What is the Commissioning for Quality and Innovation (CQUIN) Framework?

The Commissioning for Quality and Innovation (CQUIN) framework is a programme designed by the NHS in England. It aims to improve the quality of care provided to patients while also ensuring value for money. The concept is simple: commissioners agree to pay extra funds to healthcare providers that meet specific quality improvement goals. These goals are tied to measurable outcomes, encouraging a continuous drive for better care standards.

CQUIN was introduced in 2009 with the broader aim of embedding quality at the heart of NHS-funded services. It rewards healthcare providers for achieving agreed-upon improvements in care delivery. This creates a financial incentive for organisations to think beyond basic service delivery and focus on delivering care that improves patient outcomes.

What Are Commissioners and Providers?

To understand the CQUIN framework, you first need to know what commissioners and providers are. Commissioners are organisations that plan, purchase, and monitor healthcare services for a specific population. Integrated Care Boards (previously CCGs) are a key type of commissioner in the NHS. They decide how NHS money is spent locally.

Providers, on the other hand, are organisations that deliver healthcare services. These include NHS hospital trusts, mental health services, and community care providers. Providers deliver the care that commissioners pay for. The CQUIN framework bridges the gap between these two entities, ensuring that the money spent on healthcare achieves higher care standards.

How CQUIN Works

The idea behind CQUIN is straightforward. Commissioners and providers agree on specific quality goals. These goals are set at the start of a contract and must be met for providers to earn their full payment. The payments linked to CQUIN are extra funds, often a percentage of the overall value of the contract. This means providers who achieve CQUIN targets receive a financial reward for their efforts.

Commissioners and providers negotiate and agree on the specific improvement goals. These goals are measurable and time-bound, ensuring clear accountability. For instance, goals might focus on reducing hospital-acquired infections, improving patient discharge processes, or increasing staff training in specific areas of care.

If the provider meets the targets, they receive the extra payment. If they fail, they risk losing a proportion of their funding. This approach motivates providers to focus on quality and service improvements.

National and Local CQUIN Goals

CQUIN goals fall into two categories: national and local.

National Goals

National goals are consistent across the NHS and focus on broad priorities. These are set by NHS England and apply to all providers. They address issues that affect a wide range of patients, like reducing sepsis, improving mental health services, or achieving better outcomes for cancer patients.

For example, a national CQUIN might require providers to screen all at-risk patients for sepsis and ensure timely treatment. Another might focus on ensuring patients discharged from hospital have adequate follow-up support in the community to avoid readmissions.

National goals ensure that major challenges impacting the NHS are addressed consistently across the country.

Local Goals

Local goals are tailored to the needs of the local population. These are agreed between commissioners and providers based on specific issues or healthcare gaps in the local area. Localised goals give flexibility to focus on unique challenges affecting smaller, regional populations.

For example, in an area with high rates of diabetes, a local CQUIN might focus on improving foot care for diabetics to reduce long-term complications like amputations. In another area, the priority could be supporting patients with dementia in care homes to improve their quality of life.

Together, national and local goals combine to address broad healthcare outcomes while allowing flexibility for the needs of distinct populations.

Aims of CQUIN

The overarching aim of the CQUIN framework is to improve the quality of healthcare delivery in the NHS. Specific aims include:

• Encouraging innovation by rewarding new approaches to care.
• Improving patient safety by addressing issues like hospital-acquired infections or medication errors.
• Increasing efficiency by driving service improvements that offer better value for money.
• Enhancing patient satisfaction by focusing on their needs and improving their experience.
• Reducing health inequalities by tailoring local interventions to underserved populations.

How CQUIN Promotes Continuous Improvement

CQUIN motivates organisations to move beyond meeting basic contractual obligations. It pushes healthcare providers to improve their services continuously. Here’s how it achieves this:

Financial Incentive

The financial reward attached to meeting CQUIN targets encourages organisations to focus on quality. A proportion of funding is tied directly to performance, incentivising improvement at all levels.

Focus on Measurable Outcomes

CQUIN goals are measurable. For example, a goal might require reducing infection rates by a specific percentage within a year. Measurable goals help teams focus efforts and track progress effectively.

Encourages Innovation

Providers often need to adopt new methods or technologies to meet the goals. CQUIN pushes organisations to explore fresh ways of working, accelerating improvements in patient care.

Collaborative Working

CQUIN encourages collaboration between commissioners, providers, and staff teams. Teams work together to address shared goals, fostering a culture of collective problem-solving.

Facilitates Long-Term Change

Meeting CQUIN targets often requires organisations to make changes that have lasting impacts, such as better staff training or improved patient pathways.

Examples of CQUIN Goals

Some real-world examples of CQUIN goals include:

1. Supporting Healthy Behaviours: Encouraging hospitals to identify inpatients who smoke or are at risk of alcohol misuse. Referral to stop-smoking services or alcohol support services may form part of this goal.
2. Preventing Hospital-Acquired Infections: Reducing specific infections such as MRSA or C. difficile by implementing better hygiene procedures and monitoring systems.
3. Improving Staff Health and Wellbeing: Supporting the mental health and wellbeing of staff to improve job satisfaction and reduce absenteeism.
4. Timely Screening: Improving access to specific diagnostic screenings for conditions like cancer to ensure early detection and better outcomes.
5. Reducing Medication-Related Errors in Care Homes: Training staff to spot and report errors related to medication administration in vulnerable populations.

Challenges with CQUIN

While CQUIN offers many benefits, it’s not without challenges. These include:

• Administrative Burden: Collecting data and reporting on progress can require significant time and resources.
• Short-Term Focus: The financial focus of CQUIN may lead some organisations to prioritise short-term gains over sustainable improvements.
• Target Selection: Poorly chosen targets may not reflect the biggest improvement needs of an organisation or community.
• Risk of Inequity: Smaller or less resourced providers may struggle to achieve CQUIN targets compared to larger organisations with more infrastructure.

Adjustments have been made over time to ensure that the framework remains relevant, achievable, and balanced.

Why CQUIN Matters to Patients

CQUIN has a direct impact on patient care in several ways:

• Safer Services: Patients benefit from improved safety measures like reduced infection rates or better medication management.
• Higher Satisfaction: Care designed around patient needs leads to better experiences and outcomes.
• Improved Access: Patients are more likely to receive timely and appropriate care under a system focused on outcomes.

CQUIN ensures that patients remain central to decisions about service improvement.

Future of CQUIN

Over the years, the CQUIN framework has evolved to respond to changing healthcare priorities. NHS England continues to refine the programme to ensure it remains relevant. Integrating CQUIN goals with other NHS initiatives, such as Integrated Care Systems, is part of future plans. This means more joined-up care and a continued focus on quality.

CQUIN is not a static framework. It has flexibility to adapt and address emerging healthcare challenges, ensuring it continues to drive improvements where they are needed most.

Final Thoughts on CQUIN

The CQUIN framework is a unique tool within the NHS. Its focus on linking payments to specific quality improvements helps drive better outcomes. Patients benefit from safer, more efficient, and person-centred healthcare. Healthcare providers benefit from innovation and collaboration motivated by clear goals. And commissioners gain value for money while addressing the needs of local populations.