The concept of clinical governance in the NHS, whereby patients take centre stage and staff learn from their mistakes to improve the quality of care, is starting to reap benefits for patients, although some trusts are doing better than others, says a report.
According to the National Audit Office three quarters of trusts in England can identify specific improvements in patient care that have grown out of clinical governance. However, the overall implementation of clinical governance is patchy, with large variations between and within trusts, it says in its report.
The review—which was based on a census of acute trusts, mental health trusts, and ambulance trusts, a survey of trust managers, and reports from the Commission for Health Improvement—is the first assessment in England of the impact of clinical governance. It shows that most of the elements needed for clinical governance, such as reporting of adverse incidents, information for patients, and clinical risk management, are in place in most trusts. But the will to change the culture of the NHS was often lacking.
Many trusts blamed a lack of resources, conflicting priorities (especially the focus on waiting times targets), and organisational changes and mergers for their failure to achieve greater improvements in care. Karen Taylor, who led the review team, admitted that the number of inspections that trusts have had to undergo may also have inhibited the delivery of clinical governance.
However, she also said that the clinical governance support team, set up specifically to enable swift progress, had been underused by trusts. Greater commitment to the initiative and use of the team could help trusts implement changes, she said.
Trusts that have achieved the most in terms of clinical governance are those whose chief executive has embraced the initiative and inspired other staff to do the same, said Ms Taylor.
Two areas that have not been well established are the involvement of patients and knowledge management, she said. In particular, knowledge management, where staff learn from and respond to the results of audit and review, needs to be addressed in the next few years, she added.
Sir John Bourn, head of the National Audit Office, said: "Trusts have made good progress in the early stages of implementing the clinical governance programme. It is important, however, that they maintain the momentum that has been built up and overcome barriers in order to ensure that the National Heath Service derives the intended benefits and, crucially, that patients see a clear improvement in their treatment and quality of their health care."
Achieving Improvements through Clinical Governance: Progress Report on Implementation by NHS Trusts is accessible at www.nao.gov.uk