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2. Clinical Governance: the vision and the reality
For most of its first 40 years, the NHS worked on the understanding that if one provided well-trained staff, good facilities and equipment, high quality healthcare would implicitly follow.
A more systematic approach was shown in later quality initiatives such as medical and clinical audit. But they were often criticised as being dominated by professionals and distant from everyday healthcare activities. Their benefits were not readily apparent to the health service or to patients.
Many doctors and nurses criticised the over-emphasis by health service management on workload and financial targets at the expense of quality, and argued that the quality of care is what matters most to patients and staff. There were other factors that drove the quality of care to the top of the agenda. In the late 1980s and early 1990s, a series of failures in standards of care in NHS services hit the national headlines.
In particular, events at the Bristol Children's Heart Surgery Service were a watershed in public and professional attitudes. Standards of care at the service became the subject of a major national controversy that led to the General Medical Council striking off two doctors from the medical register, and resulted in an £11 million public inquiry that made far-reaching recommendations on NHS culture and practice.
In the 1999 Health Act, the Government placed a statutory duty of quality on each health care organisation. Clinical governance turns this duty into reality.
Clinical governance seeks to transform the culture, ways of working and systems of every health organisation so that quality assurance, patient safety and quality improvement are an integral part of everyday work.
This requires good leadership throughout organisations, patient care that is based on different professional groups working together in teams and improved communication; not only between all services involved in patient care, but between healthcare professionals and patients and carers.
Clinical governance is a unifying concept drawing together and integrating the fragmented approaches to quality that previously existed.
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