Quality Accounts: Stakeholder Engagement

Introduction

Structure of the presentation and objectives These slides will provide: –An Overview of High Quality Care and the Quality Framework –An Overview of the purpose of Quality Accounts and initial thinking on their development –Areas for discussion on Quality Accounts The objectives of the engagement are to: –Find out from a wide range of stakeholders what Quality Accounts should look like; concentrating on form, content and the publication timetable –Raise awareness of Quality Accounts among staff and key stakeholders

The quality framework

Quality is at the heart of everything we do High Quality Care for All defined quality as having three dimensions: ensuring that care is safe, that it is effective, and that it provides patients with the most positive experience possible. Safety Effectiveness of process and outcomes Positive patient experience

Seven key elements of the Quality Framework High Quality Care for All gives seven key elements of the Quality Framework –Bringing clarity to quality – by being clear about what quality looks like –Measure quality – through a new quality measurement framework at every level –Publish quality performance – by requiring providers to publish quality accounts –Recognise and reward quality – by ensuring that the right incentives are in place –Raise standards – by promoting stronger clinical and managerial leadership –Safeguard quality – through regulating appropriate services and professions –Stay ahead – by supporting innovation

Measurement for Quality Improvement An engagement process started on 18 th November 2008 to look at Measurement for Quality Improvement The objective of this is to identify indicators to support improvements in quality This work will provide the foundations for other quality initiatives This process is due to finish by the end of January 2009

Key purposes NQB Quality Report Regional quality measures Services from Quality Observatory Clinical Team quality measure and dashboards Example product Provider quality account National Regional Local Team Improvement against national priorities Accountability to taxpayers International benchmarking Improvement in quality within the region and progress against the regional vision Enable benchmarking Service improvement Board accountability Provider benchmarking Service improvement Team benchmarking for improvement Sources of evidence-based indicators include Royal Colleges, specialist societies, NHS Information Centre, universities, commercial sector Local clinical ownership of indicators Co-production at all levels of the system Subsidiarity How do quality accounts fit in?

Quality Accounts – overview

Background We will require, in legislation, healthcare providers working for or on behalf of the NHS to publish their Quality Accounts from April 2010 – just as they publish financial accounts. These will be reports to the public on the quality of services they provide in every service line – looking at safety, experience and outcomes High Quality Care for All

Timetable Passage of primary legislation through Houses of Parliament Engagement with stakeholders Jan 2009July 2009 Oct 2009March 2010 Public consultation on the detailed secondary legislation Continuing stakeholder engagement Development and publication of guidance

Purpose of quality accounts Quality accounts are a mechanism for public reporting The purpose of quality accounts is to enable: –Boards/organisation managers of providers to focus on quality improvement as a core function –The public to hold providers to account for the quality of NHS Healthcare services they provide –Patients and their carers to make better informed choices

Principles of quality accounts To ensure that quality accounts can achieve these purposes, they should cover the provision of NHS Healthcare services and contain information that is: –A trustworthy and reliable picture of the quality of services provided –Meaningful and relevant to users of quality accounts –Designed to allow for comparisons to be made –Produced in a timely fashion –Published in a way that promotes easy access for users

Initial thinking

Progress until now When developing legislative provisions the aim has been to avoid placing detail of the scheme in the primary legislation The detail on quality accounts will go into the secondary legislation However, the need to draft the bill correctly has meant that some early thinking has been done on the broad form and content This is still subject to discussion and consultation

Initial thinking on Quality Accounts The legislation, subject to the approval of Parliament, will require all providers who supply healthcare services for or on behalf of the NHS to prepare a Quality Account There will be centrally and locally determined elements to quality accounts –There are some issues of key, often national importance which will need to feature in all quality accounts –However, most NHS priorities are set locally and Quality Accounts will need to report on the most important of these

Initial thinking on centrally set elements on content The following lists the types of information that could be required –Information required by Department under the terms of the Operating Framework, published by the Care Quality Commission in its periodic reviews, or through other national reporting frameworks –Information relating to safety and quality which as supplied to the Care Quality Commission to assure providers compliance against their registration requirements –Information relating to quality which is supplied to the Care Quality Commission in respect of special reviews, investigations or studies which have concluded –Data on quality which may be required under the terms of a contract with a PCT –Information supplied for clinical audits

Initial thinking on locally determined elements Providers will be able to make their own decisions on this part of the account However, the thinking is that Quality Accounts would be stronger if providers worked with local bodies / people on content It is suggested that they should seek validation from external bodies The local metrics for Quality Accounts are being discussed as part of the MQI engagement SHAs have been asked to report back to DH on this by Jan 2009

Initial thoughts on process Who will need to provide Quality Accounts? –All trusts and independent sector providers to publish quality accounts in 2010 covering 2009/10 financial year –Independent primary care contractors will join at later date Sign off? –It is expected that Boards of NHS Trusts and senior management equivalents in non-NHS organisations will sign a declaration that their Quality Accounts provide a true and fair view of the services they provide Publication? –Published electronically with hard copies on request Validation? –No plans for formal audit but external validation will be encouraged

Having your say

Areas for discussion Is the purpose of Quality Accounts clear? What difference will Quality Accounts make for patients, NHS managers, clinicians/staff? What are your views on the proposed content of Quality Accounts? What should be the balance be between the centrally-set and locally determined parts of the account? Has DH suggested the right sources for the core of nationally consistent information? Boards must sign their Quality Accounts as a guarantee for users that the content is reliable. What will be the impact of this? When and how should quality accounts be published? Open it up…

Continue the discussion online If you would like to engage further in this debate, you can sign up to the on-line bulletin boards by sending an to: We will send you your login details to access the board which will be active from 2 nd February to end April Thanks for your input. The results from this engagement will be analysed by Ipsos MORI and used to inform the further development of Quality Accounts