Serving skate: achievements and challenges for clinical audit

1. Serving skate:achievements and challengesfor clinical audit Nick Black Chair National Clinical Audit Advisory Group 27 April 2010

2. Quality Accounts NSFs Nursing & Midwifery Council Medical Education England NICE Care Quality Commission National Clinical Directors NHS Litigation Authority National Patient Safety Agency NHS Trusts Royal Colleges NHS Evidence National Institute for Innovation & Improvement ACCEA General Medical Council NHS Choices NHS Commissioners NHS Ombudsman National Clinical Assessment Service

3. NHS Quality Framework • Dimensions of quality • Safety • Effectiveness • Experience (humanity) • Three stages of quality assurance • Establishing/defining good quality • Assessing quality • Improving quality

4. Our concern: the contribution of clinical audit • Need to strengthen position of clinical audit in new quality framework • Both local and national clinical audits need to be seen to be making essential contributions • Need for clarity as to the essential role of clinical audit in quality management

5. National Clinical Audit Advisory Group:recent areas of policy advice to DH • Quality Accounts: role of clinical audit • Reconciling data ownership, data use/access, intellectual property rights for national clinical audits • Long term funding of national clinical audits

6. Quality Accounts • June 2010: accounting for 2009-10 • National clinical audits • Participation by provider • Recruitment rate of eligible patients • Examples of actions taken to improve quality • Local clinical audits • Examples of actions taken to improve quality

7. Criteria for selection of national clinical audits in Quality Accounts • Coverage: intention to achieve participation by all relevant providers in England. • Data: collected on individual patients • Comparisons of providers (processes and/or outcomes) • Recruited patients during 2009-10

8. Data ownership, data use and intellectual property rights of DH-funded national clinical audits • Ensure availability of aggregated NCA data • CQC; revalidation; commissioners etc • Maintain continuity of NCA databases • Respect the intellectual property rights of NCA contractors • Ensure DH interests are respected • Protect privacy and rights of patients

9. Long-term funding for national clinical audits • Currently about 25 NCAs fully funded by DH through the NCAPOP (about £7m pa) • Role of NCAPOP to support establishment of new audits • Need to shift to alternative funding for most of the established NCAs • Subscription from providers and/or commissioners (cost included in tariff) • Other supplementary sources

10. Looking to the future • Shift to primary care focus for audits of long-term conditions • new adult national diabetes audit • Encompass social care • new audit of nutrition in elderly • Include patients’ views of outcomes • patient reported outcome measures (PROMs)

11. Coordination between national and local audit • Role of Foundation Programme doctors • Defining and managing outliers • Improve links between assessments of different dimensions of quality • safety • effectiveness • humanity

12. Concluding thoughts • Encourage diversity, stimulate innovation, minimise central control • Financial challenges ahead • need to make robust case for clinical audit to be seen as part of the solution not part of the problem • Cultivate support from politicians, DH, clinical professions and the public • Interest and expectations high • exciting time to be involved in clinical audit