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HQIP: Clinical Outcomes Publication quarterly newsletter
February 2017

Welcome to the latest edition of HQIP’s quarterly Clinical Outcomes Publication (COP) newsletter, designed to keep you updated on all COP-related news and developments.

In this issue:


  • COP 2016/17 progress update
  • COP at Patient First 2016
  • Report on National Lung Cancer Audit
  • National Clinical Audit Benchmarking (NCAB)
  • New project manager arrangements
Dr Kieran Mullan
COP 2016/17 progress update

Dr Kieran Mullan, HQIP clinical lead for COP

It’s been a very good roll out of publications for 16/17 with 11 audits having already published and our February publications on track. This is a big improvement on last year. I want to thank everyone for their hard work in meeting deadlines and dealing quickly with any last minute hiccups.

This time around we are aiming for a delay-free year without missing any available publication slots. As the programme expands our friends at NHS Choices will become very busy. Therefore there may be some occasions when a publication needs to be pushed back to a quieter month. If everyone endeavours to keep to their advised publication date, we’ll in a good place. Meanwhile, behind the scenes HQIP will do everything it can to support a smooth publication run.

We’re delighted that the programme continues to be of real interest to key stakeholders. This month we have been advising former RCS President Sir Norman Williams about the content, scope and ambitions for the programme as part of a policy review he is carrying out on behalf of the Secretary of State. Making data more widely available and easily accessible remains a key goal for the NHS in England and COP remains at the leading edge of this.

COP presentations bring thought-provoking debate to Patient First 2016
Back in November, HQIP and the National Quality Improvement and Clinical Audit Network (NQICAN) teamed up to co-host the Quality Improvement Theatre as part of the Patient First 2016 Conference at London’s Excel centre. 

Chaired by HQIP medical director Professor Danny Keenan, the theatre featured engaging and interactive 'how to' seminars, case studies and discussions that provided the audience of clinicians, managers and QI/audit staff with helpful learning opportunities . Naturally COP formed part of the programme with a reprisal of the adult-cardiac surgery outlier-based session (featuring Danny Keenan and Kieran Mullan from HQIP, plus Graham Cooper from the SCTS and Stephen Holmberg, medical director from Brighton and Sussex university hospitals Trust), first seen at the HQIP Clinical Leadership Seminar in May. On day two of the event NJR regional clinical coordinator, Matthew Porteous spoke about the progress of the joint registry’s data quality audit, including a reflection on individual- and team-based reporting, and plans for its continuation.

The presenters spoke to a full house of around 50 seated delegates, plus a further 50 standing in the open-floor theatre. Having heard the important experiences of working with outliers in a transparent and positive way, the session provoked lively and progressive debate.

Footage from Matthew’s session was streamed live via social media and is still available to watch on the NJR Facebook page. So far, the presentation has been watched 1,461 times. Other sessions from NCAPOP partners including NCEPOD and NELA can be found on the HQIP Facebook page.
 

Report on National Lung Cancer Audit
In December the National Lung Cancer Audit (NLCA), in collaboration with the Society for Cardiothoracic Surgery in Great Britain & Ireland (SCTS), published the third lung cancer clinical outcomes publication (LCCOP). 

The audit reported the outcomes of operations to remove lung cancer (including non-small-cell lung cancer, carcinoid and small-cell lung cancer) during the period between 1 January and 31 December 2014. The data are available on both the NHS Choices and SCTS websites. 

NHS hospitals submitted the details for all lung cancer patients, including patients undergoing lung cancer surgery, to the NLCA via the National Cancer Registration and Analysis Service (NCRAS). The data are linked to other datasets, including Hospital Episode Statistics (HES). A list of all lung cancer patients undergoing surgery is generated from these data and linked to individual surgeons from each surgical unit. The surgical unit has the opportunity to validate the dataset prior to publication.

As previous years, the audit published the number of operations performed by individual surgeon and by units. The results include perioperative 30-day and 90-day survival rates for Trusts and for the first time these were adjusted for patient variables that may influence survival. A new indicator, length of stay during surgery for lung cancer resection by unit, was also included. 
Overall the results show encouraging improvements in the services provided to NHS patients in England including:

• The number of operations performed increased from 4,895 resections in 2013 to 5,657 in 2014, a 16% increase.
• Survival at 90 days after surgery rose to 96.2%, while 30-day survival is broadly static at 97.9%
• There were no outliers identified and the results compare favourably with similar databases in other countries
• Although not published on NHS Choices, the accompanying LCCOP report included new data at national, including survival rates 1 year after surgery and details on the type of procedures performed. 

In 2017, the team plans to publish 2015 survival data at 30 and 90 days after surgery, together with the number of operations that surgeons have performed. Resection rates (the chances of a lung cancer patient being treated by surgery) for cancer teams, as well as the names of the surgeons who work within them will also be published. Alongside this the team will review the outcome measures for lung cancer to ensure they are providing the best indicators of quality of care.

You can find copies of the latest LCCOP report and view members of the team discussing the key findings on our website: www.rcplondon.ac.uk/LCCOP2016 or contact the team for further information at NLCA@rcplondon.ac.uk 
HQIP/CQC joint working progress -  National Clinical Audit Benchmarking (NCAB)
We wanted to update the national clinical audit community on the progress of the HQIP/CQC joint data sharing project.  To remind everyone, this project has enabled audits to supply benchmarked key outcomes data to the CQC to support its inspection teams. At the same time, HQIP is going to support the sharing of this data with provider organisations, commissioners and the public, although it is primarily aimed at the first two groups who are in the best place to make improvements.

The first bit of news is that we have decided to give this project a formal title; National Clinical Audit Benchmarking (NCAB). This reflects the emphasis on making a wider array of benchmarked data available to our audiences.

By way of a recap last year, we piloted data sharing slides for five  audits in the Manchester region. Data from the National Hip Fracture, National Vascular Registry, the Oesophageal Cancer audit, Bowel Cancer audit and the Intensive Care Programme were used. Eight Trusts took part, in addition to academics and the Greater Manchester Academic Health Science Network (GMAHSN), providing feedback on the content and layout of the slides.  The response was overwhelmingly positive, with some medical directors commenting that it was the first time some of them had seen the  data. This feedback clearly evidences the benefits of this work and how it fast tracks data into the right hands.

For those of you supplying data and wondering what is happening with it, given the positive response received, the CQC has moved ahead, automating the process so that subsequent iterations can be produced much more quickly. They are incorporating slides  into the inspection information packs on a provider by provider basis.

Both CQC and ourselves are very grateful for your cooperation on this project. We understand  and appreciate the increase in workloads that this has created for some of you. In taking this more granular benchmarked data out to Trusts and commissioners we are certain that your audit programmes should realise even more of their full potential. 
 
Next stages 
Our next step is to develop and pilot a standardised nationwide approach for sharing slides for the first tranche of audits across all Trusts in England.  This will be via an online portal and we hope to have it available by May 2017.  Then later in the year we’ll be expanding  this to  encompass many more of the national audits. We know local audit staff see this as a hugely effort-saving particularly in regards to summarising audit data for local audience at their organisations. So we are keen to make progress.

We will keep you updated as this exciting project progresses. Please feel free to pass this newsletter on to those who were involved so that they’re aware of the realisation of their hard work.
New project manager arrangements
New arrangements for COP project support are now in place. For NCAPOP audits, the first point of contact is  the designated HQIP Project Manager. For non-NCAPOP audits Kieran Mullan will be your first point of contact. We are currently recruiting to replace former PM Louise Cleaver, and in the interim Nancy Turnbull will be supporting us and so you may hear from her on occasion. To email Nancy with any enquiries contact cop@hqip.org.uk
HQIP COP points of support
Dr Kieran Mullan, COP clinical lead - T: 07980 541946, E: Kieran.mullan@hqip.org.uk
Nancy Turnbull temporary project manager (non-NCAPOP audits)E: cop@hqip.org.uk
Your feedback
We welcome your feedback. Please let us know your thoughts on this newsletter and any other topics you’d like to see included. Please email your feedback to: cop@hqip.org.uk.
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