A few days after NHS deputy chief executive David Flory issued a curt letter warning the health service not to allow any further failures to hit waiting time targets, an NHS North West board meeting considered the problem.

Ten of the 47 NHS providers in England that failed to hit the 18 week referral to treatment target in April were in the North West region.

Stockport Foundation Trust and Pennine Acute Hospital Trust treated less than 72 per cent of patients and East Cheshire Trust saw just 53 per cent inside 18 weeks. The target is to begin treatment for 90 per cent of patients within the time window.

The strategic health authority’s performance report suggests April’s poor performance was a hangover from severe weather and flu in the winter, but it acknowledges “a small number of providers’ plans” show they will continue to have “constraint in delivery of the required standard”.

Two of those also have to consider the need to try to become foundation trusts – and so juggle daunting savings plans and the pressures of NHS reform, too.

The SHA has rated East Cheshire’s status on the foundation trust pipeline as “high risk” and Pennine Acute’s as “high risk plus”.

Performance has to be improved as the pressures of reform are being felt at all levels. At provider level, that means continuing the drive for foundation status.

According to an NHS North West board paper, there are four trusts in the region whose status on the FT pipeline is “high risk plus”: North Cumbria University Hospitals and Trafford Healthcare, which are both seeking takeover by larger foundations; St Helens and Knowsley Teaching Hospitals; and Pennine Acute.