Demystifying the quality agenda

Lord Darzi outlined his plans for the quality agenda in his report last year and some of his initiatives are already under way – at least in pilot form. Emma Wilkinson takes a look at the developments that will have an effect on PBC

Quality must be at the heart of everything the NHS does, Lord Darzi proclaimed in the final report of his Next Stage Review published last summer. There are three key facets to his vision – patient safety, patient experience and effectiveness of care.

World Class Commissioning is at the centre of this drive for quality – ensuring high standards in clinical service provision.

So how does PBC fit into all of this?

Providers’ pay will be linked to quality

Since April, PCTs have been expected to push ahead with the Commissioning for Quality and Innovation (CQUIN) payment framework.

As outlined by Lord Darzi in his Next Stage Review, the idea is to improve services locally by linking a small proportion of providers’ payments with the quality of service delivered.

Under the scheme for 2009/10, PCTs must make 0.5% of contract value dependent on achievement of these goals by providers of acute, ambulance, community and mental health services. This proportion is expected to grow over time.

Local CQUIN schemes should be an agreement between the provider and commissioner – not just set down by the PCT – and specify quality indicators, the improvement or threshold expected, how that achievement is to be measured and how payments are made.

The only nationally set requirement is that there should be at least one goal in each of four areas: safety, effectiveness, patient experience and innovation.

For example, if a hospital is doing poorly on infection, commissioners may choose to look at audit standards that have to be met for payment to be made. Other examples are discharge summaries (see box) or readmission rates.

It is thought that in the first year, use of CQUIN will be limited and may be mainly about getting data with which to benchmark services but will expand as commissioners get to grips with its use.

However, there is a ‘clear expectation’ this year that PCTs should be making provision for the use of CQUIN payments, says Dr David Jenner, NHS Alliance ’s PBC lead.