Clinical and care governance framework: guidance

Annex C: Clinical and Care Governance of Integrated Health and Social Care Services

What is Clinical and Care Governance?

1. Clinical and care governance is the process by which accountability for the quality of health and social care is monitored and assured. It should create a culture where delivery of the highest quality of care and support is understood to be the responsibility of everyone working in the organisation - built upon partnership and collaboration within teams and between health and social care professionals and managers.

2. It is the way by which structures and processes assure Integration Joint Boards, Health Boards and Local Authorities that this is happening - whilst at the same time empowering clinical and care staff to contribute to the improvement of quality - making sure that there is a strong voice of the people and communities who use services.

3. Clinical and care governance should have a high profile, to ensure that quality of care is given the highest priority at every level within integrated services. Effective clinical and care governance will provide assurance to patients, service users, clinical and care staff and managers, Directors alike that:

• Quality of care, effectiveness and efficiency drives decision-making about the planning, provision, organisation and management of services;
• The planning and delivery of services take full account of the perspective of patients and service users;
• Unacceptable clinical and care practice will be detected and addressed.

4. Effective clinical and care governance is not the sum of all these activities; rather it is the means by which these activities are brought together into this structured framework and linked to the corporate agenda of Integration Authorities, NHS Boards and Local Authorities.

5. A key purpose of clinical and care governance is to support staff in continuously improving the quality and safety of care. However, it will also ensure that wherever possible poor performance is identified and addressed. All health and social care professionals will remain accountable for their individual clinical and care decisions.

6. Many clinical and care governance issues will relate to the organisation and management of services rather than to individual clinical decisions. All aspects of the work of Integration Authorities, Health Boards and local authorities should be driven by and designed to support efforts to deliver the best possible quality of health and social care. Clinical and care governance, however, is principally concerned with those activities which directly affect the care, treatment and support people receive.

Five Process Steps to Support Clinical and Care Governance

1. Information on the safety and quality of care is received

2. Information is scrutinised to identify areas for action

3. Actions arising from scrutiny and review of information are documented

4. The impact of actions is monitored, measured and reported

5. Information on impact is reported against agreed priorities

Five Key Principles of Clinical and Care Governance

1. Clearly defined governance functions and roles are performed effectively.

2. Values of openness and accountability are promoted and demonstrated through actions.

3. Informed and transparent decisions are taken to ensure continuous quality improvement.

4. Staff are supported and developed.

5. All actions are focused on the provision of high quality, safe, effective and person-centred services.