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23.09.15

RTT sanction for incomplete pathways to double next week

NHS providers have just over a week before the Referral to Treatment (RTT) sanction for incomplete pathways doubles from £150 to £300. 

The increased sanction of the incomplete standard – which is now used as the single measure of RTT performance, as it identifies the patients waiting to start treatment – will come into effect from 1 October 2015. 

These changes to the NHS Contract have been made as part of a contract variation, published at the end of August. 

At this week’s board meeting, NHS England said the standard is that 92% of those still waiting to start treatment have been waiting less than 18 weeks. This gives a simplified, clearer focus on one RTT standard, which covers all patients on the waiting list, and focuses on those who have waited the longest.

At the end of July 2015, the incomplete standard was met, with 92.9% of patients waiting less than 18 weeks. 

Dame Barbara Hakin, national director of Commissioning Operations at NHS England, stated in her report that although the cumulative position is 1% above plan “it is still relatively early” in the year. 

Hakin, who will be leaving the organisation at the end of the year, as will Tim Kelsey, said: “We will keep under review the volumes of activity and what this means for growth against plan. To help ensure that all available capacity across the country is fully utilised, we are putting in place a project team to identify spare capacity, including in the independent sector, to help the NHS deliver the contracted volumes of activity for 2015-16.” 

The changes have come about after Sir Bruce Keogh recommended in June that the NHS should abolish the admitted and non-admitted operational standard, with the incomplete standard becoming the sole measure of patients’ constitutional right to start treatment within 18 weeks. 

After agreeing to these recommendations, NHS England chief executive Simon Stevens wrote to providers saying that this meant from 24 June, no provider or commissioner would receive any form of sanction – neither regulator investigation or intervention, nor the levying of financial sanctions – for missing the admitted or non-admitted standards.

Shortly after this NHS England consulted on a National Variation to make in-year changes to the 2015-16 Contract to formally remove the financial sanctions for the two completed pathway standards. This also included the increase in the RTT sanction breach for incomplete pathways. 

Nikki Brunt, technical delivery and training manager at Project Source, recently wrote for NHE on what the new changes could mean for providers. 

She warned that there is an inherent lack of understanding of 18 Weeks RTT, leading to RTT statuses being applied incorrectly and duplicate pathways being created as patients pass from one stage of treatment to another, or when referrals are cancelled and redirected. 

Brunt added that providers have become reliant on validation teams reviewing and correcting their 18 Weeks RTT data prior to submission each month; a “practice that does not tackle the real issues”.

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