News / Wales unveils sanctions and incentives scheme

The framework, implemented immediately, is part of the government’s strategy to achieve world-class healthcare by 2015. It includes a number of targets in two parts.

Part A lists eight core targets, including achievement of financial balance. Part B includes 14 ‘ministerial priority targets’, such as treatment within 52 weeks of GP referral. All targets apply to both trusts and local health boards (LHBs).

NHS organisations will be given a point for achieving each target and placed into one of four bands depending on their total score, which will be calculated at the year-end.

Performance against the part A targets will be calculated first. An organisation that fails any of these may be placed in special measures, at the discretion of the Welsh Assembly Government. The measures include appointment of a turnaround director and increased performance monitoring.

Organisations that achieve all eight core targets will be measured against the part B targets. Those that meet seven or less (a total less than 16) may be given targeted support.

A score of 16 or more will gain organisations entry into national awards and non-recurrent payments.

Organisations will have to put together a business case to bid for the money and use any reward for service development. The level of payments will depend on the organisation’s total score. At the higher level trusts will receive £2m and local health boards (LHBs) £1m; at the lower level trusts will get £500,000 and LHBs £250,000.

HFMA Wales chairman Chris Lewis said trusts’ priority would be to meet the basic standards. ‘The announcement of an incentives and sanctions framework has already worked in terms of focusing attention on the priority areas,’ he said. ‘The biggest incentive will be to ensure that organisations are not subjected to special measures or focused support. Only after that are thoughts likely to be focused on financial incentives available for maximising performance against the specified target areas.’

Some finance directors, however, were concerned that the framework could stifle innovation, while others said that even those eligible for rewards might be turned off by the additional application process.