The Commissioning for Quality and Innovation framework is being used to reward the achievement of minimum standards rather than high quality care, research has found.
The report, Accounting for Quality by consultancy Health Mandate, examined the CQUIN indicators that are written into the contracts between primary care trusts and providers and determine a proportion of payments.
“Improving clinical effectiveness” was the most common aim of CQUIN indicators, accounting for over half of those assessed. Within that group of indicators, “improving the quality of discharge planning” and “improving stroke care” were the most commonly adopted targets.
The framework was launched in April 2009 to make sure quality was part of discussions between commissioners and providers but the report reviewing the first year of implementation found CQUINs found that was not always the case.
The authors criticised the setting of targets which do not relate to quality or innovation but instead reward the achievement of only minimum standards. Submitting “usable data” was a payment by results target for Papworth Hospital NHS Foundation Trust, while Weston General Hospital NHS Trust was rewarded for accurately recording its carbon emissions, the report said.
Some trusts were found to have agreed CQUINs relating to meeting waiting time targets. Managing director of Health Mandate, Mike Birtwhistle, said that was inappropriate as these targets are covered elsewhere in the performance management regime. He said: “They should be shut down if they can’t meet these, not given a bonus for hitting it.”
Under CQUIN 0.5 per cent of trusts’ funding in 2009-10 was dependent on meeting locally and nationally agreed targets. The proportion is expected to rise in coming years and in the white paper the Department of Health said it “will extend the scope and value of the Commissioning for Quality and Innovation payment framework, to support local quality improvement goals”.