Quality Accounts: Stakeholder Engagement

1
Quality Accounts Stakeholder Engagement
2
Introduction
3
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

4
The quality framework
5
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

6
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

7
Measurement for Quality Improvement

• An engagement process started on 18th 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

8
How do quality accounts fit in?
Key purposes
Example product

• Improvement against national priorities
• Accountability to taxpayers
• International benchmarking

National

• NQB Quality Report

• Improvement in quality within the region and
  progress against the regional vision
• Enable benchmarking

• Regional quality measures
• Services from Quality Observatory

Co-production at all levels of the system
Regional

• Service improvement
• Board accountability
• Provider benchmarking

• Provider quality account

Subsidiarity
Local

• Clinical Team quality measure and dashboards

• Service improvement
• Team benchmarking for improvement

Team
Local clinical ownership of indicators
Sources of evidence-based indicators include
Royal Colleges, specialist societies, NHS
Information Centre, universities, commercial
sector
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Quality Accounts overview
10
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
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Timetable
Jan 2009
July 2009
Oct 2009
March 2010

• Passage of primary legislation through Houses of
  Parliament
• Engagement with stakeholders

• Public consultation on the detailed secondary
  legislation

• Continuing stakeholder engagement
• Development and publication of guidance

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Purpose of quality accounts

• Quality accounts are a mechanism for public
  reporting
• The purpose of quality accounts is to enable
• Boards/organisations 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

13
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 truthful and fair 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

14
Initial thinking
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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

16
Initial thinking on Quality Accounts

• All providers who supply healthcare services for
  or on behalf of the NHS will need 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

17
Initial thinking on centrally set elements on
content

• The following lists the types of information that
  could be required
• Information which may be required by DH under the
  terms of the operating framework ie rates of
  HCAIs
• Information on quality that providers supply to
  the CQC
• Information on quality that may be required by
  Monitor
• Quality metrics or standards that a provider may
  need to supply to their PCT under the terms of
  their contract or for CQUIN purposes
• Information that providers have supplied to
  Cancer Networks or in respect of clinical audits

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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

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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

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Having your say
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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 off quality accounts as being
  truthful and fair. What will be the impact of
  this?
• When and how should quality accounts be
  published?
• Open it up

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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 email to
• nhsquality_at_ipsos-online.com
• We will send you your login details to access the
  board which will be active from 23rd January to
  27th
• March
• 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