Problem
Dementias are common neurodegenerative conditions affecting older people. People with dementia currently occupy 25% of hospital beds.1 They remain in hospital for significantly longer than people without dementia.1 Commissioning for Quality and Innovation (CQUIN) is an NHS payment framework launched by the Department of Health in 2009. It links part of English healthcare providers' income to specific quality improvement goals.2 The dementia CQUIN, introduced for in 2012/13, was designed to encourage the recognition of dementia in hospital. The framework is also intended to promote appropriate follow-up for people with dementia after discharge from hospital.3 The remuneration for the dementia CQUIN is significant. It is an additional 2.5% of outturn value of a Trust's contract or 0.125% of the actual contract value, provided all of the goals are attained.3
The Royal Surrey County Hospital NHS Foundation Trust is based in Guildford. It provides district general hospital services to a population of 330,000 people in Guildford and the surrounding area. It has 520 inpatient beds and 14 operating theatres, and employs 2,800 staff. Each year, the hospital sees approximately 336,000 outpatients, admits 90,000 patients and sees 73,000 patients in Accident and Emergency.4 The trust introduced new procedures to meet the CQUIN targets. However, adherence to the changes was a problem. This project aimed to improve hospital's implementation strategy, standardising dementia care and gaining additional revenue.
Our SMART goals were as follows:
Specific target – to assess >90% of older adult inpatients in accordance with CQUIN criteria
Measurable indicators of progress – results from audit of medical notes
Assigned tasks – Junior doctors, with support from the Clinical Audit Department, the Clinical Lead for Dementia and the Dementia Nurse Specialist
Realistic ambition – The hospital was willing to provide significant resources from the Clinical Audit Department to implement the CQUIN, therefore the target was realistic.
Time-bound – From the beginning of this project, the hospital had almost a year before the CQUIN took effect.