The health service in Scotland is improving but needs to work harder to ensure that it provides safe and effective clinical care that is responsive to the needs of patients.
A report from NHS Quality Improvement Scotland has found that progress is being made in establishing systems that make sure patients receive the highest quality of care. However no NHS Trust in Scotland was able to achieve the top assessment category for any of the standards assessed in the report.
In this, the first graded assessment of NHSScotland on these topics, most Trusts achieved the assessment category which demonstrates that they have made positive steps to develop strategies and are beginning to implement them. This assessment category is mid-way on the assessment scale used for these standards, which ranges from little development, to strategies being in universal practice.
The standards state that hospitals and other health services need to have the right systems in place to ensure that:
· patients are seen by staff with the appropriate skills;
· clinical practice is continuously updated in the light of new evidence;
· lessons are learned from mistakes;
· risks are assessed and minimised;
· feedback is sought from patients and the public with a view to improving services; and
· patients and carers are involved in decision making.
Effectively, the standards set out to answer two key questions - how good is patient information, communication, assessment and discharge, and how good are the systems to make sure that care is safe, effective and continually improving?
The report commends the steps taken by NHSScotland to address action points highlighted in the first review published in April 2002, demonstrating great effort and commitment by NHS staff. However, it also identifies a number of areas where further work is needed to ensure the expectations and concerns of the public are addressed:
· staff do not always have ready access to information to help them treat patients effectively;
· staff are apprehensive about reporting concerns and risks;
· very few NHS organisations routinely involve patients in their care;
· poor communication with patients continues to be of concern;
· many NHS organisations do not have systems in place to manage potential risks effectively; and
· staff shortages continue to impact on patient care.
The report says that NHS Trusts and Boards in Scotland continue to respond to problems rather than trying to anticipate and avoid them. It also found that although policies have been drawn up to improve procedures, they are not always known or understood by staff and patients. Too often, organisations have several different policies addressing the same issues.
The report is in effect an annual ‘MOT' or health check for the NHS. It tests the component parts of the NHS system to see if they are in good order. It does that by assessing the performance of NHS Trusts and Boards against generic standards that are common to all services. The standards cover a variety of indicators including the provision of information to patients; involvement of patients in decision making; accessibility of services; discharge arrangements; record keeping; guidelines and audit; risk management and risk environment; and staff development and training.
Clinical governance is the framework through which NHS organisations are accountable for continuously improving the quality of their services, and safeguarding high standards of clinical care by creating an environment that encourages excellence. The generic clinical governance standards were developed by the Clinical Standards Board for Scotland (now part of NHS Quality Improvement Scotland) to assess the progress being made by the NHS in Scotland in implementing clinical governance arrangements.
The report says that, although worthwhile progress is being made, "very few parts of the service could demonstrate that they have implemented a common approach across the organisation, and, as expected, top ratings are an aspiration that have yet to be achieved." Trusts have developed strategies and are beginning to implement them, but the effect of these is not yet being monitored.
The chairman of NHS Quality Improvement Scotland, Lord Naren Patel said: "Clinical governance may seem like a difficult concept but it is vital to the future of healthcare. A health service that has effective clinical governance systems in place will be achieving high standards of care for patients. Trusts that do these things well will be doing everything well.
"That is why it is disappointing that not one Trust in Scotland has so far been able to achieve the highest rating on the new assessment scale we have produced. There continues to be a high degree of variability in performance across the country. Many Trusts are making good progress but greater action is needed in others. We will continue to monitor progress annually to ensure that we drive forward improvements in this crucial area."
The chairman of the Group which produced the report, the Very Reverend Graham Forbes said: "A lot of work has been carried out in recent years in developing the right strategies for implementing clinical governance. Strategies are important but they have to be communicated and they have to be implemented. The development of a strategy is the start of the process, not the end. We need to put the strategy into action and to monitor its effectiveness if services are to benefit from the continuous improvement we all want to see. "
The report also includes a set of questions for both patients and staff which they can use to help find out the progress being made in their area on quality matters.
The report follows a review of services in Scotland's 28 Trusts, 3 Island NHS Boards and in the Scottish Ambulance Service and the State Hospitals Board for Scotland. The performance reviews were carried out between July 2002 and March 2003 by teams of health professionals and members of the public. This is the second annual report examining performance in this area.