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Quality accounts: frequently asked questions

  • Last modified date:
    26 March 2010
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Background to quality accounts

1. What are Quality Accounts?

Quality Accounts are annual reports to the public from organisations which provide NHS services. They provide information about the quality of the services which that organisation delivers.

The public, patients and others with an interest will use a Quality Account to understand:

  • what an organisation is doing well;
  • where improvements in service quality are required; 
  • what the organisation’s priorities for improvement are for the coming year; and,
  • how the organisation has involved people who use their services, staff, and others with an interest in their organisation in determining these priorities for improvement.

Quality Accounts aim to enhance accountability to the public and engage the leaders of an organisation in their quality improvement agenda.

2. Has the production of Quality Accounts been piloted?

In preparation for Quality Accounts, the NHS Foundation Trusts and NHS provider organisations in the East of England produced Quality Reports for 2008-09 (They were called Quality Reports as the term Quality Accounts is subject to legislation). These were published in June 2009 and included:

  • a statement on the quality of care offered by the organisation, signed by the chief executive; 
  • a description of the priorities for quality improvement, the action the organisation plans to take, and the rationale for the prioritisation; 
  • a response to issues raised by the regulators or public representatives in the last year; and; 
  • a quantitative description of the quality of care including indicators selected by the organisation covering patient safety, clinical effectiveness and patient experience. This was supplemented by indicators covering the Department of Health’s national priorities and compliance with core standards (as declared to the Care Quality Commission)

Pricewaterhouse Coopers (PwC) were commissioned to conduct an evaluation exercise of the Quality Reporting process. In this evaluation of the Quality Accounts testing exercise, PwC undertook:

1. A structured survey of participating organisations,
2. An evaluation of a sample of the accounts of quality produced in the exercise, and
3. A review of existing guidance and international perspectives with regard to accounts.

The report and recommendations arising from this project was published in August 2009 and informed the recommendations for a framework for Quality Accounts which was subject to public consultation over Autumn 2009. The results of this consultation shaped the final regulations and guidance for Quality Accounts in 2010.

The framework for 2010 applies to those providers who deliver acute, mental health,learning disability and ambulance services. Providers of primary care and community services will be brought into the requirement in 2011 subject to a testing and evaluation exercise.

NHS North East and NHS East Midlands are piloting Quality Accounts in primary care and community services with a selection of providers in these regions across general practice, dentistry, community pharmacy, out of hours and urgent care provision and community services. A framework for this pilot has been developed with the providers involved as well as commissioners, representatives of professional organisations, representatives of patient organisations and others with an interest. The pilot sites will deliver Quality Reports in 2010 and these will be evaluated for process and content to shape the requirements for these providers when brought in to the legal duty.

3. Who is the audience for Quality Accounts?

Quality Accounts are public documents. They aim to improve public accountability of quality of services information and engage boards in quality improvement. By publishing their Quality Account each provider led by their Board or equivalent, is committing to improve the quality of care it delivers locally and inviting the public to hold them to account.

Each Quality Account should address the quality of services offered by the organisation and be presented as a short, readable document that is accessible to members of the local community. It would therefore need to be produced with stakeholders – staff, patients, the wider community – not just for them.

However, Quality Accounts will not provide a comprehensive account of the quality of every service and is not intended to provide patients with the information they need to make an informed choice regarding services.  Other more appropriate formats of information are available for this purpose, for example via NHS Choices.

Real quality improvement will only be delivered if it is driven locally by the boards, clinicians and managers in NHS organisations.  Producing Quality Accounts requires leaders of an organisation to consider the quality of the services their organisations offer, their priorities for improvement, the actions they intend to take to secure these improvements, and finally to make this information available to the public.

4. How will the public engage with Quality Accounts?

If the aim of improving public accountability is to be achieved, boards will need to take account of the views of their local communities and ensure that their Quality Accounts are accessible and informative. NHS organisations are encouraged to involve local communities, members and governors and patient groups, including Local Involvement Networks (LINks) in developing their thinking on Quality Accounts, and crucially their priorities for improvement with regards to quality of care provided.

The Department of Health and the Care Quality Commission commissioned a project from Ipsos MORI in Summer 2009 to look at patient and public engagement in Quality Accounts. The report on their findings was delivered in September 2009 and is found on the Quality Accounts webpage:

5. How will Quality Accounts be tailored for different types of provider?

As well as providing a statement on the quality of care offered by the organisation and a description of the priorities for quality improvement, provider organisations will be asked to select and report on indicators covering the three domains of quality set out in High Quality Care for All: safety, effectiveness and experience, which are relevant to the services their organisation provides.  A small amount of content is mandated through regulations, which were consulted on during Autumn 2009 and laid before parliament in February. The aim of the nationally requested information is to provide a degree of consistency and comparability across provider Quality Accounts, based on cross cutting issues relating to quality.

The Department of Health has commenced a further engagement and testing project to examine how Quality Accounts can best be developed for primary care and community services providers which will examine the particular needs of these providers. NHS North East and NHS East Midlands are testing Quality Accounts with some of their providers in 2010 through the production of Quality Reports and these will be evaluated and the results consulted upon in order to shape the requirements for these providers.

 6. What is the timescale for implementation?

The Health Act 2009 created the duty for all providers of NHS services (including those in the independent and voluntary sector) to produce a Quality Account. The regulations applying to the first year of Quality Accounts come into effect on April 1st 2010 and state who is exempted in the first year.

All providers who provide NHS acute, mental health, learning disability and ambulance healthcare services are required to prepare a Quality Account in respect of the financial year 2009/10. The deadline for submission of this Quality Account is 30th June 2010.

The independent sector and voluntary sector providers who provide acute, mental health and ambulance healthcare services for the NHS, such as independent treatment centres, will also be required to produce a Quality Account in June 2010.

Primary and community care providers, including for instance General Practitioners and dentists will be brought into the Quality Accounts regimen by way of further regulations. Depending upon the outcome of the engagement and testing project, the aim is for these providers to be brought into the requirement in 2011.

The independent sector and voluntary sector providers who provide primary and community care services, will also be brought in at a later date in line with the above.

7. Why is part of the Quality Account for local determination?

The NHS is primarily a locally-run organisation where priorities are set, measured and delivered at local level. Issues of local concern will not be captured by a Quality Account which only contains information about national priorities. Stakeholder feedback during the design of Quality Accounts showed that most people thought that Quality Accounts should contain information which is relevant to both national and local priorities, but with an emphasis on local content.

We encourage providers to involve local people and organisations in making decisions about what to include in their Quality Account, which will make it more locally interesting and relevant.


8. How will the content of Quality Accounts be assured?

Powers have been taken in the Quality Accounts section of the Health Act 2009 that:

  • give the CQC and Strategic Health Authorities (SHAs) a role in asking for errors and omissions identified in published Quality Accounts to be corrected;
  • require providers to send a copy to the Secretary of State;
  • enable the DH to make regulations about:

1. the form and content, in addition to the nationally mandated content;
2. imposing duties to ensure the accuracy of information;
3. how and when a Quality Account must be published;
4. the provider having regard to guidance issued by the Secretary of State

The assurance mechanisms for this first year if Quality Accounts require providers to:

  • include a set of mandatory data quality statements within their Quality Account , covering:

1. the use of NHS number (which measures the completeness of the data held on patients),
2. the clinical coding error rate (which measures the accuracy of data recording),
3. the use of GP Practice Code (which again measures patient data completeness), and
4. the Information Quality and Records Management score (covering the quality of data systems and process within an organisation);

  • provide a self-certification from the board about service quality, and of the accuracy and representativeness of the Quality Account itself, by the Board;
  • set up a mechanism of pre-publication clearance by the coordinating commissioning PCT, LINks, and OSC.

Monitor are holding a consultation on proposals for third party assurance of Quality Accounts and will be testing this approach in 2010. The Department of Health will work with Monitor and other partners to evaluate the results of these proposals and make recommendations for the future development of the policy to introduce a form of third party assurance for all Quality Accounts from 2011.
Quality Accounts and Measuring for Quality Improvement

9. How will you ensure Quality Accounts allow for meaningful comparisons between providers, with best practice, and over time?

The Department, working with the NHS and professional and patient organisations has released a menu of Indicators for Quality Improvement (IQI) for use by local clinical teams and NHS providers. While we want providers to have the freedom to decide on the content of the local element of their Quality Account, we will nevertheless encourage providers to make use of the IQI.

Therefore, providers will not necessarily report on all the same indicators, but those that select the same indicator from the IQI would be able to compare themselves against each other, and against the national picture.

Quality Observatories will also be able to support the identification and development of quality indicators at provider level to feed into Quality Accounts.

10. What does 'quality' cover?  How can patient experience be covered   in a Quality Account?

High Quality Care for All defined quality in terms of patient safety, effectiveness and patient experience. The Measuring for Quality Improvement Programme is aiming over time to build the availability of indicators across all these domains, including patient experience. Currently available indicators include questions in the national inpatient survey run by the Care Quality Commission and the Patient Environment Assessment Tool, relating to the experience of care reported by patients. These indicators may be included in a Quality Account, and we would encourage providers to think about how they will measure patient experience meaningfully, as part of the public and patient engagement that must underpin how they record and report quality.

11. How will Quality Accounts reflect innovation, education, and research?

Quality Accounts offer a transparent way to ensure that trusts report to their local populations on research activities, which are an important enabler of quality of care.  Providers who conduct research will include in their Quality Accounts data about the number of patients recruited in the previous year to clinical research (i.e. research which has received Research Ethics Committee approval).
Local NHS organisations will be supported in developing indicators for inclusion in their Quality Accounts that have the potential to consider quality of research and quality of care in the broader terms where they feel appropriate. There will also be data arising from local schemes to recognise and reward quality and innovation.

 12. What are you doing to minimise the burden on providers, especially clinical staff?

The Indicators for Quality Improvement will initially consist of indicators derived from existing data collections. There are many areas in which indicator development is happening in its own right, eg the development of Patient Reported Outcome Measures, but the Measuring for Quality Improvement Programme itself is not explicitly mandating new data collections at this time. However, in time as indicator coverage is improved (eg. by developing new indicators), this will need to take account of current processes for agreeing new data collections, for example through the existing Review of Central Returns.

The relationship between Quality Accounts and Quality Standards

13. What are NICE Quality Standards?

As a result of the High Quality Care for All report, (June 2008), NICE has started to develop independent standards clarifying what high quality care looks like for specific services across the three dimensions of quality: clinical effectiveness, patient safety and patient experience. NICE quality standards will act as a final distillation of clinical best practice, derived from the best available evidence from NICE guidance or other sources accredited by NHS Evidence to provide a set of specific concise quality statements and associated measures that:

  • act as markers of high quality, cost effective patient care across a pathway or clinical area;
  • are derived from the best available evidence from NICE guidance and other sources accredited by NHS Evidence; and,
  • are produced collaboratively with the NHS and social care professionals, along with their partners and service users.

 Potential audiences for NICE quality standards include: patients and the public; clinicians; public health practitioners; commissioners; and service providers.

NICE is currently running a pilot development exercise on four topics decided by the National Quality Board. These topics are Stroke, Dementia, VTE Prevention and Neonatal Care. We expect the first NICE quality standards developed from the pilot process to be available in April 2010.

Once developed, Quality Standards will become a useful resource for Quality Accounts, and the Department of Health will work with NICE to explore how the relationship between the two could best be developed, with a view to requiring Quality Accounts to cover information relating to the use of NICE quality standards. In the meantime, for further information regarding NICE Quality Standards, please visit:

14. What are Quality Observatories and what is their role in Quality Accounts?

As set out in High Quality Care for All, each SHA has been asked to establish a Quality Observatory to lead on analysis and information for quality improvement for the region. This will include supporting the development of quality indicators as a tool for quality improvement, and providing access to a range of quality information sources across the region.

Quality Observatories will be able to support the identification and development of quality indicators at provider level to feed into Quality Accounts.

15. What is the National Quality Board and what is their role in Quality Accounts?

The National Quality Board has been established to provide overall leadership on quality across the NHS. It is chaired by David Nicholson, and contains membership from across DH, the system (eg. CQC, NICE etc), as well as expert and lay members.

Their role in supporting the Quality Accounts scheme is an indirect one:

  • supervising the development of new standards and indicators;
  • providing advice on how, for example, Quality Accounts can help organisations connect with their communities;
  • ensuring that the components of the system (for example, the regulators and the Department of Health) work together towards the overall aims of the scheme.

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