English hospitals would have been fined £227m in 2012 if they had been subjected to the penalty regime written into their contracts for the current financial year, according to analysis shared exclusively with HSJ.

Checklist Partnership, which develops predictive planning software for hospitals, took the penalties in the NHS standard contract for 2013-14 and applied them to 2012 performance data for 150 acute trusts. It found more than a third of acute providers would have lost in excess of £1m, with the bulk of those losses resulting from fines for trusts that leave patients waiting more than a year for treatment.

It estimated the trusts would have incurred total fines of £227m. Of that, £174m would have come from a penalty introduced this year, under which trusts are docked £5,000 a month for every patient who has been on their waiting lists for more than 52 weeks. The remainder of the overall figure was made up of fines for breaches of referral-to-treatment waiting targets, long waits for diagnostics or cancer treatment, cancelled operations, mixed sex accommodation, and 12-hour trolley waits for emergency admissions.

The analysis found the nine trusts that would have incurred the highest overall penalties were the same nine that would have incurred the highest 52-week wait penalties. Checklist estimated Guy’s and St Thomas’ Foundation Trust would have incurred total penalties of £18.1m, of which £16.4m would have been for 52-week waits (see table, below).

However, the number of patients waiting over a year for treatment declined steeply and consistently in 2012. Checklist director Anthony Thompson suggested that introducing steep penalties for such patients had “put the issue on the table in a form where people understand that these longer waiting times need to be dealt with”.

A spokeswoman for Guy’s and St Thomas’ said the trust had made significant progress to improve its performance against “a range of access targets”. Over the course of 2012-13 the trust had cut the number of patients who had been waiting for more than 52 weeks to be treated from 454 to four.

She added that, as one of the largest acute trusts in the country and a national centre for specialist treatment of various conditions, “demand for our services is high and patients may be referred to us from other hospitals late in their treatment pathway”.

A spokeswoman for King’s College Hospital − which would have incurred estimated fines of £11.6m in 2012 − said it too was one of London’s largest hospitals and a centre for specialist treatment. “High demand for these services means that sometimes non-urgent patients have waited for longer than we would like,” she added.

“We have been working hard to reduce the number of people waiting for these treatments in 2012-13. We aim to reduce patients waiting in the first quarter of 2013-14 and our current trajectory implies there is a minimal risk of penalties in the next financial year.”

Top five: the trusts that would have incurred the highest penalties if 2013-14 fines had been imposed in 2012

Trust2012 ‘shadow’ fines* (£m)
Guys’ and St Thomas’ Foundation Trust18.1
King’s College Hospital Foundation Trust11.6
Newcastle upon Tyne Hospitals Foundation Trust11.2
Epsom and St Helier University Hospitals Trust9.1
North Bristol Trust8.9

*Source: Checklist Partnership analysis