The National Clinical Audit Support Programme Diabetes Audit

The National Clinical Audit Support Programme (NCASP) is one of the organisations that supports the implementation of the NSF for Diabetes. The NCASP is part of the NHS Information Authority, an initiative designed to underpin the modernisation of the NHS by providing national information and infrastructure services.

The NCASP Diabetes Audit is currently being tested and is due to go live in April 2004. The purpose of the exercise is to provide national comparative data for diabetes services by the end of 2004 in primary and secondary care in England.

Aims
Following initiation, the aim of the first year is to answer two questions:

• Whether everyone with diabetes is recorded on a GP practice diabetes register.
• What the annual rate of diabetes complications is.

To this end the dataset includes individuals’ NHS number, sex and type of diabetes as priority items. Additional items include mostly biomedical information such as HbA1c levels and serum creatinine.

It is planned that additional items can be submitted if available (this is recommended) and that the dataset will expand in the future. Questions to be addressed will include the proportion of people with diabetes who achieve treatment targets and those who receive the key processes of diabetes care (NHS Information Authority, 2004).

At first glance, the Diabetes Audit seems to be of little direct relevance to diabetes nurses and most of the data could be deemed to be of importance mainly to primary care. However, there is potential for diabetes nurses to find the project useful in the future. The impetus to collect information to enable the comparison of services between similar organisations may help to ensure that adequate and appropriate computerised information systems are available in primary and secondary care. There are probably many of us in secondary care who still collect and analyse activity data by hand. The provision of computerised systems should enable more efficient and effective information collection.

Potential constraints
One of the constraints to developing diabetes nursing services is the lack of knowledge about how well we provide care, particularly in comparison with others. Standard 3 of the NSF (empowering people with diabetes) may be the most pertinent for many diabetes nurses. Measuring specific data in relation to this is difficult due to the nature of the topic area, which could explain why it is not specifically discussed in the Diabetes National Audit. However, neither is it excluded, which may mean that as the project develops we may be able to submit information in relation to this standard.

Another constraint relates to inpatient care. Research has shown us that hospital DSNs have a positive impact on length of stay (Davies et al, 2001), but we have little or no information in the public domain about whether NSF Standard 8 (which addresses hospital inpatient care) is being met, or how well. Unfortunately, the care of inpatients with diabetes is not covered by the National Diabetes Audit. Sharing audit data about this issue via published articles for instance, would help us to compare our own processes and outcomes of care and raise standards where necessary.

There is every reason for diabetes nurses to consider what information they think should be submitted to the NCASP Diabetes Audit in the future. For those based in secondary care the lack of specific dataset items about the NSF standards most likely to be within our sphere of influence could be seen as disappointing. However, the publication of this document may spur us on to devise other ways to share information and improve the quality of the care that we provide as a consequence.