National Health Service clinical commissioning groups (CCGs) are not directly penalised for each breach of NHS Constitution waiting time commitments, or the associated operational standards. However, access to Quality Premium scheme funding, which CCGs can earn in addition to their normal allocations for achieving specific improvements in care or outcomes, is partially dependent on each CCG’s performance against waiting times standards. More broadly, NHS England is supported by legislation in exercising formal powers of direction if it is satisfied that a CCG is failing or at risk of failing to discharge its functions. The NHS Standard Contract provides for financial sanctions against acute hospital trusts for breaching waiting time operational standards.

NHS England issues planning guidance annually, the latest of which is NHS Operational Planning and Contracting Guidance 2017-2019. This sets out the waiting time standards, other operational standards and quality requirements that providers of NHS healthcare services are expected to meet in order to deliver the rights and pledges in the NHS Constitution. Copies of the Guidance and the NHS Constitution are attached.

These requirements are set out in the NHS Standard Contract that must be used by CCGs for all contracts with hospital providers of NHS healthcare services. The Contract sets out the consequences of breaches of the waiting time standards and other requirements by hospital providers. For waiting time standards, this consequence is in the form of a financial sanction.

However, from 2016-17, the operation of contractual sanctions for poor performance against waiting time standards has been suspended where a hospital provider is receiving funding from the Sustainability and Transformation Fund (STF), and meets certain other specified conditions, including the agreement of performance trajectories with NHS Improvement and NHS England. These arrangements are arranged at avoiding ‘double jeopardy’ for hospital providers within scope of the STF. If they fail to achieve their agreed performance trajectories, these hospital providers will face withdrawal of an element of their STF funding by NHS Improvement, but will not face application of the normal contractual sanctions by their commissioners.