Injury to kidneys when patients are acutely unwell is common, can affect anyone, including children, and there is no cure. To mark World Kidney Day (9 March) we have published a series of blogs to address some of the challenges faced by our Kidney Health programme, which aims to drive system change by providing a platform for a large scale evaluation of complex interventions to support improved kidney health.
Written from the perspective of an academic researcher, a facilitator and a project manager, the three blogs centre upon the topic of ‘pay for performance’ commissioning or, ‘incentive schemes’. They take as their exemplars two of the most widely known and used schemes in the NHS – the Quality Outcomes Framework (QOF) and Commissioning for Quality Improvement (CQUIN), and discuss changes in the way in which Chronic Kidney Disease (CKD) and Acute Kidney Injury (AKI) are being understood and managed through these systems.
A key issue discussed in each blog is the use of financial resources to direct the attention of health services staff (clinicians, managers and researchers) towards particular priority areas. While this might be an effective way to divert resources towards a particular area, each blog shows us how this can become problematic in the longer term, as new priorities emerge, old incentives are ‘retired’ and resources are redirected elsewhere.
A context of shifting priorities is one in which it is difficult to plan, to make decisions about resource allocation, to develop quality standards around core competencies, and to sustain improvements beyond the short term. All of these difficulties also relate to a single problem: if finance is the means used to incentivise action, then what happens when finance is taken away?
To learn more about our extensive Kidney Health Programme, please watch our Programme focussed video