1. Introduction
Clinical governance is the way in which NHS organisations monitor, assure and improve the quality of their services year on year, and make sure that they are safe.
It is something that all NHS organisations such as hospitals, primary care services, mental health and ambulance services can use to transform the way quality care is delivered to patients.
A framework through which NHS organisations are accountable for continually improving the quality of their services and safeguarding high standards of care by creating an environment in which excellence in clinical care will flourish.
In 1997 Chief Medical Officer (CMO) Sir Liam Donaldson devised the concept of clinical governance, drawing attention to the fact that quality of healthcare did not seem to be as high on the NHS agenda as, say, financial and workload targets. Yet quality was what mattered most to patients, doctors, nurses and other health professionals.
He argued that quality should have an equal place in boardroom discussions alongside activity and resources, as part of an explicit framework. This recognises the central purpose of healthcare: to provide the best possible outcome for every patient who comes through the doors of a hospital, health centre or doctor's surgery.
Sir Liam also pointed out that the approaches to quality within the NHS were fragmented and lacked co-ordination. For example, the managerial view of quality was different from the medical view and it was not clear what methods would reliably lead to improvements in quality.
If quality was to be placed at the top of the agenda, and clinical governance to be truly patient-centred, a profound cultural change was required.
In its NHS White Paper, 'The NHS: modern and dependable', published in December 1997, the Government proposed that a statutory duty of quality was placed on all NHS organisations. The proposals became law in the 1991 Health Act and clinical governance became the tool used to ensure that this duty was met at a local level. In particular, a quality framework was set out in the policy document 'A First Class Service: Quality in the New NHS'.
Since then, clinical governance has taken off. This progress report describes what has happened so far and what is planned for the future.
