OHE Awarded Research Grant to Evaluate PSS CQUIN Interventions

OHE together with York, Manchester and Imperial have been awarded a grant from the NIHR PRP to evaluate the PSS Commissioning for Quality and Innovation (CQUIN) schemes.

OHE, together with the universities of York, Manchester and Imperial College London, has been awarded a grant from the National Institute for Health Research (NIHR) to evaluate the Prescribed Specialised Services (PSS) Commissioning for Quality and Innovation (CQUIN) schemes.

During the last 15 years, financial incentives have been widely introduced into the English National Health Services (NHS) as an instrument to promote quality health care by linking monetary incentives to the performance of health care providers. The empirical evidence on the effectiveness of introducing incentive schemes associated with health policy under the English NHS is mixed, and questions remain unanswered regarding the impact of the design of financial incentives on programme effectiveness.

In April 2013, NHS England became responsible for commissioning 143 specialised services and managing its budget. In general terms, specialised services in England refer to services that are provided by relatively few hospitals to support people with a range of rare and complex conditions. The budget for specialised services in England for the financial year 2017/18 is around £16.6 billion. 

The Prescribed Specialised Services (PSS) Commissioning for Quality and Innovation (CQUIN) schemes were introduced by NHS England. Each scheme links an incentive payment to a hospital provider’s performance for improving the quality of specialised services. In 2017/18, PSS CQUIN schemes include seven national programmes covering a total of 24 schemes. NHS England intends to allocate £900 million to this programme between April 2016 and March 2019. It is therefore important for policymakers to understand the effectiveness and efficiency of this significant investment.

OHE, in collaboration with Imperial College London, the University of Manchester, and the University of York, have been awarded research funding from the NIHR Policy Research Programme (PRP) to conduct an evaluation of the Effectiveness and Value for Money of Prescribed Specialised Services Commissioning for Quality and Innovation (CQUIN) interventions 2016/17 to 2018/19. This two-year project will evaluate 10-12 selected PSS CQUIN schemes. Findings from this study will be used to inform contracting decisions for 2019/20 and future rounds of contracting of specialised services and will contribute to a wider knowledge-base on optimal contract design in secondary care.

This study aims to address the following five research questions:

1. How effectively do the PSS CQUIN schemes improve the quality of hospital services for specialised care in the English NHS?
2. Are specific interventions supported by different PSS CQUIN schemes cost effective?
3. What lessons can be learned from the ongoing PSS CQUIN schemes to inform NHS England in their preparations for contracting from April 2019?
4. Should specific quality innovations under the PSS CQUIN schemes be supported in future contracting rounds and, if so, how?
5. What lessons can be learned from this study to develop optimal contract designs for quality incentives in the NHS?

The project adopts a mixed methods approach including quantitative and qualitative analysis. For the quantitative aspect of the study, the team will conduct econometric analyses to evaluate the effectiveness and cost-effectiveness of the selected schemes. For the qualitative aspect of the study, the team will conduct semi-structured interviews and focus groups with NHS commissioners, healthcare providers, and finance leads to identify factors affecting a scheme’s uptake, challenges and barriers for implementation, and complexities underlying the contracting/delivery process.   

The project is led by Yan Feng at OHE (Principal Investigator). The project team includes Paula Lorgelly and Marina Rodes Sanchez from OHE, Søren Rud Kristensen from Imperial College London, Matt Sutton and Rachel Meacock from the University of Manchester, and Luigi Siciliani from the University of York.

The project is funded by NIHR Policy Research Programme (Reference number: PR-R18-0117-22001). The views expressed in this blog post are those of the author and not necessarily those of the NHS, the NIHR or the Department of Health and Social Care.

For further information, please contact Yan Feng.

Related research

Feng, Y., Ma, A., Farrar, S. and Sutton, M., 2015. The tougher the better: an economic analysis of increased payment thresholds on the performance of general practice. Health Economics, 24(3), pp.353-371. DOI | RePEc

Karlsberg Schaffer, S., Sussex, J. and Feng, Y., 2015. Incentives to Follow Best Practice in Health Care. OHE Briefing. RePEc

Maynard, A., 2014. Contracting for Quality in the NHS. OHE Monographs. RePEc