Improving the national clinical audit programme

2 November 2011

HQIP outlines strategy to improve the national clinical audit programme

Starting this month (November 2011), with support from the Department of Health, HQIP is starting a rolling programme of improvement of aspects of the national audit programme.

The purpose of this work is to act on some areas of key government policy (such as in relation to transparency of data and openness of dissemination of findings) and to improve the functionality of the programme and related activity such as Quality Accounts (QA).

This strategy has also been created to address some issues with the effectiveness of some of the national audits and act on feedback received from local stakeholders. This has been under discussion for some months, and our recent conference for local audit staff was useful in confirming some of the detail of what we needed to do.

The key elements are:

I.       Agreeing consensus in key principles in national audit

II.       New process for agreeing inclusion of national audits in the QA list

III.       Transparency and reporting

IV.       Review of quality of existing funded audits

V.       A feedback system for national audits

I.       Agreeing consensus in key principles in national audit

The creation of a document which sets out essential criteria and principles for national clinical audits. This will have multiple purposes, but it will help inform commissioning decisions, help those designing audits, and set out key aspects HQIP expects to see in any audit project, including governance, purpose, methodology, relationship to other data, transparency, action to drive change, and measurement of outcomes. It will resemble, and draw from but extend beyond, a similar document produced in Australia and available here.   

HQIP will consult extensively on the draft document with a wide range of stakeholders, both at national and local level. The new document will be complete by April 2012.

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II.       A new process for agreeing inclusion of national audits in the Quality Accounts list

HQIP will supervise a new consultative process to agree a final list of audits to be included in the quality accounts reporting. This will involve obtaining the views of local and national stakeholders and be completed in adequate time for preparation in relation to participation and reporting at local level. This will start very soon.

The Department listened to concerns raised about the current list, and emphasise that Quality Accounts don't mandate participation in particular clinical audits, only that providers describe which audits they have participated in.  This is in order to: 1) alert providers to NCAs that they can participate in, 2) support the description of which audits providers have participated in and 3) provide comparability between each provider's Quality Account.  Overall, this approach has worked very well in the two previous years. HQIP will be consulting with stakeholders with the aim of producing a list of NCAs whose quality/usefulness has been assessed, to aid providers in deciding which NCAs to participate in.

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III.       Transparency and reporting

HQIP will make an agreement with every funded audit, a plan for when they will publish their data at the appropriate level of granularity for their audit. This will be complete by April 2012. In nearly all cases this will be to report at a default level of the Trust/hospital, as soon as possible;  but for audits which can work towards an even more detailed level of reporting, we will seek to agree a plan for how this can be worked towards over time, where this is appropriate, protects patient confidentiality and is adequately supported by the data.

HQIP will also increasingly expect to see the production of audit findings in a manner easily understood by the general public, with an expectation of a patient appropriate version of their annual reporting, with guidance on how to do this.

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IV.       Review of quality of existing funded audits

From April 2012 HQIP will be commencing a more detailed, ongoing process of independent review of audits before they are renewed. HQIP will also be reviewing each audit with the NIGB to ensure there is full compliance with their expectations and making changes as necessary.

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V.       A feedback system for national audits

HQIP will, before the end of 2011, be rolling out a new system for obtaining feedback on existing national audits, which will involve gathering stakeholder views on a regular basis. This will incorporate findings from work being led by the National Audit and Governance Group (NAGG). We will also expect all national audits to carry out request for feedback from key stakeholders as part of their work, and report to HQIP on how they have addressed the findings. All feedback will be used to help improve the functionality and output of these projects.

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