The value of audit in identifying health inequalities

6 Apr 2025

Multiple inequalities in diagnosis and treatment are identified by the National Prostate Cancer Audit (NPCA)

What has the NPCA found?

The NPCA’s most recent State of the Nation report, published in January 2025, included a section which focused on inequalities in prostate cancer diagnosis and treatment. More specifically socioeconomic, demographic and ethnic differences between people diagnosed with prostate cancer between 2020 and 2023 in England. What they found showed that the inequalities identified in previous studies persist. Here they explain more… Inequalities at diagnosis: 90% of men diagnosed with prostate cancer had their ethnicity recorded and of these 90% were white, 5% Black and 2.4% Asian. 84% of men diagnosed with prostate cancer were between 50 and 79 years old and 24% lived in the least deprived areas. When adjusting for the size of the male population, white, Black or Asian, the Black population has the largest number of new diagnoses compared to the white and Asian groups, with 17 new diagnoses per 1000 men in black men aged 70-74. 79% of diagnoses had a stage recorded and of those, Black ethnic groups had a higher proportion of new diagnoses per 1000 men at stage 1 than other ethnic groups. We found stage 4 cancer to be the most common diagnosis in white men aged 85 years and over, which highlights late diagnosis in older men. These findings are limited by the low data completeness (49%) of stage for white men aged 85 years and over. Inequalities in treatment: 68% of black men aged 60 to 69 years with high-risk/locally advanced cancer received radical treatment compared to 82% white men of the same age and disease stage. We found a difference in radical treatment between least and most deprived areas, from 83% to 75% for men aged 60 to 69 years. A final finding was that treatment declines significantly from the age of 75 and that younger patients are more likely to receive treatment. In men with prostate cancer that has already spread at diagnosis, Black men were 24% less likely than white men to receive chemotherapy or additional hormone treatments. The same difference (24%) was observed when comparing men living in the most deprived areas than in the least. The special report on inequalities highlights a need for specific interventions to improve prostate cancer care so that it is equitable across all patient groups.

How can these findings be used to improve standards of care?

Results from the NPCA, in both our annual State of the Nation Reports and in our research articles, serve to highlight unwarranted differences in diagnoses and treatment at the population level which can be used as real-world evidence if national prostate cancer care guidelines are revised. Subsequent changes in wording would raise awareness of potential variation and provide support for patients to access equitable care at every step of their journey. This would ultimately lead to improved outcomes for people diagnosed with prostate cancer, regardless of when or where they were diagnosed and treated. There are many factors which influence the differences in prostate cancer care which we have described, whether alone or in combination, some of which may relate to patient choice and preference. These are complex in nature and different approaches by multiple groups and decision makers will be required to ensure men diagnosed with prostate cancer are offered and receive optimal care, ultimately resulting in improved outcomes. The NPCA, being commissioned by the English NHS and the Welsh Government, work closely with clinical leads to provide evidence of where improvements are needed and our stakeholders include professional bodies across the care pathway and colleges with influence on national level policy making.

What is the National Prostate Cancer Audit?

The National Prostate Cancer Audit is part of the National Cancer Audit Collaborating Centre (NATCAN), commissioned by Healthcare Quality Improvement Partnership (HQIP), on behalf of NHS England and the Welsh Government, as part of the National Clinical Audit and Patient Outcomes Programme (NCAPOP).

What does the NPCA do?

The aims of the NPCA, and audits within NATCAN, are to provide cancer services in England and Wales with regular updates on their performance against national standards (when these exist) and other providers, through annual and quarterly reports. This means that we can also evidence whether different patterns of care are seen in different trusts or health boards. By shining a light on these differences, the audits enable NHS services to reflect on their provision and identify changes needed in order to provide equitable access to treatments for all patients, regardless of where they present. The NPCA, and audits within NATCAN, don’t ‘collect’ clinical data, we receive it from the National Disease Registration Service (NDRS) in NHSE and the Wales Cancer Network in Public Health Wales, with whom we work to improve data completeness. We have access to information on the diagnosis, treatments and outcomes of all patients newly diagnosed with prostate cancer in England and Wales as recorded by the providers themselves. This includes staging, how the patient presented, what their health is like generally, and what procedures they underwent, including surgery, radiotherapy or if they received systemic treatment such as chemotherapy or hormonal treatment.

What are the aims of the NPCA?

The NPCA redefined the scope of its work in 2023 and alongside that, identified key Quality Improvement goals in 2024 which ensure patient benefit continues to be at the heart of the work of the audit. Among these, reducing variation in prostate cancer management among NHS providers and improving experience of care among men with prostate cancer.

How does the NPCA achieve this?

The NPCA summarises the information received from routine data collections and produces an annual report (since 2014) which provides a national picture of the state of prostate cancer care in England and Wales. This means we have been able to monitor variation and changes in prostate cancer care for over a decade and make targeted suggestions to providers and commissioners on how to improve care. The audit feeds back information and recommendations to each provider so that they can truly reach the clinicians who can act on it, through the use of local action plans. Since 2024, we also produce quarterly reports, and since April 2025, a data dashboard updated quarterly is available collating data quality of key items and one performance indicator. Prior research undertaken by the audit reported on variation in care by ethnicity, age, socioeconomic status, and geographic location such as our report on treatment of men with high-risk or locally advanced prostate cancer. This identified differences in receipt of treatment for black and socio economically more deprived men. Short reports in 2020 and 2022 separately highlighted variation in diagnosis and care by ethnicity, age and socioeconomic status, so a comprehensive update on these findings was warranted to be able to identify the reasons behind the variation. A research study published in April 2025, looking at the geographic, socioeconomic and demographic inequalities in the incidence of prostate cancer which has spread at time of diagnosis identified unwarranted variation in England (2018-2022). Key findings include:

Regional annual rates of prostate cancer diagnoses where it has already spread (metastatic) were found to vary between 4 and 7 per 100 000 men
Higher rates of metastatic prostate cancer were seen in regions with lower rates of prostate cancer diagnosis overall
Higher rate of metastatic prostate cancer and a lower rate of prostate cancer overall was also seen among men living in more deprived neighbourhoods

In the future, the NPCA will aim to monitor the incidence of prostate cancer which has already spread at time of diagnosis considering these findings. This would provide an opportunity to assess improvements in timely diagnosis (and the ensuing ramifications for national policy about screening and early detection) more thoroughly than by just reporting the proportion of men diagnosed with prostate cancer who have metastatic disease. The programme of research of the NPCA is embedded in the audit activities and is key to the NPCA’s aim to get a better understanding determinants of variation and propose ways to ensure men diagnosed with prostate cancer at any stage benefit from equitable care.

What else is the NPCA doing?

The NPCA will be running a quality improvement initiative aiming to improve rates of treatment for men diagnosed with prostate cancer that has spread. We have already found that older men and Black men (when compared to white men) are less likely to receive treatment during earlier stages of the disease. We hope to understand the barriers to treatment which exist and by working with our partners at local and national levels, propose recommendations which will improve care, and ultimately outcomes, for men diagnosed with prostate cancer that has spread. Further information – links:

National Prostate Cancer Audit (NPCA)
The National Cancer Audit Collaborating Centre (NATCAN).

This article was shared as part of Clinical Audit Awareness Week 2025. Have your say on #CAAW25: Feedback form.

My data, my health

6 Mar 2025

The importance of data sharing from a patient perspective

At HQIP, we have long-since advocated the value of data and patient voice in delivering evidence-informed healthcare improvement. But don’t just take our word for it. Find out what patients think in this exclusive interview with two public members of HQIP’s Data Access Request Group (DARG), which considers requests to re-use the healthcare data commissioned by HQIP.

Healthcare data is viewed as a gift by those considering access to it”

As commissioner of the National Clinical Audit and Patient Outcome Programme (NCAPOP), HQIP is responsible for the largest clinical audit programme of its type in the UK. This work results in an enormous amount of invaluable data that is used by healthcare providers to deliver targeted improvements. However, we also have a duty to re-use this data to bring about even greater public benefit where relevant, and so we run a stringent process to consider access requests from service planning, research and other similar projects. Being responsible for such data is something we do not take lightly. As such, we ensure that that any access granted is only given after the greatest of scrutiny. Critically, this involves members of the public, who add a unique – and vital – perspective to the decision-making process.

Since the data collected – whether access for secondary use is granted or not – belongs to patients, we have invited two public members of DARG to share their thoughts on what it means to them to be involved in this important work…

Let’s start with healthcare improvement more generally. It can be difficult to see the changes that are taking place to bring about data-informed improvements on a day-to-day basis, but do you have any experiences of this?

WENDY: When I was in hospital recently, I presented with symptoms that were initially put down to anxiety by the clinicians I saw. But one doctor came and said that they’d read a journal paper recently about how females can experience my health condition in atypical ways, and how these symptoms can be under reported. With this research in mind, they observed me, and determined that my symptoms did relate to my health condition. They were then able to identify the care that I needed. This, to me, was a clear example of how data and research are having a direct impact on healthcare.

If done correctly, there is absolutely a case for using healthcare data more”

PHIL: Over my 40 years in healthcare, I have seen many examples of how good data collection and evaluation has made a difference – though it can require determination to move away from ‘we’ve always done it this way’. In dementia care, for example, we’ve seen the introduction of Dementia Care Coordinators, a very positive change which came about by evaluating the experiences of those living with dementia. More recently, I’ve personally been involved in conversations with my doctor about a change in the approach to my medication, based on the latest research. So, yes, I am able to see the impact that data is having on healthcare.

In your view, what are the pros and cons of using healthcare data to inform research and improve care?

PHIL: Firstly, we need to remind ourselves that healthcare data belongs to patients. Then, the truth is that collecting data comes at a cost. These two factors mean that there is a moral obligation to use data for the benefit of patients wherever possible. However, I agree that this needs to be done carefully and safely.

Data provides a sound rationale for why we offer care in the way we do”

WENDY: Using data to inform care is incredibly important and powerful, but it needs to be approached with care. If done correctly, there is absolutely a case for using healthcare data more. In my experience, healthcare data is viewed as a gift by those considering access to it. Though I would like to see more case studies being shared with the public, to help us all to understand the stringent processes that are followed before releasing data for research, and the positive impact it has on patient care.

Why did you want to become involved in HQIP’s DARG; why is it important to you?

WENDY: I joined HQIP’s Service User Network (SUN) first, and was then offered the opportunity to join a short project to determine the feasibility of involving patients in decisions around access to data. We spoke to experts in patient engagement as well as other groups actively working with patients, to find out what worked well for them for use as inspiration for HQIP. When they advertised for public members to join DARG, I thought “I would love to be involved in that”, as I have real passion for health and data, and wanted to bring a patient perspective to the access process. For me, a big factor in patients getting involved is that they want to make a difference.

PHIL: As a frontline healthcare worker, I was involved in using clinical audit in its early days, and could see that data needs to form the basis for every single decision made. I joined DARG because I believe that data provides a sound rationale for why we offer care in the way we do, but I wanted to make sure that it is used primarily for the benefit of patients.

There is a moral obligation to use data for the benefit of patients wherever possible”

What does your involvement in DARG include; what do you do in practice?

WENDY: Regular meetings are held to decide on the latest tranche of applications for data. We are sent information in advance, which we review independently, from the perspective of a patient. Then, we actively participate in the meetings – which are pragmatic, thorough and methodical – to make decisions about whether to release the data or not. We very much work together as a group, collaborating alongside experts from a range of fields, to shine a light on each request from every possible viewpoint. All in all, I am confident that the decisions taken are solid and well thought through.

What works well, and what are the benefits of being involved?

WENDY: We are able to offer a unique viewpoint, asking ‘what is the benefit to the patient?’, learning every time we look at a request. We feel that we have had an impact on the process as well as the resultant research and, ultimately, healthcare. It’s like looking through a window, and then being invited to a seat at the table.

PHIL: I agree. Our discussions enable a robust decision to be made. There is no deference to status and everyone is happy to challenge, and that is very important. Patient involvement within HQIP’s data access process isn’t tokenistic. Our voice is heard, and our view is respected and accepted.

Conversely, what are the challenges and learning points?

WENDY: In hindsight, it would have been beneficial to trial taking part in a meeting, before joining DARG. It can be a little daunting as a non-clinical person but I remind myself that, if I’m asking, others may also be thinking the same thing. It’s important not to doubt yourself, as it’s vital to have a patient perspective in the room to ensure that the healthcare data available delivers maximum benefit for patients.

At HQIP, we couldn’t agree more. We see it as part of our mission to ensure that the data we commission is not only protected, but also put to good use. We know that researchers face complex and sometimes time-consuming barriers to accessing NHS data. Our aim is to help remove those barriers while upholding our responsibilities of patient confidentiality, data security and public trust. That means enabling researchers to ask better questions, produce stronger evidence, and ultimately influence how care is planned and delivered.

Further information – links:

The National Clinical Audit and Patient Outcome Programme (NCAPOP)
HQIP’s data access request process and group (DARG)
HQIP’s initial feasibility study to involve patients in data access requests:
- Case study: Developing meaningful public involvement in HQIP’s Data Access Request Group (DARG)
- A short video with the project team describing how they worked together to co-design outputs and processes
- A poster illustrating the aims and outcomes
- A short presentation that was used during the 2024 Clinical Audit Awareness Week Lunch and Learn session on Patient & Public Involvement (PPI)
Video: Shared decision making – https://youtu.be/W4ybDpAiRNo (YouTube)
Video: Patient advocacy in healthcare – https://youtu.be/GqEzUPQ6M_c (YouTube)
Case study: Listening to marginalised voices in maternity, helping to reduce health inequalities
Case study: Improving health outcomes by embedding patient voice in procurement.

Meet our patient interviewees…Phil has over 40 years’ experience as a Registered Nurse. His career began in a NHS Acute Trust, where he specialised in Intensive Care before moving into hospital general management, spending the last 20 years as a Senior Lecturer at a UK University teaching Undergraduate healthcare students. He joined HQIP’s Data Access Request Group (DARG) in 2024 as a patient representative, following a diagnosis of Dementia with Lewy Bodies, a type of dementia caused by abnormal protein deposits in the brain. These deposits cause chemical changes in the brain, leading to problems with thinking, movement, balance and more, and makes daily activities increasingly difficult over time. Phil is also involved with the work of Dementia UK and the Alzheimers Society in advocating for those living with Dementia.Wendy is a parent, working full time as a Data Manager for a large private healthcare company. She has a number of complex heart conditions, including a mechanical heart valve, a pacemaker and Atrial Fibrillation. She also had a stroke three years ago, caused by Atrial Fibrillation. Wendy says her health has given her a deeper appreciation for life, and she is driven by a passion to make the most of every day. She joined HQIP’s Data Access Request Group (DARG) in 2024, and loves being able to represent the public in key decisions about health data. She also volunteers for the British Heart Foundation and the European Society of Cardiology.

This article was shared as part of Clinical Audit Awareness Week 2025. Have your say on #CAAW25: Feedback form.

How to access HQIP-commissioned dataIf you are a researcher working in health services, clinical science, policy analysis or population health, we invite you to explore what the NCAPOP programme can offer. It is a valuable tool for those committed to evidence-informed care, and we are dedicated to supporting you in accessing it. To ensure transparency and responsible data use, HQIP has put in place a clear and structured application process. This requires you to:

Review the full Access to NCAPOP Data overview

Read detailed Information for Applicants

Complete the Data Access Request Form

Outline the intended use and public benefit of your project

Provide evidence of appropriate governance and ethical approvals.

Applications are considered by HQIP’s Data Access Request Group. This multidisciplinary panel includes HQIP staff, information governance experts, clinical advisors and public members. The group assesses requests against legal, ethical and strategic criteria to ensure that patient data is used appropriately, lawfully and securely.We encourage early engagement with our team. If you are unsure whether NCAPOP data is suitable for your project, or you would like to discuss your proposal informally before applying, we welcome a conversation. Contact us: datasharing@hqip.org.uk.

Blog: Procurement Act 2023 leaves no room to ignore patient voice

2 Mar 2025

Judith Hughes, Associate Director of Procurement (MCIPS)

On 24 February 2025, the Procurement Act 2023 (PA23) goes live amid a wider backdrop of significant change and pressure in UK health and care. Public sector procurement enters a new era – and for the NHS, the patient voice can no longer be ignored. Patient involvement has been very prominent in recent months, with increased social value obligations, PA23 requirements and Lord Darzi’s report. And this is only set to continue with the development of the 10 Year Health Plan for England, which aims to reduce the burden on NHS Trusts.

What’s changing – and the opportunities this brings

A key PA23 requirement is preliminary market engagement, a mandate for improving transparency and encouraging meaningful supplier interaction. The aim is to improve transparency and help ensure that providers understand the details of the tender exercise. This brings greater opportunities for the NHS to incorporate much needed change into the procurement process. Ignoring this isn’t just bad practice, it’s a missed opportunity for efficiency, innovation, and cost savings. Meaningful patient involvement leads to:

Smarter procurement – Solutions that better meet patient needs, encouraging adherence to treatments or uptake of new technologies.
Greater innovation – Diverse input leads to better, more relevant products, but also innovation of the clinical pathway itself.
NHS burden reduction – Better pathways of care mean better patient outcomes. Fewer failed procurements; saving money and resources.

Involving internal stakeholders and patients as part of that will now not only be valuable – it will also be essential to make the preliminary market engagement meaningful. From 24 February, PA23 will bring a fundamental shift to NHS procurement. Against a backdrop of budgetary strain and rising patient dissatisfaction, one thing is clear: the NHS can no longer afford to ignore the patient voice in procurement.

Why is the patient voice so important?

Let’s look at the evidence around patient and public involvement and the need to have it built into procurement activities. Lord Darzi’s report on the English NHS highlighted the lack of the patient voice:

Patient engagement. The patient voice is not loud enough.

The NHS should aspire to deliver high quality care for all, all of the time. That not only means care that is safe and effective but that treats people with dignity, compassion and respect, making their experiences as positive as they can be. Yet patient satisfaction with services has declined and the number of complaints has increased, while patients are less empowered to make choices about their care. A familiar theme in inquiries into care failings has been patients’ concerns not being heard or acted upon. The NHS is paying out record sums in compensation payments for care failures, which now amount to nearly £3 billion or 1.7 per cent of the entire NHS budget.

The 10 Year Health Plan for England, currently being drafted, will focus on three shifts that the Government, health service, and experts agree need to happen to create a health service fit for the future. These are:

Moving care from hospitals to communities
Making better use of technology
Focusing on preventing sickness, not just treating it

The patient voice is a key driver for this plan to work – and procurement professionals play a pivotal role in achieving these goals. Involving the patients early in the design of the tendering process gives the opportunity to:

Have real life experiences help shape the requirement
Identify health inequalities
Understand what it is that patients want and the impact on them
Create an all-encompassing, fit for purpose specification
Highlight to providers how important the patient voice is, ensuring they design solutions with patients in mind
Improve outcomes

HQIP have been involving patients and carers in commissioning for many years with great success. This has enabled improvements in relevance, patient-centeredness and efficiency; maximising both value for money and social value through better patient outcomes.

How can you embed the patient voice under PA23 ?

I recently attended the HFMA/HCSA Procurement Forum, where the speakers honed in on the biggest issue facing NHS procurement professionals today – how to release cost savings for the NHS, whilst still delivering a high quality service. Embedding the patient voice in service design significantly reduces the NHS burden by streamlining processes, enhancing efficiency, and driving cost savings. Prioritising patient-centred care not only improves outcomes but also optimises resource allocation, making healthcare delivery more sustainable. It also meets the needs under PA23 for robust market engagement, making it clear to potential providers that the patient is at the heart of the requirement. There are two key stages where patient engagement will now need to be an essential part of procurement with the launch of Procurement Act 23: Pre-Procurement Preparation – This helps you to fully understand and engage with the market, develop your strategy and plan the procurement process effectively. Whilst this is not a new step in the process, it does allow for greater engagement with internal stakeholders and the patient to really set out the objectives and aims of the requirement. Internal stakeholders are the subject matter experts, but they don’t always engage with the patient to be able to incorporate that much needed voice! Preliminary Market Engagement – This sets out the needs and benefits of your requirements. Including the patient voice as part of this will be a powerful tool to achieving a successful outcome. Potential providers will be armed with the right information to help them in their bid submission and understand how important the patient needs are.

Need to improve patient engagement ? Act now – or risk falling behind!

The NHS is under immense pressure to deliver cost savings without compromising quality. Ignoring the patient voice isn’t just poor procurement—it’s a failure in service design.

Is your organisation ready for PA23?

If not, we can help. HQIP’s procurement specialists have proven expertise in embedding the patient voice, ensuring compliance, efficiency, and long-term value. Doing this sustainably and valuably throughout the commissioning process can be complicated and time-consuming; it’s a journey that needs careful consideration at each stage. If the patient voice isn’t yet integrated into your organisation’s procurement, our expert team can help you understand what to prioritise and how to gain the support of key stakeholders – ensuring readiness for the new market engagement requirements of Procurement Act 23. HQIP is a not-for-profit, with a vision of improved health outcomes for all and a belief that patient and public involvement is imperative to healthcare improvement. We have healthcare procurement specialists with proven expertise of incorporating patient voice, working alongside our Patient and Carer Engagement team. This tailored expertise enables us to support projects that require deep NHS system knowledge, providing opportunities for long-term value and sustainable improvements that the large generalist consultancies often miss. Talk to us about how we can help you: workwithus@hqip.org.uk Or learn more about developing a strategic approach to embedding patient voice in procurement in this recent blog.

Blog: The uncomfortable truth – Why MCF4 falls short for NHS procurement

14 Jan 2025

Clare Fountain, Associate Director of Quality Improvement

When it comes to procurement, it’s not just about how much you spend – it’s about how well you spend it. A tailored approach aligns every pound with quality outcomes, ensuring that each investment directly contributes to a better, more effective solution. In contrast, a generic approach spreads resources thinly; often compromising on fit, efficiency and impact.

If you’re an NHS organisation considering the Crown Commercial Services Management Consultancy Framework 4 (MCF4) as a compliant route to market, you’re not alone. But will MCF4 be the right tool for your complex procurement needs? While MCF4 offers value in certain contexts, it often struggles to address the unique demands of healthcare procurement:

Favouring the same large organisations with their ‘off-the-shelf’ solutions: NHS projects frequently require specialist expertise, deep NHS system knowledge and tailored specifications, KPIs and benefits realisation. Solutions via MCF4, particularly by large consultancies, tend to be generic rather than carefully tailored to meet individual organisational needs. This means opportunities for long-term value and sustainable improvement are often missed.
Not tapping the most specialist expertise: Suppliers selected during the framework’s setup may not represent the most innovative or specialised in the market. MCF4’s design can unintentionally sideline many SMEs – organisations that often bring specific expertise, agility and a deep understanding of NHS systems. These qualities are not just beneficial, they’re essential for addressing the complex, multi-layered challenges facing healthcare services today.

What’s the answer?

In-house procurement teams can run bespoke invitations to tender (ITTs), but they risk reinventing the wheel or struggle with resourcing. In certain situations, employing a procurement specialist will pay dividends for NHS trusts by offering:

A transformational focus: Procurement isn’t just about sourcing or signing contracts. It should be a catalyst for long-term healthcare improvement with:
- A deep understanding of the challenges to be addressed
- Consideration of value along the whole pathway
- Clear benefits realisation – contracting is not the end point!
Contracting the right solutions, not just the usual suspects: SMEs with expertise, innovation and deep NHS insight are sidelined by rigid framework structures, but procurement specialists like HQIP can do the leg work for you to find the best fit.

Effective pre-market engagement, including patient involvement: Patient voices are often added late in the process, or not at all, reducing alignment with real-world healthcare needs. NHS procurement teams are also not always equipped to do this effectively. Procurement specialists with patient engagement experience can support teams with a strategic approach to embedding this throughout the procurement process.

Higher value delivered: When done right, tailored procurement delivers better outcomes – outcomes that are sustainable, impactful and aligned with the needs of patients, clinicians and healthcare teams.

Procurement + Patient Engagement + Quality Improvement = Better Value

HQIP’s exemplary commissioning approach: Delivering better outcomes

We go beyond transactional procurement by embedding quality improvement principles, patient involvement and social value into every stage of our commissioning work. With years of experience developing and refining our exemplary commissioning approach, we can help you navigate some common pitfalls. HQIP commissions the National Clinical Audit and Patient Outcomes Programme (NCAPOP), a nationally recognised quality improvement initiative funded by NHS England since 2009. Through rigorous, specification-driven commissioning, we measure the quality of care across a range of medical specialties, driving:

Clinical pathway improvement
Reduced variability in care standards
Improved patient outcomes

Reasons to commission HQIP procurement

Aligned with NHS values	Quality and value for the NHS is at our core. As a not-for-profit organisation, we share NHS values, focusing on long-term outcomes over short-term returns.
Flexible, tailored procurement	Our approach is adaptive and context-specific, ensuring each procurement strategy is fit for purpose. We can provide capacity or manage procurements end-to-end, as well as mentoring and training your local procurement team.
Pre-market engagement	We can help you maximise the benefits. A unique strength of HQIP is how we embed the patient voice through every stage of the procurement. Doing this produces significant benefits by ensuring all commissioning considers exactly what end users want – delivering better value and outcomes.
Social value-driven	We are experienced in awarding suppliers based on multiple criteria that assess their capacity to impact long-term patient outcomes and social value, in addition to cost.
Continuously improving	HQIP leads best-practice in procurement by continuously refining commissioning and supportive practices for greater social benefit.

When healthcare commissioning demands flexibility, deep NHS expertise and meaningful patient involvement, contact us at: workwithus@hqip.org.uk Our value-based Procurement+ service combines expertise in procurement, patient engagement and quality improvement to ensure you achieve better value and outcomes. Schedule a consultation with our team today.

Blog: Increasing value by embedding the patient voice in procurement

28 Oct 2024

Clare Fountain, Associate Director of Quality Improvement

With 25% of the NHS budget allocated to procurement, the need to identify and act upon every opportunity to drive greater value across the entire supply chain is clear. Integrating patient input into procurement can play a transformative role here, shifting the focus to how the product or service contributes to patient care. By embedding patient engagement into the procurement process, improvements can be made in relevance, patient-centeredness and efficiency, maximising both value for money and social value through better patient outcomes. It’s undoubtedly the right thing to do – but now it’s also becoming an essential thing to do. With Lord Darzi highlighting that the patient voice is not loud enough in NHS England, plus the launch of Change NHS, patient engagement is under the spotlight. The Social Value Act and the UK Government’s Social Value Model mandate the inclusion of social value criteria in supplier selection and the Procurement Act 2023 is set to raise expectations even further. Drawing on our years of specialist procurement experience, we outline key considerations for developing a strategic approach to integrating the patient voice in your organisation’s procurement. We also offer top tips for a structured, impactful and inclusive process.

1. Ensure your purpose for engaging patients is clear – and supported

For each procurement, consider how patient engagement could improve your decision-making. Use this understanding to identify a well-defined set of outcomes that you are looking to achieve. These outcomes should translate into specific patient engagement procurement goals and activities. Ensure you have the support of senior leaders and other key stakeholders by clearly communicating the value of patient engagement. For example, patient engagement can help to:

Increase your social value metrics
Form part of the Procurement Act preliminary market engagement, to help providers understand and prioritise key criteria, features and functionality of goods and services
Future proof, by building aspirational intent into your procurement
Improve both quality of care and patient adherence with treatment by better meeting patient needs
Reduce risk

2. Engage early and throughout the procurement process

For engagement to be meaningful it needs to form a fundamental part of the commissioning process, not just be a formality. As with any other stakeholder engagement, start early and plan how you will engage throughout the procurement lifecycle. This might include:

Pre-market engagement to better understand needs and inform later procurement practices
Patients helping to set supplier selection criteria and/or questions in the Invitation to Tender process
Inviting patient participation in tender evaluations to influence bid scoring
Incorporating measures for patient engagement in the contracts and ensuring continuous involvement throughout the project lifecycle, to help maintain a focus on patient outcomes
Patients co-designing contract management metrics, to monitor supplier progress and compliance
Ongoing engagement for continuous refinements in service delivery

Embedding patient involvement at each stage of the process:

3. Develop structured and inclusive engagement plans

Structured, multi-dimensional planning up-front helps maximise the benefits of engagement, ensuring clarity of roles, streamlined communication and compliance with best practices. Getting this right from the outset can often prove challenging. Some key points to consider are: Your engagement model:

Consultation – gathering input from patients and the public on specific issues
Collaboration – involving patients directly in decision-making processes, from policy development to care pathway design
Advisory – panels for regular feedback and contribution to strategic planning

Legal and confidentiality requirements:

Information Governance when collecting personal or sensitive data, e.g. consent, legitimate interest, privacy notices
Declarations of interest to protect both patients and the integrity of the process

Participation support

Valuing people’s time, including payment for involvement (using set criteria)
Using an experienced engagement facilitator – the benefits will easily outweigh the costs
Developing a code of conduct for both staff and participants
Safeguarding and emotional support

Participation of participants:

Ensure engagement reaches a diverse range of patients, including marginalised and underserved communities (you could use the CORE20PLUS5 list as a guide) to gather perspectives from different demographics and lived experiences
Tailor engagement formats and methods (e.g. larger fonts, translations, different communication formats) to remove barriers to participation, ensuring diverse voices are heard
Create realistic timelines for engagement to allow meaningful contributions

Communicate continuously and effectively: Use various methods, like focus groups, surveys and social media, to keep patients informed and engaged throughout the procurement process, tailoring communication to their needs. Consider setting up feedback loops so that participants know how their input has been used to shape decisions – this reinforces the value of their involvement.

4. Ensure your team have the right skills – and your participants do too

Effective patient engagement not only involves equipping your team to engage with patients successfully, but also ensuring participants have the skills and knowledge for meaningful participation. You may wish to consider:

Training: Educate patients on procurement processes, bid evaluations and legal considerations
Resources: Use patient advisory councils, workshops and online platforms to provide necessary tools
Engagement toolkit: Create a toolkit with guidelines for evaluations and responsibilities
Education: Offer informational sessions and materials to clarify patients’ roles in healthcare

5. Recognise the importance of continuous improvement

Embedding patient engagement into procurement is a journey. If this is new to your organisation, we would recommend a) starting with involvement in part of a procurement process and b) selecting a procurement with clear benefit of patient involvement (a ‘quick win’). We would not suggest adopting all aspects we have outlined at the same time. Ultimately patient engagement will become embedded in your ‘business as usual’, with engagement practices tweaked and improved over time. Measuring procurement outcomes (i.e. the benefits enabled) from the outset and ensuring ongoing engagement with wider stakeholders and participants means that you will be able to take a structured, data-informed approach to continuous improvement.

At HQIP, we know that your procurement challenges are unique – that’s why our solutions are too.

Our value-based Procurement+ service combines expertise in procurement, patient engagement and quality improvement to ensure you achieve better value and outcomes.

Talk to us about how we can help you: workwithus@hqip.org.uk

Blog: Insights from Lord Darzi’s independent investigation of the English NHS

20 Sep 2024

Re-establishing Quality as an organising principle of the NHS

Chris Gush, Chief Executive Officer, HQIP

Lord Darzi’s report candidly highlights key areas requiring urgent attention within the NHS. Those involved in, and connected to, healthcare delivery already know that the ‘system’ of care must function better for both patients and staff. We must improve access, elevate care quality, and boost outcomes for everyone. Shifting care closer to home, preventing illness, integrating services, and embracing technology are all critical—if expected—themes.

We welcome the report’s emphasis on amplifying the patient voice and giving patients more control over their care, on boosting productivity through improved operational management, and on the crucial need to reduce health inequalities. However, it remains unclear how policy and funding will address these areas and how the strategic challenges that have hindered progress to date will be overcome. We aspire to be part of these solutions.

We have selected three areas to comment on that align to our work:

The importance of data-driven insights and identifying variances from evidence-based provision
The emphasis on increasing patient and community engagement and patient empowerment
Improving management within the NHS to enhance productivity and quality.

Clinical Audit: The powerhouse behind data-informed quality improvement

“The extraordinary richness of NHS datasets is largely untapped either in clinical care, service planning, or research” Paragraph 14

“… the availability of data—and in itself demonstrates the need to invest in measurement and transparency across all areas of the NHS” Paragraph 29

Clinical audit reports provide powerful, clinically curated, data-driven insights into the quality of care measured against evidence-based standards, with national benchmarking. A robust design and commissioning process, involving patient engagement, evidence-based guidance (e.g. NICE) and clinician collaboration drives this work.

Numerous clinical audits are referenced in the Darzi report and can continue to play a leading role in tackling the challenges that Darzi highlights.

Adherence to evidence-based clinical guidelines: A stark finding of the report is the “insufficient adherence to clinical guidelines” across many clinical specialties.

The key focus of clinical audit as a methodology is to provide data-driven insights of variance from evidence-based guidance, which enables sustained improvement in both patient outcomes and operational efficiency.

Addressing performance variability: Performance variability is a major issue. Darzi highlights troubling variations in elective care outcomes and persistent avoidable harm.

Clinical audit, as a methodology, national or local, can support teams to implement a stronger process reliability approach identifying, unpicking and helping reduce unwarranted variation from the standard as well as tracking the effectiveness of improvement strategies through data dashboards.

The need for national audits in wider settings: As Darzi reminds us, performance standards are currently heavily focused on hospitals, with insufficient attention to primary care, community services and mental health.

Collaborating with colleagues in primary care to expand clinical audit coverage to these areas would enable more comprehensive quality improvement. Data flow and sharing challenges in primary care are starting to be addressed by OPENSafely, as referenced by Darzi, laying the foundations.

Bringing together robust audit measures across acute, ambulance, primary and social care could elevate quality monitoring still further, for the benefit of population health management, triangulation and national sharing of good practices.

Amplifying the patient voice: A step towards equity

In some respects, particularly in its decision-making and systems, the patient voice is simply not loud enough” Paragraph 4

Darzi is correct in stating that the patient voice needs to be louder. Our patient engagement work shows that genuine co-production of services with patients is crucial for understanding what truly matters to them and for driving meaningful change. Partnerships with patient groups and charities ensure that marginalised voices are heard. However, some patient groups have repeatedly shared their experiences and are now fatigued by the process; they seek action rather than more consultation, as well as personal empowerment – particularly in critical moments like childbirth.

At HQIP, we embed patient engagement in every step of our commissioning processes for clinical audit, ensuring diverse voices—especially from underrepresented groups—are heard loud and clear. By amplifying patient voices, we push for equitable care improvements. But is this enough? Can we do more?

Lord Darzi emphasises that stronger patient engagement is central to creating truly patient-centred care and tackling health inequities. His report highlights the growing dissatisfaction, noting that “patient satisfaction with NHS services has steadily declined, with many feeling their concerns are not being heard.” In particular, the report draws attention to significant disparities in care, such as the threefold higher mortality rate among Black women during childbirth (MBRRACE audit). Addressing these inequities requires urgent action across all healthcare sectors, including cancer care, mental health, and children’s services. This focus on patient engagement aligns with the broader need to address social determinants of health, such as income and housing, which continue to drive disparities in healthcare outcomes.

Quality as an “organising principle”: Systems of quality management

“The problem is not too many managers but too few with the right skills and capabilities. International comparisons of management spend show that the NHS spends less than other systems” Paragraph 24

Darzi’s 2008 report made the case that raising the quality of care should be the organising principle of the NHS. The 2024 investigation report provides an analysis of the NHS’s current state in England, and “there is much work to be done if quality of care is to become the organising principle of the NHS once more”. As expected, ‘productivity’ is a term abundant in the report (59 mentions in the main report), with the key link to Quality for Patients made clear “a productive NHS can mean high quality care for all”.

Darzi’s report outlines deep challenges in leadership and operational processes, stressing that these are systemic, not individual failings. As Darzi outlines “managers are there to ensure efficient organisation and process so that clinicians can deliver high quality care to meet the needs of patients”.

Many of the elements Darzi talks about hint at the benefits of organisational Quality Management Systems (QMS), a term that many will be familiar with from the NHS Impact framework but which are also not yet optimised.

So, what might be the benefits?

Giving clinicians time back with ‘systems of work’ that function and streamline operations. QMS can help by providing a structured approach to improving processes, reducing waste and enhancing productivity. The QMS methods are not unknown, but not optimised.
Reducing unwarranted variation systemically, for example by embedding clinical audit standards in EPRs, providing real-time decision support bundles and/or order sets as well as real-time variance data. Darzi’s report acknowledges that the NHS is “in the foothills of digital transformation“, but if we could progress this, the productivity and quality gains could be exponential.
Effective process management: Ensuring that the NHS has experts in process design and control could further help streamline processes, reduce variability, and alleviate the workload on clinicians, enabling a more focused approach to patient care.
Culture of learning: A focus on system factors, rather than individual errors, fosters a culture of continuous learning and improvement enhancing patient outcomes, operational efficiency, and care consistency.

While the Darzi report sets out significant challenges, it also points to opportunities for systemic improvement. By leveraging clinical audits as a core tool for quality improvement, the NHS can address some of the critical issues highlighted in the report. HQIP stands ready to support this effort. Data-driven insights and patient voices must guide the NHS as it rebuilds quality as its core organising principle.

Talk to us about how we can help you: workwithus@hqip.org.uk

For more details, you can view the full report here.

Blog: What’s Next for NHS Procurement?

10 Jul 2024

Judith Hughes, Associate Director of Procurement (MCIPS), HQIP, shares her reflections from Procurement 4 Health 2024

Attending the Procurement 4 Health (P4H) event in Birmingham this September was a reminder of just how crucial healthcare procurement is to the overall functioning of the NHS. What really stuck with me was a staggering statistic:

25% of all NHS spending is on procurement, over £30 million annually

It’s an eye-opener, especially when you consider the immense pressure on the NHS budget. That figure highlights why effective procurement isn’t just a financial concern – it’s about ensuring that every pound spent translates into better patient outcomes. Unsurprisingly one of the hot topics on everyone’s mind at the event was the delay in the implementation of the Procurement Act. How are you feeling about the Act? Optimistic? Or perhaps a little overwhelmed at everything that needs to be done? The potential for streamlined processes and improved supplier engagement is undeniable, and I’m eager to see how it will impact the way we work. However I do know that many of us are secretly pleased that the Act is delayed, as it gives us more time to digest and implement these changes into our organisations. The day kicked off in the Keynote Arena with a welcome from the Chair Tracy Cramond, Commercial Advisor to NHS Shared Business. Tracy emphasised the need for collaboration across the NHS, something that really shouldn’t be as difficult as we make it.

This resonated deeply with me. Healthcare procurement is not a siloed activity. It requires partnerships, cross-departmental co-operation, and – frankly – a shared commitment to do what’s best for patients.

This collaboration bleeds into supplier relationships and partnership working, and it’s a key focus for HQIP and our supplier base. We work closely together to deliver the best patient outcomes throughout the lifecycle of the contracts. The sector is clearly on a journey, but it has already come a long way in terms of innovation and best practice. Zones dedicated to digital transparency, infrastructure and sustainability were buzzing with ideas, with the NHS Commercial and Procurement Pavilion a particular hive of activity. There were an array of topical presentations in the different areas, but one thing I noted that was missing from the event was any kind of focus on the patient and the linkage between procurement and patient outcomes. I took the opportunity to attended the following presentations:

How will the Procurement Act Support Better Engagement in the NHS Supply Chain? This was presented by Sarah Coldrake, Associate Director of Commercial Governance and Policy, NHS England (see, I knew the Procurement Act would get a mention…).
Social Value in Action, presented by Michelle McCann, Chief Sustainability and Innovation Officer, NHS London Procurement Partnership. A thought-provoking presentation, with good points to note and learn from. Michelle made it clear that we must act now to integrate social and environmental value into our procurement decisions. As someone who believes that procurement has a direct impact on patient care, I found her points compelling.
Provider Selection Regime: A Six Month Progress Review, presented by Lucy Probert, Senior Associate, Hill Dickinson. This was very interesting. The Provider Selection Regime (PSR) came into force in January 2024 and focuses on the procurement of healthcare services. The PSR applies to the procurement of goods or non-healthcare services and the uptake of the PSR seems to be slow.
Making Sustainability Real in Procurement, presented by Neil Hind. Neil stated that “the climate emergency is a health emergency”, supporting his presentation with strong facts and figures. As a procurement professional, this resonated with me and was a timely reminder of the sheer volume of the challenges we face.

I specifically wanted to touch base with the Health Care Supply Association (HCSA). I caught up with Alan Hoskins, who I’ve known for quite a number of years, and we had a chat about the HCSA conference, 13-14 November. HQIP are going to have a stand at this event to promote our procurement consultancy services that offer something quite unique. We combine our expertise in procurement, patient engagement and quality improvement to enable those we work with to achieve better value and outcomes. Alan also referred me to the HCSA Women’s Network, which I look forward to following up on. Whilst HQIP are not part of the NHS, we do provide pivotal healthcare insights and support through our work. I also caught up with Hannah Quinn-Hill, NHS Business Director from Michael Page, who HQIP have partnered with on a thought leadership event on 17 October. As guest speakers, we will be highlighting the importance of the patient voice in procurement. Registration for this free event is open to all NHS procurement leaders. Patient engagement in procurement is a topic that HQIP is passionate about and it has been reassuring to see patient voice referenced strongly in Lord Darzi’s recent report on the pathway to NHS reform. Our CEO, Chris Gush, shares his thoughts on this and other key themes from the report in his recent blog post. The day flew by and before I knew it, the conference was over. Having started the day looking forward to attending the event, it certainly did not disappoint. I met many great people who are as passionate as me about healthcare procurement and the changes that we can bring – through our combined expertise and insight – into the market.

Talk to us about how we can help you: workwithus@hqip.org.uk

Blog: Yes we can

24 Jun 2024

The importance of national clinical audit in addressing health inequalities

Professor Danny Keenan, Medical Director, HQIP

We all know instinctively that health inequalities are complex. Why a person who lives in an affluent area, or is white, is likely to have better health outcomes than their more deprived, or non-white, counterpart (for example) is difficult to unpick. But unpick it, we must. However, in doing this, we are not faced with a blank sheet of paper. We have data, which can support a better understanding of the issues and help us to tailor solutions. And that’s where national clinical audit comes in. For HQIP, as commissioner of the National Clinical Audit and Patient Outcomes Programme (NCAPOP) on behalf of NHS England, we understand the potential value of this vast font of knowledge (the NCAPOP is the largest of its type in the UK) in addressing health inequalities. In November 2023, we published a report on Improving Health Inequality Data in the NCAPOP, to explore the barriers to health inequality data being routinely reported within the programme. Written by our then-Medical Director’s Fellow, Dr Alice Bradley, this report found significant variations in the reporting, analysis, and use of health inequality data among different audits. Now that a little time has passed since this report was published, I want to reflect again on its findings, to ensure that the important messages within are kept to the fore and, more importantly, that the recommendations are implemented.

This is a call to arms. We must utilise our collective initiative and resources to collect the data needed to enable insights in relation to ethnicity and deprivation

The report drew from two previous studies where we, with previous Fellows, looked at the outputs from a random group of NCAPOP audit reports, to identify which, if any, analyses were being performed in relation to the influence of ethnicity and deprivation on patient outcomes. Clearly, we were hoping to gain insights into any differing outcomes relating to these factors. However, we found there to be less focus on their influence than we had hoped. There was much good practice to support insights into the influence of gender and age – but much less in relation to deprivation, and even less, to ethnicity. Accordingly, we surveyed our audit providers to explore why this might be. From formal and informal discussions, we understood that they had much interest in understanding inequalities in relation to ethnicity and deprivation, but barriers persisted nonetheless. Alice piloted, and then undertook, a definitive survey to explore what these barriers might be. There was very good compliance in the survey from the audit providers, which supported a variety of findings. As might be expected, some issues are more easily solved than others. Therefore, it’s easier to consider them in terms of those that can be more easily overcome, alongside those that are more complex. Issues that can be more easily overcome can be summarised as follows:

When using routine data sources:
- Poor or incomplete coding
- Difficulties with categorisation
- Miscoding, with different codes used for the same patient on different occasions.
When using bespoke data:
- Time pressure on clinical staff
- Engagement challenges with patients
- Consent issues.

The more complex areas can be grouped as follows:

Small numbers problem: At the analysis stage, this makes data analysis statistically inaccurate. Furthermore, there are concerns that small numbers at reporting stage may make data identifiable. There is currently a lack of guidance on how to aggregate small numbers.
Population data: There is a lack of population statistics to allow comparisons to be made at the analysis stage.
Costs: It was clear that detailed analysis along the lines of ethnicity and deprivation would increase the costs, increasing the resources required for clinical audits.

Several of these areas can be addressed together with our audit providers. This would include changing the specifications for new and renewed programmes within the NCAPOP, so that the recording of ethnicity and deprivation is paramount. However, as is clear from the findings, many of the themes will require multiple agencies working together to bring about change. This would involve a fundamental shift for all. However, this has been achieved previously and, if we work together, I believe we can do it again – when we were faced with the COVID-19 pandemic, everyone came together and made quick and significant strides to tackle difficult problems. The same approach is possible for health inequalities. While there are significant local projects that are making in-roads, this issue is worthy of a major push to update coding so that all involved, especially patients, will benefit from the targeted improvements that will arise from much more detailed information.

Data providers had much interest in understanding inequalities in relation to ethnicity and deprivation, but barriers persisted nonetheless

A digital solution is the obvious approach to take. We must not rely on frontline staff working harder. The systems we use routinely must be used to solve this problem. With the significant roll-out of electronic records, there must be a way of incorporating information about ethnicity linked to NHS number, and about deprivation linked to postcode? And if this could be extended to linking between primary and secondary care, there would be even greater benefits. NHS Digital, now incorporated into NHS England, has already improved coding. This was a very important step that enables us to pick out, not just the ‘big picture’ differences in care and outcomes between different ethnic and socio-economic groups, but also the more nuanced differences. If we work together with agencies such as NHS England, the Welsh Government, the Model Health System, the UK Health Security Agency and the Office for Health Improvement and Disparities, we can move on to develop strategies to address more complex issues, such as the small numbers problem associated with health inequality data outlined above.

When faced with the COVID-19 pandemic, everyone came together to tackle difficult problems. The same approach is possible for health inequalities

I want to end on a note of caution. Whatever strategies are developed, we must recognise that there will always be a population that is transitory or who want to remain private, for whatever reason. While difficult to include in national data collection, it is imperative that they are accommodated by whatever system we introduce to improve health inequalities. In summary, while there’s no denying that health inequalities are complex, appropriate data collection can help us to understand these complexities. As such, this blog is a call to arms. We must utilise our collective initiative and resources to gather the data needed to enable these insights to take place, particularly in relation to ethnicity and deprivation. Then we will be able to ‘blow the lid off’ health inequalities, and peer inside to understand why differences exist. More importantly, we can make changes to health and care – as well as other – services to transform and save many, many lives. I, for one, am ready for this challenge – and I know that the whole healthcare sector is too. Yes we can. This blog was released as part of Clinical Audit Awareness Week 2024; for more information, go to: www.hqip.org.uk/clinical-audit-awareness-week.

Further information

The National Clinical Audit and Patient Outcomes Programme (NCAPOP)
Report on Improving Health Inequality Data in the NCAPOP
CORNERSTONE 2023, HQIP’s quality improvement magazine, with an article on health inequalities (pages 14-15)
2023 Clinical Audit Awareness Week / Clinical Audit Hero Healthcare Inequalities case study – Sandwell & West Birmingham NHS Trust
Spotlight on the Early Years report to identify cross-cutting lessons relating to early years healthcare with a focus on health inequalities.

Avoiding ‘lost in translation’

4 May 2024

Using national healthcare data to support meaningful change

Jill Stoddart, Director of Operations (National Clinical Audit and Patient Outcome Programme), HQIP

What keeps you awake at night? When I worked in clinical practice, questioning whether I’d provided the very best care for patients kept me awake. Now I commission national clinical audits and other patient outcome programmes, this is still a primary concern – but the focus is on whether the data we collect supports the best care for patients. How can we ensure that evidence derived at a national level is well received and implemented at Trust level? And, critically, are we really making a difference to patient care?

I understand the pressure and challenges that Trusts face with increasing demand, financial constraints, bed shortages, recruitment freezes and preparing for winter pressures – all in addition to national and regional scrutiny. Against this backdrop, it can be extremely difficult to make sense, and practical use, of the vast array of national healthcare data available. Between April 2022 and March 2023, the National Clinical Audit and Patient Outcome Programme (NCAPOP), commissioned by HQIP, published 64 reports and 368 recommendations alone. Factor this up across the national clinical effectiveness landscape – including National Institute for Health and Care Excellence (NICE) guidance, Getting It Right First Time (GIRFT) reports, Healthcare Safety Investigation Branch (HSIB) investigations and multiple other national enquiries – and we can safely say that Trusts are awash with reports and recommendations.

Widely disseminate information about both negative and positive outliers – share the learning!

This is why, in 2023, HQIP reshaped its outputs. We undertook discussions with policy makers and healthcare providers, which identified a need to reduce the burden and increase the timeliness of data, culminating in:

Shorter user-friendly ‘state of the nation’ reports
Quality Improvement (QI) resources, replacing local recommendations in reports
A focus on approximately ten metrics, and
Near real-time dynamic reporting, refreshed at least quarterly.

However, while these changes were welcomed by healthcare providers, we know that information provision alone does not change behaviour. It takes much more than knowledge to leverage change. The starting point for transformation at a Trust level is to continually question the quality of care provided. Questions are vital, they do not mean resistance and should be actively encouraged. These questions can take many forms, and can help to clarify understanding.

Questions that healthcare organisations can ask themselves about their performance* were highlighted in the 2023 edition of CORNERSTONE by Mirek Skrypak (pages 22-23) and are worth reiterating here, since they are the starting point for a Trust:

Do we know how good we are?
Do we know where we stand relative to the best?
Do we know where, and understand why, variation exists in our organisation?
Over time, where are the gaps in our practice that indicate a need for change?
In our efforts to improve, what’s working?

Alongside asking key questions about clinical effectiveness performance, all Trusts need to also invest time in building an open and transparent data and quality improvement culture. NHS England’s approach to improvement is outlined in their NHS IMPACT (Improving Patient Care Together) programme. It includes five components which form the ‘DNA’ of all evidence-based improvement methods, and which underpin a systematic approach to continuous improvement:

Building a shared purpose and vision
Investing in people and culture
Developing leadership behaviours
Building improvement capability and capacity, and
Embedding improvement into management systems and processes.

NHS England also makes a wide variety of useful improvement resources available to health and other care providers. These include good practice pathways and guidance documents as well as cross-cutting workstreams such as GIRFT, intensive support and national clinical audit.

The starting point for innovation and change at a Trust level is to continually question the quality of care provide

So, what difference can clinical audit make? The audit cycle includes taking action to bring clinical practice in line with evidence based standards, to improve the quality of care and health outcomes. Healthcare providers need to consider the link between the evidence base, national policy, national clinical audit and local implementation. This can take many forms, but here are some top tips that are useful when considering how best to use data intelligently and achieve change at a local level:

Share information widely across the Trust, understand variation, make data available and transparent but don’t stop there – discuss it and agree the changes required. Widely disseminate information about both negative and positive outliers – share the learning!
Report by exception to the relevant assurance committees and Board – ensure regular Board airtime is given to discussing the data, its meaning and the required QI actions.
Remove Trust level obstacles – bureaucracy stifles innovation.
Remember the 80:20 rule (Pareto Principle) – 80% of outcomes (or outputs) result from 20% of causes (or inputs) for any given event.
Always set deadlines and agree who is responsible for delivering actions, following up on progress. Set regular small milestones – these are much more likely to be successfully implemented.
Action plans need to be robust and identify system actions which remove the reliance on individuals. Where possible, use standardised and permanent (physical or digital) designs to eliminate human error, sometimes referred to as ‘forcing actions’ (as cited in the Perinatal Mortality Review Tool (PMRT)’s infographic relating to their 2022 annual report).
Be aware of national clinical audit publication schedules – and make plans to receive reports and data as they are published.
Know your Trust plan and timetable for the national clinical audit programme.
Monitor your own internal Trust data and take actions to unpick and explore early, using NHS England Making Data Count resources.
Make an explicit Trust link between data and Quality Improvement (QI) and avoid silo working.

All seemingly obvious and sensible. But, in fact, it’s easy to get this wrong. The Kirkup report on maternity services at the East Kent University NHS FT was published in October 2022. It highlighted several important points when it comes to understanding variation, and presenting and interpreting data, stating “The unit-level information that is available tends to be presented in the form of ‘league tables’… These serve to conceal the variation between different units, with no indication of whether one or more units are outliers”. To address this, Kirkup noted two requirements:

1. From Section 6.9: The first [requirement] is the generation of measures that are:

meaningful – that is, related clearly to outcomes
risk adjustable
available – they are available from data already routinely collected
timely.

2. From Section 6.10: The second requirement is that the measures:

are analysed and presented in a way that shows both random variation and trends
use sound, statistically based approaches to detecting the signal among the noise
are presented graphically to show variation, significant trends and outliers in the form of statistical process control charts and funnel
plots are extended to clinically relevant outcome measures.

These, and many other messages in the Kirkup report, can be extrapolated and applied across Trusts and other healthcare providers. Data are everywhere, often difficult to interpret, can be complex and, at times, additional information is required to get a clear picture of what is happening. As such, it can be difficult for Trusts to understand where they need to improve. The following tools offer a suggested approach:

Questions for Trusts to ask themselves about how they use data

1. Is there evidence that the Trust is aware of the requirement to participate in NHS England’s Quality Accounts (QA) List of clinical audits / programmes?

Limited and sporadic use of data. Data are reviewed but only when a problem has occurred.

Pockets of data used across the Trust, clear QI peer leaders – the Trust is on a journey, but work is needed to embed a culture of data use across all workstreams.

Commitment to improving patient care and active understanding that clinical audit is a key element in that process. Consistent and regular use of high quality data, both qualitative and quantitative, with data triangulation across all directorates, and with a proactive approach where ideas are shared collaboratively.

2. Is there evidence that the Trust is aware of the requirement to participate in NHS England’s Quality Accounts (QA) List of clinical audits / programmes?

Limited understanding of the NHS Contract requirement to participate in national clinical audit. The Trust has no comprehensive and accurate record of the audits it has / hasn’t participated in, with no plan to address this.

The Trust is aware of the QA List but: does not participate in all of the relevant listed audits / programmes has poor case ascertainment. Has a plan but lacks annual achievement, and lacks ability to move forward with the plan to full implementation.

There is a Trust clinical audit plan in place that is aligned with the annual national publication date of the QA List, with evidence of Trust Medical Director support that demonstrates: 100% participation in all relevant QA List audits 100% case ascertainment. There is a Trust annual clinical audit report where progress is discussed quarterly at the relevant Quality Committee and reviewed annually by the Trust Board (with an indication of whether the Board is assured or not assured).

3. Is there evidence that using data are included in relevant staff training / Learning and Development (L&D)?

The use of data is not incorporated into Trust L&D programmes. There is no evidence that the Trust is investing in data / QI skills and capabilities.

Training is in place but there is no carry through to staff objectives and appraisals.

The Board has evidence of an annual presentation by the Making Data Count NHS England team, and all relevant Trust staff are required to watch the Making Data Count virtual presentation as part of their mandatory training. The use of data is incorporated into relevant staff objectives and performance and personal development reviews. There is evidence of a commitment to develop the skills and capabilities for improvement across the Trust.

4. What data are used?

Scant use of national or local data.

Uses monthly dashboard ‘sound bite’ data with limited use of longitudinal trends from statistical process control charts. Limited data triangulation and lacks awareness of data sources available.

Understand and appropriately uses: National data that has been quality assured and risk adjusted (lacks timeliness given the linking and extra analysis required) Uses near real-time local data (timely but not risk adjusted) to watch for ‘smoke signals’ at a -2 standard deviation alert level and takes early proactive action to head off -3 standard deviation alarm outliers Proactively uses local surveillance data where this is made available by national audit providers Triangulates data Reacts rapidly to national data notifications (for example outlier status notifications from audit providers and/or the CQC) The HQIP ‘Directory’ is used to identify high level and key information for each work programme.

5. What format is the data presented in?

No distillation or synthesis of the data – huge amounts of confusing data are presented with no attempt to synthesis or interpret the findings, lacking focus.

Data are presented in a succinct, clear and meaningful way but there is limited discussion, with no conclusion drawn and no link to QI.

Data are presented where relevant using a combination of: Longitudinal trends in the form of Statistical Process Control charts (SPC) updated monthly Regional or national dashboards There is understanding and management of variation Data are clearly benchmarked Data are discussed, interpreted, and conclusions made with explicit links to QI.

6. How are the data interpreted?

Directorates work in silos with no clear allocation of lead responsibilities for the data interpretation, no triangulation of data, and no cross-fertilisation of QI ideas and activities. Does not act upon the data. Knee jerk reactions to isolated data points.

Understands which key metrics need to be reported but lacks clear roles and remits for monitoring, reporting and interpreting the trends – ‘data rich, information poor’.

There is a dedicated Trust data intelligence group who proactively INTERPRETS longitudinal trends for pre-agreed key Trust metrics / data outputs, with joined-up messages across workstreams, triangulation of data and an understanding of the bigger picture.

7. There is a clear audit trail from national clinical audit, longitudinal data interpretation, with active discussions and links with QI

There is limited use of data, and QI mechanisms are yet to be fully developed and implemented – there is no joined-up approach.

Data are available but there is no agreement about the key metrics, and data outputs are not linked to the Trust strategic objectives or QI initiatives. The Trust lacks a clearly articulated approach for using data and linking it effectively with QI.

There is a seamless, consistent, standardised, harmonised and coherent approach to data collection, interpretation and Quality Improvement. Information is actively shared across the Trust in relevant committees and the Trust Board.

8. The Trust Board reviews and discusses data

Trust Board receives ad hoc clinical effectiveness reports with limited discussion about the meaning and interpretation of data outputs. Not linked to QI and no indication in the Board papers about whether the Board is assured / not assured.

Clinical effectiveness issues and data are escalated to the Board by exception.

There is an agreed clinical effectiveness strategy linked to the Trust’s vision and objectives that describes how the Trust will intelligently interpret data and indicates how this data will be used across the Trust with seamless links to QI initiatives. Regular Board airtime is given to reviewing and discussing clinical effectiveness data. Quality improvement is a clear leadership priority for the Trust Board. The Board gives regular feedback with an indication of whether the Board is assured / not assured.

Trusts can either internally review these questions to judge where they might sit, or it may be helpful to ‘buddy’ with a peer Trust for independently reviewed opinions, such that a relevant professional team, external to the Trust / Board, provide ‘fresh eyes’ and an independent perspective. Translating national data into effective change at a local level isn’t easy. It may be littered with potential pitfalls and difficulties, but it is, of course, vitally important. So, I will leave you with just one takeaway thought, a lightbulb moment (neatly inspired by the inventor of the lightbulb, Thomas Edison): “I have not failed 700 times. I have succeeded in proving that those 700 ways will not work. When I have eliminated the ways that will not work, I will find the way that will work”. Here’s to continuing to work together, and supporting each other, to find the ‘right way’ to use national clinical data to support meaningful change at a local level.

Further information and resources

HQIP commissioned audit and programme reports (subscribe to notifications here)
Information and resources to support the use of the National Clinical Audit and Patient Outcome Programme (NCAPOP) to stimulate healthcare Quality Improvement (QI)
Support with Developing a clinical audit programme
NHS England Quality Accounts (QA) List of clinical audits/ programmes
HQIP ‘Directory’ with high level and key information for each work programme
National Clinical Audit Benchmarking (NCAB) website
Article: When is data ‘good data’? HQIP CORNERSTONE magazine 2023 (pages 22-23)
NHS IMPACT (IMproving PAtient Care Together) programme
NHS England IMPACT resources and materials
NHS England Making Data Count

This article was originally featured in HQIP’s quality improvement magazine, CORNERSTONE – to see more articles on topics such as healthcare inequalities and sustainability in healthcare, go to: www.hqip.org.uk/wp-content/uploads/2023/11/HQIP_Cornerstone_2024.pdf.

How do I compare thee?

4 Apr 2024

A review of benchmarking in healthcare.

Professor Danny Keenan, HQIP Medical Director and Associate Medical Director to the Manchester University NHS Foundation Trust.

Benchmarking in healthcare is far more than mere comparison. It is a powerful tool that can support healthcare providers to identify opportunities for improvement and improve patient care. But, in a minefield of data and information, what are the key resources and developments in relation to benchmarking in healthcare, and what steps are HQIP taking to support effective measurement of performance? Our Medical Director, Professor Danny Keenan, provides a helpful overview…

Your first port-of-call should be audit and similar programme reports and outputs. Be familiar with what is available in your field, and understand how often – and when – data is shared. For HQIP commissioned audits and programmes, the reports and other outputs can be found on the HQIP website, while our publication schedule (which is updated monthly) is here. Importantly, our outputs were changed after the COVID-19 pandemic, following a series of webinars with the national audit providers to explore if the programme was ‘digital ready’. As a result, changes – such as shorter reports, less metrics and a move towards near real-time dynamic reporting – were introduced to reduce the burden on Trusts and healthcare service providers. It is also worth noting that, in addition to these commissioned summary reports, many clinical audit and outcome review programmes have websites where further background data can still be accessed.

A benchmarking chart based on data from the National Hip Fracture Database (NHFD) showing ‘prompt surgery’ (surgery by the day following presentation with hip fracture) with confidence intervals. Each hospital is denoted on the x axis (not shown here):

Another starting point is the National Clinical Audit Benchmarking website (NCAB), which provides a visual snapshot of individual Trust audit data set against individual national benchmarks. There is no barrier to use, such as login or an NHS email address, so it’s easy to use and available to all – from healthcare professionals through to policy makers and patients. Created by HQIP in collaboration with the Care Quality Commission (CQC), this resource contains datasets on a variety of clinical disciplines, with additional data being added on an on-going basis (to receive notifications of new datasets as they are added, subscribe to HQIP’s mailing list). It provides a snapshot view of each healthcare provider, stating whether, for example, they are above, in line or below expectations for each measure. NCAB also enables Trusts to determine if there are any metrics for which they are a (positive or negative) outlier. This is important for highlighting when patient outcomes fall significantly outside of the norm of what is expected. In light of its significance and in response to the COVID-19 pandemic, HQIP has undertaken extensive consultation with stakeholders, including patients, to revise its guidance relating to outliers. The result is a ‘softer approach’ which retains the principles of benchmarking, and includes:

The introduction of a ‘nonparticipation category’ so that Trusts that should be contributing data towards national audits but are not, will be regarded as an outlier.
Changes to the notification of significant outliers. For key predetermined audit metrics, such as mortality, ‘alert’ level results will be notified directly to the CQC and NHS England. Other less significant metrics with alert outlier results would be available for review when annual reports are published.

In addition to these resources, HQIP is involved in a number of developments to support Trusts and other health and care providers to measure performance, starting with talking to clinicians and analysts to identify better ways of visualising HQIP and NHS outputs (to ensure maximum impact). Work in this area includes making more timely data available on NCAB, and looking at how we could standardise coding systems that are already in use. We are also talking to patient and service user groups as well as the independent sector, to include the latter in the National Clinical Audit programme. The Paterson review made it clear that all patients’ data should be included, no matter where their operation has taken place or how their care is commissioned. This will ensure that patient care is equally assured, and that their data is available for quality improvement initiatives irrespective of geography. Of course, performance measurement and benchmarking are of utmost importance to the NHS too. In 2023, I chaired a series of ‘National Clinical Audit for Improvement Implementation Group’ webinars run by NHS England. These explored the development of clinical effectiveness across the service and, in particular, looked at ways to support clinical audit colleagues who are very much on the frontline of this work, with initiatives such as NHS IMPACT, the Futures NHS platform and the Model Health System. To further support the sharing of innovation, they also coordinate the NHS Benchmarking Network, which helps members to improve patient outcomes, raise health standards and deliver quality health and care services through data excellence, benchmarking and the sharing of innovation.

The Paterson review made it clear that all patients’ data should be included, no matter where their operation has taken place or how their care is commissioned

One area that everyone is interested in (quite rightly), is how to address health inequalities; and audit data and performance measurement is proving to be a powerful tool for this, shining a light on where inequalities exist. The COVID-19 pandemic highlighted inequalities in health outcomes due to ethnicity and deprivation. As a result, HQIP is investigating how the National Clinical Audit programme can track patients’ outcomes better using markers such as ethnicity and deprivation. In particular, we sponsor a National Medical Director’s Faculty of Medical Leadership and Management (FMLM) Fellow each year, and they have led a series of reviews on this topic. The 2023 review, due for publication in late 2023, is a survey concerning the obstructions encountered in relation to health inequalities, and includes a number of strong recommendations concerning basic issues such as coding, use of postcode and how to manage small numbers in the audit programme (all of which could make a big difference). We are now working with the Health Inequalities team at NHS England, regarding the plans for implementation of these important recommendations.

Audit data and performance measurement is proving to be a powerful tool for… shining a light on where inequalities exist

All the tools and resources I have mentioned so far are available to support benchmarking here and now (and I do hope you will take a look at them, if you are not already doing so). But I will end on more of a nod to the future. Firstly, we must improve how we celebrate excellence. Currently HQIP works with audit providers to produce “scenarios” concerning units that appear at the ‘excellent end’ of benchmarking charts. But, we need to raise excellence across the board. One of the downsides of benchmarking is that units sitting in the middle of the chart can become complacent, whereas we all need to keep moving towards the excellent end. HQIP will work with audit providers on ways of celebrating excellence better, so as to promote a ‘move to the right’. Secondly, to support strategic- and forward-thinking around audit data and performance review in healthcare, HQIP runs a Methodology Advisory Group (MAG), comprised of a broad spectrum of stakeholders including policy makers, healthcare professionals, and patients. In 2023, we hosted a MAG webinar dedicated to Artificial Intelligence (AI) and machine learning. We reviewed the use of these technologies in relation to National Clinical Audit, and discussed what work was already taking place and how we could foster best practice in this area. As a result, we are now exploring how best to share current and proposed best practice using AI. Furthermore, we have also committed to investigate the use of ChatGPT-4, or alternatives, to explore current anonymous datasets to search for disease and outcomes linkages. I’m sure that you, as do I, await news on how these developments can support us in measuring performance and improving outcomes for patients with eager anticipation. Watch this space…

Further information and resources

Article: Patient and Public Engagement in practice

3 Mar 2024

A win-win for healthcare providers and patients alike

There are many well-documented reasons as to why it’s important to work with the people and communities we serve, not least improved health outcomes. But these benefits apply to both care-givers and -receivers alike. Kim Rezel, Head of Patient and Carer Engagement at HQIP, talks to both the staff and volunteers from two past winners of the Patient and Public Involvement category of the Clinical Audit Heroes Awards (Epilepsy12 and Side-by-Side – see more about these projects at the bottom of this article) about their experiences of effective patient engagement, in the hope that others may be inspired to think about how they could include patients and carers in their projects…

The healthcare professional perspective…

The patient perspective…

Q: What motivated you to set up a patient group to support your audit?

Epilepsy12: We weren’t getting through to patients’ “real voices”; there was a distance. We were beginning to get some sense of people’s views through the patient experience measures that we’d built into the audit, but there was a strong sense that they wanted more direct “contactability” with our service. At the same time, we realised the irony that our patients had limited involvement in the design and running of the audit, and so we needed an approach that would address that.

Q: Do you have any hints or tips on how to get started?

Side-by-Side: Ask people to be involved and provide a genuine offer of real involvement; don’t just pay lip service to patient engagement. Side-by-Side was created from when we held a traditional research conference in 2014, in which we invited a group of patients to provide feedback. It wasn’t positive. We apologised and asked them to help us to make it “better” next time. This was the start of building relationships and working together to put patients at the heart of what we do.

Q: How does it work, in practice?

Side-by-Side: We have a group of patients and service users who work alongside us. They meet regularly (every 6 to 8 weeks) and we present involvement opportunities to them, while they hold us accountable to all the things we said we were going to do. We are very fortunate to be in a position where we have a participation team to support liaison such as sending email updates etc. It can take some time to set up in the first instance, but it’s so worth it – and now we’ve got to a point where the group is happy to be contacted via a quick text or WhatsApp message. We genuinely see them as part of the team; they have this wealth of experience, skills and ideas that we feel really privileged to utilise in what we do.

Q: What do you see as the main benefits of setting up a patient group?

Epilepsy12: The quality of the feedback we get has exceeded my expectations. For example, at first, when we sent the group a patient-facing report to review, I was expecting something fairly light touch, but actually the feedback was much more profound than that. Because it comes from a patient, the information comes with experience and passion. It made me realise that there isn’t anything the group can’t do. Now there isn’t a part of the process that they’re not involved with; they’re involved in the full methodology, from design to delivery.Side-by-Side: This has completely transformed the way I work, even to the point where our patients contributed to my appraisal. Working with patients means you can come out with something entirely different, but also better and more fit-for-purpose and with greater longevity.

Q: And what about the challenges?

Epilepsy12: If you’re not careful, you can be pulled in different directions. We needed to ensure that everyone involved was aware of each other’s visions and perspectives. So, we focused on getting a ‘balance of autonomy’ among the different groups. But it’s a delicate balance; a dance between autonomy and empowerment. When you start to empower others, you are admitting that you might move the power base elsewhere – and there’s a vulnerability to that. You’ve got to accept that you are not always in control of where you’re going.

Q: How do you ensure appropriate representation in the project?

Side-by-Side: Over the last year, we have expanded the group by involving people from across Solent NHS services. We did this by reaching out to different charities and communities. As a group, we continuously review and work together to improve the diversity of Side-by-Side.

Q: What are your main learning points now that the project has been running for some time?

Epilepsy12: We’ve had a growing perspective of how to engage and embed young people directly in the audit. Initially, we had quite a narrow view of what an audit was, thinking it was about young people. But now we think of it as being with young people. In fact, we don’t really think of it as an audit anymore; it’s more of an improvement project with young people that uses audit methodology.

Side-by-Side: We have come a long way but we have made mistakes along the way (I actually wrote a blog about when it goes wrong). The thing I love most about our group is that we have an open and honest relationship, where they can feed back to us ‘in the moment’ and we learn how to improve. We’re still learning but I do think that having a relationship where people can give constructive feedback is really, really important.

Q: What are your visions for the future of your patient engagement work?

Epilepsy12: I’d like to see participation on every level. We have really strong involvement in the team and at national level, but I’d like to see participation move to more of a network model so that we can link to professional networks. There are different layers of influence, and it would be good to see our young patients involved in all those layers. For example, embedded in local teams, Integrated Care Systems (ICS), and at a regional level. Then, these networks could link up with young people with other health problems. However, while it’s not entirely within our gift to solve, we can build patient networks in the same way that we can build professional networks. Another aspiration with the audit is to build patient-facing elements into the data streams. To that end, we’re trying to get automated data flow for whole populations, to support research as well as clinical care. We’d also like to see more joined-up data – so it feels like it’s the patients’ data, not the hospital or the professionals’ data. Ideally, we’d even see ‘live involvement’ from the person with epilepsy in the audit e.g. with them filling in their forms, not just clinicians doing it for them.

Q: Why did you become involved?

Side-by-Side: Having the opportunity to add a community perspective into projects within Solent NHS Trust, to provide a patient voice, is really important. We have something extremely valuable to add into discussions around our care.

Epilepsy12: We wanted to make sure that young people and their families were heard, since discussion and patient engagement means better care. In a nutshell, we wanted to create a gold standard in epileptic care.

Q: How did you become involved?

Epilepsy12: Initially, I became associated with different epilepsy charities, completing feedback forms etc. Then, I became involved in this programme’s Board, speaking at a conference and working with a group of others to help launch the Epilepsy Passport. But then we became keen to be more involved, to put our views into practice. Following a conference in 2019, we realised that we wanted to reach out to clinicians to look for the best ways to speak out about epilepsy care, which we did. Consequently, several clinics from across the UK got in touch and said “yes, please come and visit us”. Unfortunately, because of the COVID-19 pandemic, we weren’t able to go out and speak to people in person; however, we still made contact, but using online methods instead.

Q: What happened next; what did your involvement look like, in practical terms?

Epilepsy12: I went to an initial meeting, and something really clicked. The group started creating videos and analysing different sorts of leaflets, sending them to the doctors to say, “look, this is what young people really want”. More and more clinics wanted to come and speak to us, and we ended up embarking on a sort of ‘youth advocate road trip’. We worked out how we could make a difference going forward. Since then, we’ve been able to think about good practices, such as making a welcoming environment and having good conversation starters.

Side-by-Side: We are involved in a lot of different ways, for example in the recruitment of staff. I helped to interview for a research nurse; I was sent all the relevant application forms and was able to adapt the interview questions. During the interviews, I was given the opportunity to ask a set of questions, and then I was involved in the discussion afterwards. We are also regularly involved in co-producing training on research, improvement and working alongside people. I have been involved in the content and planning from the outset, and in the delivery on the day. It was clear that the attendees genuinely valued our input too. A lot of opportunities can be fulfilled online, which really helps.

Q: What do you enjoy about participating in a project like this?

Side-by-Side: It’s a great opportunity to be part of a panel of people who are all very lovely and positive; all with different backgrounds and different skill sets, which is what makes it so interesting. We have the ability to get involved in lots of different sorts of activities, which is great. It’s really enjoyable and rewarding to see the difference our contribution makes.

Q: Are there other benefits to being involved, particularly those you hadn’t envisaged at first?

Epilepsy12: We have managed to find our own unique way of engaging with doctors. Our discussions are interactive, and we get to hear their views. By being part of this work, I’ve been exposed to so much and learnt a huge amount about the epilepsy world.

Side-by-Side: The more I’ve become involved, the more I have gained confidence, and that seems to stand for the group as a whole. We understand more and more the important part we can play, and we’re always made to feel such an integral part of the team. There’s no divide between volunteers and paid members of staff, and that’s why I think it works really well. There’s a great level of mutual respect.

Q: What have been the most challenging aspects of being involved?

Epilepsy12: Epilepsy care can be a very difficult subject for young people to talk about when they are going through it. It can make you feel very vulnerable, and you need to be sure that the group is a safe space. I needed to be happy that I would be able to talk about my experiences honestly, as well as try to change policy and improve epilepsy care. In truth, it can also be quite challenging to get through to clinicians sometimes – you need to work out the best way of communicating, whether it’s sending emails, communicating by post or using social media.

Q: Are you paid for your involvement?

Side-by-Side: Payment was never an expectation when I became involved, but actually it does serve to reinforce the value that we bring, recognising that we are giving not just our experience, but also our time. It does make a difference and reinforces the notion that I’m worth something because I work really hard at this. Receiving payment for my contribution enhances my self-worth and, for some people, payment is what makes involvement possible.

Q: In hindsight, what would you change?

Side-by-Side: Definitely get patients involved from the start of any project, and don’t make it a retrospective activity. We can provide valuable input right from the start. A lot of people think, well, that’s a lovely idea, but I wouldn’t know where to begin. But you can start small – maybe just through an informal conversation – and work from there, so it isn’t insurmountably difficult or time consuming.

Q: How do you see this work developing in the future?

Epilepsy12: We’re already starting to see the sorts of changes we want to see – for example, having families and youth advocates lead the work. From a young person’s perspective, we have this group where young people are sharing their views and actually having a say; and I think that will continue. However, we do want our partnerships to grow, joining up with key allies – and that will be the next phase for us.

We hope that others from the health and care sector are able to take inspiration – as well as practical tips – from these exemplar projects. While we recognise that effective patient engagement is not an easy task, particularly in the current climate, these interviews demonstrate the impact it can have on patients’ care (and, in turn, their lives). It’s also true that there’s no magic wand for embarking on patient engagement activities; however, these projects show that small steps can turn into bigger ones, so it’s often a case of getting started, and listening and learning as you go along. Dr Colin Dunkley, Clinical Lead at Epilepsy12, offers a word of caution: “It’s easy to involve people, but it’s also easy to involve them badly. When people share their experiences, they’re giving something of themselves – so that does need careful management to make sure it isn’t tokenistic, non-inclusive or exploitive.” But he clearly thinks that it’s worth the effort: “Engaging with patients properly can take you to unexpected places, but you’ll realise that that’s where you should have been going anyway – so you’ve just got to jump. Otherwise, you might end up in the wrong place.”

With that in mind, you may find it useful to look at case studies of exemplar projects from HQIP’s Richard Driscoll Memorial Awards, which celebrate excellence in patient engagement in the National Clinical Audit and Patient Outcomes Programme (NCAPOP). Finally, as this is about patients after all, we would like to give the final word to a young patient, Owen Thurston (a Youth Advocate from Epilepsy12): “It’s really essential to keep the patient at the centre of healthcare at all times. If we do that, then the sky’s the limit for patient voice!”

About the interviewees

More about the winning projects from the Patient and Public Involvement category of the Clinical Audit Heroes Awards featured in this article:

Epilepsy12 is an audit delivered by the Royal College of Paediatrics and Child Health (RCPCH) that is supported by a group of epilepsy experienced or interested children, young people, families, and an epilepsy specialist nurse. They volunteer to shape the Epilepsy12 clinical audit and lead improvement activities with patients, families, and epilepsy services. They bring their voices, experiences, hopes and wishes to life, together, through youth-led project work and advocacy.

Interviewees:

Dr Colin Dunkley, Clinical Lead
Owen Thurston, Youth Advocate

Side-by-Side is a partnership between the Solent Academy of Research and Improvement team and a dedicated group of patient and public involvement representatives who support the integration of clinical audit, service evaluation, quality improvement, research and library teams within the Solent NHS Trust. Support comes in many forms, such as co-designing and codelivering training workshops, supporting improvement projects, reviewing reports, sitting in interview and award panels, and organising an annual conference.

Interviewees:

Sian Lloyd Jones, Side-by-Side member
Juliet Mosney, Side-by-Side member
Sarah Rowcliffe, Side-by-Side member
Colin Barnes, Head of Improvement
Carl Adams, Head of People Participation
Natalie Royston, People Participation Facilitator

Get involved

Join HQIP’s Service User Network. It is now easier than ever – and without the need for a fixed commitment. We are seeking those with lived experience as patients or carers to sign up to receive regular newsletters about involvement opportunities as well as updates on local and national engagement activity. Opportunities include inputting into the development of an HQIP commissioned programme and new project proposals, patient advocate positions on national audits, and providing feedback to resources, among others. Read more about HQIP’s SUN here and complete and complete this form to get involved.

About patient engagement at HQIP

The Healthcare Quality Improvement Partnership (HQIP) is committed to involving, engaging and informing patients and their representative organisations throughout our work. We ensure that patients and carers are reflected in all aspects, from commissioning programmes through to resource development. Find out more: www.hqip.org.uk/involving-patients.

Blog: In for the long haul

29 Feb 2024

Taking an effective and sustainable approach to clinical audit

Vicky Patel, Chair, National Quality Improvement (incl. Clinical Audit) Network (N-QI-CAN)

“Any commissioner or provider of health and care has a duty to review and monitor the quality of the services delivered, making improvements, where appropriate, that are sustainable. The clinical audit community fully supports this responsibility, and there are a number of exemplar projects that have made a difference to patient care and outcomes that take sustainability into consideration. However, this comes with challenges, and these need addressing if we are to enable teams to strengthen and future-proof our systems. Here, we outline some considerations and approaches that could support you in overcoming these challenges… Firstly, there’s the sheer volume of clinical audits that health and care organisations are eligible to participate in, in order to review, monitor and improve health and care. This highlights resource issues that, if not understood and addressed, can impact on the ability to be both effective and sustainable. Then, even once resources are in place, there are a number of other considerations to take into account… Clinical audit topic selection is based upon the health and care priorities for our nations at a national level, and for our local communities at a local level. Patients and service users should be involved to bring a ‘lived experience voice’ to the topics for inclusion but, most importantly, they should inform the metrics for measurement. They can provide the ‘what matters to me’ that we need to embed into our decision-making, to improve and further strengthen health and care. But, once we know what the clinical audit programme should include, how do we ensure that it delivers on what it sets out to achieve effectively? Principles of Best Practice For many years the clinical audit community has promoted Preparation and Planning as the most important stage to take time to get right. The other stages will be more easily achieved if we have planned and prepared for the right data being collected in the right way at the right time – and then validated, triangulated and translated for the right audience(s), to inform timely decision making. For example, we need to ensure that the workforce has the capability and capacity to implement an improvement plan and evidence the impact. We also need to plan for measuring over time, to ensure the improvements implemented have sustained impact. The National Quality Improvement (incl. Clinical Audit) Network (N-QI-CAN) encourages health and care staff to not see each clinical audit as an additional workload or task, but to find ways to embed the activity as business as usual. Make a pledge to undertake a Quality Improvement (QI) project after reviewing the processes for participating in each clinical audit in your programme. This supports a focus on reducing the data burden and releasing resources for taking action for improvement as well as evidencing the impact on improving patient and service user outcomes. Also, don’t forget to share your learning with each other, celebrating success. With most organisations experiencing a high number of projects on their programme, this could all feel like an overwhelming task, but take it one step at a time. Focus first on the highest priority section of your programme. Follow the ‘Do One Thing’ approach, start with Just One Clinical Audit and consider the following top tips:

When planning, don’t start at the beginning. Identify where the vision is going to take you and where the journey will end. If this is a national audit, agree where the priority fits within the local picture. Clarify the drivers both nationally and locally. Buy-in at all levels is key. Link the clinical audit topic to the wider QI plans and work streams within your own organisation and across the system. If the QI function is not part of your team, protect some time with those colleagues and align the clinical audit to patient pathways and other QI workstreams, to ensure the wider improvement plan includes the clinical audit and a move towards continuous measurement. Additionally, ensure that any further QI as a direct result of the clinical audit measurement, is taken forward collaboratively with all relevant stakeholders.
Build your team and supporters. Identify and engage an individual who will be the ‘Clinical Champion’ for the clinical audit. In addition, identify and include leadership roles for those who will be the decision makers. They need to sponsor the project, committing to actively reviewing the outcomes and resourcing actions needed to improve. There will also be further individuals who will need to undertake QI projects as part of training programmes, curriculums, revalidation, appraisals and Personal Development Plans. Implement local processes to involve and engage them in improvement work that matters, and which is a priority for the organisation and local system.
Embed data identification, collection, validation and submission into everyday practice. Implement processes to ensure that all eligible audit or QI cases are identified for inclusion, to ensure a valid review of the selected population. Build in a validation process to confirm that the data for submission is accurate. Confirm which roles will take responsibility, and ensure deadlines are made known and committed to. Then, map the dataset and work with your Informatics team to automate the extraction of metrics from existing systems, working to add further fields to collect data where they don’t currently exist. Consider building forms and reports within Electronic Patient Records (EPRs) to prospectively collect the data that can be extracted electronically, where these don’t already exist. Leave any metrics remaining that may have to be collected prospectively at the point of contact or retrospectively from case notes. For organisations not yet on EPRs, consider designing an electronic form to collect the data and use software with queries set up to analyse the data automatically. Confirm the skills required to collect and interpret the information. You will need to establish the project team based upon capability as well as capacity.
Plan and agree both the timeline and process for review of data and actions for improvement, moving to a proactive rather than reactive approach. Forward plan the clinical audit timeline of data submission as well as publication releases of data and reports. Agree in advance the forums where the data will be reviewed and discussed with the right level of roles to inform decision making for QI plans. Plan in wider triangulation with data and information, to understand the context and further inform actions required to improve. Make contact with relevant partner organisations within the local system and agree how to take forward a QI plan across the system that improves both health and care along the Patient and Service User pathway. This should support effective and efficient access of data and reports, to inform decision making and enable timely action on improvements.
Evidence the impact. Identify at the start what measurement needs to be built in, to evidence the impact of any changes made. For a number of national clinical audits that continuously collect and present data over time, this is already incorporated into the design of the audit – but there may still be measures you want monitoring in more real time locally. For local audits and those that are not continuously measuring and monitoring, consider what available metrics you can access to evidence the impact. Where these are not already available, take action to build this in. Ensure that there is a focus on timely identification of unwarranted variations, continuous decision-making and an improvement journey; not just on one point in time.

Clinical audit agreement processes So, to bring this full circle, we should go back to the beginning and urge you to consider these two questions when potential audit topics are identified:

Why this topic?
Why now?

Determine the real driver behind the selection, and who is driving it. Is there an urgency to measure and improve now? Make informed decisions on a truly prioritised clinical audit programme. Place additional emphasis on sustainability in terms of cost, efficiency and environment, while still achieving the best possible outcomes, keeping patients safe and providing the best experience for each individual patient at the time of need. Consider utilising Clinical Audit as a tool for measuring the impact of adopting technologies that can release efficiencies in the system while improving health outcomes and experience for patients and service users. This model of thinking and action-taking aligns with the NHS IMPACT strategy. It links clinical audit with wider Quality Improvement while automating data where possible, to free up resources to influence improvements that are sustainable across the pathway. In summary, a clinical audit should be sufficiently resourced to ensure both efficiency (in relation to undertaking the project) and effectiveness (in relation to delivering on its purpose). In other words, for sustained improvements to be achieved, clinical audit resources must be available throughout all stages. Furthermore, taking the time to effectively plan and prepare each clinical audit to measure health and care that address all the domains of quality – effectiveness, safety, experience (responsive and person-centred), well led, sustainably resourced and equitable – alongside data-driven discussions and decision-making on improvement plans, will contribute to future-proofing our healthcare system. To conclude, it is imperative that we work collaboratively across our systems to implement sustainable improvements, measuring over time to evidence the impact of any change in practice or service. If we focus on ensuring sustainability, any changes made will be embedded in practice and support the achievement of all domains of quality, both now and into the future. ————— National Quality Improvement (Incl. Clinical Audit) Network (N-QI-CAN) N-QI-CAN is a professional network of colleagues undertaking clinical audit and other healthcare improvement work across England, which was founded in 2000 (originally as the National Audit Governance Group). They have over 1000 active members from more than 500 organisations that provide care to patients in the NHS and hospices, which are organised across twelve regional networks. To find out more, visit the N-QI-CAN website.”

More like this

This article is one of a number of articles written for CORNERSTONE, HQIP’s free publication, designed to support Quality Improvement. This article was featured in the 2024 edition, which features other articles on patient engagement, benchmarking, and the using health data to influence change (among other topics). For more information, go to www.hqip.org.uk/magazine.

20 years of the National Joint Registry

3 Feb 2024

How the NJR benefits hospitals.

The National Joint Registry (NJR), which is hosted by HQIP, was founded in 2002 and started collecting data to monitor the performance of hip and knee replacement surgery in England and Wales in 2003. Since then, they have expanded their scope of both joints and territories covered. Elaine Young, Chris Boulton and Deirdra Taylor from NJR’s Management Team, explain more about the Registry’s interactive reporting tools and the benefits they offer to hospitals…

The NJR has invested in the development of a wide range of interactive reporting tools over the years for both hospitals and surgeons. Most of these can now be accessed through our dynamic software reporting platform NJR Connect – Data Services, which includes Annual Clinical Reports on joint-related procedure performance outcomes.

Supporting best practice

We support local clinical governance through the provision of hospital- and surgeon-level reports, providing an independent assessment of the safety and effectiveness of local practice compared to national benchmarks. We alert hospital Medical Directors of any adverse patterns in patient outcomes attributable to their hospital and provide data and analysis to support local investigation of root causes for raised alerts. In 2022, we launched the NJR implant scanning app to support medical device implant checking during an operation, to help prevent the occurrence of ‘never events’ where incompatible implants are inadvertently used in patients. Every six months, a comprehensive analysis is undertaken of the performance of all surgical units undertaking joint replacement in the NJR’s operational areas. Each hospital, regardless of their performance, receives a comprehensive in-depth analysis of their practice, including a list of all revisions and deaths. This regular reporting mechanism enables hospitals to reflect on best practice and address any issues relating to worsening outcomes.

Regular reporting mechanism enables hospitals to reflect on best practice and address any issues relating to worsening outcomes

NJR annual clinical reports (hospital-level reports)

Annual Clinical Reports are provided for all hospitals submitting data to the registry, enabling a detailed analysis of activity and outcomes across joint replacement services. This also provides Medical Directors with a summary of the performance outcomes for each surgeon operating in their units. This is supplemented by analyses that provide indications for revision across their hospital so that trends can be identified, in addition to a summary of how individual surgeons are contributing to a hospital’s overall outcomes. This data is supplemented by customisable reporting tools within our NJR Connect platform, as well as a detailed appendix of individual patient outcomes, which means that data can be analysed locally. In summary, key benefits include:

The ability to monitor and identify ‘never events’ such as use of the wrong implant, or wrong body side (and increasingly prevent them from happening with use of the NJR scanning interface).
Poorly performing units and surgeons are identified and supported to improve.
Poorly performing implants are identified and this information is escalated to regulators.

Example extract from NJR Management Feedback reporting function in NJR Connect – Data Services

Price benchmarking

With a view to improving the cost effectiveness of joint replacement surgery, the NJR’s implant price benchmarking service gives hospitals the information they need to benchmark the price they pay for hip, knee, ankle, elbow and shoulder implants against the ‘best’ national prices achieved across all hospital implant procurement services. This service enables hospitals to drill down into their pricing data, including the additional capability to give surgeons individual reports relating to their own implant use. The NJR’s enhanced implant price-benchmarking service, EMBED, supports hospitals to understand, in greater detail, their use of joint replacement implants in terms of cost, evidence and trends in comparison to the national picture. This service provides clinicians, management, procurement and finance teams with an objective set of data and analysis to inform their decision-making. With a focus on cost and value alongside procedure outcomes, it also underpins the Getting It Right First Time (GIRFT) and NHS England’s Model Health System initiatives.

A sample of the EMBED price bench-marking report

Shared decision-making in a clinical setting

Patient information and knowledge is vital for hospitals to ensure understanding, confidence, manage expectations and contribute to shared decision-making. We publish hospital-level information about patient outcomes following joint replacement surgery that enables patients to understand what to expect from their treatment and to inform their decision about where to be treated: The National Joint Registry – Surgeon and Hospital Profile (njrcentre.org.uk).

We also produce guidance from NJR’s Annual Report to provide patients with digestible data on the type and quality of joint replacement surgery undertaken, to increase patient awareness and patient choice: The National Joint Registry reports (njrcentre.org.uk).

The NJR patient support tool

Additionally, the NJR Patient Decision Support Tool is a freely available online tool that was developed using NJR data on hip and knee surgery, to help those considering joint replacement surgery to better understand the risks and benefits of having a hospital procedure. The patient enters simple details such as age, sex, height, weight, general health and how their joint disease affects them. The tool then uses NJR data from similar patient experiences to calculate how much better the patient will be likely to feel after surgery. The tool also calculates the risk of death after surgery, as well as the likelihood of repeat surgery being needed. Patients with a better understanding of their surgical procedure, their own risk level, and what will be happening to them are likely to be better prepared for their hospital procedure and to thereafter have better outcomes. The Patient Decision Support Tool is an example of how both patients and surgeons can make informed decisions jointly in their hospital consultation time, as an important part of patient-centred medicine. Developed as part of NJR’s supported research programme, it has been accessed by many tens of thousands of patients across over 110 countries to better understand their risks and benefits before surgery. With this brief overview, we hope we have given a flavour of some of the benefits that the NJR delivers to hospitals. By recording, monitoring, analysing and reporting on performance outcomes in joint replacement surgery, we are committed to supporting a continuous drive to improve service quality and enable research analysis – and, ultimately, improve patient outcomes.

About the National Joint Registry

Described as a global exemplar of an implantable medical device registry, the National Joint Registry (NJR), which covers England, Wales, Northern Ireland, the Isle of Man and Guernsey continues to be the largest orthopaedic registry in the world, with an international reputation and over 3.7 million procedure records submitted. They collect information on hip, knee, ankle, elbow and shoulder joint replacement surgery and monitor the performance of joint replacement implants.

More information: www.njrcentre.org.uk

An ′umbrella approach′ to audit: sharing, efficiencies and results

24 Jan 2024

The National Cancer Audit Collaborating Centre (NATCAN) – one year on.

Caroline Rogers, Associate Director, Quality and Development (NCAPOP), HQIP and Dr Julie Nossiter, Director of Operations, NATCAN

In 2023, Professor Peter Johnson, National Clinical Director for Cancer at NHS England acknowledged the transformative power of healthcare data, saying: “We’re in the middle of a real data revolution in the health service”. It goes without saying that the clinical audit community plays a pivotal role in that ‘data revolution’. However, to best realise the potential of data in healthcare, it too is going through a transformation. We look at the National Cancer Audit Collaborating Centre (NATCAN), which takes a truly collaborative approach to clinical audit.

Healthcare improvement strategies will be the guiding light for each audit, providing targeted, measurable goals for cancer outcomes and patient experience

NATCAN was set up to make the most effective use of the cancer data available, in order to bring about improvements in the care provided to patients. The Centre, which celebrated its one-year anniversary in October 2023, heralds a new approach to commissioning national clinical audits; one with collaboration at its heart. The Royal College of Surgeons of England (RCS) – in partnership with the London School of Hygiene and Tropical Medicine – was contracted to run the Centre by the Healthcare Quality Improvement Partnership (HQIP) on behalf of NHS England and the Welsh Government.

Experts in relevant clinical disciplines, methodology, statistics, organisation, data, epidemiology and logistics have been brought together, with the aim of largescale healthcare assessment and improvement. More specifically, NHS England and the Welsh Government are providing £5.4 million over an initial three-year period for the Centre to manage new clinical audits covering all NHS hospitals in England and Wales that care for patients with:

Ovarian cancer
Pancreatic cancer
Non-Hodgkin lymphoma
Kidney cancer
Primary breast cancer
Metastatic breast cancer.

In addition, the following established audits, already hosted by the RCS, were also incorporated into the Centre:

Oesophago-gastric cancer
Bowel cancer
Prostate cancer
Lung cancer.

Within NATCAN, each clinical discipline has its own audit. The Centre focuses on ‘the three Rs’ of clinical audit best practice, ensuring that all its activities are:

clinically Relevant (asking the right questions, as a result of close collaboration between clinical and academic experts)
methodologically Robust (using the best epidemiological and statistical approaches to carry out fair comparisons between hospitals),
and technically Rigorous (making sure data science is put to the best use, in order to drive quality improvement).

What are the aims of the new Centre?

The aim of NATCAN is to strengthen NHS cancer services and, ultimately, improve patient outcomes. People who have experienced, or are experiencing, cancer are important in this endeavour; and patients and patient charities are involved in all aspects of the Centre and its work. Each audit has its own Patient and Public Involvement (PPI), enabling patients to have a strong voice within the clinical committee. Everyone involved in cancer treatment knows it is complex. There may be multiple treatment options, including combinations of treatments, for different types of cancer. A patient’s treatment plan needs to take into account the stage of their cancer and how they respond to treatment. A key aim for each audit is to ensure that the information produced for cancer services recognises these differences, and supports hospitals to focus on specific parts of the care pathway. The Centre uses and links together the existing national datasets that are already routinely collected, reducing the burden and costs on the system as a whole. Organising clinical audits in this way creates a critical mass and capacity of experts, meaning that best practice can be shared.

So, what has been happening so far?

As of late 2023, each audit is drawing up its healthcare improvement strategy, which contains explicit quality improvement goals. These will be the guiding light for each audit – a set of targeted, measurable goals for cancer outcomes and patient experience. Meanwhile, staff and experts have been appointed, and applications made for the data required. As you would expect, the Centre will operate with the highest level of expertise in information governance and the rules surrounding the use of patients’ data; and robust processes are being put in place to support this.

When will we see the data?

The existing audits (lung, prostate, bowel and oesophago-gastric cancers) will continue to report data, while the new audits will produce analysed benchmarked results for each Trust and Health Board in 2024, to be released quarterly thereafter. From September 2024, summary annual ‘State of the Nation’ reports will be produced by each audit, containing key findings and national recommendations for improvements in cancer care. Alongside the data releases, the audits are each developing improvement tools that services can use to improve the care they provide.

Organising clinical audits in this way creates a critical mass and capacity of experts

As with any transformative change, taking a new approach in setting up this national centre of excellence has not been without challenges. But with benefits as significant as greater knowledge and best practice sharing, as well as efficiencies and economies of scale – and, of course, improved outcomes for patients – at stake, the team has worked hard to overcome them. We now look forward to strengthening NHS cancer services, using joined-up thinking and data to provide a wider understanding of cancer treatments and patient outcomes across the country.

About NATCAN

The National Cancer Audit Collaborating Centre (NATCAN) was established as a new national centre of excellence in October 2022. It is a partnership between the Royal College of Surgeons of England and the London School of Hygiene and Tropical Medicine, and was commissioned for an initial three-year period by the Healthcare Quality Improvement Partnership (HQIP), on behalf of NHS England and the Welsh Government. NATCAN brings national cancer audits together in one place, enabling the sharing of best practice and clinical excellence as part of the overall strategy of improving healthcare.

Find out more: www.natcan.org.uk.

Further information and resources

HQIP commissioned audits and programmes – National Clinical Audit and Patient Outcomes Programme (NCAPOP)
HQIP commissioned audit and programme reports (subscribe to notifications here).

The role of Artificial Intelligence in healthcare: potential use in national clinical audit

21 Nov 2023

Dr Claudia Snudden, Clinical Fellow and Drew Smith, Associate Director at HQIP.

In the ever-evolving realm of technological advancements, Artificial Intelligence (AI) stands out as a beacon of transformative change. From smart home systems to predictive algorithms in finance, AI is reaching into more and more corners of our modern existence. The face of this revolution is generative AI, that is: learning models that can generate text, images, and other content based on the data they were trained on. Perhaps the most well known generative AI tool is OpenAI’s ChatGPT, but others such as Bing and Bard work on the same principle. This rapid assimilation of data and generation of information is not just transforming industries on a macro scale; it’s redefining tasks as granular as administrative chores and as expansive as biomedical research.

For those of us at The Healthcare Quality Improvement Partnership (HQIP) and our audit providers, the rise of AI offers both challenges and opportunities. We stand at the cusp of a new era where we must consider the nuances of integrating this technology into our daily workflows. How can we harness it for efficiency, while also navigating its complexities to ensure we remain compliant, especially concerning data protection? In this exploration, we’ll delve into two ways that generative AI can add value to national clinical audits: data analysis and content generation.

Your virtual data analyst

The processing and interpretation of data can often be a bottleneck for many organisations, especially in the realm of healthcare where accuracy is paramount. Generative AI can alleviate some of these challenges. For programmers and analysts, AI can act like an on-demand mentor, providing insights on programming languages like Python, Java, or R, offering solutions to coding conundrums, and even guiding on the nitty-gritty of debugging. It can also advise on data cleaning techniques, suggest appropriate statistical tests, and recommend variables or relationships worthy of investigation.

By feeding or uploading aggregate non-personalised data to the model, you can receive not just analyses but also guidance on presentation. Should you opt for a bar chart or a scatter plot? Which patterns should be highlighted for your target audience? Even more excitingly, as the functionality of AI tools grows these visualisations can be crafted in real-time, serving as a dynamic aid in data interpretation and communication.

Content creation and synthesis

In an age of information overload, the ability to effectively communicate findings is as critical as the discoveries themselves. Beyond numbers and codes, generative AI boasts impressive capabilities in the domain of text. The myriad of possibilities here are genuinely extensive: from distilling the core findings of a lengthy research paper into a concise summary, to translating content across languages, or to converting raw bullet points into coherent prose.

And it’s not just about simplification; it’s about tailoring. An audit report, for instance, could be transformed into an accessible blog post or an informative pamphlet, depending on the target audience. Stuck with where to start when writing a report? Upload your outline to a generative AI tool and let it kick off the creative process for you.

Walking with caution: the limitations

As with any technological advancement, generative AI isn’t without its limitations. A primary concern resides in the realm of data protection and privacy. It’s vital to approach online tools as if you’re releasing information into the public domain. Personalised or even pseudonymised details should never be entered into such a tool. Similarly, one should refrain from uploading unpublished content such as national clinical audit report drafts.

Moreover, whilst the reservoirs of knowledge that AI tools are built on are vast they are not infinite, nor are they always up-to-date. Tools may sometimes stumble with deeply technical jargon or misinterpret the context behind a query.

With all this in mind our most important caveat is that artificial intelligence is… well… artificial. As exciting, insightful, and revolutionary as AI can be, it doesn’t (yet) replace the 2 million years of human evolution that’s gone into us. Generative AI tools are known to ‘hallucinate’, that is: to create incorrect information and present it as fact. Even, in some cases, fabricating its own citations. AI hallucinations can be difficult to spot and arise from a model being trained on a limited, out-of-date, or low-quality data set. Or they can occur because the tool doesn’t possess the contextual understanding of the prompt.

It follows therefore that as users the onus is on us to cross-check citations provided by generative AI, and sense-check the information it produces. As Gartner points out: “Generative AI creates artifacts that can be inaccurate or biased, making human validation essential and potentially limiting the time it saves workers.”

Looking forward

The incorporation of generative AI within both the infrastructure at HQIP and our audit providers promises a slew of benefits. From data analysts to communication specialists, the potential for AI models to elevate our workflows, bolster efficiency, and sharpen our outputs is undeniable. As we look ahead, there’s also the exhilarating prospect of using tools to develop bespoke AI analytical models tailored for audit data extraction and analysis across clinical audit themes. This endeavour, though filled with promise, will require concerted effort, continual learning, and strategic investments.

Current models, whilst impressive, largely result in users being able to perform existing tasks more quickly. But in the next few years we anticipate that continued growth in investment and computational power will see a blossoming of AI capabilities and an increasing democratisation in the use of tools.

The advent of generative AI offers a glimpse into a future brimming with possibilities. As we embark on this journey, let’s tread with curiosity, caution, and the unwavering aim to better our practices for the greater good. The future of HQIP, in many ways, is intertwined with the possibilities this technology brings, and it’s a future we eagerly anticipate.

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1. Ensure your purpose for engaging patients is clear – and supported

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3. Develop structured and inclusive engagement plans

4. Ensure your team have the right skills – and your participants do too

5. Recognise the importance of continuous improvement

At HQIP, we know that your procurement challenges are unique – that’s why our solutions are too.

Our value-based Procurement+ service combines expertise in procurement, patient engagement and quality improvement to ensure you achieve better value and outcomes.

Talk to us about how we can help you: workwithus@hqip.org.uk

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Professor Danny Keenan, HQIP Medical Director and Associate Medical Director to the Manchester University NHS Foundation Trust.

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A win-win for healthcare providers and patients alike

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The National Cancer Audit Collaborating Centre (NATCAN) – one year on.

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