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.
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).
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
I was at this event which was very worthwhile and enjoyable. Given that MH and CH Trusts are spread thinly across England, this was a great opportunity to discuss issues affecting us. It was very pleasing that CASC identified this need and filled the gap.
I attended the day and it was a breath of fresh air. in my experience, most events and network meetings focus on the acute sector. It was great to meet like-minded colleagues who had similar experiences and face similar issues.
For someone working in a small team I often feel isolated. I met others I can now link in with and learned about NQICAN in the afternoon – who I previously knew little of. It was also great to know the majority of others present feel the same way in terms of how irrelevant/poor most national audits are for community teams and how unfair the recent subscription funding changes are. I do hope there will be a follow-up event as CASC intimated they would push for this on the day.
Excellent event! It was great to network and discuss issues that affect CH and MH Trusts. Big thank you to Stephen and Tracy for arranging the event and thank you to Carl for bringing his commitment and enthusiasm which is was very inspiring.
This was a really worthwhile use of my time, the event was professional, thought-provoking and provided me with a much needed boost as I had started to lose faith in clinical audit. I work in a trust on my own and feel isolated and so was so happy to be allowed to go to this day. It was better than my network meeting as we talked about topics that were relevant to me and the the type of trust I work in. Thanks to CASC for running this, I hope you can run another one and I can come to that.
Interesting read. A couple of questions if I may:
1. Where was this event ‘advertised’?
2. Who funded it?
3. In terms of the perceived NCAPOP ‘imbalance’ how many Acute Trusts are there compared to Community and Mental Health?
4. What is the ‘penalty’ for a Trust not paying their annual NCAPOP subscription?
Thank you to all who have taken the time to comment. We are really pleased that the event was well received. We always try to make our events/training relevant and useful to those who give up their time to attend.
A few questions have been raised and we will endeavor to provide answers:
1) We hope to run the event again and will be speaking to HQIP about future collaboration. We are optimistic that they would see benefit in supporting a larger event in the Autumn, perhaps as part of Clinical Audit Awareness Week
2) The event was advertised in many places but mainly: CASC website, eNewsletter and via CASC Twitter
3) The event was entirely funded by CASC. We paid for the venue, refreshments, food and all materials. We gave up our time to set up and run the event free of charge. There were no sponsors. The NQICAN chairman gave his time freely
4) As per the FOI request we mention towards the end of the blog, there are 144 Acute Trusts, 49 Mental Health and Community, 23 Community, 6 Specialist Services and 5 Children’s Services. 63% of Trusts are therefore Acute Sector, 37% non-Acute. NCAPOP audits predominantly focus on the Acute Sector
5) It was mentioned on the day by a number of attendees that their Trust had refused to pay the £10,000 annual NCAPOP subscription, but we are not able to verify this. We do not know if there are ‘penalties’ attached to non-payment of NCAPOP subscription fees. Hopefully, NQICAN can pass this question on and HQIP (as the agency responsible for delivery of NCAPOP and collection of subscriptions) can supply a definitive answer within this message sequence to clarify the position.
We welcome more comment and further questions in relation to this blog.
Just been informed of this via the CASC enewsletter, I didn’t know before this that NQICAN were running a blog. As a clinical audit facilitator working in a partnership trust it’s good to see that mental health and community clinical audit is getting into the spotlight, this is so rare. I echo the comments from a previous ‘poster’ what is is the situation if your trust opts out of paying the NCAPOP subscription? Thanks to NQICAN for setting up this blog and allowing me to comment.
Thanks for your positive feedback – we have asked HQIP for a comment on the NCAPOP non-payment so will share as soon as we receive. We will discuss any relevant issues raised in blogs at our June NQICAN meeting.
Thanks for the various replies to my queries. It is a breath of fresh air to receive such transparent and rapid feedback via this blog. I look forward to the HQIP response on NCAPOP – thanks to NQICAN for following this up. I hope this does not take long given 1) its importance and 2) the vast resources at HQIP’s disposal including their own communications and PR team.
Really well done to Stephen and Tracy for organising such a brilliant day: great job, you two!
Echoing other comments – it was great to get to talk to clinical audit professionals from the same setting who face the same issues and challenges that we do.
In the nicest way possible, it felt a little bit like a support group: “Hi, my name’s Dave and I’ve been a Community & Mental Health Clinical Audit professional for 10 years now….”
Very much agree re: the changes to NCAPOP funding – entirely inequitable – we could much more fruitfully employ a part time clinical audit assistant, rather than throwing money the trust doesn’t actually even have at funding acute trusts to take part in methodologically questionable quasi research of limited quality improvement value.
Definitely want to go again if they organise another – The cakes were great!
[…] with the tools to change practice? Why shouldn’t we be facilitating change ourselves? The recent blog post from CASC re: their “Clinical Audit Summit for Mental Health and Community professionals” noted […]
What deadline did NQICAN give HQIP in terms of replying on the ‘opt out’ of NCAPOP funding question? NQICAN reported on 8th May and it is now almost July. It almost feels like HQIP don’t want to answer this elementary but critical query. Looking across all the blogs HQIP haven’t engaged at all. For a publicly funded body existing to support clinical audit do NQICAN find this satisfactory? If NQICAN can’t hold HQIP to account, who can?
We discussed this at NQICAN meeting earlier this month and neither NHSE or HQIP senior reps present had heard of any trust opting out as it is not an optional payment. It was agreed that if more details are provided we can look into this further.
[…] with the tools to change practice? Why shouldn’t we be facilitating change ourselves? The recent blog post from CASC re: their “Clinical Audit Summit for Mental Health and Community professionals” noted […]
[…] with the tools to change practice? Why shouldn’t we be facilitating change ourselves? The recent blog post from CASC re: their “Clinical Audit Summit for Mental Health and Community professionals” noted […]