Hospitals face a “zero-tolerance” approach to MRSA and long waits for treatment, as well as new fines, under the NHS Commissioning Board’s planning guidance.

From April providers should expect to be fined for patients who wait longer than a year from referral to treatment and for delays in ambulance handovers.

At the end of October there were 1,281 patients who had been waiting longer than 52 weeks. This is down from more than 11,000 in October 2010 when the issue was first highlighted in the media.

The guidance says it “unfair” to provide patients with a right to treatment within 18 weeks and not deliver against it. Other measures planned to tackle the issue include a requirement in the NHS Standard Contract for all first outpatient appointment letters to include standard information on the right and what to do if they are waiting longer.

Acute trusts will also face fines for ambulance handover delays longer than 30 minutes and a further fine for delays of more than an hour. Although fines for poor performance on handover are often used locally by commissioners this is the first time fines have been imposed nationally. Ambulance services will also be fined if crews are not ready to accept new calls within 15 minutes of handover.

The guidance also says patient should not have to “tolerate” an operation being cancelled more than once for non-clinical reasons with trusts forced to pay costs of treatment at an alternative hospital of the patient’s choosing if they cannot rearrange the procedure within 28 days.

All MRSA infections should involve a post infection review as part of the “zero-tolerance” approach while the board also expects to see significant reductions in incidences of C. difficile.

The guidance states: “Commissioners must enforce the standard terms [of the NHS contract], including the financial consequences for under-performance or failure to provide data on which to assess performance.

“We will be rigorous in supporting clinical commissioning groups and our direct commissioners to ensure the contract terms are implemented.”

The guidance also introduces new requirements for providers’ performance payments under the commissioning for quality and innovation scheme. To qualify for the payment at all providers will have to meet the minimum requirements of the relevant high-impact innovations set out the government’s Innovation, Health and Wealth report last year. These include introduction of telehealth and improved support for carers of people with dementia.

As in previous years, CQUIN will be worth 2.5 per cent of the value of services commissioned under the NHS Standard Contract and a fifth of the CQUIN will be paid on the basis of performance against national requirements.

These are: improving dementia care, risk assessment for venous thromboembolism, improvement against the NHS Safety Thermometer and, for the first time, performance against the “friends and family” test.