Patchy progress on bringing in clinical governance in hospitals, NAO report says
The foundations for clinical governance now exist in nearly all hospital trusts in England but its implementation is patchy, according to a progress report from the National Audit Office (NAO).
The report found that implementation varies “between trusts, within
trusts and between components of clinical governance”. It says
that there is scope for improvement in developing a coherent approach
to quality and in communications between boards of management and clinical
teams. It adds that there is also a need to improve the way in which
lessons are learnt, both within and between trusts — something
the Commission for Health Improvement (CHI) highlighted as one of the
most common themes emerging from its inspections
of trusts (PJ, 7 December
2002, p797).
Overall, the National Audit Office says that since 1997 the Government’s
drive to improve the quality of service to patients within the National
Health Service, of which clinical governance forms a central part, “has
had many beneficial impacts”. In particular, clinical quality issues
have become more mainstream with trust boards realising that they are
part of their responsibilities and clinicians beginning to see that clinical
concerns can be corporate issues rather than professional and personal
ones. There have also been changes towards transparent and collaborative
professional cultures with staff attitudes being less defensive and more
open, the NAO says.
The report recommends that the NHS Modernisation Agency’s clinical
governance support team should be strengthened and ways of sharing best
practice between trusts should be explored. CHI and its successor body
should ask more questions during its inspections about staff experience
of clinical governance, it suggests.
The NAO has restricted its progress report to secondary and tertiary
care trusts because, it says, they have had longer to bed in clinical
governance systems. Primary care is to be examined later, as are issues
surrounding the management of the suspension of clinicians and organisational
learning as applied to patient safety.
The NAO report notes that guidance on clinical governance has been issued
by the devolved administrations in Scotland and Wales but does not look
at how well this guidance has been implemented. |
