,health outcomes), equit y,access to their services), and humanit y,patients'
and carers' views).With these three elements of clinical governance as a broad framework I want to
consider the ethical aspects of this new policy. Clinical governance can be seen as a
move towards a more ethical health care policy. Stressing the importance of the
qualit yof health care and ensuring that someone is legall yresponsible for clinical
performance will, hopefully, result in a better service for patients. Further,
patients' and carers' views will be given more prominence in, for example, the
national patient and user surveys and this is a welcome development.
However, although qualit yof health care provision is something we all want, the
term `quality' is very hard to define. As Professor Campbell notes:
`to measure qualit ywe need to know the values to which we all aspire and, in
reality, the worlds of patients, clinicians, managers and educators are often far
removed from one another.' [3]The term quality' is a value judgement; it is an expression that the intervention provides us with certain outcomes that we think are desirable. Qualit yis not a scientific term, it is our opinion of the outcomes data. It is our judgement of whether the intervention is appropriate or helpful for the condition we want to treat and is an expression of how we compare it to other treatments. So, rather than assuming that b yemplo ying the termqualit y' we can answer the questions of what
we should be doing with certainty, we need to remember that there could be
disagreement over the definition of qualit yand there will not be one `right' wa yof
defining or interpreting the term. Hence, questions of what we should be doing
will require us to make important value judgements and these should be made
explicit so that the ycan be subject to justification.
11.12 Setting standards
Various bodies have been established to set standards and policies for the NHS.
The National Institute for Clinical Excellence ,NICE), established on 1 April 1999,
produces evidence based clinical guidelines and information on good practice. A
ke yfunction is the s ystematic appraisal of medical interventions. An example of
this is the appraisal of the flu vaccination Relenza. In October 1999 NICE stated
that there was not enough evidence that Relenza benefits those who are most at
risk of flu and recommended that it should not be prescribed. The National Service
Frameworks have the overall aim of ensuring equit yof access and standardisation
of care for all patients in the NHS and link related policies to formulate an inte-
grated national policy. For example, the Tobacco White Paper and the National
Priorities Guidance are brought together to create an integrated polic yfor cor-
onar yheart disease. These frameworks bring together the best evidence of clinical
and cost effectiveness, with the views of users, to determine the best ways of
providing a particular service.
However, before it is possible to speak of how to improve the qualit yof health
care practice we need to have some notion of what we mean b yqualit yin this
Clinical Governance 241