Clinical Audit Job Vacancies Report
June 2010
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).
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 Corporate Audit Programme Facilitator’ and ‘Clinical Audit and Quality Improvement Co-ordinator’.
Figure 1
Job Title / FrequencyClinical Audit Facilitator / 29
Clinical Audit Assistant / 12
Clinical Audit and Effectiveness Facilitator / 8
Clinical Audit Co-ordinator / 6
Clinical Audit Manager / 6
Clinical Audit Officer / 5
2.2 Clinical Audit Job Vacancies – By Pay Bandings
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).
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
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).
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 Co-ordinator 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
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
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, 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 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.
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 should 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.