Annex A > Chapter 18 - Medical and Clinical Audit > Audit at district and unit level > The BRI and the BRHSC pre-1991
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The BRI and the BRHSC pre-1991
268 Before April 1991, clinicians regarded audit as being part of medical practice. Audit activity was undertaken voluntarily by clinicians at specialty level.
`... left to the individual practitioner ...' [321]
`The systems of audit were consciously maintained but they functioned through the commitment and interest of the practitioners.' [322]
`Some doctors may have kept records of results ... but it was certainly not systematic and it certainly did not involve all doctors or all specialties.' [323]
270 Dr Roylance stated that, in 1989:
`The guidance emanating from the profession at this time emphasised that it was for doctors to take corporate responsibility for clinical care in terms of outcome measurements, and it was for management to facilitate the conduct of audit and to respond to the conclusions from audit but not to involve themselves in the audit itself. Those conducting audit were required to identify any management action that was necessary as a result of an audit and then to inform management. Essentially, audit was seen as a professional activity which should be led by the profession.' [324]
271 `Audit', as defined for the Inquiry, [325] however, was not apparently taking place. Rather, the Inquiry heard evidence of changes in practice being introduced as the result of studying the relevant literature, attending and holding scientific meetings, visiting hospitals and keeping logbooks of operations. [326]
272 There was also some indication that comparisons of practice at the Bristol hospitals were being made with recognised benchmarks or standards. For instance, a comparison of the results for paediatric cardiac surgery at the BRI with national figures is documented in the BRHSC and BRI Annual Reports on Paediatric Cardiology and Cardiac Surgery for 1987, [327] 1988, [328] April 1989-March 1990. [329] The standards referred to related to mortality associated with a particular operation. There were differing views as to whether or not national mortality figures provided a reliable benchmark.
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Footnotes
[321] WIT 0097 0322 Dr Joffe
[322] WIT 0120 0406 Mr Wisheart
[323] WIT 0523 0003 Mr Paul Barker, Administrator at the BRI from 1979 to 1985
[324] WIT 0108 0043 - 0044 Dr Roylance
[326] WIT 0352 0025 Dr N Brian Williams, WIT 0084 0022, 0031 Mr Dhasmana
[327] UBHT 0055 0009; annual report 1987
[328] UBHT 0089 0023; annual report 1988
[329] UBHT 0055 0068; annual report 1989-1990