We should warn you now, this blog isn’t really a blog. Indeed, what follows will make very odd, disjointed, peculiar but nevertheless fascinating reading. This might just be one of the most important blogs we have ever written, certainly in terms of providing an insight into national clinical audit.
Let’s start with a little background. Most of us working in clinical audit and QI know that the national clinical audit programme is well established and that HQIP (on behalf of NHS England) have run the National Clinical Audit and Patient Outcomes Programme (NCAPOP) since 2008. NCAPOP covers two main sub-programmes: the National Clinical Audit Programme and the Clinical Outcome Review Programmes. For more details, simply click here.
National clinical audit is never far from the spotlight. It has always featured heavily in our annual clinical audit survey and whenever we train, meet or converse with local clinical audit and QI professionals, discussion almost always turns to national clinical audit.
Given the importance of national audit and the fact that the NCAPOP is effectively paid for by the taxpayer, in September we decided to submit a simple Freedom of Information (FOI) request to NHS England.
The FOI was in two parts and sent to NHS England on 03.09.20. It asked for:
1. Total annual HQIP payments to EACH separate NCAPOP national audit for the last 3 full financial years (and)
2. For the last year of those full NCAPOP payments, which organisation/s were paid the funding for each NCAPOP project.
In the meantime, we published a Twitter poll (as shown):
The results speak for themselves, with 95% voting that the annual spend on EACH NCAPOP project should be in the public domain.
On 16 September, NHS England replied to our FOI request with ‘thank you for contacting NHS England, with regard to your FOI request we are unable to provide the information as it is commercially sensitive’. To advise, we have replied by email asking for more clarity on this decision. For us, knowing how much each NCAPOP supplier is paid would have obvious benefits: 1) allowing us to see the variability of funding needed to run each project and 2) at the time of re-tender the financial information would give potential new bidders the chance to lower costs. It is also disappointing that NHS England are not allowing us to see who HQIP are paying to run these projects and it appears from our Twitter poll and respected people we speak to in our profession seem to agree.
Is this the end of the story? Not quite. That’s because last year on 01.10.19 we submitted an initial FOI request to NHS England asking three questions in relation to the National Quality Board’s NCAPOP Partners Subgroup:
1. Who the members of the group are and positions of members on the group, e.g. chairman, secretary, treasurer, etc.
2. Any governance documents for the operation of the group, e.g. Terms of Reference, aims and objectives, job descriptions, etc.
3. Minutes of the meetings [I am happy for commercially sensitive information to be removed or blotted out]
To be honest, we only became aware of the NCB’s NCAPOP Partners SubGroup via Twitter. At that point we had never heard of the sub-group and a quick search on the internet revealed very little. However, they clearly have a vital role and on HQIP’s website it is noted ‘[NCAPOP topic prioritisation is now a process that NHS England undertakes with advice from the National Quality Board NCAPOP Partners Subgroup.
You can read more details about how the group were proposed via a 2017 document here. Within this it is stated: “The group recommended the new NCAPOP Partners Group should do two things. It should help to shape the NCAPOP portfolio, where there is opportunity to do so. And it should also review the ways in which clinical audit recommendations can sustainably support delivery of the objectives of the NQB members to improve patient care. This should include an assessment of any work already being done to address clinical audit findings”.
On 19.10.19 NHS England replied to our FOI and you can read the full reply here. To assist, we can tell you that NHS England were only willing to tell us part of question 1. They would not reveal names and positions of those attending the Subgroup, but have advised that the following organisations are core members:
NHS England and NHS Improvement, Co-chair of National Quality Board (NQB) Partners Sub-group, National Medical Director for Professional Leadership and Clinical Effectiveness
NHS England and NHS Improvement
The National Institute for Health and Care Excellence (NICE), Co-chair of NQB Partners Sub-group, Deputy Chief Executive & Director of Health & Social Care
National Quality Improvement (including Clinical Audit) Network (N-QI-CAN)
Care Quality Commission (CQC)
Health Education England (HEE)
NHS Digital
Public Health England (PHE)
Healthcare Quality Improvement Partnership (HQIP)
Welsh Government
Association of Medical Royal Colleges
Healthwatch
NHS Providers
Audit providers (by invitation).
For those of us working in clinical audit it is great to see NQICAN as part of this core membership and we assume the NQICAN Chairman attends meetings on behalf of the wider local clinical audit and QI community that he represents, but at this stage it is not clear how discussions from the meeting are reported back to the wider audit community. A review of NQICAN minutes from 2019 and 2020 revealed only one reference to the Subgroup from the meeting held on 11.06.19 and this is shown in the following screenshot:
In conclusion, since last October the Clinical Audit Support Centre have submitted two FOI’s to NHS England. We think that given our FOIs relate to important work undertaken using public money and it is right to be transparent and to make this information public.
In a nutshell, we aren’t able to find out how much HQIP pay for each NCAPOP project they commission. Nor can we tell you who that money is paid to. We can tell you the names of the organisations that sit on the National Quality Board NCAPOP Partners Subgroup, but not the structure or governance arrangements of that Subgroup or their terms of reference. As meeting minutes are not available, we are not able to tell you what they discuss and it is unclear how constituent members share key information from the Subgroup back to their wider members.
Sticky questions then. Unanswered questions too. Let’s see what happens next. If you want us to put in an FOI on your behalf but are reluctant to do so yourself as you work in the NHS, just ask us. We are always happy to constructively challenge. After all, clinical audit is all about digging deep and finding out the key information, isn’t it?
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