Clinical audit is critical for NHS 10 Year Plan

Published: 04 Jul 2025

The NHS 10 Year Health Plan for England was published this week, promising extensive reform and focusing on three ‘shifts’: prevention, community care, and technology. It is an ambitious strategy that asks a great deal of the health service, and crucially it acknowledges the important role that national clinical audit will play in its delivery. The Plan makes a strong case for a renewed focus on outcome measures and quality improvement, recognising that the NHS must make full use of the clinical audit and registry programmes already in place.

“There is a moral obligation to use the data that is already available, for the benefit of patients” Phil, NHS patient

As noted in the Plan, HQIP’s National Clinical Audit and Patient Outcomes Programme (NCAPOP)* will play a key role in ensuring that reform is grounded in evidence. The largest programme of its kind in the UK, it includes 44 national clinical audits and clinical outcome review programmes, covering a wide spectrum of conditions and services across the NHS. Managed independently, and trusted by patients and clinicians alike, these audits measure quality of care, providing a clear view of what is working well and where improvement is needed most. Data from this programme has been collected, analysed and published for decades, and supports clinical effectiveness, patient safety, equity in access, and outcomes for patients. Its impact is well evidenced, for example improving survival, identifying variation, supporting better use of NHS resources and informing clinical guidance (eg Epilepsy12 contributed to NICE guidance on the importance of timely specialist input for children with suspected epilepsy).

This NHS Plan emphasises transparency and accountability, including commitments to publish provider-level quality data, and expand the use of digital tools such as the NHS App. It outlines plans to enable patients to search for healthcare providers based on clinical outcomes, patient feedback and waiting times (pages 13-14). This is precisely the kind of data that HQIP already commissions. Our audits are structured, trusted, publicly available and co-designed with patients. Used by clinicians, regulators, commissioners and patient groups, they provide a robust foundation for the Plan’s ambitions. Their inclusion in this document reinforces this credibility, and underscores their value to the NHS in the future: “There are multiple audits and reviews of quality of care routinely carried out within the NHS in England…for example, 30 audits as part of the national clinical audit programme [and] 5 clinical outcome review programmes” (page 87).

“As healthcare becomes more data-driven, the NHS has a huge advantage” 10 Year Health Plan

Chris Gush, HQIP’s CEO, explains: “Audit data is one of the few constants across the system, cutting across organisational boundaries and clinical disciplines to track the impact of reforms.” In other words, clinical audit is uniquely placed to support improvements that will deliver maximum impact, and hold a mirror up to the system as it changes.

How will HQIP clinical audits support the 10 Year Plan?

By supporting “an NHS that is fit to face the future” (Prime Minister, Kier Starmer, 3rd July 2025) through the three ‘shifts’ set out in the Plan:

  1. From sickness to prevention

Audits can identify where avoidable harm occurs and where earlier intervention can reduce the need for crisis care. CVDPrevent, which focuses on the prevention of cardiovascular disease, has seen increases in interventions to reduce the risk of CVD eg 85% of people with, and 62% of high-risk patients without pre-existing, CVD are now prescribed lipid-lowering therapy. By highlighting both successes and areas needing improvement, it provides GPs, neighbourhood teams and commissioners with the information they need to act earlier, direct investment more intelligently, and design services around keeping people well. Equally important is the role that audits play in tackling health inequalities. Whether through neonatal mortality data revealing stark ethnic disparities, or stroke audits showing variation in access to post-acute rehabilitation, audit data makes inequality visible, measurable and actionable.

  1. From hospital to community

Audits follow the patient, not the building. By tracking care across the pathway, they generate evidence on where services could – and should – be delivered closer to home. For example, the National Respiratory Audit Programme (NRAP) has recently published a review of asthma and COPD care across both hospitals and the community recommending that patients should be offered alternatives to centre-based care where appropriate. These insights help local systems redesign care around the person, not the institution. Furthermore, patient voice is embedded in HQIP’s audit system, supporting the move towards personalised, community-based services that respond to what matters most to the individual.

  1. From analogue to digital

Audit data is already structured, standardised and linkable across settings. It works on the principle of ‘collect once, use multiple times’, and is well-placed to feed into the development of single patient records and real-time dashboards. HQIP’s audit data are already publicly available and they are linked to primary and secondary care data, hospital episodes, mortality statistics and disease-specific registries. This creates a unified view of care quality over time, which can be easily fed into platforms such as the NHS App and the broader ‘digital ecosystem’ that the Plan seeks to make more available to both patients and healthcare providers. For example, HQIP already publishes comparative provider-level outcomes for stroke, cancer, orthopaedics (we host the National Joint Registry) and many other specialties. These are exactly the kinds of metrics that will prove pivotal when delivering informed patient choice, to improve standards across the system.

So, it’s clear that the 10 Year Plan recognises the critical value of data in delivering reform, stating that ‘as healthcare becomes more data-driven, the NHS has a huge advantage’. Professor Danny Keenan, HQIP’s Medical Director and Associate Medical Director at Manchester University NHS Foundation Trust, agrees, providing a clinician’s point of view: “If we are to reduce variation, improve outcomes, and drive smarter investment in services, then the system needs high quality, trusted data.”

Given that the aim of the Plan is to “bring the state – and the people it serves – into a partnership” (Kier Starmer, 3rd July 2025), that partnership must be based on patient feedback. As such, the final word should go to an NHS patient, Phil, who volunteers with HQIP: “There is a moral obligation to use the data that is already available, for the benefit of patients”. We are heartened to know that the NHS is in agreement.

*Page 87 of the NHS 10 Year Plan: “There are multiple audits and reviews of quality of care routinely carried out within the NHS in England. These include, for example, 30 audits as part of the national clinical audit programme, 5 clinical outcome review programmes and the Getting it Right First Time programme.” Note that the National Clinical Audit and Patient Outcomes Programme (NCAPOP) includes ten audits that fall under one ‘umbrella’ cancer audit

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