www.hqip.org.uk

Clinical Audit and Commissioning

Mandy Smith Quality Improvement Facilitator CAI, 8th March, 2016

Who are HQIP?

Developing HQIP guidance

• HQIP has commissioned and produced guidance on best practice in clinical audit for clinicians and healthcare providers, and we want to do the same for commissioners.

• How can commissioners use clinical audit to improve the quality of services?

• How can clinical audit answer the questions commissioners need to ask?

• The relationship between CCGs and healthcare providers

Workshops, Autumn 2015

Aims:

• To bring CCG quality leads together

• To reflect on current practice

• How can HQIP help?

• What kind of guidance should we be producing?

What we heard

• ‘Evidence of actions taken as a result of local clinical audit are not usually seen in practice, just words on an action plan or report.’

• ‘Much hostility working through contracts, providers defensive, commissioners not always supportive or offering solutions, or stimulating quality improvement other than through penalties.’

• Wide variation in both practice and ambition

What we heard

• 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 . . .

What does it say about clinical audit and quality improvement?

The NHS Standard Contract

• Applies to all contracts for NHS funded services in England

• Standard contract terms specify national quality requirements, e.g. waiting times, cancer treatment times, hospital acquired infections, duty of candour, never events, Safety Thermometer, Friends and Family Test, CQUINS requirements, reporting requirements, etc. etc.

• Commissioners can add local quality requirements – e.g. locally agreed CQUINS, etc.

• Has teeth – enforcement is between the CCG and provider, and breaches can result in financial penalties

The NHS Standard Contract

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)

The NHS Standard Contract

Specific requirements relating to clinical audit:

• The provider must:

– 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)

Pitfalls to avoid

• 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)

• Appointing auditors - GC15.8.1: The coordinating commissioner may at any time appoint an auditor to audit . . . the quality and outcomes of any service . . . BUT must do this within the data protection legislation

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

In summary

• 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

And finally . . .

www.hqip.org.uk

Guidance, resources, e-bulletin, workshops

mandy.smith@hqip.org.uk

07946 545 279