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Clinical Audit for Improvement 2016: News and Updates from the Conference

Through a series of national updates, practical case studies, masterclasses and poster presentations, this One day Healthcare Conferences UK  Clinical Audit for Improvement conference brought together an exceptional gathering of leading practitioners, clinicians, policy makers and academics to set out the major developments, promote innovative areas of clinical audit, and debate the key challenges affecting clinical audit practice.

The conference focused on clinical audit for improvement with a particular focus on the development of effective local clinical audit leading to audit recommendations that change practice and improve patient care. The day opened with a joint introductory session featuring presentations from Healthcare Quality Improvement Partnership (HQIP) and NHS England.

Jenny Mooney NCAPOP Director of Operations and Yvonne Silove NCAPOP Associate Director Healthcare Quality Improvement Partnership delivered a National Clinical Audit & Patient Outcome Programme Update the session provided an update on the National Clinical Audit and Patient Outcome Programme, looking at design features of outputs of national audits that are most effective at stimulating quality improvement. Jenny updated delegates on the 34 national clinical audits and 4 clinical review programmes ran by HQIP. Yvonne discussed the challenges around national audit, how much should be local v national, time limited v continual, when to report and the best report format. 

Yvonne and Jennys presentation is available here 

Richard Arnold Clinical Programme Lead National Medical Directorate NHS England followed in the joint introductory session with a presentation on ‘National clinical audit for quality and patient outcomes improvement’. Richard discussed:

  • developing meaningful and comparable measurements for all major pathways of care for every provider
  • measuring the impact of clinical audit
  • developing better use of clinical audit in commissioning
  • NHS England Update


Richard discussed the national clinical audit components of quality accounts. 

Richards presentation is available here

Following the joint introductory session the conference programme split into a series of focus issues providing delegates with the opportunity to hear from and question a variety of clinical audit leads, clinicians and managers on issues such as using clinical audit to monitor performance – the CQC perspective, addressing co-morbidity in national and local audit – moving from disease specific audit, delivering an effective local clinical audit programme, ensuring implementation of audit recommendations, using clinical audit findings to change commissioning practice, reporting audit findings and engaging clinicians in clinical audit.

Carl Walker Chair National Quality Improvement & Clinical Audit Network (NQICAN) Clinical Audit Manager University Hospitals of Leicester NHS Trust opened the main stream sessions with a presentation on ‘Developing an effective local quality improvement programme and supporting staff to deliver quality care’ in his presentation Carl discussed:

  • supporting and enabling clinicians to test changes and sustained improvement
  • how do you measure the effectiveness of your quality improvement
  • how do you identify where patient care activities require immediate improvement?
  • our experience

Carl Walker Chair National Quality Improvement & Clinical Audit Network (NQICAN) Clinical Audit Manager University Hospitals of Leicester NHS Trust Full Presentation Click Here

Dawn Nortman Head of Clinical Audit & Research Kent Community NHS Foundation Trust & Former Chair North London Clinical Audit Network (NLCAN) Followed with a presentation on ‘Delivering an effective annual Clinical Audit Programme at a local level that ensures implementation of audit recommendations’ and discussed:

  • delivering an effective annual clinical audit programme which encompasses risk and quality issues and delivers on board priorities
  • using the HQIP 4-step prioritisation model to systematically prioritise topics for inclusion in the annual audit programme
  • how do we ensure implementation of recommendations from audit including pathways of escalation when this does not occur

Following the lunch session Mandy Smith Quality Improvement and Development Facilitator Healthcare Quality Improvement Partnership (HQIP) opened the afternoon sessions in the main stream with a presentation on ‘How commissioners can use clinical audit to improve the quality of services’. In her presentation Mandy discussed:

  • the use of national and local clinical audit in commissioning high quality services
  • how clinical audit can answer the questions commissioners need to ask
  • working in partnership with providers to develop clinical audit and quality improvement programmes

Mandy Smith Quality Improvement and Development Facilitator Healthcare Quality Improvement Partnership (HQIP) Full Presentation Click Here

In her presentation Mandy Smith stated: 

”CCGs ‘would like to be part of a collaborative culture celebrating, sharing and supporting best practice in quality improvement and clinical audit, rather than a punitive culture of performance management. ’..They feel they need to understand more about the local and national data available…And they want to support trusts to use quality improvement methods”

“The NHS Standard Contract - The key document governing the relationship between commissioners and providers…Standard terms apply nationally, options for local agreement…Contractual obligations, penalties for failure, lots of legal language and fine print…”

The NHS Standard Contract -  Applies to all contracts for NHS funded services in England

The Standard has specific requirements relating to clinical audit:

  • The provider must:
    • participate in the national clinical audits within the National Clinical Audit and Patient Outcomes Programme (NCAPOP) relevant to the Services; and
    • make national clinical audit data available to support national publication of Consultant-level activity and outcome statistics in accordance with HQIP Guidance (SC26.1.2 & 26.1.3)
    • implement and/or respond to all relevant recommendations . . . of any appropriate clinical audit (GC15.5.3)
    • implement an ongoing, proportionate programme of clinical audit of the services in accordance with good practice ……. (GC15.7.1)
    • provide to the coordinating commissioner on request the findings of any audits carried out …. (GC15.7.3)

What do CCGs need to know?

  • That providers have effective clinical audit programmes in place to measure and improve the quality of services they deliver
  • That providers use the outputs from national clinical audits to inform local quality improvement activities
  • That providers use clinical audit as a key element in a broad range of quality improvement and service development activities

What actions can CCGs take?

  • Review a providers clinical audit policy and look at individual audits to assess practice
  • Specify audits and/or ask for the outcomes of audits in areas of concern
  • Understand and use all of the available data sources (quality accounts, national audit outputs, local audit reports, etc)

“Don’t agree to vary the service conditions or general conditions – variations are not allowed even if the contracting parties agree (e.g. allowing a provider not to participate in a mandatory audit)”

“Honorary contracts are not sufficient – if an external auditor is appointed patients must be asked for consent before their data can be shared”

“How can commissioners use clinical audit to improve the quality of services? By understanding the clinical audit information available to them, and by supporting providers in making improvements”

“How can clinical audit answer the questions commissioners need to ask? By providing data on compliance with standards, and evidence of quality improvement.”

“The relationship between CCGs and healthcare providers should be a partnership, with the shared aim of delivering effective clinical audit and quality improvement programmes”

The following session from Rotherham, Doncaster and South Humber NHS Trust discussed ‘Reporting audit findings’ followed by Jen Knight Clinical Audit Manager Berkshire and South Central Lead NQICAN, who delivered a presentation on ‘Engaging Clinicians in Clinical Audit’ and discussed:

  • engaging clinicians in clinical audit: what works?
  • ensuring clinically led change as a result of clinical audit recommendations
  • where does accountability for change lie?

Jen Knight Clinical Audit Manager Berkshire and South Central Lead NQICAN Full Presentation Click Here

An depth interactive masterclass from the Clinical Audit Support Team took place during the main session focusing on Clinical Audit in 2016: have we met Liam’s reinvigoration challenge? Along side an extended interactive session from the Healthcare Quality Improvement Partnership (HQIP) on Consultant Outcomes Publication: 2015/16 review and plans for 2016/17.

Following the afternoon tea break and in a Joint closing session lead by the Care Quality Commission, Dr Sundeep Thusu Clinical Advisor Care Quality Commission delivered a presentation on ‘Using Clinical Audit to monitor performance’. In his presentation Dr Sundeep Thusu discussed:

  • what the CQC look at in terms of Clinical Audit
  • is it possible to use multiple audits to look at a provider’s overall performance?
  • an update from the Care Quality Commission

Dr Sundeep Thusu Clinical Advisor Care Quality Commission Full Presentation Click Here

The conference closed with a presentation from Dr Ian Woolhouse Consultant & lead for the National Lung cancer Audit Queen Elizabeth Hospital Birmingham on ‘Addressing co-morbidity and patient reported outcomes in national and local clinical audit’.

The conference aimed to empower clinicians and clinical audit leads to demonstrate to trust board’s the importance of clinical audit. Clinical audit and clinical audit skills have a vital place in the centre of quality improvement and improving outcomes for patients. The conference aimed to ensure audit is impacting on patient outcomes at a local level and answers the questions that trust boards are asking.

Future events of interest:

Clinical Audit Masterclass
Tuesday 21 June 2016
Hallam Conference Centre, London

8 March 2016


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