Richard (Dick) Waite is an independent healthcare consultant with a background in
outcomes and regulation, drawing on 25 years of experience as a senior with the Healthcare
Commission, Audit Commission and the Institute for Employment Studies.
Interim COO, NICOR-UCL
UCL’s National Institute for Cardiovascular Outcomes Research (NICOR), established
by Professor Sir Bruce Keogh and currently directed by Professor Sir Roger Boyle,
won the contract to provide six national cardiac clinical audits. As Interim Chief
Operating Officer, I led the work to ensure that:
NICOR’s mission to provide information to improve heart disease patients’ quality
of care and outcomes can be achieved.
Effective liaison with the existing audit supplier ensured uninterrupted service
on transfer to UCL and the TUPE transfer of the central audit IT and administrative
staff was successful.
Contracts to deliver the audits were negotiated and governance arrangements established.
Successful application to the Ethics and Confidentiality Committee for NICOR to handle
confidential information. UCL was granted approval under section 251 of the NHS Act
2006 to process patient audit data.
Led the process to agree, and then produced, NICOR’s strategic plan (available at
Clinical Audit within the Hong Kong Hospital Authority
I partnered with Dr Jonathan Boyce to review the state of clinical audit across the
Hong Kong Hospital Authority. Currently there are areas of good clinical audit practice,
but also significant gaps. There is an appetite to do more clinical audit and potential
to improve the quality and consistency of care by expanding clinical audit. The HA
has an excellent standard information system that can underpin new Hong Kong-wide
clinical audits. We recommended specific measures and a strategy for the reinvigoration
and development of clinical audit.
National Clinical Audit and Patients’ Outcomes Programme
To meet the challenges arising from the introduction of Quality Accounts, Commissioning
for Quality and Innovation and the ‘information revolution’, commissioners and service
providers alike will need access to good quality information about whether services
are safe and effective. The range and complexity of services offered by NHS trusts
mean that there is currently no single source of such information. The National Clinical
Audit and Patients’ Outcomes Programme (NCAPOP) is a set of centrally-funded national
projects that provide local trusts with a common format by which to collect data
that is fed back as benchmarked information, often against NICE or professional standards.
My work for several years as head of this programme means that I know about the range
of audit information available, and how it can be used by trust boards as ‘headline’
indicators of quality—as well as providing very detailed feedback to individual clinicians
to help them reflect on and change their practice. I also needed to work with other
partner organisations offering information from audits and outcomes systems outside
of NCAPOP. My comprehensive knowledge of what is available can help trusts assure
themselves about whether their services reach the necessary standard of clinical
quality and sensitivity to patients’ views.
The NHS Constitution requires NHS services to reflect the needs and preferences of
patients, their families and their carers. Every project that I undertook with the
Healthcare Commission and Audit Commission included patients and representative organisations
in its project governance arrangements; and measured patients views and experiences
of services. For example:
We undertook focus groups to explore people’s experiences with – and views about
– dentistry and knowledge of preventive care. These explored issues around access
and revealed unexpected barriers that had not been revealed in discussions with managers
or dentists… “What people said during these meetings is quoted throughout the report.
There are more negative than positive statements about the state of services at the
moment. This is not selective quotation on our part, as readers of the full report
will be able to see. It reflects genuine concerns about the state of NHS dental services,
and these concerns, stated to us by members of the public and by dentists themselves,
were one of the main reasons for carrying out the study….”(Audit Commission Dental
We surveyed patients’ opinions about their local anaesthetic and pain relief services.
We produced booklets for patients suggesting key questions to ask about the way in
which their cancer services were being provided.
Efficiency and value for money (VFM)
Improving efficiency while maintaining quality will be increasingly required in a
future of ‘flat’ or even declining budgets, yet ever increasing and changing demands.
I have managed the production of national VFM studies and also worked with local
trusts as an auditor applying the approach. We always worked in partnership to produce
realistic, achievable action plans that managers and clinical leaders could own.
Our recommendations always helped trusts save money through improved efficiency,
while maintaining quality standards. For example, in relation to:
How improving day surgery rates can reduce costs and waiting lists while increasing
Nursing skill mix, rostering and the quality of care.
Meeting best practice standards for children’s hospital services in cost-effective
I used my experience of commissioning the national clinical audit programme to help
the Health Foundation select projects for its Engaging with Quality and Closing the