Serving skate achievements and challenges for clinical audit
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Serving skate: achievements and challenges for clinical audit. Nick Black Chair National Clinical Audit Advisory Group 27 April 2010. Quality Accounts. NSFs. Nursing & Midwifery Council. Medical Education England. NICE. Care Quality Commission. National Clinical Directors.

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Serving skate:achievements and challengesfor clinical audit

Nick Black


National Clinical Audit Advisory Group

27 April 2010

Quality Accounts


Nursing &



Medical Education



Care Quality





NHS Litigation


National Patient

Safety Agency

NHS Trusts

Royal Colleges

NHS Evidence

National Institute for

Innovation & Improvement





NHS Choices

NHS Commissioners

NHS Ombudsman

National Clinical

Assessment Service

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 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

  • 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

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

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