Local Improvement Following National Clinical Audit Bristol 4 th October, 2012

1. Local Improvement Following National Clinical Audit Bristol 4th October, 2012

2. Welcome • Housekeeping • Why are we here? • HQIP is committed to increasing the impact of national clinical audit (NCA) • How can you ensure that your participation in NCAs leads to improvements in the quality of local services? • Sharing ideas and good practice

3. Programme 10:00 Introduction – HQIP and the national perspective 10:30 Laying the Groundwork – policy and processes 11:00 Preparing for change – local example and group discussion 11:30 Refreshments 11:45 Breaking down the report – presentation and discussion 12:30 Lunch 13:15 Facilitating improvement 1 – effective action planning 14:15 Facilitating improvement 2 – change management 15:00 Refreshments 15:15 Case study – improvement in a local trust 15:45 HQIP NCA feedback mechanism – how can it help? 16:00 Workshop evaluation 16:10 Close

4. HQIP’s role • 2008 – To manage and improve the national Clinical Audit and Patient Outcomes Programme (NCAPOP). • The Department of Health decides which projects should be part of NCAPOP, on the recommendations of the National Advisory Group on Clinical Audit and Enquiries (NAGCAE). • HQIP implements the decisions, commissions the projects, and manages the contracts with the NCA providers. • The programme is expanding – 31 active projects, 9 more planned • 2013 - Decision making will move to the National Commissioning Board, management contract will be renewed.

5. HQIP’s role • HQIP also contract manages the National Joint Registry and the Clinical Outcomes Review Programme (CORP – previously National Confidential Enquiries) • What about non-NCAPOP NCAs? • HQIP has no direct control over projects outside the NCAPOP, but can advise and provide guidance • Wide variation in approach, methods and effectiveness • At present, no system of review or accreditation • Principles of Quality in National Clinical AuditHQIP 2012 http://hqip.org.uk/hqip-principles-of-quality-in-national-clinical-audit/

6. Why participate? • Quality in the new health system (Draft report) National Quality Board 2012 https://www.wp.dh.gov.uk/publications/files/2012/08/nqb-quality-draft.pdf • Measuring quality and using clinical audit data to drive improvement • Statutory and mandatory requirements for clinical audit http://hqip.org.uk/statutory-and-mandatory-requirements/ • NHS standard contract • Providers must participate in the NCAPOP audits which are relevant to the services they provide • and must implement all relevant recommendations of any appropriate clinical audit.

7. Why participate? • CQC Essential Standards • Outcome 16 - Healthcare providers must regularly assess and monitor the quality of the services provided. • They must use the findings from clinical and other audits, including those undertaken at a national level, and national service reviews to ensure that action is taken to protect people who use services from risks associated with unsafe care, treatment and support • CQC Quality and Risk Profiles • Used to monitor compliance with Essential Standards • Compiled from sources including NCA reports

8. Why participate? • Monitor • Current compliance framework: Foundation Trust Boards must certify that they have effective arrangements in place for the purpose of monitoring and continually improving the quality of healthcare provided to patients. • Consultation on the new provider licence (2013 onwards) • NHSLA • Risk management standard 2.1: All organisations must have an approved documented process for making sure that all clinical audits are undertaken, completed and reported on in a systematic manner.

9. Quality Accounts • Statutory obligation introduced by the Health Act 2009. • Act and regulations specify the format which must be used for clinical audit information. • Key content: • Number of national clinical audits and national confidential enquiries which the provider has participated in • Number of national and local clinical audit reports reviewed by trust board • Actions the provider intends to take to improve services • Clarity of reporting in the first year was ‘variable’, so Department of Health published the Quality Accounts Toolkit.

10. Quality Accounts • The toolkit introduced the Quality Accounts list • The list is compiled by NAGCAE, publicised by HQIP http://www.hqip.org.uk/national-clinical-audits-for-inclusion-in-quality-accounts/ • The list includes both NCAPOP and non-NCAPOP audits, and the HQIP resource provides information on data collection schedules and reporting. • No obligation to participate in listed projects – BUT ‘For each national audit or confidential enquiry that you are not currently participating in, you are encouraged to explain your reasons for not doing so’ • Changes for 2013/2014?

11. Summary • NCAs can lead to sustained improvements in local services • Trusts have contractual and statutory obligations to participate in NCAs, AND to report on what actions they take as a consequence • Patients, the public, commissioners, regulators and licensing authorities are all making increasing use of NCA results to make decisions about local services • How can you ensure that your participation in NCAs leads to improvements in the quality of local services?