Advice Paves the Way for National Clinical Audit

Advice is published this week on the National Clinical Audit Support Programme (NCASP) which will eventually yield comparative data on the performance of clinical services and on individual practitioners.

The programme forms part of the government’s response to the Kennedy Report on child heart surgery at the Bristol Royal Infirmary between 1984 and 95.

Kennedy recommended that indictors of clinical performance should be comprehensible to the public. In his response, health secretary, Alan Milburn, said the indicators should be "robust, rigorous and risk-adjusted."

The advice, on the NHS Information Policy Unit’s website is also highlighted in the current Chief Executive’s bulletin.

NCASP has looked at immediate needs for comparative data in key clinical areas – cancer, mental health, coronary heart disease, older people’s services and diabetes. The Department of Health is developing a national strategic framework for clinical audit which will provide the context for a more comprehensive programme. This will be developed by the Commission for Health Improvement’s Office for Information on Healthcare Improvement.

The advice summarises the state of play in the development of clinical audit in the specialties it covers. Most are at the stage of exploratory work. Predictably, given the history of the initiative, coronary heart surgery is further along the development route.

Agreement has been reached with the Society of Cardio-Thoracic Surgeons to produce robust, risk-stratified validated data that will allow the publication of surgeon-specific outcomes by April 2004. Collection of data has been mandatory since April 2002.

Bruce Keogh, secretary of the Society of Cardio-Thoracic Surgeons told delegates at Quality Information Solutions 2002 conference last week that heart surgeons were persevering with their pledge to publish surgeon-specific figures despite concerns that results will be misinterpreted.

Mr Keogh, who is also associate medical director of governance and cardiac surgical lead at the University Hospitals, Birmingham, said, "If we go back, it will be perceived as doctors closing ranks again." He said innovative ways of presenting the material had to be found.