18.03.15
Fines ‘floor’ for A&E breaches dropped in new Standard Contract
The fines ‘floor’ for breaching A&E wait times has been reduced from 92% to 85% in the new Standard Contract for NHS Providers in 2015-16.
However, NHS England said that the sanction per excess breach of the A&E four-hour wait has also been reduced, from £200 to £120.
Chris Hopson, chief executive of NHS Providers, said: “We strongly welcome the fact that NHS England have listened to providers and our representations on the proposed fine levels for breaches of targets on four-hour A&E waits and two of the 18-week Referral to Treatment targets.
“Reducing the A&E fine level further and dropping proposals to increase the Referral To Treatment target fines is welcome.”
But he claims that dropping the fines ‘floor’ means even more pressure is being put on A&E departments that are already facing unprecedented increases in activity.
NHS England added that for the first time it has set out guidance on how commissioners may use funding they retain as a result of the application of contractual sanctions, whether for failure to achieve national quality standards or for other contractual breaches.
The Contract states: “Where there has been a breach of a national standard, however, we strongly recommend that the commissioner considers whether it is possible to invest the withheld funding in a way which will help to rectify the performance problem.”
This could mean, for instance:
- where 18 weeks standards have been breached, commissioning additional activity (either from the provider where the breach occurred or from other providers) and paying for this under the normal National Tariff rules; or
- where the A&E waiting times standard has been breached, commissioning additional community-based alternative services to reduce the pressure on A&E; or
- where an acute provider has breached its element of the ambulance handover standard, providing additional resource to the ambulance services provider to address the consequences.
Hopson said: “With the growing challenge of meeting the needs of patients with multiple morbidities and long term conditions, we need action that will genuinely improve patient flow and make it easier to deliver timely and effective care for patients.
“Therefore we would reiterate that any financial sanctions that just penalise providers due to problems that result from whole system issues is not a sensible approach.”
However, he was happy to see that recommendations on CQUIN (Commissioning for Quality and Innovation) quality payments give “clear guidance” to commissioners that NHS providers in receipt of CQUIN payments must receive the full 2.5% allocated and no less if the appropriate targets are hit.
The 2015-16 CQUIN scheme is available to providers that have chosen the enhanced alternative – the Enhanced Tariff Option (ETO) for the full year 2015-16. “The percentage value earned will be dependent on provider performance,” the new Standard Contract states.
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