Trusts are staking around £280m a year on the ability of nurses to help hit local targets, a Nursing Times investigation has revealed.
Nursing Times has carried out a comprehensive analysis of the measures, called commissioning for quality and innovation (CQUIN) indicators, used to monitor the performance of each acute hospital trust in England in 2010-11.
Primary care trusts are able to pay providers 1.5 per cent less than a contract is worth if they miss the targets, which cover areas such as falls, nutrition and stroke care.
Nursing Times’ analysis of the 94 acute trusts for which data is available found that, on average, 39 per cent of the CQUIN targets for acute trusts rely heavily on nurses to achieve them.
To an average trust with an income of £230m, the achievement of nurse-centred targets are worth up to £1.3m a year. Nationally, across all acute and mental health trusts, the nursing targets are worth around £280m.
King’s College London national nursing research unit director Peter Griffiths said: “It’s a huge responsibility to put on nurses, but what nursing delivers is a huge responsibility.
“All too often that fundamental fact hasn’t been recognised outside the nursing profession and probably within it as well.”
While some trusts - such as Harrogate and District Foundation Trust - are using as many as 13 nurse-centred CQUINs out of a total 23, others - including Lancashire Teaching Hospitals Foundation Trust -have only chosen one out of seven.
Royal College of Nursing head of policy development and implementation Howard Catton said the low take-up of nurse-centred CQUINs in some trusts raised questions.
He said: “There’s no doubt that, in the vast majority of situations, the overwhelming majority of care delivered will be provided through nurses.
“There’s something about making sure the indicators we’re using are reflective of that contribution.”
Chesterfield Royal Hospital chief nurse Alfonzo Tramontano said having 12 nurse-centred indicators “focuses the attention and raises the profile of the work with the board”.
He added: “It is great having them nurse led because it means our focus is on improving patient care, the same as the PCT.”
However, Ian Bramley, acting director of nursing at Weston Area Health Trust, which only has two nurse-centred CQUINs out of seven, said other indicators, while not explicitly nurse focused, were still led by nursing staff, such as smoking cessation.
Paul Archer, head of governance at Lancashire Teaching Hospitals Foundation Trust, said the nursing contribution was “vital” to each of its targets.
Many of the top nurse-centred indicators reflect the high impact actions for nursing and midwifery.
East Sussex Hospitals Trust chief nurse Jane Hentley said her trust’s decision to include just one of the high impact actions in the CQUIN was the PCT’s decision. “That work is happening, just not in CQUINs,” she said.
Other, less popular, nurse-centred CQUINs involve goals to improve the experience of black and minority ethnic patients, pain management and dignity.
Imperial College Healthcare Trust director of nursing Janice Sigsworth said she wanted CQUIN to “drive real change at the bedside”.
Should trusts with poor nursing outcomes face tougher financial penalties?