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Quality Accounts

About Quality Accounts

A Quality Account is a report about the quality of services by an NHS healthcare provider. The reports are published annually by each provider, including the independent sector, and are available to the public.

Quality Accounts are an important way for local NHS services to report on quality and show improvements in the services they deliver to local communities and stakeholders.

The quality of the services is measured by looking at patient safety, the effectiveness of treatments that patients receive and patient feedback about the care provided.

The Department of Health requires providers to submit their final Quality Account to the Secretary of State by uploading it to the NHS Choices website by June 30 each year. The requirement is set out in the Health Act 2009. Amendments were made in 2012, such as the inclusion of quality indicators according to the Health and Social Care Act 2012. NHS England or Clinical Commissioning Groups (CCGS) cannot make changes to the reporting requirements.

The Quality Accounts FAQ, below, provides necessary guidance on how to produce and publish your Quality Account, including:

  • who to share your Quality Account with
  • how to publish your organisation’s Quality Account
  • how to access the indicator data through the HSCIC indicator portal
  • the technical definitions of indicators and dates when specific data sets are available, including the Quality Accounts Data Dictionary (DOC, 66kb) 

Other useful resources 

 

Quality Accounts FAQ

 

Where is the final guidance issued in 2014 setting out the expectations of Quality Accounts for 2014/15?

An evaluation has been undertaken with a broad range of stakeholders to consider ways in which Quality Accounts could begin to give the reader confidence that the board was being open and honest about the quality of services being provided across the organisation and committed to driving continuous quality improvement. This evaluation has produced a number of recommendations including;

  • Healthwatch should to consider to produce guidance that will enable them to effectively challenge Quality Accounts locally.
    This recommendation came directly from a number of Healthwatch organisations and the thinking is that NHS England would ask Healthwatch to produce this guidance.
  • NHS Choices website functionality reviewed
    Improvements have already been made for 2013/14. Further improvements could be made in 2014/15 to improve functionality from a patients and provider perspective.
  • Presentational guidance issued.
    Guidance should focus on the use of plain English and simplifying/standardising the presentation of data.
  • The Quality Account’s Data Dictionary maintained
    NHS England developed a Quality Account’s .Data Dictionary. It is recommended this is maintained as a reference source for people responsible for preparing Quality Accounts. It is also valuable for auditors as it contains the date’s different data sets become available. This ensures auditors can provide assurance that the correct data was provided at the point the Quality Account was produced.

These recommendations mean the existing core functionality and process for developing your Quality Accounts will be maintained in 2014/15.

What information can be found in a Quality Account?

A healthcare provider has to provide and give a detailed statement about the quality of their services. Every Quality Account will include:

  • A signed statement from the most senior manager of the organisation. Managers will describe the quality of healthcare provided by their organisation and the areas they are responsible for. Within this statement, senior managers should declare they have seen the Quality Account; that they are happy with the accuracy of the data reported; are aware of the quality of the NHS services they provide, and highlight where the organisation needs to improve the services it delivers. The statement is also an acknowledgement of any issues in the quality of services currently provided.
  • Answers to a series of questions that all healthcare organisations are required to provide. This includes information on how the healthcare provider measures how well it is doing, continuously improves the services it provides, and how it responds to checks made by regulators such as the Care Quality Commission (CQC). Guidance on how to answer each question is given to all providers to ensure the questions are answered in a uniform way. Find more detail in the Guide to questions and statements section.
  • A statement from the organisation detailing the quality of the services they provide. Clinical teams, managers, patients and patient groups may all have a role in choosing what to write about in this section, depending on what is important to the organisation and to the local community. At the end of each Quality Account you will find a statement from the provider’s main commissioner (buyer of their NHS services).
  • You may also find statements from the local Healthwatch and the Health and Wellbeing Boards. These groups represent patients and the public on healthcare issues.

What services are not covered in a Quality Account?

Quality Accounts do not report on primary care services or NHS Continuing Healthcare.

Primary care refers to services provided by GP practices, dental practices, community pharmacies and high street optometrists.

NHS continuing healthcare refers to a package of continuing care arranged by the NHS to be provided outside hospital for people with ongoing healthcare needs. Find more information about NHS continuing healthcare.

Organisations that provide primary care services or NHS Continuing Healthcare are encouraged to voluntarily produce a Quality Account about these services.

Who has to produce a Quality Account?

The requirement to publish a Quality Account covers:

  • organisations that provide healthcare commissioned by NHS England or Clinical Commissioning Groups (CCGs). This includes independent sector, charitable and voluntary organisations
  • organisations that provide NHS services under an NHS standard contract, have over 50 staff and a turnover greater than £130k per annum

If your organisation provides a mix of NHS and non-NHS services, such as social care services commissioned by a local authority, then you only need to publish a Quality Account about the quality of your NHS services.

Exemptions

Organisations with less than £130k NHS income per annum and a relatively small number of staff members (less than 50) are not required to produce a Quality Account.

Organisations that solely provide primary care or NHS continuing healthcare do not have to produce a Quality Account.

Primary care refers to services provided by GP practices, dental practices, community pharmacies and high street optometrists. NHS continuing healthcare refers to a package of continuing care arranged by the NHS to be provided outside hospital for people with ongoing healthcare needs. Find more information about NHS continuing healthcare.

As a foundation trust, do I have to produce both a Quality Account and a Quality Report?

The Health Act 2009 requires NHS foundation trusts to publish a Quality Account each year, in the terms set out in the NHS (Quality Accounts) Regulation 2010. This Quality Account must be uploaded onto NHS Choices by June 30 each year. 

By uploading your Quality Account on NHS Choices, you have fulfilled your statutory duty to submit your Quality Account to the Secretary of State.

Monitor's annual reporting guidance for the Quality Reports (PDF, 503kb) incorporates the requirements set out for Quality Accounts in the 2010 Regulations, as well as additional reporting requirements set by Monitor. 

An NHS foundation trust may therefore produce either:

  • one report satisfying both Monitor's and the Department of Health's requirements, for inclusion in their annual report and for uploading to NHS Choices
  • a Quality Account report and a Quality Report to satisfy each set of requirements, should they not wish Monitor's additional reporting requirements to be included in their Quality Account.

 

Do I have to provide a Quality Account per site or per organisation?

The duty to publish a Quality Account falls on a body or person providing NHS services. Multi-site organisations only need to produce one Quality Account covering the quality of healthcare provided across the entire organisation.

However, to make Quality Accounts more meaningful to service users at a local level, it is recommended that large multi-site organisations provide site-specific data on the quality of their healthcare services and ensure the report covers data across all sites.

Failure to account for the spread of activities will likely cause critical commentary by CCGs, Healthwatch and the Health and Wellbeing Board. 

How do newly established foundation trusts report their Quality Account?

A newly authorised foundation trust only needs to produce one Quality Account to cover the entire reporting period, including the pre-authorisation portion when it was an NHS trust.

To help readers it may be useful to include an explanation at the beginning of your report that the Quality Account relates to the quality of services across the entire year – including the time when they were provided by the NHS trust.

What statements do I have to provide on the actions following national and local audits?

The regulations require providers to complete the following two statements:

1. The reports of [number] national clinical audits were reviewed by the provider in [reporting period] and [name of provider] intends to take the following actions to improve the quality of healthcare provided [description of actions].

2. The reports of [number] local clinical audits were reviewed by the provider in [reporting period] and [name of provider] intends to take the following actions to improve the quality of healthcare provided [description of actions].  

You can provide a summary of actions where it is not practical to list all the individual steps your organisation is planning to take following a review of an audit. You should then highlight those of greatest importance and include a link to where further information can be found.

Where do I report on my past and future priorities?

A description of future areas for improvement and achievements against the previous year's priorities should be included in part 2 of your Quality Account. Part 3, which should cover the locally decided review of quality performance, can also look back to historic performance to highlight trends.

How to publish your Quality Account

The regulations state that Quality Accounts must be published by June 30 each year following the end of the reporting period. By publishing your Quality Account on NHS Choices, you have fulfilled your statutory duty to submit it to the Secretary of State.

NHS bodies

Quality Accounts produced by NHS bodies (including acute, mental health, ambulance and most foundation trusts) should be uploaded to their organisations' profile on NHS Choices by June 30 each year.

NHS bodies with an organisation profile on NHS Choices will have a named person who has NHS Choices editing rights and who can upload your Quality Account to the site. If you need to find out who has editing rights for your organisation, please email NHS Choices on: servicedesk@nhschoices.nhs.uk.

If you have editing rights and you need to know how to upload information to your profile, visit the Your Pages section for guidance. If you still have problems then you can also contact the NHS Choices help desk servicedesk@nhschoices.nhs.uk.

To view your Quality Account on your organisation's NHS Choices profile once it’s been uploaded, use the Services near you facility.

NB: There may be a delay in a Quality Account being visible on NHS Choices. Please only contact NHS Choices if your Quality Account is still not visible after 72 hours.

Non NHS bodies

Quality Accounts produced by non-NHS bodies should be sent to qualityaccounts@dh.gsi.gov.uk by June 30 each year.

All Quality Accounts should be sent in PDF format (see PDF requirements below). Your email should clearly state in the subject field that the document needs to be uploaded and published on NHS Choices.

NHS England will then ensure your Quality Account is uploaded to the website. All Quality Accounts submitted to NHS Choices by NHS England will be uploaded to a central place. To check if your document was published go to View quality accounts for non-NHS bodies.

There may be a delay between submitting your Quality Account to NHS England and it being published on NHS Choices. Please only make contact if your Quality Account is still not visible after 72 hours. In this case you should email qualityaccounts@dh.gsi.gov.uk for any updates.

PDF requirements

Please use sufficient labelling for you Quality Account by adding your organisation’s name. A PDF's metadata should contain a title, an author (which can be an organisation), a subject (a short description of what the document is), and some keywords. Fields are provided for these items in the document properties.

Please ensure the PDF's security settings do not allow editing. The settings should, however, allow printing, content copying, page extraction and filling of form fields.

Finally, PDFs should be 'tagged for accessibility', which is something you have the option of doing when creating a PDF.

Do I need hard copies of my Quality Account on record?

The Health Act 2009 requires you to make hard copies of the Quality Account available for the last two years if requested. It is acceptable for these to be printed off locally on request.

Who do I have to share my Quality Account with?

If you are providing NHS services across a large area and you are not sure whether you have to share your Quality Account with NHS England, CCGs, Healthwatch or the Health and Wellbeing Board, then you should take a look at the NHS (Quality Accounts) Regulations 2010, which provide guidance. Otherwise you should send your Quality Account to:

Commissioners

If over 50% of your services are commissioned by NHS England, you should send your Quality Account to england.qualityaccounts@nhs.net for comments.

If you are commissioned by a CCG, you should send your Quality Account to the CCG for which you provide services. If there is more than one, then send it to the lead CCG that co-ordinates the others.

If there is more than one lead CCG (or none) you should send your Quality Account to the CCG that is responsible for the largest number of patients that you have provided NHS services to during the reporting period. Find Clinical Commissioning Groups.

Healthwatch

Local Healthwatch use Quality Accounts to support discussions about NHS healthcare matters in the area. They also provide the opportunity for healthcare providers to engage with stakeholders representing their patients and service users.

You should send your Quality Account to the Healthwatch in the local authority area where you have your registered or principal office. The NHS (Quality Accounts) Regulations 2010 set out the legal requirement to send Quality Accounts to one Healthwatch only. This is a minimum requirement aimed at reducing the administrative burden on providers. Find local Healthwatch offices.

Health and Wellbeing Boards

You can send your Quality Account to the Health and Wellbeing Board in the local authority where you have your registered or principal office. This, however, is not a regulatory requirement.

Foundation trusts' and NHS trusts' regulatory duty to share Quality Reports/Accounts with Health and Wellbeing Boards

To be read in conjunction with Quality Reports 7.76 and Quality Accounts Reporting Arrangements, Letter dated January 9 2014, Gateway Reference No.00931

NHS England wishes to clarify that foundation trusts and NHS trusts are only required by regulation to share their Quality Report/Account with NHS England or relevant clinical commissioning groups - as determined by the NHS (Quality Accounts) Amendment Regulations 2012 - and with Local Healthwatch organisations and Overview and Scrutiny Committees.

There is no regulatory requirement for foundation trusts to share their Quality Report/Account with Heath and Wellbeing Boards.

Are Health and Wellbeing Boards required to comment on Quality Accounts?

To be read in conjunction with Quality Reports 7.76 and Quality Accounts Reporting Arrangements, Letter dated January 9 2014, Gateway Reference No.00931

NHS England wish to clarify, foundation trusts and NHS trusts are only required by regulation to share their Quality Report with NHS England or relevant clinical commissioning groups (as determined by the NHS (Quality Accounts) Amendment Regulations 2012), Local Health Watch organisations and Overview and Scrutiny Committees. There is no regulatory requirement for foundation trusts or NHS trusts to share their Quality Account/Report with Health and Wellbeing Boards.

No central guidance will be issued to Health and Wellbeing Boards in terms of the expectation of comments, however, comments may be made on the following areas:

  • the degree to which you feel local communities have been engaged in priority setting
  • other priority areas that could have been included in the Quality Account
  • the approach the organisation has towards quality improvement overall

Do Healthwatch or Health and Wellbeing Boards have to supply a statement for every Quality Account they receive?

No. Healthwatch and Health and Wellbeing Boards voluntarily provide assurance of a provider's Quality Account. Depending on their capacity, a Healthwatch or Health and Wellbeing Boards may decide to prioritise and comment on those providers where members and the service users they represent have a particular interest.

Healthwatch and Health and Wellbeing Boards should let providers know as soon as possible if they do not intend to supply a statement, so that this does not hold up the Quality Account's publication.

Which Quality Accounts need to be externally audited?

Monitor requires NHS foundation trusts to have their Quality Accounts audited.

Since 2012 all NHS acute and mental health trusts are required to have their Quality Accounts externally audited.

Organisations that are not NHS acute or mental health trusts or NHS foundation trusts will not have to do this.

Comments

The 4 comments posted are personal views. Any information they give has not been checked and may not be accurate.

Quality Framework Team said on 03 June 2014

Thank you for your question. If you refer to the FAQ 'Who has to produce a Quality Account', it should answer your query.

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We Care said on 02 June 2014

We are a community interest company(social enterprise) that went live on 1st April 2011 as a successor organisation of the Community Provider arm of the Primary Care Trust. Please can you clarify the requirements for our Quality Account as we are not an NHS trust.
Many Thanks.

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Quality Framework Team said on 02 May 2014

Thank you for your comments, we have now amended the section ‘Who do I have to share my Quality Account with?

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MoreMrNiceGuy said on 15 April 2014

The guidance on who to share it with is wrong. It does not have to be shared with the Health and Wellbeing Board. It is the Health Overview and Scrutiny Committee it needs sharing with, as per clause 10 of the 2010 regulations. They have the opportunity for their statement to be included verbatim.

http://www.legislation.gov.uk/uksi/2010/279/regulation/10/made

(which has been left unchanged following the passage of the 2012 Health and Social Care Act).

Please correct this.

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Page last reviewed: 05/03/2014

Next review due: 05/03/2016

PDF requirements

Please ensure sufficient labelling on your Quality Account by adding your organisation’s name. A PDF's metadata should contain a title, an author (which can be an organisation), a subject (a short description of what the document is) and some keywords. Fields are provided for these items in the document properties.

Please ensure the PDF's security settings do not allow editing. The settings should, however, allow printing, content copying, page extraction and filling of form fields.

Finally, PDFs should be 'tagged for accessibility', which is something you have the option of doing when creating a PDF.

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