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

Audit in the UBHT

4 The UBHT took over the District's role with respect to audit in 1991. The Medical Audit Committee (MAC) of the UBHT was established soon after the Trust came into being. The MAC was a sub-committee of the Hospital Medical Committee (HMC) and its membership was almost wholly medical. The MAC's remit was to follow the regional strategy and to promote, facilitate and co-ordinate audit within the Trust. It did not manage the audit activity within the various hospitals nor did it have any formal powers or resources.

5 Between 1991 and 1995, on average, £250,000 a year was provided to the UBHT to spend on audit activities. These funds were allocated directly from the Region through the Regional Medical Officer (RMO). They were allocated to the consultant medical staff, not to the MAC. Management took no part in the distribution or allocation of these funds. The funds were spent mostly on local IT systems and on the salaries of audit assistants. The MAC did not have any control over these funds nor was it in a position to monitor how they were used.

6 The MAC produced annual reports that included general information about audit and examples of audit activity within the UBHT over the previous year. It was for each specialty to decide on audit topics and on how the audits were to be arranged. Specialties and departments within the trust were asked to supply regular returns to the MAC about their audit activity. Some specialties, such as oncology and ophthalmology, responded; others did not. The information in the annual reports, therefore, was drawn from such information as the MAC had been able to gather. It had no powers to require that it be given information about audit activities where none was forthcoming.

7 The annual reports of the MAC were given by the UBHT to the Region. Dr Roylance stated, however, that detailed results of audit were not communicated to either the Region or the District. Dr Roylance was not personally involved in the process or the detailed arrangements, since, in his view, to have become involved might have threatened the process of audit and the co-operation of the clinicians. [4] The Trust Board did not see the reports of the MAC.

8 The annual reports of audit activity within the UBHT offer insights into the way audit was perceived at the time and the manner in which it was carried out in the UBHT. The 1992 Annual Report, for example, stated that medical audit: `... must continue to be seen to be a confidential and independent educational process - not merely the inquisitional arm of purchasers under the auspices of the Regional Health Authority.' [5] An extract from the 1993 Annual Report shows the difficulties encountered by members of the MAC. As responsibility for audit was devolved by management to clinical directorates, the MAC was of the view that it was: `... quite difficult for the Audit Committee to influence and record audit activities ... the Audit Committee has no budget and is not made up of clinical directors.' It was pessimistic about the future unless: `... some agreement can be made between senior management and the [new] Clinical Audit Committee (CAC) as to the future of audit in the UBHT.' [6]

9 A further insight into audit at the UBHT can be gained from the annual reports about audit activity in the South West produced by the Region. Its report for 1992/93 noted that there was only a small amount of information about the UBHT's audit activity because very little had been received from the Trust, and that which had been received was in a form which meant that it could not be used. A similar picture appeared in the Region's annual audit report for 1993/94.

10 In terms of the role of management, Dr Roylance saw it as being to ensure that audit was being carried out whilst: `the actual audit figures were to remain confidential to those providing the service i.e. the clinicians.' [7] It was not envisaged at the time that management would be given the data underlying or produced by audit. Dr Roylance was of the view that any such involvement of management would, in fact, inhibit the development of the audit process.

11 The MAC was reconstituted as the CAC in early 1994, reflecting the change from medical to clinical audit. A number of non-medical clinicians became members. The CAC reported via the Medical Director and the Patient Care Standards Committee, to the Trust Board. Mr Wisheart took over as Chairman of the CAC from Dr Thomas in July 1994 and held that position for six months. The CAC was responsible for encouraging and monitoring the introduction of the process of audit but with the emphasis now being on the shared care of patients by a range of healthcare professionals. As with the MAC, the CAC's reports were seen by Dr Roylance and the Region. From 1995, they were also seen by the Trust Board.

12 There was no mention of PCS in the annual reports of the MAC of 1992 or 1993/94. Audits of cardiac surgery (although not specifically of PCS) are mentioned in the reports of 1990 and 1994/95. Dr Thomas told us, however, that he knew that audit meetings and activity were occurring within the specialty of PCS, and that returns were being made to the UK Cardiac Surgical Register (UKCSR). [8]

Footnotes

[4] WIT 0108 0043 - 0044 Dr Roylance

[5] UBHT 0032 0080; MAC Annual Report 1992

[6] UBHT 0058 0309; MAC Annual Report 1993

[7] WIT 0108 0019 Dr Roylance

[8] T62 p.140 Dr Thomas