Over the last 2 weeks we have used our QI blog to focus attention on national clinical audit… looking at both the best qualities of NCAs and suggestions on how improvements could be made. This week, we are continuing the theme and looking at some of the more controversial and left-field suggestions on how to improve NCAs that were shared in December 2019 via our annual survey. What we have below is ten suggestions to share and discuss. A real mix of new, controversial and left-field ideas. Let’s get straight to it and think about whether these suggestions really could make a positive difference!
Suggestion 1: Make national audits bi-annual. A recommendation that is not going to please the purists and research folk who look after NCAs and who hanker for complete data sets, but this suggestion shows just how great the burden of NCAs is at the moment. If a Trust is performing consistently well year-on-year in a particular NCA would it be more valuable for them to turn their attention (and resources) to a different aspect of their care where they have concerns?
Suggestion 2: Make them optional. Wow! Building on from suggestion 1, this suggestion has the smell of revolution about it. One can only imagine the response from HQIP, NHS England and all the NCA suppliers to this stick of dynamite!
Suggestion 3: NCAs should be run by one body! Of course, this isn’t possible (or is it?), but we can perhaps understand why this suggestion has been made. We have NCAPOP and non-NCAPOP audits. We have HQIP running the national audit programme, but wait, they don’t run all of it. By and large the Royal Colleges deliver most of the NCAs, but it is all a bit bewildering isn’t it? And we’ve never understood how HQIP can award NCAs to Royal Colleges, considering HQIP are made up of the Royal Academy of Medical Royal Colleges! Did someone say ‘conflict of interest’? Some might argue that NHS England could simply run the entire show themselves!
Suggestion 4: involve audit teams and clinical teams in their design. This is a great idea. At the moment we still (by and large) have local and national audit teams sitting in two distinct camps. We rarely meet local audit staff who have helped design NCAs. Why? Massive blindspot. If you want to improve NCAs… then get local audit experts involved, or better still get them actively collaborating and competing to win the tenders. Competition in the marketplace would raise standards and jolt the cartels.
Suggestion 5: Break the monopoly secondary care has over national audit. Frankly whoever wrote this is quite mad! Do they not understand that all meaningful care takes place in hospitals and therefore NCAs must continue to measure the same variables in secondary care that they have done for years? The upstarts from mental health, primary care, ambulance trusts, care homes, etc, must be kept down. Tried and tested, tick!
Suggestion 6: Insist on NCAs costing the data collection burden for NHS organisations. Now this is an interesting point, and in our book a very valid one. When you sign up to a national audit, what level of workload are you actually agreeing to? And what is the cost of this locally? More research needs to be done on the real cost of NCAs and this involves how much manpower and time Trusts need to devote to talking part in these mandatory projects.
Suggestion 7: Make them government funded. Nice idea, but never going to happen.
Suggestion 8: NCAs should ask each participating Trust for an official response to annual reports and publish these online. Isn’t this already part of the process and if not, why not?
Suggestion 9: Honest review of the cost of NCAs. Gold star for this suggestion in our opinion. Indeed, we’ve banged on about how hard it is for years to find out what tax-payers money is being spent on each NCA. In an era of transparency and accountability, it should be easy to find out what income is paid to each NCA supplier. Frankly, we should then all be able to see a breakdown of how each supplier spends their money. This in itself would be a really useful exercise to better understand how NCAs operate. Go and have a look online to see if you can find how much is being paid to each NCA supplier (good luck!). Also, this suggestion dovetails into suggestion 6 and the delivery cost of NCAs for Trusts.
Suggestion 10: Axe HQIP and get CASC to run them. Good to see someone completing our survey that has a sense of humour! CASC are a team of two people with zero procurement expertise. We don’t know the first thing about contracting (thankfully). That said, we do know about clinical audit! Not picking on HQIP but if you look at their army of staff via LinkedIn, you won’t see much evidence of people who have any experience of working in clinical audit. And this goes back to suggestion 4. It is no coincidence that HQIP, NHS England and most NCA suppliers aren’t involving local audit staff in the improvement cycle for NCAs and why NQICAN members are largely only paid lip-service (from conversations we have had). CASC have no interest in running NCAs but we would make all suppliers include local audit staff and patients in their contract bids.
There you have it… ten suggestions from our survey. big thank you to everyone who took the time to take part and give feedback and share ideas. There is a facility to reply on this blog. We wonder how many of the national leaders will take the opportunity to share theirt thoughts on the ideas from the coalface?