The National Clinical Audit Programme

Anxiety and Depression

The National Clinical Audit of Anxiety & Depression will focus on improving care received by people during and after a period of inpatient treatment, including access and acceptability of services; waiting times and management between referral, assessment and treatment; access to services at times of crisis; employment support; training and supervision of therapists; and pharmacotherapy use.

Arthritis: Rheumatoid and early inflammatory

This audit ran until 2016 and after a short pause is currently being recommissioned by HQIP. It reported on the quality of care and patient outcomes for newly referred rheumatoid and inflammatory arthritis patients being cared for by NHS secondary care rheumatology outpatient services.

National Audit of Breast Cancer in Older Patients

The National Audit of Breast Cancer in Older Patients (NABCOP) will assess the processes of care and outcomes for women aged over 70 years. NABCOP’s results will help NHS breast cancer services in England and Wales to benchmark and improve the care delivered to these women. NABCOP is a new project that began in April 2016. It is run by the Association of Breast Surgery and the Clinical Effectiveness Unit at the Royal College of Surgeons of England. The clinical audit will focus on the patient pathway from diagnosis to the end of primary therapy, for women diagnosed with breast cancer from 2014 onwards.

Cancer: Head and neck cancer audit

The most common sites for head and neck cancer are the larynx (throat) and oral cavity (mouth). Head and neck cancer treatment requires a wide range of expertise, and treatment is usually discussed and agreed by multidisciplinary teams (MDTs). The aim of this audit is to produce meaningful results that act as a vehicle to improve delivery of care to patients.

Cancer: Bowel cancer audit

The bowel cancer programme audit is delivered jointly by the Royal College of Surgeons (RCS) Clinical Effectiveness Unit, NHS Digital, and the Association of Coloproctology of Great Britain and Ireland (ACPGBI). NHS Digital provides project management and technical infrastructure, while the ACPGBI provides clinical leadership and direction.

Cancer: Lung

The National Lung Cancer Audit (NLCA) was developed in response to the finding in the late 1990s that outcomes for lung cancer patients in the UK lagged behind those in other westernised countries, and varied considerably between organisations within the UK. The audit began collecting data nationally in 2005, and since then has become an exemplar of national cancer audit. In 2015 the Royal College of Physicians won the tender to run the audit for the next three-to-five years.

National Oesophago-gastric Cancer Audit

Oesophago-gastric (OG) cancer is the fifth most common cancer in the UK, affecting around 16,000 people each year. The audit collects prospective data on all adult patients diagnosed in England and Wales with either invasive epithelial cancer of the oesophagus, gastro-oesophageal junction (GOJ) or stomach, or HGD of the oesophagus.

Cancer: Prostate

Prostate cancer is the most common solid cancer in men with 40,000 new cases diagnosed each year in the UK and its incidence is increasing. The Royal College of Surgeons’ Clinical Effectiveness Unit (CEU) was awarded the contract for the audit, which started on the 1 April 2013, and is managed as a partnership between a team of clinical, cancer information and audit experts from the British Association of Urological Surgeons, the British Uro-oncology Group, the National Cancer Registration Service and CEU.

COPD: Chronic obstructive pulmonary disease

This audit programme brings together primary care, secondary care, and pulmonary rehabilitation, along with patient experience and pilot linkage. Its partnership approach with multidisciplinary, collaborative working aims to drive improvements in COPD patient care. The audit programme supports the Department of Health (DH) aim to improve the quality of services for people with COPD by measuring and reporting the delivery of care as defined by standards embedded in guidance.

National Audit of Dementia: Care in general hospitals

The National Audit of Dementia examines aspects of the care received by people with dementia in general hospitals in England and Wales. It is managed by the Royal College of Psychiatrists’ Centre for Quality Improvement. It builds upon two earlier rounds of the audit which ran between 2010-13 which were also managed by the Royal College of Psychiatrists.

Diabetes: Adult

Diabetes is a chronic condition affecting over two million people in England and Wales. It is caused by an inability to use or produce the hormone insulin and leads to a rise in blood glucose. The National Diabetes Audit is considered to be the largest annual clinical audit in the world, providing an infrastructure for the collation, analysis, benchmarking and feedback of local data across the NHS.

National Paediatric Diabetes Audit

Diabetes is a chronic condition affecting over two million people in England and Wales. It is caused by an inability to use or produce the hormone insulin and leads to a rise in blood glucose. This clinical audit aims to improve the care, outcomes and experiences of children and young people with all types of diabetes treated within NHS Paediatric Diabetes Units (PDU) until the age of 24 years.  

National Epilepsy 12 Audit

HQIP has recommissioned this audit which was awarded to the Royal College of Paediatrics and Child Health in 2017. The audit aims to enable improvement in the quality of and outcomes from care provision for children and young people with epilepsy or suspected epileptic seizures.

Emergency laparotomy

This audit of a high mortality (c 15%) emergency surgery specifically seeks to improve the key determinants of outcome which are all underpinned by professional standards such as those detailed by NCEPOD, the Department of Health and Royal College of Surgeons. It focusses on systematic pre-op prioritisation based on formal risk assessment, pre-op imaging and antibiotics, timely access to theatre and critical care and appropriate input from consultant surgeons and anaesthetists

Falls and fragility fractures (includes the Hip Fracture Database)

The Falls and Fragility Fracture Audit has been managed as a programme (FFFAP) designed to audit the care that patients with fragility fractures and inpatient falls receive in hospital and to facilitate quality improvement initiatives.

Heart: National Adult Cardiac Surgery Audit

Part of the National Cardiac Audit Programme (NCAP), the audit aims to reduce mortality and improve outcomes for patients undergoing adult cardiac surgery. It reports comparative data on all major heart operations carried out on NHS patients in the UK.

Heart: National Heart Rhythm Management Audit

Part of the National Cardiac Audit Programme (NCAP), the audit details clinical activity in the fields of: pacemakers; implantable defibrillators; and cardiac resynchronisation therapy. Implant rates and recent trends in these rates are presented for the UK as a whole (alongside other European nations), for the constituent nations in the UK, and for each Clinical Commissioning Group in England.

Heart: Congenital heart disease

Congenital heart disease refers to any defect of the heart present from birth. It includes structural defects, congenital arrhythmias (heart beats with an irregular or abnormal rhythm) and cardiomyopathies (abnormal heart muscles). At least eight in every 1,000 babies are born with a heart or circulatory malformation, although only a quarter to a third of these are detected by scans (antenatal ultrasound). Diagnosis and treatment of complex heart defects has greatly improved over the past few decades and almost all children who have heart malformations survive to adulthood. 

Heart: National Percutaneous Cardiac Interventions (PCI) Audit

Part of the National Cardiac Audit Programme (NCAP), the purpose of the audit is to stimulate quality improvement through the provision of comparative information on: the structure and activity of PCI services; the access to, appropriateness and quality of care against national standards; outcome for patients such as complications, adverse cardiac events and death/survival.

National Heart Failure Audit

Heart failure results in a large burden on the NHS, accounting for around one million inpatient bed-days – 2% of the NHS total – and 5% of all emergency hospital admissions. Part of the National Cardiac Audit Programme (NCAP), the audit aims to improve the quality and outcomes of care for patients with unscheduled admission to hospital with heart failure. It captures data on clinical indicators which have a proven link to improved outcomes, and encourages the increased use of clinically recommended diagnostic tools, disease modifying treatments and referral pathways.

Heart: Myocardial ischaemia national audit project

The Myocardial Ischaemia National Audit Project (MINAP) was established in 1999 in response to the national service framework (NSF) for coronary heart disease, to examine the quality of management of heart attacks (myocardial infarction) in hospitals in England and Wales. Part of the National Cardiac Audit Programme (NCAP), the audit aims to improve the quality of care and outcomes of patients who have heart attacks. It aims to improve the whole pathway from the call to the emergency services, to the prescription of preventive medications on discharge from hospital. The audit describes aspects (process measures) of the quality of care of hospitals and of ambulance trusts, and is based on analyses of data that have been directly submitted by the participating organisations.

HIV/STD

MEDFASH is working with Public Health England (PHE), the British Association for Sexual Health and HIV (BASHH) and the British HIV Association (BHIVA) to conduct a one-year feasibility project exploring and evaluating the design of a future national clinical audit of healthcare for HIV, chlamydia, gonorrhoea, and syphilis.

IBD: Inflammatory bowel disease

The Inflammatory Bowel Disease (IBD) Audit was commissioned in England and Wales between 2006 – 2017 as part of the centrally-funded National Clinical Audit and Patient Outcomes Programme (NCAPOP). It was managed by the Royal College of Physicians.

Intensive and special care: Neonatal

Approximately one in eight, or around 95,000 babies born each year in England, Scotland and Wales will be admitted to a Neonatal Unit (NNU) which specialises in looking after babies who are born too early, with a low birth weight or who have a medical condition requiring specialist treatment. Established in 2006 to assess whether babies admitted to neonatal units in England and Wales receive consistent and high quality care as measured by adherence to a set of agreed professional guidelines and standards. The audit aims to identify areas for quality improvement in NNUs in relation to the delivery and outcomes of care.

Paediatric Intensive Care Audit (PICANET)

PICANet was established in 2002 and aims to continually support the improvement of paediatric intensive care provision throughout the UK by providing detailed information on paediatric intensive care activity and outcomes. This audit collects personal, organisational and clinical data on all children with a clinically determined need for paediatric intensive care. It audits the quality of care delivered against the Paediatric Intensive Care Society (PICS) standards, which cover the whole patient pathway from the initial referral to paediatric intensive care, specialist transport and then inpatient care.

Joint replacement surgery: the National Joint Registry

Hip, knee, ankle, elbow and shoulder joint replacements are common and highly successful operations that bring many patients relief from pain and improved mobility. More than 200,000 of these joint replacement operations take place in the UK every year. The National Joint Registry (NJR) was set up by the Department of Health and Welsh Government in 2002 to collect information on joint replacement operations and to monitor the performance of implants, hospitals and surgeons. Northern Ireland joined in February 2013 and the Isle of Man in 2015.

Kidney: Chronic kidney disease (primary care)

The National Chronic Kidney Disease (CKD) Audit’s objectives are to improve the identification of CKD patients in primary care, improve the management and outcomes of CKD patients and tailor the care of people with CKD to local care pathways.

National Maternity and Perinatal Audit

Programme overview

Using timely, high quality data, the National Maternity and Perinatal Audit (NMPA) aims to improve the treatment of mothers and babies during their stay in a maternity unit by evaluating a range of care processes and outcomes in order to identify good practice and areas for improvement in the care of women and babies looked after by NHS maternity services. The audit will include information about all mothers who have a baby after 1 April 2014.

Ophthalmology

The NOD Audit will prospectively collect, collate and analyse a standardised, nationally agreed cataract surgery dataset from all centres providing NHS cataract surgery in England and Wales to update benchmark standards of care and provide a powerful quality improvement tool. In addition to cataract surgery, electronic ophthalmology feasibility audits will be undertaken for glaucoma, retinal detachment surgery and age related macular degeneration (AMD).

Psychosis

Schizophrenia affects almost 300,000 people in the UK. The National Clinical Audit of Psychosis audit will focus on key concerns about treatment of people with severe mental illness including: access to services; delivery of evidence-based pharmacological and psychological therapies; quality of physical health care; and social exclusion. It aims to increase the quality of care that NHS Mental Health Trusts in England and Health Boards in Wales provide to people with psychosis.

Stroke: Sentinel stroke national audit programme

This audit assesses the quality of the organisation and delivery of multi-disciplinary inpatient stroke health services in England, Wales and Northern Ireland. It audits the care provided for patients during and after they receive inpatient care following a stroke.

Specialist rehabilitation for patients with complex needs following major injury

The National Clinical Audit of Specialist Rehabilitation for Patients with Complex Needs Following Major Injury is conducted in partnership with the British Society of Rehabilitation Medicine (BSRM) and led by the UK Rehabilitation Outcomes Collaborative (UKROC), London North West Healthcare NHS Trust, the Trauma Audit and Research Network (TARN), Manchester University, and the Cicely Saunders Institute, King’s College London. It will provide a comparative assessment of services provided in this area in relation to specialist injuries caused by events such as road accidents and falls.

Vascular: National Vascular Registry

The National Vascular Registry audits the care provided by NHS vascular units in England and Wales, and reports on the process and outcomes of care for:

• Patients undergoing carotid endarterectomy
• Patients undergoing abdominal aortic aneurysm (AAA) repair
• Patients undergoing a revascularisation procedure (angioplasty/stent or bypass) or major amputation for lower limb peripheral arterial disease (PAD)

Feasibility Study of a National Clinical Audit for Venous Thromboembolism (VTE) prevention

Programme overview
The Feasibility Study of a National Clinical Audit for Venous Thromboembolism (VTE) Prevention. The study is to test both the feasibility and the likely impact, of an NCA by identifying:

  • what would be its specific improvement aims;
  • the patient group(s) and services that it should include;
  •  the quality indicators and outcome measures that would best support the improvement aims;
  • the methodology that would deliver its required outcomes most efficiently and effectively in terms of local burden and central costs; and 
  • the roles, groups and/ or professions who would need to be influenced to realise and drive any required change locally and their needs in terms of reporting and other outputs