The financial penalty imposed on accident and emergency departments that fail to meet the 95 per cent four hour target has been strengthened to encourage ‘radical transformation’ from struggling NHS providers.

NHS England’s draft standard contract for 2015-16, published this week, states that the penalty should “reinforce” the work the urgent and emergency care review is doing to move demand out of hospitals and improve standards.

A&E departments are required to see, treat, admit or discharge 95 per cent of patients within four hours.

Currently, providers are fined £200 for each patient who pushes the trust over 95 per cent, which is capped at 92 per cent. If a provider’s performance falls below 92 per cent, it will not be fined more.

However, under the proposals for 2015-16 this will be reduced to 85 per cent.

This means that a trust that is performing well below 95 per cent will be fined more than a trust that is only narrowly missing the target.

The fine for breaches under the 95 per cent target will be reduced from £200 to £150 per patient.

The document states: “At present, there is no increased financial consequence for providers that achieve less than 92 per cent performance in any month.

“We will reduce this ‘floor’ to 85 per cent for 2015-16. At the same time, we propose reducing the financial sanction per excess breach from £200 to £150.”

It adds: “For those trusts furthest from delivering the NHS constitution standards for their patients, this change is intended to encourage more radical transformation, as envisaged by the urgent and emergency care review.”

The urgent and emergency care review is being led by national director for acute episodes of care at NHS England, Keith Willett.