Quality accounts FAQs
These are some frequently asked questions about Quality Accounts.
FAQs
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.
Alongside a statement, Quality Accounts must also include reporting against a set of common indicators. Further information on indicators is below.
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)/ Integrated Care Boards (ICBs). 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 (fewer 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.
But to make Quality Accounts more meaningful to service users at a local level, it’s 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/ ICBs, Healthwatch and the Health and Wellbeing Board.
The regulations require providers to complete the following 2 statements:
- 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].
- 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. You must upload your Quality Account to a page on your website and subsequently send the link to the following:
- NHS providers – england.quality-accounts@nhs.net
- Independent providers – QualityAccounts@dhsc.gov.uk
By publishing your Quality Account on your website and forwarding the link to NHS England or DHSC, you have fulfilled your statutory duty to submit it to the Secretary of 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 2 years if requested. It is acceptable for these to be printed off locally on request.
If you’re providing NHS services across a large area and aren’t sure whether you have to share your Quality Account with NHS England, CCGs/ ICBs, Healthwatch, Overview and Scrutiny Committees or the Health and Wellbeing Board, you should take a look at the NHS (Quality Accounts) Regulations for 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.quality-accounts@nhs.net.
If you’re commissioned by a CCG/ ICB, you should send your Quality Account to the CCG for which you provide services.
If there’s more than 1, send it to the lead CCG that co-ordinates the others.
If there’s more than 1 lead CCG (or none), you should send your Quality Account to the CCG responsible for the largest number of patients you have provided NHS services to during the reporting period.
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’s 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 isn’t a regulatory requirement, however.
NHS England wishes to clarify that foundation trusts and NHS trusts are only required by regulation to share their Quality Report with NHS England or relevant CCGs (as determined by the NHS (Quality Accounts) Amendment Regulations 2012), local Healthwatch 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, but 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 don’t intend to supply a statement so this doesn’t hold up the Quality Account’s publication.
- Also read Healthwatch guidance: Quality Accounts (Word, 37kb) for more advice
Quality Accounts no longer have to be externally audited, although providers may choose to do so to verify that they are accurate.
The core set of indicators to be included in 2021/22 quality accounts is set out in annex 1 below. These are defined in the quality accounts regulations and the listing is not set by NHS England and NHS Improvement. Providers may wish to disclose additional indicators, such as the most pertinent indicators for the trust in the NHS System Oversight Framework.
Additionally, where the necessary data is made available to the organisation by NHS Digital, a comparison of the numbers, percentages, values, scores or rates of the provider should be included for each of those listed in the table with:
- The national average for the same; and
- With those NHS trusts and NHS foundation trusts with the highest and lowest of the same, for the reporting period.
For each indicator the following statement must be included the quality account:
The [name of provider] considers that this data is as described for the following reasons [insert reasons]. The [name of provider] [intends to take/has taken] the following actions to improve this [percentage/proportion/score/rate/number], and so the quality of its services, by [insert description of actions].
The data should be presented, in a table format, with the [percentage/proportion/score/rate/number] shown for at least the last two reporting periods.
Some of the indicators will not be relevant to all providers – for instance, ambulance response times. Providers are only required to include indicators in their quality accounts that are relevant to the services they provide.
Where to find the data
NHS Digital provides a quality accounts section within their corporate website. This will provide links to the latest data for each of the indicators that trusts are required to report on. Further details can be found at: https://digital.nhs.uk/data-and-information/areas-of-interest/hospital-care/quality-accounts.
The NHS website also carries additional information, at http://www.nhs.uk/quality-accounts, including the technical definitions of indicators and dates when specific data sets are available. The quality account should contain the most recent data sets available at the time of production.
Annex 1: The core quality account indicators
The following items are required per the regulations except for the Friends and Family Test – Patient element.
The core indicators are listed in the table below. The numbering scheme used in the table corresponds with the numbering of the indicators in the Regulation 4 Schedule within the quality accounts regulations. This list is not defined by NHS England and NHS Improvement and we are unable to change the regulations.
Some of the indicators will not be relevant to all providers, for instance, ambulance response times. Providers are only required to report on indicators that are relevant to the services that they provide or sub-contract in the reporting period.
| Prescribed information | Type of trust | Comment | |
| 12.
|
(a) The value and banding of the summary hospital-level mortality indicator (‘SHMI’) for the trust for the reporting period; and
(b) The percentage of patient deaths with palliative care coded at either diagnosis or specialty level for the trust for the reporting period. |
Trusts providing relevant acute services | In the table showing performance against this indicator, both the SHMI value and banding should be shown for each reporting period. |
| 13. | The percentage of patients on Care Programme Approach who were followed up within 7 days after discharge from psychiatric inpatient care during the reporting period | Trusts providing relevant mental health services | |
| 14. | The percentage of Category A telephone calls (Red 1 and Red 2 calls) resulting in an emergency response by the trust at the scene of the emergency within 8 minutes of receipt of that call during the reporting period.[1] | Ambulance trusts | In the table showing performance against this indicator, Red 1 and Red 2 calls should be separate. See also footnote below. |
| 14.1 | The percentage of Category A telephone calls resulting in an ambulance response by the trust at the scene of the emergency within 19 minutes of receipt of that call during the reporting period. 3 | Ambulance trusts | See footnote below. |
| 15. | The percentage of patients with a pre-existing diagnosis of suspected ST elevation myocardial infarction who received an appropriate care bundle from the trust during the reporting period. | Ambulance trusts | |
| 16. | The percentage of patients with suspected stroke assessed face to face who received an appropriate care bundle from the trust during the reporting period. | Ambulance trusts | |
| 17. | The percentage of admissions to acute wards for which the Crisis Resolution Home Treatment Team acted as a gatekeeper during the reporting period. | Trusts providing relevant mental health services | |
| 18. | The trust’s patient reported outcome measures scores for:
(i) groin hernia surgery (ii) varicose vein surgery (iii) hip replacement surgery and (iv) knee replacement surgery during the reporting period.
|
Trusts providing relevant acute services | |
| 19. | The percentage of patients aged:
(i) 0 to 14 and (ii) 15 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. |
All trusts | It has been acknowledged that an error was made in the drafting of the regulations and that the split of patients for this indicator should be
(i) 0 to 15; and (ii) 16 or over The regulations do refer to 28-day readmissions rather than 30. |
| 20. | The trust’s responsiveness to the personal needs of its patients during the reporting period. | Trusts providing relevant acute services | |
| 21. | The percentage of staff employed by, or under contract to, the trust during the reporting period who would recommend the trust as a provider of care to their family or friends. | Trusts providing relevant acute services | |
| 21.1 | Friends and Family Test – Patient. The data made available by National Health Service Trust or NHS Foundation Trust by NHS Digital for all acute providers of adult NHS funded care, covering services for inpatients and patients discharged from Accident and Emergency (types 1 and 2)
Please note: there is a not a statutory requirement to include this indicator in the quality accounts reporting but provider organisations should consider doing so. |
Trusts providing relevant acute services | Not part of the quality accounts regulations |
| 22. | The trust’s ‘Patient experience of community mental health services’ indicator score with regard to a patient’s experience of contact with a health or social care worker during the reporting period. | Trusts providing relevant mental health services | |
| 23. | The percentage of patients who were admitted to hospital and who were risk assessed for venous thromboembolism during the reporting period. | Trusts providing relevant acute services | |
| 24. | The rate per 100,000 bed days of cases of C.difficile infection reported within the trust amongst patients aged 2 or over during the reporting period. | Trusts providing relevant acute services | |
| 25. | The number and, where available, rate of patient safety incidents reported within the trust during the reporting period, and the number and percentage of such patient safety incidents that resulted in severe harm or death. | All trusts |
[1] NHS Improvement comment: The quality accounts regulations only refer to the ‘Category A’ ambulance indicators. Many ambulance trusts may no longer be able to report on these standards. NHS Improvement recommends that ambulance providers may replace these disclosures in the quality account with performance against the Category 1, 2, 3 and 4 standards instead if this is considered a better way of communicating the ambulance trust’s performance.