The Commissioning for Quality and Innovation framework (the CQUIN) was introduced to reward care excellence, encouraging a culture of quality improvement, and to achieve better outcomes for patients. The Framework sets a number of quality improvement goals and rewards trusts that achieve them with financial incentives. The CQUIN framework was suspended during the pandemic, but has now been reinstated for 2022/23.
Community acquired pneumonia is included in the CQUIN for 2022/23
The community acquired pneumonia (CAP) CQUIN[1] is based on the British Thoracic Society’s care bundle which sets out the discrete steps that providers need to follow to improve care for patients.
The CQUIN identifies four high impact steps to be taken within four hours of patients admitted with CAP.
- Chest x ray within four hours of arrival in hospital
- Pneumonia severity score (CURB65) calculated and documented in the medical notes during the ED and/or acute medical clerking
- Antibiotics received within 4 hours of hospital arrival time
- Antibiotic prescription concordant with severity score and local guidelines
These steps are known to improve patient outcomes by reducing 30-day mortality, length of stay (potentially by as much as one day) and improve overall patient experience. It will make a particularly positive difference for people with learning disabilities, where CAP is known to be a common, and often preventable, cause of death, and in reducing health inequalities, as admissions are generally higher in more deprived areas.
Changes from the previous CQUIN
The CQUIN scheme has changed since it was last used in 2019/20. The funding will be included in the trusts ‘bottom line’ with an expectation of the acute provider and the Clinical Commissioning Group/Integrated Care Board to be working together to chose five of the potential CQUIN goals to deliver against.
There is a further key change which now mandates that all providers in scope for CQUIN are required to report their performance against all indicators where they deliver the relevant services, irrespective of whether the indicator is included within their CQUIN scheme.
This change means that organisations will now have to report their performance against the CAP CQUIN even if they do not participate.
For example, should an organisation choose not to adopt the CAP CQUIN, it will still be required to collect and return data as if the CAP CQUIN had been adopted. This performance data gathered will be shared centrally, which will highlight potential variations in care.
Why adopt the CAP CQUIN?
Adopting the CAP is in the best interests of both patients and providers. We encourage our respiratory colleagues to advocate for the adoption of the CAP CQUIN to support funding staff to improve care and ensure data collection.
Further reading and references
A webinar which gives more background on the 2022/23 CAP CQUIN is available here: Future NHS - CAP CQUIN Webinar
FAQs and a template data collection tool is available here: CAP CQUIN Guidance Documents 2022/23 - Respiratory Disease Programme - FutureNHS Collaboration Platform
[1] B1119-i-cquin-guidance-22-23.pdf (england.nhs.uk)