Quality accounts are intended to achieve two things – to increase boards' focus on quality, and to provide greater public accountability for quality. They were originally a major initiative of the previous government's health minister Lord Darzi's NHS Next Stage Review, but they have been embraced by the new government as part of its drive to promote greater transparency about the quality of NHS services.
More are still being added each day to a dedicated page of the NHS Choices website, but already well over 100 are available to download. They are also supposed to be available on the trusts' own websites, and trusts have been encouraged to make them available to their local population in other ways too.
Quality accounts give locally selected information about the quality of services the organisation provides, alongside mandatory information such as tests of data quality and participation in clinical audits. There is also a comment from a lead primary care trust and, if they choose to provide it, comment from the local involvement network and the local health overview and scrutiny committee.
Building on our previous and current work on public involvement in quality accounts, how to measure quality, and how to present quality information to patients to help them make choices, we will be spending some time over the summer reading and analysing a sample of the quality accounts. From a quick browse of the website we can see a huge variety of styles and sophistication of presentation, many different quality indicators used and varying evidence of involvement: the good, the bad and the average.
Overall, many organisations seem to have worked hard to produce readable and meaningful documents. Hopefully, the process of producing quality accounts will have helped the organisations’ leaders to focus more on quality. And if, and this is a big if, they are promoted and used well, the documents will prove useful for patient and public groups active in holding their local NHS to account.
However, there is a tension at the heart of the quality accounts policy. If they are to support local improvement, then they should reflect local priorities, with trusts able to choose which quality indicators to use. But if they are to support accountability then there is a stronger argument for standardising the indicators, so that patients and the public can compare performance between organisations. As with the previous administration, the coalition government says it wants both – more local control but also greater transparency. Quality accounts attempt to serve both these goals in one document, with a mixture of some locally chosen and some nationally required content. As the government evaluates this first year of quality accounts, it will need to decide whether it has got this balance right.