• Trust says CCG refusing to fund regulator-backed elective recovery plan
  • Says there is disagreement over “what level of elective performance is seen to be safe and appropriate”
  • NHSE/I arbitrating two separate contract disputes between the trust and CCG

A West Midlands trust has warned people will be left waiting for surgery for more than a year after commissioners refused to fund a regulator-backed plan to cut its elective waiting list.

Wye Valley Trust’s chief executive Glen Burley told his board last week that he had sought NHS England/Improvement intervention after a disagreement with Herefordshire Clinical Commissioning Group over “what level of elective performance is seen to be safe and appropriate”.

In a paper to the board, Mr Burley said the number of elective procedures the CCG proposed funding “could not be delivered without either wasting capacity or breaching the 52-week waiting time standard”.

The paper said the trust had previously agreed to an elective recovery plan with the CCG, NHS Improvement and the Care Quality Commission after concerns were raised about long waits for surgery at the trust.

The plan required the trust to hit the national target of treating 92 per cent of patients within 18 weeks of referral by April 2021. It was agreed the trust would hit 86 per cent by April 2020.

However, the paper said the CCG has subsequently told the trust it could “no longer afford to commission the activity levels in this financial year to meet the agreed plan”. The trust has offered a compromise, which would include hitting 82.6 per cent by the end of the year with no 52-week breaches, but the CCG had countered that the trust should instead maintain its current performance of treating 80.2 per cent patients with 18 weeks of referral.

In last quarter of 2018, the trust had one of the worst referrals to treatment performances in the country but has improved since. There were no 52-week breaches in May this year, the most recent data available shows.

The paper stated: “Whatever position we reach, it appears that we will need to work carefully with the CQC to ensure that they are satisfied with a less ambitious plan.”

The funding of elective activity is one of two ongoing contract disputes between the small trust, that runs hospital and community services in Herefordshire, and its main commissioner. Both matters are with NHSE/I for arbitration.

In December, HSJ reported the trust had unilaterally withdrawn from its block contact with the CCG for 2018-19, claiming it did not cover the growing demand placed on it – specifically clearing the dozens of patients waiting more than 52 weeks for treatment – or shoulder a fair share of the £6m in savings needed across the system.

NHSE/I subsequently ruled the trust should not have withdrawn from its contract, but a dispute is ongoing over who should pay for £8.5m of elective activity carried out by the trust in 2018-19 without payment. 

Wye Valley Trust reported a deficit of £42.2m in 2018-19, which was £19.2m worse than planned. Herefordshire CCG reported a £4.1m deficit for 2018-19.

The CCG did not answer HSJ’s questions regarding the dispute, including whether it accepted the trust’s assertion that lower activity would lead to patients waiting for more than 52-weeks for treatment.

In a statement, a spokesman said: “National planning guidance requires the CCG to commission at least the same levels of performance as the previous year while also ensuring no one waits more than 52 weeks for treatments. Herefordshire CCG has commissioned elective activity from Wye Valley Trust in line with this national planning guidance and is working with the trust to support it in meeting these requirements.”

“Within its own recovery plan it agreed with the CQC the trust has set a higher performance target for elective care than the CCG has commissioned for 2019-20. The trust and the CCG are currently working on how to close this financial gap with NHS England/Improvement.”

An NHSE/I spokeswoman said: “We are working with the trust and the CCG to reach a solution that is beneficial to patients and meets the requirements of both commissioner and provider.”

The CQC and the trust were both approached for comment but did not respond before publication.