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North Staffordshire trust fined again over waiting time failures

University Hospital of North Staffordshire has been fined £2.5m by commissioners for its continued failure to hit a key accident and emergency target.

The money is being withheld as a contract penalty by the Staffordshire primary care trust cluster on top of an earlier fine of £1m in March.

The £420m turnover trust failed to meet the 95 per cent target for four-hour waits in A&E every week from the start of the financial year up to 8 July.

In the past month one patient was kept on an A&E trolley for 19 hours while two more patients waited for at least 12 hours.

Despite the poor performance at the start of the financial year the trust is now hitting the target, reporting a performance of 97 per cent or more in the last three weeks of July. If the trust can keep its performance above target the cluster could return the money at a later date.

The trust has blamed an “unprecedented” rise in A&E demand which has led to a shortage of bed space. The hospital is currently trying to shrink its acute services.

Last month the trust was forced into a U-turn by the rising demand. It announced 130 beds due to close would be maintained at a cost of £7.7m for at least two years.

The hospital has said the A&E department was seeing an average of 320 people a day since the start of the year – 50 more than in 2011.

Cluster chief executive Graham Urwin said that while patients are “having a poor experience by waiting so long, they are still safe”.

“But every patient who stays a day too long in hospital is put at a higher risk of infection and is denied the chance of independent living,” he said.

“We can impose still more draconian measures if there are no improvements.”

Mark Mould, chief operating officer at the trust, told HSJ: “We know that our emergency centre offers a high quality, safe service for the people of North Staffordshire and beyond.”

He said the whole health system was working together to achieve the four hour target and the flow of patients through wards into the community was being improved.

Readers' comments (7)

  • What happened to partnership working? What are the PCT doing with the money from the fines? Not offering to help the hard pressed provider to manage demand from patients in their community, I'd say, prefering to threaten and bully even more. Not helpful.

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  • This got me worried as my trust has struggled recently with A&E target. However, reviewing the contract i can't see any mechanism for imposing a £2.5 million fine mid way through a year. Any details on how they have managed to impose such a heavy penalty on a target that is full year and limited to 2% of A&E service line in the contract? I can't believe that the trust will have a £100 million A&E department. Ours is only about £6-7 million, and I would have thought even the biggest trusts would not be more than £15-20 mill. Even then the penalty is a full year penalty, not something that can be imposed at the end of the 1st quarter. I assume that this is not something outside of the contract, otherwise what is the point of agreeing a contract with penalties etc detailed? Perhaps they have some additional clauses in their contract that placed much hevier penalties on A&E performance than the national standard?

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  • The question is: will the fine help to improve patient care? Will it increase the probability that waiting times will improve? If there is good evidence to suggest that the answer to these questions is 'yes', then fair enough.

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  • Anon 8.55, your last sentence is the answer, it depends on the detail of what they agreed. Floors, ceilings, collars, caps and so on. What their forecast outturn was, what value they placed on demand management schemes, perhaps results of various audits, PbR/ cost and volume or block, whether they agreed to electronic discharge summaries as part of the quality schedules..... As the other poster says, there's only one cake and we can't deliver what we need to in silos, we have to work together.

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  • Failure of demand management at a PCT level is to blame. You cannot blame a provider completely, they respond to those patients who turn up at A+E.

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  • Anon 10.14, couldn't agree more, what is also missing form the article is that since the contract was developed with North Staffs the Staffordshire cluster have closed Mid Staffs A&E overnight therefore increased pressure on the North provider.

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  • Anonymous 8.55 - My understanding from the Staffordshire Cluster of PCTs was that the £2.5m figure was calculated by taking 10% of the contract value over a specific period in time when performance was not good enough. This was imposed by the PCT using the levers and powers available to it through its contract with UHNS.

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