2002/014 NICE & CHI launch handbook to help NHS staff improve standards following the Bristol Royal Inquiry

2002 / 014 Press Release

NICE & CHI launch handbook to help NHS staff improve standards following the Bristol Royal Infirmary Inquiry

The National Institute for Clinical Excellence (NICE) and the Commission for Health Improvement (CHI) have today jointly launched a book that aims to support staff leading clinical audit and clinical governance projects in the NHS.

Principles for Best Practice in Clinical Audit will help clinical staff learn lessons from everyday practice to help them improve the care they give to their patients. The book is being published in response to demand from healthcare professionals throughout the NHS who are keen to develop effective tools to review their practice.

The publication of Principles for Best Practice in Clinical Audit follows the Government's strong support for clinical audit in its response to the Bristol Royal Infirmary Inquiry (Kennedy) Report. As part of its response the Government agreed with Kennedy's recommendation that "clinical audit should be compulsory for all healthcare professionals providing clinical care."

Clinical audit is a key component of clinical governance, enabling healthcare professionals to systematically review the care they are providing for patients, and implement changes where necessary in order to ensure best practice. Principles for Best Practice in Clinical Audit describes the methods, tools, techniques and activities related to each stage of clinical audit - preparing for audit, selecting audit criteria, measuring level of performance, making improvements and sustaining improvements.

The book draws on a systematic review of literature relating to audit, which is outlined in an appendix and included in full on an accompanying CD-ROM. The message of the book is that a dual approach is needed to ensure local success in clinical audit, with a supportive local environment encouraging appropriate investment in audit accompanied by effective clinical audit methodology.

Professor Sir Michael Rawlins, NICE Chairman, said: "There is a real need for the NHS at a local level to make a commitment to clinical audit as part of a process of continuous quality improvement throughout the NHS. The Report of the Bristol Royal Infirmary Inquiry focused hearts and minds on the issue of quality in the NHS. We must support healthcare professionals throughout the NHS to ensure they have sufficient time and resources to review the care they are providing for patients, and can implement changes where necessary to bring that care closer to best practice."

CHI's Chairman, Dame Deirdre Hine, said: "I am very pleased that we are jointly publishing this report with NICE. This report is a valuable tool for clinical staff. Learning the lessons from practice is vital so that we can deliver improvements to patients' care in the future. I commend this report to those working in NHS organisations as a useful guide on how to implement clinical audit effectively."

Principles for Best Practice in Clinical Audit has been written by experts from the Quality Improvement Programme at the Royal College of Nursing and from the Clinical Governance Research and Development Unit at the University of Leicester. The book was funded by NICE.

Ends

Notes for Editors:

1. The National Institute for Clinical Excellence (NICE) is The National Institute for Clinical Excellence (NICE or 'the Institute') is part of the NHS and its role is to provide authoritative and reliable guidance on healthcare for patients and their carers, healthcare professionals and the wider public in England and Wales. www.nice.org.uk

2. The Institute produces three key guidance products for the NHS: technology appraisals, which assess the clinical and cost effectiveness of specific medicines, medical devices, diagnostic techniques, surgical procedures and health promotions; clinical guidelines; and clinical audit advice.

3. The Commission for Health Improvement (CHI) is the independent voice on the state of the NHS. CHI aims to help the NHS deliver real improvements to the quality of patient care. CHI carries out routine reviews of every NHS organisation in England and Wales and launches investigations into serious service failures. www.chi.nhs.uk

4. Clinical audit is a quality improvement process that seeks to improve patient care and outcomes through systematic review of care against explicit criteria and the implementation of change. Aspects of the structure, processes and outcomes of care are selected and systematically evaluated against explicit criteria. Where indicated, changes are implemented at an individual, team or service level and further monitoring is used to confirm improvement in health-care delivery.

5. Clinical governance is the organisational approach for quality that integrates the perspectives of healthcare professionals, patients and their carers, and those charged with managing the NHS.

6. The recommendations of Learning from Bristol: the Report of the Public Inquiry into Children's Heart Surgery at the Bristol Royal Infirmary 1984-1995 (Department of Health, 2001) include the following:

• 143: The process of clinical audit, which is now widely practised within trusts, should be at the core of a system of local monitoring of performance.
• 144: Clinical audit must be fully supported by trusts. They should ensure that healthcare professionals have access to the necessary time, facilities, advice, and expertise in order to conduct audit effectively. All trusts should have a central clinical audit office that coordinates audit activity, provides advice and support for the audit process, and brings together the results of audit for the trust as a whole.
• 145: Clinical audit should be compulsory for all healthcare professionals providing clinical care and requirement to participate in it should be included as part of the contract of employment.

7. CHI, the Modernisation Agency in England and the Innovations in Care (IiC) Team and Clinical Governance Support and Development Unit (CGSDU) at the National Assembly for Wales have roles in helping to sustain quality improvements in NHS organisations. CHI does this by providing feedback on the implementation of clinical management strategies within organisations in which a wide range of indicators of performance are considered, and the Modernisation Agency (England) and CGSDU (Wales) by facilitating the development of an environment within the NHS in which clinical audit can thrive.

8. The NHS Reform & Health Care Professions Bill currently before Parliament includes proposals for an independent new Office for Information on Health Care Performance within CHI. The Office will collect, analyse and publish reports on clinical and other NHS data.

9. The Office for Information on Health Care Performance will also develop a clinical audit programme incorporating audits that currently fall within the NICE work programme.

10. Principles for Best Practice in Clinical Audit is published by Radcliffe Medical Press Ltd (ISBN 1-85775-976-1). For more information please contact Radcliffe Medical Press Ltd, telephone 01235 528 820, email contact.us@radcliffemed.com or alternatively visit the website at www.radcliffe-oxford.com.