The thing that sells recipe books is probably not so much the list of ingredients for each concoction, but the style in which they are mixed together and the stories and flair demonstrated by the culinary expert. So it is that Delia Smith continues to sell and Mrs Beeton is past her prime. Modern books have the advantage of colour photographs and often benefit from reference to warmly entertaining, even slightly risqué presentations on live television. One cannot say that for this very disciplined presentation of audit in practice to a standard format and with highlights in humourless grey. However, it is clearly a good idea to encourage clinical audit and there is little doubt that those who have been prepared to offer their work for consideration on a national stage have done us good service.
We can be encouraged by the range of topics addressed by old age psychiatry services - it is interesting to know who is worrying or wondering about what. It is also interesting to know how they went about informing their own worrying and wondering and what sort of outcomes they discovered. Many of us, having read at least some of the topics, will want to make contact with particular authors, for we have similar interests and might have made a bit of progress ourselves in answering some of the questions. Roger Bullock makes the interesting observation that “clinical audit is not research and therefore can be done by anybody”: research and development leaders, of course, have it on the highest authority that research can only be done by very special individuals.
The principles of audit have been understood and accepted for over a decade, and the enthusiasm that people might have had 10 years ago has perhaps faded with time. Some of us have become rather bored with the process, particularly when it is not closely integrated into service developments and evaluations that are constructive and productive. It is still often the case that one audit does not lead on to a re-audit and to demonstrable, progressive improvements. Over and again we seem to start from scratch, including audit as just another of those extremely good things that we should be doing as part of clinical governance. For most people the process will have to deliver something more worthwhile than a feeling that one is fitting in with the Government's latest exhortation to be good.
This is the first collection of its type. It confirms what audit as a process looks like and that it can be applied across the whole range of old age psychiatry endeavour. Future editions might benefit from discussion of how to prioritise projects, establish good standards and accumulate, prioritise and integrate evidence from research, clinical expertise and user views. Some guidance on locating evidence would be helpful and a more extensive list of internet addresses likely to give useful information could be added.
This book is a start and will encourage us, but its greatest lack is a sense of joy. Let us hope that future editions include more colour and zest.
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