- NHS England will be able to “instruct” clinical audit authors on the report length and number of recommendations
- It will now take up to three months to sign off reports but give just one week’s notice before publication
- National leaders told to focus on improving the outcomes, rather than “the message”
NHS England and its communications team have been accused of an “unprecedented power grab” after imposing strict new rules around the publication of national clinical audit reports.
Senior clinicians told HSJ that NHS England is interfering in an independent process with new rules that allow its communications team to sign off reports and even “instruct” clinical audit authors on the length of their reports and the number of recommendations they can make.
Clinical audits are seen as an important way to spread good practice, as well as highlighting shortcomings or variations in care.
Clinicians working for several national audits and confidential enquiries said they were concerned about the impact the new rules would have.
Other aspects of the rules include NHS England aiming to “clear all reports no later than three months from submission”, while giving organisations just one week’s notice of a publication date chosen by NHS England.
Launch events can only be organised after a confirmed publication date, the new rules say, so logistical issues, such as venue hire and ensuring clinicians can attend, would mean events being held months after publication.
A clinician who works on one of the national audits told HSJ: “This is an unprecedented power grab by NHS England. They are interfering in what is supposed to be an independent process and its only to serve their corporate interests rather than the public.”
Another senior clinician with many years experience of national clinical audits said: “For national clinical audits to be useful and genuinely independent, their clinical leaders should be free to describe not only good practice but highlight gaps and variations in care.
“They should also be free to make recommendations for providers, commissioners and central NHS bodies without any central interference with their messaging, even if at times the conclusions and recommendations in the reports make for inconvenient reading.”
NHS England told HSJ it had agreed changes to the process to to deliver accurate, timely and well-written reports.
According to an email sent last month by the national lead for the MBRRACE, or Mothers and Babies Reducing Risk through Audits and Confidential Enquiries programme, the changes meant “substantial avenues of communication are being closed and we are no longer being open and transparent with our findings to the very organisations, eg our third sector stakeholders and the colleges and professional associations who can make a difference and also be involved in the implementation of the recommendations.”
The email, provided to HSJ by a recipient, was written by Jenny Kurinczuk who warned: “The maternal confidential enquiry has long been held up as a global gold standard. Although unintended, this new process risks giving the appearance that findings of maternal and perinatal mortality enquiries are being hidden in the very country that pioneered their introduction more than 60 years ago. We cannot predict the international ramifications of this.”
She said the changes included “the entire process of report approval and sign-off”, and it was deemed “necessary because the NHS England communications team cannot manage the release of all the reports which are being produced by the national clinical outcomes programmes and the national audits”.
The National Clinical Audit and Patient Outcomes Programme is managed on behalf of NHS England by the Healthcare Quality Improvement Partnership and covers 40 national audit topics looking at common conditions such as stroke, diabetes, mental health and maternity.
The audits use clinical data to draw out national level learning as well as reports for local providers about their quality of care.
Maureen Treadwell, research officer at the Birth Trauma Association, told HSJ that NHS England’s actions were “appalling and will affect outcomes”.
She said: “We were told transparency, candour, honesty and engagement with stakeholders would be the cornerstone of the new open NHS. This is turning that aspiration on its head.
“The DH needs to ensure that NHS England is focused on improving the outcomes and not improving the message. We want a bit of action and for this to be reversed.”
A spokesman for NHS England said: ”NHS England funds clinical audits as part of a transparent assessment of health services, and we have agreed with HQIP improvements to the quality of their management of this programme and to individual audits, to ensure accurate, timely data and well-written reports can inform better patient care, which remains our priority.”
HQIP and the DHSC declined to comment.
This article was updated at 9.30am 2 November to include NHS England’s response.
Leaked email and interviews