Clinicalgovernanceisunderpinnedbythestatutorydutycontainedinsection18
and includes the following components which health bodies must ensure they
satisfy:
. clear lines of responsibility and accountability for the overall quality of care;
. acomprehensive programme of quality improvement activities;
. clear policies aimed at managing risk;
. procedures for all professional groups to identify and remedy poor perfor-
mance [23].
The NHS controls assurance project operates alongside the clinical governance
initiativeandismoredirectedatensuringthatorganisationalcontrolsareinplace
to ensure proper management. It is defined as:
`...aholisticconceptbasedonbestgovernancepractice.Itisaprocessdesigned
toprovideevidencethatNHSorganisationsaredoingtheir``reasonablebest''to
managethemselvessoastomeettheirobjectivesandprotectpatients,staff,the
public and other stakeholders against risks of all kinds.' [24]Risk management isseen as the `common thread' linking controls assurance and
clinical governance [24].
5.4 The cumulative effect of the reforms
The cumulative effect of all these initiatives should be to bring more effective
controlofthemanagement ofuntowardincidentsintheNHS.Healthlawyers for
claimantsanddefendantswillneedtobeawareoftheclaimsreporting,complaint
systems and the general quality controls environment that exists in order to
effectivelymanagethepresentationoftheircase.Effectivelegaldisclosurewillbe
dependent on lawyers' knowledge of these systems. Clinicians' professional
practicewillbesubjecttothesesystemsfromreportingproceduresofincidentsto
theadoptionofsetclinicalpracticeguidelines.Alreadytherearedefinedstandards
whichmustbemetunderthe Clinical NegligenceSchemeforTrusts.CNST)and
these have been revised [25].
`Standard1:ClinicalRiskManagement±StrategyandOrganisation.Theboard
has a written strategy in place that makes their commitment to managing risk
explicit. Responsibility for this strategy and its implementation is clear.'The centrally orchestrated initiatives of clinical governance, controls assurance,
clinical risk management and patient empowerment, and CHI and NICE, will
directlyinfluencethepracticeofnursesandothers.Professionaldiscretioncanbe
seen to be compromised but this is being done for the laudable public interest
motives of quality and accountability.
The centre, in terms of the Department of Health and its component bodies,
NHS Executive, NICE, CHI, NHSLA and the .to be formed) NPSA, will have
increasing practical control over the delivery of health care services and over the
managementandresolutionofdisputes.Theconceptofpatientempowermentwill
beseentodominatehealthqualityandotherNHSinitiativesforsomeconsiderable
70 Nursing Law an dEthics