CCGs divided over fines waiver as trusts strive to clear waiting lists

Of 34 CCGs spoken to by HSJ, 16 have agreed to waive the fines they are allowed to impose on trusts that miss 18 week referral to treatment targets. Seventeen will continue to impose financial penalties and one is still deciding what approach it will take.

The number of breaches are expected to rise over the next few months as trusts use their share of a £250m Department of Health fund to clear their waiting lists.

NHS England told HSJ it expected commissioners to ensure providers were “not disadvantaged” by efforts to clear their backlogs.

Scarborough and Ryedale CCG, whose main provider is York Teaching Hospital Foundation Trust, has agreed to waive the fines in July and August.

• Planned care waiting list in ‘danger zone’
• Elective waiting list at its longest in six years
• Ian Gillespie: NHS leaders must be more confident in tackling waiting lists
• Rob Findlay: more analysis of waiting list trends

North Lincolnshire CCG described the imposition of penalties as “counter productive”, and Oxfordshire CCG said it would rather “work with our colleagues to help them meet the targets than fine them for not doing so”.

However, Hambleton, Richmondshire and Whitby CCG, whose main provider South Tees Hospitals Foundation Trust has a large backlog according to the latest data, said it would stick to “normal contractual rules, and [take] appropriate measures if/when necessary”.

Sandwell and West Birmingham CCG said “referral to treatment time targets are a national contract and we will apply financial penalties as directed nationally”.

Solihull CCG said it would be “fining providers who breach 18 weeks referral to treatment time targets” and three CCGs in east London said they also plan to follow the “contractual process” and impose fines.

Most CCGs that are continuing to fine have pledged to plough any cash raised into initiatives that help providers meet their targets in the future.

One trust chief executive told HSJ its local CCG backed down when the trust refused to clear its backlog if fined.

“I don’t think [commissioners] understand in detail how the 18 week target works and the implications in managing backlog issues,” they added.

A group of nine CCGs in the north east said in a statement issued through their commissioning support unit that they had received a letter from NHS England’s northern team calling for an “amnesty” on fines and that no trusts would be “penalised in July and August while addressing the backlog of patients”.

Meanwhile, trusts have also warned they were given insufficent time to prepare for the collective effort to clear waiting lists over the summer.

July board papers for East and North Hertfordshire Trust said that acute trusts were “initially given 72 hours’ notice to submit a request for funding”.

“This initiative also occurs during the peak in annual leave when most trusts see a drop in elective activity due to staff leave,” the papers said.  

The chief executive of another trust told HSJ: “The idea that we can just gear up and clear lots of patients without any planning or logistical organisation is a little optimistic.”