On 24 March 2017 – Clinical Audit Support Centre (CASC) were delighted to host our first Clinical Audit Summit for Mental Health and Community professionals. We called it a “Summit” as that seems to be an in-word among those at the top but essentially it was a networking event aimed at getting like-minded people together for 5 hours!

Why did we do it? Well, not to knock acute care but hospitals have always been the ‘chosen ones’ when it comes to clinical audit. Look at the public funding for national audits, speakers at national events and membership of National Advisory Group for Clinical Audit and Enquiries (the group who advised NHS England on all things audit from 2008-16) and you will find acute sector dominance.

When we announced details of the event we didn’t know what to expect but all 20 places were booked in less than 24 hours!  Come the day of the event it was great to see no drop off in interest with the room full including three regional network Chairs and Carl Walker (Chair of National Quality Improvement and Clinical Audit Network) kindly giving up his time to present in the post-lunch “graveyard” slot.

The key learning point from the day was that we simply under-estimated time needed. All in attendance were eager to talk about the hot topics of the day and share their experiences.

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Indeed, it was a huge privilege to host a day that created a real buzz in the room from start to finish. In some ways it felt like a coming together of a disparate group of professionals starved of the opportunity to talk openly and frankly. It was also good to see that the Tweets from the event generated some genuine external interest in the day.

Huge swathes of ground were covered in small group work and via inclusive discussions with particular focus paid to the current state of local and national audit, the emergence of quality improvement and recent changes to National Clinical Audit Patients Outcomes Programme (NCAPOP) funding.  That last point generated unanimous agreement in the room, namely that the 2016 mid-year change to NCAPOP funding was inequitable and unfair. As someone mused over lunch “you wouldn’t take 3 items to the supermarket checkout and agree to pay for 30” yet that is just how the NCAPOP is now set up for Mental Health and Community Trusts. Interestingly some attendees claimed their Trusts had refused to pay the £10,000 levy and others were keen to know if this challenge held up. Our afternoon SWOT analysis proved a great success with attendees providing an honest and intelligent collective overview of the current state of local and national audit. Of course there was inevitable positivity towards local audit as most attendees work in that sector, but there was also recognition that improvements need to be made at a local level, namely: increase re-audit rates, eliminate audits of limited value, share results/outcomes of audits more widely and improve the consistency of audit methodology applied. The collective critique of national audit via the SWOT was fascinating with the group struggling to identify the strengths of NCAs beyond the opportunity to adopt a uniformity of approach and benchmark results (see table below).

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Interestingly it was great to see a collective awareness of the recent Yorkshire Effectiveness and Audit Regional Network (YEARN) report that has been widely promoted by NQICAN. Those present at the summit entirely supported YEARN’s critique of NCAs. Rather worryingly, when we asked if attendees would like more NCAs (given the current NCAPOP disparity) approximately half said ‘no’! For a group who undertake very few NCAs at present the message is loud and clear: “we only want NCAs if they are methodologically-sound, streamlined projects tailored to our patients that allow us the ability to review results rapidly to enable us to improve patient care”.

Let’s end this blog how we started the event on 24 March, namely by reporting back what words attendees used to describe clinical audit in 2017. The first answer we had was ‘endangered’! That was followed by ‘tick-box’ and ‘unappreciated’. However, we ended with a flourish of positivity: ‘powerful’, ‘challenging’, ‘innovative’, ‘patient-focused’ and ‘valuable’.  It is clear that while we have a group of local audit professionals as hard working, skilled, knowledgeable and dedicated as those we met at our summit, audit will continue and remain a valuable discipline. However, if audit wishes to thrive in the mental health and community sector then it is time for some of the vast resources historically spent on hospitals measuring physical care of patients to be urgently re-allocated. A suggestion would simply be to ensure mental health and community-based services get back a fair share of the £720,000 they invest into the annual £2,270,000 NCAPOP funding pot (figures obtained via a Freedom of Information request we recently made to NHSE). In effect, the current model means this sector is subsidizing national audits for hospitals! Is this what Sir Liam Donaldson had in mind almost 10 years ago when he proclaimed that “national clinical audit needs to be re-invigorated” and the remit of national clinical audits broadened?

We would be interested to know your views

Stephen and Tracy

Clinical Audit Support Centre Directors