Operational Standards, National Quality Requirements and Never Events, Schedule 4 Part A: Operational Standards Ref Operational Standards Threshold (2015/16) Method of Measurement (2015/16) Consequence of breach Timing of application of consequence Applicable Service Category RTT waiting times for non-urgent treatment E.B.1 Percentage of admitted Service starting treatment within a maximum of 18 weeks from Referral Operating standard of 90% at specialty level (as reported on Unify) Review of monthly Service Quality Performance Report Where the number of breaches in the month exceeds the tolerance permitted by the threshold, £400 in respect of each excess breach above that threshold Monthly Services to which 18 Weeks applies E.B.2 Percentage of Service Users starting treatment within a maximum of 18 weeks from Referral Operating standard of 95% at specialty level (as reported on Unify) Review of monthly Service Quality Performance Report Where the number of breaches in the month exceeds the tolerance permitted by the threshold, £100 in respect of each excess breach above that threshold Monthly Services to 18 Weeks applies E.B.3 Percentage of Service on incomplete RTT pathways (yet to start treatment) waiting no more than 18 weeks from Referral Operating standard of 92% at specialty (as reported on Unify) Review of monthly Service Quality Performance Report Where the number of breaches at the end of the month exceeds the tolerance permitted by the threshold, £150 in respect of each excess breach above that threshold Monthly Services to which 18 Weeks applies non-
Diagnostic test waiting E.B.4 Percentage of Service Users waiting less than 6 weeks from Referral for a diagnostic test Operating standard of >99% Review of monthly Service Quality Performance Report Where the number of breaches at the end of the month exceeds the tolerance permitted by the threshold, £200 in respect of each excess breach above that threshold Monthly A CS CR D S A&E waits E.B.5 Percentage of A & E attendances the Service User was admitted, transferred or discharged within 4 hours of their arrival at an A&E department Operating standard of 95% Review of monthly Service Quality Performance Report Where the number of breaches in the month exceeds the tolerance permitted by the threshold, £120 in respect of each excess breach above that threshold. To the extent that the number of breaches exceeds 15% of A&E attendances in the relevant month, no further consequence will be applied in respect of the month Monthly A+E U Cancer waits - 2 week wait E.B.6 Percentage of Service referred urgently with suspected cancer by a GP waiting no more than Operating standard of 93% Review of monthly Service Quality Performance Report Where the number of breaches in the Quarter exceeds the tolerance permitted by the threshold, £200 in respect of each Quarterly A CR R
two weeks for first outpatient appointment excess breach above that threshold E.B.7 Percentage of Service Users referred urgently with breast symptoms (where cancer was not initially suspected) waiting no more than two weeks for first outpatient appointment Operating standard of 93% Review of monthly Service Quality Performance Report Where the number of breaches in the Quarter exceeds the tolerance permitted by the threshold, £200 in respect of each excess breach above that threshold Quarterly A CR R Cancer waits – 31 days E.B.8 Percentage of Service Users waiting no more than one month (31 days) from diagnosis to first definitive treatment for all cancers Operating standard of 96% Review of monthly Service Quality Performance Report the number of breaches in the Quarter exceeds the tolerance permitted by the threshold, £1,000 in respect of each excess breach above that threshold Quarterly A CR R E.B.9 Percentage of Service Users waiting no more than 31 days for subsequent treatment where that treatment is surgery Operating standard of 94% Review of monthly Service Quality Performance Report Where the number of breaches in the Quarter exceeds the tolerance permitted by the threshold, £1,000 in respect of each excess breach above that threshold Quarterly A CR R E.B.10 Percentage of Service Users waiting no more than 31 days for subsequent treatment where that treatment is an anti-cancer drug regimen Operating standard of 98% Review of monthly Service Quality Performance Report Where the number of breaches in the Quarter exceeds the tolerance permitted by the threshold, £1,000 in respect of each excess breach above that threshold Quarterly A CR R
E.B.11 Percentage of Service Users waiting no more than 31 days for subsequent treatment where the treatment is a course of radiotherapy Operating standard of 94% Review of monthly Service Quality Performance Report Where the number of breaches in the Quarter exceeds the tolerance permitted by the threshold, £1,000 in respect of each excess breach above that threshold Quarterly A CR R Cancer waits – 62 days E.B.12 Percentage of Service Users waiting no more than two months (62 days) from urgent GP referral to first definitive treatment for cancer Operating standard of 85% Review of monthly Service Quality Performance Report Where the number of breaches in the Quarter exceeds the tolerance permitted by the threshold, £1,000 in respect of each excess breach above that threshold Quarterly A CR R E.B.13 Percentage of Service Users waiting no more than 62 days from referral from an NHS screening service to first definitive treatment for all cancers Operating standard of 90% Review of monthly Service Quality Performance Report Where the number of breaches in the Quarter exceeds the tolerance permitted by the threshold, £1,000 in respect of each excess breach above that threshold Quarterly A CR R E.B.14 Percentage of Service waiting no more than 62 days for first definitive treatment following a consultant’s decision to upgrade the priority of the Service User (all cancers) [Insert as per local determination] Review of monthly Service Quality Performance Report [Insert as per determination] Quarterly A CR R Category A ambulance calls
sex accommodation breaches E.B.S.1 Sleeping Accommodation Breach >0 Verification of the monthly data provided pursuant to Schedule 6B in accordance with the Professional Letter £250 per day per Service User affected Monthly A CR MH Cancelled operations E.B.S.2 All Service who have operations cancelled, on or after the day of admission (including the day of surgery), for reasons to be offered another binding date within 28 days, or the Service User’s treatment to be funded at the time and hospital of the Service User’s choice Number of Service Users who are not offered another binding date within 28 days >0 Review of monthly Service Quality Performance Report Non-payment of costs associated with cancellation and payment or reimbursement (as applicable) of re-scheduled episode of care Monthly A CR S Mental health E.B.S.3 Care Programme Approach (CPA): The percentage of Service Users under adult mental illness specialties on CPA who were followed up within 7 days of discharge from psychiatric in-patient care Operating standard of 95% Review of monthly Service Quality Performance Reports the number of breaches in the Quarter exceeds the tolerance permitted by the threshold, £200 in respect of each excess breach above that threshold Quarterly MH MHSS
Schedule 4 Part B: National Quality Requirements National Quality Requirement Threshold (2015/16) Method of Measurement (2015/16) Consequence of breach Timing of application of consequence Applicable Service Category E.A.S.4 Zero tolerance MRSA >0 Review of monthly Service Quality Performance Report £10,000 in respect of each incidence in the relevant month Monthly A E.A.S.5 Minimise rates of Clostridium difficile [Insert Baseline Threshold identified for Provider] Review of monthly Service Quality Performance Report As set out in Schedule 4G, in accordance with applicable Guidance Annual A E.B.S.4 Zero tolerance RTT over 52 weeks for incomplete pathways >0 Review of monthly Service Quality Performance Report £5,000 per Service User with an incomplete RTT pathway waiting over 52 weeks at the end of the relevant month Monthly Services to which 18 Weeks applies E.B.S.7a All handovers between ambulance and A & E must take place within 15 minutes with none waiting more than 30 minutes >0 Review of monthly Service Quality Performance Report £200 per Service User waiting over 30 minutes in the relevant month Monthly A+E E.B.S.7b All handovers between ambulance and A & E must take within 15 minutes with none waiting more than 60 minutes >0 Review of monthly Service Quality Performance Report £1,000 per Service User waiting over 60 minutes (in total, not aggregated with E.B.S.7a consequence) in the relevant month Monthly A+E E.B.S.8a Following handover between ambulance and A & E, ambulance crew should be ready to accept >0 Review of monthly Service Quality Performance Report £20 per event where > 30 minutes in the relevant month Monthly AM
new calls within 15 minutes and no longer than 30 minutes E.B.S.8b Following handover between ambulance and A & E, ambulance crew should be ready to accept new calls within 15 minutes and no longer than 60 minutes >0 Review of monthly Service Quality Performance Report £100 per event where > 60 minutes (in total, not aggregated with E.B.S.8a consequence) in the relevant month Monthly AM E.B.S.5 Trolley in A&E not longer than 12 hours >0 Review of monthly Service Quality Performance Report £1,000 per incidence in the relevant month Monthly A+E E.B.S.6 No urgent operation should be cancelled for a second time >0 Review of monthly Service Quality Performance Report £5,000 per incidence in the relevant month Monthly A CR VTE risk assessment: all inpatient Service Users undergoing risk assessment for VTE, as defined in Contract Technical Guidance 95% Review of monthly Service Quality Performance Report Where the number of breaches in the month exceeds the tolerance permitted by the threshold, £200 in respect of each excess breach above that threshold Monthly A Publication of Formulary Continuing failure to publish Publication on Provider’s website Withholding of up to 1% of the Actual Monthly per month until publication Monthly A MH MHSS CR R Duty of candour Each failure to notify the Relevant Person of a Review of monthly Service Quality Performance Report Recovery of the cost of the episode of care, or £10,000 if the cost of the Monthly All
suspected or actual Reportable Patient Safety Incident in accordance with SC35 episode of care is unknown or indeterminate Completion of a valid NHS Number field in mental health and acute commissioning data sets submitted via SUS, as defined in Contract Technical Guidance 99% Review of monthly Service Quality Performance Report Where the number of breaches in the month exceeds the tolerance permitted by the threshold, £10 in respect of each excess breach above that threshold Monthly A MH MHHS Completion of a valid NHS Number field in A&E commissioning data sets submitted via SUS, as defined in Contract Technical Guidance 95% Review of monthly Service Quality Performance Report Where the number of breaches in the month exceeds the tolerance permitted by the threshold, £10 in respect of each excess breach above that threshold Monthly A&E Completion of Mental Health Minimum Data Set ethnicity coding for all detained and informal Service Users, as defined in Contract Technical Guidance Operating standard of 90% Review of monthly Service Quality Performance Reports Where the number of breaches in the month exceeds the tolerance permitted by the threshold, £10 in respect of each excess breach above that threshold Monthly MH MHSS Completion of IAPT Minimum Data Set outcome data for all appropriate Service Operating standard of 90% Review of monthly Service Quality Performance Reports the number of breaches in the month exceeds the tolerance permitted by the Monthly MH MHSS
Users, as defined in Contract Technical Guidance threshold, £10 in respect of each excess breach above that threshold Schedule 4 Part D: Never Events Event Breach Threshold Method of Measurement Never Event Consequence (per occurrence) Applicability Applicable Service Category The occurrence of a Never Event as defined in the Never Events Policy Framework from time to time >0 Review of reports submitted to NRLS/Serious Incidents reports and monthly Service Quality Performance Report In accordance with Never Events Policy Framework, recovery by the Responsible Commissioner of the costs to that Commissioner of the procedure or episode (or, where these cannot be accurately established, £2,000) plus any additional charges incurred by that Commissioner (whether under this Contract or otherwise) for any corrective procedure or necessary care in consequence of the Never Event All healthcare premises and settings All