The pay-for-quality arrangements set out by Lord Darzi in the next stage review are sparking disagreement between some trusts and commissioners.

Several foundation and acute trust directors said they felt they had not been consulted on measures that will be linked to their tariff payments under the CQUIN (commissioning for quality and innovation) scheme.

Directors of several trusts, mostly in Yorkshire and the Humber, where primary care trusts have well developed plans for a region-wide scheme, told HSJ the measures were not in line with their own quality improvement plans.

The PCTs have agreed a set of indicators which reflect the region's vision document Healthy Ambitions, including some of the metrics used by NHS North West's Advancing Quality scheme.

Strong leadership

Doncaster PCT director of quality and clinical assurance Julie Bolus, who is developing the framework, said it was important commissioners took a strong lead. It had already engaged clinicians, she said.

Ms Bolus said: "We have tried to include all the trusts in the consultation. That doesn't mean they don't think we could have done more. We have said that for where we are and the timescale we have done as much as possible."

Strategic health authorities are all developing programmes to support quality of care improvements, as recommended in the health minister's reform programme. They have been asked to report plans for measures to be used in quality accounts to the Department of Health by the end of January.

The content of the accounts will be decided by provider trusts but several SHAs said they expected to see at least some CQUIN indicators.

Forming principles

NHS West Midlands director of strategy Peter Spilsbury said it had decided against specifying measures to be used for CQUIN, though it has set principles for how schemes should work.

"It is for commissioners and providers to agree on the measures that make most sense," he said.

"It is the commissioners' prerogative to make the first bid but we won't accept any scheme where there isn't evidence to show it is agreed by [clinicians from the provider and PCT]."

NHS North East deputy medical director Paula Whitty said that because nearly all its providers are foundations it was not asking them to report plans.

She said: "While it is for local determination we are hoping to move towards alignment."

NHS North West chief executive Mike Farrar said quality measurement in the region would include bundles of clinical indicators in its Advancing Quality scheme, patient recorded outcome measures, patient experience and patient safety.

"We are working with PCTs at the moment and using Advancing Quality to help us develop what we do with CQUIN," he said.

HSJ is holding conferences on quality improvement on 30 and 31 March in Birmingham. For details visit


North East

  • Providers largely free on quality accounts

  • Quality observatory-style model under development

  • Likely to include support for clinical teams' improvement work

North West

  • Incentives in existing quality programme

  • Expanding to mental health, stroke and patient focused measures

  • To be related to CQUIN for further incentives

West Midlands

  • CQUIN measures decided locally

  • Quality observatory with information and assurance functions

  • Rolling peer review programme

Yorkshire and the Humber

  • Set of CQUIN measures agreed by all PCTs

  • Can be complemented locally

  • Metrics "expected" to feature in quality accounts