National Bowel Cancer Audit

National Bowel Cancer Audit
Name	National Bowel Cancer Audit
Formation	2007
Headquarters	United Kingdom
Region served	England and Wales
Leader title	Director
Parent organization	Royal College of Surgeons of England

National Bowel Cancer Audit is a clinical audit that measures care and outcomes for patients with colorectal cancer across hospitals in England and Wales. It collects data on diagnosis, treatment, and survival to inform quality improvement and commissioning decisions. The audit interfaces with national bodies, professional colleges, and research institutions to benchmark performance and drive change in colorectal services.

Overview

The audit aggregates patient-level data from hospital trusts, linking surgical, oncology, and pathology records to produce national reports used by the National Health Service (England), NHS Wales, Royal College of Surgeons of England, Royal College of Physicians, and specialty associations. Data outputs inform stakeholders such as the Care Quality Commission, National Institute for Health and Care Excellence, British Society of Gastroenterology, and Association of Coloproctology of Great Britain and Ireland. The audit’s outputs are used by commissioners including NHS England and regional clinical networks like the London Cancer Alliance to shape service redesign and pathways involving multidisciplinary teams exemplified in trusts like Guy's and St Thomas' NHS Foundation Trust and Royal Marsden Hospital.

History and Development

The audit originated from initiatives in clinical governance promoted by bodies such as the Department of Health (United Kingdom), the Clinical Effectiveness Unit (Royal College of Surgeons of England), and charities like Bowel Cancer UK and Macmillan Cancer Support. Early development involved methodological collaboration with academic groups at institutions such as University College London, University of Oxford, University of Edinburgh, and University of Leeds. Governance frameworks referenced standards from National Confidential Enquiry into Patient Outcome and Death and drew on precedents set by audits including the National Hip Fracture Database and the Trauma Audit and Research Network. Over successive annual reports the audit expanded its indicators, reflecting guidance from NICE guideline NG151 and commissioning directives from Monitor (NHS Trust Development Authority).

Scope and Methodology

The audit captures data on patients diagnosed with colon and rectal cancer treated in secondary care settings including trusts such as Addenbrooke's Hospital, Oxford University Hospitals NHS Foundation Trust, and St George's Hospital. Data fields include demographics, staging, surgical urgency, ASA grade, operative approach, pathology margins, lymph node yield, adjuvant therapy, and 30‑/90‑day mortality; these align with classification systems like the AJCC Cancer Staging Manual and performance metrics used by Clinical Outcomes Publication. Data linkage uses identifiers compatible with registries including the National Cancer Registration and Analysis Service and mortality linkage with Office for National Statistics. Methodological oversight involved collaborations with academic units at King's College London and the University of Manchester and statistical support from groups associated with the MRC Biostatistics Unit.

Key Findings and Outcomes

Reports have highlighted variation in emergency presentation rates, perioperative mortality, and long-term survival across providers such as Leeds Teaching Hospitals NHS Trust and Aneurin Bevan University Health Board. Analyses influenced reductions in elective stoma rates at centers including Royal Liverpool University Hospital and improvements in lymph node harvest comparable to benchmarks from Memorial Sloan Kettering Cancer Center. The audit identified disparities linked to deprivation indices measured by analyses referencing areas like Tower Hamlets and Manchester and informed targeted interventions similar to those adopted by Newcastle upon Tyne Hospitals NHS Foundation Trust. Findings have underpinned peer-reviewed studies published by collaborators at Imperial College London and University of Birmingham.

Impact on Clinical Practice and Policy

Audit outputs informed national initiatives such as the implementation of colorectal cancer multidisciplinary team standards promoted by the National Cancer Peer Review Programme. Policy changes influenced by the audit include pathway redesigns referenced by NHS Long Term Plan priorities, adoption of enhanced recovery protocols championed by Guy's and St Thomas' NHS Foundation Trust, and commissioning decisions by regional bodies like NHS North West. Professional practice adaptations included surgical audit participation encouraged by the Association of Surgeons of Great Britain and Ireland and guideline updates from Royal College of Surgeons of England and British Association of Surgical Oncology.

Data Quality and Limitations

The audit faces challenges common to large registries: variable data completeness across trusts such as Brighton and Sussex University Hospitals NHS Trust and coding differences tied to systems like the Hospital Episode Statistics. Case ascertainment depends on accurate pathology and staging entry and linkage quality with the National Cancer Registration and Analysis Service. Limitations noted in technical appendices include potential confounding, residual case-mix differences despite risk adjustment methods used by collaborators at University of Bristol, and lag times in reporting compared with real‑time systems piloted at centers like Sheffield Teaching Hospitals NHS Foundation Trust.

Governance and Funding

Governance arrangements involve stakeholders including the Royal College of Surgeons of England, the Healthcare Quality Improvement Partnership, and partner charities such as Bowel Cancer UK and Cancer Research UK. Funding has come from NHS bodies including NHS England and program grants from agencies like the National Institute for Health Research alongside support from professional societies such as the British Association of Surgical Oncology. Data governance adheres to frameworks involving the Information Commissioner's Office and ethical oversight by academic institutions including University of Cambridge.

Category:Health audits in the United Kingdom