Trust Board papers - University Hospital Southampton NHS ...

UHSFT – Directors’ Actions Summary for 18 th December 2012 Trust Board – Open sessionCONFIDENTIAL___________________________________________________________________________________________________________________________________________Action & Minute Reference By whom TargetDateTrust Board 28 th August 2012IM&T Strategy Refresh including Quarter Report (agenda item 6.1) MinuteRef 125/12 c)• An analysis of what can be done for both double and half theinfrastructure investment.• Links and collaboration with the University of Southampton beinvestigated and reinvigorated.• A discussion on the balance of capital priorities and the impact achievedto take place at a Study Session.Trust Board 29 th October 2012Patient Safety Quarter Report (agenda 5.1) Minute Ref 152/12 c)• The 24/7 indicators to be brought to A&AC for a deep dive review.• Board to be reminded of the infection control actions through the BoardInformation Pack.• An understanding of bed moves to be provided.AB/MHIC/AB/MHSA/AB/MHJG/MMJGJH18/12/1218/12/1218/12/12Current StatusIn hand for Q3 - Agenda TB 26/3/13Complete and will report in December.Agenda TBSS 15/1/1321/1/13 Agenda A&AC 21/1/13Complete – TB 27/11/12To be provided at TB 18/12/12 in Exec UpdatesAssurance Framework & Corporate Risk Register 2012/13 Quarter 2Report (agenda item 6.3) Minute Ref 156/12 c)A forecast on the risk position in the coming quarter to be included in thesummary.JG 21/1/13 Agenda A&AC 21/1/13Trust Key Performance Indicators for Month 6 (agenda item 7.2) Minute Ref159/12 c)A&AC to consider the issues around R&D. MM/SA 21/1/13 Agenda A&AC 21/1/131

Finance169/12 Finance Report for Month 7 (agenda item 4.1. Enclosure 2)a) AM presented the report which updates Board on the financial, activity and savingsperformance of the Trust for October 2012. AM noted that October was a highactivity month and an estimate had been made of expected income in the report;the actual income had been reported yesterday and the actual income is slightlyfavourable to the estimate such that the Trust is more on plan than reflected in thereport.Still working hard on CIPs. Trust liquidity quite tight. Raised concern about thelevel of activity in the hospital and amount of non-elective activity which is impactingupon elective activity with an impact upon income.169/12 b) A discussion followed covering: NM confirmed that Strategy and Finance Committee had scrutinised the reporton 26 November. Committee happy with the report but concerned about thelevel of activity which could impact upon the finances as the position is reallytight MH confirmed that the Trust is working hard to identify further savings to seek toremain on financial target.169/12 c) After discussion Trust Board: Noted that in October the Trust has delivered a pre-impairment surplus of£504k, £223k worse than Plan and the cumulative position is a surplus of£2,352k which is £203k worse than Plan Noted that Cost Improvement Programmes (CIPs) delivered were cumulatively£0.9m below Plan, which is phased based on a historic delivery profile. Thiswas a £0.1m deterioration in October. The target is fully identified at 31stOctober although a significant element remains classified as amber Noted that divisions and headquarters overspent against expenditure budgetsby £1.8m, this was exacerbated by a £0.4m overspending on reserves andcorporate budgets. This was largely offset by income being £1.8m above plan inthe month Noted the October position is based on a number of specific assumptions onIncome.170/12a)Reference Cost Index 2011-12 Full Publication (agenda item 4.2. Enclosure 3)AM stated that the report, which informs Board members of the Trust’s referencecost index for 2011-12, is for information. The data has just been released by theDH. UHS is lowest in the peer group of hospitals. The report includes a brief noteof future developments in costing the tariff.170/12 b) A discussion followed covering:Query on whether calculating costs/tariffs based on foundation trusts or tertiaryhospitals would impact upon the tariffs. Possible that there could be a shiftamong tariffs and a tariff more akin to costs in non-elective and tertiary work Will be sharing the result with the commissioners NM noted that Strategy and Finance Committee had discussed this andcongratulated execs on achieving lower costs than average and encouragedthat this is shared within the organisationMMu noted the information will be used in business case preparationClarification of how RCIs are included in strategic objectivesNeed to link to quality etc as having a low Reference Cost Index (RCI) is not anend in itself but part of the cost, quality and activity triangle.170/12 c) After discussion Trust Board: Noted the reportNoted that this secures a strategic objective set by Trust Board in 2012/13 tokeep RCI at or below the average of our peer group.2

172/12 b) A discussion followed covering: Query on key message. MD stated team is exceeding expectations on servicedelivery and that it should be a key concern for Board to ensure appropriatestaffing levels. Working hard to maintain appropriate staffing levels givenincreasing number of births. Discussing with the university to have two cohortsof midwives a year Number of midwives being trained will be driven by the LETB Consultant cover in labour ward. MD assured Board that cover is accessibleand believed to be sufficient New investment in obstetric theatre NHSLA level 3 work is ongoing. Financial reward of achieving this will be£0.5m and assessment will be in September 2013 Query about The Times article to reduce still births. MD stated the Trust’sstrategy is concentrated on ante-natal care and adherence to NICE guidance.MM noted that still births can be influenced by lifestyles Future requirement of obstetric and maternity services in the local healtheconomy and opportunity to influence service re-configuration.172/12 c) After discussion Trust Board: Congratulated the team on the achievements particularly around the Ghanaproject Agreed it would like to receive the dashboard as part of the performance report Noted and recognised that the service remains under pressure from increasedactivity and complexity, and that there is regular review and planning regardingstaffing and safety to ensure an effective and safe service Noted that the Maternity Service is working towards NHSLA accreditation atLevel 3, and that this will be assessed in 2013 Noted the current achievements, challenges and future developments of theMaternity Services.MD/JGMMu/MHGovernance173/12 Chief Executive’s Report (agenda item 6.1. Enclosure 6)a) MH stated that the report, which updates Board in accordance with StandingFinancial Instructions, is to note. There was a query on the purchase of a houseand MH replied that the Trust’s strategy is to purchase property bordering the siteto provide opportunity for site footprint expansion. Noted no consultantappointments to be ratified.173/12 b) Items for RatificationActions taken by the Chair as set in paragraphs 3.1.1 – 3.1.2 were ratified.174/12a)Infection Prevention & Control 2012/13 Quarter 2 Review and Matron Reportto include Health System Noro-Virus Action Plan (agenda item 6.2. Enclosure 7)JG introduced the paper which reports the 2012-13 Q2 infection preventionperformance within UHS, and quarter 2 Matron reports. Noted that Norovirusseason is starting. The Trust has been working hard with partners to have a robustplan to deal with the infection.4

174/12 b) A discussion followed covering: Matrons reports not included in the report. JG noted that these were discussedin TEC and could in future be circulated in the supporting paper informationpack Delivery of C.Diff against plan and the significant financial penalty of notachieving the target Work to address norovirus which includes decision not to convey by ambulanceservice, working with the port health authority and nursing home patients beingcared for there Anti-biotic prescribing. MM updated Board on prescribing patterns and actionstaken to address and the work in place to ensure appropriate prescribing. ICnoted that the University of Southampton’s Primary Care Group has had astrong track record in antibiotic prescribing, and JH noted the issue may beaddressed through e-prescribing MM noted benefit of e-prescribing which can flag anti-biotic use and initiate areview.174/12 c) After discussion Trust Board: Requested the Matron reports be circulated in the information pack Requested information on e-prescribing be circulated in the information pack Noted the key infection prevention priorities and quarter 2 performance Acknowledged the norovirus preparations for Winter 2012/13 Noted the care group accountability to Trust Delivery Group for compliance withUHS policy to ensure appropriate management of patients with MRSA and Cdifficile colonisation Noted the outlier high prevalence of antibiotic use in UHS relative to nationalaverage and actions being taken in relation to this.JGMM175/12a)Annual Emergency Planning & Business Continuity Report (agenda item 6.3.Enclosure 8)JH introduced the paper which provides an annual update to the Board on itscurrent state of Emergency Preparedness, and flags the impact of external factorson the Trust’s business and supply line. Seeking to ensure have the right amountof stock and plans to address. Thanked Salisbury and Portsmouth for their helpfollowing the New York floods and the Trust’s shortage of blood materials.175/12 b) A discussion followed covering:Partnership working which is identified as none in the paper. The front covershould reflect the informal arrangements as demonstrated in this paper Need to consider the unknown unknowns and ensure that as issues emergeplans are put in placeOutcomes of the Winchester hospital fire in the MRI unit are underconsideration.175/12 c) After discussion Trust Board: Noted the report.176/12a)Operational PerformanceMonitor and Operational Performance Report for Month 7 (agenda item 7.1. Enclosure9)JH introduced the report which provides a summary of the Trust’s performanceagainst the access times and operational performance targets as agreed by TrustBoard. JH flagged the good performance in Q2 and noted that for the first time theTrust had met some long waits targets which indicates that the back log is reducing.Biggest area of concern is performance in ED which is currently just achieving thetarget.5

176/12 b) A discussion followed covering: C.Diff target identified in Annual Plan as a risk in Q3. JH reported that the trustis still working hard to deliver within target No guarantee that will achieve ED target in Q3. Working as hard as possiblebut extremely challenging and finding it hard to gain support from partners torelease beds in the hospital Waits – JH stated that she is seeking to implement plans and reduce waits andis working with commissioners to achieve this. Aiming for an average of 14week wait. Plans to be considered by Strategy and Finance Committee Definition of re-attendance and whether this is appropriate. Noted that mainarea of re-attendance is in Eye Casualty.176/12 c) After discussion Trust Board: Noted this report, in particular 18 week incompletes future performance, Strokeperformance and Emergency Department performance Considered that there is appropriate assurance regarding current and futureperformance Noted performance risks across each quarter in 2012/13 Did not request any further plans to mitigate these risks Considered performance for Quarter 1 and Quarter 2 13/14 to support themonitor submission Requested that Strategy and Finance Committee consider plans to reducewaits.177/12a)Key Performance Indicators for Month 7(agenda item 7.2. Enclosure 10)JH noted that this is the second such report and includes new KPIs requested bythe October Board. The report provides a summary of the Trust’s performanceagainst a range of high level internal key performance indicators agreed by theTrust Board. JH noted that performance has improved and that a key concern isworkforce and staff experience re sickness and staff turnover.177/12 b) A discussion followed covering:JG noted the need to understand staff sickness and any potential actions by theTrust which could be undertaken to address. Will be considering exit interviewdata. To be scrutinised by Audit and Assurance CommitteeNumber of staff increasing which is reflective of issues discussed earlier in theBoard and impact on patient safety R&D performance improved but recruitment to studies remains a concern.Some risk that will not achieve the year end targets. IC noted that some currentstudies require a smaller cohort therefore need to identify more studies tomaintain the number of participants. Will not impact upon application forAcademic Health Science NetworkEconomic situation and impact upon research funding and projects. MM notedthat charitably funded studies have dropped slightly but bio-medicine fundingremains relatively constant.177/12 c) After discussion Trust Board: Requested deep dive in Audit and Assurance Committee re staff sickness andturnover Noted the Key Performance Indicators Report Considered that there is appropriate assurance regarding current and futureperformance.JH/NMJG6

178/12178/12 a)Executive Updates (Oral Reports on emerging issues and ‘hot-spots’) (agendaitem 7.3)Operational PerformanceApprenticeships: The Trust has been named as one of top 100 companies by TheGuardian along with some big commercial companies.HSJ Awards: The Trust has won an award re research and its embedding in theculture of the organisation. Also significant recognition of how the Trust isdeveloping nursing research.RSH Ward for Medicine for Older People: Models for doctor led servicesuperseded due to lack of recruitment by a proposal for a nurse led orthopaedicrehab model. Failed to recruit and the Trust is now creating capacity on SGH siteand seeking a site where it could have rehab along with appropriate staffing.178/12 b) QualityPaul Grundy – clinical leader of the year: Awarded by HSJ. The Trust was alsoshortlisted for five further HSJ Awards. In addition the CommunicationsDepartment has been nominated for seven awards.AHSN: MH is discussing this and the application will be assessed early next year.178/12 c) StrategyNHS Global: This is DH support for trusts to develop international business. Theorganisation is having discussions with many governments and is seeking todevelop trade networks with commercial FTs and international business partners.Currently the focus is mainly around training and includes a thrust to developnetworks. Board noted the opportunities for links with the university.179/12179/12 a)Any Other BusinessThere were no items of any other business.179/12 b) The Chair asked whether there were any comments/questions from the public.There were none.180/12 Date and Time of Next MeetingTuesday, 18 th December 2012 commencing at 9.00am in the Dean’s CommitteeRoom, SAB, SGH7

UNIVERSITY HOSPITAL SOUTHAMPTON NHS FOUNDATION TRUSTFinance ReportReport to: Trust Board - 18 th December 2012Report from:SponsoringExecutive:Purpose of Report:Review History toDate:Andy Wood, Deputy Finance DirectorAlastair Matthews, Finance Director and Deputy CEOTo update Trust Board on the financial, activity and savings performance of the Trustfor November 2012.The Trust Board has previously agreed the income and expenditure budgets for2012/2013 with a full year plan pre-impairment surplus of £6m.RecommendationThe Board are asked to note:(1) In November the Trust has delivered a pre-impairment surplus of £926k, £6kbetter than Plan although the cumulative position is a surplus of £3,278kwhich is £196k worse than Plan.(2) Cost Improvement Programmes (CIPs) delivered were cumulatively £1.0mbelow Plan, which is phased based on a historic delivery profile. Thisrepresents a £0.1m deterioration in November. The target is fully identified at30 th November although a significant element remains classified as amber.(3) Divisions and headquarters overspent against expenditure budgets by£1.8m, exacerbated by a £0.9m overspending on reserves and corporatebudgets. This was largely offset by activity above plan with income estimatedto be £2.5m above plan in the month.(4) The November position is based on a number of specific assumptions onincome.SummaryThe Trust delivered a pre-impairment surplus of £0.9m in November, which was inline with Plan. EBITDA was £3.3m compared to a Plan of £3.6m. Cumulativelypreimpairment surplus is below Plan by £0.2m.Cumulative NHS Clinical Income at month 8 is estimated to be £3.4m above plan.A phased budget is used to reflect expected actual activity more accurately thanusing a straight line, unphased approach. The budgets for Southampton City andHampshire were adjusted with budget brought forward to the first quarter of thefinancial year, to reflect the expectation that significant activity management forthese PCTs would not be achieved during the first quarter.Actual income reported at month 8 consists of cumulative activity to month 7 asreported in SLAM plus an estimate for month 8 which extrapolates the first 7 months'income and then applies the appropriate phasing as a proxy for actual activity inmonth. Additional income has been anticipated for clinical activity which started inMonth 7 and would therefore not be recognised in this extrapolation, as well as earlydata indicating that spells are likely to be higher than usual.Provisions have been made for likely impacts from fines for 30 day readmissionsand 18 week breaches, a technical adjustment regarding the method for calculatingMRET, and provisions for the risk of partial non-achievement of C Diff and CQUIN.1

Non - NHS clinical income was £0.1m better than Plan and is cumulatively £0.5mabove Plan. Notably private patient income continues to improve and is £0.2mbehind plan cumulatively.There is an in month positive variance of £0.6m on other operating income andcumulatively this income is £4.9m over plan. Of this, £1.7m relates to R&D (mirroredby increased spend) and £1.2m is additional capital works recharged to theUniversity. The balance relates to Divisional sundry income.Divisions and Trust Headquarters were £12.0m overspent against expenditurebudgets cumulatively, offset by underspends on corporate and reserve budgets togive a £9.7m adverse variance overall. The former number includes £5m which isthe impact of adding back the positive variance on divisional income, to give a trueexpenditure variance.Savings required for the year (CIPs) total £23.2m. In November, savings of £2.2mwere delivered (£2.1m in October), leading to a cumulative adverse variance againstPlan of £1.0m.The period end cash balance at £16.3m was £6.9m below plan due mainly toincreased working capital balances(£4.1m) higher net capital expenditure (£2.2m)and lower cash generated from earnings (£0.9m) partly offset by lower financingcosts (£0.3m).Key Messages forNovember:The year end cash forecast at £15.7m is £4.7m lower than plan due mainly to highernon cash income within the Trust planned surplus and less external income tosupport the capital programme.Delivery of the Trust’s financial targets in 2012/2013 will principally be determined byperformance in four areas:a) Divisional and Headquarter Directorates controlling expenditure to within theirbudgetary targetsb) Delivery of in-year financial savings of at least £23.2m plus activitymanagement savings of a further £5.1m. Activity Management cost savings arephased into the corporate budget from 1 st July 2012.c) Delivery of activity levels in line with budgets and the Capacity Plan.d) Development of a contingency reserve to offset any unexpected variations onthe above, and to manage the risks associated with Activity Managementand other unforeseen risks emerging.This report provides an update on these four areas.a) Controlling of expenditure to within the agreed ‘runrate’ budget targetsIn overall terms the Trust was cumulatively above Plan on operating expenditure by£9.7m at the end of October. Divisions and Trust Headquarters were £12.0moverspent against expenditure budgets cumulatively, offset by underspends oncorporate and reserve budgets to give a £9.7m adverse variance overall. The formernumber includes £5m which is the impact of adding back the positive variance ondivisional income, to give a true expenditure variance. Total revenue at 31 stNovember was £8.8m above Plan, largely offsetting the £9.7m overspend onoperating expenditure.As previously noted a number of reserves are now phased in fixed twelfths. Thecumulative underspend on reserves at month 8 was £2.9m. The reserves that havebeen phased in twelfths include NESC, the capacity reserve, nonpay and druginflation, IT and consultant increments.2

Worked wtes rose by 105 in November to 7,654. Within this, agency usage rose by24 wte and overtime / excess hours increased by 14 wte. The hospital has beenunder significant capacity pressures for much of November and in addition to theimpact on performance targets, the agency spend was £2.0m in month, up £0.3m onthe year to date average and a cause for concern.Division ADivision A over spent by £0.2m in November which is also £0.2m greater thanforecast (£9.9m total expenditure for the month). Mid-month concerns with meetingthe Emergency Department (ED) access targets, led to Critical Care Unit nursingshifts being fully filled for the weekend with high cost agency, to ensure that patientswere not held up in ED. This meant the Critical Care Care Group missed its financialforecast by £120k. Agency spend in Critical Care doubled from last month to £0.3mfor November and because extra capacity was open clinical supplies expenditurewas also greater than forecast.Spend for the Division as a whole is £211k more than last month. An increase in runrate was not forecast for November and is largely attributable to the change inapproach in Critical Care.At the end of November Division A was £2.4m over spent largely due to the CancerCare Care Group (£2.2m) and specifically Drugs (£1.7m). Year to date slippageagainst the CIP target is £0.7m. On a positive note, debtors, which were £2.3m inMay and as such have been subject to much control action, have this month fallenbelow the £1m threshold for the first time.Division A has generated £60m of clinical income after the first 7 months of thisfinancial year (latest data available) and is above plan. Whilst Cancer Care isoverspending it is also over performing, in income terms, against its production plantarget (£1.5m over ytd).At the end of November the Division has identified 91% of its £4.1m CIP target. TheDivision has actioned 128 schemes so far this financial year with a total value of£2.7m, this represents 66% of the total CIP Target.The Division is currently forecasting to spend £115m in FY2012/13; this will bereviewed in light of the change in Critical Care capacity provision.Division BIn November Division B spent £6.9m which is £0.2m more than October and £0.1mmore than that forecast. The main reason for the adverse position is MSSEexpenditure within the respiratory centre on high cost ventilators, endoscopyconsumables and medical equipment maintenance.There is an in month overspend of £0.5m against the Divisional budget due to CIPshortfall of £0.1m, £0.2m agency nursing net of vacancies, £0.1m MSSE and £0.1mdrugs. The main concerns going forward are the agency use both in nursing anddoctors required to close the vacancy gap and cover winter pressures, plus theability to keep pace with the expected CIP delivery which increases to £0.7m permonth in Q4.At present the Division is continuing to focus on overseas recruitment and limiting itsturnover rate. Achievement against CIP depends on the length of stay scheme inEmergency Care which to month 7 is reporting activity over plan of £1.3m (4.5%). Intotal the Division is over-performing against production plan by some £2.1m (3.5%)which includes high cost drugs.3

Division CDivision C was favourable in November by £97k (the cumulative position is £379kadverse) and spent £8.5m in month which was the same as October and as perforecast levels.CIP shortfalls, staffing pressures in Women & Newborn and pressures on staffing, xray film & clinical supplies within Neonates and Theatres were offset by supportservices underspends and lower non pay & higher income on car parking.The Divisional pay bill has increased since last month by £108k. This is due tovacancies being filled in Clinical Support and Non Clinical Support and higherDietetics agency covering vacancies. The total actual wte has increased by 41wte,30wte within Support Services on Therapies & Non Clinical support and the balancein Child Health.The main financial problem facing the Division is slippage against identified schemesplus unidentified CIPs with 10% (£571k) of the Divisional target still to identify.The latest activity figures show an over-performance of approx £1.2m (2.02%).Division DDivision D is £2.7m adverse at month 8, which is an adverse movement of £512k inthe month.The main issues in the month were unfound CIP in Cardiac, Medical staff spend inT&O, Nursing spend in T&O due to “specialing” of a patient , Stroke Unituncommissioned beds, Sub Contracting in T&O & Cardiac, high non pay costs forInterventional Radiology & CSI and low PP Income. This has in part been offset by ablood rebate.The Division spent £10,608k in November with agency expenditure at £447k.Headcount was 1,657 wte. (up 25 on the previous month). Latest activity figuresindicate the Division is £2m behind Plan, mostly in T&O due to combined Traumaand Winter related pressures.THQTHQ budgets overspent by £99k in November and are cumulatively £9k overspent.Clinical Governance (including training & development) overspent by £143k as theresult of returning budget for flexible SpRs to reserves following a reduction in NESCfunding in line with falling expenditure. CEO overspent by £101k including £73k inthe PSC. Estates overspent by £69k due to slippage on CIP delivery andengineering maintenance.Other Services underspent by £159k thanks to favourable movements on Thornburyagency bills, the EU emissions scheme and finance leases.Other THQ Directorates were close to break-even.4

) Delivering an in-year financial saving of £23.2mAt the end of November savings of £12.8m had been delivered, compared to theTrust Plan of £13.8m.Month YTDVariance due to: Actual Plan Variance Actual Plan Variance£m £m £m £m £m £mTrust profile 2.2 2.3 (0.1) 12.8 13.1 (0.3)Unidentified 0 0.0 (0.0) 0 0.7 (0.7)Total 2.2 2.3 (0.1) 12.8 13.8 (1.0)At 30 th November 55% (£12.8m) of CIP schemes had been delivered. Thiscompares to 54% (£14.9m) at 30 th November 2011. At 30 th November 103% of thefull year plan had been identified, with 98% of identified schemes rated either greenor amber.Key issues to note are:(i) £6.3m of the identified £24.0m schemes are non recurrent, albeit the FYE ofthose schemes identified is £5.4m(ii) £3.9m of the identified schemes are amber and £0.4m red rated.Schedule 7 shows the analysis of plans by Divisions, Headquarters Directorates andcentral schemes and Schedules 8a and 8b show the detail of the overall savingsprogramme.c) Achieving the agreed volumes of activity to deliver the income planCumulative NHS Clinical Income at month 8 is estimated to be £3.4m above plan.A phased budget is used to reflect expected actual activity more accurately thanusing a straight line, unphased approach. The budgets for Southampton City andHampshire were adjusted with budget brought forward to the first quarter of thefinancial year, to reflect the expectation that significant activity management forthese PCTs would not be achieved during the first quarter.Actual income reported at month 8 consists of cumulative activity to month 7 asreported in SLAM plus an estimate for month 8 which extrapolates the first 7 months'income and then applies the appropriate phasing as a proxy for actual activity inmonth. Additional income has been anticipated for clinical activity which started inMonth 7 and would therefore not be recognised in this extrapolation, as well as earlydata indicating that spells are likely to be higher than usual.Provisions have been made for likely impacts from fines for 30 day readmissionsand 18 week breaches, a technical adjustment regarding the method for calculatingMRET, and provision for the risk of partial non-achievement of C Diff and CQUIN.Non - NHS clinical income was £0.1m better than Plan and is cumulatively £0.5mabove Plan. Notably private patient income continues to improve and is £0.2mbehind plan cumulatively.There is an in month positive variance of £0.6m on other operating income andcumulatively this income is £4.9m over plan. Of this, £1.7m relates to R&D (mirroredby increased spend) and £1.2m is additional capital works recharged to theUniversity. The balance relates to Divisional sundry income.d) Creation of a contingency to cover unexpected variations on the aboveThe approach for 2012/13, as in previous years, is based on identifying contingencyreserves to cover the likely risk from variations in costs against Plan, and additionalworkload due to unsuccessful activity management. If risks are successfully5

managed out, these reserves will become available to put into the central “bank” towhich bids for funding to improve services, quality and the hospital environment, canbe made.Cash & LiquidityThe period end cash balance at £16.3m was £6.9m below plan due mainly toincreased working capital balances(£4.1m) higher net capital expenditure (£2.2m)and lower cash generated from earnings (£0.9m) partly offset by lower financingcosts (£0.3m).The year end cash forecast at £15.7m is £4.7m lower than plan due mainly to highernon cash income within the Trust planned surplus and less external income tosupport the capital programme.With a working capital facility in place of £43m, the current financial position resultsin a liquidity rating of 3 and an overall Monitor risk rating of 3 (Schedule 1 and Annex5). This is forecast to remain a 3 at the year end.Schedule 1 also shows some key balance sheet indicators.Annex 4 shows cumulative capital expenditure compared to Plan. £12.7m has beenspent to date, £1.1m less than the updated Plan. £1.9m of new finance leases havebeen taken out in the first eight months of the year, compared to a Plan of £3.9m.ForecastA review of the year end Forecast was carried out in the light of October’s results.Whilst the forecast remains in line with Plan there was a level of control actionrequired to ensure the Trust delivers the planned surplus for the year. There will be afurther review of progress following the production of the November.RisksIdentifiedDescriptionPotentialValue £mLikelihoodWeightedvalue £mMitigationRisksOveralldemandlevelsThe Trust isanticipating incomein excess ofcontracted levels,based on capacityin place to deliveranticipated demandand experience ofdrug growth£15m L -10%£1.5m Ensure that paymentsfor overperformanceare secured. If activitydoes not occur ensurethat capacity andcosts are reducedaccordingly.CIPsNon-delivery ofCIPs£5m M –50%£2.5m Strong performancemanagementActivityManagementCost reductionrequired inresponse tosuccessful ActivityManagement.(NB: This risk andthe risks regarding“overall demandlevels” abovecannot becompounded).£5m L –10%£0.5m Ensure fullengagement in ActivityManagement; ensurecosts which can beremoved are removed.DivisionaloverspendingRisks ofoverspending dueto operationalpressures, capacityissues etc£10m M-50%£5.0m Strong performancemanagement.6

FINANCE REPORTSchedule 1 2012/13 Month: 8KEY METRICSCurrent Cumulative Year End ForecastPlan Actual Variance Plan Actual Variance Plan Forecast Variance£000's £000's £000's £000's £000's £000's £000's £000's £000's1) INCOME & EXPENDITURERevenue 46,625 49,129 (2,504) 369,166 377,955 (8,789) 554,441 574,056 (19,615)EBITDA (3,558) (3,337) 221 (23,124) (22,245) 879 (36,523) (36,030) 493Pre-impairment (surplus)/loss (919) (926) (6) (3,474) (3,278) 196 (6,000) (6,000) 02) STAFF COSTS and WTEEmployee benefits expenses 27,653 28,635 982 222,610 221,944 (666) 333,026 335,341 2,315Paybill (wte) 7,654Locum and agency spend 1,308 1,956 648 10,464 13,739 3,2753) CIPsCIP Delivered vs Trust Target 2,254 2,190 64 13,802 12,794 1,008 23,236 23,236 0% Identified 103%% Green rated 82%% Amber rated 16%% Red rated 2%4) CASHFLOWOpening Cash balance 21,511 20,680 831 29,540 29,540 0 29,540 29,540 0Income from operations 3,558 3,337 221 23,124 22,245 879 36,522 36,185 337Working Capital movement 15 (4,896) 4,911 (12,288) (16,412) 4,124 (14,574) (15,353) 779Capex (1,413) (2,580) 1,167 (13,154) (15,406) 2,252 (18,806) (23,005) 4,199Other (488) (261) (226) (4,039) (3,687) (352) (12,259) (11,665) (594)Closing Cash balance 23,183 16,280 6,903 23,183 16,280 6,903 20,423 15,702 4,7215) STATEMENT OF FINANCIAL POSITIONStock days 38 40 -2 36 36 0NHS trade debtor days 5 2 3 5 4 1Non NHS trade debtor days 11 11 0 10 9 1Trade creditor days 25 22 3 27 23 46) RISK RATING Plan Actual Plan ActualRiskRatingno. Plan ForecastRiskRatingno.EBITDA margin 7.4% 6.5% 6.0% 5.7% 3 6.3% 6.0% 3EBITDA % achieved 93.6% 98.0% 4 98.7% 4Return after financing 3.9% 3.9% 1.8% 1.7% 3 2.1% 2.1% 4I&E Surplus margin 2.0% 1.9% 0.9% 0.9% 2 1.1% 1.0% 3Liquid ratio 23 18.7 3 23 19.2 3Overall score 3 3

Schedule 2INCOME STATEMENT( ) Denotes Favourable Variance1st April 2012 to March 31st 2013 2012/13 Month: 8Annual Current Quarter CumulativeBudget Plan Actual Variance Plan Actual Variance Plan Actual Variance£000's £000's £000's £000's £000's £000's £000's £000's £000's £000'sIncomeNHS Clinical Revenue 442,455 37,292 39,058 (1,765) 74,367 76,705 (2,338) 294,509 297,946 (3,437)Non NHS Clinical Revenue 7,651 638 737 (100) 1,275 1,607 (332) 5,101 5,590 (489)Other Operating Income 104,335 8,695 9,334 (639) 17,389 19,044 (1,656) 69,557 74,420 (4,863)Total Revenue 554,441 46,625 49,129 (2,504) 93,031 97,356 (4,326) 369,166 377,955 (8,789)Operating ExpensesEmployee Benefits Expense 333,026 27,653 28,635 982 55,305 56,931 1,626 222,610 221,944 (666)Drug Costs 41,543 3,442 4,322 880 6,884 8,538 1,655 27,803 32,128 4,325Clinical Supplies 56,905 4,779 5,365 585 9,558 10,459 901 37,869 40,201 2,331Non-Clinical Supplies 13,196 1,083 1,230 146 2,167 2,445 279 8,888 9,782 894Other Costs 73,249 6,110 6,241 131 12,220 12,638 418 48,872 51,655 2,783Total Operating Expenses 517,918 43,067 45,792 2,725 86,134 91,012 4,878 346,042 355,710 9,668(Profit)/Loss from Operations (EBITDA) (36,523) (3,558) (3,337) 221 (6,896) (6,345) 552 (23,124) (22,245) 879Non Operating Income (70) (5) (11) (6) (11) (23) (12) (44) (74) (29)Non Operating Expenditure 30,593 2,644 2,422 (222) 5,262 4,939 (323) 19,694 19,041 (653)(Net Surplus) / Deficit excl Impairments (6,000) (919) (926) (6) (1,646) (1,429) 217 (3,474) (3,278) 196Impairments 2,400 0 34 34 0 21 21 0 225 225(Net Surplus) / Deficit post Impairments (3,600) (919) (891) 28 (1,646) (1,408) 238 (3,474) (3,052) 422

Schedule 2bINCOME & EXPENDITURE FORECAST1st April 2012 to March 31st 2013 2012/13 8Current forecastPlan Forecast Variance£000's £000's £000'sOperating IncomeNHS Clinical Revenue 442,455 452,467 (10,012)Non NHS Clinical Revenue 7,651 8,460 (809)Other Operating Income 104,335 113,129 (8,794)Total Revenue 554,441 574,056 (19,615)Operating ExpensesEmployee Benefits Expense 333,026 335,341 2,315Drug Costs 41,543 48,076 6,533Clinical Supplies 56,905 59,241 2,336Non-Clinical Supplies 13,196 14,617 1,421Other Costs 73,249 80,751 7,502Total Operating Expenses 517,918 538,026 20,108Profit /Loss from Operations (36,523) (36,030) 493Non-Operating income (70) (86) (16)Non-Operating Expenditure 30,593 30,116 (477)(Net Surplus) / Deficit excl Impairments (6,000) (6,000) (0)Impairments 2,400 5,640 3,240(Net Surplus) / Deficit post Impairments (3,600) (360) 3,240

LTFM PlanActual1234567891011121314151617181920212223242526272829303132333435363738394041424344454647484950515253545556575859606162636465666768697071727374757677A B C D E F G H I J K L M N O P Q R S2000150010005000-500-1000-1500Schedule 3GRAPHS 2012/13 Month: 87700760075007400730072007100700025000200001500010000500001.Pre-impairment Income and ExpenditureIn Month - surplus (deficit)A M J J A S O N D J F M3.Workforce WTEA M J J A S O N D J F MApr-12Excludes Agency, overtime and excess hoursActualProfile as per TrustPlanMay-125.Cost Improvement ProgrammesProfiled Savings Programme 2012/2013Jun-12Jul-12Aug-12Sep-12Oct-12Nov-12Dec-12Jan-13ActualFeb-13ActualLTFM PlanMar-1370006000500040003000200010000-1000-200035030025020015010050350003000025000200001500010000500002.Pre-impairment Income and ExpenditureCumulative - surplus (deficit)A M J J A S O N D J F M4.Agency and Overtime WTE( overtime Includes excess hours )M A M J J A S O N D J F MNew graph - cash vs forecast 6.CashflowM A M J J A S O N D J F MActualLTFMPlanagency Actualovertime Actual

Schedule 4Central and Divisional Revenue PerformanceApril 1st 2012 to March 31st 20132012/13 Month: 8Current Quarter CumulativeAnnual Current Current Current Quarter Quarter Quarter Budget Actual VarianceBudget Month Month Month To Date To Date To DateBudget Actual Variance Budget Actual VarianceNHS Clinical Revenue £000's £000's £000's £000's £000's £000's £000's £000's £000's £000'sNHS Hampshire (134,468) (11,263) (12,069) (806) (22,460) (23,440) (980) (89,791) (93,088) (3,297)NHS Southampton City (117,481) (9,841) (10,900) (1,059) (19,622) (20,897) (1,275) (78,448) (82,765) (4,317)Isle of Wight PCT (7,071) (599) (572) 27 (1,194) (1,097) 97 (4,695) (4,969) (274)Portsmouth PCT (3,186) (270) (307) (37) (559) (545) 14 (2,115) (2,308) (193)South Central Specialised (99,678) (8,379) (9,473) (1,094) (16,708) (17,363) (655) (66,441) (66,931) (490)Thames Valley Specialised (4,552) (386) (302) 84 (769) (528) 241 (3,023) (2,581) 442Other (299) (25) 21 46 (51) (27) 24 (199) (304) (105)Total South Central SLAs (366,735) (30,762) (33,602) (2,840) (61,362) (63,897) (2,535) (244,712) (252,946) (8,234)NHS Dorset (4,392) (372) (163) 209 (742) (652) 90 (2,916) (3,057) (141)NHS Bournemouth & Poole (1,687) (143) (16) 127 (285) (97) 188 (1,120) (1,451) (331)NHS Wiltshire (5,407) (458) (454) 4 (999) (1,049) (50) (3,590) (4,360) (770)Other. (29,217) (2,475) (3,282) (807) (4,849) (5,604) (755) (19,400) (20,846) (1,446)Total South West SLAs (40,703) (3,448) (3,915) (467) (6,875) (7,402) (527) (27,026) (29,714) (2,688)SACS & Surrey (3,270) (277) (205) 72 (552) (475) 77 (2,172) (2,276) (104)Channel Islands (8,743) (741) (950) (209) (1,477) (1,434) 43 (5,805) (6,378) (573)London Specialised Commissioning (BMT) (399) (34) (50) (16) (67) (44) 23 (265) (167) 98South East Specialised Commissioning (9,404) (797) (756) 41 (1,588) (1,493) 95 (6,244) (5,445) 799Milton Keynes Specialised Commissioning (72) (6) 83 89 (12) 43 55 (48) (122) (74)Total other SLAs (21,888) (1,854) (1,878) (24) (3,697) (3,403) 294 (14,534) (14,388) 146TOTAL CONTRACTED INCOME (429,326) (36,064) (39,395) (3,331) (71,934) (74,702) (2,768) (286,272) (297,048) (10,776)Non Contracted Activity (NCAs) (5,342) (452) (752) (300) (902) (1,015) (113) (3,547) (4,375) (828)Phasing and other adjustments 1,004 26 75 49 893 (1,123) (2,016) 894 3,687 2,793Total SLA & NCA Income (433,664) (36,490) (40,072) (3,582) (71,943) (76,840) (4,897) (288,925) (297,736) (8,811)Anticipated & Additional Clinical / Off Tariff Income (10,152) (802) 1,014 1,816 (2,424) 135 2,559 (6,944) (1,038) 5,906Old Year Transactions 1,361 0 0 0 0 (0) (0) 1,361 828 (533)Total Misc Commission Income (8,791) (802) 1,014 1,816 (2,424) 135 2,559 (5,583) (210) 5,373TOTAL NHS CLINICAL REVENUE (442,455) (37,292) (39,058) (1,765) (74,367) (76,705) (2,338) (294,509) (297,946) (3,437)Non NHS Clinical RevenuePrivate Patients (5,104) (425) (520) (95) (851) (1,003) (152) (3,403) (3,218) 185CRU (2,547) (212) (217) (5) (425) (604) (180) (1,698) (2,372) (674)0 0TOTAL NON NHS CLINICAL REVENUE (7,651) (638) (737) (100) (1,275) (1,607) (332) (5,101) (5,590) (489)Other Operating IncomeOverseas Visitors (285) (24) (29) (5) (48) (84) (36) (190) (270) (80)Research & Development. (26,347) (2,196) (2,275) (79) (4,391) (4,976) (585) (17,565) (19,248) (1,683)Education Income (40,704) (3,392) (3,303) 89 (6,784) (6,663) 120 (27,136) (26,347) 789Clinical Excellence Awards (3,821) (324) (318) 5 (647) (637) 11 (2,526) (2,547) (21)Misc. Other Operating Income (see annex 2) (33,178) (2,760) (3,408) (649) (5,519) (6,685) (1,166) (22,140) (26,008) (3,868)TOTAL OTHER OPERATING INCOME (104,335) (8,695) (9,334) (639) (17,389) (19,044) (1,656) (69,557) (74,420) (4,863)TOTAL REVENUE (554,441) (46,625) (49,129) (2,504) (93,031) (97,356) (4,326) (369,166) (377,955) (8,789)

Schedule 5OPERATING EXPENSES2012/13 Month: 8Current Quarter CumulativeAnnual DESCRIPTION Month Month Month Budget Actual Variance Budget Actual VarianceBudget Budget Actual Variance To Date To Date To Date£000's £000's £000's £000's £000's £000's £000's £000's £000's £000'sEMPLOYEE BENEFITS EXPENSE109,736 Medical and dental. 8,461 9,100 639 17,190 18,193 1,004 71,382 70,993 (389)41,766 Administration 3,722 3,516 (206) 7,020 7,065 44 27,746 27,785 402,096 Estates 177 183 6 354 327 (27) 1,388 1,268 (120)28,717 Healthcare assistants and other support staff. 2,411 2,193 (218) 4,797 4,454 (344) 19,196 17,402 (1,793)105,618 Nursing, midwifery and health visiting staff. 9,660 8,958 (701) 17,654 17,763 109 70,122 69,828 (294)0 Nursing, midwifery and health visiting learners. 0 (0) 0 (0) 0 1 143,225 Scientific, therapeutic and technical staff. 3,792 3,401 (392) 7,090 6,716 (374) 28,742 26,306 (2,437)116 Non-Executive Directors. 10 10 1 16 20 5 78 77 (0)4,000 Locum Medical costs / Agency Medics 333 402 69 667 853 186 2,667 3,389 7238,696 Agency Nursing 725 1,184 459 1,449 2,159 709 5,797 7,493 1,6953,000 Agency Other 250 371 121 500 754 254 2,000 2,857 857NHS Professionals Spend Included within Agency 462 716 2,838(2,719) Vacancy Factor. (266) 266 (500) 500 (1,860) 1,860(3,433) Pay Savings. (71) 71 (382) 382 (1,223) 1,223(5,524) Staff Recharges. (1,578) (683) 895 (600) (1,372) (772) (3,676) (5,457) (1,781)81 Activity Management. 9 (9) 19 (19) 67 (67)(2,349) Other Employee Benefits Expense 17 (17) 32 0 (31) 185 2 (183)333,026 TOTAL EMPLOYEE BENEFITS EXPENSE 27,653 28,635 982 55,305 56,931 1,626 222,610 221,944 (666)NON-PAY EXPENDITURERaw Materials and consumables used41,543 Drug Costs. 3,442 4,322 880 6,884 8,538 1,655 27,803 32,128 4,32556,905 Clinical Supplies 4,779 5,365 585 9,558 10,459 901 37,869 40,201 2,331Decrease (increase) in inventories of finished goods & WI13,196 Non-Clinical Supplies 1,083 1,230 146 2,167 2,445 279 8,888 9,782 894111,644 Total Raw Materials and consumables used 9,304 10,916 1,612 18,608 21,443 2,834 74,560 82,110 7,5511,444 Cost of Secondary Commissioning of mandatory services 167 328 161 272 485 213 886 1,846 96013,976 Research & development expense (915) 1,099 2,014 628 2,569 1,942 9,318 9,565 2471,160 Training and Development expense 93 187 94 181 246 65 788 924 135(25) Activity Management (3) 3 (6) 6 (13) 1356,694 Misc. Other Operating expenses (see below) 6,769 4,627 (2,142) 11,146 9,338 (1,808) 37,892 39,321 1,428PFI Operating Expenses184,892 TOTAL NON-PAY EXPENDITURE 15,414 17,157 1,743 30,829 34,081 3,252 123,432 133,766 10,334517,918 TOTAL OPERATING EXPENSES 43,067 45,792 2,725 86,134 91,012 4,878 346,042 355,710 9,6686,017 Services from other NHS Trusts. 544 586 41 1,059 1,167 107 4,045 4,291 2476,980 Services from other NHS Bodies. 582 98 (484) 1,175 542 (633) 4,653 4,010 (643)1,915 Services from Foundation Trusts. 149 469 320 313 708 395 1,284 2,029 7453,521 Establishment. 274 316 41 607 698 91 2,367 2,581 2141,584 Transport. 89 104 15 172 194 22 1,226 1,403 17823,410 Premises. 2,075 1,418 (656) 3,887 2,780 (1,107) 15,153 12,179 (2,974)275 Bad debts. 23 32 9 46 95 49 183 315 132226 Audit fees & other auditors renumeration. 19 48 29 38 34 (4) 151 117 (34)9,082 Clinical negligence. 757 757 1,514 1,514 6,055 6,055 0(2,463) Non Pay Savings (331) 331 (267) 267 (508) 508Non Po Accrual (3) (3) (7) (7) 63 6337 General Reserves 3 2 (1) 8 3 (4) 26 10 (17)432 Consultancy 27 32 4 34 65 31 274 170 (104)5,679 Other Operating Expenses 2,558 770 (1,788) 2,561 1,546 (1,015) 2,984 6,098 3,11356,694 TOTAL MISC. OTHER OPERATING EXPENSES 6,769 4,627 (2,142) 11,146 9,338 (1,808) 37,892 39,321 1,428The premises line above includes a share of the reserves budget totalling £488k Fav in month and £3050k Fav to date which is materially effecting the reported underspends.

Schedule 6DIVISIONAL/HEADQUARTERS PERFORMANCE 2012/13 Month: 8Net Expenditure PerformanceForecastWorkforceOpening Issues From Current CumulativeDivisional Forecast Forecast ForecastAnnual Reserves Annual Period Plan Actual Variance Income Budget Actual Variance Total Memo:Plan & Virements Budget Variance £000's £000's £000's position on Worked Agency Excess & Actual Last£000's £000's £000's £000's Adv. O Drive £000's £000's £000's WTE WTE OT WTE WTE MonthAdv. (Fav.) Variance ytd ActualDivisions (Fav.) wteSurgery 22,762 1,717 24,479 113 16,126 16,723 597 1,132 24,854 25,624 770 372 37 2 410 408Cancer Care 30,633 1,315 31,948 280 21,122 23,346 2,223 (1,501) 31,739 35,062 3,323 353 14 5 371 365Critical Care 49,294 2,594 51,888 234 34,544 34,879 335 (125) 52,408 53,034 626 847 33 25 906 894Division A Management 1,122 (36) 1,086 (425) 1,299 587 (711) 1,086 931 (155) 24 1 25 22Sub Total Division A 103,811 5,590 109,401 203 73,091 75,534 2,443 (493) 110,087 114,651 4,564 1,595 84 33 1,712 1,689Specialist Medicine 36,053 (111) 35,942 269 24,344 24,895 551 (774) 35,718 37,392 1,674 387 8 3 399 397Emergency Care 34,912 2,476 37,388 235 25,094 26,075 981 (1,331) 37,851 39,788 1,937 723 104 11 839 831Division B Management 1,024 150 1,174 (24) 864 776 (88) 1,157 1,157 22 22 22Sub Total Division B 71,989 2,515 74,504 480 50,302 51,746 1,444 (2,105) 74,726 78,337 3,611 1,133 112 15 1,259 1,249Women and Newborn 31,050 1,096 32,146 172 21,549 22,585 1,035 78 32,129 33,891 1,762 632 5 29 666 662Child Health 32,222 2,703 34,925 70 23,551 23,653 101 (749) 34,870 35,697 827 533 11 7 551 543Clinical Support 15,190 2,100 17,290 (141) 11,623 10,835 (788) (543) 17,511 16,620 (891) 484 32 516 498Non Clinical Support 16,522 (1,375) 15,147 (52) 10,252 10,314 62 15,192 15,203 11 180 27 207 197Division C Management 590 (146) 444 (146) 365 333 (32) 444 504 60 7 7 6Sub Total Division C 95,574 4,378 99,952 (97) 67,340 67,719 379 (1,214) 100,146 101,915 1,769 1,834 17 96 1,947 1,906Trauma & Orthopaedics 18,139 1,824 19,963 146 13,604 13,575 (29) 1,727 20,820 20,919 99 234 27 3 265 250Cardiothoracic 34,322 639 34,961 364 23,507 25,585 2,078 81 35,011 39,459 4,448 486 21 3 510 507Neurosciences 22,198 1,171 23,369 (11) 15,782 15,925 143 71 23,363 23,876 513 301 23 3 327 323Pathology 15,626 641 16,267 19 10,904 11,237 334 (18) 16,311 17,118 807 231 4 235 233Radiology 20,177 1,737 21,914 55 14,439 14,717 278 142 22,327 22,967 640 299 1 6 306 307Division D Management 1,030 431 1,461 (61) 989 924 (65) 1,453 1,232 (221) 13 1 14 12Sub Total Division D 111,492 6,444 117,936 512 79,224 81,963 2,739 2,003 119,285 125,571 6,286 1,565 72 20 1,657 1,632Miscellaneous AdjustmentsAct Man and Fin adjs not yet allocated to Divisions (3,093)TOTAL DIVISIONS 382,866 18,927 401,793 1,098 269,957 276,963 7,006 (4,902) 404,244 420,474 16,230 6,127 285 164 6,575 6,476HeadquartersStrategy (564) 2,086 1,522 15 1,001 809 (192) 1,579 1,329 (250) 24 24 25Finance 4,634 282 4,916 9 3,269 3,256 (13) 4,928 4,865 (63) 76 76 74Estates 14,926 885 15,811 69 10,553 10,317 (235) 15,811 15,362 (449) 108 6 3 117 114Clinical Governance 2,177 233 2,410 (65) 1,566 1,582 15 7,212 6,875 (337) 39 4 43 42Medical Director 509 (4) 505 1 340 360 20 515 544 29 6 6 6Training and Development 3,636 239 3,875 208 2,789 2,757 (32) within clinical governance 67 67 70Chief Executive Office 3,027 2,456 5,483 101 3,631 3,731 99 5,547 5,435 (112) 145 4 149 146Research & Development (4,287) (14) (4,301) (0) (2,867) (2,867) 0 (4,046) (4,046) 215 1 215 216Human Resources 2,991 106 3,097 4 2,092 1,959 (133) 3,133 2,985 (148) 110 5 116 111IM&T 5,187 223 5,410 (58) 3,660 3,646 (13) 5,410 5,488 78 147 5 152 153Other Services (6,988) (6,988) (159) (4,898) (4,263) 634 (6,985) (10,142) (3,157)CLRN (0) (0) (0) (0) 12 12 12SWPHO 0 (0) (0) 0 66 0 66 67OPA's 286 286 (24) 191 (0) (191) 286 4 (282)Clinical Neg/Employer Liab. 9,849 193 10,042 (2) 6,695 6,744 49 10,042 10,149 107 2 2 2Headquarters Total 35,383 6,685 42,068 99 28,021 28,031 9 43,432 38,848 (4,584) 1,018 6 22 1,045 1,040Division/Headquarters Income Removal as per annex 2 67,353 3,470 70,822 632 44,967 49,961 4,995Division/Headquarters Total 485,602 29,081 514,683 1,829 342,945 354,955 12,010 (4,902) 447,676 459,322 11,646 7,144 290 186 7,620 7,516Balance Sheet. (0) (1) (1)Capital Programme 885 (67) 818 (208) 563 (334) (896) 32 1 34 33Central Reserves 31,155 (24,728) 6,427 836 2,898 (2,898) 1,645 1,344 (301)Corporate Costs 168 (1,004) (836) 67 (576) (65) 511 33,873 35,691 1,818Corporate Income Removal 109 (3,284) (3,174) 201 212 1,154 942 (486,794) (496,717) (9,923)Total Operating Expenses 517,919 (1) 517,918 2,725 346,042 355,710 9,668 (4,902) (3,600) (360) 3,240 7,177 290 187 7,654 7,549

Schedule 7CIPS BEING WORKED ON 2012/13 Month: 8Identified CIP SplitScheme StatusPay Non-Pay Income Total CIP Variance Variance Pay % Non Pay % Income % Green Amber Red Unmarked ToCIP's CIP's CIP's CIP Target (Fav) / Adv%DivisionCare Group / Directorate ` No. £'000 No. £'000 No. £'000 No. £'000 No.Division ASurgery 766 229 64 1,059 1,039 (20) 102% 72% 22% 6% 48 894 7 165 55Cancer Care 537 225 407 1,169 1,342 173 87% 46% 19% 35% 41 950 9 197 2 22 52Critical Care & Theatres 993 299 167 1,459 1,684 225 87% 68% 20% 11% 52 1,102 15 357 67Division A Total 2,296 753 638 3,687 4,065 378 91% 62% 20% 17% 141 2,946 31 719 2 22 174Division BEmergency Care 1,365 455 4 1,824 1,968 144 93% 75% 25% 0% 13 483 5 1,341 18Specialist Med & Ophthalmology 530 279 998 1,807 1,993 186 91% 29% 15% 55% 28 1,529 18 246 2 32 48Pathology 207 540 364 1,111 1,092 (19) 102% 19% 49% 33% 34 1,054 4 27 1 30 39Radiology 340 617 156 1,113 1,341 228 83% 31% 55% 14% 24 1,002 11 110 1 1 36Division B Total 2,442 1,891 1,522 5,855 6,394 539 92% 42% 32% 26% 99 4,068 38 1,724 4 63 141Division CWomen & Newborn 656 327 477 1,460 1,897 437 77% 45% 22% 33% 49 1,136 18 224 6 100 73Child Health 948 186 376 1,510 1,779 269 85% 63% 12% 25% 59 1,431 5 48 2 31 66Clinical Support 869 101 458 1,428 1,155 (273) 124% 61% 7% 32% 54 1,264 7 104 2 60 63Non Clinical Support 171 276 376 823 961 138 86% 21% 34% 46% 25 687 4 74 2 62 31Division C Total 2,644 890 1,687 5,221 5,792 571 90% 51% 17% 32% 187 4,518 34 450 12 253 233Division DCardiothoracic 787 497 445 1,729 2,306 577 75% 46% 29% 26% 28 1,640 2 51 2 38 32Trauma & Orthopaedics 326 516 842 908 66 93% 39% 61% 15 833 1 9 16Neurosciences 460 316 826 1,602 1,445 (157) 111% 29% 20% 52% 17 1,540 2 61 1 1 20Division D Total 1,573 1,329 1,271 4,173 4,659 486 90% 38% 32% 30% 60 4,013 5 121 3 39 68Total Clinical Services 8,955 4,863 5,118 18,936 20,910 1,974 91% 47% 26% 27% 487 15,545 108 3,014 21 377 616Trust HeadquartersFinance 61 294 10 365 342 (23) 107% 17% 81% 3% 9 136 5 229 14Estates 735 175 910 753 (157) 121% 81% 19% 9 787 2 123 11Medical Director 100%Chief Operating Officer 128 15 13 156 156 100% 82% 10% 8% 8 155 1 1 9Human Resources 260 8 39 307 209 (98) 147% 85% 3% 13% 10 234 3 73 13IM&T 295 161 1 457 370 (87) 124% 65% 35% 0% 11 346 6 111 17Strategy 23 76 230 329 89 (240) 370% 7% 23% 70% 13 329 13Clinical Governance 79 235 25 339 339 100% 23% 69% 7% 13 279 2 60 15Chief Executive 45 9 54 68 14 79% 83% 17% 2 54 2Trust HQ Total 891 1,533 493 2,917 2,326 (591) 125% 31% 53% 17% 75 2,320 19 597 94Central Schemes 261 261 (261) 100% 100% 2 261 2A Other 1,899 1,899 (1,899) 100% 100% 7 1,899 7THQ Restructure 100%Total Other 2,160 2,160 (2,160) 100% 100% 7 1,899 2 261 9U.H.S. Trust Total 9,846 8,556 5,611 24,013 23,236 (777) 103% 41% 36% 23% 569 19,764 129 3,872 21 377 719=100%2% =100%

Schedule 7CIPS BEING WORKED OotalDivisionCare Group / DirectorateDivision ASurgeryCancer CareCritical Care & TheatresDivision A TotalDivision BEmergency CareSpecialist Med & OphthalmologyPathologyRadiologyDivision B TotalDivision CWomen & NewbornChild HealthClinical SupportNon Clinical SupportDivision C TotalDivision DCardiothoracicTrauma & OrthopaedicsNeurosciencesDivision D TotalTotal Clinical ServicesTrust HeadquartersFinanceEstatesMedical DirectorChief Operating OfficerHuman ResourcesIM&TStrategyClinical GovernanceChief ExecutiveTrust HQ TotalCentral SchemesOtherTHQ RestructureTotal OtherU.H.S. Trust Total£'0001,0591,1691,4593,6871,8241,8071,1111,1135,8551,4601,5101,4288235,2211,7298421,6024,17318,936365910156307457329339542,9172611,8992,16024,013

Schedule 8a 2012/13 Month: 8University Hospital Southampton NHS FT Savings Programme 2012/13CIP Delivery - Scheme Analysis2012/13 AWL Year to Date Split by: Full Year RollClosed Target Identified Identified Actual Variance Profile Actual Variance Rec Non Rec Total Effect ForwardAs at Period 08 - November Beds £'000 £'000 WTEs WTEs WTEs £'000 £'000 £'000 £'000 £'000 £'000 £'000 £'000IncIncCare Pathways 44 3,716 2,762 77.02 14.30 62.72 2,207 714 1,493 2,724 38 2,762 394 3,118IncInformation Technology 0 462 234 6.84 0.00 6.84 274 116 158 146 88 234 191 337IncWorkforce 0 5,346 6,563 133.48 54.46 79.02 3,176 4,235 (1,060) 3,807 2,756 6,563 736 4,543IncCarryforward 0 73 73 0.00 0.00 0.00 43 49 (5) 73 0 73 0 73IncNHS Patient Income 0 2,751 3,150 0.00 0.00 0.00 1,634 1,336 298 2,610 540 3,150 1,552 4,162IncNon-NHS Patient Income 0 1,744 1,499 0.00 0.00 0.00 1,036 882 154 940 559 1,499 162 1,102IncNon Patient Income 0 642 814 0.00 0.00 0.00 381 505 (124) 457 357 814 45 502IncProcurement - Drugs 0 765 508 0.00 0.00 0.00 454 141 313 508 0 508 2 510IncProcurement - Other 0 2,851 2,971 0.00 0.00 0.00 1,693 1,397 296 2,414 557 2,971 715 3,129IncInnovation Bids 11 1,058 720 10.40 0.00 10.40 628 75 553 698 22 720 424 1,122IncMiscellaneous 0 1,632 2,328 0.00 0.00 0.00 969 1,881 (912) 1,185 1,143 2,328 513 1,698IncLocal Non Pay 0 988 2,390 0.00 0.00 0.00 587 1,463 (876) 2,126 249 2,375 687 2,813Spare 3 0 0 0.00 0.00 0.00 0 0 0 0 0 0 0 0Spare 4 0 0 0.00 0.00 0.00 0 0 0 0 0 0 0 0Spare 5 0 0 0.00 0.00 0.00 0 0 0 0 0 0 0 0Spare 6 0 0 0.00 0.00 0.00 0 0 0 0 0 0 0 0Spare 7 0 0 0.00 0.00 0.00 0 0 0 0 0 0 0 0IncUnidentified 1,208 718 718IncTotal U.H.S. 55 23,236 24,012 227.74 68.76 158.98 13,802 12,794 1,008 17,688 6,309 23,997 5,420 23,108IncIncSchemes split by:Acute A&E 0 0 0 0.00 0.00 0.00 0 0 0 0 0 0 0 0Acute Day Case 0 0 13 0.00 0.00 0.00 0 13 (13) 0 13 13 0 0Acute Elective 0 1,100 0.00 0.00 0.00 0 426 (426) 950 150 1,100 302 1,252Acute Non-Elective 0 0 0.00 0.00 0.00 0 0 0 0 0 0 0 0Acute Other NHS 0 127 0.00 0.00 0.00 0 61 (61) 127 0 127 106 233Acute Outpatient 0 50 0.00 0.00 0.00 0 0 0 50 0 50 150 200Other Revenue 0 3,671 0.00 0.00 0.00 0 1,950 (1,950) 2,373 1,298 3,671 1,102 3,475IncTotal Income 0 4,961 0.00 0.00 0.00 0 2,449 (2,449) 3,500 1,461 4,961 1,660 5,160Medical Consultant 0 991 5.90 4.80 1.10 0 676 (676) 585 406 991 113 698Medical Other 0 329 1.95 0.95 1.00 0 239 (239) 145 184 329 28 173Nursing Trained 50 4,814 127.26 30.50 96.76 0 1,782 (1,782) 4,198 616 4,814 851 5,049Nursing Untrained 0 156 0.92 0.00 0.92 0 108 (108) 140 16 156 4 144Science, Prof & Technical 0 1,428 8.68 7.48 1.20 0 933 (933) 501 927 1,428 85 586Admin 9+ 0 62 0.00 0.00 0.00 0 21 (21) 52 10 62 26 78Admin Band 1-5 0 1,194 72.33 17.43 54.90 0 623 (623) 1,050 144 1,194 355 1,405Admin Band 6-8 0 462 4.76 2.50 2.26 0 361 (361) 154 308 462 6 160Other 5 375 5.10 5.10 0.00 0 241 (241) 103 272 375 39 142IncTotal Pay 55 11,556 9,811 226.90 68.76 158.14 6,864 4,984 1,880 6,928 2,883 9,811 1,506 8,434IncDrugs 0 1,374 894 0.00 0.00 0.00 816 306 510 894 0 894 205 1,099IncClinical Supplies 0 4,578 2,111 0.00 0.00 0.00 2,719 1,019 1,701 2,052 59 2,111 561 2,613IncNon Clin Supplies 0 1,367 785 0.00 0.00 0.00 812 603 209 775 10 785 149 924IncOther Non Pay 0 4,360 5,450 0.84 0.00 0.84 2,590 3,433 (843) 3,539 1,896 5,435 1,340 4,879IncTotal Non Pay 0 11,679 9,240 0.84 0.00 0.84 6,937 5,361 1,576 7,260 1,965 9,225 2,254 9,514IncIncTotal U.H.S. 55 23,235 24,012 227.74 68.76 158.98 13,802 12,794 1,007 17,688 6,309 23,997 5,420 23,108

Schedule 8b 2012/13 Month: 8University Hospital Southampton NHS FT Savings Programme 2012/13CIP Delivery - Divisional Analysis2012/13 AWL Year to Date Split by: Full Year RollClosed Target Identified Identified Actual Variance UHS Prfl Actual Variance Rec Non Rec Total Effect ForwardAs at Period 08 - November Beds £'000 £'000 WTEs WTEs WTEs £'000 £'000 £'000 £'000 £'000 £'000 £'000 £'000DivisionDivision A 14 4,065 3,687 71.51 19.76 51.75 2,415 1,613 802 3,132 555 3,687 1,321 4,453Division B 31 6,394 5,855 68.27 24.98 43.29 3,798 2,662 1,136 4,798 1,057 5,855 882 5,680Division C 0 5,792 5,224 42.58 13.52 29.06 3,440 2,809 631 3,511 1,713 5,224 1,641 5,152Division D 10 4,659 4,169 43.68 8.80 34.88 2,767 2,269 498 3,558 611 4,169 807 4,365THQ 0 2,326 2,917 1.70 1.70 0.00 1,382 1,910 (528) 1,989 913 2,902 329 2,318Other 0 2,160 0.00 0.00 0.00 0 1,532 (1,532) 700 1,460 2,160 440 1,140UHS Total 55 23,236 24,012 227.74 68.76 158.98 13,802 12,794 1,008 17,688 6,309 23,997 5,420 23,108Schemes split by:Acute A&E 0 0 0 0.00 0.00 0.00 0 0 0 0 0 0 0 0Acute Day Case 0 0 13 0.00 0.00 0.00 0 13 (13) 0 13 13 0 0Acute Elective 0 1,100 0.00 0.00 0.00 0 426 (426) 950 150 1,100 302 1,252Acute Non-Elective 0 0 0.00 0.00 0.00 0 0 0 0 0 0 0 0Acute Other NHS 0 127 0.00 0.00 0.00 0 61 (61) 127 0 127 106 233Acute Outpatient 0 50 0.00 0.00 0.00 0 0 0 50 0 50 150 200Other Revenue 0 615 3,671 0.00 0.00 0.00 365 1,950 (1,585) 2,373 1,298 3,671 1,102 3,475IncTotal Income 0 615 4,961 0.00 0.00 0.00 365 2,449 (2,084) 3,500 1,461 4,961 1,660 5,160Medical Consultant 0 991 5.90 4.80 1.10 0 676 (676) 585 406 991 113 698Medical Other 0 329 1.95 0.95 1.00 0 239 (239) 145 184 329 28 173Nursing Trained 50 4,814 127.26 30.50 96.76 0 1,782 (1,782) 4,198 616 4,814 851 5,049Nursing Untrained 0 156 0.92 0.00 0.92 0 108 (108) 140 16 156 4 144Science, Prof & Technical 0 1,428 8.68 7.48 1.20 0 933 (933) 501 927 1,428 85 586Admin 9+ 0 62 0.00 0.00 0.00 0 21 (21) 52 10 62 26 78Admin Band 1-5 0 1,194 72.33 17.43 54.90 0 623 (623) 1,050 144 1,194 355 1,405Admin Band 6-8 0 462 4.76 2.50 2.26 0 361 (361) 154 308 462 6 160Other 5 375 5.10 5.10 0.00 0 241 (241) 103 272 375 39 142IncTotal Pay 55 11,437 9,811 226.90 68.76 158.14 6,794 4,984 1,810 6,928 2,883 9,811 1,506 8,434IncDrugs 0 1,374 894 0.00 0.00 0.00 816 306 510 894 0 894 205 1,099IncClinical Supplies 0 4,609 2,111 0.00 0.00 0.00 2,738 1,019 1,719 2,052 59 2,111 561 2,613IncNon Clin Supplies 0 1,367 785 0.00 0.00 0.00 812 603 209 775 10 785 149 924IncOther Non Pay 0 3,834 5,450 0.84 0.00 0.84 2,277 3,433 (1,156) 3,539 1,896 5,435 1,340 4,879Total Non Pay 0 11,184 9,240 0.84 0.00 0.84 6,643 5,361 1,282 7,260 1,965 9,225 2,254 9,514IncTotal U.H.S. 55 23,236 24,012 227.74 68.76 158.98 13,802 12,794 1,008 17,688 6,309 23,997 5,420 23,108

Schedule 9 2013/142012/13 Month: 8 Actual Actual Actual Actual Forecast Forecast Forecast Forecast ForecastOriginalAnnual PlanForecastOutturn YTD Plan YTD Actual Quarter 1 Quarter 2 October November December Quarter 3 Quarter 4 Quarter 1 Quarter 2CASHFLOW £000s £000s £000s £000s £000s £000s £000s £000s £000s £000s £000s £000s £000sSurplus (deficit) after tax 3,606 360 3,474 3,052 1,030 615 517 891 504 1,912 (3,196) 955 547Finance income / charges 1,536 1,620 716 716 277 284 71 83 226 381 678 738 747Depreciation and amortisation, total 21,640 21,640 14,040 13,610 5,029 4,987 1,845 1,749 2,007 5,601 6,023 6,111 6,111Impairment losses / (reversals) 2,400 5,556 0 225 (16) 220 (13) 34 0 21 5,331 0 0Gain / (loss) on disposal of property plant and equipment 0 9 0 9 0 0 9 0 0 9 0 0 0PDC Dividend expense 7,341 7,000 4,894 4,633 1,735 1,740 579 579 587 1,745 1,780 1,836 1,836EBITDA 36,522 36,185 23,124 22,245 8,056 7,845 3,008 3,337 3,324 9,669 10,616 9,640 9,241Other Non Cash movements with profit/(loss) from operations 0 0 0 0 0 0 0 0 0 0 0 0 0Operating cash flows before movements in working capital 36,522 36,185 23,124 22,245 8,056 7,845 3,008 3,337 3,324 9,669 10,616 9,640 9,241Increase / (decrease) in working capital:(Increase)/decrease in Inventories 1,607 1,607 1,107 (780) (397) 460 (1,219) 376 2,087 1,244 300 0 0(Increase)/decrease in NHS Trade Receivables 1,603 (129) 1,603 3,101 1,865 1,092 268 (124) (2,230) (2,086) (1,000) (579) 0(Increase)/decrease in Non NHS Trade Receivables 165 3,964 (21) 1,615 1,137 648 (1,188) 1,017 2,204 2,033 145 (156) 0(Increase)/decrease in other Receivables (485) (1,730) (485) (818) (2,236) 1,774 96 (453) (912) (1,268) 0 (500) 0(Increase)/decrease in accrued income 0 0 0 0 0 0 0 0 0 0 0(Increase)/decrease in Other financial assets (323) (2,426) 277 (13,399) (3,036) (2,360) (2,970) (5,032) 4,652 (3,350) 6,321 500 0(Increase)/decrease in Prepayments (3) (3) (3) (1,968) (2,938) 364 324 282 665 1,271 1,300 (1,800) 0(Increase)/decrease in Other assets (non-charitable) 0 0 0 0 0 0 0 0 0 0 0 0 0Increase/(decrease) in Deferred Income (5,915) (4,454) (2,515) 1,753 (1,778) 1,059 1,863 608 (2,729) (257) (3,478) 78 0Increase/(decrease) in Provisions (29) 0 (29) 0 0 0 0 0 0 0 0 0 0Increase/(decrease) in post employment benefit obligations 0 0 0 0 0 0 0 0 0 0 0 0 0Increase/(decrease) in Trade Creditors - NHS 0 (580) 0 36 241 (1,655) 1,280 170 (706) 744 90 407 0Increase/(decrease) in Trade Creditors - Non-NHS (7,905) (8,144) (8,933) (9,436) (8,407) 18 452 (1,499) (2,876) (3,923) 4,168 (578) 178Increase/(decrease) in Other Creditors (728) (728) (728) 322 328 286 (398) 107 (1,050) (1,342) 0 0 0Increase/(decrease) in PDC Dividend Creditor 0 0 0 0 0 0 0 0 0 0 0Increase/(decrease) in accruals (2,551) (2,653) (2,551) 3,160 1,041 3,835 (1,366) (349) (5,313) (7,028) (500) 0 0Increase/(decrease) in other financial liabilities (10) 0 (10) 0 0 0 0 0 0 0 0 0 0Increase/(decrease) in Other liabilities (non-charitable) 0 (79) 0 0 0 0 0 0 (79) (79) 0 0 0Increase/(decrease) in Other liabilities (charitable) 0 0 0 0 0 0 0 0 0 0 0 0 0Movements in working capital (14,574) (15,353) (12,288) (16,412) (14,180) 5,522 (2,859) (4,896) (6,287) (14,042) 7,346 (2,628) 178NET CASHFLOW FROM OPERATING ACTIVITIES 21,949 20,832 10,836 5,833 (6,124) 13,367 149 (1,559) (2,963) (4,373) 17,962 7,012 9,419Cash flow from investing activitiesProperty, plant and equipment - maintenance (16,956) (21,154) (11,304) (13,044) (3,595) (5,991) (2,044) (1,414) (2,027) (5,485) (6,083) (3,840) (5,401)Property, plant and equipment - replacements 0 0 0 0 0 0 0 0 0 0 0Property, plant and equipment - new builds and enhancements 0 0 0 0 0 0 0 0 0 0 0Proceeds on disposal of property, plant and equipment 0 0 0 0 0 0 0 0 0 0 0Purchase of intangible assets 0 0 0 0 0 0 0 0 0 0 0Proceeds on disposal of intangible assets 0 0 0 0 0 0 0 0 0 0 0Increase / (decrease) in capital creditors (1,850) (1,851) (1,850) (2,362) (2,275) (297) 1,376 (1,166) 511 721 0 0 0Government grants received 0 0 0 0 0 0 0 0 0 0 0Purchase of current asset investments 0 0 0 0 0 0 0 0 0 0 0Proceeds on disposal of current asset investments 0 0 0 0 0 0 0 0 0 0 0Other Cashflows from investing activities 0 0 0 0 0 0 0 0 0 0 0NET CASH INFLOW (OUTFLOW) FROM INVESTING ACTIVITIES (18,806) (23,005) (13,154) (15,406) (5,870) (6,288) (668) (2,580) (1,516) (4,763) (6,083) (3,840) (5,401)NET CASH INFLOW / (OUTFLOW) BEFORE FINANCING 3,143 (2,173) (2,318) (9,573) (11,994) 7,079 (519) (4,139) (4,479) (9,137) 11,879 3,172 4,018Cash flow from financing activitiesPublic Dividend Capital received 0 0 0 0 0 0 0 0 0 0 0 0 0Public Dividend Capital repaid (0) 0 (0) 0 0 0 0 0 0 0 0 0 0Dividends paid (7,341) (6,649) (3,670) (3,129) 0 (3,129) 0 0 0 0 (3,520) 0 (3,670)Interest (paid) on non-commercial loans (1,597) (863) (625) (439) 0 (439) 0 0 0 0 (424) 0 (437)Interest (paid) on bank overdrafts 0 0 0 0 0 0 0 0 0 0 0Interest element of finance lease rental payments 0 (862) 0 (214) (83) (80) (26) (26) (162) (213) (486) (543) (543)Capital element of finance lease rental payments 0 (4,016) 0 (2,169) (952) (755) (317) (145) (469) (931) (1,378) (1,326) (1,335)Interest received on Cash and Cash equivalents 63 94 41 74 23 27 13 11 5 29 15 15 15Movement in other grants / capital recceived 0 0 0 0 0 0 0 0 0 6 15Drawdown / (repayment) of overdraft 0 0 0 0 0 0 0 0 0 0 0 0 0Drawdown / (repayment of working capital facility 0 0 0 0 0 0 0 0 0 0 0 0 0Drawdown of non-commercial loans 5,000 5,000 5,000 5,000 0 5,000 0 0 0 0 0 0 0Repayment of non-commercial loans (8,385) (3,381) (4,786) (1,696) (5) (1,688) (2) (1) 0 (3) (1,685) 0 (1,935)(Increase) / decrease in non-current receivables 0 (751) 0 (879) (120) (499) (190) (69) 128 (131) 0 0 0Increase / (decrease) in non-current payables 0 (238) 0 (236) (26) (190) 11 (31) (2) (22) 0 116 (12)Other cash flows from financing activities 1 0 1 0 0 0 0 0 0 0 0 0 0NET CASH INFLOW (OUTFLOW) FROM FINANCING (12,259) (11,665) (4,039) (3,687) (1,162) (1,753) (511) (261) (500) (1,272) (7,478) (1,732) (7,902)NET INCREASE / (DECREASE) IN CASH AND CASH EQUIVALENTS (9,117) (13,838) (6,357) (13,260) (13,156) 5,326 (1,029) (4,400) (4,979) (10,408) 4,401 1,440 (3,884)Opening Cash and Cash Equivalents 29,540 29,540 29,540 29,540 29,540 16,384 21,710 20,680 16,280 21,710 11,301 15,702 17,142Closing Cash and Cash Equivalents 20,423 15,702 23,183 16,280 16,384 21,710 20,680 16,280 11,301 11,301 15,702 17,142 13,258

Schedule 10Finance Risk Indicators:Y/N1 Unplanned decrease in (quarterly) EBITDA margin in two consecutive quarters N2 Self-certification by trust that the Quarterly FRR may be less than 3 in the next 12 months N3 FRR 2 (or less) for any one quarter N4 Working capital facility (WCF) agreement includes default clause N5 Debtors > 90 days past due account for more than 5% of total debtor balances N6 Creditors > 90 days past due account for more than 5% of total creditor balances N7 Two or more changes in Finance Director in a twelve month period N8 Interim Finance Director in place over more than one quarter end N9 Quarter end cash balance 125% of plan for the year to date NTo be reported by exception only:1 Unplanned significant reductions in income or significant increases in costs N2 Requirements for additional working capital facilities beyond those incorporated in the Prudential NBorrowing Limit (PBL)3 Failure to comply with the NHS Foundation Trust Annual Reporting Manual N4 Discussions with external auditors which may lead to a qualified audit report N5 Transactions potentially affecting the risk rating and/or resulting in an "investment adjustment" N6 Proposed disposals of protected assets or removal of protected status N

Annex 1Non-Operating Income and Expenditure 2012/13 Month: 8Annual DESCRIPTION Current Quarter CumulativeBUDGET Plan Actual Variance Plan Actual Variance Plan Actual Variance£000's £000's £000's £000's £000's £000's £000's £000's £000's £000'sNon-Operating IncomeFinance Income(70) Interest Income (5) (11) (6) (11) (23) (12) (44) (74) (29)Other Non-Operating Income0 Gain/ (Loss) from Investments 0 0 0 0 0 0 0 0 00 Proft (Loss) on asset disposals 0 0 0 0 0 0 0 0 00 Other Non-Operating Income 0 0 0 0 0 0 0 0 0(70) Total Non-Operating Income (5) (11) (6) (11) (23) (12) (44) (74) (29)Non-Operating ExpensesFinance Costs0 Interest Expense on Overdrafts and Working Capital Facilities 0 0 0 0 0 0 0 0 0493 Interest Expense on Non-Commercial Borrowings 42 69 27 58 126 68 297 574 277985 Interest Expense on Finance Leases 89 16 (73) 178 32 (146) 375 132 (243)132 Interest Expense on PFI leases and liabilities 11 10 (1) 22 20 (2) 88 83 (5)Depreciation and Amortisation21,642 Depreciation and Amortisation 1,890 1,749 (141) 3,780 3,594 (186) 14,040 13,610 (430)0 Depreciation and Amortisation - finance leases 0 0 0 0 0 0 0 0 00 Profit (Loss) on Asset Disposals 0 0 0 0 9 9 0 9 97,341 PDC Dividend Expense 612 579 (33) 1,224 1,158 (65) 4,894 4,633 (261)0 Expenditure of NHS Charitable Funds 0 0 0 0 0 0 0 0 00 Other Non-Operating Expenses 0 0 0 0 0 0 0 0 030,593 Total Non-Operating Expenses 2,644 2,422 (222) 5,262 4,939 (323) 19,694 19,041 (653)

Annex 2DIVISIONAL/HEADQUARTERS INCOME 2012/13 Month 8Annual Current Current Current Budget Actual Variance Budget Actual VarianceBudget Month Month Month Quarter Quarter To Date To Date To Date To DateBudget Actual Variance£000's £000's £000's £000's £000's £000's £000's £000's £000's £000'sAdv. Adv. Adv.Divisions (Fav.) (Fav.) (Fav.)Surgery (466) (39) (16) 23 (78) (43) 35 (311) (247) 63Cancer Care (6,902) (577) (608) (31) (1,266) (1,332) (66) (4,761) (4,925) (164)Critical Care (824) (66) (103) (37) (69) (172) (103) (562) (519) 42Division A Management 1,612 133 (133) 316 2 (314) 1,247 2 (1,244)Sub Total Division A (6,580) (548) (727) (178) (1,097) (1,545) (448) (4,387) (5,689) (1,303)Specialist Medicine (1,526) (126) (119) 6 (251) (262) (10) (1,053) (1,047) 6Emergency Care (87) (2) (6) (4) (4) (24) (20) (78) (121) (43)Division B Management 260 178 (178) 160 (0) (160) 341 (0) (341)Sub Total Division B (1,352) 50 (125) (175) (95) (286) (190) (790) (1,168) (378)Women and Newborn (1,605) (138) (145) (7) (273) (288) (16) (1,065) (965) 100Child Health (647) (55) (68) (13) (109) (121) (11) (428) (436) (8)Clinical Support (2,631) (218) (267) (49) (432) (494) (62) (1,761) (1,876) (115)Non Clinical Support (4,059) (333) (362) (28) (639) (748) (109) (2,739) (3,021) (281)Division C Management 818 67 (67) 99 (99) 577 (577)Sub Total Division C (8,124) (677) (841) (164) (1,354) (1,651) (297) (5,416) (6,297) (881)Trauma & Orthopaedics (25) (2) (0) 2 (4) (0) 4 (17) (28) (11)Cardiothoracic (438) (37) (27) 9 (73) (73) (0) (292) (254) 38Neurosciences (359) (30) (17) 12 (60) (63) (3) (239) (264) (24)Pathology (4,629) (386) (383) 3 (772) (770) 2 (3,085) (3,007) 78Radiology (3,577) (469) (407) 61 (743) (759) (17) (2,454) (2,461) (8)Division D Management (147) (12) (1) 12 (25) (1) 24 (97) (10) 87Sub Total Division D (9,175) (936) (835) 100 (1,676) (1,666) 10 (6,184) (6,024) 159Divisions Total (25,231) (2,111) (2,528) (417) (4,222) (5,147) (925) (16,776) (19,179) (2,403)HeadquartersStrategy (992) (84) (87) (3) (168) (170) (2) (657) (696) (40)Finance (50) (4) (13) (9) (8) (16) (8) (33) (43) (10)Estates (1,914) (160) (173) (14) (319) (372) (53) (1,276) (1,409) (133)Clinical Governance (118) (7) (27) (20) (17) (8) 9 (96) (62) 34Medical Director (1) (1) (1) (1) (2) (2)Training and Development (181) (15) (106) (91) (30) (76) (46) (120) (436) (316)Chief Executive Office (521) (55) (97) (42) (124) (155) (31) (349) (407) (58)Research & Development (18,388) (89) (1,516) (1,427) (2,100) (3,170) (1,071) (12,259) (12,058) 201Human Resources (1,690) (142) (164) (21) (271) (304) (33) (1,120) (1,159) (39)IM&T (911) (76) (57) 18 (173) (129) 44 (608) (592) 16Other Services (4,028) (1,480) (366) 1,114 (1,015) (952) 62 (473) (3,397) (2,924)CLRN (9,816) (818) (710) 108 (1,636) (1,663) (27) (6,544) (6,625) (81)SWPHO (6,956) (580) (402) 178 (1,159) (876) 283 (4,637) (3,841) 796OPA's (0) (0) (0) (0)Clinical Neg/Employer Liab. (27) (2) (7) (5) (5) (8) (3) (18) (54) (36)Headquarters Total (45,591) (3,512) (3,727) (214) (7,024) (7,900) (876) (28,191) (30,783) (2,592)Division/Headquarters Total (70,822) (5,623) (6,255) (632) (11,246) (13,047) (1,801) (44,967) (49,961) (4,995)Balance sheet. (0) (0) (0) (0) (1) (1)Capital Programme (194) (194) (304) (304) (1,153) (1,153)Central Reserves 3,360 7 (7) 14 (14) (27) 27Corporate Costs 0 (0) (2) 2Total Divisional Income (67,462) (5,616) (6,449) (833) (11,233) (13,352) (2,119) (44,995) (51,115) (6,120)MEMORANDUMDIVISIONAL INCOME BY SUBJECTIVEPrivate Patients (5,104) (425) (520) (95) (851) (1,003) (152) (3,403) (3,218) 185Overseas Visitors (285) (24) (29) (5) (48) (84) (36) (190) (270) (80)CRU (2,547) (212) (217) (5) (425) (604) (180) (1,698) (2,372) (674)Research & development. (26,347) (2,196) (2,275) (79) (4,391) (4,976) (585) (17,565) (19,248) (1,683)Patient Income (50) (4) (3) 1 (8) (8) (0) (33) (25) 8Nursery Fees (1,416) (118) (74) 44 (236) (159) 77 (944) (760) 184Non-Patient Care Services to other Bodies (12,030) (1,011) (1,095) (84) (2,012) (2,279) (267) (7,974) (9,130) (1,156)Car Parking (3,221) (271) (299) (28) (542) (604) (62) (2,136) (2,256) (120)Staff accommodation rentals (70) (6) (3) 3 (12) (7) 4 (47) (32) 15Cancer Drugs Fund (4,814) (361) (453) (92) (882) (949) (67) (3,369) (3,659) (289)Donated Income (1,556) (130) (129) 1 (259) (307) (48) (1,037) (598) 440Charitable and Other Contributions to Expenditure (724) (60) (58) 2 (121) (118) 2 (483) (748) (265)Hosted Services Income (6,956) (580) (402) 178 (1,159) (876) 283 (4,637) (3,841) 796Other Income (2,341) (218) (891) (673) (287) (1,375) (1,088) (1,479) (4,960) (3,481)Total Divisional Income by Subjective (67,461) (5,616) (6,449) (833) (11,233) (13,352) (2,119) (44,995) (51,115) (6,120)Being Other Operating Income (74,420) see schedule 4plus Non NHS Clinical Revenue (5,590)less Education Income 26,347Clinical Excellence Awards 2,547(51,115)

Annex 3STATEMENT OF FINANCIAL POSITION 2012/13 Month 8EOY PREVIOUS YEAR TO YEAR TO YEAR END YEAR ENDBALANCE MONTH DATE DATE FORECAST PLANPREVIOUS YEAR CUMULATIVE ACTUAL BALANCE PLAN BALANCE BALANCE BALANCEASSETS, NON CURRENTProperty, Plant and Equipment, Net 274,606 277,176 277,271 283,917 286,635 285,657Intangible Assets, Net 7,159 5,684 5,385 0 0 0Investments, Non-Current 0 0 0 0 0 0PFI: Property, Plant & Equipment 995 958 948 0 0 0PFI: Other Assets 0 0 0 0 0 0Trade & Other Receivables, non-currentNHS Trade Receivables, non-current 0 0 0 0 0 0Non NHS Trade Receivables, non-current 0 0 0 0 0 0Other Receivables, non-current 2,244 3,052 3,121 2,244 2,993 2,244ASSETS, NON-CURRENT, TOTAL 285,004 286,870 286,726 286,161 289,628 287,901ASSETS, CURRENTInventories 12,307 13,463 13,087 11,199 10,700 10,699Trade & Other Receivables, currentNHS Trade Receivables, current 9,519 2,146 2,270 5,854 5,500 5,854Non NHS Trade Receivables, current 5,334 6,532 5,549 3,372 3,200 3,185Provision for Bad Debt (4,063) (1,711) (1,745) 0 0 0Other Receivables, current 3,215 3,580 4,033 3,700 3,200 3,700Accrued income 0 0 0 0 0 0Other Financial Assets, current 3,406 11,772 16,804 4,679 5,779 5,279Prepayments, current 3,197 5,447 5,165 3,200 3,200 3,200Cash and cash equivalents - GBS 29,464 20,598 16,245 23,183 15,702 20,423Cash and cash equivalents - Commercial banks and in hand 76 82 35 0 0 0Other Assets, current 0 0 0 0 0 0ASSETS, CURRENT, TOTAL 62,454 61,910 61,443 55,187 47,281 52,340ASSETS, TOTAL 347,458 348,779 348,169 341,348 336,909 340,242LIABILITIESLIABILITIES, CURRENTInterest-Bearing Borrowings , currentBank Overdraft 0 0 0 0 0 0Drawdown in committed facility 0 0 0 0 0 0Loans, non-commercial, current (3,385) (3,941) (3,941) (3,908) (3,956) (3,908)Deferred Income, current (8,465) (9,619) (10,210) (7,500) (4,022) (4,100)Provisions, current 0 0 0 0 0 0Post Employment Benefit Obligation, current 0 0 0 0 0 0Trade and Other payables, currentTrade creditors, current, NHS (4,350) (4,215) (4,386) 0 (3,770) 0Trade creditors, current, non-NHS (17,312) (9,375) (7,876) (12,723) (9,168) (13,751)Other Creditors, current (13,728) (13,943) (14,050) (14,263) (13,000) (14,263)Capital Creditors, current (4,350) (3,154) (1,989) (2,500) (2,500) (2,500)Other Financial Liabilities, currentAccruals, current (12,205) (15,714) (15,365) (9,500) (9,500) (9,500)Payments on Account (11) (1) (19) 0 0 0Finance Leases, current (2,892) (3,143) (3,159) (6,000) (3,583) (6,000)PFI Leases, current 0 0 0 0 0 0PDC Dividend creditor, Current 346 (579) (1,158) (1,223) 0 0Interest payable on non-commercial interest bearing borrowings, current (43) (112) (180) (127) (37) 0Other Financial Liabilities, current (1,375) (1,375) (1,375) 0 (1,375) 0Other Liabilities, currentOther Liabilities, current 0 0 0 0 0 0Donated assets, deferred income 0 0 0 0 0 0LIABILITIES, CURRENT TOTAL (67,770) (65,172) (63,709) (57,745) (50,911) (54,022)NET CURRENT ASSETS (LIABILITIES) (5,315) (3,263) (2,266) (2,558) (3,630) (1,681)LIABILITIES, NON CURRENTLoans, non-current, non-commercial (24,756) (27,504) (27,503) (27,289) (25,804) (25,347)Deferred income, non-current (376) 0 (376)Provisions, non-current (3,353) (3,436) (3,403) (3,324) (3,324) (3,324)Post Employment Benefit Obligation, non-current 0 0 0 0 0 0Trade Creditors, non-current 0 0 0 0 0 0Other Creditors, non-current (210) (88) (90) 0 (88) 0Finance Leases, non-current (7,230) (6,639) (6,653) (5,171) (12,507) (9,602)PFI Leases, non-current 0 0 0 0 0 0Other Financial Liabilities, non-current (166) 0 0 0 0 0Other Liabilities, non-current 0 0 0 0 0 0LIABILITIES, NON-CURRENT, TOTAL (35,715) (37,668) (37,649) (36,161) (41,723) (38,649)TOTAL ASSETS EMPLOYED 243,973 245,939 246,811 247,443 244,275 247,571TAXPAYERS' AND OTHERS' EQUITYPublic Dividend Capital 185,352 185,352 185,352 185,352 185,352 185,352Retained Earnings 34,852 37,116 38,033 23,581 35,340 23,709Donated Asset Reserve 0 0 0 21,060 0 21,060Revaluation Reserve 23,770 23,472 23,426 24,063 23,583 24,063Other Reserves 0 0 0 (6,613) 0 (6,613)TAXPAYERS EQUITY, TOTAL 243,973 245,939 246,811 247,443 244,275 247,571TOTAL EQUITY EMPLOYED 243,973 245,939 246,811 247,443 244,275 247,571

Annex 4CAPITAL EXPENDITURE 2012/13 Month 8Year To Date Year To Date Foundation Trust Year EndPlan Actual Plan ForecastProject £000's £000's £000's £000'sDay Surgery Unit 1,739 1,486 3,200 1,739Backlog maintenance 1,284 1,916 2,253 2,826Radiopharmacy 100 82 115 100Car Park Strategy 882 821 900 882Childrens Hospital 20 21 785 30Major Trauma Centre Equipment 824 654 646 700Translational Immunology WISH 371 78 1,400 700Dalkia CHP Project 1,035 944 1,035 1,035Medical Equipment Panel 1,045 595 1,750 1,952IT schemes 1,124 1,067 1,150 2,162Capitalisations 864 535 1,500 800Teenage Young Adult Unit 62 130 0 893Haematology Day Unit 31 79 0 678Other Schemes 4,374 4,318 2,266 6,653Income from Charitable Funded Schemes (1,600) (2,850)Total Capital Expenditure 13,755 12,726 15,400 18,300Finance Leases 3,896 1,860 9,984 9,984

Annex 5University Hospital Southampton NHS Foundation TrustFoundation Trust KPI's and risk rating calculation and modelling based on M8 (November) resultsSection A - Financial Risk Rating (before the application of over riding rules)YTD 2012/13 2013/14Risk Ratings (where 5 = lowest risk):Metric/ KPI Criteria Actual Rating RAG* Q3Forecast* Q4Forecast* Q1Forecast* Q2Forecast Weight 5 4 3 2 1RAG RAG RAG RAGEBITDA margin Underlying Performance 5.7% 3 A A A A A 25% 11% 9% 5% 1%

Trust Board ReportTITLEFRIENDS AND FAMILY TESTPROJECT IMPLEMENTATION PLANDate 18 th December 2012Sponsoring ExecutiveAuthors’ names & JobtitlesPurpose of the paperRecommendation /Action RequiredJudy Gillow, Director of Nursing and ODJulia BartonAssociate Director of Nursing & Patient ExperienceTo provide Trust Board members with the detailed project plan forthe implementation of the Department of Health’s Friends andFamily Test.TEC members:1. Approved the project implementation plan and did notrecommend any amendments.2. Agreed to ensure regular care group attendance at theproject group and prioritise staff for attendance at plannedbriefing sessions.3. Agreed to ensure consideration of the trusts FFT project planand guidance at governance committees and other keygroups.4. Will support clinical areas to achieve the necessary culturalchange for patient focussed care through a new process forpatients to nominate staff who have delivered excellent careand to ensure matrons and ward leaders are given sufficienttime in clinical practice to deal immediately with anyperceived deficits in care.Trust Board are asked to formally approve the Friends and Familytest project plan version 1.0 (this is a DoH/SHA requirement).Other committees wherethis issue has beenconsideredTEC September and December 2012Patient Experience Steering and Customer Care groups December2012Related Trust Objectives Objective 3. Excellence in HealthcareRelated Board None to note.Assurance Framework /Risk Register EntriesFinancial and resource Project funding agreed as indicatedimplicationsLegal implications None to note.Equality and DiversityimplicationsPartnership working &public engagementimplicationsThe Friends and Family test must be implemented in a mannerwhich ensures compliance with the 9 protected characteristics ofthe Equality Act (2010).The Friends and Family Test supports the trust’s patient andpublic involvement and the patient experience strategies as akey measure of patient satisfaction.1

1 Purpose1.1 The Friends and Family test (FFT) is a new Department of Health (DoH) national metric aimedat “…improving patient care and identifying the best performing hospitals in England. “ (DavidCameron, 25 th May 2012).1.2 The FFT is based on net promoter methodology and provides a headline metric to indicatepatient willingness to recommend a hospital to family and friends.1.3 The FFT will be included in the standard NHS contract for 2013/14 and will be a nationalCQUIN for patient experience. It is not yet clear how incentives/penalties will be applied.1.4 This paper clarifies the final DoH guidance on delivery of the FFT. It details current and futureDoH/commissioning monitoring and reporting requirements.1.5 The paper also outlines the trust’s approach to delivering the mandated FFT requirements andthe project resources secured to achieve this.1.6 The paper provides version 1.0 of the trust’s internal project implementation plan atappendix A.2 Key Issues2.1 DoH Guidance Received and ExpectedThe DoH published final guidance to trusts on the implementation of the FFT in earlyNovember 2012. Additional guidance is expected as follows:o Collection and reporting of data to Unify2 expected January 2013o Display of data on trust’s public websites is expected in January 2013.oFAQs are being developed at the DoH and will be incorporated into training materials.o Posters and leaflets are being developed at the centre and will distributed to trusts inDecember 2012.2.2 The Final FFT QuestionFraming: We would like you to think about your experience in the ward where you spent the most time duringthis hospital stayQuestion1: How likely are you to recommend our ward to your friends and family if they need similar care ortreatment?Response:1. Extremely Likely2. Likely3. Neither likely or unlikely4. Unlikely5. Extremely unlikely6. Don’t knowQuestion 2: In one sentence, please tell us why you would/would not recommend us to your friends & family?Question 3: Is there any member of staff you would like to recommend for giving great service?………………………………………………………………………………………………………Thank you for telling us about your experience. We would value you taking the time to complete a fuller surveyabout your experience. You can access this survey by: Web address; Hospedia Unit Volunteers2

2.3 Other Guidance ReceivedThe DOH intend to roll the question out to maternity units in October 2013. Guidance will beavailable in March 2013. There is currently no implementation date set for outpatient or daysurgery units, or for under 16s inclusion, however it is likely that these will also be mandated in2013.2.4 SHA Project Structure and ReportingNHS South of England have formed a steering group and project structure. The group hasrepresentation from the SHA, commissioners and providers across the region. Judy Gillow,Director of Nursing and OD at UHS is a member of the group, with Julia Barton, AssociateDirector of Nursing & Patient Experience deputising. The steering group are holding monthlyconference meetings. In addition, the SHA are hosting fortnightly “webexes” for trust projectleads.A detailed project plan has been established by the SHA, with key implementation milestonesas follows:January 2013 trusts begin collection of some survey dataFebruary 2013 trusts complete implementation of project for full data collection sampleMarch 2013 trusts achieve 15% response rate across full sample in readiness for “go live “on 1 st April 2013.May 2013 trusts report first data return to Unify2 and results placed in public domain.The SHA is required to report progress with each trust’s implementation plans to the DoH bythe 15 th working day of each month.2.5 Commissioner ReportingCommissioners (SHIP/CCG) will be collating trust project implementation plan data returns forthe SHA by the 8 th working day of each month.3 Next Steps / Way Forward3.1 The UHS FFT Project Implementation Plan can be found in Appendix A4 Recommendations4.1 Please see recommendations on page 1 of this report.3

Appendix A:Friends and Family TestProject PlanProject DetailsDate 29 th November 2012Version 1.0Status DraftTitle UHS Friends and Family Test Implementation PlanAuthor Julia Barton, Associate Director of Nursing & Patient ExperienceDistribution & approvals historyVersion Distributed to: Date Action taken Approved by1.0 Trust ExecutiveCommittee7/12/12 1) The project plan wasapproved.2) That senior medicalmembership of the FFTproject group be confirmed.TEC (Chair A.Matthews)1.0 Project Title: Friends and Family Test Project Plan2.0 Aims/Objectives of the Project2.1 To deliver a new patient experience survey, which will provide a headline measure ofpatient satisfaction and loyalty.2.2 To determine the level of patient satisfaction of trust services by ward or clinicaldepartment2.3 To provide the majority if inpatients and those attending the emergency departmentwith an opportunity to express satisfaction/dissatisfaction with trust services.2.4 To ensure dissemination of patient feedback and learning to front line staff in orderto initiative change and improvement programmes.2.5 To meet SHA and DoH key milestones for project delivery – on time and in budget.2.6 To maximise the opportunity to ensure UHS continues to develop a patient centredfocus as stated in the trust value “Patients First.”4

3.0 Scope of the ProjectThere are 4 current areas of exclusion:o Maternity (will go live October 2013)o Outpatientso Day Surgeryo Children under 16.100% of inpatients who are discharged after a 1-night stay and 100% of patients dischargedfrom the Emergency Department will be asked the question.The recommended response rate is 15%, which equates to approximately 2,400 patients permonth.4.0 Approach and MethodThe following method to deliver the FFT will be utilised:1. All patients will be given a post card detailing the question and other key information.2. Patients will be given the option to fill the question out on the bed side Hospedia units oronline when they return home (within 48 hours).3. For areas without Hospedia bedside TV units, cards will be able to be completed and postedinto a drop box or via a freepost option.4. Volunteers will be deployed to assist any patients who request assistance to complete thequestion.5. Carers/relatives can answer the question for patients who are unable to do so, e.g. due toaltered consciousness states or altered mental capacity.5.0 Project StructureProject Groups and Reporting LinesTrust BoardTrust ExecutiveCommitteeQuality GovernanceSteering GroupPatient Experience SteeringGroup (Strategic Delivery)Customer Care Group(operational Delivery)Patient Survey Group(Project Management)5

4.1 Patient Survey Group MembershipName Role Division PositionJulia BartonAssociate Director of Nursing and PatientExperienceLauren FIndlay Project Manager THQ/Div C Deputy ChairJoanne Dimmock Patient Experience Advisor, PSS THQ/Div CAilsa Gibb Quality Contracts Manager Div DMike Ives IT Manager THQElaine Lennan Nurse Consultant, Cancer Care Div AMaria Dore Head of Midwifery Div CPatricia Norman Clinical Effectiveness Manager THQCath Battrick Matron, Child Health Div CVickie Purdie Matron, General Surgery Div ARachel Spreadborough Matron, Cardiac Div DKim Sutton Voluntary Services Manager THQMavis Ayer/LindaMonkSister/Matron, NICUTHQDiv DDiv B Rep Vacant TBC TBC TBCChair5.0 Project Deliverables and MilestonesPhase 1 - PlanningPhase 2 - PilotingSep to Nov 2012Dec 2012 to Jan 2013GoalsGoals1 To agree the projectstructure2 To establish a detailedproject plan3 To interpret the DOHguidance4 To agree theinpatients approachand methods whichUHS will use5 To agree the projectcosts and securefunding1 To finalise the deliveryapproach for inpatients and ED2 To begin collecting data via theHospedia units and online3 To ensure staff and patientsare informed of theforthcoming initiative4 To finalise the ED approach5 To participate inSHA/Commissioner assuranceprocess and meet all deadlinesPhase 3 - ImplementationFeb 2013 – April 20131 Collecting ED data2 To analyse the datareturns and consideramendments to themethods to be deployed3 To begin6.0 Detailed Project GANTT chart – please see appendix B7.0 Detailed divisional project plans – please see appendix C6

8.0 Project BudgetDoH anticipated average costs for full implementation per organisation are £35k.Planned Project CostsItem Recurring Non -RecurringPayProjectManagerSurveyAdministratorNon PayUplift in PickerPatient SurveycontractCards,Scanning andprocessingcostsInterpretercostsFreepostAddressTBC0.5 WTEBand 50.2 WTEBand 7Kiosk for ED £2kPosters andLeaflets2012/13PartYearCosts2013/14Full YearCosts£5k £2.5k £5k£12k £4k £12k£2k £0.5k £2k£2k 0.5k £2kComments6/12 (Oct 6/12 Funded from current resourcesto Mar)in Governance DirectorateNil 12/12 Frozen post in PSS department£1.5k £.5k £1kTotals £21k £3.5k £8k £22k9.0 Communication and Engagement PlanRegular and open communications are critical for the success of the FFT project. This willbe managed by the project team and a wide range of methods will be used to ensure thatnews and information about the initiative is easily accessible to all key stakeholders.The table below defines the key communications and engagement methods that arerequired in order for the project to achieve its objectives. The project group will finalisethis plan in due course.Audience Message Frequency Methods Info. ProviderPatientsPublicStaffMembersCommissionersPartnersMediaTrust BoardRisk LogA project risk log will be established7

Appendix B: FFT Project Gantt Chart (please email Lauren.findlay@uhs.nhs.uk for a live version of this chart)03-Sep 10-Sep 17-Sep 24-Sep 01-Oct 08-Oct 15-Oct 22-Oct 29-Oct 05-Nov 12-Nov 19-Nov 26-Nov 03-Dec 10-Dec 17-Dec 24-Dec 31-Dec 07-JanPrparation for roll outBriefing paper to JGJBBriefing paper to TECJBAppoint project Lead JB LFCostongs/Funding agreedJBBudget ReviewJBFeedback to SHAJBPCT state of readiness Survey (1)JBPCT State of Readiness Survey (2)JBMonthly commisioner / SHA reportsJBAgree final wording of question/sub questionJB / LF100% patients to be askedFinal plan to Trust / TEC board JB submit TEC BoardWebMeet Matt Beedle to agree Q on public website JB /LF S.ColesAgree with Matt B the design of results sectionon public website JB /LF S.ColesCQDmeet Chris Parr for implimentation ontodashboardLFinputting of data; process & whoLFEDAgree final wording of ED questionJB /LFkiosk position agreed LF J. Dimmockinformation booklet / card designLFNew poster / sticker for boxes / FFT logo LF S.ColesPublicity and Commsposters plan LF DOHposters size & design agreed LF DOHposter numbersLFdistrubutionLFcore brief / staff netJBcomms internalLFcomms externalLFpatient support services involvement briefingLFCardsAgree wording and framingJB/LFscanning processJBward supply processLFCollate current ADT data to facilitate numbers of cards requiredconfirm free post addressLFADTdesign, provisionalLFdesign, reviewLFdesign, final / agreedJB/LFpost boxes1. numbers required agreed LF2. design / size / Safety compliant LF A.Dowell N.Hardwell3. costing / supplier agreed JB/LF4. position in Trust / wards LF J.Dimmockcollection arrangements / volunteers LF K.SuttonPlan for collating results LF K.Sutton8

Roll out to wards/departmentsdevelop training packLFtraining staffLFKHWAD boardsLFcommunication staffLFnews letter on progress alternate monthsLFPresentation to each Divisional ClinicalGovernence meeting LF Dates TBCDiv ALFDiv BLFDiv CLFDiv DLFTrust HQLFpresentation of up-dates to Customer Care /Patient Group meetingLFpresentation to NMG on up-dates prnJBconfirm which wards in project roll out- see excellsheetsLFincluded wards / areas- see Div excel sheetsLFexcluded wards / areas- see Div excel sheetsLFcontact details of included areas excel sheetLFcontact details of FFT project leads for staffLFcommunication patients / relatives / slinksStaff AwardsWording on cardsLink to HospediaJBJB/LFJBHospediaCollect numbers of wards with hospedia LF matronsarrange start-up meetingJB2 week pilot JB/LFDiversitymeet Kim Sutton, top 5 languages agreedLF1 Polish LF2 Russian LF3 Farsi LF4 Chinese / Mandirine LF5 Punjarbi LFbrailleLFvisually imparired / large print optionsLFprotected characteristicsJB/LFReportingmeet with member of performance teamformonthly data brieffinal process and monthly deadlines &responsibilitiesarrange meeting with Jonathan BurwellJB/LFJB/LFLFNext Stageappsmsbenchmarking processLFfeedback & learningLF?plan for excluded areasJB/LFGo live, maternityGo live, Under 16yrsGo live, Day SurgeryGroupSet meeting dates LF D.PenfoldFinalise membershipLFDraft terms of refenreceLFLF hols9

Appendix C: Example Divisional Implementation plan (Division A)Division A surgeryTBC inclusion or notinclusion in FFTmatron name care group ward lead name contact details date seen exclusion in FFTJenny Russell ext 4319. blp 2498GICUSHDUTVSVickie Purdie ext 4430. blp 1252. mob 07788685449DoSE5E7urology endoscopydivisional associate practioner teamsurgical hospital at nightTBC ext 4630. mob 07799656486D8Jenny vowlessurgical OPDmedical OPDmax fax OPDT&O OPDENT OPDpre-assessment deptTracy RichardsE8F5F6Liz MiddlehurstLorraine Bunting / Kerry RaynorRuth Finney ext 6928. mob 07795306370F level theatres, centre blockJenny Barltrop ext 6928. mob 07795317352E level theatres, centre blockCaroline Tomkins ext 8156 mob 07795290823E level theatres, centre blockLiz Hall ext 8478 blp 9186 mob 07767754451C3C4Diane SaggsC6D3Ocology OPDJacqui Kelly ext 8683 mob 07920700662 CMH 02380475528palliative care CMHcommunity hosp palliative care teamschannel island liasion teams10

Trust Board PaperTitleQuarterly Patient Experience ReportDate 18 th December 2012Sponsoring ExecutiveJudy Gillow, Director of Nursing & ODAuthors’ names & Job titlesPurpose of the paperRecommendation / ActionRequiredJulia Barton, Associate Director of Nursing & Patient ExperienceTo provide a briefing to Trust Baord members on all aspects of patientexperience covering the period August to October 2012.TEC members:1. Confirmed the revised report structure (parts 1 and 2) wasappropriate and helpful.2. Noted the themes and trends from multiple sources of patientfeedback.3. Considered the actions taken to improve patient feedback on thequality of hospital food and agreed to review the sufficiency ofthese at the next quarterly report.4. Supported the joint PSS/Care Group actions planed in order todeliver improvements on patient feedback about communication5. Did not recommend any additional actions necessary to ensureother KPIs continue to improve.Other committees where thisissue has been considered /where supporting evidence canbe foundTrust Board members are asked to consider what patients aresaying about the trust’s services and recommend any areas foradditional focus or action in order to maintain the trust’s currentimprovement trajectory.Patient Experience Steering Group November 2012Customer Care Group November 2012TEC December 2012Related Trust Objectives Objective 1. Trusted on Quality Objective 3. Excellence in HealthcareRelated Board AssuranceFramework / Risk RegisterEntries Trusted on QualityFinancial and resourceimplicationsLegal implicationsEquality and DiversityimplicationsPartnership working & publicengagement implications2012/13 CQUIN for Patient Experience with a value of £500kFulfilment of duty for patient and public engagement in the NHS Act(2012)Fulfilment of duties under Equalities Act (2010)Report focuses on what patients and the public are saying about UHSservices and the trust’s improvement priorities and actions inresponse to this feedbackKey Messages of This Report:96% of all patients surveyed rated their care as good, very good or excellent98% of older people surveyed rated their care as good, very good or excellent79% of patients would definitely recommend the hospital to their family and friends92% of patients report always being treated with privacy and dignity89% of patients had confidence and trust in the nurses caring for themContinued focus on the current improvement actions for communication and hospital food1

1 Introduction1.1 Report StructureThis report provides a detailed analysis of patient experience feedback and the programmes ofimprovement established in response to this feedback, set as patient experience performanceindicators for 2012/13. The report covers the period August, September and October 2012.This is the 13 th such report, and the data has been considered previously at the trust’s patientexperience steering and customer care groups. This report has been restructured into two parts.Part I – provides a summary of what patients are saying about UHS and its services from avariety of sources, including complaints, concerns (PALS), comment cards, email and webfeedback and independent online feedback sites such as NHS Choices and PatientOpinion, as well as the trust’s monthly real-time patient survey which samples 3-400patients per month.Part II. – provides details of performance in the reporting quarter against key improvementprogrammes which are currently in place in response to patient feedback.1.2 Friends and Family Test (FFT)One of the most significant national (DOH) initiatives to emerge related to patient experience waslaunched in August 2012. The Friends and Family Test is based on net promoter methodologyand seeks to determine how willing patients are to recommend the hospital’s services to familyand friends if they were to experience a similar condition. A briefing paper was submitted to TECin September and December 2012.A detailed FFT implementation plan report has been submitted to this board (December 2012) forformal ratification. Trust board members may be interested to note the current trust performanceagainst the FFT included in the dashboard in Part 1 of this report (page 3).1.3 National SurveysReports on the national patient surveys for cancer and emergency care have been received.The findings of the surveys have been considered at the trust’s patient experience steeringgroup, and actions plans are under development. Further details on the survey results and areasfor action are available from the report author.1.4 Patient Experience StrategyThe trust’s patient experience strategy has been refreshed and revised. The final version of thestrategy is submitted to this board for final ratification (December 2012).2

2 SECTION 1: What Patients are Telling Us About Our ServicesTable 1Part I - Patient Experience KPIs: What Patients are telling Us About Our ServicesPatient ExperiencePriorityCQUIN 65.0 AnnualInpatient SurveyCQUIN MonthlyComplaintsPALS Concerns &EnquiriesPIF ‐ CommunicationOverall Satisfactionwith CareTarget Q Perf. Apr May June Jul Aug Sep Oct Nov Dec Jan Feb MarYTDAv./TotalYear EndPrediction65 N/A Results from national survey due Jan/Feb 2013AmberCQUIN 82.0 MonthlyRealtime SurveyTotal no. complaints 60Dissatisfied complaints always treated P&D Amber 92% 93% 93% 94% 92% 92% 92% Amber No change to targetNoise at Night fromstaffNo TargetNo target applicable80%> pts do not experience Amber 74% 80% 72% 79% 75% 79% 74% Amber No change to targetDo you always havetrust & confidencein the nursestreating you?Care of OlderPeopleNo target set.95%> older people/carersrate their care as good,V.Good or ExcellentN/A89%(2% no)87% (2%no)90%(2% no)Green 97% 99% 96% 97% 98% 97% 98% GreenN/ANew target for2012/13 - taken form65+ age group oninpatient real timesurvey3

2.1 CQUIN for Patient ExperienceThe patient experience CQUIN target is split into two deliverables. The national inpatient surveyCQUIN score target is 65.0. The national inpatient survey was carried out in October 2012 for patientsattending the trust in August 2012. Results from the survey will be available in February 2013.The local CQUIN target to be achieved in Q4 is set at 82.0. August saw a dip in performance withrecovery in September. October results are tentative due to low numbers of surveys on patients fromthe discharge facility due to its relocation this month.Local results from two of the 5 survey questions are reported below:Since June’s positive result when the data point wasabove the upper control limit, results from theprevious four months sit just below. However, theyare all above the mean.October saw an improvement on theprevious month’s result and is abovethe mean. Since December 2011 whenthe result went above the upper controllimit, all results have been within controllimits.Actions in Quarter: Divisional CQUIN scores have been calculated and shared with divisions/care groups. Actionplans have been submitted from some care groups in order to ensure sustainable performance.4

2.2 Complaints and ConcernsIt is positive to note that during the 3-month reporting period, the number of complaints received by theTrust has fallen well within the performance target of

3.4.3 Other emerging themes this quarterThe rise in feedback about estates issues in October related to one particular group ofpatients attending an outpatient facility who all completed cards on the same day. Theconcerns have been escalated to the estates department.Table 4:MonthEmerging themescleanliness Smoking Lack of staff Facilities Parking/transportFeb ‘12 1 2 - 1 1Mar - 1 3 1 1Apr 4 1 1 4 4May 1 1 2 4 3June 1 1 1 4 2July 3 - - 5 -Aug 2 2 2 - 3Sept 3 1 1 3 -Oct 3 - 3 19 32.4 Website feedback and enquiries through Patient Support ServicesTable 5:Month Total Positive Negative Both Positive with suggestionnumberNov ‘11 14 4 2 7 1Dec 14 5 6 3 0Jan ‘12 12 4 2 4 0Feb 21 8 7 2 4Mar 11 2 3 5 1Apr 17 3 5 8 1May 5 0 3 2 0June 3 0 2 1 0July 1 1 0 0 0Aug 5 0 4 0 1Sept 7 1 5 1 0Oct 4 0 4 0 02.5 NHS Choices & Patient Opinion FeedbackTable 6:Month Positive NegativeAugust Maternity X 2September Emergency Department Children and YP Services Gynaecology X2October Allergy booking clinic times Wait for colon surgery2.6 Communication and staff attitudesTwo Patient Improvement Framework (PIF) targets apply to priorities to improve patient communicationin 2012/13.2.7.1 Improving complaints received about poor communication (primary and secondary causes) by20%. The trust is currently red on this KPI with an average of 56 complaints received in the reportingquarter against a target of 39.2.7.2 Improving complaints received about poor staff attitudes (primary and secondary causes) by10%. The trust is on target with an average of 13 complaints received in the reporting quarter against atarget of 13.6

Actions in the reporting quarter Increase in delivery of customer care training. Train the trainers programme for AKD customer care training held Customer care programme for Improving Customer Services improvement programme hastrained over 170 key administrative and clerical staff. E-learning customer care training completion rates have increased. Essence of Care communication audit completed July 2012 and care group action plans forimprovement in place.Actions planned Pilot “think tank” approach to improving patient communications and address staff attitudes insurgery and T&O care groups Programme to launch values and behaviours trust wide improvement programme beingdeveloped. Roll out of AKD customer care training7

3.0 SECTION 2: Progress with Patient Experience Improvement ProgrammesTable 7:Patient ExperiencePriorityNutrition andHydrationVulnerable AdultsTarget Q Perf. Apr May June Jul Aug Sep Oct Nov Dec Jan Feb MarMUST Screening 98%Must Care Plan 95%Hospital food rated poor10% older people/carersrate their care as good,V.Good or ExcellentPart II - Patient Experience KPIs: Patient Experience Improvement InitiativesYTDAv.TotalYear EndPositionAmber 92% 92% 93% 94% 94% 95% 94% AmberAmber 86% 92% 90% 79% 88% 90% 86% AmberRed 17% 14% 24% 16% 18% 15% 14% Red2012/13 KPIChangesTarget increased from95% to 98% for2012/13Target increased from90% to 95% for2012/13Target changed in2012/13 to 10%

3.1 Nutrition3.1.1 MUST Screening and Care PlansPerformance on MUST screening and care plans is stable (amber) at 95% and 88% respectively.MUST screening on all wards bar AMU is 100%. AMU continues to take action to ensure MUSTscreens are completed as patients are transferred between AMU and the trust’s medical wards.Continued focus on compliance is maintained by the AMU matron. A new MUST e-learningprogramme has been launched.3.1.2 Meal times assistance96% of patients surveyed received or did not identify a need for mealtimes assistance against a targetof 100%.3.1.3 Protected mealtimesCompliance with protected mealtimes has improved by 11% between quarter 1 and 2 with theaverage compliance for the reporting quarter at 89% against a target of 80%.3.2 Catering and Hospital Food3.2.1 Patient Feedback via Monthly Real-time Inpatient SurveySince June’s poor result when the data point exceeded the lower control limit, there has been anupwards trend in the food rating over the last few months, with this month’s result sitting above themean.3.2.2. Medirest Patient Survey Performance9

Actions taken in Quarter New Steamplicity Menu October 2012 New management structure now in place Move from quarterly to monthly patient experience surveys and increase sample to 200 New training personnel will be F/T form November 2012Key Medirest Investment to ensure improvement in ratings (OCT 2011- SEPT 2012) Rapid Improvement Event (2011) and subsequent detailed actions delivered New Dish Washers New Catering Manager Visual boards New Dedicated Supervisors x 5 Specialty Feeding equipments New Temperature books Diet Grid books New Training resources3.3 Noise at NightOctober’s result sits just below the mean. However, results from the last eleven months are within thecontrol limits, meaning they have neither deteriorated nor improved significantly.Actions taken in Quarter New night time standards were launched trust wide in October 2012. Order codes for ear plugs and eye shades have been distributed with trust night time standards Matrons continue to undertake regular night time unannounced visits and all staff working atnight are encouraged to enforce the night time standards.3.4 End of Life CareThe trust is making good progress with the implementation of its end of life care strategy. However, areview of the Liverpool Care Pathway is underway in response to patient and public concerns raised inthe national media about this pathway.3.5 Same sex accommodationThere have been 0 non clinically justified same sex accommodation breaches in the reporting quarterPatient perceptions of sharing remain off target at 7% (for sleeping) and 14% (for facilities) sharing inOctober, and continue to need carefully management/framing by both clinical staff and volunteersrecording real time inpatient surveys.3.6 Clinical Accreditation Scheme10

The Clinical accreditation Scheme (CAS) has been developed as a key element in the trust’s clinicalassurance programme.The Clinical Accreditation Scheme offers a comprehensive method for providing standardisedassurance about quality of care at ward level which staff and patient workshops have identified asuseful to them. The purpose of the clinical accreditation scheme (CAS) is to use existing sources ofquality assurance that will enable each ward/department to be accredited according to set measures ofquality. This will ensure that the standards of expected care are communicated effectively to all staffdelivering care at ward level.The clinical accreditation scheme is being delivered in 2 parts: the clinical quality dashboard (CQD)which is now operational in all relevant clinical areas, and the implementation of the scheme itself. Overthe following 14 months all relevant wards and clinical departments will undergo clinical accreditationassessment. This involves a retrospective review of clinical metrics in 4 KPI domains and a panel visit tothe clinical area, including PPI reps and peers. The CAS implementation plan can be summarised asfollows:• Phase 1 – Clinical Quality Dashboard development• Essence of care - benchmarks to be included in the accreditation process• ‘15 steps challenge’ adapted to facilitate CAS reviews (including PPI reps)• 4 Domains to cover all essential aspects of care:– Patient safety– Patient experience– Ward Environment– Staff Experience/Workforce• Phase 2 – Pilot of CAS on 4 wards between June- July 2012 (2 now fully accredited)• Phase 3 – Full roll out commenced November 2012• 4 levels of accreditation• Exemplar• Full with no conditions• Full with conditions• ReferA CAS research project is underway led by researchers from the University of Southampton. 3 wardswill undergo accreditation (intervention) and 3 will act as a control until after the research study hasbeen completed. Staff are being asked to complete questionnaires at three key points in order to assessthe value of the clinical accreditation process in improving quality, patient experience and safety KPIsand staff engagement.3.7 Supporting CarersThe trust has undertaken several listening events and audits of carer’s experience of acute hospitalcare. A key theme in carer feedback relates to the provision of information and signposting. Working inpartnership with Southampton City Council and Carer’s Together, the trust has piloted a carer’sinformation trolley on the Medicine for Older People’s Unit and this is now rolled out to other clinicalareas.The trolley is staffed by Carers Together volunteers and cited in different locations around the trust 6days per week. One of these sessions incorporates a specific “Memory Clinic” to support carers ofpatients with dementia, facilitated by the trust’s new Admiral Nurse Specialist. Further initiatives tosupport carers include carer support assessment proformas, which will be implemented in the followingquarter.4 Summary and ConclusionThis report has summarised patient feedback from a variety of sources (part 1) and demonstrated thatmajority of patients continue to rate their experiences of care and treatment at UHS positively. Part 2 ofthe report details progress against some of the trust’s key improvement programmes which reflect thekey themes which have emerged form patient feedback. Trust board members will note the 3 areas ofperformance which require continued focus; communication, sharing mixed gender facilities (evenwhen they are not) and hospital food, although some improvements are noted in October since thechange of the Medirest Steamplicity menu.11

Trust Board Paper Cover SheetTitlePatient Improvement Framework Priorities 2013/14 and QualityAccount developmentDate 18 th December 2012Sponsoring ExecutiveJudy Gillow, Director of NursingMichael Marsh, Medical DirectorAuthors’ names & Job titlesGail Byrne, Deputy Director of Nursing & Head of Patient SafetyJane Druce, Head of Quality Contracts & ImprovementsPurpose of the paper To agree the Trust approach for the Patient Improvement Framework(PIF) consultation and priorities for 2013/14, To update on integration of the PIF to the annual FT Quality Report toMonitor and our published Quality Account.Recommendation / ActionRequiredMembers of Trust Board are asked to: - Approve the approach being taken to agree the Patient ImprovementPriorities (PIF) for 2013/14, which includes wider consultation, furtherdevelopment and inclusion in our annual NHS Trust Quality Account,and NHS FT Quality Report. Agree the proposed PIF new format which incorporates the NHSOutcomes Framework Consider the future reporting and performance monitoringdevelopment plan and frameworkOther committees wherethis issue has beenconsidered / wheresupporting evidence can befoundA&AC 19 th November 2012TEC 7 th December 2012Related Trust Objectives Objective 1. Trusted on Quality Objective 2. Delivering for Tax payers Objective 3. Excellence in HealthcareRelated Board AssuranceFramework / Risk RegisterEntriesFinancial and resourceimplicationsTrusted on QualityLegal implications The Quality Account is a statutory requirement by Department ofHealth The Quality Report is a statutory requirement by MonitorEquality and DiversityimplicationsPartnership working &public engagementimplicationsOver the last 4 years the Trust has agreed annual quality priorities withCommissioners and public to form the Patient Improvement Frameworkfor the year ahead. These priorities provide clear focus and direction toTrust staff for improvement. The PIF is also formally reported in ourQuality Report.1

1 Purpose1.1 The UHS patient quality improvement framework (PIF) is reviewed on an annual basis to both informand support the Trusts consultation on key patient improvement priorities for the year ahead(2013/14).1.2 The outcome of the PIF review and the future agreed quality improvement priorities are reported inthe review section of the Quality Report. This is published and submitted as part of the Annual Reportto Monitor by 31st May 2013, and as a separate document Quality Account to Department of Healthand NHS Choices by 28th June 2013.1.3 After the audit of last years Quality Account KPMG made the following recommendations for thedevelopment of this years account: - To ensure final quality Report/ Account is ready for the Monitor new submission date of 30th May2013. To increase visibility of consultation towards development of the priorities and of the qualityReport/Account, beginning earlier in the process and inviting stakeholders more widely.2 External and Regulatory requirements2.1 Quality account/reports are seen to enhance accountability to the public and demonstrate seniorleader engagement in the Trust quality improvement agenda. There is a set template for the formatand the content needs to include: - Where improvements in service quality are required; What the priorities for improvement are for the coming year; How we involve service users, staff and others in determining the priorities for improvement.2.2 These requirements are reflected in the development of our Patient Improvement Framework.3 PIF priorities content3.1 The White Paper ‘Liberating the NHS’, for 2010-2015 outlined the intention to move to measuringhealth outcomes rather than process targets. The NHS Outcomes Framework sets out indicators thatwill: - Provide a nationally consistent level overview of how well the NHS is performing; Provide an accountability mechanism for the effective spend of public money; Drive up quality by encouraging a change in culture and behaviour.The framework is summarised in Appendix A4 Integration4.1 It is proposed that the outcomes framework will form the basis for the 2013/14 PIF .4.2 The proposed PIF Priorities for 2013/14 will continue to use a “bottom up” and “top down” approach toidentify the key priority areas.4.3 This approach will align to both external and internal drivers where possible. These may include localand national CQUIN priorities, DH national targets, Operating Plan and Outcomes Framework, theMonitor Compliance Framework and relevant outcomes from the Francis report.4.4 The development of our UHS Patient Quality Improvement Framework will also include: - Local and national benchmarking, Local and national surveys, Risk register priorities Quality performance information, Members Council engagement in priority setting2

Divisional annual review day where previous performance is assessed using internal and externaldrivers5 PIF Format5.1 To reflect our development approach, the PIF format has been updated. The brand principles of the2012/13 PIF have been retained in a simple succinct and recognisable design but this moves fromfour priority pillars to five, reflecting the NHS outcomes framework domains5.2 Performance measures are fully integrated to the quality domains. To continue with a focusedapproach there will be more than three key priorities in each of the five domain areas.6 Communication and Engagement6.1 The Quality Account engagement process will invite Board members, senior managers, andclinicians, and Trust staff, key external stakeholders and patient/Lay groups including LiNKs andCouncil of Governors to comment on and support identification and final setting of the key priorities.6.2 Key leads have made early initial proposals for the 2013/14 improvement framework, and draftpriorities at Appendix A to facilitate further discussion, engagement and consultation.6.3 The summary version of the original format Patient Improvement Framework (PIF) for 2012/13 isenclosed at Appendix C for reference.7 Delivery Plan7.1 The development of this PIF will support and align to the refreshed annual strategic objectives. Arobust performance monitoring framework will remain in place.7.2 Following final agreement of the patient quality improvement framework priorities for 2013/14 in April2013, divisional implementation and delivery plans will be finalised.7.3 Quarterly reports on each of the sub-sections of the PIF will continue to monitor performance againstcorporate metrics. How these will be reported will need further consideration. Divisional targets will beagreed and monitored through the Executive quarterly performance meetings.7.4 The monthly Board KPI report will include the revised national performance metrics.7.5 The ward/department Quality Dashboard will be updated with the revised metrics and priorities.8 Key dates and timetable for 2013:8.1 A detailed quality report project plan is available to cover Trust, Auditor, DH and Monitor needs. Thiswill be updated as final Monitor and DH guidance for 2013 becomes available. The QualityReport/Account process will coordinate with the wider Annual Report timetable led by the Director ofCommunications & Engagement, and will integrate to the Annual Plan led by the Director of Strategy& Business Development, as appropriate.8.2 Key milestones for the quality report are contained in AppendixTrust Board are asked to:- Approve the approach being taken to agree the Patient Improvement Priorities (PIF) for 2013/14,which includes wider consultation, further development and inclusion in our annual NHS Trust QualityAccount, and NHS FT Quality Report. Agree the proposed PIF new format which incorporates the NHS Outcomes Framework Consider the future reporting and performance monitoring development plan and framework3

DRAFT UHS Patient Improvement Framework 2013/14Appendix A1. Preventingpremature deaths2. Long Term conditions 3. Episodes of ill health orinjury4. Positive experience ofcare5. Safe environmenta) Reduce prematuremortality ratesa) Improving diagnosis ratefor people with dementia(Cquin)a) Patient reported outcomemeasures (PROMS)a) Friends & family testrecommendingto others(Cquin)a) Patient safety incidentsreported & learningb) Management ofdeteriorating adults: Trauma centreoutcomesb) Integrated pathways ofcare (Cquin) Pathways to beidentifiedb) Efficient emergency pathways AMU/ED admission, EDWaits (Cquin) Emergency surgery timeto theatreb) Culture of staff behavioursfor positive patient feedback Using patient stories /listening Values & behavioursprojectb) Harm-free care (Safetythermometer) VTE Falls Pressure ulcers CAUTIc) Cancer waits c) Stroke pathway(performance)c) Improve outcomes fromsurgery (Cquin) 18 weeks & 52 weeksincomplete(performance), 14 weeksstretch target Focus on older people,and children

Appendix B2013/14 NHS Outcomes Framework(summarised to acute hospital provision improvement indicators only)1.Preventing People from Dying prematurely3.Helping people to recover from episodes of ill healthor following injury4.Ensuring that people have a positiveexperience of care Potential Years of Life Lost (PYLL) from causesconsidered amenable to healthcare Emergency admissions for acute conditions thatshould not usually require hospital admission Patient experience: Friends and family test Reducing premature (under 75 years) mortality from: cardiovascular diseaseo respiratory diseaseo liver diseaseo cancero one, and ii. Five-year survival from allcancerso One- and iv. Five-year survival from breast,lung and colorectal cancer Reducing deaths in babies and young childreni Infant mortalityii Neonatal mortality and stillbirthsiii Five year survival from all cancers in children Emergency readmissions within 30days Total health gain as assessed by patients forelective:Hip replacement ii Knee replacement iii Groinhernia iv Varicose veins v. Psychological therapies Emergency admissions for children with lowerrespiratory tract infection Proportion of people who recover from major trauma Proportion of stroke patients reporting animprovement in activity/lifestyle on the ModifiedRankin Scale at 6 months Improving people’s experience of:o outpatient serviceso A&E services Hospital responsiveness to in-patients’personal needs Women’s experience of maternity services Bereaved carers’ views on the quality of carein the last 3 months of life Improving children and young people’sexperience of healthcare: Underdevelopment Improving people’s experience of integrated Excess under 60 mortality rate in adults with alearning disability Proportion older people offered rehabilitationfollowing dischargecare: Under development2.Enhancing quality of life for people with long-term conditions5.Treating and caring for people in a safe environment and protect them fromavoidable harm Patient safety incidents reportedo Safety incidents involving severe harm or deatho Hospital deaths attributable to problems in care Reducing time spent in hospital by people with long-term conditionsi Unplanned hospitalisation for chronic ambulatory care sensitive conditions(adults)ii. Unplanned hospitalisation for asthma, diabetes, epilepsy in under 19s Estimated diagnosis rate for people with dementia Incidence of hospital-related venous thromboembolism (VTE) Incidence of healthcare associated infection (HCAI)i MRSAii C. difficileIndicators in italics are still to be developed by Department of Health Incidence of newly-acquired category 2, 3 and 4 pressure ulcers Incidence of medication errors causing serious harm Admission of full-term babies to neonatal care Incidence of harm to children due to ‘failure to monitor’5

2012/13 PIF (For Reference)Appendix CUniversity Hospital Southampton NHS Foundation Trust2012/13 Patient Improvement Framework PrioritiesTrusted on QualityPatient Safety Patient Experience Patient Clinical Outcomes Performance Targets Reduce pressure ulcers* Improve Diabetes care* Reduce falls* Reduce Venous Thrombo-Embolism (VTE)* Achieve 24/7 safe emergency care Children’s services◦ less full-term babies admitted toNeonatal care*◦ one-to-one care in labourSustainability Improve nutrition & hospitalfood* Improve patient communication*◦ discharge planning◦ patient information Address the needs of vulnerablepeople*◦ implement delirium & dementiapathway Deliver compassionate andfundamental care to all patients*◦ ensure privacy & dignity◦ meeting the needs of olderpeople Reduce mortality rates* Efficient emergencypathway* Management ofdeteriorating adults* Patient Reported OutcomeMeasures (PROMS)**◦ hip & knee replacements◦ cardiac intervention Improve outcomes fromsurgery*◦ for older people◦ children under age 1 year Improve ED waits Reduce 18 week waits Stroke pathway Improve cancer waits Improve 52 weeks surgery Incomplete pathwayPatient Safety Patient Experience Patient Clinical Outcomes Performance Targets Infection prevention and control Medication errors Theatre safety checklist Never eventsCQUIN Safety Thermometer VTE risk assessmentSustainability Same sex accommodation End of Life care Patient feedback, Safeguarding children & adultsSustainability Effective policies and guidance NICE guidance, QualityStandards Map of Medicine/clinicalpathwaysSustainability Monitor Compliance Internal performancemonitoring frameworkPatient Safety Patient Experience Patient Clinical Outcomes Performance TargetsCQUIN Patient experience survey Delirium and DementiaCQUIN Emergency frequent attendees Reduce non-electiveadmissions Health improvementassessmentCQUIN National quality indicators(Gateway) High impact innovations6

ContentPIF Priorities:Leads review 2012/13 Q1-3 to draft 2013/14 outlinev1 & engagement to TEC & Trust BoardIn overview, key milestones for the quality report process are:LEAD Dec Jan Feb Mar Apr May Jun JulMiM,JG/ GB,JBPIF Priorities Final Draft to TEC and Trust Board,approve for Core Brief& implementation in April JGQuality Report Draft to Trust Board, and toExternal Audit for scrutiny JG, JDAnnual Report FINAL inc Quality Report to TrustBoardConsultationsDraft QR Core brief: invite staff comment AA, JGAwayday: All Trust review PIF 2012/13, prioritysetting 2013/14JH, JGOSCs, LINKs, Council of Governors, & PCTs fordevelopmental engagement on draft prioritiesCouncil of Governors choose PIF indicator forExternal AuditFinal draft Quality Report to OSCs, LINKs, Councilof Governors, & PCTs for 30 day consultation onpriorities JDLegal, Statutory etcExternal auditors signed limited assurance report JGExternal auditors submit governors report JGFull Annual report inc Quality Report to Parliament AAPublication Quality Account to DH NHS Choices JDTECSetdate7

Board Paper Cover SheetTitleChief Executive’s Report on Current Issues andActions Taken – December 2012Date 18 th December 2012Sponsoring ExecutiveAuthors’ names & JobtitlesPurpose of the paperRecommendation /Action RequiredMark Hackett, Chief ExecutiveSarah Anderson, Head of Corporate AffairsTo update Trust Board in accordance with StandingFinancial Instructions1. Ratify the Action undertaken by the Chair (para3.1.1).2. Note this report.Related TrustObjectivesObjective 1. Trusted on QualityObjective 2. Delivering for Tax payersObjective 3. Excellence in HealthcareRelated BoardAssurance Framework /Risk Register EntriesFinancial and resourceimplicationsLegal implicationsEquality and DiversityimplicationsPartnership working &public engagementimplicationsN/ANoted where applicable in the report.Noted where applicable in the report.Noted where applicable in the report.Noted where applicable in the report.1

Chief Executive’s Report on Current Issues and Actions Taken – December 20121. Current News1.1 Current news is available on the Trust website at http://www.uhs.nhs.uk/Home.aspx2. Actions from Trust Executive Committee (TEC)2.1 The Trust Executive Committee (TEC) is a formal standing committee of the TrustBoard, which executes actions from the Board and supports the operationalmanagement of the Trust. Business from the November-December 2012 period whichwas not passed onto Board included:2.1.1 Commissioning for Quality and Innovation (CQUIN) 2012/13 QuarterReport – requested Divisional Management Teams to expedite the actionsnoted in the report that are required to deliver year end CQUIN compliance.2.1.2 Hospital at Night Update – agreed in principle the next phase of the Hospitalat Night implementation but requested further work including input fromDivisions on the timings. This will be considered via the budget setting process.2.1.3 Culture and Learning Points from Care Quality Commission (CQC) Visit –noted the need to address behaviours and then culture within the Trust.Requested that Divisions discuss the issue to identify behaviours that they canengage with prior to a workshop in early January.2.1.4 Analysis and Improvement Report from Incidents, Complaints and Claims– noted the themes and issues arising.2.1.5 Workforce Planning Process – approved the new approach and agreed theGovernance framework. Agreed to engage with Divisional workshops for anintegrated approach to workforce planning and development.2.1.6 Adult Congenital Heart Cardiologist Consultant Business Case – approvedin principle and agreed Chair’s action outside of the meeting once requestedinformation provided.2.1.7 Medicine for Older Persons Consultant Business Case – was agreed.2.1.8 Update of the Never Events Framework Policy and Amendments to theNever Events List for 2012/13 – noted the policy and requested Divisionalmanagement Teams to ensure staff are aware of the changes, that guidance toprevent Never Events is adhered to and no Never Events occur.2.1.9 Final Patient Experience Strategy (2012 Refresh) – was approved.2.1.10 Annual Health & Safety Report 2011/12 – was approved.2.1.11 Patient Level Information & Costing System (PLICS) – Service LineReporting Quarter Report – was noted and divisions and care groups wereasked to consider the position for each service line.2.1.12 Consultant Ophthalmologist with Specialist Interest in Medical RetinaBusiness Case (for Ozurdex Service Development – approved in principleand agreed Chair’s action outside of the meeting once requested informationprovided.2.1.13 Hospital at Night Consultant Business Case – was approved.3. Chair’s Actions3.1 The Board has agreed that the Chair may undertake some actions on its behalf. Thefollowing action has been undertaken by the Chair in the period 22 nd November 2012 –12 th December 2012.3.1.1 Single Tender Action for Sacral Nerve Stimulation (10 systems for plannedoperations in December 2012) for Surgery from Medtronic Ltd at a cost of£176,700 inc. vat. Approved by the Chair on 30 th November 2012.2

4. Signing & Sealing4.1 The Seal of the Trust is required to be fixed to some documents. No seals were fixed inthe period 22 nd November 2012 – 12 th December 2012.5. Recommendations5.1 To ratify the Action undertaken by the Chair (para 3.1.1)5.2 To note this report.3

UNIVERSITY HOSPITAL SOUTHAMPTON NHS FOUNDATION TRUSTMonitor and Operational Performance ReportNovember 2012Report to: Trust Board – 18 December 2012Report from:Sponsoring Executive:Aim of Report /Principle Topic:Review History to date:Recommendation(s):Andy Hyett, Director of PerformanceJane Hayward, Chief Operating OfficerProvides a summary of the Trust’s performance against the access timesand operational performance targets as agreed by Trust Board.Regular report to Trust Board, TEC review a version of this report.Trust Board are asked to note this report, in particular EmergencyDepartment performance, and consider whether there is appropriateassurance regarding current and future performance.Trust Board to note performance risks across each quarter in 2012/13 andto set out expectation to receive plans to mitigate these risks.Trust Board to consider performance for Quarter 1 and Quarter 2 13/14 tosupport the monitor submission.1. Strategic ContextAn overview of performance within the Trust against key operational performance and financeindicators. This also supports the development of the Intelligent Board principles within the organisation.2. Supporting GuidanceA supporting document which provides guidance on the information contained within this report, andhow it should be interpreted, is available upon request. Such information has been removed from themonthly report in order to reduce its length, and to enable better focus on the reported performance /actions.3. Executive Summary3.1 Monitor Compliance Framework (Foundation Trust Indicators)In line with the Monitor performance reporting requirements, this report provides a four quarterpredictive performance based on the known Monitor Compliance Standards. These predictionsare based on known seasonality, historical performance and proximity to the publishedthresholds.Actual PerformancePredicted PerformanceAnnual plan based on Monitor declaration in April 20122012/13 Qtr 1 2012/13 Qtr 22012/13 Qtr 32012/13 Qtr 42012/13 Qtr 3 2012/13 Qtr 4 2013/14 Qtr 12013/14 Qtr 2RAG Score RAG Score RAG Score RAG Score RAG Score RAG Score RAG Score RAG ScoreService PerformanceAggregate ScoreAmber/ Red2.0 Green 0.0Amber/ Green1.0Amber/ Red2.0Amber/ Green1.0Amber/ Red2.0 Green 0.0 Green 0.0ActualPerformancePredicted PerformanceYear to Date2012/13 Qtr 3 2012/13 Qtr 42013/14 Qtr 1 2013/14 Qtr 2Financial IndicatorstbcGreenGreenGreenGreenBased on current targets and performance standards. Further discussion is needed around any newKey Performance Indicators Report Page 1 of 2

performance target and C-Diff target reductions.Predicted risk in Quarter 3 is the 4 hour ED target.Predicted risks in Quarter 4 are the 4 hour ED target and C Difficile performanceSee Appendix 1 for further analysis of the financial rating.3.1.1 Monitor Service Performance Aggregate ScoreAreas of concern• ED• Stroke• 18 Weeks IncompletesMore detailed exception reports are included in Appendix 24. Performance as at the end of November 2012 (Appendices 1)The scorecards showing current performance can be found in Appendices 1. The summaryaction plans to support any areas of concern are included as Appendix 2.5. Changes to indicatorsThe unplanned re-attendance at A&E within 7 days indicator has been updated to show all reattendancesto A&E regardless of complaint. Previously, the indicator only showed thepercentage of re-attendances within 7 days for the same complaint as per guidance at the time.This has been updated to ensure it accurately reflects the national guidance. The impact of thechange is performance drops from an average of 3% per month to a YTD figure of 8.9% pushingthe Trust above the 5% target. A mitigation plan is being agreed between Divison B and theDirector of Performance.The performance will be impacted by frequent attendee projects and other QUIP schemesdesigned to reduce re-attendance to ED. As per DoH best practice guidance and reflected in ourcontracts, UHS needs to delivery against one of the two patient impact indicators. UHS isconsistently delivering against the standard of percentage of patients who left the departmentbefore being seen. This has no impact on the Monitor rating as Monitor only measures the 4hour 95% target.Key Performance Indicators Report Page 2 of 2

University Hospital Southampton NHS Foundation TrustMonitor Compliance Framework - Foundation Trust Service Performance Aggregate ScoreApril 2012 to March 2013Executive LeadJane Hayward, Chief Operating OfficerTolerancesPredictedPredictedPredictedPredictedMonthQuarter to DateYear to DateMonthly TrendQuarterly TrendActionOn target Of concernrequiredG A RFoundationTrustWeightingScoreFoundation Trust - Service Performance Aggregate Score2012/13 Qtr 3Performance FT Score Performance FT Score Performance FT ScoreFTPerformanceScore2012/13 Qtr 4FTPerformanceScore2013/14 Qtr 1FTPerformanceScore2013/14 Qtr 2FTPerformanceScoreMar-12 Apr-12 May-12 Jun-12 Jul-12 Aug-12 Sep-12 Oct-12 Nov-122011/12Qtr 32011/12Qtr 42012/13Qtr 12012/13Qtr 2≥ 95% ≥ 94%

University Hospital Southampton NHS Foundation TrustPerformance Scorecard for 2012/2013Trust Executive Committee ReportApril 2012 to March 2013PerformanceQuarterly RAGTolerancesOn target Of concernActionrequiredG A RTargetMonthQuarter to DateYear to DateForecast FinalYear PositionApr-12 May-12 Jun-12 Jul-12 Aug-12 Sep-12 Oct-12 Nov-12 Dec-122011/12Qtr 32011/12Qtr 42012/13Qtr 12012/13Qtr 22011/12Qtr 32011/12Qtr 42012/13Qtr 12012/13Qtr 2≥ 95% ≥ 94% 5 to ≤ 6% > 6%≤ 4 hours> 4 to ≤ 5hours> 5 hours< 5% > 5 to ≤ 6% > 6%≤ 15minutes≤ 60minutes> 15 to ≤ 30minutes> 60 to ≤ 90minutes> 30minutes> 90minutes% patients spending less than 4 hours in A&E(SUHT alone, full year)95.0% 94.57% A 94.76% A 95.10% G G 93.49% 93.70% 96.70% 95.91% 94.21% 97.38% 94.86% 94.57% 95.18% 92.75% 94.65% 95.83% G R A GUnplanned re-attendence at A&E within 7 days oforiginal attendence (including if referred back by 5% 8.7% R 8.9% R 8.9% R A 8.9% 8.7% 8.8% 8.4% 9.1% 9.0% 9.3% 8.7% 2.6% 2.5% 2.6% 2.5% G G G Ganother health professional)Total time spent in A&E department - 95thpercentile≤ 4 hours 04:23 A 04:18 A 04:00 G G 04:54 04:49 03:59 04:00 04:35 03:59 04:14 04:23 04:00 05:22 04:25 04:00 G R A G% patients who left the department before beingseen5% 2.9% G 3.2% G 3.5% G G 3.3% 4.3% 3.8% 3.7% 3.8% 3.1% 3.4% 2.9% 3.2% 2.8% 3.7% 3.5% G G G GTime to initial assessment - 95th percentile≤ 15minutes00:02 G 00:03 G 00:06 G G 00:04 00:08 00:09 00:09 00:07 00:08 00:03 00:02 00:04 00:05 00:07 00:08 G G G GTime to treatment in department - median≤ 60minutes01:05 A 01:10 A 01:13 A A 01:14 01:12 01:17 01:20 01:14 01:09 01:14 01:05 01:12 01:07 01:14 01:14 A A A A≥ 93% ≥ 92%

University Hospital Southampton NHS Foundation TrustPerformance Scorecard for 2012/2013FinanceExecutive LeadAlastair Matthews, Director of Finance and InvestmentTolerancesPerformanceCumulative Position at the end of each MonthOn targetOf concernActionrequiredTargetNovemberYear to Date% VariationForecast FinalYear PositionApr-12 May-12 Jun-12 Jul-12 Aug-12 Sep-12 Oct-12 Nov-12 Dec-12 Jan-13 Feb-13 Mar-13G A RFinance (Foundation Trust Indicators on separate sheet)≤ 0% ≤ +10% >+10% Income and Expenditure (£000) (Pre Impairment)TBC TBC TBC G -125.3% -3% 16.1% -10.3% -1.1%favourableor 20%adverseCashflow (£000)TBC TBC TBC G -19.9% 63% 512.5% 348.6% -12.3%≤ 0% ≤ +4% >+4% Paybill (£000)TBC TBC TBC G -3.0% -2.2% -2.0% -1.9% -1.4%≤ 0% ≤ +10% >+10% Cost Improvement Plan (£000)TBC TBC TBC A 43.7% 18.2% 16.7% 10.4% 8.7%>10% fromPBL>10% fromLimitLimit FT - Annual debt service to Revenue2.5% 1.6% -36.0% G G -44.0% -44.0% -44.0% -36.0%Grow Defining Services (using 2012/13 M7 activity data comparedto 2011/12) (%)6.3% G GSLA Activity (Based on Production Plan)TargetOctober onlyYear to Date% VariationForecast FinalYear Position> 0% 0.5% 1% Total income (£000)Finance 257,217 -4.5% G 262,119 -1.3% G G 1.0% -6.4% 0.8% 0.4% -1.9%Payment of overperformance risk indicator (against Sales< £1m > £1m < £2m > £2m Finance TBC GPlan) (£000)Activity 63,407 -14.9% A 69,445 -9.5% A A -3.3% -11.5% 1.0% -1.8% -8.5%> 0% ±5% ±25% A&E Attendances (finance in £000)Finance 6,724 -19.4% A 7,549 -12.3% A A -3.6% -11.3% 0.4% -3.8% -9.7%> 0% ±5% ±25%Spells (inc PSD and short stay):ElectiveActivity 38,385 -4.8% G 37,129 3.3% G G 11.2% -4.1% 8.0% 5.7% 3.3%Finance 62,247 -4.5% G 58,751 5.6% A A 12.8% -1.2% 11.1% 8.5% 6.7%> 0% ±5% ±25%Spells (inc short stay):Non-ElectiveActivity 34,475 -11.0% A 37,653 -9.2% A A -3.8% -14.5% 1.7% -2.0% -9.8%Finance 74,863 -6.4% A 79,566 -6.3% A A -3.0% -13.2% 1.5% -0.8% -7.3%> 0% ±5% ±25%OutpatientsActivity 265,049 -8.0% A 272,914 -3.0% G G -6.9% -27.1% 3.3% 1.3% -2.5%Finance 31,212 -11.1% A 32,387 -3.8% G G 3.9% -14.4% 3.1% -0.2% -2.9%> 0% ±5% ±25%Excess bed-daysActivity 24,243 -5.9% A 23,741 2.1% G G -2.7% -9.9% -5.4% -3.2% 0.6%Finance 6,195 -3.3% G 6,011 3.0% G G 1.9% -12.2% -4.9% -3.2% 0.9%> 0% ±5% ±25%ICU and HDU bed day usage (finance in £000),incorporating WIP adjustmentActivity 28,655 11.3% A 27,870 2.7% G G -6.8% 7.6% 1.4% 1.2% 1.7%Finance 28,278 2.1% G 28,490 -0.8% G G -16.4% 3.0% -2.2% -4.0% -2.3%All negative variances (finance and activity) are favourable and positive variances are adverse

Appendix 2Exception Reports – November 2012Patient PathwayEmergency DepartmentCommentsPerformance against the 4 hour standard remains a considerable concern in Q3. A detailed action plan is monitored daily by the COO team – actions include increasednursing, medical and senior management staff, increased weekend diagnostic support and improved emergency patient pathways. In addition to regular operationalreviews a high level oversight group including the CEO and Non Executive Director are meeting regularly.Key Performance Indicators Report – Appendix 4Page 1 of 1

UNIVERSITY HOSPITAL SOUTHAMPTON NHS FOUNDATION TRUSTTrust Key Performance IndicatorsNovember 2012Report to: Trust Board – 18 December 2012Report from:Sponsoring Executive:Aim of Report /Principle Topic:Review History to date:Recommendation(s):Directors TeamJane Hayward, Chief Operating Officer on behalf of Trust ExecutiveDirectorsProvides a summary of the Trust’s performance against a range of highlevel internal key performance indicators agreed by Trust Board.Regular report to Trust Board, TEC do not review this report, the proposednew format is attached as requested.Trust Board are asked to note the Key Performance Indicators Report andconsider whether there is appropriate assurance regarding current andfuture performance.1. Strategic ContextA range of high-level indicators to give an overview of performance within the Trust and to support thedevelopment of the Intelligent Board principles within the organisation.2. Supporting GuidanceA supporting document which provides guidance on the information contained within this report, andhow it should be interpreted, is available upon request. Such information has been removed from themonthly report in order to reduce its length, and to enable better focus on the reported performance /actions.3. Scorecard and Indicator Changes3.1 Quality Indicator Pyramid – Early Alert – October 2012 positionKey Performance Indicators Report Page 1 of 2

Monthly MeasuresPatient ExperienceHow would you rate the care you received?Patient SafetySerious Incidents Requiring Investigation (SIRI)Patient OutcomesUnadjusted Mortality RateClinical EffectivenessReadmission Rate (28 days)Staff ExperienceSickness AbsenceClinical EfficiencyTrust Inpatient Bed Occupancy (%)Financial EfficiencyCost Improvement PlanFinancial ManagementIncome and ExpenditurePatientExperiencePatient SafetyPatient OutcomesClinical EffectivenessStaff ExperienceClinical EfficiencyFinancial EfficiencyFinancial Management‣The summary action plan for Staff Experience can be found in Appendix 2 of the Trust BoardKey Performance Indicator report.4. Performance as at the end of November 2012 (Appendices 1)The scorecards showing current performance can be found in Appendices 1. The summaryaction plans to support the Red Indicators are included as Appendix 2.5. ConclusionsTrust Board are asked to note the Key Performance Indicators Report and consider whetherthere is appropriate assurance regarding current and future performance.Key Performance Indicators Report Page 2 of 2

Appendix 1Summary Risk Assessment of Key Performance Indicators as at the end of November 2012Please Note: These about RAG ratings show the risk assessment for the key Trust performanceindicators. These may differ from the individual monthly, quarterly and YTD RAGs but highlightareas of concern.% Appraisals1. WorkforceCompleted2. Patient Experience3. Patient Safety4. Patient Flow and OutcomesSickness AbsenceSurvey - Overallsatisfaction withcareTurnover(excluding Percentage Junior ofDoctors) complaints closedin target timeSurvey -Recommendhospital to familyand friendsNutrition - %Patients withMUST Screeningin 24 hoursSurvey - SameSexAccommodationMRSAbacteraemiareductionNever EventsClostridiumdifficile reductionSerious IncidentsRequiringInvestigation(SIRI)Pressure Ulcers(Grades III and IV)No. of Falls% Pts spending90% of time onStroke UnitHigher Risk TIAcases seen within24 hoursRe-adsmissionswith 30 daysHospitalStandardisedMortality Rate(HSMR) - UHStotal% Patients VTEAssessedTotal WorkforceSigned off by(FTE)the Director of Nursing Signed off by the Director of Nursing Signed off by the Director of Nursing Signed off by the Medical Director and ChiefOperating Officer5. R&Dand to targetTotal recruited toNIHR portfoliocommercialstudiesTotal recruited toNIHR portfolio noncommercialstudies (excl. % of studiesband 1)% of NIHRportfolio studiesrecruiting on timeachieving NHSpermission within30 days of receiptof application.Income fromcontractcommercialstudiesDamage/Misuse -Number ofBreakdownsTotal noncommercialincome% Maintenancecompleted withinplanned time6. Estates% PlannedMaintenanceCompleted -MandatorySystem Reliability% PlannedMaintenanceCompleted -Statutory7. IM&T ‐ Updated QuarterlyReportingReliabilityTraining NeedsAnalysisMandatoryTraining8. Education ‐ Updated QuarterlyE-prescribing% PlannedProjectEvaluation ofSigned off by the Medical Director Signed off by the Director Maintenance of Finance Signed off by the Director of IM&T Signed off by the DirectorClinicalof NursingCompleted - GoodPlacementsPracticeExternalAccreditationVisitsEffective Use ofEducationBudgetsEnc 8 ii Appendix 1 Key Performance Indicators Page 1

Appendix 2Exception Reports – November 20121. WorkforceAppraisals Completed (non-medical)Current Performance:Target (12 MonthRolling Average)Month ((12 Month Rolling Average)Next Month Forecast≥ 90% 88.54% A AExplanation of Performance Actions Previous PerformanceRolling average appraisal levels have increasedmarginally to 89% but still remain 1% below target of90%.Performance support through DivisionalHR Business Partners and DDOS. Lowperforming areas to be addressed withperformance plansUHSFTAppraisals Completed (non-medical)95%90%Letter from Director of Nursing and OD toDivisions regarding performance.85%80%Regular monthly provision of performanceinformation on outstanding appraisals.Performance levels discussed duringOctober Divisional Performance Reviews75%70%65%60%55%Dec-11Jan-1 2Feb-12Mar-12Apr-12May-12Jun-12Jul-12Aug-12Sep-12Oct-12Nov-12Sickness AbsenceCurrent Performance:Target (12 MonthRolling Average)Month ((12 Month Rolling Average)Next Month Forecast≤ 3.35% 3.64% A AExplanation of Performance Actions Previous PerformanceKey Performance Indicators Report – Appendix 2 Page 1 of 7

Appendix 2Exception Reports – November 2012Staff sickness absence has risen since February 2012to a rolling average of 3.64%. There has been someimprovement in the rolling average rate since October2012.Turnover (excluding junior doctors)Specific resource being focused on sicknessabsence. Long term cases being reviewedand action plans being developed to expediteconclusion where possible.Employee assistance programme launchedduring July by OH with good feedback andusage by early users of system.Continued coaching and training for managerson sickness absence. Regular training slotsto be made available to line managers during2013.Increased provision of information tomanagers through E-rostering systemSickness discussed during DivisionalPerformance Reviews in OctoberAgreed report o Audit and Assurance inJanuary 20133.8%3.7%3.6%3.5%3.4%3.3%3.2%3.1%3.0%UHSFTSickness Absence (rolling 12 months)Dec‐11Jan‐12Feb‐12Mar‐12Apr‐12May‐12Jun‐12Jul‐12Aug‐12Sep‐12Oct‐12Nov‐12Current Performance:Target (12 MonthRolling Average)Month(12 Month Rolling Average)Next Month Forecast≤ 9.4% 10.13% A AExplanation of Performance Actions Previous PerformanceKey Performance Indicators Report – Appendix 2 Page 2 of 7

Appendix 2Exception Reports – November 2012Slight decrease in turnover average following theincrease attributable to seasonal trends.Continue to monitor turnover against otherindicators of staff satisfaction.UHSFTTurnover (excluding junior doctors) (rolling 12 months)Consideration of purchase of electronic exitquestionnaire to provide increased intelligenceon underlying turnover reasons.10.8%10.6%10.4%10.2%10.0%9.8%9.6%9.4%9.2%9.0%Dec-11Jan-12Feb-12Mar-12Apr-12May-12Jun-12Jul-12Aug-12Sep-12Oct-12Nov-124. Patient Flow and OutcomesStandardised Hospital Mortality (reported a month in arrears)Current Performance:TargetMonthForecast Year EndPosition< 100 107.6 A GCommentsMortality and HSMR are reviewed in detail each month, and report and actions are included in the detailed quarterly clinical effectiveness and outcomes report toTrust Board (See November papers). Actions remaining in place include:Divisional Clinical Directors to ensure accurate recorded primary diagnosis and co morbidity recording for all patients by all clinical teams.Division A to continue to monitor percentage of non-elective admissions to CMH.Clinical leads to investigate the four patient safety indicators and ensure that the system for clinical validation is embedded effectively.Key Performance Indicators Report – Appendix 2 Page 3 of 7

Appendix 2Exception Reports – November 20125. Research and DevelopmentTotal number of patients recruited to NIHR portfolio non-commercial studies (excluding band 1)Current Performance:Year End Target Latest Month Year To Date Year End Forecast7990 646 G 2936 R GExplanation of PerformanceRecruitment to non-commercial studies is on target for the month, but remainsbelow target for the year to date.Total number of patients recruited to NIHR portfolio commercial studiesActionsThe Research and Development Steering Group (RDSG) is reviewing time totarget metrics to ensure recruitment to portfolio non commercial studies.A Study Delivery Group, led by the Senior Research Nurse Manager, identifiesrecruitment issues and escalates / resolves problems.The R&D Information Manager is reviewing open studies UHS could potentiallyparticipate in.The R&D Governance Manager is reviewing new studies for which UHS is Sponsorto ensure adoption to the portfolio.Current Performance:Year End Target Latest Month Year To Date Year End Forecast610 28 R 214 R GExplanation of PerformanceRecruitment to commercial portfolio studies is also below target.ActionsThe Research and Development Steering Group (RDSG) is reviewing time totarget metrics to ensure recruitment to portfolio commercial studies.A Study Delivery Group, led by the Senior Research Nurse Manager, identifiesrecruitment issues and escalates / resolves problems.The appointment of a Commercial Research Manager (seconded from Novartis) inAugust will also bring new insight into strategies for recruitment, by assisting inquicker start up times therefore allowing for improved recruitment opportunities.Key Performance Indicators Report – Appendix 2 Page 4 of 7

Appendix 2Exception Reports – November 20126. Estates% Planned Maintenance – Completed StatutoryCurrent Performance:Target (YTD) Month Year to Date (actual)Forecast Year EndPosition≥ 90% 98% G 78% R AExplanation of Performance Actions Previous PerformanceThe completed statutory PPM for this month has againincreased to 98% up from 92% in October.% Planned Maintenance – Completed MandatoryA thorough review of the operational maintenanceworking practice is continuing, this review includes allPPM.The developed implementation plan targeting statutoryand mandatory PPM maintenance items has continuethe good progress shown in the last few months, theimplementation plan has enabled statutory andmandatory PPM to be carried out in a more timelyfashion.Dedicated works teams have been introduced solelyfor statutory and mandatory works; this has helpedimprove the performance figures.Vacant posts are being advertised.TBCCurrent Performance:Target (YTD) Month Year to Date (actual)Forecast Year EndPosition≥ 90% 97% G 84% A AExplanation of Performance Actions Previous PerformanceGood progress is continuing, the performance hasincreased again for this month to 97% up from 91% inOctober.The developed implementation plan targeting statutoryand mandatory PPM maintenance items has continuethe good progress shown in the last few months.TBCKey Performance Indicators Report – Appendix 2 Page 5 of 7

Appendix 2Exception Reports – November 2012% Planned Maintenance – Completed Good PracticeCurrent Performance:Target (YTD) Month Year to Date (actual)Forecast Year EndPosition≥ 80% 89% G 71% A AExplanation of Performance Actions Previous PerformanceProgress has been made with the Good practicemaintenance completed for November, increasing to88% (October 87%)Damage / Misuse Number of breakdownsA thorough review of the operational maintenanceworking practice is continuing.Current Performance:Target (Monthly) Month Year to Date (actual)Forecast Year EndPosition≤ 21 31 R 327 R AExplanation of Performance Actions Previous PerformanceDamage / Misuse number of breakdowns forNovember was 31, a reduction from last month, 52 forNovember.Analysis of the numbers of breakdowns and misusejobs has shown that they are fairly insignificant incomparison with the total number of reactive jobs,The following information identifies the percentage ofdamage/ misuse calls compared to the total number ofreactive calls per month:MonthNo. of No. ofCalls MisusePercentageApr 12 1786 35 1.96%May 12 1976 45 2.28%Jun 12 1756 43 2.45%Jul 12 1936 45 2.32%Aug 12 1909 35 1.83%Sep12 1701 37 2.18%Oct 12 2228 52 2.33%Nov 12 2090 31 1.48%The overall average percentage from April is 2.10%Key Performance Indicators Report – Appendix 2 Page 6 of 7

Appendix 2Exception Reports – November 201210. Research and DevelopmentTotal number of patients recruited to NIHR portfolio non commercial studies (excluding band 1)Current Performance:Year End Target Latest Month Year To Date Year End Forecast7990 330 R 3079 R GExplanation of PerformanceRecruitment to non-commercial studies remains below target for the year to date.Total number of patients recruited to NIHR portfolio commercial studiesActionsThe Research and Development Steering Group (RDSG) is reviewing time totarget metrics to ensure recruitment to portfolio non commercial studies.A Study Delivery Group, led by the Senior Research Nurse Manager, identifiesrecruitment issues and escalates / resolves problems.The R&D Information Manager is reviewing open studies UHS could potentiallyparticipate in.The R&D Governance Manager is reviewing new studies for which UHS is Sponsorto ensure adoption to the portfolio.Current Performance:Year End Target Latest Month Year To Date Year End Forecast610 45 A 265 R GExplanation of PerformanceRecruitment to commercial portfolio studies is also below target.ActionsThe Research and Development Steering Group (RDSG) is reviewing time totarget metrics to ensure recruitment to portfolio commercial studies.A Study Delivery Group, led by the Senior Research Nurse Manager, identifiesrecruitment issues and escalates / resolves problems.The appointment of a Commercial Research Manager (seconded from Novartis) inAugust will also bring new insight into strategies for recruitment, by assisting inquicker start up times therefore allowing for improved recruitment opportunities.Key Performance Indicators Report – Appendix 2 Page 7 of 7

Board Paper Cover SheetTitle IM&T Report - Nov 2012Date Trust Board – 18 th December 2012Sponsoring ExecutiveAuthors’ names & JobtitlesPurpose of the paperRecommendationMark HackettAdrian Byrne -Director IM&TQuarterly report1. That trust board notes the progress on the IM&Tstrategy and work planLinks to Trust Annual Plan (please mark in bold)Objective 1. Trusted on QualityObjective 2. Delivering for Tax payersObjective 3. Excellence in HealthcareLinks to Trust Risk Register/ Board Assurance Framework (please providedetails of the risks associated with the subject of this paper):Risk Register ReferenceRisk DescriptionFinancial and resource implications / impactn/aLegal implications / impactn/aEquality and Diversity implications / impactn/aPartnership working and public engagement implication / impactA key piece of work with Microsoft HealthVault in engaging patients in the on-lineaccess of UHS services is requiring work with commissioners, as well as directaccess to patient groups including trust members.Other committees / groups where evidence supporting this paper has beenconsideredTrust Executive Committee – 7 th December 2012.1

IM&T Report – Nov 20121. Purpose1.1. This is the quarterly IM&T report on progress with the strategy1.2. The 3 year IM&T strategy was refreshed and brought to the board in Aug 2012. Theagreed themes are drawn down from the national document “Power of Information”which talks about: delivering better information to clinicians through “connectedinformation”; delivering information to patients; and using quality information to planservices. The trust IM&T strategy will deliver better: Information for clinicians Information for patients Information for managers1.3. The focus, as previously, will be on achieving paper-light working, standardization,co-production and decision support within systems.1.4. The strategy aims to deliver: High quality patient care by improving decision making and increasing patientsafety. A reduction in the cost of creating, handling and storing data.2. Key Issues2.1. Information to support cliniciansEPMA(ePrescribing)DWL (DoctorsWork List)ElectronicDocumentManagement(EDM)The rollout has gone to plan and is live across medicine, T&O and hasalmost completed in surgery. The team are reporting a positiveresponse from staff particularly nursing. The system is having abeneficial effect on bed position due to the need to have the patient inthe ward to administer the drugs. A report to the project steering groupindicated elimination of errors around the prescribing of anticoagulants.The project is moving into a more operational mode andIM&T need to focus on the benefits now particularly around decisionsupport development.The product to support patient treatment has been rolled out acrossthe trust (paediatrics and cancer still remain). This is now also beingused to deliver CQUIN data requirements for VTE and dementia, keytargets this year. DWL has become the EPR portal for inpatient workand developments are coming forward to bring in other staff groups (are-branding “the patient treatment manager”). Doctors can now use theDWL to access/update all EPR information on a patient including theHampshire Health Record (HHR), and also to drop into their own truste-mail account. They can open a prescribing window and complete adischarge summary, bringing the TTO drugs forward into that.A business case is almost complete for the introduction of a EDM forclinical functionality that will support paper-light outpatients, clinicalcoding and library down-sizing. The objective is to build a platform forall future EDM needs including non-clinical e.g. finance and HR. It isexpected that this piece of work will request approval from TEC earlyin the new year (2013).2

Acuity systemICU systemCancer systemDecision supportOther providersupportPACSPathologyIt has been agreed [at ISSG] that a limited deployment of an acuitysystem should go ahead to prove the benefits. The business case sitswith the medical and nursing teams, whilst IM&T are in discussionswith the preferred product supplier about the scalability of their costmodel.Discussions ongoing about the presentation of a business case. Needto ensure that any system recommended will cater for all ICU areasplus any HDU needs. The UHS suite including order communications(eQuest), EPMA, and the eDischarge summary, make the integrationissues larger for a system that will inherently do these things, as manyITU systems will. Further market research is ongoing re integrationcapabilities of available products.There is no change in the status of UHS cancer systems. Ascribe, thesupplier of the current system is investigating the possibility ofproductizing what UHS has. A widely used cancer dataset system isalso being checked for suitability to deploy within the UHS systemsmix. In palliative care, a new system has been procured that willreplace the deprecated system that was in use in that area.Minor work has been started in this area with the introduction of EPMAand the subsequent work to bring some of the data forward into webviews. UHS development team is currently over committed withintegration work in EPMA, the new PACS system, and a migration ofthe enterprise integration platform. The EPMA business caserecognized a need to put development time into this area of work andit is time to consider the introduction of that development under thedirection of the medical teams and the lead responsibility for IT.There is no indication that Solent or Southern Health are going todepart at this stage from a strategy of combined EPR products.Southern Health have also indicated they are willing to buy in to theEDM proposals from UHS. This is on-going and will be monitored.Preferred bidders are announced for the RIS/PACS consortium(Salisbury, Southampton, Portsmouth, IoW, Solent and SouthernHealth). Radiology (RIS) will be HSS CRIS PACS will be Sectra Vendor neutral archive will be Acuo Hosting and sharing will be Phillips with Burnbank and ForcareA single contract will be let and managed for the consortium.Work has started with the letter of intent in place.The plan is to be live before the end of the current contract in June2012The consortium for the service presents a risk to the UHS IM&Tarchitecture and integration. The required timescales and [lack of]progress to date are adding to this. UHS IM&T are contributing to thework, but a clear direction on a number of key issues such as wherethe system sits and how the service wider than the LaboratoryInformation Management System (LIMS) is to be provided, arerequired.3

2.2. Information to support patientsMy health record(HealthVault)Two pathways (IBD and gestational diabetes) are live on the system.Clinical staff are actively recruiting patients and various ways are beingexplored to encourage take-up. The system is technically proven.Development resources are currently directed at general outpatientsfunctions such as appointments management, where it is felt the trustcan start to scale up users quickly into large numbers. At this point thefocus will start to concentrate on engaging patients in some of thetransactional activity i.e. data entry in forms.2.3. Information to support managersInformationstrategyQlikview projectAlthough the information strategy is directed to serve all staff groupsand purposes it has been reported under an information for managersheading.The information manager, Richard Brooker, has been communicatingthe strategy with divisional teams via one-to-one meetings, caregroups and divisional boards.The feedback is being used to inform the future direction for theQlikview development, which is the strategic tool for delivery ofinformation to the desktop.A steering group is to be set up, chaired by the director ofperformance.A working system is now available for demonstration and comprisesdashboards for ED and RTT data. The development times of theinformation and the ability to provide refreshed and up-to-dateinformation are proving that the product is a good fit with what the trustwishes to achieve.Following the current round of demonstrations, and the steering groupbeing set up, a development and roll out plan will be published.2.4. InfrastructureIntegrationplatformDesktop productsNetwork upgradeThe scoring has been completed and the technical preferred producthas been identified. This must be in place to complete the interfacesfor the new PACS system.Licences have been an issue with Microsoft since the breakup of theenterprise agreement (EWA) in 2010. Discussions are on-going butUHS has stabilized its current position with regard to use. A session isplanned for a trust board study session to demonstrate the newcapabilities such as messaging and video conferencing. This will beused to inform assessment of future business cases.In order to achieve best value for future network developments, theplan to upgrade both the wired and wireless network, plus firewallproducts, has been included in the service renew for the overallnetwork support. This is currently out for reprocurement under OJEU.4

2.5. RiskThere are no critical (16+) risks in the IM&T register currently, and none that are significantlyincreasing. Oracle licences are in the same round of negotiations as those for Microsoft,being also subject to an EWA that will expire in 2014. This however is being mitigated bydiscussions currently and the score will be revised downwards following indications of apositive outcome. It is currently felt the level of exposure can be handled within existingIM&T plans.2.6. ReliabilityThe IM&T department has had one significant outage in this period. The pathology databasesuffered a problem that caused it to shut down on 13 th November. This was supported bythe supplier (Clinisys) for the afternoon and overnight, when staff from IT and pathology(pathology IT manager) were also working on the problem. The system was out of action foraround 12 hours during which time electronic orders were not being passed to the system.The analysers were carrying out the work but urgent results had to be phoned. Messagequeues took most of the following day to catch up.Investigations by IT and the supplier have not indicated what caused the problem, but somerecommendations have been made about monitoring, which will be acted upon.The pathology system is a very reliable platform and the data showed that the hardware hadbeen “up” for more than 400 days without a reboot since the last scheduled maintenance.Pathology and IT will consider however whether more frequent scheduled re-boots would bebeneficial.3. Next Steps / Way Forward3.1. The main pieces of work in the next period are as followsEPMAComplete the adult roll out and plan for paediatrics. Hand over tooperational working. Plan for decision support developmentsDWLDevelopment of the multi-professional patient treatment managerEDMBusiness case to be presented to TECAcuity system Business case is expected to TEC in Feb 2013 (not IM&T)PACSContracts will be signed and installation will be in full flow. Level ofconfidence is proposed dates will be firmed up as tasks are completed.PathologyA procurement exercise is expected to startInformationstrategyA steering group for this piece of work and a plan for delivery. Somelive use of the Qlikview system.IntegrationplatformDesktop productsNetwork upgradeStrategycommunicationProcurement of the new platform will be completeA session will be set up for trust board study session as a part ofdemonstrating the “future hospital”Procurement of a new network support contractA trust board study session is being arranged (Jan) to discuss the itemraised at the IM&T strategy presentation to board regarding theoptions for IM&T spend (less/more). This will be supported by thesession including Microsoft looking at future technologies.4. Recommendation4.1. That trust board notes the progress on the IM&T strategy and work plan.5