Assessment of the Clinical Governance Model's Impact on UK Healthcare

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Contents
INTRODUCTION.....................................................................................................................................1
CLINICAL GOVERNANCE MODEL IN UK..................................................................................................2
SOCIAL CONTEXT...................................................................................................................................3
COMPONENTS OF CLINICAL GOVERNANCE MODEL IN ENGLAND.........................................................5
RISK MANAGEMENT..............................................................................................................................7
PATIENT AND PUBLIC INVOLVEMENT....................................................................................................8
CLINICAL EFFECTIVENESS.....................................................................................................................10
CONCLUSION.......................................................................................................................................11
REFERENCES........................................................................................................................................12
1

INTRODUCTION
Clinical governance is the system that is defined to have control of the health and
social care working in the nation and it is the synthesis of the overall system that is
held responsible for the improvement of the health and social care scenario in a
particular region (Webb et al., 2010). The aim of clinical governance is to promote
safe and protected environment as well as enhance the quality of the services with
advanced and leading modernization. Clinical governance has certain basic
requirements that ensure continuous monitoring and improvement of the services
and in the UK these requirements in health and social care sector are being fulfilled
by NHS and health and social care monitoring and organizing sector (Mirza et al.,
2013). This assignment is aimed at description and evaluation of the clinical
governance model currently working in the UK and its aspects that helps in
continuous delivery of high quality care and services in the health and social care
organization. This assignment is a piece of reflection on how the clinical governance
model helps by benefiting the health and social care service quality in the region and
what further improvements are required in the nation for better and more enhanced
health and social care.
Clinical governance is a system that is being planned on seven aspects that includes
the services as well as monitoring of the quality for the services. Its aim is to focus
on standardized, quality based and uniform services with aim of achieving
satisfaction of the client and promoting best patient centered care (Walshe., 2010).
The seven components of the clinical governance includes managing patient,
managing risks, managing clinical effectiveness, patient safety and incident reporting
guidelines, involvement of patient in care system, use of evidence based practice
and accountability and quality assurance in the system (Heyrani et al., 2012). This
system was laid but to implement it into the health and social care system various
models were introduced and developed at managerial, agency and organization
levels each to ensure appropriate implementation of the services. Different agencies
as per their caliber and understanding used different models to implement clinical
governance in their system and functioning for example the Wakefield and
Pontefract Community Health NHS trust used pyramid model to implement this
system in their functioning (Veras et al., 2014). Another borough in London
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implemented the five stages PRISMA model for implementation of governance in
their system (Van Zwanenberg & Harrison., 2018). These models are the driving
forces that help in driving the services to achieve enhanced accountability,
effectiveness and cultural competence in the working of health and social care
organizations.
CLINICAL GOVERNANCE MODEL IN UK
The concept of clinical governance in the health and social care system of UK came
into force when in the government of UK identified the need to introduce an agency
with powers to promote services to the residents of the nation regarding adequate
health and social care and to be held responsible for the system of health and social
care in the nation (Larcher et al., 2010). The need of auditing the practices for better
quality and future scope of the health and social care sector made the government
introduce an agency under the name NHS (National Health Services). NHS had the
major aim of introducing self-audit concept to the doctors and health care
professional in its initial developmental stages (Checkland et al., 2016). Initially the
audit that was known as medical audit was only referred to as evaluation of the
doctor’s practice later the agency identified that the success of health and social care
quality improvement is not only in hands of the doctor’s performance but the allied
health professionals and their practices are to be simultaneously enhanced and
improved to achieve clinical excellence in the field (Thompson, & France., 2010). In
1990 the need for more authorized and strategic system for clinical governance and
excellence was identified and the UK government introduced more politically firm
ideologies that help in introducing better system for the high quality services in health
and social care (Veras et al., 2014). One of the famous failures of the clinical audit
system in UK through the Bristol Infirmary case made it evident that the audit is not
entirely reliable aspects and strategy to aim at quality enhancement (Inquiry &
Kennedy., 2001).
Under the development and introduction of various policies and light of the
regulations issued by the Labor government during this time the NHS was authorized
as a responsible agency and system that will ensure the quality development of
services din health and social care. Two critically important legislative aspects that
helped in smooth implementation and revision of the health and social care system
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included the introduction of the “White Paper: Modern, Dependable” (Department of
Health, 1998). This paper was introduced to state that NHS is revised into the
system and agency with public and national responsibilities towards the betterment
of the quality of services in health and social care (Larcher et al., 2010). The paper
also enlightened some approaches that focused on the internalization of markets
and financial performances related to quality enhancement. After this paper was
introduced and highlighted the roles of NHS in the clinical governance of the nation
another crucial policy that was introduced was the “A First Class Service: Quality in
the new NHS” (Department of Health, 1997). The aim of this system was to ensure
that the public and patient involvement in the governance system is focused on and
included to enhance the quality of services and approaches (Heyrani et al., 2012).
The policy included aspects like quality improvement, professional regulation, quality
management, and education as continuous development of the professionals that
provides main aim of effective and quality care. The policy focused on identifying the
roles of the quality improvement system as well as the role of professionals in
improvement of the quality of the services. The professionals hold great
responsibility and accountability towards the improvement of the system. Also to
support these aspects the new regulations provided patient safety, risk management
and reporting and training programmes. These legislation and piece of regulations
denoted that the clinical governance model therefore is an integral and important
requirement of the health and social care system in the UK.
SOCIAL CONTEXT
Social aspects are referred to as the factors that are responsible for the social and
cultural values and beliefs of the individual and that enable the accessibility and
delivery of the health and social care system and services in a particular region
(Heyrani et al., 2012). Social factors are always been taken care of in the health and
social care setting. These factors influence the coverage of services as well as
pattern of its delivery for different individual and group. The social factors that impact
the services are cultural belief, age, gender, ethnicity, values, socioeconomic status,
communication, interpersonal agendas and rapport with the client (Van Zwanenberg
& Harrison., 2018). The user of the services access quality and have different
perceptions regarding quality in health and social care and these perceptions are
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well modulated by their social values, status and belief. For instance if we compare
the accessibility and perception of the services in health and social care as per the
socioeconomic status of the individual it is seen that the individual from high
socioeconomic income group usually has disposable income to spend on high
quality services with better facilities and technological support while an individual
from a low socioeconomic income group usually avoids any such expenses and their
perception regarding accessing health and social care is different than others
(Heyrani et al., 2012). The health and social care industry is planned in that way that
these needs are addressed as per the perception and requirement of the individual
in small boroughs where the income groups are from low status the services
governed by the system are mostly focused on effective approaches of care rather
than more of the technical and fancy supportive ideas whereas the high income
groups are focused to have better quality with better technical aids and support that
is one way to address their perception (Sheikhtaheri et al., 2013). Other social
factors include the demographics and age and gender of the individual. As some
diseases and health issues are more prevalent with age the old age population in
certain areas is affected more and requires priority health care services. Some
diseases such as AIDS and HIV are more prevalent in minority ethnic groups may be
due to low education level and low awareness of the issues and this rings a call for
higher service provision and enhanced quality for these groups of individuals
(Larcher et al., 2010). Culture being another aspect for the delivery of health and
social care needs to be taken into consideration. The organizations that aim at
providing transcultural facilities and care to the entire individual with equal rights and
equal treatment are the ones that have best advocated clinical governance system.
One of the aspects of the clinical governance system includes advocacy of the
transcultural approach. Organizational culture is an important aspect that is focused
at by the clinical governance model to ensure safe and healthy functioning of the
health and social care system and promotion of health and wellbeing to the
individuals in it.
Another aspect that is social to the services is the perception and personal values of
the health and social care staff that needs to be addressed and handled
appropriately. The health and social care setting is beyond personal values and
includes different set of values and attitude. The delivery of health care services
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includes unbiased attitude and appropriate skills towards the role to deal with
different individual with same attitude and equal focus.
Patient involvement in clinical governance is an essential factor that helps in delivery
of adequate care and appropriate services. Communication and building of the
therapeutic relationship are the essential constituents of the patient involvement in
the care process. Communication helps in assuring better patient outcomes by
enabling the professional to build a rapport with them and making them a part of their
own plan and health care (Thompson, & France., 2010). Empowerment and control
are the basic needs of every individual and this aspect allows the health care
professional to empower and provide control to the patient for their own life decisions
and health and social care decisions (Larcher et al., 2010). The model focuses on
achieving feedback and addressing the queries that helps in self-evaluation,
examination of services and future development and improvement of the services as
per the concept of clinical governance.
The rate of prevalence or the presence of specific disease or health issue in the
community or the nation is equally responsible for driving the services and prioritizing
the service quality and delivery in the region (Mills & Batchelor., 2011). Safety from
any source of harm or ailment in society is the role of health and social care sector
and this is well governed in clinical governance model. Similarly the leading
prevalence and incidence of AIDS, HIV, Tuberculosis, Ebola etc are some of the
issues that drives the probability and working of the services in health and social
care and influence the service delivery and enhancement on the basis of its priority.
England is seen to have high rate of mortality due to cardiovascular diseases and
this is the reason why the most of the services are focused at enhancement of the
health and social care for the following health issue on the priority basis. Mental
health issues are increasing with increasing age and this gives rise to another social
issue that elderly population is raising in UK that needs to be addressed with
competent approaches (Heyrani et al., 2012).
COMPONENTS OF CLINICAL GOVERNANCE MODEL IN
ENGLAND
Clinical audit was in trend till 1990 but the failure of various aspects of clinical audit
made it evident that the need for a better and more applicable governing system in
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health and social care is present (Trong Tuan., 2014). The government of UK
identified this need and so established the components of the clinical governance
system. Clinical governance was differentiated from clinical audit as clinical audit
included only the performance examination and enhancement of the professionals
but clinical governance pose the responsibility and accountability for the services
and quality in health and social care services (Van Zwanenberg & Harrison., 2018).
The clinical governance system is a transparency towards the system and includes
the involvement of the individual in the care process. The seven key components are
discussed above that includes various aspects of high quality and accountability of
services in health and social care. Some of the components will be discussed below
to have an in depth knowledge of the aspects of the governance and allow better
understanding of these aspects.
The government of UK plays a crucial role in enhancing the quality of health and
social care services. The main body that governs health and social care laws in the
UK is Department of Health UK but it is aligned to other agencies such as Health
Watch, Public Health UK, NHS and CCG (Mirza et al., 2013). Clinical Commissioning
Group is another essential agency that is responsible other than NHS to govern the
clinical quality and effectiveness of the services in the health and social care system
in the UK. This agency has a crucial role as it governs the NHS trust and the quality
of services been granted by the NHS in the UK. It is a supervisor agency that audits
and inspects every aspect of all the organizations working under NHS and enables
the services to be of the standards of care authorized for the nation. Other than CQC
there are the allied agencies and government support services that helps in funding
the services and enhancement of quality of the services at NHS trust and other
organizations.
NICE is another department of health and social care associations that avails the
guidelines and formation of particular regulations for the smooth working of high
quality health and social care system in the UK (Mills & Batchelor., 2011). NICE
stands for National Institute of Clinical Excellence that was established in 1999 with
aim to provide adequate information and proper formation of guidelines for each
aspect of services in health and social care. The services in NHS trust and other
organizations have to follow the guidelines prepared by NICE to make sure how the
services and standards of care issued and followed throughout the UK are
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presenting on similar grounds (Thompson, & France., 2010). The components of
clinical governance are discussed to understand how these affects the working and
functioning of the health and social care sector in the region.
RISK MANAGEMENT
A wide term risk management is used to portray variables including management of
patient risks, risk to practitioners and risk to the organizations (Heyrani et al., 2012).
Whenever the patient is entered to achieve health and social care services every
aspect of the patient care plan has to be evaluated to manage any sort of risks
towards the individual. The guidelines for care always mention to assess the risks
and identify it to provide appropriate solutions for the management of any sort of risk
towards the patient. According to Maslow hierarchy of needs promoting safety and
sound environment is essential for the individual and is one of the basic living needs
of the human being. To perceive a safe environment while being treated in a hospital
or the care center is the requirement of every patient and is their human right that
should be addressed. Patient is evaluated as the person who is dependent on the
services in some way and this dependency makes them vulnerable towards harm or
abuse from different elements in society (Mirza et al., 2013). The safety of these
individual from harm or abuse is a part of risk management. Some aspects taken into
consideration while addressing this requirement includes complying with the
statutory guidelines that promotes better and favorable conditions for safe services
to the patient and minimizes the risks towards the patient. Reviewing of system by
the external agencies is another way of monitoring and minimizing risks towards
patients. Sticking to medical ethics is another way to minimize the risk towards
patients.
Risk to the organization is another aspect that is to be managed. Compromised
quality of care and services results in defaming of the organization and leads to
negative publicity that affects the business of the organization as well as the patient
outcomes. It can lead to serious legal non-compliances and can also result in
cancellation of the license to practice for the organization or the authorities. The
agencies such as CQC and NICE are authorized to regular audit for the quality of
care in the organization providing health and social care services. These agencies if
confirms non-satisfactory service standards for any of the organization this can be a
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great harm to the organization and to minimize these regulations and standards are
to be followed appropriately. Another way to manage the risk towards organizations
is to attempt to provide patient centered care at worth of the patient’s money and life.
Development of better local and in house policies by the organization may help in
eliminating any compliance issues with the system (Hooshmand et al., 2014).
Risk towards the provider of services is the third factor that is kept into consideration.
This includes occupational risk, risk from infection, and hazard from equipment
handling, injury, physical and mental trauma, risk of emotional deterioration and risk
from substances (Mills & Batchelor., 2011). The risk management for the provider of
services includes in depth training and skill management of the individual to follow
proper aseptic guidelines and self-safety measures. The environment that the
individual works in should be framed appropriately for minimum risk to injury and
overcrowding of the settings should be avoided.
Risk management also includes other aspects of care and service delivery that
includes assessing the current and potential risk to the individual in care. To do so
there are various tools for assessing different risks towards a patient and these tools
and guidelines can be used to effectively assess the potential risk and manage them
appropriately (Mills & Batchelor., 2011). There are certain steps for managing risk in
health and social care and this includes identification of risk, assessment of severity
of the risk, to evaluate the outcomes of the risk and to device strategies for
implementation for reduction and prevention of the risks identified. Proper education,
training and skill development leads to competent approaches for risk identification
and reduction by the professionals that will helps in promoting better quality care and
services.
PATIENT AND PUBLIC INVOLVEMENT
Patient involvement is the main aspect of patient centered care in health and social
care system. It is a crucial aspect that needs to be addressed and is focused in
modern health care (Arulkumaran., 2010). Similarly public involvement in the health
and social care is an important aspect. The patient involvement in health and social
care is defined as the right of the patient or service user to have control and be a
part of own care planning and treatment process. The public involvement is the role
of public and local communities in framing and implementation of policies and
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legislation and the process that are being introduced in health and social care
system of the nation (Sheikhtaheri et al., 2013). There have been cases in past that
were reported for failure of the quality of services and clinical audit system
implemented initially as part of UK’s health and social care system. These reports
provided requirement for the implementation of the new and enhanced system and
clinical governance model that will include patient and public in the system to ensure
better services as per the demands of the public in the region. Brennan, & Flynn
(2013), stated that to best understand the demand the feedback from the user is
essential similarly to know the health and social cared demands it is important to
involve the patients in their own care process and assess their requirements and
needs in different aspect of their life. Health and social care is supposed to be
holistic approach with integrated services for addressing every aspect of human
needs may it be physical, spiritual, emotional, psychological etc. this holistic
approach is well addressed with the involvement of patient in its center (Sheikhtaheri
et al., 2013). This component of clinical governance is a strong pillar in the health
and social care system and is responsible for the successful delivery of quality
services that aims at achieving patient satisfaction and better outcomes for the
patient. It includes building a well communicative rapport with the patient,
presentation of patient requirements, involvement of patient on every level of care
planning, empowering the patient, involvement of the patient in decision making
during the planning, and establishing preventive measures for public health. NHS
was appointed the role and mandatory duty to involve the patient in their care
planning as per the revised Health and Social Care Act (2012). There are certain
advantages of this component of the clinical governance model that includes the
empowering patient policy where the patient is provided some extent of control and
power over own health and decision making for own life(Mirza et al., 2013). The
application of democratic policy is supported by enhancement of confidence among
patient regarding the quality of the care. The policies that are introduced in public
interest have to be created with the public demand in mind and when this is achieved
the success of policy is high rated. Jaggs-Fowler (2011), illustrated that the benefit of
public involvement in health care is also towards the efficacy of the clinicians and
this minimizes the risk towards the patient’s health. The information regarding the
disease, diagnosis, risk, management and prognosis every element of health and
social care is provided to the patient it promotes better opportunities of trust building
10

and rapport formation among the patient and the professional that yields better and
optimistic outcomes.
CLINICAL EFFECTIVENESS
Clinical effectiveness refers to the extent to which a particular intervention in the
setting is effective and promotes appropriate outcomes (Dodds & Kodate., 2011).
The interventions that are being designed for the management of various health and
social care issues is essential in the setting but the effectiveness and comparative
evaluation of these interventions to promote high quality care is essential (Chambers
et al., 20116). The service user with limited knowledge on any intervention mainly
evaluates its efficacy on the evidence of effectiveness provided by the past
experiences and the value it hold for their money. To evaluate the effectiveness and
enhance the clinical effectiveness of the services this component of clinical
governance is appropriately implemented. The aim of every intervention and
guidelines of management created by NICE is to satisfy the clinical effectiveness
standards with keeping in consideration patient safety and patient outcomes
(Arulkumaran., 2010). The best concept to implement clinical effectiveness and
achieve high quality care is to adhere to the evidence bases practice, performance
indicators, best knowledge and standard protocol and practice from patient
experiences. This component provides benefit by promoting high quality care and
services and promotes bench markers and standards of quality to be followed by the
clinicians and professionals working in health and social care setting (Mills &
Batchelor., 2011).
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CONCLUSION
Clinical governance is the system that is defined to have control of the health and
social care working in the nation and it is the synthesis of the overall system that is
held responsible for the improvement of the health and social care scenario in a
particular region. The aim of clinical governance is to promote safe and protected
environment as well as enhance the quality of the sed5rvices with advanced and
leading modernization. The seven components of the clinical governance includes
managing patient, managing risks, managing clinical effectiveness, patient safety
and incident reporting guidelines, involvement of patient in care system, use of
evidence based practice and accountability and quality assurance in the system.
Under the development and introduction of various policies and light of the
regulations issued by the Labor government during this time the NHS was authorized
as a responsible agency and system that will ensure the quality development of
services din health and social care. Two critically important legislative aspects that
helped in smooth implementation and revision of the health and social care system
included the introduction of the “White Paper: Modern, Dependable” and “A First
Class Service: Quality in the new NHS”. The user of the services access quality and
have different perceptions regarding quality in health and social care and these
perceptions are well modulated by their social values, status and belief. The health
and social care industry is planned in that way that these needs are addressed as
per the perception and requirement of the individual in small boroughs where the
income groups are from low status the services governed by the system are mostly
focused on effective approaches of care rather than more of the technical and fancy
supportive ideas whereas the high income groups are focused to have better quality
with better technical aids and support that is one way to address their perception.
Hence it can be concluded that the components of clinical governance are well
framed and executed to allow better and high quality services and appropriate
measures if taken to implement it will help in enhancing the quality of service4s to
greater extent.
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