Measure, Learn, Improve: Audit data and continuous learning in the NHS

15 Apr 2026

Across the NHS, clinicians and teams collaborate every day to provide safe, effective, and compassionate care. Drew Smith, HQIP Associate Director, argues that what turns this collective effort into a system that continuously learns and improves is not intention alone, but evidence…

Clinical audit and outcomes data provide that evidence. They allow us to see clearly how care is delivered, where variation exists, and what difference improvement efforts make over time. In short, successful learning and improvement are built on audit data, resulting in the most valuable of outcomes: improving and saving patients’ lives.

Interest in learning health systems is growing internationally as a means of solving problems and driving continuous improvement. In the UK, the Ten Year Plan for the NHS in England anticipates that “data will fuel continuous learning”. A learning health system is one in which data from routine care are systematically collected, analysed, and fed back to those delivering and planning services, creating a continuous cycle of learning and improvement. Audit and outcomes data sit at the heart of this cycle. They bring together high-quality, standardised data across organisations and care pathways to measure patient care against nationally-recognised standards.

What turns the NHS “into a system that continuously learns and improves is not intention alone, but evidence”

But at their best, audits do more than measure compliance with standards. They ask meaningful questions about quality: Are patients receiving the right care, at the right time, in the right place? Are outcomes improving, and are improvements experienced by everyone? Have changes to service delivery actually made a difference to what matters to patients?

Transparency is a critical mechanism through which audit data drive improvement. When data are fed back in a timely, accessible, and clinically credible way, they prompt reflection and dialogue. Teams can benchmark their performance, identify unwarranted variation, and learn from peers who are achieving better outcomes. Creating the conditions for curiosity and shared learning is as important as quality assurance.

Audit data also support improvement by enabling prioritisation. Health systems face constant pressure on time and resources. Robust outcomes data help leaders and clinicians focus improvement efforts where they will have the greatest impact for patients. They provide a basis for difficult decisions and help ensure that improvement activity is aligned with objective evidence rather than subjective assumptions.

“At their best, audits do more than measure compliance with standards; they ask meaningful questions about quality”

Importantly though, learning does not happen through data alone. It happens when data are interpreted in context and combined with clinical expertise, patient experience, and improvement capability. This is why projects commissioned by HQIP through the National Clinical Audit and Patient Outcomes Programme (NCAPOP), make quality improvement support available alongside measurement. Providing tools, case studies, and networks for shared learning helps translate insight into action and accelerates the pace of change.

For example, the National Audit of Care at the End of Life (NACEL) breaks the quality improvement journey down into six phases and signposts to resources at each stage. Alongside this, NACEL offers inspiration through an impact compendium and regular QI webinars.

Audit and outcomes data also play a vital role in addressing health inequalities. By disaggregating data by factors such as age, sex, ethnicity, deprivation, and geography, audits can reveal differences in access, treatment, and outcomes that might otherwise remain hidden. Making these differences visible is a necessary first step towards tackling them. A learning system is one that learns for all patients, not just the majority.

The pace of learning is another defining feature of a learning health system. NCAPOP audits are increasing the frequency with which data and quality improvement resources are made available, so clinical teams are able to test changes, see early signs of impact, and adapt more quickly.

“When we use audit and outcomes data wisely, we move closer to a health system that learns continuously”

Finally, audit and outcomes data help sustain improvement over time. One-off projects can deliver short-term gains, but without ongoing measurement it is difficult to know whether those gains have been sustained. Continuous audit provides a way to monitor progress, reinforce good practice, and adapt to new evidence or changing circumstances. To this end, many NCAPOP projects publish dashboards that track national and hospital performance over time, such as this dashboard on asthma in adults as part of the National Respiratory Audit Programme.

In the NHS, the ambition to become a learning health system is not abstract. It is rooted in the daily realities of care and the shared commitment to do better for patients. Audit and outcomes data give us the means to learn systematically from those realities. By investing in high-quality audits, focusing on meaningful outcomes, and supporting teams to use data well, we can create a virtuous cycle of measurement, learning, and improvement.

When we use audit and outcomes data wisely, we move closer to a health system that learns continuously – and one that delivers safer, more effective and more equitable care for everyone.