• West Hertfordshire Hospitals Trust faces large fines from Herts Valley CCG for not meeting national target
  • Money to be used to outsource activity to private and specialist providers

A struggling acute trust faces fines of £5m in relation to its elective performance, with most of the cash expected to pay for capacity from private and specialist providers instead.

Herts Valley Clinical Commissioning Group has told West Hertfordshire Hospitals Trust it will be fined around £500,000 a month until its referral to treatment performance reaches the national target of 92 per cent. 

The sanctions will help pay for capacity with other providers, which could include BMI Healthcare or a specialist NHS trust. The CCG is aiming to clear a backlog of almost 100 patients that have waited more than a year for routine procedures. National leaders have said there will be “zero tolerance” for year long waits.

In recent years, there have been significant concerns at NHS Improvement about the amount of elective activity being outsourced to private providers, and the impact this has had on provider sector finances.

A paper to the Herts Valley CCG’s November board meeting said private providers “may expect a premium”, which would be “negotiated as necessary”.

It added: “Additional capacity to the value of approximately £3.8m has been identified… The additional costs can be funded at least partly from the sanctions being levied on WHHT as a result of their failure to meet the constitutional RTT targets.”

The CCG paper said the trust had already outsourced some elective activity to Spire Group, HCA Healthcare, and One Healthcare.

They added: “Discussions are ongoing with BMI Healthcare and the Royal National Orthopaedic Hospital (NHS Trust); to ascertain whether they have capacity to assist, with the latter expected to be able to accept more complex spinal patients.”

Patients requiring paediatric services, or ear, nose and throat care are most likely to be referred to alternative providers, the paper suggested.

The CCG is able to fine the trust because West Herts did not sign up to a control total in 2018-19.

Don Richards, chief financial officer at WHHT, warned the fines would “worsen” the trust’s financial position, which is already forecast to be a £53m deficit for 2018-19.

He said: “If levied, these fines would worsen our financial position and we are in discussion with the CCG about how this money could be used to good effect to alleviate elective and emergency pressures at the trust.”

The trust also believes its underperformance has been exacerbated by NHS England’s decision to suspend elective and non-urgent surgery for two months last winter, according to the CCG papers.

At the end of October, the trust had 92 patients who had been waiting more than a year to start treatment. The trust is not expected to meet the 92 per cent target on the 18 week pathway until April 2019, with its recent performance at around 85 per cent. It says the fines could total around £5m.

The CCG said in a statement: “We have written to the trust notifying them of our intention to apply fines to the value of £888k for April and May 2018. Further fines will also apply once [RTT] data has been verified”. It said the fines had not yet been levied.