NHS incentive schemes 'unlikely to succeed'

Incentive schemes hope to improve hospital performance
Incentive schemes hope to improve hospital performance

By Alexis Alison

Introducing incentive schemes for NHS hospitals is unlikely to improve standards, University of York researchers have claimed.

In an article published on the British Medical Journal's website today, Alan Maynard and Karen Bloor express concern over the government's proposal to use rewards and penalties in the current healthcare system.

Modelled on what the pair claim is a weak US pilot scheme, the plan, known as the commissioning for quality and innovation framework (CQUIN), is being tested in the NHS North West region, where hospitals in the top two performing quartiles are offered four per cent and two per cent increases in tariff payments.

Although early data and results suggest good clinical engagement, there is still not enough empirical evidence to justify the cost of fully implementing the scheme in NHS hospitals.

In the article, Prof Maynard and Ms Bloor state: "If clinicians and hospitals allocate scarce resources to incentive schemes aimed at improving a particular set of conditions, there is a risk that other clinical conditions and procedures will get less attention and their outcomes will not be improved."

The shortcomings of the original US pilot scheme suggest further problems, such as effects on motivation and increasing financial instability, they argue.

The pair say the NHS must be wary of the potential dangers of clinical and organisational performance improvement programs - especially given current fiscal constraints.


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