Duty to require and monitor delivery of fundamental standards

Accepted in principle.
Fundamental standards of care will be a key part of Care Quality Commission registration requirements and so commissioners will only contract with providers that are meeting these standards.
Commissioners must have regard to any fundamental standard that relates to a service they commission, and they should apply it where they can. They can set safety and quality standards for all services they commission, through clear specification. The NHS Standard Contract allows for agreement at local level of the method of measuring compliance with such standards, and any appropriate sanctions.
We have considered whether commissioners should consider incentivising compliance through redress for individual patients, which has been tested with providers and commissioners, and the overwhelming response was that this would not be practicable. Potential difficulties would be:
• a drain of funds from the local health community, where funds may be most needed;
• the potential for perverse incentives to claim compensation;
• duplication with existing rights for patients to be recompensed through litigation; and
• methodological challenges in assessing the appropriate level of recompense.

The NHS Standard Contract 2024/25 includes a service condition (no. 37) on local quality requirements. This allows for the agreement of enhanced standards as part of the annual contractual agreement between commissioners and providers.

For specialised services, national service specifications additionally set out key quality requirements.

CQUIN

The Commissioning for Quality and Innovation (CQUIN) incentive scheme is intended to support improvements in the quality of services and the creation of new, improved patterns of care. CQUIN centres on set of annually agreed evidence-based improvement indicators, supported by specifications and an element of provider income was conditional on demonstrating related improvements in quality. Providers and commissioners agree a fixed element that assumes full achievement of CQUIN criteria, with funding then paid back by providers if they achieve less than this.

The clawback element of the scheme is currently paused for 2024/25. A wider review of incentives for quality is now being undertaken.

Revised provisions, particularly relating to commissioner’s rights to suspend the provision of services, were published in December 2013 as part of the NHS Standard Contract for 2014–15. NHS England will continue to keep the provisions in the NHS Standard Contract under review.

This recommendation was accepted in principle by the Government.

In the January 2014 Hard Truths report, the Government said that commissioners would only contract providers that are meeting fundamental standards, and commissioners were to have regard to any fundamental standard that related to a service they commission, with the NHS Standard Contract allowing for agreement at a local level for the method of measuring compliance with such standards and any appropriate sanctions.

The Government said it had considered whether commissioners should incentivise compliance through redress for individual patients, but decided not to after consultation.