National Health Service staff could feel threatened in the short term as a result standards setting, according to Mr David Steel, the chief executive of the Clinical Standards Board for Scotland (CSBS).
Speaking at the Royal Pharmaceutical Society's house at Edinburgh, Scotland, on November 10, Mr Steel said that this could be the result of the setting of standards that were stretching, but reasonable, and the subsequent production of reports on performance. However, the public was entitled to effective and efficient treatment. The CSBS had a vital role to play in assisting the Health Service to achieve this.
Explaining the link between clinical standards and clinical governance, Mr Steel said that the promotion of clinical effectiveness in Scotland through a substantial research and development programme was creating an evidence base, together with effective clinical guidelines established by the Scottish Intercollegiate Guidelines Network (SIGN). However, there was still much work to be carried out and complacency was inadvisable.
Mr Steel said that specific aspects of NHS practice needed to be targeted, so that individual initiatives could be co-ordinated for maximum effect. One area in which data were lacking was cost-effectiveness. The Scottish Health and Technical Assessment Centre (SHTAC) was investigating this.
Explaining how clinical governance related to clinical standards, Mr Steel defined clinical governance as "corporate accountability for clinical performance", while clinical standards revolved around peer accreditation, the setting of appropriate standards and the monitoring of performance by practitioners and users.
The key features of clinical governance were that it was mandatory for the organisation involved, managed internally within the NHS to improve service and was a part of daily core activities, rather than an occasional bolt-on package.
Conversely, the clinical standards process was external and periodic and involved reporting on performance, rather than actually effecting change. Clinical standards were explicitly concerned with the quality of clinical care in all sectors of the NHS.
Over the past seven months, the CSBS had developed several templates for standard setting and had commissioned reports on coronary heart disease, four types of cancer and adult schizophrenia.
In an ensuing discussion, participants asked whether there were likely to be cross border discrepancies in clinical standards. Mr Steel explained that the CSBS's sister organisation in England - the Commission for Health Improvement (CHI) - had a slightly different role, but both bodies would be working with the same evidence base so that any differences that might arise in the longer term would not be significant.
Professor Stephen Hudson (professor of pharmaceutical care, University of Strathclyde) enquired about standards for continuing professional education, which, he said, was an important requirement for clinical effectiveness. He was told that a standard template should be available next year.
In answer to another question, Mr Steel explained that no mechanism yet existed for monitoring the activities of the CSBS itself, but he hoped that a consensus would emerge as to its effectiveness. He went on to say that he saw consensus as being just as valuable as a formal report. It could be that the board's role would be to assist the spread of good practice from an area where standards were being exceeded to an area where they were not.