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Papers Council of Governors 20 July 2022

Description: Agenda attachments 1 CoG Agenda - 20.07.2022.docx Date Time Location Chair Agenda Council of Governors 20/07/2022 14:00
Url: /Media/UHS-website-2019/Docs/About-the-Trust/Trust-governance-and-corporate-docs/2022-Trust-documents/Papers-Council-of-Governors-20-July-2022.pdf

Sponsor-Request-Form_Jan2020

Description: UHS Sponsorship Application Section 1 – To be completed for all projects requesting UHS to act as Sponsor Study title 1. Propose
Url: /Media/Southampton-Clinical-Research/Downloads/Sponsor-Request-Form-Jan2020.docx

Form_020_Sponsor_Request_Form_v3_03-01-2020

Description: UHS Sponsorship Application Section 1 – To be completed for all projects requesting UHS to act as Sponsor Study title 1. Propose
Url: /Media/Southampton-Clinical-Research/Downloads/Form-020-Sponsor-Request-Form-v3-03-01-2020.docx

Papers Trust Board - 15 July 2025

Description: Agenda Trust Board – Open Session Date 15/07/2025 Time 9:00 - 13:00 Location Conference Room, Heartbeat Education Centre Chair
Url: /Media/UHS-website-2019/Docs/About-the-Trust/Trust-governance-and-corporate-docs/2025-Trust-documents/Papers-Trust-Board-15-July-2025.pdf

Standing Financial Instructions

Description: These Standing Financial Instructions (SFIs) are issued for the regulation of the conduct of Trust members and officers in relation to all financial matters with which they are concerned.
Url: /Media/UHS-website-2019/Docs/About-the-Trust/Finance/StandingFinancialInstructions.pdf

Papers Trust Board - 30 January 2024

Description: Date Time Location Chair Apologies Agenda Trust Board – Open Session 30/01/2024 9:00 - 13:00 Conference Room, Heartbeat/Microsoft
Url: /Media/UHS-website-2019/Docs/About-the-Trust/Trust-governance-and-corporate-docs/2024-Trust-documents/Papers-Trust-Board-30-January-2024.pdf

Application for CORE Support - Version 3 18-01-2023 corrected

Description: Application for CORE Support Instructions: Please complete this form in full and submit by email to Jess Boxall or another member
Url: /Media/Southampton-Clinical-Research/Downloads/Application-for-CORE-Support-Version-3-18-01-2023-corrected.docx

Papers Trust Board - 29 November 2022

Description: Date Time Location Chair Agenda Trust Board – Open Session 29/11/2022 9:00 - 13:20 Conference Room, Heartbeat/Microsoft Teams
Url: /Media/UHS-website-2019/Docs/About-the-Trust/Trust-governance-and-corporate-docs/2022-Trust-documents/Papers-Trust-Board-29-November-2022.pdf

Papers-CoG 26.04.2023

Description: Agenda attachments 1 CoG Agenda - 26.04.2023.docx Date Time Location Chair Agenda Council of Governors 26/04/2023 14:00 - 16:05 Microsoft Teams Jenni Douglas-Todd 1 Chair’s Welcome and Opening Comments 14:00 2 Declarations of Interest 14:02 3 Minutes of Previous Meeting 14:03 Approve the minutes of the previous meeting held on 25 January 2023 4 Matters Arising/Summary of Agreed Actions 14:04 5 Strategy, Quality and Performance 5.1 Annual Report and Quality Accounts Timetable 14:05 Note the Annual Report and Quality Accounts Timetable Sponsor: David French, Chief Executive Officer Attendee: Craig Machell, Associate Director of Corporate Affairs and Company Secretary 5.2 Chief Executive Officer's Performance Report 14:10 Receive and note the report Sponsor: David French, Chief Executive Officer 5.3 Operational Plan 2023/24 14:30 Receive and note the update Sponsor: Ian Howard, Chief Financial Officer Attendees: Andrew Asquith, Director of Planning and Productivity and Philip Bunting, Director of Operational Finance 5.4 Non-NHS Activity 14:50 Receive and note the update Sponsor: Ian Howard, Chief Financial Officer Attendee: Pete Baker, Commercial and Enterprise Director 15:00 Break 6 Governance 6.1 Appointment of Deputy Lead Governor 15:10 Note the appointment of Sandra Gidley as Deputy Lead Governor Sponsor: Jenni Douglas-Todd, Trust Chair Attendee: Karen Russell, Council of Governors' Business Manager 6.2 Review Terms of Reference - Council of Governors and Working Groups 15:15 Approve the proposed changes to the terms of reference Sponsor: Jenni Douglas-Todd, Trust Chair Attendees: Craig Machell, Associate Director of Corporate Affairs and Company Secretary and Karen Russell, Council of Governors' Business Manager 6.3 Council of Governors' Elections 2023 15:20 Note the timetable for the Council of Governors' elections Sponsor: Jenni Douglas-Todd, Trust Chair Attendee: Karen Russell, Council of Governors' Business Manager 6.4 Appointed Governor for Hampshire County Council (Oral Update) 15:25 Receive an update regarding the appointed governor for Hampshire County Council Sponsor: Jenni Douglas-Todd, Trust Chair 6.5 Proposal for Filling the Vacancy in the Rest of England and Wales 15:30 Constituency Approve the proposal for filling the vacancy in the Rest of England and Wales constituency Sponsor: Jenni Douglas-Todd, Trust Chair Attendee: Karen Russell, Council of Governors' Business Manager 7 Membership Engagement and Governor Activity 7.1 Membership Engagement 15:35 Receive and note the report Sponsor: David French, Chief Executive Officer Attendee: Sam Dolton, Events and Membership Officer 7.2 Feedback from Strategy and Finance Working Group 15:45 Chair: Mandy Fader 7.3 Feedback from Patient and Staff Experience Working Group 15:50 Chair: Sandra Gidley 7.4 Feedback from Membership and Engagement Working Group 15:55 Chair: Kelly Lloyd 8 Review of Meeting 16:00 Review and feedback on the content of this meeting Sponsor: Jenni Douglas-Todd, Trust Chair 9 Any Other Business 16:02 Raise any relevant or urgent matters that are not on the agenda 10 Date of Next Meeting: 26 July 2023 16:04 Note the date of the next meeting Page 2 3 Minutes of Previous Meeting 1 3 COG Minutes Open Session Final - 25.01.2023.docx Minutes - Council of Governors (CoG) Open Session Date Time Location Chair Present 25 January 2023 14.00-16.00 Conference Room, Heartbeat Education Centre and Microsoft Teams Jenni Douglas-Todd, Trust Chair Jenni Douglas-Todd, Trust Chair Theresa Airiemiokhale, Elected, Southampton City Shirley Anderson, Elected, New Forest, Eastleigh and Test Valley Patricia Crates, Elected, New Forest, Eastleigh and Test Valley Dr Nigel Dickson, Elected, New Forest, Eastleigh and Test Valley Helen Eggleton, Appointed, Hampshire and Isle of Wight Integrated Care Board Lesley Gilder, Elected, Southampton City Sathish Harinarayanan, Elected, Medical practitioners and dental staff Linda Hebdige, Elected, Southampton City Sandra Gidley, Elected, New Forest, Eastleigh and Test Valley Jenny Lawrie, Elected, Southampton City Kelly Lloyd, Elected, Health Professional and Health Scientist Staff and Lead Governor Councillor Cathie McEwing, Appointed, Southampton City Council Catherine Rushworth, Elected, Isle of Wight Liz Taylor, Elected, Non-clinical and support staff Quintin van Wyk, Elected, Rest of England and Wales Professor Emma Wadsworth, Professor of Work Environment and Vice Provost Research and Innovation, Solent University JDT TA SA KB PC ND HE LG SH LH SG JL KL CMc CR LT QvW EW In attendance Tracey Burt, Minutes Sam Dolton, Events and Membership Officer Steve Harris, Chief People Officer (for Item 6.1 Craig Machell, Associate Director of Corporate Affairs and Company Secretary Karen Russell, Council of Governors’ Business Manager David French, Executive Officer (for Item 5.1) TB SD SHa CMa KR DAF Apologies Katherine Barbour, Elected, Southampton City KB Professor Mandy Fader, Appointed, University of Southampton MF Councillor Alexis McEvoy, Appointed, Hampshire County Council AM Esther O’Sullivan, Elected, New Forest, Eastleigh and Test Valley EO Ian Ward, Elected, Rest of England and Wales IW 1 Chair’s Welcome and Opening Comments JDT welcomed everyone to the meeting and in particular EW who was attending for the first time. 1 2 Declarations of Interest There were no new declarations of interest relating to matters on the agenda. 3 Minutes of Previous Meeting The minutes of the meeting held on 19 October 2022 were approved as an accurate record of the meeting. 4 Matters Arising/Summary of Agreed Actions The updates on the actions in the paper were noted. Young governor representatives (action no. 444) was on the agenda for discussion (item 6.3). 5 Strategy, Quality and Performance 5.1 Chief Executive Officer’s Performance Report DAF joined the meeting to present the performance report. He also provided updates on the last three months and the Trust’s financial position. He advised that the last peak of Covid-19 had been in October 2022, when there had been nearly 100 patients with Covid-19 in the hospital, although most had been admitted for other reasons. That had caused operational challenges as it had been necessary to cohort patients with Covid-19, which had not been the most efficient way to run the hospital and was also not ideal for the patients. Despite national and local efforts, the uptake of flu vaccinations had been less strong than in previous years. Going into December another wave of Covid-19 had just started and there had also been a high prevalence of flu and RSV. Children’s ED and 111 had been close to being overwhelmed and ED attendances had more than doubled at UHS, which had put massive pressure on the hospital. That picture had been mirrored nationally and many hospitals (excluding UHS) had gone into critical incident mode. It had been an exceptionally difficult time going into Christmas and pressure created by non-elective emergency patients had continued throughout the holiday period. A year ago, attendances during a typical day in ED at UHS (excluding Eye Casualty) had been around 300 but during December, that number had exceeded 500 on several days. Whilst the hospital had regained a more normal feel during the latter half of January, the RCN strikes had commenced. UHS had not been impacted by the first wave of industrial action but it had experienced two days of action last week and the Trust had aimed to achieve four things: 1. to respect people’s right to strike. 2. to keep as much work going as possible, even with the capacity problems the hospital faced. 3. to keep the hospital safe. 4. to ensure that there was not polarisation amongst the staff after the strikes. DAF said that he felt the Trust had done reasonably well at achieving its aims but around 700 of its nurses had taken industrial action on both days, which had been higher than expected. The Trust had, however, kept roughly half the elective surgery going and he thanked the planning team and senior nurses for their efforts. 2 In response to questions from governors, DAF advised that issues around contractual pay and conditions were a matter for the government to resolve but UHS had tried to focus on the smaller things it could do to support staff, e.g. discounted meals/food and reduced parking costs. The Staff Satisfaction Survey had, however, shown a deterioration in satisfaction levels but UHS remained one of the top ten hospitals in the country to work in. With regard to the Trust’s financial position, DAF advised that the hospital was currently spending around £4m more each month than it was earning and the reserves it had built up over the years for capital investment, were dwindling. The number of patients in the hospital’s beds was higher than planned due to the difficulties of discharging to social care and the cost of staffing those extra beds was significant. Trusts had been challenged to do 104% more activity than they had done in the year prior to Covid-19. UHS had achieved 106% and in some months around 110%, which was more than many Trusts and was worth around £25m. The Trust had not, however, received any money for that activity and it was lobbying for payment. SA queried whether the extra activity was impacting on quality. DAF advised that the Trust’s clinical outcomes remained strong but it was beginning to have an impact and he noted that organisations under pressure often did less well. Staff tended to suffer morale injury if they were so busy they felt unable to do the best for their patients and that was being seen across the country. DAF described the hospital as feeling like a hamster wheel and he advised that the Trust Board had recently discussed how it could be slowed down. If it was not possible to increase capacity, then it may be necessary to consider ways of reducing demand. HE highlighted the cancer metrics and the psychological impact on patients who had to wait longer for their treatment. DAF noted that cardiac patients faced similar delays, due to capacity issues, and acknowledged that whilst work was being done to improve these situations, more work was needed. 6 Governance 6.1 Chair and Non-Executive Director Appraisal Process SHa advised that each year the Non-Executive Directors (NEDs) and the Trust Chair were required to participate in an annual appraisal process. The results were shared with the Governors’ Nomination Committee (GNC) and the CoG. The appraisal process was based on a national framework from NHSE and guidance provided by them would be used. High quality, multi-source feedback would be obtained from Trust Board members and governors for both the NED and Chair appraisals. Feedback from the Integrated Care System (ICS) would also be sought as part of the Chair’s appraisal process. The Chair would conduct individual appraisal meetings with each NED, once feedback had been collated and would consider objectives for the following year. The appraisal process for the Chair would be undertaken by Jane Harwood, NED and Senior Independent Director (SID) and a summary would be provided to the NHSI Regional Director. 3 SHa advised that he would guide KL through the process of collecting feedback from the governors as this was her first term as Lead Governor. He also acknowledged that many governors were relatively new in their roles and he assured them that guidance would be provided in good time. Decision: The CoG approved the appraisal process as recommended by the GNC, following its meeting on 11 January 2023. 6.2 Annual Business Plan 2023/24 KR highlighted the Business Plan and advised that the CoG was required to review (and approve) it on an annual basis, prior to commencement of the new financial year. Decision: The CoG approved the Annual Business Plan for 2023/24. 6.3 Composition of the Council of Governors CM advised that as part of a review of the composition of the CoG, the Membership and Engagement Working Group had discussed proposals regarding the representation of young people on the CoG. In the past, two young people had been appointed to the CoG, one from a college and one from a university. The Trust already had a Youth Ambassador Group (made up of service users) and it had been suggested that the group was asked to provide two representatives (one each from the 16-18 and 18-25 age groups) to join the CoG as associate members. They would be non-voting roles and would not affect the formal composition of the CoG or require any change to the Trust’s constitution. Following discussion, the governors agreed that the young governor representatives should be invited to become associate members for up to two years. The possibility of reaching out to other minority groups, in a similar way, was also suggested and may be considered in the future. Decision: The CoG approved the proposal to invite two representatives from the Trust’s Youth Ambassador Group (one each from the 16-18 and 18-25 age groups) to become associate members of the CoG for up to two years. 6.4 Vacancy for the Nursing and Midwifery Staff Governor JDT advised that Wendy Marsh, who had been elected as the governor for the Nursing and Midwifery staff group, with effect from 1 October 2022, had stood down for personal reasons with effect from 6 December 2022. In accordance with the Trust’s constitution, the paper outlined the three options available to fill the vacancy but JDT advised that given the circumstances, the first was the only viable option. KR advised that once the election had been arranged, the vacancy would be publicised and Gail Byrne, Director of Nursing and Midwifery, would be asked to encourage interest from within the Trust’s nursing and midwifery community. Decision: The CoG approved Option 1 to fill the vacant seat for the Nursing and Midwifery staff group by calling an election to coincide with the scheduled governor elections in 2023. 4 6.5 Confirmation of Chair of the Patient and Staff Experience Working Group JDT advised that a vacancy had arisen for the chair role of the CoG Patient and Staff Experience Working Group as the previous incumbent had stood down when his first term of office had ended on 30 September 2022. SG had expressed an interest in the role and the working group had voted unanimously to support her appointment. Decision: The CoG confirmed the appointment of SG as chair of the CoG Patient and Staff Experience Working Group following her election by the working group. 6.6 Appointment of Deputy Lead Governor JDT advised that HE would complete her first term of office as Deputy Lead Governor on 11 March 2023. Any governor who wished to apply for the role would be required to submit a written statement to the Company Secretary by a specified date (tbc). The statements would then be circulated to all governors by email and an electronic vote would take place. HE advised that she would be happy to talk to any governor about the role. Decision: The CoG noted the process for the appointment of a new Deputy Lead Governor. 6.7 Audit and Risk Committee Terms of Reference The Terms of Reference for all Board committees should be reviewed regularly, and at least once annually, to ensure that they reflected the purpose and activities of each committee. The NHS Foundation Trust Code of Governance required consultation with the Council of Governors on the Audit and Risk Committee Terms of Reference. The Terms of Reference were then to be approved by the Board of Directors (the Board). The Terms of Reference ensured that the purpose and activities of the Audit and Risk Committee were clear and supported transparency and accountability in the performance of its role and complied with the NHS Foundation Trust Code of Governance. The Code of Governance for NHS Provider Trusts, applicable from April 2023, included provisions which stated that the Deputy Chair should not be Chair of the Audit Committee. However, the key concern was that the Audit Committee Chair should be independent, and where the Deputy Chair was expected to act as Chair of the Board, there was potential for the director’s independence to become compromised over time. It was proposed to include the proviso in the Audit and Risk Committee Terms of Reference, that should the Deputy Chair have to act as Chair of the Board for an extended period of time, they would resign as committee Chair in order to preserve the independence of the committee Chair. Given the current committee Chair’s experience and qualifications, it was considered appropriate that he should remain as committee Chair and that the non-compliance could be justified under the ‘comply or explain’ principle and that the underlying concern in respect of independence was to be mitigated through that proviso. This explanation was to be documented in the Trust’s Annual Report. This had been discussed with the Audit and Risk Committee and the CoG Governors’ Nomination Committee (GNC) had also been consulted. 5 An additional consideration was that, as part of succession-planning and Board composition discussions, the Board was to consider the need for an additional suitably (financially) qualified individual to be a member of the committee, who could replace the committee Chair should he have to resign due to his Deputy Chair commitments. The CoG was asked for its views on the proposals: • in response to questions from SG and CMc about the possibility of replacing either the Audit and Risk Chair or Deputy Chair, CMa advised that this would be difficult due to the relevant experience and qualifications of the individual. CMa also explained that the Code of Governance for NHS Provider Trusts was not in alignment with corporate business and agreed that feedback on the change should be provided in the annual review. • KL felt that the proposals had been well considered and were justified but agreed that feedback on the change should be provided. Decision: The CoG agreed with the proposals subject to feedback being provided regarding the changes introduced to the Code of Governance and that its views would be considered when the proposals were reviewed by the Board. 7 Break 8 Membership Engagement and Governor Activity 8.1 Membership Engagement SD introduced the Membership Engagement report and noted that over the last three months most of the Trust’s membership engagement had been through virtual and digital platforms but there had been some activity in the community. He highlighted the following: • a Connect membership newsletter had been sent out in October and December 2022; • approximately 275 postal members of the Trust had now provided their email address which would make it easier to keep in touch with them on a more cost effective basis; • in October public members who specified a stated interest in cardiac, orthopaedics or rheumatology had been invited to take part in real examinations from final year University of Southampton medical students on placement at the Trust. This had resulted in a good interest rate among members; • the Annual Members’ Meeting had taken place in November and had included highlights from the report and accounts as well as a look at progress made in implementing the Trust’s five-year strategic plan. An update on the membership strategy had kindly been provided by HE; • as part of the global men’s health awareness month in November, the Trust had held a men’s health matters event for both public and staff members. IT had focussed on raising awareness on prostate and testicular cancer and also mental health; • members had been invited to a virtual event to mark 20 years of the Trust’s Wessex Blood and Marrow Transplant Programme in November, with staff and former patients reflecting on the service; • the Trust had marked Disability History Month in November with a virtual event looking at how Workforce Disability Equality Standards data was put into action to improve the experience of its disabled staff, with guest speaker Pete Loughborough, a senior analyst at NHS England; • to mark Black History Month in October, Lou Taylor, director of Black History Month South, had been invited to speak about his organisation’s new 6 partnership with the Trust. Staff of black heritage had been encouraged to take part in a project; • a virtual event had been held in January inviting members to contribute to the Trust’s plans to become a tobacco smoke-free hospital site, with examples of interventions to help patients to quit smoking; • the Trust, including some of the governors, had taken part in community sessions in public libraries across Southampton. These provided an opportunity for the public to learn more about how they could get involved in developing UHS services, participate in specific projects and give their views on care received; and • there had been good engagement with stories on social media. For example, a team of UHS medics had received the Best Team award at The Sun’s Who Cares Wins awards after transporting 21 young Ukrainian cancer patients back to England so they could continue their life-saving treatment. Priorities included: • the continuation of virtual health education events exclusively for members; • production of an edition of Connect in February 2023; and • engagement with the University of Southampton Students Union and other stakeholders on attracting younger members. As most of the recent community activities had taken place in the Southampton area, SD encouraged public governors from other constituencies to contact him if they would like any support in engaging with their constituents. 8.2 Feedback from Governors’ Nomination Committee (GNC) A meeting of the GNC had been held on 11 January 2023 to consider the Chair and Non-Executive Director appraisal process for 2022/23. This had been presented to the CoG for approval earlier in the meeting. There was still a vacancy on the GNC and KR had emailed governors on 18 January 2023 to invite expressions of interest. JDT encouraged governors to consider if they would like to volunteer for this additional role. 8.3 Feedback from Strategy and Finance Working Group A meeting of the Strategy and Finance Working Group had been scheduled for 24 January. Unfortunately, this had been cancelled as the Chair had become unwell. This would be re-arranged once she had recovered. 8.4 Feedback from Patient and Staff Experience Working Group A meeting of the Patient and Staff Experience Working Group had been held on 17 January. SG, who had been appointed by the Working Group members as its new Chair, had been unable to attend. KR advised that following a request from the Southampton City governors, there had been a discussion on tackling health inequalities which included a presentation on a prevention project related to diabetes which was underway at the Trust. The presentations had been well received by governors. 8.5 Feedback from Membership and Engagement Working Group A meeting of the Membership and Engagement Working Group had been held on 19 January. SD had attended to provide an update on membership engagement which had also been covered at Item 8.1, and there had been a discussion regarding proposals for young governor representatives which had been presented to the CoG at Item 6.3. 7 KL also advised that where virtual membership events had been recorded and the videos were available for viewing at a later date, via social media, these could incorporate a link to join as a member of the Trust. Consideration was also to be given to inviting network leads to attend future Membership and Engagement Working Group meetings. Proposals for financial support for international staff had been put to SHa which included a possible loan. 9 Any Other Business A question was raised as to whether governors could use the Park and Ride facility when attending CoG meetings as car parks on site could be extremely busy. KL reminded governors that Hampshire and Isle of Wight ICB were to hold a virtual strategy update event for governors on 14 February from 5.30pm-7pm. KR had circulated the calendar invitation. Action: KR to establish whether governors could use the Park and Ride facility when attending CoG meetings. 10 Review of Meeting There were no comments following the meeting. 11 Date of Next Meeting - 26 April 2023 The next meeting would be held on 26 April 2023. 8 4 Matters Arising/Summary of Agreed Actions 1 4 Action items as at 19 April 2023.docx List of action items Agenda item Assigned to 19 April 2023 17:56 Deadline Status Council of Governors 31/03/2021 5.5 Amendment to the Trust's Constitution - CCG Merger 444. Review the Council of Governors' Composition Craig Machell Karen Russell 26/04/2023 Explanation action item A review of the Council of Governors' composition is to be carried out to check that it still remains appropriate. Closed Following discussions by the Membership and Engagement Working Group, proposals for a change to the composition of the CoG, it was agreed to reduce the number of governors representing the Rest of England by one governor; and to increase the number of governors representing New Forest, Eastleigh and Test Valley by one governor. Suggestions regarding young governor representatives were considered further at a sub-group on 24 August 2022 and these will be discussed at the Membership and Engagement Working Group at its meeting on 17 October 2022. Proposals have now been prepared and will be presented at the Membership and Engagement Working Group Meeting on 19 January 2023. Explanation Russell, Karen At its meeting on 25 January 2023, the CoG approved the proposal to invite two representatives from the Trust’s Youth Ambassador Group (one each from the 16-18 and 18-25 age groups) to become associate members of the CoG for up to two years. We have now been advised that the two associate members have been selected and details of their appointment was confirmed to governors on 19 April 2023. 19 April 2023 17:56 Council of Governors 19/10/2022 8.2 Governors' Nomination Committee Feedback 868. Public and Staff Governor Vacancies on the Governors' Nomination Committee (GNC) Russell, Karen 26/04/2023 Closed Explanation action item There were two vacancies on the GNC. Governors who were interested in joining the GNC were invited to submit an expression of interest to the Chair. KR also circulated an email to governors inviting expressions of interest on 24 October 2022. KR circulated an email to governors inviting expressions of interest on 24 October 2022. Shirley Anderson submitted an application and the CoG approved her membership of the GNC by written resolution in November 2022. A further email to invite expressions of interest for the remaining vacancy was sent to governors on 18 January 2023. Patricia Crates submitted an application and the CoG approved her membership of the GNC by written resolution in March 2023. Council of Governors 25/01/2023 10 Any Other Business 890. Use of the Park and Ride facility by governors Russell, Karen 26/04/2023 Closed Explanation action item Two governors asked about the possibility of using the Park and Ride facility when attending CoG meetings as car parks on site could be extremely busy. Explanation Russell, Karen It has been agreed that governors are able to use the Park and Ride facility. Information regarding its use was circulated to governors on 7 February 2023. Page 2 5.1 Annual Report and Quality Accounts Timetable 1 5.1a Annual Report and Quality Accounts timetable cover sheet.doc Report to the Council of Governors Title: Agenda item: Sponsor: Author: Date: Purpose Issue to be addressed: Annual Report and Quality Accounts Timetable 5.1 David French, Chief Executive Officer Craig Machell, Associate Director of Corporate Affairs and Company Secretary 26 April 2023 Assurance Approval or reassurance Ratification Information Y NHS England has published the timetable for the 2022/23 annual report and accounts and associated guidance. The Trust is required to produce an annual report and accounts as well as a Quality Account. The Trust has decided to align the timetables of both the Quality Account and the annual report and accounts, and to incorporate these into the same document. Response to the issue: Implications: Risks: Summary: Conclusion and/or recommendation The Quality Account is required to be published by 30 June 2023, whereas the annual report and accounts cannot be published until after they have been laid before Parliament. Parliament’s summer recess commences on 20 July 2023. The Trust has taken the decision to produce the annual report and accounts and the quality accounts on the same timetable as a single document. However, due the additional work required to complete the value for money external audit, the quality accounts will be published as a separate document by 30 June 2023. The attached timetable sets out the process in greater detail. The Trust meets the requirements of the National Health Service Act 2006, The National Health Service (Quality Accounts) Regulations 2010 and the NHS foundation trust annual reporting manual 2022/23. 1. Non-compliance with the National Health Service Act 2006, The National Health Service (Quality Accounts) Regulations 2010 and the NHS foundation trust annual reporting manual 2022/23. 2. Ensuring openness, transparency and accountability regarding the performance and activities of the Trust. 3. Pressure on staff to provide information for inclusion in the annual report and accounts and the quality accounts as the Trust deals with significant emergency pressures and delivers the elective recovery programme. The Council of Governors is asked to note the timetable. 1 5.1b Annual Report and Quality Accounts Timetable.doc Annual Report and Accounts (including the Quality Accounts) 2022-23 Timetable NHS England (NHSE) has published the timetable for the 2022/23 annual report and accounts and guidance on producing the annual report and accounts. The proposed timetable is set out below Action Draft quality account reviewed at Council of Governors’ meeting Deadline for draft accounts submission to NHSE Issue final draft quality accounts to ICB, Local Healthwatch, Overview and Scrutiny Committee and Council of Governors for one month consultation Early May Bank Holiday Coronation Bank Holiday Circulation of first draft annual report to external auditor, Board of Directors and Council of Governors Draft annual report and accounts reviewed at Audit and Risk Committee meeting Draft quality account reviewed at Quality Committee meeting Draft annual report and accounts reviewed at Board of Directors meeting Spring Bank Holiday Final draft annual report and accounts including quality accounts reviewed at Audit and Risk Committee meeting Final draft annual report and accounts including the quality accounts approved by Board of Directors Deadline for submission of signed annual report and accounts and supporting documentation to NHS England Add quality accounts to Trust website and forward the link to quality-accounts@nhs.net Final audit opinion and audit certificate (following completion of value for money external audit) Submit annual report to Parliament Publish annual report and accounts (including quality accounts) on Trust website Present update on annual report and accounts and external audit report to Council of Governors (in closed session) Present final annual report and accounts (including the quality accounts) to Council of Governors Annual Members’ Meeting Date Wednesday, 26 April 2023 Thursday, 27 April (noon) By Friday, 28 April 2023 Monday, 1 May 2023 Monday, 8 May 2023 w/c Monday, 8 May 2023 Monday, 22 May 2023 Monday, 22 May 2023 Thursday, 25 May 2023 Monday, 29 May 2023 Monday, 19 June 2023 Monday, 19 June 2023 By Friday, 30 June 2023 (noon) Friday, 30 June 2023 TBC TBC TBC TBC - Tuesday, 19 July 2022 TBC TBC Page 1 of 1 5.2 Chief Executive Officer's Performance Report 1 5.2a Council of Governors Cover Sheet.docx Report to the Council of Governors Title: Agenda item: Sponsor: Author: Date: Purpose Chief Executive Officer’s Performance Report 5.2 David French, Chief Executive Officer Jason Teoh, Director of Data and Analytics 26 April 2023 Assurance Approval or reassurance Ratification Information Y Issue to be addressed: Information about Trust performance supports the Council of Governors in their role. Response to the issue: This report is intended to inform the Council of Governors about aspects of the Trust’s performance. Implications: This report provides performance information relating to a broad range of Trust services and activities. There are no specific implications. Risks: This report is provided for the purpose of information. Summary: This report is provided for the purpose of information. 1 5.2b COG Chief Executive's Performance Report Apr 2023 FINAL.docx UHS Council of Governors 26th April 2023 Chief Executive’s Performance Report 1. Purpose and Context The purpose of this report is to summarise the Trust’s performance against a range of key indicators. Where available, this report covers data from the period December 2022 to February 2023, noting that some performance data in relation to some of the targets is reported further in arrears. This has again been a challenging operational period for the Trust. Notable features of the period included: • Ongoing high volume of attendances to the Emergency Department – particularly in December 2022 due to a high number of paediatric attendances due to Strep A. • A significant number of patients not meeting the criteria to reside, usually at between 180 – 210 patients, continuing to occupy hospital beds, restricting flexibility in our elective programmes, and impacting flow through the hospital (including patients awaiting admission from the Emergency Department onto wards). • Challenges with cancer services due to higher cancer referral volumes and the need to balance staffing capacity. • A number of days of industrial action impacting elective services during the period. • Ongoing growth in the RTT waiting list due to higher post-pandemic referral volumes causing the waiting list to rise to over 54,000 patients. However, good progress has been made in reducing the longest waiting patients at both 104+ and 78+ weeks. 2. Safety Infection Control Clostridium Difficile infection MRSA Bacterium infection Target 95.0% ≥ 90.0% Dec 2022 55.9% 66.2% Jan 2023 65.4% 72.9% Feb 2023 68.6% 73.3% Attendances to the Emergency Department (ED) have remained high through this period, averaging 371 per day (compared to 347 per day a year before – a 7% increase). This included a particularly challenging 12 day period in December 2022 where daily attendances were over 400 each day, including two days with over 500 attendances, due to the Strep A incidents before Christmas. The improvement in performance in January and February 2023 is linked to lower attendances compared to December 2022. Alongside the ongoing flow challenges due to the number of patients no longer meeting the Criteria to Reside, means that UHS four-hour performance remains below target. However, we continue to benchmark well against other trusts which demonstrates that this is a national challenge. In the period of December 2022 to February 2023, UHS ranked in the top quartile of the 17 teaching hospitals that we benchmark against (Type 1 attendances). In addition, UHS continues to ensure that we do not delay ambulance handovers. The average time to handover remains stable (approximately 16 minutes), and we have one of the lowest volumes of ambulance handover delays over 30+ and 60+ minutes in the South East and South West regions. Page 3 of 5 Referral to Treatment (RTT) % incomplete pathways within 18 weeks in month Total patients on a waiting list Target => 92% Dec 2022 63.3% 53,941 Jan 2023 63.7% 54,254 Feb 2023 63.1% 54,692 The number of patients on the RTT waiting list continues to increase as higher referrals continue above prepandemic levels. The proportion of patients that we have being treated within 18 weeks is in line with other teaching hospitals, with UHS within the top third of teaching hospitals. UHS continues to make good progress in reducing the longest waiting patients. We ended the year with no patients waiting over two years for treatment, and only 15 patients (all complex patients) who had waited over 78 weeks for treatment. Cancer Target Urgent GP referrals seen in 2 weeks => 93% Diagnosis within 28 days > =75% Treatment started within 62 days of urgent GP referral => 85% Dec 2022 79.6% 79.1% 55.3% Jan 2023 82.3% 68.7% 50.8% Feb 2023 Check after 31.03 Check after 31.03 Check after 31.03 As a specialist teaching hospital, we treat some of the more complex cancer cases from the region. However, all cancer services are under pressure from higher demand and this is a national trend. In January and February 2023, cancer referrals were 9.3% higher than the equivalent months in 2019. UHS has historically benchmarked in the upper quartile, relative to our teaching hospital peers. Our position slipped in the face of operational challenges in October and November 2022, into the second and third quartiles. To correct this each tumour site has developed clear recovery action plans, and we have seen signs of recovery and an upward performance trajectory in between December 2022 to February 2023. The Trust is focussed on progressing the action plans with support from the ICB and Wessex Cancer Alliance. 5. Finance The financial position for the trust is particularly challenging with a forecast deficit for 2022/23 of £11m. However, this position is supported by a number of non-recurrent measures including additional income, meaning our underlying deficit is well in excess of this position. The key drivers are: • COVID-19 related cost pressures – patient numbers remained significant in the early part of the year and staff sickness absence has also remained above pre-COVID levels. This has generated a cost pressure compared to plan assumptions. • Inflationary pressures especially related to energy costs – these are emerging to a greater extent as the year progresses with energy costs particularly high over the winter period despite the government price cap offering some protection. Energy costs are more than three times greater than they were in 2019/20. • An increase in the volume of patients not meeting the criteria to reside who are medically optimised for discharge – this is causing particularly acute operational challenges and means the trust has unfunded bed capacity open. This has also limited the Trust's ability to deliver additional elective activity supressing Elective Recovery Funding (ERF). • More recently industrial action is also creating one off costs due to backfill requirements needing to be put in place at short notice. This is likely to remain a challenge into 2023/24. Despite this the cost improvement programme for the Trust continues to deliver savings with the £45m savings plan forecast to be delivered in full. Page 4 of 5 Looking forward, there is a significant challenge for 2023/24 in improving both the Trust and HIOW Integrated Care System’s finances. For UHS we are currently projecting a £35m deficit, predicated on the achievement of a £60m (5%) cost improvement programme. Both internally, and with system partners, there is a focus on productivity improvement and exploring initiatives that can make a scalable difference. Similarly, financial controls and governance have been reviewed to ensure there isn’t any further deterioration. The Trust has made significant progress with its capital programme, including a new wards project and theatres refurbishments. The Trust remains on target to spend its full capital budget of £48m for 2022/23. Additional to this the Trust has been successfully awarded external capital of c£27m for spend in 2022/23 which will further support investment in capacity, infrastructure and digital. This will be spent in full in this financial year. 6. Human Resources Indicator Staff recommend UHS as a place to work Staff survey engagement score Target - Q3 22/23 6.91 7.1 Q4 22/23 6.92 7.02 The Pulse Survey results shows a small improvement in recommendation of UHS as a place to work (although down compared to last year), and a further decline in the engagement score. We believe this reflects the ongoing challenging environment that staff are working in. However, we remain slightly better than national averages. Indicator Turnover (internal target) Sickness absence 12 month rolling (internal target) Nursing Vacancies (Registered Nurse only in clinical wards) (internal target) Target 65 weeks by March 2024 • Deliver a balanced income and expenditure budget i.e. no financial deficit • Improve A&E waiting times to at least 76% within 4 hours • Improve maternity staffing ‘fill’ rates and safety 3 National Financial Framework 2023/24 • How will the trust be paid? – Fixed income in relation to most hospital activity, non-elective admissions in particular – Variable payments, at national tariffs, for elective, daycase, and outpatient activity (excluding follow ups) • Funding allocated for other specific service opening / increases requested of UHS, typically for specialised services • £28m (2.9%) increase for inflation (risk given headline CPI @ 10%) • £27m (2.8%) decrease relating to efficiency requirements (Covid reductions of £11m + Efficiency £16m) • Challenge therefore to 'consume your own smoke' 4 UHS Context 2022/23 • Exceptional growth in attendances to Emergency Department since 19/20 (15% approximately), deterioration in treatment times to 75% within 4 hours • Elective waiting list size increasing by 3% per annum, but waiting times > 104 weeks eliminated and waiting times > 74 weeks reduced to under 150 patients • UHS and HIOW ICS delivering relatively high levels of elective activity, but with relatively high costs / deficit compared to other ICSs / Regions • Increase in UHS staff by 2000 (18%) since 19/20, approximately ¼ for specific new services, ½ for activity/capacity increases, ¼ for a range of other reasons • UHS continues to be productive / cost effective in comparison with other hospital trusts, though our costs have grown faster than activity since 2019/20 5 UHS Context 2022/23 • Underlying UHS financial deficit (difference between expenditure and income) of £45m, largely as a result of factors outside local control e.g. inflation, energy costs, COVID funding reduction, increase in delayed discharges, sickness absence rates, unfunded cost of new NHS approved drugs • Increased Cost Improvement target of £45m delivered in full during 22/23, though only half of these savings were made through recurrent schemes, and savings were mainly achieved through non-pay costs • £88m Capital invested (using a combination of local funds and external bids mainly to NHSE programmes), including ward construction, theatre refurbishment, MRI scanner replacement, ‘park and ride’ for staff • Reducing levels of cash held, as a result of both the revenue deficit, and funding capital investments i.e. Buildings, Medical Equipment, IT Systems 6 Our Plan 2023/24 (Submitted 30th March with UHS Board Approval) • Increase elective activity levels to 113%, or ideally higher • Planned reduction in the number of follow-up appointments of 10%, compared to 2022/23 • Reduce the rate of growth in the elective waiting list size, and hold this level from Q4 onwards • Eliminate waiting times for treatment greater than 65 weeks • Reduce waiting times for cancer treatment and diagnostic tests, return to the national target of 85% of cancer treatment starting within 62 days • NHSE funded service expansions including Mechanical Thrombectomy, CAR- T, Paediatric ICU retrieval, and two inpatient wards to support elective activity 7 Our Plan 2023/24 (Submitted 30th March with UHS Board Approval) • Plan to keep numbers of staff posts level – increases of approx. 300 related to funded expansions, offset by reductions through efficiency / cost improvement • Plan to increase the number of employed staff (WTE) by 340, reducing the use of bank/agency workers by a similar amount • Cost Improvement requirement of £60m (6%), plan to achieve through pay / non-pay savings, financial contributions on additional NHS activity/income etc. • Financial Deficit of £35m (since improved to £30m), with the intention of fully recovering financial balance in 2024/25 • Avoid cash deterioration beyond £30m • Capital investment of £70m, including £21m externally funded 8 Our Plan 2023/24 (Submitted 30th March with UHS Board Approval) 9 Our Plan 2023/24 (Submitted 30th March with UHS Board Approval) Supporting notes: • The UHS Plan is submitted to NHSE as part of a combined HIOW ICS Plan which includes the ICB, 4 Acute Trusts, Solent, Southern, South Central Ambulance Trusts • Current NHS arrangements are ‘System by default’ i.e. NHSE expects to hold ICS to account collectively for their performance, and also seeks to distribute the majority of NHS funds via ICBs on a population based ’fair-shares’ basis • Our plan is the product of intensive focus on both planning and implementation, governance including consideration by UHS Executive Committee and Board monthly since January, and significant dialog between UHS and HIOW ICB and system partners 10 HIOW ICS 23/24 position, and NHSE view • ‘Re-submission’ (typically an amended submission) will be required from all NHS organisations / ICS at the start of May • NHSE has not accepted our current plan • We are being challenged, as part of HIOW ICS, to: • Justify the level of workforce growth since 19/20 • Set a sustainable (affordable) workforce and financial model, and trajectory as to how quickly we could reach this • Increase the scale of ambition in relation to follow-up activity reduction • There is substantial concern that HIOW ICS would, otherwise, be anticipating a large financial deficit in the year 23/24 11 Commentary • Our plan is extremely challenging, as a result of the combination of financial and non-financial objectives • Delivery of our plan in full is our intention, but is not guaranteed • UHS has reasons for positivity, including investments in physical capacity, our recruitment levels, our people, and record of efficiency / control / innovation • Aligning both the right physical capacity and staffing levels will be critical to delivering higher volumes of treatment and care whilst operating efficiently • The impact of ICS initiatives to better manage emergency demand and reduce discharge delays, that both impact on hospitals, is very important • Achieving further / more rapid financial improvements a part of plan re- submission is being considered by the Executive and Board currently 12 Implementation and Monitoring • We are in the process of communicating the detailed requirements by service / budget area, and securing agreement of these 23/24 plans • Transformation programmes (for inpatient ‘Flow’/Outpatient improvement/ Theatres) are established and resourced to support improvement • A Trust Savings Group was established in 22/23, chaired by the Chief Financial Officer, this oversees other financial recovery programmes of work • Additional financial controls have been implemented • Progress against our plan and national targets is reported and monitored monthly by both the Trust Executive Committee and by Trust Board • Supported by a range of other groups / meetings focused on the review of specific topics or areas e.g. Operational Performance, Value for Money 13 Council of Governors - Operating Plan for 23/24 Questions? Phil Bunting, Director of Operational Finance Andrew Asquith, Director of Planning and Productivity 26 April 2023 University Hospital Southampton NHS Foundation Trust Tremona Road, Southampton Hampshire, SO16 6YD www.uhs.nhs.uk 5.4 Non-NHS Activity 1 5.4 Non NHS Activity.doc Report to the Council of Governors Title: Agenda item: Sponsor: Author: Date: Purpose Non-NHS Activity 5.4 Ian Howard, Chief Financial Officer Peter Baker, Commercial & Enterprise Director 26 April 2023 Assurance or Approval reassurance Ratification Information Issue to be addressed: X One of the responsibilities of the Council of Governors is to determine whether the Trust’s non-NHS activity would significantly interfere with its principal purpose, which is to provide goods and services for the health service in England, or the performance of its other functions. This paper seeks to provide an update to the Council on the portfolios of activity within the Commercial Service. Response to the issue: Commercial Services undertake activity in a range of portfolios, delivering additional value through non-core income to the Trust. The below outlines activities that we will be focussed on for the financial year 2023-24. Private Patients: During the past financial year, the Trust will have supported clinicians to undertake activity in their own time. By supporting clinical staff to undertake this work, we can secure new income. The alternative to not undertaking this work is that the activity would be undertaken by another private provider such as Spire or Nuffield, and the profit would likely go to their shareholders rather than be ploughed back into the NHS. UHS has zero permanent beds for private patient activity. The plan for 2023/4 is to focus on key areas of service that can provide growth to generate income to support the services financial plans, areas such as neuro, paediatrics, and robotics. Overseas Visitors: All patients are able to access NHS services for emergency treatment, no matter what their nationality or permanent residence. However, for ongoing treatment, cost can be recovered for non-UK nationals and UK nationals not residing in the UK. New processes and investment into the overseas visitor’s team will see delivery of increased income 2023-24. Partnership: This area of the service focuses on how we can better interact with busi
Url: /Media/UHS-website-2019/Docs/About-the-Trust/Governors/Papers-CoG-26.04.2023.pdf

STH816 v1 Department of infection user handbook

Description: Microbiology and Specialist Virology Services User Handbook STH816/02-25 Issued Date 23.07.2025 Authorised by R. Allen Page 1 of 48 Contents About our Services Core Service hours On-call/out of hours service Location of laboratory Key contacts Availability of clinical advice Completion of the request form Specimen collection Why has my specimen been rejected? High risk specimens and safety Transportation of samples Results reporting Telephoning of Urgent and significant results Quality assurance Patient confidentiality Complaints handling procedure A to Z of diagnostic tests and investigations STH816/02-25 Issued Date 23.07.2025 Authorised by R. Allen Page 2 of 48 About our services The department of infection provides a full clinical service for the diagnosis of infection, which includes bacteriology, virology, serology, parasitology, mycology, molecular epidemiological studies to UHS, other NHS Trusts, general practitioners and local authorities. Specialist sections include: • Antimicrobial chemotherapy, carrying out antibiotic assays and sensitivity tests on clinical isolates • Mycology, providing diagnostic mycology, medical parasitology and fungal serology services • The molecular diagnostics unit provides rapid identification of bacterial and viral pathogens directly from various patient specimens, by detection of pathogen DNA or RNA. • Microbiological and epidemiological information, advice and support to consultants in communicable disease control and their colleagues in Public Health Medicine; local surveillance and special studies in infectious disease • Laboratory expertise for the control of infections including investigations in the community and during national outbreaks of infection. • The Southampton specialist virology centre (SSVC) offers specialist virology diagnostic molecular and serological testing for hospital and community patients Core Service Hours Monday to Sunday including bank holidays, 09:00 to 17.30 During normal laboratory hours please telephone urgent requests to the main enquiry number and the call will be directed to the appropriate member of staff in the laboratory to ensure priority processing. Either bring the specimen to the laboratory reception yourself or arrange urgent transport. Details of the out of hours service may be found below. Out of hours service • There is a small team of staff on site to process some clinically urgent samples • Urgent specimens can be processed if requested and agreed criteria satisfied, depending on availability of competent staff • These requests need to be phoned and discussed directly with the laboratory on a case-by-case basis STH816/02-25 Issued Date 23.07.2025 Authorised by R. Allen Page 3 of 48 Location of laboratory STH816/02-25 Issued Date 23.07.2025 Authorised by R. Allen Page 4 of 48 Key contacts: All Enquiries: 023 8120 6408 UHS clinical services lead for the department of infection / consultant medical microbiologist & infectious diseases / microbiology/ID training programme director for Wessex. Dr Julian Sutton Laboratory manager Rebecca Allen Laboratory lead for bacteriology / consultant medical microbiologist / Dr Kordo Saeed deputy infection control doctor Consultant medical microbiologist Dr Sarah Glover Consultant medical microbiologist Infection control doctor / Dr TatShing Yam Consultant medical infectious diseases microbiologist & Dr Andrew Rosser Consultant medical microbiologist Dr Nitin Mahobia Consultant medical infectious diseases microbiologist & Dr Tom Cusack Consultant medical microbiologist Associate Professor UoS & Dr Adam Dale Consultant medical infectious diseases microbiologist & Dr Nicholas Norton Laboratory lead for Virology/Consultant medical virologist Dr Emanuela Pelosi Consultant medical virologist Dr Eleri Wilson-Davies Consultant medical virologist Dr Adhyana Mahanama Availability of Clinical Advice Consultation about investigation and management of infection is welcomed. • For advice on diagnosis and the interpretation of microbiology results and antimicrobial use contact the main enquiry number STH816/02-25 Issued Date 23.07.2025 Authorised by R. Allen Page 5 of 48 • A senior member of medical staff is always available • Outside normal hours of service medical staff may be contacted through the hospital switchboard Completion of the request form Microbiology and virology tests can only be carried out when the appropriate request forms are used. N.B. Additional tests in other disciplines, e.g. for histological testing, require that a separate sample and the appropriate form are sent for that purpose. A request form must accompany all specimens sent to the laboratory and should clearly state the following information: • NHS number • Patient name and full address • Date of birth • Sex • GP/Consultant code (preferred) or name • Surgery/Ward code (preferred) or name • Type of specimen • Date and time specimen taken • Tests required • All relevant clinical details including any antimicrobial treatment (recent, current and intended) and foreign travel. Also, indicate if patient is pregnant and if so provide EDD • Risk status of patient should be clearly stated • Date of onset and duration of illness, particularly for serology • Signature of requester • For antimicrobial assays: provide date of last dose of antimicrobial and time given and dose • For wound specimens: detail anatomical site from which "wound" specimens were taken • Supply useful epidemiological information e.g. with children and ? shigella sonnei: give the name of the school with adults and ? salmonella -give the place of work and occupation • ? Campylobacter, Giardia, Cryptosporidium: state if contact with livestock or external water sources e.g. recreational or work related Specimen collection The best results are obtained when an appropriate, correctly taken specimen, in the proper container, is delivered to the laboratory promptly and relevant clinical information is provided on the request form. Guidelines on specific samples may be found in A to Z of diagnostic tests and investigations (Appendix), but in general: • Do not send specimens in non-sterile containers • Containers should be leak proof and CE marked STH816/02-25 Issued Date 23.07.2025 Authorised by R. Allen Page 6 of 48 • Specimens should be obtained before antimicrobial agents have been administered • An adequate quantity of material should be obtained for complete examination • Always send pus rather than a swab of the pus • The specimen taken should be representative of the disease process. For example, material swabbed from the opening of a sinus tract is more likely to yield commensal micro-organisms on the skin than would material obtained by curettage or biopsy of the base of the tract • Care must be taken to avoid contamination of the specimen by micro-organisms normally found on the skin and mucus membranes. Sterile equipment and aseptic technique must be used for collecting specimens, particularly for those from normally sterile sites • Material must be transported promptly to the laboratory. Fastidious organisms may not survive prolonged storage or may be overgrown by less fastidious organisms before culturing • Please contact the laboratory if there is any doubt about the best specimen to take or concerning the availability of a test • Occasionally further tests are required on samples that have already been received by the laboratory. The laboratory uses 'The Retention and Storage of Pathological Records and Specimens (5th Edition 2012)' for guidance on retaining samples for testing. However, depending on the nature of the sample and its viability after storage some clinically important samples are kept for longer e.g. CSF. Serum samples are stored for a period of two years since collection, thus allowing retrospective testing whenever it is clinically required. Tests - key responsibilities 1. Ensure the appropriate test has been requested for the suspected infection 2. Ensure the correct amount of the correct specimen in the correct container is sent for any given test (see A-Z of Tests) 3. Ensure the patient details on request form and specimen correspond 4. Ensure prompt transportation of specimen to laboratory 5. Ensure high risk specimens are appropriately marked and transported 6. Ensure that the laboratory is notified in advance about urgent specimens 7. Ensure the specimen request form contains all appropriate information, full clinical details and correct contact details 8. Ensure tests are not requested in duplicate 9. It is the responsibility of the requestor to check results in a timely fashion High risk specimens and safety a. Specimens are regarded as HIGH RISK if taken from patients known to be affected by a serious infectious disease such as tuberculosis or typhoid, or from those at risk of being infected by one of these agents. These specimens must be labelled as HIGH RISK on the container and the request form. b. The appropriate yellow sticker 'DANGER OF INFECTION' must be used. The specimen must be placed in a biohazard bag. STH816/02-25 Issued Date 23.07.2025 Authorised by R. Allen Page 7 of 48 c. Great care must be taken in obtaining specimens. Equipment such as needles and blades must be immediately disposed of safely in approved sharps boxes. d. Should a spillage occur of blood, fluids, tissues, or other specimens, this should be made safe and disposed of no matter what the risk status of the patient is. e. Specimens should be transported to the laboratory as rapidly as possible after collection to allow for the most accurate generation and interpretation of results f. Ensure appropriate action is taken for abnormal results and, if unsure, seek advice in interpretation of test results and treatment from senior biomedical scientists and medics. g. Turnaround times will vary depending on the test h. For best results, please ensure the correct type of specimen is sent in the correct container i. Please note that availability for some tests is restricted and requires prior discussion/ authorisation by a microbiologist/ virologist j. If unsure as to how to interpret a result, contact us. Please be ready with a full clinical history, up to date clinical data and recent antimicrobial treatment details before you call Why has my specimen been rejected? Specimens are only rejected for valid reasons: • Inadequately labelled/unlabelled specimen • Labelling error/discrepancy (for example, between specimen and request form) • Unsuitable specimen or unsuitable specimen container • Leaked specimen • Contaminated specimen • Lack of/no relevant clinical information on request form Transportation of samples • Specimens should be placed in the appropriate container which must be securely fastened. This must be placed in a clear plastic bag and sealed and transported to specimen reception in an approved secondary container together with absorbant material • Hand-written request forms should be placed in the side compartment with the card folded inwards to help preserve request confidentiality • Request forms must not be placed in the same compartment as the sample • All high-risk specimens should be placed in a biohazard bag • If a specimen is to be posted the packaging must comply with postal regulations https://www.hse.gov.uk/biosafety/blood-borne-viruses/transportation-ofinfectious-substances.htm • Specimens are transported to level D pathology reception before being distributed to the microbiology/virology laboratory STH816/02-25 Issued Date 23.07.2025 Authorised by R. Allen Page 8 of 48 • Specimens may not be suitable for testing if they are so inadequately labelled that the patient's identification is in doubt, or if they have leaked, been contaminated or if no relevant clinical information is given with the request • Rapid inpatient e.g. respiratory samples for viral pathogens may need to be brought directly to the laboratory or sent to Pathology Specimen Reception using the POD system Results reporting • Validated results are reported electronically to results server at UHS. • Electronic reports are produced for GP sources every hour for delivery via EDI PMIP services. • Hard copy reports for valid locations are printed and dispatched every working day, including Saturdays. Apart from negative urines which can be reported after one working day, most bacteriology culture results are reported after 2-5 days, depending on the investigation. Serology/immunology, virology reporting depends on the frequency of testing and the urgency of the request. • In order to provide the most clinically beneficial, operationally efficient and costeffective service, the laboratory employs a number of multiplex assays and it is normal practice to use these even when not all tests within the multiplex panel are requested. It is our policy to report all results along with those requested to provide as much information as possible to aid diagnosis. Telephoning of Urgent and Significant results Results of urgent requests and results which may aid the immediate patient management will be telephoned. This includes all likely true positive blood cultures and CSFs. Certain results may be rapidly available, and to aid the management of certain infections will be telephoned when they become available. Examples are: • Gram stain on CSF, pus from abscesses or empyema • Ziehl-Neelsen or phenol-auramine stain for acid and alcohol-fast bacilli • Positive PCR results in lower respiratory tract samples for Pneumocystis jirovecii. • Positive HSV PCR results in blood and surface swabs of neonates • CSF: Positive PCR results from patients with encephalitis clinical suspicion of meningitis/encephalitis CSF/fluid/tissue/pus etc referred for bacterial culture • At the time of request, the requester will be informed that the result will be on the computer system as soon as possible after receipt. No results will be telephoned. The result will be entered onto the computer and the following laboratory comment will be added: 'Sample processed on-call. Please refer to empiric guidelines if treatment required. If unsure what action to take please consult a senior member of your clinical team in the first instance. A senior member of the clinical team should contact an infection/microbiology doctor via switchboard if they require further advice.' STH816/02-25 Issued Date 23.07.2025 Authorised by R. Allen Page 9 of 48 • For advice on diagnosis and the interpretation of microbiology results, antimicrobial use, infection control including the use of containment facilities, contact the duty NHS medical microbiologist via the Southampton General Hospital switchboard Quality assurance Samples from National Quality Assurance schemes are analysed routinely within the department. The laboratory is assessed by UKAS to ISO15189:2022 accreditation number: 8403, Full scope of accredited activities can be viewed on the UKAS website https://www.ukas.com/find-an-organisation/ There is a quality management system in place and the department participates fully in this process. The microbiology laboratory is accredited for the training of biomedical scientists by the Institute of Biomedical Science (IBMS). Patient confidentiality All staff working for Pathology have a legal duty to keep information about patients and staff members confidential and to protect the privacy of individuals. All staff adhere to the Trust’s data protection and confidentiality policy and are mandatorily required to perform annual Information governance training. Complaints handling procedure University Hospital Southampton complaints team, comprised of a complaints manager and complaints coordinators, can be contacted via email at complaints@uhs.nhs.uk or via email at pals@uhs.nhs.uk. Contact telephone number is 02381206325 or write to Patient advice and liaison service (PALS), Mailpoint 81, Southampton General Hospital, Tremona Road, Southampton, SO16 6YD STH816/02-25 Issued Date 23.07.2025 Authorised by R. Allen Page 10 of 48 A to Z of diagnostic tests and investigations (Appendix) Diagnostic tests and investigations • This is an alphabetical listing of all the diagnostic tests offered by the laboratory • This consists of tests performed onsite and tests that are referred to a reference laboratory • Reference tests stated turnaround times referred to are working days Test Adenovirus PCR (Qualitative assay) AFB (acid-fast bacilli) Amikacin assay Amoebic serology Ano-genital ulcer PCR Antenatal Screening:(Full screen consists of: Syphilis total antibodies, Hepatitis B surface antigen (HBsAg), HIV antigen/antibody) Specimen Container Respiratory secretions (NPA, Throat Swabs, BAL), Eye swabs, Blood(serum) Sterile Universal See under Mycobacteria See under Antibiotic Assays Blood (serum) Clotted blood (redtop) Swab Swab in VTM Blood (serum) Clotted blood (redtop) Required volume Minimum 200 µl 5-10 ml 5-10 ml Laboratory Turnaround time Additional information SGH 3 days Reference 28 days SGH 2 days SGH 8 days eQuest ordering: Select [Partial Antenatal screen] for patients declining HIV test Select [Minimal Antenatal] for patients declining HIV and HBsAg STH816/02-25 Issued Date 23.07.2025 Authorised by R. Allen Page 11 of 48 Test Anthrax (serology/ isolation/ PCR) Antibiotic Assays Amikacin pre-dose (trough) & post-dose (1 hour after drug has been given) Teicoplanin pre dose. Post-dose and random levels are NOT routinely needed. Loading dose regimen essential and wait for one week before testing level. Antibiotic Assay (OTHER)not listed above Anti streptolysin O titre] Antral washings Ascaris microcsopy Specimen Container Required volume Laboratory Turnaround time Additional information Blood (serum) Clotted blood (redtop) 5-10 ml (blood) Reference 5 days Consult microbiology to arrange & discuss request • Please HANDWRITE on the request form, the exact time that blood is drawn. • Vancomycin, gentamicin and tobramycin levels are processed in biochemistry 24 hours-a-day. • Other antibiotic assays are NOT performed on-call [2000-0900 hours]. Blood (serum) Clotted blood (redtop) 5-10 ml Reference 5 days Conventional 2-3 times daily dosing: aim for a pre-dose of 2 weeks. Reference SGH Reference Reference SGH SGH 11 days Consult microbiology to arrange & discuss request 3 days for standard MC&S 14 days Please specify if TB, fungal, viral or other test required (eg PCP . 14 days 2 days for negative, 3 days for presumptive positive 2 days for negative 3 days for positive . Specimens are rejected if > 48 hrs as sub optimal for the isolation or organism STH816/02-25 Issued Date 23.07.2025 Authorised by R. Allen Page 15 of 48 Test Cerebrospinal fluid (CSF) MC&S For cell count, Gram staining and culture send 2 - 3ml of CSF in each of 3 sterile universal containers CSF for virological investigations CSF for Mycobacteria/ Fungal investigation [CSF for MC&S] and specify additional tests in clinical details Chagas' disease Chickenpox Chlamydia trachomatis/ NAATS Specimen CSF CSF Container Require d volume Sterile Universal 30ml 2-3 ml Sterile Universal 30ml 2-3 ml Laboratory SGH SGH Turnaround time 2-4 hrs (Microscopy) 2-3 days (Culture) 2 days Additional information If meningitis/ encephalitis is suspected contact the laboratory and send the specimens immediately. Send separate specimens for glucose and protein analysis to the appropriate departments Provide a date of onset, symptoms and travel history. Routine PCR testing includes: HSV, VZV, Enterovirus, parechovirus, Neisseria meningitidis If additional tests are required, contact virology CSF Sterile Universal 30ml 2-3 ml SGH Up to 8 weeks Send a separate sample for mycobacteria/ fungi Send blood films for diagnosis of acute infection, otherwise see Trypanosomiasis serology See under Varicella Urine/genital/HVS/ pharyngeal/rectal/ eye swab Alinity m collection tube As specified in collectio n kit SGH 2 days Contact laboratory if information regarding Alinity m collection kits are required. STH816/02-25 Issued Date 23.07.2025 Authorised by R. Allen Page 16 of 48 Test Chlamydia serology Clonorchis serology Test Clostridium difficile PCR ribotyping Clostridium difficile toxin testing CMV serology (IgM, IgG, IgG avidity) CMV PCR (Quantitative assay) Coccidiodes serology Cold agglutinins (Mycoplasma) Corneal scrape Specimen Container Blood (serum) Clotted blood (redtop) See under Fasciola serology Specimen Container Faeces Required volume 5-10 ml Required volume 1-2 gm Laboratory Reference Laboratory Reference Turnaround time 5 days Turnaround time 14 days Faeces Universal 30 ml faecal pot With the spatula provided transfer a plum-sized portion of faeces or equivalent volume of fluid SGH 1 day Blood Clotted blood (redtop) 5-10 ml SGH 1 day Blood EDTA blood 1-5 ml (minimum 200µl/ assay) SGH 2 working days Blood (serum) Clotted blood (redtop) 5-10 ml Reference 5 days Test performed by Haematology- consult Haematology for advice. Corneal scrape SGH 3-5 days Additional information Additional information Initial screening performed by PCR. . Discuss interpretation of results with virologist. Discuss with microbiologist if suspected. Please state clearly if fungal/ mycobacterial or viral investigations required STH816/02-25 Issued Date 23.07.2025 Authorised by R. Allen Page 17 of 48 Test Coxiella burnetii serology Coxsackie virus serology Cryptococcal antigen Cryptosporidium spp. (see Enteric Pathogens PCR) CVP tips Cystic sputum Cysticercosis Dengue serology Dermatophytes Specimen Container Blood (serum) Clotted blood (redtop) See under Enterovirus IgM Blood (serum) CSF Clotted blood (redtop) Required volume 5-10 ml 5-10 ml (blood) 1 ml minimum (CSF) 1-2 gm Faeces Universal 30 ml faecal pot With the spatula provided transfer a plum-sized portion of faeces or equivalent volume of fluid See under Vascular Access Devices See under Sputum (cystic) See under Taenia/ Tapeworms Refer to Arboviral serology See under Mycology Laboratory Reference SGH SGH Turnaround time 14 days 2 days 1 day Additional information Discuss with microbiologist if suspected. . . STH816/02-25 Issued Date 23.07.2025 Authorised by R. Allen Page 18 of 48 Test Specimen Container Diphtheria isolation Swab Swab in Amies transport medium with charcoal Diphtheria antibody for determination of immune status. Blood (serum) Clotted blood (redtop) Ear swab Swab in Amies N/A transport medium with charcoal. Ebola virus See Viral Haemorrhagic Fever EBV PCR Blood EDTA blood (purple top) EBV serology VCA IgG, VCA IgM, EBNA IgG, EBV VCA IgG avidity Blood (serum) Clotted blood (red top tube) Echinococcal (Hydatid) microscopy Cyst fluid Sterile Universal Echinococcal (Hydatid) serology Blood (serum) Clotted blood (red top tube) Required volume N/A 5-10ml N/A 1-5 ml 5-10 ml N/A 5-10 ml Laboratory Turnaround time SGH 3 days Reference 15 days SGH 4 days SGH 2 working days SGH 1 day SGH Reference Reference 1 day 14 days 14 days Ehrlichia (Anaplasma) serology Endotracheal aspirate (ETA) Entamoeba histolytica Enterobius vermicularis Blood (serum) Clotted blood (red top tube) 5-10 ml Reference Respiratory secretions Sterile Universal N/A SGH See under Amoebic serology & Send Faecal parasitology/ OCP See under Threadworms 14 days 3 days Additional information Discuss with microbiologist if suspected. Please discuss with laboratory STH816/02-25 Issued Date 23.07.2025 Authorised by R. Allen Page 19 of 48 Test Specimen Enterovirus/Parechovirus (Qualitative RT-PCR Faeces, CSF, EDTA blood or clotted blood Mouth, Eye, Skin Swabs in viral transport medium) Enterovirus IgM Escherichia coli (E.coli) O157 serology Blood (serum) Blood (serum) Container Sterile Universal, EDTA or clotted blood tubes or Swab in viral transport medium Clotted blood (red top tube) Clotted blood (red top tube) Required volume 1-2 gm faeces 1 ml CSF 1-5 ml 5-10 ml ESBL Screening Swab Swab in Amies transport medium Eye swab for MC&S Swab Eye swab for virological investigations (HSV, VZV and adenovirus PCR) Eye fluids (intraocular fluids - vitreous and aqueous) for retinitis & uveitis panel (HSV, VZV, CMV, Syphilis and Toxoplasma gondii) Swab Intraocular fluids in syringe Swab in Amies transport medium with N/A charcoal. Swab in Viral Transport N/A Medium Intraocular fluids At least in syringe 0.25 mL Laboratory Turnaround time SGH 2 days Reference Reference SGH 14 days 15 days 2 days for negative 3 days for presumptive positive SGH 4 days SGH 4 days SGH 2-3 days Additional information Minimum required volume for assay: 200µl (includes Coxsackie viruses) See also Faeces MC&S Send a separate chlamydia swab if this is suspected. Advised to inform virology if expedite turnaround time is needed clinically STH816/02-25 Issued Date 23.07.2025 Authorised by R. Allen Page 20 of 48 Test Specimen Faecal parasitology/ ova, cysts and parasites (OCP) Faeces Faeces for Viral Pathogens (Adenovirus/ Rotavirus/ Norovirus/Sapovirus/ Astrovirus) Faeces Norovirus Vomit samples Container Universal 30 ml faecal pot Universal 30ml faecal pot Universal Required volume Laboratory 1-2 gm With the spatula provided transfer a plum-sized portion of faeces, or equivalent volume of fluid With the spatula provided transfer a plum-sized portion of faeces, or equivalent volume of fluid SGH SGH Turnaround time 7 days 1 day SGH 1 day Additional information 3 specimens taken within a 5 day period-please give clinical details. This is an unverified sample type, testing is available on request. STH816/02-25 Issued Date 23.07.2025 Authorised by R. Allen Page 21 of 48 Test Faeces for Enteric Pathogens PCR (includes Giardia & Cryptosporidium) Salmonella spp (inc typhoid, paratyphoid), Shigella sp p, E.coli 0157 PCR positives confirmed by culture. N.B.Yersinia spp, Vibrio s pp (inc Cholera) confirmed by culture only Faeces Swab for Rapid G I panel PCR Fasciola & other intestinal fluke serology (Clonorchis/ Paragonimus) Filarial serology Fish & Shellfish Poisoning Flavivirus serology & PCR Fransicella tularensis Specimen Faeces Swab Container Required volume Laboratory Universal 30ml faecal pot 1-2 gm With the spatula provided transfer a plum-sized portion of faeces, or equivalent volume of fluid SGH Caryblair media N/A SGH Blood (serum) Clotted blood (red top tube) 5-10 ml Reference Blood (serum) Clotted blood (red top tube) 5-10 ml Reference Please call to discuss. [Scombroid/ Ciguatera/ PSP/ NSP/ ASP/ DSP] See under Arboviral serology See under Tularaemia Turnaround time 2 days 4-6 hours 28 days 28 days Additional information Please do not request for patients who have been in hospital for over 3 days STH816/02-25 Issued Date 23.07.2025 Authorised by R. Allen Page 22 of 48 Test Fluids, tissues, biopsies for microscopy and culture (includes aspirates, biopsies, tissue samples/ curettage, heart valves) General comment Genital herpes Genital swab for MC&S Genital swab for MC&S Gentamicin levels Giardia Gonococcal NAATS Specimen Fluid/ tissue Container Required volume Laboratory Turnaround time Additional information [If biopsy is small add 0.5ml of Ringers or sterile saline to prevent it from drying out. Ensure there is NO preservative or formalin] Sterile Universal Dependant on specimen type SGH 3 days For Equest serology tests when unable to find specific tests- enter request under clinical details See under Herpes Simplex Virus HVS, LVS, Vulval, Vaginal, Penile Swab in Amies medium with N/A charcoal SGH 3 days Urethral, Cervical, Endocervical Swab in Amies medium with charcoal See under Antibiotic Assays See under Faeces Enteric Pathogens PCR Urine/Genital swab Specific collection tube dependent upon sample type N/A As specified in collection kit SGH SGH 3 days 2 days Please specify if culture for fungi, mycobacteria or other fastidious organisms is required. Send ECS/URE for PID or STD Specimens are rejected if > 48 hrs as sub optimal for the isolation of organisms. Specimens are rejected if > 48 hrs as sub optimal for the isolation of organisms. Contact laboratory if information regarding specific collection kits is required. STH816/02-25 Issued Date 23.07.2025 Authorised by R. Allen Page 23 of 48 Test HACEK organism isolation Haemophilus aphrophilus/ paraphropilus; Actinobacillus actinomycetecomitans; Cardiobacterium hominis; Eikenella corrodens; Kingella kingae Haemophilus ducreyi Hantaviruses- serology and PCR H F with renal syndrome (Hantaan v, Puumala v) Hantavirus pulmonary syndrome(Sin Nombre v) Heart valves/ tissue for MC&S Helicobacter faecal antigen Helicobacter serology Specimen Blood cultures Genital swab Blood (serum) Container BD Bactec culture vials Required volume Laboratory Turnaround time Additional information 8-10 ml SGH Fastidious organisms require up to 14 days incubation Please specify HACEK organisms on request form. N/A Reference 12 days Discuss with Microbiologist Clotted blood (red top tube) 5-10 ml Reference 10 days Discuss with a virologist See under Fluids Faeces Universal 30ml faecal pot > 1 gram should be sent in standard sealed specimen containers. SGH 7 days Faecal antigen testing is now the recommended test for the diagnosis of Helicobacter infection. Patients MUST NOT have taken any antibiotics or proton pump inhibitors for a minimum of 2 weeks prior to specimen collection for testing. Samples should be sent within 3 days of collection STH816/02-25 Issued Date 23.07.2025 Authorised by R. Allen Page 24 of 48 Test Specimen Hepatitis A serology Blood (serum) Acute Hepatitis serology (Hepatitis B surface antigen, Hepatitis C IgG, Hepatitis A IgM, Hepatitis E IgM & IgG, CMV IgM, EBV) Hepatitis (past history) serology ( Hepatitis B core antibody, Hepatitis A IgG, Hepatitis C IgG) ] Hepatitis B: send a request for HBsAg and HBV core antibodies. In case of positive results, additional investigations to assess HBV status will be added as reflex tests. Blood (serum) Blood (serum) Blood (serum) Container Clotted blood (red top tube) Required volume 5-10 ml Laboratory Turnaround time SGH 1 day Additional information This is for testing for immunity. Please state on form if you suspect acute infection. Clotted blood (red top tube) 5-10 ml SGH 2 days Clotted blood (red top tube) 5-10 ml SGH 2 days Clotted blood (red top tube) 5-10 ml SGH 2 days Send a surface antibody for post-immunisation check. STH816/02-25 Issued Date 23.07.2025 Authorised by R. Allen Page 25 of 48 Test Hepatitis B DNA/ viral load (Only for use on hepatitis B surface antigen positive patients) Hepatitis C serology Hepatitis C RNA/ viral load Specimen Blood (serum) Blood (serum) Blood (serum) Hepatitis C genotype Hepatitis D serology (IgM/ IgG) & PCR To be requested ONLY for patients who are HBsAg positive Hepatitis E serology (IgM/ IgG) Hepatitis E PCR Blood (serum) Blood (serum) Blood (serum) Container Clotted blood (red top tube) Clotted blood (red top tube) Clotted blood (red top tube) Clotted blood (red top tube) Clotted blood (red top tube) Clotted blood (red top tube) Required volume Laboratory Turnaround time Additional information 5-10 ml (min. vol 200 µl) SGH 7-10 days HBV VL monitoring is requested by Hepatology 5-10 ml 5-10 ml (min. vol 200 µl) 5-10 ml SGH 2 days SGH 7-10 days Reference 5 days 5-10 ml Reference 28 days 5-10 ml SGH SGH 2 days 5 days Requested restricted to patients who are HBsAg positive STH816/02-25 Issued Date 23.07.2025 Authorised by R. Allen Page 26 of 48 Test Herpes simplex virus PCR (HSV1 & HSV2) PCR] see Ano-Genital screen Herpes Simplex virus (HSV 1/2) resistance testing Herpes simplex virus (HSV 1/2) serology Specimen CSF Swabs Swabs Blood (serum) HHV6 & HHV7 Serology Blood (serum) HHV6 & HHV7 PCR Blood and CSF HHV8 PCR Blood Histoplasma serology HIV1/2 antigen/ antibody HIV-1 or HIV-2 resistance testing Blood (serum) Blood (serum) Blood (plasma) Container Sterile universal Swab in Viral Transport Medium Swab in Viral Transport Medium Clotted blood (red top tube) Clotted blood (red top tube) EDTA (purple top) CSF in universal Required volume 1 ml CSF N/A 5-10 ml 5-10 ml 1-5 ml Laboratory Turnaround time SGH 2 days Reference 7 days SGH 2 days Reference 7 days Reference 7 days Additional information EDTA (purple top) Clotted blood (red top tube) Clotted blood (red top tube) EDTA 1-5 ml 5-10 ml 5-10 ml 10 ml Reference 7 days Reference SGH 10 days 2 days Reference 14 days Please specify if patient is positive for HIV-1 or HIV-2 STH816/02-25 Issued Date 23.07.2025 Authorised by R. Allen Page 27 of 48 Test HIV-1 Viral load HIV-2 viral load Hookworms HTLV 1&2 serology Human Papillomavirus (HPV) testing Hydatid reference test Influenza A/B PCR Interferon assays for TB Intestinal flukes Intrauterine infection serological tests Itraconazole levels Specimen Container Required volume Laboratory Turnaround time Blood EDTA blood (purple top) 5-10 ml (min 1 ml) SGH 7-10 days blood EDTA blood (purple top) Send Faecal Parasitology/ OCP Blood (serum) Clotted blood (red top tube) Tissue Sterile Universal See under Echinococcal serology See under Respiratory virus PCR/ NPA See under Mycobacteria See under Fasciola See under TORCH screen (mother) 5-10 ml (min 1 ml) 5-10 ml N/A Reference SGH Reference See under Antibiotic Assays 2 weeks 2 days 4 days Additional information Please note that the viral load assay is time critical. Freshly drawn specimens (whole blood) may be held at 2-30°C for up to 6 hours prior to centrifugation in the laboratory. After this time there may be degradation of nucleic acid with a resultant reduction of the viral load value. PCR: Contact virology STH816/02-25 Issued Date 23.07.2025 Authorised by R. Allen Page 28 of 48 Test IVF screen Includes: HIV Ab/Ag Hepatitis B surface Ag Hepatitis B Core antibody Hepatitis C IgG Syphilis total antibodies Japanese B encephalitis JC virus PCR Kala-azar Lassa fever virus Legionella serology Legionella antigen Specimen Container Blood (serum) Clotted Blood (red top tube) See under Arboviral serology CSF Sterile Universal See under Leishmania See under Viral Haemorrhagic Fever Blood (serum) Clotted Blood (red top tube) Urine Sterile Universal Required volume 5-10 ml 1 ml min 5-10 ml 20 ml Leishmania reference test (serology) Leprosy Leptospira PCR Blood (serum) Tissue biopsy CSF/ /Urine/Blood Clotted Blood (red top tube) 5-10 ml Consult a microbiologist Sterile Universal/ 8-10 ml Laboratory Turnaround time SGH 2 days Reference 7 days Reference SGH 14 days 2 days Reference 28 days Reference 7 days Additional information Pre-treatment IVF screen. (Rubella and chlamydia need to be requested separately if required.) Discuss with a virologist Needs prior discussion with microbiologist Please state travel history and date of exposure. Discuss cases with microbiology Discuss cases with microbiology STH816/02-25 Issued Date 23.07.2025 Authorised by R. Allen Page 29 of 48 Test Specimen Leptospirosis reference test] (serology) Blood (serum) Lyme disease serology] (Borreliosis) (screening test) Blood (serum) Lyme Immunoblot Blood (serum)/CSF Container Clotted Blood (red top tube) Clotted Blood (red top tube) Clotted Blood (red top tube) or Sterile Universal (CSF) Required volume 5-10 ml 5-10 ml 5-10 ml 1-2 ml Laboratory Turnaround time Reference 10 days SGH 2 days Reference 10 days Additional information Take sample 5-7 days after onset of symptoms. Please state date of onset or exposure and travel/ risk factors. Please provide clear history including risk factors and date of symptom onset. Lyme (Borreliosis) PCR CSF Lymphadenopathy/ sore throat] serology screen Blood Lymphocytic choriomeningitis virus (LCMV) serology Lymphogranuloma venereum (LGV) serovars of Chlamydia trachomatis Blood (serum) Rectal swab Sterile Universal 1 ml Reference 14 days Clotted Blood (red top tube) 5-10 ml Clotted Blood (red top tube) 5-10 ml Swab in Alinity m transport N/A medium SGH 3-4 days Reference 14 days Reference 14 days Discuss with microbiology Consider , EBV, CMV IgM, Toxoplasma gondii, Syphilis and HIV serological investigations Discuss with a virologist Discuss with a virologist or Sexual Health STH816/02-25 Issued Date 23.07.2025 Authorised by R. Allen Page 30 of 48 Test Malaria detection Malaria reference test Marburg virus Acute measles serology (IgM) Measles IgG Measles PCR Meliodosis investigations Meningococcal PCR Meningococcal PCR If meningitis/ meningococcal sepsis is suspected contact the laboratory and send the specimens immediately. Meningococcal serology Microscopy Microsporidia serology Specimen Container Required volume Laboratory Turnaround time Blood EDTA (purple top tube) 5-10ml SGHHaematology Not useful for diagnosis of acute infection. Discuss with microbiologist if requested. See under Haemorrhagic Fevers Blood (serum) Clotted Blood (red top tube) 5-10 ml Reference 7 days Blood (serum) Clotted Blood (red top tube) Discuss with a virologist Discuss with a microbiologist Blood EDTA (purple top tube) 5-10 ml 5-10 ml SGH SGH 2 days 2 days Additional information Test performed by haematology CSF Sterile Universal 2-3 ml SGH 2 days Send separate specimens for glucose and protein analysis to appropriate departments Blood (serum) Dependant on specimen type Blood (serum) Clotted Blood (red top tube) Dependant on specimen type Clotted Blood (red top tube) 5-10 ml Dependa nt on specimen type 5-10 mls Reference SGH Reference 28 days same day 28 days Discuss with a microbiologist Discuss with a microbiologist STH816/02-25 Issued Date 23.07.2025 Authorised by R. Allen Page 31 of 48 Test Specimen Container Milk bank serology screen Blood (serum) Clotted Blood (red top tube) Mouth swab Swab in Amies transport medium with N/A charcoal. MRSA screen Swab Swab Acute mumps serology IgM Mumps IgM reference test For clinical cases of mumps Mumps IgG [Mumps immunity] Mumps PCR Blood (serum) Clotted Blood (red top tube) Blood (serum) Discuss with a Virologist Clotted Blood (red top tube) Required volume Laboratory 5-10 mls SGH N/A SGH N/A SGH Turnaround time 3-4 days Additional information Consists of: HIV-1/-2 Ab/ Ag HTLV 1+2 Ab Hep B surface Ag Hep C IgG Syphilis IgG 3 days 2 days (> 3 days if culture positive). Specimens are rejected if > 48 hrs as sub optimal for the isolation or organisms 5-10 ml Reference 7 days Please state date of onset and contact history. 5-10 ml SGH 2 days STH816/02-25 Issued Date 23.07.2025 Authorised by R. Allen Page 32 of 48 Test Mycobacteria/ AFB (Tuberculosis & Atypical/ non- tuberculous): Microscopy (Ziehl-Nielsen/ auramine), Isolation Please state clearly on request form that Mycobacterial/ TB/ AFB investigation required. Specimen Sputum BAL/ gastric aspirates CSF/ fluids/ tissue Urine Bone marrow Container Sterile Universal (send 3 sputa for suspected pulmonary TB) Sterile Universal Sterile universal (send early morning urine on 3 consecutive days Inoculated to BD Bactec Myco/F Lytic Culture Vials Required volume Min req vol (fluids) = 3 ml N/A Mycobacterium tuberculosis immunoassays (QuantiFERON Blood QuantiFERON kit N/A Mycobacterium tuberculosis PCR (fasttrack)/ Rifampicin probes (MDR suspected) BAL/Sputum/Tissue Sterile Universal 3 ml minimum Laboratory SGH/ Reference SGH SGH Turnaround time Additional information 6 -8 weeks Samples are monitored continuously. Any flagging positive are communicated to clinicians as an urgent result. Mycobacterial investigations are not performed on-call (from 2000hrs to 0900hrs) 3-5 days Same day testing once approved by microbiologist Discuss with a microbiologist See also Quantiferon-TB Gold Guidelines Please note this is a time critical assay. Samples must be received in the laboratory within 16 hours of collection. Failure to adhere to this may compromise the validity of the result. Discuss with a microbiologist. STH816/02-25 Issued Date 23.07.2025 Authorised by R. Allen Page 33 of 48 Test Specimen Mycology micro and culture (Systemic mycoses) Tissue, fluids, systemic Mycology micro and culture] (Dermatophytes) Skin, nail & hair Mycoplasma genitalium PCR Request restricted for the following syndromes: . Women with query PID . Men with urethritis . Their sexual partners Skin, nail and hair High vaginal swabs for women Urine for men: min volume 3 ml Mycoplasma pneumoniae serology IgM and IgG Nasal swab Blood (serum) Swab in Amies transport medium with charcoal. Container Sterile Universal Required volume N/A Laboratory SGH Turnaround time Additional information Microscopy 23 days culture up to 6 weeks Please state clinical history and if not E-quest order state clearly on request form that fungal culture is required. Sterile Universal or Dermapaks N/A SGH Microscopy 23 days days culture 2 weeks Abbot Alinitym collection tube SGH 3 days Follow kit instructions to collect the correct volume of urine for men: if tubes are underfilled or overfilled will be rejected. Clotted Blood (red top tube) 5- 10ml SGH 3 days N/A N/A SGH 3 days STH816/02-25 Issued Date 23.07.2025 Authorised by R. Allen Page 34 of 48 Test Specimen Needlestick donor serology Consists of Hep B surface Ag, Hep C IgG, HIV-1/-2 ag/antibody, serum store Blood (serum) Needlestick recipient serology Blood (serum) Neonatal Viral Sepsis Screen EDTA blood, CSF, Eye/Rectal/Throat Swab. New leukaemic serology screen Blood (serum) Container Required volume Laboratory Turnaround time Additional information Clotted Blood (red top tube) 5-10 ml SGH 2 days It is your responsibility to consent the patient. Clotted Blood (red top tube) 5-10 ml SGH Minimum volume for EDTA or CSF 500 ul SGH Clotted Blood (red top tube) 5-10 ml SGH 2 days 2 days 7 days Hepatitis Bs Ab, serum store Consists of: CMV IgG EBV HIV-1/-2 ag/ab Hep B surface Ag Hep C IgG Syphilis total antibodies Toxoplasma IgG, IgM Varicella IgG HTLV-1/-2 STH816/02-25 Issued Date 23.07.2025 Authorised by R. Allen Page 35 of 48 Test Norovirus PCR Occupational Health Screen Ova cysts and parasites Specimen Container See Faeces for Viral Pathogens Blood (serum) Clotted Blood (red top tube) See under Faecal parasitology. Pacemaker tips/ leads & other cardiac prostheses Device Sterile Universal Parainfluenza virus Parvovirus serology IgM & IgG See under respiratory viruses/ NPA Blood (serum) Blood (serum)/ amniotic fluid Clotted Blood (red top tube) Required volume Laboratory Turnaround time Additional information 5-10 ml SGH 7-10 days N/A SGH 3 days Will NOT be processed routinely. Only where line sepsis is suspected. SGH 5-10 ml 2 days Please state date of onset and if patient is pregnant. Parvovirus B19 PCR Pernasal Swab Pertussis investigations Pinworms Plague Pneumococcal antigen Pneumococcus PCR Liver samples in cases of miscarriage or IUD Use specific pernasal swab, see under Bordetella pertussis See under Bordetella pertussis See under Threadworms See under Yersinia pestis. Contact a Microbiologist urgently. Reference Urine/ CSF Sterile Universal 10-20 ml SGH Discuss with a Microbiologist 7 days 1 day Discuss with Consultant Virologist Needs prior authorization by a microbiologist STH816/02-25 Issued Date 23.07.2025 Authorised by R. Allen Page 36 of 48 Test Pneumocystis jiroveci (PCP) PCR Specimen Lower respiratory secretions (sputum/ BAL/ETS) Polio serology Polio PCR Polyomaviruses (BK/ JC virus) PCR Postnasal swab for MC&S Pus Blood (serum) Faeces/ CSF Urine (BK) CSF (JC) EDTA blood (BK) Swab in Amies transport medium with charcoal. See under Fluids Container Sterile Universal Clotted Blood (red top tube) Sterile Universal Sterile Universal EDTA (purple top tube) N/A Required volume 1 ml minimum Laboratory Turnaround time SGH 2 days Additional information 5-10 ml N/A Reference Reference Reference 14 days 14 days 7 days Discuss with a virologist Discuss with a virologist Discuss with a virologist N/A SGH 3 days STH816/02-25 Issued Date 23.07.2025 Authorised by R. Allen Page 37 of 48 Test [Q fever reference test] Rabies investigations Rash (viral serology screen) Rash non-vesicular Parvovirus IgM, IgG Rubella IgM, IgG Specimen Container See under Coxiella burneti Discuss with a virologist Required volume Laboratory Turnaround time Additional information Blood (serum) for parvovirus and rubella virus Clotted Blood (red top tube) 5-10 ml SGH 2-3 days Please state type and distribution of rash- this dictates which tests are performed. Please state if patient is pregnant. Rash vesicular Varicella zoster PCR HSV PCR Enterovirus PCR Respiratory syncytial virus (RSV) IF/ PCR Respiratory virus PCR Influenza A&B/ Parainfluenza viruses/ RSV/SARS-CoV2, Adenovirus/Metapneumovirus/Rhinovirus and Enterovirus] Respiratory virus Rapid PCR Influenza A&B/RSV/SARS-CoV-2 Lesion swab Lesion swab in Viral Transport Media See under Respiratory viruses PCR/ NPA Respiratory secretions NPA, BAL, Sputum, Nose and throat swab in viral transport medium. Nose and throat swab in viral transport medium Sterile Universal Swab in viral transport medium 2 ml (min vol 200µl) SGH 1ml SGH 2-3 days 4 hours Testing is seasonal only, October-March STH816/02-25 Issued Date 23.07.2025 Authorised by R. Allen Page 38 of 48 Test Respiratory virus Rapid PCR (Qiastat) Extended Panel Specimen Nose and throat swab in viral transport medium Container Swab in viral transport medium Required volume Laboratory Turnaround time Additional information 1 ml SGH 4-6 hours Rickettsial serology- Typhus or Spotted Fever Ross River virus serology Rotavirus Rubella serology (acute) Rubella serology (immunity) Salmonella serology Blood (serum) Clotted Blood (red top tube) 5-10 ml See under Arboviral serology See under Faeces Virology investigations Blood (serum) Clotted Blood (red top tube) 5-10 ml Blood (serum) Clotted Blood (red top tube) 5-10 ml Blood (serum) Clotted Blood (red top tube) 5-10 ml Reference 10 days Discuss with microbiology. Provide a full travel history. SGH 1-2 days SGH 1-2 days Reference 17 days Please state if patient is pregnant. Requires prior discussion with a microbiologist STH816/02-25 Issued Date 23.07.2025 Authorised by R. Allen Page 39 of 48 Test Schistosomiasis microscopy Specimen Faeces Urine (3 consecutive terminal urine samples collected at midday) Container Sterile Universal Sterile Universal Required volume 1-2 gm With the spatula provided transfer a plum-sized portion of faeces Laboratory SGH Turnaround time 7 days Additional information 3 specimens on 3 consecutive days – give clinical details 10 ml Schistosomal serology Sellotape slide Seminal fluid for MC&S Shigella serology Shingles Sleeping sickness Sputum/ ETA/ BAL/ NBL Blood (serum) Clotted Blood (red top tube) 5-10 ml Reference 14 days Send at least 6 weeks postexposure. See under Threadworms Seminal fluid Sterile Universal N/A SGH 1-2 days Blood (serum) Clotted Blood (red top tube) 5-10 ml Reference 14 days Requires prior discussion with a microbiologist See under Varicella Send blood films for diagnosis of acute infection, otherwise see Trypanosomiasis serology Respiratory Sterile Universal 5-10 ml SGH 2-3 days Please refer to Mycobacteria for TB investigation. STH816/02-25 Issued Date 23.07.2025 Authorised by R. Allen Page 40 of 48 Test Sputum (Cystic) Cystic Sputum/cough swab) Staphylococcal serology Staphylococcal reference test Staphylococcal (MSSA/ MRSA) PCR Stem cell transplant screen Streptococcal serology (ASOT, Anti DNAse B) Strongyloides microscopy Specimen Respiratory Container Required volume Laboratory Turnaround time Additional information Sterile Universal 5-10 ml SGH 6-8 days Please refer to Mycobacteria for TB investigation. Blood (serum) Clotted Blood (red top tube) 5-10 ml Reference 15 days Tissue/ Pus/ Swabs/ Fluids Requires prior discussion with a microbiologist Blood (serum) Clotted Blood (red top tube) 5-10 ml SGH 7 days See under ASO titre/ Anti Streptolysin O and Anti DNAse B titre See Faecal Parasitology/ OCP (may need up to 6 samples as is insensitive) Requires prior discussion with a microbiologist Consists of: CMV IgG EBV (EBNA IgG) HIV Ab/Ag HTLV 1+2 Ab Hepatitis B Core Ab Hepatitis BsAg Hepatitis C IgG Syphilis IgG Toxoplasma IgM, IgG Varicella IgG STH816/02-25 Issued Date 23.07.2025 Authorised by R. Allen Page 41 of 48 Test Strongyloides serology Supra-pubic aspiration (SPA) Swabs for MC&S (skin/ wound etc) Syphilis serology (blood) or Syphilis antibody (CSF) Tapeworms / Taenia spp Taenia (cysticercal) serology TB investigations Teicoplanin levels Tetanus toxin serology Tissue/ Biopsy for MC&S Thread worms Specimen Container Blood (serum) Clotted Blood (red top tube) See under Urine MC&S Swab in Amies transport medium with charcoal. Blood (serum) N/A Clotted Blood (red top tube) CSF (VDRL, TPHA) Sterile Universal See Faecal Parasitology/ OCP Blood (serum) Clotted Blood (red top tube) See under Mycobacteria See under Antibiotic Assays Blood (serum) Clotted Blood (red top tube) See under Fluids Place sellotape over perianal region Transfer to clean microscope slide Required volume Laboratory Turnaround time Additional information 5-10 ml Reference 14 days N/A 5-10 ml 1-2 ml SGH 4 days SGH Reference 1-3 days 6 days Do not request MRSA swabs unless screening. 5-10 ml 5-10 ml N/A Reference 14 days For diagnosis of cysticercosis. Reference 21 days Collect before antitoxin given. Discuss with microbiology if suspected. SGH 1-2 days Best taken early morning STH816/02-25 Issued Date 23.07.2025 Authorised by R. Allen Page 42 of 48 Test Throat swabs for MC&S Tobramycin levels Congenital infection screen (infant)] For serological investigation of suspected congenital infection. Toxoplasma gondii, CMV, Rubella Syphilis, parvovirus Congenital infection screen (mother)] For serological investigation of suspected intrauterine infection. Toxoplasma gondii, CMV, Rubella Parvovirus Syphilis. Specimen Container Swab in Amies transport medium with N/A charcoal. See under Antibiotic Assays Blood (serum) Clotted Blood (red top tube) Blood (serum) Clotted Blood (red top tube) Required volume Laboratory Turnaround time Additional information N/A SGH 4 days 5-10 ml SGH 1-2 days 5-10 ml SGH 1-2 days If not requesting via e-QUEST please state "suspected intrauterine infection" and give clinical details
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