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3. Quality: the wider context
While clinical governance is the local manifestation of the statutory duty of quality placed on all NHS organisations, it operates within a national framework for healthcare quality in which new structures and mechanisms have been created.
The NHS quality programme
The NHS quality programme is built upon:
- Setting clear standards (National Institute for Clinical Excellence, National Service Frameworks)
- Accountability for service quality in every NHS organisation through clinical governance
- Measures to ensure quality assured practice by all staff working in the NHS as annual appraisal for all doctors and addressing poor clinical performance
- Effective systems for recognising
"adverse events"
or errors, and learning from these to manage risk effectively and improve patient safety
- A robust system of inspection to ensure that standards are being met and proper quality improvement systems are in place at every level. In April 2004, the Commission for Healthcare Audit and Inspection (Healthcare Commission) replaced the Commission for Health Improvement (CHI) which previously carried out and reported on reviews of clinical governance in NHS trusts. The new independent body promotes improvement in quality not only in the NHS, but also in private and voluntary healthcare across England and Wales.
- Strong mechanisms to spread and learn from good practice and research evidence such as the collaboratives covering cancer services and primary care
- Active participation of patients and provision of information
The NHS plan
The NHS Plan emphasises the importance of successful implementation of all these new quality structures and mechanisms. It also sets out a wide range of new initiatives to involve and empower NHS patients.
There is a continuing need to ensure that clinical governance is embedded throughout the NHS and its performance is managed, so that organisations have a way of showing that they are fulfilling their statutory duty of quality. This has been highlighted in the Department of Health document Shifting the Balance of Power: The Next Steps.
Strategic health authorities
The 28 strategic health authorities (SHAs) across England have responsibility for managing the performance of local services and ensuring the delivery of safe, high-quality services through effective clinical governance arrangements in NHS trusts. The trusts report on the implementation of clinical governance in their annual reports and draw up and implement development plans for progress.
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