NHS England backtracks by confirming CQUIN shake up

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CQUIN payments to be “simplified” and focussed on a smaller number of indicators from April 2019
Scheme is worth more than £1bn nationally, although last year around £270m of the fund was held back as a “risk reserve”
Changes represent a change of tack from NHS England

National leaders have confirmed they will “significantly reduce” the value of CQUIN incentive schemes, despite NHS England previously denying that major changes were planned.

In a letter to local leaders, NHS England chief executive Simon Stevens and NHS Improvement chief executive Ian Dalton said “commissioning for quality and innovation payments” will be “simplified” and focussed on a smaller number of indicators from April 2019.

CQUINs have been in place for almost 10 years and make a proportion of providers’ income conditional on demonstrating improvements in specified areas of patient care.

The scheme is worth more than £1bn nationally, although last year around £270m of the fund was held back as a “risk reserve” to offset provider deficits.

The letter, which was sent out today, said: “From 1 April 2019, the current CQUIN scheme will be significantly reduced in value with an offsetting increase in core prices.

“It will also be simplified, focussing on a small number of indicators aligned to key policy objectives drawn from the emerging long-term plan.”

This appears to represent a victory for local leaders who had lobbied for significant changes, as well as a change of tack from NHS England.

Three months ago, a well-placed source told HSJ that major changes were being planned for CQUIN. But in a statement, NHS England said there were “no plans to scrap or significantly change” it.

Julie Wood, chief executive of NHS Clinical Commissioners, called for the scheme to be reviewed at the time, saying: “Whilst CQUIN was established with good intentions, for trusts it is seen as core income and for commissioners, therefore, has not always achieved the service change that has been sought. [It] risks creating a set of processes with little added value.”

The letter also says the approach to the “quality premium” for 2019-20 is also under review. This refers to payments made to clinical commissioning groups linked to quality improvements. In 2017-18, around £70m of these funds remained “unearned” nationally.

It also sets out an expectation for local health economies to create five year plans during the first half of 2019-20. Organisations and systems will also have to develop one-year operational plans for 2019-20 - a “transitional year” - and the letter asks them to begin work this autumn on activity, capacity and efficiency planning.