Reports > The Fifth Report > CHAPTER TWELVE - Clinical Governance >
Introduction
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12.1 |
I have already said in Chapter 5 that clinical governance is the means by which it is intended that NHS organisations should discharge the duty of quality imposed by the Health Act 1999. The theory of clinical governance developed from the initiative of corporate governance which originated in the early 1990s as a means of addressing unacceptably low standards in the world of business. It was heralded in the White Paper ‘The New NHS’, published in December 1997. At that time, there was a recognition on the part of Government that standards of care in the NHS were very variable and that this was leading not only to harm to patients, but also to loss of confidence on the part of the public. Clinical governance was to address that problem. |
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12.2 |
Clinical governance is defined by the Department of Health (DoH) as: |
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‘... a framework through which National Health Service organisations are accountable for continuously improving the quality of their services and safeguarding high standards of care by creating an environment in which excellence in clinical care will flourish’.
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12.3 |
I personally did not find that definition easy to understand and it does not seem surprising that, in the early days at least, there was a great deal of confusion and uncertainty in the medical profession about the concept of clinical governance and about what it would mean in practice. Some general practitioners (GPs) were suspicious about its purpose (believing it to be an attack on their independent contractor status) and hostile to its introduction. These feelings were heightened by the speed with which it was implemented and by the changes to the organisation of primary care which were occurring at the same time. |
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12.4 |
I hope that my own understanding of the concept of clinical governance has improved in the last few months. For those who are still unfamiliar with it, I shall attempt, not to define it, which seems to me well nigh impossible, but to describe it. Clinical governance is a system for improving the standard of clinical practice in the NHS and for protecting the public from unacceptable standards of care. The system comprises several different types of activity which should all fit together into a framework. This integrated system has replaced the previously disparate and fragmented approaches to the improvement of quality of care. The different types of activity include continuing education, the introduction and maintenance of good management systems, the promotion of clinical effectiveness, clinical audit, risk management, research and development and the fostering of an ethos of openness and accountability. Some of these activities are developmental in nature, such as continuing education and the dissemination of good practice. Risk management, by which organisations seek to analyse untoward events and learn from them, is another example of a developmental activity. Other activities are of a monitoring or supervisory nature; for example, organisations are required to collect data and information about the care being provided by their clinicians. This should enable the organisation to detect poor performance so that it may be corrected, but data collection should also draw attention to good performance and therefore have a developmental effect. Yet other activities are designed to encourage clinicians to monitor themselves, with the intention that this should provide the opportunity and incentive to improve clinical performance. For example, clinicians are provided with data about their own performance and that of their team or group; they are also encouraged to audit their own activities and those of their colleagues. |
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12.5 |
DoH guidance published in 1999 required NHS trusts and primary care organisations (PCOs) to identify clinical governance leads (who were to be clinicians) and to set up appropriate structures for overseeing clinical governance within their organisations. Once the primary care trusts (PCTs) came into existence, they appointed their own clinical governance leads and sub-committees. Many of these clinical governance leads were local GP volunteers, who were uncertain of their precise role and lines of accountability. Some found their dual role as members of the local medical community and part of the PCT ‘establishment’ difficult to reconcile. Others were uncertain about how they could seek to promote good clinical governance without any ‘teeth’. There were, however, many within the medical profession who welcomed the emphasis on quality that clinical governance brought and who viewed positively the opportunity of working with PCT managers to raise local standards. |
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CHAPTER TWELVE - Clinical Governance
