PERFORMANCE: A major West Midlands trust could be forced to change its leadership unless it starts hitting waiting times targets, according to a condition placed on its licence by Monitor.

Under the condition, directors could be removed from Heart of England Foundation Trust if it does not improve.

The action was taken because of the trust’s failure to reduce waiting times alongside “concerns regarding mortality rates”.

Heart of England has missed the four hour accident and emergency target for seven consecutive quarters and has been subject to enforcement action since  December last year.

Its referral to treatment and two week cancer wait targets have also been missed for two quarters, and its 62 day cancer waiting time target for one quarter.

It also had higher than expected mortality rates for 2013 as measured by the Hospital Standardised Mortality Ratio indicator.

In addition to the new licence condition, the trust has agreed to legally binding enforcement undertakings which require it to take specific improvement actions and report to Monitor in various areas.

The trust has commissioned independent governance and mortality reviews which will report before the end of the year.

Monitor’s regional director for the Midlands and East, Adam Cayley, said the intervention would “ensure that the trust’s leadership takes appropriate and swift action to address our concerns around how it is led and run”.

He said Monitor would continue to scrutinise the trust “rigorously” and take further action if necessary.

A spokeswoman for Heart of England said the trust had experienced a year-on-year increase of 13 per cent in emergency admissions and a 10 per cent increase in emergency ambulances.

This “unprecedented demand and consequent overcrowding” had meant the targets were missed.

She said the trust had made key appointments to the trust’s leadership and would invest £85m in buildings to meet the growing demand for services.

She added: “We are also working with our partners in the local health economy to address the challenges of increasing demand, ensuring that people are cared for in the most appropriate setting, including their own home.”