Hospital bosses urge NHS England to drop 'unfair' fines as Covid admissions rise

Exclusive: targets on returning patient care to pre-pandemic levels ‘impossible’ to meet, say trusts

Hospitals in England will be fined for failing to meet “impossible” targets on patient care within weeks, in a scheme criticised by NHS trust bosses as “mad, wrong and unfair”.

NHS England is facing calls to urgently rethink plans to impose financial penalties on trusts that fail to return non-emergency operations to near-normal levels by the end of this month.

The directive, which has sparked alarm among regional public health directors and local councils, was issued to hospitals in August and is still going ahead despite a resurgence of coronavirus cases that threatens to seriously disrupt the NHS this winter.

Chris Hopson, the chief executive of NHS Providers, which represents hospital trusts in England, said he had raised the issue urgently with NHS England and NHS Improvement, the body responsible for overseeing foundation trusts, following concerns raised by trust bosses.

“It would be mad, wrong and unfair to penalise hospitals for failing to reach targets that it was impossible for them to meet,” he said.

There is growing concern that the sharply rising number of coronavirus patients in England’s hospitals will undermine their ability to provide non-Covid care and tackle waiting lists for non-urgent care. On Thursday, 609 Covid patients were admitted to hospital, while government officials said the number of people in intensive care would pass its April peak in 21 days in parts of northern England if the current trajectory did not change.


The number of people waiting more than a year to start hospital treatment is at its highest since 2008 and almost 90 times higher than at the same time last year. In August, there were 111,026 people who had waited more than 52 weeks to start hospital treatment, up from 1,236 in August 2019.

Amanda Pritchard, the chief operating officer of NHS England and NHS Improvement, set out the plans for financial penalties in a letter to NHS trusts on 20 August. She said payments to trusts would “flex” depending on their ability to reach targets including returning, by this month, to 100% of last year’s activity for diagnostic tests such as MRI and CT scans.

They were also tasked with returning outpatient appointments to normal levels from September onwards. Failure to meet the targets would result in trusts losing 25% of the money they were due between this month and March 2021 for undertaking planned operations and 20% of that for for holding outpatient appointments.

An NHS trust chair in one of the parts of England worst hit by Covid-19 said the targets were “impossible”, given the rapidly rising number of Covid admissions, social distancing rules on wards and the huge backlog of patients caused by the shutdown of normal NHS care in March.

“The target is to hit 90% of previous activity by October, which is really, really demanding given everything else that’s going on, and social distancing just makes it impossible,” he said. “It’s going to be a real challenge and it’s punishing those that are struggling anyway.”

At least one local authority has written to the health secretary, Matt Hancock, urging him to step in to scrap the fines, warning that they would “widen the gap [of health inequalities] and increase disadvantage” in their area. “Every single penny removed from our [health and care] system would have the potential to cause harm to our population who need our support,” the letter said.

One council leader, whose area was also hit hard by the pandemic, said: “Pre-Covid, if we had four patients waiting more than 52 weeks in the system, there was a big inquiry into why. We now anticipate that we’ve got nearly 600 people on this waiting list. To financially penalise us is just outrageous.”

About a third of England’s daily hospital admissions with Covid are in the badly hit north-west of England, where some hospitals are set to run out of beds for coronavirus patients within a week.

In Greater Manchester, about 30% of the region’s Covid-19 beds are occupied after an almost fourfold increase since the start of September to 323 on 6 October, according to figures released by health officials this week. The number of patients in intensive care has more than doubled in the same period, to 40 this week.

The British Medical Association, which represents doctors, has warned that the targets NHS England has set trusts for restoring normal services “are unlikely to be realised”.

NHS England said last Thursday that in September hospitals had successfully performed 80% of the number of planned operations they did in the same month last year. However, a Royal College of Surgeons of England survey of almost 1,000 surgeons published two days earlier showed that 39% said their trusts were doing fewer than 50% and 48% said theirs were managing 50%-80%.

NHS Providers said medics were determined to clear patient backlogs during any second Covid-19 surge, but that the speed of the recovery would “inevitably be impacted wherever there is a full-blown second spike”. Some hospitals have begun turning elective patient wards back into Covid wards as the number of admissions have risen.

Hopson said: “There is concern from some hospital trusts about being fined if their system does not meet their non-Covid activity recovery targets. NHS England and Improvement set some very stretching targets – that’s their job. But, crucially, they were set before a second spike of Covid arrived.

“We having raised the issue urgently with NHS England and Improvement and reminded them that they committed to covering the full costs of any Covid second spike and that must obviously cover the financial impact of not being able to reach recovery targets.”

An NHS spokesperson said: “Hospitals are pulling out all the stops to increase tests and operations that were disrupted during the Covid wave one peak, and are rightly getting extra funding to support this. It is obviously crucial that Covid is kept under control so as to avoid a repeat of these patient disruptions.”


Josh Halliday and Denis Campbell

The GuardianTramp

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