4 Oct 2025

How National Clinical Audit Supports System Level Priorities.

Healthcare data highlights the changes that will have the greatest impact on services and patient outcomes. It is critical in ‘lighting the way’ for system leaders, to understand where to target resources to deliver improvements, particularly in these changing times when pressures have never been greater.  HQIP’s CEO, Chris Gush, explains how national clinical audit helps Integrated Care Systems (ICSs) and other healthcare leaders to maximise resources and deliver their priorities.

Integrated Care Systems (ICSs) – through their Integrated Care Boards (ICBs) – were established to improve population health, enhancing productivity and value, and supporting broader social improvements such as reducing health inequalities​. In other words, support the NHS to pursue ambitious goals for better care.

As we all now know, the NHS in England is changing. However, the aspiration to deliver improved care and outcomes for patients remains. If anything, it is now more important than ever. NHS England’s functions are being absorbed into the Department of Health and Social Care (DHSC)​, and ICBs have been tasked with drastically cutting both their management costs and workforce. Leaders acknowledge the need to eliminate duplication and stabilise finances, but there is widespread concern that such steep cuts “will inevitably make the task of delivering long term transformation of the NHS much harder”, to quote Matthew Taylor, Chief Executive of NHS Confederation​.

The aspiration to deliver improved care and outcomes for patients…is now more important than ever

Harder it may be, but data makes it feasible. The NHS has invested for decades in national clinical audits and registries that systematically track the quality of care across a broad range of services. These programs (encompassing dozens of medical, surgical, and mental health conditions) generate a wealth of information that is already collected and ready to use. In light of the current push to reduce costs – leaving far fewer hands available for analysing data – they are, in fact, an invaluable resource in the drive for transformation.

That’s where the National Clinical Audit and Patient Outcomes Programme (NCAPOP), the largest programme of its kind in the UK, plays a vital role. Commissioned by HQIP, it generates trusted, clinically validated data across the NHS. National audit data are robust and published openly, and so inform clinical guidelines, regulatory oversight, and commissioning decisions​. In other words, the comparative insights from audits are a built-in evidence base for what is working well and what isn’t. Over the years, such high-quality comparative data have proven to be a stimulus for real and meaningful improvement in patient care​, driving changes in practice that have saved and improved lives.

In an era of tightening resources, data becomes a force-multiplier: turning raw numbers into actionable insights

Crucially, tapping into this data doesn’t require additional local manpower to gather new information; it leverages existing intelligence to guide action. For NHS leadership, whether in an ICB boardroom, a DHSC office, or a hospital executive team, the importance of maximising this existing data asset cannot be overstated. In an era of tightening resources, data becomes a force-multiplier: turning raw numbers into actionable insights is one way to effectively “add” capacity without adding staff. National clinical audits and registries, in particular, offer an arsenal of knowledge to support system-wide learning, service transformation, and quality improvement. By making national clinical audit and registry data central to their strategy, system leaders can continue to deliver improvements despite limited capacity. Used to its fullest potential, this data can help health systems to:

• Pinpoint unwarranted variation – identifying differences in outcomes or care quality across an ICS, so leaders know where to focus attention (for example, spotlighting a service or population group that is falling behind the national benchmarks).
• Highlight best practices – revealing which Trust or locality is excelling in a particular domain, so that successful approaches can be shared and scaled up across other parts of the system.
• Inform strategic planning and investment – providing hard evidence of needs and what works, thereby guiding ICBs in prioritising initiatives (and making the case to allocate resources where they will have the greatest impact on quality and equity).
• Track improvement over time – enabling leaders to measure the results of interventions and service changes through objective outcomes data, ensuring accountability and learning as the system evolves.

By harnessing this wealth of information, ICS and ICB leaders can exercise informed system leadership, targeting interventions that make a difference even when manpower and money are limited. It means that despite the challenges of reorganisation and austerity, the NHS can continue to innovate and improve care, using evidence as its guide and data as a catalyst for delivering on ICS and ICB priorities​. So, in specific terms, how can HQIP’s NCAPOP data be harnessed to support key ICB and ICS priorities?

1. Driving Quality Improvement Across Systems

One of the core responsibilities of ICBs is to coordinate quality improvement at scale. National audits provide a powerful platform for this.

Take the Sentinel Stroke National Audit Programme (SSNAP) its ICB-level performance dashboards offer system leaders a bird’s-eye view of stroke care across all local providers. Armed with this insight, ICBs can convene collaborative improvement efforts, target underperforming areas, and share current best practice across Trusts.

Similarly, CVDPREVENT, which focuses on cardiovascular disease prevention, enables comparison of risk factor management and treatment coverage across general practices, primary care networks, and places. This supports system-level interventions that improve outcomes not just in one GP practice, but across entire localities.

By aligning providers around shared outcomes and a single evidence base, audit data gives ICS leaders the foundation to drive real, sustained improvement across complex care pathways.

2. Tackling Health Inequalities with Data That Shows Where to Act

Reducing health inequalities is at the heart of the ICS mission – and national audit data offers a uniquely valuable lens into where disparities exist.

Audit reports often reveal variation in access to services, quality of care, or outcomes across demographic groups, local geographies or levels of deprivation. This kind of data is essential for identifying where action is needed, whether that’s improving rehabilitation access in underserved communities or addressing differential outcomes in chronic disease management.

By offering granular, real-world data, NCAPOP audits enable ICBs to monitor inequalities at population level, target resources, and track the impact of interventions over time. This directly supports the Core20PLUS5 framework and other system-level health equity initiatives.

3. Strengthening Oversight and Assurance

ICBs are responsible for the performance and safety of the services they commission. National clinical audits bring credibility and transparency to these oversight functions.

Audits such as the National Emergency Laparotomy Audit (NELA) and SSNAP provide comparative, risk-adjusted outcome data and benchmarking tools. These can be used in quality committees, system performance meetings, and provider assurance frameworks.

Recent NELA reports, however, highlight a plateau in some key care standards and outcomes, including 30-day mortality and time to theatre, reinforcing the need for renewed focus on improving emergency surgical pathways.

In particular, audit outlier alerts, generated when providers consistently underperform against national standards, offer early warnings and opportunities for supportive intervention. They also provide a consistent framework for celebrating excellence, understanding variation, and driving accountability in a constructive, evidence-based way.

4. Informing Outcomes-Based Commissioning

As the NHS shifts towards outcomes-based commissioning, ICBs need reliable measures to define what good looks like and to track whether services are delivering meaningful results for patients.

National clinical audits provide exactly that. For example, the National Diabetes Audit (NDA) publishes ICB-level data on key care processes and outcomes, from HbA1c control to diabetic foot complications. This allows ICBs to build commissioning strategies that incentivise better outcomes, not just activity.

Audit findings can also be incorporated into service specifications, evaluation frameworks, or population health investment decisions, enabling leaders to commission with confidence, based on what actually works.

5. Enhancing Population Health Intelligence

Integrated care systems are expected to understand and improve the health of their populations, and this requires rich, longitudinal data.

Audit programmes like CVDPREVENT contribute to this intelligence by aggregating data across primary and secondary care, enabling systems to see where the biggest risks, gaps and opportunities lie in long-term condition management.

Whether it’s identifying communities with uncontrolled hypertension, mapping variation in cancer staging, or planning dialysis services using renal audit data, NCAPOP programmes help give ICSs a 360-degree view of their population’s health needs and outcomes. When combined with demographic and social data, this becomes a powerful platform for prevention, pathway redesign, and place-based planning.

6. Supporting Service Transformation with Evidence

Transforming services at system level, whether centralising specialist care, introducing new models, or improving access, requires a solid evidence base.

National audits provide that evidence. They often identify where current practices are falling short, highlight what ‘good’ looks like, and make the case for change. For instance, audit data may demonstrate that survival rates improve when services are consolidated, or that certain interventions need to be delivered earlier in the pathway.

Audit evidence has been used to inform service redesign across stroke, vascular surgery, mental health and more, helping ICSs design pathways that are safer, more effective, and more equitable.

Turning data into improvement

The availability of data is just one part of the solution to delivering these priorities. At HQIP, we understand that integrated care leaders need more than data; they need insights that are timely, relevant, and aligned to their priorities. That is why we are working in partnership with those involved in system-level improvement to:

• Publish more ICB- and place-level breakdowns
• Support access to audit data for population health analytics
• Make our outputs easy to interpret and apply in commissioning and transformation planning
• Listen to system leaders about which topics matter most.

In this way, we are ensuring that national programmes serve local, regional and system needs, and the resultant insights support the decisions you are making every day to improve care.

How to get started – help is at hand

Whether you are designing a transformation programme, refreshing your ICS five-year plan, or seeking assurance on provider performance – HQIP and the NCAPOP can support you. Explore how our national clinical audits and wider quality improvement resources can support your system goals. Connect with us to ensure future programmes meet your evolving needs, and support long-term transformation and equity in healthcare. Together, we can turn data into insights; insights into action; and action into better care for the patients we serve.

More information:

• For access to HQIP-commissioned, national clinical audits, reports and data: hqip.org.uk
• For information about HQIP’s services to support evidence-informed quality improvement: hqip.org.uk/services