King’s Fund finds quality accounts tension

In June last year, all acute and mental health trusts had to publish their first quality accounts, describing their services during 2009-10. The publication of quality accounts was a major commitment in the previous government’s next stage review, which has been reconfirmed by the coalition.

In a report published this week, the King’s Fund analysed accounts from 64 trusts. It concludes: “The overriding impression that this analysis gives is of variation and a lack of comparability. The quality accounts are extremely varied on almost all dimensions, from the number and choice of measures and how they are presented, to variation in coding quality and participation in national clinical audits and confidential enquiries, and variation in the extent of local involvement.”

It says accounts are “extremely varied in the number and choice of measures, statistical rigour, and format and quality of presentation” which “coupled with lack of benchmarking information, means it is not practically possible to differentiate quality of care between providers on the basis of their quality accounts”.

The report, How do Quality Accounts Measure Up? also says there is huge variation in trusts’ involvement of patients and public in the development of the accounts.

The King’s Fund says much of the variation is because the aims of quality accounts and the intended audience are too vague. In particular it says the “fundamental tension at the heart of quality accounts is between requiring content that enables comparability and allowing providers local flexibility in the information chosen”.

Report author and King’s Fund senior fellow Catherine Foot told HSJ the government should decide which purpose it wanted. “At the moment, quality accounts are falling between the two roles. It is not clear what they can or cannot give you.”

The report recommends the Department of Health review how useful accounts have been to different audiences, and how much they cost trusts to produce, and use that feedback to decide their future. It also proposes that “core quantitative measures of the quality” used in the accounts should be defined nationally, so they are more comparable.

The King’s Fund’s findings echo those from HSJ’s review of 50 quality accounts, which found many had left out vital elements such as past year’s performance, benchmarking information, and in some cases quantitative measures themselves.

The report follows news the DH has backed out of requiring GP practices to produce quality accounts next year. They will now only be “encouraged” to do so.