1. Local Improvement following National Clinical Audit The View from a National Clinical Audit Provider – the Health & Social Care Information Centre

2. National Clinical Audits Majority funded by Department of Health Supported by Professional bodies Commissioned by the Healthcare Quality Improvement Partnership (previously by Healthcare Commission) and other organisations eg Special/National Commissioning Groups Partnership – IC, Royal Colleges, Professional bodies Measure the quality of care received by patients in England and Wales (and Scotland, Northern Ireland etc) Maturity of the audit –Reports start with data quality and move to reporting clinical performance Use of clinical audit outputs –Quality Accounts, CQC, national initiatives eg NAEDI (early detection of cancer), research requests, service reviews, transparency agenda, national training initiatives, NHS Choices, revalidation, NHS Outcomes Framework, commissioning services

3. Clinical Audit Support Unit –Diabetes –Kidney care –Heart / Cardiovascular disease –Hip fracture –Cancer –Dementia –Minor Surgery All subject to competitive tender Single largest provider of national clinical audit

4. Current Reports Annual reports (paper and/or electronic) case ascertainment and clinical outcomes at various levels – national, trust (LHB), PCT, clinical network etc Interim reports – data quality, findings to date, participation, case ascertainment – local and clinical network level Outlier reports (Bowel & OG cancer & MBR) to make local organisations aware of findings prior to publication Local Action Plans – follow up from annual report for local organisations to reflect on findings locally and agree action

5. Clinical Audit Support Unit – Annual Reports Eligible trusts submit data Data Quality - national picture requires good participation, case ascertainment and data completeness Analyse data, adjust for casemix, link to other national datasets for enriched picture of patient care Publish audit outcomes in Annual Reports Best practice Outliers Recommendations for service improvement Varied audience –Public and Patient Summaries

6. Producing Reports (annual) – the process The overriding aim of the reports is to provide national comparative information to assess clinical performance against agreed standards, both nationally & locally We can only publish what is submitted Timeliness vs. usefulness Different reporting platforms – data collection system, iView – transition to same platform across all audits Who do we send the report to/ notify ?

7. Barriers to delivering local data Legal –The data have to go to the people who are authorised to see it – e.g. via single sign on Small numbers –Cause two problems, potential disclosure of sensitive information and meaningless data due to large random fluctuation Balancing use with timeliness –including enough to be useful but not so much that it takes 12 months to publish them

8. How are organisations expected to use the reports Annual report –Discuss findings within the clinical team providing care –Identify if local service is acceptable –Agree action for change if needed (use of LAPs – cancer audits) –Re-audit locally or monitor with next annual report Outlier reports – check data entered & report back to HSCIC / professional body Data quality / completeness reports –Identify gaps in data & re-submit

9. National Bowel Cancer Audit - background The Audit is a collaboration between the Association of Coloproctology of Great Britain and Northern Ireland and the Health and Social Care Information Centre. The Clinical Effectiveness Unit of the Royal College of Surgeons are contracted to provide the analysis for the annual reports (2010, 2011 and 2012) Collects prospective data on patients diagnosed with bowel cancer Established to investigate whether the care received by bowel cancer patients is consistent with recommended practice and to identify areas where improvements can be made

10. National Bowel Cancer Audit – How we present audit outcomes Annual reports Potential outlier notification –30-day / 90-day post-operative mortality –Permanent stoma rates Local action plans –Recommendations from the AR –Suggest actions for trusts / cancer networks to achieve the recommendations On-line reports –Network and trust specific results

11. National Bowel Cancer Audit – How we target improvement in data quality Quarterly network reports –Participation –Case ascertainment –Data completeness Data quality reports –Data submission deadline –Highlight gaps in data quality Data extraction –Local picture

12. National Bowel Cancer Audit – impact of feedback reports 2006 Annual Report –Trust level outcomes anonymised –30% participation –56% case ascertainment –17% data completeness for risk adjustment 2012 Annual Report –Outcomes reported on trust identifiable basis –100% participation –87% case ascertainment –80% data completeness for risk adjustment Possible to determine the survival status at 30-days and 90- days of over 99.9% of patients who had major surgery

13. National Bowel Cancer Audit – improvements in data quality improve clinical outcomes reported –Characteristics of patients submitted to the Audit –Management of patients –Surgical and pathological outcomes of patients undergoing major surgery –Complications (return to theatre, failure to rescue, emergency readmissions) –Permanent stoma rates –Emergency admissions –Rates of laparoscopic surgery and its outcomes –Length of stay –Post operative mortality

14. Group Work Consider the current reports you receive: –What is good about them –What is bad about them –What could be done differently –What would you like to see that isn’t there