Ahead of this month's deadline for NHS trusts to submit draft quality accounts, The King's Fund has today published Accounting for quality to the local community. This new research highlights the potential of quality accounts to improve local public accountability, but only if scepticism about their value can be overcome through genuine public involvement.
With the main parties' election manifestos emphasising stronger local accountability and public involvement in health, the report suggests that existing mechanisms for achieving these aims have so far had limited impact. Quality accounts – reports for the public on the quality of NHS services – aim to increase public accountability on quality and encourage NHS boards to focus on improving quality.
With all NHS trusts due to submit draft quality accounts by 30 April, the research identified three key challenges to ensure their success:
- Involvement: the research highlighted significant opportunities to improve local accountability as long as trusts make a genuine commitment to involve the public, avoid tokenism and are open to change. It also revealed some concern about over-burdening local community representatives given the volume of quality accounts that will be produced by different trusts and providers.
- Trust: the research revealed a strong degree of scepticism about quality accounts, highlighting the need to build trust and confidence by allowing the public to shape priorities, reporting honestly on performance and responding to patients' concerns.
- Presentation: the pilot quality reports used for the research were heavily criticised, emphasising the need for quality accounts to be readable, provide relevant contextual and comparative information, explain data clearly and avoid the use of jargon.
The report contains a number of recommendations for trusts in preparing quality accounts.
- Input from patient and public groups should be sought as early as possible and trusts should see quality accounts as a year round, ongoing dialogue.
- Services should be comprehensively reviewed and indicators chosen carefully to accurately represent the quality of services provided.
- High-quality data must be used and indicators must be robust and comparable.
- Attention must be paid to presentation and ensuring that quality accounts are readable and accessible.
Notes to editors:
- The King’s Fund seeks to understand how the health system in England can be improved. Using that insight, we help to shape policy, transform services and bring about behaviour change. Our work includes research, analysis, leadership development and service improvement. We also offer a wide range of resources to help everyone working in health to share knowledge, learning and ideas.
- Accounting for quality to the local community: findings from focus group research is the result of findings of five two-hour focus groups held between August and November 2009 in Norwich, Cambridge, Bedford, Stevenage and London. These locations were chosen because the NHS trusts in these areas had taken part in the pilot ‘quality reporting’ exercise earlier in 2009. Locally relevant quality reports were used as prompts for discussion.
- The groups included people involved in formal local accountability structures for health; members of local involvement networks (LINks); local voluntary sector representatives; health overview and scrutiny committee (HOSC) members; foundation trust governors and members. However, many participants had more than one relevant role, including:local authority staff responsible for scrutiny; member of a patient and user group organised by a local NHS organisation; service user; carer. In total, 35 people took part.