Press Release - Achieving improvements through clinical
governance: a progress report on implementation by NHS trusts
17 September 2003
A major initiative to secure better quality care by the NHS and
improve patients’ confidence in its services has made early
progress and is already delivering benefits. However, according to
a report by the National Audit Office, progress in implementing
‘clinical governance’ is patchy, varying between and within NHS
trusts and between the components of the initiative.
According to today’s report to Parliament by head of the NAO Sir
John Bourn, the structures and organisational arrangements to make
clinical governance happen have been put in place in the corporate
systems of most NHS trusts. And the initiative has had many
beneficial effects. Clinical quality issues are now more mainstream
and there is greater or more explicit accountability of both
clinicians and managers for clinical performance. Reviews by the
Commission for Health Improvement have focused attention on
improvements needed in individual trusts. The professional culture
has also moved towards more open and collaborative ways of
working.
Most of the individual components of clinical governance –
including clinical risk management, adverse incident reporting,
better information for patients and use of information technology -
are in place in most NHS trusts. The commitment to each component
within individual trusts varies widely; and many trusts face other
major barriers including a lack of resources, poor training
attendance and a culture that is not conducive to reporting risks.
Trusts need to build on achievements so far by, for example, making
themselves more ‘patient-centred’ by demonstrating active working
with patients, users, carers and the public. Clinical audit is not
as well established as might be expected, with only a half of all
trusts reporting its use in more than 80 per cent of their clinical
directorates or departments. And many trusts are not achieving
effective standards of risk management.
However, today’s report points out that the clinical governance
strategy is changing the way trusts deal with quality of
care. Up to now most of the changes have been to
processes. There are now clear indications that there have
been changes to the culture of trusts, in that boards have become
more involved in clinical concerns; clinicians have begun to see
those concerns as corporate rather than professional and personal;
and attitudes of staff within trusts have become less defensive and
more open. The components of clinical governance have been
substantially developed and used more effectively and, as a result,
some three quarters of trusts can identify specific improvements to
patient care.
Apart from lack of resources and cultural difficulties, the
other main barriers or problems trusts cited are conflicting
priorities, particularly the concentration on short term waiting
targets, organisational changes and mergers, the size, spread and
heterogeneity of trusts and a lack of organisational direction and
impetus for clinical governance. It is difficult to unpick the
relative importance and merits of these barriers, but improving the
rate of progress will require action on all of them.
Among the NAO’s recommendations are that the Department of
Health should do the following:
- ensure that the Clinical Governance Support Team (part of
the NHS Modernisation Agency) continues to develop and enhance its
advice and support function, to satisfy the present unmet demand
from trusts;
- explore with the Clinical Governance Support Team more
effective ways of disseminating good practice, including examples
identified by the Commission for Health Improvement; and
- evaluate the impact of the various patient empowerment
initiatives and develop a set of good practice guidelines to help
trusts make improvements in this area.
In addition, NHS trusts should act in the following areas:
- review the information requirements on quality issues required
by their board and establish systems to ensure that such
information is provided on a regular basis;
-
consider developing with their clinical teams
systems of internal reporting on quality on the lines being
developed by the Clinical Governance Support Team; and
-
benchmark key clinical governance
initiatives with similar trusts and build on and share examples of
good practice.
Sir John said today:
“Trusts have made good progress in the early stages of
implementing the clinical governance programme. It is
important, however, that they maintain the momentum that has been
built up and overcome barriers in order to ensure that the National
Health Service derives the intended benefits and, crucially, that
patients see a clear improvement in their treatment and the quality
of their healthcare.”
Notes for Editors
- Sir Liam Donaldson, now the Department of Health’s Chief
Medical Officer, in 1997 called for a programme of change in
respect of quality in the NHS and proposed the concept of
clinical governance. The aim of clinical governance is to
secure better quality care from the £54 billion a year spent
on healthcare services and, through improved accountability, to
give patients and the general public greater confidence in NHS
services. The key principles of clinical governance are a
coherent approach to quality improvement, clear lines of
accountability for clinical quality systems and effective processes
for identifying and managing risk and addressing poor
performance. The Department of Health expects clinical
governance to integrate the previously rather disparate and
fragmented approaches to quality improvement, such as clinical
audit, risk management, incident reporting and continuing
professional development into a single system and to ally it to
accountability for quality.
- learning mechanisms (clinical risk management,
clinical audit, adverse incident reporting, learning networks,
continuing professional development);
- patient empowerment (better information, patient
complaints, patients’ views sought and patients involved throughout
the NHS); and
- knowledge management (information and
information technology, research and development, education and
training).
- Press notices and reports are available from the date of
publication on the NAO website at http://www.nao.org.uk/ Hard copies can
be obtained from The Stationery Office on 0845 702 3474.
- The Comptroller and Auditor General, Sir John Bourn, is the
head of the National Audit Office which employs some 800
staff. He and the NAO are totally independent of
Government. He certifies the accounts of all Government
departments and a wide range of other public sector bodies; and he
has statutory authority to report to Parliament on the economy,
efficiency and effectiveness with which departments and other
bodies have used their resources.
Press Notice 59/03
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