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Clinical Audit Job Vacancies Report
Section 1: Background
The Clinical Audit Support Centre Ltd (CASC) provide information, advice and support in relation to clinical audit and a wide range of quality assurance and improvement techniques for healthcare professionals. The company was established in September 2006 and since June 2009 have produced a fortnightly ‘Clinical Audit Jobs Bulletin’. The bulletin is a simple word document that lists all clinical audit job vacancies that appear on the NHS jobs website ( www.jobs.nhs.uk
). The bulletin can be downloaded via the CASC website www.clinicalauditsupport.com
This report examines the job vacancies that have been featured in the bulletin from July 2009 to March 2010 (inclusive). The report examines the range of job vacancies advertised in relation to clinical audit, the pay bandings of job vacancies and the contract length offered. Given that clinical audit is undergoing a period of ‘reinvigoration’ at present but also noting the increased pressures on NHS organisations to make financial savings, the report also focuses on the number and financial value of clinical audit vacancies advertised during the nine months from July 2009 to March 2010.
Section 2: Findings
2.1 Clinical Audit Job Vacancies – By Type
It is well known within the clinical audit profession that there is little consistency in terms of job titles for those working in clinical audit. This became clear during the Agenda for Change process and it appears as though there continues to be little standardisation in terms of job titles for clinical audit professionals.
Predictably the most advertised job title (see figure 1) during the period of our study was Clinical Audit Facilitator (29). This was followed by: Clinical Audit
Assistant (12), Clinical Audit and Effectiveness Facilitator (8), Clinical Audit
Co-ordinator (6), Clinical Audit Manager (6) and Clinical Audit Officer (5). A further nine job titles appeared at least twice and these included: Senior
Clinical Audit Facilitator (4), Clinical Audit and Effectiveness Manager (4),
Senior Clinical Auditor (3) and Cancer Audit Officer (2).
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In total, from July 2009 to March 2010, 140 job vacancies were advertised that related to a total of 63 different job titles. It is not possible to list all of the various job titles that appeared just once, but there is a bewildering array of terms used to denote clinical audit professionals and these include: Bank
Clinical Audit Analyst, Clinical Audit Analyst/Facilitator, Clinical Audit Project
Co-ordinator and Clinical Audit Nurse. Many job titles related to a particular specialty of care, for example: Cancer Audit Facilitator, Cardiology Clinical
Audit Officer, Stroke Audit Co-ordinator, etc.
For information, the longest job title noted was that of ‘Healthcare Associated
Infection Audit and Surveillance Co-ordinator ’, this narrowly ‘beat’ ‘Clinical
Guidelines and C orporate Audit Programme Facilitator’ and ‘Clinical Audit and
Quality Improvement Coordinator’.
Figure 1
Job Title
Clinical Audit Facilitator
Clinical Audit Assistant
Clinical Audit and Effectiveness Facilitator
Clinical Audit Co-ordinator
Clinical Audit Manager
Clinical Audit Officer
2.2 Clinical Audit Job Vacancies
– By Pay Bandings
Frequency
29
12
8
6
6
5
As this report has established a wide range of terms are used when describing clinical audit job titles. It is perhaps of no surprise therefore that rates of pay for clinical audit professionals vary considerably. The graph below (see figure 2) shows the pay banding frequency of the 140 clinical audit jobs advertised between July 2009 and March 2010. Of 140 jobs advertised, two did not give specific details of the relevant pay banding. Of the remaining
138 job vacancies the range was from Band 2 to Band 8b . For information the pay scales for Band 2 NHS jobs are currently (£13,653 to £16,753) and the pay scales for Band 8b are (£45,254 to £55,945).
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Figure 2
The most common banding for clinical audit vacancies was Band 6 (43) with
Band 5 (36) second. Overall, Band 5 and 6 jobs represented 56.4% of all clinical audit job vacancies reviewed during this study.
2.3 Clinical Audit Job Vacancies – By Contract Types
The report shows (Figure 3) that the majority of clinical audit job vacancies were offered on a permanent contract 115 (82.1%). Of the remaining 25 vacancies, 20 (14.3%) were offered on a fixed-term temporary basis, 2 (1.4%) were offered on a temporary basis, 2 (1.4%) did not have a contract type specified and 1 (0.7%) was offered as a ‘bank’ contract.
Figure 3
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2.4 Pay Band - By Most Frequent Jobs
Figure 4 looks at the 29 Clinical Audit Facilitators posts advertised during the study. Of the 29 posts – 4 (13.8%) were Band 6, 19 (65.5%) were Band 5, 5
(17.2%) were Band 4 and 1 (3.5%) was Band 2. Discounting the one Band 2 post as an
‘outlier’, the remaining 28 vacancies were banded from Band 4 up to Band 6. Interestingly, this exactly replicates the findings of the 2008
‘Mapping Local Clinical Audit’ 1 Report for the Department of Health conducted by Frontline that found “audit facilitators are between a Band 4 and a Band 6”.
To put this into financial perspective it means that a Clinical Audit Facilitator at the top of Band 6 (£34,189) could be earning an annual salary almost double that of a counterpart at the bottom of Band 4 (£18,152).
Figure 4
2.5 Pay Banding
– By Clinical Audit Assistants
Figure 5 looks at the pay bandings for Clinical Audit Assistant posts. Of the 12 posts
– 8 (66.7%) were Band 3 and the remaining 4 (33.3%) were Band 2. To put this into financial perspective it means that a Clinical Audit Assistant at the top of Band 3 (£18,577) could be earning an annual salary of almost £5,000 more than a counterpart at the bottom of Band 2 (£13,653).
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Figure 5
2.6 Pay Banding – By Clinical Audit Co-ordinators
Figure 6 looks at the pay bandings for Clinical Audit Co-ordinator posts. Of the
6 posts – 3 (50.0%) were Band 6, 2 (33.3%) were Band 5 and 1 (16.7%) was
Band 4. To put this into financial perspective it means that a Clinical Audit Coordinator at the top of Band 6 (£34,189) could be earning an annual salary of almost double that of a counterpart at the bottom of Band 4 (£18,152).
Figure 6
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2.7 Pay Banding – By Clinical Audit Managers
Figure 7 looks at the pay bandings for Clinical Audit Manager posts. Of the 6 posts – 5 (83.3%) were Band 7 and 1 (16.7%) was Band 6. To put this into financial perspective it means that a Clinical Audit Manager at the top of Band
7 (£40,157) could be earning an annual salary of appreciably more than a counterpart at the bottom of Band 6 (£25,472).
Figure 7
2.8 Pay Banding – By Clinical Audit Officers
Figure 8 looks at the pay bandings for Clinical Audit Officer posts. Of the 5 posts
– 2 (40%) were Band 6 and 3 (60%) were Band 4. To put this into financial perspective it means that a Clinical Audit Officer at the top of Band 6
(£34,189) could be earning considerably more than a counterpart at the bottom of Band 4 (£18,152).
Figure 8
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2.9 Clinical Audit Job Vacancies – By Month
The number of clinical audit vacancies advertised over the period of July 2009 to March 2010 has varied from month-to-month. During the nine months that this study reviewed the peak for vacancies occurred in July 2009 (28 vacancies) with a low of 6 in January 2010. Figure 9 below provides details of the number of job vacancies advertised per month.
Figure 9
It is clear that the number of clinical audit job vacancies has started to drop dramatically. In the third quarter of 2009 (July to September) a total of 76 clinical audit jobs were advertised. The final quarter of 2009 (October to
December) saw a considerable drop to 36 vacancies with the number falling further in the first quarter of 2010 (January to March) to just 28 vacancies.
Indeed the number of vacancies in the month of July 2009 (28) equaled the combined number of vacancies for the first quarter of 2010 (28).
It is impossible to conclude precisely why the data is showing a fall in clinical audit job vacancies and in order to interpret the information more clearly the
CASC plan to continue monitoring the situation and we will soon be able to start producing comparative month-by-month data once we reach July 2010.
The logical explanation for the sharp decline in clinical audit job vacancies is that the current poor economic climate is impacting on clinical audit. However,
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there may be a number of forces at play here and it is impossible to say which is having the greatest effect. First, it is possible that Trusts are cutting back on employing clinical audit staff in order to save money. Anecdotally, since
February 2010 the CASC have been contacted by a number of clinical audit professionals who have informed us that they have recently been put on the
‘at risk’ register. Although clinical audit is undergoing a ‘reinvigoration’ at a national level it is quite likely that some finance teams are looking to make cost savings by reducing the number of staff who support clinical audit work at a local level. We expect that those taking this approach will, in the first instance, not replace clinical audit professionals who leave their job, although redundancies cannot be ruled out.
The second likely explanation for the recent decline in clinical audit job vacancies is that clinical audit staff are changing jobs less frequently. This may be for a number of reasons relating to the current economic climate. For example, clinical audit is often a ‘springboard’ to other jobs in the NHS.
However, if less jobs are available collectively across the NHS community clinical audit staff currently have less opportunity to take up new positions.
Equally, owing to the current financial uncertainty it is possible that clinical audit professionals are opting to stay in their current role while waiting to see a clearer financial picture. At a third level the prospect of a general election and the potential change of government may have led some NHS Trusts to play a waiting game in terms of making recruitment decisions during the first few months of 2010. Equally, the end of the financial year may explain the reduction in job vacancies towards March 2010 to some degree (e.g. if Trusts needed to make financial savings for year 2009/10).
Overall, it is not possible to explain precisely why the clinical audit jobs market declined significantly from Q3 (2009) to Q1 (2010). We can only report the fall in vacancies and collect more data over coming months to see if the trend is sustained or reversed.
2.10 Clinical Audit Vacancy Salaries - By Month
Figure 10 displays the value of vacancies per month in monetary terms. Over the course of the study the peak salary month was July 2009 (when audit job vacancies totaled in excess of £600K) with the lowest figure reported in
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January 2010 (less than £150K). As one would expect figure 10 mirrors the results of figure 9. However, figure 10 does help identify that significant monies are being spent to resource clinical audit in the NHS. From July 2009 to March 2010 the minimum total salary value of clinical audit vacancies exceeded a combined total of £3 million (see notes section).
Figure 10
Section 3: Recommendations
The findings of this report show that the number of clinical audit job vacancies reported via the NHS Jobs website has decreased significantly from Summer
2009 to Spring 2010. Anecdotal evidence gained from the CASC indicates that some clinical audit posts are not being replaced when current staff leave their position and we have also seen an increasing trend in the number of clinical audit professionals working in England who are ‘at risk’ or facing redundancy.
With the likelihood that ‘back-office’ NHS resources may be targeted to save funds and cut the public sector deficit it is conceivable that clinical audit professionals may be targeted as a way of making efficiency savings.
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The CASC make the following four recommendations to clinical audit professionals and teams in terms of helping them to protect their positions over the coming months.
1) In our experience relatively few clinical audit teams keep a full record of their re-audit rates. Re-audit is a vital part of the clinical audit process and if re-audit does not take place it is impossible to quantify what impact the audit has had on patient care and service delivery. It is good practice for clinical audit teams and professionals to ‘audit themselves’ and keep a record of their re-audit rates. This data will increasingly be useful for external requirements (e.g. the production of Quality
Accounts) and a high re-audit rate will show finance teams assessing clinical audit that work is complete and improvements in care can tangibly be measured. Anecdotally, the CASC have found no studies that give details of the likely current re-audit rate in England, but from our work across the country we believe the re-audit rate is approximately 20%.
2) Clinical audit teams and professionals should maintain detailed records of clinical audit projects that have raised standards, proved compliance, improved patient care and enhanced service delivery.
Clinical audit professionals who cannot show detailed examples of how their work has led to significant benefits may become vulnerable if they are reviewed and audited.
3) Although clinical audit shou ld primarily be seen as a ‘quality improvement process’, audit has the potential to reduce wastage, decrease inefficiency and save money. Clinical audit has the potential to save money in a number of ways, e.g. changing a patient’s treatment to a less expensive but equally effective treatment. If audit teams and professionals can show that their work leads to the most cost effective use of resources this is likely to be seen in a very positive light. HQIP and the National Clinical Audit Forum have picked up on linking clinical audit to saving money so visit www.hqip.org.uk
for further details.
4) Professor Nick Black (Chair of the National Clinical Audit Advisory
Group) has noted that in recent times the
“planets have aligned”
with respect to clinical audit. When medical audit was established in 1989 via the Working for Patients (White Paper) 2 , audit was not mandatory
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for healthcare professionals and the drivers for carrying out audit work were limited. In 2010, there are now many drivers that relate to the need for local clinical audit support, these include: revalidation of doctors, registration through the Care Quality Commission, production of annual Quality Accounts, meeting NHSLA requirements, proving compliance with NICE guidance, demonstrating involvement in the
National Clinical Audit and Patients’ Outcomes Programme, etc.
Clearly, clinical audit professionals who may face pressure to prove their value and effectiveness should link their work to the many initiatives that require clinical audit work to be undertaken.
Further, we recommend that several leading national bodies will play a key role in ensuring that clinical audit jobs are protected and thus the reinvigoration of local clinical audit is achieved. The three most obvious national bodies with a role in monitoring clinical audit recruitment and ensuring that local clinical audit posts are protected are:
1. National Clinical Audit Advisory Group – NCAAG was established in
2008 and according to their website
( www.dh.gov.uk/ab/NCAAG/index.htm
) their role is “to drive the reinvigoration programme and provide a national focus for discussion and advice on matters relating to clinical audit”. NCAAG have a memorandum of understanding with HQIP and the National Institute for
Health and Clinical Excellence (NICE). NCAAG are the strategy and policy leaders for clinical audit and advise the Department of Health on all matters relating to clinical audit. We suggest that NCAAG have a key role in promoting the value of clinical audit at the highest levels within the NHS.
2. Healthcare Quality Improvement Partnership
– HQIP was established in 2008 and according to their website ( www.hqip.org.uk
) their role is to
“increase the impact that clinical audit has on healthcare quality in
England and Wales”.
HQIP is a consortium made up of the Academy of
Royal Medical Colleges, the Royal College of Nursing and National
Voices. HQIP have a key implementational role in revitalising clinical audit .
We suggest HQIP have a key role in promoting the value of clinical audit at all levels and maintaining local networks of clinical audit
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professionals. HQIP’s work should also supply the clinical audit community with numerous examples of audits that have improved patient care and sustained best practice thus providing audit staff with
‘ready made’ audit tools that can be used to implement effective work at a local level.
3. National Audit Governance Group
– NAGG was established in 2000 and according to their website ( www.nagg.nhs.uk
) their role is to represent the clinical audit community and to “improve communication between national and local level to facilitate clinical audit”
. NAGG is a group of approximately 30 senior clinical audit professionals who meet quarterly and work in collaboration with HQIP and the Department of
Health. NAGG’s own literature describes them as the “the network of clinical audit networks”.
We suggest NAGG have a key role in reporting trends at the clinical audit coalface (e.g. staff redundancies, etc) to the likes of NCAAG and HQIP. NAGG also have a key role in keeping the wider clinical audit community informed of trends and concerns and the
NAGG should also help raise the profile of clinical audit at local and national levels.
Section 4: Summary
The CASC reviewed all clinical audit job vacancies advertised on NHS jobs website from 1 st July 2009 to 31 st March 2010. A total of 140 job vacancies were listed and the main summary points of this report are as follows:

A wide range of titles are used to describe similar clinical audit roles

Similar clinical audit jobs attract significantly different pay bandings, e.g. the pay range for Clinical Audit Facilitators could be as wide as
£18,152 to £34,189

56.4% of clinical audit jobs advertised were Band 5 or 6

Over 80% of audit vacancies advertised were permanent

The number of clinical audit vacancies has dropped significantly from
July 2009 to March 2010

Data i ndicates a significant proportion of money (in excess of £3 million) is being spent on employing clinical audit staff to support local clinical audit
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Anecdotal evidence reported to the CASC suggests that clinical audit posts are being targeted as a way of making efficiency savings in some
NHS Trusts (e.g. not recruiting to vacant posts, placing audit staff ‘at risk’ or making audit staff redundant)

CASC have made four recommendations in terms of how audit teams and staff can protect their positions

CASC believe that NCAAG, HQIP and NAGG have a key role to play in ensuring that clinical audit jobs are retained at a local level and that the reinvigoration of clinical audit is achieved

CASC plan to update this report on a 6 monthly-basis. In December
2010 we will report on data from July 2009 to September 2010 and this will allow us to compare like for like data over two years from July,
August and September.
Section 5: Limitations of this Report
There are a number of limitations that CASC would like to note in relation to the production and publication of this report:
1. This report only looks at clinical audit job vacancies listed on the NHS jobs website. Therefore, this report will not relate to all clinical audit job vacancies from July 2009 to March 2010. It is likely that a number of jobs will only have been advertised locally and not via the national media. This report can therefore only claim to be a sample of vacancies over a 9-month period.
2. This report has not examined pay bandings in comparison to the wider job descriptions (including key roles and responsibilities). We have compared salary bandings for jobs simply in relation to job title and concede this has obvious limitations.
3. Information reported by CASC in this report with regard to local audit staff informing us of recruitment freezes for vacant clinical audit posts, local audit staff being put ‘at risk’ or being made redundant has not been quantified and simply serves as anecdotal evidence in this report.
4. This report has not assessed recruitment rates for clinical audit vacancies advertised nationally from July 2009 to March 2010.
However, further analysis of the data collected shows that 17/140 job vacancies were subsequently advertised at least once = 12.1%. All readvertised posts were graded as a Band 4 or higher. Sadly we do not
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know how many of the 140 vacancies were ultimately recruited for. The authors of this report suggest that in most cases advertised clinical audit vacancies were filled on either the first or second submission of a national job advert.
Section 6: Notes
A number of notes should be taken into consideration when reading this report:
1. Job vacancies per month (see Section 2.9) were calculated with reference to the closing date for applicants. For example, if the closing date for the job was 29 th August, that job was classified as a vacancy for the month of August.
2. Total salaries by month (see Section 2.10) were calculated by taking the lowest value for each job pay band. For example, if a Band 2
(£13,653 to £16,753) post was advertised the lowest grading within that band (£13,653) was used to calculate the total salary per month. Thus, the £3 million worth of job vacancies advertised from July 2009 to
March 2010 represents an absolute minimum in value.
3. To find up-to-date details of NHS pay bandings visit www.nhscareers.nhs.uk
Section 7: References
1. White Paper, Department of Health, Working for patients (Cm.555) London:
HMSO, 1989
2. Frontline, Mapping Local Clinical Audit – Report for Department of Health ,
2008 (available via HQIP website)
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