Appendix 2: Operational Standards and National Quality Requirements Schedule 4 Part A: Operational Standards Ref Operational Standards Threshold Method of Measurement Consequence of breach Timing of application of consequence Application RTT waiting times for non-urgent treatment E.B.3 Percentage of Service Users on incomplete RTT pathways (yet to start treatment) waiting no more than 18 weeks from Referral* Operating standard of 92% at specialty level (as reported on Unify) Review of Service Quality Performance Reports the number of Service Users waiting more than 18 weeks at the end of the month exceeds the tolerance permitted by the threshold, £300 in respect of each such Service User above that threshold Monthly Services to 18 Weeks applies Diagnostic test waiting E.B.4 Percentage of Service Users waiting 6 weeks or more from Referral for a diagnostic test* Operating standard of no more than 1% Review of Service Quality Performance Reports Where the number of Service Users waiting 6 weeks or more at the end of the month exceeds the tolerance permitted by the threshold, £200 in respect of each such Service User above that threshold Monthly A CS CR D A&E waits
initially suspected) waiting no more than two weeks for first outpatient appointment* exceeds the tolerance permitted by the threshold, £200 in respect of each such Service User above that threshold 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 Service Quality Performance Reports Where the number of Service Users who have waited more than 31 days during the Quarter exceeds the tolerance permitted by the threshold, £1,000 in respect of each such Service User above that threshold Quarterly A CR R E.B.9 Percentage of Service waiting no more than 31 days for subsequent treatment where that treatment is surgery* Operating standard of 94% Review of Service Quality Performance Reports Where the number of Service Users who have waited more than 31 days during the Quarter exceeds the tolerance permitted by the threshold, £1,000 in respect of each such Service User 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 Operating standard of 98% Review of Service Quality Performance Reports Where the number of Service Users who have waited more than 31 days during the Quarter exceeds the tolerance permitted by the Quarterly A CR R
first definitive treatment for all cancers* the threshold, £1,000 in respect of each such Service User above that threshold Ambulance Service Response Times (With effect from 1 April 2018) Category 1 calls – percentage of calls resulting in a response arriving within 15 minutes ** Operating standard that 90th centile is no greater than 15 minutes Review of Service Quality Performance Reports Issue of a Contract Performance Notice and subsequent process in accordance with GC9 Quarterly AM (With effect from 1 April 2018) Category 1 calls – mean time taken for a response to arrive ** Mean is no greater than 7 minutes Review of Service Quality Performance Reports Issue of a Contract Performance Notice and subsequent process in accordance with GC9 Quarterly AM (With effect from 1 2018) Category 2 (emergency) calls – percentage of calls resulting in an appropriate response arriving within 40 minutes ** Operating standard that 90th centile is no greater than 40 minutes Review of Service Quality Performance Reports Issue of a Contract Performance Notice and subsequent process in accordance with GC9 Quarterly AM (With effect from 1 April 2018) Category 2 (emergency) calls – mean time taken for an appropriate response to arrive ** Mean is no greater than 18 minutes Review of Service Quality Performance Reports of a Contract Performance Notice and subsequent process in accordance with GC9 Quarterly AM
(With effect from 1 2018) Category 3 (urgent) calls – percentage of calls resulting in an appropriate response arriving within 120 minutes ** Operating standard that 90th centile is no greater than 120 minutes Review of Service Quality Performance Reports of a Contract Performance Notice and subsequent process in accordance with GC9 Quarterly AM (With effect from 1 April 2018) Category 4 “assess, treat, transport” calls only) – percentage of calls resulting in an appropriate response arriving within 180 minutes ** Operating standard that 90th centile is no greater than 180 minutes Review of Service Quality Performance Reports Issue of a Contract Performance Notice and subsequent process in accordance with GC9 Quarterly AM Mixed sex accommodation breaches E.B.S.1 Mixed sex accommodation breach* >0 Review of Service Quality Performance Reports £250 per day per Service User affected Monthly A CR MH Cancelled operations E.B.S.2 All Service Users who have operations cancelled, on or after the day of admission (including the day of surgery), for non-clinical reasons to be offered another binding date Number of Service Users who are not offered another binding date within 28 days >0 Review of Service Quality Performance Reports Non-payment of costs associated with cancellation and payment or reimbursement (as applicable) of re-scheduled episode of care Monthly A CR
National Quality Requirement Threshold Method of Measurement Consequence of breach Timing of application of consequence Application E.A.S.4 Zero tolerance Staphylococcus aureus* >0 Review of Service Quality Performance Reports £10,000 in respect of each incidence in the relevant Monthly A E.A.S.5 Minimise rates of Clostridium difficile* [Insert baseline threshold identified for Provider: see Schedule 4F] Review of Service Quality Performance Reports As set out in Schedule 4F, in accordance with applicable Guidance Annual A E.B.S.4 Zero tolerance RTT waits over 52 weeks for incomplete pathways* >0 Review of Service Quality Performance Reports £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 Service Quality Performance Reports £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 place within 15 minutes with none waiting more than 60 minutes* >0 Review of Service Quality Performance Reports £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 new calls within >0 Review of Service Quality Performance Reports £20 per event where > 30 minutes in the relevant month Monthly AM
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 Service Quality Performance Reports £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 waits in A&E not longer than 12 hours* >0 Review of Service Quality Performance Reports £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 Service Quality Performance Reports £5,000 per incidence in the relevant month Monthly A CR VTE risk assessment: all inpatient Service undergoing risk assessment for VTE, as defined in Contract Technical Guidance 95% Review of Service Quality Performance Reports Issue of Contract Performance Notice and subsequent process in accordance with GC9 Quarterly A Duty of candour Each failure to notify the Relevant Person of a suspected or actual Notifiable Safety Incident in accordance with Regulation 20 of Review of Service Quality Performance Reports Recovery of the cost of the episode of care, or £10,000 if the cost of the episode of care is unknown or indeterminate Monthly All
the 2014 Regulations 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 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 A MH MHSS 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 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 A&E Completion of Mental Health Services Data Set ethnicity coding for all Service Users, as defined in Contract Technical Guidance Operating standard of 90% Review of 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 Users, as defined in Operating standard of 90% Review of Service Quality Performance Reports Where the number of breaches in the month exceeds the tolerance permitted by the threshold, £10 in Monthly MH MHSS
Contract Technical Guidance respect of each excess breach above that threshold E.H.4 Early Intervention in Psychosis programmes: the percentage of Service Users experiencing a first episode of psychosis or ARMS (at risk mental state) who wait less than two weeks to start a NICE-recommended package of care* For the period 1 April 2017 to 31 March 2018, operating standard of 50%. From 1 April 2018, operating standard of 53% Review of Service Quality Performance Reports Issue of Contract Performance Notice and subsequent process in accordance with GC9 Quarterly MH MHSS E.H.1 Improving Access to Psychological Therapies (IAPT) programmes: the percentage of Service Users referred to an IAPT programme who wait six weeks or less from referral to entering a course of IAPT treatment* Operating standard of 75% Review of Service Quality Performance Reports Issue of Contract Performance Notice and subsequent process in accordance with GC9 Quarterly MH MHSS E.H.2 Improving Access to Psychological Therapies (IAPT) programmes: the percentage of Service Users referred to an IAPT programme who Operating standard of 95% Review of Service Quality Performance Reports Issue of Contract Performance Notice and subsequent process in accordance with GC9 Quarterly MH MHSS