News / Fines for target breaches set to change

In addition, NHS England intends to scrap the flexibility for sanction variation introduced in 2014/15.

It believes this has not increased the transparency of commissioners’ decisions on fines.

Instead, financial sanctions will be automatically applied for breaches of national quality standards and commissioners will be required to publish details of sanctions applied.

The NHS England response to a consultation on the standard contract said it would change sanctions on A&E four-hour and RTT 18-week breaches to ensure patients received their rights under the NHS Constitution.

The fine per excess breach of RTT will rise by 25%. Currently, trusts are fined £200 for every A&E breach that takes its performance below target (95% of patients treated within four hours). However, losses are limited by a ‘floor’ of 92%.

The new contract will cut the fine to £150, but it will also reduce the floor to 85%. NHS England believes this will encourage transformation consistent with the urgent and emergency care review in trusts furthest from delivering the A&E standard.

The consultation response was published after NHS England, Monitor and the NHS Trust Development Authority issued the 2015/16 planning guidance, The forward view into action: planning for 2015/16.

The main points of the guidance include the following:

• Commissioners must set aside 1%, non-recurrent spend in 2015/16 for strategic investment, including in new care models outlined in the Five-year forward view.
• There should be greater consistency between provider and commissioner activity and finance plans.
• The national bodies will oversee a new ‘success regime’, under which organisations in the most challenged areas will be brought together to address problems in their health economy.