National Diabetes Audit Programme

The NDA helps improve the quality of diabetes care by enabling participating NHS services and organisations to:

• assess local practice against National Institute for Health and Care Excellence (NICE) guidelines
• compare their care and outcomes with similar services and organisations
• identify gaps or shortfalls that are priorities for improvement
• identify and share best practice
• provide comprehensive national pictures of diabetes care and outcomes in England and Wales

Through participation in the audit, local services are able to benchmark their performance, identify where they are performing well, and improve the quality of treatment and care they provide.

A Quality Improvement Toolkit has been developed in collaboration with the Royal College of General Practitioners (RCGP) to help practices use their diabetes data to improve services.

Diabetes UK manages Quality Improvement Collaboratives (QICs) which set local aims to improve diabetes care. Using audit data, specialist services work together with other providers to develop skills, share learning and improve clinical practice.

NHS England has been instructed to establish and operate a system for the collection and analysis of the NDA. This type of instruction is commonly known as a Direction (under section 254 of the Health and Social Care Act 2012).

The Secretary of State for Health and Social Care is only able to give a Direction where they consider the information to be collected or analysed necessary to provide NHS services.

The information is required by NHS England under section 259 of the 2012 Act to comply with the National Diabetes Audit Directions 2017. In line with section 259, all organisations in England that are in scope of the NDA Data Provision Notices, must comply with the requirement and provide information to NHS England in the form, manner and period specified, therefore patient consent is not required.

A Direction must specify the information to be collected and include relevant details such as why the information is needed and what analysis is to be carried out. This information is included in the NDA Programme requirement specification and Technical Specification documents.

Digital Health and Care Wales has requested NHS England establish and operate a system for the collection and analysis of the NDA Programme in Wales. The request is made under Section 255(1) of the 2012 Act. The NHDA Data Provision Notice for Wales requests the submission of data relating to the treatment and outcomes of patients with diabetes from services in Wales that are in scope.  

Where a collection is directed under the mechanism described above, the national data opt-out (NDOO) does not apply. Therefore, all patients’ records must be submitted to NHS England.

This is detailed in section 6.4 ‘When does a national data opt-out not apply?’ of the NDOO operational policy guidance document.

We are obliged to apply the national data opt-out if we supply the data onwards to any other organisation. For example, if a research body applies for NDA data via the Data Access Request Service (DARS) run by NHS England, then we are required to apply the NDOO to the data before supplying the data extract to the research body. We do this by checking the patient cohort against the national register.

People with diabetes should receive annual care checks and should achieve a target for their blood glucose, cholesterol and blood pressure values; see the NICE Clinical Guidelines and Quality Standards.

As a result, Core NDA, NPID, NDISA, NDFA and GDM all collect patient identifiable data. This data allows patient records to be linked across the diabetes audit programme and to other health care datasets, such as hospital episode statistics (HES), patient episode database for Wales (PEDW) and Office for National Statistics Mortality dataset.

The NDA does not collect patient names. The patient identifiable data we collect is:

• NHS number
• date of birth
• postcode (Core NDA only)

Linking to other datasets decreases the burden on services of entering the data. Demographics such as ethnicity, diabetes type and postcode recorded in Core NDA can be used for patients registered in NDFA or NPID so it doesn’t need entering twice. Data linkage allows us to understand the types of complications people with diabetes can experience. These linkages help us to give a better picture of diabetes care whilst managing the burden on services for data collection.

NHS England has strict criteria to make sure patient data is kept safe. All data is held securely on encrypted servers. Access to patient records is restricted to crucial personnel. Once the data is received the datasets are pseudonymised to protect patient identity. This means that:

• data items such as date of birth are converted to age, or year of birth
• postcodes are converted to lower layer super output areas (LSOA)
• NHS numbers are converted to a unique ID for that person

NHS England will only share patient identifiable data with another provider if they have a clear and approved legal basis to receive such data. For example, a research project that has Section 251 support, or consent from patients for us to share the data.

The NDA is commissioned and managed under contract by the Healthcare Quality Improvement Partnership (HQIP) on behalf of NHS England and the Welsh Government. The NDA is delivered by NHS England in collaboration with Diabetes UK.

The NDA collection has been assured through the Data Standards Assurance Service (DSAS) process, with the findings presented to the national Data Coordination Board (DCB). The DCB acts with delegated authority from the Digital Delivery Board (DDB) and directly from Secretary of State as the main governance route through which data and standards requirements are agreed.

As part of this assurance the data items, collection process and guidance documentation have been reviewed and assessed to understand the burden on services. The DCB have fully approved the NDA as a collection, awarding it a certificate of assurance.

For further information about the audit please email [email protected] or call 0300 303 5678. Lines are open Monday to Friday 9am to 5pm.