The independent foundation trust regulator has warned that progress towards the 18-week target could be slowed down by primary care trusts attempting to cut spending.

The independent foundation trust regulator has warned that progress towards the 18-week target could be slowed down by primary care trusts attempting to cut spending.

In its summary of findings from foundation trusts' annual plans, seen by HSJ, Monitor warns that the 'lack of clarity in future commissioning plans gives rise to a number of risks for foundation trusts'.

The summary cautions that foundation trust financial and operational planning will become 'increasingly uncertain' and that 'the progress towards 18-week waiting targets may be slowed'.

The document, sent to all foundation trusts, also says financial performance, including liquidity, will be adversely impacted if over-performance disputes between trusts and PCTs continue to arise.

The Monitor review blames the current reconfiguration of PCTs and strategic health authorities for adding to the difficulty of resolving disputes for the last financial year and agreeing contracts for 2006-07.

And it warns that 'commissioning uncertainty' will have a number of implications for foundation trusts. 'Operational and financial planning is complicated as foundation trusts balance waiting list targets with commissioners' desire to minimise activity,' it says.

The regulator also says the 'priority to achieve financial balance is leading some commissioners to demonstrate behaviour which conflicts with payment by results reform'.

The summary of annual plan findings, which covers the 32 trusts to achieve foundation status by March 2006, states that seven have forecast a deficit for the end of the current financial year.

University College London Hospitals is predicting the biggest deficit -£10m by year-end. But this compares with a£36m deficit in 2005-06.

Chief executive Robert Naylor blamed the trust's financial difficulties on the significant costs associated with the building of its new private finance initiative-funded development.

'We will not achieve financial balance this year but we have agreed a financial deficit of up to£10m with Monitor,' Mr Naylor told HSJ.

'The acid test is whether we can live within this target; I think we can but I would not want to be as bold as to say we will beat it by the end of this year,' he added.

Countess of Chester Hospital, Gloucestershire Hospitals, Barnsley Hospital, Doncaster and Bassetlaw Hospitals, City Hospitals Sunderland, and Homerton University Hospital foundation trusts are forecasting deficits ranging from£1m-£3m.

The review also highlights 12 foundation trusts that have been rated amber for risk on governance and says eight organisations have been 'unable' to self-certify that they have plans in place to ensure targets and standards are met.

And it warns that the government's 62-day cancer waiting time target, along with those for MRSA and thrombolysis, were proving the most difficult to meet.

HSJ understands that the regulator will publish a public version of trusts' annual plan findings in September.