Regulator puts Bolton FT in 'significant breach' over waiting times

The move brings the number of foundation trusts in significant breach to 18, up from just nine a year ago.

The foundation trust regulator said its action had been triggered by failings in board governance at Bolton and the trust’s poor performance on accident and emergency and referral-to-treatment waiting times.

In a notice sent to the trust’s chairman, Monitor said the trust had breached the national 18-week waiting times target for admitted patients in three consecutive quarters in 2011-12.

It also failed against the four-hour waiting target for A&E in Q3 (October to December), and was due miss it for the following quarter unless there was a “significant improvement” in March.

“There is concern that the trust does not understand the key causes of failure,” the notice stated. “The trust has failed the A&E four-hour wait target in Q3 in three of the last four years.”

Minutes of the trust’s February board meeting showed staff had “expressed concerns about the potential for patient harm as a consequence of the current pressures in urgent care and that the experience for both patients and staff is currently poor”, it noted.

Bolton gave the regulator a list of reasons for its decline in A&E performance, including ward closures due to Norovirus, rules against mixed-sex accommodation reducing “the flexibility of the bed base”, and efforts to clear its backlog of planned surgery. The trust reported that there was “currently no evidence” of patient harm.

But Monitor said the trust board had taken “false assurance” from its improved performance in 2010-11, when it hit the four hour A&E target in Q3 for the first time since it became an FT.

The board took this improvement as evidence it was acting effectively to reduce waiting times, the notice stated. In fact it was due to an increase in cancelled operations in response to poor weather conditions, and the “ring fencing” of urgent care capacity in anticipation of winter pressures.

The regulator added that it was “unclear” how the board had assured itself that the risk of patient harm had been “adequately mitigated”.

Bolton said it would fail the RTT target in the final quarter of this year, but would be compliant again from the start of 2012-13. But Monitor said this would only be possible due to extra funds the trust had secured from its commissioners to help clear the backlog.

The notice added that there was “a concern” that the trust “allowed itself to be constrained by a focus on finance, choosing to delay actions which could have prevented or reduced the RTT issue until additional financial support was confirmed”.