The National Prostate Cancer Audit — Introducing a New Generation of Cancer Audit

摘要

Health service providers and healthcare professionals are expected to assure the quality of their services and safe-guard high standards of care. Successive UK governments have claimed that it is their ambition to provide a health service that achieves 'world-class healthcare outcomes' [[1]Department of Health Equity and excellence: liberating the NHS.2010https://www.gov.uk/government/uploads/system/uploads/attachment_data/file/213823/dh_117794.pdfGoogle Scholar]. The current government has translated this into three priorities for the National Health Service (NHS): (a) empower local clinicians to deliver better outcomes, (b) provide information to patients that will help them to make choices and (c) create greater accountability to all those who use the NHS [[2]National Commissioning Board Everyone counts: planning for patients 2013/14.2013http://www.england.nhs.uk/wp-content/uploads/2012/12/everyonecounts-planning.pdfGoogle Scholar]. Although there is ongoing political debate about how we can create an 'NHS which achieves results that are amongst the best in the world', it is evident that national clinical audits have an important role to play [[3]Black N. Time for a new approach to assessing the quality of hospitals in England.Br Med J. 2013; : 347Google Scholar]. In this editorial, we describe the National Prostate Cancer Audit (NPCA) as an example of a new generation of national audits of cancer services in England and Wales (http://www.npca.org.uk). The audit is part of the National Clinical Audit and Patient Outcomes Programme, which also includes four additional cancer audits focusing on head and neck oncology, lung cancer, oesophago-gastric cancer and bowel cancer [[4]Healthcare Quality Improvement Partnership (HQIP) National clinical audit projects managed and commissioned by HQIP: programme list 2013/14.2013http://www.hqip.org.uk/ncapop-programme-list/Google Scholar]. Current political initiatives have moved away from measuring process targets in the NHS towards a 'relentless focus on clinical outcomes', which should be measured and reported in the public domain to encourage quality improvements [[1]Department of Health Equity and excellence: liberating the NHS.2010https://www.gov.uk/government/uploads/system/uploads/attachment_data/file/213823/dh_117794.pdfGoogle Scholar]. The current NHS outcomes framework presents a series of indicators covering five outcome domains designed to provide a balanced coverage of NHS activity [[5]Department of Health The NHS outcomes framework 2013/14.2013https://www.gov.uk/government/uploads/system/uploads/attachment_data/file/213055/121109-NHS-Outcomes-Framework-2013-14.pdfGoogle Scholar]. For cancer services, new indicators will measure overall 1 and 5 year survival for all cancers (including childhood cancers), as well as specific 1 and 5 year survival for breast, lung and bowel cancer combined [[5]Department of Health The NHS outcomes framework 2013/14.2013https://www.gov.uk/government/uploads/system/uploads/attachment_data/file/213055/121109-NHS-Outcomes-Framework-2013-14.pdfGoogle Scholar]. However, quality itself is a multidimensional concept that reflects many different aspects of the healthcare system, including safety, effectiveness and patient experience, as well as issues related to equity [[6]Institute of Medicine (US) Crossing the quality chasm: a new health system for the 21st century. National Academies Press, 2001Google Scholar]. Therefore, the scope of national clinical audits should extend beyond the provision of outcome data alone. The NPCA has been commissioned on behalf of NHS England. It started on 1 April 2013 and will continue for at least 5 years. It aims to collect information on the stage of newly diagnosed patients and their subsequent treatment choices. It will provide detail on early complications, longer term survival and quality of life. The audit also focuses on areas of controversy, such as the management of patients with low-risk disease ('are we o