Quality accounts need re-think to support information revolution

New reports on the quality of NHS services have in many cases failed to provide the public with meaningful information about the performance of local health services, according to a new report, How do quality accounts measure up? Findings from the first year, published by The King's Fund today.

Last year, for the first time, NHS providers were required to publish quality accounts – annual reports aimed at giving the public more information about the quality of local services. The King's Fund analysed around a quarter of quality accounts, and while there were some good examples, found significant variation in the quality and presentation of the information published. The shortcomings identified in the report included the following.

  • Very few quality accounts mapped quality against individual services and where they did, they usually provided information on only one service or specialty.
  • Less than 1 in 5 of the measures presented were benchmarked against comparative data and only around half showed more than a single year's results, making it difficult for patients to compare performance against other providers or to see trends in performance over time.
  • Equality issues were almost entirely ignored despite guidance from the Department of Health that data should be broken down by different population groups – a striking failure given that all NHS organisations are required to comply with equality legislation.
  • Only around a third of providers incorporated information from staff surveys, despite staff feedback clearly being an important indicator of the quality of management and patient care.
  • Many failed to provide definitions or explanations about the measures used and showed poor presentation of graphs. One NHS trust expanded the vertical axis on a bar chart to suggest a three-fold improvement in cleanliness when the improvement on the previous year was in fact 0.6 per cent.

The report describes the variation in quality accounts as an 'inevitable' outcome of the way they have been designed, in particular the conflicting aims of publishing them as a tool for local quality improvement and as a form of public accountability. While it supports the retention of locally defined measures, the report concludes that the public would be better served by including some nationally comparative, quality-assured key measures of quality. This information could then be replicated consistently in all quality accounts, with providers adding other measures relating to local priorities.

The publication of the report follows a letter sent to NHS providers last month by Sir Bruce Keogh, the NHS Medical Director, and David Bennett, Chief Executive of Monitor, which noted the variation in the content and presentation of quality accounts and made minor changes to the process for publishing this year's quality accounts.

Catherine Foot, Senior Fellow at The King's Fund and the report's lead author, said:

'Quality accounts have a crucial role to play in delivering the information revolution called for by ministers but are not yet consistently providing the public with meaningful information. To overcome this, the government needs to clarify the aims of quality accounts and ensure that quality-assured, comparative information is made available to the public. On a positive note, we saw some really good examples of quality accounts, which shows that it is possible for providers to make good on the commitment to provide patients with clear information about the quality of local services.'

Read the report: How do quality accounts measure up? Findings from the first year

Notes to editors: 

1. How do quality accounts measure up? Findings from the first year is published on Thursday 6 January and will be available on The King's Fund website.

2.  NHS Medical Director, Professor Sir Bruce Keogh and Monitor’s Chief Executive, David Bennett set out their the expectations for the 2010-11 quality accounts, including likely revisions to Regulations and formal guidance; the medium to long-term vision for quality accounts and their intentions for extending quality accounts to community services for 2010-11

3. The report authors read and analysed a representative sample of 2010 quality accounts of the providers of acute and mental health services from both the NHS and independent sector, focusing on three selected aspects:

  • The quality measures used to review performance
  • Data quality and participation in national clinical audits and confidential enquiries
  • Patient and public feedback, local involvement and external scrutiny

The team reviewed 64 quality accounts, approximately 25 per cent of the total quality accounts for 2010. This is an approximation because no comprehensive list exists of all the providers who met the criteria for being required to produce a quality account in 2010.

4. In April 2010, The King's Fund published Accounting for quality to the local community, which examined how far the then Labour government’s plans for quality accounts meet its objective to increase NHS accountability by making more information about quality available to the public. It outlined the conclusions of focus groups that were conducted with local community representatives, such as members of local involvement networks (LINks) and health overview and scrutiny committees (HOSCs), and with members and governors of foundation trusts and included recommendations for policy makers.