In excess of 50 NHS trusts across the UK are to be allowed to miss waiting time targets without sanction, after NHS bosses agreed to introduce new measure to help hospital trusts deal with spiraling debt.
The new measures were announced by top bosses at the three major NHS regulators: NHS England, NHS Improvement and the Care Quality Commission (CQC) in response to hospitals exceeding budget restrictions by an all-time high during 2015-2016. Hospitals struggling to stay financially viable are also to be placed under the administration of special “failure regimes”, with regulators appointing senior executives in charge for the express purpose of improving management of the Trusts and financial performance.
As it stands, five trusts have been placed under the jurisdiction of failure regimes:
- Barts Health in London
- Croydon Health Services
- Maidstone and Tunbridge Wells
- Norfolk and Norwich Hospitals
- North Bristol
It’s also understood that a further 13 trusts have been threatened with the measure should they continue to miss key financial targets.
Recent Statistics Reveal Poor NHS Performance
Up until this announcement from NHS England, NHS Improvement and the Care Quality Commission, strict targets for waiting periods were in place to stop waiting lists growing and incentivise good performance, with fines imposed for missed targets. A&E departments for example are set the target to see 95% of patients within four hours of arrival, with fines of £120 per patient levied where this was not the case. 92% of patients awaiting routine operations are supposed to start treatment within 18 weeks of referral, with fines of £400 per patient levelled where this target wasn’t met. When patients are referred urgently to hospital for cancer treatment, 85% were supposed to begin treatment within 62 days, with £1,000 per patient fees imposed where this was not enacted.
Recent statistics showing how often these targets have actually been met in recent years make for worrying reading however. In a previous article we pointed out that A&E waiting times were at their worst for 10 years, and the situation doesn’t seem to have improved. The four-hour waiting period target for 95% of A&E patients was missed in both the 3rd and 4th quarters of the 2015/2016 year for example, falling to 91.5% and 87.9% respectively. Admissions to Major A&E divisions fared even worse, with NHS trusts failing to achieve the mandated 95% success rate since the 2nd quarter of 2012/2013, and figures dropping to 81.8% in 4th quarter of 2015/2016, the lowest level shown in the NHS statistics which show results since 2004.
At a time when Blackwater Law clinical negligence solicitors are seeing an increase in inquiries relating to making a claim relating to misdiagnosis of cancer compensation, we are concerned to discover that the 2015/2016 nationwide 62-day waiting period targets for those referred urgently for cancer treatment by their GP were missed since 2013/14. In 2014/15 NHS trusts in England achieved only 83.4% of those urgently referred by their GP receiving first treatment and in 2015/16 this was 82.4%.
Providing for further concern surrounding delayed diagnosis of cancer, statistics relating to the number of patients seen by specialists after an urgent two-week referral by GPs for suspected breast cancer also demonstrate missed targets. Only 92.4% of patients met these criteria in the second quarter of 2015/16, compared to national targets of 93%. The same target was also missed in the 1st quarter of 2014/15 and the 4th quarter of 2013/2014, indicating that these failures are not a one-off occurrence. For the year 2015/16, a total of 15,551 patients referred by their GP to a specialist with suspected breast cancer were not seen within the target of two weeks.
NHS Trusts Will No Longer Be Sanctioned for Missing Targets
Under new regulations, NHS trusts will no longer have money deducted from their budgets for failing to meet the targets outlined above. Instead, trusts will seek to earn a slice of additional NHS investment on the part of the government in upcoming years by improving on their current performance. Targets are to be set on a case-by-case basis, and regulators hope that this will free-up more money to be spent on patients instead of money being paid out in fines. However not all experts are convinced:
Nigel Edwards from the Nuffield Trust think tank issued the following statement to the BBC:
“My big worry is what happens next. I fear that in order for hospitals to virtually eradicate their deficits the next steps could be a series of brutal service reductions and bed closures – which will shock an unprepared public.”
Department of Health Struggling to Balance Books
Perhaps most concerning, it emerges that the Department of Health as a whole is struggling to balance its books, narrowly avoiding sanctions from the Treasury only by redirecting surplus cash from other areas of our health services. The department also moved £950m from the capital budget for buildings and maintenance, and mysteriously identified an additional £417m of extra income from national insurance receipts that had somehow been overlooked until now. Auditors insist that the current measures are not sustainable, and that it’s clear that ours is a health service in crisis.
Our Thoughts on the Removal of Financial Sanctions
Commenting on the removal of financial sanctions for poor performance against targets, Jason Brady, clinical negligence solicitor at Blackwater Law said:
“This is a worrying development. Sanctioning poor performance and incentivising good performance against NHS targets aims to ensure Trusts provide care to an acceptable standard and that care is provided consistently by Trusts across the country. Allowing Trusts to miss these targets without repercussion seems to send the wrong message.
“Whilst redirecting funds from the payment of fines to direct provision of care is a noble motivation, such a change in policy, on the face of it this seems to be little more than a short-term money saving exercise that does not deal with the underlying issues that have created the financial instability within said Trusts or the issues in delivery of care that have led to the failure to meet the targets in the first instance.
“As a solicitor dealing with clients that have suffered life-changing and debilitating injuries or illnesses due to clinical negligence, we at Blackwater Law worry that a failure to address the financial issues facing the NHS will lead to lower quality inconsistent care provision; ultimately leading to more instances of clinical negligence that could be avoidable.”