Patient voice in clinical audit: A powerful partnership improving asthma and COPD care

Published: 18 Jul 2025

With the NHS 10 Year Plan promising to “put power back in the hands of people and professionals to make the best choices about their own lives, treatment and care”, and highlighting the crucial role that clinical audit will play, the HQIP-commissioned National Respiratory Audit Programme (NRAP) is just one example of how clinical audit already involves patients meaningfully to improve care and outcomes.

Patient-engaged clinical audit to improve discharge outcomes

“Having a little time at discharge to make sure everything you’re expecting has happened – and you’ve planned for anything you maybe aren’t expecting – can make the process of going home feel less daunting and can break the cycle of breathing problems before they get worse again.” Heather, patient

NRAP, delivered by the Royal College of Physicians (RCP), recently released Catching Our Breath, a report offering important insights into the current state of respiratory care across England and Wales – including highlighting a need for improved discharge planning.

Effective discharge planning is key to ensuring better health outcomes for patients with asthma and COPD. In 2023–24, only 47%* of people with asthma received all required asthma discharge bundle elements, while only 28%* of people with COPD received all elements of their discharge bundle. For children and young people (CYP), only 25%* with asthma received all three elements required for best practice CYP asthma discharge planning.

Patient panels, alongside Asthma and Lung UK and clinicians, considered how best to share and promote the report’s key messages to patients and the public, seeking to empower people to understand the healthcare that they should be receiving during treatment and, in particular, at discharge.

“It’s vital to include the voice of people with lived experience throughout the production of resources from clinical audits. Everything we do as an audit is to improve patient care and outcomes, so we should always produce resources in collaboration with the people that they are intended for.” Ellie Rochell, NRAP Project Manager

One approach didn’t fit all

Co-designing resources with adults: Initial discovery sessions with both the adult and CYP groups gave participants the opportunity to consider how they would like to share the audit outputs with patients and the public – and highlighted that the groups had different concerns, priorities and requirements.

The adult panel really valued being able to see the data and understand what it meant in terms of their healthcare. Ensuring that the data was accessible to patients and the public was a priority for them. This meant much thought was given to the presentation of data, such as including infographics and fully explaining what each graph or figure showed.

They decided that a patient and public version of the original report, using less technical jargon and explaining the ‘why’ behind the recommendations, would be beneficial, and proposed the inclusion of a glossary to explain terminology and acronyms.

A first draft of this patient and public report was shared with the panel in an insight gathering session, as well as further rounds of feedback via email. The group had final sign off on the report, ensuring their changes and requirements had been addressed. This report is available and is now being used to support adults with asthma and COPD.

Co-designing resources with children and young people (CYP): In comparison, many in the CYP group found the data and figures quite daunting. Instead of sharing these figures with other children and young people, the group wanted to create a resource to empower people to understand what they should receive from hospital when being discharged after an asthma attack.

The CYP joined a design day which included the attendance of a graphic illustrator, funded by RCPCH, to capture their ideas as they were generated. This led to the creation of two resources:

“I really appreciate how lung patients are now given the chance to share experiences. Years ago, this was not possible. The people living with these conditions are as much of an expert as the medical professionals.” Sue, patient

Clinical audit’s critical role in the 10 Year Plan

Our recent news article highlights how the new NHS 10 Year Plan acknowledges the important role that national clinical audit will play in its delivery. In challenging and rapidly changing times, involving patients from the very beginning of commissioning audits ultimately enables better quality services that are more responsive to the needs of patients, focusing on the areas that truly matter to them, their families and carers.

NRAP demonstrates how thoughtful, patient-informed clinical audit engages patients and leads to improved care outcomes – because only they truly know the impact that their illness has on them. For an audit to be its most effective, patient involvement in the dissemination of findings, and the development of resources, is crucial. This ensures that information is accessible, relevant and, above all, useful in delivering care.

Heather, a respiratory patient, sums things up perfectly by reminding us: “It’s understandable that inputting data will be pushed down the priority list when you are constantly stretched for time. But, as patients, we rely on this audit process to help make sure our conditions are managed consistently.”

More on patient engagement in clinical audit

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*Refers to the percentage of people recorded as being in receipt of a discharge bundle. Additionally, in England there is best practice tariffs available for COPD and adult asthma discharge bundle completion.