We are calling on all those involved in funding and running national clinical audits to support our campaign #makemydatacount. National clinical audits are important to measure how care is being delivered and how medical professionals are delivering that care to the highest standards possible. National audits are developed and continually improved to measure performance and outcomes, identify risk and interventions and reduce variation in care at a national level.
In January 2019 the NHS published its Long-term Plan (LTP), outlining ambitions to meet the increasing patient demand by putting prevention, patient care and quality of services at the centre of its aims. However, the LTP lacks significant details on how performance and standards will be maintained or measured.
The national ophthalmology audit database (NOD), managed by The Royal College of Ophthalmologists, is a clear example of a large scale audit that has improved the quality and safety of cataract surgery, reducing unwarranted variation and making savings for the NHS by reducing risks and supporting continued professional learning.
Yet NOD is under threat as funding by the Healthcare Quality Improvement Partnership (HQIP) comes to an end in August 2019. NHS England’s current model of funding national audits is short-sighted. Funding is generally withdrawn after a contracted three years or more and if organisations are unable to secure further funding, all that data and learning is potentially lost.
The Royal College of Ophthalmologists believes that NHS England and NHS Improvement must wish to be informed on how their services are performing and ultimately how they are meeting their duty of care to patients. Mandated audit and data driven knowledge used by clinicians, commissioners and the wider NHS to measure performance must be at the heart of sustainable high-quality patient care.
This can only be achieved by working directly with medical royal colleges, bodies responsible for patient safety standards, and patient groups to find a solution to sustainably fund clinician-led audits and datasets for the long-term. As NOD shows, national audits deliver clear savings to NHS England through identifying and reducing risks. More importantly, national audits demonstrate improved outcomes and learnings for patient safety and care.
The Royal College of Ophthalmologists believes that national audits require a sustainable funding model to deliver on the aim of NHS ‘big data’ driving the transformation of healthcare. Funding models may include direct funding from NHS England or for a nationally mandated trust / provider fee.
We hope that the campaign will be supported by partner organisations, MPs, patient groups and charities to lobby and challenge NHS England in its current funding model of national audits and to find a way to secure a sustainable solution.
The Royal College of Ophthalmologists calls for the National Ophthalmology Database to be recognised as an exemplar model of where ‘big data’ contributes to maintaining and improving standards of patient care and enhancing continued professional development and learning.
NOD executive summary
Since 2010, the National Ophthalmology Database audit (NOD) has analysed the outcomes of cataract surgery, the most commonly performed operation in the NHS (England & Wales). Ophthalmology is now the highest volume outpatient specialty with 8% of all NHS surgery.
NOD enables a cataract surgeon to compare their performance against that of their peers nationally. This is a vital safeguard of patient safety and a promoter of best practice, eradicating variation in the provision of cataract surgery and patient care.
The NOD provides reassurance to patients and the public that the hospital eye service is of a good standard and drives continuous quality improvement within the profession. It is recognised by clinicians, NICE and industry as an important safety and research tool that can also be used to audit the treatment of two other common, potentially blinding diseases, glaucoma and age-related macular degeneration (AMD).
- 38% overall reduction in intraoperative complications since 2010 (equates to ~3,400 fewer complications annually across the NHS)
- Represents an estimated financial saving of £2million for the NHS each year (2010 – 2018)
- Overall, posterior capsule rupture (PCR) and Visual Acuity (VA) loss continue to reduce
- Identifies patients at high risk of complications, ensuring that they are operated on by appropriately experienced surgeons
- Enables surgeons to compare their performance against that of their peers nationally, promoting learning and best practice
- Allows poorly performing eye departments and individual surgeons to reflect on and modify their practice
- Drives the NHS Digital and use of ‘big data’ agenda in the move toward electronic working
- Demonstrates the benefits of simulation training, reducing the morbidity for patients being operated on by trainees