1. NATIONAL CLINICAL AUDIT A VOLUNTARY SECTOR PERSPECTIVE National Diabetes Audit (NDA) Laura Fargher Diabetes UK

2. National Diabetes Audit and Diabetes UK Diabetes UK has been a key partner in the National Diabetes Audit (NDA) since it started in 2003 2010-11 – HSCIC, Diabetes UK and YHPHO won a tender to deliver the NDA 2011-14 (2016) First time NDA delivered collaboratively, with specific responsibilities assigned to each partner

3. National Diabetes Audit (NDA) Programme 2011-16 NDA covers 5 distinct areas of diabetes care, treatment and outcomes: 1.Core audit 2.Inpatient care of people with diabetes 3.Pregnancy and diabetes (commenced 2013) 4.Diabetes foot care (commenced 2014) 5.Diabetes patient experience (piloted 2013-14)

4. National Diabetes Audit (NDA) Programme 2011-16 Audit streamMethod of data collection Core AuditSemi-automated data extraction from GP practices and hospitals Inpatient auditSnapshot audit of all hospital beds occupied by person with diabetes. Largely paper based Pregnancy careContinuous data collection by all joint antenatal and diabetes teams. Electronic data submission Foot careContinuous data collection by all foot care services that treat foot ulcers. Electronic data submission

5. National Diabetes Audit (NDA) Diabetes UK’s role Manage governance – advisory groups and board Engagement around participation and using the audit data Develops information for patients and general public Led on patient experience survey Leads on quality improvement initiatives

6. National Diabetes Audit (NDA) Governance NDFA NaDIA NPID audit Core (inc pumps) Core (inc pumps) Partnership Board Responsibilities: Executive appraisal, strategic direction, audit promotion Chair: Diabetes UK Members: RCP, RCGP, RCPCH, PCDS, HSCIC, ABCD, CDC, RCN, PHE (NCVIN), HQIP, RCOG, NICE, Advisory Group Chairs, Executive Board members, people with diabetes, Executive Board members Partnership Board Responsibilities: Executive appraisal, strategic direction, audit promotion Chair: Diabetes UK Members: RCP, RCGP, RCPCH, PCDS, HSCIC, ABCD, CDC, RCN, PHE (NCVIN), HQIP, RCOG, NICE, Advisory Group Chairs, Executive Board members, people with diabetes, Executive Board members Diabetes UK Responsibilities: Clinical and patient engagement, audit governance and communications Diabetes UK Responsibilities: Clinical and patient engagement, audit governance and communications HSCIC Operational Team Responsibilities: Day to day management Functions: Informatics System development Financial and information governance Data collection Data quality assurance Reporting and dissemination HSCIC Operational Team Responsibilities: Day to day management Functions: Informatics System development Financial and information governance Data collection Data quality assurance Reporting and dissemination Executive Board Responsibilities: Executive decision making, contract delivery, clinical governance Chair: Specialist clinical lead Members: GP lead, HSCIC, Diabetes UK, PHE (NCVIN) Executive Board Responsibilities: Executive decision making, contract delivery, clinical governance Chair: Specialist clinical lead Members: GP lead, HSCIC, Diabetes UK, PHE (NCVIN) Advisory Groups – managed by Diabetes UK Responsibilities: audit advice and guidance (design, processes, outputs, communications), audit promotion Members: clinicians, people with diabetes, project team Advisory Groups – managed by Diabetes UK Responsibilities: audit advice and guidance (design, processes, outputs, communications), audit promotion Members: clinicians, people with diabetes, project team Methodology advisory group Responsibilities: advice on methodology and audit outputs Chair: PHE (NCVIN). Members: HSCIC, NDA clinical leads, Advisory Group chairs, methodology specialists Methodology advisory group Responsibilities: advice on methodology and audit outputs Chair: PHE (NCVIN). Members: HSCIC, NDA clinical leads, Advisory Group chairs, methodology specialists

7. How does Diabetes UK add value to National Diabetes Audit (NDA) ? Independent relationship with stakeholders Involvement of people with diabetes Critical friend Influence outputs to meet stakeholder needs Make links to other work around diabetes Diabetes – political and strategic insight

8. Benefits to Diabetes UK Opportunity to influence data collection, analysis and reporting at an early stage Strengthened stakeholder engagement/new relationships Ensure patient voice is heard and audit is grounded in real experience Credibility Funding

9. How does Diabetes UK use NDA data? Evidence for: o Campaigning o Influencing the NHS/service improvement o Media activity o Planning delivery – regions Resources: o Diabetes Watch Online Tool o State of the Nation report

10. NICE Clinical Guidelines diabetes care Every person over 12 years old with diabetes should receive the following nine healthcare checks at least once a year: HbA1c test to measure overall blood glucose control Blood pressure measurement Cholesterol test Eye screening (retinopathy) Foot examination – to check the skin, circulation and nerve supply of legs and feet Kidney function (blood creatinine) – a blood test to measure kidney function Urinary albumin– a urine test to for kidney problems Weight or BMI (body mass index) measurement Smoking review, including advice and support if you are a smoker

11. NDA 2012-2013 findings Care process recorded All patients in England and Wales Type 1Type 2 ALL care processes59.9%41.3% 61.9% HbA1c92.4%80.5% 93.8% Blood pressure95.3%88.8% 96.1% Cholesterol91.1%78% 92.5% Foot exam85.1%72.3% 86.7% Kidney function92.5%81% 93.7% Urinary albumin73.6%57.1% 75.4% Body mass index (BMI)90.7%84.1% 91.5% Smoking review86.1%79.8%86.8%

12. Diabetes UK 15 Healthcare Essentials Campaign

13. Diabetes UK campaigns

14. Diabetes UK Diabetes Watch Online Online tool to find out what care is like in your area

15. Diabetes UK Media activity

16. Patient ‘friendly’ reports

17. Patient Information Leaflets about Audit

18. How does national audit help? Participants in audit: examine levels of service compared to other areas Identify variations in health outcomes to make improvements as appropriate Inform service development and planning across whole systems of care Voluntary sector: Inform Influence Campaign Plan activity Based on quality, robust, benchmarked audit data.

19. Any questions? Laura.Fargher@diabetes.org.uk www.hscic.gov.uk/nda