The first clinical governance reviews to come out of the Commission for Health Improvement (CHI) have shed valuable light on what to expect from an investigation by the government's clinical services watchdog.
Over the next four years every hospital, health authority, primary care trust, NHS trust, and local health group in England and Wales will be visited by a team of assessors to evaluate the clinical services being provided.
To help finalise the review process, three trusts—covering hospitals in Chesterfield, Southampton, and Sunderland—were assessed in a pilot scheme.
The reports on the trusts, published last week, highlight areas for which the hospitals are performing well and others for which there is room for improvement.
The assessment team, which is made up of senior NHS staff plus a lay person, is more interested in what actually happens in hospitals than what a management plan might say is supposed to happen. For example, as well as looking at a trust's policy on induction for new staff, the team will ask doctors and nurses about their personal experiences of induction. And it is not enough to have collected reliable clinical data—trusts must show they are putting it to good use (for example, by comparing their own performance with that of a similar organisation).
In the reviews conducted so far, more than 100 doctors and nurses from each hospital were interviewed during the one-week visits. In addition, clinical and audit data were collected, and 50 patients were asked to complete a diary of their care (though this number is to be increased to 200 in future reviews).
Performance is rated by looking at the culture of the trust, the experiences of patients, and the performance of the clinical teams, explained a spokesperson for the commission.
After the visits each hospital produced an action plan to address the commission's criticisms. Implementation of the plans is to be monitored by the NHS regional offices and the National Assembly for Wales.
“Everyone knows that standards vary across the NHS. CHI will raise standards across the board by highlighting excellence and not pulling punches where improvement is needed,” said Peter Homa, the commission's chief executive. “The key to CHI is that we don't just say what we've found; we help the health service to develop plans for improvement. And in four years we will be back to see how they have done.”
At Chesterfield and North Derbyshire Royal Hospital NHS Trust the commission team found “very good risk management procedures and commitment to further improving care for patients.” But the trust could not explain why its mortality was higher than the national average.
Commenting on the finding, the hospital's chief executive, Avril Johns, said: “This information was already in the public domain through the national high level performance indicator tables. There are many causes affecting them, and we have to identify why we seem to have higher [than the] national averages. This is the first point of our action plan and builds on the work we started earlier this year.”
A spokesperson for Southampton University Hospitals NHS Trust—where serious problems were found in the trust's orthopaedic departments, though in general performance was better than average—said it had welcomed the experience.
More information on the commission's procedures can be obtained from www.doh.gov.uk/chi