National Clinical Audit is often in the spotlight and rightly so given the considerable sums of public money spent on these projects and the vast amount of time and effort that goes into them. Indeed, if there is one recurring theme in the CASC annual survey that comes up again and again, it is the burden/workload associated with NCAs.
Interestingly, in recent years, another common theme from our survey relating to NCAs has been the issue of balance and inequity. This seems to have gained momentum since NHS England and HQIP changed the annual payment for participating in the NCAPOP to £10,000 for all Trusts (irrespective of the number of NCAs they are eligible to take part in).
We’ll leave you to visit the HQIP website here to take a more detailed look at the distribution of national audits, but the current programme is dominated by audits that measure care in acute hospitals. Community, primary care and mental health hardly get a look and good luck finding a national audit for care homes! While NCAs measure the care of patients in hospitals to death, social care providers that are often the cause of bed-blocking and prolonged patient stays in hospital are untouched by the NCAPOP.
In March we attended the national audit summit in London and Celia Ingham-Clark (NHS England) @CInghamClark gave the audience a refreshing message that ‘underperforming NCAs will be put out to grass’ (or words to that effect!). However, we have since heard via our recent regional network meeting that NHS England and HQIP will be adopting a ‘one-in, one-out’ approach to the NCAPOP. Such a system is unlikely to see a much-needed re-balancing of national audit that drastically reduces the current huge burden on acute hospitals. What is more, the NCAPOP now seems very stagnant…. A far cry from a few years ago when Sir Nick Black and his NAGCAE group of experts were seemingly assessing ideas for possible new NCAs on a monthly basis.
The saddest part of all this is that so many vulnerable patients are being firmly ignored by the NCAPOP. Plus, as auditors we know the one thing we are supposed to be experts in is making CHANGE HAPPEN! When it comes to the NCAPOP, it looks like there is a determination to preserve the status quo. Frankly, will we ever see national audits for care homes or hospices?
On a final note, we’d love to know how national audits are commissioned!!! The diagram we have created above provides a flowchart to suggest the probable system in place. Of course, this is tongue-in-cheek, but if you know different, then do explain how it all works.
PS Just to clarify: CASC have never been involved in any NCAPOP audits. Our company view is that we support national audits that make a real difference to patients. For us good national audits meet our minimum expectations of local audits: they look at current care, are not burdensome, measure against agreed best practice and report results without delay.
I would certainly agree that we are overburdened with NCAs, some of which seem to be more registries than audits. They are also extremely resource-heavy; our Respiratory lead for the National COPD and Asthma audit decided to pull out of this after the first year, when his admin support for the audit came to an end. He said “the outcome of our 1 year national COPD audit participation is that we couldn’t do the audit!( because of lack of staff and funding)”. RCEM audits are particularly difficult to administrate, the inclusion criteria making it virtually impossible to easily identify the eligible patients and the manner of reporting making it very difficult to implement findings. Our Trust, however, continues to subscr…