Comparable quality accounts
Department of Health/the NHS Commissioning Board/regulators should ensure that provider organisations publish in their annual quality accounts information in a common form to enable comparisons to be made between organisations, to include a minimum of prescribed information about their compliance with fundamental and other standards, their proposals for the rectification of any non-compliance and statistics on mortality and other outcomes. Quality accounts should be required to contain the observations of commissioners, overview and scrutiny committees, and Local Healthwatch.
- Quality Accounts were mandated by section 8 of the Health Act 2009, with detailed requirements set out in the National Health Service (Quality Accounts) Regulations 2010 (SI 2010/279), in force from 1 April 2010. All NHS providers meeting prescribed thresholds must publish annual Quality Accounts by 30 June each year (Health Act 2009; NHS (Quality Accounts) Regulations 2010).
- Quality Accounts must contain prescribed information in a common form: Part 1 (a summary statement on service quality signed by the responsible person); Part 2 (prescribed quality metrics enabling comparison between organisations); and Part 3 (additional quality information). The NHS (Quality Accounts) (Amendment) Regulations 2017 added a requirement for trusts to report on patient deaths during the reporting period.
- Quality Accounts are required to include commentary from commissioners (now ICBs), local Healthwatch organisations, and overview and scrutiny committees, as Francis specifically recommended (NHS England, Quality Accounts Requirements).
- The common format prescribed by the regulations enables comparison between organisations, directly fulfilling Francis's call for information "in a common form to enable comparisons to be made."
How was this evidence gathered?
Response
Accepted
Response
AcceptedThe government published "Hard Truths: the Journey to Putting Patients First" (Cm 8777) on 19 November 2013, responding to all 290 recommendations of the Francis Report. This followed an initial response "Patients First and Foremost" in March 2013. Key reforms included a new Chief Inspector of Hospitals, strengthened Care Quality Commission inspection regime, a statutory duty of candour, and the fit and proper person test for NHS directors. Volume 2 (Cm 8754) contains the government's detailed responses to each of the 290 recommendations. See: https://assets.publishing.service.gov.uk/media/5a7cd486ed915d63cc65d167/34658_Cm_8777_Vol_1_accessible.pdf
Published Evidence
Published assessments of progress from inspectorates, select committees, official progress reports, and other sources. Source type badge indicates whether each assessment is independent or government self-reported.
NHS providers required to publish annual quality accounts under Health Act 2009 and NHS (Quality Accounts) Regulations 2010. Strengthened by Health and Social Care Act 2012. Published annually by 30 June. Includes mandatory quality indicators.
Summary Hospital-level Mortality Indicator (SHMI) published monthly as Accredited Official Statistics by NHS England. Provides standardised transparent methodology for comparing hospital mortality rates. Ratio of actual deaths within 30 days of discharge to expected deaths.
Penny Dash Review (commissioned May 2024) found significant failings at CQC. Health Secretary declared CQC "not fit for purpose". Key findings: one in five services never rated; inspection levels well below pre-pandemic levels; lack of specialist inspector expertise; 5,000 notification-of-concern backlog. CQC consulting on resetting its approach from October 2025.
Research published 2023 marking ten years since the Francis Report found mixed results. Structural and legislative changes largely delivered (duty of candour, FPPR, CQC overhaul, revalidation, Freedom to Speak Up Guardians). However, cultural change not fully embedded; understaffing, fear of speaking up, and poor complaint handling persist in parts of the NHS.
Clinical Commissioning Groups replaced by 42 Integrated Care Boards from 1 July 2022 under Health and Care Act 2022. ICBs have broader responsibilities for population health, bringing together NHS organisations, local authorities and partners. Implements some Francis recommendations on commissioning integration.
Government published "Culture Change in the NHS" (Cm 9009) reporting progress on all 290 recommendations. Key achievements: 19 hospitals placed in special measures; those trusts recruited 109 additional doctors and 1,805 additional nurses; 129 board-level changes made; excess avoidable deaths fell by 450 in less than a year.
New "Fundamental Standards" replaced previous CQC registration requirements from 7 November 2014. Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 introduced clearer minimum standards including: person-centred care (Reg 9), dignity (Reg 10), safe care (Reg 12), staffing (Reg 18), good governance (Reg 17), fit and proper persons (Reg 5), duty of candour (Reg 20).
CQC overhauled its inspection regime in response to Francis. Professor Sir Mike Richards appointed as first Chief Inspector of Hospitals (July 2013). New methodology based on five key questions (Safe, Effective, Caring, Responsive, Well-led) rolled out nationally October 2014. Four-tier ratings introduced (Outstanding/Good/Requires Improvement/Inadequate). Specialist expert-led inspection teams replaced generalist compliance model.
Government published "Hard Truths: The Journey to Putting Patients First" (Cm 8777) in two volumes. Vol 1 set out new actions; Vol 2 provided detailed response to each of the 290 recommendations. Approximately 204 of 290 recommendations were fully accepted.