suspected cancer <2 week waits to first appointment from urgent referral with breast symptoms First treatment within 31 days of cancer diagnosis First cancer treatment within 62 days of urgent referral from screening service First cancer treatment within 62 days of urgent GP referral Subsequent cancer treatment in <31 days: surgery Subsequent cancer treatment in <31 days: drugs Subsequent cancer treatment in <31 days: radiotherapy RTT: >52 week waits, Admitted pathways - Average vs OUH total RTT: >52 week waits, Non-admitted pathways - Average vs OUH total RTT: >52 week waits, Incomplete pathways - Average vs OUH total Standard Data Period England Shelford OUH 95% Sep- 88.94% 85.48% 88.02% 93% Aug- 91.69% 92.94% 97.57% 93% Aug- 90.62% 93.78% 96.21% 96% Aug- 97.00% 95.34% 94.67% 90% Aug- 90.05% 87.79% 96.15% 85% Aug- 79.36% 76.39% 68.06% 94% Aug- 93.83% 94.76% 100% 98% Aug- 99.47% 99.32% 100% 94% Aug- 97.11% 96.43% 98.31% 0 Aug- 7.1 32.7 43 0 Aug- 5.7 17.7 36 0 Aug- 5.7 17.7 203 RTT: % < week waits, Admitted pathways 90% Aug- 72.85% 76.68% 71.05% RTT: % < week waits, Incomplete pathways 92% Aug- 86.79% 87.83% 83.88% RTT: % < week waits, Non-admitted pathways 95% Aug- 88.43% 88.70% 84.75% 8. Trajectories 8.1. Waiting list and activity trajectories were sent to NHS Improvement for 20/19. 8.2. The trajectory for four hour waits was met in April-July. The increased trajectory figures for August and September were not met. Table 6: OUH 4 hour wait trajectory 20/19 OUH four hour waits Apr- May- Jun- Jul- Aug- Sep- >4 hour waits - plan 1,890 1,930 1,915 1,890 1,570 1,290 >4 hour waits - actual 1,665 1,581 1,191 1,682 1,616 1,572 Attendances - plan 12,598 14,159 13,919 13,940 12,744 13,002 Attendances - actual 12,149 13,900 13,354 14,173 12,450 13,1 Performance - trajectory 85.0% 86.4% 86.2% 86.4% 87.7% 90.1% Performance - actual 86.30% 88.63% 91.08% 88.13% 87.02% 88.02% Integrated Performance Report M6 Page 16 of 20

8.3. The 95% national standard has not been met by the NHS in England or by OUH since July 2015. 8.4. Oxfordshire s NHS met the 90% trajectory figure set for it in Quarter 1 20/19 and in July, but it was not met in August or September. Quarter 2 performance therefore fell below the 90% standard at which 920,000 of Provider Sustainability Funding would have been paid to the Trust by NHS Improvement. 8.5. The basis for calculating eligibility for these payments has been changed to include performance in the year to date. When added together, OUH and Oxford Health s year to date performance was above 90% to the end of Q2. Some corrections have also been made by Oxford Health to their attendance figures which form part of the updated table below. Table 7: Oxfordshire 4 hour wait performance OUH + Oxford Health Jul- Aug- Sep- Q1 Q2 YTD >4 hour waits - actual 1,850 1,672 1,648 4,753 5,170 9,923 Attendances - actual,227 15,808 16,833 50,474 50,868 101,342 Performance - trajectory 90.0% 90.0% 90.0% 90.0% 90.0% 90.0% Performance - actual 89.85% 89.42% 90.21% 90.58% 89.84% 90.21% 8.6. The trajectory for improvement against the 62 day cancer standard is shown below. Performance since June has been below the expected trajectory. Table 8: Cancer 62 days from urgent GP referral trajectory, 20/19 Cancer 62 days Apr- May- Jun- Jul- Aug- Sep- Waits of >62 days: plan 33.0 39.5 46.5 46.5 44.5 39.0 Waits of >62 days: actual 33.0 38.5 59.0 53.0 65.0 48.0 Total seen: plan 165.0 192.0 2.0 0.0 0.0 173.0 Total seen: actual 165.0 194.5 214.0 5.5 203.5 165.5 Performance %: plan 80.0% 79.4% 74.5% 74.2% 75.3% 77.5% Performance %: actual 80.0% 80.2% 72.4% 71.4% 68.1% 71.0% 8.7. For elective care waits (RTT incomplete pathways) in September: 8.7.1. Total list size reduced again from its June peak. On 30 September, it was 2,804 above the level it was at on 31 March 20. 8.7.2. Completed pathways for admitted and non-admitted care were above plan but the number of people waiting for over weeks grew by 336 (3.9%). 8.7.3. The number of over 52 week waits reduced slightly and remained within the expected level. Table 9: RTT trajectories, 20/19 Referral to Treatment: incomplete pathways Number of incomplete RTT pathways <= weeks Number of incomplete RTT pathways > weeks Mar- Apr- May- Jun- Jul- Aug- Sep- Plan 42,560 42,790 42,911 42,832 42,758 42,584 Actual 42,691 44,342 45,102 46,287 46,010 45,276 43,915 Plan 7,464 7,580 7,848 8,265 8,277 8,431 Actual 7,456 7,672 7,555 7,834 8,040 8,700 9,036 Number of incomplete Plan 217 200 216 228 241 252 Integrated Performance Report M6 Page 17 of 20

Referral to Treatment: incomplete pathways RTT pathways >52 weeks Number of completed admitted RTT pathways Number of completed non-admitted RTT pathways Number of New RTT pathways (clock starts) Mar- Apr- May- Jun- Jul- Aug- Sep- Actual 1 176 7 7 198 203 199 Plan 2,576 2,954 3,053 2,873 2,871 2,893 Actual 3,398 3,593 3,408 3,496 3,475 3,429 Plan 6,649 8,811 8,738 8,884 9,501 9,425 Actual 11,426 12,548 12,138 12,805 11,838 11,904 Plan 16,965 21,159 20,385 20,647 20,240 19,303 Actual 19,717 20,628 20,914 19,901,240 9. Additional information 9.1. Quality, Operational and Workforce indicators are shown at Appendix 1. 10. Recommendation 10.1. The Board is asked to receive the Integrated Performance Report for Month 6. Sara Randall Acting Director of Clinical Services October 20 Integrated Performance Report M6 Page of 20

Appendix 1 Quality, Operational and Workforce indicators Data Quality Indicator The data quality rating has 2 components. The first component is a 5 point rating which assesses the level and nature of assurance that is available in relation to a specific set of data. The levels are described in the box below. Rating Required Evidence 1 Standard operating procedures and data definitions are in place. 2 As 1 plus: Staff recording the data have been appropriately trained. 3 As 2 plus: The department/service has undertaken its own audit. 4 As 2 plus: A corporate audit has been undertaken. As 2 plus: An independent audit has been undertaken (e.g. by the Trust's internal or external 5 auditors). The second component of the overall rating is a traffic-light rating to include the level of data quality found through any auditing / benchmarking as below Rating Data Quality Green Satisfactory Amber Data can be relied upon but minor areas for improvement identified. Red Unsatisfactory/significant areas for improvement identified. Quality Standard Current Data Period Period Actual Outcomes Summary Hospital-level Mortality Indicator** NA Mar- 0.92 5 Total number of deliveries NA Sep- 660 3887 5 Proportion of normal deliveries 62% Sep- 57.88% 59.8% 5 Proportion of Caesarean section deliveries 23% Sep- 25.3% 24.3% 5 Proportion of assisted deliveries 15% Sep- 16.82% 15.8% 5 Maternal Deaths NA Sep- 0 0 4 30 day emergency readmissions 0% Sep- 3.41% 3.6% 5 Medication reconciliation completed within 24 hours of admission 80% Sep- 69% 71.6% 4 Medication errors causing serious harm 0 Aug- 1 7 5 Number of CAS alerts closed having breached during the month 0 Sep- 0 0 5 Dementia CQUIN patients admitted who have had a dementia screen NA Aug- 82.64% 76.4% 4 Dementia diagnostic assessment and investigation NA Aug- 100% 100% 4 Dementia: Referral for specialist diagnosis NA Aug- 100% 100% 4 Patient Friends & Family test response rate (Inpatients) NA Sep- 19.93% 21% 4 Experience Friends & Family test response rate (Maternity) NA Sep- 5.17% 8.5% 4 Friends & Family test response rate (Emergency Departments) NA Sep- 22.52% 23.6% 4 Friends & Family test % not likely to recommend (Emergency Departments) NA Sep- 5.78% 7.6% 4 Friends & Family test % not likely to recommend (Inpatients) NA Sep- 2.3% 2.1% 4 Friends & Family test % not likely to recommend (Maternity) NA Sep- 0.95% 1% 4 Friends & Family test % likely to recommend (Emergency Departments) NA Sep- 89.58% 87.7% 4 Friends & Family test % likely to recommend (Inpatients) NA Sep- 95.8% 95.8% 4 Friends & Family test % likely to recommend (Maternity) NA Sep- 94.29% 96.5% 4 Safety Serious Incidents Requiring Investigation NA Sep- 6 50 5 % of Patients receiving Harm Free Care (Pressure sores, falls, C-UTI and VTE) NA Sep- 92.67% 92.8% 3 Never Events NA Sep- 1 7 5 Cleaning Scores: % of inpatient areas with initial score >92% NA Sep- 50.79% 51.1% 5 % of incidents associated with moderate harm or greater NA Aug- 0.6% 0.7% 5 # newly acquired pressure ulcers (category 2, 3 and 4) NA Aug- 40 278 5 YTD Data Quality Integrated Performance Report M6 Page 19 of 20

Appendix 1 Operational Standard Current Data Period Period Actual Standards RTT: % < week waits, Admitted pathways 90% Sep- 66.96% 70.7% 4 RTT: % < week waits, Non-admitted pathways 95% Sep- 82.48% 85.2% 4 RTT: % < week waits, Incomplete pathways 92% Sep- 82.94% 84.7% 5 % Diagnostic waits waiting 6 weeks or more 1% Sep- 1.73% 2.4% 3 RTT: >52 week waits, Admitted pathways 0 Sep- 62 307 4 RTT: >52 week waits, Incomplete pathways 0 Sep- 199 1,150 4 RTT: >52 week waits, Non-admitted pathways 0 Sep- 58 217 4 Emergency Department attendances NA Sep- 13,1 79,144 5 % <=4 hour waits from Emergency Department attendance 95% Sep- 88.02% 88.2% 5 Last minute cancellations: % of elective admissions 0.5% Sep- 0.65% 0.7% 3 % patients not rebooked within 28 days 0% Sep- 5.88% 10.7% 5 Urgent cancellations second time 0 Sep- 0 0 5 Urgent cancellations 0 Sep- 31 123 5 Contract Variations Open NA Sep- 16 Contract Notices Open NA Sep- 0 Delayed transfers of care: number (snapshot)* 0 Sep- 51 342 4 Delayed transfers of care as % of occupied beds* 3.5% Sep- 6.09% 6.2% 5 Theatre utilisation elective 80% Sep- 75.9% 74.6% 4 Theatre utilisation emergency 70% Sep- 47.23% 48.7% 4 Theatre utilisation total 75% Sep- 68.07% 67.5% 4 Results endorsed within seven days NA Sep- 72.07% 74.7% 4 % of discharge summaries sent to GP within 24 hrs 95% Sep- 86.1% 86.1% 4 First cancer treatment within 62 days of urgent GP referral 85% Aug- 68.06% 74.2% 4 First cancer treatment within 62 days of urgent referral from screening service 90% Aug- 96.15% 87.4% 4 First treatment within 31 days of cancer diagnosis 96% Aug- 94.67% 95.3% 4 Subsequent cancer treatment in <31 days: surgery 94% Aug- 100% 94.4% 4 Subsequent cancer treatment in <31 days: drugs 98% Aug- 100% 99% 4 Subsequent cancer treatment in <31 days: radiotherapy 94% Aug- 98.31% 97.8% 4 <2 week waits to first appointment from urgent GP referral with suspected cancer 93% Aug- 97.57% 96% 5 <2 week waits to first appointment from urgent referral with breast symptoms 93% Aug- 96.21% 93.9% 5 Same sex accommodation breaches 0 Sep- 43 289 5 Patients spending >=90% of time on stroke unit 85% Sep- 79.63% 89.9% 5 Time to Surgery (% patients having their operation within the time specified according to their clinical categorisation) NA Sep- 86.75% 92% 3 MRSA bacteraemia 0 Sep- 1 2 5 Clostridium Difficile incidence 6 Sep- 3 28 5 % adult inpatients having VTE risk assessment 95% Sep- 97.73% 97.2% 5 YTD Data Quality Workforce Workforce Performance Target Current Data Period Period Actual Data Quality Vacancy rate 5% Sep- 7.8% 3 Sickness absence** 3.2% Sep- 3.19% 5 Turnover rate 12% Sep- 13.72% 5 Substantive staff in post against plan 11,760.62 Sep- 10,862.33 4 Integrated Performance Report M6 Page 20 of 20