Website of the Department of Health

"Patients should not be expected to take the condescending remark or the petty humiliation in their stride."

Sir Liam Donaldson speaking about patient care, in “Passing the patient the crown”, Scrubbing Up, BBC, 12 November 2008.

 "I am encouraged by what I see as a paradigm shift in the world around us: the old-fashioned professionalism, often critiqued as paternalistic and distant - a closed shop, has genuinely given way to a new, inclusive and patient-centred concept of professionalism.  The drivers to this change have been many, both within and external to the profession, but the change itself is important.  “

(Taken from “What makes a good doctor?” a speech given by Sir Liam Donaldson to the Joint Committee on Postgraduate Training for General Practice, at the Royal College of General Practitioners, 21st February 2006)

“In the future, I envisage a system where mature clinical governance processes and the regulation of the individual practitioner interlink to take us closer to the end-game: safer practice, informed by evidence and delivered by individuals who are demonstrably fit for purpose.

“Medical regulation should not be primarily designed to detect another Shipman. But an interlinking system with medical regulation, clinical governance, careful student selection, good employment practice and new professionalism as its foundations has the potential to produce a professional environment in which quality care is near universal, excellence is commonplace and poor practice is immediately obvious and goes un-tolerated.”

(Taken from “What makes a good doctor?” a speech given by Sir Liam Donaldson to the Joint Committee on Postgraduate Training for General Practice, at the Royal College of General Practitioners, 21st February 2006)

 "When I express concern about the priority given to the quality of safety of care by NHS managers and boards compared to financial balance and productivity targets, I am told not to worry because performance is judged on a 'balanced scorecard'. I sometimes feel that the reality is more like a 'scratch card' where the money and service activity boxes are revealed but quality and patient safety remained covered over."

(Sir Liam Donaldson, speaking at The Health Foundation European Quality Meeting at Danesfield House Hotel, Marlow-on-Thames, Buckinghamshire on Saturday, 26 November 2005.)

4.
All the evidence tells us that patients don’t put their trust in sparkling new architecture or state-of-the-art equipment or gilt-edged certificates from prestigious halls of medical learning – but in simple things like the first 46 seconds between doctor and patient and whether, at the end of it, the doctor is still listening attentively or has already curtly interrupted.

(Sir Liam Donaldson speaking at a GMC dinner held at the Institute of Physics, London on 6 July 2004.)

"We have to rediscover and re-ignite the idealism which first brought us to medicine, nursing and the NHS – our desire to make sick people better.  We have to put our patients at the centre of our policies and practice, and to review – constantly, and in concert with colleagues and the communities we serve – how well we are working together to give our patients safe, excellent care.

We have to re-engage across our professional boundaries and unite in a deep, purposeful sense of ownership of our patients’ welfare – an ownership that is both common to us all, and personal to each of us.  And in this spirit of collective and individual responsibility, we have to face up to present weaknesses in the way we deliver safe, high-quality care – and respond with commitment, on behalf of those committed to our care, even if it involves taking risks or challenging convention and established opinion.

(Sir Liam Donaldson speaking at a GMC dinner held at the Institute of Physics, London on 6 July 2004.)

 “Clinical governance is a process – indeed, more than a process.  It’s an organising principle, a state of mind, the day-by-day, flesh-and-blood embodiment of how we practise – acting together across the traditional boundaries of our different roles and responsibilities; concentrating our will to care, the skills we have acquired, and the resources at our disposal – in order to give our patients – all of them, whatever their means, wherever they are – the best and safest care that a good health service can deliver.

“Clinical governance is about our organisational conscience, our DNA, the things we do when we’re not being supervised; it’s about remembering whom and what we first came here for.  It’s about asking ourselves, as clinicians: How would I be feeling if I were the patient in front of me?  What more would I need?  What more would possibly help me?”

(Sir Liam Donaldson speaking on the subject ‘Making quality count in today's NHS’ for the Purvis Oration to the West Kent Medico-Chirurgical Society, Trafalgar Tavern, Park Row, Greenwich, 12 December 2003.)

"Health services are striving to create the kinds of organisation where a passion for quality is instilled throughout the organisation. Where all staff have a curiosity, a drive, an enthusiasm for innovation and improvement. Where solving individual clinical problems is still vital but where seeing opportunities for better care for hundreds of patients captures the imagination of all staff."

(Sir Liam Donaldson writing in Clinical Governance, Wright J & Hill P (Eds), London: Churchill Livingstone, 2003)

"Increasingly people being treated by health services legitimately see themselves as consumers of that service - a service which they pay for through their taxes. They make comparisons with other services which they pay for directly. They have expectations as consumers so that part of giving patients respect is also to treat them as they would want to be treated themselves."

In a message to the United States Congress way back in 1962, President John F Kennedy put it rather well. He identified four basic rights of consumers:

• the right to be informed
• the right to be heard
• the right to choose
• the right to safety
  

To this we could add in modern health care:

Increasingly patients are being involved in helping to define quality of services, in participating in decisions about their care and in planning and improving services for future patients."

(Sir Liam Donaldson speaking on the subject 'Health care delivery: ethical dimensions' at a conference, Difficult Decisions: Ethics Support in the Delivery of Health Care, organised by Nuffield Trust, BMJ and ETHOX, London, 27 February 2001.)

"The vision of high quality care must be implemented so that the visible signs of poor quality care, albeit in the minority, are seen to be reduced to the lowest level possible."

(Sir Liam Donaldson writing in Journal of Clinical Excellence 2001; 2:199-202.)

 "The exercise of professional judgement and the development of clinical skills are important determinants of the quality of surgical care provided to patients. In turn, the way in which high standards in these areas are assured and developed within an organisational setting is a key function of a modern health service."

(Sir Liam Donaldson speaking at a conference on the development of surgical competence on clinical performance and priorities in the NHS, organised by The Smith & Nephew Foundation and The Royal College of Surgeons of England, at The Queen Elizabeth II Conference Centre, Westminster, Tuesday 2 November 1999.)

"It has long been recognised that settings which have the features of a 'total institution' - an isolated facility, depersonalised environment, little contact with the external community, regimented routines, small staff turnover - are those in which abuse is more likely to occur. Indeed, some of the scandals of the past have occurred in just such places."

(Sir Liam Donaldson speaking on the subject 'Professional abuse in the context of clinical governance' at the AGM and conference of the Prevention of Professional Abuse Network (POPAN), at the Mental Health Foundation, London, Monday 22 November 1999.)

"These are all part of a malaise that has affected some parts of the NHS in the past and helped to create the fertile ground for whistleblowing as the last desperate act to smash the windows of the classical introverted cultures where such problems existed."

(Sir Liam Donaldson speaking on the subject 'Whistleblowing and clinical governance' at the BMA/BMJ Conference - Whistleblowing: Changing the way we work held at BMA House, Friday 10 December 1999.)

"Over the last four years accountability for the quality of care delivered to NHS patients has been entirely recast at both the organisational and the individual practitioner level."

(Sir Liam Donaldson writing in Quality in Health Care 2001; 10 (suppl II): ii8-ii12.)

"Rising patient and public expectations are becoming a key stimulus to improving quality in the NHS. People - particularly those under 45 years - are less ready than in the past to accept a paternalistic style of service from the NHS. As well as good quality clinical care, they want fast and convenient services, tailored to their individual needs, and not to endure long waits at each stage of the process."

(Sir Liam Donaldson speaking at an international symposium Quality in health care: the US/UK policy perspectives, organised by the Commonwealth Fund of New York and The Nuffield Trust, Ditchley Park, May 21st-23rd 1999.)

"The duty of quality is an historic and unprecedented step in the history of the NHS. It brings accountability for the things that matter - the assurance and improvement of quality. It has brought (and I am delighted to see it) - clinical commitment to the concept of clinical governance and clinical leadership to implement it. It brings new forms of regulation - the proposed self-regulation conducted by the GMC and the Royal Colleges and the role of NICE and the Commission for Health Improvement."

(Sir Liam Donaldson speaking on the subject 'Whistleblowing and clinical governance' at the BMA/BMJ Conference - Whistleblowing: Changing the way we work, held at BMA House, Friday 10 December 1999.)

"At the heart of any consideration of clinical quality lie three elements: the philosophy or concept of quality which is being pursued, the methodologies which are being used to assure or improve quality and the measures which are used to assess it."

(Sir Liam Donaldson speaking at a conference on the development of surgical competence on clinical performance and priorities in the NHS, organised by The Smith & Nephew Foundation and The Royal College of Surgeons of England, at The Queen Elizabeth II Conference Centre, Westminster, Tuesday 2 November 1999.)

"Good quality improvement strategies need to be underpinned by an ethos of multidisciplinary team work at all levels within health organisations."

(Sir Liam Donaldson speaking at an international symposium Quality in health care: the US/UK policy perspectives, organised by the Commonwealth Fund of New York and The Nuffield Trust, Ditchley Park, May 21st-23rd 1999.)

"Relatively, little progress has been made in developing routinely available measures of health care quality. Waiting times for surgical operations and outpatient consultation is an important measure of a health service's performance but it gives no insight into more fundamental aspects of quality."

(Sir Liam Donaldson speaking at a conference on the development of surgical competence on clinical performance and priorities in the NHS, organised by The Smith & Nephew Foundation and The Royal College of Surgeons of England, at The Queen Elizabeth II Conference Centre, Westminster, Tuesday 2 November 1999.)

"A frequently aired concern of health professionals throughout the world is the extent to which financial issues dominate the health care agenda. If most of the time of the senior management of health care organisations is directed towards finance, it is argued, how can a commitment towards quality be anything other than rhetoric?"

(Sir Liam Donaldson writing in Journal of Epidemiology and Community Health 1998; 52: 73-4.)

"Clinical governance is essentially an organisational concept aimed at ensuring that every health organisation creates the culture, the systems and the support mechanisms so that good clinical performance will be the norm and so that quality improvement will be part and parcel of routine clinical practice."

(Sir Liam Donaldson speaking at a conference on the development of surgical competence on clinical performance and priorities in the NHS, organised by The Smith & Nephew Foundation and The Royal College of Surgeons of England, at The Queen Elizabeth II Conference Centre, Westminster, Tuesday 2 November 1999.)

"The implementation of the Public Interest Disclosure Act in the NHS is an important failsafe but if the whistle blows regularly then we are failing to implement clinical governance to the full."

(Sir Liam Donaldson speaking on the subject 'Whistleblowing and clinical governance' at the BMA/BMJ Conference - Whistleblowing: Changing the way we work held at BMA House, Friday 10 December 1999.)

"The clinical governance role will be wide ranging and include ensuring that: quality improvement processes are in place and integrated with the quality programme for the organisation as a whole; that evidence-based practice is in day to day use with the infrastructure to support it; that good practice ideas and innovations are systematically disseminated and applied; that poor clinical performance is promptly recognised and dealt with to prevent harm to patients; and, that the quality of data collected to monitor clinical care is itself of a high standard."

(Sir Liam Donaldson writing in the Journal of Epidemiology and Community Health 1998; 52: 73-4.)

"Placing a duty of quality on the NHS - a duty not just to assure high standards but to improve year on year - is a bold and imaginative step and an approach which attempts to reset the balance in which financial and workload targets have dominated management thinking in the NHS."

(Sir Liam Donaldson speaking at a conference on the development of surgical competence on clinical performance and priorities in the NHS, organised by The Smith & Nephew Foundation and The Royal College of Surgeons of England, at The Queen Elizabeth II Conference Centre, Westminster, Tuesday 2 November 1999.)

"The days of quality improvement by exhortation have surely gone. We are in a new era of partnership where teamwork will be the route to success and where we must specifically address the rough edges which stop organisations joining together to form genuine partnerships."

(Sir Liam Donaldson speaking at the conference Facing up to professional accountability a national medical directors gathering, London, 20 November 1998.)

"An organisation that is well governed clinically will be built from the bottom like a rock face."

(Sir Liam Donaldson speaking at a conference on the development of surgical competence on clinical performance and priorities in the NHS, organised by The Smith & Nephew Foundation and The Royal College of Surgeons of England, at The Queen Elizabeth II Conference Centre, Westminster, Tuesday 2 November 1999.)

"As hospitals in the capital are reconfigured, as services currently located in specialist hospitals which are perceived as too dispersed are relocated, and as some skilled staff take the opportunity to bow out of the service, it is essential that the present and future place of specialised services are secured within the network of care."

(Sir Liam Donaldson writing in the British Medical Journal 1992; 305:1280-4.)

"The results of this study have shown that patients with relatively straightforward surgical problems without any coexisting morbidity are keen to travel to have the problem dealt with quickly, and this could prove to be a major factor in improving one important aspect of the quality of care."

(Sir Liam Donaldson writing in the British Journal of General Practice 1991; 41: 508-9.)

"The creation of a shared view of health care quality, incorporating consumer, managerial and professional perceptions, and the development of effective organisation-wide processes for continuously improving quality, poses a major challenge for the NHS."

(Sir Liam Donaldson writing in the Journal of Public Health Medicine 1990; 12:149-51.)