Integrated Performance Report: Month 2€¦ · May 2017. 1.5. Performance on the 62 day cancer wait...

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Trust Board Meeting: Wednesday 12th July 2017 TB2017.66

Title Integrated Performance Report: Month 2

Status For information.

History The report provides a summary of the Trust’s performance against a range of key performance indicators as agreed by the Trust Board.

Board Lead(s) Mr Paul Brennan, Director of Clinical Services

Key purpose Strategy Assurance Policy Performance

Oxford University Hospitals NHS FT TB2017.66

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Executive Summary

1. The Cancer 62 day wait standard was met in April 2017 for the first time since June2016, reflecting sustained effort across several Trust services.

2. The two week wait and 62 day screening standard were not met in April, the formerbecause of breaches for Lower GI patients.

3. Diagnostic waits returned in May 2017 to meeting the national six-week standard.

4. Four-hour wait performance in May 2017 was 86.4%, down from 88.8% in April 2017.This was below the trajectory level of 90% but Emergency Department (ED)attendances and emergency admissions for the month were both up on the sameperiod one year earlier.

5. Bed occupancy in the Trust’s acute beds remained high and delayed transfers of carein OUH beds continued at above 100 as they have since January.

6. Performance against the 92% Referral to Treatment Time (RTT) Incomplete standardimproved to 90.12% at the end of May 2017, though the waiting list continued to growand can be expected to continue to do so until activity levels match the levels requiredto keep pace with referrals.

7. Elective and outpatient activity was above plan in April and May.

8. Seventeen people were waiting for treatment for over 52 weeks on Incompletepathways at the end of May 2017.

9. Vacancies and turnover were above plan in May 2017 while sickness absence waswithin the Trust’s target.

10. Performance is reported against waiting time trajectories in place with NHSImprovement and provided to the Board in March 2017.

11. RecommendationThe Board is asked to receive the Integrated Performance Report for Month 2.


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Integrated Performance Report: Month 2 (May 2017)

1. Key headlines on performance1.1. In May 2017, 1,861 people waited over four hours in Oxford University Hospitals’

Emergency Departments. The number of over four hour waits per day was up from 45 per day in April to 60 per day in May.

1.2. Four-hour wait performance in May 2017 was 86.4%, down from 88.8% in April. In both months, performance was below the trajectory level of 90%, but attendances at the Trust’s Emergency Departments were up on the same period in 2016, by 1.4% in April and 1.8% in May. An average of 441 ED attendances per day took place in May 2017.

1.3. Bed occupancy has remained high since late April, with on average over 92% of the Trust’s general and acute beds (excluding maternity, neonatal and day case beds) being occupied at midnight during May.

1.4. The number of patients delayed in OUH beds awaiting transfer to care in another setting remained well above the level seen in December 2016, reaching 135 -in late May 2017.

1.5. Performance on the 62 day cancer wait standard improved in April 2017 to meet the national standard. 132 of 153 patients receiving first treatment in April after urgent GP referral did so within 62 days of referral, performance of 86.3% against the 85% standard. The two week wait and 62 day screening standards were not met in April.

1.6. Elective inpatients were below plan in April and May 2017, but elective admissions overall and outpatients were above plan for the two months. Performance against the RTT standard improved slightly in May 2017, though the waiting list continued to grow and can be expected to continue to do so until activity levels match the levels required to keep pace with referrals.

1.7. 0.76% of patients having diagnostic tests or imaging in May had waited for over six weeks. The standard of no more than 1% of patients waiting for over six weeks was met again, having been achieved in eleven months of 2016/17.

1.8. An incident meeting national criteria for reporting as a Never Event was reported to local and national authorities on 24 May 2017. This is described within the Board Quality Report.

1.9. One case of MRSA bacteraemia was reported in April, but none in May. Seven cases of Clostridium Difficile were reported in May, above the trajectory for the month, although the year to date level was within the trajectory.

1.10. VTE performance improved further to 97.78%, remaining above the 95% standard.

2. Areas of exception on performanceCancer

2.1. Two of the eight national cancer standards were not met. 2 week waits

2.2. 92.4% of patients referred from a GP with suspected cancer were seen within 2 weeks of referral, below the 93% standard.


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2.3. As can be seen from Chart 1, this was largely due to waits in Lower Gastrointestinal (LGI). A LGI Cancer Improvement Plan has been developed with the multidisciplinary team. Two week wait booking and tracking processes have been reviewed and amended to ensure the timely processing of referrals. Chart 1: 2 week wait performance by tumour site, April 2017, showing numbers seen after 14 days

62 day waits - screening 2.4. The second standard not met was for treatment within 62 days from screening

referral. With half patients recorded to reflect shared accountability between referring hospitals and OUH as a Cancer Centre, of 14.5 patients whose treatment OUH was accountable for in April 2017, 1.5 patients waited longer than 62 days for first treatment. This took performance to 89.66%, below the 90% standard. 62 day waits from GP referral

2.5. In April 2017, the 62 day wait standard from urgent GP referral with suspected cancer was met for the first time since March 2016. This represented a continued improvement since January 2017. OUH had better performance on this standard than the national average in both April and May 2017.

2.6. Tumour sites contributing to the 21 patients waiting over the 62 day standard are shown in Chart 2 below. It should be noted that breaches of this standard in the Urological pathway have reduced from 10.5 in March. Significant work has been done and continues to be done in multiple tumour site groups and in diagnostic services to achieve this standard.

64 18

13 11

8 2

2 2

1 1

0 50 100 150 200 250 300 350 400 450

Suspected lower gastrointestinal cancer

Suspected upper gastrointestinal cancer

Suspected urological malignancies (excluding…

Suspected gynaecological cancer

Suspected breast cancer

Suspected head & neck cancer

Suspected lung cancer

Suspected haematological malignancies…

Suspected skin cancer

Suspected brain/central nervous system tumours

Suspected children's cancer

Suspected sarcoma

Suspected testicular cancer

Within 14 days After 14 days


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Chart 2: 62 day waits to first treatment from urgent GP referral, April 2017, showing breaches by tumour site

31 day waits for first treatment

2.7. This standard was met in April 2017. Chart 3 below shows the number of breaches by tumour site, indicating that Lower GI and Urological are the only tumour sites with breaches of this standard. Chart 3: 31 day waits by tumour site, April 2017, showing numbers of breaches

Overall position on national cancer standards 2.8. The position in April compared to that for NHS England is shown in Table 1 below. Table 1: OUH performance against national cancer standards and England comparison

Standard OUH performance England Oct-16 Nov-16 Dec-16 Jan-17 Feb-17 Mar-17 Apr-17 Apr-17

At least 93% of patients referred from a GP with suspected cancer will be seen within 2 weeks of referral.

93.0% 91.8% 94.5% 91.8% 89.1% 96.4% 93.5% 92.4% 92.8%

At least 93% of patients referred from a GP with breast symptoms but not suspected cancer will be seen within 2 weeks of referral.

93.0% 91.7% 85.8% 83.3% 94.7% 98.2% 99% 100% 89.7%

At least 96% of patients will receive first definitive treatment within 31 days of a decision to treat.

96.0% 92.3% 93.3% 96.80% 94.6% 96.5% 97.5% 98.4% 97.4%

4

3

5

2.5

6.5

0 10 20 30 40 50 60

Breast

Lower Gastrointestinal

Lung

Other

Skin

Urological (Excluding Testicular)


30 31

38 49

69 84

3

2

0 10 20 30 40 50 60 70 80 90

LungLower Gastrointestinal

BreastSkin

UrologicalOther



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Standard OUH performance England At least 85% of patients will receive their first treatment within 62 days of referral from a GP.

85.0% 68% 74.4% 77.7% 66.1% 78.4% 83.5% 86.3% 82.9%

At least 94% of patients will receive subsequent treatment with surgery within 31 days of decision to treat.

94.0% 98.1% 89.9% 95.7% 96% 96.2% 96.6% 94.4% 95.4%

At least 98% of patients will receive subsequent treatment with anti-cancer drug regimen within 31 days of decision to treat.

98.0% 98.6% 100% 100% 98.8% 100% 100% 100% 99.4%

At least 94% of patients will receive subsequent radiotherapy within 31 days of a decision to treat.

94.0% 97.8% 98.2% 98.5% 98.3% 99.5% 98% 98.8% 96.9%

At least 90% of patients will receive their first treatment within 62 days following referral from a screening service.

90.0% 95.2% 100% 88.9% 98% 100% 93% 89.7% 93.1%

4 hour waits 2.9. 4 hour wait performance reached 94.1% in the second week of April but reduced to

82.9% on the first Bank Holiday weekend of May. 2.10. Four-hour wait performance for the month of May 2017 was 86.4%, down from 88.8%

in April 2017.

Figure 1: 4 hour wait performance by week, OUH, weeks ending 4 December 2016 - 11 June 2017

2.11. Emergency Department attendances and emergency admissions both reduced in April from the peak seen in March, but rose in May, which contained the three weeks with the highest total ED attendances at the Trust for the calendar year to date. Attendances have appeared to remain high during June.

Figure 2: ED attendances, weeks ending 4 December 2016 - 11 June 2017

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2.12. Emergency admissions were lower in late April but grew in May.

Figure 3: Emergency admissions (all sources), weeks ending 4 December 2016 - 11 June 2017

2.13. Delayed transfers have run at or slightly above 100 since mid-April and reached 135 on 25 May, a reduction from the peak of 156 seen on 9 March but still above the level expected. The last time there were fewer than 100 patients delayed awaiting transfer from OUH beds was in the week ending 5 January 2017.

Figure 4: Delayed transfers of care, OUH beds (weekly snapshot, all commissioners)

2.14. A high level of vacancies and high turnover of staff are causing a reduction in bed and theatre capacity, which is exacerbated during peak holiday times. RTT Performance

2.15. 52,622 people were waiting for elective treatment by OUH at the end of May 2017, representing a continuation of the growth in the waiting list seen since June 2016. Of these, 5,197 had been waiting for over 18 weeks, up slightly from 5,155 at the end of April. Performance against the RTT Incomplete standard improved slightly to 90.12%, above the trajectory figure for May.

2.16. At the end of May 2017, 17 people were waiting for treatment for over 52 weeks on incomplete pathways, 16 for Gynaecology and one for Paediatric Neurology. Waiting times: component waits

2.17. As can be seen from Table 2 below, seven specialties did not meet the RTT Incomplete standard in May 2017, with Gynaecology having the most >18 week waits.

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Table 2: RTT Incomplete pathways by specialty and waiting time in weeks, May 2017

Incomplete pathways

<18 >18 >52 %

Cardiology 2135 65 97.05%

Cardiothoracic Surgery 161 7 95.83%

Dermatology 2441 105 95.88%

ENT 2471 560 81.52%

Gastroenterology 2224 228 90.70%

General Medicine 71 2 97.26%

General Surgery 1471 54 96.46%

Geriatric Medicine 224 1 99.56%

Gynaecology 2601 928 16 73.37%

Neurology 1316 108 92.42%

Neurosurgery 563 75 88.24%

Ophthalmology 4283 363 92.19%

Plastic Surgery 886 97 90.13%

Respiratory Medicine 1065 10 99.07%

Rheumatology 1037 14 98.67%

Trauma & Orthopaedics 4551 818 84.76%

Urology 1525 150 91.04%

Other 18400 1595 1 92.02%

Grand Total 47425 5180 17 90.12%

Elective activity 2.18. A template to report on activity against plan has been developed with Divisions and

in liaison with NHS Improvement’s Elective Care Intensive Support Team, who are continuing to provide support to the Trust’s analysis and delivery of its RTT plans.

2.19. Activity against plan for April and May 2017 was as follows:

Apr-17 May-17 Year to date Plan Actual Variance Plan Actual Variance Plan Actual Variance

New outpatients 23,072 23,735 2.9% 26,917 28,408 5.5% 49,989 52,143 4.3%

Day cases 4,491 4,650 3.5% 5,230 5,567 6.4% 9,721 10,217 5.1%

Elective inpatients 1,809 1,774 -1.9% 2,107 1,933 -8.3% 3,916 3,707 -5.3%

Total admissions 6,300 6,424 2.0% 7,337 7,500 2.2% 13,637 13,924 2.1%

Endoscopies 1,214 1,224 0.8% 1,415 1,384 -2.2% 2,629 2,608 -0.8%

Table 3: elective activity against plan, April 2017

2.20. Plans for April took account of the reduced number of working days in the month. 2.21. Activity above plan for new outpatients took place in all specialties except

Orthopaedics, where the reasons for the apparent variance are being checked. 2.22. Activity was marginally below plan in endoscopies in May 2017 and below plan in

elective inpatients for April and May 2017, but above plan in day cases and above plan for elective admissions as a whole. Outpatient activity was also above plan.

2.23. Data on referrals will be reported to future meetings.


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2.24. Appendix 2 provides information about elective activity against plan for April and May 2017. A Trust-wide summary is given, with separate sheets for the clinical Divisions and for the nine specialties with the most patients waiting over 18 weeks as at 31 March 2017. The forward plan shows activity agreed for July-September 2017. Planned activity from September will be adjusted by the time of the next Board meeting to incorporate as a recurring baseline the additional activity agreed for July-September.

3. Access standards: performance trajectories2017/18

3.1. Performance to date in 2017/18 against the first six months of trajectories in place for the year is shown below.

Emergency Care: 95% of patients will wait no more than four hours from arrival to admission, transfer or discharge

Apr-17 May-17 Jun-17 Jul-17 Aug-17 Sep-17 >4 hour waits - plan 1,200 1,344 1,268 1,349 1,230 1,261 >4 hour waits - actual 1,358 1,861 Attendances - plan 12,000 13,442 12,680 13,496 12,308 12,610 Attendances - actual 12,172 13,680 Performance - plan 90.0% 90.0% 90.0% 90.0% 90.0% 90.0% Performance - actual 88.84% 86.40%

3.2. Triggers previously discussed by the Board have been agreed by the Oxfordshire A&E Delivery Board alongside the four hour wait trajectory. In April and May 2017, growth in ED attendances above the level seen in the previous year (by 1.4% and 1.8% respectively) meant that this trigger applied. As noted above, delayed transfers also remain above expectations.

Referral to Treatment Time Incomplete pathways: 92% of patients will wait no more than 18 weeks

Apr-17 May-17 Jun-17 Jul-17 Aug-17 Sep-17 Over 18 weeks - plan 6,019 6,251 6,486 6,724 6,966 7,211 Over 18 weeks - actual 5,155 5,197 Total Number Waiting - plan 49,340 49,810 50,280 50,750 51,220 51,690 Total Number Waiting - actual 51,207 52,622 Performance - plan 87.80% 87.45% 87.10% 86.75% 86.40% 86.05% Performance - actual 89.93% 90.12%

3.3. As noted above, the RTT trajectory based on existing planned activity was met for April and May 2017.

Cancer: At least 85% of patients will receive their first treatment within 62 days of referral from a GP

Apr-17 May-17 Jun-17 Jul-17 Aug-17 Sep-17 >62 days - plan 29 26 26 26 28 25

>62 days - actual 21

Total patients seen - plan 198 176 173 173 190 170

Total patients seen - actual 153

Performance - plan 85.0% 85.0% 85.0% 85.0% 85.0% 85.0%


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Performance - actual 86.27%

3.4. As also noted above, the 62 day Cancer standard was met in April 2017.

4. Workforce4.1. The Trust’s Vacancy rate rose to 9.04% in May from 8.69% in April 2017 and 6.32%

in March, well above the 5% target. The figure does not take account of vacancies held through recent freezes on non-clinical recruitment. However nurse vacancy levels in the wards, theatres and major departments have grown to concerning levels with 560 posts vacant as at 30 June 2017.

4.2. The turnover rate reduced slightly to 14.83%. 4.3. Sickness absence at 3.17% in May 2017 remained below the 3.2% target. 4.4. Costs for bank and agency staffing and financial metrics are reported in the Finance

Report to the Board.

5. Additional information5.1. Quality, Operational and Workforce indicators are at Appendix 1.

6. Recommendation6.1. The Board is asked to receive the Integrated Performance Report for Month 2.

Paul Brennan Director of Clinical Services July 2017

Report prepared by: Jonathan Horbury


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Appendix 1 Quality, Operational and Workforce indicators Data Quality Indicator The data quality rating has 2 components. The first component is a 5 point rating which assesses the level and nature of assurance that is available in relation to a specific set of data. The levels are described in the box below. Rating Required Evidence

1 Standard operating procedures and data definitions are in place. 2 As 1 plus: Staff recording the data have been appropriately trained. 3 As 2 plus: The department/service has undertaken its own audit. 4 As 2 plus: A corporate audit has been undertaken.

5 As 2 plus: An independent audit has been undertaken (e.g. by the Trust's internal or external auditors).

The second component of the overall rating is a traffic-light rating to include the level of data quality found through any auditing / benchmarking as below Rating Data Quality

Green Satisfactory Amber Data can be relied upon but minor areas for improvement identified.

Red Unsatisfactory/significant areas for improvement identified.

Quality Standard Current

Data Period

Period Actual YTD Data

Quality

Outcom

es

Summary Hospital-level Mortality Indicator** NA Sep-16 0.94 5

Total # of deliveries NA May-17 657 1,212 5 Proportion of normal deliveries 62% May-17 61.95% 63.5% 5 Proportion of C-Section deliveries 23% May-17 22.98% 21.8% 5 Proportion of Assisted deliveries 15% May-17 15.07% 14.7% 5 Maternal Deaths NA May-17 0 0 4 30 day emergency readmission 0% May-17 3.12% 3.3% 5 Medication reconciliation completed within 24 hours of admission 80% May-17 72.41% 72.2% 4

Medication errors causing serious harm 0 May-17 2 4 5 Number of CAS alerts that were closed having breached during the month 0 May-17 0 0 5

Dementia CQUIN patients admitted who have had a dementia screen 0% May-17 62.53% 60.8% 4

Dementia diagnostic assessment and investigation 0% May-17 100% 100% 4

Dementia :Referral for specialist diagnosis 0% May-17 100% 100% 4

Patient Experience

Patient Satisfaction: Response rate (friends & family - Inpatients) 0% May-17 20.22% 20.3% 2

Patient Satisfaction: Response rate (friends & family - Maternity) 0% May-17 9.71% 13.8% 2

Patient Satisfaction: Response rate (friends & family - ED) 0% May-17 23.13% 22.3% 2

Friends & Family test % not likely to recommend - ED NA May-17 8.19% 7.2% 2

Friends & Family test % not likely to recommend - Inpatients NA May-17 2.39% 1.9% 2


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Quality Standard Current

Data Period


Quality

Friends & Family test % not likely to recommend - Maternity NA May-17 1.69% 0.9% 2

Friends & Family test % likely to recommend - ED NA May-17 87.26% 88% 2

Friends & Family test % likely to recommend – Inpatients NA May-17 95.33% 95.4% 2

Friends & Family test % likely to recommend – Maternity NA May-17 95.36% 95.6% 2

Safety

Number SIRIs NA May-17 12 24 5 % of Patients receiving Harm Free Care (Pressure sores, falls, C-UTI and VTE) May-17 92.53% 92.8% 3

Never Events NA May-17 1 1 5 Cleaning Scores- % of inpatient areas with initial score >92% NA May-17 36.36% 35.3% 5

% of incidents associated with moderate harm or greater NA May-17 0.8% 1% 5

# newly acquired pressure ulcers (category 2,3 and 4) NA Apr-17 56 56 5

Operational Standard Current

Data Period


Quality

RTT: Incomplete % within 18 weeks 92% May-17 90.12% 90% 5 RTT: Admitted % within 18 weeks 90% May-17 75.49% 74.3% 4 RTT: Non-admitted % within 18 weeks 95% May-17 87.32% 86.6% 4 >52 week RTT waits: Incomplete 0 May-17 17 29 4 >52 week RTT waits: Admitted 0 May-17 10 17 4 >52 week RTT waits: Non-admitted 0 May-17 4 6 4 % Diagnostic waits of 6 weeks or more 1% May-17 0.76% 1% 3 Last minute cancellations - % of all elective admissions 0.5% May-17 0.68% 0.6% 3

% patients not rebooked within 28 days 0% May-17 1.56% 4% 5 Urgent cancellations 0 May-17 22 42 5 Urgent cancellations - second time 0 May-17 0 0 5 # of Emergency Department attendances May-17 13,680 25,852 5 % ≤ 4 hours from arrival to admission, transfer or discharge 95% May-17 86.4% 87.5% 5

Delayed transfers of care: # (snapshot)* 0 May-17 135 247 4 Delayed transfers of care as % of occupied beds* 3.5% May-17 11.69% 10.6% 5

Theatre Utilisation - Elective 80% May-17 76.04% 76% 4 Theatre Utilisation – Emergency 70% May-17 51.98% 50.9% 4 Theatre Utilisation – Total 75% May-17 69.66% 69.1% 4 Results Endorsed within 7 days NA May-17 78.92% 78.5% 4 Contract Variations Open NA May-17 8 Contract Notices Open NA May-17 0 % of discharge summaries sent to GP within 24hrs 98% May-17 79.51% 80.1% 4

%patients first cancer treatment <62 days of urgent GP referral 85% Apr-17 86.27% 86.3% 4


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Operational Standard Current

Data Period


Quality

%patients first cancer treatment <62 days of screening referral 90% Apr-17 89.66% 89.7% 4

%patients first treatment <1 month of cancer diagnosis 96% Apr-17 98.37% 98.4% 4

%patients subsequent cancer treatment <31days - surgery 94% Apr-17 94.38% 94.4% 4

%patients subsequent cancer treatment <31days - drugs 98% Apr-17 100% 100% 4

%patients subsequent treatment <31days – radiotherapy 94% Apr-17 98.75% 98.8% 4

% <2 week wait for first appointment from urgent GP referral for suspected cancer 93% Apr-17 92.36% 92.4% 5

% <2 week wait from urgent referral with breast symptoms 93% Apr-17 100% 100% 5

Same sex accommodation breaches 0 May-17 0 0 5 % stroke patients spending ≥ 90% of time on stroke unit 85% May-17 86.3% 86.5% 5

Hospital-acquired MRSA bacteraemia 0 May-17 0 1 5 Clostridium difficile incidence 6 May-17 7 11 5 % adult inpatients assessed for VTE risk 95% May-17 97.78% 97.6% 5

Workforce Plan Current

Data Period


Quality

Sickness absence** 3.2% May-17 3.17% 5 Turnover rate 12% May-17 14.83% 5 Vacancy rate 5% May-17 9.04% 5 Substantive staff in post 11813 May-17 10,745 4

Appendix 2

Apr May Jun Q1 Jul Aug Sep Q2 Oct Nov Dec Q3 Jan Feb Mar Q4 TotalTarget Theatre Sessions 0 0 0 0 0Actual Theatre Sessions 0 0 0 0 0Target Elective Inpatients 1,809 2,107 2,207 6,123 2,210 2,210 2,210 6,631 2,536 2,539 2,182 7,256 2,559 2,360 2,468 7,387 27,398Actual Elective Inpatients 1,774 1,933 3,707 0 0 0 3,707Target Daycases 4,491 5,230 5,476 15,197 5,471 5,471 5,471 16,412 6,243 6,266 5,352 17,861 6,265 5,741 6,007 18,013 67,483Actual Daycases 4,650 5,567 10,217 0 0 0 10,217Target Total Cases 6,300 7,337 7,683 21,320 7,681 7,681 7,681 23,043 8,778 8,805 7,534 25,117 8,825 8,101 8,475 25,400 94,881Actual Total Cases 6,424 7,500 0 13,924 0 0 0 0 0 0 0 0 0 0 0 0 13,924

Target Endoscopy Sessions 0 0 0 0 0Actual Endoscopy Sessions 0 0 0 0 0Target Cases 1,214 1,415 1,482 4,111 1,563 1,563 1,563 4,690 1,721 1,721 1,486 4,927 1,721 1,564 1,643 4,927 18,656Actual Cases 1,224 1,384 0 2,608 0 0 0 0 0 0 0 0 0 0 0 0 2,608

Target Outpatient Clinics 0 0 0 0 0Actual Outpatient Clinics 0 0 0 0 0Target New Outpatients 23,072 26,917 28,199 78,188 27,669 27,669 27,669 83,007 30,031 30,150 26,020 86,201 30,179 27,568 28,920 86,666 334,063Actual New Outpatients 23,735 28,408 52,143 0 0 0 52,143

New GP Referrals 2016/17 14,399 14,054 13,988 42,441 13,716 13,634 14,116 41,466 13,971 13,990 11,912 39,873 13,823 13,726 15,722 43,271 167,051Other New Referrals 2016/17 10,516 11,273 11,591 33,380 11,435 11,370 11,255 34,060 12,507 11,232 9,949 33,688 10,757 10,710 11,878 33,345 134,473Total New Referrals 2016/17 24,915 25,327 25,579 75,821 25,151 25,004 25,371 75,526 26,478 25,222 21,861 73,561 24,580 24,436 27,600 76,616 301,524New GP Referrals 2017/18 12,239 14,277 26,516 0 0 0 26,516Other New Referrals 2017/18 9,418 10,094 19,512 0 0 0 19,512Total New Referrals 2017/18 21,657 24,371 0 46,028 0 0 0 0 0 0 0 0 0 0 0 0 46,028

Target Pre-Operative Appointments 0 0 0 0 0Actual Patients Seen 0 0 0 0 0Actual Patients Fit for Surgery 0 0 0 0 0

< 6 weeks 13,528 14,310> 6 weeks and < 18 weeks 9,908 9,437> 18 weeks 1,188 1,217

< 8 weeks 4,487 4,478> 8 weeks and < 18 weeks 2,297 2,626> 18 weeks and < 36 weeks 974 1,016> 36 weeks 144 144

< 8 weeks 2,856 2,852> 8 weeks and < 18 weeks 2,827 3,187> 18 weeks and < 36 weeks 1,868 1,805> 36 weeks 351 421

NB: Q1 and Q2 planned activity is now updated to match what is entered in SLAM.

Outpatient Waiting List

Inpatient Waiting List (Admitted Component

Wait)

Inpatient Waiting List (Total Incomplete RTT

Wait)

Endoscopy

RTT Delivery MonitoringTRUST TOTALS

Admitted Patients

Outpatients

Referrals

Pre-Operative Assessment

of 27

Apr May Jun Q1 Jul Aug Sep Q2 Oct Nov Dec Q3 Jan Feb Mar Q4 TotalTarget Theatre Sessions 0 0 0 0 0Actual Theatre Sessions 0 0 0 0 0Target Elective Inpatients 781 909 951 2,641 991 991 991 2,972 1,068 1,071 913 3,052 1,080 1,014 1,057 3,151 11,816Actual Elective Inpatients 785 843 1,628 0 0 0 1,628Target Daycases 1,458 1,697 1,776 4,931 1,842 1,842 1,842 5,527 2,087 2,111 1,762 5,959 2,110 1,961 2,041 6,111 22,529Actual Daycases 1,501 1,807 3,308 0 0 0 3,308Target Total Cases 2,239 2,606 2,728 7,572 2,833 2,833 2,833 8,500 3,154 3,181 2,675 9,011 3,189 2,975 3,097 9,262 34,345Actual Total Cases 2,286 2,650 0 4,936 0 0 0 0 0 0 0 0 0 0 0 0 4,936




< 6 weeks 5,598 6,068> 6 weeks and < 18 weeks 4,492 4,387> 18 weeks 644 655

< 8 weeks 2,441 2,169> 8 weeks and < 18 weeks 1,243 1,464> 18 weeks and < 36 weeks 503 492> 36 weeks 40 30

< 8 weeks 1,417 1,223> 8 weeks and < 18 weeks 1,498 1,683> 18 weeks and < 36 weeks 1,173 1,096> 36 weeks 139 153




Wait)


Wait)

RTT Delivery Monitoring by SpecialtyNEUROSCIENCES, ORTHOPAEDICS, TRAUMA & SPECIALIST SURGERY

Admitted Patients

Outpatients

Referrals


of 27

Apr May Jun Q1 Jul Aug Sep Q2 Oct Nov Dec Q3 Jan Feb Mar Q4 TotalTarget Theatre Sessions 0 0 0 0 0Actual Theatre Sessions 0 0 0 0 0Target Elective Inpatients 381 444 465 1,290 448 448 448 1,344 617 617 533 1,767 624 568 595 1,787 6,188Actual Elective Inpatients 328 392 720 0 0 0 720Target Daycases 1,331 1,551 1,624 4,506 1,564 1,564 1,564 4,691 1,832 1,832 1,583 5,246 1,832 1,667 1,748 5,246 19,689Actual Daycases 1,457 1,786 3,243 0 0 0 3,243Target Total Cases 1,712 1,995 2,089 5,796 2,011 2,011 2,011 6,034 2,449 2,449 2,116 7,013 2,456 2,235 2,343 7,033 25,877Actual Total Cases 1,785 2,178 0 3,963 0 0 0 0 0 0 0 0 0 0 0 0 3,963

Target Endoscopy Sessions 0 0 0 0 0Actual Endoscopy Sessions 0 0 0 0 0Target Cases 1,214 1,415 1,482 4,111 1,563 1,563 1,563 4,690 1,721 1,721 1,486 4,927 1,721 1,564 1,643 4,927 18,656Actual Cases 1,224 1,384 0 2,608 0 0 0 0 0 0 0 0 0 0 0 0 2,608




< 6 weeks 1,972 1,766> 6 weeks and < 18 weeks 1,036 837> 18 weeks 107 122

< 8 weeks 1,122 1,260> 8 weeks and < 18 weeks 430 456> 18 weeks and < 36 weeks 37 41> 36 weeks 16 17

< 8 weeks 737 824> 8 weeks and < 18 weeks 720 780> 18 weeks and < 36 weeks 135 150> 36 weeks 13 20





Wait)


Wait)

RTT Delivery Monitoring by SpecialtySURGERY & ONCOLOGY

Admitted Patients

Endoscopy

Outpatients

Referrals

of 27

Apr May Jun Q1 Jul Aug Sep Q2 Oct Nov Dec Q3 Jan Feb Mar Q4 TotalTarget Theatre Sessions 0 0 0 0 0Actual Theatre Sessions 0 0 0 0 0Target Elective Inpatients 268 312 326 906 321 321 321 963 361 361 312 1,034 361 328 344 1,034 3,936Actual Elective Inpatients 313 322 635 0 0 0 635Target Daycases 572 667 698 1,937 678 678 678 2,033 834 834 720 2,388 834 759 796 2,388 8,746Actual Daycases 652 729 1,381 0 0 0 1,381Target Total Cases 840 978 1,024 2,843 999 999 999 2,996 1,195 1,195 1,032 3,422 1,195 1,087 1,140 3,422 12,682Actual Total Cases 965 1,051 0 2,016 0 0 0 0 0 0 0 0 0 0 0 0 2,016


New GP Referrals 2016/17 2,081 2,035 1,993 6,109 1,869 1,836 1,962 5,667 1,895 2,043 1,729 5,667 2,015 1,994 2,327 6,336 23,779Other New Referrals 2016/17 1,151 1,066 1,175 3,392 1,082 1,178 1,046 3,306 1,078 1,158 995 3,231 1,110 1,062 1,357 3,529 13,458Total New Referrals 2016/17 3,232 3,101 3,168 9,501 2,951 3,014 3,008 8,973 2,973 3,201 2,724 8,898 3,125 3,056 3,684 9,865 37,237New GP Referrals 2017/18 1,761 2,009 3,770 0 0 0 3,770Other New Referrals 2017/18 942 1,089 2,031 0 0 0 2,031Total New Referrals 2017/18 2,703 3,098 0 5,801 0 0 0 0 0 0 0 0 0 0 0 0 5,801








Wait)


Wait)

RTT Delivery Monitoring by SpecialtyCHILDREN'S & WOMEN'S

Admitted Patients

Outpatients

Referrals


of 27

Apr May Jun Q1 Jul Aug Sep Q2 Oct Nov Dec Q3 Jan Feb Mar Q4 TotalTarget Theatre Sessions 0 0 0 0 0Actual Theatre Sessions 0 0 0 0 0Target Elective Inpatients 354 413 433 1,200 421 421 421 1,263 459 459 397 1,315 463 421 442 1,327 5,105Actual Elective Inpatients 332 354 686 0 0 0 686Target Daycases 990 1,155 1,210 3,355 1,225 1,225 1,225 3,676 1,311 1,311 1,132 3,753 1,311 1,191 1,251 3,753 14,537Actual Daycases 894 1,086 1,980 0 0 0 1,980Target Total Cases 1,345 1,568 1,642 4,554 1,646 1,646 1,646 4,939 1,770 1,770 1,529 5,068 1,774 1,613 1,693 5,080 19,641Actual Total Cases 1,226 1,440 0 2,666 0 0 0 0 0 0 0 0 0 0 0 0 2,666










Wait)


Wait)

RTT Delivery Monitoring by SpecialtyMEDICINE, REHABILITATION & CARDIAC

Admitted Patients

Outpatients

Referrals


of 27

Apr May Jun Q1 Jul Aug Sep Q2 Oct Nov Dec Q3 Jan Feb Mar Q4 TotalTarget Theatre Sessions 0.0 124.0 155.0 124.0 403.0 0.0 0.0 403.0Actual Theatre Sessions 0.0 120.0 136.0 110.0 366.0 0.0 0.0 366.0Target Elective Inpatients 90 104 109 304 112 112 112 337 117 131 117 365 131 121 126 379 1,385Actual Elective Inpatients 97 80 177 0 0 0 177Target Daycases 133 155 162 451 167 167 167 501 173 194 172 540 194 180 187 561 2,053Actual Daycases 158 164 322 0 0 0 322Target Total Cases 223 260 272 754 280 280 280 839 290 326 289 905 326 301 314 941 3,438Actual Total Cases 255 244 0 499 0 0 0 0 0 0 0 0 0 0 0 0 499

Target Outpatient Clinics 0 0 0 0 0Actual Outpatient Clinics 0 0 0 0 0Target New Outpatients 669 780 817 2,266 788 788 788 2,363 819 935 824 2,577 950 876 913 2,740 9,947Actual New Outpatients 621 810 1,431 0 0 0 1,431

New GP Referrals 2016/17 1,069 939 910 2,918 885 895 920 2,700 896 923 711 2,530 899 849 958 2,706 10,854Other New Referrals 2016/17 274 341 275 890 291 342 277 910 318 257 259 834 252 381 429 1,062 3,696Total New Referrals 2016/17 1,343 1,280 1,185 3,808 1,176 1,237 1,197 3,610 1,214 1,180 970 3,364 1,151 1,230 1,387 3,768 14,550New GP Referrals 2017/18 719 806 1,525 0 0 0 1,525Other New Referrals 2017/18 308 386 694 0 0 0 694Total New Referrals 2017/18 1,027 1,192 0 2,219 0 0 0 0 0 0 0 0 0 0 0 0 2,219


< 6 weeks 750 627> 6 weeks and < 18 weeks 953 999> 18 weeks 139 144






Wait)


Wait)

RTT Delivery Monitoring by SpecialtyPaediatric and Adult ENT

Admitted Patients

Outpatients

Referrals


of 27

Apr May Jun Q1 Jul Aug Sep Q2 Oct Nov Dec Q3 Jan Feb Mar Q4 TotalTarget Theatre Sessions 0.0 76.0 95.0 76.0 247.0 0.0 0.0 247.0Actual Theatre Sessions 0.0 69.0 69.0 62.0 200.0 0.0 0.0 200.0Target Elective Inpatients 20 23 24 67 23 23 23 69 32 32 25 90 32 30 31 94 320Actual Elective Inpatients 14 13 27 0 0 0 27Target Daycases 419 487 510 1,416 573 573 573 1,719 684 684 529 1,897 684 638 661 1,983 7,016Actual Daycases 396 524 920 0 0 0 920Target Total Cases 439 510 534 1,483 596 596 596 1,789 716 716 554 1,987 716 668 692 2,077 7,336Actual Total Cases 410 537 0 947 0 0 0 0 0 0 0 0 0 0 0 0 947


New GP Referrals 2016/17 1,035 961 981 2,977 957 1,097 1,066 3,120 998 1,078 855 2,931 967 1,015 1,146 3,128 12,156Other New Referrals 2016/17 405 447 602 1,454 436 679 677 1,792 759 558 580 1,897 534 498 619 1,651 6,794Total New Referrals 2016/17 1,440 1,408 1,583 4,431 1,393 1,776 1,743 4,912 1,757 1,636 1,435 4,828 1,501 1,513 1,765 4,779 18,950New GP Referrals 2017/18 887 1,091 1,978 0 0 0 1,978Other New Referrals 2017/18 410 483 893 0 0 0 893Total New Referrals 2017/18 1,297 1,574 0 2,871 0 0 0 0 0 0 0 0 0 0 0 0 2,871


< 6 weeks 1,189 1,224> 6 weeks and < 18 weeks 792 810> 18 weeks 59 82






Wait)


Wait)

RTT Delivery Monitoring by SpecialtyOphthalmology

Admitted Patients

Outpatients

Referrals


of 27

Apr May Jun Q1 Jul Aug Sep Q2 Oct Nov Dec Q3 Jan Feb Mar Q4 TotalTarget Theatre Sessions 0.0 76.0 95.0 76.0 247.0 0.0 0.0 247.0Actual Theatre Sessions 0.0 68.0 67.0 72.0 207.0 0.0 0.0 207.0Target Elective Inpatients 44 51 54 149 51 51 51 154 74 74 66 213 74 69 71 213 729Actual Elective Inpatients 65 46 111 0 0 0 111Target Daycases 171 200 209 580 200 200 200 599 284 284 256 823 284 265 274 823 2,826Actual Daycases 189 231 420 0 0 0 420Target Total Cases 215 251 263 729 251 251 251 753 357 357 322 1,036 357 334 345 1,036 3,555Actual Total Cases 254 277 0 531 0 0 0 0 0 0 0 0 0 0 0 0 531


New GP Referrals 2016/17 460 446 252 1,158 419 398 579 1,396 579 504 521 1,604 513 494 468 1,475 5,633Other New Referrals 2016/17 159 190 176 525 180 189 172 541 181 181 179 541 112 146 171 429 2,036Total New Referrals 2016/17 619 636 428 1,683 599 587 751 1,937 760 685 700 2,145 625 640 639 1,904 7,669New GP Referrals 2017/18 296 219 515 0 0 0 515Other New Referrals 2017/18 142 150 292 0 0 0 292Total New Referrals 2017/18 438 369 0 807 0 0 0 0 0 0 0 0 0 0 0 0 807








Wait)


Wait)

RTT Delivery Monitoring by SpecialtyOMFS

Admitted Patients

Outpatients

Referrals


of 27

Apr May Jun Q1 Jul Aug Sep Q2 Oct Nov Dec Q3 Jan Feb Mar Q4 TotalTarget Theatre Sessions (exc Trauma) 0.0 280.0 350.0 280.0 910.0 0.0 0.0 910.0Actual Theatre Sessions (exc Trauma) 0.0 216.0 265.0 248.0 729.0 0.0 0.0 729.0Target Elective Inpatients 275 320 335 931 365 365 365 1,095 381 381 316 1,078 361 351 366 1,078 4,182Actual Elective Inpatients 288 328 616 0 0 0 616Target Daycases 162 188 197 547 215 215 215 644 226 226 187 639 214 208 217 639 2,468Actual Daycases 161 178 339 0 0 0 339Target Total Cases 437 508 532 1,478 580 580 580 1,739 607 607 503 1,716 575 559 583 1,716 6,650Actual Total Cases 449 506 0 955 0 0 0 0 0 0 0 0 0 0 0 0 955


New GP Referrals 2016/17 1260 1331 1316 3,907 1321 1162 1154 3,637 1140 1241 970 3,351 1202 1245 1260 3,707 14,602Other New Referrals 2016/17 1794 2092 1924 5,810 2130 2000 2034 6,164 2006 1685 1478 5,169 1598 1600 1773 4,971 22,114Total New Referrals 2016/17 3,054 3,423 3,240 9,717 3,451 3,162 3,188 9,801 3,146 2,926 2,448 8,520 2,800 2,845 3,033 8,678 36,716New GP Referrals 2017/18 1,288 1,784 3,072 0 0 0 3,072Other New Referrals 2017/18 1,777 1,735 3,512 0 0 0 3,512Total New Referrals 2017/18 3,065 3,519 0 6,584 0 0 0 0 0 0 0 0 0 0 0 0 6,584


< 6 weeks 907 1,143> 6 weeks and < 18 weeks 563 479> 18 weeks 30 45






Wait)


Wait)

RTT Delivery Monitoring by SpecialtyOrthopaedics (inc Trauma and Medical Oncology)

Admitted Patients

Outpatients

Referrals


of 27

Apr May Jun Q1 Jul Aug Sep Q2 Oct Nov Dec Q3 Jan Feb Mar Q4 TotalTarget Theatre Sessions 0.0 124.0 155.0 124.0 403.0 0.0 0.0 403.0Actual Theatre Sessions 0.0 124.0 155.0 114.0 393.0 0.0 0.0 393.0Target Elective Inpatients 85 99 103 287 101 101 101 304 109 109 95 312 138 128 133 399 1,303Actual Elective Inpatients 93 97 190 0 0 0 190Target Daycases 31 36 38 104 36 36 36 109 39 39 34 113 50 47 49 146 472Actual Daycases 38 47 85 0 0 0 85Target Total Cases 116 135 141 392 137 137 137 412 148 148 129 425 188 175 182 545 1,775Actual Total Cases 131 144 0 275 0 0 0 0 0 0 0 0 0 0 0 0 275

Target Outpatient Clinics 0 0 0 0 0Actual Outpatient Clinics 0 0 0 0 0Target New Outpatients 195 227 238 661 243 243 243 728 268 268 204 741 236 247 258 741 2,870Actual New Outpatients 211 234 445 0 0 0 445

New GP Referrals 2016/17 90 103 96 289 84 74 75 233 90 86 75 251 81 75 87 243 1,016Other New Referrals 2016/17 199 206 229 634 178 142 156 476 233 272 190 695 193 221 259 673 2,478Total New Referrals 2016/17 289 309 325 923 262 216 231 709 323 358 265 946 274 296 346 916 3,494New GP Referrals 2017/18 66 104 170 0 0 0 170Other New Referrals 2017/18 185 208 393 0 0 0 393Total New Referrals 2017/18 251 312 0 563 0 0 0 0 0 0 0 0 0 0 0 0 563








Wait)


Wait)

RTT Delivery Monitoring by SpecialtyNeurosurgery

Admitted Patients

Outpatients

Referrals


of 27

Apr May Jun Q1 Jul Aug Sep Q2 Oct Nov Dec Q3 Jan Feb Mar Q4 TotalTarget Theatre Sessions 0.0 83.0 103.8 83.0 269.9 0.0 0.0 269.9Actual Theatre Sessions 0.0 53.0 53.8 51.0 157.9 0.0 0.0 157.9Target Elective Inpatients 90 104 109 303 108 108 108 325 146 146 126 417 146 133 139 417 1,462Actual Elective Inpatients 94 104 198 0 0 0 198Target Daycases 199 230 241 670 243 243 243 730 351 351 303 1,004 351 319 335 1,004 3,409Actual Daycases 246 330 576 0 0 0 576Target Total Cases 288 335 350 974 352 352 352 1,056 496 496 429 1,421 496 451 473 1,421 4,871Actual Total Cases 340 434 0 774 0 0 0 0 0 0 0 0 0 0 0 0 774


New GP Referrals 2016/17 597 567 576 1,740 536 442 570 1,548 547 474 648 1,669 582 632 621 1,835 6,792Other New Referrals 2016/17 168 190 169 527 145 148 134 427 128 90 85 303 138 162 175 475 1,732Total New Referrals 2016/17 765 757 745 2,267 681 590 704 1,975 675 564 733 1,972 720 794 796 2,310 8,524New GP Referrals 2017/18 477 459 936 0 0 0 936Other New Referrals 2017/18 141 137 278 0 0 0 278Total New Referrals 2017/18 618 596 0 1,214 0 0 0 0 0 0 0 0 0 0 0 0 1,214








Wait)


Wait)

RTT Delivery Monitoring by SpecialtyUrology

Admitted Patients

Outpatients

Referrals


of 27

Apr May Jun Q1 Jul Aug Sep Q2 Oct Nov Dec Q3 Jan Feb Mar Q4 TotalTarget Endoscopy Sessions 0 0 0 0 0Actual Endoscopy Sessions 0 0 0 0 0Target Cases 1,214 1,415 1,482 4,111 1,563 1,563 1,563 4,690 1,721 1,721 1,486 4,927 1,721 1,564 1,643 4,927 18,656Actual Cases 1,224 1,384 2,608 0 0 0 2,608

Target Outpatient Clinics 0 0 0 0 0Actual Outpatient Clinics 0 0 0 0 0Target New Outpatients 489 571 598 1,657 591 591 591 1,774 721 721 623 2,065 765 696 730 2,191 7,687Actual New Outpatients 327 477 804 0 0 0 804

New GP Referrals 2016/17 531 555 537 1,623 550 576 484 1,610 586 544 455 1,585 574 487 572 1,633 6,451Other New Referrals 2016/17 114 138 105 357 121 105 97 323 152 143 104 399 69 256 115 440 1,519Total New Referrals 2016/17 645 693 642 1,980 671 681 581 1,933 738 687 559 1,984 643 743 687 2,073 7,970New GP Referrals 2017/18 418 675 1,093 0 0 0 1,093Other New Referrals 2017/18 116 134 250 0 0 0 250Total New Referrals 2017/18 534 809 0 1,343 0 0 0 0 0 0 0 0 0 0 0 0 1,343








Wait)


Wait)

RTT Delivery Monitoring by SpecialtyGastroenterology & Endoscopy

Endoscopy

Outpatients

Referrals


of 27

Apr May Jun Q1 Jul Aug Sep Q2 Oct Nov Dec Q3 Jan Feb Mar Q4 TotalTarget Theatre Sessions 0.0 92.0 115.0 92.0 299.0 0.0 0.0 299.0Actual Theatre Sessions 0.0 62.0 68.0 84.0 214.0 0.0 0.0 214.0Target Elective Inpatients 85 98 102 285 98 98 98 294 155 155 134 444 155 141 148 444 1,466Actual Elective Inpatients 98 88 186 0 0 0 186Target Daycases 148 172 179 499 172 172 172 515 291 291 251 834 291 265 278 834 2,680Actual Daycases 181 142 323 0 0 0 323Target Total Cases 232 269 282 784 269 269 269 808 446 446 385 1,277 446 405 426 1,277 4,146Actual Total Cases 279 230 0 509 0 0 0 0 0 0 0 0 0 0 0 0 509


New GP Referrals 2016/17 1287 1218 1224 3,729 1242 1214 1227 3,683 1188 1173 1057 3,418 1172 1229 1378 3,779 14,609Other New Referrals 2016/17 234 225 314 773 244 303 229 776 266 255 218 739 240 270 323 833 3,121Total New Referrals 2016/17 1,521 1,443 1,538 4,502 1,486 1,517 1,456 4,459 1,454 1,428 1,275 4,157 1,412 1,499 1,701 4,612 17,730New GP Referrals 2017/18 1,068 1,206 2,274 0 0 0 2,274Other New Referrals 2017/18 180 183 363 0 0 0 363Total New Referrals 2017/18 1,248 1,389 0 2,637 0 0 0 0 0 0 0 0 0 0 0 0 2,637





NB: Q1 and Q2 planned activity is now updated to match what is entered in SLAM.Note that the Q2 plan for Gynae has been slightly revised and these changes are not yet reflected in SLAM.



Wait)


Wait)

RTT Delivery Monitoring by SpecialtyGynaecology

Admitted Patients

Outpatients

Referrals


of 27

Apr May Jun Q1 Jul Aug Sep Q2 Oct Nov Dec Q3 Jan Feb Mar Q4 TotalTarget Theatre Sessions 180 210 220 610 210 220 210 640 0 0 1,250Actual Theatre Sessions 162 196 358 0 0 0 358Target Elective Inpatients 85 99 104 289 99 99 99 298 125 125 108 357 125 113 119 357 1,302Actual Elective Inpatients 71 93 164 0 0 0 164Target Daycases 318 370 388 1,075 441 441 441 1,322 477 477 412 1,366 477 434 455 1,366 5,130Actual Daycases 359 397 756 0 0 0 756Target Total Cases 403 469 492 1,364 540 540 540 1,620 602 602 520 1,724 602 547 575 1,724 6,432Actual Total Cases 430 490 0 920 0 0 0 0 0 0 0 0 0 0 0 0 920


New GP Referrals 2016/17 686 705 693 2,084 767 670 617 2,054 589 541 599 1,729 674 734 937 2,345 8,212Other New Referrals 2016/17 649 611 865 2,125 807 644 629 2,080 760 613 548 1,921 483 399 407 1,289 7,415Total New Referrals 2016/17 1,335 1,316 1,558 4,209 1,574 1,314 1,246 4,134 1,349 1,154 1,147 3,650 1,157 1,133 1,344 3,634 15,627New GP Referrals 2017/18 619 796 1,415 0 0 0 1,415Other New Referrals 2017/18 270 293 563 0 0 0 563Total New Referrals 2017/18 889 1,089 0 1,978 0 0 0 0 0 0 0 0 0 0 0 0 1,978





NB: Q1 and Q2 planned activity is now updated to match what is entered in SLAM.Note that the Q2 plan for Cardiology has been slightly revised and these changes are not yet reflected in SLAM.



Wait)


Wait)

RTT Delivery Monitoring by SpecialtyCardiology

Admitted Patients

Outpatients

Referrals


of 27

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