1. Who has to publish a Quality Account?
The requirement to publish a Quality Account only covers organisations that:
- provide NHS services, i.e. services that are commissioned by a PCT or SHA, apart from primary care services or NHS Continuing Healthcare (the Regulations set out the definitions of these); and
- are not classed as ‘small providers’, i.e. the organisation’s total income from NHS services is not more than £130,000 per annum and it employs less than 50 staff
This means that you do not need to publish a Quality Account if:
- you do not provide any NHS services at all; or
- the only NHS services you provide are primary care services or NHS Continuing Healthcare; or
- you are a small provider
2. Where can I find the legal requirement to publish a Quality Account?
The requirement to publish a Quality Account is set out in the Health Act 2009.
Exemptions and requirements about the content of Quality Accounts are set out in the NHS (Quality Accounts) Regulations 2010.
The 2010 Regulations were amended in 2011.
3. My PCT or SHA has said that it does not expect me to publish a Quality Account this year. Does that mean I don’t need to do one?
Publishing a Quality Account is a Department of Health requirement. It is set out in legislation, and cannot be changed by a PCT or SHA.
Question 1 considers in detail whether you need to produce a Quality Account.
Your commissioning PCT / SHA is also under legal requirements. They must check the draft Quality Account before publication and provide a written statement about its accuracy, which should be included in the Account when it is published.
4. What kind of services do Quality Accounts cover?
Quality Accounts do not need to be produced for primary care services and NHS Continuing Healthcare.
The definition of “primary care services” is set out in the NHS (Quality Accounts) Regulations 2010, which in turn refer back to the NHS Act 2006.
“Primary care services” are NHS services provided under a contract, agreement or arrangement made in relation to the following services:
- primary medical services
- general medical services
- general dental services
- primary dental services
- ophthalmic services
- pharmaceutical services
- additional pharmaceutical services
- local pharmaceutical services schemes
Or primary medical, dental or ophthalmic services provided by a PCT. The definition of “NHS Continuing Healthcare” was added to the 2010 Regulations in 2011.
“NHS Continuing Healthcare” means a package of care arranged and funded solely by the health service for a person aged 18 or over to meet physical or mental health needs which have arisen as a result of illness.
The continuation of these exemptions is under evaluation. In the meantime, organisations that provide primary care services or NHS Continuing Healthcare are encouraged to voluntarily produce a Quality Account about these services.
5. Does a voluntary and community sector provider have to produce a Quality Account on all the healthcare services they provide?
All providers of NHS services must produce a Quality Account in respect of those services, except for small providers, primary care services and NHS Continuing Healthcare (considered in questions 1 and 4 above). This requirement applies to all such providers, whether they operate in the voluntary and community sector or not.
Therefore, voluntary and community sector providers will need to publish a Quality Account this year if:
- they provide NHS services, i.e. services that are commissioned by a PCT or SHA apart from primary care services and NHS Continuing Healthcare (if the only NHS services they provide are primary care or NHS Continuing Healthcare, they will not need to publish a Quality Account); and
- they are not a small provider
6. What if my organisation provides a mix of services?
NHS and non-NHS services
Quality Accounts are about NHS services. If you provide a mix of NHS services and other services (e.g. social care services commissioned by a local authority):
- you are required to publish a Quality Account only about the quality of your NHS services;
- but if it is difficult to talk about the quality of your NHS services in isolation from your other services, your Quality Account should instead show how you measure quality, involve stakeholders and strive for improvement across all of your services.
Primary care services / NHS Continuing Healthcare and other NHS services
You do not need to produce a Quality Account in relation to any primary care services or NHS Continuing Healthcare that you provide. If you provide a mix of these and other NHS services (e.g. NHS Continuing Healthcare as well as NHS acute services):
- your Quality Account does not need to include information about the quality of your primary care services or NHS Continuing Healthcare;
- but if it is difficult to talk about the quality of your NHS services in isolation from your primary care services or NHS Continuing Healthcare, your Quality Account should instead show how you measure quality, involve stakeholders and strive for improvement across all of your services.
Quality Accounts are about the services that you provided in the previous reporting period. If you provided NHS services in the reporting year, you should publish a Quality Account for that year reporting on the quality of these services.
However, as you will cease providing services from 1 April, your Quality Account for that year does not need to include priorities for future quality improvement. The provider taking over your community services should consider these when setting priorities in its own Quality Account for that year.
8. I’m a foundation trust. Do I have to produce a Quality Account if I am producing a Quality Report?
Yes. Monitor’s annual reporting guidance requires NHS foundation trusts to include a report on the quality of care they provide within their annual report.
The Health Act 2009 requires NHS foundation trusts to also publish a Quality Account each year, in the terms set out in the NHS (Quality Accounts) Regulations 2010. This Quality Account must be sent to the Secretary of State and uploaded onto NHS Choices.
Monitor’s annual reporting guidance for the Quality Report incorporates the requirements set out for Quality Accounts in the 2010 Regulations, as well as additional reporting requirements set by Monitor. This guidance is available from Monitor’s website.
An NHS foundation trust may therefore produce either:
- one account/report that satisfies both Monitor’s and the Department of Health’s requirements, for inclusion in their annual report and for uploading to NHS Choices; or
- one Quality Account and one Quality Report to satisfy each set of requirements, should they not wish Monitor’s additional reporting requirements to be included in their Quality Account.
9. I’ve become a foundation trust during the Quality Accounts reporting year. How do I report my Quality Account?
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 a NHS trust.
To help readers it may be helpful to include an explanation upfront in your report 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.
10. Does a provider have to provide a Quality Account per site or per organisation?
The duty to publish a Quality Account falls on a body or person providing NHS services. So multi-site organisations need only produce one Quality Account covering the quality of healthcare provided across the whole organisation.
In order to make an Account more meaningful to service users at a local level, it is suggested that large multi-site organisations provide site-specific data on the quality of healthcare services provided and ensure that their Account covers the quality of healthcare across all sites.
If a provider operates on a national or regional level, it is likely that the commentary given by the PCT, LINk and OSC would be critical of a failure to account for the spread of activities.
11. How do I know what the mandated statements look like?
The statements are clearly set out in Chapter 4 of the toolkit.
12. Can I change the format of the mandated statements to better suit the purposes of my organisation?
No. You should respond to the statements as they are written in the 2010 Quality Account Regulations (and described in the toolkit). The language needs to be common to allow a reader to read across different organisations’ Accounts. Where some statements might not be relevant to your organisation, an alternative statement is provided for you to include in your Quality Account.
If you feel that these statements do not provide a rounded picture of your organisation, you can clarify the information conveyed by adding an additional comment in part 1 or 2. If the size of this additional content is likely to disrupt the flow of parts 1 or 2, then you should make use of part 3 to expand upon your story.
13. In which sections of the Quality Account do I report on my future priorities and report back on progress towards the previous year’s priorities?
A description of future areas for improvement and achievements against the previous year’s priorities should be included in Part 2. Part 3 (the locally decided review of quality performance) can also look back to historic performance to highlight trends.
14. For the statements that report on the actions following national and local audits, do I have to describe in the response every action the provider intends to do following a review of the audit?
The Regulations require providers to complete the following 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].”
Where it is not practical to list all the actions a provider intends to take following a review of an audit then it is acceptable to provide a brief summary of all the actions, highlighting those of greatest importance, and preferably including a link to where further information can be found.
15. Where can I find out which national clinical audits are for inclusion in Quality Accounts?
We provide a list of national clinical audits.
16. Where can I find the data for the mandatory indicators you will be introducing for Quality Accounts from 2012/13?
A summary of the mandatory indicators planned to be introduced from 2012/13 can be found in the annex of the letter sent to providers in February 2012.
The annex of the letter also gives the known source of the published data for each indicator, correct at the time of writing.
17. How do I publish my Quality Account?
Information about publishing your Quality Account is set out in Chapter 8 of the toolkit.
18. Which organisations can upload their Quality Account to their NHS Choices page?
All acute, mental health and ambulance trusts can upload their Quality Account to their profile page on NHS Choices. Please contact the NHS Choices helpdesk if you have any difficulty uploading your Quality Account: firstname.lastname@example.org.
19. If I have not got access to upload my Quality Account to NHS Choices what should I do?
Please send your Quality Account in a PDF format and an explanation that you cannot upload to NHS Choices to: email@example.com.
Your Quality Account will then be uploaded to the Quality Accounts page on NHS Choices.
20. Do I have to print off hard copies of my Quality Account? There is no mention of this in the Regulations for Quality Accounts.
The Health Act 2009 requires you to make available hard copies of the Quality Account (for the last two years) if requested. You should also put up a notice in your premises saying where people can obtain copies.
21. Where can I find my local hospital’s Quality Account?
Providers must publish their Quality Account electronically on the NHS Choices website.
Most providers also publish their Quality Account on their own website, although this is not a legal requirement.
22. I provide NHS services across a large area. Which commissioner / LINk / OSC should I send my Quality Account to?
The NHS (Quality Accounts) Regulations 2010 set out which commissioner / LINk / OSC you should sent your Quality Account to.
If you are a PCT, you should send your Quality Account to the SHA for the area in which you are established.
If your services are commissioned by an SHA but no PCTs, you should send your Quality Account to that SHA. If your services are commissioned by more than one SHA, but still no PCTs, you should send your Quality Account to the SHA responsible for the largest number of patients that you have provided NHS services to during the reporting period.
If your services are commissioned by a PCT, you should send your Quality Account to that PCT or, if there are more than one, the lead PCT that co-ordinates the others.
If there is more than one lead PCT, you should send your Quality Account to either the lead PCT that is:
- established in the SHA region where you are located; and
- responsible for the largest number of patients that you have provided NHS services to during the reporting period
Or if there is no lead PCT in the SHA region where you are located, the lead PCT that is responsible for the largest number of patients that you have provided NHS services to during the reporting period.
If there is no lead PCT, you should send your Quality Account to the PCT that is responsible for the largest number of patients that you have provided NHS services to during the reporting period.
You should send your Quality Account to the LINk in the local authority area where you have your registered or principal office.
You should send your Quality Account to the OSC in the local authority where you have your registered or principal office.
23. Why is a provider’s Quality Account only being sent to the LINk in which the provider’s principal office is located? Not all the provider’s service users will be represented by that one LINk.
Quality Accounts support local LINks to discuss NHS healthcare matters together and provides the opportunity for healthcare providers to engage with stakeholders representing their patients and service users.
The NHS (Quality Accounts) Regulations 2010 sets out the legal requirement to send Quality Accounts to one LINk only.
This is a minimum requirement aimed at reducing the administrative burden on providers. Providers and LINks are free to do more, and we would encourage them to do so - especially national and/or multi-site organisations.
24. Does a LINk or OSC have to supply a statement for every Quality Account it is sent?
No. LINks and OSCs voluntarily provide assurance of a provider’s Quality Account. Depending on their capacity, a LINk or OSC may decide to prioritise and comment on those providers where members and the service users they represent have a particular interest.
It would be helpful for LINks and OSCs to let providers know as soon as possible if they do not intend to supply a statement, so that this does not hold up the Account’s publication.
25. In February 2012 you announced that Quality Accounts should be externally audited - who does this apply to?
From 2011/12, NHS acute and mental health trusts will need to have their Quality Accounts externally audited.
Monitor already requires NHS foundation trusts to have their Quality Accounts audited.
Organisations that are not NHS acute or mental health trusts or NHS foundation trusts will not have to do this.
The toolkit will be updated as needed, which might not be every year. A link to the latest toolkit will be on the Quality Accounts page.