Hospitals face a “zero-tolerance” approach to MRSA and long waits for treatment, as well as new fines, under the NHS Commissioning Board’s planning guidance.
From April NHS providers should expect to be fined for patients who wait longer than a year from referral to treatment and for delays in ambulance handovers.
At the end of October there were 1,281 patients who had been waiting longer than 52 weeks. This is down from more than 11,000 in October 2010 when the issue was first highlighted in the media.
The guidance says it “unfair” to provide patients with a right to treatment within 18 weeks and not deliver against it.
Acute trusts will also face fines for ambulance handover delays longer than 30 minutes and a further fine for delays of more than an hour. Although fines for poor performance on handover are often used locally by commissioners this is the first time fines have been imposed nationally.
Ambulance services will also be fined if crews are not ready to accept new calls within 15 minutes of handover.
The guidance also says patient should not have to “tolerate” an operation being cancelled more than once for non-clinical reasons with trusts forced to pay costs of treatment at an alternative hospital of the patient’s choosing if they cannot rearrange the procedure within 28 days.
All MRSA infections should involve a post infection review as part of the “zero-tolerance” approach, while the commissioning board said it also expects to see significant reductions in incidences of C. difficile.
The guidance states: “Commissioners must enforce the standard terms [of the NHS contract], including the financial consequences for under-performance or failure to provide data on which to assess performance.
As in previous years, trusts will receive bonus payments for good performance on national priorities under the Commissioning for Quality and Innovation (CQUIN) system. These areas are: improving dementia care, risk assessment for venous thromboembolism, improvement against the NHS Safety Thermometer and, for the first time, performance against the “friends and family” test.
Peter Carter, chief executive and general secretary of the Royal College of Nursing, said: “We’re particularly pleased to see guidelines on reducing ambulance handover times as this has been an area of concern in the past and it’s encouraging to see a zero tolerance stance on MRSA.
“Our main area of concern is in relation to issuing fines to trusts who do not deliver on the 52 week target. Logic would suggest that if a trust is unable to achieve this target then a fine will only make matters worse.”