Quality Accounts

For the June 2018 Quality Accounts, providers are expected to report how their investigations and learnings from deaths have informed their quality improvement plans. This would be an annual summary of monthly/quarterly trust board reports on reviewing and learning from deaths.

This builds on the work of the Royal College of Physicians in developing a methodology to support this process. Other resources to support this learning and process are in the pipeline.

This early notice of intent should help you start thinking now about how to bring your boards up to speed with this new development in the Quality Improvement toolkit. Also read the information provided in the Royal College of Physicians' National Mortality Case Record Review (NMCRR) programme.

On page 20 of the Quality Accounts audit guidance, Mandated Indicator 19 should read:

19. The data made available to the NHS trust or NHS foundation trust by the Health and Social Care Information Centre with regard to the percentage of patients aged

• (i) 0 to 15; and
• (ii) 16 or over

readmitted to a hospital which forms part of the trust within 28 days of being discharged from a hospital which forms part of the trust during the reporting period.

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 and 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 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 like 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 it provides. 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 the local community. You will find a statement from the provider's main commissioner (buyer of their NHS services) at the end of each Quality Account.
• 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.

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.

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

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.

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.

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 specifying 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.

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.

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.

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

You should upload your Quality Account to your organisation's profile on NHS Choices,

1. Log into your account
2. Select the module labelled "Quality Accounts"
3. Select edit and upload your document
4. Save

If you don't know your log-in details or who manages the account in your organisation contact our Service Desk team nhschoicesservicedesk@nhs.net. For more information about managing profiles on NHS Choices visit our help and support section.

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

Not all organisations will have editing rights for profiles on NHS Choices such as hospices. Also the overall trust can up load a QA but not individual hospitals. Please email your Quality Account PDF to qualityaccounts@dh.gsi.gov.uk by June 30 each year.

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. View quality accounts for non-NHS bodies.

NB: There may be a delay between your documents submission and it appearing on NHS Choices. If your Quality Account is still not visible after 72 hours contact qualityaccounts@dh.gsi.gov.uk for any updates.

PDF requirements

Please use sufficient labelling for 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.

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.

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, Overview and Scrutiny Committees 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 more than 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 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 give healthcare providers the opportunity 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.

Overview and Scrutiny Committees

It is a requirement to send your Quality Account to your local Overview and Scrutiny Committee

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.

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, 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

No. Healthwatch and Health and Wellbeing Boards voluntarily provide assurance of a provider's Quality Account. Depending on their capacity, 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.

• Also read Healthwatch guidance – Quality Accounts (Doc, 37kb) for more advice

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.