Q2 2011-12: Report on the activity of HQIP

Report on the activity of HQIP, July to September 2011

Headlines:

1.     National Clinical Audit

This work involves commissioning and contract managing large programmes of national audit and confidential enquiries, known as CORP

1.1   We monitor the progress of all the audits we commission as part of their contract management. This includes reviewing audits coming up to the end of their funding and where an agreed plan is in place to change the contract in some way. This currently includes  streamlining of four specific projects, on stroke and falls and hip fracture, into two combined audits. This contract work includes monitoring methodology, governance and information management, offering help and suggestions.

1.2   We have completed a process of selection of topics for national audits which will be invited for tender from providers, after having taken advice from the Department's advisory group, NCAAG. The various approved audits have been prioritised with DH for roll-out of the process of procurement. We have written to all topic proposers to let them know whether the topic has been successful or not. We are offering feedback to those who ask for it - we know this is welcome. Once DH confirmation has been received we will communicate the list publicly. The process of starting the writing of specifications for the first group, with input from relevant specialists, is underway.

1.4   We await the DH announcement of the go-ahead re subscription by trusts to provide payment for national audit and are prepared for this to start with additional staff time to prepare the approach to Trusts. This will include consideration of how to ensure capacity on clinical audit within their organisation is maintained, as well as other concerns.

1.5   We have taken on a further procurement officer and an additional contracts officer. One contracts officer has left.

1.6  We have agreed a format or template for the appraisal of existing audits by HQIP and NCAAG for continued funding. This will be used to assess projects before re-funding decisions are made.

1.6   The index of participation by local trusts in national audits (PAR-CAR) is live on our site and has been updated and continues to be extended gradually to cover all of the national audits. We are working on plans to make the list searchable.

1.7   We of course continue to run a very large clinical audit, the NJR, which on a daily basis enables us to experience all the issues of methodological improvement, data linkage, information governance, patient involvement and feedback, communication of results and liaison with professional bodies that all audits experience, which informs the way we handle their contracts. It is currently undertaking a large amount of work on data quality, alongside other areas identified by a recent refresh of its strategic plan, which has been instigated by the new chair of the steering group, Laurel Powers-Freeling.

1.8   We are continuing our rolling survey of each national audit in the NCAPOP programme, via meetings with their clinical leads, to determine their needs for support and where their major issues lie from their persepctive.

1.9   For information: We have taken over the management of the CORP - the Clinical Outcomes Review Programme - from the National Patient Safety Organisation, the NPSA, on September 1st and will shortly be producing the specification for the combined Maternal, perinatal and infant deaths review. We are setting up advisory groups for each of the four areas. This set of projects is UK wide.

1.10   We continue to work with each national audit contractor to ensure they are compliant with governmental requirements re transparency of data. This will involve developing a statement of by when each audit will be reporting its results down to local trust level, or in the case of surgical audits, potentially below this to individual surgeon level. This involves considerable work and is an ongoing piece of work as much will need to be done before this can be achieved in meaningful form.

1.11 We work closely with the Department of Health at all times to refine and advance the programme. We are looking with them at how quality in national audit can be assessed and improved. We have supported them in their work on the mandation of national audit for secondary care.

1.12   For information: We advise the Welsh Assembly government on its involvement in national audit and how it can improve Welsh participation and use of the programme, and in turn how the programme can be made responsive to Welsh interests.

1.13  For information: We offer advice to the Scottish and Northern Ireland governments regarding participation in these audits, and manage their funding and participation in selected audits.

1.14 We are preparing a national conference on transparency for next spring for national audit providers, and also a series of seminars on methodological and other interests.

1.15 We are developing guidance to providers on information governance, including release, and to local providers who supply data, to improve understanding of how data will be shared and used. This will include an update of our template for national audit reports.

1.16   With separate departmental funding, we contract manage work on Asthma related deaths and provide advice re. the commissioning of the Burns database.

1.17  We provide funding nd contract manage a programme of multi-site audit.

1.18  Our advice and information and resources are available to all those who run national audits, not just the audits we fund. We work with the Department and WAG to determine how these other audits can be integrated into a mandated programme for national audit.

1.19  We have agreed a data sharing protocol with the Care Quality Commission.

2.  Cross cutting work on clinical audit

2.1   Clinicians: We will shortly be placing a detailed mapping of specialist bodies, from colleges down to faculties and societies with their interests in audit included, on our website. We are engaging with these bodies to promote their greater involvement in audit. This includes advising them how to develop national audits with a view to improving the size and quality of the UK market of providers in audit. We also continue to provide material about audit in revalidation and appraisal.

2.2   As part of our audit education programme the set of standards and curricula guidelines for education about clinical audit for clinicians and audit specialists is out for wider consultation, with responses due back by the 23^rd September. We expect substantial revisions as there is a wide spread of views in the sector.

2.3  For educational resources we are inviting proposals for GP education products at the present time; other contracts are let to produce NED guidance and for Internal auditors; other educational products for junior clinicians and audit specialist are now live.

2.4   Work continues on producing the integrated governance handbook through GGI, whose partners wrote the original clinical governance handbook whilst at DH; this has been delayed but will be complete in the autumn.

2.5       We have completed a thorough review of our resources, which will lead to some being deleted or fully rewritten, but the bulk is simply being updated. New guidance for GPs as commissioners will appear as part of the educational products above. Various new products will be commissioned, including a guide for medical or nursing directors on boards.

2.6  We continue to speak at events as required, notably on September 8^th at the Westminster Health Forum conference on quality in healthcare.                                                                           

3. Supporting Local Audit practice

3.1       We continue, as ever, to support local teams through advice, information, local networks and events. Items under 2 above relate to local practice. We support the national audit practitioners group. NAGG, the regional groups, and a new pilot regional clinicians group in the North East.

3.2       Much work is underway in organising our own national conference for local audit staff in October in Manchester at which Bruce Keogh will be the keynote speaker. We will be making our annual awards again this year. The event will also include a consultation for the Future Forum's work on information.

3.3       CAKE (audit benchmaking software) is now available and in use on our website.

3.4       We have run with, Healthcare Quality Quest, a fully booked out series of local seminars around the country on improving data quality in local audit. These have been very well received.

3.5       We are consulting, via our consultants the Social Care Association, on the formation of a possible professional body for those who work in audit/and or QI generally.

4. Other work

4.1  We continue to manage contracts, with funding from the Department, for congenital anomalies registers in England and a central analytical hub, provided through BINOCAR. We are developing new business plans for the continued funding of this network, including those other regional registers facing uncertain financial futures, for the Department.

4.2  We publish on our website and continue to refine and update a index of registers and clinical databases which do not provide audit functions. We have provided small development funding to a small group of registers

4.3   We continue to promote the role of audit in social care, partnering SCIE in this work, and working with the key policy groups, such as TLAP, to help drive this forward. We have engaged a consultant to consult on and write learning materials aimed at the sector.

4.4  We continue to explore the idea of other device registers.

4.5  We are exploring the possibility of work on audit in Europe and in developing countries.

4.6 We continue to explore other areas of activity in closely related areas of quality improvement.

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