Annex A > Chapter 18 - Medical and Clinical Audit > Audit at district and unit level > 1985-1988 The B&WDHA Performance Assessment Committee
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1985-1988 The B&WDHA Performance Assessment Committee
194 In 1985 the B&WDHA formed the Performance Assessment Committee (PAC). The Inquiry was told that the PAC was made up of lay members of the B&WDHA. [232] It was not an audit committee but, by means of examining `work-related figures', concerned itself mainly with the task of ensuring that the hospitals in the Area functioned as efficiently as possible. [233]
195 Dr Trevor Thomas, Chair of the Medical Audit Committee (MAC) 1991-1993, told the Inquiry that the PAC had, on occasion, been less than tactful in its treatment of information and medical staff. Subsequently, this had adversely affected the introduction of medical audit at Bristol in 1990. [234]
196 One of the functions of the PAC was to monitor the care of patients. To this end it received statistical information from a Medical Information Working Group (MIWG). The MIWG consisted of both clinicians and managers. It seems to have been a sub-group of the PAC and assisted it by interpreting technical and medical information. The Inquiry was told that it was formed following misinterpretations of information and consequent misunderstandings between the PAC and members of the medical staff of the United Bristol Hospitals. [235]
197 Most of the data considered by the MIWG and the PAC was of a general nature, relating principally to bed usage, operating theatre usage, patient throughput and bed occupancy.The PAC received figures such as how many patients each consultant saw and the numbers of operations performed. As regards mortality, the data related only to general mortality statistics. [236]
198 The MIWG was not considered to be a medical or clinical audit committee:
`The nature and paucity of the available data, and its relative age, coupled with the cumbersome way in which it had to be assessed, manipulated and reported, through a regional system known as "Centrelink" was not conducive to its being used for audit purposes. This was widely recognised.' [237]
199 In February 1986, B&WDHA agreed that its District Medical Officer (DMO) should `continue to assess clinical performance in an extended but carefully selected number of specialties'. [238] The difficulties of such assessment were acknowledged in the Authority's `Strategy for Neonatal Care 1986-1994', adopted in May 1986, which pointed out that:
`No separate routinely available information is recorded for the outcomes of neonatal care in relation to neonatal surgery both cardiac and non-cardiac.' [239]
200 In June 1986 the SWRHA required DHAs to provide performance indicators and key indicators. In the view of Pamela Charlwood: [240] `... none was narrow enough to isolate paediatric cardiac surgery and none was concerned with surgical outcomes.' [241]
201 In 1986, the PAC reviewed four of the services provided in Bristol. Paediatric cardiac services was not one of them.
202 Ms Charlwood also told the Inquiry that, in April 1987, the PAC decided that a sub-committee of itself, together with the District General Manager (DGM), should conduct Unit reviews in September or October each year.
203 Consequently, in September 1987, the PAC appointed a Review Group, which reviewed the Central Unit (including the BRI and BRHSC) in October 1987. This Review Group reported to B&WDHA in November 1987. [242] It did not identify paediatric cardiac surgery as an area of concern.
204 Ms Charlwood informed the Inquiry that in August 1988 the MIWG reported that a steering group had been set up under the Chairmanship of Dr Thomas to oversee implementation of `Medisgrps', a clinical management information system. It was designed to take into account the severity of the patient's condition as it affected the actual outcome of care. It was hoped that it would be applied to data relating to adult cardiology and cardiac surgery. It appears that it was never developed beyond a pilot stage.
205 In September 1988 the MIWG considered cardiothoracic surgery. Ms Charlwood stated that the report `... stressed there were no comparative figures in the form of performance indicators but Mr Wisheart is minuted as having referred to the "national register of cardiac cases".' [243]
206 In summarising developments during this period, Ms Charlwood stated:
`By the end of 1988 the DHSS had announced an intention to place greater value on medical audit ... Up to that point B&WDHA had
`i) recognised the need to monitor performance in terms of outcomes for patients;
`ii) acknowledged the impracticability of assessing all outcomes in all specialties;
`iii) opted to monitor specific services each year;
`iv) not seen or heard anything about paediatric cardiac surgery to warrant selecting it for scrutiny.' [244]
207 In October 1988 the PAC received the BRI/BRHSC 1987 `Paediatric Cardiology and Cardiac Surgery Annual Report on Paediatric Cardiology'. Mortality rates were described as virtually identical to those obtained nationally as published in the UK Cardiac Surgical Register. The PAC's minute (119/88) stated: `Members ... noted that there were no national performance indicators'. [245]
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Footnotes
[233] T62 p.70 Dr Thomas. He does not define in which sense `efficiently' is used, but the context is that of workload
[235] WIT 0323 0003 Dr Thomas
[236] WIT 0323 0003 Dr Thomas
[237] WIT 0377 0016 Mr Alan Carter, former Director of Information Technology and Assistant Director of Operations, UBHT
[238] WIT 0038 0022 Ms Charlwood, Chief Executive Avon Health Authority 1994 to present
[239] HAA 0128 0033; `Strategy for Neonatal Care 1986-1994'
[240] Current Chief Executive, Avon Health Authority (since 1994)
[241] WIT 0038 0022 - 0023 Ms Charlwood
[242] WIT 0038 0023 Ms Charlwood
[243] WIT 0038 0023 Ms Charlwood
[244] WIT 0038 0023 Ms Charlwood
[245] WIT 0038 0023 Ms Charlwood