Commissioners have been given the freedom to impose smaller penalties on trusts which breach rules on mixed sex accommodation, but told they have “no excuse” not to impose the fines.

Updated Department of Health guidance sets out plans to “eliminate” mixed sex accommodation, except where it is in patients’ best interest or reflects a personal choice.

This echoes a pledge in June’s revised operating framework, which said the DH would introduce “additional sanctions”.

The new rules allow PCTs to impose smaller fines. Previously, the penalty for breaching the rules was 100 per cent of treatment costs for each patient affected, but from January this will drop to as low as 10 per cent.

While this gives PCTs some choice, the DH has made it clear to HSJ the aim is to ensure no trust breaching the rules goes unpunished.

A DH spokeswoman said: “By allowing commissioners flexibility in approach and the ability to impose a proportionate sanction, the system will be stronger - there is now no room for excuses for a failure to apply sanctions.”

The guidance comes in a letter from NHS deputy chief executive David Flory and chief nursing officer Dame Christine Beasley sent to senior managers last week.

PCT Network director David Stout said the letter contained “strong messages simultaneously which are quite difficult to combine”.

While PCTs would welcome the extra flexibility, there may be instances in which fines would be inappropriate, for example where a trust was already facing major financial difficulties and there was no quick solution to the problem, he said.

The letter describes in full how “mixed sex accommodation” is to be defined. It refers to all “sleeping accommodation”, including areas where patients are admitted and cared for on beds or trolleys, even if they do not stay overnight.

Any breaches will published from January.