CQUIN - NHS staff health and wellbeing Commissioning for quality and innovation June 2016

What is a CQUIN? The CQUIN payment framework enables commissioners to reward excellence, by linking a proportion of English healthcare providers' income to the achievement of local quality improvement goals. The framework aims to embed quality within commissioner-provider discussions and to create a culture of continuous quality improvement, with stretching goals agreed in contracts on an annual basis. It makes a proportion of provider income conditional on the achievement of ambitious quality improvement goals and innovations agreed between commissioner and provider, with active clinical engagement. Since the first year of the CQUIN framework (2009/10), many CQUIN schemes have been developed and agreed. Goals should be agreed between commissioners and providers, with clinical engagement locally, and should reflect both local priorities and priority areas set out in the NHS Operating Framework. CQUIN schemes are not intended to comprehensively cover all service areas, but to focus on locally agreed priorities for ambitious improvement and innovation. Commissioners are required to make this funding available from their allocations. The NHS Commissioning Board will assume responsibility for leading use of the framework and will agree its financial value with Monitor (subject to legislation)

Simon Stevens, chief executive of NHS England, says: “As the largest employer in Europe, the NHS needs to practice what it preaches by offering better support for the health and wellbeing of our own 1.3 million staff. A good place to start, is by tackling the sources of staff sickness absence, including mental health and musculoskeletal injuries, while doing our bit to end the nation’s obesity epidemic by ditching junk food and sugary drinks in place of tasty, healthy and affordable alternatives. If we can do this well, we hope that more parts of the public and private sector will see the sense of it and also take the plunge.” NHS England 2016

Why is there an increasing national focus on health and wellbeing? The benefits of a healthier workforce to the NHS and to individual trusts are becoming increasingly clear. Improved patient safety and experience. Improved staff retention. Reinforced public health and prevention messages. Setting an example for other industries and employers to follow. Reduced costs – currently sickness absence costs the NHS £2.4bn annually. NHS England 2016

The Health and Wellbeing CQUIN In March 2016 NHS England announced a health and wellbeing CQUIN, linking 0.75 per cent of provider income to improving staff health and wellbeing. Introduction of health and wellbeing initiatives 0.25% Introducing improved mental health initiatives using NICE guidance. Introducing physical activity schemes. Improving access to physiotherapy for those with MSK issues. Healthy food for NHS staff, visitors and patients 0.25% Submitting data on food suppliers operating on NHS premises. Banning price promotions on foods high in fat sugar and salt (HFSS). Banning advertising on HFSS foods. Stopping the sale of HFSS foods at checkouts. Ensuring healthier meals are available out of hours. Improving uptake of flu vaccinations 0.25% Achieving an uptake of flu vaccinations by frontline healthcare workers of 75 per cent by December 2016.

What is the CQUIN aiming to achieve? The CQUIN encourages organisations to: offer frontline nurses, therapists, doctors, care assistants and other staff access to workplace physio, mental health support and healthy workplace options. take action on junk food and obesity by ensuring that healthy food options are available for their staff and visitors, including those working night shifts increase the uptake of the flu vaccine for their frontline healthcare workers so as to reduce sickness absence and protect vulnerable patients from infection. increase staff vaccination rates from around 50 per cent to 75 per cent by the end of December 2016. To qualify for the scheme, trusts will be required to submit information on their current fast food franchises, vending machines and retail outlets in preparation for the NHS ‘sugar tax’. The annual NHS staff survey will be used to track the progress that trusts are making. To qualify for the scheme, trusts will need to remove adverts, price promotions and checkout displays of sugary drinks and high fat sugar and salt food from their NHS premises. They will also be required to submit information on their current fast food franchises, vending machines and retail outlets in preparation for the NHS ‘sugar tax’. The aim is to increase staff vaccination rates from around 50 per cent to 75 per cent by the end of December 2016. Trusts will be able to receive CQUIN funds which are linked to the percentage of frontline healthcare workers that have been vaccinated: If 75 per cent of frontline healthcare workers are vaccinated by December 2016, trusts will receive 100 per cent of the funds allocated for flu. If 65-74 per cent of frontline healthcare workers are vaccinated, trusts will receive 50 per cent of funds allocated for flu. The funds allocated to flu will not be paid to trusts where vaccination uptake is 64 per cent or less.

What is the incentive for trusts to participate? Trusts will be able to receive a percentage of CQUIN funds, which have been allocated to each of the three key improvement areas. Specifically for flu, this is linked to the percentage of frontline healthcare workers that have been vaccinated: If 75 per cent of frontline healthcare workers are vaccinated by December 2016, trusts will receive 100 per cent of the funds allocated for flu. If 65-74 per cent of frontline healthcare workers are vaccinated, trusts will receive 50 per cent of funds allocated for flu. The funds allocated to flu will not be paid to trusts where vaccination uptake is 64 per cent or less.

Support and resources A range of tools and resources on developing ways to support staff health and wellbeing are available to view on our health and wellbeing webpages. Examples of health and wellbeing good practice across England can be found on our case studies webpage. The flu fighter webpages provide advice and resources to support a successful flu campaign including the seven areas of good practice. You can also listen to a recording of the flu fighter CQUIN webinar here.

Contact us Jennifer Gardner Programme Lead E: healthworkandwellbeing@nhsemployers.og W: www.nhsemployers.org/healthandwellbeing T: @NHSE_wellbeing Helen Bogan Programme Lead E: flufighter@nhsemployers.org W: www.nhsemployers.org/flu T: @NHSflufighter