Policy and strategy, Document

NHS Wales national clinical audit and outcome review plan 2025 to 2026

How we will measure the quality and safety of healthcare services as part of an annual rolling programme.

First published: 23 April 2025

Last updated: 23 April 2025

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Annual rolling programme from 2025 to 2026, March 2025

The annual National Clinical Audit and Outcomes Review Plan confirms the list of National Clinical Audits and Outcome Reviews that all health boards and trusts are expected to participate in 2025 to 2026 (where they provide the service). The plan confirms how the findings from audits and reviews will be used to measure and drive forward improvements in the quality and safety of healthcare services in Wales.

Section 1 of the National Health Service (Wales) Act 2006 places a duty on the Welsh Ministers to continue the promotion of a comprehensive health service designed to secure improvement in the physical and mental health of the people of Wales. Section 2 of that act empowers Welsh Ministers to do anything which is calculated to facilitate, or is conducive or incidental to, the discharge of that duty.

What do we want to achieve?

NHS Wales needs to be a learning organisation, which regularly seeks to measure the quality of its services against consistently improving standards and, in comparison with other healthcare systems across the UK, Europe and the world. This measurement should be used to set improvement priorities.

The Welsh Government and NHS Wales are committed to the principles of value-based healthcare to help meet the challenges of rising costs and increasing demand, while continuing to improve the quality of care.

Clinical audit is an integral component of the quality improvement process and is embedded within the Welsh healthcare standards.

The programme of audits

The agreed NHS Wales programme of audits includes the majority that are currently supported by the National Clinical Audit and Patient Outcome Programme (NCAPOP) and managed by the Healthcare Quality Improvement Partnership (HQIP) but can also include a number of other national or multi-organisational audits that are recognised as being essential.

The Clinical Outcome Review Programmes (formerly Confidential Enquiries) are commissioned by HQIP on behalf of the Welsh Government, NHS England, Northern Ireland Department of Health, Scottish Government and the Channel Island and Isle of Man governments. The programme is designed to help assess the quality of healthcare and stimulate improvement in safety and effectiveness by systematically enabling clinicians, managers and policy makers to learn from adverse events and other relevant data.

The final agreed list of audits and reviews is published annually. The programme for 2025 to 2026 is attached at Annex A and B below.

How will participation, learning and action on findings be encouraged throughout Wales?

National Clinical Audits (NCA) are not just an impetus for service improvement and value-based healthcare. They help benchmark, identify best practice, provide assurance, and monitor and evaluate change.

Continued encouragement of audit:

providing feedback relating to the benchmarked performance of individual providers within clinical audits and reviews to organisations as appropriate for reflection and action
raising the profile of clinical audit with boards, patient groups, clinicians and all staff working within the NHS; to include organisational visits and liaison with professional bodies in Wales to encourage audit amongst their disciplines and specialism
developing closer partnerships working with health boards/trusts clinical audit teams to improve knowledge and understanding of national and local audit/review activities
working in partnership with other healthcare organisations such as NHS Executive, Public Health Wales, Digital Health and Care Wales (DHCW) to promote and encourage a culture of participation in audit and action on findings

Identifying areas needing a national approach to improvement:

reviewing common issues for all Welsh healthcare providers arising from audit and reviews and sharing solutions
ensuring the findings and recommendations from audits are fully considered by the appropriate national advisory groups/networks
working in partnership, via HQIP and with audit project teams to ensure the provision of Welsh-specific findings and potential solutions and develop and organise workshops and events to disseminate them

Addressing clinical services where performance may give cause for concern:

clearly identifying the comparative performance of individual provider organisations and understanding the reasons for any unwarranted variation
ensuring issues are considered in regular performance review meetings between health boards/trusts and in Welsh Government Quality Delivery Board meetings
ensuring a process for the identification and handling of organisations identified in audits and reviews as being “outliers” including such activity designed to improve and encourage quality improvement

Greater transparency:

By seeking to improve the way in which the findings, recommendations and improvement actions from audit and reviews are made available to patients, public and all staff working in the NHS

What is the role of Welsh Government?

In partnership with NHS England and HQIP, the Welsh Government supports and funds the cost of NHS Wales’ participation in the NCAPOP. The Welsh Government along with DHCW will seek to encourage greater participation and learning from clinical audits and reviews leading to improved services, better patient outcomes and safer patient care.

The Welsh Government is a member of the NHS England Executive Quality Group – Clinical Audit Subgroup and provides the Welsh Government’s position and context to ensure the audits align with the long-term plan in Wales.

What is the role of Digital Health and Care Wales

DHCW has become the joint data controller with HQIP for the delivery of any audits commissioned by HQIP as part of NCAPOP and for which Wales is involved and funds.

As part of its statutory functions as a special health authority, the Welsh Government has requested that DHCW identify data sharing opportunities to support clinicians and networks in Wales and provide advice and support to health boards.

What are the responsibilities of Welsh health boards and trusts?

Welsh health boards and trusts should provide the resources to enable their staff to participate in all audits, reviews and national registries included in the annual plan (where they provide the service). They should ensure participation and full case ascertainment with completion of a full audit cycle. The findings and recommendations from clinical audit should link directly into the quality improvement programme and lead to improved patient care and outcomes.

To ensure the maximum benefit is derived from the clinical audit programme health boards and trusts should:

ensure the necessary resources, governance and organisational structures are in place to support complete engagement in audits, reviews and national registries included in the annual plan
appoint a clinical lead to act as a champion and point of contact for every national clinical audit and clinical outcome review programme, which the health board is participating in; health boards and trusts should also encourage and support clinical leads to take on the role of all-Wales representative on audit steering groups and networks where required
ensure there is a formally recognised process for reviewing the organisations performance when reports are published; this review should include consideration of improvements (planned and delivered) and an escalation process to ensure the executive board is made aware when issues around participation, improvement and risk identification against recommendations are identified
have clear lines of communication, which ensures full board engagement in the consideration of audit and review of findings and, where required, the change process to ensure improvements in the quality and safety of services take place
work with DHCW to facilitate the wider use of data from audit and national registries to be used as supporting information for medical revalidation and peer review
ensure learning from audit and review is shared across the organisation and communicated to staff and patients
existing data sharing agreements between the health boards and NHS Trusts shall be utilised for the information sharing event, and this should be documented on the national information flows register as held by DHCW
DHCW, local health boards and the trusts shall produce such Data Privacy Impact Assessments (DPIAs) as may be necessary to comply with the GDPR where new identifiable data is to be shared or otherwise processed

Prior to 2022 to 2023, health boards were tasked with submitting a proforma to Welsh Government for each published audit report. As the audit process has matured, audit results feed into a range of networks and policy development and as such it was determined that these proformas were an additional layer and no longer required. Since 2022 to 2023 routine proformas to the Welsh Government for every audit have not been required. Welsh Government policy officials may ask for feedback when required.

How will we measure success?

By year-on-year consideration of audit reports and in comparison with other UK, European and International healthcare systems to determine how compliance with best practice and achievement of healthcare outcomes compares to national and international benchmarks.

The following key criteria will also be used for judging success:

100% participation, and appropriate levels of case ascertainment and submission of complete data sets by all health boards and trusts (where applicable) in the full programme of national clinical audits and clinical outcome reviews
less variation between local services and measurable year on year improvements in performance to achieve the highest standards; organisations recognised as being above the audit “average” or within the top quartile for each audit and maintaining that level
improvements in the quality and safety of patient outcomes and experience brought about by learning and action arising from the findings of national clinical audit and clinical outcome review reports

Where health boards/trusts do not participate in a national clinical audit or clinical outcome review where they provide the service, they will automatically be given alarm outlier status.

How will we maintain success?

The audit and quality improvement approach has the advantage of engaging those placed to make change and those expected to deliver and maintain change on a daily basis. This approach has a demonstrated track record of delivering and maintaining service improvement for a range of issues in a range of settings. Where there are expectations of delivering and maintaining better quality care and outcomes, the audit and quality improvement should be the normally used first-line approach.

Conclusion

The findings and recommendations from national clinical audit, outcome reviews and all other forms of reviews and assessments will be one of the principal mechanisms for assessing the quality and effectiveness of healthcare services provided by health boards and trusts in Wales.

In line with our stated ambition to develop a healthcare service that is recognised as being one of the best in the world, and to drive forward improvement, the clinical audit process will also be used to assess Welsh healthcare services against similar services being provided in other countries across the UK, Europe and internationally.

Annual programme for 2024 - national clinical audit and outcome reviews

In which all Welsh health boards and trusts must participate (where services are provided).

Acute

National programme name:

National Joint Registry.

Workstream / topic name:

Joints.

Managed by / hosted by:

Healthcare Quality Improvement Partnership (HQIP).

Audit website:

National Joint Registry website.

Email:

enquiries@njrcentre.org.uk

Collecting data in 2025 to 2026:

Yes.

National programme name:

Case Mix Programme (CMP), Intensive Care National Audit and Research Centre (ICNARC).

Workstream / topic name:

Intensive care.

Managed by / hosted by:

ICNARC.

Audit website:

ICNARC website.

Email:

cmp@icnarc.org

Collecting data in 2025 to 2026:

Yes.

National programme name:

National Emergency Laparotomy Audit (NELA) ^[^{footnote 1}^].

Workstream / topic name:

Emergency laparotomy.
Non-Laparotomy.

Managed by / hosted by:

HQIP.

Audit website:

NELA website.

Email:

NELA@rcoa.ac.uk

Collecting data in 2025 to 2026:

Yes.

National programme name:

National Major Trauma Registry (previously TARN)

Workstream / topic name:

Trauma.

Managed by / hosted by:

(National Health Service England) NHSE.

Audit website:

NHSE website.

Email:

england.support.nmtr@nhs.net

Collecting data in 2025 to 2026:

Started in November 2024.

Older people

National programme name:

Falls and Fragility Fracture Audit Programme (FFFAP) ^[^{footnote 1}^].

Workstream / topic name:

Fracture Liaison Service Database (FLS-DB).
National Audit of Inpatient Falls (NAIF).
National Hip Fracture Database (NHFD).

Managed by / hosted by:

HQIP.

Audit website:

Email:

Collecting data in 2025 to 2026:

Yes.

National programme name:

National Audit of Dementia ^[^{footnote 1}^].

Managed by / hosted by:

HQIP.

Audit website:

Royal College of Psychiatrists website.

Email:

nad@rcpsych.ac.uk

Collecting data in 2025 to 2026:

Yes.

National programme name:

Sentinel Stroke National Audit Programme (SSNAP) ^[^{footnote 1}^].

Managed by / hosted by:

Healthcare Quality Improvement Partnership (HQIP).

Audit website:

SSNAP website.

Email:

ssnap@kcl.ac.uk

Collecting data in 2025 to 2026:

Yes.

Cancer

National programme name:

National Cancer Audit Collaborating Centre ^[^{footnote 1}^].

Workstream / topic name:

National Audit of Metastatic Breast Cancer.
National Audit of Primary Breast Cancer.
National Bowel Cancer Audit (NBOCA).
National Oesophago-Gastric Cancer Audit (NOGCA).
National Lung Cancer Audit (NLCA).
National Prostate Cancer Audit (NPCA).
National Ovarian Cancer Audit.
National Pancreatic Cancer Audit.
National Non-Hodgkin Lymphoma Audit.
National Kidney Cancer Audit.

Managed by / hosted by:

HQIP.

Audit website:

Email:

Collecting data in 2025 to 2026:

Yes.

Long-term conditions

National programme name:

Renal Registry (UK Kidney Association) ^[^{footnote 2}^].

Workstream / topic name:

Kidney disease.

Managed by / hosted by:

UK Kidney Association.

Audit website:

The UK Renal Registry page on the UK Kidney Association website.

Email:

renalregistry@renalregistry.nhs.uk

Collecting data in 2025 to 2026:

Yes.

National programme name:

National Early Inflammatory Arthritis Audit (NEIAA) ^[^{footnote 1}^{] [}^{footnote 2}^].

Workstream / topic name:

Inflammatory arthritis.

Managed by / hosted by:

HQIP.

Audit website:

The British Society for Rheumatology website.

Email:

audit@rheumatology.org.uk

Collecting data in 2025 to 2026:

Yes.

National programme name:

National Paediatric Diabetes Audit (NPDA) ^[^{footnote 1}^{] [}^{footnote 2}^].

Workstream / topic name:

Paediatric Diabetes.

Managed by / hosted by:

HQIP.

Audit website:

National Paediatric Diabetes Audit webpage of the The Royal College of Paediatrics and Child Health website.

Email:

npda@rcpch.ac.uk

Collecting data in 2025 to 2026:

Yes.

National programme name:

National Adult Diabetes Audit (NDA) ^[^{footnote 1}^].

Workstream / topic name:

National diabetes core audit:
- care processes / treatment targets
- complications and mortality
- type 1 diabetes
- learning disability and mental health
- structured education
Diabetes Prevention Programme (DPP) Audit.
National Diabetes Footcare Audit (NDFA).
National Diabetes Inpatient Safety Audit (NDISA).
Gestational diabetes audit ^[^{footnote 2}^].
National Pregnancy in Diabetes Audit (NPID) ^[^{footnote 2}^].
NDA integrated specialist survey.
Transition (adolescents and young adults) and young type 2 audit.

Audit website:

Email:

Collecting data in 2025 to 2026:

Yes.

National programme name:

National Respiratory Audit Programme (NRAP) ^[^{footnote 1}^{] [}^{footnote 2}^].

Workstream / topic name:

Adult asthma secondary care.
COPD secondary care.
Paediatric asthma secondary care.
Pulmonary rehabilitation.
Wales primary care audit.

Managed by / hosted by:

HQIP.

Audit website:

Email:

nrapinbox@rcp.ac.uk

Collecting data in 2025 to 2026:

Yes.

National programme name:

Audiology Quality Standards ^[^{footnote 2}^].

Managed by / hosted by:

Audiology Standing Specialist Advisory Group.

Audit website:

Adults Audiology Quality Standards 2016.

Email:

jane.deans@wales.nhs.uk

Collecting data in 2025 to 2026:

Yes.

End of life care

National programme name:

National Audit of Care at the End of Life (NACEL) ^[^{footnote 1}^].

Managed by / hosted by:

HQIP.

Audit website:

National audit of care at the end of life website.

Email:

Nhsbn.nacelsupport@nhs.net

Collecting data in 2025 to 2026:

Yes.

Heart

National programme name:

National Audit of Cardiac Rehabilitation (NACR).

Workstream / topic name:

NACR.

Managed by / hosted by:

National Cardiac Audit Programme (NCAP).

National programme name:

National Vascular Registry (NVR) ^[^{footnote 1}^].

Workstream / topic name:

NVR.

Managed by / hosted by:

HQIP.

Audit website:

Vascular Services Quality Improvement Programme.

Email:

nvr@rcseng.ac.uk

Collecting data in 2025 to 2026:

Yes.

National programme name:

National Cardiac Audit Programme (NCAP) ^[^{footnote 3}^].

Workstream / topic name:

Myocardial Ischaemia National Audit Project (MINAP).
National adult cardiac surgery audit.
National Audit of Cardiac Rhythm Management (CRM).
National audit of percutaneous coronary interventions. (coronary angioplasty).
National Congenital Heart Disease Audit (NCHDA) ^[^{footnote 2}^].
National heart failure audit.
National audit of Mitral Valve Leaflet Repairs (MVLR).
The UK Transcatheter Aortic Valve Implantation (TAVI) Registry.

Managed by / hosted by:

Arden and Gem Commissioning and Support Unit (CSU).

Audit website:

The National Institute for Cardiovascular Outcomes Research (NICOR) website.

Email:

nicor.auditenquiries@nhs.net

Collecting data in 2025 to 2026:

Yes.

Mental health

National programme name:

National Clinical Audit of Psychosis (NCAP) ^[^{footnote 1}^].

Managed by / hosted by:

HQIP.

Audit website:

National Clinical Audit of Psychosis (NCAP) webpage on the Royal College of Psychiatrists website.

Email:

NCAP@rcpsych.ac.uk

Collecting data in 2025 to 2026:

Yes.

Women and children's health

National programme name:

National Clinical Audit of Seizures and Epilepsies for Children and Young People (Epilepsy12) ^[^{footnote 1}^][^{footnote 2}^].
National Maternity and Perinatal Audit (NMPA) ^[^{footnote 1}^{] [}^{footnote 2}^].
National Neonatal Audit Programme (NNAP) ^[^{footnote 1}^].
Paediatric Intensive Care Audit Network (PICANet) ^[^{footnote 1}^{] [}^{footnote 2}^].

Managed by / hosted by:

HQIP.

Audit website:

Email:

Collecting data in 2025 to 2026:

Yes.

National programme name:

Perinatal Mortality Review Tool (PMRT) ^[^{footnote 2}^].

Managed by / hosted by:

DHSC.

Audit website:

The perinatal mortality review tool page on The National Perinatal Epidemiology Unit (NPEU) website.

Email:

mbrracele@npeu.ox.ac.uk

Collecting data in 2025 to 2026:

Yes.

Clinical outcomes review programme

The Clinical Outcome Review Programme (CORP) is designed to help assess the quality of healthcare and stimulate improvement in safety and effectiveness by enabling learning from adverse events and other relevant data. It aims to complement and contribute to the work of other agencies such as NICE, the royal colleges and academic research studies, which support changes to improve NHS healthcare.

Without high quality data, improvement in clinical care is unlikely to occur. National clinical audits and outcome reviews are focused on areas of healthcare considered to be important, where there are often issues of concern and where national results are considered essential to improve practice and standards.

With the ability to measure against recognised standards and compare services on a local, regional or national basis, clinical audit and outcome reviews are very powerful tools for assessing the quality of services being provided. When used as part of the wider quality improvement cycle, they provide a strong mechanism for driving service change and improving patient outcomes, but full participation and a determination to learn from the findings is essential.

Service provider contracts for these programmes have been awarded to the following suppliers (links are provided to website homepages):