The NHS today emphasises co-operative agreements with reference to flexibility, quality and efficiency, intending to build on the flexibility and decentralisation of the previous internal market but remove its waste and excessive sense of autonomy. Clinical governance is about retaining devolved decision making but co-operative structures for developing quality with efficiency.
Department of Health/ NHS Executive carries out:
- National action
- Integrating health and social services policy
- With clinical professions develops National Service Frameworks
- National Service Frameworks across the NHS
- Surveys of performance by different patients and between geographical areas
- The NHS Charter for patients' rights and responsibilities
- And the Secretary of State has reserve powers of intervention
Regional Offices oversee that:
- Primary Care Groups and Health Authorities work together
- Partnerships are developed between the NHS and Local Authorities
Health Authorities oversee and so:
- Develop the framework of operations - Health Improvement Programmes
- Allocate funds to Primary Care Groups on an equitable basis
- Hold them Primary Care Groups to account
NHS Trusts deliver care and:
- Agree long term service agreements with Primary Care Groups under National Service Frameworks around a
- - Particular care group
- - Disease area
Primary Care Groups (all GPs as independent contractors in an area together with community nurses) deliver care and:
- Commission services for the local community.
- Accountable to Health Authorities
- Resource allocation within the Health Improvement Programme.
- May become Primary Care Trusts
And it is into this context that clinical governance is to be understood.
Whilst the key themes include:
- Increasing efficiency
- Increasing performance
- New roles and responsibilities
- Raising quality
- Clinical governance is especially concerned with quality service but in the context of accountability.
In terms of health quality the emphasis is on:
- Quality measurement in terms of objectively doing what is correct at the right time, first time, and with a good subjective experience of the patient.
- Evidence based medical care monitored by National Service Frameworks for access and quality consistency across the country.
- National Institute for Clinical Excellence to give a strong lead on clinical and cost-effectiveness.
- Teams of local GPs and community nurses work together in new Primary Care Groups to shape and deliver prompt and high qualityservices for patients.
Quality standards come in local service agreements between Health Authorities, Primary Care Groups and NHS Trusts, reflecting national standards and targets.
Efficiency is not seen as restricting quality but enhancing it, through making more resources available, for example.
And so clinical governance in NHS Trusts and Primary Care intends that clinical standards are met, and that processes are in place to ensure continuous improvement, with a statutory duty for quality in NHS Trusts with emphasis on.
- Health improvement in general
- Fair access to health services
- Effective delivery of appropriate health care that complies with agreed standards
- Efficiency achieving value for money
- Surveys of patient/ carer experience with results published locally and nationally
- Health outcomes of NHS care specifically
In order that these can be measured standard indicators are developed in each of these areas, to be applied to the different providers of health care.
Clinical governance uses the notion of a quality organisation. This ensures that
- Quality improvement processes (e.g. clinical audits) integrate with the quality programme for the organisation as a whole
- Leadership skills are developed at clinical team level
- Institutionally supported evidence-based practice is active
- Good practice, ideas and innovations are developed and communicated within the organisation
- Clinical risk reduction programmes of a high standard are active
- Bad outcomes are quickly investigated, and lessons learned applied promptly
- Complaints made by patients form a learning process for improvement
- Poor clinical performance is recognised early and dealt with to prevent harm to patients
- All professional development programmes reflect the principles of clinical governance
- Data collected to monitor clinical care is itself of high quality
It is the purpose of the library and information services among others within NHS structures to disseminate information which supports clinical governance.