CRANE Outlier Policy

In accordance with HQIP guidance for national clinical audits, CRANE has developed an outlier policy for assessing and managing the performance of cleft services against agreed process and outcome parameters. The policy was developed with the support of the Cleft Development Group (CDG).

This document sets out the process by which the performance of NHS cleft services in England, Wales, Scotland and Northern Ireland which provide specialist support and clinical care to children born with cleft lip and/or palate and their families will be assessed. It also describes the process the CRANE Database Team will follow to manage any service that is found to fall outside the expected range of performance and is therefore flagged as an outlier.

Click here to download the CRANE Outlier Policy

The policy was piloted in 2021, and found to be successful in terms of process. However, following CDG review of the pilot, it was agreed that adding extra administrative stresses to clinical services already struggling to deliver routine clinical care during the COVID-19 pandemic and its aftermath would be inappropriate.

Given the long-term importance of including an outlier process in the assessment of commissioned cleft services, the CDG agreed that the outlier process should be instituted in a passive form for the first three years following introduction (2022 -2024 inclusive). Passive introduction means that services will be notified of their status and allowed to respond, but will not be mandated to do so.  This passive introduction takes account of two main concerns:

• Ongoing pressures on services to navigate delivery and recovery of clinical care/assessment during the waves of the COVID-19 pandemic.
• The need to allow time for local outlier policy processes (introduced for the first time in 2021) to become embedded within routine clinical and administrative practice.

It is planned that from 2025 the outlier policy will be implemented in full.

Policy approved by the Cleft Development Group (CDG) 1 April 2021; staged implementation approved by the CDG 10 November 2022.