• Royal colleges raise “significant concerns” over NHS England interference with clinical audit programme
  • Reports have been delayed for more than two months despite planned launch dates
  • Clinicians warn delays mean patients are at risk from known variations in care

Patients are being put at risk because NHS England is delaying the publication of national clinical audits, HSJ has been told.

Several royal colleges have expressed “significant concerns” about NHS England’s interference with the national clinical audit programme process.

HSJ has learned a number of clinical audit reports have been delayed by months because NHS England and its communications team have not given their approval for publication under its new report approval process.

In addition, several reports for the National Confidential Enquiry into Patient Outcome and Death have also been delayed. These include a report on acute heart failure, which was due to be published in the summer, and a report on cancer in children and teenagers, which was due for publication in September.

A third NCEPOD report on perioperative diabetes is due to be published later this month but has not yet been signed off by NHS England.

The National Emergency Laparotomy Audit was due to be published in the first week of September. One clinician close to the audit work told HSJ: “We had a number of talks scheduled to launch the messages in the report in September. We are now many weeks down the line and there is no sign of our work being shared.

“This threatens the integrity of the audits. The data is far from timely as it is, without a two month delay from NHS England. I believe it’s the same with all the other NCAs.

“We are hugely frustrated at the delays. We’ve been talking about it for months. The national audits work on priority clinical areas. These are patients who really are at risk from variation in practice and poor working practices. The audits must share their data in a timely fashion, to share the lessons quickly.

“Today’s patient is genuinely at risk because we haven’t been able to share the learning from last year’s care and the work of thousands of NHS staff collecting the data is wasted.”

On Monday, HSJ asked NHS England to explain why the NELA audit was being delayed. The Royal College of Anaesthetists was informed a few days later that it could be published today.

NHS England has declined to share a full copy of its approval and sign-off protocol with HSJ.

Last week, HSJ revealed the new process NHS England had imposed on the audit programme, delivered by the Healthcare Quality Improvement Partnership. The process, described as an “unprecedented power grab”, includes NHS England having control over when reports are published, with publication dates chosen with just one week’s notice.

It also allows NHS England to “instruct” clinical audit authors on the length of their reports and number of recommendations.

Alastair Henderson, chief executive of the Academy of Medical Royal Colleges, told HSJ: “Our members have raised this as a very serious concern and the issue is to be considered at the next academy council meeting on 21 November for the academy to discuss and take up with NHS England.”

Clinical vice president at the Royal College of Physicians, David Oliver, said clinical audits were an “invaluable tool” for exposing variation and gaps in care and ensuring evidence based standards were developed.

“It is vital that audit data, conclusions and recommendations remain completely independent of interference through changes, or delayed publication, by central NHS bodies if they are to retain their credibility, objectivity and impact.”

The Royal College of Surgeons also added its concerns. A spokeswoman said the audits played a vital role in disseminating best practice but that there was no doubt improvements could be made in how they are communicated.

She added: “Recent guidance on communicating audits has aimed to do that but risks being too restrictive in not giving royal colleges sufficient freedom to point towards deficiencies in care. For example, it reduces the ability of organisations to advance plan publication of audits at conferences which can be an essential part of communicating with clinicians. We are currently in discussions with NHS England to resolve this situation.”

The Royal College of Obstetricians and Gynaecologists told HSJ it was in discussions about the potential impact of the changes. It added it was “vital all communication channels remain fully open in order to disseminate information to stakeholders and to facilitate reflection and learning among the clinical community with the ultimate aim of improving patient safety”.

An NHS England spokesman said: “There are 60 to 70 audit reports, written independently and published transparently, every year. Working together, HQIP and NHS England have agreed needed improvements to the delivery of the clinical audit programme.

“The aim is to ensure that clinicians get clearly presented data that can improve patient care, responding to criticism that some audits do not appear to be leading to fast enough clinical practice changes over successive years.”