Hospital payments to be linked to nursing indicators

The Department of Health is considering linking the amount hospital trusts get paid to how well they perform in clinical areas such as reducing pressure sores and falls.

Since the publication of the NHS next stage review in June 2008, the DH has developed a series of nursing quality indicators which trusts are being encouraged to implement.

As reported by Nursing Times earlier this month, chief nursing officer for England Dame Christine Beasley has also called on nurses to lead the implementation of eight “high impact” actions – closely linked to some of the indicators – which the DH believes could improve care and save up to £9bn.

Officials are now looking at making some of the indicators and actions a compulsory part of its “commissioning for quality and innovation” framework (CQUIN), which allows primary care trusts to refuse to pay hospitals if targets are not met.

Speaking at the Nursing Times Delivering High Quality Nursing Care conference this month, DH programme director for quality in nursing Gerry Bolger, said: “CQUIN is going to be aligned to some national priorities, and we hope to see some of [the nursing indicators] in there.”

DH officials believe that tying improvements in such areas to trust finances would help nurses get support from their trust to carry them out. It would also help soften the message to staff that the NHS must save huge amounts of money in coming years.

Though it is not compulsory this year, some PCTs have already started linked payments to nursing indicators, including those in the West Midlands. For example, Heart of England Foundation Trust’s funding is already tied to performance in areas including falls assessment, pressure area care and food and nutrition.

The trust’s chief nurse Mandie Sunderland, who has led the rollout of nursing quality indicators, said she would welcome the system being spread nationally.

She said: “By making the nursing metrics part of CQUIN we are compelled as an organisation to deliver improvements in nursing care.

“For me as a chief nurse, it gives me a huge lever with my board to ensure delivery of nursing care is one of the key parts of their agenda,” added Ms Sunderland.

Additionally in the NHS Yorkshire and the Humber region, all PCTs have agreed to use pressure sore rates and use of malnutrition screening as a CQUIN measure.

Doncaster PCT director of quality and clinical assurance Julie Bolus said: “Requiring this nationally will be welcome if we make sure we work to the same definitions, so we can benchmark.

“One of the challenges we have had is for everyone to the same specific data requirements,” he said.

The DH told Nursing Times that changes to CQUIN would not be confirmed until later in the year.

A spokesman said: “Information on the CQUIN framework for 2010-11, including the financial value, will be communicated through the operating framework and contract guidance.

“The CQUIN framework allows for quality improvement goals to be developed at a local level, so there is opportunity for all local health economies to use nursing indicators if they wish to do so.”

Dame Christine Beasley has sold the high impact actions, which were recommended by organisations and nurses across the country, as a way to save the NHS millions of pounds without risking arbitrary “slash and burn” cuts from managers.

In September she told Nursing Times: “It’s about saying to nurses: ‘We can lead the way on this and we can do it early so there is less chance there will be a slash and burn.”

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