The National Office of Clinical Audit (NOCA) was established in 2012 to create sustainable national clinical audit across the Irish healthcare system. NOCA is funded by the Health Service Executive Office of the Chief Clinical Officer, governed by an independent voluntary Board and operationally supported by the Royal College of Surgeons in Ireland (RCSI). Working with the HSE and the Department of Health (DoH) through its National Clinical Effectiveness Committee (NCEC), NOCA designs, establishes and supports a portfolio of national clinical audits based on national priorities that include burden of care, variation of care, availability of clinical standards and economic benefit. Each audit focuses on a unique area of healthcare such as hip fracture, major trauma, heart attack, stroke, hospital mortality, ICU care and joint replacements. Governance structures are established both in NOCA and locally in each hospital to oversee the management and sustainability of the audit. All our audits are led at a hospital level by clinicians and supported by their management teams. NOCA advocates for change at a national level, arising from key findings in our audits. We do this by working with senior decision makers at both policy and operational levels within the Irish healthcare system. NOCA promotes transparent reporting and publishes national annual reports for each of its audits as well as providing regular reports to hospitals. National clinical audit, while still relatively new in Ireland, is recognised by those who deliver and manage healthcare as a key component to improve healthcare through the systematic collection and analysis of data that assesses if the level of care provided meets the required standards.