Clinical Audit in Irish Healthcare: Governance, Roles and Staff Training

Clinical audit in Irish healthcare is a quality improvement process: services review their practice against agreed standards, act on what they find, and check again. For managers, quality leads and training coordinators, the question is less how to audit clinical care and more how to govern it: who owns the audit programme, who has a defined role, and what staff need to be told or trained to do. This guide looks at what HIQA, the HSE and the National Office of Clinical Audit (NOCA) say on those workforce and governance points. It does not cover clinical content, and it does not replace the documents it summarises.

What the official sources mean by clinical audit

NOCA describes clinical audit as a clinically led, quality improvement process that reviews care against set standards; where standards are not met, improvements are made and the care is re-audited. HIQA's national procedures for one specific area, clinical audit of medical radiological procedures, draw on the same idea. That document quotes the definition in the Patient Safety (Notifiable Incidents and Open Disclosure) Act 2023, which describes clinical audit as a clinically led quality improvement process reviewing care against explicit clinical standards or guidelines. The HSE publication on the practical guide to clinical audit (2023) presents a standardised framework of seven audit stages and covers audit design, governance, data protection and ethical issues.

NOCA also explains how audit differs from research: audit measures care against agreed standards for all patients meeting the audit criteria, while research has different purposes. NOCA also notes that data supplied to it is limited to an agreed dataset.

Where HIQA fits in

HIQA's National Standards for Safer Better Healthcare underpin its monitoring of healthcare services. The version we read is Version 2, dated September 2024, which says it was approved by the Minister for Health on 27 August 2024. Standard 2.8 states that "the effectiveness of healthcare is systematically monitored, evaluated and continuously improved." The features listed beneath it include monitoring and evaluating performance by developing and implementing clinical and non-clinical audits, an agreed annual plan for audit that incorporates participation in national audit programmes, and an evidence-based methodology in line with national guidelines where they exist.

That gives managers a concrete checklist: is there an agreed annual audit plan, does it include national audit programmes, and is the method evidence based? HIQA announced on 24 August 2026 that it has started a review to update these standards, beginning with an evidence review. The announcement gives no end date for the update, so the current standards remain the reference until HIQA says otherwise. Our own piece on the review of the HIQA Safer Better Healthcare standards covers that process in more depth.

Radiology: a worked example of formal procedures

HIQA's national procedures for clinical audit of radiological procedures involving medical exposure to ionising radiation (Version 2.0, updated 20 August 2024) show how prescriptive a regulatory audit framework can be. The document explains that the main legal instrument is the 2018 Basic Safety Standards regulations (S.I. No. 256 of 2018), as amended by S.I. No. 528 of 2022, which transferred responsibility for establishing the national procedures to HIQA. According to the document:

• an undertaking, meaning the person or body carrying out or engaging others to carry out these procedures, must have a clinical audit strategy;
• it is the undertaking's responsibility to ensure audit is carried out in line with the national procedures;
• audit responsibilities, including who will lead the audit, must be clear;
• the examples of documentation it lists include a steering committee that meets regularly and a strategy approved by the steering committee and the clinical governance committee;
• each audit topic follows a five-stage cycle: plan, select standards, measure performance, improve practice and sustain improvements, with re-audit after an agreed period.

On workforce, the document lists, as an example of the documentation an undertaking might hold, clinical audit training available to all staff, including training on tools and available techniques. It also says people taking part in an audit should understand its aim and their role in it. It also says the resources, time and staff needed must be identified and provided. Not every service is an undertaking in this sense, so check whether the radiation rules apply to you. For the radiation protection side of staff training, see our guide to radiation protection training for healthcare staff.

The HSE position

The HSE National Centre for Clinical Audit (NCCA) developed the HSE National Strategy for Clinical Audit 2026 to 2030. According to the HSE page, it aims to establish a coordinated national system for clinical audit, and it is built around four pillars: strategic leadership and governance, building organisational capability, quality improvement impact and assurance, and culture, communicating and partnering for progress. The NCCA leads, with the National Steering Group for Clinical Audit, and will produce a national implementation plan for the same period. The page names NOCA, the RCPI Specialty Quality Improvement Programmes and the National Perinatal Epidemiology Centre as partners.

The page does not name local audit leads and does not describe a training programme in detail, and the implementation plan was still to be created when we read it. It does list an implementation checklist for teams and services. Services should therefore watch for the NCCA's implementation plan rather than assume what it will require of local teams.

NOCA and national audits

NOCA runs a suite of national clinical audits, and its website lists 16 of them, including hip fracture, stroke, heart attack, major trauma, hospital mortality and intensive care audits. According to NOCA, each audit is led locally by clinicians and supported by hospital management teams. Audit coordinators in hospitals, usually a nurse or an administrator, collect and check the data, which goes to NOCA through a secure electronic database. NOCA's audit team analyses it, and each audit publishes an annual report developed by an audit governance committee that includes former patients, members of the public and healthcare professionals.

NOCA states that it has no investigative remit: it forwards concerns to the accountable person and points complaints to the Ombudsman. This matters for governance because audit findings feed quality improvement, not individual investigations.

Roles and training: a practical approach

The sources describe roles in different ways, and none gives one universal job description. A practical approach, labelled as our suggestion rather than a requirement, is to write down:

• Who owns the audit programme. HIQA's radiology procedures list an identified lead or coordinator for clinical audit as an example of documentation, and say responsibilities must be clear.
• Which committee approves and reviews audit plans. The radiology document refers to a steering committee and a clinical governance committee.
• Who collects data. NOCA's model uses local audit coordinators, and the data stays within an agreed dataset.
• Who follows up recommendations and how re-audit is scheduled.
• What each group of staff is trained to do, from taking part in data collection to implementing changes.

Evidence of training is only useful if you can find it. A training records matrix lets a quality lead show who has completed audit-related training and when, and our guide to a training records matrix for Irish healthcare employers explains how to build one. If you organise staff cover in Dublin hospitals or community services, plan audit training in the same rota cycle as other mandatory sessions so it is not the first thing dropped.

Learnsignal's offices are off Baggot Street in Dublin, and we offer in-person training from there. For current details, see our CPD pages.

Frequently asked questions

Is clinical audit the same as research?

No. NOCA says audit measures care against agreed standards for all patients meeting the audit criteria, with no randomisation, while research has a different purpose.

Does HIQA require every service to have an annual audit plan?

The National Standards for Safer Better Healthcare list an agreed annual plan for audit as a feature under Standard 2.8. HIQA's August 2026 announcement says the standards apply to primary, community and acute services provided or funded by the HSE, plus private hospitals, and excludes mental health services; check how they apply to your service.

Who should train staff in clinical audit?

For radiological procedures, HIQA's national procedures list clinical audit training available to all staff as an example of the documentation an undertaking can hold for its resources. The other sources we read do not set out a general training duty, so confirm what applies to your setting.

Is the HSE national strategy for clinical audit already in force?

The strategy covers 2026 to 2030, but the HSE page says a national implementation plan for the period was still to be created. Watch the NCCA for updates.

Standards, strategies and procedures in this area are being reviewed and updated, so check the current documents on hiqa.ie, hse.ie and noca.ie before making governance decisions.