Serving skate: achievements and challenges for clinical audit Nick Black Chair National Clinical Audit Advisory Group 27 April 2010

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

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

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

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

Quality Accounts June 2010: accounting for 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

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

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

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

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)

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

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