1. Annual Quality Statements
08 January 2014
Annual Quality Statements
A perspective from 2013 Structured Assessment work
PLEASE PRINT HANDOUTS IN BLACK AND WHITE
Carol Moseley

2. Content Background to: Structured Assessment 2013; and review of AQS’
What did we look at?
What did we find?
drafting
contents
Improvement suggestions for Year 2
Annual Quality Statements 2013

3. Background: Structured Assessment
Structured Assessment work has formed part of the Wales Audit Office annual audit programme at Welsh NHS bodies since 2010
The work examines the arrangements NHS bodies have in place to support good governance and the efficient, effective and economical use of resources
In 2013, our Structured Assessment approach included:
a specific focus on quality governance arrangements; and
a high level review of Annual Quality Statements
Annual Quality Statements 2013

4. Background: review of Annual Quality Statements
In reviewing the Annual Quality Statements:
We accounted for Welsh Government guidance/requirements; and
what we might expect to see in an annual quality statement
The work provided a general overview; it was not a compliance audit
We did not report on the Annual Quality Statements in detail as part of our local work, but have provided suggestions for improvement where applicable
it was not a compliance audit, but used to compare with our findings and overall view of the quality governance arrangements and quality processes
Annual Quality Statements 2013

5. What did we look at? Auditors broadly looked at: Use of the summary
Description of:
the overall quality framework;
quality performance;
quality and safety risk management
quality improvement initiatives & actions
Internal review and publishing
Accessibility – style, language
Balance
What did we look at: AQS review criteria
Quality Statement Summary: Includes a summary which
Highlights the organisational commitment to quality and key points from the body of the statement
Sets out how the NHS body is working with partners to ensure good quality, effective and safe services
demonstrates a culture of candour and transparency recognising both strength and weakness.
Overall Quality Framework:
Quality and Safety and sub-Committee Structure
Quality and Safety Committee and sub-committee attendance records
Coverage of the Quality and Safety Committee's work
How the Board receives assurance via the quality framework
Quality performance:
Information on complaints, Concerns, Incidents and Whistle blowing
Information on Redress, Putting things right
Self-assessment of quality of services
Self-assessment of effectiveness of quality framework
Information on access to services
Information on patient outcomes
Information on patient experience
Quality and Safety Committee and Sub-committee Reporting:
Highlights of Quality and Safety Ctte reports
Highlights of External Reviews (HIW, DSU etc.)
Highlights of clinical audit reports and conclusions
Highlights of Welsh Risk Pool reports
Doing Well Doing Better: Promotes use of standards for service review, share good practice, identify current effectiveness and improvement aims with a focus on Standards 3, 6, 7, 22 and 23.
1000 Lives: Engages with 1000 lives programme & promotes improvement
Quality and Safety Risk Management:
Risk assessment & risk profile
How risks to quality and safety are managed
Any newly identified risks or high risks
Internal review and publishing
Internal audit review:
Ensuring consistency with audit knowledge
Ensuring a fair and balanced view is presented
Ensuring internal controls are in place over the collection, calculation and reporting of measure and indicators
Publishing requirements:
AQS is formally signed off by Executive
The AQS has been published by 30 September 2013
Annual Quality Statements 2013

6. What we thought about drafting and publication of Annual Quality Statements
Published by required timeframe
Reviewed by internal audit in advance
Significant variation in format, style and length
Some quite technical and not ‘public’ facing
too many acronyms and NHS jargon
Variation in how promoted/communicated to the public/ stakeholders
AQS’s ranged from 34 pages to 102 pages. Shorter statements were more readable and publically accessible, but lacked detail – longer statements had good detail, but were not, in general as accessible to the lay public. Is there a happy medium? Could separate summaries help?
Annual Quality Statements 2013

7. Overall view of the contents of the Annual Quality Statements
Most organisations are effectively describing their environment, identifying their strengths, quality improvement initiatives and providing some quality performance information
Organisations were reasonably effective at providing an overview of quality arrangements for their locally provided services
Most organisations were not good at identifying their quality objectives, targets and their key risks to the quality of services.
Most Health Boards were not effective at defining its quality oversight and control arrangements for services commissioned from partners
Annual Quality Statements 2013

8. Our thoughts on areas for improvement for year 2 (i)
Start to embed the quality assurance / statement process in your organisation’s directorates and localities
Develop the Annual Quality Statement as part of the on-going quality assurance framework. Make it live - not a year end exercise
Make sure the lay-reader could understand it: does it pass the plain language test?
Include consideration of the quality assurance approaches for commissioned services
For example the North Locality in Powys has produced a locality annual quality statement, which sets local context, quality arrangements and expectations for achievement of quality services for the locality. This type of approach would make drafting the corporate AQS very easy, if adopted and embedded across organisations.
Annual Quality Statements 2013

9. Our thoughts on areas for improvement for year 2 (ii)
Candour and openness:
we saw differences in the degree of candour this year, in describing the quality of services, the risks and actions being taken to improve
Set quality objectives and targets which are ambitious and realistic
use the AQS to help drive quality improvements
Better balance of detail, length and readability
if detailed, consider an accompanying Quality Statement Summary that highlights the key points for the public
Include highlights and messages from external regulators
every organisation has difficulty at some point
the AQS should provide an honest and fair view of the quality of services, the risks and actions being taken to improve
C&V introduction was notably honest
Annual Quality Statements 2013

10. Questions?
Annual Quality Statements 2013