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

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Quality accounts are a key mechanism through which health care organisations can demonstrate their focus on improving the quality of their service.

The government has recently undertaken an evaluation of the 2009/10 quality accounts and set out their expectations for 2010/11.

The King's Fund undertook an independent analysis of a sample of quality accounts produced by a range of providers – acute trusts, mental health trusts, independent providers. The analysis focused on three particular aspects of the quality accounts:

  • the choice of quality measures used to review performance, their reliability and presentation

  • the quality of the data and how far providers have participated in national clinical audits and confidential enquiries

  • how providers have reported patient and public feedback and involvement of local stakeholders and what external comments have focused on.

This paper includes examples from 2009/10 quality accounts that show how the content and the presentation of information can vary. Based on these examples, we make recommendations for providers when they are developing and writing a quality account.

We also have recommendations for policymakers for future guidance on quality accounts; on data quality; on clinical audits and confidential enquiries; and on external scrutiny.

We conclude that, fundamentally, quality accounts are so varied because they are having to provide commentary on a wide range of services, are serving a broad range of audiences and are also attempting to meet two related, but different, goals of local quality improvement and public accountability. The future for public accountability needs to focus more on the centralised provision of standard, consistent and comparable measures, published in forms that enable interpretation and comparison. Individual quality accounts can then both draw on these measures and select local priorities and measures, as long as those measures can be given with benchmark or trend information to provide some context for interpretation.


Mark Rickenbach

GP trainer, Assoc Dean, Professor Healthcare,
Comment date
24 January 2011
I think the drive to quality will also be supported by collation of anonymised neutral feedback to identify patterns of problems. It is the overall pattern that can then be used to determine the focus of action for the organisation and for the leads of each clinical care pathway. Standards and comparison to others does help if clearly presented, but I believe it needs locally owned feedback and evaluation with a clear lead person for each pathway to empower healthcare teams in making improvements

Dr Donal O'Donoghue

Consultant Renal Physician,
Salford Royal NHS Foundation Trust
Comment date
18 January 2011
Quality accounts were introduced into the NHS by the Health Act 2009. They are a new form of annual report to the public about the quality of services. They were introduced with the dual aim of increasing NHS accountability about the quality of services offered and to encourage Boards and senior managers to focus on quality improvement and state where they intended to make improvements. They remain a key part of making “quality the only organising principle of the NHS” – the current Secretary of State for Health stated vision for the NHS.

A Kings Fund analysis of findings from the first year makes interesting reading. NHS organisations collect lots (and lots and lots) of information about services and therefore they have to make choices about what information sources, services and specialities to include in their quality accounts. Most acute NHS Trusts, where kidney departments will be found, report on between 20 and 40 quality measures. The reports were generally strong on effectiveness, patient experience, safety, outcomes and achieved a balance between what’s going well and what needs to be improved. Few provided service level coverage and most reports were weak on staff feedback and measuring equality.

The majority of quality accounts cover healthcare associated infections, patient experience, delayed transfers, prescribing errors and complaints. All of these are relevant to kidney care but I wonder if Trusts are missing a trick by not providing details of individual specialities? This is not surprising given the wide range of services provided by our hospitals and the need to keep quality accounts to a readable length and format for a lay audience. However, this does highlight a key tension in quality accounts, between comprehensiveness of coverage of the range of service provided on the one hand, and length and complexity of the document on the other. But, if the collected data that form the report is to be useful information so that front line staff can gain greater knowledge and understanding of their particular service, be that orthopaedics or kidney care, then the service level detail is much more powerful than the aggregated data.
The Kings Fund comment that the views of staff are an important marker of an organisation’s managerial competence, workforce wellbeing and hence its ability to deliver high quality care. In short, the NHS is its staff. Kidney care healthcare professionals, commissioners of kidney care, local kidney patient associations and individual service users should make a point of looking at your hospital’s quality accounts and should be considering the questions – “so what does this mean for kidney services?”, “how can kidney teams be involved in quality initiatives across the whole pathway of care?” and, to paraphrase Kennedy, asking “what you can do to leverage quality accounts to drive local quality improvement”.

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