Using national clinical audit data to improve quality Nick Black Chair National Clinical Audit Advisory Group NNAP & NDAU Collaborators’ Meeting 21 January 2011

White Paper (July 2010) “…there will be a relentless focus on clinical outcomes. Success will be measured, not through bureaucratic process targets, but against results that really matter to patients…” David Cameron, Prime Minister

White Paper (July 2010) “The Department will extend national clinical audit to support clinicians across a much wider range of treatments and conditions…”

National clinical audit Clinical audit is the assessment of the process and/or the outcome of care. Its aim is to stimulate and support national and local quality improvement interventions and, through re-auditing, to assess the impact of such interventions.

Establish criteria Set standards Quality assessment Quality improvement interventions Stimulate quality improvement Quality assurance cycle National Clinical Audit

NCA portfolio in England ( ) 54 NCAs meet the three criteria – intention to achieve participation by all relevant providers in England – data collected on individual patients – provides comparisons of providers (eg Trusts) Funding – DH National Clinical Audit & Patient Outcomes Programme (NCAPOP) funds 27 – Variety of other funders: DH; charities; NHS Trusts; Special Health Authorities; NPSA

Clinical areaTotal number Peri & neo-natal2 Children7 Acute & emergency care8 Long term conditions8 Surgery/interventional procedures 8 Cardiovascular disease6 Renal disease4 Cancer3 Trauma3 Psychological conditions/treatments 3 Blood transfusion2 Clinical areas

Establish criteria Set standards Quality assessment Quality improvement interventions Education Regulation Revalidation Legislation Incentives Redesign Stimulate quality improvement Quality assurance cycle National Clinical Audit

Improving quality: how will it happen? Clinicians and managers: redesign services; education Patients/public: informed choice PCTs/GPCCs: commissioning; reimbursement (CQUIN; Best Practice Tariff) Royal Colleges/GMC: revalidation NHS Litigation Authority: risk management Care Quality Commission: regulation Trusts: public accountability (Quality Accounts) NHS Commissioning Board: performance management (NHS Outcomes Framework)

Current policies Expand the NCA portfolio Improve quality of NCAs Improve NCA output Public disclosure of information from NCAs Encourage use of NCA data for quality improvement

The future NCA for too long the poor cousin of research – Inadequate funding – Insufficient scientific rigour – Little professional esteem/status Opportunity to realise the potential NCAs can offer for driving quality improvement