How do quality accounts measure up?

Quality accounts were introduced into the NHS by the Health Act 2009. They are a new form of annual report to the public about the quality of services. They were introduced with the dual aim of increasing NHS accountability about the quality of services offered and to encourage Boards and senior managers to focus on quality improvement and state where they intended to make improvements. They remain a key part of making “quality the only organising principle of the NHS” – the current Secretary of State for Health stated vision for the NHS.

A Kings Fund analysis of findings from the first year makes interesting reading. NHS organisations collect lots (and lots and lots) of information about services and therefore they have to make choices about what information sources, services and specialities to include in their quality accounts. Most acute NHS Trusts, where kidney departments will be found, report on between 20 and 40 quality measures. The reports were generally strong on effectiveness, patient experience, safety, outcomes and achieved a balance between what’s going well and what needs to be improved. Few provided service level coverage and most reports were weak on staff feedback and measuring equality.

The majority of quality accounts cover healthcare associated infections, patient experience, delayed transfers, prescribing errors and complaints. All of these are relevant to kidney care but I wonder if Trusts are missing a trick by not providing details of individual specialities? This is not surprising given the wide range of services provided by our hospitals and the need to keep quality accounts to a readable length and format for a lay audience. However, this does highlight a key tension in quality accounts, between comprehensiveness of coverage of the range of service provided on the one hand, and length and complexity of the document on the other. But, if the collected data that form the report is to be useful information so that front line staff can gain greater knowledge and understanding of their particular service, be that orthopaedics or kidney care, then the service level detail is much more powerful than the aggregated data.
The Kings Fund comment that the views of staff are an important marker of an organisation’s managerial competence, workforce wellbeing and hence its ability to deliver high quality care. In short, the NHS is its staff. Kidney care healthcare professionals, commissioners of kidney care, local kidney patient associations and individual service users should make a point of looking at your hospital’s quality accounts and should be considering the questions – “so what does this mean for kidney services?”, “how can kidney teams be involved in quality initiatives across the whole pathway of care?” and, to paraphrase Kennedy, asking “what you can do to leverage quality accounts to drive local quality improvement”.