Supporting Patient Safety in NHSScotland Hazel Borland Head of Clinical Governance and Patient Safet

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Supporting Patient Safety in NHSScotlandHazel
BorlandHead of Clinical Governance and Patient
Safety
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Origins of clinical governance

• White Paper Designed to Care (1997)
• Acute Services Review (1998)
• NHS MEL(1998)75, NHS MEL(2000) 29, NHS HDL(2001)
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• Our National Health A Plan for Action, A Plan
  For Change (2000)
• Partnership for Care Scotlands Health White
  Paper (2003)
• Building a health service fit for the future A
  national framework for service change in the NHS
  in Scotland (2005)
• Delivering for Health (2005)

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Clinical Governance Context

• SEHD
• Strategic Policy and direction
• NHS QIS
• Standards development and review
• Support with implementation
• NHS Boards
• Accountability for safe and effective clinical
  care
• But only one of a number of systems used by NHS
  Boards to ensure good Governance

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The Role of the NHS Board Governance

• Collective responsibility for the organisations
  performance (clinical and non-clinical)
• Leadership within a framework of risk assessment
  and control
• Strategic planning and performance review
• Setting organisational values and standards to
  meet obligations to patients, the community and
  Scottish Executive Health Department

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NHS QIS Clinical Governance and Patient Safety

• January 2003 Scottish Executive Health Department
  gave NHS QIS responsibility for supporting the
  implementation of clinical governance and risk
  management across NHSScotland.
• March 2004 NHS QIS established the Clinical
  Governance and Patient Safety Support Unit.
• September 2005 NHS QIS clinical governance and
  risk management standards published.

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NHS QIS Patient Safety Principles

• Patient safety is an integral part of clinical
  governance and risk management.
• Learning from experience is a powerful driver for
  change.
• Local ownership and national co-ordination is the
  key to success.

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Clinical Governance and Patient Safety Support
Unit
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CGPSSU Work programme

• Aim to support NHS Boards in ensuring that
• patients and staff are as safe as possible
• risks are managed
• care is effective
• continuous quality improvement
• staff are competent and fit to practice
• experience is learned from

• Focussing on
• Clinical Effectiveness
• Patient Focus
• Risk Management
• Work streams
• Support and Development
• Networking and Information Sharing

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Progress (1)

• Support Development
• Purchased the licence for AS/NZS Risk Management
  Standards (43602004) on behalf of NHSScotland in
  January 2005.
• Commissioned the development of accredited
  education for risk management and clinical
  governance (September 2006).
• Funded 180 module places across NHSScotland over
  next 2 years.
• Developing an on-line knowledge resource on
  clinical governance for NHSScotland staff (live
  by end 2006).

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Progress (2)

• Support and Development
• Completed a review of incident and near miss
  reporting across NHSScotland (report published
  January 2006).
• Incident reporting cultural survey completed
  across all the acute care sector in NHSScotland
  (March August 2006).
• Alert mapping exercise on behalf of the Chief
  Medical Officer (completed April 2006).
• Commissioned Root Cause Analysis training from
  NPSA on behalf of NHSScotland.

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Progress (3)

• Networking and information sharing
• Risk management and clinical governance staff
  networks.
• Non-Executive Director network for Clinical
  Governance.
• Developed and established a working agreement
  with the NPSA that includes disseminating alerts,
  safer practice notices and patient briefings to
  NHSScotland.

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Progress (4)

• Networking and information sharing
• Established a working group to improve learning
  lessons across NHSScotland from Fatal Accident
  Inquiries.
• NHS QIS Clinical Governance Patient Safety
  Reference Forum.
• The first NHS QIS national clinical governance
  and patient safety conference January 2006
  (biannual event).

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Every day you may make progress. Every step may
be fruitful, yet there will stretch out before
you an ever-lengthening, ever- ascending,
ever-improving path. You know you will never get
to the end of the journey. But this, so far from
discouraging, only adds to the joy and glory of
the climb.
Winston Churchill 1874-1965
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Thank you.

• Any questions?