Month: September 2026

Finding the missing millions: Driving improvements in cardiovascular disease prevention

30 Sep 2026

In light of World Heart Day on 29 September 2026, we revisit the CVD Modern Service Framework, together with CVDPREVENT (National Audit of Cardiovascular Disease Prevention in Primary Care)

Following the publication of the Government’s Cardiovascular Disease (CVD) Modern Service Framework (MSF) in July 2026, CVDPREVENT (commissioned in part by HQIP*), reflects on how it supports the audit’s core aim of “finding the missing millions who don’t yet know they are at risk” (as their Clinical Lead, Dr Peter Green, puts it). In other words, how will the CVD Framework work in tandem with programmes like audits and the wider sector to prevent ‘heart disease’, and reduce related complications and deaths over the next decade? 

A single national ambition 

The Modern Service Framework has one main clear and measurable ambition: to reduce premature deaths from heart disease and stroke among people under 75 by 25% within ten years. To achieve this, it sets out a goal of reaching people who are most likely to experience heart attacks and strokes before these events occur. The Framework adopts a cardiovascular-kidney-metabolic (CVKM) approach, which recognises the close connection between cardiovascular disease, kidney disease and metabolic conditions such as diabetes. Rather than addressing these conditions separately, it seeks to improve prevention, diagnosis and treatment across the whole pathway. 

Aligning CVDPREVENT with the Framework’s priorities 

The MSF’s initial focus is on driving improvements in twelve priority areas over the next three years. Each priority has a baseline, a three-year target and a ten-year target. Such clear goals support clear metrics for CVDPREVENT, and so they are aligning their work to relevant priorities in the Framework. To enable ICBs and other healthcare planners to work toward one consistent set of national ambitions, CVDPREVENT is adopting the MSF’s ambitions where they supersede the audit’s previous targets. In the case of some priorities, their work is able to already evidence progress: 

Framework priority CVDPREVENT indicator 
Priority 3: SGLT2 inhibitors The new CVDP001VCVKM indicator supports monitoring of appropriate SGLT2 inhibitor use as part of a broader CVKM approach 
Priority 4: Hypertension treatment to target CVDP007HYP measures treatment to target among people with hypertension who do not have established cardiovascular disease 
Priority 5: Lipid optimisation CVDP008CHOL supports the assessment of lipid management among people without established CVD 
Priority 7: Blood pressure and cholesterol optimisation For people who already have cardiovascular disease, the framework will use: CVDP010HYP, a new hypertension indicator CVDP012CHOL, which measures cholesterol treatment to target 
Priority 8: Four-pillar therapy for heart failure The new CVDP004HF indicator supports monitoring of four-pillar therapy for people with heart failure with reduced ejection fraction, commonly known as HFrEF 

Case finding – identifying the missing millions 

The audit’s indicators also support the measurement of two further CVD MSF priority areas: smoking cessation (priority 1) and CVRM case-finding (priority 2). In relation to the latter, the scale of case-finding required is significant. CVDPREVENT’s data indicate that more than one million people across England have a recorded marker that may suggest undiagnosed hypertension, chronic kidney disease (CKD) or diabetes. In March 2026, 1.86% of the registered population (942,504 people) had a single blood pressure reading of 140/90mmHg or above but no GP-recorded hypertension. A further 0.39% had their last two eGFRs (measure of kidney function) below 60ml/min/1.73m², meeting the diagnostic criteria, but no GP record of CKD. Finally, 0.044% had their last two HbA1c records at 48mmol/mol or above, meeting the diagnostic criteria, but no GP record of diabetes. Over 1.1 million people remain in these potential missed diagnosis groups. Identifying these people is central to the ambition of “finding the missing millions”. Earlier diagnosis provides opportunities to manage risk factors before someone experiences a heart attack, stroke or other serious complication. Case-finding is therefore not simply about adding diagnoses to patient records. It is about connecting people to appropriate services, and saving and improving lives. Millions of lives, in fact. 

Data indicate that more than one million people across England have a recorded marker that may suggest undiagnosed hypertension, chronic kidney disease or diabetes 

Liz Corteville, Quality Improvement Lead at CVDPREVENT, adds: “What this scale tells us is that the opportunity to save lives is already sitting in GP records, right now. Our job at CVDPREVENT is to make that visible and actionable, through the Quality Improvement Data Packs, the Data & Improvement Tool and targeted educational outreach, so finding these million-plus people isn’t an abstract national ambition but something a practice or PCN can genuinely work through, quarter by quarter.” 

Making variation visible 

One of CVDPREVENT’s greatest strengths lies in making variation visible. As of March 2026, cholesterol treatment of patients with identified CVD target stood at 52.96% nationally, however achievement varied significantly by ethnicity (ranging from 40.8% in the Black ethnic group to 56.9% in the Asian ethnic group1). Insights like this enable ICBs, GP practices and other healthcare providers to target support, rather than treat CVD prevention uniformly.  

The audit’s insights are also extremely valuable in aligning resources with local need. For example, in Hampshire and the Isle of Wight, where CVDPREVENT data have been used to compare local performance with other areas of England, and target support accordingly. As a result, between March 2022 to September 2025, the ICB reported considerable improvements: 

  • Additional 55,000 people without established CVD being identified as being at high risk of developing it.
  • Additional 62,500 people being diagnosed with hypertension
  • Additional 70,000 people having their blood pressure treated to target
  • Additional 47,000 people at high risk of CVD starting lipid-lowering treatment 

Also, between June 2024 and September 2025, a further 5,000 people with known CVD had their cholesterol treated to target.

Looking forward  

The Modern Service Framework signals that further indicators aligned to CVDPREVENT’S work are likely to follow. As outlined above, the audit has already introduced new baseline indicators in the current reporting round, including measures relating to CVKM risk and heart failure. Over time, this should expand the programme’s treatment-to-target role from the priorities it already covers to fuller CVKM reporting.  

While CVDPREVENT will be the principal source of information on the Framework’s primary care priorities, it will not cover every aspect. Priorities concerned with acute hospital care and rehabilitation are likely to remain within the remit of other national audits, such as stroke. This reflects the broader value of the MSF: bringing together information from different parts of the health system around a shared set of outcomes and ambitions. This vision is consistent with the aspirations of wider national healthcare strategy. As the first Modern Service Framework to be published following the NHS 10 Year Health Plan, the CVD MSF’s importance extends beyond preventing, and improving care for, cardiovascular disease (acutely important though that is). Its publication, and subsequent delivery, offers a blueprint for improving treatment, and reducing premature deaths from, a spectrum of conditions, by aligning national strategy and targets with improvement initiatives, including national clinical audits. CVDPREVENT, whose reporting now feeds into the NHS Oversight Framework, is a forerunner of this approach. 

And, as for the “missing millions” living with undiagnosed hypertension, chronic kidney disease, diabetes or other cardiovascular risk factors? By combining clear strategic ambitions with robust national and local intelligence, we stand a much better chance of identifying who they are – and, importantly, saving and improving their lives. If the ambition of the Modern Service Framework is realised, they will no longer be missing; they will be found, supported and given the opportunity to live long and healthy lives. 

1 CVDPREVENT Data & Improvement Tool 

*About CVDPREVENT 

CVDPREVENT is commissioned by HQIP as part of the National Clinical Audit and Patient Outcomes Programme (NCAPOP), and delivered by NHS England, NHS Arden and Greater East Midlands Commissioning Support Unit (AGEM CSU) and the NHS Benchmarking Network (NHSBN), which leads the audit’s reporting and quality improvement workstream. It aims to support professionally-led quality improvement in primary care for the prevention of cardiovascular disease (CVD) in England, and has reported on a quarterly basis since data collection began in 2019/20.  

Further information 

CVD MSF

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NHS England Quality Accounts List 2027-28: Annual scoping survey

28 Sep 2026

Providers of national audits and quality improvement projects that would like to be considered for inclusion in the NHS England Quality Accounts List 2027-28 are invited to complete the scoping survey linked below by Tuesday 13 October 2026.

Please note that projects commissioned by HQIP as part of the NCAPOP do not need to complete a scoping survey.

Please complete the survey here: https://www.surveymonkey.com/r/J8DDKXG

Further information can be found on the HQIP webpage.

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21 Oct 2026

Benchmarking data published

Data relating to maternity and perinatal care has been published on HQIP's benchmarking site, NCAB.

HQIP launches procurement process for new national sepsis audit

28 Sep 2026

A new National Infection and Sepsis Audit in Acute Care will benchmark care, identify variation and support improvements for children and adults in acute NHS settings.

HQIP has launched the procurement process for a new national clinical audit focused on severe infection and sepsis in acute care. The National Infection and Sepsis Audit in Acute Care (NISA-Acute) will provide benchmarked data to help identify variation in care and drive improvement over time.

The audit will initially focus on the early stages of care, including recognition, escalation, investigation and treatment during approximately the first 72 hours. It will cover children and adults receiving NHS-funded care in acute hospital settings in England and Wales. Its development will align with NHS England’s Sepsis Modern Service Framework, the National Patient Safety Plan for NHS Wales and the UK Antimicrobial Resistance National Action Plan.

Once established, NISA-Acute is expected to provide regularly updated, publicly accessible performance results and an annual state-of-the-nation report. Patients, carers and the public will be involved throughout the audit’s design and delivery to help ensure its outputs support better care and outcomes.

Professor Ramani Moonesinghe, Deputy National Medical Director for NHS England, said: “Establishing a new national audit for sepsis is a key goal of the Sepsis Modern Service Framework, launched by NHS England in July. We are delighted to be working with HQIP to commission this important audit, which is expected to begin in April 2027.

Find out more: https://www.hqip.org.uk/tender/sepsis/

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Latest news: September 2026 eBulletin

24 Sep 2026

The September edition of HQIP’s eBulletin is out now! It features the latest news and updates relating to clinical audit, outcome reviews and data-informed healthcare improvement, including:

What’s new?

  • NHS England Quality Accounts List 2027-28: Annual scoping survey
  • World Patient Safety Day 26: New HQIP articles and case studies to support safer care delivery
  • Article: Skills passport for clinical audit professionals
  • Premarket engagement: National Emergency Laparotomy Audit
  • Tender: Infection and Sepsis Audit – Acute care settings (NISA-Acute)

Did you see?

  • Latest reports and data

In other news

  • NHS Productivity Commission report
  • Join HQIP at the HSJ Patient Safety Congress
  • NATCAN State of the Nation Reports 2026: A three-part webinar series

Read HQIP’s latest eBulletin here.

Don’t forget to sign up: Keep up to date with our latest news, events and work programmes by subscribing to our mailing list today. You can also follow us on: LinkedIn and X: @HQIP

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21 Oct 2026

Benchmarking data published

Data relating to maternity and perinatal care has been published on HQIP's benchmarking site, NCAB.

Health Foundation NHS Productivity Commission report calls for focus on outcomes

23 Sep 2026

A new report from the Health Foundation’s NHS Productivity Commission calls for a greater focus on outcomes and more effective use of data, to enable the NHS in England to “deliver high-quality patient care and remain on a sustainable footing.” As the organisation responsible for commissioning and managing the UK’s largest suite of national clinical audits and clinical outcome reviews, HQIP agrees. Our programmes, which are delivered on behalf of NHS England, the Welsh Government and others, are already providing much of the evidence needed to support this ambition. The report argues that productivity improvement must be “hardwired” into how the NHS in England operates. HQIP believes that systematic use of national clinical audit, registry and outcomes data should form part of that operating model.

To meet rising demand within its budget, [the NHS] cannot keep doing more of the same” Health Foundation NHS Productivity Commission report, 2026 

Breaking the cycle: how to build a more productive NHS stresses that “at its heart, productivity means achieving better health outcomes from the resources available”, stating that productivity shouldn’t be “viewed as a purely financial issue or through the narrow lens of technical efficiency”. Instead, the report is clear that “productivity is about creating a health system that consistently makes well-judged trade-offs to direct resources where they will have greatest impact on patient outcomes.”  

To achieve this, it argues that “systems, providers and boards should have more scope to use data to guide improvement”. This would put reliable healthcare data at the heart of productivity. The Commission highlights the NHS’s rich data as one of its major strengths, but identifies underinvestment in data, technology and improvement capability as a barrier to better performance. As such, it recommends stronger outcomes measurement, consistent recording of high-quality data and transparent reporting, as well as interoperable systems and greater analytical capacity at provider, system and regional levels.  

NHS provider organisations…should face stronger expectations to use data” Health Foundation NHS Productivity Commission report, 2026 

Clinical audits have an important contribution to make in the delivery of these recommendations. By measuring care against evidence-based standards, and comparing performance across organisations and populations, they show where resources are maximising outcomes and where variation, delays or gaps in care need to be addressed. National clinical audit and registry data (managed through HQIP’s programmes) should form a core part of the NHS’s approach to improving productivity, care and patient outcomes. They cover major pathways including cancer, mental health and maternity, and are developed with both clinicians and patients. HQIP’s CEO, Chris Gush explains: “They are an existing national asset for productivity, not an optional extra.” Although the report does not refer specifically to national clinical audit, its emphasis on outcomes measurement, benchmarking, high quality data and shared evaluation strongly reinforces this case, stating that the NHS’s “national data assets should make it one of the world’s leading environments for real-world evaluation.” 

Crucially, HQIP’s national programmes reduce the need for every organisation to build a new evidence base from scratch. Standardised data, national benchmarking, and established improvement resources help to avoid duplicated local analysis and repeated small-scale pilots. This supports the Commission’s call for shared learning, pooled expertise and reusable national infrastructure, rather than requiring individual organisations to solve common problems alone. 

In an era of tightening resources, data becomes a force multiplier, turning raw numbers into actionable insights” HQIP’s CEO, Chris Gush 

Of course, data will not improve productivity on its own. It must be translated into insights, combined with clinical leadership, and used to guide practical changes in care. Clinical audit provides the evidence needed to focus improvement where it will deliver the greatest benefit. It can reveal unwarranted variation, identify high-value practice, support safer and more efficient pathways, and show whether service redesign has achieved its intended results. Used well, it connects productivity with quality, ensuring that efficiencies are judged not by lower costs or higher activity, but by better outcomes and experiences for patients. 

The challenge now is to make systematic use of this data, that is already being collected by the NHS. Embedding national clinical audit and registry data within planning, commissioning and improvement will help healthcare providers to make more informed choices, use scarce resources more effectively, and spread successful practice faster. The Health Foundation’s report sets out the conditions for a more productive health service. HQIP’s programmes offer part of the practical infrastructure needed to deliver this; helping the NHS to turn data into insights, insights into action, and action into better care. Or, as HQIP’s CEO, Chris Gush, puts it: “In an era of tightening resources, data becomes a force multiplier, turning raw numbers into actionable insights.” This is not a call for more local data collection or reporting. It is a call to make better use of information already collected nationally, reduce duplication, and connect data more directly to decisions.

Read in full: Health Foundation NHS Productivity Commission report, Breaking the cycle, September 2026 

More about HQIP 

HQIP manages the UK’s largest suite of national clinical audits and clinical outcome reviews and hosts the National Joint Registry, the largest orthopaedic registry in the world, on behalf of NHS England, the Welsh Government and others.  

Resources from HQIP

Productivity Commission

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NHFD report finds hip fracture care shaped by where you live

21 Sep 2026

A patient’s chances of surviving a hip fracture can depend more on the hospital where they are treated than their age, sex, ethnicity or socioeconomic background, according to the latest National Hip Fracture Database (NHFD) report, published in September 2026 by HQIP. Focused on inequalities, the report also highlights a need for more universal provision of care to be provided by fracture liaison services, calling on hospitals and other parts of the healthcare system to work more closely together to prevent secondary hip fractures.

“We know what good care looks like. Every patient who breaks a hip should receive high-quality care regardless of where they live or which hospital they attend. Reducing unwarranted variation must remain a priority if we are to improve outcomes and prevent avoidable harm.” Dr Sunil Nedungayil, senior clinical lead for the Falls Fragility Fracture Audit Programme 

Each year, more than 72,000 people are treated in hospital for a hip fracture in England, Wales, Jersey and Northern Ireland. These patients occupy around one in 30 hospital beds, costing the NHS an estimated £1.1 billion annually, and social care a further £1.25 billion in the first 120 days after injury.  

The NHFD report sets out several key findings:  

  • A patient’s chances of surviving a hip fracture depend more on the hospital they attend than their socioeconomic background: Variation in 30-day mortality between hospitals was five times greater than the difference seen between the most and least deprived communities.
  • Delirium remains a major and preventable threat to recovery after hip fracture: Patients experiencing delirium are three times more likely to die in hospital and three times more likely to move into a care home after their injury – with hospital screening rates varying.
  • Thousands of hip fractures could potentially be prevented: Around a quarter of patients admitted with a hip fracture each year have previously suffered a fragility fracture, yet many were not receiving treatment to strengthen their bones and reduce the risk of further fractures. Nearly half of NHS trusts in England do not have a Fracture Liaison Service.
  • Patients with other fragility fractures are missing out on specialist care: Nearly all hospitals provide specialist geriatric assessment for hip fracture patients, but people with pelvic and other fragility fractures are significantly less likely to receive equivalent care.
  • People living in more deprived areas face a higher risk of hip fracture: Men in the least deprived communities are around half as likely to experience a hip fracture as those in the most deprived communities. The report states that more than 8,500 hip fractures among men could be avoided each year if this inequality in risk were reduced.
  • Waiting times for surgery have worsened since COVID-19: Average time to theatre increased from 33.6 hours in 2020 to 39.3 hours in 2025, reflecting ongoing pressures on NHS services. 

Previous work using NHFD data showed that ethnicity was not associated with significant differences in adjusted outcomes, although patients from ethnic minority backgrounds were less likely to be mobilised on the day after surgery, highlighting the importance of accessible patient information and family involvement in rehabilitation.  

This report makes four key recommendations for national commissioning bodies and other organisations planning healthcare: 

  • Mandatory monitoring of routine delirium screening using the 4AT (a brief bedside assessment tool used for the rapid initial detection of delirium and cognitive impairment in clinical settings), for all hip fracture patients.
  • Address variation in care for people with pelvic and other fragility fractures. 
  • Monthly clinical governance meetings in every hip fracture service to review outcomes, safety events and patient feedback. 
  • Universal provision of effective fracture liaison services to improve secondary fracture prevention. 

The NHFD collects data from hospitals across England, Wales, Jersey and Northern Ireland, to support improvements in the quality and outcomes of care for people who sustain hip fractures. It is delivered by the Royal College of Physicians (RCP) as part of the Falls and Fragility Fracture Audit Programme (FFFAP), and commissioned by HQIP on behalf of NHS England, the Welsh government and others. This report highlights the value of these programmes in improving healthcare and, ultimately, improving and saving lives. The data and outputs from this work are an invaluable, publicly available resource that shine a light on where improvements will have the maximum impact; supporting healthcare providers to implement changes that will improve care and outcomes for everyone. 

Read the report in full: Challenging inequities in hip fracture care  – HQIP 

Further information 

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World Patient Safety Day 2026: Using data to deliver safer care 

17 Sep 2026

17 September 2026 marks World Patient Safety Day, a global campaign led by the World Health Organisation to raise awareness of patient safety and promote action to reduce avoidable harm in healthcare. This year, the focus is on safe care for non-communicable diseases, highlighting the importance of delivering effective, coordinated, and evidence-based care for people living with long-term conditions.  

At HQIP, patient safety is at the heart of everything we do. Through the commissioning and oversight of national clinical audits, clinical outcome review programmes and registries, we help ensure that healthcare teams have access to robust data and evidence that can identify risks, reduce variation, support improvement, and ultimately improve outcomes for patients. As highlighted on our new patient safety insight hub, learning from audits and registries plays an essential role in helping healthcare services identify where harm may occur and take action to build safer systems of care.  

Insufficient use is made of the NHS’s data resources to generate insights and support improvement” Review of patient safety across the health and care landscape (July 2025)

Patient Safety resources from HQIP 

NEW Article – Spotlight on stroke: From data to safer care  

Stroke provides a powerful example of why improving the safety of care for non-communicable diseases matters. Earlier this month, HQIP published From data to safer care: The role of stroke audit in improving quality of care, in partnership with Patient Safety Learning, highlighting how the Sentinel Stroke National Audit Programme (SSNAP) uses national audit data to support safer, more effective stroke care.  

Stroke remains one of the leading causes of death and disability, with more than 92,000 people admitted to hospital with stroke between April 2024 and March 2025. Ensuring patients receive rapid assessment, timely treatment, and effective rehabilitation is critical, with delays often having significant consequences for outcomes and recovery. 

SSNAP demonstrates how national clinical audit can help address these challenges. By measuring care across the entire stroke pathway and benchmarking performance against evidence-based standards, the programme provides actionable insight that supports quality improvement and patient safety. Recent findings show improvements in access to timely brain imaging and increases in the use of life-saving treatments such as thrombolysis and thrombectomy, illustrating how data can help drive meaningful improvements in care.

Read the article

Clinical Audit Awareness Week: Patient Safety webinar recording and case study

During Clinical Audit Awareness Week 2026, patient safety was one of the campaign’s five featured themes – including a webinar that brought together expert speakers from across the healthcare system to explore how data can support safer care. The webinar recording and presentations remain available, providing a valuable opportunity to revisit the discussions and share learning more widely. 

The 2026 campaign week also showcased numerous examples of how audit can improve patient safety in practice via the Excellence in Clinical Audit Awards. For example, the runner-up of the Evidence into Practice category explored the impact of improved clozapine monitoring in medium secure services and demonstrated how audit findings can be translated into practical improvements that strengthen monitoring processes and support safer prescribing, reducing risk for patients receiving clozapine treatment.

Discover the case study

A dedicated resource for patient safety 

HQIP has recently launched a new patient safety section of our website, bringing together resources, articles, case studies, and examples from across our programmes in one easily accessible place.

Access these resources

Further resources from HQIP  

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Quality Improvement Week 2026: Quality data is the bedrock of robust QI

14 Sep 2026

As Quality Improvement Week (14-18 September 2026) begins, healthcare organisations across the country are coming together to share learning, celebrate success, and explore how evidence can be translated into better care for patients. 

We do audit because we believe that tomorrow can be better than today” Professor Henrietta Hughes OBE, Patient Safety Commissioner (Clinical Audit Awareness Week 2026) 

The week comes at a pivotal time for the NHS. The Government’s 10 Year Health Plan sets out an ambition for a health service that is more preventative, more community-based and more digitally enabled. Delivering those ambitions will require more than policy change alone. It will require a culture of robust continuous improvement. To achieve that, the healthcare sector will need high-quality data and insights that highlight what is working (and what is not), where variation exists, and where change will have maximum impact. 

The key role of national data 

Data from national clinical audits, clinical outcome reviews, and registries has a critical role to play in the transformation of our healthcare services. Evidence from HQIP’s programmes enables healthcare teams to understand performance, identify opportunities for improvement and ultimately achieve better outcomes for patients. As NHS services continue to evolve, ensuring that data is used not only for assurance, but also for learning and improvement, has never been more important. Indeed, there is growing recognition that its greatest value lies not simply in measuring performance, but in driving targeted improvement. 

Quality improvement resources from HQIP 

This week, we take the opportunity to share some of HQIP’s resources that are publicly available, to support QI in healthcare. In addition to reports and infographics from our programmes – which span a multitude of conditions – our website offers a range of resources, including guidance, case studies, benchmarking tools, and more. Find below some key resources that are relevant to QI Week. 

Article: Healthcare data – the key to improvement and efficiency 

HQIP’s Chair and former NHS England deputy Medical Director, Dame Celia Ingham Clark, features in BMJ Leader, sharing why clinical audit must play a key role in designing an NHS that is “Fit for the Future”: www.hqip.org.uk/news/bmj-leader-3dec25 

Benchmarking data to drive QI 

HQIP’s National Clinical Audit Benchmarking (NCAB) website provides an interactive visualisation of metric results from across our programmes, searchable by audit, topic, keyword and healthcare provider: www.hqip.org.uk/programmes-data/benchmarking 

NHS Best practice guide: Clinical audits and registries 

This guidance sets out a unified approach for commissioning and overseeing clinical audits and registries across the NHS in England and within the audit and registry community: www.england.nhs.uk/long-read/clinical-audits-registries-best-practice-guide 

Article: Integrating clinical audit and quality improvement to deliver impact for patients 

HQIP Associate Director, Dr Iain Smith discusses the subject of integrating clinical audit and quality improvement to deliver impact for patients: www.hqip.org.uk/news/bmjleader-ca-for-patient-impact 

Clinical Audit Awareness Week resources 

Designed to celebrate the critical role of clinical audit and data-driven healthcare improvement, the campaign explored how insight becomes action across five themed days, and generated a wealth of resources: www.hqip.org.uk/news-and-articles/clinical-audit-awareness-week-2026 

Find out more about QI Week 2026: QI Week | The Academy of Research and Improvement 

Further resources from HQIP 

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New improvement reports published

10 Sep 2026

We are pleased to announce that the following NEW RESOURCES to support improvement in healthcare, from HQIP’s audits and programmes, have been published:

Inequities in hip fracture care

  • Mind the Gap; National Hip Fracture Database (NHFD) – Highlights persistent inequalities in hip fracture care, showing that where a patient is treated has a greater impact on outcomes than who they are or where they live. Key findings stress the importance of factors such as delirium screening, clinical governance, and quality improvement.

More reports and resources on: Musculoskeletal & rheumatology; and health inequalities

Maternity care

More reports and resources on: Maternity, perinatal and neonatal care; and health inequalities

Cancer

Reports from some of the audits with the National Cancer Audit Collaborating Centre (NATCAN), including:

More reports and resources on: Cancer

Further data

In addition, we are pleased to share that the following data is also available: 

All reports: All HQIP-commissioned reports can be accessed via our dedicated reports webpage.

Stay up to date: Join our mailing list to receive notifications when new reports are published.

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World Suicide Prevention Day: Working together to save lives

10 Sep 2026

On World Suicide Prevention Day 2026, we take time to acknowledge those who have died, and been bereaved, by suicide, and recognise the importance of continued efforts to improve mental health care, support, and suicide prevention.

This year’s World Suicide Prevention Day, which has a theme of Changing the narrative on suicide), comes at a significant moment for mental health services in England, with the announcement of £343 million in expanding community mental health support, including 100 new community mental health centres and 59 dedicated mental health emergency departments. The aim is to help people access support earlier, closer to home, and in environments designed to meet their needs before they reach crisis point.

The expansion reflects a wider NHS shift towards community-based care, bringing together mental health professionals, GPs, local authorities, voluntary organisations, and wider support services to provide more joined-up care within local communities. By improving access to support and intervention at an earlier stage, these services have the potential to make a meaningful difference to people’s lives.

The important role of data

Evidence and learning play a vital role in ensuring mental health services continue to develop in ways that improve safety and outcomes. The Healthcare Quality Improvement Partnership (HQIP) commissions the Mental Health Clinical Outcome Review programme (delivered by the National Confidential Inquiry into Suicide and Safety in Mental Health / NCISH), which examines the circumstances surrounding deaths by suicide and identifies opportunities to improve care.

Its internationally leading database allows NCISH to make recommendations for clinical practice and policy that will improve safety locally, nationally, and internationally” NCISH annual report 2026

The most recent NCISH annual report, published in February 2026, analysed UK data from 2013 to 2023. The report found that nearly half of all patients who died by suicide lived alone or were unemployed, and 17% had recently experienced serious financial problems. The majority (61%) had a history of self-harm, and nearly a third had self-harmed in the previous three months. These findings reinforce the value of accessible, coordinated care delivered within communities, with holistic support extending beyond clinical treatment alone.

As new community mental health services are developed across England, ongoing audit, review and learning will remain essential to understanding what improves care. By understanding what is working in relation to care delivered, we can identify areas for improvement and support safer care for patients. Together, through evidence, learning and compassionate care, we can continue to strengthen services and help ensure that people receive the support they need, when and where they need it.

On World Suicide Prevention Day, we recognise the dedication of mental health professionals, researchers, people with lived experience, carers, and families working to prevent suicide and support those affected by it.

Further resources from HQIP

World Suicide Prevention Day 2026

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From data to safer care: The role of stroke audit in improving quality of care

7 Sep 2026

Published in partnership with Patient Safety Learning.

Ensuring patients receive the right care at the right time is one of the most important patient safety challenges facing the NHS, not least in stroke care where every minute matters. Rapid recognition, assessment, timely access to reperfusion therapy and effective specialist rehabilitation can mean the difference between a good recovery and lifelong disability.

That challenge is becoming more significant. Stroke remains a leading cause of death and disability, with more than 92,000 people admitted to hospital with stroke across England, Wales and Northern Ireland during the period from April 2024 to March 2025. High-quality care for these patients requires coordination across the entire pathway, from prevention and emergency response through to specialist hospital care, rehabilitation and long-term support.

With this year’s World Patient Safety Day focusing on safe care for noncommunicable diseases, this article reflects on the critical role that national clinical audit plays in supporting safer care, with a focus on stroke. The Sentinel Stroke National Audit Programme (SSNAP), led by King’s College London and commissioned by the Healthcare Quality Improvement Partnership (HQIP), demonstrates how evidence-based standards developed from national guidelines can help drive quality improvement across a complex healthcare pathway.

Driving improvement through data and innovation

SSNAP measures the quality and organisation of stroke care across England, Wales and Northern Ireland. By collecting and analysing data across the patient journey, it gives a detailed understanding of where services are performing well and where care can be strengthened. This aligns closely with the ambitions of the NHS 10 Year Health Plan, which emphasises the importance of using data and innovation to improve outcomes, reduce inequalities and support continuous quality improvement.

While audit provides the evidence and insight to support improvement, progress in stroke care depends on the collective efforts of multidisciplinary stroke teams, patients and their representatives, commissioners, researchers, charities and many others working across the pathway. Clinical audit forms a vital part of that infrastructure, with routine, tangible, clinically meaningful data measured against evidence-based standards to support quality improvement and patient safety.

This role has become even more essential following publication of the new Cardiovascular Disease Modern Service Framework, which sets out a 10-year ambition to reduce premature deaths from heart disease and stroke through earlier prevention, access to organised stroke care and rehabilitation, supported by innovation and adoption of evidence-based interventions in order to reduce health inequalities. National clinical audit provides insight and stimulates enquiry to identify reasons for variation and priorities for quality improvement.

The impact of this approach can already be seen across stroke services. Many of the most encouraging developments reflect the same themes of data and digital transformation that underpin the NHS’s shift from analogue to digital healthcare. Advances in imaging, AI decision-support technologies and data-driven pathways are helping more patients access time-critical treatments and improving outcomes.

For example, SSNAP’s latest State of the Nation report, which covers April 2024 to March 2025 (2024/25), shows that access to brain imaging continues to improve. The proportion of patients receiving brain imaging within 20 minutes of hospital arrival increased from 26.5% April 2023 to March 2024 (2023/24) to 28.3% in 2024/25, and the proportion receiving imaging within one hour increased from 59.5% to 61.4%. These improvements matter because timely imaging is crucial to select patients for targeted effective hyper-acute treatments. Hospitals need to perform all the necessary imagery at the same time, as well as using artificial intelligence tools to support clinical decision-making, to improve the delivery of reperfusion therapy and provide patients the best opportunity to recover.

Encouragingly, access to hyper-acute treatments such as thrombolysis and thrombectomy has also improved. The proportion of patients receiving thrombolysis increased from 11.6% to 12.2%, while thrombectomy rates increased from 3.9% to 4.4% (2023/24 vs 2024/25). Both treatments can significantly reduce disability when provided promptly. Use of national audit data has stimulated quality improvement for thrombolysis rates in several stroke services and progress has been made for a number of time-metrics for thrombectomy, although growth of thrombectomy rates still requires further attention.

Further, there has been notable progress in the treatment of intracerebral haemorrhage, where the proportion of eligible patients receiving an appropriate hyper-acute intervention within one hour of hospital arrival increased from 24.9% to 32.0%, an important patient safety improvement for a group of patients who often experience poorer outcomes. These advances demonstrate how audit can support innovation by identifying where new approaches are succeeding and where further improvement is needed.

Progress is not universal

While there are many reasons for optimism, there are also areas where progress has been more difficult. Perhaps the most striking example is the growing delay between stroke onset and hospital arrival. In 2024/25, the median time from stroke onset to arrival at hospital increased to 4 hours and 11 minutes, compared with 2 hours and 25 minutes a decade earlier (2013/14). The reasons are complex and may include public awareness and recognition of symptoms, ambulance pressures and wider system factors. There is a continuing need for sustained public education to enhance awareness of stroke symptoms, faster ambulance recognition and triage through innovation such as pre-hospital video assessment.

Access to specialist stroke care, which is the most effective intervention to reduce disability and mortality from a population level, also remains challenging. Less than half of patients (46.5%) were directly admitted to a stroke unit within four hours of hospital arrival, while the proportion spending at least 90% of their hospital stay on a specialist stroke unit fell slightly to 74.0%.

Importantly, acknowledging these trends, through national clinical audit, is the first step in finding solutions in order to reverse them, and illustrates why continuous measurement and quality improvement is essential. National clinical audit helps identify where delays and barriers occur, enabling local systems to focus improvement efforts where they are likely to have the greatest impact on patient outcomes and safety.

Understanding variation: a nuanced picture

One of the most important messages from the recently published SSNAP Atlas of Variation Report is that variation is not necessarily unwarranted. Too often, variation is assumed to indicate poor performance. In reality, differences between areas may reflect population characteristics, levels of deprivation, geography, service configuration, patient preferences, access to specialist services or differences in local health needs.

For commissioners, this is an important distinction. The purpose of examining variation is not to assign blame. Rather, it is to understand why differences exist and to identify opportunities for learning and more equitable care. It is also important that organisations responsible for commissioning stroke care compare their performance with both peer organisations and the national average. These comparisons can highlight areas of good practice, encourage shared learning and support ongoing quality improvement across the stroke pathway.

This approach is echoed in the recently published Cardiovascular Disease Modern Service Framework, which argues that “success is judged on closing the gap, not just the average”. For commissioners, providers and clinical teams, this highlights the importance of looking beyond headline performance measures to understand where inequalities persist, where variation may reflect different population needs and where targeted efforts could have the greatest impact.

The Atlas provides numerous examples of variation. Nationally, 25.9% of patients with known atrial fibrillation were not receiving anticoagulation before their stroke, with a range regionally from 9.8% to 32.3% – a key opportunity for prevention. There is also substantial variation in thrombolysis rates and other aspects of care across different populations and regions.

The report also points to significant future challenges. Stroke admissions in England are projected to increase by 28.8% over the next decade, with considerable variation between areas (ranging between 7.1% in NHS Derby and Derbyshire to 61.5% in NHS North Central London). Understanding local patterns of demand and care delivery will become increasingly important for planning future services, and national clinical audit provides insight to support that planning.

Looking beyond hospital care

“One of our key goals is to make sure more patients can access the full specialist stroke pathway, as this leads to better recovery and outcomes.” SSNAP State of the Nation Report 2025

The NHS 10 Year Health Plan sets out a shift from hospital-based care towards more integrated community care, and stroke services are already moving in this direction. SSNAP reports continued growth in access to specialist community rehabilitation services following discharge from hospital. The proportion of patients discharged to a stroke/neurology-specific community rehabilitation service has increased to two-thirds of all discharges: 66.6% in 2024/25. Over a third (23.1%) of these patients were transferred to a combined stroke/neurology specific Early Supported Discharge and Community rehabilitation team. This reflects the ongoing commitment to implementation of the national service model for an integrated community stroke service across England.

However, the audit also highlights areas where further progress is needed once patients leave hospital. The proportion of patients receiving a 6-month review after stroke has continued to decline since 2019/20, falling to 35.1% in 2024/25 (38.8% in 2023/24). Long-term support after stroke is critical to patient outcomes and quality of life. As care increasingly shifts into community settings, robust data will remain help ensure services provide safe and equitable care.

Looking beyond recovery and rehabilitation, the NHS’s shift from sickness to prevention is equally relevant. Findings from the Atlas of Variation demonstrate opportunities to improve management of risk factors such as atrial fibrillation and hypertension before stroke occurs. Preventing strokes in the first place will be as important to improving population health as advances in acute treatment.

Evidence that leads to improvement

Overall, the story of stroke care is one of continued improvement, with SSNAP demonstrating how national clinical audit can support safer, higher-quality care for conditions such as stroke.  Importantly too, the programme has evolved over time and with the evidence. For example, in 2024 the audit initiated its most substantial reform to date, reflecting the 2023 National Clinical Guideline for Stroke and NICE stroke rehabilitation guidelines – setting a renewed benchmark for what best practice should look like. These standards provide confidence and reassurance to both clinicians and patients that the most effective stroke care is being delivered.

Over recent years, patients have benefited from advances in imaging, increasing access to specialist treatments and progress in aspects of hyper-acute care. Yet challenges remain, including delays before hospital arrival and the need to strengthen long-term community support.

Looking ahead, SSNAP’s comprehensive data collection and timely feedback aligns closely with NHS England’s recently published Quality Strategy, by enabling the use of meaningful data to identify unwarranted variation, monitor outcomes, support continuous improvement and drive more equitable care. Providing actionable intelligence across the stroke pathway, the audit helps create the conditions for safer, more effective and patient-centred services, while supporting the NHS ambition to use data and digital tools to improve quality at scale.

“National clinical audit helps make challenges visible. By providing robust evidence about what is working, where gaps remain and how services compare across populations, SSNAP enables clinicians, providers and commissioners to focus improvement efforts where they can make the greatest difference. With World Patient Safety Day shining a light on patient safety for noncommunicable diseases, the message from stroke audit is clear: better evidence leads to better decisions, and better decisions help deliver safer care for patients.” Chris Gush, HQIP CEO

Further resources from HQIP

  • Discover more of our programmes, reports, and other resources and news related to neurology and stroke care.
  • More articles on using healthcare data to improve and save lives
  • How HQIP supports organisations to use clinical audit and healthcare data to drive improvement – from strategy development to implementation or training
  • Reports and infographics
  • Benchmarked results, searchable by project name, trust, hospital or unit

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Seeking direction – Skills passport for clinical audit professionals

6 Sep 2026

Jack Hiscock, an NHS-based Clinical Audit and Effectiveness Coordinator and member of the HQIP-hosted National Clinical Audit and Clinical Effectiveness Collaborative (NCA-ACE), explains why he believes that a ‘skills passport’ for clinical audit professionals would deliver value for the healthcare sector, for patients and, of course, for the professionals themselves…

“In the current NHS environment, with increasing financial pressures, the need to professionalise clinical audit has never been more urgent. Establishing a structured progression pathway would help us standardise what should be expected of individuals working in our sector at different levels, including those moving into senior roles. It would also create clearer opportunities for people to gain experience and develop into recognised specialists within our field. One of the most effective ways to achieve this, I believe, is through the development of a ‘skills passport’.

Skills passports? What are those?

Skills passports are used widely across the healthcare sector, with clinical competency passports now either established, or being established in nursing, pharmacy, and allied health professions. They are also increasingly common outside healthcare – in fields such as archaeology and energy where they enable individuals to move between organisations while clearly demonstrating their suitability for a role.

There are, however, important differences between types of passports. Clinical skills passports tend to be highly explicit, with competencies broken down into discrete tasks that require formal sign‑off by trained and competent staff. This is not something we are likely to replicate in our sector, given the limited opportunities for formal qualifications and the nature of our work. Our skills are not always granular in the same way. For example, while many of us support colleagues in developing project proposals, these types of skill are not processes that can naturally be reduced to step by step, technical actions in the way that changing a drug giving set can.

As a result, our approach aligns more closely with the skills passports used in non‑healthcare sectors, which emphasise broader capabilities and areas of experience. This may be more beneficial, particularly as data‑focused roles continue to grow, where demonstrating experience in handling large datasets is often more meaningful than outlining the specific steps used to do so.

How might this look for us?

The mention of the archaeology skills passport given above is no accident. As someone who in a previous life (over 15 years ago) was in the archaeological sector just prior to the release of the Archaeology Skills Passport, I’ve seen how role expectation has become more consistent and supported by more structured workplace development. By aligning with professional standards produced by the Chartered Institute of Field Archaeologists, the passport provides a common framework for recording competencies, supports professional development, and can evidence progression towards professional accreditation.

By using a similar structure to the archaeology skills passport, with skills grouped from Primary through to Tertiary, we could start to map out the wider capabilities needed in clinical audit roles. Primary skills could be anchored to the HQIP four‑stage model which comprises preparation and planning, measuring performance, implementing change, and sustaining improvement. Relevant secondary and tertiary competencies could then be woven into each stage.

For example, the planning and preparation stage could include ‘understanding sources of projects’ – which could be further separated into learning around requirements for NICE compliance audits as well as audits that link in with national and regional priorities and strategies (such as the 10 Year Health Plan for England and NHS Quality Strategy).

As part of the measuring performance stage, acquisition of more hands-on skills could be demonstrated via apprenticeships in data analysis or via in-house Excel training offerings, dependent on your Trust’s development opportunities. The passport could also bring in learning on understanding coding as part of obtaining patient data, and understanding patient experience to assist with patient involvement in projects and programmes.

The implementing change stage may be a good place for Quality Improvement (QI) skills to fit into the passport. While some QI techniques are already commonly included in clinical audit roles (such as root cause analysis using fishbone diagrams and the 5-whys), others such as PDSA cycles and testing changes could also be aligned here.

Action planning and implementation following successful tests-of-change might better align with the sustaining improvement stage alongside continued measurement and re-audit.

Specific alignment of audit and QI skills may help to explain the relationship between them and better articulate how they work together across assurance and improvement.

Next steps

I’ve floated this idea before with colleagues in other Trusts, and the reaction has been mixed. The concern, understandably, is that a skills passport might lead to revisiting job bandings—especially if we begin mapping skills against banding levels or move toward more standardised job titles. That is a possibility. But given the current climate, where the number of clinical audit roles are shrinking and bandings are already being considered, it may be more important than ever to have a clear framework that evidences the skill requirements of our sector. Something that sets out what our roles involve, the skills we bring, and the experience we’ve built up.

And finally

In the end, we must look for ways that can help us give new colleagues starting out in this field a framework in which they can develop and get the most out of what can be a rewarding career in helping to improve care for patients and families. We also need to demonstrate the value of the experience we have developed – often over many years.  The skills passport is just one way that we can begin this journey.”

This article reflects the author’s personal perspective and is intended to prompt discussion among clinical audit and clinical effectiveness professionals.

Have your say

If you have would like to share your thoughts about Jack’s article, please do so on the NCA-ACE workspace on the NHS Futures platform (open to eligible professionals).

Further information about NCA-ACE

The National Clinical Audit and Clinical Effectiveness Collaborative (NCA-ACE) is a national forum for local NHS trust clinical audit and clinical effectiveness professionals, hosted by HQIP. Monthly virtual meetings feature guest speakers, thematic presentations, Q&A and shared learning. Members are supported through the NCA-ACE workspace on NHS Futures, with discussions and sharing of information and materials.

For more details about NCA-ACE, and details of how to join, email HQIP.

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