| 0 Trust Board Integrated Performance Report 6 th May 2010

| 1 NUH at a Glance Legend / key Forecasts Shows whether next month’s position will meet the standard RGA Data Quality indicator Timeliness Source Completeness Granularity Validation Audit Judgment of Executive Director Not sufficient Sufficient Exemplary Not yet assessed 1

| 2 Escalation pages (1/4) Michelle Rhodes Successful Choose and Book appointments ▪ General reduction across services of slots availability over the Easter bank holiday period. ▪ Ophthalmology – impact of significant increase in referrals following the change in Royal College referral guidance. ▪ Ophthalmology - A referral refinement pathway for NHS Nottingham City went live on 4th Jan and NHS Notts County referral pathway will live by 30th April A triage service went live from March for Nottingham City PCT – limited success made date. ▪ ENT: Shortage of specialised staff. New staff due to commence in post over period of the next 2 months. ▪ Work continues with PCTs to redirect appropriate referrals into the appropriate community based service. Referral criteria are agreed and the pathways for the Nottingham Back Care Team, Pain Management and Spinal Service have now also been agreed. Michelle Rhodes What actions have we taken to improve performance? What is driving the reported underperformance? 96% 91% Bed and theatre capacity Standard YTDForecast 5% 9.4% 7.8% ▪ Weekly reviews of reasons for cancelled operations is highlighting any emerging trends. This is enabling appropriate actions to be taken, for example reviews of theatre scheduling Indicator level 1 Lead Director Expected date to meet standard % of successful Choose and Book referrals to appointments booked via the Telephone Appointment Line, over number of TAL slots A What actions have we taken to improve performance? What is driving the reported underperformance? % patients whose operation was cancelled, by the hospital, for non-clinical reasons, on the day of or after admission, treated within 28 days Standard MarchYTDForecast Lead Director Expected date to meet standard Breaches of the 28 day readmissions guarantee Indicator level 1 March September 2010 July 2010 A

| 3 Escalation pages (2/4) Screening all day case patients for MRSA ▪ Certain areas continue to develop systems and practices to allow screening of all day cases ▪ Due to screening and clinical coding data there is a two month gap which may not reflect improvement made until later data is released ▪ Underperforming areas identified and being performance managed via the Infection Control Operational Group ▪ Clinical Leads have developed Action plans to ensure greater compliance in future months Stephen Fowlie What actions have we taken to improve performance? What is driving the reported underperformance? 90% 75% N/A ▪ This does not become a reportable national target until 31st December 2010 ▪ Currently NUH screens all emergency patients admitted to surgical wards. At present there is not the lab capacity to process the increased swabs to extend to other clinical inpatient areas Standard YTDForecast 90% 58% N/A ▪ Work is being undertaken to ensure that the lab capacity is in place. Once completed clinical areas will be asked to commence screening all emergency admissions Indicator level 2 Lead Director Stephen Fowlie Expected date to meet standard Screening of all day case patients for MRSA; exclusions currently includes Children, Radiology, ophthalmic, Routine Obstetrics, Termination of Pregnancies, Pain management, Endoscopy, Minor Dermatology What actions have we taken to improve performance? What is driving the reported underperformance? Screening of all relevant emergency admissions for MRSA 'Relevant emergency admissions' is currently defined as excluding all children Standard MarchYTDForecast Lead Director Expected date to meet standard Screening all emergency patients for MRSA Indicator level 2 March June 2010 December 2010 A

| 4 Escalation pages (3/4) Diagnostic waiters (number waiting 6 weeks and over) - as reported in QDIAG ▪ Visual electo diagnostic - Ophthalmic Science - Delayed referral due to Admin error ▪ Nerve conduction test - Neurophysiology. Delayed referral received from Kings Mill ▪ Admin and process procedures reviewed and amended to avoid any recurrence ▪ Issue has been taken forward with Kings Mill for them to ensure systems are reviewed and revised Michelle Rhodes What actions have we taken to improve performance? What is driving the reported underperformance? 0 2 N/A StandardYTDForecast Indicator level 1 # patients waiting over 6 weeks for diagnostic procedures in endoscopy, imaging, pathology and physiological measurement Standard MarchYTDForecast Lead Director Expected date to meet standard Primary Angioplasty within 150 mins Indicator level 1 March April 2010 Lead Director Michelle Rhodes Expected date to meet standard September 2010 ▪ This is a jointly owned target with EMAS and the long delays for March have been experienced in the call to door times not door to perfusion ▪ We will be operating a 24 hour service in September before which we are planning to work with colleagues at a 'productive cath lab‘ ▪ A project manager has been appointed to start in May. ▪ We will instigate regular performance meetings with our colleagues from EMAS as we plan to move towards full operational 24/7. ▪ We also need to ensure that the data capture is accurate and in line with MINAP guidelines, we have put in an audit officer for PPCI within the business case to ensure the accuracy of data being used for this indicator What actions have we taken to improve performance? What is driving the reported underperformance? 75% 63% N/A Patients receiving Primary Angioplasty within 150 mins A

| 5 Escalation pages (4/4) Patient complaints responded to within agreed time ▪ Matrons and Clinical Leads have been supporting the increased operational activity during the winter months, which has led to challenges in delivering timely responses ▪ During this period the Complaints Lead has provided addition support by reviewing and editing response letters for those directorates where timelines have been more difficult to achieve Jenny Leggott What actions have we taken to improve performance? What is driving the reported underperformance? 90% 89% Indicator level 1 % patient complaints responded to within agreed timescale Standard MarchYTDForecast Lead Director Expected date to meet standard June 2010 % theatre usage over past month ▪ Session utilisation (due to cancelled list) ▪ In session utilisation ▪ Theatre closure ▪ Productive elective specialty (Better for you) ▪ Performance management framework ▪ Cancellation fees Michelle Rhodes What actions have we taken to improve performance? What is driving the reported underperformance? 80% 72% Indicator level 1 Specialty Usage of Session Time Standard MarchYTDForecast Lead Director Expected date to meet standard Incremental as Better for You rolls out 71% A

| 6 The In-Depth Review: Cancelled ops SOURCE: ORMIS, PAS, HISS, Information team Cancelled ops Signed off by:Expected date to meet standard: Plan for next Board report: Reasons for Cancellations Number Cancellations Trend Number per month MarMayNovJulJanMarSep Number of cancellations Number of 28 Day breaches 38 Cancellations by Directorate % per directorate in Mar 10 % of last minute elective cancellations for non-clinical reasons. Last minute means on the day the patient was due to arrive, or after the patient has arrived in hospital, or on the day of operation Agreed corrective actions (planned and commenced)Issues causing underperformance ▪ Revised processes and procedures to be followed have been finalised with directorates ▪ Weekly PLT meeting set up to look at reasons for cancellations ▪ Directorate level trajectories have been set up ▪ Performance management framework in place ▪ Cancellations in March were due largely due to lack of ward beds available due to D&V virus City Campus (Lister ward) and at QMC (D8), in addition to Operating list over runs. Scheduling of Operating lists being reviewed to ensure effective utilisation of lists by Directorates Red Latest performance YTDForecast Indicator level AmberGreen Ward Bed Unavailable Emergencies/Trauma Surgeon Unavailable Other Equipment Failure/Unavailable Medical/Anaesthetist/Theatre staff unavailable Replaced By Urgent Case Theatre Time Unavailable No ICU/HDU Beds List Overrun Complications Previous Patient Michelle Rhodes 0.8% in month for Dec 10 – Mar 11 July 2010 >1.5%1.53%1.6%Amber1 0.8% - 1.5% <0.8% Cancer and associated specialities Musculo- skeletal and neuro- sciences Diagnostics and clinical support Thoracic and digestive diseases Family health Diabetic, infection, renal and cardiovascular Head and neck Feb 10 Mar 10

| 7 The In-Depth Review: 18 week Number of treatment functions which are failing the 18 week admitted or non-admitted targets Signed off by:Expected date to meet standard: Plan for next Board report: The number specialties with <85% of eligible admitted patients whose adjusted RTT clock stopped in 18 weeks or less (<127 days) or <90% of eligible non- admitted patients whose RTT clock stopped in 18 weeks or less (<127 days) Michelle RhodesSeptember 2010July 2010 Red Latest performance YTDForecast Indicator level AmberGreen 1 3N/ARed1 N/A 0 Bed and theatre capacity Funding approved to open 6 beds Additional spinal theatre capacity Imminent appointment of locum neurosurgeon. Use of private sector Additional capacity Reduction in day case procedures Cancer surgery has been extremely active in the first quarter All daycase beds now open Additional consultant capacity Ward closure due to D&V virus Consultant sickness leave Patients moved out to the private sector Beds opened on a temporary basis to allow more electives admissions Review of administration services within the specialty Agreed corrective actions (planned and commenced)Issues causing underperformance Spines Neuro- surgery Maxillo Facial Trauma and Ortho Admitted: Spines Admitted: Trauma and Ortho Admitted: Neurosurgery Admitted Maxillo Facial Non admitted: Neurosurgery Standard Month Actual # TreatedBreaches 90%74.9% %84.0% %79.2% %81.0% %82.6% 6912 A G G G G G G G G G G AAA G Bed and theatre capacity Non admitted: Spines 95%91% Non admitted: Trauma and Ortho 95%94.1% Non admitted: Maxillo Facial 95%92.6% 44433

| 8 The In-Depth Review: Sickness Rate Sickness Rate Signed off by:Expected date to meet standard: Plan for next Board report: Danny MortimerMarch 2011Monthly Red Latest performance YTDForecast Indicator level AmberGreen 3.5% 4.09%N/ARed % 3.0% The Trust has made significant progress with reducing sickness absence, with an underlying downward trend. Directorates continue to work towards the challenging Trust target of 3% sickness by March 2011 Robust sickness management policy in place Closer scrutiny on 2 areas reporting highest sickness Ongoing monitoring of all sickness absence Trust-wide Further escalation methods being considered Agreed corrective actions (planned and commenced)Issues causing underperformance A G G G G G G G G G G AAA G Sickness Rate per Directorate % Mar-10 Sickness Rate %

| 9 62 days urgent referral to treatment of all cancers ▪ Specialties produce a Root Cause Analysis report to understand the cause of their breaches. This is presented at the weekly Cancer PTL meeting. ▪ There is Directorate Management representation at the Cancer PTL, with Directorates feeding back on patients. This has improved the lines of communication and accountability. ▪ A red alert system for cancer diagnostic referral requests has been implemented both at NUH and Treatment Centre with a maximum 5 days turnaround time for tests. ▪ The majority of Patient Navigators are now working within the specialty areas, which has improved clinical engagement as well as identifying where potential problems exist with the patient’s pathway. ▪ Patient pathways for each tumour site have been reviewed and bottle necks identified. The new pathway are currently being agreed and signed off by the Clinical Leads. ▪ A daily PTL has been developed with all 62 day patients from day 1 of entering the pathway. Specialties have received training on how to use and access this report. Actions taken and lessons learnt % of patients receiving first definitive treatment within 62-days following referral from an NHS Cancer Screening Service during a given period Projected Improvement Trackers YTD 80.5% Standard Month escalated Latest period Performance when escalated 85% May % 77.9% Lead Director Michelle Rhodes YTD 97% A&E 4 hour wait target ▪ Implemented actions from national emergency care intensive support review ▪ Additional senior mangers support to patient flow process ▪ Additional clinical start in ED and admission wards ▪ Development programme for advance nurse practitioners ▪ Additional winter beds Actions taken and lessons learnt Standard Month escalated Latest period Performance when escalated 98% Aug 09 99% 97% % of patients spending four hours or less in all types of A&E department, until discharge/ admission/ transfer Lead Director Michelle Rhodes

| 10 Appendix 1: NHS Performance Framework Indicators 2009/2010 Standards and targets: SOURCE: NHS Performance Framework Implementation Guidance (Annex 1: Operation Standards and targets indicators acute trusts - June 2009) 2