Final Report > Chapter 7: The Audit and Monitoring of the Paediatric Cardiac Surgical Service in Bristol > Introduction

Introduction

1 In this chapter we describe the way in which the national policy for medical and later clinical audit (as described in Chapter 5) was implemented in Bristol. Secondly, we turn to paediatric cardiac surgery (PCS) in particular and set out in broad terms the types of activity undertaken by the clinicians in Bristol to audit their work. A fuller account of the evidence received by the Inquiry on these matters is in Chapter 18 - Medical and Clinical Audit and 19 of Annex A. Further papers commissioned by the Inquiry from experts are set out in Annex B. [1]

2 As we have seen, from the inception of the NHS, individual clinicians have reviewed the quality of the care given to their patients and the clinical outcomes of such care. Such reviews might take place within a specialty, or at meetings held regionally, nationally and internationally, or as part of the process of writing an article for a professional journal. With the emergence of audit the emphasis moved from a situation in which individual clinicians decided whether and how to participate in a review of the care provided, towards a more formal, systematic approach. Local audit committees were established, audit was encouraged and supported financially, and information about the range and impact of audit activity in a given hospital or area was collected.

3 Notwithstanding the national endorsement of medical and then clinical audit, the approach adopted was educational. The aim was to encourage review. Audit was not seen as a tool systematically to identify problems or to monitor the outcome of care for all patients. As Dr Roylance put it, referring to the requirements placed on trusts in 1991: `At that stage, it was simply required that there be audit activities in which every doctor participated and that general results be reported. Audit was still said to be primarily an educational activity: its monitoring potential was very much underplayed at this stage.' [2] He also stated `... I was aware of a strong feeling within the medical profession that audit was going to be used as yet another management tool and I felt that its introduction to the formal structure of Bristol and Weston Health Authority as it was at that time, and then the UBHT, needed to be handled very carefully in order to encourage doctors to participate.' [3]

Footnotes

[1] Annex B paper 10m Walshe K, Offen N. `An evaluative commentary on systems for review and audit at the United Bristol Hospitals NHS Trust from 1984 to 1995'. Also paper 11c Humphrey C. `Medical and Clinical Audit in the NHS'

[2] WIT 0108 0046 Dr Roylance

[3] WIT 0108 0043 Dr Roylance