NATIONAL CLINICAL AUDIT A VOLUNTARY SECTOR PERSPECTIVE

National Diabetes Audit (NDA)

Laura FargherDiabetes UK

National Diabetes Auditand Diabetes UK

• Diabetes UK has been a key partner in the National Diabetes Audit (NDA) since it started in 2003

• 2010-11 – HSCIC, Diabetes UK and YHPHO won a tender to deliver the NDA 2011-14 (2016)

• First time NDA delivered collaboratively, with specific responsibilities assigned to each partner

National Diabetes Audit (NDA) Programme 2011-16

NDA covers 5 distinct areas of diabetes care, treatment and outcomes:

1. Core audit 2. Inpatient care of people with diabetes3. Pregnancy and diabetes (commenced 2013)4. Diabetes foot care (commenced 2014)5. Diabetes patient experience (piloted 2013-14)

National Diabetes Audit (NDA) Programme 2011-16

Audit stream Method of data collection

Core Audit Semi-automated data extraction from GP practices and hospitals

Inpatient audit Snapshot audit of all hospital beds occupied by person with diabetes. Largely paper based

Pregnancy care Continuous data collection by all joint antenatal and diabetes teams. Electronic data submission

Foot care Continuous data collection by all foot care services that treat foot ulcers. Electronic data submission

National Diabetes Audit (NDA) Diabetes UK’s role

• Manage governance – advisory groups and board

• Engagement around participation and using the audit data

• Develops information for patients and general public

• Led on patient experience survey• Leads on quality improvement initiatives

National Diabetes Audit (NDA)Governance

NDFANDFA NaDIANaDIA NPID auditNPID auditCore(inc pumps)

Core(inc pumps)

Partnership BoardResponsibilities: Executive appraisal, strategic direction, audit promotionChair: Diabetes UKMembers: RCP, RCGP, RCPCH, PCDS, HSCIC, ABCD, CDC, RCN, PHE (NCVIN), HQIP, RCOG, NICE, Advisory Group Chairs, Executive Board members, people with diabetes, Executive Board members

Partnership BoardResponsibilities: Executive appraisal, strategic direction, audit promotionChair: Diabetes UKMembers: RCP, RCGP, RCPCH, PCDS, HSCIC, ABCD, CDC, RCN, PHE (NCVIN), HQIP, RCOG, NICE, Advisory Group Chairs, Executive Board members, people with diabetes, Executive Board members

Diabetes UKResponsibilities:Clinical and patient engagement, audit governance and communications

Diabetes UKResponsibilities:Clinical and patient engagement, audit governance and communications

HSCICOperational TeamResponsibilities:Day to day managementFunctions:•Informatics•System development•Financial and information governance•Data collection•Data quality assurance•Reporting and dissemination

HSCICOperational TeamResponsibilities:Day to day managementFunctions:•Informatics•System development•Financial and information governance•Data collection•Data quality assurance•Reporting and dissemination

Executive BoardResponsibilities: Executive decision making, contract delivery, clinical governanceChair: Specialist clinical leadMembers: GP lead, HSCIC, Diabetes UK, PHE (NCVIN)

Executive BoardResponsibilities: Executive decision making, contract delivery, clinical governanceChair: Specialist clinical leadMembers: GP lead, HSCIC, Diabetes UK, PHE (NCVIN)

Advisory Groups – managed by Diabetes UKResponsibilities: audit advice and guidance (design, processes, outputs, communications), audit promotionMembers: clinicians, people with diabetes, project team

Advisory Groups – managed by Diabetes UKResponsibilities: audit advice and guidance (design, processes, outputs, communications), audit promotionMembers: clinicians, people with diabetes, project team

Methodology advisory groupResponsibilities: advice on methodology and audit outputsChair: PHE (NCVIN).Members: HSCIC, NDA clinical leads, Advisory Group chairs, methodology specialists

Methodology advisory groupResponsibilities: advice on methodology and audit outputsChair: PHE (NCVIN).Members: HSCIC, NDA clinical leads, Advisory Group chairs, methodology specialists

How does Diabetes UK add value toNational Diabetes Audit (NDA) ?

• Independent relationship with stakeholders• Involvement of people with diabetes• Critical friend• Influence outputs to meet stakeholder needs• Make links to other work around diabetes• Diabetes – political and strategic insight

Benefits to Diabetes UK

• Opportunity to influence data collection, analysis and reporting at an early stage

• Strengthened stakeholder engagement/new relationships

• Ensure patient voice is heard and audit is grounded in real experience

• Credibility• Funding

How does Diabetes UK use NDA data?

Evidence for:o Campaigningo Influencing the NHS/service improvementoMedia activityo Planning delivery – regions

Resources:o Diabetes Watch Online Toolo State of the Nation report

NICE Clinical Guidelinesdiabetes care

Every person over 12 years old with diabetes should receive the following nine healthcare checks at least once a year: • HbA1c test to measure overall blood glucose control• Blood pressure measurement• Cholesterol test• Eye screening (retinopathy) • Foot examination – to check the skin, circulation and nerve supply of legs

and feet • Kidney function (blood creatinine) – a blood test to measure kidney function• Urinary albumin– a urine test to for kidney problems• Weight or BMI (body mass index) measurement• Smoking review, including advice and support if you are a smoker

NDA 2012-2013findings

Care process recorded All patients in England and Wales

Type 1 Type 2

ALL care processes 59.9% 41.3% 61.9%

HbA1c 92.4% 80.5% 93.8%

Blood pressure 95.3% 88.8% 96.1%

Cholesterol 91.1% 78% 92.5%

Foot exam 85.1% 72.3% 86.7%

Kidney function 92.5% 81% 93.7%

Urinary albumin 73.6% 57.1% 75.4%

Body mass index (BMI) 90.7% 84.1% 91.5%

Smoking review 86.1% 79.8% 86.8%

Diabetes UK15 Healthcare Essentials Campaign

Diabetes UK campaigns

Diabetes UKDiabetes Watch Online

Online tool to find out what care is like in your area

Diabetes UKMedia activity

Patient ‘friendly’ reports

Patient Information Leaflets about Audit

How does national audit help?Participants in audit:• examine levels of service compared to other areas • Identify variations in health outcomes to make improvements as

appropriate • Inform service development and planning across whole systems of care

Voluntary sector:• Inform• Influence• Campaign• Plan activity

Based on quality, robust, benchmarked audit data.

Any questions?

Laura.Fargher@diabetes.org.ukwww.hscic.gov.uk/nda