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Quality Accounts

Volume 505: debated on Friday 5 February 2010

I have today placed in the Library the Government’s response to the recent consultation on detailed proposals for Quality Accounts. Copies are available to hon. Members from the Vote Office and the response can also be seen at: www.dh.gov.uk/en/Healthcare/Highqualitycareforall/Qualityaccounts/index.htm

“High Quality Care for All”, published in June 2008, was the final report of the national health service next stage review, a year-long process led by the Department and the NHS which involved over 60,000 NHS staff, patients, stakeholders and members of the public.

“High Quality Care for All” committed the Department and the NHS to developing a quality framework to support local clinical teams and NHS organisations to improve the quality of care locally, a key part of which was publishing quality information—in Quality Accounts.

Quality Accounts are annual reports to the public from providers of NHS healthcare services about the quality of services they provide. The public, patients and others with an interest would look to a Quality Account to understand what an organisation is doing well; where improvements in service quality are required; what priorities for improvement are for the coming year; and how involved users of services, staff, and others with an interest in the organisation are in determining these priorities for improvement.

Quality Accounts will improve public accountability and engage the leaders of an organisation in their quality improvement agenda. Public accountability comes from the presentation of honest, rounded and meaningful information regarding quality of services into the public domain. The leaders of an organisation will be engaged in the quality improvement agenda both in order to achieve public accountability but also as a result of it.

Quality Accounts are therefore a key component of the overall framework. The purpose and proposed content of a Quality Account, and the processes that should be in place to produce one, have been shaped by a comprehensive stakeholder engagement process and the successful introduction of quality reporting for 2008-09 by NHS foundation trusts and by NHS trusts in the east of England. Work on this has been led by the Department, in partnership with Monitor, the Care Quality Commission and NHS East of England.

The primary legislation for Quality Accounts in the Health Act 2009 set out the broad principle that all NHS providers should produce an annual account of the quality of their healthcare services. Because we are committed to developing our approach to Quality Accounts in partnership with the NHS, and also with patients, their carers, the wider public as well as professional and academic stakeholders, the Health Act left detailed implementation to be achieved by way of secondary legislation.

Following the collaborative design work, we set out our proposals for Quality Accounts in a consultation document, “The Framework for Quality Accounts: a consultation on the proposals”, the public consultation on which ran from 17 September 2009 to 10 December 2009.

Around 170 individuals and organisations responded to the consultation, and proposals attracted wide support. In response to detailed representations, we modified and clarified our original proposals. In summary:

we made the regulations less prescriptive about the number of priorities for quality improvement that a provider should set by removing the maximum and leaving that to local discretion;

we simplified the statement on participation in clinical audit;

we made clear in our guidance that providers should explain how participation in clinical audit and research improves patient care;

the information on data quality (inclusion of valid NHS number) will be supplied separately by admitted patient care, outpatient and accident and emergency;

ensuring that both Local Involvement Networks (LINks) and Overview and Scrutiny Committees (OSCs) will be given the opportunity to comment on a provider’s Quality Account;

the regulations are now less prescriptive about the number of priorities for quality improvement that a provider should set. A minimum has been set but no maximum requirement—this allows larger organisation to set a higher number of priorities;

the statement on participation in clinical audit has been simplified. The Department’s response to the consultation acknowledges that there is limited benefit in asking providers to calculate what percentage of patients were covered by the audits undertaken;

departmental guidance will make it clear that providers when reporting on the number and type of clinical audits undertaken and the number of patients recruited to clinical research should explain how participation in both processes has improved patient care in their organisation;

the information on data quality (inclusion of valid NHS number) will be supplied separately by admitted patient care, outpatient and accident and emergency;

both LINks and OSCs will be given the opportunity to comment on a provider’s Quality Account as both organisations have roles to play in providing assurance over the content of a Quality Account; and

although some responses indicated that all providers, irrespective of their size, should produce a Quality Account, the majority view was that providers that do not have a significant NHS workload should be exempt. The definition of a small provider is based on the definition used in the Standard NHS Contract (those whose annual contract value is less than £130,000 and who employ 50 or fewer full-time employees) and will be used as the cut off for exemption from the requirement to produce a Quality Account.

These proposals will now be used to draft regulations that will shortly be laid before Parliament. These regulations will also set out the initial assurance mechanism for Quality Accounts—we will be consulting on proposals for a more formal mechanism later this year, the proposed content and manner of publication, and any exemptions that will apply in the first year.

For the first year of Quality Accounts all providers or sub-contractors of NHS services will have to produce a quality account unless they are exempted by the regulations. Their first Quality Accounts, covering activity in 2009-10, will be published this summer. We will also be publishing shortly a comprehensive toolkit to enable providers to produce Quality Accounts that their patients, the population they serve, and their own staff will recognise as a fair and balanced view of services.

The regulations exempt primary care and community health services from the quality account obligations. It is intended these services will be exempt only for the first year. We plan to introduce Quality Accounts for primary and community care sectors from 2011. An engagement and testing process, similar to that run within NHS foundation trusts and NHS East of England providers but focused on the particular needs of these two sectors, started in autumn 2009. The providers participating in the testing work are in NHS North East and NHS East Midlands, and a framework for test reporting will be published over the next few weeks, with a view to starting the pilots this spring and evaluating them in the summer. This exercise will help shape the development of Quality Accounts further as they begin to apply to all providers, and a further consultation on proposed regulations will therefore start later this year.