Frequently Asked Questions

What is NCAB?

National Clinical Audit Benchmarking (NCAB) is a new initiative aimed at making it easier to access national clinical audit data. National clinical audits (NCAs) offer an unmatched resource for how individual hospitals are performing in specific clinical areas against agreed standards, in the context of a robust national picture. NCAB distils what can be necessarily extensive reporting into a concise set of key metrics for each audit topic. Results are presented in an easy to understand visual form, specific for each Trust, hospital and in some cases ward and where available against national benchmarks.

What is the aim of NCAB?

The aim of NCAB is to support local improvement in care quality. The aim of presenting key metrics either benchmarked against other providers or against national aspirational standards (based on NICE guidelines and recommendations from the national audit provider) is to provide meaningful context to local performance information to help focus local quality improvement activity. The aim of providing the same metrics for local use as will be considered by the CQC as part of its regulatory approach is to promote a shared vision of quality between local organisations, national clinical audits and the regulator.

The aim of providing downloadable data is to make it easier for local clinical audit staff to prepare local reports and presentations for the wider organisation with off the shelf data packs, saving them time.

How did NCAB come about?

NCAB originated as a partnership with the CQC with the aim to promote national clinical audit and support quality improvement by maximising the use of audit results. It is based on existing clinical audit data, and HQIP worked with the audit providers to define and collate the NCAB-relevant data, and then CQC worked to agree key metrics and national standards with each audit provider and produce slides for each healthcare provider for each audit. The early development of the project was overseen by a steering group that included representation from NCAs and Trust clinical leadership and local clinical audit staff.

How does the CQC use the audit data?

CQC is now incorporating these key metrics into its monitoring dashboard and inspection information on a provider-by-provider basis to inform the intelligence-driven approach to regulation and support quality improvement.

Do Trusts need to supply additional data for NCAB?

No. The NCAB slides are based on pre-existing audit data.

What national clinical audits are taking part?

At the moment we have data slides available from six national clinical audits:

  1. Emergency Laparotomy Audit (NELA)
  2. Intensive Care National Audit and Research Centre case mix programme (ICNARC)
  3. National Audit of Dementia (NAD)
  4. National Bowel Cancer Audit Programme (NCBA)
  5. National Hip Fracture Database (NHFD)
  6. National Lung Cancer Audit (NLCA)
  7. National Maternity and Perinatal Audit (NMPA)
  8. National Neonatal Audit Programme (NNAP)
  9. National Paediatric Diabetes Audit (NPDA)
  10. National Prostate Cancer Audit (NPCA)
  11. National Vascular Registry (NVR)
  12. Oesophago-gastric Cancer Audit (NOGCA)
  13. Paediatric Intensive Care Network Audit (PICANet)

We aim to add further NCAs as the project progresses. The CQC are making use of data from a wider range of audits separately to the data from the six audits available on the NCAB website.

Are all the metrics shown against national aspirational standards?

No, there isn’t always the necessary agreed standard to compare performance again. But the benchmarking against other organisations can provide helpful comparative information to support quality improvement activity.

How were the metrics chosen?

The metrics were chosen as a result of detailed discussion and collaboration between the relevant NCA, HQIP and the CQC considering factors such as reliability, safety, the pathway of care and comparability. The aim was to be able to present a comprehensive and meaningful insight into local performance.

Where can I find out more about each of the metrics?

Each data slide has an associated context document which explains what each of the metrics relates to and potential questions to ask in relation to quality improvement.

You can find these guides here.

If a Trust or hospital is in the bottom quartile for a metric is the care being provided unsafe or of a poor quality?

National clinical audit data provides a statistical snapshot about a Trust or hospital. But it does not give concrete answers about the quality of care. There will be other factors that affect the results including local patient demographics, the complexity of the patients being cared for and differences in how data is being collected locally. This means the benchmarking comparisons are only a starting point for understanding the quality of care being provided.

Some of the metrics are shown with risk adjusted outlier calculations being made to make the comparisons more reliable. Performance shown to be poorer than expected for these metrics should be scrutinised closely as it is much more likely to reflect poor care in reality.

Why are the performance boundaries different for different organisations?

Some of the benchmarking analyses use statistical methods that are more precise depending on the volume of activity. Where more procedures or patients are being analysed it is less likely that any variation will be due to chance and so narrower boundaries of performance can be used. This is just one example of why data like this can only be the start of an exploration of quality and is not definitive.

How up to date is the data?

We have launched the website using data from the latest available national clinical audit report. The time periods to which the data relates vary depending on the audit. We aim to refresh the data as soon as a new national clinical audit dataset is published.

What do the CQC key questions relate to?

The CQC asks five questions of all care services as part of its regulatory approach. To find out more about these key questions visit the CQC website.

Each of the metrics is linked to one of these five questions to support providers in understanding how the CQC considers the data within a wider regulatory context.

Data for my hospital or Trust is not showing for a particular audit. Why not?

Not every hospital or Trust will fit the eligibility criteria for the audits and so data won’t always be available for every hospital or Trust. If you believe your organisation is eligible and/or is participating but no data is being provided then please contact us on benchmarking@hqip.org.uk.

Data is only available at Trust level for my organisation, where can I get hospital-level data?

Not every audit collects or publishes data at the level of individual hospitals. If you believe the audit slide you are asking about is from an audit that does (for example you can see hospital level slides for other Trusts) then please contact us on benchmarking@hqip.org.uk.

Can I download and use the slides locally e.g. at Board level presentations or papers?

We welcome the downloading and reuse of the data slides locally. We want them to be used as widely as possible to support quality improvement activity. Please just acknowledge the source of the data slides as being from the NCAB website.

I have spotted what I think is a mistake in a data slide. Who do I contact about this?

Please contact us on benchmarking@hqip.org.uk.