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Acute trusts rely on nurses to earn quality payments


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.

The five most popular nursing CQUIN indicators related to pressure ulcers, discharge planning, end of life care, general patient experience and medicines management.

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”.


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Readers' comments (5)

  • its a shame nurses can't just be left alone to nurse which is what they have been trained to do and the only way to maintain quality of care. sitting in offices filling out yet more forms and statistics isn't nursing care and won't achieve this

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  • so when do we get our bonuses?

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  • I would hazard a guess that most of my colleagues who actually 'nurse' patients are oblivious [thankfully] of the existence of CQUIN's. Thus they will be oblivious of their pivotal role in the trust getting 'fined' for not for acheiving this latest fad. I have only recently become aware of CQUIN because I thought the meeting I was attending had turned into a sewing class! For goodness sake! we all know what will improve patient care, and as the trend seems to be to give indicators silly acronyms here goes, to achieve your CQUIN get MNOTF!! it'll take the bofffins ages to work that one out it's so unrealistic.......

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    no idea what these are any more than those up there no what will improve patient care. it is up to us to tell them but the problem is that they have too many other preoccupations and won't listen, or even if they do they are unable to grasp it or take it in. this isn't a new problem it all started when general management was introduced to the nhs to manage resources and ??? 'to improve patient care'??? as it was said at the time doctors and nurses and the other healthcare professions were not necessarily good managers (even though they are the best qualified to know their patients and their needs better than anyone else) and should be getting on with what they are best at anyway which in case there is any doubt is direct, individualised and holistic care.
    I guess the end part of my last sentence sounds old fashioned. As I have said in another comment on other services outside the NHS but which equally applies here - Customer/Client/Patient as King is Dead. Long live the Customer/Client/Patient as a system or target from which provides revenue and statistics and worse still, while I am on the subject, I recently saw a book title to the effect that in organisations it is the employee who now comes first, obviously after the organisation, CEO, board of Directors, and Management, and then the Customer/Client. As a modern-day nurse also once told me if we don't look after ourselves first (i.e. go home on time even if there is an emergency on the ward) we will be no use to our patients. Obviously not her own idea but infiltrated by them up there who have never ever even washed a bum.
    Cynically Yours Truly

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  • re MNOTF - i'll come clean - it's not a new directive, I made it up, but it serves to demonstrate how meaningless these acronyms are, especially when used to make 'hands on' nurses feel as if they out of the loop by those higher up the pecking order. Maybe us 'hands on' nurses ought to start a bottom up campaign, by the way MNOTF stands for
    More Nurses On the Floor....
    [not literally of course - just in the working sense]

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